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Royal Commission into Victoria’s Mental Health System

Case study:

Single-session family therapy

Single‑session family therapy supports family inclusion in a consumer’s treatment, care and support for mental health challenges. The process is time limited and generally includes initial phone contact between a clinician and consumer and/or the completion of a pre‑session questionnaire, one face‑to‑face session and a follow‑up phone call, which functions both as a clinical contact and a means to determine future treatment or referral options.

Single‑session family therapy is increasingly practiced across a range of service settings. Its application is largely based on evidence that suggests a large proportion of people only attend one session of care, and the majority of those who do not attend a second session do so because they are satisfied with the service they received. In Victoria, single‑session family therapy is used by a range of service providers such as headspace, the Bouverie Centre and area mental health services such as the Alfred Child and Youth Mental Health Service. Its format does not require extensive training for practitioners.

Research indicates that single‑session family therapy can be effective for young people. Findings from one study, which recorded client self‑reported outcomes four to five weeks following a session, suggested the therapy led to considerable improvements to a young person’s wellbeing. Another study, which involved a meta‑analysis of findings from 50 randomised controlled trials (over 10,000 young people in total), indicated that while there was large variation between studies, overall young people who received single‑session interventions were 58 per cent more likely to ‘fare better’ than those who did not.

Involving the family through this process can facilitate greater understanding, beyond a technical understanding, of a consumer’s mental health challenge. It helps family members to develop an empathic response and understand their role in a consumer’s treatment, care and support, which is critical to creating a supportive environment in which a consumer can recover. It can also provide an opportunity to acknowledge the impact of the mental illness on all family members. Single‑session family therapy can be a less daunting experience, for both consumers and family members, than more intensive ways of involving family in treatment.

Single‑session family therapy can be appealing to consumers because the session is focused and often targeted at pre‑determined concerns (for example, those identified through the pre‑session contact). It provides the opportunity to respond to what the consumer and family feels is important, rather than what the clinician might otherwise make a priority.

Single-Session Family Consultation Clinic at the Alfred child and youth mental health service

The child and youth mental health service at the Alfred includes the client’s whole family and/or their social network within its definition of ‘client’. Dr Paul Denborough, Clinical Director of Alfred Child and Youth Mental Health Service and headspace, Alfred Health, said it is vital that families and carers are welcomed into community care services and provided with support as soon as possible.

Dr Denborough also said that family‑based treatment for young people who are suffering from a suicidal crisis can be particularly effective as it can directly mediate risk factors like isolation, disconnection and loss of meaningful engagement. He noted that the severity or complexity of consumers’ mental health challenges did not appear to affect outcomes.

The clients and their families all had challenges that had been deemed serious enough to meet the threshold for a tertiary mental health service and level of severity or complexity did not appear to be a factor related to successful outcome. The only exclusion criteria for this approach was if the family specifically requested for a diagnostic assessment such as for autism.

Alfred child and youth mental health service first introduced single‑session therapy as a family‑based intervention in 2006 and has since expanded to three teams of six to eight clinicians. Two hours and 15 minutes is allocated to the session. A pre‑session questionnaire is mailed to families to prompt them to think about the issues the consumer and family want to address through the session, and a written summary is sent to families afterwards.

A 10‑year review of the program at the Alfred has shown that for almost 70 per cent of families, one session is sufficient. Only 5 per cent attend more than one session, with the remaining 26 per cent being accepted for case management. Four to six weeks after the session, a therapist will call the family to see what changes have been made as a family and if more support is needed.

Source: Jeff Young, Pam Rycroft and Shane Weir, ‘Chapter 7: Implementing Single Session Therapy: Practical Wisdoms from Down Under’, in Capturing the Moment. Single Session Therapy and Walk-In Services (Crown House Publishing Limited, 2014); Liza Hopkins and others, ‘Single Session Family Therapy in Youth Mental Health: Can It Help?’, Australasian Psychiatry, 25.2 (2017), 108–111; Jessica L Schleider and John R Weisz, ‘Little Treatments, Promising Effects? Meta-Analysis of Single-Session Interventions for Youth Psychiatric Problems’, Journal of the American Academy of Child and Adolescent Psychiatry, 56.2 (2017); Witness Statement of Paul Denborough, 11 May 2020; Witness Statement of Dr Brendan O’Hanlon, 17 June 2020; Fry, D, Alfred Child and Youth Mental Health Service Single Session Program Ten Year Review; The Bouverie Centre, ‘Single Session Family Consultation Practice Manual’ [accessed 30 September 2020]; Dr Paul Denborough, Correspondence to the RCVMHS, 2020.