Friday, December 11, 2015

Not a Day Care?

Recently, the president of a college in Oklahoma penned a note on the school's web site in response to a student who apparently complained about feeling victimized by a sermon there. Dr. Piper pointed out rather adamantly that higher education is for learning which often involves, by definition, sometimes feeling uncomfortable. He expressed the same frustrations felt by many in the field who daily struggle with the unreasonable expectations of students and others. As higher education has adopted business models along with that came a customer service orientation, not that this is always a bad thing. It can be a very good thing to improve one's services and meet the needs of customers. Sometimes, however, this progresses into an orientation of entitlement such that the customer may demand the product (a degree) with as little discomfort (dissonance or struggling) as possible, much as one might do when one purchases, say, shoes. This obviously flies the face of time-worn traditions in education since the time of Socrates. Further, those of us in the mental health professions know that any growth worth achieving is difficult, while the rewards of the struggle are enormous and life-altering.

In another part of the blogosphere, a student countered with her own message that the notion of the coddled college student is a myth. Ms. Sampath rightly points out that a great many students have real struggles having to do with overcoming trauma, discrimination, and harassment. She notes that today's student may be more vocal in their search for recognition and equality in education. There is truth in this, though I believe more so for the individual; group activism on many campuses is at an all-time low.

The two authors are both right though they capture trends in education from different vantage points. This should not be surprising since one is an administrator and one is a student, populations that often do not see eye-to-eye. We should listen carefully to both. Incorporating and adjusting to the student experience is paramount if we hope to remain relevant and just in our work. At the same time we need to uphold reasonable boundaries with respect to expectations or else we diminish our product, an educated and balanced citizen, substantially. Should we understand who our students are and how they best succeed? Absolutely. Should we allow their parents to schedule appointments for them, or lobby for a better grade? Positively not.

As with most things in life, the devil of this debate is in the details, and the truth is somewhere in between. Let's find it.

Sunday, October 18, 2015

Trigger Warnings and Warning Triggers

We are living in a strange time in college mental health. One the one hand we are negotiating through thorny issues related to trigger warnings in higher education; faculty now are being counseled to take care to issue warnings to those who may be offended by course content, to soften their language, or to avoid upsetting topics altogether. Trigger warnings actually have a long history in mental health, starting with helping combat soldiers recover from trauma, then later survivors of sexual or physical trauma for the same reason. The concept now has expanded to virtually anyone with a sensitivity to something (is there anyone who does not have this?). Emotions are high on all sides of this issue. Those in recovery do not want to be overlooked or re-traumatized. Teachers and other leaders do want their speech infringed.

On the other hand, those of us working in higher education are increasingly alarmed about the press on "school shootings" (though many of these are actually targeted crimes and not random episodes of violence). Also unsettling are the debates about open and concealed carry of firearms on campus. Some have left the field altogether due to their anxiety over this. Campus police departments tend to align with the opposition to carry, and even these experts in campus safety are concerned. Others seem aloof, uninformed, or blindly supportive with no acknowledgement of the complexities involved.

So everyone has a right to their opinion, and there are good reasons for having several different views on these matters. But, seriously, are we to soften the hardships of life for everyone through our speech, but harden life for everyone through access to our weapons?

Wednesday, September 30, 2015

Finding Your Voice: Assertiveness

In nearly 25 years of practice, I have not met or known anyone who did not need to improve their communication skills, including yours truly. All people struggle in expressing themselves and in deciphering the meaning of others' expressions. A vast body of psychological research has repeatedly demonstrated how communication is hampered by limits in perception including biases. We can spend the rest of our lives working on this and still not achieve perfection.

But we should try anyway. One simple way to begin is to classify our speech patterns in one of four types, aiming for the most effective one of the four: assertiveness. Here are the four types:
  1. Passive: failing to express one's needs or preferences, or expressing them in such an indirect manner, such that one's rights are easily overlooked or violated.
  2. Aggressive: expressing one's needs or preferences in a hostile manner such that other's rights are easily overlooked or violated.
  3. Passive-aggressive: Communicating in a passive manner in another's presence and an aggressive manner in their absence. (Most of what we call drama originates with this pattern.)
  4. Assertive: expressing one's needs and preferences in a calm, direct, clear, and often brief manner such that others respect them and theirs are respected at the same time.
Here's the thing. All of us are capable of using all of four types of communication. That is part of what makes us human. Additionally, we tend to use each type in specific circumstances and also with specific people. Some of us are assertive at home, but not at work. Or vice versa. Some of us are assertive with a partner, but not our friends. Or with women but not men. And so on. These patterns usually derive from negative or stressful experiences and the emotional injuries or traumas that go with them, resulting in fears and anxieties arising when we are confronted by similar situations. But as with any fear or anxiety these can be overcome if you work hard enough..


We can begin this work by learning to reliably identify the patterns we use, and when and with whom we use them. This takes a lot of focus and time, so patience is needed. Once these patterns have been identified, the next task is to identify the history behind the preference; we once had good reasons for avoiding assertive communications in some scenarios, but now we have to realize that those reasons are probably no longer valid.

Now the real work begins...we must increasingly employ assertive language across all situations and all people. As you can imagine, this takes a lot of work and it progresses slowly at first. But it tends to pick up pace once you have even minor successes, and at times moves very rapidly once you get the hang of it. The quality of our lives, including the overwhelming majority of successful stress management, is then enhanced accordingly.

If you'd like a resource to accompany you on this path, try Your Perfect Right: Assertiveness and Equality in Your Life and Relationships (2001), by Michael L. Emmons and Robert E. Alberti, Impact Publishers.

Thursday, August 27, 2015

Love and War in Cyberspace

Students are quite adept at the practice of cyber-relationships. Email, IM, texting, gaming, Facebook, Twitter and other media have become popular communication methods for students, even replacing face-to-face contact for some. While such methods are appealing due to ease of use and apparent anonymity, students are often not aware of the potential problems that can result. Some of the bad things that happen in actual relationships, such as harassment, stalking, and predation, can also occur online. There is even evidence that social media use can result in negative mental health outcomes.

Here are a few tips on how to protect yourself in cyberworld:

  • Protect your identity. It is not a good idea to inform the whole world of your hometown, birthdate, high school, address, telephone number, credit card information, or Social Security number. Even just one or two of these items gives a predator all the means they need to find you. Also, be aware that some online services allow users access to programs that identify the physical location of other users.
  • If you are planning on actually meeting someone, request a photograph or other identifying information, and cancel your plans if he or she refuses or makes excuses.
  • Also, speak with the person by telephone before meeting with him or her. You can learn a lot about a person by paying attention to their social skills.
  • If you decide to meet someone, do so in a public place, tell a friend where you're going and with whom, and drive yourself to and from the meeting.
  • Look for warning signals of an unhealthy relationship, whether it be online or not.
  • Listen to your discomfort. If something is occurring online that makes you feel uncertain, disconnect.
  • Don't break the law or violate your code of student conduct. Threats and verbal abuse that occur online are still subject to these provisions, and you'll have written proof of it too!
  • Keep an online time limit. It's harder to do well in class when you're online for more than a couple of hours per day.
  • Finally, there's nothing like a real, live human being. Make time to relate to others in real space too!
To learn more about protecting yourself online, talk with someone at your IT department and counseling service.

Wednesday, July 15, 2015

How to Transmit Anxiety to the Next Generation

Today's college students are experiencing anxiety at higher rates than before, and anxiety is now more common than depression and many other presenting concerns. It used to be the other way around. Various arguments can be made as to why this is. One researcher claims that there has been an increase in a sense of threat combined with a diminishment in affiliating with others over the past 50 years in American culture. This would certainly be a recipe for heightened anxiety. Readers should be cautioned here: this does not mean than younger generations are "sicker", as some have claimed, more out of their own financial interests in my opinion.

Some believe that parents have responded to these cultural shifts by increasing parental supervision and control of their children, in part based on fears or mistrust of others. While there may be a rational basis for such choices, this "helicopter" parenting style may also result in further problems. The style is increasingly implicated in the problems young adults experience at a later stage. The thinking goes like this: if you put your child in a bubble to protect them, they won't learn how to handle life's scrapes and bruises and, later, cannot cope well when they have those scrapes and bruises, as we all will. Certainly, many college counselors will recognize this pattern among the issues they see in students.

It has been noted that such anxiety is even "contagious". That is, it can be transmitted from one party or generation to another over and above any contribution by genetics. This transmission may in fact happen in just the manner described above, by overprotecting them we deprive them of the opportunity to adapt. Some parents were raised in a similar manner and thus pass it along to the next generation. But this is not inevitable if we all learn how to better to confront life's challenges and gain emotional mastery over them. 

In this coping and adjustment sense, anxiety is not always bad. We have to experience it to know what to cope with and learn how best to manage it. In short, it is a necessary part of learning and maturity. Without it we can be easily overwhelmed by even the simplest of life tasks, such as managing time, taking healthy risks, coping with periods of stress, and making important decisions.

Put simply, it is always better to acquire new skills than it is to avoid a problem. This is especially true if the problem is not truly avoidable. One may successfully get through life by avoiding snakes, for example (though even that can be overcome too!). But one would have great difficulty getting through life avoiding stress and ordinary challenges.

Monday, June 29, 2015

The Comprehensive Counseling Center

In a previous post I presented information about counseling center service models currently in use higher education, quickly gleaned from an informal survey of center directors. It revealed a range of diversity in organizations that I believe is healthy for campuses and students, as it serves to match local needs and culture to practice. Occasionally there are efforts to homogenize organizations, just as what may occur in other industries. In order to preserve the richness of centers and advocate for their continuing vitality, a group has formed to define what is central to an impactful and thriving center, no matter in what organization or structure it is embedded.

To that end, the Comprehensive Counseling Center (CCC) has been defined. Here I present this definition, as well as the purpose of its advocacy. Though I post it in this blog, this is authored by several current counseling center directors and is supported by more than 20 others to whom it has been presented thus far.

PURPOSE

  • Establish a support network among and on behalf of CCC's.
  • Develop a presence and a voice supporting CCC's, particularly with college and university administrators and governing bodies.
  • Promote the full range of CCC capabilities.
  • Foster joint projects of interest, conduct research, gather data and publish findings related to the work of CCC's.
  • Share creative and effective ideas among participants, and generate new ideas through dialogue.
  • Support allied organizations - AUCCCD, IACS, CCMH, ACCA, ACPA CCAPS, ACCCO, ACCCCS, ACCTA, APA Division 17 CC group and others whose work primarily focuses on counseling centers functions on campuses. Advocate for dialogue with organizations such as NASPA, ACHA and APA.
WHAT IS A COMPREHENSIVE COUNSELING CENTER (CCC)?
  • The CCC is focused on quality professional mental and behavioral health services and roles, including as its prime mission excellent counseling and therapy services provided to students by credentialed, licensed, diverse and experienced staff. College mental health is a specialty in its own right and worthy of recognition and support from campus administrators.
  • A cornerstone of college counseling is a developmental orientation toward students that is entirely consistent with the deepest traditions of education, understanding young adults as well as non-traditional students through the lens of an emerging process of becoming contributing adults and citizens. Special awareness and attention is given to the needs of diverse populations and underserved groups. Academic success is a vital component in this work. The CCC assists students in building their strengths, beyond solely a content-based perspective of symptoms and deficits.
  • The CCC is an out-reaching center, connecting to the entire campus community. It is centered on the full range of individual, group and systemic needs and engaged in prevention and early intervention as well as remediation. It is concerned with all facets of well-being and resilience, anchored in multicultural awareness and approaches that are sensitive to diversity at all levels of service. When firefighters are not fighting fires, they are working on community education and prevention – these are all the roles of the CCC.
  • The CCC serves as the primary consultant to the campus in all efforts to improve the mental health and behavioral health of students. CCC staff proactively engage students, administration, faculty, staff and parents through collaboration and consultation, supporting a larger vision for campus mental health. CCC staff are personally involved and proactively engaged wherever possible on campus, lowering stigma and promoting meaningful conversations, partnerships and actions that lead to effective intervention at all levels. Partnerships include student services and academic administrators, student life, residence life, health services and wellness, recreation and athletics, campus safety/police, student academic support staff, parents and families, and foremost, students and student organizations and coalitions.
  • The CCC has an additional vital role in consulting with those who are concerned about students needing help related to mental health concerns. This is done through avenues such as on-call services, Student of Concern committees and Threat Assessment committees.
  • The CCC has primary role that differs from that of any other department as the leader in campus mental and behavioral health and thus not an auxiliary to any other role or function. The CCC’s licensed staff members possess specific and unique skills in supporting mental and behavioral health efforts within the complex and diverse world of the college campus. The CCC has a proud and credible history of service on college and university campuses that has endured for decades. Overall support for these services has increased on campuses in recent years and reflects the value campuses place on them.
  • The CCC focuses on training and education at three levels:
    • Where feasible, the CCC trains future professionals through supervised practice, including trainees engaged in the full spectrum of CCC work.
    • The CCC trains students and campus partners as mental health gatekeepers and partners through both brief and more intensive training experiences in mental health awareness, suicide prevention, etc.
    • CCC staff pursue their own continued training and professional development to stay fresh and current in the field.

Sunday, May 24, 2015

The Village and Mental Health

R. Buckminster Fuller once said that human beings were not meant to live in an area any larger than a village. This type of community, he believed, afforded us the greatest opportunity for both advancement and mutual protection. This point of view is also appropriate as we consider how to best manage the mental health of students (and ourselves).

College environments are inherently protective, due largely to proximity to others, availability of supportive resources, and the possibility of protective monitoring offered by some offices such as a dean of students or campus police. At the same time college campuses can be very large and, depending on housing features and a student's choices, isolating. Here is where "the village" comes into play.

It takes an entire campus community, the village, to advance and protect students. Too often this responsibility is left solely to certain supportive offices, such as a counseling center. While such services can and do work wonders, going a long way toward the preservation of mental health, they simply cannot and never will be able to accomplish it alone. Just as villagers must cooperate to survive, so all campus constituencies must work together for the sake of its members.

Everyone has a role and no one should be excused from this duty. From salaried administrators to those on hourly wages, each community member has knowledge of and are witness to issues student's face, no matter how remote it may seem. The primary task is to sensitize everyone to this fact, and to give them the tools they need to communicate accordingly. It is the simple buddy system, people. This system has stood the test of time since we all lived in caves, and it still works today.

The single best antidote to a host of emotional health issues and social ills is the proactive involvement of the entire campus community. When we all care for each other and are paying attention, we can resolve seemingly insurmountable problems. We can prevent episodes of depression. We can reduce anxieties. We can prevent suicide.

The training for this approach is available on most campuses. The skills needed are quite elementary and easy to learn. Often, what stands in the way is the attitude that "this is not my job", sometimes borne of an inaccurate assessment of liability. Training can address such myths as well. When you boil it all down, all that is needed is a street-level human response to student concerns. Once others are notified more sophisticated interventions can be arranged and are left in their hands. The work is not difficult to do and, just like CPR, everyone can and should be familiar with it. This ought to be required training on every college campus. And if you really want to address this worldwide, make it a part of the earliest part of all education.

Sunday, April 26, 2015

Rule of Thumb: Getting Involved

In some ways college students are more connected than ever. Social media has provided multiple methods of staying in touch with friends and sharing information and content. Gaming has also provided a venue of being connected with others and having fun at the same time.

But in other ways many students are not connected at all, and they struggle with "face-time" that is real and not just virtual. Many living environments are both heavily wired and private; if one chooses one may isolate for huge chunks of time and "communicate" widely, yet not actually interact with anyone at all. This is a recipe for diminishing mental health.

So here is a rule of thumb to protect against that deterioration: at least twice a week, get involved in something that takes you out of your living environment, puts you in physical contact with others, and has nothing to do with class, work, or partying. This simple strategy incorporates crucial skill sets which, once learned, will benefit you for a lifetime. The skills also promote good mental health and are also related to retention and academic success.

So what kinds of things can you do? Most students had interests and hobbies in middle and high school, but they may have drifted from them in the excitement of starting college. Consider returning to them, or perhaps be more adventurous and take up new ones. Psychologists believe that learning new skills every five years or so is actually protective of brain health, so it will be good for you on that score as well. On most campuses there are dozens if not hundreds of student organizations, covering topics such as sport, politics or advocacy, environmental awareness, outdoor recreation, art, and so on. If you can't find one that suits you, start your own. You can also see some ideas on this listThere is really no excuse not to try something.

On the other hand, there is no need to get over-involved, as this can lead to meaningless activity and burnout. Trying new activities also does not have to lead to long-term commitment. Simply try some and if they don't feel like a good fit, move on and try another. Frankly, what you pick does not matter. What matters is that you pick something in the first place, and that you expand your skills and relationships. This is part of the recipe for feeling satisfied and in good emotional health, and generally your grades will improve too. That's hard to beat!

Monday, March 9, 2015

Annals of Idiocy: Discouraging Students who Need Help

Getting right to the point, it is highly irresponsible for anyone to discourage others who need help, especially adolescents and young adults.  It is tough enough for them to deal with fear, stigma, and the labyrinth of mental health care systems.  For them to break through such barriers only to have someone discourage them should outrage all of us.

In recent months there have been at least two cases of this irresponsibility.  In one, a journalist covering the issue of withdrawals from campus due to mental health issues, an admittedly complex process, allowed the following title to be used in a Huffington Post article: "Using College Mental Health Services Can Lead To Students Getting Removed From Campus".  In another an attorney allowed the following title in a Chronicle of Higher Education piece concerning the alleged mismanagement of therapy records in a rape case: "Raped on Campus? Don’t Trust Your College to Do the Right Thing", and then added further damage by stating "Students: Don’t go to your college counseling center to seek therapy."

It is not that the authors had no point to make.  I do not take issue with advocates calling attention to allegations that there may be problems in the application of procedures on some campuses.  But making sweeping condemnations of an entire field in a large country goes well beyond that.  The number of cases mentioned in articles or blog posts like these is typically very small, as it was in these articles.  This, friends, is what you call over-generalization.  There are over 1,000 college counseling centers in the United States providing millions of therapy sessions annually and they, I dare say, do so competently and with good results.  OK, so the ethics of blogging may be loose indeed, fine.  But these authors are advising potentially millions of our youth to avoid the most convenient, least costly, most specialized services for the college student population.  Doing so is patently absurd, hurtful, and wrong.

Sometimes, actual college counselors are quoted in the articles, but generally very few.  Even rarer are articles written by someone who actually does the work.  Say what you will about attorneys and journalists, but the fact is they do not know, and cannot know, the work from the inside.  They are not managing extremely challenging circumstances while being intimately knowledgeable about and adhering to our specific professional codes of ethics.

Students, listen to those who do the work.  Use your campus counseling service.

Saturday, February 14, 2015

Healthy Relationships in College

On this Valentine's Day, let's take a brief look at the ingredients of a good, healthy relationship. While the focus of this blog is on college students, what follows can certainly apply to anyone, at any age. College students have many opportunities to meet new friends and develop enriching relationships on campus. Such relationships can make the difference between a positive and negative college experience. It is important to know the difference between healthy and unhealthy relationships, and to know how to make choices to preserve the former and improve the latter. Here are a few hallmarks of a healthy relationship:
  • Mutual respect and civility
  • A sense of reciprocity, or "give and take"
  • Feeling supported and supporting the other
  • A significant degree of trust and honesty
  • Fairness and equality as adults
  • Comfort with emotional intimacy or closeness
  • Comfort with distance and "separateness", or being able to have your own life apart from the other
  • Open, direct communication without fear of reprisal, hidden agendas, or manipulation
  • Good "boundaries", or being able to set personal limits with self and others
While no relationship is perfect and we all have bad days, students should be able to evaluate their relationships and feel, on the whole, that they are positive and healthy. If they are less than healthy, steps should be taken to improve them. Such steps involve both assertiveness and listening. If you have concerns about the state of your relationships with family members, friends, roommates, faculty, co-workers or others, contact your campus counseling service for assistance.

Saturday, January 17, 2015

A Problem with Brain-based Models

We are living in a time of obsession with the brain.  It is true that neuroscience is producing discoveries which are interesting an may be useful (time will tell), though humans will always amount to much more than what we carry in the cranium.  On a daily basis I see in my news feeds items like "Gene found responsible for chronic tardiness", or "CAT scan shows region involved in ADHD", or "Bipolar Disorder rise attributed to increase in brain abnormality".

A problem I have with research like this, and like so much that we consume, is that it does not appear to take into account developmental, contextual, and environmental factors. Because of this the dialog focuses on a reductionist and brain-based model as though the person-in-environment does not exist. This facilitates intrusive and authoritarian “treatments” and is often a dead end in improving human welfare. To say that diagnosis X is rising really does not tell us what we need to know, which is why or how. And that’s putting aside all the arguments involving inadequate support for diagnoses and the inter-rater reliability problems associated with them. Sometimes it seems as though the research paradigm is oriented toward simplistic goals for the purpose of developing efficient delivery of interventions, mainly drugs. And by efficient I mean not having to develop human relationships or spending much face time with people.

The "innovations" all seem to actually reduce time spent in human contact, thereby increasing the ROI in billing.

I am not an expert in the technicalities of diagnosing, though I think I do well in the formulation of human life problems.  I do know that our young adults are functioning in a context which is often pathogenic in and of itself. Here are some of the factors we see as relevant:

  • 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
  • Alcohol and drug abuse
  • Poor nutrition
  • The inherent “volatility” of the late adolescent and young adult
  • The seasonal nature of the stresses in the academic environment
  • Corruption, or at least mutual and self-serving contamination, among our leaders including those involved in healthcare and the Pharma-Insurance conglomerate
  • Violence, rape, sexual assault, harassment
  • Environmental toxins and their suspected role in some diagnoses (see http://bit.ly/1kRI8Dw)
If I bathed your brain in even half of these factors, what would you look like?

I have personally worked with many young folks who “looked” Bipolar (or ADHD or Whatever 209.45), but who were really experiencing intense emotion which they could not articulate in language nor act to soothe. The intense emotion was, more often than not, a result of a pathogenic environment of people, places and things, some of which they created themselves.

This is not a new problem.  Some years back we hanged and drowned and burned some women in Salem, MA.  It wasn't even thought until the 1970s that there might have been a fungus in the rye they ate which caused some alarming behavior.  Never mind whatever proportion of them were being assaulted.  But they were killed, because it was easier to attribute behavior to the individual rather than her context.  This is still the case.

Please recall Seurat and his pointillism, the painting style consisting of a series of dots.  A diagnosis is a few dots.  You have to stand back from the painting to see the darn thing.  It is much the same with humans.

I am sure there are other views. This is mine, and it does not necessarily foreclose on the concept of serious illness.  But I submit the threshold for this is much higher than what many appear to believe, especially those with an investment in the "treatment" for the illness.