Single-Session Therapy by Walk-In or Appointment

Administrative, Clinical, and Supervisory Aspects of One-at-a-Time Services

Michael F. Hoyt, Monte Bobele, Arnold Slive, Jeff Young, Moshe Talmon, Michael F. Hoyt, Monte Bobele, Arnold Slive, Jeff Young, Moshe Talmon

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351112413
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Single-Session Therapy by Walk-in or Appointment is based on the idea that one session is often all a client will need and choose to attend. The option of a single-session responds to the growing need for greater accessibility and responsiveness of mental-health services. With considerable data supporting both the demand for and the effectiveness of walk-in and by-appointment single sessions, the field is expanding rapidly. This book includes many clinical examples and cultural nuances, as well as discussions of recent research, training and supervision, and implementation and administrative arrangements. This is an essential title for clinicians, program developers, and policy makers interested in providing the effective, client-responsive, economic option of one-at-a-time single-session therapy on a walk-in or by-appointment basis.

Section 1

Editors’ Introduction

1 Single-session/one-at-a-time walk-in therapy

Michael F. Hoyt, Monte Bobele, Arnold Slive, Jeff Young, and Moshe Talmon

The town of Banff, perched in the beautiful Canadian Rockies, was the site for the appropriately named Capturing the Moment 2: Scaling New Heights in Single Session Therapy and Walk-In Services symposium held September 28–30, 2015.¹ Building on the first Capturing the Moment conference, which was held near Melbourne, Australia during March 2012, an international group of presenters and a keenly attentive audience came together in Banff from Canada, the U.S., Israel, Australia, Haiti, China, Finland, Mexico, and Sweden to exchange the latest information about developments in the rapidly growing field of single-session, walk-in, and one-at-a-time therapy. Therapy models and techniques, cultural nuances, implementation of service delivery systems, issues of training and supervision, and research findings were discussed and explored.

While many of the contributions contained herein were inspired by those presentations, they are much amplified. The papers are carefully curated around the theme of single-session/one-at-a-time therapy (SST/OAAT), and there are papers in this book that were not presented at the conference and conference papers that were not included in this book. As will be discussed later, the book is distinguished by its clear focus on the practice of SST/OAAT, by its attention to the walk-in (and by-appointment) delivery model, by its range of contexts and applications, by a broad array of clinical case examples, and by its assortment of contributing expert practitioners.

The field of Single-Session Therapy (SST) is expanding rapidly, as more consumers use one-at-a-time (OAAT) services in clinics, health maintenance organizations, and walk-in (and call-in and online) counseling centers. The growing need for accessible services that are responsive to client need is increasingly being recognized by practicing professionals and by graduate students preparing for careers in healthcare, as well as by funders, program planners, and policymakers interested in cost-effective service delivery systems.

Intentional SST/OAAT

Although therapists have sometimes seen clients for one visit of successful therapy since the time of Freud (see Sproel, 1975; Bloom, 1981/1992), the concept of intentional (or planned) Single-Session Therapy was most clearly articulated by Talmon (1990, p. xv; see Chapter 10 this volume) in his eponymous book, Single Session Therapy: Maximizing the Effect of the First (and Often Only) Therapeutic Encounter: “Single-session therapy is defined here as one face-to-face meeting between a therapist and patient with no previous or subsequent sessions within one year. As such, SST is the most frequently used length of therapy.”²

Along with colleagues Bob Rosenbaum and Michael Hoyt, in the late 1980s, Talmon conducted studies of SST at a large health maintenance organization (Kaiser Permanente) based in Northern California. After examining the existing clinical and research literature, they retrospectively reviewed the charts of 200 patients who had de facto attended therapy for only one visit and found that many of the patients had been very satisfied with their one-session experience and did not feel the need for continuing therapy. Talmon and his colleagues then prospectively treated a series of 58 outpatients, ages 8 to 80, with a wide range of diagnoses. They presented statistical data and clinical examples in a series of publications (Talmon, 1990, 1993; Hoyt, et. al., 1992; Rosenbaum, et al., 1990). Their basic quantitative findings were that:

• over half of the patients (58.6%) elected to complete their therapy in one session even when more sessions were available

• more than 88% reported significant improvement in their original “presenting complaint” and more than 65% also reported “ripple” improvements in related areas of functioning, and

• while not experimentally assigned to one session or longer, on follow-up there was no difference in satisfaction and outcome scores between those who chose to stop after one visit (SST) versus those who continued for more sessions.

It is important to recognize that in the Kaiser study, clients were advised that although more sessions would be available if desired, the therapist’s intention was to work with them to see if one session could be adequate to meet their needs. Although earlier there had been reports of incidental one-off sessions where the therapists’ expectations were for on-going therapy, this “SST” approach was different. SST is therapy that the therapist expects, from the beginning, to potentially comprise a single visit. The therapist acts as if the first session will be the last. It is a planned, deliberate approach to make the most of the first encounter, informed by the research that shows many clients will not return for future planned sessions. As Hymmen, Stalker, and Cait (2013, p. 61) have written:

SST refers to a conscious approach to make the most of the first session knowing it may be the only session the client decides to attend—not to the situation where there is an expectation that the client will attend multiple sessions but chooses to attend just one. Service delivery methodologies that make the most of the first session, whilst providing options for further support should clients decide they want further support can be scheduled or provided in a “walk-in counseling clinic.”

As we will see in the following chapters, there are many ways in which SST thinking can influence a range of practice situations. Single-session therapists employ a variety of theoretical models and work in diverse settings: clinics, private-practice offices, hospital consultation-liaisons, “second-opinion” interviews, and clinical demonstrations.³ What these practices all have in common is the idea that all we really have is now and this one meeting may be enough—or may be all that the client will decide to attend. Contact data suggests that when therapy is organized with a planned and deliberate attitude that one session may be sufficient, clients frequently decide one session is adequate and choose to attend only that one session; although perhaps 50% will decide they require further work and will return for at least another visit (Young & Rycroft, 2012; Young, Rycroft, & Weir, 2014—see Chapter 3 this volume).⁴

In his Foreword to Slive and Bobele’s (2011) book, Hoyt (p. xii) referred to SST as being “one at a time.” Bobele and Slive (2014) elaborated this idea in their chapter, “One Session at a Time: When You Have a Whole Hour.” We chose the title of the present volume, Single-Session Therapy by Walk-In or Appointment: Administrative, Clinical, and Supervisory Aspects of One-at-a-Time Services, to emphasize just that: therapy takes place one contact at a time, and one contact may be all the time that is needed.⁵ Rosenbaum (2008, p. 8), one of the co-originators of the SST approach, put it this way: “Psychotherapy is not long or short; to view it this way sets up a false dichotomy. Psychotherapy depends instead on ‘good moments’ where something profound shifts for a client. All the rest is preparation and consolidation.”

SST/OAAT addresses the dilemma of how to provide the opportunity for a single session to be sufficient while providing options for on-going care and support. This has led to innovative walk-in services. Developed in response to community consultation, walk-in services are beginning to have a considerable impact on health service provision in parts of Canada and the United States—and are expanding worldwide.

Walk Right In and Sit Right Down: A Brief History of Walk-In Services

Recognizing that, if it were accessible and affordable, many clients would come for psychological (and medical) help just at their moment of need, in 1967 both the Los Angeles Free Clinic (now called the Saban Clinic) and the Haight-Ashbury (San Francisco) Free Clinic were established to provide such services. Two years later, in 1969 the Minneapolis Walk-In Counseling Clinic (see Chapter 9, this volume) opened its doors. In Calgary, Canada, the Wood’s Homes Eastside Family Centre began in 1990 to provide walk-in/single-session community-based mental-health services (Clements, McElheran, Hackney, & Park, 2011; McElheran, et al., 2014; Slive, Maclaurin, Oakander, & Amundson, 1995; Slive, McElheran, & Lawson. 2008; see Chapter 5). In the early 1990s, while on an American Association for Marriage and Family Therapy (AAMFT) site visit to Calgary, Monte Bobele met Arnie Slive and saw the innovative work being done; he subsequently brought the idea back to San Antonio, Texas, and began to incorporate WI/SST training and services into the graduate counseling psychology programs at Our Lady of the Lake University.

Slive, et al. (2008, p. 6) succinctly described the essentials of a WI/SST service:

Developed … as a result of community demands for greater accessibility to mental health services, walk-in therapy enables clients to meet with a mental health professional at their moment of choosing. There is no red tape, no triage, no intake process, no waiting list, and no wait. There is no formal assessment, no formal diagnostic process, just one hour of therapy focused on clients’ stated wants. As well as meeting client needs, walk-in therapy is highly rewarding to professionals due to the simple fact that the clients’ ability to access the service at their chosen moments of need without having to jump over multiple hurdles means that a large percentage are highly motivated. Also, with walk-in therapy there are no missed appointments or cancellations, thereby increasing efficiency.

Bobele and Slive (2014, p. 98) also noted that a walk-in session can be both a discrete event and part of a larger process:

We prefer to think of walk-in therapy as a solitary pearl. Pearls begin as a solution to an oyster’s problem. The formation of a pearl has a beginning, a middle, and a point where it is complete. If a jeweler anticipates making a long string of pearls, then each one is understood as related to, connected to, the one before and the one to come. Therapy is a lot like this process. If therapists view each session as connected to the one before and a precursor to the ones to come, then no session truly stands on its own. Instead, it is always contextualized by what came before and the anticipation of what is coming after.

Many of the chapters in this book describe ways, both administratively and clinically, that such services can be organized to provide timely access. Clients⁶ who walk in often come expecting a single session—and some may intermittently return again for another single session, or for more continuous services.

The Emerging Empirical Basis for SST/OAAT Practice

Case studies and aggregate statistics are both empirical (from the Greek empeirokos, meaning “experienced” or “based on observation”). The idiographic-nomothetic debate has a long history in psychology and counseling (Cone, 1986; McLeod, 2007). Idiographic (from the Greek idios) means “own” or “private” and refers to what is individual or unique; nomothetic (from the Greek nomos) means “law” and refers to what is common or general. Idiographic studies are usually qualitative (e.g., case reports), whereas nomothetic studies are usually ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• List of Illustrations
• About the Contributors
• Acknowledgments
• Section 1 Editors’ Introduction
• Section 2 Administrative
• Section 3 Clinical
• Section 4 Supervisory
• Section 5 Editors’ Conclusion
• Index