But in practice, how is Single Session Therapy carried out?
In the article Where to practice Single Session Therapy I considered in which contexts this framework can be used and with which orientations it can be integrated. I have also declined, as you have read in the previous articles, Guidelines and Principles of the 3 main models (Californian, Canadian and Australian) that practice Single Session Therapy in the world.
Models that adapt to different contexts, which maintaining a minimum common denominator have produced their own operating lines and tools.
The Canadian experience of the Eastside Family Center
Let’s now try to go into detail with respect to a tool used in the Canadian structure of the Eastside Family Center, described by Slive & Bobele (2014).
The described tool is used in walk-in services, open structures where people can access without an appointment to request a consultation, as Flavio Cannistrà has already written in the article Direct access psychotherapy: the logic and advantages of walk-in services.
Another feature of the walk-ins is that the person, in most cases seen for a single session, can return to the Service but not necessarily, indeed rarely, will meet the same professional who first welcomed them.
These services are characterized by teamwork, managed by a team of 6 professionals plus a supervisor who governs the process. The committed operators can be composed, in addition to professionals of the helping relationship, by students and volunteers who dedicate time to the community by acquiring experience and expertise.
Sometimes the professional is assisted in the room by a co-therapist, other times he acts alone in the room, while the supervisor and other staff members have the opportunity to follow the session from behind a one-way mirror or through monitors connected to CCTV cameras.
During the session, the staff has the opportunity to meet to discuss, make observations and define a coherent and congruous action plan with the situation presented by the person.
Much attention in this walk-in clinic is given to the reception space. When people enter they are welcomed in a very comfortable waiting room: the basic idea is to immediately put people in a state of relaxation and tranquility before the start of the work session.
Later we will talk in more detail about the Eastside, but now we want to focus on a particular point, which anyone – even the freelancer – can use in their work to facilitate the implementation of a Single Session (and therefore to make the most of each meeting). People are invited to fill out a questionnaire in the waiting room by a staff member, and in the meantime the other team members prepare the session.
The usefulness of the questionnaire
The questionnaire is used to collect personal data, ask the person for authorization to be observed by the staff and videotaped and to investigate the level of stress perceived by the person with respect to the situation, measured on a scale ranging from 1 to 10. It takes a few minutes and its value is very high.
Let’s see together the short questionnaire proposed by Slive & Bobele, commenting on it to understand its usefulness. It consists of 7 simple questions (6 open and 1 Likert scale) and, as you will see, you can easily take them up too, print them and propose them to your client five minutes before starting the session.
- What is the single issue (concern) that you consider most important and that you would like to discuss today?
Given that, as we saw in the article on guidelines, it is essential to define a precise goal to maximize the effectiveness of each individual session, the questionnaire, even before the session begins, begins to orient the person’s perception towards this goal. , to have a clear and limited focus on which he intends to work in the here and now. Circumscribing allows you not to indulge in digressions and always have a clear course on which to stay with respect to the request made by the interlocutor. The present time is highlighted, remaining on the here and now. Furthermore, consider that establishing a precise goal positively affects the therapeutic relationship (Norcross, 2010) and allows it to be established more quickly.
- In your opinion, what is important to know, in terms of past and background aspects, about this concern?
The question gives specific weight to the past by asking the person for the salient background, present or past, that may be connected with the current concern. In doing so, the person is oriented towards defining priority aspects and connections, in her opinion, which must be taken into consideration and does not have the feeling that her history is forgotten.
- On a scale of 1 to 10, where 10 is the best score and 1 is the worst score, how are things going in your life today?
It helps the person to give an objective indication of the level of stress induced by the worry experienced; the scale will also be a good indicator that can be used in the follow up evaluation, foreseen in the Single Session Therapy after 2/3 weeks. This question takes up the ladder technique, widely used within Solution Centered Therapy (De Shazer & Dolan, 2007).
- Have you ever had a consultation before? Yes No. What was the most and least useful thing about this previous experience?
The question makes it possible to investigate, where previous interviews had been carried out, any useful strategies or maneuvers or those to be avoided, thus considering which aspects to use to encourage change.
- What would others respect and admire in you if they had years or months to get to know you?
The question allows the person to offer space for the consideration of his own resources rather than focusing on the problem or discomfort, valuing the strengths. Since Single Session Therapy is a resource based and strength oriented methodology, a questionnaire that allows you to begin to orient the perception of the person on your own resources, and to express some that can then be used in the session, proves to be precious.
- What would others respect and aspire to in your child (or children) if they had months or years to get to know them?
The question offers space to the skills of the person and the role played, once again proposing a clarification of resources rather than limits. Note that it is not important whether the person has children or not: this question serves to elicit her values, to make her imagine a future scenario, a direction in which to tend.
- For many people, a single session with a counselor is enough to take a first step. What would be the smallest change that would make you say you are heading in the right direction?
The person is put in a position to know that a single work session can be enough, as it has been for many other people. This promotes the person’s expectation and confidence in the possibility of succeeding (according to various researches, the expectation of a positive change significantly affects the outcome of therapy – Asay & Lambert, 1999). It is oriented to seek a change of a tangible nature that can be an indicator of its progress, once it has obtained an avalanche effect that will continue, even independently, the path towards the desired goal and the desired change.
Federico Piccirilli
Psychologist, Psychotherapist
Co-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 ”or participate in one of our workshops (click here).
Bibliography
Asay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors in therapy: Quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 33–56). Washington, DC: American Psychological Association.
De Shazer, S. & Dolan, Y. (2007). More Than Miracles: The State of the Art of Solution-Focused Brief Therapy. New York: Routledge.
Hoyt, M.F. & Talmon, M. (eds.) (2014). Capturing the Moment. Single Session Therapy and Walk-In Services. Bancyfelin, UK: Crown House.
McElheran, N., Stewartm J., Soenen, D., Newman & J., Bruce, M. (2014b). Walk-in Single Session Therapy at The Eastside. In M.F. Hoyt & M. Talmon (eds.) (2014a), op. cit., pp. 177-194.
Miller, J.K. (2008). Walk-in single session team therapy: A study of client satisfaction. Journal of Systemic Therapies, 27, 78-94.
Norcross, J. C. (Ed.) (2011). Psychotherapy Relationships That Work: Evidence-Based Responsiveness. London: Oxford University Press.
Short, D., Erickson, B.A., and Erickson-Klein, R. (2005). Hope and resilience. Understanding psycotherapies strategies of Milton H. Erickson. Carmarthen, Crown House Publishing Limited.
Slive, A. & Bobele, M. (2014). Walk-in Single Session Therapy: Accesible Mental Healt Services. In M.F. Hoyt & M. Talmon (eds.) (2014), op. cit., pp. 73-94.