Brief Therapy at a University Counseling Center: Working Alliance, Readiness to Change, and Symptom Severity

Abstract

The authors investigated whether students receiving short-term individual counseling at a university counseling center showed progress as evidenced by perceived client and counselor outcomes and the roles that client readiness to change and working alliance played in this setting. The results indicated that the counselor reports, not the client reports, reflected statistically significant change in client symptoms. Changes in symptom severity were not associated with working alliance and readiness to change. Keywords: college counseling, working alliance, client change ********** University counseling centers help students to ameliorate psychological distress so that they may take full advantage of the academic setting (Watson & Schwitzer, 2010). Typically addressed issues include, but are not limited to, depression, anxiety, interpersonal problems, academic concerns, eating disorders, substance abuse, sexual abuse, anger management problems, self-esteem, stress, suicidal ideation, inability to concentrate, sleep difficulties, hopelessness, and intimate partner violence (Alschuler, Hoodin, & Byrd, 2009). College counselors' role in this process is multidimensional, including working with students, parents, faculty, staff, and administrators to create positive change in the campus environment (Schwitzer, 2008; Wolgast, Lambert, & Puschner, 2004). It is increasingly important for college counselors to assess the effectiveness of their treatment (Lambert et al., 2003; Watson, 2011). The International Association of Counseling Services' (IACS; 2011) Accreditation Standards for University and College Counseling Centers identifies that research investigating ongoing evaluation and accountability is a central counseling center responsibility. According to these standards, university counseling centers should regularly conduct assessments to determine the effectiveness of the services provided and work to improve the quality of these services (IACS, 2011). The Standards' call for documenting effectiveness coincides with an age characterized by decreased budgets and declining student enrollment. As a consequence of these dynamics, university administrators increasingly request empirical evidence that counseling centers are effective and helpful to students. Therefore, it is important that college counselors assess the services they provide to students and justify their existence with concrete data (Bordeau, Glatthorn, & Gage, 2006). One way that university counseling centers have attempted to accomplish this task is by reporting the number of students who sought services, the most frequent problems presented by the students, and the results of satisfaction surveys to the administration (Talley & Clack, 2006). Although satisfaction surveys are used in many university counseling centers, this method of data collection is not an evaluation, nor does it assess outcomes (Cooper & Archer, 2002). A problem inherent in measuring student satisfaction with counseling services is that many of the students who are surveyed are regular clients. It can be assumed that these students are at least mildly satisfied with their experiences in counseling because they keep coming back. A major issue in measuring client satisfaction with counseling is that satisfaction is different from actual change. Cooper and Archer (2002) described the use of satisfaction survey practices as relatively simplistic assessments and encouraged counselors to conduct formal and extensive outcome research. Measuring client change is central to determining effectiveness (Sexton, Whiston, Bleuer, & Walz, 1997). Therefore, more research examining client change is needed to advance the knowledge of the effectiveness of university counseling center services. Vonk and Thyer (1999) provided a two-part rationale for studying client outcomes at university counseling centers: (a) to provide both clients and counselors with information that can be used to understand clients' presenting problems and needs and (b) to assist with evaluating centers' services. …