What is going to be useful for you today?   Maximizing every mental health conversation and interaction

Jul 8, 2025

A One-at-a-Time (OAAT) Approach is a core component of our evidence-informed Stepped Care 2.0® model. OAAT counselling – sometimes called Single Session Therapy (SST) – offers a strengths-based, trauma-informed, person-centric practice which considers that every interaction within mental health and substance use health care systems is an opportunity for a person to have a helpful experience and address their immediate concerns.

By: Alesya Courtnage, MA, RP

I have facilitated training with people from all over the world in One-at-a-Time (OAAT) practices and one of the questions I get almost every time is: “Okay, so I can see how that works with the ‘easy’ problems, with the ‘lite’ problems. But what happens when things are complicated? What happens when there is a crisis? What happens when there’s trauma? What happens when there’s risk?”

When faced with these kinds of “big” situations, practitioners seem to struggle with the idea that we’re going to need to do something different, because the OAAT approach won’t be sufficient. I think this makes sense since most of us are taught, as we’re learning about mental health and how to do mental health interventions, that big problems require big treatment.

In One-at-a-Time, we push back against that.

Why? It may be different where you are, but certainly in my experience, and in my therapy practice, the people who are experiencing the most distress, the most difficulty, the most complicated situations, are actually the ones who are least likely to come back.

Why? Because they have a lot going on. Because their lives are often systemically disorganized with many competing needs and pressures. So this idea of coming back at a set time–or committing to things in the future–is just not realistic for them. 

In One-at-a-Time thinking, instead of fighting against this reality by trying to coerce or  convince people to come back for these big treatments, we just accept that it is not going to work for everyone. No matter how big or small the problem. 

What that means for us as therapists and counsellors is that we have to start approaching the work and encounters with people differently. We have to begin our conversation by asking what is going to be useful in the time we have together. Instead of trying to figure out what the client needs, we can ask them what is going to make a difference today, regardless of how large, severe, or intense the problem is.

To do that effectively, we must believe and see people differently than most of us are taught. We have to look at people and see them from a position of strength or capacity. We have to see their resources and recognize that maybe our job is to mobilize the things that are there, instead of trying to introduce some kind of brand new way of being. 

Why? Because even if they’re in “hot mess” territory, they are here with you. Which means they are currently alive and surviving, even imperfectly. And that means that they have done something well and something right. 

And so the focus of One-at-a-Time therapy is not on solving all these big problems. The focus of an OAAT counselling session is to say, “Okay, here we are. What’s going to be useful for you today?”

The beauty of that is that it aligns really closely with things like trauma-informed practices which say that people get to choose when, where, how, who, and if they talk about their big problems. One-at-a-Time respects this. 

One-at-a-Time works with what’s in front of us, in that moment. Not what we think should be in front of us or what might be in front of us in the future. This is a very different way of approaching our practice–but it is incredibly powerful. Not just for those on the receiving end, but for us as mental health professionals, too. 

Alesya Courtnage is a subject matter expert and trainer in One-at-a-Time (OAAT) practices with Stepped Care Solutions and a registered psychotherapist in Ontario, Canada.

 

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: