It is certainly no secret to anyone that it is in this historical-geographical context, that overall in the contemporary world, the need to think about the possibility of short therapies becomes more and more urgent.
The economic crisis that has hit Italy and the rest of the world, and more generally the set of crises that characterize the era in which we find ourselves, bring with them many consequences, on a small and even large scale, even front of the personal well-being of citizens (see the in-depth article in the article The future of psychotherapy: trends and prospects).
In this article, of particular interest to healthcare facilities, we try to give a brief glimpse on how and why TSS helps in reducing costs. In particular, we will focus on the problem of waiting lists, although in this first article we will only give a very quick overview.
The economic crisis as a health crisis
Given the limits of investments dedicated to public health, in all countries of the world, obviously including Italy, the centers and communities dedicated in various ways to mental health, as well as the vast public, private and affiliated organizations, often they face important limits of budget and human and professional resources. The resulting problems are of different nature: one above all, the inevitable lengthening of waiting lists, which in fact risks boycotting the effectiveness of even the best intervention.
It is easy to understand that neglected problems can become chronic or precipitate clinical situations that are much more burdensome both for the patient and for those who intervene to take care of them. Worse still, the person can be discouraged from trying to ask for help, aware of a system that responds in an inadequate way to his needs, especially when these are experienced as urgent and needing answers in a short time.
And this, as mentioned, is only one of the problems.
The alternative of Single Session Therapy in reducing waiting lists
A work set up according to the principles of TSS allows, alternatively, to obtain a series of otherwise inaccessible results, also in terms of economic expenditure:
- A timely intervention that takes care of the problem in real time before it falls, like a snowball that over the days, weeks, years, becomes a destructive avalanche that overwhelms the patient’s life, his wallet, and consequently the resources of the national health system. Consider that even before the systematic studies on TSS it was shown how single psychotherapy sessions helped to reduce the patient’s recourse to other medicalizations (Follette & Cummings, 1967).
- The possibility of directing the person more quickly to structures and resources present in the area dedicated to the problem presented, creating the conditions to be able to support the long waiting lists that entail, in a synergistic network work.
- The opportunity to welcome people who, out of shame or prejudices about psychotherapeutic intervention, feel scared at the idea of entering a psychological study, imagining that they have to spend years there and concluding that they are not so crazy that they really absolutely need it . Being able to do a single session allows you to review an often stale and unrealistic imaginary on the psychotherapeutic intervention, returning to the client his own competence on his own resources, and therefore also positively affecting the future attitude towards the next possible difficulties, increasing the sense of self-efficacy perceived, and therefore reducing the risk of relapses and additional healthcare costs.
- The interception of all those problems that simply escape the traditional and traditionally long health system, because a person can actually suffer from a problem which, however, is mild for the moment, and it is not worth bothering a long path … Often these situations wait in a corner but slowly they grow until they can no longer be ignored, and then it becomes necessary to face them, only that over time they have become more complex, serious and expensive. Other times these people contact health facilities, but the long waiting lists discourage them and lead them to cancel the appointment.
- Greater trust in the health system, and therefore a willingness to use it more precisely and less indiscriminately.
In addition, if the Single Session Therapy were implemented in a free entry system (walk-in service), missed sessions would naturally also be reduced, i.e. appointments in which the patient simply does not show up, without giving explanations. This leads to an aggravation of public spending which makes available resources of time and money for someone who does not actually use them, while others wait in line (Slive & Bobele, 2014).
Expected and unexpected positive effects
The reduction times shown by TSS are remarkable, as are their unexpected beneficial effects.
With the promise of discussing the topic in more detail later, with extensive references to the Italian context, it is enough for now to know that in one of the largest research conducted in this area, Weir et al. (2008) helped a few dozen health care facilities to implement TSS as a common practice. The waiting time was reduced by about a week in the structures that were already highly performing (or that had a low access flow), and in those with the longest waiting times it was possible to reduce them by even months!
To this were added a series of further beneficial effects which, as we have said, were decidedly positive, such as:
- improved perception of the structure by patients
- general improvement of the service, able to respond more quickly to needs
- improvement of the staff working climate, with a significant decrease in burnout
- improvement in the allocation of resources, thanks to a reduction in the no show of patients
As mentioned, this article is just an introductory glimpse. We hope, however, that it will give you an idea of the further potential of this way of doing therapy.
The Single Session Therapy is able on the one hand to help health facilities to reduce the load and respond more efficiently to the client’s needs, and on the other hand it allows the person to re-establish a healthy relationship with the health institution, thanks to a service that responds to their needs, which reduces obstacles and allows them to quickly solve their problems using what is most important to them: their resources (Talmon, 2014).
Tania Da Ros and Flavio Cannistrà
Trainer and Founder of the Italian Center
for Single Session Therapy
Follette, W. T. & Cummings, N. A. (1967). Psychiatric services and medical utilization in a prepaid health care setting. Medical Care, 5, 25-35.
Hoyt, M.F. & Talmon, M. (eds.) (2014). Capturing the Moment. Single Session Therapy and Walk-In Services. Bancyfelin, UK: Crown House.
Slive, A. & Bobele, M. (2014). One Session at a time: When you have a Whole Hour. In M.F. Hoyt & M. Talmon (eds.) (2014), op. cit., pp. 95-120.
Talmon, M. (2014). When less is more: Maximizing the effect of the first (and often only) therapeutic encounter. In M.F. Hoyt & M. Talmon, (eds.) (2014), op. cit., pp. 27-40.
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.