Thanks for your interest and quick response to my posting. You raise many important and complex issues that go to the heart of much of the controversy about managed care and empirically "validated" treatments. I can shed a little light on some of these issues particularly as they pertain to the Case of Kathy.
You noted that briefer "solution focused" therapy might have facilitated Kathy's change in a shorter time span. Most studies of psychotherapy for depression find that the symptoms of depression can be significantly reduced by 16 sessions of therapy. This was the conclusion of the state-of-the-art clinical trial study (the NIMH Treatment of Depression Collaborative Research Program) as well as the meta-analytic "dose-effect" research of Ken Howard and his colleagues. It turns out that the Case of Kathy was no exception to this rule. Jones and his colleagues (1993) reported that Kathy's depressive symptoms (as measured by the Beck Depression Inventory) were dramatically reduced by the sixteenth session of Dr. B's Control Mastery Therapy. So, it may be the case that whether you take a long term approach or a short term approach you can ameliorate depression in a short time.
Nonetheless, as others in this case conference have pointed out, the treatment of "depression" per se may be of little clinical importance for psychotherapists. I would offer your professor an alternative to his/her "broken arm" analogy. Psychotherapy patients who come to treatment complaining about "depression" may be much more like medical patients who come to treatment complaining about "chronic pain". No one would question the debilitating effects of either complaint. No one would argue against efforts to relieve either condition. However, most physicians would want to know something about the origins/source of the pain before simply prescribing a painkiller to remove the symptoms. Otherwise, it is likely that the symptoms will return absent treatment. This is exactly what happens to depression when it is treated with brief psychotherapy (or drug therapy for that matter). Shea et al (1992) reported the following results of the 18 month follow up of the patients in the NIMH Treatment of Depression Collaborative Research Program: "Among patients who had recovered, rates of Major Depressive Disorder relapse were 36% for those in the cognitive behavior therapy group, 33% for those in the interpersonal therapy group, 50% for those in the imipramine plus clinical management group and 33% for those in the placebo plus clinical management group. The major finding of this study is that 16 weeks of these specific forms of treatment is insufficient for most patients to achieve full recovery and lasting remission." I would encourage you to peruse this literature to address your questions about how long changes last following brief therapy.
So returning to the Case of Kathy, our data do not and cannot speak to whether greater than 16 sessions were NECESSARY to produce a shift of guilt from the unconscious to the conscious. However, the data provides quantitative evidence based on the systematic observation of multiple judges (and a theory-blind computer program) that such a change did occur following the 96th session of therapy. You might ask, "was there a relationship between Kathy's symptom change and this change in her conscious experiencing of guilt?" According to our data, the answer is yes. It turns out that one of the surprising findings from our study was that decreases in Kathy's symptoms predicted an increase in her experiencing of guilt during subsequent sessions. We interpreted our findings as consistent with the work of Howard, Lueger, Mailing & Martinovich (1993) who showed that symptomatic improvement tends to precede changes in long-standing maladaptive patterns.
Taken together, the evidence seems to point to the conclusion that brief therapies are effective up to a point. However, it is evident that other changes can occur over the course of longer-term therapies. Our data hint at the possibility that symptom reduction may be an important part of opening the door to more substantive change. It will be the challenge of contemporary psychotherapists and psychotherapy researchers to articulate the nature of these changes and to develop innovative ways to measure and study them.