Cognitive-Behavioral And Psychodynamic Models For College Counseling 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 therapists 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 clients 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 isnt 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 criteri …