By: Dana Warren, MSW, RSW
noun: approach; plural noun: approaches
a way of dealing with something.
“we need a whole new approach to the job”
A lot has been written about Single Session Therapy or One-at-a-Time Counselling. Over and over again, evidence demonstrates the flexibility and ability of the approach to diminish waitlists and save time and money. One of the criticisms is its effectiveness in building rapport with the client, a long-held belief about what works in therapy. Another is the “value” to the service user of traditional Western diagnostic assessment. These are two considerations that I will briefly explore based on my community practice and supervision experiences.
As a practitioner and someone who’s been working in community for almost a decade using a single session model approach, I have found that one of the ongoing challenges both at the practitioner and user level is the “one at a time” concept and if it’s possible to connect in a meaningful way. During my community work, I came to the approach for many of the reasons similar to larger mental health services: to offer immediate service and fill gaps. Working in community, we needed a nimble approach to mental health services, this seemed to fit the bill.
Early in the development of the drop-in-counselling service, we used the concept of “single session school” to keep us all in the principles of the approach. Each week, we’d mull over a concept, like connection in our group supervision, and then embody that in the one-at-a-time counselling sessions of the week. We had to fight hard against the doctrine of therapy as a process that only worked over time through the development of a working alliance that took several sessions. I don’t remember when I made the switch, but I know it took a leap of faith and especially trust in the person sitting across from me that they actually knew what they needed.
Over the years, I supervised numerous students and therapists who couldn’t quite buy into the idea that connection, empathy, understanding, and meaningful outcomes could occur during a single conversation – a perspective that evokes the idea of our value and expertise to believe that people know what they need. Human beings have been connecting and caring for each other since time began. Convincing ourselves that we don’t have to know everything despite the professionalization of counselling was, by far, the biggest challenge.
Over time, I developed a series of workshops that explored the idea of suspending our assumptions that are based on professional knowledge so that we could become free to lean into an OAAT approach. There’s no doubt that this approach to therapy (or any interaction for that matter) goes against what we traditionally learn through various therapy/counselling courses. Institutions grade and value our knowledge base, as well they should. Over time, I imagined my professional knowledge as something that could either become a wall between me and the person seeking service, or it could be the adjunct to the relationship in the moment. Holding knowledge loosely allows me to use my knowledge AFTER I get curious about the person sitting across from me.
Let’s talk about an example. Kate sat in the chair, and we reviewed her intake. She wanted to know if she was depressed and what she should do about it. A traditional approach might be to bring out the list of the symptomatology of depression. I could have asked questions that would confirm or deny the state of being and focus on depressive symptoms. I would have had a theory that would inform the evidence I was seeking. Or, in a single session approach, we could explore the impact of the problem and utilize a curiosity that is informed by professional knowledge while suspending conclusions about the problem.
I asked Kate many questions about her life, how she was experiencing the problem/problem exceptions, who noticed it, when it was more or less dominant, and if it was there all the time or just some of the time. When did it show up? Mapping the life of the problem lets us see firsthand how it comes to be. Through curious inquiry and the suspension of my knowledge, she shared with me that she had lost a very close friend a year ago, and another one left their sports team suddenly a few months ago. She said she missed her friends, and she described sadness and loss and how she wondered what she did to “break up” the friendship. The pandemic also all but shut down her sports events, which left her feeling disconnected and alone.
All the time, I was checking my knowledge. I could see the list of depressive symptoms in my head, and the more I let that sit on the sidelines, the better I could be present for whatever the outcome would be, to be determined by Kate herself. Toward the end of our conversation, I said, “So here’s what depression looks like, and I listed the symptoms. I asked, “Do you think you’re depressed?” Even though she could tick the boxes of numerous symptoms, she said, “No, I think I’m sad and lonely because I lost my friends and the things I love to do.” I asked, “Where did you get the idea you were depressed?” “My Aunt told me I was depressed and that I had to go to the doctor and get something for it, and I didn’t want to do that, so I came here instead,” she said. We smiled together.
We continued to explore how she would approach her feelings by creating a plan of support based on past experience. We were able to create a very fulsome approach to how she could re-engage in the things that were important to her, and she said that she felt “better” and more empowered with the knowledge that she was sad but that her sadness made sense. Strangely, one of those things that I still remember was that an unexpected part of Kate’s plan was to ride the bus – an activity that gave her pleasure. I couldn’t make that one up! I wrapped up our session with more questions to help reinforce her success, she filled out an evaluation in the lobby, and we said goodbye.
While the easier route is to diagnose problems, it doesn’t always lead us to the place where people are. Kate never returned for counselling. I assumed that she was doing well and re-engaged in her life. She may have even had a chat with her Aunt to let her know what depression actually was….and how she didn’t have it.
Based in St. John’s, NL (Ktaqmkuk), Dana Warren (she/her) is a lifelong learner and feminist social worker and therapist. Her passion for equity and access to robust mental health services has led her to create and influence programming and service approaches that centre folks as experts. She has a specialized focus on gender-based violence (GBV) and one-at-a-time counselling.
Dana Warren on LinkedIn
Stepped Care Solutions has embarked on a special series to explore different perspectives on One-at-a-Time thinking. Through blog posts, podcast episodes, webinars and conversations, we will learn from various individuals about how OAAT thinking can be applied in different contexts. We hope you join our conversation and share your thoughts.
More in our OAAT Series:
- Introducing the One-at-a-Time (OAAT) series (November 10, 2023)
- Shifting Mindsets in Italy with a Single Session Approach (The “So, why?” Podcast with guest Dr. Flavio Cannistrà, October 20, 2023)
- New Brunswick transforms mental health services through SC2.0 (November 21, 2023)