When it comes to Single Session Therapy, three possible scenarios can be configured, starting from the same setting of the therapeutic intervention.
In a nutshell, referring to the classic subdivision of Talmon (1990), we can say that essentially a SST can be of 3 types:
1) Agreed: in this case, both patient and therapist are aware that this could be their only session. It is necessary to point out that we said “could”: although both agree that this will be a single session (agreement that is generally made at the end of the meeting), it does not mean that there will be no other sessions, in fact the patient may want to return and generally is good to give him this chance.
An interesting fact is that some health structures that provide SST give the patient the possibility to come back and see the same therapist; others specify that the next therapist could be someone else, depending on availability: strange as this option sounds, it does not actually affect the outcome of single session.
However, regardless of this, this is the best form of SST, since both patient and therapist are aware and agree to have a single session: commitment from both sides is focused on get the most out of the single therapeutic session, and also the session is structured in order to work by itself.
2) At the initiative of the patient: in this case it is the patient who decides to stop after just one session. This was the most common form of Single Session Therapy before SST began to be used with more awareness. Often these cases are considered “failures”, in the sense that it has failed to produce any benefit or improvement for the person. Although some of them certainly are, actually an average of 50% believe only one session is enough for their needs (see the review on Hoyt & Talmon, 2014).
These data invite us to radically rethink the possible meaning of the “drop out”, not to tell ourself that every drop out is automatically a success, but as a little incentive to better understand what are the elements that make each session produce the desired change.
3) At the initiative of the therapist: in this case, it is the therapist who does not make another session, even if the patient wants it. It usually occurs when the therapist believes that the problem presented “is not that serious”, that it is part of “the normal difficulties of life”, or that the patient “is not suitable for his psychotherapy”. It is less wanted than the agreed SST, because the patient may come out with the impression of not having been understood, or of not yet having the resources to solve the problem.
However, about this last, we can make several observations. In fact, in the experience of the Italian Center for Single Session Therapy we are studying two applications of the latter type of SST:
1) First case: when the therapist believes that the patient may have acquired the necessary resources to solve the problem already in that first session, although the patient doesn’t feel as strongly. In this case he is told that, in the therapist’s opinion, another meeting may not be necessary, but you let him choose, with the option of calling for an other session.
Although initial data are not enough, there are two interesting trends.
The first is that some people follow the therapist’s suggestion and don’t ask for an appointment: subsequently, only some of them call back for a second session.The therapist’s “prophecy” comes true, in the sense that the client also realizes that he has acquired the necessary resources to overcome his problem.
The second concerns those who, despite the therapist’s opinion, immediately ask for a second session: in this case it may happen that therapy continues with other sessions, but, in the second session, they often realize to feel better and decide they don’t need any further sessions.
2) Second case: therapist can be startegic and use it with patients with low motivation to changes or with whom you can’t establish a strong enough relationship. In this case you prevent the possibility of a “drop out” and the patient is explicitly told that there will not be a second session, asking him to take a few days before deciding whether to return.
The first data, although based on a still too small number of people, show that most of those who are given this opportunity (57%) choose to return and continue psychotherapy. And on those who do not return, we are conducting follow-ups to understand how many, with that one session, have found benefit.
In conclusion, the therapist who wants to integrate the SST can ask patients, at the end of the session, if they consider there is a need for any other sessions. It is essential to start from the expectation that one meeting may be sufficient and, of course, act in that session conceiving it as complete, i.e. with the idea of leaving nothing pending.
But in general, we want to remember that SST is a key way to enhance every single session, even on all those occasions in which, in agreement with the people, more meetings are needed to help them solve their problem.
Flavio Cannistrà e Tania Da Ros
Psycologists and psycotherapists
Founder e Trainer dell’Italian Center
for Single Session Therapy
Bibliography
Hoyt, M.F. & Talmon, M. (eds.) (2014a). Single Session Therapy and Walk-In Services. Bancyfelin, UK: Crown House (in traduzione).
Talmon, M. (1990). Single Session Therapy. San Francisco: Jossey-Bass (Tr. it. Psicoterapia a seduta singola. Milano: Erickson).