University Counseling Center Research Articles

Early distress score instability predicts outcome in brief psychotherapy.

Among psychotherapy patients, unstable early distress scores are known to predict substantial intersession improvement later in treatment. The evidence has been ambiguous as to whether early distress instability also predicts outcome. We investigated the links among early distress instability, later intersession improvement, and outcome. In a sample of 1,796 students treated with brief psychotherapy at university counseling centers, we sought to predict intersession improvement and treatment outcome from an index of distress instability, as assessed during the first four treatment sessions. Large intersession shifts late in treatment appeared to mediate the link between early distress instability and outcome. These relationships were limited to participants who demonstrated early score shifts larger than measurement error. As hypothesized by dynamic systems theory, some psychotherapy patients experience stepwise improvement that is preceded by early instability in distress scores. However, the effect size linking early instability to outcome is small. Sudden gains may not be the optimal measure to elucidate these relationships. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A data-driven simulation approach to quantify the effect of group counseling on system performance of college counseling centers

Objective: To investigate the effectiveness, from a system’s perspective, of offering group counseling options in college counseling centers. Methods: We achieve this through a data-driven simulation-based approach with the aim of providing administrators with a quantitative tool that informs their decision-making process. Results: Our simulation experiments reveal that offering group counseling options without resource reallocation does not have the desired positive impact on the system’s performance. However, with resource reallocation, our results demonstrate that the introduction of group counseling options can significantly improve the performance of the system by as much as 40%. Conclusions: Group counseling options, coupled with proper resource reallocation strategies, are effective in reducing access time of first-time patients by as much as 40%. The effect of group counseling is highly dependent on both the number of offered groups as well as their scheduling policy. Scheduling policies have to be scrutinized in light of their resulting group waiting time and resource-utilization efficiency.

Outcome expectations and working alliance may be more important for patients from rural areas during the transition to college life: An exploratory within-patient analysis

ABSTRACT Objective Research has given limited attention to the distinction between patients from rural and urban areas, especially concerning the frequent overlap between rural living and low socio-economic status (SES). To shed more light on this, we explored the differential treatment processes between patients from rural and urban areas. Method Seven hundred and fourteen patients recruited from a university counseling center in China filled out the questionnaires for Outcome Expectation (OE), Session Alliance Inventory (SAI) and Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) each session. Data was analyzed using the disaggregated cross-lagged panel model and the asymmetric fixed-effect model. Results The findings indicated a reciprocal within-patient relation between OE and SAI for the whole sample. SAI mediated the effect of OE on next-session CORE-OM for patients from rural areas, with a significantly greater indirect effect than for patients from the urban areas. Asymmetric effects were found for OE among patients from urban areas, for whom drops in OE predicted worse next-session CORE-OM more strongly than improvements in OE predicted improved CORE-OM. Conclusion This study provided preliminary evidence for differential OE-alliance-outcome predictions between patients with different SES and affirmed a reciprocal OE-alliance relation in a Chinese sample during the transition period of college.

Longitudinal Measurement Invariance of CCAPS-34 Scores with a Large University Sample

Objective Counseling Center Assessment of Psychological Symptoms (CCAPS-34) scores were studied for longitudinal bias-free construct evidence. Method A sample of 4,696 university students referred to a university counseling center were assessed twice for evidence of longitudinal measurement invariance. Results Adequate or marginal longitudinal measurement invariance (LMI) of all subscales except for Eating Concerns was confirmed. Coefficients alpha and omega suggested that the internal consistencies for both initial and subsequent administrations were largely adequate for screening level test scores (≥ .80), except for the Hostility and Alcohol Use subscales (≥ .73). Second session effect sizes (Cohen’s d) were small but detectable and statistically significant for most subscales (-0.02–.17). Conclusions Counselors can use most CCAPS-34 subscale scores for tracking psychological symptoms and constructs over time with confidence. The Generalized Anxiety, Social Anxiety, Academic Concerns, and Alcohol Use subscales can be used with great confidence. Some confidence is warranted from the LMI evidence when using the Depression and Hostility subscales, but caution in warranted when using the Eating Concerns subscale.

Conflicting cultures, compromising care: A heuristic inquiry of women directors of college counseling centers.

Conflicting cultures, compromising care: A heuristic inquiry of women directors of college counseling centers.

What’s Next? On Better Supporting Women of Color Clinicians in University Counseling Centers

As university counseling centers (UCCs) are diversifying, research on the experiences of clinicians of color, particularly women of color (WOC), and how they navigate their sociocultural identities at UCC workplace settings remains limited. We used a qualitative thematic analysis approach to explore the current support they receive, suggestions for UCCs to better support WOC, and suggestions for other WOC interested in pursuing a career at UCCs. A total of 56 participants responded to an online survey. Two broad themes emerged with the data around (a) existing and expanding support from UCCs for WOC and (b) advice for WOC interested in pursuing a career in UCCs. Subthemes delineated were (a) professional development and support and (b) workplace climate. While most participants named how their agencies supported them, many provided suggestions on how UCCs can improve from the process of recruitment, retention, leadership, and professional development to being respectful of WOC’s boundaries and needs. Related to workplace climate, participants appreciated the spaces created for either them or their clients of color. They suggested UCCs to be strategic in providing spaces where genuine feedback can be provided, creating various spaces for WOC (e.g., listserv, lunch group), and facilitating ongoing diversity training and discussions. Participants also imparted their wisdom to WOC through encouragement and practical advice. This study centers the voices of WOC clinicians and discusses the importance of self-advocacy, the various supports needed from institutions, and how White supervisors and mentors can better serve their WOC supervisees and trainees.

화상상담 내담자의 상담 성과 탐색을 위한 합의적 질적 연구

Objectives The purpose of this study is to explore counseling outcomes and related factors of clients, focusing on university counseling centers that actively operated video counseling, which emerged as a new counseling operation method.
 Methods To this purpose, individual interviews were conducted from September to October 2022 with a total of 10 college students who experienced video counseling, The research team organized all the data collected based on the interview questions into verbatim, and conducted the analysis and conducted a rating process of analysis using the Consensus Qualitative Analysis (CQR) method.
 Results As a result of the analysis, 6 areas, 14 categories and 36 subcategories were derived. First, the experiences of the video counseling clients were expressed as environmental and process factors and were divided into comfort and discomfort in the counseling environment, and satisfaction and dissatisfaction in the counseling process. Second, the counseling outcomes of video counseling were identified as cognitive, behavioral, and emotional changes, and the factors related to counseling outcomes were identified as counselor factors and client factors. Third, factors for selecting future video counseling were ease of access, risk of COVID infection, and personal characteristics. In addition, suggestion for the development of video counseling were presented.
 Conclusions This study in-depth were explored counseling outcomes and related factors of the university counseling center clients who actually experienced video counseling. Based on this, effective counseling strategies using video counseling and implications for counselor education were discussed.

The Cascade of Care for Early Psychosis Detection in a College Counseling Center.

Programs for early detection of psychosis help identify individuals experiencing emerging psychosis and link them with appropriate services, thereby reducing the duration of untreated psychosis (DUP). The authors used the cascade-of-care framework to identify various care stages between screening and enrollment in coordinated specialty care (CSC) and to determine attrition at each stage, with the goal of identifying points in the referral process that may affect DUP. Project partners included a college counseling center and CSC program. All college students seeking mental health services at a counseling center between 2020 and 2022 (N=1,945) completed the Prodromal Questionnaire-Brief (PQ-B) at intake. Students who met the distress cutoff score were referred for a phone screening. Those who met criteria on the basis of this screening were referred for assessment and possible enrollment into CSC. Six stages in the cascade of care for early detection were identified. Of the students who completed the PQ-B as part of intake (stage 1), 547 (28%) met the PQ-B cutoff score (stage 2). Counselors referred 428 (78%) students who met the PQ-B cutoff score (stage 3), and 212 (50%) of these students completed the phone screening (stage 4). Seventy-two (34%) students completed a CSC eligibility assessment (stage 5), 21 (29%) of whom were enrolled in CSC (stage 6). The cascade-of-care framework helped conceptualize the flow within a program for early psychosis detection in order to identify stages that may contribute to lengthier DUP. Future research is warranted to better understand the factors that contribute to DUP at these stages.

Mental health in undergraduate engineering students: Identifying facilitators and barriers to seeking help

AbstractBackgroundEngineering students encounter high levels of stress, which may negatively impact their mental health. Nevertheless, engineering students who experience mental health distress are less likely than their peers to seek professional help, even when controlling for gender and race/ethnicity.PurposeWe examined beliefs that undergraduate engineering students have about barriers and facilitators to seeking professional help for their mental health. We also sought to identify cultural and systemic factors within and beyond engineering that might affect help‐seeking. Together, these beliefs influence students' sense of personal agency around seeking mental health care.MethodWe implemented a pragmatic qualitative design that incorporated the integrated behavioral model to investigate engineering students' (N = 33) professional mental health help‐seeking beliefs. We used thematic analysis to analyze help‐seeking beliefs and perceived barriers and facilitators that students described during interviews.ResultsWe identified four themes: Navigating the system impacts personal agency; sacrifices associated with help‐seeking act as a barrier; engineering culture acts as a barrier to help‐seeking; and student confidence in help‐seeking varies significantly. These themes portray the effect of perceived barriers and facilitators on students' personal agency for accessing mental health care. Our findings have implications for engineering departments and university counseling centers that want to minimize barriers to help‐seeking.ConclusionsEngineering stakeholders must improve access to professional help for engineering students. Implementing changes to normalize help‐seeking behaviors, enhance personal agency, and facilitate engagement with mental health resources will create better conditions for engineers. Further research is necessary to understand how other beliefs (e.g., attitudes, perceived norms) inform the relationships between student mental health, professional help seeking, and engineering culture.

The differential mediating roles of resilience in the relationship between meaningful living and stress among college students during the COVID-19 pandemic

The current literature, mostly Euro-American based, indicates that the presence of meaning in life (MIL) improves resilience and lowers stress. However, the differential mediating roles of resilience in the relationship between the search for and presence of MIL, and stress have not been explored. This study aimed to investigate the differential mediating roles of resilience in the relationship between the presence of and search for MIL, and stress among Omani college students amid the COVID-19 pandemic. This cross-sectional study consisted of the Brief Resilience Scale, Perceived Stress Scale 4, and Meaning in Life Questionnaire, as well as socio-demographic questions. A path analysis model was used to examine the hypothesis. A total of 970 Omani college students responded to the questionnaire. Findings indicate that searching for MIL was significantly associated with a high level of stress directly (β = 0.023; p < 0.001) and indirectly, through a negative effect on resilience (β = 0.006; p < 0.001). Conversely, the presence of MIL was significantly associated with a decreased level of stress directly (β = − 0.045; p < 0.001) and indirectly via a positive effect on resilience (β = − 0.151; p < 0.001). In keeping with the proposed hypothesis, this study contributes to the current knowledge, by extrapolating the effect of searching for MIL on resilience and stress, and culturally re-contextualizing MIL research. University counseling centers could adopt meaning-based strategies to mitigate stress by promoting meaningful living and resilience.

Birth Order Differences and Overall Adjustment among First Year Undergraduate Students in One Selected University

The study examined the effect of birth order differences on adjustment among first year undergraduate students in one selected university in Kenya. A cross-sectional survey research design was adopted. The sample size comprised 213 first year students selected using both stratified and simple random sampling techniques. The adjustment questionnaire was used to collect data. The inferential statistics such as Analysis of Variance (ANOVA) and Tukey’s post hoc tests were used to analyze data. The ANOVA results indicate a significant effect, [F (5, 207)=8.279, p=0.000], of order of birth of first year students on their level of overall adjustment. The Tukey’s HSD Post Hoc test results indicate that 1st born students presented a significantly higher overall adjustment compared to the rest. The study recommends that staff at university counseling centers should develop specific orientation programmes to enhance the adjustment of first year students who occupy later orders of births in their families apart from first born students. Keywords: birth order, overall adjustment, first year, undergraduate students, university

Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic

Objective The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance and clinical outcome in the context of teletherapy compared to in-person treatment. Methods We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome. Results Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress. Conclusions Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy – in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed.

Psychotherapy outcomes with Latinx clients attending Hispanic-serving institutions and predominantly White institutions.

In the present study, we used a large, national data set to examine psychotherapy outcomes from 9,515 Latinx clients seeking treatment in 71 college or university counseling centers in the United States, 13 of which were in Hispanic-serving institutions (HSIs) and 58 in predominantly White institutions (PWIs). We examined the hypothesis that Latinx clients in HSIs, compared to Latinx clients in PWIs, would experience greater relief in symptoms of depression, generalized anxiety, and academic distress over the course of psychotherapy. Results of multilevel modeling offered partial support for our hypothesis. Compared to their counterparts in PWIs, Latinx clients in HSIs were found to experience significantly greater relief in academic distress over the course of psychotherapy, but there were no significant differences between Latinx clients in HSIs and PWIs in terms of changes in depression or generalized anxiety over time. We offer recommendations for future research and discuss the practical implications of these findings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

More Sessions Make a Difference: University Counseling Centers and Student Retention

We examined the role of counseling centers in retention in universities, specifically for students who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+); as first generation; and as Black, Indigenous, or people of color (BIPOC) and students who have a mental illness diagnosis. Number of sessions at the center was associated with increased likelihood to stay enrolled (p < .001). First-generation (p < .01) and LGBTQ+ (p < .05) students were less likely to stay enrolled. We provide suggestions for student affairs administrators to emphasize student mental health to impact retention.

Changes in clients' relational patterns with parents and therapist during psychodynamic psychotherapy: Their association and relation to treatment outcome.

The study aimed to explore how changes in clients' relational patterns during psychodynamic psychotherapy relate to treatment outcomes and therapy effectiveness. Seventy clients receiving psychodynamic psychotherapy in a university counseling center were interviewed three times and filled out the OQ-45 questionnaire five times during therapy. We used the Core Conflictual Relationship Theme (CCRT) to study clients' relational patterns. Mixed models were used to assess the interaction between clients' CCRT intensity toward their parents and toward their therapists, treatment effectiveness, and treatment outcome. First, we found that clients' relational patterns with their parents correlated with relational patterns with their therapists across several time points in therapy. Then, we found significant interactions, indicating that treatment effectiveness moderates the relationship between clients' CCRT intensity and treatment outcomes. The findings suggest that the transference phenomenon is related to therapy outcomes differently in effective and less-effective therapies, depending on the transference intensity. Further research is needed to expand knowledge about the intensity of transference and its possible impact on treatment choice and management.

외국인 유학생 내담자의 자살을 겪은 유학생 상담자의 경험에 대한 질적연구

Objectives This study was conducted to examine the difficulties of international student counselors who suffered suicide of a foreign student client and their experiences in the process of overcoming them. Methods An in-depth interview was conducted with a total of 9 counselors at the university counseling centers, and analyzed according to the consensual qualitative research method(CQR). Study participants were selected through significant sampling and snowball sampling. Results A total of 7 areas, 14 categories, and 57 subcategories were derived. Seven of these areas were “characteristics of the client's suicide-related experience,” “factors affecting the client's suicide experience,” “emotions experienced in counseling,” “difficulties experienced in counseling,” “experience after counseling,” and “expectations for multicultural crisis counseling.” Conclusions This study has the implication of expanding the scope of research related to domestic international student counselors, which is still in its early stages by confirming the characteristics of suicide crisis intervention in international student counseling, and is worth being used to lay the foundation for the development and protection system of international student counselors.

Mental Health Problems Among Graduate Students in Turkey: a Cross-Sectional Study.

In this study, depression/anxiety and academic distress were investigated among graduate students in Turkey. The study sample comprised 459 graduate students who voluntarily completed an online survey (294 women, 64%). Independent t-tests and multivariate analyses were performed to examine group differences. The results confirmed that depression/anxiety and academic distress scores varied according to sociodemographic variables. Whereas depression/anxiety and academic distress did not show significant differences in terms of gender and place of residence, students who had previously sought psychological help had higher levels of depression/anxiety and academic distress. Younger age, being a master's student, and being single increased the risk of having higher levels of depression/anxiety and academic distress. University counseling centers may benefit from these findings in efforts to identify graduate students at risk and apply appropriate prevention and intervention strategies.

Reach and uptake of digital mental health interventions based on cognitive-behavioral therapy for college students: A systematic review.

Mental health problems are increasing in prevalence among college students, yet few students receive treatment due to barriers such as insufficient resources in college counseling centers. Digital mental health interventions (DMHIs) have potential to overcome barriers and offer accessible, evidence-based care to college students. However, to evaluate the true public health impact of evidence-based DMHIs, it is important to assess the reach and uptake rates of DMHIs on college campuses. We conducted a systematic review to examine the reach (i.e., % of invited students who express interest) and uptake (i.e., % of enrolled participants who initiate an intervention) of DMHIs based on cognitive-behavioral therapy (CBT) for college students. Eight databases were searched. Inclusion criteria included: (1) college population; (2) experimental design; (3) CBT-based intervention; (4) intervention targeting specific mental health conditions; and (5) digital intervention. Reach and uptake rates were calculated from data reported. A systematic narrative review framework was used to synthesize results. Of 10,315 articles screened, 90 were included. Seventeen studies (19%) reported sufficient data to calculate reach; 35 studies (39%) reported uptake rates. Of studies that reported reach or uptake, most evaluated unguided (n = 20) or guided (n = 16) self-help programs. Measurement methods varied widely. Overall reach was low, whereas uptake was high among enrolled participants. Despite evidence that improving reach and uptake can increase the public health impact of DMHIs, most studies did not report on either outcome. Suggested practices to improve these outcomes, and their reporting, are discussed.

Risk scores in digital psychiatry: Expanding the reach of complex smartphone data by condensing it into simple results

As college counseling centers struggle to meet the growing demands of behavioral health services, digital mental health tools like smartphone apps offer a scalable solution to increase access to care. However, clinicians report greater time demands and uncertainty over how to act upon digital data. In this paper, by using established statistical techniques, we condense complex smartphone data into results that are quickly understood and clinically meaningful. Specifically, we show how smartphone digital phenotyping data collected by college students can be used to predict an individual’s anxiety and depression level on a daily or weekly basis with an error of less than 10%. These predictions are then condensed into a 1 to 5 scale with a 1 representing patients with the lowest risk of presenting high anxiety or depression, and a 5 representing the patients with the highest risk. If used in a clinical setting, these risk scores have the potential to help college counseling centers monitor symptom severity in real-time via students’ own smartphones, allocate resources more efficiently, and ensure that students are receiving the appropriate level of treatment.

The sum of competing parts: Religious and sexual identity disparities in therapist effectiveness.

The discussion of the influence of culture in psychotherapy is expanding to honor and incorporate the ways identities intersect within complex social systems. Some clients present for therapy with two or more identities that are in conflict, whereby the values or needs associated with different parts of the self are at odds. The resulting tension can be a significant driver of distress. This study sought to investigate therapist variability in facilitating change with clients depending on the interaction of their sexual orientation and the role of religion in their life (RR). We analyzed the depression scores of clients (n = 1,792) who received care at a university counseling center. After controlling for clients' pretherapy depression scores, the association between their sexual orientation and their posttherapy depression varied across therapists; however, the association between their RR and posttherapy depression did not. We also found that the association between the interaction of clients' sexual orientation and RR, and posttherapy depression varied across therapists. Therefore, some therapists had clients who experienced more or less change in their depression and that variability was predicted by the identity combinations clients endorsed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).