--- title: "Case study: one session, one shift. A single-session intervention with three-month follow-up" canonical: "https://strategictherapy.eu/case-study-single-session-three-month-followup/" lang: en description: "A composite case showing what one strategic session can do for a narrow problem, with a three-month follow-up on whether the change held." author: name: "Maurizio Iengo" url: "https://strategictherapy.eu/author/strategictherapy/" title: "Psychologist" registration: "Ordine degli Psicologi della Regione Campania 9624" date_published: 2026-09-19 date_modified: 2026-09-19 publisher: "Strategic Therapy" section: "Case studies" keywords: "single session therapy case study" --- # Case study: one session, one shift. A single-session intervention with three-month follow-up > A composite case showing what one strategic session can do when the problem is narrow enough for one meeting to be the whole plan. ## In short - This is a composite illustrating the single-session format, not a specific client. - The session was narrowed deliberately to one attempted solution. - The task was designed to be evaluated by the client alone. - At three months the change had held and no second session had been booked. The client below is a composite, written to show what [a genuinely single strategic session](https://strategictherapy.eu/?p=48) can look like when the case fits [the model](https://strategictherapy.eu/?p=34) well. ## One clearly nameable problem A man in his early forties books a single appointment and is explicit from the start. He wants to address one thing: a fear of speaking in front of colleagues that has started costing him promotions he would otherwise be offered. No other significant difficulties. Stable home life. He has been declining every opportunity to present for close to two years. ## Narrowing to one solution The session stays on his attempted solution rather than attempting a full map of his life. He turns down every opportunity, which has kept the fear from ever being tested and, by his own account, has made the avoidance feel more necessary with each refusal. [A reframe built from his own language](https://strategictherapy.eu/?p=38) lands visibly: he has been protecting a version of the fear that has never had to prove itself. ## A hesitation, and what was done with it Partway through agreeing the task he pauses and says the small opportunity he has in mind still sounds harder than it should for something so minor. The session stays with the observation instead of reassuring him. That gap, between how small this is and how hard it still feels, is the thing worth watching before he begins. Offered as the measurement rather than as comfort, it settles him more than reassurance would have. ## A task he can evaluate alone He agrees to accept the next low-stakes opportunity, however small. A five-minute update in a team meeting, not a formal presentation. He will notice specifically what happens to the fear in the ten minutes before he starts, since that is the window where avoidance has always intervened. The close is explicit. This was designed as a single meeting. He is welcome to book another if the task does not hold, and doing so would not mean anything failed. ## Three months on The agreed follow-up call finds he took the opportunity within a fortnight. The anticipated dread arrived much as predicted and dropped sharply once he started speaking, not afterwards. He has accepted two further opportunities since and has not booked a second session. One favourable outcome, not a demonstration that cases resolve this cleanly in one meeting. ## What a different result would have looked like Had the call found the fear unchanged, the plan already covered it. He had been told returning would not mean the session failed, and a second appointment would have picked up from where the task left off instead of restarting the assessment. That built-in permission is as much a part of the format’s design as the content of the hour. A single-session model that implies failure when a client comes back makes clients less honest at follow-up without making them any better. ## Where this composite is unrepresentative Two features made it easy, and neither is typical. He booked the single session himself, already knowing what he wanted from it, which spared the opening ten minutes usually spent establishing whether one meeting is the right container at all. And his avoidance had a ready supply of low-stakes tests built into ordinary working life, so the task cost him almost nothing to attempt. Clients whose feared situation arises twice a year, or who arrive unsure what they are there for, need a different shape of task and frequently a second appointment. [The format article](https://strategictherapy.eu/?p=48) sets out which features make the format viable, and this case has most of them. ## Frequently asked questions ### How was the client contacted at three months? With a brief check-in call agreed at the first session and framed as a courtesy rather than as an assumption that more sessions would be needed. ### What if he had needed more help? The session closed with an explicit statement that returning would be welcome and would not mean it had failed. That sentence belongs in any single-session close. ## References 1. Talmon M. (1990). Single Session Therapy: Maximizing the Effect of the First (and Often Only) Therapeutic Encounter 2. Bertuzzi V., Fratini G., Tarquinio C., Cannistrà F., Granese V., Giusti E. M., Castelnuovo G., Pietrabissa G. (2021). Single-session therapy by appointment for the treatment of anxiety disorders in youth and adults: A systematic review of the literature. https://doi.org/10.3389/fpsyg.2021.721382