distressed and distressing students working with students with psychological disorders, learning...

Distressed and Distressing Students

Working With Students With Psychological Disorders, Learning Disabilities and

Medical Problems

Dan Jones Ph.D., ABPP

Faculty & Staff as Helping Resources

• Faculty & staff members at ETSU have the unique opportunity of having ongoing, direct contact with students and can identify students who are struggling.

• To support your efforts, here are helpful practical tips about assisting students most effectively and referring them to other helpers when needed.

What to Look For

• Marked changes in academic/personal performance or behavior.

• Unusual behavior or appearance.• References to suicide, homicide or death.

Marked Changes in Performance or Behavior

• You find you’re spending more time with the student doing “counseling” rather than advising.

• Marked decrease in performance and/or preparation

• Withdrawal from others• Excessive absence or tardiness• Repeated requests for special consideration• Excessively anxious when called upon in class

Marked Changes in Performance or Behavior

(continued)• Dominates or avoids discussion• Disruptive behavior• Problems with roommates or family• Exaggerated emotional response inappropriate

to the situation

Unusual Behavior or Appearance

• Depressed or lethargic mood• Marked increase or decrease in activity• Outbursts of anger• Unexplained crying• Conversations that do not make sense• Marked decline in personal hygiene

Unusual Behavior or Appearance

(continued)• Dramatic weight loss or gain• Coming to class or events intoxicated or

high/smelling of alcohol or drugs• Difficulty concentrating

References to Suicide or Homicide• If a student talks or writes about suicide or

homicide ALWAYS take it seriously.• Overt references to suicide• Expressed thoughts of hopelessness or

helplessness• Expressed plan for suicide/homicide• Isolation from friends and family• Giving away possessions

What Can You Do?

• If you talk with a student you are concerned about, or if a student approaches you directly for help…

Talk Listen Communicate Give Hope Maintain Boundaries Refer

TALK

• Talk to the student in private when both of you have time and are not rushed or preoccupied

• Give the student your undivided attention. Often a few minutes of effective listening may be enough to help the student feel cared about and more confident about what to do

• If you feel anxious, keep your door open or meet the student in a public place

LISTEN

• Listen to the student’s thoughts and feelings in a non-threatening way

• If you have initiated the contact, express your concerns in behavioral, non-judgmental terms. For example “I’ve noticed you’ve been absent from class over the last two weeks and I’m concerned,” rather than “You keep skipping class. You’re going to fail if you don’t watch it.”

COMMUNICATE

• Let the student talk. Your job is to listen.• Communicate understanding by repeating back

the essence of what the student told you.• Try to include both content and feeling for

example “It sounds like you haven’t made new friends since you’ve been here and you’re feeling lonely and worried.”

GIVE HOPE

• Assure the student that things can get better.• It’s important to help them realize there are

options and things won’t always seem hopeless.• Suggest resources: family, friends, clergy or

professionals on campus.

MAINTAIN BOUNDARIES• Maintain clear and consistent boundaries and

expectations. You are the professor/advisor/etc., not their counselor, parent or friend.

• It is important to maintain the professional nature of the staff/student relationship and the consistency of academic and other expectations, such as exam schedules, etc. If the student cannot maintain these expectations, they should look at options such as withdrawing from the course, taking an incomplete, etc.

REFER

Refer to other resources, such as Personal Counseling, when…

• The student asks for assistance with a problem that is outside your range of knowledge

• You are very busy and don’t have the time to give the student the time they need

• The problem is more serious than you feel comfortable handling

REFER(continued)• Helping the student would compromise your

relationship, e.g., asking for money, a place to live or your home number to call in a crisis

• The support you’ve already provided doesn’t seem to be enough

• You feel overwhelmed, overly responsible for or worried about the student’s safety

REFER(continued)• You think your personal feelings about the

student will interfere with your objectivity• The student admits there’s a problem but

doesn’t want to talk about it• The student is disrupting others

Referring to the Counseling Center• Approach the student you are concerned about in a

gentle, caring, and non-judgmental way.

• State specifically why you are concerned. Describe

behaviors, then suggest a visit to the Counseling Center.

• Normalize the process of seeking help.

• When referring students to Counseling Services, suggest

it as a possible resource rather than telling a student to go

because he or she “needs help” or is “causing problems”

for others.

Referring to the Counseling Center• Present the Counseling Center as a resource

used by hundreds of students a year.• Receiving counseling can be like “taking a

course in yourself.”• Remind students that they don’t have to have a

“deep dark” problem nor does the problem need to reach crisis proportions for them to benefit from professional help. We’d rather have someone come in with a small problem than wait for it to become a big one.

Referring to the Counseling Center• Reluctant students might also be relieved to

know that they can just come in for Walk-in and speak to a counselor on a one-time basis without making a commitment to ongoing therapy.

• If you want to offer extra support, you can have the student call the Counseling Center from your room or office, and/or you can offer to accompany the student to his or her first session.

Referring to the Counseling Center• Remind the student that the services are free

and the same service in the private sector can cost between $75 and $125 per hour.

• Inform the student that Counseling Center staff try to help people help themselves.

• Remember that many students will feel ambivalent about seeking help from any source including the Counseling Center. You may need to remind them that, “What you’re doing to solve your problems isn’t working.”

Referring to the Counseling Center• The ambivalence can often be characterized by statements

such as, “I don’t want to go there because my problem isn’t that serious.” Or, “I don’t want to go there because I think my problems are too serious and they can’t help me.” In either of the two preceding cases, the person you are trying to refer may be fearful of the unknown. A direct response to such objections can sometimes be helpful. “If your problem is not appropriate for the Counseling Center, they can make sure that you are directed to the right place.”

Guilt Inducing Students

• In addition to teaching our students the humanities, math and science we must also help students to develop a sense of personal responsibility.

• Holding people responsible is constructive helping and empowering instead of enabling and rescuing.


• Negative enabling stops the student from experiencing the consequences of his or her behavior.

• Some ways in which we “enable”.· Carrying incompletes for more than one semester· Allowing excessive absences· Inflating grades


• Some ways in which we “enable”. (continued)

· Allowing students to frequently hand in papers or take tests late

· Not clearly stating problems for fear of upsetting someone.

· Allowing students to circumvent appropriate channels for problem resolution


• We in the Counseling Center, usually believe that suffering the natural consequences of one’s actions is at times the most therapeutic thing that can happen to a student.


• Most of us in the health, counseling and student development fields went into this work because we like to help others. Unfortunately, some of our efforts that come out of kindness, compassion and a desire to give people what they want may in the long run cause more harm than good.


• Researchers have found that holding people responsible for their actions with appropriate sanctions is important in treating and managing impulsive individuals.


• Some students have little perspective about future consequences of their behavior and consider what happened in the past to be irrelevant. Only what is happening now matters. And what does happen is often viewed as someone else’s fault.


• Impulsive students view themselves as victims who demand satisfaction, thus they lash out at resident assistants and university officials feeling they should be able to do anything they want.


• “Do” is the key word since their actions often bring impulsive students to the attention of university officials.

• Therefore, to understand these students staff must focus on what they do, NOT what they say. Rely more on observations of behavior than on explanations or promises.


• When we try to hold impulsive students accountable they will often accuse us of being unfair, rigid, insensitive and uncaring – accusations that trouble most of us.

• Impulsive students often try to shift the focus from their behavior to legalistic issues.


• They will often promise to change as another strategy asking for leniency promising to change if “given a chance”.

• Increased degrees of freedom and responsibility should be based upon the demonstration of a consistent pattern of behavior not upon promise of change.


• What happens when university representatives reduce sanctions due to impulsive students’ explanations? Each successful manipulation reinforces the student’s belief that the goal should be more skillful manipulation rather than personal change. These students may try to reduce or eliminate sanctions as just another game.


• Sometimes university representatives reinforce denial by sending students to a counselor without imposing other sanctions.


• Counseling intake imposed as a sanction is sometimes viewed by impulsive students as them having succeeded in a con game; their actions have no consequences because they need only to go through the motions at the counseling center.


• Students may say, “How would you like to be forced to do this?” Staff often feel they should not sanction a student because they would not want to be sanctioned. They would not be going by the golden rule and would feel unfair and mean.

• The students underlying message is if you were nice your wouldn’t sanction me.

Guilt Inducing Students• Staff members have not hurt anyone the

student has. Such students hurt themselves or others by their actions, which is why they go before the judicial board. By trying to make the staff feel guilty they avoid feeling guilty themselves over the way they treat themselves or others. Staff members impose limits not to hurt those students but to stop them from hurting others.


• Other students say, “I’ve been through so much lately”. My grandmother died this year, my girlfriend broke up with me and my goldfish died. You are making me suffer even more.


• Staff members have done nothing. The student has. Disruptive students put themselves through the judicial process for doing something disruptive, then try to reverse the responsibility.


• Staff are not responsible for the actions of impulsive students; the students are saying “Don’t hold me accountable given my mental conflict.” Staff members often feel guilty sanctioning people with emotional problems believing they aren’t responsible for their actions or that their illness is.


• Setting sanctions and limits is a caring act. The firm adherence to sanctions is the single most important therapeutic strategy for impulsive students.

Manipulative or Time Demanding Students

• Will tell you how wonderful you are.• Will induce guilt when you let them know you

can’t be available when they want you.• They tell you that no one understands them

like you do. They don’t want to talk about their problems with anyone but you and

perhaps others in their circle of support.


• Some such individuals will have a history of mental health treatment and will tell you of the many mental health professionals that have let

them down or treated them poorly. Ask yourself, are most counselors, therapists, and psychologists really that bad and uncaring?


• You may find that the student has gone through a succession of roommates, hall mates, R.A.’s, coaches, or teachers, etc., frustrating the best efforts of each to help the student feel better or solve problems, and requiring on-going and expanding amounts of time and energy.


• They tend to view people or situations as good or bad with all or nothing thinking.

• The utmost time and energy given these students will not be enough. They can be like a bottomless well.

• They often seek to control your time and unconsciously believe that the amount of time received is a reflection of their worth.

• Can have broad shifts in moods and emotions.


• Often engage in impulsive behaviors (e.g., spending, sex, substance abuse, binge eating, self-mutilation, etc.)

• Will often hint at being suicidal without making a direct threat.

• Often create conflict between others. (Lets you and him fight.)


• May have a new crisis (“crisis du jour”) almost daily or weekly (e.g., roommate conflict, romantic relationship breakup, conflict with parents, etc.)

Don’t let them use you as their only source of support.

The ETSU Counseling Center

• The ETSU Counseling Center (439-4841) only serves STUDENTS– Individual and couples counseling– Psychiatry– Crisis response– Preventative psycho-educational programming– Case management– Career exploration

Current Mental Health Realities on College Campuses

• Suicide is the 3rd leading cause of death among adolescents and the 2nd among college students

• Approximately 1100 college students die each year by suicide.

• Females are 3 to 5 times more likely to attempt suicide, but males are 4 to 5 times more likely to complete suicide.

New Challenges for Faculty

• Knowing the network of student support services is imperative.

What Has Changed

• Without question, campuses are seeing more individuals with significant mental health issues.

• The community resources for mental health have been greatly diminished.

• More students have anger management issues and violence is increasingly common on campuses.

Syllabus Suggestions

• General policy on eating, drinking, smoking in class.• General policy regarding children and visitors in class.• General policy regarding breaks, and leaving and

entering class at other than break time(s).• General policy on plagiarism.• General policy regarding cell phones, pagers, laptop

computers, PDAs, etc…• General policy regarding attendance, punctuality and

tardiness, including consequences.

De-Escalating Verbally

• Do NOT– Engage in defending yourself or debating– Engage in a power struggle– Tell the individual what they should do– Ask them “why”– Threaten or challenge the individual– Use put-down or insults

Hostility and Verbal Abuse

• It is acceptable and sometimes necessary to simply ask the person to leave.

• Understand the goal(s) of the person– To get what he/she wants– To be heard– To gain control– To provoke a reaction (pick a fight)

Why are Some People Difficult

• Emotional wounds and/or self-esteem

Recognizing the Troubled Student: Level 2

• Repeated requests for special consideration

• Unusual or exaggerated emotional responses to situations

What Stops Faculty and Staff from Intervention

• Fear of harming the psychologically fragile student

• Fear of legal or physical reprisals• View of discipline as a negative process

What Can You Do to Help Our Students

• File a CARE Report

(Jeff Howard, Dean of Students,

Dean of Students, 439-4210)

Making a Counseling Referral

• Do not attempt to make a referral when the student is so upset they can’t listen to you. Wait until they’ve calmed down enough to be able to respond to your suggestions.

FAQs

What if I’m uneasy about a student?• Call the Counseling Center for advice (423) 439 -

4841 before you meet• Do not ignore your uneasy feelings• Try to identify what specific behavior makes you

uncomfortable and ask the student to change that behavior

FAQsWhat if I’m uneasy…(continued)• Do not confront the person, but don’t give in to

inappropriate behavior to help feel safe. Set boundaries immediately, e.g., “I’d like you to lower your voice.”

• Stay in a public place or keep your door open and make sure colleagues are around

• Offer to listen. Ask what the student wants to accomplish

FAQsWhat if I’m uneasy…(continued)• Involve a third party; tell student “I’ll get . . . To

help me understand how we can help you.”• Have a code word for calling a colleague or

Campus Police if you feel threatened, e.g., “Please call Dr. Thomas to help me understand what I can do for this student”

• Call Campus Police beforehand 423-439-4480 to stand by in the vicinity if you feel frightened or to intervene in the early stages if the person acts out.

FAQsWhat if I’m uneasy…(continued)• You can and should take disciplinary action with

respect to the student. Often informal mediation will help. The Dean of Students Office can also contact other professors to find out if there is a broader problem. Often, what is perceived as a psychological problem, is a discipline issue.

FAQs

How can I best help a student with problems?

• The best thing you can do is call us (423) 439-4841 and consult. Faculty and staff are here at ETSU because they care about students. The best way to show you care is to ask for advice early on. We can consult with you about maintaining your professional role while still helping the student.

Finally

• The counseling staff strives to provide services to help students that will enable them to succeed academically and personally. We know that faculty and staff have the same goals and we believe we can accomplish these goals most effectively, the closer we work together.

Counseling Center Website

• http://www.etsu.edu/students/counseling/

http://www.etsu.edu/students/counseling/

American Foundation for Suicide Prevention Quote

• “Prevention may be a matter of a caring person, with the right knowledge, being available at the right time.”

– American Foundation for Suicide Prevention

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