In recent years, much of the information, research and innovations regarding Single Session Therapy have come directly from the application field of walk-in centers.
It is no coincidence that today’s article focuses on the 6 fundamental principles of clinical practice adopted within the Community Counseling Center in San Antonio (Texas), masterfully summarized by Slive and Bobele (2011). The authors managed to condense a wide range of levels and concepts: both of theoretical / epistemological and technical / operational origin.
As we have repeated several times, the Single Session Therapy differs (in some respects) from a walk-in session; however, the elements presented in this article can be very useful both for those who approach TSS and for those who already know the subject.
It will be possible to obtain excellent food for thought even for those who do not usually practice Single Session Therapy, as the themes represented concern very important and delicate aspects of our clinical sector.
- It is only an hour
The concept of time represents one of the crucial factors for a Walk-in Single Session Therapy; therefore it is very important to estimate how the session is conceived and implemented, especially in terms of the patient-therapist relationship.
In the sixty minutes available, you have plenty of time to build a good therapeutic alliance, as long as you focus on the most important aspects of the client’s story (Hoyt, 2009).
Listening and empathy (elements of a good relationship) must always be considered through the lens of time, requiring the therapist to carefully refine their skills, both in the choice of questions (which bring back to the focus), and in the ability to listening and relationship.
The therapeutic alliance must therefore be strictly taken into consideration, but in light of what has just been said and the organizational structure of the intervention session.
- Focus on information
In a therapy the amount of information transmitted by the client is usually very significant.
In Single Session Therapy, as well as in a walk-in session, it is necessary to restrict the “database size” through some procedures.
Fisch (1994) argues that the more focused and restricted the amount of information present in a therapeutic conversation, the shorter the therapy will be.
First of all, the focus is on the problem and how it works in the present. Therapists will then have to set up discussions on current and / or future-oriented information (not belonging to the past), selecting descriptive ones at the expense of explanatory ones.
Doing so will highlight when, what, how and with whom the problem arises, thus favoring the level of interpersonal relationships.
Second, the change must be viewed in terms of specific goals, possibly described in behavioral terms. This can be achieved, for example, through prescriptions to be carried out outside the study.
The therapeutic session will therefore be more effective precisely in terms of the amount of information transmitted and retained, postponing the possibility of change to a real experience, rather than to explanatory factors.
- A session represents an entire therapy
Dealing with a session thinking that it may be the only one represents one of the greatest difficulties for therapists approaching Single Session Therapy.
This dimension mainly concerns the mindset of the expert and how much this scenario is able to foresee. If we approach a Single Session Therapy with the idea that we will hardly be able to find a focus for the client, this will undoubtedly lead us to failure.
On the other hand, learning and internalizing an adequate mindset is more difficult than learning any theory or technique.
From a practical point of view, it will be useful to divide the session into three key moments: an initial phase, a central one and a final one; each with different actions and objectives.
By following the established steps, it will be easier to organize the session in such a way as to consider it an entire therapy.
- Common factors
Many studies on the effectiveness of psychotherapy, carried out over the last forty years, agree on a very interesting aspect. That is, this effectiveness derives from some shared (common) factors rather than from the unique aspects of the various schools of thought (Hubble, Duncan & Miller, 1999; Wampold, 2001; Duncan, Miller & Sparks, 2004).
Among the most important are the relationship and the therapeutic alliance, therefore good listening, a good empathic and supportive capacity of the specialist. On the other hand, the client must perceive all this, together with the idea that there are good conditions for the session and for the solution of his problems.
How is all this done within a Walk-in Single Session Therapy?
Slive and Bobele illustrate some basic steps, such as:
- help customers use their internal and external resources (relational or system)
- listen to their motives or wishes
- create hope that the therapeutic process will lead to improvement.
The continuous feedback and monitoring process carried out on the customer is very important, and during the work he will evaluate whether the methodology used is adequate for him.
- The theoretical basis
The main theories underlying the applications we are talking about have their roots essentially in the constructivist matrix, with particular attention to the schools (of psychotherapy) that derive from it. We are talking, for example, of the Mental Reaserch Institute (therefore also of Eeriksonian influences) and of all Systemic (Bateson, 1972) and Strategic (Haley, 1973; Watzlawick, Weakland & Fisch, 1974) therapy, of Solution-Focused (De Shazer & Dolan , 2007), Narrative Approach (White & Epston, 1990) or Cognitive-Behavioral Therapy (Young, 2008)
In general, the orientation is aimed at brief therapies, from a pragmatic perspective (Amundson, 1996).
- The session is a consultation
As the authors themselves state (Slive & Bobele, 2011), Walk-in Single Session Therapy should be thought of as a consultation process in which the therapist offers ideas and the client decides whether to accept, reject, or put them aside. Clients leave the session and may or may not use the therapy conversation.
This last aspect, also linked to the mind-set, has a very specific purpose: to make the person and not the specialist fall the responsibility for change. But that is not all.
On the other hand, we must also believe that the client is the greatest resource of the therapy and at the same time the privileged point of view for evaluating the results. The therapist’s major task is to create an appropriate context for the development of these resources.
Pier Paolo D’Alia
Psychologist
Italian Center team
for Single Session Therapy
Bibliography
Bateson G. (1972). Steps to an Ecology of Mind. San Francisco: Chandler Publishing Co.
De Shazer, S. & Dolan, Y. (2007). More Than Miracles: The State of the Art of Solution-Focused Brief Therapy. New York: Routledge. Duncan, Miller & Sparks, 2004
Haley J. (1973). Uncommon Therapy. The psychiatric techniques of Milton Erickson. New York: Norton (Trad. It, Uncommon therapies. Hypnotic techniques and family therapy, Astrolabio, Rome, 1976).
Hubble, M., Duncan, B., & Miller, S. (1999). The Heart and Soul of Change. Washington: American Psychological Association Press Slive, A. & Bobele, M. (2011). When One Hour is All You Have. Phoenix: Zeig, Tucker & Theisen. Wampold, 2001;
Watzlawick, P., Weakland, J. H. & Fisch, R. (1974). Change. Principles of Problem Formation and ProblemSolution. Palo Alto: M.R.I. (Tr. It. Change. On formation and problem solving. Rome: Astrolabio, 1975).
Withe, M., Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton. Young, 2008