FREE ESSAY ON COGNITIVE-BEHAVIORAL AND PSYCHODYNAMIC MODELS FOR COLLEGE COUNSELING

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
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 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 it's 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 don't 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
Genter's "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 psychoeducational, 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
client's 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
client's
beliefs/values and behaviors, this has potentially harmful implications for culturally
diverse
populations/client's. It is especially important that the counselor make himself aware of
the cultural
context and values of these client's 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 client's 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 client's
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, it's 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. P. (1978). Research on brief and crisis oriented
psychotherapies. In S. 
L. Garfield & A. E.Bergin (Eds.), (2nd ed., pp. 725-768). Handbook of psychotherapy and 
behavior change. New York: Wiley
Corey, G. (1996). Theory and Practice of Counseling and Psychotherapy. Brooks/Cole
Publishing.
Gage, L. A., & Gyorky, Z. K. (1990). Identifying appropriate clients for time-limited
counseling. 
Journal of College Student Development, 31, 476-477.
Gallagher, R. P. (1991). National survey of counseling center directors. University of
Pittsburgh, 
University Counseling and Student Development Center, 1-25.
Garfield, S. L. (1989). The practice of brief psychotherapy. New York: Pergamon.
Garfield, S. L., & Kurtz, E. (1975). Clinical psychologists: A survey of selected
attitudes and views. 
Clinical Psychologist, 28, 4-7.
Gurman, A. S., & Kniskern, D. P. Research on marital and family therapy: Progress,
perspective and 
prospect. In S. L. Garfield and A. E. Bergin (Eds.), Handbook of psychotherapy and
behavior
change: An empirical analysis (2nd ed.). New York: Wiley, 1978.
Nugent, F. A. An Introduction to the Profession of Counseling (2nd ed.). New Jersey:
Prentice-Hall, 
5, pp. 96-98, 16, pp. 356-358.
Saposnek, D. T. Short-Term Psychotherapy. In Personality And Behavioral Disorders (2nd
ed.). 
New York: John Wiley, 33, pp. 1031-1068
Small, L. The briefer psychotherapies. (Rev. ed). New York: Brunner/Mazel, 1, pp.5.
Stone, G. L., & Archer, J., Jr. (1990). College and university counseling centers in the
1990s:
Challenges and limits. The Counseling Psychologist, 18, 539-607.
Wells, R. A. Planned Short-Term Treatment. New York: The Free Press, 1, pp. 1-20.
Bibliography
REFERENCES
Butcher, J. N., & Koss, M. P. (1978). Research on brief and crisis oriented
psychotherapies. In S. 
L. Garfield & A. E.Bergin (Eds.), (2nd ed., pp. 725-768). Handbook of psychotherapy and 
behavior change. New York: Wiley
Corey, G. (1996). Theory and Practice of Counseling and Psychotherapy. Brooks/Cole
Publishing.
Gage, L. A., & Gyorky, Z. K. (1990). Identifying appropriate clients for time-limited
counseling. 
Journal of College Student Development, 31, 476-477.
Gallagher, R. P. (1991). National survey of counseling center directors. University of
Pittsburgh, 
University Counseling and Student Development Center, 1-25.
Garfield, S. L. (1989). The practice of brief psychotherapy. New York: Pergamon.
Garfield, S. L., & Kurtz, E. (1975). Clinical psychologists: A survey of selected
attitudes and views. 
Clinical Psychologist, 28, 4-7.
Gurman, A. S., & Kniskern, D. P. Research on marital and family therapy: Progress,
perspective and 
prospect. In S. L. Garfield and A. E. Bergin (Eds.), Handbook of psychotherapy and
behavior
change: An empirical analysis (2nd ed.). New York: Wiley, 1978.
Nugent, F. A. An Introduction to the Profession of Counseling (2nd ed.). New Jersey:
Prentice-Hall, 
5, pp. 96-98, 16, pp. 356-358.
Saposnek, D. T. Short-Term Psychotherapy. In Personality And Behavioral Disorders (2nd
ed.). 
New York: John Wiley, 33, pp. 1031-1068
Small, L. The briefer psychotherapies. (Rev. ed). New York: Brunner/Mazel, 1, pp.5.
Stone, G. L., & Archer, J., Jr. (1990). College and university counseling centers in the
1990s:
Challenges and limits. The Counseling Psychologist, 18, 539-607.
Wells, R. A. Planned Short-Term Treatment. New York: The Free Press, 1, pp. 1-20.