How can Single Session Therapy be implemented in professional practice? Today we want to illustrate 2 ways to be able to integrate it into your professional practice, especially in private practice.
With this article we address all those professionals (psychologists, psychotherapists, psychiatrists, doctors, nurses, social workers, rehabilitation technicians, etc.) who see psychotherapy, or more generally in the helping relationship, a service aimed at the person and for this reason, they feel the constant need to do research, update themselves and come into contact with innovative practices in order to maximize the effectiveness of their intervention and respond in a targeted manner to changes and new requests from citizens.
A flexible approach
Single Session Therapy approach, as we’ve seen, arrived in Italy a few years late for many reason, but looking for the “causes” of a phenomenon not always leads us to find its solution, therefore today we prefer to find out how to approach this practice.
The SST, for those who have not yet familiarized with this concept, is a transversal method to different therapeutic approaches (for example: cognitive-behavioral, systemic-familial, strategic, solution-oriented, hypnotic or psychodynamic).Not only that, it can be applied in many ways (for example we have talked about “single session psychological counseling”) and different areas of intervention (public health contexts: hospitals, emergency contexts, private contexts).
It is an approach firmly based on the theory of change, that is, on the observation of how change occurs spontaneously in people’s lives (as well as in therapeutic contexts) and on the observation on how people have the resources to change. Its goal is to maximize the effectiveness of the intervention in each individual interview (to the point that in many situations the first session can be the one and only available intervention!).
Those who intend to approach SST, therefore, will be asking themselves many questions regarding its validity and effectiveness and above all how to integrate it into daily practice.
Integrating Single Session Therapy into Practice: 2 Examples
As we know, the theoretical study of an approach, although in-depth, cannot ignore its practical application and the only way to understand its real functioning is to use it.
Therefore, for professionals who have decided to make a change in their professional path, moved by the desire to improve their clinical work and begin to respond more adequately to new customer requests, welcoming SST means, first of all, making a radical change of own mindset and start swimming in the open sea of possibilities.
Seil away, however, does not necessarily mean letting yourself go to the mercy of the waves without maps, lifeboats and life jackets. More than anything else, it means experimenting, and, with an open view, find out how it feels!
For example, if you have recently started private practice or, on the contrary, you are a long-time professional, but you feel the need to shift yourdirection, this article may interest you.
SST as an alternative to the free interview
Anyone who, at the beginning of the profession, did not use a free session as a strategy to promote their work, cast the first stone! Not all, of course, but there are many psychologists who use the free interview and it has been seen that many people do not return after that first interview: why? And by what principles is the professional pushed to adopt this strategy?
Generally there are two beliefs (not supported by real scientific data!) at the basis of the choice to do a free session:
1- on the one hand, the idea of bringing people closer to psychotherapy, allowing them to choose and evaluate the professional’s skills
2- on the other hand, that of responding to the economic crisis by approaching the patient’s need not to feel trapped in a network from which a long and endless journey could begin.
But does this strategy work?
And, by logical deduction, what conclusions does it lead us to?
What we observe is that often the patient does not return, leaving no trace of the reasons that led him to this choice. This phenomenon called drop-out is often “interpreted” as the result of a “resistant patient”, of a “lack of motivation to change” or of a “borderline personality”, convincing ourselves of this reality.
What does data say?
Research conducted around the world over the past thirty years confirm that:
· 1 is the most frequent number of sessions done in psychotherapy, with an average ranging between 20 and 50% depending on the studies; and, where therapists are aware of making this choice, it can even reach 80% of cases (Hoyt & Talmon, 2014 – note: “the most frequent” means that it is more frequent than 2-session therapies, 3 , of those of 4 etc. It does not mean, however, that most of the therapies last one session, which anyone can ascertain is not true);
· 70-80% of people who choose a Single Session report having got exactly what they needed (Hoyt & Talmon, 2014; Bloom, 2001);
· on a scale of 1 (resolved or much better), to 5 (unchanged), the average rate of improvement is 1.5 (Talmon, 2012, 1990);
· the results are maintained in the follow-up for up to 8 years (Slive & Bobele, 2011).
Finally, in Italy we are conducting the same studies, arriving at the same conclusions: SST is an effective model, capable of responding to today’s needs of those seeking help relating to mental health.
So the fact that emerges is that often people do not return to the psychologist’s office simply because they are doing well.
And if these data were not enough, we can examine other research, unrelated to the SST, which have examined the phenomenon of drop-out, wondering why people stop treatment prematurely. The answer most frequently given by patients, often with surprisingly similar results, is always the same: “Because I was fine”. Even after just one session.
In fact, we know how much a single interview can have a strong restructuring power in itself and help the person to perceive reality and its problems in a different way. Some of the key ingredients to achieve this are:
· establish a good alliance
· work on clear and defined objectives
· identify and use patient resources
So why not use SST to maximize this power and have a full-fledged session, rather than a mere free “cognitive” interview?
The psychologist (and with him psychotherapists, psychiatrists and other similar figures) must know that in a single interview there is a good chance of giving the person exactly what they need to help them feel well. They also have to see that, most likely, those who do not return will not do so for economic reasons, because they did not feel comfortable with the clinician, or because “they are resistant”, but simply because in that one session the professional helped them enough – while not realizing it.
SST as a second opinion
How many colleagues will have met patients, came to their office discouraged towards a professional, after having faced a long therapeutic path without having obtained results and afraid of having to embark on endless therapy again?
Or worse still, to have met patients, unsure of the chosen path, who have decided to give up a second chance, in order not to face unsustainable costs again?
And how many times, even in these circumstances, have we relied on the belief that at the basis of this behavior there was a resistance to change by the patient and not a real need to overcome their problems with times and costs appropriate to their needs?
What does data say?
Again, in order not to fall into the trap of easy interpretation, we can refer to some interesting research that has investigated how people understand “self-care”. These researches highlight two general trends (PwC, 2015), the willingness of people to solve their problems (from difficulty to illness, from disorders to psychopathologies), and to want to do it quickly and at a low cost.
For example, according to PwC:
- more than half of people (54%) do not want to travel long distances to be treated (but they would do it to reach centers of excellence);
- over 2/3 (66%) are unwilling to engage in long-lasting care;
- more than 8 out of 10 people (81%) do not intend to sustain high economic figures to take care of themselves (but, even here, they would do so in centers of excellence).
What emerges is that, despite the economic crisis, people’s will to feel good has not diminished, but what has changed is the way in which the person tries to feel good. For example, do-it-yourself health care is rapidly increasing, also due to the unstoppable evolution of digital technologies (IBM, 2008; IlSole24Ore, 2012; PwC, 2015).
In this context, therefore, SST can also represent a valid tool to provide a second opinion and maximize the effectiveness of that session, helping the person to focus his resources, to find the key to deal with a blocked situation or simply to have a clearer view of yourself and your problems.
Give tailor-made help
We recall that the basis of SST is the idea that a change can also occur with a single session, if we start from the assumption that:
- in each session it is possible to identify the elements that maximize its effectiveness (good alliance, clear objectives, patient resources);
- (abilities, skills, competences) to change and solve the problem (resource-based approach), facilitating the therapist’s work and the speed of therapy, as well as overcoming resistance;
- : this leads to reconsidering the role of the therapist, now seen as a “guide”, who must lead the patient out of a dangerous situation, as a “facilitator”, and help him to unlock and initiate change which will lead him to the autonomous big problems do not need big solutions resolution of the problem.
Yet the purpose of SST is quite another: to maximize the effectiveness of each session, whether it is the last one, the reception one, a second opinion, or more.
Angelica Giannetti
Psychologist, Psychoterapist
Trainer dell’Italian Center
for Single Session Therapy
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