Ten years ago, when the Italian Center for Single Session Therapy began working systematically on Single-Session Therapy, the idea that a single session could constitute a complete intervention rather than a treatment that had been interrupted or was merely at its beginning was very much a minority view in Italy.
Today, after ten years of clinical work, research, training, and international exchange, the situation is different: Single-Session Therapy has become part of professional training, public services, and the private practice of an ever-growing number of clinicians.
At the heart of this change is a finding that international research has documented for quite some time: in many treatment settings, the most frequent number of sessions is one (Talmon, 1990; Hoyt & Talmon, 2014). A single session therefore appears to be the most common form of contact across services in different countries (see Schleider et al., 2025, for a review), and in a significant proportion of cases this is not due to dropout, but rather to the fact that that one meeting was sufficient. Taking this finding seriously means reorganising clinical work around a simple principle: making every session potentially self-contained.
The problem that emerges when time is limited to a single session
This approach, however, brings to the forefront a problem that can be managed over time in long-term therapy: engagement.
If the treatment is long, clinicians can afford to build the therapeutic alliance gradually, tolerating a few sessions of initial mistrust. If, on the other hand, the meeting may be the only one, the relationship has to be built within a few minutes and it has to be built also, and above all, with someone who did not seek it out in the first place.
This is far from a marginal condition. It applies to patients referred by a service, a doctor, a court, or a school; adolescents accompanied by their parents; referred families; and adults who show up because “someone” has decided that they should.
In all these cases, the silent assumption underlying much of our professional training that the person sitting in front of us, to some extent, wants to be there and wants to work with us simply does not hold.
No Bullshit Therapy: authenticity as a clinical tool
Jeff Young has devoted a large part of his career and fieldwork to this very problem. A clinical psychologist and family therapist, Professor Emeritus at La Trobe University, Young directed the Bouverie Centre in Melbourne, the world’s largest specialised family therapy centre, from 2009 to 2022. During those years, he formalised an approach that he chose to call, without euphemisms, No Bullshit Therapy.
No Bullshit Therapy is an approach grounded in authenticity: its main strength lies in its ability to transform even the most complex working situations with clients who may be particularly difficult to engage.
The name itself is deliberately blunt, but the approach is not provocative in any way. Its core consists in transforming situations characterised by fear, resistance, or relational difficulties into concrete and workable agreements, explicitly creating and negotiating with the client a context of mutual honesty and candour.
All of this is grounded in respect and in a clear, transparent, and non-coercive use of power within the therapeutic relationship, with the ultimate goal of promoting the person’s autonomy and capacity for choice.
It is not, therefore, a technique for confrontation, but rather an agreement about how the conversation will take place, established before even addressing the problem itself.
The most significant aspect of this approach is based on mutual honesty and direct communication, sometimes simply by explicitly explaining one’s way of working something that can be both extremely liberating and productive. This is particularly important when working with people who have not chosen to seek counselling voluntarily, who may view the professional with suspicion, or who generally distrust such services or institutions.
When clarity and candour are combined with warmth, attentiveness, and respect for the constraints within which the intervention takes place, a professional who avoids excessively technical or structured language and adopts an authentic and direct style, without losing authority, can foster greater relational closeness and strengthen trust.
The underlying logic of this way of working is, in fact, relational. People who distrust services rarely do so without reason: they often have a history of experiences in which they were described in someone else’s words, assessed without their knowledge, or not helped at all. Naming first what the other person is already suspicious of removes from the relationship the very element that would otherwise block it.
The October event
Part of this work, however, can only be conveyed partially through the written word. The point at which a direct statement feels welcoming rather than offensive depends on tone, timing, and what comes before it: this is material that can be conveyed more effectively in person, by observing the clinician at work.
On October 16, 2026, at the Quirinale Hall of the Cavour Congress Centre in Rome, Jeff Young will lead a full day of training devoted entirely to clinical work with difficult-to-engage patients, including discussion of real cases and opportunities for direct exchange.
For the Italian Center for Single Session Therapy, in the year of its tenth anniversary, bringing him to Italy represents the natural continuation of a clear and well-defined line of work: the effectiveness of an intervention does not depend on the number of sessions or on the quantity of techniques available, but on the quality of the relationship that can be established and, in many cases, on the degree of honesty one is willing to bring into the room.
Selena Tomei
Psychologist, Psychotherapist specialised in
Brief Systemic-Strategic Therapies
at the ICNOS Institute
References
Hoyt, M.F., & Talmon, M. (Cur.). (2014). Capturing the Moment: Single Session Therapy and Walk-in Services. Crown House Publishing.
Schleider, J. L., Zapata, J. P., Rapoport, A., Wescott, A., Ghosh, A., Kaveladze, B., Szkody, E., & Ahuvia, I. L. (2025). Single-session interventions for mental health problems and service engagement: Umbrella review of systematic reviews and meta-analyses. Annual Review of Clinical Psychology, 21, 279–303. https://doi.org/10.1146/annurev-clinpsy-081423-025033
Talmon, M. (1990). Single-session therapy: Maximizing the effect of the first (and often only) therapeutic encounter. Jossey-Bass.
Young, J. (9 Settembre 2026). https://www.latrobe.edu.au/research/centres/health/bouverie/courses/pd/self-paced/nbt