The Micro-Session Is the Newest Trend in Therapy
But does a one-time, 60-minute shrink appointment actually help?
I’ve gone to therapy exactly once. I was glad I showed up, but when my session concluded, I shook my therapist’s hand and never saw her again. I assumed this was the complete opposite of what you’re supposed to do. But mental-health professionals who have integrated a single-session-therapy (SST) approach into their practice don’t actually consider a “one-and-done” session such as mine a failure.
Not at all, in fact.
Moshe Talmon, the founder and director of the International Center for SST who teaches his methodologies at universities and health centers around the world, is one such psychotherapist. Born in Israel and educated at the University of Pennsylvania, Talmon wasn’t long into his career with Kaiser Permanente in the Bay Area when he took notice of how many of its clinic’s patients didn’t come back for a second visit. Alongside his colleagues Michael Hoyt and Robert Rosenbaum, Talmon began following up with these patients and soon realized that many of them didn’t return because they hated the therapy or found it ineffective; no, instead, many actually thought one session was more than enough.
That, in turn, inspired Talmon to rethink his approach to his first encounters with patients, listening more deeply and actively from the very start of their communications and using his initial time with them to generate as much practical change as possible — rather than using that first session to develop a long-term treatment plan (per the industry standard).
Tell me more about how you became interested in single-session therapy as a treatment technique. During [my time at Kaiser], I encountered this phenomenon of people who’d never seen a psychotherapist before. They came for what’s usually called an intake, which is just to gather information. They never, however, showed up for a second appointment. At the beginning, we clearly thought this was a failure of the therapist to connect well with the client. In the literature, we called these people “dropouts.” But when we started to follow up with them, we realized a lot of them felt that much had been accomplished with that one intake — much beyond what the therapist could anticipate.
This experience started a series of projects where we researched the possibility that one session may be enough from the very beginning, allowing both the client and the therapist to do whatever they can in that one session. For an early project, we essentially created two groups and compared them. One group was people who selected to come for only one session, who we then followed up with for three months, six months, a year and two years after that single session. We compared them to the people who selected to go to ongoing therapy. This comparison yielded surprising results. We found that many of the single-session patients did as well as the people who were doing ongoing therapy. People who only had a single therapy session weren’t just pleased and satisfied with their outcome, they also reported a better outcome than people in the long-term group, too.
All of which started to show us how to conduct a session in the here-and-now that allows people to choose for themselves whether or not they want to have that one session and then get back to the business of life without the help of a therapist. I published my first work about this in 1990 and was sure people would either not read it or reject it. Surprisingly enough, though, quite a few people picked up on it and research began in other states and countries, where the results proved similar.
After your initial research into SST, did the way you approached your new clients change significantly? It made a huge change in my way of operating with people in both single-session therapy and in ongoing therapy. This, though, was very challenging. When we became clinical medical psychologists, the assumption was problems have a lot of layers and were very deeply rooted. We were taught to get the heart of the problem, and in order to do so, we needed to know a lot about the client. We needed to create what therapy calls transference and countertransference in the relationship, in which clients begin to project all kinds of feelings on you and analyze them and so forth.
SST helped me realize somebody can make a shift in their thinking, feeling or behavior at any given moment. Profound change can happen at any time, at any minute during any session, including the first one. So the most important thing I learned was to never underestimate my clients and never give up on them. When you look at studies of people with major depression over the course of 24 sessions, the research shows that those people who improved and got out of their depression did so during their first three sessions. Much of the power of therapy is in the beginning.
In other words, a deep contact can happen even if I might be missing a lot of information about somebody’s history. Not all of the time, but sometimes. It’s like the ability of people to fully love at first sight. There’s something meaningful and powerful that can occur during those first moments when someone is overwhelmed and comes in hoping for the best but preparing for the worst.
Are there certain types of clients that you think are best suited for single-session therapy? We’ve spent a lot of time trying to answer that question, but we haven’t been able to come up with any clear or conclusive findings. That said, people who come in with a very real problem that they’re very aware of do really well in SST. An immediate problem. A painful problem. Something they want to solve, or something that gives them back the power over their own lives or their own choices in life. This sort of awareness going into a session does facilitate a more effective single-session therapy experience.
This is why there are therapeutic walk-in clinics all over the world now [and similarly oriented apps]. You basically walk into a place — it could be in a shopping mall, for example — and there’s no paperwork or exams to take before you meet with a therapist five minutes after walking into the clinic. You hit the ground running and try to do everything you can within that one hour. It’s a remarkable mindset that allows both the therapist and client not to bullshit each other too much.
Do you think that the opposite can be true, too — that SST can help people, especially men, who aren’t as clear about their problems or even that likely to try therapy in the first place? It can overcome some of the fears people have that make them avoid therapy. It’s unfortunate that more than 50 percent of people who suffer from serious mental health problems still have never seen a therapist. It’s not because there’s a lack of therapists or a lack of people who want to provide therapy. It has more to do with the fears people have about how long, how extensive and how much it will require them to dig into things they might not want to deal with.
So yeah, SST is more likely to help people who aren’t interested in long-term therapy and more likely to help people who cannot afford long-term therapy. It also can allow people who aren’t interested in psychoanalyzing themselves to acknowledge a serious problem they want to cope with or solve.
In SST, we respect the focus or definition of the problem that the client brings into the session. We don’t say to them, “Oh, you don’t have any problem with your boyfriend. You have a problem with your father,” or “You don’t have a problem with your stomach. It’s a problem with your avoidance.” We aren’t trying to teach them a new language or a new way of psychoanalyzing themselves. I think that allows people to engage, to open up and feel like they were heard and understood. SST is effective at validating a person’s experience, which is sometimes all they need.
In that way, SST has taught me not to try to outsmart or “cure” my clients, but to be as useful and helpful as I can be during our time together and hope we can connect in a meaningful way. Sometimes this doesn’t even require a whole session. It can happen in five good moments — or just one good moment.
Tierney Finster is a contributing writer at MEL. She last wrote about why it’s so difficult to bring the #MeToo movement to the porn industry.