Month: August 2023

Q&A with Marcus Hotaling, Director of the Eppler-Wolff Counseling Center at Union College and President of AUCCCD

Posted on by Amadeo Rodriguez

In March 2023, the Association for University and College Counseling Center Directors (AUCCCD) released a policy paper that provides a foundation for structuring how higher education can approach mental health support. “Navigating a Path Forward for Mental Health Services in Higher Education” lays out some of the issues facing the field, including staff burnout and turnover, misallocation of resources, lack of coordination between campus stakeholders, ineffective or incongruous treatment models and the proliferation of third-party vendors. The paper offers some recommendations for addressing these concerns with an overarching theme that campus stakeholders must work together to create a realistic, agreed-upon, campus-wide approach–and then act on that plan with consistent messaging and communication to all constituents. This month, LearningWell (LW) magazine interviewed Dr. Marcus Hotaling, director of the Eppler-Wolff Counseling Center at Union College and president of the AUCCCD, to discuss the paper and “the path forward.”

LW: The AUCCCD recently published a paper that lays out a path forward for college mental health services amid high rates of mental health concerns and help-seeking among college students, and at the same time, increased burnout and dissatisfaction among counselors. What led the AUCCCD to develop this paper?

MH:  I think we’ve all been feeling the burnout for some years. Every year, up until the pandemic, my counseling center was seeing increased utilization—more students and more sessions. And while more students is understandable, we continuously saw more sessions with the same amount of staff, going above the national standard of about 65% face-to-face time for counselor. When I became president of AUCCCD in 2021, we had started to look at themes as to why people were leaving. We have 895 active members. In that first year, 81 of our members left for various reasons. Burnout was a huge factor, due to, in large part, getting pressure from all directions. You’re getting pressure from the students who want to be seen right away. You’re getting pressure from parents calling you. And then you’re getting pressure from the higher-ups who are getting called by parents or faculty members.

We also looked at where these counselors were going. The majority of them, two thirds, left the field of higher education and went into private practice. And there were two factors that led to that. The first was salary—you can make more in private practice. Some people went to the local hospitals and the salary is $50,000 more than their institution was paying. And the second reason was that, when you’re in private practice and you’re full, you just say, “I’m sorry, I’m not accepting new patients.” You can’t do that in a college setting. So, we started to look at the burnout piece and how higher ed and counseling can work together to try to resolve this problem.

LW: What were your goals in issuing this paper? What was it meant to convey?

MH:  We didn’t want to just say, “Colleges, you just need to hire more people,” because we know that’s not realistic. But what is realistic is everybody coming to the table and saying, “What services do we want to offer?” Let’s all be on the same page; let’s all have the same messaging around that, and then let’s actually do that. Because, in the counseling center, we can develop whatever service model we want, but if admissions or faculty or someone else is telling a student they could be seen six times a week, that’s not helpful. If we have people saying there are session limits when we don’t have session limits, that’s not helpful.

It’s important for counseling center leadership and student affairs leadership, and presidents, to come up with a plan of action to determine, based on the staffing we have, what we can provide. There needs to be a plan of action.

LW: The paper points out that colleges are making decisions about the service delivery model based on meeting the volume of demand, rather than taking an outcomes-based approach. Why, in your view, are institutions approaching mental health care that way? 

MH: I think part of it is that, for the most part, it’s really just fallen onto the counseling center staff to say what we need to do. And the reality is, that can be really hard when you don’t have the opportunity to step back and try something different or think about how it can be done differently.

I’m going to use my center as an example. There was one day that I opened up the schedule and there were just tons of appointments. And I said to my associate director, “Look, I’m seeing your schedule today. That’s not healthy. Your last patient is getting nothing from you. You’re exhausted.” So, we sat down over a school break and looked at how to change things. Everything was on the table. And that takes time, and it takes trust. We did get some pushback from our staff, but the approach was to give it a shot until the end of the year. And if it didn’t work, we’d change it again.

The reason why the usual approach is all over the place is that we’re just trying to meet the demand. And it’s like a dam that’s breaking where we plug one hole, and then all of a sudden there’s another hole over here. It’s still coming in; the water’s still flowing. And how many fingers do I have to plug these holes? And it’s only when you can take that step back that you can come up with a new way of doing things.

The demand is so high and you’re just trying to bail water out of the boat before you can actually sit down and plan. And that’s what we were trying to say in this paper: Do the planning, take the initiative to sit down with your leadership and say, “What can I do? What do you want? What does this school want to offer?” And we will work around that with the current staff. And maybe we’ll need to grow staff in the future.

But we are starting to see the numbers fall. One of the positives that came out of the pandemic is that states are starting to look at patients being able to cross over state lines for care. Clinicians are also more comfortable using telehealth and teletherapy. So, if you’ve been working with somebody for a long time, rather than saying, “Go see somebody at college because you’re two hours away,” counselors can continue to see their patients. So, the numbers are falling a little bit, but a little bit from a flood is still a flood.

“Do the planning, take the initiative to sit down with your leadership and say, “What can I do? What do you want? What does this school want to offer?”

LW: You point out that there is a mismatch of expectations, like having admissions promote a certain number of sessions that does not align with the reality of what can be offered. But even if you fix that inconsistency in messaging, do you think there’s also a cultural expectation that students, when they get to college, are going to be cared for in this way and they’re going to have access to therapy? And if so, is there going to be a difficulty in pushing back against that cultural expectation?

MH: Absolutely. Look, students are paying a lot of money to go to college, and with that comes a certain level of expectation across the board. When it comes to the expectations that parents have or families have, we also need to move away from the normalcy that every student is going to get through in four years. And that taking some time off isn’t a bad thing if you’re making good use of that time by working on yourself and getting healthy, so that when you come back, you’re going to be in a better place.

LW: So many issues, like leaves of absence as you suggest, involve more of a public health approach. What is the role of the counseling center in this approach?

MH: This whole thing is a public health problem. And I say that not to remove our responsibility or the individual responsibility of the students or counseling center. There are two reasons I say this is a public health problem. One, counseling centers and mental health for the past 20 years has been pushing for parity. We should be treated just like physical health. Let’s reduce the stigma. And it worked and that’s good. And then you have a challenging outside world. There’s war, there’s political unrest, a recession, a pandemic, school shootings. All these things create anxiety. On top of that, we have these expectations, real or imagined, that everybody else’s life is perfect, which we can see on their Instagram reel.

So, for a public health approach, yes, the community needs to do better about addressing gun violence and addressing systemic racism. But once they’re on our campuses, we can give students the tools to stay happy and healthy, while also recognizing that [every person is] going to have bad days.

We also need to help our constituents around campus recognize when somebody actually needs therapy versus when they might just need empathy or a listening ear. We need to help faculty and staff understand that referring a student to counseling is not the first thing you do. The first thing to do is say, “Are you okay? What do you need? I’m so sorry.”

These are public health approaches that are very, very simple and need no training from a mental health professional. All of us on a college campus can be approaching this from a public health perspective. It’s a public health issue, and now we need to be using our public health solutions.

LW: All of this – counseling staff wellbeing, policies and procedures and service delivery–its all about overall student health, correct? 

MH: Absolutely. Because if we’re not healthy, how are we helping anybody?

And evidence shows that students who utilize mental health services are retained and graduate at a higher percentage than those who don’t receive mental health care. And in theory, those are the students that are most at risk—the ones that are unhappy, the ones that have a mental health diagnosis. In a National Association of Mental Illness report, 64% of students that are no longer enrolled in higher ed list mental health as the main reason. So, it’s about student success as well.

Bucknell on Purpose

Posted on by Gaby Harlid

The Bucknell University seniors trod onto the grassy quad outside the Breakiron Engineering Building. Their professor, Joseph Tranquillo, explained the rules of the game, which were straightforward, though not necessarily intuitive: Make a human chain with your teammates without touching them. The students eyed each other nervously, waiting for someone else to kick things off. 

One walked out and turned to face the others, striking a pose before them. Then another moved to his side, making a shape with her body that linked with his. The rest of the class followed suit, sticking hands under bent elbows and air-hugging arms around ankles. Eventually their tangle of shapes came together to form a sculpture of limbs and torsos.  

Professor Tranquillo then asked them to complete the task more quickly, requiring a higher level of teamwork and a lower threshold for awkwardness. They met the challenge and got into a rhythm that taught them instinctively what Tranquillo was hoping to impart: When entering an existing situation, always look for the open opportunity. On a new team or organization, consider: “What can I learn here and how can I leave my own mark behind?”


This exercise was part of “Bucknell-on-Purpose,” a Senior Dinner Seminar Tranquillo, associate provost for Transformative Teaching and Learning, co-teaches with Keith Buffinton, dean emeritus of Engineering  at Bucknell. Part of the university’s Residential College Program, Bucknell’s Senior Dinner Seminars bring together an intimate group, in this case 17, once a week for an hour-and-a-half. Over two semesters, the students build trust and connection with each other and their instructors, while eating and exploring their course topic of choice.

In Tranquillo and Buffinton’s class, this topic—“purpose”—required students to reflect on their college experiences and, as those came to an end, their futures beyond just post-graduate jobs or degrees. Even Tranquillo’s warm-up exercises, like the game of allegorical Twister, emphasized collaboration and letting go of self-consciousness, but also prompted them to consider how they envision contributing to the wider world.

“We spend a lot of time preparing students academically for their professional lives after graduation but less so on their human development—their values and sense of purpose and how those align with what they decide to do,” said Keith Buffinton. “We chose to offer this seminar so seniors will ask themselves these important questions before they leave here.”

An emphasis on discovering purpose has become more prevalent in educational and professional spheres as a way to combat personal and professional discontent and increase engagement. Another driving force is its effect on wellbeing for an emerging generation experiencing widespread mental health issues. A 2019 report, “Forging Pathways to Purposeful Work: The Role of Higher Education,” produced by Gallup and Bates College, showed 80% of college graduates believed having purpose in their work was important, but less than 50% had actually found it. Graduates who reported having high purpose in their work were nearly ten times more likely than their low purpose peers to have high overall wellbeing.

“We spend a lot of time preparing students academically for their professional lives after graduation but less so on their human development—their values and sense of purpose and how those align with what they decide to do.”

The object of Tranquillo and Buffinton’s course was not necessarily to help students decide what career path would be most satisfying but to help them conceive of a more general blueprint by which to live their lives. Stanford University engineering professors Bill Burnett and Dave Evans popularized this work—taking an intentional approach to plotting the future—with their course, “Designing Your Life: How to Build a Well-Lived, Joyful Life.” In “Bucknell-on-Purpose,” students read excerpts and participated in activities from the Palo Alto team’s book by the same name.

“We looked, in particular, at balancing ‘Workview’ and ‘Lifeview’ and asked the students to complete worksheets from the book to better understand and to reconcile their ‘philosophy of work’ and their ‘philosophy of life,’” Buffinton wrote in his report on the class for Bucknell President John Bravman.

Coursework for the Bucknell seminar ventured beyond the “Designing Your Life” curriculum. In the first session, the seniors determined three major themes to guide the class: Discovering the Purpose Within, Exploring Purpose in Others, and Finding Purpose in Community. To explore these areas, they engaged in activities, including using body outlines and post-it notes to map their “external self” (how the outside world views them from surface-level interactions) compared to their “internal self” (more hidden thoughts or elements of who they are); and research and interviews to develop insight into and empathy for the unique experiences and senses of purpose of others. Guest speakers included Rev. Kurt Nelson, director of Religious and Spiritual Life at Bucknell, who talked about finding purpose through communal connection; and President Bravman, who participated in the external/internal mapping exercise. 

“Engaging students in any way that’s not their typical structure is difficult,” Tranquillo said of the course’s variable structure and emphasis on self-exploration. The instructors said they enjoyed allowing students to dictate the material, moving away from putting restrictions on what or how they choose to learn. Students also encountered a space, rare in most classrooms, to focus on better understanding themselves, rather than scholarly concepts. “We have faculty willing to go there [help students through questions of self or identity], but that’s not the point of their courses,” Tranquillo added. He and Buffinton hope similar, less traditionally “academic” forums will become available for not only seniors but all classes in the future.

As for teaching “purpose,” those interested in expanding the work may need to clarify what it entails for not only faculty but students. Some seniors in “Bucknell-on-Purpose” admitted to enrolling for the free dinner or because they already knew a friend or professor involved. “I had zero expectations. Someone I respected told me about it, so I took it,” one student revealed. He ended up getting more than he bargained for. “It surpassed my expectations because I thought I would just kind of learn facts, and it’s actually made me think about the world in a different way.”

The experiential nature of the course helps with understanding and internalizing purpose. One guest speaker asked the seniors, “When you were a child, what did you want to be when you grew up?” One student grew up an aspiring car salesman, with a sister who planned to open a bakery attached to his dealership, but is now pursuing computer engineering to pay off tuition debt. Another was an animal lover whose veterinary dreams ended when she realized she wasn’t interested in dealing with blood but evolved into her current plans to build prosthetics for humans. One young man, David, talked about how his experience as an immigrant from Soweto, South Africa influenced his identity, how he thinks of himself, and what he hopes to do.

“I migrated to the inner cities of the U.S., and the question I always asked myself, growing up in Crenshaw, Los Angeles, was, ‘What would an average Black man who lived in the inner city, what could they see themselves becoming?’” David shared. He described feeling like his parents’ perspective as immigrants prompted him to envision a future outside the neighborhood where he grew up. Their encouragement continues to shape his plans for the future. “I think some form of the idea of stability has always been important to me—the idea of, ‘How do I make sure that if anything were to happen, my family comes first?’”

One of the ways in which the course changed students’ outlooks involved reframing the pressures they’ve internalized around professional success. “I feel like if you don’t have a job post-grad right now, it’s seen as a failure on your part,” Maya, who was also in the seminar, said. “This class really framed it more as a reflection of maybe that you don’t know what you want to do—and that’s okay. It’s okay to be kind of floundering or looking for new opportunities.”

“I think in our society, we correlate purpose with career a lot, and this class has opened up my perspective to show it’s more about the relationships that you make,” Emma, another student, added. “You can make relationships through your career, but other things outside of your career can also relate to purpose.”

While the prospect of graduating remains daunting, this course gave students tools to combat the uncertainty, even after they leave. “It has made me realize that I need to make space for these conversations in the future, regardless of where I am,” Maya said. She envisions herself carving out room for similar discussions when she matriculates to graduate school in the fall.

“I don’t think it needs to be this exact same structure of a class, but I think the idea of ‘Let’s think about things critically when we think about our future and our purpose’ is something I will be able to recreate, and want to, after this course.”

New report on the enduring impact of COVID on the mental wellbeing of emerging adults

Posted on by Gaby Harlid

In a new paper sponsored by the Ruderman Family Foundation, Jeffrey Arnett, PhD, details the disproportionate and enduring impact of COVID-19 on the mental wellbeing of “emerging adults.” Arnett, a senior research scholar at Clark University, is a uniquely appropriate author for the paper, as he coined the term “emerging adults” over 20 years ago to describe young people in their twenties who exist in the “space between adolescence and young adulthood.” Arnett is also the executive director of the Society for the Study of Emerging Adulthood (SSEA), and author of Emerging Adulthood: The Winding Road from the Late Teens Through the Twenties.

In The Mental Health Effects of COVID-19- A Continuing Crisis, Especially for Emerging Adults ages 18-29, Arnett examined national data from before and during the COVID-19 pandemic from sources such as the CDC, the National Center for Health Statistics, the U.S. Bureau of the Census, the National Opinion Research Center, and the Pew Research Center, as well as numerous longitudinal studies from the literature.  His research showed that psychological distress was consistently higher for young adults ages 18-29 than all older age groups from March 2020 to September 2022, despite that group being at lowest risk physically from the disease.

“You would think that it would be the older people who would be the most affected in their mental health, because they were the most at risk for hospitalization and death during the pandemic, and they still are,” said Arnett in a June interview for the Mary Christie Institute’s podcast, the Quadcast. “It’s actually just the opposite. The oldest Americans are the ones who are least likely to report symptoms of anxiety and depression. Meanwhile, the emerging adults, the 18- to 29-year-olds, were the most affected in terms of their mental health.”

While Arnett said he was initially surprised by the data, he posited a few justifications in the report, starting with the outsize influence of the pandemic’s disruption on people in the midst of an intense developmental period.  While life disruptions were not unique to the age group, Arnett said, “from age 18 to 29, you’re trying to build the structure of an adult life. That’s the age where most people are getting the education that’s going to form the basis of a long-term occupation or profession, when people are moving out of their parents’ household, learning how to function as an adult on their own. It’s the age when people are having romantic relationships, thinking about what they want in a partner. And suddenly, all of this is blown up.”

In the report, Arnett pointed out that this population experienced disruptions or changes to the five features distinctive to the emerging adulthood life stage: identity explorations, during which they explore who they are, “trying out various possible futures;” instability, which was greatly exacerbated by the pandemic; self-focus (specifically in relation to parental ties waning), which veered into loneliness when they were cut off from their friends; feeling in between childhood and adulthood, which was extended during this time period; and optimism and high hopes about future possibilities, which were dimmed by the circumstances surrounding the pandemic.

“You would think that it would be older people who would be the most affected in their mental health, because they were the most at risk for hospitalization and death during the pandemic but it’s actually just the opposite.”

But, while there are clear, reasonable causes for the intense reaction to the initial disruption of the pandemic by emerging adults, Arnett said he was mystified that their rates of anxiety and depression have remained so high. In the paper, he noted that the rates of anxiety and depression for emerging adults remained as high in early 2023 as at the peak of the pandemic before vaccines were available–nearly 40% for anxiety disorder and nearly 35% for depression. (In fact, symptoms have remained above pre-pandemic levels for all adult age groups.) That pattern is continuing even now as the pandemic has waned, the report states. “Even after life has returned to normal in most ways, rates of anxiety and depression are nearly as high as they were at the peak of the pandemic. That was shocking,” he said. “Why do people still feel so bad even though life appears to have gone back to normal in so many ways?” he continued.

The report also highlights subgroups of emerging adults that have disproportionately borne the brunt of the pandemic from a mental wellbeing perspective: women and Asian Americans. Even though young women’s rates of depression and anxiety were already higher than young men before the pandemic, the report states, the gap between them has grown since the pandemic began. Arnett noted that this follows a long-standing pattern in mental health research, in which females report worse mental health outcomes across the spectrum. However, he called the widening of the difference “striking.”

Disturbingly, the pandemic triggered a racist backlash against Asian Americans, which may account for their disproportionate worsening of mental health. In addition to higher rates of mental health issues, most Asian Americans also reported believing that violence against their ethnic group is increasing; almost three quarters said they worry sometimes, almost every day, or every day that they might be threatened or attacked due to their ethnicity.

The paper outlines five recommendations for addressing the current mental health crisis and preparing for the next pandemic. Arnett recommends: reforming the mental health delivery system; expanding and improving teletherapy services; creating a website of resources for parents of emerging adults; improving online learning techniques; and holding a national conference of practitioners and policymakers at colleges and universities that examines which policies and programs were effective and which were not. He also recommends further examination into the phenomenon of why these levels of distress are not subsiding for emerging adults, including in-depth qualitative research with the young people themselves. 

“We need to urgently go forward with interviewing people, not just survey data, not just ‘tell me on a scale of one to five how anxious you feel or how depressed you feel,’ but ‘tell me in your own words why you’re still distressed.’”