With today ‘s article we will talk about the fundamentals of Single Session Therapy , but we will do so starting from the description of a clinical case in which TSS was applied within a Walk-in service of the Eastside Family Center located in Calgary (Canada).
A few weeks ago we had already addressed the issue of the Single Session/Walk-in and how this method of intervention is used effectively within these mental health services (Slive, McElheran, Lawson, 2008) .
Today, however, we will focus on the foundations that characterize it and guide its practice .
The story of Jane and her daughter Lisa
Jane and her daughter Lisa came to the Center two days after the girl had taken an overdose of medication. The hospital ER had sent them to the Eastside to make sure Lisa could be helped and that a safety program was in place . While she was in her therapy session, it quickly became apparent that there were several problems in the family: Jane was a single mother of seven children. The woman worked in the evenings and could not always be available for her children when they needed them.
13-year-old Lisa had been in a relationship with an older man, with whom she became pregnant and miscarried without her mother’s knowledge. Lisa said her classmates made cruel comments on the Internet after finding out about her miscarriage. Additionally, she said she had had recurring thoughts for several years that had now returned, affecting her ability to concentrate on them. To manage her day, Lisa had begun to cut herself with the intention of regaining self-control.
The therapist began the session by asking Lisa if she could relate why she and her mother had decided to go to the walk-in counseling center rather than go to school that day. Lisa began by saying that her mother was worried that she was cutting herself. When asked if she could talk about the cuts, Lisa started talking about the miscarriage, the problems she was experiencing with her peers, and her perception that she was not interesting enough to others as they showed little interest in her problems. her.
At that point the mother intervened in dismay. The woman stated that as much as she tried to tell Lisa how much she worried about her and how much she only wanted the best for her, Lisa didn’t seem to believe it. When the therapist asked Jane how she could communicate to Lisa what she was feeling, she Jane said that she probably couldn’t do that since she wouldn’t be home much in those days.
The decision to go to the Center for a walk-in session was therefore dictated by her mother’s fear that Lisa might commit suicide, especially if she didn’t find someone to talk to immediately. According to Jane, she and Lisa had seen many professionals over the past few days, but none of them had seemed interested in their story or Lisa’s problem.
After consultation with the team, the therapist complimented the mother for taking her daughter’s suicide attempt seriously and for being determined to seek counseling. The therapist indicated the need for a psychiatric consultation due to the presence of the recurring thoughts described by Lisa and the recent self-harming behaviors. Knowing that Jane’s primary concern was her child’s safety, the team and family worked together to devise a plan security for Lisa. The plan was that the mother could talk to someone by phone in times of crisis and that she could call the hospital emergency room if self-harm or suicide occurred. The team asked Lisa to consider using a “touchstone” that she could keep in her pocket and touch when she felt upset and unable to concentrate. At that point she could have called one of the crisis management telephone numbers and explored her current feelings about her. Jane and Lisa were urged to return to the Center if any of the strategies used failed to address their needs in a timely manner.
The following week they returned for another walk-in session, stating that they needed more discussion. When asked what had happened again since they last went to the Eastside, Lisa said her thoughts and self-harm behaviors had significantly reduced. Instead, Jane stated that her anxiety about Lisa had increased significantly. When she was asked what she was triggering her increased anxiety, she stated that she was listened to by therapists who took her seriously. This was seen as a very positive statement as the team were initially impressed as they regarded Jane as a “devaluing” mother. Now she seemed to be a mother overwhelmed with responsibility and fear. Jane also appreciated the fact that Lisa had been listened to, as up to that point the girl had felt unwelcomed.
After the team consultation, the therapist praised the work done by mother and daughter, endorsing Jane’s concern and highlighting the work they both needed to do to improve their relationship. During the second session, the team concluded that the family had moved from “visitor” status to “customer wanting to change” status (de Shazer, 1985; Slive, McElheran, & Lawson, 2001), given Lisa’s significant change with the elimination of risky behaviors and his mother’s awareness of the gap in their relationship. At the request of the family, the journey continued, but this opportunity was made easier thanks to the brief counseling service offered where the two women felt safe, listened to and respected.
This example illustrates many aspects of the Eastside Family Centre’s walk-in therapy and below we will look at the underpinnings of this service model .
The fundamentals of the TSS/WI model:
- The surgery only takes an hour
The therapist has little time to build the therapeutic alliance , therefore explorations of the past are excluded. Therapists who, for example, begin their sessions with a multigenerational inquiry through the genogram may, for reasons of time, rethink their usual approach. With clients presenting with more problems, however, the challenge may be greater as therapists need to hone their skills to negotiate an achievable focus in an hour. The questions that a therapist chooses to ask need to be carefully considered through a time-sensitive lens. One “innocent” question could lead to 20 minutes of conversation that isn’t helpful in helping clients choose what they want to get out of the session.
- Shrink the database
Fisch (1994) argues that the narrower the therapeutic conversation database, the shorter the therapy . Therapists who conduct walk-in therapy sessions manage the interview in a way that reduces conversation times. To achieve this they focus on the problem as it presents itself in the present, driving the discussion on current (rather than past) data with a particular interest in descriptive (rather than explanatory) data. For example, the therapist is concerned with who, what , when , how and with whom the behavior develops and not with the “underlying cause” or function of the problem. Set specific goals described in behavioral termsit allows the therapist and client to focus and structure the session efficiently .
- It is a complete therapy
The following statement by Ray & Keeney (1993): “all sessions aim to be a whole therapy” , while not specifically referring to TSS or Walk-in Therapy , captures the essence of how a whole therapy can be conceived walk-in session.
Such thinking helps to find a focus of therapy. If clients return for a subsequent session, that session will be treated as a new case.
- Common factors
Common factors influencing therapeutic change in TSS/Walk-in sessions include utilization of client resources and client system related to client motivation , hope for improvement, and continued seeking client feedback regarding this to the fit between the procedures used by the therapist (the model) and his ideas about what will work.
- Therapeutic influences are tempered by pragmatism
Consistent with what is expressed by postmodern thought, for a brief therapist no model is considered more correct than another. The primary interest is in what is most useful to that customer at that moment. This is essentially a pragmatic perspective (Amundson, 1996).
- The session is a consultation
It is preferable to think of the TSS/Walk-in as a consultation process in which the therapist offers ideas (many of which come directly from the client), while the client decides whether to accept, reject or put them on hold. Consultation helps therapists not to take responsibility for the change in the client’s place, but to create the context that allows the person to discover her resources and indicate how the therapist can be a guide for him.
The reported case illustrated how in Single Session/Walk-in Therapy it is necessary to establish a focus on the clients’ needs and to address the problems with appropriate interventions . The latter always start with positive feedback aimed at enhancing people’s resources , using their ideas , urging them to take small steps and concentrate on the immediate future .
Team Psychotherapist of the Italian Center
for Single Session Therapy
Amundson, J. (1996). Why pragmatics is probably enough for now. Family Process , 35, 473–486.
deShazer, S. (1985). Keys to solution in brief therapy . New York: Norton.
Fisch, R. (1994). Basic elements in the brief therapies. In MF Hoyt (Ed.), Constructive therapies 1. New York: Guilford.
Ray, W., & Keeney, B. (1993). Resource focused therapy . London: Karnac.
Slive, A., McElheran, N. & Lawson A. (2008). How Brief Does it get? Walk-in Single Session Therapy, Journal of Systemic Therapies , pp. 5–22.