an overview of common counseling issues in college helping distressed and distressing students...

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An Overview of Common An Overview of Common Counseling Issues in Counseling Issues in College College Helping distressed and distressing Helping distressed and distressing students students attain their academic goals. attain their academic goals. Tacy Costanzo Tacy Costanzo U.C. Santa Barbara U.C. Santa Barbara College of Engineering College of Engineering

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An Overview of Common An Overview of Common Counseling Issues in CollegeCounseling Issues in College

Helping distressed and distressing students Helping distressed and distressing students attain their academic goals.attain their academic goals.

Tacy CostanzoTacy Costanzo

U.C. Santa BarbaraU.C. Santa BarbaraCollege of EngineeringCollege of Engineering

Learning OutcomesLearning Outcomes

• Increase advisors awareness of counseling issues and appropriate responses to distressed student behaviors

• Share resources to help advisors and students cope with anxiety, stress, depression and the symptoms associated with those conditions

IntroductionIntroduction

• The recent surge in mental health needs on campus is interfering with the academic mission of the university.

• College is a challenging time when individual vulnerabilities are often exposed.

• Proactive education on mental wellness during college can reduce future student crises – educate parents too

• Multiple campus resources are required to help students with counseling issues attain their academic goals

• Immediate and comprehensive intervention may lessen the impact of these psychological disruptions on a student’s well-being

• Long-term wellness requires treating the cause rather than just the symptoms

• Trust your instincts and observations and take action

• Address counseling issues FIRST, integrate academic advising in follow up appointments

Three Basic Questions Three Basic Questions students’ grapple with during collegestudents’ grapple with during college

• Who am I?• Identity development is a complex journey

• Who will I be with?• Relationship issues – friends and family

• What will my future hold?• Major field of study• Career aspirations

College Student ChallengesCollege Student Challengesthat complicate answering those 3 questionsthat complicate answering those 3 questions

• Leaving home• Making/managing new relationships• Acclimating to a new environment• Experiencing (learning) autonomy• Developing personal identity

• Cultural• Sexual• Spiritual

Challenges continued:Challenges continued:

• Selecting an academic/career path• Managing finances

• Juggling school and work

• Worrying about post college debt

• Exposure to new ideas and ideals• Navigating relationship changes with parents,

siblings and friends• Cultural mores and family attitudes vary greatly

and have substantial impact on how a student deals with counseling issues

• Distinguishing developmental struggles from mental health issues can be difficult

• Moderate levels of stress are necessary for motivation

• But unmanageable levels of stress can cause dysfunction

• Everyone feels sad once in awhile• but clinical depression requires intervention

• Demanding and Irrational Behavior• Advisors need to recognize the difference

Some current counseling issues Some current counseling issues in higher educationin higher education

• Anxiety• Stress• Depression• Demanding behavior• Irrational behavior• Substance abuse• Psychiatric disabilities

• Warning signs that may indicate more than developmental concerns:• Dramatic changes in physical appearance or hygiene

• Decline in academic performance

• Negative fluctuations in self-perception

• Loss of focus on academic goals or plans

• Unusual behavior

• Verbalization of distress

• Excessive or inappropriate anger

• Extreme emotional or mood swings

• Withdrawal

• Alcohol or drug abuse

Responding to a distressed studentResponding to a distressed student

Know your campus protocol for responding to distressed students

• Immediate intervention may keep a situation from escalating

• Refer (or walk) the student to the appropriate campus resource

• Follow up with the student• The student will benefit from knowing you care about them

• Assist with immediate academic actions• Deficit load

• Leave of Absence

• Make a long term schedule, showing how the student can complete their requirements

• ONLY share information with others on a NEED TO KNOW BASIS

• Encourage distressed students to talk to their parents about their struggles when appropriate

ANXIETYANXIETY

• Most common psychiatric condition in US with multiple distinct diagnostic categories• General anxiety• Social anxiety• Panic disorder• Obsessive-compulsive disorder• Post-traumatic stress disorder• Multiple phobias

Common Manifestations of anxiety Common Manifestations of anxiety in college students:in college students:

• Tension or fear in the absence of danger• Feelings of confusion and loss of control• Excessive worry and irrational thoughts• Withdrawal and avoidance behavior• Physical and psychological agitation • Change in eating habits• Inability to sleep

Academic impacts:Academic impacts:

• Fluctuations in concentration• Decreased information processing• Loss of information recall• Decreased comprehension• Lack of time management• Increased test or performance anxiety

Advisors should:Advisors should:• Talk to student in private

• DO NOT promise confidentiality• Focus on core issue• Speak calmly and make simple, yet specific plans

• Help student prioritize actions• Make an appointment at the Counseling Center• Attend study skills and test-taking workshops• Add physical exercise to daily routine• Stress the importance of healthy eating habits• Request student ‘check-in’ with you as the term progresses• Follow up with student in subsequent terms

Advisors SHOULD NOT:Advisors SHOULD NOT:• Overwhelm student with information• Encroach on student’s personal space

• Taking a walk with the student has been a good method for me

• Be judgmental or minimize the student’s feelings or perception of the situation

• Rush the student or put words into the students mouth

• Assume that the student’s family and friends are aware of their struggles

• Assume the student’s angst will resolve without assistance

DEPRESSIONDEPRESSION

Depression is more than passing sadness and can include severe and long-term symptoms:

• Hopelessness• Helplessness• Worthlessness• Inability to experience pleasure in daily events• Irregular sleep and eating patterns• Difficulty concentrating and retaining information• Sense of social isolation

Depressed students can experience:Depressed students can experience:

• Anxiety• Agitation• Extreme or irrational anger• Thoughts of destruction• Preoccupation with death• Thoughts, threats of suicide

Academic Advisors should:Academic Advisors should:• Validate the student’s feelings• ‘Actively’ listen • Instill hope (over 80% of patients respond to

medical intervention for depression)• Explicitly express your concern for the student

well-being• Ask if the student has thoughts of suicide• Assist the student in making a specific, yet simple

action plan, starting with a visit to the Counseling or Health Center

• Provide Counseling/Health Center pamphlets for the student’s future reference

Advisors SHOULD NOT:Advisors SHOULD NOT:

• Minimize the situation• Disagree with the student’s perspective• Offer solutions• Provide more information than the student can

retain at the time• Assume that the student’s family and friends are

aware of their struggles• Assume the student’s depression will resolve

without assistance

Demanding StudentsDemanding Students(and demanding parents)(and demanding parents)

• Some students feel entitled to treatment, services and privileges beyond what is reasonable. Some have had much of their life facilitated by ‘overly’ helpful parents.

• The enabling/disabling parent or advisor• Helping too much disserves the student

• It is important to distinguish between demanding and irrational or delusional behavior.

Advisors should:Advisors should:• Remain calm and speak respectfully to

student despite the tone or volume of their speech

• Insist that student behave/speak in a civil manner

• Get emergency assistance if you feel threatened

• Set clear and reasonable limits and expectations – hold the student accountable

• Be aware of potential manipulative behavior

Advisors should NOT:Advisors should NOT:

• Argue with the student• Accommodate inappropriate demands• Ignore the problem• Feel obligated to take care of the

student• Allow the student to intimidate you

Psychiatric DisabilitiesPsychiatric Disabilities

• Persistent psychological conditions can impair students ability to function academically and socially

• It is critical that both the CAUSE and the symptoms are treated.

• Treatment and accommodations can help students stay in class

• Some students will need time away from campus during treatment

Advisors should:Advisors should:

• Speak to the student in private, but be aware of your own safety

• Do not promise confidentiality• Be sensitive, as the student may be:

• Nervous, angry, scared, lack self-esteem, out of touch with reality

• Acknowledge the student’s difficulties• Refer the student to Counseling Services and to

the DSP office• IF the student seems to be a danger to self or

others CALL for emergency assistance

Advisors SHOULD NOT:Advisors SHOULD NOT:

• Assume situation will improve without intervention

• Appear judgmental• It is possible that the stigma of mental health issues is

already complicating their life• Pressure student to disclose details of their

situation • Share information with others except on need to

know basis• Assume that the student wants accommodations

for special needs

Irrational or Inappropriate BehaviorIrrational or Inappropriate Behavior

• Warning signs that a student might be out of touch with reality• Disorganized or unrecognizable speech

• Odd or eccentric behavior

• Inappropriate or NO emotions

• Bizarre statements and thoughts that are out of touch with reality

• Social withdrawal

• Hallucinations

Advisors should:Advisors should:

When student needs immediate help• CALL emergency personnel if the student

seems to be a danger to self or others• Remain calm while waiting for help• Tell the student you are getting them to a safe

environment• Understand that student may not retain what you say• Attempt to keep the student engaged while waiting

for help• Get counseling for yourself if you feel overwhelmed

after working with a student in crisis

Advisors should:Advisors should:

When student needs help but is not in eminent danger:

• Call Counseling Services ‘hotline’ to secure an appointment for the student

• Walk student to Health or Counseling Center (if you are comfortable with doing so)

• Speak concretely to student, do not make the student make academic decisions prior to counseling

• Be aware that the student may be paranoid and fearful

• Speak calmly and quietly, be flexible

Advisors should NOT:Advisors should NOT:• Crowd the student or argue with them

• Pacing, nervous movement and gestures, and inability to sit still are common physical manifestations

• Assume the student can take care of themselves without assistance

• Presume the student will remember your conversation• Write down the Counseling Center phone number and

appt time for the student• FOLLOW up with the studentDO NOT chase after a student who runs off, call for help

Substance AbuseSubstance Abuse

• Alcohol and drug use is a problem on most campuses across our nation

• The UC Mental Health Report showed• 44% of undergrads had indulged in binge

drinking that term• 58% had experience ‘problems’ due to drinking• 39% used marijuana during the current quarter• 14% used other illegal drugs during college

Advisors should:Advisors should:

• Withhold judgment, but treat the situation seriously

• Substance abuse is illogical behavior, so lecturing is ineffective

• Hold students accountable for their actions or inactions:• Academically• Behaviorally (in ResHalls and at Campus

Activities, etc.)

• Remember that denial is a powerful influence:• Students may lie unconsciously or consciously• May be delusional• Stress can INCREASE the need to engage in

the addicting behavior• Multiple treatment options are available and

addictive behaviors can be overcome• Instill hope as addictive behaviors can be

overcome• Refer the student to counseling• Follow up with the student

Advisors should NOT:Advisors should NOT:• Minimize the situation with comments like “most

students experiment with drinking or drugs sometime”

• Assume the behavior is harmless• Assume that the students family knows of the

behavior• Be judgmental or condescending

• Some students are just bad decision-makers and can quit drinking or experimenting with drugs at will

• Some students struggle with addiction and can not just walk away from the substance they abuse

Keeping them in schoolKeeping them in school

• Learning to Accept Yourself• Maintaining the Balance• Get Organized• How to Manage Stress• Overcoming Test Anxiety• Computer game or internet addiction

• Instant gratification

Helping Students LearnHelping Students Learn to make positive self reflections to make positive self reflections

• Self-judgment• Measure productiveness verses non-

productiveness, rather than good verses bad

• Do not over-generalize• A low exam grade does imply ‘dumb’ or ‘bad’

or ‘stupid’

• Set reasonable standards

Positive self reflections…Positive self reflections…

• Don’t compare yourself to others• Reflect on own personal growth• Learn to value who you are, rather than trying to be

someone else• Take an ACTIVE rather than passive approach to college

• Attend class and participate in supplementary academic offerings

• Get involved in community activities• Form study groups• Use campus resources to enrich your experience

From http://www.counsel.ufl.edu /

Juggling the demands of collegeJuggling the demands of college

• Acknowledge and trust your feelings• Some anxiety, sadness or anger is normal

• Understand your feelings and seek help when you are overwhelmed

• Talk honestly about your worries and feelings with family and trusted friends• You’ll see most other students have similar or

other concerns

The balancing act continues:The balancing act continues:HandoutsHandouts

• Get organized… “10 Steps to Organization in College”

• “Tips for Reducing Stress”• “How to Overcome Test Anxiety”• “Coping with Anxiety”• “How to Approach a Professor for Help.”• “Relaxation Exercises”• “Handling Common Relationship

Problems”

Campus ResourcesCampus Resources• KNOW who to call before a crisis arises

• TEAM work is essential• Build connections between the advisors network and the

counseling center, with the residence hall directors, the health educators and the office of student life.

• ASK your supervisors for training and professional development workshops

• SHARE your new awareness of counseling issues with the faculty

• HELP is available for staff experiencing stress, anxiety and depression

Remember that our Remember that our capacity to nurture, capacity to nurture,

counsel, encourage and counsel, encourage and advise our students is advise our students is

diminished when we do diminished when we do not take care of ourselves.not take care of ourselves.

“When health is absent,

wisdom cannot reveal itself,

art cannot manifest,

strength cannot fight,

wealth becomes useless,

and intelligence cannot be applied.”

HerophilusA Greek physician, born in 335 B.C.

Web ResourcesWeb Resources

• https://www.mentalhealthscreening.org/screening/welcome.asp• Online assessment for depression, anxiety, alcohol, and

eating disorders • http://ccvillage.buffalo.edu

• Numerous links to counseling resources• http://www.ccs.ohio-state.edu/

• Counseling resources and Crisis response• http://www.counseling.caltech.edu/

• Multiple counseling issues resources• www.apa.org/topics

• Resources for coping skills that help keep students in school

References:References:• Allen, Deborah and Ralph Trimble. Identifying and Referring

Troubled Students: a primer for Academic Advisors. NACADA journal, Vol 13, No 2, Fall 1993.

• Cai, Sean. Physical Exercise and Mental Health: A content integrated approach in coping with college students’ anxiety and depression. The Physical Educator. Vol 57, Number 2, Spring 2000.

• Farrell, Elizabeth. Taking Anxiety Out of the Equation. The Chronicle of Higher Education. Vol 52, No 19, January 2006.

• Heiligenstein, Eric., et al. Depression and Academic Impairment in College Students. Journal of American College health. Vol 45, Spring 1996.

• Kadison, Richard, and Theresa DiGeronimo. 2004 College of the Overwhelmed. Jossy-Bass Publishers, San Francisco.

• Kitzrow, Martha. The Mental health Needs of Today’s College Students: Challenges and Recommendations. NASPA Journal. Vol 41, No 1, Fall 2003.

• Marano, Hara. The Mental Health Crisis on Campus. The NASPA Journal - Leadership Exchange, Fall 2004.

• Ranjita, Misara, et al. “Academic stress of college students: a comparison of student and faculty perceptions. College Student Journal, Vol 34, No 2, June 2000.

• University of California at Berkeley, Office of Academic Affairs. “Prioritizing Mental Health: A Campus Imperative. Proposal for a standing academic senate subcommittee on Student Mental Health 2003.”

• University of California, Office of the President. “Student Mental Health Report”. October 2006.