Single-Session Therapy (SST)

Windy Dryden is in part-time clinical and consultative practice and is an international authority on Cognitive Behaviour Therapy. He is Emeritus Professor of Psychotherapeutic Studies at Goldsmiths, University of London. He has worked in psychotherapy for more than 40 years and is the author of over 225 books.

Contents

Preface

Part 1: The Nature and Foundations of SST






What is SST?



The development of SST



What SST is not



Even a brief encounter can be therapeutic



The expandable nature of therapy length



The modal number of therapy sessions internationally is ‘one’, and the majority of people who attend for one session are satisfied



It is difficult to predict, with accuracy, how many therapy sessions a client will attend



What is a ‘drop-out’?



Intermittent therapy through the life cycle



Sooner is better and less is more



Human beings can help themselves quickly under specific circumstances



The choice of SST is the client’s, but sometimes such choice may be limited



Three key themes: Mindset, time and client empowerment



An SST-informed attitude to clinical work



The diverse nature of SST



The goals of SST



SST challenges established beliefs about therapy and change



The length of SST



Different approaches to SST
Part 2: The Assumptions of SST




Client-centred and client-driven



Reciprocity in openness and feedback



Future-oriented, but present and past sensitive



Readiness



Strengths-based



Resources-based



Complex problems do not always require complex solutions



A journey begins with the first few steps
Part 3: Facilitative Conditions for SST




Intentionality



Expect change



Clarity



Effective session structure



Effective goal-setting



The therapist’s use of expertise rather than being the expert



Helpful attitudes for SST therapists



Characteristics of ‘good’ SST therapists



SST: The do’s



SST: The don’ts



A conducive environment for SST



The pluralistic nature of SST



Characteristics of ‘good’ SST clients
Part 4: Criteria for SST




The client criteria question



Therapist indications and contra-indications for SST



Service indications and contra-indications for SST
Part 5: Getting SST Off on the Right Foot




Respond effectively to the person’s very first contact



Prepare for the face-to-face session: I. Getting relevant information



Prepare for the face-to-face session: II. Tipping the balance towards change



Prepare for the face-to-face session III. How do you think I can best help you?



Suggest possible tasks between the pre-session contact and the session



Consider sending an email summary



Realise that the pre-session contact may be sufficient
Part 6: Getting the Most from the Session




Agree or review parameters



Be mindful of the working alliance in SST



Begin the session: I. Focus on tasks and activities carried out by the client between the pre-session contact and the face-to-face



Begin the session: II. When there has been no prior contact between therapist and client



Focus on a problem that can be solved, not one that can’t be solved



Create and maintain a working focus



Help clients deal with adversity, if possible



Negotiate a goal



Understand how clients unwittingly maintain their problems and use this understanding to help them solve these problems



What to change: I. Individual-focused change



What to change: II. Environment-focused change



Focus on and use pivot chords



Agree markers for change



Notice and encourage change



Focus on the second response not the first



Look for exceptions



Look for instances of the goal already happening



Encourage the client to do more of what works or might work and less of what doesn’t work



Make an emotional impact



Utilise the client’s strengths and resources



Utilise the client’s role model



Utilise topophilia in SST



The use of stories and parables



Use humour



Use paradox



Use the friend technique



The use of chairwork in SST



Convert meaning into a useful and memorable phrase



Educate when clients appear to lack information or have faulty information.



Agree on the solution



Encourage the client to practise the solution in the session



Summarise the process



Take-homes



End the session



After the session: Reflection, the recording and the transcript



Follow-up



Example of an SST structure: AUB
Part 7: Walk-in Therapy




Two pathways to help



The nature of walk-in therapy



The case for walk-in therapy



Foster an alliance with the service rather than with a specific therapist



How walk-in services are advertised



A guideline for walk-in session structure influenced by brief narrative therapy



Frequently asked questions (FAQs) about walk-in therapy
Part 8: Other Forms of SST




Clinical demonstrations



Filmed training tapes



Second opinions

Part 9: SST: Personal Contributions and Learning

98. ‘Single Session Integrated Cognitive Behaviour Therapy’ (SSI-CBT)

99. ‘Very Brief Therapeutic Conversations’ (VBTCs)

100. Personal lessons learned from practising SST

Epilogue: The Future of SST - Interviews with Key Figures