In many states, a new way of offering psychotherapy and psychological counseling has been taking place for several years: walk-in services. What are? And why should we know them and begin to implement them too?
In the next few articles we will talk a lot about walk-in services, because they are a slice of the future of healthcare – and psychotherapy – to be taken into consideration and why Single Session Therapy goes beautifully with them. Today we begin to give a simple but clear idea of this way of conceiving mental health.
Direct access
Let us limit ourselves to briefly outline some essential points.
Walk-in services are (health) services with direct access, i.e. without an appointment.
You know the general practitioner? Here, that’s a direct access type of service. The same could be said of the ER.
In recent years, however, this term has been used more and more associating it with some distinctive aspects. More specifically, we can identify 3 common characteristics:
- possibility to receive a visit without an appointment, simply by entering the Center, clinical study or web page (yes)
- receive the service usually in a short time (not waiting hours)
- cheapness, and in some cases free of charge, of the services
Other characteristics, although not as distinctive, can be:
- a basic level of assistance and for non-serious pathologies (if the person needs a specialist consultation, he is referred to another clinician / specialist; ditto if he needs more than one meeting)
- open 24/7 or in any case with a wide range
- the presence of the service even in unusual places, such as a shopping center or a tourist area.
Direct access psychotherapy
“We receive by appointment only”, this is what is reported on many plates of Italian psychologists.
And if the psychologist’s plate is an entity in danger of extinction (it made sense before the advent of the internet and the advertising liberalization sanctioned by the Bersani Decree – 223/2006), the concept of “by appointment only” is not so dead .
But for how long?
In countries such as the United States, Canada, England or China, walk-in realities are also widespread in psychotherapy.
And in truth this is happening in Italy too. The “psychological listening desks” before, and certain web platforms today, are the precursors and pioneers of walk-in logic.
And that’s what we need to keep in mind: logic.
As analyzed in another article (read here), people want more and more immediate and more and more appropriate answers to their needs. The offer is now so wide and so easy to find and reach that if you don’t have that service you will find it from another.
Even Italian psychotherapy will increasingly have to decline the walk-in logic. “Walk-in logic” comes before “walk-in service”: the latter, in the description I have given above, is only one of the possible products of that logic. The websites that give you the opportunity to speak to a psychologist within 10 minutes, 24 hours a day, are another (and they already exist, even in Italy). For this reason, in our workshops we have dedicated a part to the practical applications of TSS: to explain a series of ways in which to decline these logics.
But let’s get back to walk-in services. What are the benefits?
The benefits of direct access services
So many, and I don’t think I can describe them all.
I will limit myself to making a summary (I take up some points from Slive & Bobele, 2011) and I invite the reader, whether he is a freelancer or a manager of a healthcare company, to put these facts on his business:
- Give people a therapeutic approach that is as short as possible.
I understand that psychotherapy “was not born short”. I understand that in many theoretical conceptions, doing less than 10 sessions is unthinkable or useless, and doing just one is even considered a scam (“What do you want to do in 1 session? Don’t even build the relationship!”). Gentlemen… it is not so. And if we are still debating this, it means that there is a gap of decades of literature (of at least three decades, but even beyond) to be filled. up and that, above all, are good for customers. In a research by Westmacott, which I will discuss later, 44% of the people who had dropped replied that they had done so “because they were better”. The remaining 66% was divided into people who had no money, had unexpected events, had difficulty reaching the center, had not been happy with the therapist (these were less than you think), etc. But the overwhelming majority said unanimously: “I’m better. It doesn’t matter if the therapist thinks that the therapy isn’t over: I’m better ”.
And, indeed, these results are maintained in the follow-up.People want short approaches. In Italy we have 77-92% of people with psychological problems who do not ask anyone for help. To nobody. Never. But it is obvious: if I feel that, regardless of my situation (a disorder, a personal problem, a relational difficulty, a doubt …) the approach is “to therapy more (maybe many) sessions”, I am not motivated to contact a psychotherapist. Rather I go to the magician.
- Respond to the need for immediate help.
If you have a Facebook page or a website in which you advertise your service in an appropriate way, you will have necessarily received at least one email or a message asking you for “advice”. The idea that to do therapy you have to look for a professional, get the number, call (hoping to find free), make an appointment, introduce yourself … is no longer enough. It does not mean that it should be eliminated. It means, however, that other practices, other logics, must also be associated with it. Like that walk-in, in fact. Give the possibility, to those who need it “on the spot”, to be able to receive a “service when needed”. Consider that too many steps discourage the person. Those involved in analyzing purchasing processes know very well that many “steps” mean many “obstacles” in front of the customer. That’s why Amazon has been giving you the ability to buy with just one click for a while. We are not the Amazon of healthcare, of course. But it is equally obvious that this process must also affect us. Because it interests us, in the sense that we too are subject to it (these are psychology studies). If you give people the opportunity to contact you only on certain days, at certain times, only by filling out the form on your site … you are doing the right thing. But in the wrong era.
- Allowing people to come to therapy in times of need.
This point is a direct consequence of the previous one. We have all heard about dropout (when a patient unilaterally interrupts therapy) and a little while ago I talked about the emptiness of people who just do not ask for help. But there is a third fact, which is that of no shows, that is, people who make an appointment, but then don’t show up. In some situations it can be as high as 50%: 1 in 2. The fact is that people want to come when they decide. If you give them an appointment, whether it is in three, two or even just a week, you risk underestimating the importance that that problem has for them at that moment. Here, too, applied psychology in commercial companies helps us to understand better: if you pass in front of a shop window, the shopkeeper knows that if you take too long to decide, you probably won’t buy. Thus, as mentioned above, he will avoid putting obstacles to you, on the one hand, but he will also make sure to meet your motivations at that moment, on the other. The health service, public or private, professional or organizational, must consider the same logic. If a person wants help now, I should find a way to maximize the chance of giving it now, not in two weeks.
- Also be of help to those people with a higher probability of drop-out.
Analyzing many studies on drop-outs I have been able to see how the most incisive factors concern the SES, socio-economic status. Categories with a lower SES seem to drop more. More generally, however, there are certain categories that can more easily abandon therapy: it becomes therefore essential to be able to maximize the effectiveness of each individual meeting and, consequently, to provide them with psychotherapies in a walk-in logic: come whenever you want, without necessarily foresee a path of several consequential meetings. The choice is yours.
- Reduce waiting lists.
The reduction of waiting lists is certainly the most immediately visible advantage, when it comes to direct access services, and it certainly interests healthcare companies more than freelancers, although even the latter should give it a thought. view of a health facility it is obvious that reducing waiting lists is an advantage on several levels: it allows you to respond quickly to the requests of your customers, increases the supply of services and decreases the rate of losses (patients who put themselves on the list and then, due to the long wait, they do not show up on the day of the appointment) and costs (such as the “empty” hours due to the phenomenon described). But even the freelancer can reach a similar advantage.
Certainly not most of those self-employed professionals who have waiting times so long as to discourage their customers. In the world of freelance, this is also due, in part, to the organization of “patchy” visits, that is, scattered throughout the week. But for some professionals it is much more advantageous to concentrate all customers in 1-3 working days (obviously with a full time schedule), rather than seeing them throughout the week: it effectively reduces working days and also costs (for example example you can rent a room for fewer days a week) or, in particular situations, it even generates alternative revenues (the freed room can be rented to other colleagues). Of course, in this case, an increase in the waiting list can be generated, and it is here that providing a walk-in space (just one day and a time slot in which people are available to come without an appointment) cancels this possibility. however, however, I am the first to say that the possibility just described is also the least interesting. Because when a walk-in logic is conceived and combined with the digital context, those time slots dedicated to direct access can be provided regardless of the physical studio: all you need is a connection, a website and programs such as Skype ( in the case of video-consultations) or WhatsApp (for consultations via chat). Note: if you are horrified at the idea of video / chat consultations then maybe there is some problem … <
- Increase the perceived value of the customer.
Although this is not a benefit to the direct advantage of the customer, introducing a service and walk-in logic has an undoubted positive impact on the image of the structure and of the professional, who can thus be seen as able to respond to requests, to the needs and wishes of the customer. A health service, in fact, is also a… service. This means that it must be able to satisfy people in many aspects. The illusion that a “quality content” is enough (understood, in these fields, as the ability to do things well) is, in fact, an illusion. Especially in a market where with a tap you can choose between dozens and dozens of competitors.In the eyes of the person, the value increases when a service is able to respond to his needs, his problems, his desires. A facility or professional providing a service with walk-in logic will appear to the person as having greater value – and this regardless of whether that person uses that service or not.
The future of walk-in services in Italy
Walk-in services have had a great expansion in those states where an insurance-dominated health model prevails (such as the United States), yet others like Australia (which has a health system more similar to ours) also have this type. of services. But to think that “These things only work in countries like the U.S.A. because there they have insurance ”is an understatement and, above all, scarcely farsighted.
Health services are in crisis. The search for replacement answers is on the rise. And the citizen pays more and more out of his pocket in the face of a public health system unable to respond to his needs. He doesn’t make it happy, but he does. To the point that, in Italy, the main competitor of public health is private, for a fee!
It is therefore not a question of asking ourselves whether this type of logic will become a consolidated reality for us too – also because, I repeat, there are already the first Italian digital walk-in services that provide psychological counseling services. It is a question of when they will become.
Flavio Cannistrà
Psychologist, Psychotherapist
Founder of the Italian Center
for Single Session Therapy
If you want to know more about Single Session Therapy and learn more about the method, you can read our link (click here) “Single Session Therapy. Principles and Practices ”
Bibliography
Hoyt, M.F. & Talmon, M. (eds.) (2014). Capturing the Moment. Single Session Therapy and Walk-In Services. Bancyfelin, UK: Crown House.
Slive, A. & Bobele, M. (2011). When One Hour is All You Have. Phoenix: Zeig, Tucker & Theisen.
Slive, A. & Bobele, M. (2014). One Session at a time: When you have a Whole Hour. In M.F. Hoyt & M. Talmon (eds.) (2014), op. cit., p. 100.