Thou Shalt Not - Counseling and Mental Health Center
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“‘Thou Shalt Not:’ Navigating Ethical Dilemmas of Therapists in Faith-Based Institutions” By: Alanna Carrasco, M.S., LPC, Jacqueline Coppock, M.S., & Jessica Martin, M.S.
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Goals
To review current literature, outreach, consultation, and treatment methods used by therapists at small and/or faith-based institutions that may/may not be effective in reach minority populations.
To facilitate conversations and awareness of ethical dilemmas faced by university counseling therapist in providing effective mental health interventions for minority students (i.e., ethnicity and sexuality) at small and/or faith-based institutions.
To exchange ideas and enhance perspectives on ethically sound methods to meet the mental health needs of diversify college/university populations.
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Learning Objectives
At the end of the session attendees will be able to :
Discuss the unique difficulties of university therapists at small and/or faith based institutions.
Describe and analyze ethical dilemmas regarding outreach, consultation, and counseling services provided to minority groups at small and/or faith-based institutions.
Practice case formulation and provide suggestions for developing interventions tailored to minority populations at small and/or faithbased institutions.
+ Mental Health Needs of University Students
Approximately 1.8 million students who are enrolled in U.S. colleges seek help from their campus counseling centers each year (American College Health Association, 2008).
Administrators from an array of ten universities reported that the severity of mental health concerns on campus has increased (Watkins, Hunt, & Eisenberg, 2011).
77% of counseling center directors who responded to the annual survey of the Association of University Counseling Center Directors report believing that the number of students with severe psychological problems on their campuses has increased. (Barr, Rando, Krylowicz & Reetz, 2010).
91% of respondents to the annual National Survey of Counseling Center Directors affirm a trend toward a greater number of students with severe psychological problems on campus (Gallagher, 2010).
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+ Dominant Mental Health Concerns
The Center for Collegiate Mental Health (2012), reports that about ½ of students who use counseling are new to mental and behavioral health services, but about 1/3 of them have ongoing issues.
Data from the 2013 National College Health Assessment II indicate:
1/3 students across the U.S. experienced depression
½ students experienced overwhelming anxiety over the past year
20% had seriously considered suicide
5.8% attempted suicide
Commonly cited mental health concerns
Stress
Depression
Anxiety
Eating Disorders
Substance Use
Relationship Concerns
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Stress
Relationship Difficulties
Increased Alcohol Use
Difficulties with Coursework
Depression
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Mental Health Crises
73% of students stated they experienced a mental health crisis while in college.
These students site the following as the top “triggers”
Extreme feelings of anxiety, panic, and/or depression about school and life Difficulty adjusting to a new routine and environment Feelings of homesickness, loneliness, and isolation. Stressed or overwhelmed about course load. PTSD episode triggered by class content.
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The Changing Face of University Students •
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In Fall of 2014, 21 million students attended Colleges in the U.S. Females account for the majority of college students. + Traditional age college students continue to be the dominant population attending U.S. universities. The percentage of ethnic minority college students continues to increase.
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Level of institution
Sex
Race/ethnicity
American Indian/ Two or Total, all Pacific Alaska more Year students 2-year 4-year Male Female White Black Hispanic Asian Islander Native races
2010
41.2
12.9
28.2
38.3
44.1
43.3
38.4
31.9
63.6
36.0
41.4
38.3
2011
42.0
12.0
30.0
39.1
44.9
44.7
37.1
34.8
60.1
37.8
23.5
38.8
2012
41.0
12.7
28.3
37.6
44.5
42.1
36.4
37.5
59.8
50.3
27.8
39.4
SOURCE: U.S. Department of Commerce, Census Bureau, Current Population Survey (CPS), October, 1967 through 2012. (This table was prepared May 2013.)
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University Students with Minority Identities
Despite experiencing increased discrimination, marginalization, and oppression,
Ethnic minority students are less likely to utilize counseling services than their white counterparts (Davidson, Yakushka, & Sanford-Martens, 2004; Kearney, Draper, Baron, 2005).
Hayes et al. (2011).
LGBT students, though reporting a higher perceived need for counseling services, reported significantly less utilization of services than their heterosexual counterparts (Eisenberg, Golberstein, Gollust, 2007).
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Accredited college counseling services must provide:
Individual & group counseling
Testing & other assessments
Outreach efforts
Support on correcting certain educational deficiencies
Crisis intervention & emergency coverage
Professional development programs for faculty & staff
Programming focused on the developmental needs of students
Consultative services to members of university community
Research and evaluation of services
(Council for Advancement of Standards in Higher Education, 1997) (IACS; Kiracofe et al., 1994)
+ CURRENT OUTREACH, CONSULTATION, TREATMENT INTERVENTIONS FOR SMALL CAMPUSES
Small college/university – 5,000 students or less (Richardson,1985)
Small counseling staff – staffed by less than 3 full-time counselors (Thomas,2000)
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+ CURRENT OUTREACH, CONSULTATION, TREATMENT INTERVENTIONS FOR SMALL CAMPUSES
Personal counseling
Career testing and exploration
Academic advising
Public and campus outreach
Consultation services for campus community
Crisis intervention
Disability services
Drug and alcohol awareness programs
National testing services
Manage employee assistance programs
Direct peer educator and residence life training
(Thomas, 2000)
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+ CURRENT OUTREACH, CONSULTATION, TREATMENT INTERVENTIONS FOR SMALL CAMPUSES
Due to confines of maintaining confidentiality on a small campus, interpersonal processing groups may be limited
Staff therapists at small campuses may be more likely to utilize:
Structured psychoeducational groups
Workshops for campus groups, residence hall meetings, guest lectures
(Thomas, 2000)
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CURRENT OUTREACH, CONSULTATION, TREATMENT INTERVENTIONS FOR SMALL CAMPUSES Additional “non-traditional” responsibilities that many times lead to dual-relationships (Thomas, 2000)
Chair committees Teach courses Academic advising Campus social functions
Additional responsibilities/interventions toward minority populations (Brinson & Kottler, 1995)
Special interest group workshops Minority mentoring programs Consultation/outreach to minority student programs Hosting “drop-in” services
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Faith-Based Institutions
“Seeds of faith are always within us; sometimes it takes a crisis to nourish and encourage their growth” – Unknown
Beginning the journey and choosing a faith-based college/university.
Intellectual challenge, spiritual growth, and leadership development
Examining a different set of qualities – types of faith that shape educational programs, the activities or services offered for students
Public University vs. Faith-Based
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Faith-Based Institutions Spiritual Growth
College is a period of personal and professional growth.
Values and Ethics
Moral Principles
Respect for Persons
+ Religiously-affiliated universities in the “Top Colleges in Texas” (American School Search, 2015)
Baylor University (Baptist)
Trinity University (Presbyterian)
Southern Methodist University (Methodist)
St. Edward’s University (Roman Catholic)
Texas Christian University (Christian Church Disciples of Christ)
Texas Wesleyan University (United Methodist)
Abilene Christian University (Christian Churches & Churches of Christ)
University of St. Thomas (Roman Catholic)
Dallas Baptist University (Baptist)
University of the Incarnate Word (Roman Catholic)
Our Lady of the Lake University (Roman Catholic)
University of Dallas (Roman Catholic)
St. Mary’s University (Roman Catholic)
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+ RELIGIOUS/FAITH-BASED ASSOCIATIONS THAT INFLUENCE STUDENT AFFAIRS
Association of Catholic Colleges & Universities (ACCU)
Counseling for Christian Colleges & Universities (CCCU)
National Association of Schools & Colleges of the United Methodist Church (NASCUMC)
Association for Christians in Student Development (ACSD)
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+ Association of Catholic Colleges &
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Universities (ACCU)
“Good practice for student affairs at Catholic colleges and universities” Principle 1
Principle 2
Grounds policies, practices, and decision in the teachings and living tradition of the Church. Builds and prepares the student affairs staff to make informed contributions to the Catholic mission of the institution.
Principle 3
Welcomes all students into a vibrant campus community that celebrates God’s love for all
Enriches student integration of faith and reason through the provision of cocurricular learning opportunities.
Principle 4
Creates opportunities for students to experience, reflect upon, and act from a commitment to justice, mercy, and compassion, and in light of Catholic social teaching to develop respect and responsibility for all, especially those most in need.
+ Association of Catholic Colleges & Universities (ACCU) Principle 5 Challenges students to high standards of personal behavior and responsibility through the formation of character and virtues. Principle 6 Invites and accompanies students into the life of the Catholic Church through prayer, liturgy, sacraments, and spiritual direction. Principle 7 Seeks dialogue among religious traditions and with contemporary culture to clarify beliefs and to foster mutual understanding in the midst of tensions and ambiguities.
http://www.accunet.org/files/public/~ACCU%20Members%20List%281%29.pdf
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+ Counseling for Christian Colleges &
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Universities (CCCU)
“A member institution meets five requirements”:
1) It is a nonprofit, North American institution with non-probationary regional accreditation (or the Canadian equivalent) that offers comprehensive undergraduate curricula rooted in the arts and sciences;
2) It has a Christian mission statement and integrates Biblical faith into its educational programs;
+ Counseling for Christian Colleges & Universities (CCCU)
3) It has an institutional policy and practice to hire only persons who profess faith in Jesus Christ as full-time faculty members and administrators;
4) It is committed to advancing the cause of Christian higher education and is supportive of other Christian colleges and universities; and
5) It operates under the standards of the Evangelical Council for Financial Accountability.
http://www.cccu.org/members_and_affiliates
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+ National Association of Schools & Colleges of the United Methodist Church (NASCUMC)
“NASCUMC is a voluntary association of schools, colleges, and universities committed to the historic and distinctive values of United Methodist-related education. It exists”:
To advance the work of education and scholarship in member institutions,
To work cooperatively with conferences, boards and agencies of The United Methodist Church to address issues of mutual concern to the Church and the Academy,
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+ National Association of Schools & Colleges of the United Methodist Church (NASCUMC)
To work in partnership with the Church to educate students for leadership and service to the global community,
To foster and encourage the common good of member institutions, and
To strengthen the collegiality and camaraderie among member presidents, deans and heads of school.
http://www.gbhem.org/sites/default/files/documents/education/SCU_UMRELATEDSCU.PDF
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+ Association for Christians in Student Development (ACSD) “The
mission of the Association for Christians in Student Development is to equip and challenge members to infuse their Christian faith into student development practice and scholarship.”
Values:
Faith-fullness: We embrace the dynamic interplay of Biblical truth, wisdom and Christian faith as the foundation for professional and spiritual growth in Student Affairs.
Learning: We aspire to be a culture of reflection and curiosity that informs scholarship and practice.
Excellence: We strive to create a quality and distinction in what we say and do within the field of Student Affairs.
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Association for Christians in Student Development (ACSD) Innovation: We
seek to be analytical, quantitative, creative, and collaborative in discovering new and alternate ways of knowing and practice. Inclusivity: We desire to be a Christ-centered and unified community that engages effectively in difficult dialogue and fosters respect for cultural differences. Relationships: We value participating and investing in a supportive, challenging, and purposeful community.
http://www.acsd.org/about-us/mission-statement/purpose/
+ RESPONSIBILITY OF UNIVERSITY THERAPIST TO INSTITUTIONAL REQUIREMENTS
Most university/college mental health services are housed under Student Affairs
Religious-affiliated institutions may have strict guidelines of the values and standards to be held by student affairs staff
The university therapist faces the dilemma of how to respond to these institutional requirements
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Value conflicts within faithbased institutions
College and university counseling centers function in an environment that has frequently changed since such services were first developed.
Sexual orientation and gender identity
Counseling issues related to termination of pregnancies
Sexual relations outside of marriage
Counseling individuals from cultural or racial backgrounds different from that of the counseling.
Substance Use
Suicide
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Ethical Dilemmas – APA Code of Ethics Principle A: Beneficence and Nonmaleficence
Principle B: Fidelity and Responsibility Principle C: Integrity
Principle D: Justice Principle E: Respect for People’s Right and Dignity
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Ethical Dilemmas – Teased Apart
First, the code of ethics of the American Psychological Association (APA,2002) indicates that the promise of confidentiality is not an unqualified one. Standard 4.01 (Maintaining Confidentiality) states that Psychologist have a primary obligation and [must] take reasonable precautions to protect confidentiality information obtained through or store in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationships (APA, 2002, p. 1066)
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Ethical Dilemmas - ACA
The ACA Code of Ethics (American Counseling Association [ACA], 2005) makes a similar statement in acknowledging that counseling personnel may have other institutional roles. According to Standard D.1.d (Confidentiality),
when counselors are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, they [must] clarify roles expectations and the parameters of confidentiality with their colleagues (ACA, 2005, p. 11).
Ethical Responsibilities of University + Therapists to Student Clients
APA General Principles: Beneficence and Nonmaleficence Fidelity and Responsibility Integrity Justice Respect for People’s Rights and Dignity
APA Ethical Standards: Resolving Ethical Issues Competence Human Relations Privacy and Confidentiality Advertising and Other Public Statements Record Keeping and Fees Education and Training Research and Publication Assessment Therapy
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Areas of Growth Regarding Our Ethical Responsibilities to Students
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• 64% of students who are no longer attending college stated they dropped out because of mental health related concerns • Students cited “fear or concern for the impact of disclosing would have on how students, faculty, and staff perceive them” as the number one reason not to disclose their mental health condition. • Additionally, students rated stigma as the number one barrier to accessing mental health services and support. • Students believe there are not enough adequately trained mental health providers. • Students disclosed they would like for there to be more communication between mental health providers and others involved in their care.
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The chicken or the egg?
At
some point during their college experience, students may encounter personal, social, career or academic issues that call for assistances beyond the advice provided by friends and family Seeking
individual counseling and therapy Group counseling and therapy Outreach programs (i.e., eating or bullying awareness) Interpersonal Violence Prevention
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Consultation University
Counseling Center staff members are available to consult with students, faculty and staff on a broad range of issues. Common topics include resolving conflicts with roommates, classmates, coworkers and supervisors; managing crisis situations in the classroom or residence hall; and coping with emotionally distraught students, friends or family.
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Outreach Services
The
University Counseling Center provides outreach services to the campus community. These programs are specifically designed to address unique or other salient campus situations or concerns, such as eating disorders, study problems, stress relief, grieving and more, through workshops, training, flyers, and programming. These services are preventative and seek to teach the campus community coping skills, recognition of warning signs, communication skills, and more to help promote healthy mental and emotional well-being.
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Vignette – The Case of Liz
Liz is a 19-year-old White female in her sophomore year. She is a transfer student who completed her first year at a community college near home. She transferred to a local Christian University to finish her undergraduate degree in Economics. She was referred to the university counseling center by the residence hall director because she appeared to be unhappy and distraught living in the residence hall. Liz is typically described as an “outgoing” and “brilliant” girl, who makes friends easily. During the initial session, Liz expressed that she recently lost her virginity to guy she met at an off-campus party and contracted a VD. This event has caused her to feel shame and guilt, since premarital intercourse is strictly prohibited within her faith. She is also concerned that her parents may “disown” her and refuse to continue paying for her education. Additionally, Liz was recently placed on academic probation and is in jeopardy of losing all university benefits (i.e., housing, partial financial aid, and being removed from tennis team).
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Vignette – The Case of Callie
Callie, a 21 year old Philippine female is in her third year of college at a Catholic university. She reports being actively involved in the University Newman Center and photography club. Lately, Callie has found herself attracted to a female friend, though she has not acted on her feelings due to religious beliefs and family disapproval of homosexuality. Recently, Callie celebrated a friend’s birthday at a lesbian bar. As she left the bar and was walking to her vehicle, a group of male students driving by pulled over shouting out “Lezzie! Come here, I’ll show you what you need in your life.” Thankfully, some other bar patrons were passing by and safely escorted her the remaining way to her car. Callie enters counseling two weeks after this incident complaining of difficulty sleep, disturbing memories, sadness, and anxiety.
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Vignette – The Case of Daniel & his advisor
Daniel is an 18 year-old male, first generation college student, at a small, Catholic university. Daniel is an officer in the Student Government Association. Recently he has opened up to his fellow officers and student organization advisor, Mr. Schmidt, that he has been questioning his sexuality and struggling with loss of sleep, appetite, and tearfulness. His comrades refer him for on campus counseling. You are his therapist and run into Mr. Schmidt at a Student Affairs meeting. In an informal consultation with Mr. Schmidt, he says that he values being connected with the SGA officers and asks you for any information regarding Daniel’s case that might enable him to be helpful. How do you respond knowing that Mr. Schmidt is a proponent of the counseling center and frequently refers students, yet also work in Daniel’s best interest?
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References
Brinson, J.A., & Kottler, J.A. (1995). Minorities' underutilization of counseling centers' mental health services: A case for outreach and consultation. Journal of Mental Health Counseling, 17(4), 371. Council for the Advancement of Standards in Higher Education. (1997). The CAS book of professional standards for higher education. Washington, D.C.: Author. Estanek, S.M. & James, M.J. (2010). Principles of good practice for student affairs at Catholic colleges and universities. Retrieved from Association of Catholic Colleges and Universities website: http://www.accunet.org/files/public/REV4PrinciplesofGoodPractice.pdf Kiracofe, N.M., Donn, P.A., Grant, C.O., Podolnick, E.E., Bingham, R.P., Bolland, H.R., Carney, C.G., Clementson, J., Gallagher, R.P., Grosz, R.D., Handy, L., Hansche, J.H., Mack, J.K., Sanz, D., Walker, L.J., & Yamada, K.T. (1994). Accreditation standards for university and college counseling centers. Journal of Counseling and Development, 73, 38-43. Locations of Schools, Colleges, and Universities of The United Methodist Church, U.S.A. (2014). In General Board of Higher Education and Ministry. Retrieved January 20, 2015 from http://www.gbhem.org/sites/default/files/documents/education/SCU_UMRELATEDSCU.PDF
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References (cont.) Members and Affiliates. (2015). In Council for Christian Colleges and Universities. Retrieved January 20, 2015 from http://www.cccu.org/members_and_affiliates Purpose. (2015). In Association for Christians in Student Development. Retrieved January 20, 2015 from http://www.acsd.org/about-us/mission-statement/purpose/ Richardson, B.K. (1985). Delivery of counseling and psychological services in small colleges: A national study. Journal of College Student Personnel, 26(6), 508-512. Thomas, J.R. (2000). Strategies for small staff college counseling centers. In D.C. Davis & K.M. Humphrey (Eds.) College Counseling: Issues and Strategies for a New Millennium. Alexandria, VA: American Counseling Association.
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References
American College Health Association. (2008). American College Health Association—National College Health Assessment spring 2007 reference group data report. Journal of American College Health, 56, 469–488.
Blanco, C., Okuda, M., Wright, C., Hasin, D. S., Grant, B. F., Liu, S., & Olfson, M. (2008). Mental health of college students and their non-college-attending peers: Results from the National Epidemiologic Study on Alcohol and Related Conditions. Archives of General Psychiatry,65, 1429– 1437.
Barr V, Rando R, Krylowicz B, Reetz D. Association for University and College Counseling Center Directors annual survey. 2010. http://aucccd.org/img/pdfs/aucccd directors survey monograph 2010.pdf
Davidson, M. M., Yakushka, O. F., & Sanford-Martens, T. C. (2004). Racial and ethnic minority clients’ utilization of a university counseling center: An archival study. Journal of Multicultural Counseling and Development, 32, 259–271.
Douce, L. A., Keeling, R. P., American Council on Education., National Association of Student Personnel Administrators (U.S.), & American Psychological Association. (2014).A Strategic Primer on College Student Mental Health.
Eisenberg, D., Golberstein, E., & Gollust, S. E. (2007). Help-seeking and access to mental health care in a university student population. Medical Care, 45, 7, 594-601.
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References
Fisher, B., Cullen, F. T., Turner, M. G., & National Institute of Justice (U.S.). (2000). The sexual victimization of college women. Washington, DC: U.S. Dept. of Justice, Office of Justice Programs, National Institute of Justice.
Gallagher RP. National survey of counseling center directors, 2010. Alexandria, VA: International Association of Counseling Services, 2010. http://www.iacsinc.org/NSCCD%202010.pdf
Hayes, J. A., Chun-Kennedy, C., Edens, A., & Locke, B. D. (2011). Do double minority students face double jeopardy? Testing minority stress theory. Journal of College Counseling, 14, 117–126.
Hayes, J. A., Youn, S. J., Castonguay, L. G., Locke, B. D., McAleavey, A. A., & Nordberg, S. (2011). Rates and Predictors of Counseling Center Use Among College Students of Color. Journal of College Counseling, 14, 2, 105-116.
Kearney, L. K., Draper, M., & Baron, A. (2005). Counseling Utilization by Ethnic Minority College Students. Cultural Diversity & Ethnic Minority Psychology, 11, 3, 272-285.
Maramba, G. G., & Hall, G. C. N. (2002). Meta-analysis of ethnic match as a predictor of dropout, utilization, and level of functioning. Cultural Diversity & Ethnic Minority Psychology, 8, 290–297.
Watkins, D. C., Hunt, J. B., & Eisenberg, D. Increased demand for mental health services on college campuses: Perspectives from administrators.Qualitative Social Work, 11, 3, 319-337.
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