A just-published article in Professional Psychology reveals that college counseling center staffs are reporting unprecedented levels of student problems with 14 of 19 problem areas increasing in the 13 years studied. One study reported that over three-quarters of clinic directors (77.1%) noted increases in “severe psychological problems.”
While some studies ones that focus on subjective assessments of the students’ apparent emotional state on entering the counseling center report little change, a just-released study [“Changes in Counseling Center Client Problems Across 13 Years” in Professional Psychology: Research and Practice (PPRP)] published under the auspices of the American Psychological Association indicates that when the counselors report after a case is closed they reveal a different and more scientifically accurate picture. The PPRP survey examined “trends in counseling center clients’ problems from the perspective of the therapist at the time of therapy termination.”
The scholars “examined archival data across 13 years from a university counseling service located at a large Midwestern university.” The study represents over 13 thousand students who sought counseling at Kansas State University between 1988 and 2001. Interestingly, female students constituted about 2/3 of the clients over the 13 years, but in the last 3-4 years of the study males increased from barely over 30% to nearly 40% of the total.
Another very interesting, and revealing, finding is that students are more likely to need counseling the longer they are in college, that is, each successive year brings more students to the counseling centers with Senior students constituting more than a quarter (26.8%) of the total clientele and graduate students comprising another 15.4%.
Student-Clients were analyzed using the Case Descriptor List (CDL) a tool that “measures therapists’ perceptions of client developmental and relational problems along with more serious problems.” Thus, there was consistency across the 13,000 student analyses with 30 questions answered for each student by his or her clinician. These answers were fed into computers when a case was closed.
The questions covered broad categories such as: depression, personality disorders, relationship issues, and physical problems. The instrument was carefully tested for statistical accuracy and the data was analyzed by 12 full-time, fully credentialed (11 had Ph.Ds and one had an M.A.) staff members.
The 13-year period was divided into three separate time periods in order to minimize the impact of external events (media coverage of a particular problem, for instance) in a specific year. Time period one was 1988-1992; time period two was 1992-1996 and time period three was 1996-2001.
The findings are revealing:
Six of the problem areas developmental, situational, depression, academic skills, grief and medication use increased steadily among students across all three time periods.
Seven of the other areas relationships, stress/anxiety, family issues, physical problems, personality disorders, suicidal thoughts and sexual assault increased far more in the final two time periods than it did in the first time period.
In 14 of the 19 problem areas, clinicians reported increases in the percentages of individuals having difficulties.
Until 1994, relationship problems were the most prevalent issue among student clients.
During 1994, stress and anxiety problems eased ahead of relationship problems as the most frequently experienced difficulty among student clients. That remained true during subsequent years.
Educational and vocational problems were issues in the first time period, but receded in second period only to increase again the third time period.
Abuse, on the other hand, increased steadily until the third time period when it began to recede as a problem among the student clients.
Among the problems that remained steady were: substance abuse, eating disorders, legal problems and chronic mental disorders.
Over the three time periods (from 1988 2001) problems became much more complicated and complex anxiety, depression, suicidal tendencies, sexual assault, personality disorders.
Depression cases DOUBLED.
Suicidal students TRIPLED.
Sexual assault cases QUADRUPLED.
Some severe problems jumped dramatically from the first to the second time period and then leveled off such as physical, sexual and emotional abuse. In other words, these problems escalated from 1988 to 1996 and have stabilized at that high level since then.
There have been significant increases in problems affecting academics developmental problems, relationship problems, difficulties with academic skills, and situational problems.
Some “severe” problems remained statistically unchanged: substance abuse, eating disorders, legal problems and chronic mental illness.
Problems classified as “situational” problems increased dramatically throughout the 13 years. (Apparently, these are problems that the counselor thought were caused by the student’s “situation” and were deemed likely to go away when the student’s situation changed.)
The following variables affected student-client problems campus climate, changes in the larger community, media and popular press influences, changes in psychology and mental health practices.
New requirements from managed care and insurance companies mandated changes in therapy policy. For instance, students were sometimes limited to between 4 and 10 sessions with a counselor. This change seems to have forced counselors to focus on a student-client’s “immediate” or “situational” circumstances (zeroing in on the situation that produces the panic attack or stress rather than the specific psychological problem).
Educational and vocational choice produced significant increases in counseling hours through the three time periods.
Interestingly, abuse cases increased during the period 1994-1997, but declined after media focused on skepticism about “false memories.”
Over the course of the study, the percentage of student clients prescribed medicated increased from 10% to 24% of clients. The authors of the study report an unsubstantiated “impression” that more students are coming into colleges and universities using medications (especially antidepressants).
Clinic staffers are spending more time writing reports than meeting with students. The necessity for diagnostic and assessment tools, recording keeping and case management has dramatically increased.
Providing support and safety for TRIPLE the number of suicidal student clients is taxing clinic staffers.
Despite the skyrocketing increases in complex and serious problems, there are no changes in number of clinic staff. Crisis work now constitutes more of a priority than at the beginning of the study 13 years before.
Some students now receive, “dollar for dollar, more in psychological services than they paid in tuition and fees.”
The study concludes:
“Changes in counseling center client problem severity and complexity affect how psychologists are prepared to work in counseling center settings. For example, understanding diagnosis is far more important today than it was in 1989.
“Conceptualizing clients with multiple problems, within a cultural context, with attention to idiosyncratic and social and environmental factors is important. As the severity and complexity of clients’ problems increase, the need to work with a team of professionals becomes more important.
“Psychologists need to be prepared to work with physicians, social workers, other campus departments, and other health care professionals. Training in consultation is more important now than it might have been a decade ago.
“Although we did not collect data on crisis and trauma situations, the observed increases in the numbers of suicidal students suggest crisis intervention and trauma debriefing would also be an important area of training.”
Dr. Janice Shaw Crouse served as an academic administrator at a Midwestern university for 7 years. During the previous 7 years, she was a professor and debate coach.
“Changes in Counseling Center Client Problems Across 13 Years,” Sherry A. Benton, John M. Robertson, Wen-Chih Tseng, Fred B. Newton, and Stephen L. Benton, Kansas State University. Professional Psychology: Research and Practice, Vol. 34, No. 1, 66-72, 2003. Copyright 2003, The American Psychological Association, Inc.