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 plan fully 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 differen work environments, have been using brief counseling and short-term therapy approaches (Nugent, 1994; Steen barger, 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 (Gallagher, 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 want to make damn sure that I have an employable credential in the event that I should not complete my long term goals of a PhD/Psy. D. The bills are stacking up and I want to know that I have a means of paying them.
On a less selfish note, I also chose college counseling because I have direct experience in this arena and feel I will be able to relate to many of the problems I will be presented with by students. I myself received abundant counseling while an undergraduate for vocational as well as psychotherapeutic reasons. I know what its like to have and be treated for clinical depression, while being a full time student. This kind of empathy and insight is hard to learn from less than first hand experience and can be a most valuable asset when working with someone who is suffering with a problem or condition that you know about from first hand experience. If not for the help I received from counselors and therapists, I really dont think I would be in this class today. Although short-term approaches can be found based on any of the current therapy theories that exist today, the two most common are psychodynamic and cognitive-behavioral based approaches to brief therapy and counseling (Nugent).
I would integrate both of these approaches and also some Gestalt techniques (especially for group work) into my own eclectic / integrative style of brief therapy / counseling . Of the several mainstream cognitive-behavioral short-term approaches (all based upon the previous works of Ellis, Beck, Meichenbaum, Haley, M. Erickson, etc. ), I believe that Donald Centers Solution-focused model, is the best suited for the majority college student population (Nugent). In Solution-focused short-term therapy, the counselor defines the problem, establishes goals, designs an intervention, assigns a strategic task, emphasizes positive new behavior changes, and then before termination, helps clients gradually incorporate new behaviors into their everyday living. (Nugent).
This is very directive. The main reason I like this approach is because it clearly fulfills the criterium mentioned earlier for effective time-limited interventions, and like all cognitive- behavioral approaches it is psycho educational, structured, and focuses on specific target problems (Nugent). Although it can be especially effective in dealing with most normal developmental and academic issues, it is not a panacea, and may not be as effective in dealing with more intrapsychic long-term presenting problems, where I would prefer a more psychodynamic or humanistic approach, but it will probably help most of the client populations (college students) presenting problems most of the time. The limitations of this specific approach are the same as those for all cognitive-behavioral models. Cognitive therapy has been criticized as focusing too much on the power of positive thinking; as being too superficial and simplistic; as denying the importance of the clients past; as being too technique-oriented; as failing to use the therapeutic relationship; as working only on eliminating symptoms, but failing to explore the underlying causes of difficulties; as ignoring the role of unconscious factors; and neglecting the role of feelings. (Corey, 1996 p.
356). Also, because the underlying premise / techniques of all cognitive-behavioral therapy is challenging the clients beliefs / values and behaviors, this has potentially harmful implications for culturally diverse populations / clients . It is especially important that the counselor make himself aware of the cultural context and values of these clients before attempting to confront or change their way of thinking or behavior (Corey). When dealing with clients that have issues that are more of a emotional, long-standing, intrapsychic nature, I would choose a short-term psychodynamic approach possibly coupled with some gestalt techniques to help bring past issues into the here and now. In short-term psychodynamic therapies, the focus is on the analysis of transference and countertransference in the therapeutic relationship, but unlike long term psychodynamic therapy they associate this analysis to present circumstances instead of focusing on childhood traumas. This analysis of patient-therapist interactions can then be generalized to interactions with others outside of therapy.
The past may be explored, but only in the context of the clients present circumstances (Corey, Nugent). I like this approach because unlike cognitive-behavioral methods, it allows the client and therapist more room to explore the role of unconscious factors, feelings, and other underlying causes of difficulties instead of just being symptom oriented. I would use Gestalt techniques (such as role-reversal, etc. ) in both individual and group sessions when appropriate (Nugent, Corey). Some of the limitations of this approach (Psychodynamic), revolve around ambiguity and the intrapsychic nature of these therapies.
Some ethnic minority cultures, such as many Asian Americans, may not be comfortable with this focus and prefer a more structured approach to counseling. Corey states that, ... intrapsychic analysis may be in direct conflict with some clients social framework and environmental perspective. (Corey, 1996 p. 128). Gestalt, and Holistic therapies both have qualities / characteristics that fit well within the college counseling arena.
Gestalt techniques such as role play / reversal , etc. would be particularly good for group sessions. And I think that bringing the health of the physical body and spirit into play is an essential aspect to overall health and well-being as emphasized by Holistic practitioners. I would choose an integrative / eclectic approach combining particular aspects of all the previously discussed therapy / counseling theories depending on the individual case before me. In review, although brief therapy / counseling is by no means a panacea for all the presenting problems in the world of mental health, it is in fact a great therapeutic tool for the majority of the more normal developmental life issues or problems that present themselves in the lives of the average population.
Severe addictions, and psychoses may require long-term interventions and the use of psychoactive drug therapies. Although its present wide spread use and acceptance is a rather recent phenomenon, the concept of brief therapy is well rooted in historical foundation. From the early formative days of psychoanalysis Freud was looking for a quick cure for neurosis and did not intend on the long drawn-out process that psychoanalysis eventually became. I think he would have liked the brief psychodynamic therapies of today. The research shows that there is no significant difference in outcome between short and long-term approaches, but short-term is much more efficient when used with appropriate clients. In effect, even the majority of long-term therapy approaches are short (by default, not by design), when you consider the actual number of sessions the average patient attends.
In conclusion, with the pressures of an ever increasingly fast paced society such as ours, the need for an effective, efficient, and accessible therapy / counseling approach is obvious. Short-term or brief counseling / therapy is that approach. Brief therapies have been adapted to most of the major therapy / counseling theories so there should be an approach that suits just about every one. It seems inhumane to treat people for long periods of time at huge expense if they can be effectively and efficiently be helped with short-term approaches. Classic Psychoanalysis, among other long-term approaches, need to be more honest with themselves about who is really being served in the majority of time-unlimited interventions.
Old habits and attitudes often die hard, and this is especially true when they are linked to individuals professional identities and bank accounts. When long-term intervention are truly needed, its great to know we have them, but in the face of the evidence, professionals should not make, or maintain, generalized questionable claims about the efficacy and merits of open-ended therapeutic practices at the expense of the best interests of their clients. REFERENCES Butcher, J. N. , & Koss, M.
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