University Counseling Research Articles

Call to Action: Responding to COVID-19, Racism, and Student Mental Health on University Campuses

ABSTRACT The onset of the COVID-19 pandemic initiated a cascade of stressors that occurred concurrently with increasing issues of racism and racial injustice events. These compounded healthcare and societal stressors significantly impacted the mental health of individuals worldwide, including university students. To address the needs of students, a survey was administered to undergraduate, graduate, and professional students at a large public university in the southeastern United States. Qualitative data were collected regarding student mental health, recommendations for institutional resources, and support needs therein. Thematic analysis of qualitative responses from 1050 university students indicated six areas students stated they wanted the university to address to support their mental health needs: (1) Communication, (2) Academic Concerns, (3) Mental Health Resources and Connections, (4) COVID-19 Safety, (5) Social Injustice, and (6) Financial Concerns. To address these areas, we propose a set of evidence-based recommendations within the Social-Ecological Framework for colleges and universities to adopt to support student mental health considering all races, backgrounds, and experiences. Additionally, we propose strategies for university and college counseling centers to provide an essential leadership role on campuses to move these recommendations forward and positively impact the mental health of students.

대학 집단상담 분야의 연구 동향 분석

Objectives The purpose of this study is to examine the research trends on group counseling in universities, and to provide implications for future research. Methods For this study, 150 domestic journal papers on university group counseling published from 2000 to April 2024 were analyzed for basic elements, research topics, research subjects, research methods, research types, and types of group counseling. Results The research results are as follows. First, as a result of analysis as a research topic, it was classified into counseling theory, career development, self-development, interpersonal relationships, emotions, subjective well-being and learning development. Second, most of the subjects of the study were general college students, and in addition, there were college students in specific majors such as education and nursing. And college students who had disability problems, psychology, and learning problems were the subjects. Third, as a result of analysis by research method, it was classified into quantitative research, qualitative research, and literature research. Quantitative research included methods such as difference test, variance analysis, and nonparametric test, and qualitative research included content analysis, phenomenological research, grounded theory, and FGI. Fourth, research types were classified into counseling effect research, process research, development research, meta research, and research trend survey. Among them, counseling effect research accounted for the largest proportion. Fifth, as a result of analyzing the types of group counseling programs, face-to-face counseling was the most common in the form of counseling, structured counseling was the most common in the counseling structure, and counselor-centered counseling was the most common in group leaders. Conclusions It was discussed the importance of applying various perspectives and methods when studying group counseling research in universities. In addition, implications for the development and implementation of an effective university group counseling program for college students were presented.

Cultural Conversations in Therapy: How Often Clients Talk About Their Identities.

The purpose of this study was to examine how often clients report discussing cultural identities during counseling sessions; the extent to which discussion of cultural identities during treatment varies across therapists; whether identifying as BIPOC (Black, Indigenous, and people of color) predicts clients' discussion of cultural identities in sessions; and whether differences in the frequency of cultural conversations (i.e., dialogue that focuses on client cultural identities) across client groups depend on the therapist. This study examined variation in reports of engagement in cultural conversations during sessions (N=10,731) with 1,997 clients and 72 therapists from a university counseling center. Data were analyzed by using Bayesian multilevel models. Overall, clients reported having cultural conversations in 48.4% of sessions. Cultural conversations were much more likely to occur in sessions with BIPOC clients than with White clients: 66.2% of sessions with BIPOC clients involved conversations about cultural identities, compared with only 39.8% of sessions with White clients. Of note, the magnitude of this difference varied by therapist. Cultural conversations were more likely to occur in treatment with BIPOC clients than with White clients, and the presence of cultural conversations in treatment varied by therapist.

College Student Self-Care: The Missing Ingredient for Success?

College students are experiencing the highest rate of mental health challenges ever in history. This brief report on self-care consisted of nine participants, who were currently attending a public university. Three focus groups were held. Three themes emerged from the data: a.) defining and practicing self-care b.) self-care education and c.) self-care during the COVID pandemic. Since these students never received any formalized education about self-care and because of the college counseling center’ s inability to serve a growing number of students with mental health challenges, the researcher recommends that education institutions devote more time to educating students about self-care.

Finding Ourselves Anew in the Emptiness of Third-Party Vendors: Over Promises and Under Delivery

ABSTRACT College counseling centers’ increasing use of third party vendors has happened so quickly that there has been little time to explore the reasons for this development and what it means for our centers. To address this lacuna, we propose four key “myths” that drive dependence on these vendors: 1) It is too expensive to staff counseling centers. 2) Something is better than nothing. 3) There are not enough counselors. And 4) students want on-demand services. Using information gathered from a survey sent to the AUCCCD list server and discussions with representatives of third-party vendors we explore the pros and cons of these services and offer thoughts on how counseling centers can engage with them thoughtfully.

Increasing outcome measurement precision: Network analysis of items on the Outcome Questionnaire-45.

Psychotherapy outcome research mainly focuses on scale-level changes and constructs that were developed using cross-sectional statistical analysis, possibly concealing important findings on the level of single items, and limiting the clinical utility of outcome scales. Our goal was to explore changes in symptoms, interpersonal problems, and level of functioning in everyday life and to establish groups of items with similar rates of change that could be used to form more coherent targets for measuring different therapeutic outcomes. Triangulated maximally filtered graphs were used to model the network structure of the Outcome Questionnaire-45 in a data set of N = 12,075 university counseling center patients. Dynamic exploratory graph analysis was used to establish communities of items with similar rates of change. Five item communities (anxiety, hopelessness, interpersonal problems, well-being, and work impairment) were found. Compared to the original Outcome Questionnaire-45 subscales, they showed better fit to the data. The "hopelessness" community, which describes the extent of a patient's demoralization before the start of therapy, had a significantly higher rate of change compared to other communities. The discerned item communities provide clinicians with theoretically grounded, precise targets for outcome tracking, thereby enhancing the responsiveness and adaptability of treatment interventions to individual client trajectories. Such granularity enriches our understanding of therapeutic change, with direct implications for tailoring intervention strategies to maximize early therapeutic gains and sustain long-term recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessing the implementation of suicide-focused treatments delivered in hybrid telemental health format in a real-world setting

Objective The purpose of this study was to assess the implementation of suicide-focused treatments delivered via a hybrid telemental health (TMH) and in-person format. Method This study was conducted at four university counseling centers (UCCs) across the United States. Treatment-seeking clients were recruited from their local UCCs and participated in adaptive treatment strategies (ATSs) involving Treatment as Usual (TAU), Collaborative Assessment and Management of Suicidality (CAMS), and Dialectical Behavior Therapy (DBT). Implementation outcomes, including appropriateness, acceptability, feasibility, fidelity, safety, and client satisfaction, were assessed. UCC clinicians participated in qualitative interviews focused on implementation of TMH for clients presenting with suicidal ideation (SI). Results Overall, treatments delivered via hybrid format were reported to be appropriate, acceptable, feasible, and satisfactory by clinicians and clients. Implementation of TMH was reported to be equivalent to in-person treatment across multiple measurement methods. Conclusion Results from this study demonstrate that TMH is an implementable treatment modality for addressing suicidality, particularly for college students presenting to UCCs with SI. This study has implications for real-world clinical settings planning to offer hybrid treatment modalities to address SI. Trial registration: ClinicalTrials.gov identifier: NCT04728815.

Psychological distress and academic success: a two-year study comparing the outcome of two online interventions at a university counseling and consultation service in Italy.

The mental health of college students has been a significant concern in higher education, representing a priority for the institutions. Enhancing effective online interventions could represent excellent support for university counseling services that deal with students' well-being. The present study aimed to evaluate the effectiveness of two online interventions provided by the Counseling and Consultation Service for Students (SACS) of the University of L'Aquila (Italy), namely Videochat with Clinical Mental Health consultation (VCMH) and Therapist-supported Internet Cognitive Behavioral Therapy (Ts-iCBT), a 12-module asynchronous program for anxiety management. The primary outcome was focused on the emotional well-being of students (GHQ-12). The secondary academic outcome was represented by the attainment of their final degree. Students requesting help from the SACS between March 2020 and March 2022 during different periods of the COVID-19 pandemic restrictions were asked to fill out a brief structured screening tool and access the PSYDIT.COM platform. Based on their personal preferences, students chose to access one of the two different online interventions: VCMH and Ts-iCBT. Over the two-year duration of this study, 379 students (267 women, 70.4%) contacted the service. Out of 334 students, 72.5% asked to be included in the Ts-iCBT group, whereas 27.5% expressed a preference for the VCMH group. A statistically significant decrease in emotional distress was obtained by both forms of online intervention, highlighting a better outcome for VCMH. In addition to clinical variables, 28.8% of students who completed online interventions attained their degree, with a statistically significantly higher percentage of graduated students in the Ts-iCBT compared to VCMH group. A high proportion of students (37.7% of total sample) dropped out (DO) of digital interventions, with a statistically significant lower rate of dropouts in the VCMH group. The effectiveness of online interventions is extremely promising and yields a growing source of suggestions for use in providing more tailored interventions. Videochats and frequent therapist online contacts would be recommended for more severe psychopathological conditions. Students in conditions of moderate and non-severe emotional distress who feel more able to "manage the problem alone" could be addressed to asynchronous online interventions.

A Single-Session Wellness Initiative for Black College Women: Integrating Expressive Arts, Spirituality, and Political Resistance

The purpose of this qualitative case study was to understand how four Black women undergraduate students experienced a single-session wellness initiative that integrated expressive arts, spirituality, and political resistance. After participating in the group wellness session, the researchers conducted individual interviews with each participant to understand their interpretation of their paintings and their perceptions of the expressive arts group. All interviews were transcribed verbatim, and data were analyzed using a structured coding process. Three themes emerged from the cross-case analysis of the semi-structured interviews: (1) Black Women Connecting, (2) Appreciation for the Session Topic, and (3) Systemic Efforts to Promote Black Women’s Wellness. Conducting this study with undergraduate Black women from a predominantly white institution (PWI) yields recommendations for providing culturally responsive wellness programming at university counseling centers.

Pilot implementation of an evidence-based online cognitive behavioural therapy for perfectionism in university students: Lessons learnt.

Higher Education Institutes (HEIs) have been met with an unprecedented demand on their student counselling and wellbeing services in recent years with the impacts of COVID-19 and high rates of mental health concerns amongst student populations. Online mental health programs offer one solution by providing students with quick and easy access to effective therapeutic content. The Focused Minds Program is an evidence-based eight-module online self-guided cognitive behavioural intervention that targets the transdiagnostic risk factor of perfectionism and has been shown to decrease depression, anxiety, and disordered eating. The program was implemented at a UK university between 2021 and 2023. Recruitment occurred via departmental emails, academic staff, and the university's counselling staff and website. Participants were provided with access to the intervention for 6-weeks and completed weekly surveys of psychosocial measures. The trial's implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework: reach (uptake via the recruitment channels), effectiveness (outcomes on psychometric measures of mental wellbeing), adoption (staff and organisational support), implementation (intervention engagement and attrition), and maintenance (continued implementation across the trial period). Key barriers to successful implementation, as well as proposed solutions, are discussed to guide future online mental health interventions provided in HEIs.

Meeting the University Counseling Centers Demand with Outreach Competencies

ABSTRACT In the last 30 years, universities and colleges have been strongly encouraged to consider the impact these systems have on health promoting behaviors for students, staff, faculty, and surrounding communities. Higher Education Institutions are prime settings to promote prevention and outreach efforts for positive mental health. University and College Counseling Centers have historically been leaders in outreach and prevention delivery thus the need for competencies is evident. Utilizing a trauma-inclusive and social justice lens, this article will focus on outlining six outreach competencies: (1) integrate, (2) scope, (3) collaborate, (4) assess, (5) implement, and (6) evaluate. The authors provide application examples for further illustration.

Use of Technology in the Delivery of College Mental Health Services: Opportunities and Challenges

ABSTRACT This article will examine the seismic impact that technology currently has and is likely to increasingly have on college mental health services, both direct and indirect. Numerous resources and suggestions are offered to assist college counseling center administrators and clinical staff make decisions aligned with best clinical, ethical, regulatory, and legal practice. The field is changing in truly profound ways and the future is highly uncertain.

Improving Access to Mental Health Care through a Stepped Care Approach: Preliminary Results from a University Students’ Sample

Introduction: Recently, university counseling services have been faced with an increasing number of students seeking psychological support. However, human resources and time constraints limit the services to respond adequately. Recently, national guidelines for Mental Health Services in Higher Education recommended the stepped care approach to increase efficiency. The present study aimed to explore the implementation of a stepped care model in a Portuguese public university, analyzing students’ sociodemographic and clinical characteristics, and presenting the flow of the stepped care approach and the students’ waiting periods in each step. Methods: An observational study was conducted in the University of Coimbra’s health services between May 2019 and June 2021. Descriptive statistics were performed to describe the sociodemographic and clinical characteristics of the sample, the flow of the stepped care approach, and students’ waiting periods. Results: We enrolled 295 students in the present study. The findings of this study revealed that over 40% had a clinical diagnosis of anxiety or depressive disorders. In terms of students’ flow within the stepped care model, 82% of students sought psychological help through self-referral. Concerning the implementation of the stepped care model, results have shown that most students wait less than a month to access each step. Discussion/Conclusions: Although preliminary, our results suggest that the stepped care model might be a useful service organization, mainly in a community in which accessibility to services and speed of response are particularly important. Most students being self-referred highlight the importance of direct contact between the university community and the health services. Additionally, anxiety and mood disorders were the most prevalent diagnoses in our sample, which also points to the relevance of a stepped care approach, since other studies have highlighted its advantages for this kind of clinical population.

The Counseling Center Field’s Relationship with the Mental Health Marketplace

ABSTRACT One of the most significant changes to college mental health is the growing use of telehealth vendors to provide, extend, or augment mental health services provided by college and university counseling centers. In a time of sharply increased demand for services, new investments in the mental health marketplace, and the perception that mental health is a “crisis,” the relationships between counseling centers and mental health vendors are increasingly important. This paper provides an overview of these new relationships, briefly reviews relevant history and context, and explores the relationship dynamics shaping this space. In addition, this paper reviews common fears and worries faced by counseling centers when considering vendors, addresses some of the confusion surround vendor/service types, and offers a set of suggestions for the inevitable future relationship in the development of guiding principle and standards.

Demographic, academic, and clinical characteristics of college students hospitalized for psychiatric crises.

College students with psychiatric disabilities, particularly those with severe distress, have an increased risk of attrition from higher education. Highly distressed students may be hospitalized for psychiatric crises if there is a potential risk to their safety. Although college students' psychopathology has increased in severity over the last decade, hospitalized students remain an underresearched group at risk for attrition, trauma, suicide, and disconnection from their universities. The present study explored demographic, academic, and clinical characteristics of 880 undergraduate and graduate students hospitalized between Spring 2016 and Spring 2021 at a large public university in the southwestern United States. Study aims were addressed by testing proportional differences in (a) demographics of the hospitalized sample versus the student body and (b) cross-tabulations of demographic, academic, and clinical characteristics by hospital admission status (voluntary or involuntary). Results indicate that African American/Black and multiracial students; female, transgender, and lesbian, gay, bisexual, queer, or other nonheterosexual orientations students; undergraduates; and liberal arts, fine arts, and undeclared majors may be at increased risk for psychiatric hospitalization. Gender identity, sexual orientation, semester hospitalized, initiating entity, university counseling center utilization, and the presence of high-priority symptoms and suicidality were significantly associated with hospital admission status. Implications and suggestions for future research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Factors Affecting Psychological Well-Being, Depression, Anxiety, and Stress Among Dental Students in Delhi and the National Capital Region: A Cross-Sectional Study.

Introduction Research has shown that mental health issues are prevalent among university students and healthcare professionals. Dental practitioners are particularly at risk due to the demanding nature of their profession. Our study aims to survey dental students and faculty to assess their psychological well-being and identify key stressors and potential interventions. Methodology A cross-sectional study examined the psychological well-being, depression, anxiety, and stress of undergraduate (UG) and postgraduate (PG) dental studentsand faculty from the School of Dental Sciences. A questionnaire was distributed via email and WhatsApp to 350 participants. The questionnaire contained a unique set of items for each study group related to factors affecting psychological well-being among students, and a separate questionnaire was used to assess depression, anxiety, and stress (DASS-21) in the same population. Results A cross-sectional study of 350 dental students and educators found no significant changes in depression, anxiety, and stress (DASS) levels between age groups. Females, however, reported greater levels of these difficulties than men (D=71.5%, A=71.9%, S=76.7% for females vs. D=28.5%, A=28.1%, S=23.3% for men, with p-values for D=0.014, A=0.001, and S=0.031). Overall, 67.3% of UG students study away from home and live in hostels or flats, with academic and financial demands (30.6% and 33.5%, p-values: 0.014 and 0.098, respectively). Many people find their workload unpleasant (40.8%, p-value=0.143) and feel overwhelmed by academic obligations (47.9%, p-value=0.002), with 20%-25% worried about examinations, failure, and balancing well-being with academics (p-values: 0.001, 0.006, and 0.002, respectively). In total, 57.1% suffer severe social isolation (p-value=0.045), and more than 40% have mental health issues (p=0.003). While the mentor-mentee program is rated as helpful (p-value=0.68), 35% of students are ignorant of mental health options (p-value=0.006). Financial concerns are a big worry, with 38.7% seeking assistance, and second- and third-year students suffer more challenges than first-year students. Overall, 41.2% of instructors are perceived as extremely accessible, whereas 34.3% and 31.4% feel that scheduled breaks are required due to stress (38.2%, p=0.053). Most instructors (51.4%) encourage counseling and interact with students (76.5%), while 77.1% discuss mental health. Among the PGs, 74.2% of participants are content with the college's amenities, but 90.3% are stressed because of the PG seat departing bond, demonstrating widespread concern over this issue. To cope, 22.6% seek help from loved ones, while 19.4% pursue hobbies, emphasizing the value of personal support networks and leisure activities. Conclusion The study found that females perceive more stress than males. Most UG students live with supportive families and only experience academic helplessness on rare occasions. First-year students find academic effort more demanding than their peers at higher educational levels. Overall academic load gradually decreases from the first to the third year but rises significantly in the final year before declining during internships. As academic load increases, students tend to isolate themselves socially. Engaging in leisure activities can help mitigate the negative effects of stress on physical and psychological health. Faculty members recommend college counseling services to help students cope with stress.

Unlocking Success in Counseling: How Personality Traits Moderates Its Effectiveness.

Psychological distress is widespread among university students, with depression being notably more prevalent compared to the general population. University counseling services are crucial for addressing these mental health challenges, and numerous studies have demonstrated their effectiveness in reducing psychological distress and improving overall well-being. However, there is limited research on what factors predict the success of university counseling. This study aims to evaluate whether counseling improves well-being, specifically by reducing depressive symptoms, and to explore whether personality traits influence counseling outcomes. Participants included 125 Italian university students (64.8% female, mean age = 22.69; SD = 3.04) who utilized counseling services. They completed a socio-demographic questionnaire, the Beck Depression Inventory-II (BDI-II), and the Personality Inventory for DSM-5-TR (PID-5-TR) at three points: immediately after the intake interview (T0), just before the intervention (T1), and after the fourth session (T2). Linear mixed models were used to analyze changes in depression levels, revealing a significant reduction in depressive symptoms from pre- to post-intervention. Among personality traits, only antagonism showed a significant interaction with time. Additionally, higher detachment scores were associated with higher depression levels. These findings emphasize the need for focused attention on students' emotional issues and suggest that personality traits may influence the effectiveness of counseling.

Comparison of outcomes from a university counselling service before and during COVID‐19: Exploring the use of remote therapy

AbstractBackgroundResearch pooling data from UK university counselling services (UCSs) has allowed UCSs to compare their outcomes and demonstrate their effectiveness in improving student mental health. During the COVID‐19 pandemic, UCSs moved to remote delivery. Consequently, it was necessary to understand how this impacted students' outcomes.AimsThis evaluation aimed to (1) understand how the therapeutic outcomes of a UCS compared with established norms in UK UCS literature, and (2) understand whether delivering therapy online affected student outcomes compared with UK norms from in‐person therapy.MethodSessional outcome data from 627 students who attended the UCS in the 2020/2021 academic year were gathered. Descriptive analyses of students' initial clinical data (determined by the CCAPS‐34) were conducted. Paired sample t‐tests determined differences between the pre‐ and post‐therapy scores. The effect size of this difference was derived.ResultsStudents presented with high levels of academic distress, social anxiety, generalised anxiety and depression. The initial severity of mental health concerns was lower than that reported in previous literature. The largest improvements were evidenced for depression and general anxiety and 25% (n = 112) of students achieved reliable reductions in distress. Compared with existing literature, the UCS showed similar levels of improvement over therapy. It is suggested that remote therapy increased service accessibility.ConclusionThe delivery of remote therapy produced results consistent with norms in the UK data, highlighting the effectiveness of online therapy for university students. Further large‐scale evaluations of student outcomes from remotely delivered therapy are recommended.

Educational Revolution : Digital Project-Based Rotation Learning (DPBRL) Model to Improve Students' Critical Thinking Skills

The research aimed to develop and assess the effectiveness of the Digital Project-Based Rotation Learning (DPBRL) model in enhancing students' critical thinking skills. The study employed a research and development method, using a non-equivalent control group design during the pilot phase, a research method used to describe and measure the characteristics of populations or phenomena systematically using numerical data, involving 83 undergraduate students from Mulawarman University Guidance and Counseling Study Program, divided into two heterogeneous classes. Validation of the DPBRL model was conducted by experts in learning model design, materials, and media, with data collected through validation sheets, interviews, document analysis, questionnaires, observation, and documentation. The data was analyzed using descriptive technique and Independent Samples t-test. The results demonstrated that the DPBRL model effectively improved students' critical thinking skills and digital literacy, particularly through the use of digital modules with Flipbook Maker. The model’s rotation structure and presentation stage provided a structured learning approach, highlighting the importance of feedback. The study concluded that integrating technology and collaboration in project-based learning through the DPBRL model significantly benefited students’ critical thinking, digital literacy, and teamwork, offering a comprehensive and effective learning experience.