Single-Session Therapy: Therapy Now

"If personal change only occurred after lengthy therapy, then SST would not exist.…personal change can occur as a result of a brief, and even a very brief, exposure to what other people offer us" (Dryden, 2019).

Therapy services around the world are under pressure. Although health care systems and the structure of counseling and psychotherapy referrals vary from country to country, therapy services in general have continued to grow year by year globally. Typically, the expectation of the average service user is that utilization begins with an assessment, followed by speaking with a therapist on a short-, medium-, or long-term basis. Generally, a wait time is also expected between first contact and the first session. Beyond this, however, service users and participants may expect to be furnished with a series or set of sessions, which comprise the referral.

Many free (and paid) counseling and psychotherapy services face overwhelming demand in climates where resources are scarce and staffing levels are low. Referral times for these services can vary wildly, with some being a matter of days and many more being a matter of months from the initial conversation with the service user. Needless to say, dropout rates can be high. Though time since initial contact may be a factor in this, therein lies a deeper question: Are service users needing referrals months down the line from their initial conversation? If the landscape changes significantly enough for some service users that referrals become unnecessary, then perhaps a viable question at the initial inquiry could be, "What do you need right now?"

The Power of Now

In name, single-session therapy (SST) appears to be the antithesis to the classical expectation of receiving several sessions of counseling over a period of time (e.g. six sessions over six weeks). Indeed, you may be forgiven for thinking that SST encompasses a one-session-fix-all mindset by looking no deeper than its name only. The reality, though, is quite different in that SST concerns the here and now. For participants, and for providers and practitioners, it is important that there is an understanding that a single therapeutic meeting will be taking place—whether or not this is arranged or within the structure of a walk-in setting. Understanding grows intentionality, and in this sense, it is possible to create a structure—where appropriate—for a single session of therapeutic help.

The Power of Collaboration

Hand in hand with a solution-focused approach, goal setting in SST work is a cornerstone of the potential success of the therapeutic endeavor. Collaboration is key. This means that both the therapist and the participant or the client must work together to develop a definition of the work's purpose. As with any goal-setting pursuit (especially a solution-focused one), questions are important to foster a focus on the SST in action. "What is it that we need to do together today? What do you need from this time we have together now?" A truly collaborative approach to participant goals is therefore essential. When therapists let the client lead, they can glean information that they can use to help harness the power of now. Some examples of this might be as follows:

• "I don't know what I need." (I need help to figure out what I need/what's next.)
• "I've seen therapists and physicians, and they didn't understand." (I need to be heard/listened to.)
• "I'm uncertain about my future and don't know what to do." (I need this reflective space and to perhaps formulate a next-steps plan for myself.)
• "I can't get my head around what happened, and it's keeping me awake." (I need to tell you my story.)

Once a goal has been heard and established, contextualizing the participant's presenting problem brings you both together to the given moment. Simply put, why now? Often, things have come to a head. A challenging relationship situation has escalated to a breakup or a walk-out. A boss has let someone go. A change of medication has taken place that morning, casting doubt over a recovery time. Contextualizing the problem facilitates a collaborative approach, in which the work of the SST goes no further than it needs to or no further than participants are seeking at that time.

The Power of Empowerment

Beyond collaboration, empowerment awaits. If both parties bring a mindset to SST work that encompasses (a) a here-and-now attitude, (b) a readiness and a willingness to engage, and (c) a commitment to finding and defining goals for the work, then supporting participants' autonomy becomes a key component of confidence building in the SST process. In line with a solution-focused outlook, SST caters to a strengths-based perspective. With an SST mindset, the client and the therapist come together with the knowledge that an SST will take place. A collaborative process then ensues with the expectation of forward motion thereafter. The willingness and readiness of the client and the therapist may be the most important vehicle for this process to take place.

Employee assistance programs (EAPs) around the world offer assessment and consultation in the here and now, as well as referrals to (usually) brief-therapy and signposting—for example, if longer-term or transitional support is needed. Typically, an initial conversation is held over the telephone or in cyberspace (via IM, email, or video chat) with service participants directly. Inbound telephonic work and outreach from participants initiates the utilization of an employee benefit that many first-time participants did not know that they had before. In many cases, life events and life situations can be the trigger or catalyst for contact.

EAPs often include large clinical teams employing therapists from varying backgrounds and trainings. While supporting participants in their initial contact is always a best practice, harnessing an SST mindset encourages a therapy now way of working. Whether everyone knows it or not, what EAPs offer resembles a walk-in situation in telephonic and digital spaces. Participants will often see their doctor or physician and be met with waiting lists of up to one year for free services. Many times, this is on the back of challenging life events and difficulties. Also, during the wait time, things change, and the referral may no longer be needed. Participants can be left without support and disappointed.

Therapy now means having time and space from the moment the initial outreach and providing intervention at the point of need. There is no singular way to commence an SST session. But with dedication to holding the virtual so-called therapy room, change can begin by simply asking, "Can you tell me a bit about your story, and what's brought you to us today?"

References/Sources

Dryden, W. (2017). Single-session integrated CBT. London: Routledge.

Dryden, W. (2019). Single-session therapy. London: Routledge.

Dryden, W. (2020, May). Providing help at the point of need: Insights from single-session therapy. University and College Counselling, 8(2), 28–32. Retrieved July 16, 2021, from https://www.bacp.co.uk/bacp-journals/university-and-college-counselling/may-2020/providing-help-at-the-point-of-need

Dryden, W. (2020, December 10). Creating and maintaining a focus in single-session therapy [Blog post]. Retrieved July 16, 2021, from https://www.windydryden.com/post/creating-and-maintaining-a-focus-in-single-session-therapy

Dryden, W. (2020, December 18). What is single-session therapy? [Blog post]. Retrieved July 16, 2021, from https://www.windydryden.com/post/what-is-single-session-therapy

Jenkins, P. (2020, November). Single-session formulation: An alternative to the waiting list. University and College Counselling, 8(4). Retrieved July 16, 2021, from https://www.bacp.co.uk/bacp-journals/university-and-college-counselling/november-2020/single-session-formulation

Slive, A., McElheran, N., & Lawson, A. (2008). How brief does it get? Walk-in single-session therapy. Journal of Systemic Therapies, 27(4), 5–22. doi: 10.1521/jsyt.2008.27.4.5