The first research on Single Session Therapy

It is already known that psychotherapy can last one single session of therapy.

After all, also the term single session therapy had already been used. In 1981, Simon

Budman, one of the best-known scholar of brief therapies, published Forms of Brief Therapy, which included a chapter named Focused single session therapy: Initial development and evaluation written by Bernard Bloom.

In the literature research studies on therapies of a single session were also present.

What was missing was a study specifically aimed at exploring the efficacy of SST Michael Hoyt, Robert Rosenbaum e Moshe Talmon decided, therefore, to conduct the first research study on SST, from which a series of interesting results emerged.

 

Is Single Session Therapy suitable for everything?

In the study by Hoyt and colleagues (1992) an initial sample of 60 patients attended a planned SST at the Kaiser Permanente Medical Center, CA, USA. The heterogeneity of the sample (for age, gender, economic-status, and range of problems addressed) and of the methodologies of the interventions (diverse treatment approaches were randomly used for individual, couple or family therapy) were ensured to demonstrate the efficacy of the intervention in various conditions and for different problems.

In fact, it is now said that SST “is not for everyone, but for everything”. This means that, any problems can potentially be addressed in a single session and, more in general, by following the SST principles.

In fact, although in 1992 Hoyt and colleagues, in the book The First Session In Brief Therapy, described some disorders for which they believed the TSS not to be effective, further studies demonstrated this approach to be able to address a greater number of problems.

Notably, more than in relation to the specific problem, the benefits of TSS vary according to the individuals: some people may need more than one session of therapy or a more structured treatment approach – this is not surprising given that the TSS is a resource-oriented approach.

 

For 1 person out of 2 a single session is enough

Back to Hoyt et al.’s investigation (1992), 58 of 60 participants concluded the study, and 58.6% of them considered a single session of therapy to be enough.

Basically, 1 out of 2 people.

Other research came to similar findings – for example, Weir, Wills, Young and Perlesz (2008) published a study conducted on over 100’000 patients: the 42% of them believed not to need more the one therapeutic encounter.

 

8 out of 10 people solve their problem in one session

1 out of 2 people consider one session to be enough, but how many of these improve?

 In 1986, when Talmon phone-called 200 patients who attended a SST in the past, 78% of them declared they “solved”, “very improved” or “improved” their problems because of that single encounter. Could it be possible? The author, together with Hoyt and Rosenbaum (1992) decided to further verify this assumption.

Of all the people who had received a single session of therapy, 88% (almost 9 out of 10 persons) reported that after only one encounter they were “very much improved” or “improved” regarding the problem they needed help with.

Then a question arises: when a problem is “very much improved” can it be considered a success?

Hoyt and colleagues did not include the option “solved” in the survey; not because they didn’t think it to be possible, but simply as they preferred to set the range of possible answers on a scale varying from “unaltered” to “very improved”.

Along with the consideration that often a treatment (long-term, brief or single session therapy) ends before both the therapist and the patient agree to consider the problem “completely solved”, it should be also noted that those people, who believed their problem to be “very much improved” or “improved”, were the same that affirmed that they did not need another session. Essentially, the improvement they reached was sufficient for themselves.

These results were confirmed in further studies: at the prestigious Tavistock Clinic of London, as instance, David Malan and colleagues (Malan et al., 1968, 1975) treated 45 patients, and 51% of them greatly improved their symptoms in only one session.

 

SST not only solves symptoms

One of the most common criticism of the brief therapies is that “they only cure symptoms”.

However, whether to address the problem referred by the patient or to work “more in depth”, is generally an epistemological issue associated more to the therapist’s approach than to what the clients really need to feel better.

Back to David Malan’s research, besides having registered a significant symptoms improvement in more than half of the patients who attended a SST, the Tavistock group also observed that 24% of them also improved from a psychodynamic prospective. After all, the Tavistock Clinic always adopted a psychodynamic approach to therapy.

Also, Malan himself stated that «with evidence, psychiatrics specialists giving a therapy should not automatically allocate a specific long-term or short-term therapy to patients, they should, instead, be aware of the possibility that a single dynamic session could be everything patients need» (Malan et al., 1975, p. 126).

 In another study conducted at the Kaiser Permanente Medical Center, CA, USA (Follette & Cummings, 1967) was observed that those patients who undertook a single session of psychotherapy reduced their use of medications by 60%.

Considering the physical and psychological well-being are closely associated is not a surprise, but what should be noted is that it happened after a single session of therapy.

Positive spill-over effects for other aspects of life were also observed in 65% of the sample considered in Hoyt and colleagues’ study (1992), further confirming that SST may results in multiple effects.

  

Therapy on demand

 For the SST to be effective, a proper mind-set is required: people believing that only one therapeutic encounter cannot be enough, will rarely achieve any results, and for those that feel better after treatment, achievements will often be attributed to other conditions or simply not acknowledged.

Already in 1954, Anna Freud reminded that the instruments of psychotherapy must be «examined, reviewed, refined, improved and, if necessary, modified on a regular basis» (p.608). Today, psychotherapy is not required to be a single and linear process, and discontinuous therapy is currently practice worldwide: clients can choose to benefit from a service of psychotherapy “on demand”.

Just think of the walk-in services, where people have access to services (including psychotherapy) without booking and with the chance to come back whenever they desire. Still, by following this practice, people are not guaranteed to see the same therapist the following times, but those persons who want to be visited by the same professional can always ask him/her, for a private SST. One of the principles of SST is, in fact, to “always leave the door open”: persons can contact a psychotherapist according to their needs or possibilities, and not necessarily undertake multiple sessions of therapy – but the chance of using longer-term therapies when necessary is not excluded.

 

Long-term effects of Single Session Therapy

 Back to the research of Hoyt and colleagues (1992), the authors also tried to clarify the duration of the effects of a SST, and follow-up measures at 3, 6 and 12 months after treatment proved that results of a SST were successfully maintained over time.

Already Follette & Cummings (1967) had confirmed a reduction in the use of medical treatments for patients undertaking a single session of psychotherapy at 5 years after treatment, and subsequently, the effectiveness of the SST was further proven in a number of studies (CIT)up to 8 years follow-up (Hoyt & Talmon, 2014).

 

 Conclusions

 Even though SST seems not to be effective for everyone, it is certainly suitable for dealing with mostly of the problems.

1. 1 out of 2 people considers not to need a second session of therapy, with almost the totality of them believing to be significantly improved or to have solved their problem.
2. Not only SST is able to address the difficulties reported by a person, but – in a significant percentage of cases – it also produces profound, systemic, or “snowballing” changes.
3. Results are not temporary or short-term: follow-ups up to 8 years after treatment demonstrate SST to be effective over time.
4. SST is a new form of intervention, able to address problems and needs of modern life.

 

Flavio Cannistrà

Psychologist, Psychotherapist

Founder Italian Center for

Single Session Therapy

 

Bibliographical references

 Baekeland, F. & Lundwall, L. (1975). Dropping out of treatment: a critical review. In Psychological Bulletin, vol. 82, n. 5, 738-783.

Bloom, B. L. (1981). Focused single session therapy: Initial development and evaluation. In S. H. Budman (a cura di), Forms of brief therapy. New York: Guilford Press.

Freud, A. (1954). The widening scope of indications for psychoanalysis. In Journal of American Psychoanalytic Association, 2, 607-620.

Hoyt, M. F., Rosenbaum, R. L. & Talmon, M. (1992). Planned Single-Session Psychotherapy. In Budman, S. H., Hoyt, M. F. & Friedman, S. (a cura di), The First Session in Brief Therapy (pp. 59-86). New York: Guilford Press.

Hoyt, M. F. & Talmon, M. (2014). Capturing the Moment. Bancyfelin, UK: Crown House (Tr. it. in pubblicazione).

Malan, D. H., Bacal, H. A., Heath, E. S. & Balfour, F. H. (1968). Psychodynamic changes in untreated neurotic patients, I. In British Journal of Psychiatry, 114(510), 525-551.

Malan, D. H. Heath, E. S., Bacal, H. A. & Balfour, F. H. (1975). Psychodynamic changes in untreated neurotic patients, II: Apparently genuine improvements. In Archives of General Psychiatry, 32(1), 110-126. doi:10.1001/archpsyc.1975.01760190112013

Talmon, M. (1990). Single-Session Therapy. San Francisco: Jossey Bass (Tr. it. Psicoterapia a seduta singola. Trento: Erickson, 1996).

Weir, S., Wills, M., Young, J. & Perlesz, A. (2008). The implementation of Single Session Work in community healt. Brunswick, Australia: The Bouverie Centre, La Trobe University.