A single appointment with a psychologist to overcome an ordeal, such as a breakup. The “single session intervention” is gaining ground in the health and social services network in Quebec. The university family medicine group (GMF-U) Saint-Jean-sur-Richelieu offers it to its patients, and the CISSS de la Montérégie-Ouest wants to launch a pilot project. The Order of Psychologists of Quebec warns health establishments against this “very attractive” approach.
Kathy Perreault, psychologist at GMF-U Saint-Jean-sur-Richelieu, adopted the “single session intervention” in 2018 to improve access to her services. At the time, the associate clinical professor at the Université de Sherbrooke only had one day a week to see patients at the GMF-U (she has a teaching job). She offered clients “conventional” follow-ups that could stretch over several sessions.
“I realized that I was seeing 16 or 17 patients a year,” says Kathy Perreault. I found that it was not enough for a front line service. His GMF-U has 9,000 registered patients.
To offer support to more people, Kathy Perreault now uses the “single session intervention”, an approach notably present in Ontario, England and Australia. She meets patients who are going through trying times, but not individuals in crisis (eg suicidal thoughts).
“During the meeting, we will focus on a problem in the “here and now”, explains the psychologist. We will make a plan with this person to help him in his daily life to find ways that will allow him to manage the situation that he finds difficult. If necessary, the patient can consult her again.
Geneviève Bruneau, interim medical director of the GMF-U Saint-Jean-sur-Richelieu, regularly sends patients to Kathy Perreault. She cites the case of a woman in her forties whose father is struggling with a major health problem. “She was destitute enough to “deal” with her personal life, her children and the sick relative, says the family doctor. Sometimes, the meeting with the psychologist can help to temper things or ventilate. »
According to the DD Bruneau, GMF-U patients are satisfied with the service. “Sometimes they would have liked more than one session,” she admits. But they understand that resources are limited. And they know they have the right to come back. » GMF-U social workers can provide longer follow-ups.
A study
In order to measure the effectiveness of the single session, Kathy Perreault conducted a study in 2019 with 114 adult patients, in collaboration with University of Sherbrooke professor Mylaine Breton.
The psychological state of the participants has improved, according to Kathy Perreault. “The intensity of the perceived problem decreased after the single session, and it remained that way at the follow-up four to six weeks later,” she says. The intensity of the psychological distress also decreased significantly, and it remained that way four to six weeks later. The feeling of well-being increased after the session and was maintained.
One in five patients in the study needed more than one encounter. Nearly 93% said they were satisfied with their meeting.
Interested in this approach, the CISSS de la Montérégie-Ouest intends to launch a pilot project soon. In the health establishment, dozens of psychologists, social workers and human relations agents have already been trained by Kathy Perreault. Others will be soon.
“If we manage to set up this form of intervention there and we manage to offer it at the right time to our clientele, perhaps a single session will be enough and it will prevent the [problèmes des] people become chronic,” thinks Sophie Poirier, assistant director of multidisciplinary services, research and university education.
This approach, she says, could help reduce wait times for mental health services. “It will free up places for people who have more complex needs, who may need a different approach or who don’t want this approach, believes Sophie Poirier. It remains a choice. »
Gaëtan Roussy, president of the Association of Psychologists of Quebec, believes that the single session “can help people” who have “situational problems”. But you have to properly assess the patient first, he insists, to make sure this is the right avenue for them.
Reserves
Gaëtan Roussy fears that the single session will be “instrumentalized” by CISSS and CIUSSS managers in a hurry to reduce their waiting lists. “Given that there is a shortage of psychologists, we are going to take a bunch of them to just meet for one session to analyze a situation and “thank you, good evening”, he apprehends. It doesn’t have to turn the same. »
The president of the Order of Psychologists of Quebec, Christine Grou, also expresses reservations with regard to the single session. She points out that this is not psychotherapy or psychological treatment, and that it is more like counseling or at coaching.
“It doesn’t apply to all types of clients,” she points out. The single session requires someone who is motivated to change and who has the resources to change too. You’re not treating a major depressive episode with that. »
Christine Grou judges that “there is a need to do more research” on this approach. “We know that with patients who have mental disorders, it does not necessarily apply, and the literature says so,” she says.
She recalls that psychological treatments in the public network are already “very short”. “It is very dangerous to try to import this and think that it can solve the access problem [aux services en santé mentale] “, she concludes.