Single Session Therapy: The great paradox

I think it was inevitable that I would become a single session therapist. My very first placement as a mental health intern almost 20 years ago was in an acute psychiatric inpatient child and youth hospital setting in inner city Philadelphia. I was armed with good intentions and a full therapeutic toolbox but my education and training had not prepared me for the harsh reality of being surrounded by people whose lives were falling to pieces. 

            I remember walking onto the unit that first day and hearing a child scream. I remember four adults trying to physically stop a teenage girl from banging her head on the wall. I remember the vacant expression of the boy going through his first psychotic break. I remember the angry voices of parents through the doors marked “Family Room”. I remember reading the charts with their histories; poverty, intergenerational trauma, substance abuse, incest and sexual assault. I remember the expert assessments; Oppositional Defiant Disorder, Conduct Disorder, Borderline Personality Disorder, Attention Deficit Disorder, Depression, Anxiety. I remember the recommendations; medication, parenting classes, group therapy, play therapy, family therapy, individual therapy and even more medication. 

            The average length of stay on the unit was 5 days, which meant that the likelihood that any patient would receive psychotherapy services more than once during their stay was negligible. When patients were discharged the families were sent away with a referral for services, a prescription, and a bus ticket. “How many people follow through?” I asked my supervisor. “Not enough” she said.  

            This was the first, but certainly not the last time that I was hit with the great paradox that exists in mental health services. Most of the time, the clients who could benefit from the most intensive, long-term, consistent support from mental health professionals are the least likely to engage in these services. And really, who can blame them? Regardless of how helpful the intervention might be, the barriers that are created by systems for people to access those services are prohibitive; waitlists, daytime appointments, the cost of transportation, the cost of medication, childcare challenges, time off from work, and societal stigma just to name a few. As service providers we are left with a quandary. Do we continue to insist that people conform to the established, traditional norms of mental health service delivery and lose people in the process? Or do we adapt to what clients identify as being reasonable and helpful. Research has shown that 60.9% of clients feel that a single session of therapy is sufficient to meet their needs at a given moment in time (Hymmen, Stalker & Cait, 2013). It is my belief that this is significant enough for mental health professionals to take the practice, implementation and research of Single Session Therapy seriously. Not as a gateway to other services, not as a band-aid approach while waiting for “real” psychotherapy, but as a powerful, respectful and effective stand-alone clinical intervention.   

This is a blog devoted to exploring topics relevant to the practice, implementation and research of Single Session Therapy. I look forward to hearing your thoughts.

References

Hymmen, P., Stalker C. & Cait, C. A. (2013). The case for single-session therapy: Does the empirical evidence support the increased prevalence of this service delivery model? Journal of Mental Health, 22(1), 60-71.