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Creating and Maintaining a Focus in Single-Session Therapy

Introduction

Single-Session Therapy (SST) can be defined as an intentional endeavour where the client and counsellor agree to meet for a single session with the intent of helping the client to address their chosen concern in that session with the understanding that more help is available if needed. It is based on research that shows that the modal number of sessions that clients have internationally is ‘1’ and that 70-80% are happy with that session given their current circumstances (Talmon, 1990; Hoyt & Talmon, 2014).

One of my concerns as a trainer of single-session practitioners is that counsellors in training are not taught how to help a large number of clients who attend for one counselling session. To practise SST effectively, counsellors need to adopt a single-session mindset and to be able to help clients to identify a focus for the work and to help them to maintain this focus.

In this article, I will deal with the latter issue and refer the interested reader to Dryden (2020) for a discussion of the single-session mindset.


Helping the Client to Create a Focus for the Session


Once the client has given their informed consent to participate in single-session counselling, the counsellor’s primary goal is to help the client to create a focus for the session and when one has been created the counsellor needs to help the client to maintain this focus.

There are several questions the single-session counsellor can help the client to create a focus. These questions can be problem-oriented, solution-focused or goal-focused. In SST, a solution helps the person address their problem effectively so that they can achieve their goal.


Questions that help create a problem focus for the session

  • What is your most pressing concern that I can help you address today?

  • What one issue can I help you with today?


Questions that help create a solution focus for the session


  • If I could help you today to find a way of addressing your problem effectively, what your response be?

  • If I could help you to find a solution to your problem today which you could take forward to achieve your goal, would you be interested in that?

Questions that help create a goal focus for the session

  • What would you realistically like to have achieved by the end of the session which would make you glad that you came today?

  • If when you are at home this evening, and you reflect on our session today what would you have realistically liked to have achieved?

After the counsellor has asked the client a focus-oriented question, the client’s response will either indicate that a focus can be created from that response or that the counsellor needs to ask further clarificatory questions. It is also important to note that the counsellor may begin by asking a problem focus and then depending on the client’s response, use that to agree on a solution or a goal focus. This also occurs in the following exchange.

Counsellor: What one issue can I help you with today?

Client: I have been quite anxious lately.

Counsellor: Anxious about what?

Client: Anxious about my son not getting into the school of his choice.

Counsellor: What effect does your anxiety have on you?

Client: I am having sleepless nights, and I can’t concentrate on my work.

Counsellor: How do you hope that I can help you with this problem today?

Client: Help me to get some sleep and help me to concentrate on my work.

Counsellor: So, if I can help you address your anxiety about your son’s schooling

so that you can sleep and concentrate on your work, what would you

think of that?

Client: That would be great.

Counsellor: So, shall we agree that this will be the focus of the session

Client: Yes.

Helping the Client to Maintain the Agreed Focus

Once the counsellor and client have agreed on a focus, both must maintain this focus if they are going to use session time well. It is the counsellor’s primary task to ensure that this focus is maintained. The counsellor uses a variety of skills to do this.

Seeking and gaining permission to interrupt the client

When I received training as a counsellor 45 years ago, interrupting the client was strictly forbidden. The counsellor’s primary task was to encourage the client to explore their concerns and to follow them in their exploration rather than to guide it in any direction and to interrupt the client’s process to help the client reach this direction. Apart from that interrupting the client was seen as being rude. In single-session therapy, interrupting is regarded very differently. Once a session focus has been agreed, the counsellor needs to take charge to ensure that it is maintained during the session. As interrupting the client may be seen by the latter as being rude, the counsellor first provides a rationale for doing so and then seeks permission from the client to do so. Here is an example: Counsellor: So now we have agreed on a focus for the session, we both need to

maintain this focus. OK?

Client: OK.

Counsellor: In any conversation between two people it is easy for one or both to go

from topic to topic and in a social conversation that is perfectly fine, but in a therapeutic conversation when we have agreed on a focus, that is problematic. So, if that happens with us, I would like to interrupt you to bring us back to the focus. I will strive to do that as sensitively as possible, but I will need to do this. Do I have your permission to do so?

Client: Yes, that is fine. I do tend to meander around sometimes.

Counsellor: And feel free to interrupt me if I am going off topic too.

Client: (laughing) I will.


Checking that both are maintaining the focus


Sometimes it is difficult for the counsellor to know whether or not a client has wandered away from an agreed focus. Thus, what appears, at first sight, to be a departure from the focus, maybe a vital elaboration on a topic that clarifies the focus. Mutual dialogue is a critical feature in SST, so when this happens, the counsellor checks with the client that the focus is being maintained.


Counsellor: Can I just something check with you?

Client: OK.

Counsellor: We agreed to focus on your anxiety about your son’s schooling, and I

am aware that we are now discussing, so I am not sure how that fits

with your wife spending a lot of time with her sister.

Client: It doesn’t. I was going off track.

Counsellor: So, shall we get back to your feelings of anxiety about your son not

getting into his preferred school?

Client: Yes.

In the exchange above, the client acknowledges that they had gone off track. The following is an example where what seems to be a departure from the focus clarifies the focus.

Counsellor: Can I just something check with you?

Client: OK.

Counsellor: We agreed to focus on your anxiety about your son’s schooling, and I

am aware that we are now discussing, so I am not sure how that fits

with your daughter’s problems at ballet school.

Client: The way I see it, they are both instances of my anxiety that my children may

be blocked in getting what they really want in life.

Counsellor: OK, I get that. They are linked. Would it make sense for us to maintain

the focus on your son and then see if we can generalise to the situation

with your daughter?

Client: If we could do both today, that would be great.

Counsellor: OK, let’s do that.

In this latter exchange, the client’s seeming departure from the agreed focus (anxiety about the client’s son schooling) turned out to be a clarification of the focus (anxiety about my the client’s children not getting what they really want in life). The former is a specific example of the latter, and the client’s introduction of his daughter was another example of the broader focus. Note how the counsellor acknowledged the link and suggested that they remain with the specific instance of the now broadened focus (anxiety about the client’s son’s schooling). The counsellor then indicated that the client could generalise any learning to the other particular instance of the broadened focus (anxiety about the client’s daughter’s difficulties at ballet school).

This latter example shows how the single-session therapist works with both the specific and the general in SST, ensuring that both types of issue are connected.


Conclusion

Using time effectively in single-session therapy is a core skill in this form of service delivery. In this article, I have discussed the core skills of helping clients to create and maintain an agreed focus so that they can get the most from the time that they have with the counsellor.


References

Dryden, W. (2020). The single-session therapy primer: Principles and practice. Monmouth: PCCS Books.

Hoyt, M.F., & Talmon, M.F. (2014). What the literature says: An annotated bibliography. In M.F. Hoyt & M. Talmon (Eds.), Capturing the moment: Single session therapy and walk-in services (pp. 487-516). Bethel, CT: Crown House Publishing.

Talmon, M. (1990). Single session therapy: Maximising the effect of the first (and often only) therapeutic encounter. San Francisco: Jossey-Bass.


© 2021 Windy Dryden