Single-session therapy as a counselling waitlist management strategy in a public health service: A brief quality improvement evaluation

Introduction

Long waitlists for counselling and psychological services are a persistent challenge in mental health care. When demand exceeds service capacity, waiting lists are commonly used, but they raise clinical, administrative, and ethical concerns and may delay timely access to care. ¹ Timely access matters because prolonged waits may be associated with worsening distress, unmet need during the waiting period, and increased desire for additional support while awaiting treatment. ²

In this context, brief intervention models may offer a pragmatic way of improving service responsiveness. Single-session therapy (SST), and related single-session intervention models, aim to provide a meaningful therapeutic contact within a limited timeframe and may help bridge treatment gaps when longer-term care is delayed or unavailable. Evidence syntheses suggest that single-session interventions can produce positive effects for at least some mental health outcomes and may have value as low-intensity, scalable, and service-responsive options.^3,4 Single-session models have also been examined in real-world service settings, including as routine practice within an acute mental health assessment service, ⁵ within community addiction and mental health centres, ⁶ and as a structured single-session intervention in acute and crisis psychology that explicitly incorporates collaborative formulation. ⁷

Within the Australian context, single-session work has a relatively well-established history in child and adolescent mental health services and in family therapy contexts, including agency-wide implementations and follow-up studies. ⁸ By comparison, there is limited published evaluation of SST as a waitlist management strategy specifically within Australian adult community-based public health counselling services. The present project contributes preliminary local evidence to that comparatively under-reported area.

This quality improvement project evaluates a small SST pilot implemented within a counselling waitlist management initiative in an Australian public health service. The aim was to examine the feasibility and perceived helpfulness of SST as a brief intervention within routine care, rather than to test treatment efficacy.

Method

Results

Patient flow

Of 51 waitlist referrals processed, 13 patients were allocated to SST and 9 completed the intervention. Of the four patients allocated to SST who did not complete it, three were uncontactable and were discharged from the waitlist, and one did not attend the first session and was subsequently discharged. Feedback was successfully obtained from 5 of the 9 patients who completed SST; 4 were lost to follow-up despite attempted contact. Patient flow is summarised in Table 1.

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Table 1.

Patient flow through the SST pilot.

Stage	N
Waitlist referrals processed	51
Allocated to SST	13
Completed SST	9
Feedback obtained	5
Required further service input post-SST	1

Discussion

This quality improvement evaluation suggests that SST may be a feasible and acceptable component of counselling waitlist management within an Australian community public health service. Patient feedback was positive overall, and qualitative responses suggested perceived benefit through increased awareness, practical strategies, advice, and an opportunity to speak with a clinician. These findings are broadly consistent with the wider SST literature, which suggests that single-session interventions can be clinically useful across a range of presentations and service contexts.^3,4

Although based on a small sample, the service-level outcome data offer a tentatively encouraging signal: the majority of SST completers did not require further counselling input from the service, while the appropriate escalation of the one patient who did demonstrates the operation of the stepped-care pathway. For selected patients, one or two goal-focused session(s) within an SST framework may be sufficient to address the presenting concern, while the broader care pathway remains available for those who need more.

The flexible nature of the SST framework is also relevant to interpretation. Within the model used here, collaborative case formulation was one of the approaches available to clinicians, alongside cognitive-behavioural, acceptance and commitment, and solution-focused techniques. The framework shapes the structure and intent of the contact rather than mandating a specific therapeutic content. This aligns with broader work in single-session and brief intervention settings, including structured single-session models such as Comprehend, Cope, and Connect, which explicitly integrate formulation within an acute and crisis context. ⁷

The project also speaks to broader service-level efforts to improve access and responsiveness. Waitlist-management literature has highlighted the need to explore alternative pathways when demand exceeds capacity, rather than relying only on passive waiting. ⁹ Likewise, implementation work in mental health settings suggests that brief one-at-a-time or single-session models may support more rapid access when embedded thoughtfully into service systems. ⁶ In the Australian context, single-session work is well established in child, adolescent and family therapy settings ⁸ , but has been less commonly evaluated as a waitlist management strategy in adult community public health counselling. The present project seeks to address this gap.

These findings should be interpreted within the context of service-level implementation rather than clinical efficacy. The project reflects a pragmatic response to demand pressures, where the goal is not to replace standard therapy but to provide timely, meaningful intervention for selected patients. SST in this model functions as a complement to existing care pathways rather than a substitute.

Implications for service delivery

The findings suggest that SST may support improved access and responsiveness within counselling services experiencing high demand. Implementation requires consideration of workforce capacity, supervision arrangements, and training. Although routine placement supervision absorbed most of the supervisory load, the project required additional senior clinician time for the development of training materials, role plays, and ad hoc consultation. Services considering SST models should plan for these implementation costs and ensure appropriate governance, clinical oversight, clear escalation pathways for risk, and well-defined patient selection processes.

Limitations

Several limitations should be considered. This was a small local quality improvement evaluation with a single-group post-intervention design and no comparison group, randomisation, or longer-term follow-up. Feedback was obtained from only 5 of the 9 patients who completed SST, and the evaluation used a brief locally developed feedback process rather than validated outcome measures. Patients were not explicitly asked about aspects of the intervention that were unhelpful or that could be improved, which limits interpretation of the helpfulness ratings.

Allocation to SST was pragmatic rather than guided by predefined inclusion and exclusion criteria. While this reflected real-world implementation conditions, more clearly specified eligibility criteria would have strengthened the evaluation and supported clearer interpretation of feasibility findings. Future implementation work should define eligibility criteria a priori, for example, by symptom severity threshold, presenting concern, or risk profile.

The intervention was delivered by provisional psychologists who had not undertaken formal external SST training; internal training and supervision were provided by senior psychologists, only one of whom had completed formal external SST training. This reflects real-world service constraints but limits conclusions regarding intervention fidelity and broader implementation. Formal feedback was not obtained from the provisional psychologists themselves; future evaluations should include clinician-reported data on sufficiency of single contact, perceived complexity of allocated cases, and supervision needs.

Finally, the project was conducted in a single Australian community health counselling service, and findings may not generalise to other adult public health contexts. A larger, more methodologically rigorous evaluation, with prospectively defined eligibility criteria, validated outcome measures, longer-term follow-up, and capacity for clinician feedback, would be a logical next step.

Conclusion

This brief quality improvement evaluation suggests that SST may be a feasible and acceptable strategy within counselling waitlist management in an Australian community public health service. Patient feedback was positive overall, and most SST completers were able to be discharged without requiring further service input. Although preliminary and limited by small sample size, the findings support further service-level evaluation of SST as a brief intervention option in adult public health counselling contexts, an area where the Australian peer-reviewed literature remains comparatively under-developed.

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