Thursday, June 19, 2014

A Role and Philosophy of Counseling Services in Higher Education

College students have a great many needs across many dimensions of experience, including the academic, spiritual, relational, psychological and emotional, physical health, finance, occupational and avocational spheres of college life, and more. Each of these dimensions, were we able to graph them on paper, would appear very different in scale, orientation, and overlap for each individual student we attempt to describe. Yet each student needs access to various forms of support and learning in all of these areas, if we truly seek to fulfill our mission of retaining and producing ethical and contributing leaders of our society.

Developmental or Contextual Service Models

An individual’s life dimension profile places him or her in a specific context. No student lives and functions in a developmental or an environmental/contextual vacuum. It is true that each student brings with them their own internal or biochemical endowment, but one cannot fully understand the total student without placing the student in context.

Mental health service entities have choice to make concerning which service model they will follow. The most basic choice relates to the medical model, which is based in content-derived symptoms and diseases, and the developmental or contextual model, which is based in process-derived states of growth transitions and stressors in context. Each model begets related choices concerning funding priorities and goals which are rationally linked to different units of interest or focus. In the medical model the unit of interest is the student’s symptom or disorder, which must be treated and alleviated. In the developmental or contextual model, the unit of interest in the student’s growth pattern which is either enhanced or limited by their total context.

As an illustration, consider a student who has been diagnosed with ADHD or Bipolar Disorder. Each diagnosis requires meeting the criteria of a specific list of symptoms and symptom clusters. Suppose you meet such a student and you find he or she is also experiencing the following contextual factors:

• Stress related to global political and marketplace influences
• Extremely poor sleep routines and hygiene
• Arrhythmic lifestyles, or more simply put, chaos
• Too much screen time, not enough play and exercise
• A paucity of trusting, mutually satisfactory relationships, in any sphere
• Racism and discrimination
• Increased sense of threat and diminished opportunity for affiliation
• Poverty, or resources insufficient to being a good student
• Alcohol and drug abuse
• Poor nutrition
• The inherent transitional “volatility” of the late adolescent and young adult
• The seasonal and cyclical nature of stresses in the academic environment
• Violence, rape, sexual assault, harassment
• Environmental toxins in the food supply or living environment

It is not uncommon to meet a student managing half or more of these factors. If we were able to somehow bathe any person’s brain in these factors, what would that person look like? How are they likely to behave? Might they have problems with attention? Or disruptions of energy?

Benefits of the Thoughtful Orientation of Counseling Services

Orienting the focus and philosophy of a campus counseling service need not be, nor should it be, an unthinking activity, nor an activity of convenience, economics, or politics. It should ideally be purposeful and embedded in the deepest traditions of promoting the education and success of the greatest possible majority of young adults. Typically these traditions are most consistent with Student Affairs divisions.

After all, ALL students experience developmental and contextual challenges. Students experience homesickness, roommate or family conflict, stress from academic demands, communication difficulties, peer pressure, cultural biases, identity confusion or misdirection, etc., at very high rates. The prevalence of specific medical/psychiatric diagnoses range from, say, two to five percent of the general population. It makes sense, then, to orient campus counseling services accordingly. It is known that allocating resources toward the lower and middle quartiles of a distribution results in greater degrees of problem mitigation and prevention. Orienting counseling services toward a student’s overall development also provides for the greatest reach into the various cells of the classic cube model of counselor functioning (Morrill, Oetting & Hurst 1974), including each type of target, each purpose of intervention, and each method of intervention. In a purely medical model, the focus of interest tends to be on the remediation of the individual’s condition at the level of direct service alone. This results in allocating resources to the sickest who are much farther along in the development of chronic health problems, and there is a place in the world for this. The point is not whether one model should predominate; it is that there should be room for a wide range of approaches to the broadest segment of the campus population possible. We argue that higher education institutions obtain the greatest degree of cost effectiveness and problem mitigation when each point in the spectrum of human life problems may be addressed.

Breadth and Depth of Developmental or Contextual Models

Professionals providing services in developmentally oriented counseling centers provide human services and not health services per se. This means that a college counselor is free to address any human or life issue a student may bring, even those that may fall outside the scope of traditional diagnostic tools. This model confers advantages to students in concrete, observable ways. One does not have to be “sick” to go to counseling in such centers, because no concern or issue is too small or too large to discuss with a counselor. This results in a better probability of seeing students much earlier in the cycle of problem development. It also allows for an entire course of counseling to be focused on acquiring skills which are needed for future success, such as assertive communication and healthy coping behavior. In this sense the college counselor is also an educator and may advocate for the student outside of the counseling hour, or engage in activities other than traditional “clinical interventions”. Further, such centers are firmly focused on learning that will last a lifetime. And, not insignificantly, the increased comfort in accessing such positively-oriented services also results in a greater likelihood that students will reach out to this service in a time of more intense crisis.

As noted above, traditional-aged college students are living through a psychologically volatile period. They pass through various stages of identity and skill development, some of which are painful. This results in rather intense reactions and behavior which can be unsettling for all involved, but are essentially transient, unless, perhaps, something occurs to arrest their development. One week a student may appear very ill; at another time they appear calm and coherent. It is easy to mistake transient but intense mood states as serious illness, thus the risk of pathologizing normal, albeit occasionally alarming, behavior in some settings. Developmentally oriented centers are primed to “tolerate” intensity, firm in the knowledge that the psychic stew will settle down for the large majority. Holding this intensity in a safe environment allows the student to pass through the intensity unscathed, without potentially life-long labels and, most worrisome, a damaging and limiting conception of self as “sick”, and yet also allow for the learning which needs to take place. Counseling provided from this point of view places a priority on having adequate time with the student, as this is required in order to accurately determine a student’s full context and needs. The amount of time required for this is typically not available in medical facilities.

Orientation of Current Counseling Centers

Over a long period many counseling centers have worked diligently to orient the center’s mission and services to serve the greatest number of students in need. This was done with much forethought, research, and exploration. All aspects of the missions of these centers (including counseling, outreach, consultation, and training) incorporate a developmental philosophy such that each seeks to meet students where they are, develop the strengths and genuine identities possessed by them, encourage them and give them hope and confidence, and address life problems at the same time. Without care and nurturing, these approaches can become disjointed and misaligned with the student’s growth needs. When such centers are acquired by a medically-oriented entity and folded into their operations with little thought and planning, some predictable losses or reductions of various functions occur. These include: both perceived and real privacy, outreach, prevention, consultation, mental health screening, groups, programming, well developed relationships with the administration, faculty, staff and community professionals, community and campus liaisons, functionally coordinated teams, strategic directions aligned with those of the university and student learning outcomes, services proven to positively influence retention, graduation, and academic performance in positive ways, networking and exchanging information with other higher education professionals, immediate phone consultation, training residence hall staff, assigned committee participation, consulting with students concerned about another student, staff trained in young adult development and strength-based counseling, and simply a more warm and supportive environment. In my work as President of the International Association of Counseling Services, Inc., an accrediting agency, I have seen first-hand that many such centers jeopardize their accreditation status due to thoughtless mergers. In reality, these mergers are more like acquisitions in which the counseling service is consumed whole by the host; there is little to no actual integration which occurs. Generally these losses occur when the counseling service is viewed primarily as a resource for those providing medical services, much as a pharmacy, a lab, or an X-ray department is seen. This posture results in what is best called a failure to thrive syndrome in the counseling service. My position is that this should be avoided, and that the many benefits of other current models are worthy of continuation and support.

Reference: Morrill, WH, Oetting, ER & Hurst, JC (1974). Dimensions of counselor functioning. The Personnel and Guidance Journal, 52(6), 354-359.