Single Session Therapy. When less can be better?



What is it?


Single Session Therapy (SST) is an evidenced-based psychological process that has been practiced in various settings and has received growing awareness since the 1990s. It has become particularly relevant in recent times because community-facing mental health organisations have been pressed for resources and are overwhelmed with demand.


As Moshe Tolman - the founder of SST - said, “I tend to see SST more as a very realistic, practical, no bullshit, and down-to-earth form of therapy” (1990, p.32). The key elements of the SST offered by Lotus Creek Psychology to Adelaide Hills residents are as follows:


1) The SST is ninety minutes duration, which is nearly twice the time provided for sessions that are part of more intensive interventions.


2) The SST is goal-focused with a strong emphasis on defining what is essential for healing and then providing practical tools in an action plan, which leverage the resources already available to the client (Dryden, 2020).


3) The SST is designed to be a one-off, scheduled appointment. However, one-at-a-time sessions can become multiple sessions, as and when the client determines they need extra supports (Young & Dryden, 2019). SSTs are not a prescribed program, but a more flexible “see me when you need me” approach.


4) The SST is not for crisis psychology supports, which is offered by in-patient for services at hospitals. It is a private psychology service that can be delivered with very little wait time.


Will it work for you?


SST is not for everyone. Research shows that this format is effective for clients who have low to mid-range anxiety-related problems (Feldman & Dreher, 2012; Schleider & Weisz, 2018; Schleider, et al., 2020). Also, it assumes that the clients have a reasonable level of personal insight or that they already know what is best for themselves (Hoyt, et al., 2020).

Niamh O’Brien, Clinical Psychologist, at Lotus Creek Psychology believes it is her responsibility to help her clients find a strengths-based solution as quickly as possible. She said, “It goes against my principles to invite a client back for unnecessary repeat visits, when they have sufficient personal resources and family supports to reach their wellbeing goals themselves”.


SST has been tested with adolescents, college students and cancer survivors - all with encouraging results (Davidson, et al., 2018; Schleider & Weisz, 2018; Feldman & Dreher, 2012). Anecdotally, SST works well in Telehealth, possibly because some of our younger adult clients are familiar with technology and even prefer a video meeting format for its convenience and lack of intrusion in day-to-day life.


Clients respond to the “collaboration and transparency” on which SST relies (Young & Dryden, 2019, p.650). SST demystifies the psychology process and gives the client more responsibility for their healing process. Because there is an assumption that the client will take a pro-active involvement in their healing, Lotus Creek Psychology recommends that only adults engage in SST.


Does it cost more?


At Lotus Creek Psychology, SST is $100 more expensive than our standard therapy sessions but is more efficient in terms of overall cost-effectiveness. SSTs receive the full Medicare rebate of $129.55, when provided by a Clinical Psychologist, so the average gap fee is $170. A recently published survey by Lived Experience Australia reported that the largest proportion of consumers pay a gap fee of between $51-$200, with $176 as the average (Kaine & Lawn, 2021).


When less can be better?


As Niamh said, “Demand for developmentally informed, trauma-aware psychology services vastly outstrips supply and our waiting list is growing so rapidly that is becoming difficult to promise timely supports to those clients who would benefit from a quick intervention. We have been forced to innovative with our service delivery, in order that we can meet the needs of the community.” Many private practices would not thrive commercially by offering SST, but Niamh’s values are to offer timely and affordable services to local people. Niamh measures her success in this way. As Greg McKeown states, in his book 'Essentialism', less can be better (McKeown, 2020).


References


Davidson, J., Malloch, M., & Humphris, G. (2018). A single session intervention (the Mini AFTERc) for fear of cancer recurrence: a feasibility study. Psycho-oncology. https://bit.ly/3HHkO95


Dryden, W. (2020). Single‐session one‐at‐a‐time therapy: A personal approach. Australian and New Zealand Journal of Family Therapy, 41(3), 283-301. https://bit.ly/34OmMWR


Feldman, D., & Dreher, D. (2012). Can hope be changed in 90 minutes? Testing the efficacy of a single-session goal-pursuit intervention for college students. Journal of Happiness Studies, 13(4), 745-759. https://bit.ly/3GGhvxA


Hoyt, M., Young, J., & Rycroft, P. (2020). Single session thinking 2020. Australian and New Zealand Journal of Family Therapy, 41(3), 218-230. https://doi.org/10.1002/anzf.1427


Kaine, C. & Lawn, S. (2021) Consumer and carer experiences of psychologist services in Australia. Lived Experience Australia Ltd: Marden, South Australia.

https://bit.ly/3gAxhiZ


McKeown, G. (2020). Essentialism: The disciplined pursuit of less. Currency.


Schleider, J., Dobias, M., Sung, J. & Mullarkey, M. (2020). Future directions in single-session youth mental health interventions. Journal of Clinical Child & Adolescent Psychology, 49(2), 264-278, https://doi.org/10.1080/15374416.2019.1683852


Schleider, J., & Weisz, J. (2018). A single‐session growth mindset intervention for adolescent anxiety and depression: 9‐month outcomes of a randomized trial. Journal of Child Psychology and Psychiatry, 59(2), 160-170. https://bit.ly/3HH3HEi


Talmon, M. (1990). Single Session Therapy: Maximizing the Effect of the First (and Often Only) Therapeutic Encounter. San Francisco: Jossey-Bass.


Talmon, M. (1993). Single Session Solutions: A Guide to Practical, Effective, and Affordable Therapy. Reading, MA: Addison-Wesley.


Talmon, M. (2012). When less is more: Lessons from 25 years of attempting to maximize the effect of each (and often only) therapeutic encounter. Australian and New Zealand Journal of Family Therapy, 33(1), 6-14. https://bit.ly/3B5x1C9


Young, G. & Dryden, W. (2019) Single-session therapy – past and future: an interview. British Journal of Guidance & Counselling, 47(5), 645-654, https://bit.ly/3oBt4Ad

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