The aim of today’s article is to present the application of Single Session Therapy (SST) in particularly complex situations.
This article describes a clinical case drawn from the literature, developed by psychologist Patricia A. Boyhan to illustrate the key steps of the Single Session Therapy approach in complex clinical settings.
Having trained in the 1990s in the Single Session Therapy method at the Bouverie Centre (then known as the Bouverie Family Therapy Centre) in Melbourne, the author incorporated this approach into her clinical practice, finding it highly beneficial in terms of both effectiveness and efficiency.
The case, conducted at CatholicCare, a counselling and psychological support service for families in Sydney, Australia, uses pseudonyms and intentionally altered identifying details to protect the clients’ privacy.
Clinical Case: Lucy, a Rebellious Adolescent
Request for Help and Definition of the Presenting Problem
Josephine and Tom, parents of two adolescents, Josh (18) and Lucy (12), contacted CatholicCare because they were concerned about their daughter Lucy. Two years earlier, they had attended the service for their son Josh (then 16), who had been using substances. Josh had been referred to a specialist youth service for substance and alcohol misuse, while Josephine, Tom, Josh, and Lucy participated in family therapy at CatholicCare. The outcome had been positive: Josh returned to school and reconnected with a previous group of friends who did not use drugs.
When they returned to the service, Josephine and Tom described a deeply worrying situation during the intake session. While Josh continued to do well, Lucy had become increasingly rebellious and oppositional. She appeared to be successful at school and maintained good relationships there, but at home, according to her parents, “she was a nightmare.” She would stay out all night, climb out of her bedroom window, and go to nightclubs with a group of older friends. Her parents feared she might follow the same path as her brother and become involved with drugs, or even be assaulted or abducted.
Defining the Current Problem and Previous Attempts to Address It
Although Lucy was only 12 years old, she looked much older and dressed accordingly. For this reason, her parents had contacted the school counsellor. However, after attending only a couple of sessions, Lucy refused to continue.
She also insisted that she would not return to CatholicCare, arguing that she was perfectly fine and that her parents needed to stop being overprotective and allow her to enjoy her life.
Exploring Family History and Parenting Styles
After discussing the current situation with the parents and sharing information about parental responsibilities, child-rearing, possible triggers for Lucy’s behavioural changes, and the parenting strategies they had already tried, identifying what had and had not worked, the therapist explored their parenting styles and aspects of their families of origin. The aim was to understand the experiences that had shaped their attitudes toward parenting and family life.
Josephine explained that she had been born in India and sent to boarding school as a child. She had always wanted to provide her own children with a happier childhood than the one she had experienced. At the same time, she acknowledged having set very high standards because she wanted them to succeed academically. She also expected both children to contribute to household chores.
Tom, who was several years older than Josephine, also reported having experienced difficulties while growing up, although he described himself as somewhat more relaxed in his parenting approach. Nevertheless, he had always tried to support Josephine by avoiding disagreements about parenting in front of the children. Both parents explained that they had encouraged Josh and Lucy to invite friends over and that their home had become something of a gathering place for local young people.
Reframing the Request for Help and Introducing Single Session Therapy
After exploring the parents’ history, the therapist suggested offering Lucy a Single Session Therapy appointment before considering a longer course of therapy. Having explained the principles of SST, she obtained the parents’ permission to write to Lucy, inviting her to attend a single therapy session and asking her to complete a questionnaire beforehand.
The therapist also prepared the parents for the session by explaining that her primary objective would be to give Lucy the opportunity to tell her story according to her own “map of the world.” She therefore asked them not to react defensively, not to feel judged, and not to defend their position in front of Lucy. The purpose was to give Lucy a genuine voice without becoming overly focused on establishing the “truth.”
She reassured the parents that she would not allow Lucy to become verbally abusive or destructive, while hoping they could tolerate a certain amount of emotional acting out. Tom and Josephine understood and accepted these conditions.
Beginning the Single Session Therapy
About a week later, the therapist learned that Lucy had agreed to attend the SST session, requesting that only her father be present. She also explained that she had discussed this decision with both parents, who agreed.
When Tom and Lucy arrived, the therapist was initially taken aback by Lucy’s appearance. She was extremely tall, physically mature, and looked around nineteen years old. The therapist immediately understood why her parents were so anxious about the dangerous situations to which she was exposing herself. However, once they entered the counselling room and Lucy began speaking, it became clear that emotionally and developmentally she functioned very much like a typical twelve-year-old.
The session began with the questionnaire and continued with Lucy describing how old-fashioned her parents were, complaining that they never allowed her to have fun or enjoy life despite the fact that she was doing well at school. She insisted she was the “only” person among her friends whose parents held such outdated views and declared that she would not let them “ruin her life.”
She spoke about the difficulties her brother had experienced and said she had learned from his mistakes. She insisted she would never use drugs and believed she was perfectly capable of keeping herself safe when she went out. She also explained that when she stayed out late, she preferred spending time with her friends because she did not want to return home and be nagged by her parents.
After taking time to understand Lucy’s worldview, the therapist encouraged her to talk about the positive aspects of her life, even though she believed her parents were overprotective. Lucy acknowledged several positives, especially the fact that her parents welcomed her friends into their home. She commented that some of her friends thought her parents were “amazing—but they don’t have to live with them.”
The therapist then explored what Lucy thought might be reasonable expectations for a twelve-year-old and what boundaries she herself considered appropriate for someone her age.
This intervention did not go well, as Lucy quickly returned to her confrontational position. At this stage, the therapist felt powerless.
Throughout the session, Tom had remained calm and composed. He had not attempted to defend himself but instead reflected on his daughter’s growing need for independence. Then, quite unexpectedly, he became proactive.
He told Lucy that he wanted to share a family secret he had kept hidden for many years. Josephine knew about it, but neither Josh nor Lucy had ever been told.
Tom explained that he had married very young and had a daughter from that marriage. He had gone through a very painful divorce, and his former wife had prevented him from having any contact with his daughter. This had caused him immense suffering because he had desperately wanted to be part of her life.
He told Lucy that because he had already lost one daughter, she was incredibly precious to him. He lived with the constant fear of losing her as well and therefore felt compelled to do everything within his power to keep her safe and protect her.
At that moment, both Lucy and Tom burst into tears.
Feedback and Closing the Session
For both Tom and Lucy, reaching such emotional depth in a single session was remarkable.
Once they had regained their composure, the therapist asked them what they thought should happen next. After acknowledging what they had accomplished during the session, she outlined the available SST options: they could leave and try implementing what had emerged during the session, followed by a telephone follow-up approximately four weeks later, or they could schedule another Single Session Therapy appointment.
Lucy replied that she needed time to process the implications of discovering she had a half-sister but that she would like to return to counselling with both of her parents. A second appointment was therefore arranged.
Follow-Up
During the follow-up phone call, Tom explained that the SST session had given him the opportunity to tell Lucy about her half-sister with the support of a professional present in the room. He felt he had taken a significant risk and was extremely pleased with the outcome.
Following the session, he and Josephine held a family meeting during which they also told Josh about his half-sister.
The family attended several additional sessions and reached agreements regarding appropriate boundaries for Lucy. Although she remained lively and energetic, she was no longer provocative or oppositional.
At the final session, the therapist reiterated the service’s “open-door policy,” ensuring that the family understood they could contact her at any time in the future for a telephone consultation or to arrange another appointment.
Conclusion
This illustrative case highlights how Single Session Therapy can capture those moments when clients are genuinely ready for change, demonstrating that therapeutic depth does not necessarily depend on the length or frequency of counselling.
In this case, SST proved to be an effective way to engage a highly reluctant adolescent while also serving as a powerful catalyst for sharing painful family experiences within the family system.
Angelica Giannetti
Psychologist, Psychotherapist
Italian Center for Single Session Therapy Team
References
Cannistrà , F., & Piccirilli, F. (2018). Terapia a Seduta Singola: Principi e pratiche. Giunti Editore.
Boyhan P.A. (2014). Innovative Uses for Single Session Therapy:Two Case Studies in Hoyt, M.F., & Talmon, M. (A cura di). Capturing the Moment: Single Session Therapy and Walk-In Services. Crown House Pub.
Talmon, M. (1990). Terapia a seduta singola: massimizzare l’effetto del primo (e spesso unico) incontro terapeutico. Jossey-Bass