Wednesday, December 18, 2013

College Mental Health as a Specialty

I chose to focus my career on college mental health (CMH), or college counseling, in approximately 1987.  That was my first year in my doctoral program in counseling psychology.  Perhaps it was the time, perhaps the context, but I definitely perceived CMH to be a "field" of study and work.  I recall others being interested in pursuing this same career path then and especially during the early years of my professional life.

If I have learned anything from more than two decades of work in this field it is that CMH is in fact a specialty.  Explaining the nuances in this work could fill more than one volume, much more space than what is offered here.  Starting with an example of definition, the American Psychological Association (APA, 2011) defines a specialty as follows:

"A specialty is a defined area of professional psychology practice characterized by a 
distinctive configuration of competent services for specified problems and populations. 
Practice in a specialty requires advanced knowledge and skills acquired through an 
organized sequence of education and training in addition to the broad and general 
education and core scientific and professional foundations acquired through an APA or 
CPA accredited doctoral program. Specialty training may be acquired either at the doctoral or postdoctoral level as defined by the specialty."

There are professional organizations devoted to this specialty, about some of which I have posted previously.  A short list of American organizations is provided here:
  • Association of University and College Counseling Center Directors
  • International Association of Counseling Services, Inc.
  • American College Counseling Association
  • Section on College and University Counseling Centers, Division 17, American Psychological Association
  • Commission for Counseling and Psychological Services, American College Personnel Association
But these are just formalities, and not included are the many college counseling centers which provide formal training opportunities including practica and internships.  The essence of the specialty lies in the nature of the work itself.  Some hallmarks of a competent approach to this field include:
  • A thorough understanding of the holistic development of late adolescents and young adults as it relates to academic success and personal growth
  • A broad range of skills in the area of psychotherapeutic approaches to common issues faced by college students
  • An appreciation for the importance of outreach and prevention education programming on a college campus, including the skills of planning, delivery and evaluation of these activities
  • A thorough and competent approach to delivering consultation services to members of a college campus community, including faculty, staff, parents, and others
  • Where possible, a comprehensive mission of training graduate students in mental health professions in the CMH specialty
Much harder to articulate is what lies at the heart of this type of work.  The nuances mentioned above relate to the skills involved in managing very complex dynamics in multiple and sometimes conflicting work relationships, the urgency involved in responding to the needs of both the individual and the community, and the promotion of the full and genuine identities and life trajectories of students in this context.  If I was forced to explain one view in as few words as possible, which in fact I am in this space, I would offer the following statement:

"CMH is the training for, application, and on-going study of a range of psychologically-oriented human services focused on the academic success and personal growth of college students, with a full understanding of the complete context in which they function, including responsiveness to the needs of all who relate to, work with and serve them, and the successful management of professional boundaries with all involved such that the goals of the individual and community are promoted."

Sunday, November 17, 2013

Effective Campus Consultations

In the college counseling world, consultation refers to delivering mental health expertise to concerned third parties, such as faculty, staff, parents, and other community members.  On most campuses, the community sees the counseling service as a valuable resource which offers all some assistance in helping students effectively.

This aspect of services is rife with both potential conflict and opportunity (it's amazing how these two things often go together, eh?).  On the one hand, the student is always the focus of services and often also the client; on the other hand the institution is always the client, the corporate client in fact.  There are a few times when the needs of both are in conflict.  I submit, however, that such occasions are rare.  Mostly, there is enormous overlap among the needs of the two.  Indeed, each actually wants the same thing: to retain and graduate young adults.  My direct experience has been that when there is conflict it's often because one or both are nurturing needs which are unreasonable, though that is of course open to plenty of debate.

So, there are some tips on delivering effective consultations on campus.  In no particular order, here are a few.

  • Establish the identification of the primary client, and do it early and often.  If the student about whom someone is concerned is a client of the center, they are the primary client, and the obligations to them are paramount.  In this scenario the institution becomes a secondary client, though in this context this does not mean its needs are inferior.  It's just that they must be addressed by someone who does not have a dual role with the student unless the student has authorized such activity.
  • Respond promptly, every time.  The fortunes of college mental health rest on our showing up.  Always.  It is often expensive to do so, considering the labor involved.  But there is a huge return on investment.
  • Don't just say no; find a way to help and tell them you will do so.  Successful businesses put the consumer first.  There is no reason why we should not do this as well.  Even when needs conflict or dual roles exist, there is always a way to be helpful.  It may take some time and creativity to pull this off, so one could always say "I'm not sure how to help you, but keep talking to me and I will find a way."
  • Establish and maintain clear boundaries and expectations when needed.  At the same time, some requests are clearly inappropriate.  Such as when someone asks for privileged information and there is no authorization for same, nor is there any risk for harm to self or others.  You could be the FBI or a parent or an administrator.  It does not matter.  Abrogating the therapy relationship in this way can be fatal to therapy, now and perhaps well into the future for a student.  That's a really bad thing.  At the same time, there may be a need driving the request which can in fact be satisfied.  Figure out what that is.
  • Keep your word and be consistent.  Whatever happens, do what you say you will do and do it each time.  Since we're all human here, we make mistakes and no one can rightly tell you that you can't.  But if you do, own up to it and set it right whenever possible.
Consultations are wonderful opportunities to get things back on a good path, for the student as well as the community.  Often the circumstances behind the consultation represent the logical though negative conclusion of unhealthy relating and expectations.  It is a kind of bubble which needs to burst, but all involved sometimes prevent or avoid that from happening.  An effective consultation facilitates the bursting in a controlled manner, so that maximum learning and change can occur.  Which is exactly what everyone needs, whether they want it or not.

Wednesday, October 23, 2013

The Question of Marijuana

Nearly every day I read an item extolling the virtues of marijuana from a wide range of its apologists.  Even CNN's Sanjay Gupta has gotten in on the action, recently reversing his long-held opinion about its dangers.  It doesn't kill anyone, they say.  You cannot be addicted to it, they say.  Susan Sarandon says it's silly to send folks to jail over pot possession, for example, because no one has ever been harmed by weed.  It is now not only legal to have it in California and Colorado, but also to consume it.  And even distribute it.  There is even a date on which people on college campuses gather to smoke, in public, in areas in which it remains illegal to do so.  I for one won't help the cause by publishing that date.

The champions of pot like to claim that it doesn't harm anyone, that it is a natural substance "from the earth".  They report that they don't know anyone who has told them about having problems with it.  But if someone did have problems with it, would it be them that such individuals approach?  Not likely.

I know that smokers can and do see mental health professionals, and for a variety of reasons.  I know this because I am one, and I have worked with many over more than 20 years of practice.  They arrive in my office with motivational problems.  With broken relationships.  With chronic bronchial disorders.  Some have patterns of academic and career stagnation.  Some exhibit a kind of intellectual stunting, especially if they began smoking in their early teens.  About one or two of every ten present with an anxiety or psychotic disorder which was apparently unmasked by marijuana use.  It is felt that such disorders may never have been triggered were it not for the smoking.  The CDC, in its Surgeon General's Warning page on marijuana, lists many of these known issues related to use, and has done so since 1982.  Anything that has its own warning page by the CDC is worth a little scrutiny, in my opinion.

Recent studies reveal that 12% of young people have reported driving while intoxicated on pot.  It stands to reason that a portion of these drivers have been in accidents which harmed or killed themselves or others.  But I await real data about that.  Nevertheless, I think it is irresponsible to give others the impression that marijuana is always safe, no matter the full context or the individual human brain involved.  That is simply not true.  If I could I would introduce you to young people whose lives, and in some cases their bodies, were badly altered by their abuse of this substance.

This particular debate is independent of questions about legalization or incarceration.  I don't think the war on drugs has been useful or effective when it comes to pot.  Others who know me well will tell you I far from being a prude.  I believe, and have told my clients this many times, that it is possible to be safe, smart, and still have plenty of fun.  I stand by that 100%.

We speak of marijuana as though it were a single substance with uniform properties, which it is not.  It comes in many varieties and degrees of potency, and sometimes it is spiked with other substances which may or may not be known to the smoker.  The fact is that marijuana consists of chemicals which will impair some individuals.  The science has not evolved to the point where we can accurately predict exactly who will have problems resulting from consumption, at any amount and over any course of time.  Questions concerning addictive potential remain unanswered.  But I am here to tell you, if anyone can be addicted to shoes, so can some be addicted to pot.

No matter that it comes from nature.  Neither will kill or maim everyone who is exposed, but arsenic and snake venom come from nature too.

Monday, September 23, 2013

The Vitality of Youth

Much has been written about millennials and Gen Y students, a lot of it negative.  They have been variously characterized as lazy, self-absorbed, safely cocooned in electronics, and worse.  Some of this is based on real data.  But I am here to tell you, they may save us from the havoc we "adults" sometimes wreak.  We absolutely need them.

For one thing, they are apparently more optimistic than older adults.  They believe they will have more opportunity than their parents did, and that life is better today for them than it was "in the good old days."  It spite of the doom and gloom being written about the state of higher education in this country, they see it as a good investment in their future.  Who doesn't need freshness of opinion, and a hopeful view of the future?

I have written elsewhere in my blog about the energy and creativity of youth, so this item is really just another snapshot of the gifts they bring to the table.  As we older adults wrangle over chronic and confounding issues of our day, such as racism and military conflict, it is our youth who sometimes present brilliant and "never mind all your rules" approaches to problems.  Rule-breaking teens are even thought more likely to become successful entrepreneurs later in life.  I am reminded of a recent news item about a pre-teen who solved a centuries-old mathematical conundrum in just a few minutes, startling others in the room.  Their hopefulness and lack of constraint is very valuable indeed.  While adult members of faith argue over the "right" approach to inter-faith gathering and dialog, for example, younger folk go ahead and get together and talk.  This pattern has occurred among Christians, Muslims, Jews in the middle east, and among Protestants and Catholics in Northern Ireland.

If they can forge ahead there, what else can they do?  What will we encourage them to do?

Wednesday, August 14, 2013

Vignette 3: What Would You Do?

Juanita, a disoriented student

Background: Juanita has had her head on her desk throughout class.  She appears to be napping.  She is disoriented with slurred speech.  It is not clear if she is intoxicated or not.

Scene: Her professor approaches her desk after class.

Dr. Jones: Juanita class is over.  (No response)  Juanita?

Juanita: (Stirring around a little) Mmmmm?

Dr. Jones: Class is over, time to go.

Juanita: (Speech is slurred) Time to go where?

Dr. Jones: The class is over.  You can leave now.

Juanita: Books are at home.  Left them with my papers.  Be here tomorrow though.  (Giggles)

Dr. Jones: Look, it’s time to go.  What are you doing next?

Juanita: (Slurred) The big question.  No one really knows, do they?  Big planet, you know.  Time to go you say, so say you.

Dr. Jones: (More alarmed) Juanita, are you OK?  Where are you supposed to be?

Juanita: No worries, chief.  Doin’ okee dokee.  Gotta get to formica, need the ruzzle from there.

Dr. Jones: (Worriedly) What is your name?

Juanita: The one who shall not be named, in Madrid.

Dr. Jones: What is today?

Juanita: Today what?

Suggestions: Such behavior is generally an indication of a serious condition, which could be anything from intoxication, psychosis, or another medical crisis.  Consider a swift transport to the emergency department of a local hospital, or summoning paramedics.

Tuesday, July 16, 2013

Notes on the Matter of Suicide

Recent tragedies which have captivated national attention have raised both awareness and anxiety regarding college student suicide.  Though the reason for heightened awareness is of course unfortunate, the awareness is a positive development.  But the anxiety may or may not be, depending on what one does about it.

If the anxiety translates to knee-jerk reactions in policy and procedure, and in campus-wide interventions, we may not only be ineffective, we may actually unwittingly contribute to the problem.  Here's how.

Research shows that suicide prevalence rates in higher education settings is 4.3 per 100,000*.  This is in contrast to the same rates for same-age non-college peers, which fall between 11.0 and 14.0 per 100,000 according to the CDC and its data for states.  While any loss of life is a tragedy and deserving of prevention efforts, we can conclude that simply being in college offers some protection against suicide.

So one thing we could do to prevent suicide is make it easier for young adults to have dreams (thereby projecting into the future, a major protective factor as you will see below) and attend, stay in, and graduate from college.  Reflexively reacting to the fear of suicide may lead us to respond to less-than-honorable vendors who are hawking suicide reduction wares in higher education and other settings.  (Please note here that some of these may have merit, and some may not.)  In a setting in which the base rate is already considerably lower than that of the surrounding community, and depending on its features, such programs may unintentionally create an ecology of threat, making it appear that it is a larger problem than it truly is.  To the despairing, this may have the most unfortunate outcome of making it appear to be a viable option that others nearby are considering and acting upon.

Questions to ask such vendors are: What rate is your program designed to address?, and What rate will be the outcome of your program?

Surprising as it may seem, researchers are only now investigating motives for suicide among students, the "why" of suicide.  Research to date has focused largely on demographic factors, or the "who" of suicide.  A recent study tells us rather affirmatively where we might focus our attention.  The authors state it is time to move beyond "one size fits all approaches", and strongly indicate that hopelessness and overwhelming emotional pain are the two internal motivational risk factors most associated with suicide.

Campuses would do well, then, to focus on community interventions which promote hope and future orientation toward maximizing and manifesting student gifts, talents, and dreams.  It is important that students feel they belong, that their identity matters and is wanted and needed by others.  They would also do well to promote the adequate funding of mental health resources, so that those in unbearable pain have a place to go for help.  To date, most of the vendors described above appear to focus on identifying those in pain, not their ultimate assistance.  Most college counseling centers can already tell you how to identify those in distress, and their perspectives are based in local experience and not the marketing of a product.  Listen to what these professionals have to say, then make it possible for the suffering to be assisted by them.

*Schwartz, A. J. (2011). Rate, relative risk and method of suicide by students at four-year colleges and universities in the United States, 2004-05 through 2008-09. Suicide and Life-Threatening Behavior; 41(4), 353-371. 

Wednesday, June 26, 2013

The Incubator

Late adolescents and young adults need space and time to develop an authentic self.  While there are of course a great many contexts in which this can occur, perhaps few are better suited to the purpose than the higher education environment.  In my view, when carried out well, this is a major benefit of the college experience.

During such a time, youth are exposed to ideas, knowledge, experiences, social feedback, and a wide range of relationships which either enhance or detract from personal growth and fulfillment of latent promise.  A forming adult can benefit immensely from this environment, which represents an incubator of the emerging self.  In this way students experiment, explore and try on various selves to see for themselves which one fits and works the best.

It is both an exciting and trying time, for students as well as those around them, especially loved ones.  The experimentation brings highs and lows, successes and failures, flashes of brilliance and the pain of mistakes.  But these ups and downs are absolutely necessary, assuming we all want to produce healthy, competent and productive adults.  Older adults, be they professors, administrators, family members or friends, simply must respect the need for this period of incubation.  Sheltering young adults from all pains can harm them significantly, though we should of course protect them from the most serious ones if we are capable of doing so.  There were times in human history when there was no such thing as this kind of incubation, due to the hardship of living many faced.  But we are able to, and should, provide this now.

Respect requires allowing enough space and time for growth to occur.  For parents this means gritting one's teeth, teaching what one knows but allowing students to venture off, even when mistakes are a near certainty.  Doing this, a sense of faith and trust is communicated, which is the fuel on which the emerging self thrives.  It means patience in the face of a tattoo, purple hair, exploring a major which is a "bad choice", financial incompetence, or partnering which causes heartburn.  The incubation can take a very long time, but learning does in fact occur.  Students learn on their own what will and won't sustain them in life, because life itself teaches them.  We parents don't always have to do the teaching, as much as we want to.  Attempting to do that, we actually interfere with natural consequences and learning, slowing down and disrupting the entire process of development.

So give them space and time to incubate the self.  Trust that the self will unfold in the way it should, one way or another.  Students, take the opportunity to learn about and become who you are.  Just as you have the freedom to do so, so do you have the responsibility to accept the feedback you will receive, and to adjust accordingly.

Thursday, May 30, 2013

Listening Always Comes First

So there's a great little video called It's Not About the Nail out in the electronic ether, all about the importance of listening.  Upon watching it one thinks about relationship contexts mainly, especially the oft-seen tendency of men to fix things instead of just empathizing and supporting their partners.

Ah but the video is a great object lesson for professional helpers.  There is a strong sense of urgency among many healthcare providers to quickly and efficiently apply the "intervention" to the "symptom", because that is what the diagnosing/insurance/billing industrial complex demands. The forces behind this complex are tremendous and so embedded in some helping systems that many don't stop and think for a moment about how this form of "helping" may be affecting the "helped".

Sometimes, it doesn't matter how "right" the helper is.  The one receiving the help must feel heard and understood first, as this facilitates acceptance and motivation to be helped in the first place.  I recall a story about a homeless woman, hungry and cold, who upbraided a good Samaritan for "throwing me a bone".  Before she received food and clothing, she wanted to be understood.  In particular she wanted her pain to be understood.  That was her primary need at the moment.  Her "helpers" assumed her physical needs were more fundamental than her emotional or spiritual needs.  This is where many of us go awry.

The video takes us back to the early days of our training.  We were first taught basic helping skills, such as empathy, genuineness, positive regard and active listening.  Somehow the systems we work in may distract us from these elemental approaches to human suffering.  Let's go back then, and learn this all over again.  If you are involved in training the next generation of helpers, consider showing them the video.  After the jokes subside, tell them to get serious about this one.

Friday, May 17, 2013

Vignette 2: What Would You Do?

Sarah, a depressed student

Imagine you are in the position of advising a college student about her classes.  She walks into your office unexpectedly, looking for help.

Background: Sarah is a junior and does well in class and is usually perky and energetic.  Lately though she appears fatigued, quiet, and withdrawn.  Instead of being her usual talkative self, her close friends notice she just keeps her head down and seems to mope around.  Others haven’t seen her in a while and don’t know what is going on.

Scene: Sarah meets with her advisor about next fall’s schedule of classes.

Mr. Hayes: Hey Sarah!  Haven’t seen you in a while.  (He notices her appearance, which is unkempt and tired) How are you?

Sarah: (Looks down, emotionally flat) OK.

Mr. Hayes: OK, well, what did you have in mind today?

Sarah: I guess I need to set up classes for the fall.  I am not sure though…what I want or need.  Or even it it’s important.

Mr. Hayes: I have to tell you, that surprises me.  You’re usually right on top of everything.

Sarah: (Angrily) I wish everyone would stop saying that!  I am so tired of doing what everyone expects me to do!

Mr. Hayes: Whoa, Sarah.  I’m not really telling you what to do.  I’m just surprised, that’s all.  What is going on?  You seem different.

Sarah: I’m not who you think I am…

Mr. Hayes: What do you mean?

Sarah: I’m bored.  I don’t care about anything anymore.  All this school stuff is stupid.  I just want to sleep and be left alone.  I’m tired of people calling me, asking me stuff.  (Tears start to flow) My boyfriend doesn’t deserve this, so I avoid him too.  He’s getting frustrated, just like you.  Just like everyone else.  I guess I can’t blame them…all I’ve done for a couple months is sleep and watch TV and eat junk.  But I don’t care.  Goodbye Mr. Hayes, you won’t be seeing me anymore.

Suggestions: First, that last statement requires clarification.  Ask Sarah exactly what she means by that before she leaves your office.  If safety appears to be an issue, contact your campus counseling service for assistance right away.  If safety does not appear to be an issue make an attempt to understand her obvious distress.  Say "Please tell me more about what is bothering you, I'd like to help."  Asking questions about basic things like eating, sleeping, going to class, family and friendships will often reveal a lot about the type of issues Sarah struggles with.  Once you have an understanding of her concerns, focus on empathizing and not judging Sarah.  Then offer to help her see someone who can help her further.  Say "We have a great counseling center and I'd like to help you get an appointment there."  Offer to make the call for her right there in your office.  But then hand the telephone to Sarah when it is time to set the appointment.  Or you could offer to walk with her to the center yourself.  Later, follow up with her and ask her about her appointment, and encourage her to go if she has not done so.  Benign encouragement and persistence can go a long way in getting students the help they need.

Sunday, April 28, 2013

A Brief Word on ADHD

Attention-Deficit/Hyperactivity Disorder, or ADHD, is a pattern of persistent inattention and/or hyperactivity, most often evident before age seven. The symptoms cause impairment in at least two settings, such as school and work, and it is more severe than what is usually seen with others of the same age and developmental status.

Many students experience periods of time when they are restless or have trouble concentrating. In fact, almost all students will go through some adjustment strains from the time they arrive at college, and may have very similar attention problems as a result. Also, there are other problems that can mimic ADHD, such as anxiety disorders, traumatic stress, alcohol or drug abuse, overuse of social media and gaming, and even ordinary family conflict.

If you have arrived on campus with a history of ADHD, it is important to continue with your treatment and to provide your local psychologist with documentation of your past diagnosis and treatment. This will improve continuity of care and perhaps prevent unnecessary problems in school.

It is unlikely that ADHD will suddenly appear in a student's adulthood. Yet sometimes students are convinced they have ADHD and take medications offered to them by friends. And some know they don't have ADHD but choose to take amphetamines as a performance enhancement drug.  Please know this may do you no good at all and, in some cases, can actually cause you harm. Diagnosing an adult with ADHD involves a sophisticated and comprehensive evaluation by psychologists, and should be undertaken with great care so that other possibilities are ruled out.  One should avoid evaluations based on checklists and self-report measures alone, as these are likely to lead to over-diagnosing.

If you suspect you have ADHD but you have never been formally diagnosed or treated, call your campus counseling service for assistance.

Sunday, March 31, 2013

Ode to the Campus Police

There are many campus departments deserving of praise, and many that work silently toward enhancing the well-being of campus communities without receiving a shred of positive attention.  The campus police department is one of these.

College counseling centers often work very closely with the police, especially in the area of crisis intervention services and various teams whose purpose is to prevent and respond to disruption and violence on campus.  Collaborations such as these were once infrequent but soared after the Virginia Tech tragedy and statutes requiring them were developed in that state.  A great many institutions have adopted collaborative models and, as of this writing, at least two others states have either adopted similar legislation or are considering it.

And so it is that mental health and campus safety professionals work arm in arm, many times in the wee hours of the day, attending to critical student needs.  Many stakeholders are unaware of the fine-tuned responsiveness of campus police departments.  In this area of their work, they are not just certified law enforcement personnel with investigative and arrest authority, though they are certainly that as well; they are supportive educators providing students with valuable life lessons.  Beyond consequences for negative behavior, often delineated in institutional codes of student conduct, officers are a living example of institutional care for the student and community.  Through their actions one may experience powerful messages, such as: "we are paying attention to you", "we will respond to you", and "we will go to great lengths to see to your safety and the safety of others".  This level of responsiveness is many times not available in municipal police departments, simply because the missions are so decidedly different.

A campus police officer may, for example, conduct welfare checks on individuals suspected of being in acute distress.  He or she may knock on the doors of, say, 40 apartments, in a search for a student.  This could happen in the middle of the night, or even when the university is closed for a holiday.  On occasion they may transport a student to a counseling appointment, or to the hospital when situations warrant it.  They may accompany a counselor to the scene of a crisis event, without any expectation of being directly involved unless needed, just to raise feelings of security among all who are present.  All of this may happen without any further actions on the part of the officer and police department.

Much of this activity is invisible to the campus community.  But a great many adverse events are contained, and a great many students are assisted, in just this manner.  Well-trained campus police officers are not there just to get us into trouble, as some would have us believe.  They are a vital part of the overall welfare of the community, and they are deserving of our praise.

Sunday, March 10, 2013

How to Refer a Student for Counseling

There are both more and less effective ways to refer a student for counseling. Following the guidelines suggested below should help concerned others initiate and complete a successful referral.

1. Express your concern directly to the student. Be respectful, honest and straightforward in your language about the emotional health issues that you are noticing. Avoid belittling them or communicating pity. Remember that they are just not feeling well; otherwise they're just like you.
2. Check your own attitude about mental health services. If you see it as a negative thing chances are good the student will perceive that as well. Encourage them in this positive undertaking and ask them to call the counseling service to set an appointment. They can call from your location, or you can offer to call for them. If you call please be aware that centers generally don't allow third parties to set an appointment, but you can get the process started and then hand the phone to the student. You can also offer to walk the student to the center to set the first appointment.
3. You may call a psychologist first yourself if you have questions about services or about communicating with the student. If you wish to report your concerns to mental health professionals, please take great care to stay close to the facts as you know them. Steer clear of rumors, hearsay, or gossip, or at least identify it as such. A factual report leads to the best interventions and outcomes. False reports can lead to negative events for both the student and for you, including civil court proceedings and campus judicial sanctions.
4. In some cases mental health professionals will recommend that you meet with the student and give you suggestions about what and how to communicate with him or her. From the student's point of view, such an encounter is logical because you are known to them and they can understand why you might be concerned. Due to normal anxieties it is natural for you to feel an urge to disengage from the situation, but doing so is less than ideal. Try to stay engaged for the short period that is needed. After that, others will take over and assume responsibility for further assessment, counseling, or referral. Some feel they either don't have the right to "intrude" into students' personal lives, or feel they should avoid any responsibility for information they obtain about them. In our view, neither perspective is reasonable. Expressing concern for others based on observable behavior is not a violation of privacy, and once you inform others who are in a position to help, you have discharged responsibility you have for the information you obtained. This does not mean, however, that you should not remain involved to some degree, as noted above. Faculty and Staff members may also refer to FERPA guidance for other information on this topic.
5. In cases in which there is not an emergency or a life-threatening issue, one cannot "force" a student into counseling. One can only encourage it and keep monitoring the situation. Attempting to coerce or "trick" such students into counseling can backfire horribly; they may come to see counseling as negative and you as manipulative, thereby losing trust and faith in both. If they do pursue counseling on their own, it is highly important they feel a sense of privacy and a good measure of control over their affairs.
6. This does not mean, however, that you should never give a student an ultimatum about changing their behavior. Some parents or authority figures should consider doing so if the behavior in question is self-destructive or disruptive for others. The key in this scenario is "behavior change", and this can occur both in and out of the context of counseling. Counseling can be a useful mechanism of behavior change, but it isn't the only one. Sometimes parents, for example, may tell their student that they will withhold funding for school if they do not change failing grades, repeated alcohol violations, etc, and add that counseling is one way they can work on this. This can be quite effective when done well.
7. In emergency situations be mindful of your and others' safety. If safety appears to be an imminent concern, call 911 or your campus police department.  If safety is not an issue but the student is in an acute crisis with obvious signs of distress, a counselor may come to the scene to assist. Be aware that some have a policy to have a police officer with them in these circumstances, in the event that there is an escalation of disruptive or aggressive behavior.

Monday, February 25, 2013

Vignette 1: What Would You Do?

Jane, a homesick student

Let's imagine you are a member of a college's faculty and a student presents in some distress. Consider the following scenario, and think about how you might respond.

Background: Jane is a first-year student from a rural area.  She is overwhelmed with living in a larger city, learning about everything on campus, making friends, and keeping up with her studies.  She is not yet fully depressed but has bouts of crying, anxiety and stress.                                             

Scene: Jane approaches her professor after class to ask for more information about an assignment.

Jane: Dr. Roberts, I know we are supposed to write this essay for next week but I’m not sure what to do.

Dr. Roberts: It’s in the syllabus, you just write a first-person account of your experiences last summer, paying attention to sentence structure like we discussed this morning.

Jane: I know, but…

Dr. Roberts: Just let your thoughts and memories come out on paper first, then polish them up like we talked about.

Jane: Yes, but (tears start to flow) summer was a great time, and…I don’t like thinking about it.

Dr. Roberts: Well, pick something that…ummm, is everything OK?

Jane: (More tears, voice raised) No!  I think about home all the time, it brings me down and I can’t stop worrying about it.  But I know I want to be here but I hate it too.  I have all this stuff to do but it gets all jumbled up in my head, then I don’t know where to go or anything so I end up just crying and doing nothing.  Then my Mom keeps asking me how I’m doing and I want to tell her but then I don’t because she keeps bugging me about it.  I miss her…sometimes I just want everything to stop…

Suggestions: Because safety always comes first, that last statement needs clarification.  One might ask "Please tell me what you mean by wanting everything to stop."  Assuming Jane is not referring to suicide (that is not the intention of this vignette), one might encourage Jane to elaborate on her feelings, perhaps asking questions to further identify the source of distress.  Jane is likely to say more about her problems adjusting to college life, something a great many students experience.  But its prevalence ought not dissuade us from offering further assistance, because a deeper depression could result from doing nothing.  Jane would benefit from a referral to the campus counseling service.  Information about making a good referral will appear in a future post, so please stand by. 

Monday, February 11, 2013

Failure to Launch

With the help of a film of the same name, the phrase "failure to launch" has entered the common lexicon.  Not that it needed that help.  Many a college parent has experience with the issue, whether it be direct or the source of chronic fretting.  Once, on a flight home from our nation's capital, I even overheard a very prominent legislator opining over his student's launching issues.  It was difficult to avoid thinking that we are beyond hope, if such a well-connected student was having a problem with developmental stagnation.  But of course no one is beyond hope of successful transition into adulthood.

There are a great many factors involved in the matter, many more than can be addressed in a brief blog post.  But I have noticed a few recurring themes among students struggling with emergence into independence. In no particular order, these are:

  • Lack of information and/or inadequate education.  Some students have just not been exposed, for whatever reason, to the world of employment and career-making.  This group does not know where or how to begin.  A solution: Get thee to the career center, and learn what is known about career success.
  • Privilege and entitlement.  There are some students for whom the words "no", "limits", or "deference" are unfamiliar.  This group often demonstrates adaptation deficits in the areas of ambition, diligence, labor, and "paying one's dues".  They may also feel unchallenged and bored.  A solution: Get thee to the counseling center, and work on adjusting expectations.
  • Lack of resources.  Many students have the knowledge and the willpower but not the financial or other necessities for taking the next steps in advancement.  This one is harder to address of course, but not impossible with enough persistent creativity.  A solution: Get thee to financial aid and the labyrinthine network of scholarship and grant funding.
  • Aiming too low.  Students sometimes drift downward in their selection of friends, activities and goals.  It's tempting and easy to do the thing that's, well, easy.  A solution: Get thee to a mentor, and be mindful in your choice of heroes. 
  • Too much partying.  It bears repeating that this can dull the senses and result in loss of motivation for enjoying the normal vicissitudes of living, like the rhythms of sleeping and waking, resting and working, pleasure and discomfort.  A solution: Get thee to the counseling center, and stop numbing out on life.
As already mentioned, there are other contributions to this problem, but these are some big ones.  Parents have role in monitoring these dynamics long before their children arrive at college.  It is ideal for rich dialog to occur beginning in elementary school, if not earlier.  Chances are that even small children have opportunities to address the themes at various developmental milestones, such as first attending school, first exposures to some form of labor and service to others, first responsibilities to others or pets, first earning of income, and so on.  Too often we parents let these pass by assuming the lessons will be learned and achievements earned.  Those early adults who remain frozen in stagnation will tell you this assumption is very faulty indeed.

Tuesday, January 29, 2013

Causes of Horrific Violence

The fine folks at invited me to write a brief article on a mental health topic of my choosing.  After reflecting on the incident in Newtown and my experiences over 21 years I provided one concerning the cultural and societal underpinnings of violence.  I have grown weary of simplistic solutions to a very complex problem, so the article is the result of an attempt to take a deeper look.  You can find the article here.

By the way, is a wonderful site, full of information and support for mental health consumers and all that support them.  Visit the site some time soon and enjoy.

Saturday, January 12, 2013

Driving the Therapy Bus

College mental health work is a very rewarding profession.  I feel privileged to walk alongside a young person and witness or assist their blooming into an authentic adulthood, facing fears and challenges along the way.  I also feel blessed to have wonderful colleagues in student affairs who toil along with me.  It is a joy to learn from them, and I like to think that I am able to assist them by interpreting and communicating the mental health needs of students, and by offering a perspective which is incorporated into campus life.

But there are also frustrations, and here's one.  On one hand, campus communities are now more educated and sensitive to students in need; faculty, staff and parents now routinely spot and refer a troubled student for counseling and other services.  This is a good thing.  Many students have obtained assistance in just this way.  On the other hand, sometimes it is the third party that wants help for students, but not the students themselves.  When issues of safety are involved, this is not so much a predicament.  College mental health professionals are trained to creatively find ways to provide help in that scenario, up to and including the invocation of law relating to involuntary treatment.

The frustration emerges when the student's situation falls short of this safety mark, and often very, very short.  Disconcerting though it may be, students who, say, stare off into space in class may need help but one cannot force it upon them.  A student in grief over the loss of a family member is deserving of attention but they do have the right to refuse it.  The same is true about students who are homesick, partying too much, not doing well in class, angry at parents, not eating or sleeping well, sick of a roommate, and so on.  Sometimes third parties, be they parents or university personnel, literally trip all over themselves trying to arrange for care, making multiple telephone calls, writing many an email, even visiting the campus counseling service, trying their best to shoe-horn in a student to treatment.  There are occasions when days and even weeks pass while well-intentioned individuals engage in this frenetic activity.  The labor involved here can really add up, for everyone.  This occurs even when no one has asked the student if they would like some help.  There are even times, sadly and maddeningly, when someone resorts to trickery and coercion to get a student into therapy, such as posing as a student on the phone in order to set an appointment, or threatening them with undue harsh consequences if they don't.  Come on people.  This last scenario is a surefire way to make a student hate me, and I don't even know them!

In quiet moments, which are few, counselors lean back and scratch their heads over these phenomena.  Folks sure are anxious about something when they carry out such behavior.  From past experiences they surmise this anxiety may result from fear of being blamed if something goes wrong, for lack of clairvoyance in identifying a "potential shooter" (a reflection of unfortunate times we live in), of facing the wrath of a powerful or "VIP" parent, or even a lack of skill in managing cheap bullying behavior.

Not that we don't understand these anxieties.  We do.  These are all too human reactions in difficult circumstances.  Sometimes we may be victim to them too.  But let's all raise our game a bit.  It is the student who needs to drive the therapy bus, not us.  Short of life and death matters, many times a problem needs to percolate for a while before someone feels motivated to get help.  Humans, for the most part, don't take their hands off the stove until they feel some heat.  We're just built that way, especially when we are young and not fully formed.  It can be painful to watch a student twist in the wind before change happens, but this is a necessary stage many of us go through prior to our transcendence.  In fact, we can contaminate the whole process by needling in it carelessly, thus unwittingly prolonging healing or enabling the continuation of disorder.  I know in my heart no rational person wants this.

So, here's the deal.  Tell the student about your concern.  Encourage them to use resources.  You can even be a benign pest by checking in with them repeatedly when you are really concerned.  But, by all means communicate your respect for their autonomy and agency by allowing them room to make their own choices and to be responsible for them.  This course provides the fertilizer for their continued growth, which is what we all want.  Including students themselves.