If Therapy Is Too Expensive, Try Single-session Interventions

When you hear the word “therapy,” what do you imagine? Weekly hour-long sessions with someone who makes notes and occasional suggestions, so that over months or years you start to get your mental health sorted? While that’s the way we’ve traditionally approached mental health care, it doesn’t have to be the only way, according to clinical psychology professor and therapist Dr. Jessica Schleider.

Traditional mental health care is a long-term investment that many people don’t have access to. Schleider’s research indicates that finances, long wait lists, and stigma are some of the most common barriers to accessing traditional mental health care. In her new book Little Treatments, Big Effects, she writes about how effective “single-session interventions” can be when they are intentional.

What is single-session intervention?

Schleider defines single-session interventions (SSIs) as “specific, structured programs that intentionally involve just one visit or encounter with a clinic, provider, or program,” which includes digital and self-administered activities. Think of single-session interventions like a sort of mental health urgent care or first aid, meant to address your problem in the moment and send you on your way. 

“Brief and single-session mental health interventions are supported by decades of international research and practice, including my own lab’s work,” Schleider wrote in her book. “These interventions are intentionally short, designed to fit into one therapeutic encounter; that is, they acknowledge the dual realities that any therapeutic experience might well be someone’s last, and that it can be genuinely helpful anyway.”

Single-session interventions can look like one therapy session with a licensed professional, contact with a peer support specialist, or an online, self-guided activity.

“Regardless of their format, all SSIs aim to instill a ‘context of competence’ in the recipient—the idea that they already have the tools, strengths, and capabilities needed to bring about meaningful change in their lives—while instilling the belief that it is possible to take a step toward meaningful change at any moment, however brief that moment might be,” Schleider said. “This framing helps optimize people’s readiness and ability to make the most of what they learn in the next 10 to 90 minutes.”

In a mental health emergency where someone is in danger of harming themselves or others, you may call a crisis hotline, but that’s different from SSIs, Schleider explains.

“Crisis care focuses on emotional de-escalation and ensuring physical safety, whereas SSIs have potential to help people address widely varying problems, from relationship distress to low mood to anxiety about school or work. SSIs help people identify a ‘best next step’ toward a future that matters to them, regardless of their emotional starting-point,” Schleider said.

Times when a single-session intervention might be helpful

Frankly, anyone can use mental health support, and that extends to SSIs. Schleider said SSIs have been tested with people experiencing anxiety and depression, but there’s also evidence they could be helpful for traumatic stress, suicidal thoughts, and disordered eating. 

“Interestingly, the impacts of SSIs don’t seem to differ by the severity of mental health difficulty you are facing; that is, an SSI has promise to help whether you’ve struggled greatly for years, or moderately for just a few weeks,” Schleider said. “This is likely because, no matter your emotional ‘baseline,’ everyone can take a small but meaningful step in a direction that matters to them. The things that SSIs are most helpful in shifting—like a sense of hopefulness, self-confidence, or motivation to take steps forward—can help people cope with a wide variety of circumstances.”

In other words, no matter what flavor of mental health problem you face, one serving of therapy or a therapeutic activity could set you up to take the next step to feeling better.

How to access one-time mental health support

Right now in the United States, seeking mental health care can strain your finances, your time, and ironically, your mental health. Once you get to the point where you are ready to pursue therapy, you will likely wait a while for an appointment and be expected to follow through with many sessions.

“Unfortunately, there aren’t many options for people to seek out face-to-face single-session interventions at the moment—at least not in the United States,” Schleider said. “I hope my book can help spark change in that department, but training models for therapists will need to change in order for SSI availability to improve in the long-term.”

There are, however, online resources that you can access for a self-guided single-session intervention experience:

• Project YES (Youth Empowerment & Support): Designed for Schleider’s research with teens but useful for anyone. Choose from four online activities for dealing with difficult emotions, including a single-session (self-)consultation.

• Project EMPOWER: For anyone who works with or cares for children, this online activity helps you teach skills to build bravery and reduce anxiety in children and pre-teens. (But, again, it could be useful for anyone facing anxiety.)

• More resources for therapists who want to offer single-session interventions.

Additionally, there are many other ways to work on your own mental health outside of a therapy session, such as learning self-soothing techniques and other evidence-backed mental health practices.

If you want to take advantage of the growth and relief you can experience as a result of one single therapy session, tell potential therapists you would like to try “solution-focused, single-session therapy.” Though it may not be widely practiced now, the more people ask for it, the more clinicians may work to accommodate them. And while therapists may be used to approaching therapy as a long-term process, they should be familiar with providing care that is useful to people who may only access therapy once.

If you’re thinking about suicide, or are worried about a friend or loved one, call or text the Suicide & Crisis Lifeline at 988 (or chat 988lifeline.org); the lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24/7 in the U.S.