Note: Since the writing of this article, Fredonia’s Counseling Center has implemented walk-in hours, an opportunity for students to see a counselor in their moment of need. More information on walk-in hours can be found here: Counseling Center Walk-in Services Handout. An overview on the services the Counseling Center provides can be found here: Counseling Center Student Handout
Tracy Stenger, Fredonia’s Director of Counseling Services, has noticed an increase in anxiety among college students over the last decade of her mental health career:
“With the technological shifts that have occurred in our world we’re finding that college students are struggling with coping skills,” Stenger said. “I’d say that when I first started here I rarely spent time talking about that. It’s part of our regular conversation now. . . Depression and anxiety are the two most common reasons that students seek counseling services. Depression used to be more frequent, but now we see anxiety has risen as one of the main reasons.”
Our conversation in LoGrasso Hall explored the reasons for the anxiety, the coping skills that help, and the ways college students change. :
Jon-Ryan Maloney: In my experience the stigma surrounding mental health has lessened. How do students talk about mental health issues with each other, and how does that impact their willingness to seek services?
Dr. Tracy Stenger: A lot of it comes from the family culture around help-seeking that was their life experience up until coming to this university. Racial and ethnic background can play a role in what the beliefs are as far as help-seeking. Some cultures are very much, “We take care of stuff on our own. You don’t share those things outside of the family.”
Maloney: What cultures might have those beliefs?
Dr. Stenger: I find it more so for our Asian American population and our African American population, but I hesitate because that’s such an amalgamation. We know from the research that there may be more of that happening in those populations, but it’s not one-size-fits-all. Separate from racial or ethnic background, for many students this is the first opportunity they’ve had to access services because it wasn’t supported in their family. The services are free, so any student registered at Fredonia has access. Because of confidentiality we’re legally bound to not disclose anything — nothing is part of a student’s academic record. There’s a built-in safety here of, “I can finally reach out.” But when those students go home for breaks they’re hiding, or feeling shame about the fact that they’ve been seeking services and they know this isn’t what the family wants. So it can be two steps forward and one step back, and we’re trying to help them navigate living in these two different worlds.
As far as students on campus, we’d been serving about 11 percent of the population for a long time, which was pretty standard. We’re up to 17 percent of the student population right now which is a big jump; that’s just happened in the past three-to-five years. Students are actively seeking us out, getting here through word of mouth. Our students are often our best references. There’s so much more in media now: group therapy reality TV shows, 13 Reasons Why, there’s so much more that’s being talked about in mental health and students are having these conversations. There’s a lot more empowerment for a student to say, “I need help, and I’m going to advocate for myself to get that.” That is so exciting to see.
Maloney: A cynic might read the 11-to-17 percent jump in the student population you’re seeing in a negative way: are we just stressing kids out more? You could also read it in a positive way, that more people are seeking out help. How do you think about interpreting that jump?
Dr. Stenger: I think it’s a combination. I think there’s a willingness to seek assistance and a desire to engage in self care. Many of our students have been doing that; they’ve been seeing a counselor for as long as they can remember so they want to keep doing so. And I think as the world continues to change, how we learn to cope has also changed. There’s anecdotal evidence to suggest that rates of anxiety and depression have been rising among people seeking counseling services. Related to that, there’s also a lack of coping skills. There’s a desire for an immediate fix, a sense of, “I’m feeling this way, I shouldn’t be feeling this way, I want it to stop.” We’ve got the immediate fix for almost everything (points to my cell phone). Students experience significant anxiety because they texted a friend and the friend didn’t text right back: “Oh, she must hate me. She must not want to be my friend anymore.” With the technological shifts that have occurred in our world we’re finding that college students are struggling with coping skills. I’d say that when I first started here I rarely spent time talking about that. It’s part of our regular conversation now.
Maloney: About coping skills?
Dr. Stenger: About coping skills. First of all, being okay to experience some distress, and then what to do with that distress, as opposed to, “I just don’t want to feel this. Make it stop.” Understanding that that’s natural, that it’s normal.
Maloney: So what was different about students when you first started? I would think it would be the same back then.
Dr. Stenger: It was certainly a need, but I don’t recall it being so much a part of our daily conversation. Depression and anxiety are the two most common reasons that students seek counseling services. Depression used to be more frequent, but now we see anxiety has risen as one of the main reasons. It might be comorbid in the sense that there are family issues and there’s also anxiety, or there’s trauma and there’s also anxiety. Stress and anxiety are the things that we’re seeing a lot of.
Maloney: Let me go right into asking about cell phones and social media. I’m very convinced that stress has increased because of smartphones, but I’m also interested to know if there’s any good that comes from smartphones, because they’re not going to go away.
Dr. Stenger: I will say that smartphones have been a conduit to connect for students who have struggled socially. Smartphones have allowed them to do that in a way that feels safe. Maybe the face-to-face conversation for someone with social anxiety is debilitating, but they can connect in all sorts of different ways online. There’s been some research to show benefits from that. The caveat is that it doesn’t necessarily address the social anxiety. They may still be experiencing that in social situations, but they’re no longer as isolated. That’s opened up a world to people who may not have otherwise felt connected. That’s huge for students. But we also have a lot of students struggling in relationships, and come to find out they’ve never actually been face-to-face with each other. This has all been through texting, Facebook, Instagram, Snapchat, and every other social media platform, and yet there’s a lot of complexity to this relationship. That’s really challenged us as a staff, because it’s easy to think, “You’ve not even met this person, how is this a relationship?” They’re real relationships that can be very intense. We still have to help students navigate the emotions that come along with those challenges. We’re not trying to understand the history of how they connected with this person; it’s more about, “What is it that’s concerning to you about this relationship?” Through that we understand how the communication is happening.
Maloney: I don’t want to call out females, but I know in athletics that every coach of female athletes has this problem: dealing with relationships and communication. Sometimes female athletes don’t know how to talk to each other. If a group of coaches came here to get training with you, what might you tell them?
Dr. Stenger: Well, let me ask you: What are the things you’re seeing as far as the challenges?
Maloney: Conflict is big. They avoid conflict all the time. Just the other day we had a girl do something that another girl didn’t like, but the second girl was scared to do anything about it because the first girl would get her friend to “bitch her out” in public. That’s the first time I’d heard that term. It’s this “Mean Girls” mentality. There are all these instances where they don’t know how to be genuine with each other, or compassionate with each other.
Dr. Stenger: I love what you just said about being genuine and being compassionate. To me, this falls under the umbrella of coping skills — it’s conflict resolution. When you’re not taught it — and it’s something you should learn naturally through school — but if someone’s always jumping in and saving you, you never learn how to be assertive and set boundaries. That’s a ton of what we do here. Conflict resolution plays hugely into sports — it’s all about sportsmanship and teamwork. You want a cohesive group that can work together and support each other, but my gosh conflict comes up in any group of people. These aren’t skills many of our students are coming here with. The way that they’re doing it is: everyone is in a group chat except for this one person who is now the target. This person knows she’s being targeted but has no idea what’s being said. They get all the non-verbals, all the bad talk via social media, and one person might start “bitching them out,” in public, who she didn’t even know was associated with this. So much of this can happen via social media, with blocking people or with things that are said that border on harassment. That becomes a nightmare for law enforcement and judicial. When it gets to that level people want something done, and we go from a small conflict to a No Contact Order through judicial. Many schools have a campus mediator — someone who will sit down and help people have a conversation.
Maloney: Help students have a conversation?
Dr. Stenger: Yes, help students have dialogue, but it even comes up with faculty and staff. So as coaches you can expect that this conflict is going to occur, so how do you set up a group to work together in a way that supports each other and navigates conflict? It’s going to happen; we’re not going to like each other all the time, so let’s practice how we’re going to handle it to take away some of the threat and anxiety. Confronting someone is terrifying if you’ve never done that, and it feels like there are less threatening ways to get it out. But its not really addressing the problem and that’s what students are experiencing. They see others doing it so they follow suit.
Maloney: So if I’m an 18-year-old freshmen sitting here with you, what are some of the things we’re practicing right now? Are you pretending to be the person the student is having conflict with?
Dr. Stenger: I might, but it’s less likely I’d put myself in that role. If you’re the 18-year-old athlete I’m working with and you’re talking to me about a conflict with a teammate I’d say “Okay, tell me about this person. Describe what they look like and how they sound.” I might have you get up and sit over there, and be that person and say what they’re saying, what they’re doing, and take on that role. Then we’ll come back: “Okay, what was that like for you?” We slowly roleplay so that the student can experience what it’s like to be in both chairs, and I’d be directing that. It indirectly teaches empathy. You’re literally sitting in the chair of the other person that you’re in conflict with. Very often there’s aha moments: “Oh, that person has been going through a really crappy time. Their parents are divorcing and that person has been shitty to a lot of people, not just me.” We’re not just going back and forth with the role-play, we’re processing each time: “What was it like, what did you experience, how did you feel, what did you learn about ‘Ted’ by standing in his shoes?” We’re teaching empathy — empathy is a skill. It doesn’t just come naturally.
Maloney: Yes! I want to underscore the importance of that. I would say only in the last year have I personally started to intentionally practice empathy and realized that I can get better at it. We can be so overwhelmed with our own problems that it’s hard to bother with empathy.
Dr. Stenger: It is, and you’d think as counselors we’d be really good at empathy, but we have to work hard at it. A number of years ago we did an assessment in our office to learn about each other and we found that our secretary at the time had more empathy than any of the counselors here (laughs). It was striking to us that we counselors were lower on the empathy scale. It really does take effort. Listening is a skill — really trying to understand what the other person is experiencing. Really hearing means I’m not thinking about what I’m going to say next. I’m not coming up with my response. I’m not thinking about what I’m going to make for dinner. That’s clearly not empathy.
Maloney: Depression and anxiety are so common, and I would imagine it would be particularly overwhelming for a student experiencing it away at college. How do you think about anxiety and depression in college?
Dr. Stenger: Everyone’s story is unique, so the process by which change is going to happen for that individual is going to be unique as well. There’s no one-size-fits-all, and what works today might not work tomorrow. There are times when it’s necessary for there to be a medical intervention (medication). I find more often than not that it’s the students inquiring about it, but just as many students that are inquiring about (medication) are really hesitant to use it. It may be that, “I’ve been experiencing this for a really long time and I feel like maybe I do need medication, but I’d also like to see if there’s something else.” And that something else. . . my gosh there are so many options. You’ve got to individualize the treatment, so we really try to look at each session as a whole. I think about this every time I work with a student: what if this is the last time I can work with them? How can I make today’s session the most meaningful? How can I look at this as a whole, not assuming we’re going to have this ongoing conversation. Maybe part of that conversation is about having them do something, maybe starting exercise, or having a psychiatric evaluation, or to start journaling, but sometimes it’s what happens in the session itself where the change occurs. There’s been a lot of research about what makes change happen in therapy, about what works. Do you have an idea what the biggest contributing factor is that helps someone experience change in counseling?
Maloney: The first thing that pops into my mind is my relationship with you, the counselor.
Dr. Stenger: That actually is the thing that we have the most control over as counselors, but the biggest thing that allows change to occur is what are called “extratheraputic factors,” things that have nothing to do with therapy. It could be that you’re coming in and you’re dealing with depression and we’re working together on that, then you walk out of here and on your way you help someone pick up their books and you start a conversation and now you’ve got a new friendship. Now this relationship develops and your loneliness has lessened. Now your mood is elevating. That’s an extratheraputic factor. You could argue that your coming into counseling might have allowed that opportunity to occur. That’s not something we can really measure, because these extratheraputic factors are things that we don’t have any control over. But what we do have control over as counselors is the relationship. That’s the other thing we prioritize, is developing that relationship with the student because that’s where change occurs. The other thing that makes a difference is the hope, or expectancy of changing.
Maloney: Just coming in for therapy can do that.
Dr. Stenger: Yes. But the thing that accounts for change the least is the technique. Most counselors say, “Oh, I learned this new technique. I went and did this training,” but that has very little to do with it. There’s also research showing that the more training and education you have the less effective you are as a clinician. Scott Miller and Barry Duncan have done a lot of work in understanding what works in counseling. They did a lot of research where they brought in people off the street and they would have them them sit on the other side of a one-way mirror and watch counseling sessions. They often had more insight as to what was going on for the client and had better suggestions than the clinicians did.
Maloney: When you say that the biggest thing that elicits change are the extratheraputic factors, I’m tempted to ask, “So therapy doesn’t matter?” Could somebody think that?
Dr. Stenger: I think somebody could, but I hope that wouldn’t be the message you’d take from that. When you look at it though, therapy is maybe an hour a week or an hour every two weeks. You spend a whole lot of time outside of a therapy session. We’re hoping that what’s occurring in therapy is the springboard that allows for those changes to occur, but it may not necessarily be a direct correlation: you’re in this session for depression and then you have this interaction, but maybe before counseling you were so depressed that you couldn’t even look up and notice that someone needed help picking up their books. Now through therapy you at least had your eyes open and went over and helped, which led to the conversation, which led to the friendship, which led to some decreased loneliness and improved mood. So yes, therapy can help but we may not be able to see how. I know that extratheraputic factors are going to occur but I have no control over them. What I do know makes a big difference is the relationship, and that’s a pretty big chunk of it. If I can build that and we can model healthy interactions, that might translate into experiences outside.
Maloney: And outside of therapy, what are some of the things that we know work to help what you’re doing in therapy? I’m thinking of something like exercise.
Dr. Stenger: I would start with basic self-care: regular sleep, healthy eating, and exercise. These are often the first things to go when you’re experiencing negative symptoms, and yet engaging in those healthy behaviors can itself have a powerful impact. Here’s what I might hear from a student: “I’m not sleeping. I’m smoking pot, which helps with my anxiety, which helps me sleep, but them I’m missing classes because I oversleep. So I stopped exercising because I don’t have any energy.” Well, with marijuana they’re getting some benefit in reducing anxiety, but it’s also pretty social. If I say I’m going to go to bed while all my friends are up smoking, I’m probably not willing to lose that. So now we’re trying to figure out where you’re motivated, so what part of this are you willing to try to change? They’re coming in because their mood is low but they’re engaging in all these unhealthy behaviors, none of which they necessarily want to change because there’s a social piece of it that’s tying them. There’s a lot of fear that if I change this one thing I’m going to lose this other thing and I’m going to be more depressed. You’re trying to find where they are motivated. What’s important to them? Maybe it’s just, “Man if I get kicked out of school what am I going to do? I’ve got to get back on track.” Someone can say they want to do well in school, but when you peel that back a little you find out it’s really their parents that want them to do well in school. They’re just here because it was expected. Every situation is complex, so what we’re looking for is: Where’s the motivation and what’s the need? What they’re telling me might be one thing, but I’ve got to be really listening to find out what their need is. Maybe it’s connection or belonging in this hypothetical situation I made up. We’ve got to find a way to nurture that piece in a way that’s healthy, but also addresses that fear of losing something if they change these behaviors.
Maloney: Because you might.
Dr. Stenger: Right, and that might be where they’re stuck. I’m not offering solutions because the solution is within the student. Nine times out of ten what I think is going to work isn’t for you. So we might be exploring how you’ve dealt with a situation in the past that was completely different, where you identify ways you’ve been able to navigate a difficult situation but got through it: “Oh okay, I have done this, I can do this. How might I use here what I learned there?”
Maloney: I want to ask about alcohol and marijuana. On the surface it’s thought of as harmless and inherently part of the college experience. I don’t often hear about when it gets to be a problem because I don’t see it, but I imagine you do see it. What are the implications of that culture on a college campus? When does it go to far, and how often is it occurring?
Dr. Stenger: I would say of the things that people come here for voluntarily, substance abuse and eating disorders are the ones we see the least. They’re not usually coming in saying, “I have a problem with my eating, or I have a problem with substance use.” It’s usually other things that will get them here, and then we might uncover that. Or they’re just avoiding treatment altogether — they either don’t see the problem, or they know it’s a problem but they don’t want to address it. It’s hard. It usually means changing a whole lot because chances are they’re not using by themselves — it’s their whole social life. If I want to change my use behaviors I’ve got to change my social life, and that can feel devastating for someone at that age where your social connections are so powerful. We do see if often when they’ve gotten in trouble in some way, whether on-campus or off-campus. There’s an intervention that occurs based on the level of the problem. They meet with Julie Bezek, who’s our Substance Abuse and Violence Prevention Coordinator. She does a motivational interview, builds a relationship, and tries to get the student comfortable talking and exploring what happened. Often she can get them into counseling. I don’t know if I’ve ever seen substance use as the only issue. It’s usually substance use and depression, or substance use and anxiety, or substance use and past trauma, or substance use and current abusive relationship. It has high comorbidity, meaning something else is going on too. That’s often how we start to address it. If they’re still abusing the substances it’s certainly challenging to address the other mental health concerns as well.
Many students going to the hospital for alcohol poisoning are novice consumers. They haven’t used before, then they’re in a situation where they consumed way too much and ended up going to the hospital. Nationally, for the college student population alcohol use has gone down a bit. Marijuana use has increased significantly.
Maloney: Really? I didn’t know that.
Dr. Stenger: It can be perceived as harmless. There’s this belief that it doesn’t cause harm, or that there isn’t an addiction. There certainly are negative consequences to the use but they don’t tend to motivate students to change their behavior. That’s certainly challenging.