A single session with a psychiatrist to handle an issue

A single consultation with a psychologist to overcome an ordeal, such as a breakup. The “single session intervention” is gaining ground in the network of social and health services in Quebec. The university group of family medicine (GMF-U) Saint-Jean-sur-Richelieu offers to its patients, and the CISSS de la Montérégie-Ouest wants to launch a pilot project. The Quebec Order of Psychologists warns healthcare facilities against this “very attractive” approach.

Kathy Perreault, a 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 had only one day a week to see patients at the GMF-U (she works as a professor). It offered clients “conventional” side dishes that could span multiple sessions.

“I realized I was seeing 16 or 17 patients a year,” says Kathy Perreault. I thought it wasn’t enough for a frontline service. Your GMF-U has 9,000 registered patients.

To support more people, Kathy Perreault now uses “single session intervention”, an approach notably present in Ontario, England and Australia. She sees patients who are going through difficult 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 them in their everyday life to find ways that will allow them to manage the situation they find difficult. If necessary, the patient can consult it again.

Geneviève Bruneau, acting medical director at GMF-U Saint-Jean-sur-Richelieu, regularly sends patients to Kathy Perreault. She cites the case of a woman in her mid-forties whose father is struggling with a major health issue. “She was needy enough to “handle” her personal life, her children and her sick family member, says the family doctor. Sometimes, meeting with the psychologist can help to temper things or ventilate. »

According to D.D 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 return. » GMF-U social workers can provide longer follow-ups.

A study

To measure the effectiveness of the single session, Kathy Perreault conducted a 2019 study of 114 adult patients, in collaboration with University of Sherbrooke professor Mylaine Breton.

The psychological state of the participants improved, according to Kathy Perreault. “The intensity of the perceived problem decreased after the single session and remained that way at follow-up four to six weeks later,” she says. The intensity of psychological distress also decreased significantly, and remained so after four to six weeks. The feeling of well-being increased after the session and was maintained.

One in five patients in the study needed more than one encounter. Almost 93% said they were satisfied with the meeting.

Interested in this approach, the CISSS de la Montérégie-Ouest intends to launch a pilot project soon. In the health care facility, 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 manage to offer it at the right time to our clientele, perhaps a single session will be enough and prevent the [problèmes des] people become chronic”, thinks Sophie Poirier, assistant director of multidisciplinary services, research and university teaching.

This approach, she says, can help reduce wait times for mental health services. “This will free up places for people who have more complex needs, who may need a different approach or who don’t want that approach, believes Sophie Poirier. It remains a choice. »

Gaëtan Roussy, president of the Quebec Psychologists Association, believes 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 path for them.

reservations

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, let’s take a bunch of them to get together just for one session to analyze a situation and ‘thank you, good night’, he apprehends. It doesn’t have to be the same. »

The president of the Order of Psychologists of Quebec, Christine Grou, also expresses reservations about the single session. She points out that this is not psychotherapy or psychological treatment, and that it is more like counseling or in training.

“It does not apply to all types of clients”, he points out. The single session requires someone who is motivated to change and who has the resources to change as well. You are not treating a major depressive episode with this. »

Christine Grou believes that “there is a need to do more research” on this approach. “We know that with patients who have mental disorders, it doesn’t necessarily apply, and the literature says it does,” 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 it can solve the access problem [aux services en santé mentale] “, he concludes.

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