Case Book of Brief Psychotherapy with College Students

Leighton Whitaker, Stewart Cooper, James Archer Jr

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317719502
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Short-term therapy doesn't have to be second-best!This valuable book explores a variety of brief therapy approaches with young adults between 17 and 25. Each case discussion thoroughly covers the salient points of the client, the problem, and the treatment, as well as segments of the treatment transcripts that illustrate the critical aspects of the counseling. A post-hoc question-and-answer section explores alternative ways the therapist could have handled the client and allows in-depth examination of successful treatment approaches. Case Book of Brief Psychotherapy with College Students offers constructive suggestions for dealing with common presenting problems, including:

• depression
• individuation issues
• PTSD
• impulse control in mandated psychotherapy
• cult membership
• post-rape trauma
• bereavement issuesWith comprehensive references and a fascinating variety of presenting problems, Case Book of Brief Psychotherapy with College Students is a helpful resource for any psychologist, social worker, or therapist whose clients include young adults.

Chapter 1:

Introduction

The general principles of brief therapy (timely, focused, goal-oriented, an active therapist, rapid therapeutic alliance) appear to fit well with a developmental approach to counseling young adults. A developmental approach is defined here as counseling that deals primarily with blocks to normal development. Brief counseling that is focused and timely can work very well in this context. By learning to negotiate a developmental crisis or challenge, a young person may be able to overcome blocks to normal development. Such blocks could lead to serious pathology later on if they are not successfully negotiated when they are first encountered as part of normal developmental challenges.

For example, a 17-year-old male college student arrives at a residential college as a shy and rather anxious individual. The general developmental tasks creating difficulties for him appear related to interpersonal skills and perhaps the ability to form intimate relationships. He is unable to form satisfying associations in his freshman year and becomes more and more fearful of forming relationships and of asking women out for dates. Although beginning to feel quite badly about himself, if he is able to get counseling to help him learn the skills and develop the sense of efficacy necessary to develop effective relationships, he will be able to continue his development and realize that he can be a competent interpersonal and sexual being. This counseling might well be rather brief, perhaps focused on skill-building and anxiety-management, with augmentation through participation in an interpersonally oriented counseling group.

If the young man does not seek help but graduates from college as an isolated and generally unhappy person, he may move into his twenties having bouts of depression and may never establish a positive identity or sense of self. In developmental language, his identity development and capacity for intimacy are foreclosed. Were he to present himself for counseling at age 28, after having experienced several years of depression and living an isolated life style, counseling would be more complex and take considerably longer.

This is not to say that all developmental problems of young adults are simple and easily solved. A similar young man who comes into counseling with a history of severe physical or emotional abuse would probably find his issues to be much less amenable to a brief intervention. He might need to participate in more intense, lengthy therapy to overcome primal feelings of inadequacy. On the other hand, some contemporary theories of brief counseling suggest that an intermittent brief approach could be used even with this more complex kind of case.

While there are no definitive answers as to what kinds of brief therapy work with what kinds of developmental problems, this book attempts to shed light on this question. In this introductory chapter, we will set the stage for the case studies with young adults by discussing the developmental period covering late adolescence and young adulthood, ages 17–25. We will also provide a summary of the evolution of brief therapy as a treatment format and its current applications.

YOUNG ADULTHOOD

This period is far from easy. Young adults are beginning more life roles than at any other point in their lives (Super, Savickas, & Super, 1996)and most adult psychopathologies emerge at this time (Lefton, 1997).Young adulthood represents a key transitional period between adolescence and adulthood in our society. While young adults have most of the freedom and many of the responsibilities of middle and older adults, they typically lack the economic and personal resources to live completely independent lives. Moreover, our culture’s pressures to obtain substantial post-secondary school education or training has accentuated and perhaps prolonged young adulthood as a transition stage. Arnett (2000) has hypothesized a distinct stage in industrialized societies after adolescence that he calls “emerging adulthood.”

Young adults can evidence substantial energy and enthusiasm, and yet struggle with incomplete and conflicted identity issues. They are still trying to determine who they are, what their role in life will be, and how they want to relate to others, and often confront psychological conflicts related to their key objectives of separating from family, forming partnerships, beginning careers, and establishing life patterns. Some of these internal conflicts relate to abrupt shifts between childlike dependence and adult independent functioning. Others relate to the vast and sometimes overwhelming amount of options and choices available as well as the highly mixed messages they may have received from the many diverse elements of their personal life experiences. Moreover, the research suggests that gender and ethnicity issues add significant complexity to young adult development. For example, Helm’s racial identity model posits that young adulthood is an important time of racial identity development (Helms, 1990).

The study of developmental psychology has provided an extensive context for understanding young adults with problems, by explicating how people grow, mature, and change over the life span. Historically, different facets of development have been studied separately: biological (e.g., Kassin, 1998); cognitive (e.g., Piaget); language (e.g., Chomsky); social (e.g., Bowlby); psychosexual (e.g., Freud); or moral (e.g., Kohberg). Most traditional developmental theorists have espoused a stage of life perspective wherein predictable issues and change occur during differing periods of life (Lefton, 1997). Recent theories have espoused a more complex view with greater attention to sociocultural factors such as gender and minority status and on chaotic events such as the impact of specific significant life experiences (Lefton, 1997).

Still, many older theories remain viable and influential. For example, Erikson’s model of psychosocial development has been in virtually every general psychology textbook for the last several decades. His transition to young adulthood model holds that Stage 5 (identity versus role confusion) and Stage 6 (intimacy versus isolation) are critical with young college-aged men and women struggling to achieve mastery of these two domains. Specifically, identity has to do with a person having a sense of who they are, their place in the world, and where they fit; intimacy has to do with learning to relate on a warm, social basis, and forming close, intimate relationship (Erikson, 1968). This formulation has been criticized in recent years regarding its application to women. Critics suggest that women do not necessarily develop identity in the same way as men.

Chickering and Reisser (1993) incorporated Erikson’s concepts in their model of college student development. They posit seven factors:

(1) Developing competence-intellectual, physical and manual, interpersonal. (2) Managing emotions-awareness and acknowledgement, appropriate channels for release, balance of self-control and release. (3) Moving through autonomy toward interdependence-emotional independence, instrumental independence, healthy forms of interdependence. (4) Developing mature interpersonal relationships-tolerance and appreciation of differences, capacity for intimacy. (5) Establishing identity-comfort with body and appearance; comfort with gender and sexual orientation; sense of self in social, historical, and cultural context; clarification of self-concept through roles and life-style; sense of self in response to feedback from valued others; self-acceptance and self-esteem; personal stability and integration. (6) Developing purpose-vocational plans and aspirations, personal interests, interpersonal and family commitments. (7) Developing integrity-humanizing values, personalizing values, developing congruence (matching personal values with socially responsible behavior). (Chickering & Reisser, 1993, pp. 45–51)

Daniel Levinson’s (1980) concept of Life Structures can also be useful in conceptualizing young adult development; it is based on the premise that life has four distinct eras, each with its own unique qualities, typical challenges, common tasks, and likely life events. The Life Structure represents the particular ways an individual comes to perceive and respond to the social and physical world. Transitions between eras (such as from adolescence to adulthood) can be quite difficult for some and may involve high levels of anxiety and depression.

Robert Havinghurst is a leading integrationist of developmental theories and concepts. In his book, Developmental Tasks and Education, Havinghurst (1972) outlined eight development tasks of young adulthood: (1) achieving new and more mature relations with age-mates of both sexes; (2) achieving a masculine or feminine social role; (3) accepting one’s physique and using the body effectively; (4) achieving emotional independence of parents and other adults; (5) preparing for marriage and family life; (6) preparing for an economic career; (7) acquiring a set of values and an ethical system as a guide to behavior; and (8) desiring and achieving socially responsible behavior. Each of these tasks is very specific with a basis in biology, psychology, and culture.

Current textbooks on adult development and aging (e.g., Lemme, 1999; Schultz & Salthouse, 1999) are products of the dominant paradigm of psychology in general and developmental psychology specifically in their utilization of compartmentalized knowledge and study. These books cover the life span from early adulthood to death and look at physical and physiological functioning, cognitive and intellectual abilities, personality, social, familial, and intimate relationships, work and retirement, adaptation and mental health, and death and dying. Early adulthood is viewed as a time of peak performing in many areas. Middle and late stages of adulthood are discussed with an emphasis on de-bunking many of the negative myths of aging our society holds. Greater attention is now also being given to the impact of both gender and cultural factors (e.g., race, heritage, economic status, religion, geographic location, etc.).

One subfield of adult development and aging is the cross sectional and longitudinal study of psychological adjustment and psychopathology, viewed as a tentative state emerging from the complex, multifarious challenges of adulthood, particularly of the transitional phases such as adolescence to early adulthood. These transitions can create difficulties that lead to severe disorders such as major depression and schizophrenia. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) differentiates disorders of childhood and adolescence from disorders of adulthood. Many of the latter emerge in the 17–25 year old age range.

Virtually every young adult seeks outside assistance from friends, teachers, mentors, and family members in working through the issues and complicated choices of this life transition. Some by choice, and others because the challenges are too great or because their personal or interpersonal resources are insufficient, seek professional counseling and therapy. Choca (1996), in summarizing the diathesis-stress model, argues that a given individual may have a biologically, psychologically, or behaviorally based vulnerability to stress. He adds that the heightened pressure of a developmental transition will lead to increased anxiety, disorganization of behavior, and increased defensive maneuvers which, in turn, lead to a pathological exaggeration of personality style and formation of symptoms. Thus, the interaction of personal and environmental factors with the stresses of the young adult transition generates large numbers of individuals with significant personal emotional problems.

A large national study (Baron, 1993) provided insight into the most typical counseling concerns of early young adults. The investigation involved 3, 016 clients seeking services in college mental health. Numerous problem categories emerged from factor analyses: (a) autonomy, (b) break-up, (c) values, (d) social discomfort, (e) sleeping problems, (f) suicidality, (g) body image, (h) career/future, (i) homesick, (j) school concerns, (k) stress. Single item issues involved alcohol/drug problems, death or impending death, ethnic/racial discrimination, rape/sexual assault, sexual identity/orientation, and problem pregnancy/sexually transmitted diseases. Many of these problem areas are related to classic young adult developmental issues.

Just as young adults are unique as a group, so are young adults as clients unique. As a group, there is plasticity and flexibility of response, and in many cases the damage caused by negative life experiences and skill deficits is limited. Patterns of negative and self-destructive behavior are often not yet set and personal identities that include a very negative image of self have not yet jelled. The combinations of all the above makes most young adults good candidates for brief therapy.

BRIEF THERAPY

The concept of brief therapy is not new. Freud reported...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• About the Editors
• About the Contributors
• Preface
• Chapter 1: Introduction
• Chapter 2: Flight of the Appalachian Bumblebee: Solution-Oriented Brief Therapy with a Young Adult
• Chapter 3: Resolving PTSD Through Time Limited Dynamic Psychotherapy
• Chapter 4: From Hate to Healing: Sexual Assault Recovery
• Chapter 5: Don't Go There: Impulse Control in Stage-Specific Short Term Counseling
• Chapter 6: Current Conflicts as Mirrors of Unfinished Business with Mom and Dad
• Chapter 7: Fostering Development: A Case of Short Doses of Psychotherapy Over the Course of a College Career
• Chapter 8: Saying Goodbye Ten Years Later: Resolving Delayed Bereavement
• Chapter 9: Separation/Individuation in a Cultural Context: The Case of a Haitian-American Student
• Chapter 10: Saying Good-bye to the Guru: Brief Intermittent Developmental Therapy with a Young Adult in a High Demand Group
• Chapter 11: Brief Therapy with a Grieving Grad Student
• Chapter 12: A Runner's Journey
• Chapter 13: "I Am Trapped Inside of Something That I Am Not": The Case of Mary
• Chapter 14: Shoulder to Shoulder: A Single Session Success Story
• Chapter 15: The Runaway Client: Working Through Interpersonal Anxiety
• Chapter 16: Harm Reduction: From Substance Abuse to Healthy Choices
• Chapter 17: Finding the Silver Lining: Counseling a Couple in Conflict
• Chapter 18: Synthesis and Summary
• Index