Frequently Asked Questions

What is Single Session Work?

The terms SSW, single session work, single session therapy and single session, as used at The Bouverie Centre, are interchangeable. They all describe a service delivery system that results from accepting the fact that half or more of all clients attend session only once or twice. The service delivered is characterised by treating each contact as if it may be the last, while laying the foundation for ongoing work, if required. In other words, SSW makes the most of every encounter.   (Please note:   The term 'one-off session' is used to describe one discrete session, without the accompanying support process offered by SSW).

SSW is an approach formulated to optimise the possibilities inherent in a single session. The SSW process usually involves a pre-session questionnaire, one longer-than-normal, face-to-face session, and a follow-up phone call. The process can also incorporate formal pre- and post-evaluation.

How can it help my clients, my practice and/or my agency?

Research shows that a large number of clients in very different service settings attend session only once and that the majority of clients who decide to attend once report getting largely what they want from that one encounter. With that in mind, it is clearly advantageous to clinicians and organisations, as well as to clients, to have a planned and effective way of providing this type of service option, rather than doing a one-size-fits-all approach to client care.   

SSW is a responsive, client-directed process. It encourages and supports client feedback about the quality of the service received.   Feedback from SSW clients suggests that the vast majority are satisfied with the service, and that up to 50% decide they do not require further intervention.

SSW is an effective way to manage demand and maximise the efficient allocation of resources.   It promotes longer-term work for clients who need and want it, but it does not assume that all or even most clients do need or want long-term work.

As a clinician, SSW will help you in sessions to:   prioritise and focus, 'cut to the chase,' make time your friend, and avoid 'therapeutic drift' (aka, 'I think we are going somewhere, but I have no idea where.')

SSW can be implemented in a variety of ways to suit various organisational contexts, and The Community Services Team at The Bouverie Centre offers consultation and follow-up to assist services wishing to implement this approach to counselling; (see SSW Consultations, under Community Services on this site).

Who, and what presenting problems, are appropriate for this approach?

The single session literature contains lists describing clients and presentations for which single sessions are contra-indicated (eg. Talmon 1990). In essence, the more difficult, the more severe, the more complicated, dangerous, or chronic the presentation, the less single sessions are likely  to be recommended. Yet, a closer look at the literature also reveals individual accounts of successful single session therapy with clients exhibiting most of the listed contra-indicators. We have found that clients who are notoriously reluctant to attend therapy are often, ironically, prescribed a long and intensive therapeutic regime (eg. some embattled adolescents, some estranged ex-partners, people with gambling problems or drug and alcohol problems).  

However, these clients are much more likely to accept an invitation for a once-off session than to make a commitment for ongoing work. With experience, we have become less preoccupied about trying to accurately assess client suitability for single sessions. We have also found that we were surprisingly poor at predicting who would choose to have only one session and who would require ongoing work. So long as the appropriate system is in place to offer clients what they require at the conclusion of each single session, including immediate ongoing support, there is no need to be preoccupied with determining contra-indications.  

We do not believe that the question 'who is appropriate for a single session and who is not?' is the most useful one a single session clinician can ask, and, in fact, worrying about this too much might just get in the way of working effectively.   We find a more useful question for clinicians to reflect upon is, 'can I stay open to the idea that one session may be enough, and yet still feel free to initiate further sessions, if the client and I feel it is necessary?'

Does Single Session Work preclude longer-term work? (or, 'Does this mean my client can't come back?')

No. Single session therapy is a misnomer, because its main objective is not to offer only one session. Single session work is an approach that encourages the worker and client to make the most of each session because it may be the last session. It also encourages an open mind and an open organisation should the client need and want more help.  

A successful single session follow-up call leaves everyone clear, and in agreement, about what the next step is.   This is not about a single session cure. Ironically, for some people, especially people who are suspicious of counselling, a single session approach is more likely to engage them in ongoing work; if you do not assume that they need to come in for multiple sessions, then it is left up to them (which was always true, anyway, as whatever we think they should do, clients will ultimately 'vote with their feet').

What are some of the risks of SSW?

Initially, captured by the enthusiasm of our single session project, we were reluctant to initiate ongoing therapy, considering it a failed single session. We are now less likely to be captured either by the traditional therapeutic ideology, which promotes the view that serious difficulties always require ongoing work, or by the idea that single sessions can always replace the role of ongoing therapeutic support. In fact, single session's timely response often allows a speedier and more accurate risk assessment than an intake call, and may then lead to an immediate intensive response.  

How do you combine assessment requirements and Single Session Work in one session?

A new dilemma created by a single session approach is how to maintain a risk assessment function whilst optimising the therapeutic role of any session. Although a similar dilemma exists in ongoing therapy, there is something (possibly falsely) reassuring about knowing you are likely to schedule another session. Given that a client is not certain to return even if a session is scheduled, it is always important to act on risk concerns as they arise.  

General assessment requirements can seem at odds with a client-directed therapeutic approach. However, with practice, aspects of a more formal assessment can be included within a single session. The underlying philosophy of Bouverie's single session approach is that "one cannot assess without intervening, and one cannot intervene without assessment" (Pam Rycroft, 2001). The tension between assessment and therapy has always been there, and it is not always possible to alleviate this. Nevertheless, some experienced workers have been able to 'distil' and include within a single session, the essential elements of a more formal assessment.

Do I have to change my preferred model, and the way I work with clients?

It is important to emphasize that Single Session Work provides a framework, not a model for counselling. This framework attempts to make the most of   workers' existing skills and preferred ways of working. Some models (for example, solution-focused work) lend themselves to this framework very well, but, from the very beginning of planned Single Session Therapy, Moshe Talmon and his colleague Robert Rosenbaum decided against a "one-size-fits-all" way of working, and opted for maintaining their own preferred models, techniques, and personal styles.  

We have, however, suggested some useful contextualizing questions that are aimed at treating any particular contact as if it could be the first and the last, (while holding the possibility that it may not). The use of these questions, as well as the process of 'consulting' or 'checking in with' your clients about the work you are doing, can be smoothly integrated with your preferred way of working.

How do I know what to focus on?

One thing that has worked very successfully is a pre-session questionnaire, which clients fill out prior to their Single Session.   You can use the one developed by The Bouverie Centre, so long as the source is acknowledged, or you can develop your own. This provides a really useful guide to what clients are most concerned about, how they believe counselling will help, and their overall goals.

It can be read either prior to the session, or during the session itself. Apart from this, the most useful resource in the work are the clients themselves, and we suggest you 'consult' with clients regularly throughout the session, to find out whether you are talking about what is most important to them, and to be sure   that you are on the right track. In other words, share the responsibility for keeping the focus with your clients, who, if you ask, will let you know.

How can I develop a relationship with a client in just one session?

Single Session work rests on a philosophy that even brief encounters have the potential to be therapeutic. This flies in the face of some dearly-held beliefs about therapeutic relationships needing to be built up over time. The fact that there are so many unplanned single contacts across different service settings in different countries suggests that, whether we like it or not, a significant number of clients will only attend one session.  

The large number of single contacts may also suggest that a large number of clients are less concerned with developing an ongoing relationship with their counsellor, and are more concerned with getting enough help to get on with their lives. Some clients will embrace the idea of an ongoing relationship with their counsellor as a vehicle for working through their problems, but others won't.  

Single session work attempts to provide the best possible service to all clients:   those who embrace ongoing work and those who do not.   Just as in everyday life, we have various kinds and qualities of relationships. Some people want to develop a relationship in order to do the work, others prefer to do the work as a way of developing the relationship. In addition, certain circumstances invite the making of strong connections in a very short time. For example, when you meet and connect with someone whilst travelling and know you will never see them again, you can find yourself speaking very intimately.

In addition to all of the counselling ideas for developing effective working relationships, single session work suggests that stating the context and circumstance of the session as transparently as possible can help develop effective working relationships in one session. For example: 'We only have 60 minutes today, so what is the most important thing you want us to address together in that time?'

Does SSW lead only to superficial change?

It is a very common belief within psychotherapy that meaningful change requires long-term counselling, and yet there is no evidence to suggest a relationship between the length of therapy and the extent of change. On the contrary, studies have found that the greatest gains are made in the first few sessions (Miller, 2006).  

Single session work relies on the clients as experts in reporting about what kind and how much change is important for them at any particular time, whether it is seen by the counsellor as superficial or deep, significant or insignificant.

Can anyone do Single Session Work?

Just as SSW is not necessarily a framework that suits all clients and service settings, not all professionals find they can embrace the philosophy and practice of SSW either. It requires a willingness to work collaboratively, and to share decisions with our clients that have traditionally been seen as the responsibility of the counsellor, such as:   who to see; when to see them; for how long; and with what agenda.

SSW also requires that counsellors 'suspend disbelief' about some ideas like:   more is better; big problems need a long time in counselling; a good counselling relationship can only be built up over time.

Not every counsellor can agree to work in this way.   Furthermore, not everyone is experienced and / or confident enough to trust that s/he can bring to a single encounter, enough resources to be helpful to clients in one session. We have found that single session work is rewarding but also hard work that calls on the counsellor to be resourceful and flexible in utilizing whatever is likely to be helpful to the particular client(s) at the particular time.