Windy Dryden, RECBT Therapist, Trainer & Academic

In the last five years, I have become increasingly interested in Single-Session Therapy (SST) and One-At-A-Time Therapy (OATTT) as a way of providing therapeutic help at the point of need rather than at the point of availability. The consensus in the SST/OAATT community is that this way of delivering services is based on an agreement between therapist and client  that they will intentionally work together to help the client achieve what they want from the session, knowing that more help is available if needed. After the session (which may be the only session the client has), the client is encouraged to reflect on what they learned from this session, digest this learning, take action based on this learning, and see what happens before deciding whether or not they need further help.

SST/OAATT are NOT therapeutic approaches in the sense that CBT, Gestalt therapy, and person-centred therapy, for example, are, but this way of working can be used by practitioners from a broad range of therapeutic orientations if they adopt a particular mindset. As I outline this mindset, I will stress its pluralistic features.

1. Clients determine the length of therapy and many of them decide to come just once. As many people have noted, the modal number of sessions clients have is 1, and that 70%-80% are satisfied with that single session. Clients are telling us something important here and SST/OAATT therapists have listened and have provided single-session services by walk-in or by appointment. It is feature of pluralism to take very seriously what clients say and take suitable action.
2. SST/OAATT is pluralistically client-centred in several ways. First, the client is asked how the therapist can best help them. Rather than be at the therapeutic whim of the practitioner, the client is encouraged to play a major role in determining their own therapy.  This, of course, calls upon the practitioner to be responsive to the client’s sense of what is important to them and be flexible and skilful enough to be able to do so, which well-trained pluralistic therapists are Second, given that therapist and client may only meet once, the client is asked what they want to achieve from the session rather than the more often asked question concerning what they want to achieve from therapy overall. Here, the therapist helps them to be realistic framing the work as helping them to get unstuck and to take a few steps forward. Third, the client determines the focus of the session and the therapist helps them to maintain this focus. 
3. SST/OAATT is strengths-based in focus which is an important feature of pluralistic therapy. The client is invited to identify their strengths and encouraged to see how they can deploy relevant strengths in addressing their nominated issue. The client is also invited to nominate resources external to them that could be similarly helpful.
4. Rather than start from scratch with the client, the SST/OAATT asks them to share the attempts they have previously made to address the issue. The therapist encourages the client to make use of any strategies that were helpful and to cast aside those strategies that were not.
5. Based on the client’s ideas about what may be helpful to them, their internal strengths and external resources and previously helpful strategies the client and therapist engage in shared decision-making concerning a viable solution to their problem. This shared decision-making is a prominent feature of pluralistic therapy. 
6. Finally, there is no one right way of practising SST/OAATT — different clients need different things at different points in time which is another key feature of pluralistic therapy.

For more information about Single-Session Therapy and One-At-A-Time Therapy see: Dryden, W. (2019). Single-Session Therapy: 100 Key Points and Techniques. Abingdon, Oxon: Routledge.