OAAT Therapy (one-at-a-time)

[calimich]

Any other UCCs, or other locations, adopting this model? It's starting to catch on out here in the public Uni system. During internship I remember seeing data that the modal number of counseling sessions attended is 1. I'm curious to hear how clinicians like it.

APA PsycNet

psycnet.apa.org

Single-session/one-at-a-time walk-in therapy | 1 | Single-Session Ther

This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book explains why practitioners and agencies

www.taylorfrancis.com

https://www.uab.edu/humanresources/home/eacc/core-services/oaat-therapy

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[PsyDr]

One of the worst psychology books I’ve ever read: Single Session Therapy by Talmon.

Here, let me sum it up for you: Patient shows up, tells you their chief complaint. You tell them, “That problem is too big, what else you got?”. Patient tells you another problem. You tell them “no, that problem is also too big”. Repeat this process until you can identify a really minor problem. Treat that. Call it a success.

 

[AcronymAllergy]

The only single-session treatment I was aware of that had evidence for efficacy is phobia treatment. Hadn't heard of its use otherwise until now.

 

[Fan_of_Meehl]

The only single-session treatment I was aware of that had evidence for efficacy is phobia treatment. Hadn't heard of its use otherwise until now.

Only specific phobia and 'service-connection deficiency disorder' could possibly be treated in a single session.

 

[WisNeuro]

Only specific phobia and 'service-connection deficiency disorder' could possibly be treated in a single session.

Depends on the severity of SCDD. Some individuals need multiple sessions of tx for this disorder as they only recover 10% at a time. For these individuals, it can be a grueling tx. But, there are those that receive complete remission of SCDD in one session, though this depends on the provider and their skill with a rubber stamp.

 

[iliketohelppeople]

Jessica Schleider out at Stony Brook has some good stuff on SSIs for specfic populations. Overall, a lot of their work seems to be focused on brief interventions.

 

[calimich]

Jessica Schleider out at Stony Brook has some good stuff on SSIs for specfic populations. Overall, a lot of their work seems to be focused on brief interventions.

thanks for all the references, so many!

 

[WisNeuro]

Jessica Schleider out at Stony Brook has some good stuff on SSIs for specfic populations. Overall, a lot of their work seems to be focused on brief interventions.

I glanced through several of these, planning on looking through more, but I'm skeptical. Many of the references seem to be measuring different SSI's against each other. And, the most common outcome measure appears to be looking at 3 month symptoms, and those effects appear to be pretty small (e.g., cohen's d of .2 or less). Are you aware of any of these that either look at the SSI vs other efficacious treatments, or at a longer time frame?

 

[cara susanna]

Is it overly cynical for me to wonder how much of this adoption by UCCs is being pushed by having too many patients and not enough staff/access?

 

[Fan_of_Meehl]

Is it overly cynical for me to wonder how much of this adoption by UCCs is being pushed by having too many patients and not enough staff/access?

Not at all. And, to me, it represents a doubling-down on the medical metaphor model of psychotherapy. Next up, preventative single session 'vaccination' interventions (10-15 min sessions) to 'inoculate' against stress.

I'm a big fan of the emerging 'process-based therapy' model of individualized case formulation and treatment utilizing the targeting of specific mediators/moderators via evidence-based principles of behavior change.

 

[iliketohelppeople]

I glanced through several of these, planning on looking through more, but I'm skeptical. Many of the references seem to be measuring different SSI's against each other. And, the most common outcome measure appears to be looking at 3 month symptoms, and those effects appear to be pretty small (e.g., cohen's d of .2 or less). Are you aware of any of these that either look at the SSI vs other efficacious treatments, or at a longer time frame?

Yes, I think in one of their meta analysis (Schleider & Weisz, 2017) they note that the effect size is small, but note it isn't too far off of what is reported for more comprehensive treatment. I do think one weakness (and I think they mention it there) is the lack of good controls.

I think they have quite a few trials ongoing, and so we have to wait and see. I just think that lab does good work (i.e., open science practices, etc.) and so I thought they would be pertinent to this discussion.

 

[futureapppsy2]

Yes, I think in one of their meta analysis (Schleider & Weisz, 2017) they note that the effect size is small, but note it isn't too far off of what is reported for more comprehensive treatment. I do think one weakness (and I think they mention it there) is the lack of good controls.

I think they have quite a few trials ongoing, and so we have to wait and see. I just think that lab does good work (i.e., open science practices, etc.) and so I thought they would be pertinent to this discussion.

Here’s the link to the meta: https://www.schleiderlab.org/uploads/2/1/8/4/21847128/schleider_weisz_jaacap_2017.pdf

The findings that SSIs are most effective for anxiety disorders is not surprising. The finding for conduct issues is a little meh, because that’s iffy to measure and classify. Substance abuse being on the weak end is not surprising to me, as SSIs have been helpful in clients with sub-clinical substance misuse in terms of nudging them out of complete pre-contemplation, but less helpful in clients with more significant substance abuse, IME.

 

[futureapppsy2]

I glanced through several of these, planning on looking through more, but I'm skeptical. Many of the references seem to be measuring different SSI's against each other. And, the most common outcome measure appears to be looking at 3 month symptoms, and those effects appear to be pretty small (e.g., cohen's d of .2 or less). Are you aware of any of these that either look at the SSI vs other efficacious treatments, or at a longer time frame?

Also, the majority of the outcomes are looking at prevention programs, not treatments, so the results may not map exactly onto the populations who need therapy for a clinical disorder and likely have more involved or ingrained symptoms. It’s important work, though, considering access and treatment compliance barriers in a lot of populations.

 

[WisNeuro]

Also, the majority of the outcomes are looking at prevention programs, not treatments, so the results may not map exactly onto the populations who need therapy for a clinical disorder and likely have more involved or ingrained symptoms. It’s important work, though, considering access and treatment compliance barriers in a lot of populations.

I agree that the potential is something to keep studying. I'm just wary of people latching on to unrelated findings and thinking this is some sort of panacea. The access issue right now isn't much of a supply problem in terms of providers, it's reimbursement for providers. For example, finding a psychiatrist in town for an appointment using insurance will take me about 6 months. If I want to pay cash? I can get in next week. Similar with high quality therapy. Finding therapy with midlevels is pretty easy here, insurance or not, but many of the doctoral levels have waiting lists. But I could still get in within days if I'm paying cash.

So in the end, I'd just wonder if this actually increases access for the under served, or just gives them yet another inferior option?

 

[medium rare]

Access is location-dependent in many cases. In my area, even cash practices have waiting lists.

I don’t take insurance and my next new patient appointment is in mid-February. I know of several other self-pay psychiatry/medication practices in my metro with similar waiting times.

Self-pay psychologist psychotherapy practices I know have wait lists of a month to 6 weeks or more. The only people I know with immediate/more immediate openings are the folks new to practice.

Providers who take insurance are either not taking new patients or months out. Master’s-level therapists here are easier to get into.

 

[clausewitz2]

Access is location-dependent in many cases. In my area, even cash practices have waiting lists.

I don’t take insurance and my next new patient appointment is in mid-February. I know of several other self-pay psychiatry/medication practices in my metro with similar waiting times.

Self-pay psychologist psychotherapy practices I know have wait lists of a month to 6 weeks or more. The only people I know with immediate/more immediate openings are the folks new to practice.

Providers who take insurance are either not taking new patients or months out. Master’s-level therapists here are easier to get into.

This pretty much definitionally means you are charging below the market-clearing price. Have you considered raising rates?

 

[medium rare]

This pretty much definitionally means you are charging below the market-clearing price. Have you considered raising rates?

My fees are commensurate with the UCR for my area. I generally raise my fees every 2 years and periodically cold call other practices in my area to see what they are charging. My fees are about 10% less than the rates of pp psychiatrists in my metro but higher than the rates of psychologists in private practice.

 

[calimich]

Access is location-dependent in many cases. In my area, even cash practices have waiting lists.

I don’t take insurance and my next new patient appointment is in mid-February. I know of several other self-pay psychiatry/medication practices in my metro with similar waiting times.

Self-pay psychologist psychotherapy practices I know have wait lists of a month to 6 weeks or more. The only people I know with immediate/more immediate openings are the folks new to practice.

Providers who take insurance are either not taking new patients or months out. Master’s-level therapists here are easier to get into.

The market out here feels similar.

 

[WisNeuro]

I am curious as to the feeling that even the cash market is spread thin, as that is not the case when we speak with other state associations. If you are engaged with your state association, check to see if they have a practice listserv. You may be surprised at what is available in your community when you have access to that broader community.

 

[medium rare]

I try to do what I can when a new patient referral calls me to schedule and finds out I have nothing available for 3 months. I have my office manager give them my referral list that includes about a dozen providers whom I’ve vetted to contact. They often say they’ve already tried calling several of them and can’t get in. Some call back and say they’ve called everyone on the list with no luck and ask if I know of anyone else or call back and go ahead and schedule and are willing to wait until I can see them. I do maintain a cancellation list and am sometimes able to see people sooner but that’s the best I can offer. I feel badly about this but there are not enough providers with availability where I’m located.

I’ve been active in my state, regional, and local psychology, psychiatry and psych np organizations (including listserv participation) for years. I get multiple referral requests daily from each of these primarily from folks in private practice. It is clearly easier to get into someone sooner who's self-pay versus insurance but it’s still several weeks at best or more before most folks around here have openings, and insurance providers are often months out if they are taking patients at all - for doctoral-level providers. Master’s clinicians are quite a bit easier to get into. It’s a pretty universal problem in my area, unfortunately, at least for now. Maybe it will improve some as we move more latter pandemic…

 

[Mojito_15]

I work in primary care integrated behavioral health- each appt. is supposed to be a stand-alone appt. Our job really is to assist the primary care providers when the patient they are seeing has a mental health concern and to serve that patient the same as a primary care provider would. It makes sense to me somewhat in this context- most mental health problems show up in primary care, and are never going to see a psychologist. I see lots of people who almost certainly otherwise would never see a mental health provider. In this context, they get to see me 1x; sometimes, if they want, they can see me more. But we're a population-based service. A primary care doctor has a caseload of hundreds, and so does the PCBH consultant, so there's really no way to be every single person's ongoing therapist. We refer to a higher level of care if the patient needs weekly services- but referrals are hard here, like everywhere. I have seen some people substantially benefit from a single session or a few sessions. I've seen others not. The hardest part of the job is that some people perceive we're going to be a weekly counseling/therapy service and occasionally are disappointed when they're referred and discover that they cannot see us in the way they want and also cannot get referrals to elsewhere because of waitlists.

 

[cara susanna]

I work in primary care integrated behavioral health- each appt. is supposed to be a stand-alone appt. Our job really is to assist the primary care providers when the patient they are seeing has a mental health concern and to serve that patient the same as a primary care provider would. It makes sense to me somewhat in this context- most mental health problems show up in primary care, and are never going to see a psychologist. I see lots of people who almost certainly otherwise would never see a mental health provider. In this context, they get to see me 1x; sometimes, if they want, they can see me more. But we're a population-based service. A primary care doctor has a caseload of hundreds, and so does the PCBH consultant, so there's really no way to be every single person's ongoing therapist. We refer to a higher level of care if the patient needs weekly services- but referrals are hard here, like everywhere. I have seen some people substantially benefit from a single session or a few sessions. I've seen others not. The hardest part of the job is that some people perceive we're going to be a weekly counseling/therapy service and occasionally are disappointed when they're referred and discover that they cannot see us in the way they want and also cannot get referrals to elsewhere because of waitlists.

Yes, I used to work in PCMHI and we had a similar setup. The max was supposed to be 6 sessions, and refer them for specialty mental health if they need more.