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The ongoing college student mental health crisis is creating an untenable situation for the field of college counseling. Specifically, college counseling centers are facing hiring challenges, dealing with burnout and exhaustion among existing staff, and experiencing an unprecedented exodus of directors leaving for other positions. As summed up in a recently published position paper by the Association for University and College Counseling Center Directors, we need a new a path forward for college counseling centers, one that balances student care with care for clinicians. From our perspective, this is a necessary course correction for addressing what we have come to think of as the moral injuries that college counseling has undergone over the past several decades.
Defining “moral injury” broadly as feeling disconnected or alienated from personal ethics or belief, our contention is that the current situation in most college counseling centers reflects decades of neglect by institutions of the central importance of the centers charged with addressing student distress. As a result of insufficient funding and resources, a problem that preceded the existing mental health crisis and remains ongoing, counseling center professionals were forced to make unenviable decisions about how they met demand and worked with the surge of students requesting care. These choices have continually compromised the quality and efficacy of the clinical care that most of us went into counseling to provide in the first place and that we know to be most effective.
Some examples of these compromises to therapeutic practices are as follows: setting arbitrary session limits when therapeutic change requires a minimum of 12 to 18 sessions, moving to every-other-week therapy models (when weekly therapy is more impactful) or abandoning therapy to third parties (such as teletherapy providers like Talkspace, Mantra or BetterHelp, or large local hospital and health-care centers). The latter “solutions” are especially insidious, reflecting the hypocritical ways institutions pride themselves as special communities but then, with an amazingly myopic attitude, shift crucial clinical care elsewhere. External clinical providers and for-profit businesses are not stakeholders in the college communities’ evolution and welfare, nor have they any appreciation for or understanding of our communities’ culture and wonderful peculiarities. That we have at best minimal oversight over these outsourced clinical services is further problematic.
In addition to creating bad consequences for our students, these changes further generate negative feelings among those of us who make up the staff of college counseling centers. We are left feeling that our role within the college community is neither appreciated nor truly understood. This creates a significant crisis in our sense of identity and leads to feelings of moral injury. On the one hand, we want to be there for students and to be good employees. On the other hand, we know that we are not living up to our expectations and values as therapists and counselors.
We go along with changes we know to result in suboptimal student care with numerous understandable rationalizations. For instance, we may view ourselves as providing something, which, we think, is better than nothing. We might think that the demand is impossible to meet and that nothing we can do will be enough and settle into a despondent helplessness. Or we might think of ourselves as being good soldiers for the cause of the institution.
However, as we feel and know that we are not practicing in the ways we want to and that we think best, we also know that our services are being devalued, even if not with conscious intent. We know that other people in the institution do not regard our roles with the degree of importance that we do.
Not only are the consequences of decades of neglect and moral injury problematic for our students, but they also threaten the very fabric of our counseling centers. This is ironic, given the importance college leaders claim to place on student well-being; yet a vicious cycle has clearly taken hold.
Counseling center jobs have become less desirable and increasingly, it seems, are viewed by applicants with suspicion. Along with concerns about salary levels, which are paltry compared to what clinicians can earn in private practice or other systems, counselors have begun to describe working with college-aged students as being like working in crisis centers. As counselors do more triage and crisis management and less and less talk therapy, prospective clinicians are choosing to avoid counseling work altogether. Not being able to hire skilled counselors and retain them puts more pressure on existing staff and leads administration to look toward off-campus and third-party solutions, regardless of the quality of care being offered. Further, as reported recently, counseling center director jobs are also being eliminated as institutions seek to reorganize counseling centers in cynical efforts to address the mental health crisis. We expect that the loss of institutional and expert knowledge that directors possess will create a situation where institutions further feel compelled to shift toward other options, leading eventually to the decline and likely end of college counseling as we know it.
This is a significant loss. Staff positions in a counseling center were historically viewed as a prize, a position in which one could develop and exercise expertise in the developmental issues of late adolescence and young adulthood at a place where one could truly work therapeutically with students. Moreover, counseling centers played a key role in the development of future generations of clinicians through prized externships and internships. They were seen as beacons for the value of talk therapy, co-constructing meaning and alleviating suffering.
Simultaneously, counselors played significant roles in the larger institution, serving as resources to help administrators, faculty and staff think deeply about broader social and societal issues and their impacts on college students. Such a role remains crucial to help us navigate the current mental health crisis while, more broadly, reckoning with the growing challenges inherent to our having, as sociobiologist E. O. Wilson has written, “paleolithic emotions, medieval institutions and god-like technology.” Sadly, the increasing demand for services and lack of sustained institutional investment now leave little to no room for anything other than clinical work, further hampering the role of the counseling center and keeping us on this vicious treadmill.
Getting us off this treadmill and toward a place of value, integrity and positive self-esteem is no small task. While we are appreciative of calls for investment, which have been met by some institutions, as well as organizational calls for a new path forward, we think it is crucial that we are wary that in our vulnerable position, we do not act like the starving individuals we are—those who are content with only a little bit. Addressing moral injury requires not just an appreciation and observation of what has caused hurt; it also requires we be provided the means to create meaningful and sustainable working environments once again, ones in which counselors could not only provide the therapy we know to be most effective but also be widely seen as valued thought partners on campus.
We must, in other words, be strong advocates for the value of talk therapy, our students’ needs and our centers’ roles. Any attempts at sufficient redress will not come without considerable investments, financial and otherwise, in counseling centers. Not only do existing staff need to be better compensated, institutions have to address the very structures that have led to moral injury in order to ensure that counseling center professionals can align with a virtuous cycle of caring for students, their institutions and themselves.