University Counseling Center Clients Research Articles

대학상담센터 내담자의 조기종결 경험에 대한 질적 연구

This study aimed to find out what factors led to the dropout of college counseling center clients and the impact of dropout on the clients. In-depth interviews were conducted with 11 clients who experienced dropout before the 10th session at the university counseling center, and the data were analyzed using Braun and Clarke's Thematic Analysis method. Four themes, 10 sub-themes, and 26 units of meaning emerged from the data analysis. The themes were 'distrust and anxiety about counseling', 'inappropriate behavior of counselors', 'low counseling competence of counselors', and 'negative perceptions of counseling'. In the dropout experience of university counseling center clients, inappropriate counselor behavior and low counselor competence were found to be the main factors that led to dropout. In addition, the consequences of dropout include rejection of counseling and negative perception changes. The significance of this study is that it discussed the problems and development plans for college counseling centers through the experiences of dropout of college counseling center clients, and presented basic data on them. This will provide a basis for the development of effective counseling and training in the practice of college counseling. Finally, limitations of this study and suggestions for further research were discussed.

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.

Sudden gains and deteriorations: Modeling the impact across outcomes with university counseling center clients.

This study examines the longitudinal impact of sudden gains/deteriorations across the outcomes associated with the phase model. In a sample of 16,657 clients who completed the Behavioral Health Measure-20, we identified sudden gains/deteriorations and employed multilevel piecewise analyses to assess their impact on subsequent treatment phases. We found that: (1) Following a sudden gain in the well-being outcome, the mean-level for the symptom outcome increased (meaning symptoms improved), and the rate of change decreased, (2) Following a sudden gain in the symptom outcome, the mean-level for the life functioning outcome increased, (3) Following a sudden deterioration in the well-being outcome, the mean-level and rate of change for the symptom outcome decreased, and (4) Following a sudden deterioration in the symptom outcome, the mean-level for the life functioning outcome decreased. These findings reveal that sudden gains/deteriorations function and occur at different rates across phases of change in psychotherapy.

Minority status, depression and suicidality among counseling center clients

Objective This study examined race/ethnicity, gender, sexual orientation, and financial stress and their association with depression and suicidality among university counseling center clients. Methods: The sample included 3,189 participants who received services at a university counseling center. Results: Asian American college students reported more depressive symptoms than European American and Hispanic students and were more likely to have a depression diagnosis than European American and African American students. Female and lesbian/gay/bisexual/questioning (LGBQ) individuals had higher depressive symptom scores, were more likely to have a depression diagnosis, and history of suicidal ideation and attempts than male and heterosexual individuals, respectively. Students with high financial stress reported higher depression scores and were more likely to have experienced past and current suicidality. More minority statuses were associated with higher risk for depression and suicidality. Conclusions: Counseling center clients who identified with one or more minority groups had higher risk for depression and suicidality.

How will this help me? Exploring expectations at the time of intake among first-time users of a college counseling center

Objective The study explored first-time college counseling center clients’ preintake expectations of the counseling process and the extent that these expectations were related to confidence that counseling will be effective and attendance after intake. Participants: Participants were 418 first-time counseling clients with complete intake and termination data from September 2013 to April 2016. Methods: New clients reported open-ended counseling expectations which were coded into three distinct categories: don’t know, just talking, or beyond talking. Outcome measures include rated preintake confidence that counseling will be effective and client attendance at scheduled follow up session. Results: Regression analysis results indicate that expectations categorized as don’t know were associated with lower pretreatment counseling confidence while beyond talking expectations predicted postintake attendance. Conclusions: Simple expectations about how counseling will work are a relevant therapeutic factor to consider in improving outcomes for counseling center clients.

Measurement invariance and latent profiles of perfectionism in clients and nonclients.

The current study evaluated measurement invariance of the short Almost Perfect Scale-Revised (SAPS; Rice, Richardson, & Tueller, 2014) between large samples of 1,802 university counseling center clients and 1,040 university students. The clinical sample also completed the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62; Locke et al., 2011), permitting tests to evaluate support for latent classes of adaptive, maladaptive, and nonperfectionists observed in other studies. Of particular interest was whether an "adaptive" group of perfectionists can be identified within a psychologically distressed sample of counseling center clients. Measurement invariance tests supported the 2-factor SAPS structure (Standards and Discrepancy) although scalar (intercept) noninvariance was observed. Within- and between-sample replication (similarity) analyses supported a 4-class model of perfectionists and nonperfectionists. Classes were distinguished by differing elevations of the 2 perfectionism factors that showed divergent patterns of psychological problems in the clinical sample. In the 4 classes that emerged in both samples, 1 class was consistent with a higher distress, maladaptive perfectionist group, whereas another class represented a less distressed adaptive perfectionist group. Two nonperfectionistic classes were consistent with groups of clients for whom perfectionistic strivings were not rated as important. As might be expected, there was a substantial difference in the frequencies of membership in the classes within- and between-samples, with proportionally fewer adaptive and more maladaptive perfectionists in the clinical sample than in this and other nonclinical university samples. Results have implications for the use of the SAPS as a screening and treatment planning instrument for use in university counseling centers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of Brief Counseling on Nonurgent Prior- versus Never-counseled Samples

ABSTRACTThe purposes of this study were to distinguish prior- versus never-counseled nonurgent University Counseling Center (UCC) clients and to test if brief counseling had a differential impact on these two samples. The prior-counseled sample (n = 100) was more prepared for counseling, had a lower stigma for seeking help, as well as lower social connectedness and life satisfaction versus the never-counseled sample (n = 109). After brief counseling (median of four sessions after triage), the prior-counseled group (n = 33) had significantly higher social connectedness, self-esteem, and life satisfaction, while only social connectedness of the never-counseled group (n = 31) increased.

University student voices on healing and recovery following tragedy.

Guided by conservation of resources theory, this study provides empirical data on students' psychosocial adjustment following a mass murder tragedy, what changed or did not change from their pretragedy adjustment levels, and their view on what helped most in the immediate aftermath. Students (n = 593) who participated in a study of college adjustment the year prior to a mass murder that affected the university community were recontacted following the tragedy, providing prospective, longitudinal data (n = 141 pretragedy Time 1 and posttragedy; n = 73 pretragedy Times 1 and 2 and posttragedy). For both anxiety and depression, repeated-measures analysis of variance showed a significant Time × Resource Loss interaction. Students with any resource loss had a steeper incline in symptoms than did students reporting no resource loss. From pre- to posttragedy, there was an increase in psychological sense of school membership but no change in general self-efficacy and social support. Students with clinical levels of posttragedy distress reported more childhood trauma and depression symptoms at college entry. Student-initiated and -led memorial activities were rated as most helpful. Perceived resource loss is important in understanding the impact of the trauma on mental health and could be a part of intake for supportive services. Given that it was the students with greater prior trauma exposure and depression symptoms who were more likely to have clinical distress posttragedy, targeted outreach to current and former university counseling center clients to "check in" may be helpful to reach those who may be in most need. (PsycINFO Database Record

Testing Three-Item Versions for Seven of Young’s Maladaptive Schema and Wait Impact for Briefly Counseled Non-Urgent Clients

The purposes of this study were to: further test the reliability and discriminant validity of three-item measures of seven maladaptive schema scales on a sample of non-urgent university counseling center (UCC) clients; test the relationships of waiting variables to these maladaptive schema; and test if these waiting variables were related to changes in these maladaptive schema for briefly counseled UCC clients. The results supported the test-retest reliabilities and discriminant validity of these seven scales. Independent sample t-tests between two different types of wait variables, i.e., minimal versus considerable wait bother, and less than two weeks wait versus at least two weeks wait, did not show any significant differences for these scales. However, one scale, mistrust and abuse increased during brief counseling for both the considerable wait bother and at least two weeks waiting groups. It is important to make sure that non-urgent clients get timely counseling.

Exploring Outcomes and Initial Self-report of Client Motivation in a College Counseling Center

Objective: To explore the association between college counseling center clients’ initial self-report of motivation and counseling outcome. Participants: The sample was composed of 331 student clients who utilized a college counseling center from August 2007 to August 2009. The college is a public, mid-size, urban university in the Southeast. Methods: Motivation was measured at intake by a self-report of change readiness item. A quantitative study that employed a 5-group, pretest–posttest design included 331 student participants. Counseling outcome was measured using the Outcome Questionnaire 45.2. Results: As assigned by the clients’ self-report of change readiness, counseling outcome for 5 motivation groups differed significantly (p = .004; α < .05). Compulsory participation in counseling was treated as a possible confound and was not a significant factor in counseling outcome (p = .268; α < .05). Conclusions: Participants’ initial self-report of motivation was significantly associated with counseling outcome.

The relationship between session frequency and psychotherapy outcome in a naturalistic setting.

The dose-response relationship in psychotherapy has been examined extensively, but few studies have included session frequency as a component of psychotherapy "dose." Studies that have examined session frequency have indicated that it may affect both the speed and the amount of recovery. No studies were found examining the clinical significance of this construct in a naturalistic setting, which is the aim of the current study. Using an archival database of session-by-session Outcome Questionnaire 45 (OQ-45) measures over 17 years, change trajectories of 21,488 university counseling center clients (54.9% female, 85.0% White, mean age = 22.5) were examined using multilevel modeling, including session frequency at the occasion level. Of these clients, subgroups that attended therapy approximately weekly or fortnightly were compared to each other for differences in speed of recovery (using multilevel Cox regression) and clinically significant change (using multilevel logistic regression). Results indicated that more frequent therapy was associated with steeper recovery curves (Cohen's f2 = 0.07; an effect size between small and medium). When comparing weekly and fortnightly groups, clinically significant gains were achieved faster for those attending weekly sessions; however, few significant differences were found between groups in total amount of change in therapy. Findings replicated previous session frequency literature and supported a clinically significant effect, where higher session frequency resulted in faster recovery. Session frequency appears to be an impactful component in delivering more efficient psychotherapy, and it is important to consider in individual treatment planning, institutional policy, and future research.

Self‐Compassion Among College Counseling Center Clients: An Examination of Clinical Norms and Group Differences

There has been growing interest in the mental health benefits of self‐compassion. This study was designed to establish norms on the Self‐Compassion Scale–Short Form, a popular measure of self‐compassion for individuals seeking counseling, and to examine group differences in self‐compassion based on gender, race/ethnicity, sexual orientation, previous counseling, and psychiatric medication use. Data for this study were collected through the Center for Collegiate Mental Health, a practice‐research network of more than 240 college and university counseling centers.

Assessing Outcomes: Practical Methods and Evidence

University counseling center clients’ (N = 52) perceptions of precounseling functioning were highly correlated with their actual well‐being scores at intake. The magnitude of change based on perceptions of precounseling functioning to current well‐being was approximately double of what is found from the difference of actual precounseling well‐being to current well‐being scores. Retrospective methods for assessing precounseling functioning are best suited for comparison among clients or counseling processes.

Religion and spirituality in group counseling: Beliefs and preferences of university counseling center clients.

The main purpose of the present study was to explore client beliefs and preferences regarding the discussion of religious and spiritual issues in group counseling. We collected and described both quantitative and qualitative data. One major finding of this study was that on average the majority (85%) of clients at a university counseling center (N 68) reported that religious concerns are an appropriate topic for discussion in group counseling. However, only a minority of clients reported that they would like to discuss religious (24%) and spiritual (47%) concerns in group. Open-ended responses from participants provided reasons why they would or would not like to discuss religion and spirituality in their specific groups and provided insight into the discrepancy between their ratings of appropriateness and interest. In regression analyses, client spirituality and group engagement significantly predicted clients’ preferences to discuss both religious and spiritual issues. Majority religious affiliation also predicted preferences to discuss religious issues.

The Center for Collegiate Mental Health: Studying College Student Mental Health Through an Innovative Research Infrastructure That Brings Science and Practice Together

Available information about college student mental health has largely been anecdotal or based on information drawn from a single institution. This review examines ten studies published within the past 20years that focused on college student mental health using data collected from multisite college or university counseling center clients or staff. This subset of research on college student mental health is important in view of the increased demands on counseling centers and the increased emphasis on evidence-based practice. Collectively, these studies suggest that the presenting concerns of college students are changing, that those in treatment are more distressed than those who are not, that clients who identify as ethnic minorities appear to evidence slightly more distress than their white counterparts, that matching client and counselors relative to ethnicity does not appear to improve outcome, and that counseling services seem to improve outcome. While each study makes a unique contribution to the literature, this body of literature suffers from a common set of limitations that stem from the difficulties associated with multisite research, research taking place in active clinical work, and the time-limited nature of data sets. Through our review and critique of these studies, we discuss the importance of establishing an infrastructure that helps researchers to elucidate trends, effective treatments, and risk factors that will be useful to clinicians treating this population. The Center for Collegiate Mental Health, a practice-research network focused on college student mental health, is described and preliminary findings from this entity are presented.

Eating Disorders as Coping Mechanisms

This article focuses on the complex nature of eating disorders, specifically highlighting their use as coping mechanisms for underlying emotional and psychological concerns. Case examples of college counseling center clients are discussed in order to illustrate common ways in which eating disorders are utilized by clients with varying symptomatology. Offering reflections on their work with clients in the college setting, the authors discuss implications for counselors who work with similar clients.

The bilevel structure of the Outcome Questionnaire–45.

The structure of the Outcome Questionnaire-45 (Lambert et al., 2001) was examined in a sample of 1,100 university counseling center clients using confirmatory factor analysis. Specifically, the relative fit of 1-factor, 3-factor orthogonal, 3-factor oblique, 4-factor hierarchical, and 4-factor bilevel models were examined. Although the 3-factor oblique, 4-factor hierarchical, and 4-factor bilevel models fit the data well, the 4-factor bilevel model fit the data best. The results provided support for the fit of the 4-factor bilevel model where each item loads on 1 of the 3 independent scales of Symptom Distress, Social Role Performance, and Interpersonal Relations, in addition to a nonoverlapping general distress factor.

Combining Psychotherapy and Medication for College Students with Severe Psychopathology

Given the extensive and increasing use of medications to augment psychotherapy in intervening with college students with more severe psychopathology, the absence of scholarship on this topic is surprising. This article briefly summarizes earlier published pieces on combining counseling with psychotropic treatment in college counseling center settings. It then reports the results of a retrospective, descriptive study of 87 college counseling center clients receiving a combination of psychotherapy and psychiatric medication intervention. Pre-post change psychosocial impairment scores on the Carroll Rating Scale (CRS) were employed as the outcome measure. Most, but not all clients showed significant improvement on this index.

Investigation of Clinically Significant Change by Severity Level in College Counseling Center Clients

The authors investigated the number of sessions necessary for college counseling center clients of different levels of severity of distress at intake to achieve clinically significant change (CS) in therapy. The Outcome Questionnaire-45 (M. J. Lambert, N. B. Hansen, et al., 1996) was used to categorize 914 clients by severity of distress. Analyses of outcome indicated that clients with less and severe distress needed 14 and 20 sessions, respectively, for 50% in each group to achieve CS. Implications are discussed. ********** In recent years, increasing attention has been focused on the severity of mental health issues among college students (Benton, Robertson, Tseng, Newton, & Benton, 2003; Erickson Cornish, Riva, Cox Henderson, Kominars, & McIntosh, 2000; Pledge, Lapan, Heppner, Kivlighan, & Roehlke, 1998). As a result, college counseling centers (CCCs) are searching for ways in which they can effectively address the changing needs of students in college and university settings. Recent events on campus, current studies about college students (Benton et al., 2003), and latest reports from CCC directors (Gallagher, Gill, & Sysco, 2000; Goode, 2003; Guinee & Ness, 2000; O'Connor, 2001; Young, 2003) suggest that CCCs are seeing students with severe mental health issues than ever before. Benton and colleagues (2003) examined the client problems of 13,257 college students who sought services at one CCC over a 13-year period. They reviewed each client's closing record, as reported by the closing therapist, and found that between 1988 and 2001, there were increases in 14 of 19 client problem areas recognized by the in-house Case Descriptor List (CDL), which measures the therapists' viewpoints of client developmental and relational problems as well as severe issues. The CDL is a clinician report measure completed following the ending of treatment with a client. Guinee and Ness (2000) surveyed 62 counseling center directors, and 62.9% reported that the percentage of students seeking services had increased. Finally, in a poll of 283 schools for the National Survey of Counseling Center Directors (Gallagher et al., 2000), 17% of clients were reported to be using psychiatric medications, an increase from 9% in 1994. Others suggest that the increase in pathology may be related to a change in the student body. Rudd (2004) pointed out that there has been a vast increase in the overall numbers of young adults attending colleges and universities. Black and Sufi (2002) reported that the number of students from lower socioeconomic status attending colleges and universities is increasing as well. These trends support Rudd's suggestion that CCCs are in the process of becoming like community mental health centers by having clients with more severe pathology, marked comorbidity (both Axis I and II) and problems that require ongoing and longer term (p. 316). However, although students are presenting to CCCs with significant pathology (Benton et al., 2003), many CCCs have implemented session limits (Stone & McMichael, 1996). It seems imperative to assess and improve client care in light of recent lawsuits directed at counseling centers and the level of accountability to which some CCCs are being held (e.g., lawsuits against the universities in the suicides of students at the University of Iowa, the Massachusetts Institute of Technology, and Ferrum College in Virginia). A review of the literature indicates that there is no research or discussion on why session limits are being implemented at CCCs (Stone & McMichael, 1996), what the limits should be, and how much psychotherapy is sufficient (Snell, Mallinckrodt, Hill, & Lambert, 2001). It is likely that session limits have been implemented at CCCs for a variety of reasons. First, it is most likely that session limits have emerged in order to meet the growing demand for mental health services (Stone & McMichael, 1996). …

University Counseling Center Clients' Expressed Preferences for Counselors

ABSTRACT This archival study explored patterns of client preferences from a randomized sample of 881 clients at a Midwestern university counseling center. Information from client intake forms was collected for a four year time frame. Results showed that 61% of the clients did not express preferences for particular types of counselors when asked on intake forms. Thirty-nine percent of the clients did express a preference for a particular type of counselor. Chi-square analyses found that clients with preferences tended to have prior therapy experience and tended to prefer counselor gender over other traits. Women and people of color tended to be the most likely to express counselor preferences. It is suggested that future research clarify the meaning behind preferences, the lack of preferences, and clients' expectations for counseling.