Jane (name changed) came to the counseling center at Georgia Regents University (GRU) just one month after school started. A first-year student whose home was approximately a three-hour drive from the university, this was her first time being away from her parents. Her transition to college raised a number of different issues for Jane and resulted in her experiencing a high degree of anxiety, says Virginia Luke, an American Counseling Association member who serves as assistant director of the counseling center at GRU.

“She was living with three other students and was having a hard time communicating her needs to them. She was also having difficulty keeping up with her class assignments,” Luke recalls. “We developed a schedule for her to follow, as well as study skill training for college-level classes. For her relationship issues with her roommates, we worked on assertiveness training so that she could better express her opinions and needs. We worked on some relaxation training to help her with her anxiety issues.”

The true challenge of counseling today’s college students may be handling the sheer variety of issues that a single client can experience. Yes, college still stands as a time of great personal growth and joy for many of these students, but rates of anxiety and depression are also on the rise for this demographic. According to groundbreaking research by Penn State’s Center for Collegiate Mental Health (CCMH), 75 percent of all diagnosable mental health disorders become apparent by age 24. Given those numbers, it is reasonable to suspect that counselors both inside college counseling centers and outside of those facilities will be seeing more college students in their offices. In fact, counselors tuned in to the unique needs of this population may be on the front lines of preventing long-term mental health crises.

According to CCMH Executive Director Ben Locke, since CCMH began its innovative study of collegiate mental health in 2008, most student mental health concerns — including suicidality, self-injury and entertaining serious thoughts of hurting another person — have been climbing. “Part of the reason we started the project was that everyone was saying, ‘The sky is falling!’ But there was no data to back that up. This is data that really does back that up,” Locke asserts. “Now we’re able to talk about how these things are really happening, and, really, things are getting worse. We’re not just complaining.”

As an example, Locke points out that more students are entering college having experienced prior mental health treatment. This usually means they will respond to treatment in college more slowly than will students having their first experience with mental health issues, he says. Locke adds that students with prior mental health issues start off in more distress than their peers and often require more time in counseling, which puts new stresses on student mental health centers.

New life, new stressors

GRU’s Luke specializes in helping college students who are facing complicated transitions. “Many are away from their support system of family and friends. They may have issues adjusting to a new environment where they are not familiar with their surroundings such as where to shop, where to eat, where to get medical attention as well as [where to get] social support. In addition, they may find that at home they have their own space, and now they move into a residence hall where they may have to share their space with others,” she explains, adding that students may feel lonely, anxious and depressed as a result. “They are away from home and may find a new freedom for themselves and may make poor decisions about drinking, sex and drugs. They may experience stress about the amount of academic work required in college versus the amount of work required in high school.”

Wendy Killam is an ACA member and director of the clinical mental health counseling program at Stephen F. Austin State University in Nacogdoches, Texas. Her dissertation explored college student adjustment and wellness, and she knows firsthand the variety of transitions faced by these young adults. “For some, it’s the first time they have had to do their own finances, or just wake themselves to get out of bed or do their own laundry,” she says. For many students, she adds, college is also a time of significant exploration that might include drinking alcohol and having new sexual experiences.

“There are a lot of pressures, and one of the biggest things is that they often really are not ready for college in the first place,” Killam says, pointing to the number of remedial math and English courses offered at her university. “It’s hard to play catch up because your high school did not prepare you.”

Josh Gunn, the director of counseling and psychological services at Kennesaw State University in Georgia, agrees. He says both the academic and social pressures on students are starting earlier — even in elementary school — and that many students are not entering college with strong coping skills. “They show up a little less prepared to manage their personal selves, their stresses, their disappointments,” says Gunn, the immediate past president of the American College Counseling Association (ACCA), a division of ACA.

Noting the usefulness of the CCMH data, Gunn says research is showing that anxiety is the primary presenting problem for today’s college students. “For many years, [the main presenting problem] was depression. Now it’s anxiety,” he says. “I don’t think the economy has helped this at all. There was a time when you knew you would live a better life than your parents, but now kids come to college wondering if they will get through and even get a job or have health insurance at the end.”

Gunn points to outreach as a primary responsibility for counselors on college campuses. “You can’t just have a counseling center tucked away and hope they come,” he says. “We want to be as integrated as possible. We talk to anyone we can. We align with academic programs [and] we identify times in college student life when they may have more mental health issues.”

As an example, he mentions Kennesaw State’s nursing program, which is very competitive and rejects many students who apply. “When the students start applying, we [the counseling services staff] share the information, very softly, that ‘most of you won’t get into the program, and if you don’t, we are here to help you.’ It’s prevention work. We can support them and even help them find new careers.”

Killam says most schools are beginning to offer student orientation information regarding the transition to college. She adds that alcohol awareness is often a part of that education. Such programs offer prime opportunities for collegiate counseling centers to highlight mental health services, she says, but often, counseling centers don’t have the funding to support new initiatives or the necessary staff to take on all the new clients that those initiatives might generate.

“Like a lot of things, it has to do with campus culture,” Gunn adds. “The campus has a responsibility to develop a culture that pays as much attention to the students’ mental health and wellness as to their GPA.”

Max capacity

Most in the field agree that for treatment to genuinely be effective, clients need the gift of time to build a strong rapport with their counselors. But with tight budgets and a spike in the number of students seeking care, some counseling centers are feeling the pinch.

ACCA member Jonathan Kerr is director of counseling and career services at Toccoa Falls College in Georgia and also keeps a private practice on the side. He describes his center’s work as relational in nature, focusing on students’ transitions from home, changing intimate relationships, roommate issues and changes in friendship groups. “What seems to work best in therapy [with college students] is taking time to establish rapport, even though brief solution-focused therapy is the way things are moving,” Kerr says.

He describes working with one student who had suffered a breakup. She expressed feelings of depression and said her schoolwork had suffered, but it took her five sessions to feel safe enough to talk about the breakup. Both Kerr and the student noticed that the sessions that followed were more productive in moving her through the counseling process — helping her understand why she was struggling and getting her back on track with her schoolwork — but it first took time for them to build the therapeutic relationship.

After looking at Kennesaw State’s internal data, Gunn confirms that more students are using the university’s counseling services. “The number of appointments went up over the past five years, and, no, we didn’t hire more clinicians,” he jokes, adding that because college enrollment is on the rise, so is the need for counseling centers to serve those students.

Killam concurs: “If you contact just about anybody who works with college students, most of them will say they are just plumb overwhelmed by the demand [for their services]. … Most college campuses have a waitlist and will try to see people for emergencies, but more and more kids are coming in for mental health. And more and more, they are coming into campus already suffering with major mental illnesses.”

Research can be a strong tool when making the case for more collegiate mental health resources. Locke notes that some preliminary, unpublished CCMH data reaches the clear conclusion that the services provided by college counseling centers are highly effective. “We know the services are effective, so what’s the problem? The problem is the amount of services being provided,” says Locke, who explains that immediate treatment is rarely available for those who seek it via the overwhelmed college counseling centers. “The students who come [into the counseling center] a month into the semester probably are going to end up on a waiting list, or the clinician will say, ‘I can’t see you for three weeks.’ Within each campus, there is a relatively small group of people who get real treatment.”

Similar scenarios being played out on campuses across the country should provide the fuel for public policy discussions regarding the proper funding of college mental health services, Locke says. While limiting the number of sessions per client may help counseling centers manage costs, he says, those service limits can have a negative impact on treatment efficacy. “You need to provide treatment in a responsible way. You need to provide treatment until people respond,” he says.

The next step, Locke adds, is linking the effectiveness of mental health treatment to the university’s bottom line. “If we show that students who are treated effectively stay in college until graduation, that’s good for everybody,” he says. “In general, we’ve been seeing studies coming out that if you come to a counseling center, you are more likely than your general peers to remain enrolled.”

Despite the generally overburdened nature of college counseling and the low wages that may prevent people from considering it as a career path, Gunn says there are perks to working with this population that go beyond simply having summers off. “In the mental health field, we’re one of the best quality-of-life places you can work,” he says. “The fact that we are not dealing with insurance — because a majority of centers do not — we don’t have the hassles of private health care, and we’re not as bound to seeing a person only a few times due to a diagnosis. I get to do therapy with individuals and in groups, but I also talk to classes about how to sleep better, deal with stress better and have better relationships.” Gunn adds that more professional counselors are moving into college counseling at smaller community colleges, where their responsibilities may be more varied and interesting than what they were doing before.

Locke agrees, adding that compared with those working in community mental health environments, some might say collegiate mental health providers are “in the lap of luxury,” with their summers off and with clients who have more resources than the average client.

Yet he also points to the fact that, as estimated by the Institute for Health Metrics and Evaluation, mental health’s “global burden of disease” has reached 30 percent in the 15-24 age bracket in the United States. Meanwhile, the amount spent on mental health care, as compared with all dollars spent for health care in the United States, is around 6-7 percent, Locke says.

“The point is that sort of at a very bird’s-eye perspective, the burden of mental health problems is many times that at which the treatment is funded. And college counseling centers are struggling at the same place that community mental health and hospitals are struggling,” he says. “There’s a real imbalance there.”

Meeting needs

If college counseling centers are overburdened and resources are stretched thin, it stands to reason that some counselors in other settings will find college students on their caseloads. Recognizing the variety of stressors that accompany the transition to college and possessing an ability to work creatively are essential to having success with these clients. An effective treatment plan may include skills building, cognitive behavior techniques, mindfulness-based stress reduction and group work.

Luke notes that counselors working with college students should be open to dealing with a variety of problems. Counselors may see clients who come in because they feel they have deficits in time management and study skills or struggle with test anxiety, she says. “On the other end of the spectrum, we have seen more students coming in who have been previously diagnosed with psychological issues, are currently seeing a psychiatrist and are on medications,” she says. “These students typically require closer supervision and multiple sessions dealing with the transition to college.”

Counselors working with college students say healing often occurs when these students learn they are not alone in facing transition struggles. While Gunn argues that group work is often as good or even better than individual counseling for such cases, he acknowledges that many students imagine counseling being a dyadic process that doesn’t involve the input of others.

“The students who join our groups, for the most part, love them once they get in there and realize there’s a group of people who are ‘just like me.’ That’s so much more valuable,” he says. “There’s something very healing about working with peers working on common goals. It allows them to get help and to provide help to others.”

Killam agrees that groups can be highly effective but has noticed that college students are reluctant to join groups formed by college counseling centers due to the lack of anonymity. “Today’s college kids will post all kinds of things on Facebook, but they won’t go to [campus] groups because they might be embarrassed,” she says. Off-site group work can be a useful option for students afraid to show up for a group session on campus but who might thrive under the experience sharing and interpersonal learning delivered in group counseling.

Kerr has witnessed the same reluctance among students about joining therapy groups at the Toccoa Falls College counseling center. “Part of it is that we are a small campus, and it’s really hard to keep the perception of lack of confidentiality under control,” he says. However, he notes, the counseling center has had success with very small groups addressing targeted issues such as trauma and men’s issues.

Gunn encourages counselors to be creative when spreading the word about the mental health benefits of counseling, on campus and off. Citing the example of social skills training, he suggests that calling it a “psychoeducation workshop” as opposed to something that sounds more shaming might be the difference between a student getting help or trying to go it alone.

 

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Contributing writer Stacy Notaras Murphy is a licensed professional counselor and certified Imago relationship therapist practicing in Washington, D.C. To contact her, visit stacymurphyLPC.com.

 

Letters to the editor: ct@counseling.org