Counseling outcomes under session limit policy: Implications from short- and long-term counseling in collegiate integrated care.

Objective: To examine patterns of change in global mental health within a collegiate integrated primary and behavioral healthcare (IPBH) model, in order to optimize counseling outcomes under a session limit policy amid scarce university counseling center resources. Participants: Participants included 1,571 college students (59.2% female) who received services at a collegiate IPBH center between 2011 and 2018. Methods: Clients were classified into two subgroups reflecting the clinic's policy: short-term (seven or fewer sessions) and long-term (more than seven sessions). Growth curve modeling examined overall trajectories of change, while linear mixed model analysis compared rates of change between the two subgroups. Results: Growth curve analysis indicated that both short- and long-term groups showed therapeutic improvement, with clients presenting lower distress at intake showing slower improvement than those with higher distress. When comparing the two subgroups directly, the short-term group showed a faster rate of change than the long-term group, despite having lower distress at intake. Conclusions: Findings support an equity-based approach to session limits, suggesting that focused, time-limited counseling services can benefit clients even under resource constraints. Results have implications for how university counseling centers structure care within integrated primary and behavioral health models.