It’s a good thing Jodi Mullen didn’t become a counselor exclusively for the compliments.

Mullen, an associate professor and coordinator of the mental health counseling program at the State University of New York at Oswego, recalls working with a 12-year-old European American girl from a middle-class family whose presenting problem, according to the girl’s intake form, was “promiscuity.”

“Promiscuity is one of those words that means different things to different people,” says Mullen, who coauthored the book Counseling Children: A Core Issues Approach with Richard Halstead and Dale-Elizabeth Pehrsson, published earlier this year by the American Counseling Association. “In this case, her mother indicated she meant that her daughter had had intercourse with at least four boys in the last two months, and those were [just] the ones she knew about. There were actually three more, my client later disclosed, all within the last two months. My first thought was, ‘Yikes!’ I was very worried about this girl, and I wasn’t sure I could really help her. I knew I could lecture her about her behavior, but I also knew that would not be helpful [because] I am sure others had already done enough lecturing.”

It was a tough start to counseling. The girl didn’t want to talk to Mullen, draw or create anything in the sand tray. Instead, she wanted Mullen to listen to the music on her MP3 player. “That’s what I did for our first three sessions,” says Mullen, a member of ACA. “At the end of the third session, I asked if she could make a playlist or soundtrack to help me understand what the last two or three months had been like. She responded with, ‘You are so weird, and your hair is messy.’ I replied, ‘True. See you and your playlist next time.’ She ‘whatever’ed’ me, rolled her eyes and left.”

But at the next session, the girl arrived with a CD comprising 14 songs and titled “How I Screwed Up My Life.”

“We listened to each song,” Mullen says, “and then all on her own she said, ‘I am going to bring another CD next week. This one is going to be “How I Turned My Life Around by Talking to a Weirdo With Messy Hair.”’ Perfect.” The girl followed through, making the CD and doing the work that the inspiring songs implored her to do.

Halfway across the country in Texas, it’s a cautious 8-year-old girl whose growing separation anxiety eventually pushed her to refuse to go to school who sticks out in Brandy Schumann’s mind. The girl’s family walked on eggshells around her, leaving home as little as possible and hiding any changes in their schedule that might alarm the girl, says Schumann, an ACA member who runs a private practice in McKinney. When the girl refused to attend school, the family began home-schooling her.

After about 10 sessions of play therapy and a number of consultations with the girl’s parents on how to create a more predictable environment, Schumann says the girl’s anxiety decreased and she began taking more risks. “She agreed to join a social skills group, something she adamantly had refused previously,” says Schumann, an adjunct professor at Southern Methodist University who has also worked as a school counselor. “She continued to make progress, taking increased risks and seeking connection with peers.”

As the girl improved, she forged new friendships and survived stressful childhood experiences, including getting braces and having friends move away, with a manageable level of anxiety. Now 9 years old, she is registered and excited to attend public school this fall.

Simply listening and making a genuine effort to understand the girl’s feelings and situation were key to helping her, Schumann says. “I let her set the pace. I provided the environment — an accepting place where someone understood what it was like for her [and] where it was safe to be vulnerable. That facilitated her natural progression toward growth. She no longer had to adamantly refuse something in order to convey how overwhelmingly stressful something was. I also taught her parents how to provide these same qualities to her.”

From promiscuous preteens and anxious elementary schoolers to college students struggling with relationships and mental illness, counselors who work with students of any age encounter a host of complex issues. In a demanding and rapidly changing culture, school, college and community counselors play an integral role in helping struggling students overcome issues and move toward personal growth.

A scary world

Unfortunately, the anxiety Schumann’s client felt is becoming more the norm for elementary- and middle-school-age students, Schumann says. Her practice has seen many young children who met the criteria for generalized anxiety disorder, including two different second-graders just recently. Schumann’s practice has also worked with young clients presenting with mutism, adjustment disorders, phobias and some obsessive-compulsive traits, all related to anxiety. “We have kids dealing with a tremendous amount of stress,” she says.

Today’s children and young adolescents are struggling with complex issues, Mullen says, and a common theme seems to be instability. “Their lives are unstable because a parent is drug addicted or incarcerated, or because they just moved, or Mom was deployed — again! — or they didn’t make the soccer team, or because they are not ready for all the changes that come with being a sixth-grader,” she says.

Pehrsson, associate dean and professor of counselor education at the University of Nevada, Las Vegas, likewise reports seeing children more frequently diagnosed with anxiety as well as depression. Children are dealing with and experiencing so many issues today, she says, including war, frequent moves, homelessness, immigration and time spent alone as parents and caretakers work longer hours or multiple jobs in the face of mounting economic pressures. It all adds up to today’s kids having to deal with more than children in the past did, Pehrsson says. “The unabating recession and lingering wars have impacted homelessness, stress, addiction issues and more,” she says. “These two things alone have [increased] the magnitude of what they are experiencing.”

“Additionally, as schools continue to emphasize testing scores, school pressures continue to rise,” says Pehrsson, a member of ACA and the Association for Child and Adolescent Counseling, an organizational affiliate of ACA. “For many children, the schoolroom is often a place of fear and failure. This, and all the normal transitional and friendship/social issues that children struggle with, adds additional burden.”

Schumann agrees that young clients’ anxiety often stems from pressure to succeed and achieve in school. She adds that this stress is oftentimes imposed unintentionally by the school atmosphere, by parents or by the children themselves. In many instances, the kids are consumed with worry about what will happen if they “mess up” at school, Schumann says.

The solution for anxiety-filled students includes counselors working with parents, Schumann says. “Part of it is just helping them understand the child’s world as the child experiences and understands it. It’s helping them get back in touch. Do you remember when a test on Friday or the invitation to a party was the biggest stressor in your life? [Parents] can’t imagine being worried about a spelling test when they have a mortgage to pay.”

When it comes to anxiety and a host of other issues, working with the parents can be hugely beneficial to kids, Schumann says. “Parents often parent the way they were parented, or they parent in reaction to the way they were parented,” she says. Parents have usually reached a wall by the time they determine to seek counseling for their children, so they are also more open and responsive to listening to new ideas. Even so, Schumann emphasizes to parents that her guidance is not a criticism of what they have been doing and points out that perhaps their particular child’s needs require a new set of skills. Schumann’s practice also offers two-way mirrors so counselors can watch a parent and child interact — or a parent can watch the child and counselor interact.

Counselors and parents alike must trust the pace and readiness of an anxious child instead of pushing the child into situations or environments that the child is cautious of, Schumann says. “Instinctively, when adults experience children as anxious, they attempt to minimize the child’s distress, sometimes hiding information about stressful events — say an upcoming dentist appointment — in an attempt to lessen the amount of time the child is anxious,” she says. “In contrast, children with anxiety need more preparation, not less, for transitions and events. They seek predictability and structure that comes from information and knowing what’s coming up. Adults can better serve the child by validating the child’s experience of the world, understanding the child’s perspective and conveying to the child a belief that he or she can handle it.”

Schumann, who is also a registered play therapy supervisor, says her approach to working with children in general is to use play therapy. Play is a child’s natural language, she says, so asking children to engage only verbally is akin to requesting them to speak solely in a language that is foreign to them. When a child is struggling with anxiety, Schumann respects that child’s pace in play, works on simply being present with the child and anticipates that it might take the child a little longer to build a relationship with her.

Mullen is also a proponent of play therapy with younger clients, as well as other options such as drawing, music and writing. She emphasizes, however, that all counselors should secure appropriate training and supervision before using play therapy interventions.

Facebook, fights and feeling fat

Counselors point to technology and social media as another issue that greatly affects younger students. “Cyberbullying and lack of privacy has unfortunately become the norm,” Pehrsson says. “Technology can foster connection, but not always in a healthy way. Children are inundated with technological input, and deciphering the good from the bad, the true from the false, is often missing.”

“In short,” says Halstead, a professor and chair of the Department of Counseling and Family Therapy at Saint Joseph College in West Hartford, Conn., “children are struggling with all the issues that children have always struggled with, but today there is a layer of technological complexity that has served to challenge children in ways that one could not have imagined a decade or two ago.”

“I have found that children who have access to various forms of social media technology are able to engage in peer-to-peer [interactions] nonstop,” continues Halstead, a member of ACA and the Association for Counselor Education and Supervision, a division of ACA. “These children have precious little social downtime, so for social circles that trend toward the dramatic and hostile, there is little opportunity to gain distance and perspective.”

Another fairly common issue Schumann sees among elementary and middle school students is behavioral problems, which can vary by age but include things such as being aggressive, hitting or having a low frustration tolerance. “What we typically see is that children escalate in order to be understood,” Schumann says. “They’re frustrated because they’re trying to communicate something and they don’t feel the environment understands.”

“Typically, caregivers discipline in a way that sets them up against the child,” she continues. “The resulting power struggle can escalate to even more behavior problems.” Schumann points parents and other caregivers to research on limit setting that aims to understand the initial desire, intent or feeling of the child, that allows the child’s expression to occur in an acceptable manner and that allows the parent to align with the child, jointly looking at the problem. “Because the child feels understood, he or she does not need to escalate in an attempt to communicate their point to the parent who previously didn’t understand,” she says.

Body image is another common concern that often begins at a very young age, Schumann says. Her counseling practice runs social skills groups for kids, and in response to the question “If you had one wish, what would it be?” Schumann has heard children as young as second and third grade say they didn’t want to be fat. The group setting is very helpful to kids with body image concerns because it allows them to learn vicariously from each other’s strengths while taking on different — and hopefully healthier — perspectives, Schumann says.

No matter the issue, Mullen says counselors can be most helpful by creating an atmosphere in which kids and teens feel accepted and free to be themselves. “This might sound easy, but it’s not,” she acknowledges. “Youngsters recognize helpers as adults, and in the youth culture, helpers are often categorized as authority figures. In order to create a safe atmosphere, counselors need to be as nonjudgmental as possible, while simultaneously being able to use gentle confrontation to facilitate and develop problem-solving and coping skills that will last well beyond the actual clinical interventions employed.”

In accord with the guidance Schumann gives to parents, Mullen says counselors must be careful not to minimize their young clients’ worries. “Sometimes, the problems this age group deals with can seem trivial to an adult. For instance, when a 9-year-old boy is devastated because he is not on the same basketball team as his best friend. The key here is that he is devastated,” Mullen says, “and in order to have any credibility with him, one must come to understand and appreciate how badly he feels and communicate that understanding to him.”

Although school counselors generally have the most direct access to young clients, other types of counselors can also serve as valuable partners in helping children and adolescents to navigate life’s challenges. As a private practitioner, Schumann says she has a much smaller counselor-to-client ratio than school counselors do, which allows for more in-depth services and, potentially, more contact with a child’s caregivers. “Community counselors are not bound by [education association] standards dictating the type of service to be provided or limiting the number of sessions,” she points out. “Also, since someone brings a child client to each session, community counselors typically have more contact with caregivers, adding an additional point of impact.” On the other hand, Schumann says, school counselors play a particularly important role because they “reach the children who may not have someone in their lives who cares enough or knows enough to get outside help.”

Schumann also sees great benefit in community and school counselors collaborating in the best interests of children. When a school counselor has been in contact with one of her young clients, Schumann seeks consent to consult with the school counselor. “School counselors can offer an objective perspective of the child’s functioning in a structured setting and with peers,” she says. “Sometimes caregivers resist the idea of disclosing information to anyone at the child’s school, including the school counselor, for fear of their child being labeled or stigmatized. I work with them to understand the significant support, services and sensitivity that can be experienced by the child when his or her environment is aware of his or her needs.”

Striving for independence

Sure, high school means football games and prom, but it also means a buildup of pressure to make big life decisions, says Raychelle Cassada Lohmann, a school counselor at Hilton Head Island High School in South Carolina. “I think high school students face the unique issue of feeling pressured into knowing exactly what they want to do with their life,” she says. “That’s a pretty big burden to be lugging around at the age of 17 or 18. In education, we instill what we know best for postsecondary planning — more education. Some students may not be ready for that road. Many parents have high expectations and of course want what’s best for their child, but sometimes I ask myself, ‘At what cost?’”

Lohmann, a member of ACA and author of the books The Anger Workbook for Teens and Staying Cool …When You’re Steaming Mad, says relationships take on a whole new meaning in high school, with both friendships and romantic relationships being made and broken. “Emotions are more intense at high school,” she says. “There are a lot of firsts — driving, job, loves, etc. And when

an emotion is new, it feels raw when it’s experienced for the first time.”

As teens are forging their own identities, they may stray from their parents’ expectations, Lohmann says. With teens pushing to gain autonomy and parents trying to hold on to their control, it’s not uncommon for the two parties to engage in a spirited bout of tug of war.

One exercise Lohmann finds helpful with kids struggling for increased independence is to have them identify what they have control over. She asks students to write down everything going on in their lives and to put an “X” on the items they have no control over. Together, they review the list and Lohmann asks the students to rank how much the things they have control over affect them on a scale of 1 to 10.

“Now we can address the things that are in their control to change and develop an action plan, beginning with the first thing on their list,” Lohmann explains. “With the ‘out of my control’ things, we work on coping strategies. This strategy helps teens feel more empowered to conquer the things that are affecting their life. Plus, it helps them understand that sometimes in life there will be things that happen that are out of our control. It is at this point we learn to cope with what’s going on around us and keep moving in a forward motion.”

Certain issues, such as forging an independent identity, are age-old, but today’s teenagers are also being bombarded with new issues that previous generations never encountered. “The biggest, fastest change hitting the teenage population right now is the use of technology,” says Lohmann, who is also a member of the American School Counselor Association and the National Career Development Association, both divisions of ACA. Lohmann points to studies from the Pew Research Center showing that 75 percent of teens have a cell phone, 88 percent of those with cell phones text, and 73 percent of teens use a social networking site.

One obvious issue strongly connected to technology is cyberbullying, says Lohmann, who adds that schools need to address the problem because, even if the threatening texts or Facebook posts are sent from students’ homes, the stressful interactions return to school with the students and negatively affect the educational environment. Another potential problem she points out are students’ digital footprints. Students often don’t realize that what they do online can become searchable by college recruiters and even potential employers.

Lohmann says a school counselor’s role when it comes to high schoolers and technology is working with students to learn how to behave online. “As counselors in the school system, we have to educate the teens about what they should be putting up on the Internet,” she says. Lohmann sometimes asks her students to Google themselves and says they’re often surprised at what they find captured online.

Educating parents on understanding technology and encouraging them to work constructively with their teens can be helpful as well, Lohmann says. She offers the example of parents who discover their teenager is being cyberbullied and react by telling the teenager he or she can no longer use the computer. In the future, instead of reaching out to his or her parents for help, the child might stay silent, reasoning that being disconnected from the lifeline of technology is an even worse scenario than being bullied, Lohmann says.

The “fierce employment situation” in today’s economy is another hurdle for high schoolers, Lohmann says, because it’s impeding teens from finding the jobs that were more common in years past. Because students are having trouble getting the experience they used to receive through part-time or summer jobs, Lohmann says it’s important for counselors to assist them in finding unpaid internships, job shadowing experiences or other opportunities for work experience.

Likely also due in part to the unsettled economy, Lohmann says more high school students are looking at the possibility of attending technical colleges or two-year community colleges upon graduation instead of four-year colleges and universities. “By being familiar with the options that community colleges offer, counselors can help students gather the information they need to make a well-informed decision,” Lohmann says. “Admission to most community colleges is a simple process, but it doesn’t just stop there. Community colleges have a host of programs, including college transfer, remediation and career-technical. Counselors need to understand the array of opportunities that community colleges provide so they can help students make a well-adjusted transition into the program of their choice.”

Lohmann’s general advice to other counselors working with high schoolers is to remember that these students want to be respected and heard. Counselors should also aim to assist these adolescents in learning to be assertive and in understanding that their feelings do count and matter, she says. Lohmann tries to teach her high school students how to voice their opinions while simultaneously remaining respectful of other people and their feelings.

One significant benefit of being a school counselor, Lohmann says, is that it makes her accessible to students in a way that minimizes the stigma. “They can say they have a problem with their schedule and [then] tell me all about their home life,” she says. “That’s a privilege that school counselors have — we can really be there for the kids. They can seek us out when they need us.”

A time of transition

On campuses nationwide, college counselors almost always report that anxiety and depression are the top two issues with which students are struggling, according to Trey Fitch. An associate professor of counseling at Troy University in Panama City, Fla., Fitch says those two issues apply to traditional college students as well as to nontraditional students. He also says the prevalence of anxiety and depression among college students is not new.

Students ages 18 to 22 face numerous identity development issues as they make the transition from family life at home to independent living at college. “People associate that transition [with being] very stressful,” says Fitch, a member of ACA who coedited the book Group Work and Outreach Plans for College Counselors, published this year by ACA, with Jennifer L. Marshall. At that age, Fitch says, the brain is going through a major stage of development. Add to that a combination of neurological, physical and social changes, and the result can be anxiety and depression. But older, nontraditional college students often deal with anxiety and depression as well, Fitch says, because they’re generally facing “role overload” and trying to squeeze school in between family responsibilities and jobs.

A cognitive behavior approach has proved effective with clients with anxiety and depression, Fitch says, because it helps them adjust the maladaptive thinking patterns believed to be at the root of those two issues. “It has a lot to do with how people talk to themselves,” he says. For example, a student might think that because he failed a test, he’ll never graduate. The counselor’s role, Fitch says, is to help the client change his thinking and come up with a more realistic appraisal. “Although I’m disappointed about the results, I can do better next time, and it doesn’t mean I’m going to fail the class or that I’m a bad student,” Fitch says. “Sometimes [counseling is about] redirecting them back to seeing how they lack balance.”

Kenneth Jackson, director of the Purdue University Calumet Counseling Center in Hammond, Ind., echoes Fitch, saying that anxiety and depression are among the most common issues on his campus. In addition, he says, a good number of students come to the counseling center with personality disorders, eating disorders and substance abuse issues. Jackson likewise points to cognitive behavior theory and techniques as being helpful in addressing such issues, but adds that the humanistic aspect of being genuine with clients is also essential.

Often, Fitch says, there is a correlation between anxiety and depression and relationship issues, whether with family members, romantic partners or friends. Traditional college-age students generally find many relationships changing, he says.

These students are generally not in long-term relationships at this point in their lives. Their core social groups are evolving even as they’re separating from family members by living at college.

Fitch recommends using narrative, cognitive behavior or family systems approaches with college students struggling with relationship problems. The approach often needs to be brief, he adds, because college counselors aren’t usually able to see students on a long-term basis. Regardless of the approach, it is important to focus on breaking negative patterns, he says. It can also be helpful to focus on students’ strengths and those times when the problem did not exist. This often means examining their patterns of unhealthy relationships as well as their strengths in relationships, he says.

Group interventions can also offer a viable option for meeting the needs of college students, Fitch says, particularly when the school’s students greatly outnumber the school’s counselors. When Fitch worked as a counselor at Texas A&M University-Commerce, he says the counseling center offered different types of groups as well as outreach programs on topics such as stress management and career development.

Off campus, community counselors also need to be knowledgeable about the issues that college students face. For the past few years, Schumann has noticed an uptick in the number of college students who come in for counseling while they’re home on summer break. Common issues for which they’re seeking help include anxiety, academic pressure, trouble balancing their personal and academic lives, and body image concerns. “The transition of becoming quasi-adult is a lot for [college students] to handle sometimes,” Schumann says.

With college-age clients, Schumann focuses on being present and working to genuinely understand and validate their feelings. She often uses a combination of talk therapy and activity therapy, which can include sand tray or the expressive arts. In the past, she has also researched the counseling resources on her clients’ campuses and provided the students with information for getting help once they returned to school.

Emerging issues

The most surprising trend Jackson has seen of late on his campus is the rise in the severity of mental illness that students are experiencing, as well as the number of students requiring emergency hospitalizations for safety reasons. Fitch supports that observation, saying that more college students today have to be hospitalized, are seeing psychiatrists and are on medications. “It could be that there’s more stress in today’s society, it could be poor coping skills or it could be that we’re recognizing it more,” Fitch says. “My guess is it’s a little bit of all three.”

Considering the increase in severity of mental health issues among college students, Fitch urges college counselors to be vigilant, to be knowledgeable of community resources and to develop relationships with community providers, including crisis counselors, psychiatrists and contacts at area hospitals. “When these issues pop up, that’s when you have to reach out,” he says.

Fitch also notes a new trend — more combat veterans returning to college and university campuses. College counselors might be tasked with helping these veterans deal with post-traumatic stress disorder, reintegrate into the community and understand what’s involved in the shift between combat and academics. He recommends that college counselors seek additional training in preparing to work with this special student population and points out that the Department of Veterans Affairs offers educational opportunities for counselors.

Financial pressures are also increasing for students. Jackson, a member of ACA, NCDA and the American College Counseling Association, a division of ACA, says many students on his campus are seeking higher education later in life, meaning they are more likely to be under financial strain caring for children and/or elderly parents and working a full- or part-time job while going to school.

Fitch also notices the economic pressures burdening today’s college students. “As a teacher, I have a lot of students who come to me with their academic problems, but the real problem is financial,” he says. “They have to work an extra shift and they can’t make it to class, or they have to withdraw because they can’t afford it.”

In these tough economic times, Fitch tells counselors to help college-age students prioritize. “The counselor can help them set priorities when they’re in crisis,” he says. “Helping them with decision-making and priority setting are two of the most important things.”

In recent years, college counseling centers have grown more similar to community clinics, Fitch says, departing from the role of helping students solely with academic and relationship issues. That means college counselors must be properly prepared to deal with a wider variety of student problems than in the past. For that reason, Fitch urges college counselors to be active in their professional organizations, to earn continuing education credits, to keep up with the literature and to do whatever else they can to keep learning. “My biggest tip right now would be the need for extra training,” he says, “because there are so many issues now that we didn’t deal with 20 or 30 years ago.”

ACA Resources:

For more information on student issues, check out these books published by the American Counseling Association. To purchase any of the titles, visit the ACA online bookstore at counseling.org/publications or call 800.422.2648 ext. 222.

• Counseling Children: A Core Issues Approach by Richard W. Halstead, Dale-Elizabeth Pehrsson and Jodi Mullen
• Group Work and Outreach Plans for College Counselors edited by Trey Fitch and Jennifer L. Marshall
• Cyberbullying: What Counselors Need to Know by Sheri Bauman
• Suicide Prevention in Schools:
• Guidelines for Middle and High School Settings, second edition, by David Capuzzi
• Solution-Focused Counseling in Schools, second edition, by John J. Murphy
• Youth at Risk: A Prevention Resource for Counselors, Teachers and Parents, fifth edition, edited by David Capuzzi and Douglas R. Gross
• Active Interventions for Kids and Teens: Adding Adventure and Fun to Counseling! by Jeffrey S. Ashby, Terry Kottman and Don DeGraaf
• Assessment and Intervention With Children and Adolescents: Developmental and Multicultural Approaches, second edition, by Ann Vernon and Roberto Clemente

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org