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What is Single Session Therapy and Why it Works

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What is Single Session Therapy and Why it Works

Single session therapy, also known as brief therapy or one-shot deal therapy, refers to a therapeutic approach where clients only meet with their therapist for a single session.

Usually, it may seem counterintuitive that seeing a therapist only once could effectively address someone’s concerns. However, decades of research have shown that for certain issues and clients, a single therapy session can lead to meaningful change.

In this article, we’ll take a closer look at single session therapy – what it entails, the types of problems it works best for, how therapists structure these sessions for maximum impact, and the evidence supporting its effectiveness.

How Did Single Session Therapy Emerge?

The origin of single session therapy can be traced back to the 1970s when researchers and therapists started exploring new brief approaches to psychotherapy. One of the pioneers was the renowned family therapist and researcher Steve de Shazer and his colleagues at the Brief Family Therapy Center in Milwaukee.

De Shazer and his team were dissatisfied with the traditional long-term, open-ended model of therapy that often took months or years to resolve issues.

They wanted to develop techniques that could yield tangible results in a much shorter time frame. Through innovative thinking and experimentation, they formulated the foundation for what became known as solution-focused brief therapy (SFBT).

A core principle of SFBT is that clients are the experts of their own lives and already possess untapped resources and strengths to solve their problems. The therapist’s job is to help uncover these strengths and solutions through carefully crafted questions.

With this assumption in mind, de Shazer and his colleagues hypothesized that sometimes all it takes is a single session, if done skillfully, to help trigger positive change.

Initial research studies in the 1980s and 1990s by SFBT pioneers and other therapists surprisingly found single session therapy was as or more effective than multisession therapy for certain problems.

This sparked wider acceptance and testing of this model across different settings and client populations. Today, decades later, single session therapy has become a well-established approach supported by a sizable body of research literature.

What Types of Issues Respond Best to Single Session Therapy?

While no problem is definitively “ruled out” from single session therapy, research has identified certain characteristics of presenting issues that tend to fare better with this brief approach:

Well-defined, circumscribed concerns: Problems like a specific phobia, performance anxiety, low self-esteem related to public speaking, conflict with a family member, etc. that are concrete and focused in nature work best. Complex, multifaceted, and long-standing issues typically require more sessions.

Motivation to change: Clients who come in genuinely wanting to resolve their issue rather than just “check therapy off their to-do list” will get the most out of a single session. Their motivation helps power meaningful shifts forward.

Skilled use of social networks: For those who have supportive families, friends, spouse, or others they can turn to for help, one session may provide all the tools and encouragement needed to leverage existing relationships for change. Complex social problems usually benefit from more time.

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Life stage transitions: Common hurdles during big life changes like graduating college, starting a new job, moving, bereavement, etc. that naturally disrupt routines respond well to the reframing offered in a single session to aid adjustment. Recurring adjustment issues need ongoing support.

Situational crises: Acute problems born from a specific stressful event such as relationship conflicts, unemployment issues, legal troubles, and mild trauma or abuse cases where safety has been established can potentially resolve after exploring new perspectives or skills in a brief intervention. Chronic crises warrant longer term therapy.

In summary, focused problems with internal motivation to improve, access to a helpful network, or arising from a major life transition or crisis situation represent the “low-hanging fruits” best suited for single session therapy’s potential impact. More complex or deep-seated concerns typically demand a multi-session approach.

How is a Typical Single Session Structured?

Competent single session therapists draw upon their repertoire of evidence-based brief therapy models and customize techniques to each client’s unique situation. However, there is a common underlying structure and process to most single sessions.

Initial Assessment and Problem Exploration

The session begins with a thorough but time-efficient assessment to understand the presenting concern from the client’s perspective. Non-judgmental active listening and open-ended questions by the therapist allow the client space to fully explain their issue without interruption.

Key information gathered includes the history and duration of the problem, what precisely they wish to change, previous attempts at resolution, and strengths and support systems available to them. This exchange aims to operationalize the concern concretely for solution-finding.

Reframing and Instilling Hope

A core part of single session therapy is reframing how clients perceive and understand their issue. Explaining research showing even minor reframing can lead to significant benefits helps instill hope and motivation early.

The therapist might point out areas of resilience already demonstrated, external factors at play beyond their control, or alter unhelpful core beliefs about themselves or the possibility of change.

Developing a Solution-Focused Mindset

Posing solution-oriented, possibility-based questions shifts the focus from reasons for the problem to reasons for hope. Some examples include inquiring about past times the problem did not occur,

the smallest sign of progress noticed, advice they would offer a friend with a similar issue, or what their lives might look like once the problem is resolved. These solution-finding questions spark new insights.

Developing Concrete Action Steps

Having explored strengths and solutions, clients are supported in formulating specific, measurable, time-bound action steps tailored to their capabilities and context.

Examples include practicing a new skill with peers, communicating needs to a family member, making lifestyle adjustments, or scheduling fun distracting activities. The action plan aims to be neither too ambitious nor vague, focusing on attainable next right steps.

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Reinforcing and Building on Existing Resources

The therapist helps identify any existing internal or external resources that can aid their action plan. These may include personal qualities like perseverance, supportive friends, relaxing hobbies, spirituality practices, previous coping strategies, or public services. Affirming and leveraging these untapped resources is important to maximize their confidence and chances of success between sessions.

Scheduling Follow-Up Contact

While the goal is for clients to implement their action plan independently, follow-up contact is scheduled – whether by phone or future session – in case obstacles emerge or they wish to report back on progress.

The prospect of reconnecting with the therapist reinforces their commitment and accountability to the prescribed action steps. Progress is celebrated, while minor setbacks are reframed as opportunities to try new approaches versus signs of failure.

Post-Session Reflection and Evaluation

For quality assurance, the therapist reflects on each single session’s process and effectiveness to identify any areas for improvement. Was it optimally structured based on the model employed?

What feedback can be incorporated to refine their brief techniques? Did the goals align with the client’s needs and resources? Analysis of single session outcomes guides continuous refinement of skills for this specialized therapeutic approach.

Evidence Supporting Single Session Therapy’s Effectiveness

Over four decades of research have consistently shown that for the right issues and client types, single session therapy produces comparable or in some cases superior outcomes to longer term therapy options:

Meta-analyses find single session clients achieve approximately 65-70% symptomatic relief post-session, on par with four to six session therapy conclusions. Gains are usually maintained over follow up periods.

Randomized clinical trials report equal or better effectiveness rates for problems like specific phobias, health anxiety, domestic violence, substance abuse, ADHD, and depression treated briefly versus traditional long-term care.

Studies across countries and settings demonstrate single session therapy’s utility for student counseling centers, community mental health clinics, child services, court diversions programs, and emergency rooms.

Economically, it represents an impressive 20-30% savings on therapy costs compared to standard multi-session treatment, expanding access to care for large unmet needs.

Client satisfaction surveys repeatedly show the majority feel their issues were well addressed within a single meeting with experienced brief therapists and appreciate the expediency.

Brain science suggests brief reframing is enough to initiate whole network neural rewiring underpinning problem resolution and personal growth for some concerns.

In summary, a wealth of good quality empirical data analyzed across diverse populations establishes single session therapy as a proven clinical intervention for suitable problems, not just as a pragmatic cost-saving measure. With proper training, it represents a valuable treatment modality within any therapist’s toolbox.

Areas for Development and Future Research

While single session therapy has solid evidentiary support, some questions remain or aspects could be further optimized through additional research:

Outcome predictors: Identifying more objective pre-session client factors and therapist technique variables linked to successful outcomes may aid targeted application and resource allocation.

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Hybrid models: Exploring “brief plus” models blending a single introductory session with a few optional follow ups for extra accountability or problem complexity may increase effectiveness rates.

Client fit determinants: Precise guidelines on the ideal psychographic or clinical profile of clients most apt to benefit fully from a single encounter could help maximize appropriate referrals.

Cultural adaptions: Investigating cultural adaptations to assessment, reframing strategies and action planning for increasingly diverse populations may further broaden the reach and impact of single session interventions worldwide.

Long-term follow ups: Existing studies typically evaluate outcomes a few weeks or months post-session. Longer term follow ups of years later would provide robust evidence for any lingering impact or need for “tune ups.”

Training protocols: Research to establish optimized therapist training curricula with live observations and supervision to certify competency in single session models before independent practice remains lacking but important for standardizing quality care.

Evaluation tools: Developing validated patient-reported outcome measures specifically tailored to single session therapy may allow more nuanced evaluation of important change mechanisms like hope, motivation and resource activation compared to traditional tools.

Client experiences: Qualitative research eliciting in-depth client perspectives andstories of how and why single session therapy worked well for their personal situations could offer rich practice-based evidence to supplement trials.

As advancements in brief therapy research continue addressing the above areas, single session therapy’s versatility, strengths and advantages will become even clearer.

Its ability to effectively improve well-being for appropriately matched clients facing common difficulties through rapid, low-cost interventions makes it a crucial component of any holistic mental health system. With ongoing refinement, one day it may reach even wider global populations in need.

How To Decide If Single Session Therapy Is Right For You

If you’re considering single session therapy to address a concern, here are a few helpful questions to ask yourself:

  • Is my issue reasonably defined and targeted like a specific fear or problem versus complex and long-standing?
  • Am I internally motivated to make a change rather than just seeing what therapy is about?
  • Do I have strong social support from family/friends that could back me up through action steps?
  • Is this related to a major life transition, stressful event or crisis that caused upset versus a recurring pattern?
  • Have I tried unsuccessfully resolving this on my own already through self-help methods?
  • Am I willing to do homework between sessions of trying new strategies or skills learned?
  • Do I like the idea of expedited results within a single meeting if possible?
  • Could revisiting progress possibly strengthen results long-term if needed?

If you answer yes to most of these, discussing single session therapy with a qualified brief therapist may be worthwhile.

But don’t hesitate to consider more sessions too if needed for complex problems. The most crucial thing is finding the right fit to meet your specific situation and goals for optimal care.

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