A one-time session with a psychologist

A one-time session with a psychologist to address a problem

A one-time session with a psychologist to address a serious problem, such as a failed relationship. 'One-session interventions' are on the rise in Quebec's health and social service network. The University Group of Family Medicine (GMF-U) in Saint-Jean-sur-Richelieu offers it to its patients, and the CISSS in Montérégie-Ouest wants to launch a pilot project. The Ordre des psychologues du Québec warns health care institutions against this "very attractive" approach.

Kathy Perreault, a psychologist at GMF-U in Saint-Jean-sur-Richelieu, introduced "individual therapy" in 2018 to improve access to her services. At the time, the University of Sherbrooke lecturer had only one day a week to visit GMF-U patients (she has a teaching position). She offered her clients "conventional" follow-up care, which could include several sessions.

"I found that I was seeing 16 or 17 patients a year, Kathy Perreault says. I didn't think that was enough for frontline service." Her FMG-U has 9,000 registered patients.

To help more people, Kathy Perreault is now applying the individualized intervention approach used in Ontario, England, and Australia. She accepts patients who are going through a difficult time, but not people who are in crisis (e.g., suicidal thoughts).

During the session, we focus on a problem in the here and now, the psychologist explains. Together with the person in question, we work out a plan to help him or her cope with the difficult situation in everyday life. If necessary, the patient can be consulted again.

Geneviève Bruneau, deputy medical director of GMF-U in Saint-Jean-sur-Richelieu, consults regularly with Kathy Perreault. She mentions the case of a 40-year-old woman whose father had severe health problems. "She was quite helpless when it came to her personal life, her children, and her sick relative," says the family doctor. Sometimes talking to a psychologist can help calm or defuse the situation.

Dr. Bruneau says GMF-U patients are satisfied with the service. "Sometimes they want more than one session," he acknowledges. But they know resources are limited. And they know they have the right to come back. GMF-U's social workers can provide longer care.

A study

To measure the effectiveness of the one-on-one sessions, Kathy Perreault, in collaboration with Professor Mylaine Breton of the Université de Sherbrooke, conducted a study of 114 adult patients in 2019.

According to Kathy Perreault, the mental state of the participants improved. "The intensity of the perceived problem decreased after one session and remained so at follow-up four to six weeks later," the expert explains. The intensity of psychological distress also decreased significantly and remained so four to six weeks later. Well-being increased after the session and remained unchanged.

One in five patients in the study needed more than one treatment. Nearly 93% were satisfied with the session.

The CISSS in Montérégie-Ouest is interested in this approach and plans to launch a pilot project soon. Dozens of psychologists, social workers, and human resources managers have already been trained by Kathy Perreault. More will be trained soon.

"If we can develop this form of intervention and offer it to our clients at the right time, a single session could be enough to prevent problems from becoming chronic," says Sophie Poirier, associate director of interdisciplinary services, research, and higher education.

He believes this approach can help reduce waiting times in mental health services. This frees up places for people with more complex needs who need or don't want another approach," Poirier explains. That leaves one option.

Gaëtan Roussy, president of the Quebec Psychological Association, believes that individual counseling can help people with "situational problems." But the patient must first be carefully evaluated to determine if this is the right path for them.

Some reservations

Gaëtan Roussy fears that the single session will be "instrumentalized" by CISSS and CIUSSS administrators who are in a hurry to reduce waiting lists. "Since there is a shortage of psychologists, a simple phone call is enough for many to analyze a situation and say 'thank you, good evening,'" he fears. We don't want it to end the same way.

The president of the Ordre des psychologues du Québec, Christine Grou, is also against the individual interview. She stresses that it is not psychotherapy or psychological treatment, but counseling or training.

"It is not suitable for all types of clients," she says. An individual session requires a person who is motivated to change and has the means to do so. It is not about a major depressive episode.

Christine Grou believes that this approach "needs more research." "We know that it is not necessarily applicable to patients with mental disorders, and this is reflected in the literature," says the expert.

She stresses that psychological treatments in the public network are already "very short". "It is very dangerous to introduce such a system and think that it can solve the problem of access to mental health care," he concludes.