Cognitive Behavioral And Psychodynamic Models For College Counseling Term paper

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Short-term or Brief Counseling/Therapy:

Cognitive-behavioral and Psychodynamic Models for College Counseling

Abstract

“Short-term” or “Brief Counseling/Therapy” and the current mental health system

seem to be inexorably linked for at least the foreseeable future. This paper discusses

the history, objectives, appropriate clientele, efficacy, and the other benefits, and

short comings, of this therapeutic/counseling modality and its relevance to my

present career direction, College Counseling. Cognitive-behavioral, Psychodynamic,

and Gestalt applications of brief therapy/counseling methods will be addressed.

For a working definition of short-term or brief therapy/counseling I would like to quote a

couple of authors on the subject. Wells (1982) states that, “Short -term treatment, as I shall use the

term, refers to a group (or family) of related interventions in which the helper deliberately and

planfully limits both the goals and duration of contact”(p. 2). Nugent (1994) says that, “In contrast

to traditional therapies, brief counseling and therapies (or time-limited therapies) set specific goals

and specify that the number of sessions will be limited.” He then adds that, “Counselors using brief

therapy approaches help clients develop coping skills that will enable them to anticipate and manage

future problems more effectively”(p. 96). In short, brief counseling/therapy is more directive and

time-limited, regardless of the particular therapeutic theory being employed. The counselor assumes

an active instead of a passive role in his relationship with the client. Due to budget constraints, the

rising cost of mental-health care, and a growing demand for services over the last decade, a large

number of counselors, in a large variety of different work environments, have been using brief

counseling and short-term therapy approaches (Nugent, 1994; Steenbarger, 1992). Short-term therapy

and counseling have consistently proven to be a powerful, efficient, and effective approach for

resolving human emotional and behavioral problems, and it is a major force in the field of

psychotherapy and counseling today (Saposnek, 1984).

Although the overwhelming emphasis on brief counseling/therapy in the mental health

system is a relatively recent phenomenon, the concept itself is at least as old as Freud. Freud

originally viewed psychoanalysis as a research tool that had powerful therapeutic applications.

Although he tried to limit his early analysis to six to twelve months, he had hoped that in time it

would be superseded by more efficient methods (Saposnek, 1984; Nugent, 1994; Phillips, 1985).

According to Small (1979), “Historically, it is clear that Freud first sought a quick cure; when he

began he could not foresee the developments that would lengthen the psychoanalytic process.” Who

would have believed that Freud would have preferred a brief therapy over the open-ended, time-

unlimited therapy process that classical psychoanalysis had become.

Social changes brought on by the pressures of World War II led to a great demand for short-

term interventions. “The stress-related emergencies of World War II necessitated the development

of early forms of crisis intervention aimed at symptom reduction, strengthening of coping

mechanisms, and prevention of further breakdown” (Saposnek, 1984). Brief therapy had found a

niche and was made accessible by government funding through the Veterans Administration. One

of the ironies of war is that it often creates large market niches and economic boon at the expense

of humanity.

In 1963, due to an increasing need for services, President Kennedy and the Congress passed

the Community Mental Health Centers Act. This Act required an emergency service in every

community mental-health center and increased the demand for brief therapy services (Small, 1979).

“The community mental health concept was intended to eliminate waiting lists from clinics (which,

not infrequently, were up to two years long!) and to get services out to the truly needy.” (Saposnek,

1984). To date, with our current emphasis on managed health care and an ever increasing need for

mental health services, the demand for efficient, effective and accessible intervention has increased

even more, making brief therapy all that much more popular and necessary in the ‘80's and ‘90's

(Nugent, 1994).

Short-term or brief therapy refers to more than just the length of time or duration of

counselor-client contact. It also incorporates the use of sophisticated directive skills on the part of

the counselor. According to Richard Wells, author of Planned Short Term Treatment, “The

therapist’s activities throughout the helping process are directed toward (1) making problems and

goal definitions as clear as possible, (2) supporting the client in systematic, step-by-step problem

solving, and (3) using the pressures of an explicit time limit as a key factor towards change”(Wells,

1982, p. 9). Garfield (1989) states that, “The specificity of the goals of brief therapy, the active role

of the therapist, and the expectations concerning the length of therapy all help to facilitate the process

of therapy and to avoid some of the pitfalls that occur in long-term psychotherapy” (p. 12). From

these statements we can conclude that the concept of brief therapy incorporates a strategic,

systematic frame work for intervention as well as the element of time-limitation.

Although brief therapy has been adapted to the majority of intervention theories that exist,

it generally stems from either psychodynamic or cognitive-behavioral theories of which

psychodynamic approaches are the most abundant. For short-term psychodynamic therapists the

focus is on the analysis of transference and countertransference, but unlike long-term analysts, the

short-term therapist is more concerned with the client’s present circumstances rather than with issues

of childhood. The majority of cognitive-behavioral short-term therapists are concerned with setting

specific goals, de-emphasizing past events, teaching new skills, and emphasizing the practice of new

and adaptive behavior (Nugent, 1994).

The question of who is or isn’t an appropriate client for brief therapy seems to point to

anybody who is not suffering from serious disorders such as psychoses, major addictions, etc..

According to a review of approaches by Butcher and Koss (1978), they concluded that there were

four kinds of patients considered to be best suited for brief techniques: “(1) those in whom the

behavioral problem is of acute onset; (2) those whose previous adjustment has been good; (3) those

with a good ability to relate; and (4) those with high initial motivation.” (Saposnek, 1984). Garfield

(1989) states that, “With the exception of very seriously disturbed individuals ...., brief therapy can

be considered for most patients who are in touch with reality, are experiencing some discomfort, and

have made the effort to seek help for their difficulties.” This sounds like a fairly average person fits

the criterium for brief therapy/counseling. Long-term therapies are generally elitist by nature. Those

who can afford the unlimited-time frame and expense involved are not in the average, mainstream,

working class population.

The empirical evidence in support of short-term therapy approaches is overwhelming. It has

been shown in reviews of studies that there are essentially no differences in outcome between short

and long-term psychotherapies but short-term therapies are significantly more efficient. This is also

the case when comparing varieties of short-term therapies among themselves (Saposnek, 1984). In

fact, the whole concept of long-term psychotherapy may be a myth based on the actual numbers of

long-term cases. Studies over the last four decades have consistently shown that the average number

of therapy sessions attended per patient across a wide variety of psychiatric clinics, ranged from four

to eight (Garfield, 1986). Even in psychoanalysis, clients tend to drop-out before ten sessions over

half the time and before twenty sessions more than 70% of the time (Garfield and Kurtz, 1952;

Gurman and Kniskern, 1978 ). The reasons for these high drop out rates among long-term therapies

vary. However, Saposnek (1984) gives a good overview of the potential reasons stating:

While some patients do drop out of therapy dissatisfied, because of a mismatch of values and

expectations with their therapists, it has also been found that those who leave therapy early

seldom go for therapy elsewhere. No doubt, in some of these cases, the clients may well have

been turned off to therapy forever. However, it appears more likely that the clients felt that

the problems for which they came had been resolved to their satisfaction (p. 1033).

A study by Butcher and Koss (1978) stated that improvement was reported in about 70% of cases

in various modalities of short-term therapies. This is a strong testimony to the efficacy of short-term

therapy especially when you consider the time factor. This is not to say that all long-term therapy has

no valid place in the mental health system (it does!), but if outcomes are equal between short and

long-term therapies in general, then that shows that the majority of clients (that are not suffering

from the before mentioned serious disorders), can be served well by short-term therapy.

In relationship to my present career path, college counseling, brief counseling/therapy

approaches have particular significance. Due to budget and logistic constraints, most college

counseling centers are overburdened and understaffed with a ratio of counselors to students of

1:1,765 (Galagher, 1991). These conditions are a specific example of a situation where short-term

therapy/counseling can play an invaluable role. Obviously students are in need of counseling

services. If not for time-limited intervention, I wonder where and how they would get the help that

they need. Referring to a review of the literature by Stone and Archer (1990), Nugent (1994) states

that, “Stone and Archer recommend that counseling centers should maintain their emphasis on

developmental concerns of the students, offer career counseling as a major service, focus on outreach

programs for personal and psychological growth, and emphasize time-limited counseling.” Nugent

also refers to a study by Gage and Gyorky (1990) and states that, “College students with specific

developmental concerns related to academics, careers, relationships, and loneliness are most

appropriate for time-limited counseling. Those clients who have mild disturbances and strong egos

and are capable of focusing on specific goals are most likely able to benefit from brief therapy.” By

this criterium, college campuses appear to be a perfect setting for the use of brief therapy/counseling

approaches. With the recent influx of older students returning to college, the diversity of presenting

problems among the college client pool should be rather large. This provides the counselor with a

rich and varied source of clients with which to hone his/her skills.

Although my long term goals are to become a clinical psychologist and author, I have chosen

“College Counseling” as an interim step in order to be able to work my way (financially) through

a PhD/Psy.D program and gain valuable counseling experience along the way. My hope is to land

a job as a college counselor at a university where I plan to complete a Doctoral program in clinical

psychology. Another motivation for this interim short-term strategy is that I am already forty years

old and I...

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