Why is it Called Single-Session Therapy if Further Sessions are Available?

Single-session therapy is a way of thinking about therapy and a mode of delivering therapy services. While it may mean the client has only one session, it could also imply the client may attend additional sessions to meet their therapeutic needs.

Contemporary single-session therapy was developed from the experiences of Moshe Talmon, an Israeli psychologist who worked at the Kaiser Permanente clinic in Northern California in the mid to late 1980s. During that time, Talmon followed up with 200 clients who had only had one session with him, even though he expected them to have more. Fearing that he had not helped these clients, Talmon (1990) found, to his surprise, that 78% of the clients did not return for a second session because they had gotten what they wanted from the first session. However, and this is the point, they could have returned for a second session if they wanted to, and if they had, Talmon would have seen them.

Talmon (1990) published a book on his experiences of working at Kaiser Permanente. Talmon (2008) has said, "I wanted to call it 'Once Upon a Therapy' because I wanted mostly to deal with the fact that what happens in therapy is different than what you plan or you think, or you say will happen in therapy". However, Talmons's publishers did not consider it sufficiently catchy and used the title 'Single Session Therapy: Maximising the Effect of the First (and Often Only) Therapeutic Encounter' instead. As this title shows, Talmon's purpose was not to establish something called 'single-session therapy', but to organise therapy so that the client may not need further therapy sessions after their first session, rather than exclude them from having additional sessions.

Research has shown that many people come to therapy and stay for only one session (e.g. Brown & Jones, 2005). It would be nice if we, as therapists, could predict which clients would have one session and which would return for more. However, the reality is that we are not good at making such predictions (Young, 2018). Given this, Talmon and others have argued that we should organise the first session to maximise the possibility that a client gets what they want from the session and if they require no further help, that is fine. However, if they need further help, that is fine too, and they can have it. It follows from this that in single-session therapy, the therapist aims to get therapy off the ground immediately rather than begin the session with the more usual practices of taking a case history, carrying out a full assessment or doing a case formulation.

When therapy services are organised so that all incoming clients are offered and accept single-session therapy, it transpires that about 50% require no further help. The remaining 50% who need additional help are offered this even though they have received single-session therapy. If single-session therapy truly meant that clients were offered and could only have one session, then half of those requesting help would be denied the help that they need. Single-session therapy, then, is a way of delivering therapy that aims to help clients in a single session while allowing them access to further support. It thus aims to help all clients, not just 50% of them.

My view is that the name of the therapy is less important than what it offers in practice. If people are not happy with the term 'single-session therapy', they should be free to use a different name. Whatever term they use, it is vital that they precisely describe what is and is not on offer.

References

Brown, G.S., & Jones, E.R. (2005). Implementation of a feedback system in a managed care environment: What are patients teaching us? Journal of Clinical Psychology, 61, 187-198.

Talmon, M. (1990). Single Session Therapy: Maximising the Effect of the First (and Often Only) Therapeutic Encounter. Jossey-Bass.