Phase 2 represented, after the lockdown, an important and decisive moment for the professional
life of the psychologist . On the web and on social networks, there was a great ferment of ideas
and projects to overcome this difficult phase of recovery. There were many proposals, some focus
on marketing strategies , others concern the formation of new methods of intervention and
disorders to be treated, finally there is all the information on the state of the art of our
profession .
What does all this mean?
The question might appear rhetorical, but it’s actually worth pausing to think about it. Today more
than ever the world of psychology and mental health will have to adapt to a new way of offering
its services . Sometimes this step requires the acquisition of new skills , other times, instead, it
simply requires a change in the way of thinking and providing one’s services , using the tools
and resources already available. One such way is, for example, to implement a Walk-in/Single
Session Therapy (WI/SST) service .
But how can one orient oneself in the decision-making process with respect to the paths to be
taken at a time like this?
In today’s article we will look at some of the most common ideas and concerns expressed by
those considering providing Walk-in/Single Session Therapy services . In this regard we will
resort to an article published in 2019 by Arnold Slive and Monte Bobele in the Journal of Systemic
Therapies, entitled Ideas for Addressing Doubts About.Walk in/Single -Session Therapy in which
through the concrete experiences of professionals in the mental health community of Ontario in
Canada we will try to untie some knots.
You already know what the cornerstones of Walkin/SST services are
Walk-in/Single-Session Therapy services are based on two fundamental ideas :
1. facilitate access to mental health services , eliminating the problem of waiting lists and
other bureaucratic procedures;
2. obtain maximum results through the short form of therapy SST.
Despite the success that these services have found all over the world, what are still the doubts
of professionals who want to implement them in their professional practice?
The arguments ranged from doubts about the effectiveness of the intervention and the possibility
of establishing a therapeutic alliance with a single therapy meeting , to
more practical and organizational issues , all with the aim of overcoming
some misunderstandings that arose around these innovative services.
Let’s see what the most frequently asked questions are!
If the requests from customers increase, is it possible to deal with them all?
In 1990, when some staff members of Wood’s Homes (outpatient family therapy services) in the
Calgary community of Ontario, Canada, began to offer walk-in counseling services (without an
appointment) to solve the problem of waiting lists, they realized that soon many people began to use
them. Upon initial evaluation this result was viewed positively, however, some questioned whether
this had not led to an excessive increase in demand for the services.
If this concern initially highlighted a negative aspect of this way of providing services, at the same
time it was a sign that the clinics were on the right track. Greater access to mental health services
was the expected outcome .
Over the years, there has never been a consulting firm that has had to stop offering walk-in services
because it was too busy, and most clinics have found creative ways to adapt to the increase in
clients: by adding man hours , augmenting staff to run multiple sessions simultaneously ,
recruiting mental health professionals to volunteer or mental health professionals in training .
What if a client arrives at the clinic, showing risk of suicide/self-harm or threats of
violence, domestic abuse or child abuse? How can such serious problems be dealt with
responsibly and ethically in just one hour?
The answer to these questions is simple . In the walk-in session these problems are handled in the
same way as in the appointment services which involve the conduct of multiple sessions. You
assess the risk and try to work with the customer to develop a security plan . If necessary, the
person is ensured to go to a hospital emergency room for further evaluation or the appropriate
authorities such as the police or child protective services are contacted. Whenever possible, family
members or other supportive people are involved in the process.
How can pre and post session data be obtained?
When clients arrive at a walk-in clinic the receptionist provides the client with a short form to fill
out prior to the session . It’s usually a page that can be filled out in 5-10 minutes where customers
provide demographics and answer a few questions about why they’re asking for help. The most
representative questions are:
What is the most important concern you would like to address today?
Is there some background information you’d like to share about the issue?
Some people find that one session is enough. At the end of your session, what will tell you
that you’ve taken a step in the right direction?
After or during the session the therapist completes a session note . The template includes
description of the problem the client faced in the session, background information about their
concerns and how they were addressed, finally future plans (e.g. no plans for future sessions, call
back for other walk-in sessions, information on other community resources).
Are there no pre-session assessments?
In walk-in services, administering lengthy questionnaires or psychological tests prior to the
session is thought to be of little use . Practitioners have found that having the information with the
pre-session form is sufficient to direct the therapist to ask additional risk assessment questions such
as the following:
“Do you have any concerns that you (or your child or anyone with you) are at risk to themselves,
others or pets?”
When clients answer yes to the questions the WI/SST physician will assess the risk. Fifty years of
research indicate that there are no factors capable of predicting death from suicide (Franklin et
al ., 2017), nor prevention strategies (Zalsman et al., 2017) or screening that demonstrate the
reduction of deaths from suicide (Milner et al., 2017).
Since there is no customer screening in a walk-in service, is there a risk of violence for
staff?
When this concern was expressed by clinical staff shortly before the center opened in Calgary, the
staff consulted with the police. From their experience, the likelihood of a violent event was low or
similar to that of any other community service business. Clients experience less hostility than
traditional services because they tend to be less frustrated with the usual bureaucratic hurdles
of making an appointment . Also, most of them come at a significant time, so they’re ready to
work on the problem.
What if clients ask for something the session can’t deliver?
At the beginning of the sessions clients are asked to say what they want: “What do you hope to
achieve today?” or “When you are walking away and thinking about the time you spent together in
the session, what will tell you it was a good use of your time?
One of the reasons these questions are asked is that sometimes clients may ask for something you
can’t offer , such as medications, a formal evaluation, an investigative investigation into a
suspected child abuse case, or a formal letter I deserve a legal issue such as a custody dispute
or criminal charges . Starting from these requests at the beginning of the session it is possible to
clarify to potential customers that the intervention does not include these services. However they
may receive referral information on where they can get it.
What happens if a client is in therapy with another professional at the same time?
Sometimes a client comes to a walk-in service while in therapy with another professional. This can
happen when the client is in crisis and his therapist is traveling or on vacation . When clients
use a walk-in service because their current therapist isn’t available, you can say, “ How can we use
this session today to further the work you do with your other therapist? “
On these occasions, the person is offered the opportunity to have an interview only for that
occasion . If the client is concerned about the progress of the current therapy, they are encouraged
to address this concern with the therapist and ways are suggested on how to raise the concerns in the
next therapy session.
Types of customers such as marginalized or belonging to minorities can access wlk-in
services?
The opportunity for walk-in counseling is a way to facilitate access to services even for
marginalized or minority people who are unaccustomed to therapy . An easily accessible,
unscreened service is less intimidating than more traditional forms of service delivery.
Can clients use a WI service as an ongoing therapy?
Some customers may return to a walk-in service multiple times , their return being treated as a
single new session. This is good because customers develop a long-term relationship with the
service. However, some clients use the walk-in service as if it were a long-term therapy. When this
happens we collaborate with the customer to find the right solution for his need .
Can a customer story be shared in an hour session?
When a customer is asked “What do you want today?” or “What do you hope to achieve
today?” we might get a response like: “I just want to talk” or “There are things that have been
buried inside me for too long” . Some sessions may end without any recommendations or next
steps. Walk-in research (Miller, 2008) has shown that for many clients the primary benefit of the
single session is to be heard and understood.
Isn’t TSS just a “Band-Aid”?
When you train as a WI/SST therapist you will meet some very critical peers. Single session
therapy and brief therapies are often not featured in undergraduate training programs. Some
skeptical scholars call it a "Band-Aid" procedure . This term used in negative terms can suggest a
less effective and perhaps even unethical type of intervention. However, the plasters are very useful
therapeutically: they reduce infections and prevent the spread of disease, in addition, they promote
self-healing. In the context of psychotherapy, prevention of infection can be seen as intervention
before a normal problem worsens and requires a higher level of care. THEWI/ST prevent the
spread of disease by addressing clients’ problems before their social system is adversely
affected. Band Aid, therefore, is an economical , convenient and usable solution to a variety of
problems with minimal effort, time and cost .
Is it ethical not to provide any more contacts after the first one?
Post-session follow-up contact with walk-in clients is typically not done . On some occasions the
session may result in the co-construction of a safety plan to deal with risk situations with the
agreement of a contact to inquire about the functioning of the plan. But this is a relatively rare
occurrence. Apart from a preliminary agreement to establish post-session contact for research
purposes, the session ends with the first session. The idea of therapy as a consultation helps
therapists better manage their own concerns about what will happen to clients after the walk-in
session.
What type of training and support do new WI/TSS therapists need?
It is understandable that therapists experience a feeling of apprehension about this new form of
service delivery. Indeed, many training programs do not offer courses in brief therapy or
WI/SST, despite evidence that most psychotherapies are brief (Bloom, 1981; Talmon, 1990). But
therapists can reassure themselves, discovering that a completely new way of doing therapy is not
required for this job. What is needed is organizational support and the acquisition of a single
session mindset (Bobele & Slive, 2014; Slive & Bobele, 2011, 2012). This mindset develops as
therapists learn that the traditionally scheduled first session of psychotherapy is often the only one,
and that most clients who are seen only once are satisfied. This mindset helps give therapists
confidence that they can creatively adapt their ways of working to the WI/SST format.
Conclusions
With this article we have attempted to address the concerns , doubts and fears regarding the
implementation of WI/SST services . The concerns are understandable as this is still a new
concept to many therapists and administrators. However, there are good reasons to invest in this
new field, including the possibility of providing services more appropriate to postmodern
lifestyles, through the acquisition of an intervention method capable of enhancing the resources
and tools already possessed by the therapist.
Angelica Giannetti
Psychologist,
Team Psychotherapist of the Italian Center
for Single Session Therapy
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