Is Single-Session Therapy Psychotherapy? Is it Counselling?

People who enrol on professional training courses in counselling and psychotherapy will undoubtedly be trained to see clients in ongoing counselling/therapy. If they are trained to offer brief counselling/therapy, it will usually be in the range of 4-10 sessions. The chances are that if single-session therapy is mentioned at all on their training course, it will be in passing and they will not study it extensively. This is the case even though the modal number of sessions clients have in therapy or counselling is '1'[1]. This means that practitioners receive little or no training in their initial professional training to help a sizeable number of clients.

It is against this background that we need to understand why some professional organisations are reluctant to accept single-session therapy as psychotherapy or counselling. And of course, this view is likely to be shared by therapists and counsellors themselves.

Some therapy/counselling agencies communicate this view even when they offer single-session services to their clients by referring to them as 'single-session consultations' rather than 'single-session therapy' or 'single-session counselling'. When asked why, they say that it differentiates these services from therapy or counselling, which involves several sessions. It seems that even those who offer single-session therapy are doubtful whether it is psychotherapy or counselling.

Does it matter that single-session therapy is regarded as psychotherapy or counselling? It matters for several reasons, but here I will concentrate on the importance of professional counselling and psychotherapy organisations recognising SST as psychotherapy or counselling.

Professional Recognition

Suppose single-session therapy is not regarded as psychotherapy or counselling by relevant professional organisations. In that case, this may have implications for those who practise SST and wish to join these organisations or retain their membership. If a professional psychotherapy/counselling organisation does not deem SST to be psychotherapy/counselling, they will not count the hours that therapists spend doing SST towards professional accreditation. And if a therapist does a lot of SST, it may prevent that person from being professionally accredited.

This happened in Ontario in Canada, which was ironic given the fact that Ontario has a high number of single-session based ‘open-access, enter now’[2] clinics. In 2016, the newly formed College of Registered Psychotherapists of Ontario (CRPO)[3] decided that SST was not psychotherapy. Thus, SST hours could not count towards a person gaining registration of CRPO through the grandparenting route. Their reasoning was as follows. The presence of a therapeutic relationship characterises psychotherapy, and such a relationship can only develop over time. Therefore, as a therapeutic relationship cannot develop in single-session therapy, SST is not psychotherapy.

This was challenged in the courts, and the CRPO's decision was eventually overturned. Karen Young, a Canadian single-session therapist, served as an expert witness during the appeal and presented a wealth of evidence to demonstrate that a therapeutic relationship can indeed be established in SST (see Young & Jebreen, 2019). For example, 344 SST clients completed the Session Rating Scale (SRS) at the end of their session, and the results indicated that clients and therapists formed a strong working alliance during the session (Young & Bhanot-Malhotra, 2014). 

Although not mentioned by Young & Jebreen (2019), a study by Simon, Imel, Ludman & Steinfeld (2012) found that clients who developed a positive working alliance with their therapists in SST had better outcomes than those who did not forge such a relationship with their practitioners.

Closer to home, the British Association for Counselling and Psychotherapy (BACP)[4] initially ruled in 2019 that while counselling skills are employed in SST, as it is not a 'fully contracted' counselling session, SST is not counselling. Once again, this meant that SST hours could not be counted as practice hours towards accreditation, as only fully contracted hours could be used in this respect. 

It is difficult to ascertain why BACP regarded an SST session as not fully contracted, as transparency is paramount in SST. Thus, single-session therapy proceeds only once the client fully understands the help they are being offered and how to access further help, if necessary, before giving their informed consent. When this argument was put clearly to BACP, they relented and said that SST was counselling in the sense of being fully contracted, and that SST hours would therefore be counted as practice hours towards accreditation. BACP stipulated, however, that a person's practice hours could not just be made up of SST hours, and they had to show evidence of the practice of longer-term counselling.

Other Reasons

Once professional therapy and counselling organisations recognise SST as psychotherapy or counselling, then it is more likely a) that it will be included in the curriculum of professional training courses and b) that counsellors and therapists will regard it as an acceptable form of helping clients.

Suppose professional organisations do not regard single-session therapy as psychotherapy or counselling. In that case, the public may well take the lead from these organisations in this respect and may be concerned that they are being offered an inferior type of service when they are offered SST. If this occurs, this would be regrettable.

References

Simon, G.E., Imel, Z.E., Ludman, E.J., & Steinfeld, B.J. (2012). Is dropout after a first psychotherapy visit always a bad outcome? Psychiatric Services, 63(7), 705-707.

Young, K., & Bhanot-Malhotra, S. (2014). Getting Services Right: An Ontario Multi-Agency Evaluation Study. www.excellenceforchildandyouth.com

Young, K., & Jebreen, J. (2019). Recognising single-session therapy as psychotherapy. Journal of Systemic Therapies, 38(4), 31-44.

[1] The mode is the most frequently occurring number in a series. [2] Previously known as ‘walk-in.’

[3] CRPO differentiates clearly between psychotherapy and counselling

[4] BACP does not clearly differentiate between counselling and psychotherapy.