Carlo, not his real name, contacts us about a problem: he absolutely has to solve his panic attacks. He has a family, children, and the situation has become serious: he no longer drives due to anxiety and his wife does not have a driving license, so he had to take sick leave from work (which is more than 70 kilometers from his home).
We are in May and he has asked for an appointment at the Mental Health Center of his reference ASL. It was given to him in December.
The recent and real case of Carlo seemed to us to be emblematic of a widespread problem in many health systems, including ours: the long waiting lists for a psychological visit – and more.
In this article, data in hand, we will try to explain how Single Session Therapy is an adequate response to reduce waiting lists in healthcare.
The anger of waiting lists
It is news these days that 2 out of 5 Italians (37.8%) feel anger towards the health system due to waiting lists that are too long (Adnkronos, 2018).
The fact is not new and also closely concerns psychological visits to the ASLs and public centers. Let’s see some data, making some clarifications: these are some cases merely by way of example, they should not be generalized but only read to get some ideas of some conditions.
Furthermore, we would like to clarify that in no way do we want these data to be taken as “signs of medical malpractice”, of “bad management”, or of a more general criticism of health facilities and their operators. While they may have had unpleasant experiences, the reader must imagine that the work of the majority of public health service employees is aimed at ensuring the best possible performance with the resources they have at their disposal. The specific problem of waiting lists, we repeat, does not concern only the examples shown here, nor only our country: it is a general problem of most countries and health systems in the world.
Waiting lists: examples in Lazio
According to an investigation by the Order of Psychologists of Lazio, in this region it takes up to a year and a half before being able to complete the diagnosis service of Specific Learning Disorder: it should be noted that without ASL certification, schools cannot activate the personalized learning plan (private certifications are not good – Affaritaliani, 2017).
The Order underlines that on average, in the various Regions, the waiting list is in any case 6 months (more than half the school year).
If healthcare professionals were enabled to reduce waiting times for a visit, such as psychological counseling or psychotherapy, other services, such as diagnostic ones, would also benefit collaterally.
In the more generic field of mental disorders and problems of a psychological nature, a psychologist from the ASL Rm1 of Rome had a widely appreciated idea. While patients are on the waiting list, they find themselves in an “unofficial” support group to which the professional offers his services free of charge. The wait in Rome, in fact, is 4-5 months (Corrieredellasera.it, 2016).
Waiting lists: examples in Lombardy
Moving to the big centers, according to a 2015 article, in a big city like Milan you can wait from 30 days to 6 months, before being able to make a psychological visit (Linkiesta, 2015).
In fact, “those who suffer from depression , anxiety disorders , panic attacks often find themselves having to face endless waiting times. Even more difficult becomes the struggle for those who have to fight with situations such as eating disorders , personality disorders , family problems , childhood and adolescent discomforts and disorders that require specific, often long and complex, care. “
Waiting lists: examples in Sardinia
The official brochure of the Childhood and Adolescent Neuropsychiatry Service of the ASL of Oristano openly specifies that “the waiting list for the first visits can be several months”.
Waiting lists: examples in Tuscany
In Prato, Tuscany, the father of a seventeen-year-old who suffered (we hope to be able to speak in the past) of panic attacks , was given the first appointment at the ASL 14 months later (Notiziediprato, 2014). It was December 2014 and the appointment was given for February 16, 2016.
Moreover, the commendable response of the ASL to the problem was to increase the time dedicated to psychological visits , reaching 20 hours per week. However, if on the one hand the impact this will have on waiting lists is all to be verified, on the other it opens up new scenarios and problems, including:
- an increase in public health expenditure
- an increase in the hours dedicated by staff to that type of visits (and therefore, probably, a decrease in the hours dedicated to other projects)
- a possible too slight relapse in terms of reduction of waiting lists, due to the growing increase in demand for health and psychological well-being services
Waiting lists: examples in Trentino Alto-Adige
On the site of the ASL of this Region we were not able to find the waiting lists for psychological or psychiatric visits, but for the neurological ones, depending on the city, we wait from 98 to 288 days.
Reduce waiting lists with Single Session Therapy
In the Single Session Therapy book. Principles and practices , we also report some examples of how TSS allows to reduce the waiting lists of different services. Let us mention, for example , 2:
- in the state of Victoria, Australia, TSS has been implemented by nearly twenty health districts. Waiting lists were reduced by a week in already virtuous services, and decreased by 47 weeks in those with longer waiting times.
- in the province of Ontario, Canada, the ROCK (Reach Out Center for Kids), a center for children, adolescents and families that receives thousands of cases every year thanks to 5 clinics throughout the territory, has introduced a day a week of walk -in ( direct access therapy, without appointment ), in which Single Session Therapy is performed. Until then the waiting list was up to 2 years. With the introduction of the TSS service, waiting lists have decreased by 18-20 months .
In general, the attention towards walk-in services is growing all over the world, because they seem to be the most effective and efficient answer to a series of current problems, including:
- the need for psychological support in a short time
- the need to start a path that is short
- the possibility of breaking down stereotypes and mistrust towards psychological services
- the ability to respond to the growing number of requests for these services
In Italy we are still trying to understand the extent of the walk-in logic in psychological services, although the scenario still seems far from that of other countries. An exceptional case is found in Milan, where two psychologists, trained with us in Single Session Therapy , have started a psychological walk-in service that is having growing success and which we will discuss shortly.
At this point, let’s see in more detail how Single Session Therapy for waiting lists can be an excellent solution.
How the Single Session Therapy solves the long waiting times in healthcare
As widely reported in the book , TSS is based on facts, which can be summarized as follows:
- The most frequent number of sessions in psychotherapy / psychological counseling is 1: that is, a large number of people (on average between 20 and 40% depending on the studies) come for a single session and then never come back
- Most of them, when asked why they didn’t ask for a second meeting (or, more often, when they didn’t show up for the second scheduled meeting), answer: “Because I’m fine: that single meeting was enough for me “
- Follow-ups months and years later have shown that this result holds true for the vast majority of them
- When a TSS is actively proposed (i.e. when the person is given the opportunity to choose whether that meeting is sufficient – and obviously the principles of TSS apply), between 40 and 60% of people, at the end of the session, believe not to need other meetings: of course the professional leaves the door open, so that the person knows he can come back if he needs it
- In general, then, TSS makes it possible to make the therapy / counseling path more efficient (short), since it is an approach that aims to help the person identify and use their own resources.
Given these facts, that’s why having operators trained in Single Session Therapy can greatly reduce waiting lists – and generate other benefits as well :
- A lot of people don’t show up on the second date
In our study of 499 people belonging to 3 different psychological / psychotherapy counseling services in 3 different cities in the Lazio Region, about 25% of them did not show up for the second appointment. This means that 1 out of 4 appointments is canceled by default. In practice, every 3 hours of counseling, one is lost. Or, in other words, out of 4 hours that can be allocated to 4 people, one in fact remains empty, while it could be exploited to see someone else (often the cancellation of the session is more a no show , i.e. the person has made an appointment but does not presents, without warning).
An operator trained in TSS sets up the first meeting in order to maximize its effectiveness. Eventually she asks the person if, in her opinion, that meeting was enough or if she wants a second date. As mentioned, many (40-60%) will answer that it is enough, and already in this way it can be understood how the waiting list is considerably reduced: in other words, in 40-60% of cases there will be no other sessions (with a improvement – and satisfaction – of the person maintained in the follow-ups).
In addition, the person making the second appointment is much more likely to show up, as they will have had the opportunity to assess already in the course of the first person that, in fact, they want further meetings.
- Resources are optimized
It is understandable how, from what has just been said, operators, for the same hours of work, can concentrate on more people or on more projects. Rather than having “dead hours” from missed appointments, they are more likely to see someone else, or devote those hours to other projects or tasks.
In particular, walk – in logic could make a big difference. For example, opening a window (as in the case of the ROCK, for example), in which people can show up without an appointment, knowing that they can immediately meet a psychologist, allows you to be more efficient.
In fact, this already happens with a specific service: the welcome interview. In many centers, the person comes without an appointment and is received for a welcome interview, which aims to collect the application, data and contacts, to be then called back by the operator to whom he will be entrusted or to be put in waiting list.
Integrating the principles of TSS at this stage becomes an additional resource. The welcome interview is effectively transformed into a consultation session and the data has shown us that about 1 in 2 people (40-60% mentioned above) will not ask for other visits, considering that they are satisfactory. Other people will be able to enter the traditional therapy process of multiple sessions.
- Multi-session therapy is made more effective and efficient
TSS does not replace a therapy of several sessions, if anything it supplements it, in the sense that the person is asked to choose her if he thinks he needs more meetings, or if he believes that that single session is sufficient – specifying that at any moment he can return. and make other meetings.
By setting the therapy in this way, each session can potentially be the last – the patient will decide. Indeed, TSS principles and practices conceive each meeting as complete in itself and the person can reach their goals faster. As I pointed out in the preface to the Italian translation of Capturing the moment (Cannistrà, 2018 – in print), a curation by Hoyt and Talmon on TSS, the psychologist can perform different functions for the person , who often does not need this to help him “Solve” the problem: it might be enough for you to have strategies to do it yourself, or a space for discussion, or emergency management, etc.
All things that, set up with the TSS perspective, can find space in a single session and do not require more meetings; assuming that, of course, the person decides.
- The operators have a common language and reduce burnout.
Some studies have shown that TSS, among other things, is also beneficial for operators. For example, it allows psychologists to have a shared language , which is fundamental in the face of a fragmentation of schools, orientations and theoretical paradigms.
Furthermore, the concrete and visible possibility on the spot to help people (given by the fact that they themselves say: “I believe that in this meeting we have achieved the goal we set ourselves, thank you”), increases the sense of competence and reduces distress and the consequent burn out related to missed appointments, “inexplicable” drop-outs, etc.
It also facilitates the work itself: working with a person seen immediately, or after a short time, can be much easier than working with someone seen weeks, months (or more than a year!) After they contacted the center about a problem. , which now, who knows what it has transformed into.
- People and the health system gain from it.
In addition to the advantages listed above, among the data reported in our book (and in the international books dedicated to TSS) there is evidence that people who find support in therapy (even if only for one session) reduce the use of other forms of medicalizations. In several writings by him, Hoyt reports that this can be lowered by up to 60%.
Nicola Piccinini, president of the Lazio Order of Psychologists, summarized a series of studies that show how psychological counseling allows huge savings in health care costs: there is even 20-30% savings in terms of health care costs. (Piccinini, 2017).
TSS courses last only two days. They don’t need more.
All over the world, major TSS “providers” run courses of this duration. It becomes very easy, therefore, to integrate it into your services. We, however, privilege a highly practical and experiential aspect of training, in such a way as to allow participants to immediately acquire the principles of TSS.
Continuous practice, of course, is what makes perfect (for this reason, in agreement with the clients, we provide for follow-up training courses ), but what we want to ensure, and which bring back the people trained with us, is that after two o’clock training days the participant immediately knows how to do a TSS. Indeed, more: he will have already applied a first complete TSS during the second day.
In just over a year, we trained the first 100 single session therapists. And we are already running out of places for the next workshop. Naturally, for the more complex healthcare structures, we provide on-site courses , both by going directly to us to train the operators of the structure, and by fitting the training on your specific needs.
One of these is and will increasingly be the reduction of waiting lists. And the solution seems to come from within.
Founder of the Italian Center
for Single Session Therapy
Adkronos (2018). Waiting lists and errors, 1 out of 3 Italians feels anger towards NHS
Affaritaliani.it (2017). The Region abandons dyslexic children: 18 months for a diagnosis of ASD
Cannistrà, F. (2018). Preface. In MF Hoyt & M. Talmon (ed.). Capturing the moment. Single session therapy and walk-in services. Rome: CISU.
Corrieredellasera.it (2016). Via Sabrata, waiting lists in psychotherapy
Linkiesta.it (2015) become a help group. Milan offers psychologists to those who cannot afford
them Notiziediprato.it (2014). Health, wants to schedule a psychological visit for his daughter: “Come on February 16, 2016”. And for an infiltration it takes 6 months to wait
Piccinini, N. (2017). Psychological intervention lowers health costs and produces economic, clinical and organizational benefits