Over 60% of people who need psychological counseling, or psychotherapy, do not require it. (Andrews, Issakidis, & Carter, 2001).
It means that 2 out of 3 people live in a silent and hidden hurt, that we don’t know, so much that “they prefer to get by themselves” (Andrews, Issakidis, & Carter, 2001). And even if “costs” are important, it is the social and vocational factors that influence this choice the most.
In other words, it is above all the idea of taking “long and tiring” paths that stops most people from choosing a psychological, psychotherapeutic or psychiatric path.
Let’s try to understand why and how to deal with the problem.
In Europe the data are almost the same as found by Andrews in the United States (ESEMed, 2004), and in the Italian context the situation is similar, if not worse: in some researches only 22.3% of the sample with mental health problems referred to a specialist (Fiori Nastro et al., 2013).
For example, some data from the recent ENPAP (Italian National Institution of Insurance and assistance for psycologists) (2015) showed that psychologists are perceived as a “discomfort specialist”, the “last resort to resort to” and, an Italian data in contradiction with the study by Andrew and collaborators, too expensive. Italians who think they has to do 40, 20 or even just 10 sessions with the psych-, make first an estimate of the costs.
More recently, the ENPAP (2016) asked to a representative sample of the Italian population how it would behave, in a difficult time, to achieve a condition of emotional well-being.
More than 80% would turn to their family.
Furthermore, 61% would ask for help from friends and 60% would do it themselves. While it is true that 66% argue that they would turn to a professional, this declaration of intent is not sufficient to demonstrate its effective implementation. It would be necessary to investigate how many people have suffered from psychological problems in a given period of time and how many of them have actually turned to a professional.
It is not a criticism of the ENPAP which, on the contrary, has done a commendable job, opening important prospects. In 2015, ENPAP also showed that one of the perceived limits of psychological counseling is the length of service: the idea that a path must necessarily last several months discourages many people.
Attention, not years, months. Obviously the idea that it should last for years is even more discouraging, but the thought of having to stay 2, 4, 6 months in therapy already prevents most people from contacting a psychotherapist.
“I’m not sick, I want to be well”: psychological counseling
A whole series of problems, difficulties, hardships can be faced and overcome in a short time. Even in one session. And, above all, these problems are often part of psychological counseling: the “Counseling Psychology” of the American Psychological Association to which the institution has dedicated the 17th Division.
It is now known that the demand for “well-being” is an increasing trend: we ask more to “feel good” than to “stop feeling bad”. Probably not because people are less ill than before (in fact the psychological well-being worsened, ISTAT, 2015), but because they are increasingly interested in taking care of themselves, so much so that 85% of Italians have sought at least one turn online information for your well-being (Docplanner.it, 2016).
Conflicting data: the desire to feel good increases, but most people do not turn to a professional.
On the other hand, in the “everything & now” society, why should I choose a long, expensive and difficult to access wellness path?
I need something immediate, practical and effective, and there are several possibilities out there that fit this request.
It is not a issue of “educating people about how psychotherapy works”.
After all, short therapies have been a consolidated reality for decades (Hoyt, 2009) and Single Session Therapy is their natural evolution.
If we said “You have to adapt to this way of doing things”, it would be about the needs of the therapists. Instead it is an issue of people’s needs.
For example, one of the reasons for the use of SST by many institutions was the opportunity to reduce waiting lists, which usually can range from a few days to a year (Weir et al., 2008).
Attention, as already mentioned, SST is also effective in more serious cases, which go beyond psychological counseling.
If someone in the middle of the sea yells at us “Give me a life jacket!”, it makes no sense to insist on teaching him how to swim. At best, the person will turn to someone else.
In the next hypothesis, that “someone else” will not have the same skills as us in helping him. And, in the worst case, the person will drown without us having done what we could: throw him a life jacket.
There are many disorders that can be faced and resolved in one session. But actually this sentence is not correct.
It would be better to say, that there are a lot of people who can be helped in one session.
In fact, it doesn’t depend so much on what they have, but on who they are and what they need.
Single Session Therapy according to a Personal Wellbeing Perspective.
SST can be used in different contexts and for different problems.
Among these, in addition to those situations in which the problem is (inadequately) called “psychiatric”, there are all those in which we are faced with a situation of distress, but not “deep”.We would say “mild”, according to the categorizations of the DSM. Furthermore we could refer to all those situations that do not strictly concern “psychotherapy”, but rather “psychological counseling”.
This is not new, so much so that several authors use term as Single Session Work (Young et al., 2012), and in general we could talk about interviews, activities, interventions or more generally Single Session Counseling. We are talking about providing help, assistance, counseling, as well as therapy, in a whole series of problems that fall within that submerged we mentioned at the beginning, that 60% of people who have a problem, but do not tell (to the professional).
Changing the vision of psychotherapy
Changing vision is the hardest thing, but it’s not a new process.
For example, for some time now several authors have preferred to speak of “therapy” rather than “psychotherapy”, consciously changing their perspective according to a new vision of the care of people: no longer a strictly “psycho” intervention, but a holistic approach, which takes into account different areas, systems and dimensions of human life (for example the developments of psychoneuroimmunoendocrinology – Bottacioli, 2005 -, or the more recent medical family therapy – McDaniel et al., 2014).
You can’t change the way clients see therapy, until it changes the way therapists see therapy.
And the change cannot only be in the nature of contents: therapists have to shape up themself, to let change the way in which people access, think and also require the care.
Already Nicholas Cummings (et al., 1995) was among the first to speak of intermittent therapy, or therapy along the life cycle, where the person turns to a therapist in times of need and every time for that specific need, which it can (and must) be fixed in a short time. Even in a single session. This is why approaches such as SST find themselves responding easily to the challenges and demands of the modern world.
These are concepts that should be part of therapists’ language and vocabulary, having been introduced for several decades; and that actually they are even older, considering that they were supported several times by most of the experts in short therapies – and not only.
On the other hand, as a Chinese proverb claimed:
“The best time to plant a tree was twenty years ago. The second best time is to do it now ”.
Founder dell’Italian Center
for Single Session Therapy
Andrews, G., Issakidis, C. & Carter, G. (2001). Shortfall in mental health service utilisation. British Journal of Psychiatry, 179, 417-25.
Bottaccioli, F. (2005). Psiconeuroendocrinoimmunologia. Milano: Red.
Cummings, N.A. & Sayama, M. (1995). Focused Psychotherapy: A Casebook of Brief, Intermittent Psychotherapy Throughout the Life Cycle. New York: Brunner/Mazel.
Docplanner.it (2016). Tecnologia e salute: dati e trend. (online).
ENPAP. (2015). Posizionamento e promozione della figura dello psicologo. (online).
ESEMeD. (2004). Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scadinavica Supplementum, (420), 21-7. DOI: 10.1111/j.1600-0047.2004.00327.x.
Fiori Nastro, P., Armando, M., Righetti, V., Saba, R., Dario, C., Carnevali, R., Birchwood,
M., Girardi, P. (2013). Disagio mentale in un campione comunitario di giovani adulti: l’help-seeking in un modello generalista di salute mentale. Rivista di psichiatria, 48(1), 60-66.
McDaniel, S.H., Doherty, W.J. & Hepworth, J. (2014). Medical Family Therapy and Integrated Care (2th ed.). Washington, DC: American Psychological Association.
Hoyt, M.F. (2009). Brief Psychoterapies. Principles & Practices. Phoenix, AZ: Zeig, Tucker & Teisen (Tr. it. Psicoterapie brevi. Principi e pratiche. Roma: CISU, 2016).
ISTAT. (2015). Rapporto Bes 2015: il benessere equo e sostenibile in Italia. (online).
Young, J., Weir, S. & Rycroft, S. (2012). Implementing Single Session Therapy. Australian and New Zealand Journal of Family Therapy, 33, 1, 84-97. DOI: 10.1017/aft.2012.8
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.