As Michael Hoyt (1994) recalls, patients are far less interested in therapy than the therapist himself is. Patients are quite interested in the result.
How is it possible, then, that up to now Single Session Therapy has had so little diffusion?
Althought in a synthetic way, we try to give some answers to this question.
First of all, a fact: the question is wrong.
The first studies and research on SST were conducted several decades before the term “Single Session Therapy” began to be used. Since then, the formalized TSS has been studied and applied in America (North and South), Europe, Asia and Oceania. In these continents, moreover, they have real Centers that adopt it as a basic practice (an integrated and commonly provided service); obviously, to these is added the group of professionals who practice it individually, in the private profession, in the outpatient or in other contexts.
Therefore, Single Session Therapy is not uncommon. It was, rather, in Italy.With only one translated book (Single Session Psychotherapy, 1990, which is out of print) and no scholar who has explored the vast bibliography available, Italy has had a huge gap.
The reasons are many, but here we will go into some of them.
Let it be clear, however, that our intent is not to make a sterile controversy. The reason, if anything, is just the opposite. One of the main objectives of the Italian Center for Single Session Therapy lies precisely in the spread of SST in Italy. To do this, however, it is also necessary to highlight critical issues, which build up false beliefs that will turn into blind resistances.
We know that the first to adopt SST in Italy will be (indeed, they already are) those who, speaking of the processes of diffusion of innovations, Everet Rogers (1962) defined early adopters, those who first grasp the innovative scope of a new service / product placed on the “market” and which actively contribute to its growth, followed by all the others. Perhaps the only difference in this case is that the service, in the rest of the world, is thirty years old …
SST: False beliefs and resistances
Let’s look at some of the beliefs that cause resistance in adopting Single Session Therapy as an integrated therapeutic approach
1. Money: Without too many words and without too many sentimentality, money is certainly one of the most obvious reasons – and one of the most wrong. The “money” discourse is broad, very broad, capable of covering various interests, so we do not hope to be able to rattle it off fully in a few lines. On the one hand, for example, in the private practice there is a fear of a reduction in earnings. It’s easy to understand that: given that the SST allows to reduce the number of sessions, sometimes even to 1 (“sometimes”, because it is necessary, as always, to remember that no SST scholar will ever say that all therapies will last 1 session), and since the Freelancer gets paid for every single session, it’s easy to think that your earnings will decrease. False. This is not only a limited vision (because it narrows one’s focus), but also dangerous for one’s professional future. First of all, let’s say the apparently inconvenient thing: if a therapy lasts less, you are entitled to increase your fee a little. Those who say that this speech is unseemly, hypocritical or even indecent, lie knowing that they are lying, especially when it comes to those who, as a rule, while asking little per session, conduct therapies of many sessions: the total cost far exceeds that of one shorter therapy. Secondly, such a speech is short-sighted. Current social health changes are leading people, among other things, to increasingly select the professional to turn to. This means that if you want to be able to work in the field of study you have chosen, in order to help people, you need to be able to provide the services that people actually require and need today; services that, in fact, take into account modern health and social changes. Single Session Therapy responds to these changes and these requests: we don’t make it up, the facts say so. Fortunately, if the resistance comes from people with little foresight, the opposite occurs within organized health care, whether public or private, since inevitably it is increasingly attentive to cost-effective interventions. The motivation is different (not so much, then), but the goal is the same: to give what the citizen asks.
2. Epistemology: a huge chasm probably opens up on this scenario, containing an infinity of more or less detailed criticisms, which we could summarize – albeit roughly – in this thought: it is impossible to solve a problem in one session. As already mentioned, the SST aims first of all to maximize the effectiveness of each session, in order to reduce the overall duration of the therapy. On the fact that it is impossible to solve a problem in a single session, our answer is simple: it is possible. The fact is that, in our opinion, the question to ask is another: “In which epistemology is it possible to solve a problem in a single session?” If the theoretical context of reference includes a priori that a problem (even a mental disorder) cannot be solved in a single session, then it will certainly be so. And when even Sigmund Freud reports at least two cases solved with a single meeting (the composer Gustav Mahler and the nurse Katarina), the reference theory will bring these events back into the “exceptions”, rather than studying the ways that made them possible. As the philosopher Hegel seems to have argued: “If the theory does not agree with the facts, so much the worse for the facts”.
3. Adaptability to the Italian context: we were faced with the objection that the Italian context, culture, society, profession, psychotherapy (?) are different. In what, nobody explains it well, but in reality, those who argue this are right. Italy has its own identity, very different from that of other countries, such as the United States (although some recent studies seem to show an approach of the Italian personality to that of the United States – “unfortunately” or “fortunately” let the reader decide). Simply transferring a therapeutic model from one context to another is a reductive process. This is also why we have established a Center with the aim of adapting the SST to the needs of our community.
After all, if single-session therapies are currently practiced in countries such as Australia, Canada, Chile, China, Japan, England, Ireland, Israel, Mexico, New Zealand, Sweden and the United States, it is not clear why it should not also be used in Italy. On the other hand, when the MMPI was introduced, no one said: “In Italy it can never be used because Italy is different” (or maybe yes, since it took more than 50 years before the Italian calibration).
Conclusions
We would like to say that the reasons are just these, but that’s not the case. However, already considering these 3 beliefs, with the aim of undermining their erroneous principles and the resistances they generate, is an important step for the spread of Single Session Therapy also in Italy. A diffusion that, if you have just finished reading this article, you already know is in place.
It is no longer a question of when the practice of SST will be widespread among the majority of Italian professionals, but how quickly this will happen.
Flavio Cannistrà
Psycologist, Psychotherapist
Founder ofItalian Center
for Single Session Therapy
Bibliography
Hoyt, M. F. (1994). Constructive therapies vol. 1. New York: Guilford Press.
Rogers, E. M. (1962). Diffusion of Innovations. New York: Free Press of Glencoe.
Talmon, M. (1990). Single Session Therapy. San Francisco: Jossey-Bass (Tr. it. Psicoterapia a seduta singola. Milano: Erickson).