What is START? It is a model of short-term psycho-dynamic psychotherapy that was developed at the McGill Mental Health Service in the years 1995 to 2006 for the treatment of emotional distress in students. It us specifically oriented towards an adolescent or young adult population, though it is effective in any age group. It was developed to foster quick change to ensure that students can succeed both academically and in life, while allowing a high number of students to be seen quickly and effectively.
The “active” part promotes the need in a student population to address issues quickly as to make it possible for students to continue functioning academically while dealing with emotional issues. The first session of START includes a detailed life and emotional history, an identification of crucial problems and core emotional issues, a discussion of these issues with the student, psycho-education about emotions, and preliminary elucidation of underlying emotional problems. While this my seem as a lot to accomplish in one session, this approach tends to lead to significant settling of the distressed student. A core underlying philosophy to START, is that students are emotional beings, and their emotional life is important and understandable. This philosophy is set in the first session.
A psycho-dynamic approach is used, as this modality has shown to be especially helpful to students. A multi-modal approach is integrated into this expert psycho-dynamic therapy, with supportive, directive, practical help and advice, and awareness of cognitions all contributing to the exploration and resolving of emotional issues. An important dimension in student distress these days has been the tendency in society and families to place achievement above emotional well-being. This makes therapy models that promote emotional suppression or distancing in the service of symptom reduction dangerous for many students as these therapies actually collude with the underlying problems. Symptom reduction usually occurs quickly with START as crucial emotional issues are addressed from the beginning of therapy, and safe space for exploring emotions is provided.
The Rapprochement aspect of this psychotherapy, refers to the work of Margaret Mahler and Peter Blos on Separation-Individuation. Rapprochement in this sense refers to the “checking in” that a young child does as the child begins to explore the world as a more individualized little human. Peter Blos has called adolescence a “second separation-individuation phase of development, where becoming an individual in a more adult sense is important, but where ambivalence between connection with parental figures and creating one’s own space and identity is obvious. The later adolescent and early adult period can be conceptualized as a second rapprochement phase, where individual identity and individuation is further developed, but where the need to re-connect to authority figures is also important. In the context of START, the rapprochement approach implies that the therapies can utilize and respect the normal phase of development that students are experiencing to allow therapy to proceed quickly. This is accomplished by not holding onto the student for too long, but to allow and encourage students to leave therapy to continue progress on their own with the invitation to come back to “check-in” as necessary. Thus one does not have a “termination” phase to the therapy. Issues are addressed quickly, work is done on these issues to elucidate and begin work on them, and as soon as the therapist and student feel sufficient progress has been made, the student is encouraged to go out, live their life, and practice emotional changes. The same approach can also be used with students with the most severe type of problems, including those diagnosed with Borderline Personality Disorder. Sometimes students with these type of problems don’t want to engage in long-term therapies, but do show substantial improvement with intermittent therapy, as long as the same therapist is available to them at times of crisis.
With START, students in a university centre tend to be seen for an average of 5-6 sessions. This includes space for about 25% of students to be seen long-term. Many students will show a major reduction in emotional distress and symptoms in just 2-3 sessions, and may choose to leave therapy at that point. Some may be satisfied with even one session. This form of therapy is often an introduction to the importance of one’s emotional life, and can set the stage for lifetime growth.