University Counseling Centers

Universities and colleges have provided counseling services to students for over 80 years. Early on, counseling was often conducted by psychiatrists who worked in student health services. In the 1930s, there was movement for counseling to be conducted by counselors and psychologists who viewed students’ problems from a normative developmental model and were trained in student personnel programs or psychology departments. Since then, university counseling centers have emerged as a specialty area within counseling psychology that calls for psychologists to provide counseling for students with both developmental and adjustment-related concerns as well as more serious pathology. In addition to clinical services, university counseling center psychologists provide outreach and consultation to the larger university campus communities, provide training for graduate practicum counselors and predoctoral interns in counseling and clinical psychology and social work programs, attend to staff development within their agencies, conduct research applicable to college student populations and therapeutic practices, and develop administrative policies and programs that help to inform and guide the counseling psychology field. This entry begins with a brief historical overview of university counseling centers and then describes the current six counseling center functions as originally outlined by Stone and Archer, as well as multicultural and diversity factors that are involved throughout these functions.

Historical Overview

University counseling centers (UCCs) have transformed greatly since their formative years, and these transformations have often mirrored emerging mental health needs and personal growth concerns of the larger culture. During the 1940s, the role of clinical counselor was developed as an individual who could work with the specialized needs of college students. Following World War II, counselors were called on to provide vocational guidance services for returning veterans. During the 1950s through 1970s, outreach and consultation services were added to the work of university counseling centers, causing counselors to view the entire university as their “client” rather than just individual college students. In the 1980s, UCCs were faced with increasing numbers of students with serious mental health concerns (e.g., sexual violence, eating disorders, suicide) and with the need for campus education and consultation to address these issues.

From the 1990s through the beginning of the 21st century, university counseling centers have continued to work with students with serious mental health concerns, but during this time financial constraints have necessitated decreases in service provision, such as limiting counseling sessions. This limitation of counseling sessions is similar to the current therapeutic practice allowances of many third party payment plans, which has contributed to an increase in a medical model approach. This includes a reliance on diagnosis (e.g., the use of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV), psychotropic medications, and standard of care approaches that involve the professional practice of reasonable and prudent mental health professionals who have specialized training in the diagnosis and treatment of clinical issues.

In many ways, the field has seen a full circle that also embraces many of the emerging perspectives of the last 80 years, from counseling provided by psychiatrists from a medical model during the 1920s to counselors providing mental health treatment from a developmental and adjustment-oriented perspective and back to current practices of considering both developmental and medical models when working a college student population.

University Counseling Center Functions

University counseling centers have moved away from their early, primary function of only providing mental health care for students to one that now also provides educational programming to and consultation with the larger campus community, conducts preventive and remedial interventions, and does so in ways that adhere to innovative counseling, consultation, and educative practices. Over thirty years ago, Morrill, Oetting, and Hurst developed the cube model to describe the varying dimensions of counselor functioning within the UCC setting. This cube included the targets of interventions (individual, primary group, associational group, and institution or community), the purpose of interventions (remediation, prevention, or development), and the method of intervention (direct services, consultation and training, and media).

More than 20 years later, Pace, Stamler, Yarris, and June further developed the cube model to one that was “rounded out” to describe the evolution of UCC functioning that better addressed the interdependent university community. This newer model addressed the demands on UCCs to interact with various university and community agencies in more complex ways managing student development and counseling needs. Rather than viewing UCCs as an independent entity within the university and one that considered the targets, purpose, and methods of intervention as independent from one another, the rounded out model embraces the interdependence, collaboration, and flexibility necessary to improve the developmental and clinical needs of the student population.

University counseling centers today have evolved into multifaceted agencies that are well integrated into the larger university system and provide a variety of functions. Stone and Archer randomly surveyed UCC directors and training directors and, from their findings, developed six different counseling center functions: clinical services, outreach and consultation services, training, staff development, research, and administration. While not all UCCs address these functions (e.g., not all UCCs offer training to graduate students in counseling and clinical psychology and social work), most UCCs’ functioning includes many of these areas. As a follow-up to these findings, Guiness and Ness surveyed UCC directors to assess whether there had been, in recent years, significant changes in these areas that were central to UCC functioning. They determined that more than half of the directors surveyed indicated positive changes in all six areas, suggesting that these functions remain essential to UCCs and that ongoing assessment can help identify areas of improvement.

Clinical Services

Research suggests that UCC psychologists believe that students’ presenting problems in counseling are more severe than in previous years, leading one author to suggest that UCCs are looking more like community clinics. These problems include drug and alcohol abuse, eating disorders, sexual violence and other trauma-related concerns, self-mutilation, severe mood disorders, and suicide. There are varying reasons as to why students may be presenting with more pathology than in past years.

Levine and Cureton suggest that in today’s college culture, students are less prepared academically, and they seek ways to escape from their overwhelming distress about their current concerns and uncertain future. Avoiding distress may contribute to depressive and anxiety disorders, and some escape activities (e.g., alcohol abuse) are detrimental to positive mental health. Kadison and DiGeronimo, in addressing this idea of students’ increasingly experiencing feeling overwhelmed by life, also note that some psychological concerns are likely to first manifest during young adulthood (such as bipolar disorders and eating disorders). Third, new and available psychotropic medications enable students who might not have previously been able to attend college to do so today. Fourth, college students today report valuing counseling and agree that they would seek counseling if the need were to arise. They also expect that counseling should be available at universities. Finally, the popular media have noted the rise of “helicopter parents,” or parents that pay extremely close attention to their child attending college. Such parents may be more able than parents in the past to pick up on emotional difficulties of their college student children and are likely to refer them to counseling.

At the same time that UCCs are asked to address the increased severity of students’ mental health concerns, because of financial limitations, UCCs are not increasing the number of staff to provide counseling for students. Additionally, due to dwindling resources, UCCs have increasingly instituted session limits on counseling. The challenge becomes how to address college students’ clinical severity within a brief psychotherapy model and with fewer staff than in the past. One suggestion is that UCC psychologists use empirical research and standard of care treatment options to inform them on how to best provide counseling to students with various, complex presenting difficulties in a session-limited counseling model. Another suggestion is to use outreach and consultation efforts as a primary prevention targeted to all students and asking those in close contact with students (e.g., residence hall personnel) to help identify those who are in distress. Doing so may lead these students to start counseling before they are in crisis, thus decreasing the need for numbers of counseling sessions that may be greater than overall session limits. An additional option is to employ more testing and assessments with complex cases to better diagnose and provide treatment recommendations in a timely manner. A final suggestion is for UCCs to annually assess the chronicity and severity of students’ presenting difficulties to alert university and college administration about the need for additional resources.

Outreach and Consultation

Outreach, consultation, and other related services have become an increasingly important component of university counseling centers. Stone and Archer defined outreach as an “organized program, workshop, media effort, class, or systemic attempt to provide psychological education” and consultation as an “activity where a staff member provides advice and assistance based on psychological principles to a clearly understood client (group, office, department, club, and others)” (p. 557).

Providing outreach and consultation allows UCCs to diversify their methods of service delivery, meet the needs of the ever-changing college student population, and provide educative and supportive efforts to students and university personnel outside of the counseling office.

Outreach

Organized programming and workshops can serve the needs of students who traditionally do not access counseling services, such as men and students of color. Such programming may demystify and destigmatize counseling, educate university personnel or friends of students about how to encourage those in need to seek counseling services, and inform students about ways to prevent problems during particularly stressful times (e.g., avoiding alcohol abuse during the first week living in the residence halls). Outreach efforts may also encourage students to seek counseling when they struggle with a concern but, because of varying stages of readiness to change, may not otherwise do so.

Outreach programming may include addressing less serious concerns, such as decreasing test anxiety, reducing general stress, improving time management, and dealing with long-distance relationships as well as addressing more serious concerns such as sexual assault prevention, drug and alcohol abuse prevention, body image concerns, identifying the warning signs of depression and suicide, and dealing with hate crimes on campus. Innovative methods might include using peer presenters when appropriate, online workshops, and focus groups and post presentation surveys to help improve future attendance and delivery methods.

One particularly useful way to identify the outreach presentations often used at UCCs as well as assistance in developing new programs is to visit Workshop Central at the online Counseling Center Village at the University of Buffalo. Outreach outlines and handouts, workshop design strategies, and program evaluation paperwork that have been used successfully at other universities and colleges are readily available on this site.

Consultation

The most effective consultation methods involve multifaceted services that focus on student advocacy and support as well as faculty and staff training. Quite often, distressed students come initially to the attention of faculty members, other university personnel, friends, or parents who do not know how to approach students about their concerns or where to refer them for help. Additionally, issues may arise with students that are not necessarily directly counseling related but may be distressful within a campus community. As examples, this may include how to deal with offensive student remarks directed at international students in a classroom or how to address a Greek residence when a fraternity member has been called to military service and whose fraternity brothers have differing views on war.

A variety of consultation models exist to help UCC psychologists provide advice and assistance to a client, whether the client is a faculty member in a classroom or a Greek advisor living in a fraternity house. As an example, in process consultation, a UCC psychologist acts as a facilitator who targets the interactions of group members, helps develop goals, helps the group come up with viable solutions to reach these goals, and assists the group in making the changes necessary to reach their goals. Process consultation has been further developed to address the unique needs within the university setting and help UCC psychologists more effectively provide assistance to cam-pus departments, agencies, and groups.

Graduate Training

Training models for graduate counseling psychology programs started in the late 1940s, and, in 1979, the American Psychological Association (APA) developed accreditation standards that required a pre-doctoral internship to obtain a doctoral degree in psychology. The Association of Counseling Center Training Agencies (ACCTA) was founded in 1978 to represent the interests of UCC training sites at national and state levels, provide liaisons with other groups involved in the training and credentialing of counseling psychologists, and serve as a forum for issues related to training predoctoral interns and practicum counselors. Currently, 150 UCC training directors are members of ACCTA.

In 2007, 3,430 doctoral students sought predoctoral internships at 640 sites and competed for 2,884 positions accredited by the Association of Psychology Postdoctoral and Internship Centers. Many of those who obtained an internship will be doing so at a UCC. University counseling centers provide more counseling and clinical predoctoral internship positions than other training sites. In addition to providing pre-doctoral internship training, UCCs also provide practicum training for doctoral students. Given the increased competitiveness of internship applicants (in 2007, 842 doctoral students were not matched at internship sites) and to strengthen their chances of obtaining an internship, students are completing more practicum hours than in past years. Unfortunately, despite the amount of predoctoral interns and practicum counselors who receive their training at UCCs, there are some concerns that academic training programs may not adequately prepare students to provide a wide range of services necessary to work in a university setting.

University counseling center psychologists need to be trained to work with developmental issues unique to college students as well to diagnose and treat more serious concerns. Ethical standards within counseling and clinical psychology are moving toward the adoption of uniform standards of care within the field, and UCC psychologists are increasingly expected to use the standards competently. Counseling session limits are commonplace in UCCs, and graduate programs need to train students to work within briefer therapy models. Additionally, UCC psychologists need to be well versed in assessing risk management, providing crisis intervention and group work, and addressing public health issues relevant to a college population. Training should also include competence in clinical and learning disability testing as well as drug and alcohol abuse assessment and treatment. Finally, additional competencies necessary for training include program development, outreach programming, consultation, career development, and clinical supervision and training.

All of these specialized clinical and other mental health services need to be conducted in a multiculturally competent manner. Graduate programs must provide training for future psychologists to work with multicultural and diverse communities. As the United States is becoming an increasingly diverse and multicultural society, so are student populations. As a result, multiculturally attuned UCCs are imperative in order to work effectively with the ever-changing university community. Necessary multicultural competencies for a graduate student to work in UCCs include a counselor’s awareness of her or his own assumptions, values, and biases; understanding of the worldview of culturally different clients; and the development of appropriate intervention strategies and techniques that take into account the clients’ beliefs, attitudes, knowledge, and skills.

In response to the call for graduate training in diversity and multiculturalism, in 2000, the APA adopted the Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients; in 2002, the APA adopted the Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists; and in 2007, the APA council approved the Guidelines for Psychological Practice With Women and Girls. These policies serve as aspirational documents for psychologists to integrate and infuse multicultural and sexual diversity issues and issues pertinent to the treatment of women and girls in all aspects of the practice of psychology. The adaptation of these policies in the UCC setting is a step in addressing the specific needs of increasingly multicultural and diverse student populations.

Staff Development

In order to address changes in student populations and presenting difficulties of students who seek counseling, it is important for UCC psychologists to keep up with changes in the field of professional psychology. University counseling centers must assess the demands unique to their student populations as well as changes in the broader field and modify their practices to meet these new demands. UCCs need to actively pursue well-planned programs for staff development. This may include continual improvement in clinical assessment skills, risk management and crisis interventions, and brief and solution-focused psychotherapies. In the past, UCCs have often hired psychologists who are generalists and can work with a variety of client difficulties. In response to the increased chronicity and severity of student presenting concerns and the need to respond more effectively to populations that may be underrepresented (e.g., students of color), UCCs may want to encourage staff members to seek specialization in certain clinical areas or with particular populations. Finally, it is critical that all UCC psychologists continually develop their diversity and multicultural competencies.

Additional to addressing the need for ongoing staff development to improve clinical services, UCC psychologists also need to attend to their own career satisfaction. University counseling centers are a popular career choice for new doctorates in professional psychology, and most new psychologists are satisfied with most aspects of their first professional positions. Despite this overall initial satisfaction, Parham noted three central career issues for UCC psychologists 7 to 10 years into their careers, which may provide reasons for psychologists to search elsewhere for professional positions. These include professional burnout, difficulty with finding time for personal and other professional activities, and a shift in age relative to the student population. There are a number of ways UCC administrations can address these career concerns. Developing and maintaining a supportive and positive UCC culture that provides ongoing encouragement for staff career and professional development and opportunities for leadership and administrative skill development, encouraging staff to develop programs in their areas of interest and to participate in professional organizations and research, and keeping staff involved in the planning and operation of the UCC and to confront job satisfaction issues (such as burnout) from a developmental perspective are ways to help staff improve career fulfillment.

Research

The International Association of Counseling Services (IACS) identified conducting research as a core role and function of UCCs. According to the IACS standards, research efforts include the evaluation of clinical services, program assessment, and scholarly study. Even though IACS notes the importance of conducting ongoing research, especially to determine the effectiveness and improve the quality of services, most UCCs do not do so in any systemic manner. One reason for the lack of research activity includes a lack of time and resources. UCCs’ missions are likely to focus more on clinical and ancillary service delivery than on conducting research. With dwindling resources to hire more psychologists to address increasing clinical need, research often falls as a distant priority to providing counseling and outreach services.

Another reason may be a move from some psychologists viewing themselves as scientist-practitioners to identifying as practitioner-scholars. That is, with more programs increasingly emphasizing the practice of counseling over developing research skills, psychologists who choose to work at UCCs may be less likely to value conducting research.

A final reason for the lack of research involvement is that UCC psychologists may believe that research only entails conducting carefully controlled experimental studies that are published in scholarly, peer-reviewed journals. To counter this belief, Boyd, Roberts, and Cook proposed a UCC research program: conducting research to identify demands for services, understand and assess changes in student characteristics, recognize counseling effective outcomes, and provide a data resource for the campus housed within the UCC.

Administration

UCCs may be organized in one of six ways: as a center that provides educational services; a counseling center for students and employees; a health-services counseling center; a privately contracted counseling service; a center that provides consultation for organizational and community development; and a center that provides comprehensive counseling services and community development. The way in which a UCC is organized is usually based upon the size, location, funding pattern, or philosophy of the university or college. While one organizational model is not inherently better than another, some have suggested that for the survival of UCCs, it is imperative to align UCC goals with those of the larger institution.

To this end, it may be that the preferred UCC model is one that provides multiculturally sensitive, comprehensive counseling services and community development. This type of UCC is one that offers the following: comprehensive counseling services (individual, couples, career, and group counseling); specialized counseling for more serious problems (e.g., eating disorders, alcohol and drug abuse, sexual violence); crisis services (including after-hours care); outreach and consultation services for student groups, staff, and faculty; training and supervision of graduate practicum counselors and predoctoral interns; research that involves service accountability; psychiatric care; and community development work that involves and includes many different university departments and services and local community agencies.

Future Directions

Counseling for university and college students has changed and evolved over the course of 80 years. The current mission of university counseling centers is to be full-service agencies that provide counseling for individuals, couples, and groups with developmentally related concerns as well as more complex and serious problems. Additionally, they provide outreach and consultation services, provide graduate training and supervision for counseling and clinical doctoral students and interns, attend to staff development within their agencies, conduct research and program evaluation, and help to develop administrative models and policies relevant to the field of counseling psychology. Future efforts will continue to focus on ways to provide exceptional counseling services to students in the face of dwindling resources and ways that university counseling center psychologists can conduct research to improve their efficiency while also attending to the demands of counseling and ancillary services.

References:

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