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December 6, 2001

Counseling strategies in brief

During his 25 years as head of Pitt's student counseling services, Robert P. Gallagher, associate clinical professor at Pitt's School of Education, has witnessed the gamut of problems facing students. His recent research indicates that more instances of serious mental health problems have surfaced in counseling centers across the nation, forcing counselors to adjust to greater caseloads and various legal situations.

Here Gallagher discusses some of the counseling strategies he has employed and his thoughts on today's student counseling field.

Should counselors draw on their own experiences and share those with clients?

"Over time, counseling philosophies have gone between extremes: 25-30 years ago there were group love-ins as therapy. It was all about touching and sharing feelings. Then, 10-15 years ago, it moved to the other extreme of keeping your distance entirely. Now it's somewhere in the middle, although it varies among counselors.

"Typically, I will try to stay removed from clients, to keep the focus on their issues. But there are times when the parallels are so close, you share some of that, and that's perfectly ethical.

"I think you can go too far with removing yourself. I remember hearing a counselor once say, 'Today, I did a terrible thing: A client asked me a direct question … and I answered it!' There is a danger in increasing that distance: It's like saying a hug is a terrible thing. Well, in a wrap-up session, a student-initiated hug is fine and appropriate.

"There are lots of ways of showing your humanity without revealing all of your personal side."

What if a counselor becomes physically attracted to a client?

"There are physicality issues. Using the counselor/client relationship to take advantage is strictly unethical. The reason most people who lose their license do is because of that. But research in the last 10 years has found that most counselors feel some attraction to some client at some point. They wouldn't be human otherwise.

"The point is a very small percentage of counselors act out because of that. The vast majority can handle that, especially since most counseling is short term. But now admitting an attraction is more common, talking about it with colleagues. Our training programs discuss it. It comes up all the time."

And what about the reverse situation, where a client is attracted to a counselor, so-called "transference" in the parlance of therapy?

"Sure, transference is very common. A number of therapists believe that has to happen to be successful. That's true more in long-term situations. But for the number of us working on short-term counseling sometimes transference is a negative thing. You need to discourage it; it can be hard to break."

The Counseling Center promotional materials stress client confidentiality. Are there exceptions to maintaining confidentiality?

"Confidentiality is extremely important. It's the basis of the client/counselor relationship. Parents will call and ask what's going on with their child. There is some delicacy to working around that kind of issue.

"Legally, if a student is a danger to him- or herself or to others, the counselor is required to take action. You have the responsibility to break confidentiality and give a warning to the threatened person or persons. In Pennsylvania, you're not required to protect them, but you must warn them.

"When you're convinced a student will harm himself or herself, and that student refuses to be hospitalized, your duty is to get a judge's permission to hospitalize the student against their will. Here, we commit students to Western Psych. They can restrain a student there for 72 hours for evaluation and, if necessary, get another judicial hearing to extend that time. It provides protection to a person in danger.

"There are some gray areas. In the case of child abuse, the law is quite difficult. If the student is the abuser, and it's not ongoing, there's no legal obligation to report that. I would first ask, How long ago did this happen? Is it likely it will happen again? Can we work on this issue? That allows counselors some flexibility.

"Usually, once you've gone outside confidentiality, you can't be treating the person afterwards. If you inform a third-party partner that your client is HIV-positive, for example, your client won't want to see you anymore. And they won't tell the next counselor they see about it either. It's preferable to convince the client to tell the partner."

Alcohol and drug abuse among college students is reportedly on the rise. Are these commonplace issues for a counselor?

"Rarely do students come in and say they have an alcohol problem. And the negative physical consequences of that problem don't usually appear until later.

"But if they get into trouble; they get into fights; their grades go down; they're falling apart; they seek counseling because their life is a mess or they feel trapped: In those cases, once you establish a rapport with a client, you can point out the relationship between alcohol and behavior. Only then can you have a real impact on that problem.

"We try not to become judgmental about those types of behaviors, like pot smoking or excessive drinking. The point is to look at it in terms of whether they are unhappy, and what is contributing to that. Can you show them evidence that it's impacting negatively on their lives, and whether these things are part of what might be worked on in counseling?

"Much of the work we do at counseling centers is to help people be independent and make healthy decisions for themselves, to guide them through that process. There's a commonality of that approach no matter what the problem is."

Should counselors advocate or proselytize a particular set of religious or political beliefs?

"I think that's a mistake. It's one thing to say to a client, 'You're struggling with spirituality issues and maybe pastoral counseling is better for you at this time.' But trying to draw someone into your own particular belief system by saying, for example, you need to turn yourself over to God. These are dangerous waters.

"There may be political issues, too: choice versus the right to life issue, for example. People are usually on one side of the fence or the other. As a counselor you have to keep your own biases out of it. You say that to the client up front: 'What's important here is for you to arrive at a decision that is right for you.' "You can't push your own beliefs. It's much better to refer them to someone else. You may even have a client who rubs you the wrong way, touches a nerve in a way you can't deal with. I can see a counselor becoming very upset, for example, if a client says that the U.S. deserved what they got on Sept. 11. That the client hoped there'll be more attacks. Not all counselors, but some would be unable to counsel that client. For you to accept as a client everyone who comes through the door, that would be difficult."

Speaking of Sept. 11, do those and subsequent events present new issues for counselors?

"Yes, it's new turf. Counselors themselves are impacted by it, trying to make sense of it. And part of the message is: We're all in this.

"People likely to seek counseling are those for whom this has kicked in hard — they're not sleeping, they're depressed, they feel extreme anger, they feel in danger. To the extent that it's an irrational fear, you can look back to your counseling skills and work on the irrational part. Those who go into a deep depression, I think, might already have some deep-seated issues. But post-traumatic stress is a real thing. Our expectations are that more people will seek counseling as time goes on."

(Gallagher said that last month he did a limited survey of 20 counseling center directors related to the aftermath of the events of Sept. 11 and their effects on counseling center caseloads. See related story beginning on page 4.)

"Only one school reported that 9/11 did not appear to impact on their caseload. All of the others indicated that there had been a marked increase in the number of students seeking service as compared to this time last year. Most were up between 30 and 60 percent. Most also reported that crisis counseling and after-hours calls were particularly high.

"The responding schools that were closest to New York experienced the most direct linkage between 9/11 and the kinds of problems they were seeing. Students reported anxiety attacks, nightmares, fears of further attacks, fears of anthrax, fears of going through tunnels, or over bridges or riding on subways. Many had a great deal of difficulty concentrating.

"Most of the schools that were farther away from Ground Zero reported that some clients saw a direct connection between their problems and the terrorist attacks. They were fearful of attending large classes or going to large public events.

"These students, however, did not account for the huge increase in caseloads. Many students came into centers with a wide array of developmental concerns, but there was also a large increase in students with anxiety attacks with no known precipitating events, with depression, sleeplessness, and concerns about their futures.

"It was the conclusion of most responding directors that 9/11 'lowered the threshold' for students who were struggling with other problems. One director spoke of a 'psychological fault line' that may be present in fragile students.

"I think that it is not only fragile students that have such a fault line. All of us are capable of developing stress reactions if the cumulative pressures in our lives are great enough.

"The terrorist attack seems to have precipitated or exacerbated dormant symptoms. While students were able to function reasonably well in spite of their personal issues prior to this time, the emotionally charged atmosphere that developed after 9/11 seems to have made it more difficult to ignore these problems."

–Peter Hart

Filed under: Feature,Volume 34 Issue 8

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