Single session therapy for couples: the Swedish experience

Single session therapy for couples: the Swedish experience

Is Single Session Therapy Effective with Couples?

With this question, we got in touch with Martin Söderquist, a Swedish psychologist who has been a member and director of the Couple Counseling Team in Malmö, Sweden for years, which offers Single Session Therapy services for couples.

In particular, their declination is very interesting, and has been called One Session at a Time, “One session at a time”.

This is a particular recent evolution of the Single Session, which while maintaining its constitutive characteristics (it is always TSS), from the point of view of the mindset aims to emphasize the idea of ​​intermittent therapy. In fact, the term emphasizes the possibility of requesting an appointment as often as desired, for the number of sessions deemed necessary by the client, until the client, by mutual agreement with the therapist, deems he has solved his problem.

Thus, each appointment is complete in itself, but can at the same time be part of a longer process. It is the difference that at the Italian Center we highlighted between the vertical process and the horizontal process of therapy: the first emphasizes each individual session, with a concrete goal to be achieved within its term; the second, on the other hand, underlines the traditional therapy process, consisting of a first session, followed by a second, a third, a fourth and so on.

The One Session at a Time process can provide for a horizontality, but it also has the verticality of the TSS within it. In Martin’s description, couples can come for a single session, or ask for other sessions as well – but these could be done with a different therapist.

This is a very interesting aspect of psychotherapy, because it can function as a paradigmatic turning point in the way we have conceived therapy and psychological counseling so far. So, we asked Martin to send us a description of his service and, after having translated it, we present it today exclusively to Italian psychologists.

 

One session at a time with couples: Swedish experiences by Martin Söderquist

The Eastside Family Center walk-in clinic (Calgary, Canada), Bouverie Family Center (Melbourne, Australia) and many other centers (Hoyt & Talmon, 2014) have 25 years of successful interventions with Walk-In Therapy and Therapy with Single Session.

In 2011 we started a pilot study to find out how effective Single Session could be with Swedish couples.

Today, in 2017, we call our service One Session at a Time: we know that the Single Session is suitable for couples and that it can be an effective help for many of them.

 

The Couple Counseling Team in Malmö, Sweden

The Couple Counseling Team is mandated by law to provide couples counseling to citizens of all communities that require it.
No registration is made and no data compilation is required.
There are 6 psychologists present and every year more than 1000 new couples are seen and training groups for couples conducted.
The intervention is short: 80% of couples do between 1 and 4 sessions; 30% have a single session.
Four psychologists (Martin Söderquist, Malena Cronholm-Nouicer, Lars Dannerup och Karin Wulff) work one day a week, through One at a Time sessions.

 

Background

Statistics showed that 30% of all couples who plan therapies with us take only one session. So we thought that offering a Single Session could make the job easier, both for couples and for psychologists, since both would know from the start that the session would be one. No planning is done and the focus is entirely on what can make a difference for the immediate future.

We started in 2011 with a pilot study and after two years the Single Session has become a regular service.

We have been asked a lot of questions and have had a hard time convincing others of the possibility of helping couples with severe relationship problems in a single encounter. We also had our doubts: the couples we see often have conflicts, different goals, and sometimes they are in strong conflict or in the process of separation.

Will we be able to get enough in one sitting?

 

The phases of the work

Analyzing the last few years we can see the following phases in our work:

First two years (2011-2013): from the pilot project to the regular service offer using the Talmon model (Talmon, 1990). Telephone interviews with 88 couples before the session and two months after.

Between 2013 and 2015: we stopped doing telephone interviews and we evaluate the session itself, asking couples to answer the questions of a questionnaire (Stress by problem and Confidence in handling problem) before and immediately after the meeting : the Eastside uses the first scale and the Bouverie uses the second (Hoyt & Talmon, 2014). This second phase included 127 single couple sessions and 239 traditional consultations. The latter filled the Stairs in their first session: when they planned the next appointment, they chose the option of having other meetings with the same psychologist.

Since 2016: We call our offer One Session at a Time. We think it’s a better description, to see couples when they need it and in a form they find suitable. In 2016 we saw 203 One at a Time couples. We use the same parameters as before.

 

One Session at a Time: description of the service

On our website we describe the One Session at a Time as follows:

Tuesday service: one session at a time.
The service offered with One Session at a Time is for those who want a session within a week. Call us on Monday or Tuesday morning at the special telephone number and schedule a session, or book it for next Tuesday.
Some sessions are with a psychologist, some are with a team. If you want another One Session at a Time you can call again on a Monday-Tuesday morning. However, you will likely meet another consultant.
One Session at a Time is the result of several years of experience and evaluations.

 

Couples plan One Session at a Time with different goals and expectations. After the session they can also choose between different options, which we can summarize below:

In our experience, couples have different reasons for scheduling one session at a time:

  • Couples who hope and believe that one session can be enough
  • Couples who wish each other to start changing their relationship
  • Couples who want to try couples counseling
  • Couples in which one of the partners is reluctant to consult and the other persuades him to try a session
  • Couples in acute crisis
  • Couples who prefer a short waiting list

Since the beginning of 2016 we have been offering one session at a time – within a week – for couples in relational emergency and acute crisis, and to give them the opportunity to have a meeting when they need it: they do not have to wait several weeks, and after the session they have different options to continue alone or to have other sessions in different forms.

It seems like a good service to offer to couples.

 

Discoveries and results

In recent years we have asked all couples to answer some questions about their problem and their expectations of the session. We also ask you to fill in the stairs seen above, before and immediately after the session.

We can thus compare three different groups:

127 Single Sessions (2013-2015)

239 traditional couple counseling (2013-2015)

239 One Session at A Time (2016 – early 2017)

All forms of therapy bring positive results. There is no difference in the ways in which couples define their problems and, with respect to the level of stress and confidence in managing the problem, only small differences emerge between the groups during the pre-session evaluations. Also in all three groups, couples who are going through a separation process show a reduced capacity for stress reduction and problem management.

The results of the One Session at a Time group are somewhat inferior to the Single Sessions group, probably because in the former, more couples are seen in acute crisis and in the separation phase (27% compared to 10% of all couples who ask for a appointment).

The longer waiting list for Single Sessions may have caused session cancellations. And in fact, we also see fewer canceled sessions for One at a Time couples (9%) than traditional counseling (25%).

 

The One Session at a Time process in a nutshell

In all therapeutic and counseling sessions there is a structure for the single session and for the consecutive ones. The structure of the session is very important to clarify since the single meeting represents the entire therapy. You must begin, deepen and end the session preferably by concluding it so that the couple knows how to continue.

Each session and each pair are unique in themselves. One Session at a Time is not a therapeutic model: it is a structure and a service offer. This is why it is not manual and is easy to integrate into many healthcare facilities.

In our experience, One Session at a Time sessions (which usually last 1 hour / 1 hour and a half) consist of three phases: Beginning, Deepening and Conclusion.

  1. In the first phase it is important to clarify the context, the main problem and the expectations that the partners have in the session. Often a common project / goal is found together to work on. Couples in separation and those in which there is violence from one of the two partners are often a great challenge to face and it is necessary to find out what to aim for as soon as possible: improve communication and intimacy, find ways to decrease conflicts and breaking negative patterns, or focusing on separation.
  2. In the next phase, the session continues with an in-depth study of what the partners want to achieve, the shared and divergent goals, what they are willing to do and what they can do in the immediate future. Based on the characteristics of the partners and the context, this part of the session is unique for each couple. The focus is on creating descriptions of what partners mean by “problem”, their expectations and desires, and what they can do immediately (tomorrow or next week) to get what they want as a couple.
  3. A successful conclusion is when the couple leaves the studio with the idea of ​​knowing what their path is and what they need to focus on. In our practice we often summarize what has emerged and congratulate them with suggestions on what to do (if they want to get ideas from us). We also have a lot of written material on communication, how to create good habits and love for each other, how to talk about separation to children, and much more.

 

Useful ideas and practices

The four of us who work with the Single Session and One at a Time have had some very interesting and exciting years. Despite our long experiences with couples counseling, family therapy and Solution Focused Brief Therapy, these two forms of therapy have kept us busy finding our way to work.

Let’s briefly summarize some of the ideas and practices we found useful:

 

How to start: go slow

  • Start small with a pilot project
  • Do a slow implementation. It is best to build everything carefully and have the support of the managers and the structure
  • Implement and adapt everything to the context

How to get started: be active

  • Make evaluations and follow up
  • Show the results: the results are more convincing than words
  • Write reports and articles
  • Organize seminars and conferences
  • Be transparent and open with what you do: “We like what we are doing and it seems to work”

 Mentality

  • Believe in the fact that “one session can be enough or a good start for the couple”
  • The session is led by the client: follow the couples from behind
  • Focus on the present moment and the immediate future: not on the “next session”
  • Lead the session your way – use the model you feel most comfortable with
  • Be curious about what works for the couple

 

Flavio Cannistrà and Veronica Torricelli

Psychologists, Psychotherapists

Founder and Member of the Italian Center

for Single Session Therapy

Bibliography

Hoyt, M.F., & Talmon, M. (Eds.) (2014) Capturing the moment. Single session therapy and walk-in services. Bethel, CT: Crown House Publishing.

Slive, A. & Bobele, M. (2011) When one hour is all you have. Effective therapy for walk-in clients. Phoenix, AZ: Zeig, Tucker & Theisen.

Söderquist, M. (under publication). Coincidence favors the prepared mind. Single Sessions with couples in Sweden. Chapter in Hoyt, M., Slive, A., Bobele, M., Young, J., Talmon, M. One at a time. Single Session Therapy by Walk-In or appointment.

Talmon, M. (1990) Single session therapy: Maximizing the effect of the first (and often only) therapeutic encounter. San Francisco: Jossey-Bass.

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Rosita Del Medico

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