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.