In today’s article, we will present a study (Tan et al., 2023) conducted in China related to a theoretical but highly structured Single-Session Therapy (SST) protocol integrated with Solution-Focused Brief Therapy (SFBT) (de Shazer et al., 1986) to encourage medication adherence in cases of coronary artery disease medical interventions (Lin, 2015).
The aim is to learn about a specific way of using Single-Session Therapy in the medical field.
What need gave rise to the idea of applying Single-Session Therapy in medicine, particularly in coronary artery disease?
According to some research (Simon et al., 2021; Fuller et al., 2018), medication adherence in coronary artery disease is still unsatisfactory, with particularly adverse and costly consequences for the condition.
For this reason, the need arose to introduce psychological interventions to improve medication adherence among patients (Crawshaw et al., 2016; Xu et al., 2020; Fan et al., 2021).
In general, psychological interventions have been widely used for cardiovascular diseases, but less so for promoting medication adherence (Albus et al., 2019; Grace et al., 2022) due to their long duration, making the service less accessible (Feig et al., 2023, Yang et al., 2022; Torres-Robles et al., 2022). This created the need to structure alternative psychological interventions with brief and highly structured protocols to provide more choices in clinical practice.
What is the Single-Session SFBT intervention for medication adherence?
The Single-Session SFBT for medication adherence was structured by Chinese scholar Qitang Lin (Chinese Psychological Society, 2022). He provided a conceptualization of Single-Session SFBT with four steps, called in Chinese tiejin, xiwang, nengliang, and xiuxing, which respectively mean closure, hope, empowerment, change, and action.
How is this protocol applied? The Single-Session SFBT described here (Virani et al., 2023) is considered an individual conversation between the professional and the recipient. The professional can be a doctor, nurse, or pharmacist, and the recipient is mainly the patient or their relatives.
Lin’s Single-Session SFBT is divided into two parts: assessment and intervention.
During the assessment, after introducing themselves and obtaining the patient’s consent, it is necessary to review the post-discharge treatment plan to ensure that the patient is informed and comfortable with the therapeutic regimen. Next, medication adherence is assessed from the initial diagnosis to clarify any non-adherence through the use of a self-assessment scale or medical history. Finally, the Single-Session SFBT session is introduced (Hsu et al., 2013).
In the second part, a brief general health education is provided to help the patient understand the principles of coronary artery disease treatment, including medication adherence and maintaining a healthy lifestyle (e.g., quitting smoking, limiting alcohol consumption, maintaining a healthy lifestyle, bland diet, moderate physical activity). Finally, the Single-Session SFBT is introduced.
A brief description of the four steps of Lin’s Single-Session SFBT:
- Phase 1: Closure (focus on barriers to medication adherence). This phase uses techniques of not knowing, normalization, reframing, and positive empathy to capture the client’s emotions, aiming to address feelings before shifting perceptions.
- Phase 2: Hope (establish goals). Hope helps clients see changing and beautiful perspectives in their lives, set goals, and/or use the Miracle Question (de Shazer, 1988) to propose solutions.
- Phase 3: Empowerment (discover energy). Empowerment seeks the client’s resources and energy to address current problems, mainly through questions about exceptions, coping with internal resources, and relational questions for external resources.
- Phase 4: Change and Action. Finally, the client is encouraged to change behavior and/or act by giving compliments, building solutions, and discussing tasks.
Conclusion. In today’s article, we introduced another way of using Single-Session Therapy, this time in the medical field. The example of Lin’s Single-Session SFBT shows how integrating psychological techniques and highly structured protocols can support healthcare providers in clinical practice, enhance medical interventions, improve patients’ lives, and make the work of healthcare professionals easier.
Angelica Giannetti
Psychologist, Psychotherapist
Team of the Italian Center for Single Session Therapy
References
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