The number of undergraduates reporting mental health difficulties nearly tripled in the seven years up to 2023, rising from 6 per cent to 16 per cent. Yet only 12 per cent of students thought their university handled mental health issues well, according to a survey. The gap between need and satisfaction tells its own story: something isn’t working.
While cognitive behavioural therapy (CBT) has become the default intervention, many students describe it as a plaster that covers the wound without healing what lies beneath. As a mental health researcher, I have seen up close the toll the wrong treatment takes on people. A friend of mine waited a year for support after being told she wasn’t in immediate danger, repeatedly hearing that the problem was an “attitudinal shift” rather than the lack of accessible therapy. For complex issues involving identity formation, family dynamics or unresolved trauma, universities need to offer something deeper.
CBT focuses on the here and now, changing current thinking patterns without addressing the underlying or historical factors that can inform present difficulties. While this makes it cost-effective in the short term, the revolving door of students returning after brief CBT courses suggests that deeper interventions may be more economical in the long term.
The evidence base for CBT’s superiority is less robust than commonly believed. Effect sizes comparing CBT with other therapies are minimal (around 0.06), yet this data is often cited without scrutiny. Psychoanalyst and researcher Jonathan Shedler has systematically exposed methodological flaws in CBT research in his lecture Where is the evidence of evidence-based therapy?
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This matters particularly for international students, who are less likely than their British peers to use campus counselling. With 80 per cent of international students in the UK experiencing stress or anxiety, and cultural differences affecting how therapy is understood, standardised CBT protocols often miss the mark. When 70 per cent of all students report that money worries negatively affect their mental health, yet only 5.8 per cent disclose mental health conditions, we’re clearly not reaching those who need us.
Psychodynamic therapy – sometimes called depth psychology – explores underlying patterns, relationships and unconscious processes driving behaviour and emotional responses. It helps students gain understanding of how early experiences shape current struggles, how relationship patterns repeat and how unresolved conflicts manifest in academic or social difficulties. This mode of therapy offers the necessary time and space for personal growth, change and greater self-knowledge, empowering students to make better choices that lead to healthier long-term outcomes.
Recent meta-analyses show psychodynamic therapy is as effective as other treatments for young adults, with particular benefits for complex, relational or identity-related difficulties. Its emphasis on relationships, context and individual meaning-making makes it more culturally adaptable than standardised protocols. Recovery in many cultures involves not just the individual but also the family and community – psychodynamic therapy’s flexibility allows for incorporating these perspectives. For those new to this approach, Shedler’s Fourteen concepts to understand psychoanalysis provides an accessible overview.
1. Invest in training existing staff in psychodynamic approaches. This doesn’t require wholesale replacement of your team. Many counsellors trained primarily in CBT can develop psychodynamic skills through continuing professional development. Rather than funnelling all students toward CBT, implement initial assessments that match students with appropriate therapeutic modalities based on their specific needs. A student with performance anxiety rooted in childhood perfectionism needs different support than someone managing acute exam stress.
2. For cost-conscious services, short-term psychodynamic psychotherapy offers a middle ground, focusing on one particular issue over 12 sessions and providing in-depth work within a manageable time frame.
3. Collaborate with psychotherapy training programmes to provide placements. Trainees gain supervised experience while your service accesses psychodynamic expertise at a lower cost. Ensure robust supervision structures are in place – this is essential for quality and student safety.
4. Group formats provide in-depth work at lower per-student costs while offering peer support.
This can be particularly effective for common student issues, such as relationship difficulties or identity exploration. Make it clear to students that multiple approaches exist. Some institutions allow students to negotiate brief and focused therapeutic interventions to decide how services can best support them. Students appreciate having agency in their own care.
Yes, psychodynamic therapy typically requires more sessions than brief CBT. But calculate the true cost of students cycling back through services when symptoms resurface. Include staff time for repeated assessments, the impact on waiting lists and lost opportunity costs. Many people come to psychodynamic psychotherapy after a short course of CBT has left them feeling confused and misunderstood.
Universities cannot rely solely on CBT when many students find it insufficient. Diversifying mental health provision doesn’t require wholesale restructuring or unsustainable costs. Start with staff training, flexible assessments and exploring the options outlined above. Partner strategically with training programmes and ensure cultural responsiveness.
Students navigating identity formation, complex relationships and the transition to independence deserve support that helps them heal, not just manage symptoms for long enough to complete degrees. Some institutions have already evolved beyond the brief CBT model, demonstrating that this is possible. It’s time others followed suit.
Ava Doherty is an undergraduate student and mental health researcher at the University of Oxford.
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