Therapeutic Improvement in Single-Session Therapy: Innovative Moments as Change Markers

The growing demand for mental health services, exacerbated by long waiting lists and high psychotherapy dropout rates, highlights the urgent need for brief and effective approaches. The aim of this study was to analyse the presence and impact of change markers in online narrative single-session therapy (NSST) and a change interview 1 month later. The change markers were coded in the NSST and the interview via the innovative moments (IMs) coding system. This coding system allows the identification of IMs (i.e., change markers), differentiating them into three levels of complexity (from lower complexity, Level 1, to the highest complexity, Level 3). Good and poor outcomes were categorized on the basis of the change in presession distress to the distress reported 1 month later at the change interview. Previous research has associated IMs with therapy outcomes, mostly with Level 2 and 3 IMs. In this study, more IMs emerged in the NSSTs of clients with good outcomes. The Level 3 IMs did not emerge in the NSST and only emerged in the change interview. There was a positive correlation between the decrease in distress and the emergence of Level 3 IMs in the change interview. The pattern of the relationship between the IMs in NSST and those in the change interview suggests that, in good outcome cases, there is a positive evolution in the emergence of change markers. These results demonstrate that IMs are produced in NSST, as occurs in regular psychotherapy, and suggest that the change initiated in a single session is expanded until the change interview for good outcome cases. The clinical implications of this study are discussed.