Single Session Therapy: What's in a Name?

The term ‘single session therapy’ (SST) is a great misnomer, given that almost universally, it would seem, about half the clients who are seen within this approach go on to engage in further therapy work, with a small percentage engaging in long-term therapy. It is not, as some critics (and researchers) assume, the same as offering only one session of therapy. So why call it single session therapy? The term has served us well at Bouverie, despite (and sometimes because of ) its obvious connotation. We have stuck with it, partly out of loyalty to Moshe Talmon’s original (1990) book title (though he tells us that this was his publisher’s rather than his own preferred title!), and partly because we have failed to find a term that encompasses what we are trying to offer in this work: the possibility that clients can be helped in a single encounter, as well as the possibility that it may well be useful for client families to engage in further work, and that this decision is best made not by the therapist alone, but in consultation with our clients. It is now 18 years since we at The Bouverie Centre heard about the idea of inviting clients for a planned single family therapy session, with the option of either a further single session or ongoing work, decided between therapist and clients together at a follow-up phone call. At that time, our service was struggling with long waiting times and inequities for families, in that some managed to receive urgent allocation while others languished on the waiting list without complaining. Because of this, a lot of staff time was spent ‘gate-keeping’ in an attempt to rationalise the often scarce clinical resource. There were long and often toughly debated intake–allocation meetings, often resulting in families being called back with a ‘sorry’ and re-referral options only. A common experience was that the clinician who had spoken with the family at intake (and having clearly engaged with them) argued strongly on their behalf, while other staff, conscious of the burden of the waiting list, held a tougher line, and argued against their being seen at Bouverie. We have reflected often, both then and since, that if the time put to gate-keeping and debating those issues had been spent with the families, perhaps we could have been clearer more quickly about the appropriateness of their being seen at Bouverie, and been somewhat helpful, even if ultimately it was felt a referral on was needed. However, back then the idea that some families could do well with a single clinical contact and follow-up surprised and even shocked some of us. It was only with time and learning from our clients that we came to trust that this was not only a valid option for service delivery, but a client-centred, efficient and effective way to manage a clinical service — especially given that it also allowed for useful longer-term work with those families who needed and did well with more.