Rebecca A. Janis

Are we in crisis? National mental health and treatment trends in college counseling centers.

The current state of college student mental health is frequently labeled a “crisis,” as the demand for services and severity of symptomatology have appeared to increase in recent decades. Nationally representative findings are presented from the Center for Collegiate Mental Health, a practice research network based in the United States, composed of more than 340 university and college counseling centers, in an effort to illuminate trends in symptom severity and patterns in treatment utilization for the campus treatment seeking population. Clinical data collected over 5 academic years (2010–2015) showed small but significantly increasing trends for self-reported distress in generalized anxiety, depression, social anxiety, family distress, and academic distress, with the largest effect sizes observed for generalized anxiety, depression, and social anxiety. On the other hand, a significantly decreasing trend was observed for substance use. No significant changes were observed for eating concerns and hostility. Utilization data over 6 years indicated a gradual yet steady increase in the number of students seeking services (beyond the rate expected with increasing institutional enrollment), as well as increases in the number of appointments scheduled and attended, with great variation between centers. Within the context of changing national trends, we conclude that it is advisable to consider the specific needs of local centers to best accommodate distinct student bodies.

Developing a therapeutic relationship monitoring system for group treatment.

The use of outcome monitoring systems to identify clients that are at-risk for treatment failure has now become part of daily clinical practice, shown in >25 empirical studies to improve client outcomes. These promising findings have led to outcome monitoring systems being recognized as evidence-based. Feedback systems based on client perception of therapeutic processes are recent additions to the monitoring literature, and the research suggests that these too lead to improved outcomes. Unfortunately, feedback systems and research have been primarily limited to individual therapy, creating a knowledge gap for multiperson treatment. This study reports on the development of a therapeutic relationship monitoring system for group treatment using results from 6 Group Questionnaire (GQ) studies conducted in 4 unique clinical populations: nonclinical process, counseling center, European inpatient, and seriously mentally ill inpatients. The GQ is a factor-analytically derived scale, which assesses a client’s perception of 3 relationship quality constructs (positive bond, positive work, and negative relationship) across 3 structural domains (member–member, member–leader, and member–group). The first goal of the present study was to replicate the previously established factor structure across each clinical population. The second goal was to establish normative values and relevant feedback alerts for the GQ subscales in each population. Findings support the GQ factor structure across clinical populations, indicating that the constructs measured by the GQ bear similar relationships in each population. Further, findings support the implementation of unique norms and feedback alerts in each clinical population, reflecting the reality of meaningful differences between clinical populations.

Clinicians’ prediction and recall of therapeutic interventions: practice research network study

Abstract Conducted within a practice-research network in private practice, this exploratory study was aimed at examining whether clinicians can accurately predict and recall profiles of therapeutic interventions they used during an entire treatment for a given client. Based on a small sample (7 clinicians and 30 clients), the results tentatively suggest that the predictions that therapists made after session 3 regarding which types of techniques they would use, as well as the retrospective assessment of typical techniques they reported using in therapy, were accurate and generally discriminative. Clinical implications in line with deliberate practice are suggested and future research on complex questions related to clinical prediction is proposed.

Religious and Sexual Identities: An Intersectional, Longitudinal Examination of Change in Therapy

The current study employs an intersectional framework to understand how well counselors are meeting the needs of lesbian, gay, bisexual, queer, questioning (LGBQQ) and religious clients by examining clients’ initial anxiety and depression levels and changes in these symptoms through psychotherapy. Data from 12,825 participants from the Center for Collegiate Mental Health 2012–2014 data set were analyzed. Results from hierarchical linear modeling indicate lower baseline anxiety and depression among religious clients and faster rates of change of anxiety symptoms among nonreligious clients. LGBQQ clients presented with higher initial anxiety and depression, but there were no differences in rates of change of anxiety and depression between heterosexual and LGBQQ clients. Significant but minimal interaction effects between religious and sexual identities were found, indicating a need for further research. Counselors are encouraged to be mindful of these disparities in therapy.

Presenting concerns in counseling centers: The view from clinicians on the ground.

Despite growing evidence that a greater number of students are seeking counseling in college and university counseling centers throughout the United States, there is a dearth of empirical information about (a) the presenting concerns for which students seek treatment and (b) how these concerns differ according to client demographic factors. The purpose of this descriptive and exploratory study was to explore how counseling center clinicians categorize client presenting concerns, and how these concerns vary according to client demographics. Given the importance of client suicide within the field of college counseling, the frequency of suicidality as an identified presenting concern was also explored. A sample of 1,308 clinicians from 84 counseling centers rated the presenting concerns of 53,194 clients using the Clinician Index of Client Concerns (CLICC) after an initial consultation. Results of descriptive and nonparametric analyses indicated that the most prevalent concerns were anxiety, depression, stress, family, and academic performance, and that clients who belong to different demographic groups frequently present to counseling with broadly similar types of concerns. Furthermore, suicidality represented an area of concern for 8.4% of all clients, and it ranked 20 of 44 as a clinician-rated concern. Comparable rates emerged across the range of client demographic groups examined, although rates were notably higher for a handful of groups. The findings offer one of the largest and most generalizable descriptions of why college students seek counseling services, as determined by clinicians’ evaluations of presenting concerns. Implications for research and clinical applications of the findings are discussed.

Therapist effects on dropout from a college counseling center practice research network.

Dropout has been a pervasive and costly problem in psychotherapy, particularly for college counseling centers. The present study examined potential predictors of dropout using a large data set (N = 10,147 clients, 481 therapists) that was gathered through a college counseling center practice research network as a replication and extension of recent findings regarding therapist effects on dropout. The final model resulted in a dropout rate of 15.9% and a therapist effect of 9.51% on dropout variance. Therapist demographic variables were investigated, though none were found to be significant. Variables found to be predictive of increased likelihood of dropping out included higher levels of general presenting concerns, alcohol-related distress, and current financial stress. Ultimately, this study showed that therapists may play an important role in the likelihood of client dropout, and that additional research should be conducted to identify additional predictors, particularly at the therapist and center level.

Construct validity of the Self-Compassion Scale-Short Form among psychotherapy clients

Interest has been growing in the mental health benefits of self-compassion. Whereas, most research on this topic has been conducted with the 26-item Self-Compassion Scale (SCS), a briefer 12-item version of the instrument, the Self-Compassion Scale-Short Form (SCS-SF), also exists. The SCS-SF has demonstrated good validity and reliability in non-clinical samples, but it has not been used often in research with psychotherapy clients. This study was designed to examine the factor structure and construct validity of the SCS-SF in a clinical population. Data for this study were collected from 1609 college students receiving services at 10 campus counseling centers. The previously proposed factor structure of the SCS-SF was not supported. Instead, analyses revealed two factors, Self Care and Self Disparagement. Evidence for the construct validity of these factors was found via expected relationships with indices of depression, anxiety, social anxiety, hostility, academic distress, eating concerns, family distress, maladaptive perfectionism, suicidality, self-injurious behavior, and social support. SCS-SF scores were unrelated to various measures of substance use. Implications for clinical work and future research are discussed.

A longitudinal investigation of the impact of psychotherapist training: Does training improve client outcomes?

This study is a longitudinal examination of the impact of therapist stage of training on client outcomes in psychotherapy. The study included 22 PhD-level psychologists who work in a university counseling center (8 female, 14 male) who had completed at least 2 training periods in the center where data were gathered. Therapists worked with 4,047 clients, and 40,271 sessions were included in our analyses. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-by-session basis, tracking treatment response. The effect of stage of training on both the magnitude and speed of OQ-45 change was examined through hierarchical linear modeling. Therapists were found to achieve the same amount of change or less change on average in their later stages of training. Therapists were also found, on average, to achieve the same rate of change or a slower rate of change in later stages of training. Findings suggest that as therapists progress through formal stages of training, they do not improve in their ability to effect change in their clients. Given these findings, a better understanding of expertise in psychotherapy practice and how to develop it may be an important area for future theory development, research, and training program development. We call for further work examining if and how an individual therapist can become more effective with time.