Can You Solve All Your Problems in a Single Session of Therapy?
Hoyt isn't the only one who believes a single session can do the job. In her popular podcast, Where Should We Begin?, couples therapist and best-selling author Esther Perel makes significant headway against decades-long relationship problems in three-hour stand-alone sessions. In addition, "talk-in" clinics, which provide walk-in counseling for youths and their families or caregivers, are catching on in Canada, and therapists in the UK and Australia advertise their single-session expertise.
Hoyt didn't set out to specialize in quickies. He's a clinical psychologist originally trained in psychodynamic psychotherapy, which usually involves regular sessions over the course of months or years. But in the late 1980s, he was working with fellow psychologist Moshe Talmon, PhD, at an HMO in Northern California, when Talmon noticed that many of their patients came into the clinic only once. Along with psychologist Robert Rosenbaum, PhD, Hoyt and Talmon decided to follow up with 200 of these patients to ask why. "We were surprised to hear that the great majority felt like they got what they needed," says Hoyt. And this wasn't unique to their clinic: Other research showed that 20 to nearly 60 percent of those who visited a therapist went only once. So the trio did a study with 58 patients, in which they structured every first session as if it would be the last; 59 percent left feeling satisfied with their treatment and declined additional appointments, and of these one-and-done patients, 88 percent reported improvement three months later in the complaint they'd come to address. The researchers then developed guidelines for how to reframe a typical session based on the assumption that the patient wouldn't be back.
In 1988, Hoyt, Talmon and Rosenbaum presented their findings at a psychology conference in San Francisco. While some critics called SST "Band-Aid therapy," Holt says that many practitioners were intrigued by a method that could help large numbers of people while freeing up time for those requiring extended attention. As more professionals practiced SST, follow-up questionnaires showed that not only were patients getting a lot out of their session, but solving one problem led to improvement in other areas of their lives.
So, how does it typically work? In appointments that average 60 to 90 minutes, the therapist focuses on your strengths and skills, then helps you identify and practice things you can do now to get yourself unstuck. SST uses principles similar to cognitive-behavioral and solution-focused therapies, both of which are intended to help you fix your problem yourself. "Rather than looking at what negative thoughts and behaviors might be causing your issue, we look at what positive ones could solve it," says Hoyt.
That method strongly appealed to Keren, one of Talmon's recent patients in Israel. Though Keren is 48, married, and the mother of adult children, her parents were still trying to control her finances. But she wasn't interested in a deep analysis of the past; she wanted specific advice on how to talk to her parents about an issue that had been torturing her for some time: putting the house they had purchased and she lived in into her name. She worried that even broaching this subject could damage their relationship.
After 30 minutes with Talmon, Keren felt like he fully understood her family dynamic; they spent the second half of the session focusing on the imminent conversation and role-playing. "Dr. Talmon helped me see that not only had I been depending on my parents, but they were depending on me, too," Keren says. She also realized that her reaction to her parents' response—as bad as it might be—was completely in her hands. Two days after the session, Keren sat down with her mother alone and expressed how at this point in her life, not having the property in her name put her at a disadvantage. To her surprise, her mother agreed. "She said she'd never thought about it that way." Within three weeks, her parents presented her with a legal letter saying the property was hers. Keren doesn't plan to talk to Talmon about her parents again—but she did make an appointment to discuss a totally different issue involving her boss.
People who tend to do best with SST, Hoyt says, can identify a relatively specific goal: dealing with grief, building self-esteem, validating feelings. In studies, SST has also been shown to help reduce anxiety, recurring nightmares, alcohol abuse and self-harm, as well as help manage phobias and panic attacks. (Of course, there may be cases, as when someone has been abused or is dealing with trauma, when a single session "might open a can of worms and leave the client with feelings they can't handle," says Ryan Howes, PhD, a clinical psychologist in private practice in Pasadena, California, who has done a handful of one-off sessions at patients' request. Those cases are when additional sessions make sense. And Hoyt even says SST could be called "making the most of each visit" therapy, but, he admits, "that's not as catchy.")
The suggestion that you could solve a problem right here, right now, today, can be empowering. "The most common number of therapy visits many people commit to is zero," says Brian Yates, PhD, a professor of psychology at American University in Washington, D.C., who studies the cost-effectiveness of therapy. So if someone tries one visit and comes away with a concrete plan, a referral, or even the desire to attend more sessions, "that can be a whole lot better than nothing."
And in the end, says Talmon, "no matter how many sessions you need, if you approach each one as though it's the only one, it's likely to be the most cost-effective form of therapy you'll ever have."
Can We Talk?
While there's no SST directory to help you find a provider, you can check therapists' websites for phrases like "short term," "brief therapy," "solution-focused" and "problem-solving"; call these providers and ask if they're open to meeting once or a few times. You can also experience a de facto form of SST if you have access to an Employee Assistance Program (EAP) that offers free short-term counseling to employees with personal or work-related problems. Even if EAP counselors have never heard of SST, they know that each session could be the only one they'll have with a client, so they make it as useful as possible, says Janet Schirtzinger, EAP manager of clinical services at Advocate Aurora Health, which offers EAPs to companies in the Midwest.