Implementing Single Session Therapy

In recent decades, discussion about clinical practice has been dominated by a focus on evidence‐based treatments, whilst the translation of evidence‐based treatments into practice has been neglected or avoided. The single session therapy (SST) field reflects this general trend. As a result, the community has not benefited from available service improvements simply because they have not found their way into core practice or been translated across state‐wide services. This article draws on a range of implementation projects managed by The Bouverie Centre, in particular a successful state‐wide SST implementation project conducted in collaboration with Victorian community health counselling services, to raise implementation dilemmas and suggest practical ideas about the translation of SST ideas into mainstream clinical practice. It is hoped this discussion will be of interest to those wanting to translate any new idea into practice.     

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania,Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family-inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family-inclusive approach. Future research could focus on attaining a more in-depth understanding of individual family member experiences with a view to improving SST delivery.     

Examining the Incidence and Clients’ Experiences of Single Session Therapy in Italy: A Feasibility Study

Single session therapy (SST) postulates that one session can be sufficient for a client to take charge of the process and work toward their own solutions. Research has been conducted worldwide corroborating SST assumptions with several mental health conditions, but not in Italy. For the first time in Italy, this paper aims to explore: (1) if the most frequent number of sessions in traditional psychotherapy (not SST) is one (Study 1); and (2) the satisfaction of clients who attend SST services and the number who consider one session sufficient to address their presenting problem (Study 2). In Study 1, the records of 476 voluntary clients referred to three different traditional (not SST) psychological services in the west-central region of Latium, Italy, were retrospectively screened, and the number of sessions attended by each client recorded. In Study 2, 85 consecutive clients who voluntarily asked for SST with seven mental health professionals across Italy received a link to an online ad hoc survey, 1–3 weeks after the consultation, evaluating their experience. Study 1 found that the most frequent number of traditional psychotherapeutic (not intentionally SST) sessions was one (124 out of 476 clients (26%). Study 2 found that 44 out of 85 clients (52%) considered one session to be enough, as they felt better or much better and chose not to attend further sessions. Of those who asked for a second session (41 clients), 33 clients (80.5%) indicated that the first session was not enough and 8 clients (19.5%) wanted to address a new problem. These results converge with previous international studies and provide encouragement for the use of SST in both private and public psychological services to address the demand for timely mental health services in Italy. Further research is needed to support the efficacy of SST and to evaluate its cost-effectiveness.     

Single‐Session Approaches to Therapy: Time to Review

In 2001 Bloom produced a comprehensive review of single‐session approaches to therapy (SST). In his paper he outlined the concept of single session therapy and considered the evidence that could be used to support implementation of single session approaches. At the time, Bloom's was probably the most comprehensive review of research on single session therapy available: he considered papers that provided overviews of approaches to developing and delivering single‐session treatment, as well as papers that used controlled and uncontrolled methods to evaluate outcomes. What I will do in this paper is to informally review the literature on single session therapy that has been published since Bloom's 2001 paper. The paper is not intended as a formal review or meta‐analysis of research data, partly because the field still does not have such methodological rigour.     

When Less is More: Lessons from 25 Years of Attempting to Maximize the Effect of Each (and Often Only) Therapeutic Encounter

The three main findings of studies conducted by Hoyt, Rosenbaum, and myself during the years 1986–1990 at the Kaiser Permanente Medical Group, were

• 1 . Single session is the most common length of psychotherapy.
• 2 . The first session in psychotherapy is potentially the most therapeutic and often has the greatest influence on the outcome of therapy.
• 3 . Single session therapy (SST) is the most cost‐effective mode of therapy.

The fact that less is very often better in psychotherapy is by now one of the most validated and consistent findings in evidence‐based psychotherapy research. We now think of it as a very common, very useful way of conducting therapy, employing many different approaches and methods to address a wide range of presenting problems. In retrospect, 25 years later, I believe that the essence of single session therapy is still about being present in each and every session as a whole. The goal has always been to make the most of every therapeutic session, whether seeing a client only once or over a long period of time. In a personal communication in 1978, Haley (in Talmon, 1990) predicted that a ‘single interview could become the standard for estimating how long and how successful therapy should be.’ This article explains why it didn't happen.     

Single-Session One-At-A-Time Therapy: A Personal Approach

The terms ‘Single-Session Therapy’ (SST) and ‘One-At-A-Time’ (OAAT) therapy are both used to indicate a situation where the therapist and client set out with the expressed intention of helping the client in one session while acknowledging that additional sessions are available to the client. Both terms have their advantages and disadvantages and thus the author uses the blended term ‘Single-Session One-At-A-Time’ (SST/OAAT) therapy to highlight the advantages of both. It is a core feature of SST/OAAT therapy that it is client-centred especially where the session’s focus and goal are concerned. However, in an attempt to avoid SST/OAAT therapy being highjacked by therapists who operate from the ‘expert’ source of influence, the field has downplayed the contribution of the therapist’s expertise. In this paper, I make clear that the expertise of the therapist when allied to the expertise of the client can be a potent force for good in SST/OAAT therapy. My main task, however, is to outline my own approach to SST/OAAT therapy which is a blend of general principles that are likely to be held by the majority of SST/OAAT therapist and specific ideas that are derived from working alliance theory, pluralism and Rational Emotive Behaviour Therapy.     

Families' experience of a single session therapy framework in advanced allied health practice for children with neurodevelopmental and behavioural disabilities: A thematic analysis of qualitative data

Single session therapy (SST) has emerging evidence for facilitating meaningful therapeutic change in a small number of consults, rather than more traditional long-term therapies. This study aimed to explore and describe the parent/caregiver and child experience with advanced allied health practitioners (AAHP) using SST for children with developmental disabilities, by understanding key characteristics of the consultation that led to therapeutic change. Eligible families attending an AAHP outpatient clinic for children with developmental and behavioural concerns participated in one to four SST consultations around their identified areas of need. Semi-structured interviews were conducted with 38 parents and 12 children, from 37 different families. Thematic analysis was used to analyse interviews. Demographic information was gathered through parent interviews and by reviewing hospital records. Four key themes emerged relating to the characteristics of the consultation that led to a positive experience for families: (1) the art of mutual presence; (2) the value of time; (3) the power of understanding; and (4) the trust of action. These attributes were influenced by the overarching complexities of the AAHP, the parent's and child's interpersonal skills, and the organisational mechanisms influencing patient care. Parents and children reported clinical change during the consult through increased understanding, and being heard, valued, and respected for their individual decisions on how to manage their child's and family's needs. This study provides preliminary evidence that utilising SST for children and families with developmental and behavioural needs facilitates a positive experience valued by families. SST, with a focus on a family's individual identified areas of concern, was valued and effective when delivered by AAHP. This suggests that SST, when appropriately administered by experienced and trained health practitioners, is useful for families dealing with children with developmental and behavioural challenges.     

Single Session Thinking 2020

This update presents key developments since Talmon’s original (1990) publication, including an account of the three international symposia which have taken place since the last ANZJFT special edition on single session therapy in 2012, and the major compilations that followed the symposia. Underlying elements that unite different single session approaches are explored, and an attempt is made to provide a terminology that is inclusive and coherent. As reflected in the title, the term ‘single session thinking’ is suggested as an over-arching term for the approach that is no longer limited to the therapy room, but reaches into many different contexts. In conclusion, possible future clinical and research developments in the field of single session thinking and practice are reflected upon, and the implications for contemporary health care delivery considered.     

Reflections and Learning From an Agency‐Wide Implementation of Single Session Work in Family Therapy

In November 2009, the Bouverie Centre, a centre for training, research, and clinical family therapy in Melbourne, Australia, embarked on a 12‐month trial involving the implementation of single session work as our main model of service provision for all new family appointments. We were interested in evaluating clients' and therapists' experiences of this change in our clinical service delivery. This article discusses some clinical dilemmas that arose for staff in this process, and how they were addressed. Clients' responses to single session work are outlined, followed by a discussion of outcomes of the implementation for our organisation.     

Single Session Social Work in Hospitals

This paper reports on three complementary research studies that set out to examine the incidence and nature of single sessions in hospital social work practice. The first study was a data‐mining exercise that used statistics recorded by practitioners in nine public hospitals over a 12‐month period to establish the extent of single session work, the clinical areas in which it occurred, and the types of issues it covered. This quantitative information was enhanced with the qualitative findings of the two subsequent studies: the first with hospital social workers; and the second with singlesession clients. We concluded that single session work has not been sufficiently acknowledged in social work education and literature, and that it needs to become a more legitimate part of social work practice and training. At best, it represents social work at its highest level of skill, requiring expertise in quickly building rapport, assessment, and knowledge about sources of practical aid and information.     

A Network Therapy Clinic for Clients with Intellectual Disability

Over the past 30 years a systemic approach has been applied to complex cases involving intellectual disability and behaviours of concern. This paper describes a model that draws on systemic family therapy and network therapy as well as the use of a reflective team. A single session intervention was provided for families of people with intellectual disability. A systemic consultation was used as a pre‐session meeting for professionals working with the family. The systemic consultation and single session therapy allowed the family and the professional network to gain insight. Involving the professionals in the therapy session also enhanced the alliance between professionals and family. This approach assists everyone involved in the case to find a way to progress.     

Spiritual Competence: What It Is,Why It Is Necessary,and How to Develop It

Various professional standards underscore the importance of providing effective services to all people, including those from diverse religious backgrounds. Yet despite these standards, studies have repeatedly found that most social workers receive little training in navigating this aspect of diversity during their graduate educations. To address this lack of training, the present article discusses a concept that is foundational for effective service provision with spiritual clients from diverse religious backgrounds—spiritual competence. More specifically, this article outlines what spiritual competence is and why it is important in therapeutic work, and then offers a number of strategies for developing spiritual competence. As such, this article helps equip practitioners to provide more ethical, effective services in a nation characterized by increasing religious diversity.     

Family support for the elderly in Korea: continuity, change, future directions, and cross-cultural concerns.

This article discusses major issues and concerns regarding family support for parents and elderly people in industrialized and urbanized Korea. It summarizes new trends in family support for elderly members, continuing influences of the traditional value of family support (filial piety), growing needs for public services for elderly people and their families, urgent calls for the state to assume greater responsibilities for providing social security and services for the elderly, needs for cross-cultural studies of family support, and certain cultural similarities and differences to be considered. The article concludes with some suggestions for future research.     

Hearts and Minds: Social Role Valorization, UK academia and services for people with a learning disability

The relative roles of academic thinking and ideas, the particular set of ideas called normalisation, and other influences on services for people with learning disabilities are discussed. The paper argues that in the sixties and seventies the relatively small number of academics in the field dominated the thinking about services, but not services themselves. The development of the teaching of normalisation in the eighties is argued to have had a greater effect on services, though not on academic thinking, whose influence is, in any case, seen to be in decline. Confusion then arises as normalisation is reconceptualised as Social Role Valorization, both from the way this is taught in the UK and from academia's difficulty in coming to grips with which set of ideas are the ones that have influenced services. There is therefore little recognition, either in academia or the service world, of further refinements of SRV theory in the nineties.     

Following the River’s Flow: A Conversation about Single Session Approaches with Aboriginal Families

Alison Elliott and James Dokona were interviewed by Henry von Doussa, and this article is the written version of that interview. In it, Alison and James separately refer to issues such as early skepticism about the applicability of a single session therapy approach with Indigenous families (Alison), a growing experience of its ‘fit,' philosophically and culturally, and the hope that can be engendered in one conversation. They underline the importance of the oral tradition, and other cultural concepts such as Dadirri (deep listening) as well as the trauma-informed principles of choice, collaboration, and empowerment, through using their language, asking permission, working together on solutions, and not coming across as an expert. The article is infused with the practical ideas and the values inherent in the authors’ work, including permission-seeking, reflection, containment, and their use of a whiteboard as a resource to capture multiple perspectives, a genogram (including pets), and to facilitate yarning. The flow of this conversation in itself reflects James’ imagery of the therapeutic conversation being like a river running – you don’t know which way it’s going to go.     

The New Sisters of the Road: Homeless Women and Their Children

ABSTRACT

This article examines the growing social problem of homeless women and their children. It provides a historical perspective, reasons for the increased incidence of family homelessness, the negative effects of homelessness on women and children, and programmatic responses. It also makes recommendations for effective program services and policy reforms. It urges family social workers to adopt a policy advocacy orientation. The article concludes that there is a need for further research to separate causes from effects when studying homeless women and children, and that researchers need to attend to the significance of gender for the social problem of family homelessness.     

Disability Through a Native American Lens: Examining Influences of Culture and Colonization

Disability is a socially constructed identity. What constitutes a disability and what it means to be a person with a disability can vary across cultures. This article explores meanings of disability within Native American cultures, including how ideas about wellness, balance, roles, and responsibilities influence perceptions of disabilities. This is followed by a review of disability prevalence, discussion of services, and explorations of possible reasons for the disproportionate impact of disabilities in Native American populations. The article concludes with an examination of how the colonial context frames both attitudes about and services for Native Americans with disabilities.     

Implementing the family preservation program: Feedback from focus groups with consumers and providers of services

There is a growing understanding that preventative child welfare efforts can be both more cost effective and are more desirable philosophically than strictly remedial programs. The Family Preservation Act provides funds to assist communities in strengthening and preserving at-risk families. In order to implement this program effectively, local communities must design new programs and procedures which will be both attractive to consumers and effective in meeting their needs. This study it identifies problems with contemporary child and family services and suggests solutions to those problems. This study uses a focus group format and presents ideas generated by those individuals who will be most directly affected by this legislation; front line service providers and service consumers. Several areas of weakness in the current service delivery system are identified, including bureaucratic barriers, limited resources, problematic consumer/provider relations and a range of collaborative issues, both within and between agencies and the communities they serve.     

Nations, national identities and human agency: putting people back into nations

This article stresses the necessity of more detailed considerations of social action and human agency in sociological theorising on national identity. It argues that, as much as other sociological categories such as 'class', 'gender', 'race', categories of 'nation' and 'national identity' are of important practical use in giving order to the social world. The article is primarily intended as a critique of a good deal of the sociological work in this area, and suggests the need to more systematically consider how individuals actively organise and account for ideas of nation and national identity. There is now a growing corpus of qualitative studies of national identity; what is needed now is to begin to work towards a general sociological theory of national identity.