Single Session Therapy (SST) is a therapeutic practice that allows you to integrate other therapeutic approaches within it and with today ‘s article we will illustrate how this opportunity can also be extended to Emotion Focused Therapy (EFT) long-term approach .
Although there is not much research on it, psychologist Kristin M. Matthews (2018) in the article ” The Integration of Emotion-Focused Therapy Within Single-Session Therapy”, offers a study in which she demonstrates how EFT has some useful elements for carrying out the single session . The study also provides practical indications on the use of the model in therapy and on how some elements can lead, for example, to the development of a strong therapeutic alliance .
On what assumptions is the integration of the Single Session Therapy method based with other therapeutic approaches?
Most of the literature suggests that SST is a therapeutic method that allows for the integration of different therapeutic models, useful for responding to the different requests of clients in a single session (Paul & van Ommeren, 2013; Slive & Bobele, 2011). The therapeutic models integrated with TSS on which there are more studies in the literature are the brief therapeutic approaches such as Solution Centered Therapy (TBCS) ( click here ), Cognitive Behavioral Therapy (CBT) and Strategic Family Therapy (TSF)(Iveson, George & Ratner, 2014; Ollendick & Davis, 2013; O’Neill, 2012). The models just mentioned provide for the presence of some elements common to the TSS that facilitate their integration (Slive & Bobele, 2012).
What are these elements?
The common elements according to Slive & Bobele (2012) are:
- the definition of a specific work objective
- a focus on customer strengths and problem solutions
- the belief that change always happens
- the assumption that clients do not require many sessions for changes to occur
What happens when you want to integrate Single Session Therapy with some long-term therapy models?
Since SST occurs in a single session, it can be difficult, if not impossible, to ensure that every element of that model of therapy, whether short-term or long-term, is integrated into the session. Therefore the different models undergo restructuring with respect to their processes of change (McGuinty et al ., 2016).
What do the renovations involve?
The renovations involve the elimination of some therapeutic elements , keeping others more useful for the single session. For example, in TBCS and CBT interventions, the prescription of homework and subsequent progress check-ins are foreseen as fundamental elements for change (Trepper et al ., 2013). When these two models are integrated with TSS, consultants no longer have the ability to use them to track client progress, so they will have to adapt to the principles of SST, using other techniques more suited to achieve rapid change(McGuinty et al ., 2016).
What considerations does all this lead to?
In line with this thought, proponents of SST suggest that therapeutic change is attributed to several common factors (Slive & Bobele, 2012). These factors include: a strong therapeutic alliance , clients’ internal and external resources , and a therapeutic framework independent of the therapeutic model used (Duncan et al ., 2010).
Duncan et al. (2010) also argued that therapy success is not due to the unique characteristics of a therapeutic model , but rather to the commonalities that allow factors to arrive at a positive outcome. Consequently, counselors who practice TSS should use the treatment approaches that best suit clients and their understanding of change (Duncan et al ., 2010).
Are there other elements that are fundamental to achieving rapid therapeutic change?
Researches on emotional processing processes such as awareness , expression , regulation and transformation of emotions are helpful to client change (Auszra et al ., 2013; Dalgleish et al ., 2015). Some research, for example, has shown how emotional processing leads to the reduction of symptoms of depression (Auszra et al ., 2013; Kramer et al ., 2015).
Finally Kramer et al. (2015) through their study demonstrated how the integration of emotional processes in TSS favors the development of a strong therapeutic alliance . Starting from these data, Emotion Focused Therapy (EFT) could represent another valid model to integrate into TSS.
What is Emotion Focused Therapy?
Emotion Focused Therapy (EFT) is a model of therapy that emphasizes the importance of emotions and emotional processing in changing patterns of dysfunctional interactions with others (McGuinty et al. , 2016). EFT uses an integrative framework grounded in attachment theory , family systems theory , and experiential therapy (Wiebe & Johnson, 2016) that involves expressing emotions in a safe environment characterized by a strong therapeutic alliance (Greenberg , 2014).
How does Emotion Focused Therapy work?
EFT involves carrying out work in nine phases that include three moments of emotional processing (McGuinty et al ., 2016):
- in the first stage clients work to identify dysfunctional patterns impacting their relationship attachments, accessing their emotions and establishing a strong working alliance with the counselor;
- in the second phase the consultant helps clients to express their needs, desires and related emotions;
- in the third stage, clients develop new solutions to resolve problematic relationships and establish new emotional interaction patterns (McGuinty et al ., 2016).
How can SST be integrated with EFT?
Listed below are the elements of EFT that would allow for effective integration with SST:
- EFT as in TSS involves co-construction of the problem definition , exploration of problem beliefs to develop small work goals , and focus on change (Campbell, 2012; McGuinty et al. , 2016).
- EFT considers the therapeutic relationship as a predictor of emotional processing and affect regulation (Greenberg, 2014).
- In the initial phase of EFT counselors collect history of attachment relationships to assess trauma (Goldman, Watson & Greenberg, 2011). Due to the time constraints of the SST, it may not be possible to collect a complete history of past relationships, but a short story related to the problem presented (Campbell, 2012). During this step, counselors might encourage clients to access their emotions, using empathetic reflection or the stimulation of evocative responses (Goldman et al ., 2011).
- In some cases SST consultants may work with clients who are unable to identify specific emotions. The empowerment and expansion technique of EFT can help the client identify and accept those emotions (Taylor & Lewis, 2018). This technique encourages the person to experience unpleasant feelings by exploring the physiological and cognitive reactions that emerge (Taylor & Lewis, 2018). During its application it is important that the counselor takes care of the client’s non-verbal expressions, such as tone of voice and body language (Goldman, 2017).
- Enactment is another EFT technique that may be suitable for SST (Muntigl, Chubak & Angus, 2017) . The technique involves the use of two chairs, the consultant invites the client to sit on one chair and to imagine his critical self sitting on the other empty chair (Taylor & Lewis, 2018). At that particular moment the counselor will facilitate the discussion between the client and the critical self, encouraging the client to respond to himself with empathy and understanding. Subsequently, the client, by switching seats, will respond to himself as the significant other. The empty chair technique is used, for example, when the client experiences persistent negative emotions towards a significant other with whom he cannot express himself (Taylor & Lewis, 2018).
Single Session Therapy (SST) as argued by many scholars is a therapeutic practice that allows you to integrate other therapeutic approaches within it . While the application of SST with some brief therapy models has been extensively studied, in today’s article instead we wanted to deepen its use with the Emotion Focused Therapy (EFT) model, with respect to which some elements were examined common keys to SST such as: co-constructing the problem , exploring beliefs about the problem in order to develop small work goals and focus on problem modification(Campbell, 2012; McGuinty et al ., 2016). In addition, some EFT techniques have been highlighted that are well suited to performing a single counseling such as: empathic reflection , evocative response , empowerment and expansion , and enactment .
Team Psychotherapist of the Italian Center
for Single Session Therapy
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