GUIDE FOR FACULTY AND STAFF INTERACTING WITH AND REFERRING THE DISTRESSED STUDENT

Introduction
Description of our Counseling Services
The Role of Faculty and Staff in Assisting with Student Problems
Recognizing Students in Distress
Guidelines for Dealing with Distressed Students
Making a Referral for Counseling
If a Student is Reluctant to Seek Professional Help
Scheduling an Appointment
Confidentiality
Consultation Services
Dos and don'ts for specific student concerns
The Suspicious Student
The Verbally Aggressive Student
The Violent or Physically Destructive Student
The Suicidal Student
The Student in Poor contact with Reality
The Depressed Student

The purpose of this Guide is to provide faculty and professional staff with information about Counseling Services, referral information and how to assist Curry students most effectively. Our goal is to help you recognize some of the symptoms of student distress and to provide some specific options for intervention and for referral to campus resources. We are available to assist you with problem situations and to consult with you on whether to intervene with a particular student.

This Guide will discuss the role of faculty and staff in assisting with student problems. Guidelines are offered and each individual needs to consider what is appropriate in a given situation. Basic topics cover identifying students in distress, ways of dealing with these students and how to refer them for counseling. Dealing with the reluctant student, scheduling appointments for counseling and confidentiality issues are also discussed. At the end of this Guide, there are suggestions for interacting with students presenting with different emotional concerns.

Description of Counseling Services

We offer a range of services, including crisis intervention, diagnostic assessment, psychiatric evaluation, individual therapy, therapy for couples and referral. The number of visits is determined individually. There is no predetermined limit of sessions nor is there a charge to students. All registered students are eligible for services.

Emergencies during office hours are handled immediately at the Counseling Center. In the case of an evening or weekend crisis, call Campus Safety at x2222.

The Role of Faculty and Staff in Assisting with Student Problems

Students frequently experience a great deal of stress (i.e. academic, social, financial) during their college careers. Many students successfully cope with these pressures, but some find themselves overwhelmed. Because emotional distress typically interferes with a student's academic performance and/or social interactions, faculty and staff are often in good positions to recognize students who are in trouble. You will not be able to spot every such student, nor will every student you approach be willing to accept your assistance. Nevertheless, by communicating interest and concern to a distressed student, you may play an important role in helping that student regain the emotional balance needed to cope with stress.

Much of the stress that students experience is related to the development tasks of this life phase. Please remember, however, that major mental illnesses often manifest initially when people are in their 20's. Some of the observable signs may indicate the beginning of serious psychological problems.

Recognizing Students in Distress

People dealing with personal concerns or problems tend to show signs that they are struggling in some way. The following indicators may be useful in assessing whether or not a referral should be made:

1. Changes in mood, appearance or behavior

Some students do not directly tell you that there is a problem, but their appearance and behavior can be telling indicators. Deterioration of hygiene or appearance and dress may be visible cues of a problem. A distinct decline in academic performance, poor attendance, an uncharacteristic need for additional attention or repeated requests for extensions are examples of behavioral changes you might observe. Outbursts or anger, crying, extreme levels of activity or conversations that do not make sense could indicate psychological difficulties. Threats to classmates and angry, harassing behaviors may require intervention on several levels. These behaviors should not be tolerated and action needs to be taken to stop them. In addition, underlying psychological problems may need to be addressed as well.

2. Traumatic changes in personal relationships

Students are often stressed when they experience a traumatic change in their personal lives. The death of a family member or close friend, difficulties in important relationships, a divorce or break-up or changes in family responsibilities might increase and overwhelm the individual's usual capacity to cope. If you are aware of such a problem, you might wish to inmate a conversation.

3. Drug and alcohol abuse

Coming to class or a meeting while intoxicated or high is a sign of serious abuse of drugs or alcohol. Individuals often use drugs and alcohol to copy with life stresses and psychological difficulties. Unfortunately, the substance abuse itself frequently causes a further decline in social, academic and work functioning. If you see signs of intoxication, do not underestimate their significance. Be aware that abuse of and addiction to alcohol, marijuana, opiates (such as heroin), crack cocaine, and hallucinogenics are problems in this student population.

4. Academic difficulties

Students whose academic performance declines to a noticeable degree may be feeling overwhelmed in other areas of their lives. Some students might exhibit difficulties with concentration in class or performance on exams.

5. Learning problems

Some students find the demands of college-level academic work to be greater than they anticipated. While it is expected that students will go through an adjustment period, those who demonstrate a consistent discrepancy between their ability and performance may need further assistance. Poor study habits, test anxiety or an undiagnosed learning disability may be affecting performance. The Academic Enrichment Center is equipped to help students with these issues.

6. References to suicide

If a student talks or writes about suicide, this should be taken seriously. Thoughts of suicide are not necessarily dangerous, but they may indicate that the student is feeling overwhelmed or depressed. To assume that talk of suicide is intended solely to get attention is risky and can be a regrettable mistake. If you become aware of a student who is thinking about suicide, please consider a referral to Counseling Services. You can call us for a consultation if you are unsure of how to intervene or if the student is reluctant to take your referral.

7. Leaving school

When a student indicates that he or she is considering leaving school or transferring, a referral to Counseling may be appropriate. Often a complex number of issues are at play when a student decides to leave an institution. A change of place may not be all that is at issue.

Guidelines for Dealing with Distressed Students

There are no absolutely correct procedures for dealing with a distressed student. Each person has his or her own style of approaching and responding to others. Furthermore, people have differing capacities to deal with others' problems. It is important to know your personal limits as a helper.

If you choose to help a distressed student, or if a student approaches you to talk about personal problems

• Request to see the student in private.
• Speak directly and honestly to a student when you sense that he/she is in academic and/or personal distress.
• Ask if the student is talking to anyone such as family or friends, about the problem. People tend to isolate themselves when in distress but this is rarely a useful stance.
• If you have initiated the contact, express your concern in behavioral, nonjudgmental terms. For example, "I've noticed you've been absent from class lately and I'm concerned" "rather than "Where have you been lately? You should be more concerned about your grades."
• Listen to thoughts and feelings in a sensitive, non-threatening way. Communicate understanding by repeating back the essence of what the student has told you. Try to include both content and feeling ("It sounds like you're not accustomed to this much work in so short a period of time and you're worded about failing.")
• Avoid judging, evaluating and criticizing even if the student asks your opinion. It is important to respect the student's value system, even if you don't agree with it.
• Behavior that is strange or inappropriate should not be ignored. Comment directly on what you have observed.
• Do not discuss your concerns with other students.
• If you are concerned about a student's suicide potential, keep in mind that mental health professionals assess suicide potential, in part, by asking if the student has a plan for exactly how he/she would act on these thoughts, when and where the student intends to carry out the plan, and if he/she has ever attempted suicide before. The more specific and lethal the plan, the fact of having made a previous attempt and the greater the ability to carry out the plan, the higher the risk that a suicide will occur. You need not be afraid to ask these questions. For people who are considering suicide, these questions will not furnish them with new ideas. Most people who are actively suicidal are willing to answer these questions. Conversely, many people consider suicide from time to time in passing. The less specific and lethal the plan (e.g. "I guess I'd take a couple sleeping pills sometime"), the less likely a suicide attempt, although one should not dismiss references to seemingly non-lethal means of attempting suicide.

Making a Referral for Counseling

Even though you may be genuinely concerned about students and interested in helping them, you may find yourself in situations where it would be better to refer them to other resources. Circumstances that might necessitate a referral include:

• The problem is more serious than you feel comfortable handling.
• You are either extremely busy, or are experiencing stress in your own life and are unable or unwilling to handle other requests for help.
• You have talked to the student and helped as much as you can, but further assistance is needed.
• You think your personal feelings about the student will interfere with your objectivity.
• The student admits that there is a problem, but doesn't want to talk to you about it.
• The student asks for information or assistance that you are unable to provide.
• Let the student know your reasons for making a referral (e.g., lack of time, conflict of interest, limited training) and emphasize your concern that they do get help from an appropriate source. It may help the student to know that you support his/her desire to seek help.

If a Student is Reluctant to Seek Professional Help

Many people believe that only very disturbed people seek therapy, so your referral might be interpreted as a comment on the severity of the problem. Reassure the student that therapists at the Counseling Office work with people with a wide range of concerns. Problems need not reach crisis proportions for students to benefit from professional help. In fact, it is much easier to work on problems if they are addressed before they reach crisis level. Normalizing the process of seeking help may be especially helpful for international students whose countries may not have similar views of psychological counseling. Reluctant students might also be relieved to know that they can speak with a therapist on a one-time basis without making a commitment to ongoing therapy. Furthermore, any contact and information shared by the student is kept strictly confidential within the Counseling Office and will not be disclosed to parents, faculty, other College departments, or even you, except with the student's written permission. Finally, it is important to acknowledge, validate and discuss the student's real fears and concerns about seeking help. It takes considerable courage to face oneself and acknowledge one's limitations.

In some cases, you may find that the student has already sought counseling at the Counseling Office or elsewhere and was unsatisfied with the experience. There are many reasons why counseling may not be successful in a given situation. Please encourage the student to consider giving counseling another try, perhaps with a different counselor.

While it is important to care about the emotional well-being of students, we cannot make their decisions for them and counseling will be unsuccessful. If the student resists referral and you remain uncomfortable with the situation, contact the Counseling Office at x2120 to discuss your concern.

Scheduling an Appointment

Students should make their own appointments if possible. You can assist this process by offering the student immediate use of your phone. To schedule an appointment call x2182 between 8:30am and 4:30pm. The Administrative Assistant will arrange for the student to meet with a Counselor as soon as possible. Intake appointments are usually scheduled within 1 to 3 days from the date of contact. If you or the student think the matter is urgent and needs immediate attention, the student can be seen for an emergency appointment that day. Whenever possible, please contact the Counseling Office to let us know you are referring the student to us. This will help us prepare for the student when he/she arrives.

Some students are referred to community resources for specialized or continued counseling. Others may leave the initial interview feeling able to handle their problems on their own. Students can always return to the Counseling Office if additional services would be useful.

Confidentiality

We treat all of our contacts with students confidentially and in accord with the Massachusetts mental health code. We cannot tell anyone, inside or outside of the College, that the student is receiving services unless the student signs a specific release of information authorizing us to do so. Sometimes the faculty or staff member who made the referral will call to follow up. Please understand that we cannot tell you that the student has made an appointment without his/her written consent. If you are concerned about the student, contact him/her directly to ask if s/he has followed through with the referral. We could only release information without a student's written consent in those circumstances when there is imminent danger to the student or to others, child or elderly abuse, or a duly issued subpoena. Such occasions are rare.

Consultation Services

Counseling Services provides consultation services to the entire College community. We are glad to answer any questions that you may have about our services, your concerns about a student and referral options. Your call will be routed to an available Counselor and if a Counselor is not immediately available, the Administrative Assistant will take your number and the therapist will return your call within the day. Feel free to call and talk about your concerns regarding a student and, if indicated, ways to make an effective referral.

DO'S & DON'T'S FOR SPECIFIC STUDENT CONCERNS

The Suspicious Student

Typically, these students complain about something other than their psychological difficulties. They are tense, anxious, mistrustful, loners and have few friends. They tend to interpret minor oversights as significant personal rejection and often overreact to insignificant occurrences. They see themselves as the focal point of everybody's behavior and everything that happens has special meaning to them. They are overly concerned with fairness and being treated equally. Feelings of worthlessness and inadequacy underline most of their behavior. They seem capable and bright.

Do:

• Express compassion without intimate friendship. Remember, suspicious students have trouble with closeness and warmth.
• Be firm, steady, punctual and consistent.
• Be specific and clear regarding the standards of behavior you expect.
  

Don't:

• Assure the student that you are his/her friend; agree you're a stranger, but even strangers can be concerned.
• Be overly warm and nurturing.
• Flatter or participate in their games; you don't know the rules.
• Be cute or humorous.
• Challenge or agree with any mistaken or illogical beliefs.
• Look away and not deal with the situation.
• Give away your own rights as a person.
• Be ambiguous.
  

The Verbally Aggressive Student

Students usually become verbally abusive when in frustrating situations which they see as being beyond their control; anger and frustration become displaced from those situations to you. Typically, the anger is not directed at you personally. These students often feel they will be rejected and, therefore, reject you before you reject them. They often realize the drama and intimidation behind their anger and are aware of their impact.

Do:

• Acknowledge their anger and frustration, e.g., "I hear how angry you are."
• Rephrase what they are saying and identify their emotion, e.g., "I can see how upset you are because you feel your rights are being violated and nobody will listen."
• Allow them to ventilate, get the feelings out and tell you what is upsetting them.
• Reduce stimulation; invite the person to your office or other quiet place if this is comfortable.
• Tell them that you are not willing to accept their verbally abusive behavior, e.g., "When you yell and scream at me that way, I find it hard (impossible) to listen."
• Tell them they are violating your personal space and to please move back (if they are getting physically too close) e.g., "Please stand back; you're too close."
• Help the person problem-solve and deal with the real issues when they become calmer.
  

Don't:

• Get into an argument or shouting match.
• Become hostile or punitive yourself, e.g., "You can't talk to me that way!"
• Press for explanation or reasons for their behavior. "Now I'd like you to tell me exactly why you are so obnoxious."
   

The Violent or Physically Destructive Student

Violence, because of emotional distress, is very rare and typically occurs only when the student is totally frustrated and feels totally unable to do anything about it. The adage, "An ounce of prevention is worth a pound of cure; best applies here.

Do:

• Prevent total frustration and helplessness by quickly and calmly acknowledging the intensity of the situation, e.g., "I can see you're really upset and really mean business and have some critical concerns on your mind."
• Explain clearly and directly what behaviors are acceptable, e.g. "You certainly have the right to be angry but hitting (breaking things) is not O.K."
• Get necessary help-other staff, Campus Safety (x2222), Counseling Services (x2182).
• Stay in open area.
• Divert attention when all else fails, e.g., "If you hit me, I can't be of help."

Don't:

• Ignore warning signs that the person is about to explode, e.g., yelling, screaming, clenched fists, statements like, "You're leaving me no choice."
• Threaten, dare, taunt or push into a corner.
• Touch.

The Suicidal Student

Suicide is the second leading cause of death among college students. Any one of us can become suicidal if life hits us hard enough! The suicidal person is intensely ambivalent about killing himself/herself and typically responds to help; suicidal states are definitely time limited and most who commit suicide are neither crazy nor psychotic. High risk indicators include: feelings of hopelessness, helplessness and futility; a severe loss or threat of loss; a detailed suicidal plan; history of a previous attempt; history of alcohol or drug abuse and feelings of alienation and isolation. Suicidal students usually want to communicate their feelings and the inability to do so results in a rage or anger directed toward themselves.

Do:

• Take the student seriously — 80 percent of suicides give warning of their intent.
• Acknowledge that a threat of or attempt at suicide is a plea for help.
• Be available to listen, to talk, to be concerned, but refer the student to Counseling Services x2182 or x2120 
• Administer to yourself. Helping someone who is suicidal is hard, demanding and draining work.

Don't:

• Minimize the situation or depth of feeling, e.g., "Oh it will be much better tomorrow."
• Be afraid to ask the person if they are sad, depressed or sad that they want to hurt themselves, are considering suicide, e.g., "You seem so upset and discouraged that I'm wondering if you suicidal."
• Over commit yourself and, therefore, not be able to deliver on what you promise.
• Promise confidentiality
• Ignore your limitations.

The Student in Poor Contact with Reality

These students have difficulty distinguishing fantasy from reality, the dream from the waking state. Their thinking is typically illogical, confused, disturbed; they may coin new words, see or hear things which no one else can, have irrational beliefs and exhibit bizarre or inappropriate behavior. Generally, these students are not dangerous and are very scared, frightened and overwhelmed. They are much more frightened of you than you are of them.

Do:

• Respond with warmth and kindness, but with firm reasoning.
• Remove extra stimulation of the environment and see them in a quiet atmosphere (if you are comfortable in doing so).
• Acknowledge your concerns and state that you can see they need help., e.g, "It seems very hard for you to integrate all these things that are happening and I am concerned about you. I'd like to help."
• Acknowledge the feelings or fears without supporting the misperceptions, e.g., 'I understand you think they are trying to hurt you and I know how real it seem to you, but I don't hear the voices (see the devil, etc.)
• Reveal your difficulty in understanding them (when appropriate), e.g., I'm sorry but I don't understand. Could you repeat that or say it in a different way?"
• Focus on the "here and now". Switch topics and divert the focus from the irrational to the rational or the real.
  speak to their healthy side, which they have. It's OK to joke, laugh or smile when appropriate.

Don't:

• Argue or try to convince them of the irrationality of their thinking for it makes them defend their positions (false perceptions) more.
• Play along, e.g., "Oh yeah, I hear the voices (or see the devil).'
• Encourage further revelations of craziness.
• Demand, command or order.
• Expect customary emotional responses.

The Depressed Student

Typically, these students get the most sympathy. They show a multitude of systems, e.g., guilt, low self-esteem, feelings of worthlessness and inadequacy as well as physical symptoms such as decreased or increased appetite, difficulty staying asleep, early awakening, low interest in daily activities. They show low activity levels because everything is an effort and they have little energy.

Do:

• Let student know you're aware he/she is feeling down and you would like to help.
• Reach out more than halfway and encourage the student to express how she/he is feeling, for her/she is often initially reluctant to talk, yet others' attention helps the student feel more worthwhile.
• Tell student of your concern.

Don't:

• Say, "Don't worry," 'Crying won't help," or 'Everything will be better tomorrow."
• Be afraid to ask whether the student is suicidal if you think he/she may be.
   

Consultation Services

Counseling Services provides consultation services to the entire College community. We are glad to answer any questions that you may have about our services, your concerns about a student and referral options. Your call will be muted to an available Counselor and if a Counselor is not immediately available, the Administrative Assistant will take your number and the therapist will return your call within the day. Feel free to call and talk about your concerns regarding a student and, if indicated, ways to make an effective referral.