Between 20 percent and 40 percent of psychotherapy clients stop after a single session, says Michael Hoyt, PhD, a researcher and clinical psychologist with Kaiser Permanente in San Rafael, Calif., and author of "Brief Therapy and Managed Care" (Jossey-Bass, 1995).
Though therapists may consider these single sessions failures, in his research Hoyt discovered that clients disagreed.
"Most people felt that one or two visits was all they needed," he says. "The session gave them good ideas, and they took those ideas and ran with them."
Indeed, as-yet-unpublished research by a team of psychologists from the Department of Veterans Affairs, found a single, 60-minute session can even help people with serious mental illness. After just one "motivational interview," participants were significantly more likely to enter a vocational rehabilitation program, and they stayed in the program for three months longer than a control group, says Lisa Mueller, PhD, a research associate on the study, led by psychologist Charles Drebing, PhD.
"Single sessions have also been helpful in helping people reduce problem drinking and drug abuse," she says. Of course, single sessions aren't always adequate, especially among clients with obsessive-compulsive disorder and other recalcitrant problems, Hoyt notes.
Here are some tips for making a big difference in a little time:
Zero in on a problem. "Patients sometimes just want to deal with their problems, not rework their whole life story," says Hoyt. He asks clients a question developed by social worker Steve de Shazer: "If, by some miracle, you wake up tomorrow and the problem is gone, what would your life be like?" In answering this question, people reveal what they want most, whether it's a peaceful relationship with a spouse, a lifting of depression or a more fulfilling job. Alternately, therapists can simply ask clients what they'd like to focus on first, he says.
However, if a client does want more self- exploration, it'll probably take longer than a single session and the therapist should tell them so, notes Howard Book, MD, a psychiatrist and author of "Brief Psychodynamic Psychotherapy," (APA, 1998).
Unearth hidden resources. Like Dorothy in her ruby slippers, people often have the tools they need to get where they are going, but they need help putting them to use, says Hoyt. For example, Hoyt recently asked a client with anger management issues to recall a time when he wanted to hit someone but managed not to. Upon reflection, the man realized that he has many ways to control his anger, including deep breathing, distraction and reframing the situation.
Don't cajole. In single-session situations, it's important to establish the therapeutic alliance quickly--and show that you are on the patient's side. So instead of trying to talk clients into change, Mueller encourages them to explore the pros and cons of their current dilemmas. For instance, one of Mueller's clients worried that work stress might spur a relapse of his drug addiction. Mueller acknowledged his worries and helped him come up with practical ways to minimize the chances of that happening, without avoiding work altogether.
"We want people to talk about what is tough about change," she notes.
Plan for the future. Obviously, you can't fix all of a client's problems in 60 minutes, says Hoyt. But you can help clients head in the right direction by educating them about psychological research and providing skills training. For instance, he recently educated a woman about panic attacks--particularly how her interpretation of physical symptoms can turn a harmless heart palpitation into an intensely stressful situation. They also practiced mental imagery and muscle relaxation techniques that can stem panic attacks before they spiral out of control.
"What we are trying to do is help people get unstuck or back on track," he says.
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