Therapists have a secret that they would rather most people not know.
Up to 40% of new psychotherapy clients never come back for a second session.
While many therapists would consider such single session clients “failures,” but the fact is that given how often it happens, they must provide people with some benefit or relief in some percentage of those cases. (Others likely just find the therapy experience not helpful to their needs, not what they expected, or disliked the particular therapist they saw.)
The APA’s Monitor on Psychology this month has an article on phenomenon, with helpful tips to therapists on how to make the most of a single session, including the finding that such single sessions can be helpful to people:
Indeed, as-yet-unpublished research by a team of psychologists from the Department of Veterans Affairs, found a single, 60-minute session can even help people with serious mental illness. After just one “motivational interview,” participants were significantly more likely to enter a vocational rehabilitation program, and they stayed in the program for three months longer than a control group, says Lisa Mueller, PhD, a research associate on the study, led by psychologist Charles Drebing, PhD.
Most people feel very relieved after their first session of psychotherapy. And for many, that’s sufficient. It’s a cathartic experience for them and they take something away from the chance to bare their souls to another person. Even if they never return.
The four tips offered in the article include:
- Zero in on a single problem. By focusing on a single issue of most concern to the person and the reason that brought them into therapy, a therapist may be able to help provide the person with some guidance on how to best approach the issue.
- Unearth hidden resources. The article notes that most people might have the tools and resources necessary to fix the big issue in their life. They may just need a little help finding them.
- Don’t cajole. It’s important for a therapist to show a person they are on their side, and help them explore the pros and cons of a situation. You can’t force change to happen quickly, so a therapist shouldn’t bother to try.
- Plan for the future. A therapist can be helpful if they provide the person with additional resources and direction on where to learn more about their problems on their own. One simple exercise taught in a single session can be helpful to a person to practice on their own, such as a relaxation tip or reframing of irrational thoughts.
I’d add a fifth tip — Never assume your new patient is coming back. If you treat every new patient as a possible single session intervention, you may be surprised to find how powerful and helpful that one session can be for people.
Read the full article at the American Psychological Association: Make the most of one session
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9 Comments to
“Single Session Psychotherapy”
Could we see a bit of a self fulfilling prophecy here? one plans for 1 session interventions so more clients fail to return? On the other side of the coin you could argue that this begins to take the steam out of the ‘drugs are cheaper than psychotherapy so that’s what I’ll prescribe’ attitude. Interesting…
” Others likely just find the therapy experience not helpful to their needs, not what they expected, or disliked the particular therapist they saw ”
Or perhaps they moved to a different therapist and didn’t stop after a single session after all.
True, but from a therapist’s perspective, that would’ve been a “one session” client unless told otherwise.
Most people don’t know this, but it’s okay to not like the first therapist you go and see. So many people build it up in their minds that they feel they can’t go through it all over again with a different therapist, even if it’s obvious there’s no connection or rapport between the therapist and client.
One needs to shop around for a good therapist, just as one would for any health professional, be it a dentist, family doc, etc.
I know a fair few people in therapy and it isn’t at all uncommon for people to see 10 or 12 before finding someone who they felt they could work with. That isn’t (in the significant majority of cases) either the therapist or the patients fault - it is just a matter of fit. Good fit can be hard to find.
I have seen a fair few therapists in my day and I’d say that I’d have a fairly good idea of whether we clicked or not after that first session. I’m well aware that therapists who I didn’t click with clicked really well with some of their other patients. I was surprised, however, at how many therapists thought that because I was seeing them once I was seeing them for the long haul.
That was one thing that really clicked well for me with my current therapist: He said that in the initial session we would see whether we felt we could work together. It was a mutual decision. He asked me some questions. He asked me if there was anything I’d like to ask him. He asked me what I’d like to work on / talk about. Of course that approach might not click well with other people… I guess different people are different. Some might like to focus on one particular problem in that first session, but others might not.
Therapists are like pest exterminators: it’s always in their best interest to NOT fix the problem. The toxic psychodynamic model has so infested nearly all approaches that therapists consistently report finding themselves stunned and skeptical when a client actually gets better. Or worse, gets better without the therapist!
George I think you are on the money! Unfortunately I have seen too many therapists show too much attachment to the money or to their therapeutic approach, instead of looking at what helps the client and what state they are in. The only exception seems to be those understaffed, underfunded therapists, eg in university campuses, hospital clinics and so on. For them they have to get so much done in such a short time the problem tends to be the opposite- kicking the patient out as soon as he passes the actue phase, to help the next suicidal character!
Most therapists I have seen just listen and say uh huh. They thought I just wanted to be heard but what I wanted was real change. My problems are difficult to solve as I have a severe chronic physical illness and anxiety and depression as well. I have found my own way of coping and wouldn’t waste money on therapy again. I was often looking for love and friendship which is a mistake in therapy. I would imagine a lot of people seek those things from their therapist. A good therapist will help the client find their own resources and social connections so that therapy is no longer needed. Clients usually have relationship problems which brings them to therapy. Thank God I am now my own best friend.
Speaking as a single session patient myself I can tell you that after seeking out help for my depression and then actually following through with the appointment and being able to talk with candor about my problems with a complete stranger made me realize that I had a large measure of control when it comes to my mental health, far more than
I had given myself credit for. So even though I wasn’t particularly impressed with the therapist I got the sense of empowerment
I needed from a single visit and have been alot better and more able to head off my mental problems before they become so since that single visit 8 months ago.
Actually, “single session” in the published literature is defined as clients who do not return for a second session but, upon follow-up up, have not pursued further therapy. In fact the 30 - 50% that found a single session helpful never went back for further treatment — one session was enough. (See Talmon, 1990, Bloom, 2001; Hoyt, 1995.)
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Last reviewed: By John M. Grohol, Psy.D. on 8 May 2008
