A Measure of Accountability: Clients' Perceptions of a University Mental Health Service

Abstract

The University Counseling Center at the State University of New York at Stony Brook has developed a psychodynamic model for brief therapy in order to meet increased demands for service with limited staff resources. Because the center has both a multidisciplinary staff and graduate student training program, the aim of the model was to translate already existing theories of time-limited psychotherapy into practical, usable, teachable techniques. A major issue addressed was the reluctance to accept brief therapy because of its perception of being superficial and amenable only to symptom relief as opposed to “preferred” long-term treatment, seen as providing in-depth change and personality reorganization.

The model developed is based on one or two assessment sessions followed by eight sessions of treatment. The major distinguishing characteristic of the model consists of the explicit setting of two goals with the patient. Goal I is based on an assessment of the presenting problem and is directed toward symptom relief. Goal II is based on a characterological-thematic assessment of the patient and is directed toward major theme-process issues in which the presenting problem is imbedded. The eight treatment sessions are seen as a dynamic whole. Both goals I and II are explicitly contracted for, and each session number is announced by the therapist.

Experience with the model to date has shown that eight sessions produce characteristic initial, middle, and late sessions, with planned termination, a powerful, dynamic feature not usually utilized with many psychotherapies in which natural or calendar events tend to provide motivation for termination. In addition, major characterological changes can begin when the patient participates in the ego-synthesizing function of understanding the thematic issues within which specific behaviors and emotional reactions are a part.