Conveying Hope, Empowering Teens: An Interview With Jessica Schleider

Jessica Schleider is a clinical psychologist, researcher, and founding director of the Lab for Scalable Mental Health (www.schleiderlab.org). 

She’s a leader in single-session interventions for youth mental health—an evidence-based approach that aims to provide help that’s accessible, doable, and affordable for populations around the world and is already available via open-access programs. 

On her own and with colleagues, she’s published a wide array of articles and book chapters and co-wrote a self-help book, The Growth Mindset Workbook for Teens. Most recently, she’s the author of Little Treatments, Big Effects: How To Build Meaningful Moments that Can Transform Your Mental Health.

Currently an associate professor of medical sciences of Northwestern University, Schleider earned her PhD in clinical psychology from Harvard and completed her doctoral internship in clinical and community psychology at Yale School of Medicine.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Amy Biancolli: Dr. Schleider, thank you for joining us today. 

Jessica Schleider: My pleasure. Thanks for having me.

Biancolli: So to hop right into it, what is a single-session intervention? I realize there’s a variety of them, but could you describe it generally, right off the bat, for our listeners?

Schleider: Absolutely, and it’s a term that even most clinical psychologists aren’t familiar with, so I’m more than happy to share a definition. 

Single-session intervention is an intervention that’s intentionally designed, and “intentionally” is key there, to be completed or have some kind of detectable impact within a single visit, session, or encounter. Single-session interventions can be self-guided or human-facilitated, so they can be digital supports or facilitated by either a professional or a peer. They can exist either within or outside of traditional healthcare systems. So they can be offered online on social media, in schools, by school counselors, or within routine psychotherapy—for instance, for folks on waiting lists. 

Single-session interventions are designed to make the most of every moment. So they’re capitalizing on the idea that change is possible at any time, even if no additional sessions are possible. So it’s not assuming that a single session is going to cure everything, simply that a single session can help somebody make a meaningful step in a direction that matters to them.

Biancolli: What you’re describing—and what popped out to me, as I was reading your most recent book— is that there seems to be, and correct me if I’m wrong, a harm-reduction mindset to it.

Schleider: Absolutely.

Biancolli: You’re not saying “We’re going to fix everything, wave the magic wand, give you the magic pill, just make everything better.” Instead, “We’re going to make things a little bit better in a significant way.” Is that an accurate description?

Schleider: I think that’s a great comparison. I think the harm-reduction approach has a lot in common with single-session approaches, in that we are acknowledging the fact that our system is flawed. But we’re not giving up, we can still do something and help fill these gaps in the systems we do have.

Biancolli: And the other thing that’s interesting to me about that is we’re used to the harm-reduction model in lots of different areas of public health—and most strikingly, recently, COVID, for instance. But within the context of mental health and the mental healthcare system, it’s unusual, isn’t it?

Schleider: In particular, I heard in the media folks talking about something called the “Swiss cheese” model of COVID prevention or COVID reduction, whereby we’re going to try masks and social distancing and vaccines. And all together, we’re hopefully going to catch people who are falling through the holes of any layer of cheese. But with mental health care, we just have one layer at the very top of the severity spectrum, and really nothing beneath that—and single-sessions are designed to catch people and provide more slices, essentially, where we wouldn’t otherwise help them.

Biancolli: That’s interesting. And what else makes this different from the existing paradigm of care? What distinguishes it?

Schleider: The overall model and expectancy set of what a single session or clinical encounter can do, and what strengths people are already coming in with, is quite different from the traditional model of psychotherapy that I and other psychologists and psychiatrists are trained in. We’re very used to the medical model of mental illness and disorder, which suggests that people who are struggling with mental health problems lack skills. They’re missing something, a coping strategy, a set of capacities that we need to teach them or instill in them in order to help them cope effectively. 

And that’s quite counter to the core assumptions of a single-session approach, which include the idea that everybody is coming into that session with existing strengths and capacities, and that session is designed to help them capitalize and recognize what those strengths are. And that change is possible in brief moments, not only through prolonged, months-to-years-long treatments provided by others.

So it’s a much more empowering frame. It centers on the person’s own capacities and skills rather than their deficits. And in that sense, I think it opens doors to positive change and positive steps forward in a way that traditional treatments aren’t built to, in that traditional treatments are often framed in the sense that change takes a long time, and you’ve got to work at it every week for maybe months, maybe years. It really flips the expectations of how change can happen on its head.

Biancolli: I’m also wondering whether it’s recognizing that each individual, whether it’s a teen or an adult, has the power to do something—which strikes me as kind of radical once again, in the concept of mental health care under the existing paradigm.

Schleider: It’s definitely not how mental health professionals are used to thinking, and it does take some reorienting for folks to think outside of the box in terms of what treatment can be, when I’m giving talks or workshops or clinical trainings on this approach.

Biancolli: What kind of responses have you gotten from colleagues? And have you gotten any blowback? Are people just baffled? Like wait, wait, wait, how does this work? Or are they responsive? Or is it a combination? 

Schleider: It’s been mixed, and it has changed over time in a good way. 

You know, we’ve been doing this research since 2016. My lab was founded in 2018. We have dozens of RCTs suggesting that single-session interventions can be effective, a meta-analysis of 50 randomized trials suggesting they’re effective, and now multiple systematic reviews on the topic. So at this point, the data are quite compelling to suggest that these things can help.

But there are always going to be some holdouts, regardless of the data, who are not open to the concept that any therapeutic benefit can be gained in a single session. That’s not a data-driven belief. To me, that’s more of an experience-driven belief that some people are going to hold no matter what I present to them, no matter what the research shows, and that’s okay. I’m not trying to convince them. I’m trying to convince the people who have power to change systems, and the policies around how treatment is offered to folks and where it can live.

Interestingly, the biggest pushback that I get consistently is from psychiatrists and psychologists. The least pushback I get are from folks who are on the ground providing crisis services, providing school-based mental health services or primary care-based services where the needs and the unmet scope of the mental health crisis is so apparent. So people who are closest, I think, to the problem are the ones who are the first to say, “Yeah, I understand why that could be helpful.”

Biancolli: So getting back a little bit to the single-session interventions, could you describe one specifically? I know you described generally what they are. 

Schleider: Sure.

Biancolli: A teen or somebody who finds one of your interventions—what happens? What’s the experience for them?

Schleider: So I can walk through one of our digital self-guided single-sessions for teens, one that teaches about behavioral activation. Behavioral activation is an evidence-based treatment approach from cognitive behavioral therapy, but we’ve re-packaged it, so to speak, to be effective and potent within a single session— and to center the teens’ own experience and empower them to use skills that they’ve identified within themselves before. 

The intervention starts with a message telling the teen or the user that not only can this program potentially help them, but they can also help others through this program. So we’re starting with a call to action, not just to help yourself, but also to help peers. And we say, because you as a teen have lived through this—you’ve experienced depression, you are experiencing it—and we are scientists who made this intervention, we may not know the best ways to communicate these ideas to others. We need your help to translate and help others in the future.

We then have a section on, really, a behavioral experiment. We allow teens to rate how they’re feeling, sad to happy, 0 to 10 scale. Really simple. And then we ask them to choose one of a few different videos to watch. The videos have been carefully selected, so they’re as adorable or funny as possible. So let’s say a teen saw the video of this little hedgehog eating some pumpkins and making little cute noises. We then ask them for their mood again after that 30-second video, and invariably, their mood goes up a tiny bit—and they get immediate feedback of, wow, just in 30 seconds you made a detectable impact on your mood. Imagine if you took steps to connect with people who you care about, to work towards a goal that matters to you, to do something just for yourself, for five minutes a day. Imagine what kind of impact that could have over time.

We then walk them through the brain science of, one, how change is possible for people because of neuroplasticity; and, two, how they actually have the power to elicit that change by what they do. Their actions. We include a bunch of testimonials or stories from other teens who we’ve worked with to develop these interventions about how they’ve used this idea that action can bring change, to sort of rewire how they cope with really difficult situations. We then walk the teen through making an action plan. 

So they create a three-step plan based on what they know works for them to help them feel a little bit better, to connect with others, meet a goal, and do something just for themselves. And finally, we ask the teens—based on what they just learned in the program and their own lived experience in dealing with depression—how would they help a peer through a situation where they just feel stuck, and unmotivated, and unable to move ahead.

They’re giving feedback. They’re teaching others how to use the skills they just learned, and in our open-access interventions on our website, that advice, if they allow us to use it, will go in our open advice center. So they’re actually contributing to a resource that other teens can look to in the future if they’re feeling down or they’re struggling to keep going.

Biancolli: So it’s not just giving them agency, giving them a role to play in their own wellness, but you’re engaging them—saying, “Oh, hey, actually, your role is important to us. You are important to us, you can help us help other people.”

Schleider: That’s right.

Biancolli: How hard is it to convince young people or anyone that change is possible? I mean, this is the huge thing, I think, for any human being.

Schleider: Absolutely, and it’s a prerequisite to any after-behavior change happening, right? Believing that there’s a point in trying. 

The idea is to plant a seed of hope, and actually we consistently see detectable improvements in hope and reductions in hopelessness from before to after receiving these interventions—and significant increases in teens’ sense that they have some control over their future outcomes. So we don’t need that change to be huge. We need that change to be detectable, so that they have a reason to try once, and maybe that can lead to more trying and more trying over time. So we’re not trying to completely transform their beliefs overnight. That’s not realistic. We are trying to help them take the best next step, which is a prerequisite for all future steps. So something we typically include, or we do include in a lot of our interventions, is that big change is a series of tiny changes, and you’ve got to start somewhere. And now can be that time.

Biancolli: And that reminds me of something else that I really wanted to talk to you about, which is the importance of a-ha moments. You use a lot of different terms for it in your book, and if you could speak to that a little bit—how significant is it? And how can those a-ha moments occur when some young person who’s in distress, who might be catastrophizing, thinking, “Okay, I’m going to be locked into this cell of feeling bad forever?” Could you speak to them a little bit? How is it that they’re able to find some little nugget of hope?

Schleider: It’s funny that you ask that question because we’re in the process of finishing up a paper led by one of my postdocs, Benji Kaveladze, where he looked at the experience of a-ha moments during single-session interventions—and found that experiencing one actually was related to how well they worked. 

And the reason I was really interested in this is because, from just a personal-experience perspective, from talking to folks who’ve experienced mental health problems, a lot of people can remember turning points in their journey towards recovery and their treatment process: just little memories, or little moments, that had an outsized impact on how recovery went after that, or how coping went after that. Some one-sentence thing that somebody said to them one time off the cuff. So they can happen within formal treatment settings, but a lot of them happen outside of treatment settings altogether—conversations with friends or family, or just things that they see in the world. And, for me, it felt really important to draw a connection between those experiences that a lot of people have. I interviewed a bunch of people in my book who talk about those types of experiences and the idea that change can happen in a brief moment, like a single session.

So I’ve been really interested in understanding what are these moments that people have. In my work I found they really come down to people feeling like they can do something they didn’t think they could do before. Feeling understood in a new way where they didn’t before. Seeing others who were getting through similar problems to them, and giving back. So actually helping, which are all things that we try to embed in our sessions.

Biancolli: You had mentioned CBT, cognitive behavioral therapy, but there’s actually no one modality, no one approach. It is like a combination. The idea is simply to convey, once again, nuggets that will help a young person or any person just kind of figure out a way forward. You also mentioned, just now, the interviews in your book. Could you give an example of a young person describing one such learning moment? And if you’re open to it, describe your own moment? Your turning point?

Schleider: Well, actually, our postdoc, Benji, specifically asked folks what their a-ha moments were about. And I just gave a talk earlier today where I spoke about these, so I actually have a whole list of them. They selected a variety of different elements of the intervention. But ones that really stood out: one teen said learning that depression is not only a feeling but a signal from the brain telling us to connect with others and to act meant a lot to that person. The realization that risk and perhaps even failure is a necessary part of growth: that was another turning point that stuck with a young person.

Another young person said, “Multiple parts of me feel like I was finally understood, that I wasn’t alone, and that I could do this.” So just the sense that change is possible, right? Resonating with that, for the first time, was a turning point for that or an a-ha moment for that person. So these don’t have to be big, major revelations, but they’re memorable moments that stick with people that seem to predict change over time.

Biancolli: Well, that’s huge. Just from a human standpoint, every life is filled with a-ha moments, when you realize, ah, I can do this, I can do that, I can move forward. Or somebody happens to say something to you randomly. It resonates. And I know that in your personal story you had one such out-of the-blue moment that just stuck with you, right?

Schleider: Yes. So I talked about in my book. One of the drivers, for me, in getting into this field was not just the reality of the mental health crisis, which was one, but my own lived experience of dealing with anorexia for more than a decade—a lot of failed treatments, a lot of difficulty accessing care—to the point where I was first diagnosed aged 12 or 13, and was still dealing with it as a graduate student.

In grad school, I had the best health insurance I’ve ever had in my whole life. And I was in this intensive outpatient program. Structured meals were part of it. In the past, really no treatment that I had received had worked. I kept relapsing over and over again. And right after one of the supervised meals, which is an important part of eating disorder treatments, one of the other patients in the clinic asked me, “What made you try your fear food today?” Because I had intentionally tried something that I had talked about in a group therapy session before that was really, really hard for me—that I hadn’t had in years.

And I told her I was never going to feel ready to do it. So I just kind of did it today, and dealt with it. And I don’t really have a reason beyond that. I just felt like it was a good time. And she turned to me and she said, “Well, what if that’s the whole thing? What if it’s just a matter of doing things that are uncomfortable, and not caring whether you’re ready to do it or not, but just going for it and waking up the next day and doing that again?”

Initially, I was extremely annoyed and irritated. Like if it was that easy, I would have recovered already. But she was totally right. And I just hadn’t allowed myself to hold that discrepancy of “I don’t feel ready, I’ll never feel ready. And I can still do things to take steps in a direction that I know I want to take.” And that made a big difference in how I understood my own progress, and how I allowed myself to feel unready and distressed and also move forward at the same time.

That was a first step of many. It wasn’t the whole story. But it was the first step of many towards managing it in a more consistent way where I could engage in my life fully.

Biancolli: It’s a powerful story. And in a way it’s so powerful, honestly, because it’s just so relatable. It’s almost mundane—not to diminish your experience.

Schleider: No, I agree.

Biancolli: Also, what you said just now—and a lot of what I gathered from your book—is this sense of it’s not one or the other. You’re struggling, and you also can be feeling a little better. It can be both. There’s this yin/yang, which also struck me as really countercultural within the context of the contemporary, prevailing mental healthcare system. You can be not just functional, but really succeed in a lot of ways—

Schleider: —while being in a lot of distress sometimes.

Biancolli: Yes, while navigating real difficulty. And I just think that’s so essentially human. And what you were describing before—the videos that are that are incorporated into it. I always jokingly say that one of the best things about the internet is kitten videos.

Schleider: 100%.

Biancolli: But things that make us feel better shouldn’t be dismissed. You know, exercise, making music, making art, hanging out with friends.

Schleider: Things can be therapeutic without being therapy.

Biancolli: Right. And to me, that’s both huge—and yet again, within the context of the usual conversation, it’s not part of what normally gets discussed. I mean, I know it does in some realms.

Schleider: It does, but it’s not the main event. And a lot of folks have criticized cognitive behavioral therapy, which I’m trained in; I use the interventions. You know, I’m not trying to bash CBT. But there is a lot of negative reaction to it in the realm of trying to restructure every single negative thought you have. And trying to just say, “Oh, well, that’s an automatic negative thought. . . . I have to think of a more realistic or positive thought to counter it.” Sometimes you just have to accept that there’s going to be a negative thought, and be okay with it, and not be mad at yourself for it. And just keep going.

Biancolli: The other thing that I wanted to ask you about: In the context of the history of psychiatric treatment and psychology, there’s a lot of othering—of not recognizing the humanity of people in distress. And I don’t want to put words in your mouth, but is this on some level a mission you’re on to de-other the people in distress? To go against the history, the overwhelming history, of treating people in distress not wholly human? Not seeing them, not listening to them, not giving them hope? Is this something that you’re trying to do?

Schleider: I certainly hope I can help with that. On a number of fronts, I think the stigma is so deep, and so pervasive, and particularly bad within my field. As in, folks who are mental health professionals, folks who have the expertise in these areas, are very much dissuaded from talking about or even acknowledging the fact that more than half of us—based on recent estimates—have experienced some kind of mental health problem ourselves.

The other narrative is just so untrue and unhelpful. So hopefully, the idea is that by self-disclosing in the book and including voices of people who’ve experienced a-ha moments in the book—and by pairing that with scientific evidence—I’m saying that these two can complement each other, rather than dismissing lived experiences unscientific and therefore unhelpful. That is definitely embedded in what I’m trying to do. And hopefully—and I’ve seen some positive movement in the field already—that’ll be clear in how we approach the design of mental health care.

Biancolli: So what are your aims and hopes for the implementation of the single-session interventions? What do you see? And where has it been integrated now, and where is it available?

Schleider: Our lab is really trying everything we can think of. Focusing both within traditional health care systems—for people who are falling through cracks within healthcare, like people who are stuck on waiting lists for months, and people who are stuck or falling through the cracks outside of mental healthcare. People who can’t even get an initial appointment, even if they want to.

And the main dissemination channels we focus on, given the emphasis on youth that we have, are social media platforms, schools, and integration within healthcare settings, like pediatric primary care and emergency departments.

On social media platforms, we partner with a nonprofit called Koko that contracts with social media companies to embed mental health supports as just-in-time tools, such that when they search for things like “suicide” or “self harm” or “depression” on Instagram, on Tumblr, they’re offered mental-health support immediately. One of those supports is our single-session interventions. So through Koko, they’ve been accessed by tens of thousands of people who are identifying their own distress or searching for resources through their social media platforms.

So in that way, I think that resources like this could help be one part of a larger effort to make online spaces, which are often really difficult for people to navigate, a source of support.

Biancolli: And on top of everything else you’ve discussed, is it significant that young people, or any people, can seek out these single-session interventions and not wind up with a label on them? They can say, “Okay, I need help. But you don’t need to diagnose me and medicate me. I just need a little assist right now.”

Schleider: Precisely. Yeah, they’re barrier-free. And that is across multiple dimensions. One, we don’t require a diagnosis for our billing code to access these interventions, because the skills can be helpful for anybody. We don’t specifically talk about diagnostic labels in the interventions. We just talk about coping and challenges that all people experience to normalize them.

We also don’t require parental involvement in the interventions. So in all of our research studies, we’ve secured waivers of requirements for parent permission for teens to do these interventions. Because when we talk to teens, the number-one barrier they report to accessing mental health care is actually their parents. About a third to 42%, depending on the sample of teens, cite their parents or caregivers as a barrier to accessing support. So we’ve taken a lot of steps to make sure these are available anonymously, that teens can engage with them whenever and wherever they want, and on their own terms. So we’re really centering their autonomy in that piece as well.

Biancolli: So I have one more question for you, which is: Does all of this speak to the power of narrative? Of seeing, claiming and telling your own story? Changing it? Being the protagonist in it, even being a superhero? You were talking before about empowering young people, making them recognize their own powers that they have: Is that part of it? Just saying, “Not only are you the agent, you’re the storyteller. You can decide what the arc of your story is going to be.”

Schleider: 100%. And one of the folks that I interviewed in my book had a really touching story about when she realized that anybody can be a superhero, including herself. And I think that’s a really powerful testament to the fact that this all does really come down to narrative. We have narratives. And all of our single session interventions—they’re powerful, they’re salient, and they help people orient to where they can go next. They remind people that they can write their own narrative, and it’s not being written for them. I think that can be a really great nudge in the right direction, or in a direction that they care about.

Biancolli: I think people don’t usually think in those terms. We understand narrative as, or a story is something someone else tells. We go to a movie. We know there’s a narrative, But saying, “Okay, yeah, I am the superhero in the story, and I can decide where it’s going”—that seems like a lot to give a young person.

Schleider: That’s the idea.

Biancolli: I’ve been speaking with Jessica Schleider, a researcher and clinical psychologist who works to develop single-session interventions. She founded the Lab for Scalable Mental Health, www.schleiderlab.org. Some of the interventions she described are available for free on that website. 

Dr. Schleider, thank you so much for taking the time to speak with me today.

Schleider: My pleasure. Thanks for having me.

 

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