What’s in a name?

What to call therapy where a client may come once

by Windy Dryden

In 1990, an Israeli psychologist, Moshe Talmon, published a book that would herald a way of working with people therapeutically and would challenge conventional ways of thinking about therapy and how it is normally practised. Talmon was not the first to write about working with people who often only attend one session. Indeed, Sigmund Freud wrote about times when he was asked to consult with someone when he was on vacation and was able to help them in one session (e.g., Freud & Breuer, 1895).

Therapists, in general, are very suspicious when it transpires that a client has only come once. Data from agencies across the world indicate that the most frequent number of sessions clients have is ‘1’. (e.g., Brown & Jones, 2005; Hoyt & Talmon, 2014). This is formally known as the ‘mode’. Therapists refer to the client as having ‘dropped-out’ of treatment or having terminated therapy ‘prematurely’. However, these somewhat pejorative remarks are decidedly from the therapist’s perspective. While not wishing to deny the fact that, in some cases, a person deciding not to return for a second therapy session indicates dissatisfaction with the first session, research and service data show that clients who decide to come once are often satisfied with the help they have received in the first (and only) session and decide not to seek further help. These data are more pronounced when this form of therapy delivery is planned and contracted, that is where the therapist and client agree to meet to help the client get what they came for in that one session on the understanding that more help is available to the client on request.

This way of working with people challenges perceived therapeutic wisdom such as ‘it takes time to forge a good therapeutic relationship which cannot be done in one session’. See Dryden (2022) for a discussion of this and other ways in which this mode of therapy delivery challenges more conventional ways of thinking about therapy. Another challenge is posed by what to call this mode of therapy delivery.

In this article, I will consider the issues one faces when deciding what to call therapy where the intent is to help the person in one session but where more help is available. I will review the two names currently used: Single-Session Therapy (SST) and One-At-A-Time Therapy (OAATT), and explain my reservations about them. Then I will explain why I prefer the term ONEplus Therapy.

Single-Session Therapy
Whenever I give a training workshop on single-session therapy, I emphasise that the purpose of SST is for the therapist and client to work together to see if they can help the client meet their stated wants from the session while acknowledging that more help is available to the client if requested. However, people continue to hear that the nature of single-session therapy is that it provides therapy lasting one session only. They sometimes refer to this as ‘one-off’ therapy. These people then argue that in SST, we restrict help offered to people and only offer them one session when they want more. This is decidedly not the case.

However, the difficulty here is that single-session therapy can last for one session only. This occurs when the client states in advance that this is all they want, and the therapist concurs with this. Yet, single-session therapy can also refer to the situation mentioned above, where it can be one session but involves additional help. Jeffrey Young (2018) acknowledges the difficulties inherent in the term ‘single-session therapy’ but argues for its retention because it has ‘shock’ value – it interests and challenges therapists new to this mode of therapy delivery. I understand this viewpoint, but as ‘clarity’ is one of the central principles of this mode of therapy delivery, there should be, in my opinion, a description of this way of working with people that is clear and accurate. Given the ambiguity surrounding the term ‘single-session therapy’, my approach is to look for a different, unambiguous descriptive term.

One-At-A-Time Therapy
Michael Hoyt (2011) introduced the term ‘one at a time’ to refer to SST. Hoyt et al. (2018) state that this term describes the situation where “therapy takes place one contact at a time, and one contact may be all the time that is needed” (p. 5). However, particularly in university and college counselling services in the United Kingdom, ‘One-At-A-Time Therapy’ (OAATT) has been used to describe a situation where students can only book one session at a time and in some services, what has been referred to as a ‘purposeful pause’ has been imposed so that students have to wait for a period, often two weeks before they can make another appointment. More formally here, at the end of the session, clients are asked to engage in a process called ‘reflect-digest-act-let time pass-decide’ where they are encouraged to reflect on their learning from the session, to digest it (meaning to make connections with other relevant areas of their life), to act on their reflections and digested learning and to see what happens before they decide whether or not to seek more help. I have no objection to this when it is proposed as one way forward after the session. My objection is that it is the only way forward for clients after the session. This practice reflects the situation in other agencies where clients are told that they will be contacted two weeks (for example) after their single session and asked how they are getting on and to see if they require further help. Therefore, one-at-a-time therapy excludes the possibility of the client deciding to make another appointment to see a therapist at the end of their single session. While this makes sense from an organisational perspective, it appears to be at variance with a central principle of this way of working with clients where the client is the principal decision-maker.

ONEplus Therapy
Given that I have reservations concerning the terms ‘single-session therapy’ and ‘one-at-a-time therapy’, what do I suggest instead? I have decided to call the mode of therapy delivery ‘ONEplus Therapy’ (see Dryden, 2023). I have capitalised the word ‘ONE’ because it indicates it is a principal objective of this way of working to help the person with what they have come for by the end of the session. The word ‘plus’ is attached to the word ‘ONE’ without a space to indicate that more help is available to the client on request and that this is an integral part of the delivery mode. Unlike ‘One-at- a-time therapy’, ‘ONEplus Therapy’ does not restrict when the person can access further help should they decide to do so. Also, the person can access any form of therapy delivery offered by the agency or practitioner. If they request a form of help not provided by the above, then, if possible, a suitable external referral is made.

In addition, given the dual nature of this way of working (let’s help you in one session/more help is available), the term ‘ONEplus Therapy’ does not suggest that only one session is offered to the client, which, in the minds of many, is suggested by the term ‘single-session therapy’. I hope that the term ‘ONEplus Therapy’ clarifies the essence of what we try to do in offering this mode of therapy delivery.

This is to offer therapy where the therapist and client contract to meet for a session of therapy and work together to help the client to achieve their stated wants from that session on the understanding that further help is available to the client on request.

An earlier version of this piece appeared in Dryden (2023).

Windy Dryden is Emeritus Professor of Psychotherapeutic Studies at Goldsmiths University of London. His goal is to disseminate SST/ONEplus Therapy. His latest book is ONEplus Therapy: Helping People at the Point of Need.

References

Brown, G.S., & Jones, E.R. (2005). Implementing a feedback system in a managed care environment: What are patients teaching us? Journal of Clinical Psychology, 61, 187-198.

Dryden, W. (2022). Single-session therapy: Responses to frequently asked questions. Routledge.

Dryden, W. (2023). ONEplus therapy: Helping people at the point of need. Onlinevents Publications.

Freud, S. & Breuer, J. (1895). Studien über hysterie. Deuticke.

Hoyt, M. F. (2011). Foreword. In A. Slive & M. Bobele (Eds.), When one hour is all you have: Effective therapy for walk-in clients (pp. xix – xv). Zeig, Tucker, & Theisen.

Hoyt, M. F., Bobele, M., Slive, A., Young, J. & Talmon, M. (Eds.). (2018). Single-session therapy by walk- in or appointment: Administrative, clinical, and supervisory aspects of one-at-a-time services. Routledge.

Hoyt, M. F. & Talmon, M. F. (2014). What the literature says: An annotated bibliography. In M. F. Hoyt & M. Talmon (Eds.), Capturing the moment: Single session therapy and walk-in services (pp. 487-516). Crown House Publishing.

Talmon, M. (1990). Single session therapy: Maximising the effect of the first (and often only) therapeutic encounter. Jossey-Bass.

Young, J. (2018). SST: The misunderstood gift that keeps on giving. In M. F. Hoyt, M. Bobele, A. Slive, J. Young & M. Talmon (Eds.), Single-session therapy by walk-in or appointment: Administrative, clinical, and supervisory aspects of one-at-a-time services (pp. 40–58). Routledge.

IAHIP 2023 - INSIDE OUT 100 - Summer 2023