I have long known that my therapeutic approach with Hishtalmoot has been rather unconventional.
I typically let clients book with me when they want, by giving them a link to my scheduling calendar. There is no assumption as to how frequently they will return to see me. I have worked with many people only once, other times, for many months in a row.
This goes hand in hand with my other guiding principle – to attempt to have clients reach some sort of resolution or closure in a single session. Because I can’t count on multiple sessions, this becomes all the more important, and delivers the most valuable experience to the clients.
Studies on Single-Session Therapy
I was excited to find empirical evidence to support this claim. In his introduction to counseling and psychotherapy manual (page 501), John McLeod describes a study that explored Single-Session Therapy.
- Clients were told they could have more sessions if they needed them, but that “the intention was to work s hard as possible” within the current session to resolve their difficulty.
- Sessions were deliberately made longer, with an allowance for an hour and a half to two hour sessions.
- Clients were prepared for higher intensity sessions, and clearly identified a focus for the session.
- 58% of clients opted for a single session, and, one year later, 88% of these clients rated their problem as “improved or much improved”.
The theory behind this approach is that it empowered clients to be the decision makers when it came to how many sessions they needed, and conveyed hope and positive expectations for the single session to be successful.
This study emphasizes just how effective a single session can be, and further places an impetus on therapists to attempt to maximize the value each session can deliver – the assumption that many sessions are needed can become a negative self-fulfilling prophecy.
At this point, multiple studies have shown the effectiveness of single-session therapy, often being equivalent to long-term therapy, with clients rating themselves as satisfied with their experience and having achieved the outcomes they initially set out to achieve.
In reality, many clients only attend therapy for a few sessions, due to a variety of reasons, including having alleviated the sense of crisis in their life, or having found the insight they were seeking. This approach aims to reframe these brief clients, not as failures for not having been in therapy for long enough, but as having gotten what they need in that short time period.
The second half of this approach is the idea of intermittent therapy – that a client does not necessarily need to address an issue week after week in order to see growth. Psychotherapist Nicholas Cummings argues that people can instead address aspects of their challenges in a “piecemeal fashion”, depending on their life situations and circumstances.
Indeed, I’ve seen clients work through an issue, then come back to me a few months later to attack from another angle, they’re now ready to “take things to the next level”, as it were.
The attitude with this approach is that a client is not “terminating” their therapy (a terrible term as it is), but rather pausing it with the knowledge that they can return when they need it.
Here too, there are two main factors that are considered helpful for client’s positive outcomes. Firstly, empowering clients to be masters of their own choices, to have the judgement as to when they need treatment, is seen as a key factor. In addition, the very sense that they aren’t “finished with therapy”, and in fact can return at any time, actually seems to lead to clients remembering and implementing what they’ve learned in therapy in a day to day basis (as oppose to filing it away as a one-and-done deal).
This approach invites us to think of mental health counselors more like family doctors, one that you come see when you need, or for intermittent checkups. The assumption from the outset is you’ll be seeing this person multiple times throughout your life.
I find the validation from empirical evidence to what I have seen in my own practice, exciting. Single Session Therapy and Intermittent Therapy is a radical departure from how most people think about therapy to one that empowers clients to know what they need, when they need, and aims to solve that need as quickly and effectively as possible.