College counseling and mental health practice have evolved to the point they are considered de rigueur in higher education. Confidentiality is a professional ethical mandate that the counselor conducts counseling while keeping the client’s identity and content of the sessions private. The Tarasoff decision and a number of subsequent cases held that liability applies when the counselor reasonably believed, or should have believed, that the client posed a serious danger to an identifiable potential victim. A dilemma since the mid-1980s has been whether counselors should warn partners of HIV-positive AIDS clients. The risks of encountering violence in the workplace vary considerably depending on the nature of counseling work and setting. In the post-Tarasoff era, college counselors, like all mental health professionals, have a legal and ethical obligation to prevent clear and imminent danger to the client and others.

This chapter provides an overview of the historical, developmental, medical, and contemporary considerations regarding college student development as they apply to college counseling centers. It describes documented significant transition from who provided counseling, to the focus of counseling what remains constant is the need to remain current with regard to continuing changes in higher education. The expansion of vocational services paved the way for college counselors to begin addressing social and personal concerns in a counseling context and provided momentum for universities to expand the role of college and university counseling centers. The chapter addresses historical foundations of college counseling, originating with faculty providing services to that of a specialized, highly trained staff of mental health professionals composed of psychiatrists, psychologists, counselors, social workers, psychiatric nurses, and others. Information from research and national surveys has been included to underscore the important changes in college mental health.

Today, although most counseling center directors are clinical or counseling psychologists, some are psychiatrists and some centers are merged with health services. In the 1980s, staff at counseling centers at small schools began to notice a higher demand for services and greater severity of problems. Staffing trends in the 1980s called for more broad training of staff. By far, psychologists are the largest group of counseling center directors, with counseling psychologists still representing the highest percentage within the group. More psychologists and social workers staffed counseling centers with psychiatrists providing part-time hours, sometimes in a strictly consultative role. Peer counselors or educators are usually undergraduate students who provide basic helping services to other students. Advancement of staff would be considered an important aspect of professional development to staff counselors with career aspirations of working in college counseling centers as a career.

There is a mutually beneficial relationship between international students and the United States. Dissimilar to their domestic peers, international student status may serve to complicate transitional issues as international students must quickly adapt to the United States educational system and culture to achieve academic success and avoid any immediate negative academic consequences. Financial stressors can seriously impair the mental health of international students and potentially their partners. Given the added stressors experienced by international students, it is no surprise that international students present to college counseling centers with a variety of concerns. College counseling centers provide two very important services to students with disabilities: assessment and documentation of disability, and counseling and advocacy. Veteran students may refrain from therapy services as an avoidant strategy believing that exploring past traumatic experiences to be too difficult. Determining the number of sexual and gender minority students on college campuses is difficult.

This chapter provides basic career counseling and advising information for college counselors, advisors, and student affairs professionals. Career counseling services include career counseling, testing, career planning and development interventions, cooperative education and experiential career education, and job placement and employment services. Career interest inventories may be inappropriate for students with severe mental or emotional disturbances. The chapter discusses several most popular inventories used for career and academic planning. The self-directed search (SDS) classifies an individual into six different personality-work typologies. A number of computer-based programs have been developed to assist clients and students in career exploration. Career planning resources have become very popular and can play a helpful role in providing additional information regarding career choice. The career functioning assessment (CFA) provides a conceptual framework to assess a client’s current occupational functioning and serves as a starting point for assessing future career success.

The typical age of onset for many severe psychotic disorders is late adolescence through early adulthood, an age range coinciding with the college population. Clearly, college counseling centers can play an important role in retention of students with severe mental disorders. This chapter presents a case example of how to make a referral. Due to the high-profile tragedies at Virginia Tech and other campuses, college counselors are under pressure to share concerns regarding students and to provide mandated counseling and assessment. The treatment of eating disorders continues to be very challenging for college counseling centers. College counselors have reported an increase in students presenting with self-injurious behaviors (SIBs) for some length of time. It has only been recently that college officials began to acknowledge students with autism and Asperger’s syndrome. Psychoeducational groups have become popular on virtually all college campuses.

Alcohol and other drugs (AOD)/substance use on college campuses has been an ongoing challenge for campus administrations, health services and health promotion, housing, and counseling centers. The misuse of substances by college students has a significant physiological, emotional, economic, and academic cost. Students are frequently unaware of the impact marijuana use may have on academic performance and motivation. Brief intervention (BI) and treatment have been shown to be effective treatment modalities at reducing high-risk substance abuse behaviors. Counseling centers may consider allowing for at least one session of motivational interviewing to increase the likelihood of clients following through on referrals to comprehensive substance use assessment, self-help groups, or treatment. Counseling center staff, even those with limited AOD treatment experience, can feel empowered to use the screening, brief intervention, referral to treatment (SBIRT) model. Group therapy is one of the most widely used treatment modalities for substance use.

Crisis and trauma are terms that have become alarmingly common in the United States. This chapter talks about crisis and trauma interventions which involve those of both an individual nature, students who do harm to themselves and of a mass nature, and students who do harm to multiple students or perpetuate events that threaten the safety of many students. Suicide is the second leading cause of death among college students. Risk factors for suicide include traumatic or stressful life events, prior attempts, isolation and lack of emotional support, and access to a suicide method. Safety usually involves a battery of activities: notifying parents or guardians, possible hospitalization, post hospitalization plan, medication, ongoing counseling, spiritual support for many, continued assessment, possible group counseling, support group, and so forth. The crisis management team (CMT) must communicate with campus administration, faculty, students, and legal authorities during crisis times.

This chapter addresses the typical departments on campus that consult with the counseling center on a regular basis, including chief student affairs administrators and campus police. Maintaining client confidentiality is of utmost importance in campus collaboration. Over the years, counseling center directors have continued to broaden the scope of services provided to the campus. On a broader, campus-wide scale, counseling centers are more often participating in threat assessment teams on their respective campus. Faculty is considered critical to the process of integrating college counseling centers into the broader campus. Faculty training is an integral way to build relationships with the counseling center. The chief student affairs administrator oversees the counseling center. The campus police are essential to any campus in providing safety and security to the community. Current trends of the utilization of technology, web-based materials are an optimal way of reaching a large audience of students, faculty, and staff.