What are the Differences, if any, Between Single-Session Therapy (SST) and One-At-A-Time Therapy?

In this response, I will outline several ways of answering this question. As you will see this question has no definitive answer.

Single-Session Therapy and One-At-A-Time (OAAT) Therapy are Synonymous

Hoyt (2011) introduced the term ‘one-at-a-time’ into the SST literature, and some have used it synonymously with single-session therapy. That is, they both describe the practice in which the therapist and client set out to help the client in a single session, on the understanding that the client can choose to have more sessions if they wish.

Single-Session Therapy and One-At-A-Time (OAAT) Therapy are Different

Some therapists view SST and OAAT therapy as different. Of these, some prefer the term ‘one-at-a-time' therapy to ‘single-session' therapy. When asked why, these therapists argue that the term ‘SST’ emphasises the single-session nature of the work, while ‘OAAT therapy’ emphasises that more therapy is available, even if it is delivered one session at a time. Services based on OAAT therapy principles allow clients to have additional sessions, but only, as the name implies, one at a time.

Services based on OAAT therapy

In some agencies, OAAT therapy is introduced to offer clients help at the point of need and to reduce the time it takes them to access counselling. Usually, this is in response to the practice of offering clients a block of sessions, most often six, which neither reduces waiting lists nor appreciably lowers waiting times. In these agencies, the term 'one-at-a-time' is interpreted literally, and clients can only book one session at a time. However, in these agencies, there is no cap on the number of sessions a client may have - although as noted above, these can only be booked one at a time. Indeed, some clients may have more than six sessions if they choose to do so.

In OAAT services, clients are encouraged to reflect on what they learned from a session, digest this learning, take appropriate action, and let time pass before deciding to have another therapy session. In this way, clients can get the most from every session that they elect to have.

Services based on SST

In my view, there is more flexibility in agencies that offer SST services. As we have seen, in OAAT therapy agencies, clients can have more sessions, but these can only be booked one session at a time. In SST, by contrast, if clients elect to have further therapy, after going through the same ‘reflect-digest-act-wait-decide’ process outlined above, they can choose from the services that the agency offers. Thus, they may elect to have a) another single session after the first, b) a block of counselling sessions if these are available and clinically indicated c) ongoing therapy if offered and even d) specialist services if the agency offers them itself or has an arrangement with an agency that does. What is important here is that the therapist is transparent with the client about what help is available after the first session and what is not.

Therapists’ Preferences

I argued at the beginning of this response that SST and OAAT therapy can be regarded as synonymous terms. They both describe the practice that the therapist and client set out to help the client in that session, knowing that more sessions are available. In my experience, therapists who prefer the term ‘SST’ place the greatest emphasis on the first part of this sentence, i.e., helping the client in one session. By contrast, therapists who prefer the term ‘OAAT therapy’ place most emphasis on the second part of the sentence, i.e. further help is available. OAAT therapy is therefore a term acceptable to therapists who have doubts, reservations and objections to the single-session intention of ‘single-session therapy’. These therapists often end up seeing clients for ongoing therapy with sessions occurring every two or three weeks. Doing so suits the conventional therapy mindset of these therapists.

Whether SST and OAAT therapy are the same or different, what is important is that the person using the term SST or OAAT therapy makes clear how they personally use these terms, rather than relying on generic definitions.

Reference

Hoyt, M.F. (2011). Foreword. In A. Slive & M. Bobele (Eds.), When One Hour is All You Have: Effective Therapy for Walk-in Clients, (pp. xix-xv). Zeig, Tucker, & Theisen.