Australian and New Zealand Journal of Psychiatry (1978) 12: 151
TIME-LIMITED PSYCHOTHERAPY WITH UNIVERSITY STUDENTS* by KEN BRAGAN**
SYNOPSIS
STAGE 1
A report of the developments that stemmed from initial observations in time-limited psychotherapy with University student patients. These led to the conceptualization of the process not in terms of focal conflict but in the development of the relationship itself. Autonomy came to be seen as the central issue and a similarity was noted between the pattern of the relationship in therapy and a proposed developmental model of the growth of autonomy. Within this framework reciprocity became the focus o f the relationship dimension. A case illustration is given the significance of time and separation discussed and some therapeutic and theoretical implications considered.
The starting point was time-limited therapy as described by Mann. The essence of this approach is strict limitation of time to twelve sessions, a clear statement of the therapeutic contract following initial assessment, and the definition of a central problem the attempted resolution of which is the agreed aini of therapy. As regards the latter, whereas this is understood by the therapist to relate to a particular conflict i t is defined in terms of the person's affective experience so that therapy is defined as being about a person's suffering not his o r her psychopathology. Nevertheless the aim is to apply therapeutic leverage in a focal area on conflict, and in this way it is a form of focal therapy.
This paper is an account of the changes i n conceptualization and aims that occurred while using a time-limited contract in psychotherapy with University students over a period of about two years. The attempt is made to describe the process of change and to give the important sources of ideas. The number of patients involved was forty. All were University students in the 18-22 age range and there was approximately equal representation of sexes. Patients were seen on referral in setting of a Student Health Service. Selection was tiot stringent although all those with psychotic and severe personality vulnerabilities were excluded. Working in a situation of limited psychotherapeutic resources this contract was offered to all those, with the above exceptions, whom it was felt could benefit from psychotherapy.
Mann emphasised the significance of time experientially and in therapy, and his therapy was designed to use time as a motivating and directing force in treatment. Time is part of the structure of reality, and in reality personal time is not limitless. The process of separation which leads to individuation involves the renunciation of longings for the loss of boundaries of self in fusion and timelessness and the recognition of an ending, of finitude. Limitation of time in therapy and working on the issue of separation can promote in the relationship between therapist and patient the reality of separateness, of personal differentiation, and i t was because of this that it was felt that such an approach may have something in baricular to offer to the lateadolescent and young-adult age group. I t is at this age that identity consolidation and clearer self-definition results in greater recognition of the reality of time, and failure in this process is a common source of work failure and diminished personal effectiveness.
In the briefest outline these were the ideas with which the work began. The early observation which led to other developments was of a consistent pattern to the relationship which occurred within the constraints of the contract. Repeatedly i t was found that there appeared to be three distinct phases; an initial phase of active working and relatively easy involvement, a middle phase of tension and struggle in the relationship as well as doubt about progress, and an end phase (which could be very short) in which there was a striking change of atmosphere to an easy personal relating not usually experienced by this therapist with students in the therapy situation. It was the latter that aroused particular interest. Of course there were many variations. The length of time of each stage differed widely and variability of such factors as level of anxiety, degree of passivity and resistance greatly affected the process. '"Keeeived22 April 1978 Nevertheless the impression was received of a consistent
TIME-LIMITED PSYCHOTHERAPY WITH UNIVERSITY STUDENTS* by KEN BRAGAN**
SYNOPSIS
STAGE 1
A report of the developments that stemmed from initial observations in time-limited psychotherapy with University student patients. These led to the conceptualization of the process not in terms of focal conflict but in the development of the relationship itself. Autonomy came to be seen as the central issue and a similarity was noted between the pattern of the relationship in therapy and a proposed developmental model of the growth of autonomy. Within this framework reciprocity became the focus o f the relationship dimension. A case illustration is given the significance of time and separation discussed and some therapeutic and theoretical implications considered.
The starting point was time-limited therapy as described by Mann. The essence of this approach is strict limitation of time to twelve sessions, a clear statement of the therapeutic contract following initial assessment, and the definition of a central problem the attempted resolution of which is the agreed aini of therapy. As regards the latter, whereas this is understood by the therapist to relate to a particular conflict i t is defined in terms of the person's affective experience so that therapy is defined as being about a person's suffering not his o r her psychopathology. Nevertheless the aim is to apply therapeutic leverage in a focal area on conflict, and in this way it is a form of focal therapy.
This paper is an account of the changes i n conceptualization and aims that occurred while using a time-limited contract in psychotherapy with University students over a period of about two years. The attempt is made to describe the process of change and to give the important sources of ideas. The number of patients involved was forty. All were University students in the 18-22 age range and there was approximately equal representation of sexes. Patients were seen on referral in setting of a Student Health Service. Selection was tiot stringent although all those with psychotic and severe personality vulnerabilities were excluded. Working in a situation of limited psychotherapeutic resources this contract was offered to all those, with the above exceptions, whom it was felt could benefit from psychotherapy.
Mann emphasised the significance of time experientially and in therapy, and his therapy was designed to use time as a motivating and directing force in treatment. Time is part of the structure of reality, and in reality personal time is not limitless. The process of separation which leads to individuation involves the renunciation of longings for the loss of boundaries of self in fusion and timelessness and the recognition of an ending, of finitude. Limitation of time in therapy and working on the issue of separation can promote in the relationship between therapist and patient the reality of separateness, of personal differentiation, and i t was because of this that it was felt that such an approach may have something in baricular to offer to the lateadolescent and young-adult age group. I t is at this age that identity consolidation and clearer self-definition results in greater recognition of the reality of time, and failure in this process is a common source of work failure and diminished personal effectiveness.
In the briefest outline these were the ideas with which the work began. The early observation which led to other developments was of a consistent pattern to the relationship which occurred within the constraints of the contract. Repeatedly i t was found that there appeared to be three distinct phases; an initial phase of active working and relatively easy involvement, a middle phase of tension and struggle in the relationship as well as doubt about progress, and an end phase (which could be very short) in which there was a striking change of atmosphere to an easy personal relating not usually experienced by this therapist with students in the therapy situation. It was the latter that aroused particular interest. Of course there were many variations. The length of time of each stage differed widely and variability of such factors as level of anxiety, degree of passivity and resistance greatly affected the process. '"Keeeived22 April 1978 Nevertheless the impression was received of a consistent
