Caitlin, BC ’11, began to notice familiar feelings of depression and anxiety last semester.
“I hadn’t been in therapy for awhile, but I noticed that symptoms of my depression were getting stronger and it was getting harder and harder to focus on school,” she said.
Tired of waiting for the symptoms to disappear, Caitlin, whose name has been changed by request to protect patient-doctor confidentiality, stopped by the Rosemary Furman Counseling Center on the first floor of Barnard’s Hewitt Hall in February and scheduled an appointment. She has followed up with weekly visits since then.
“It has definitely helped me cope on a weekly basis,” she said.
Each year, about a quarter of Barnard’s student population visits Furman for help with issues ranging from depression to relationship and family problems to self-esteem and body image concerns. Meanwhile, across Broadway, about 16 percent of undergraduate and graduate students at Columbia visit the Counseling & Psychological Services (CPS) offices in Lerner Hall. Many students who seek counseling for the first time are uncertain about what to expect, and administrators at CPS and Furman are working to address whatever concerns these students may have.
“My experience has been really good,” Kendra Moore, CC ’09, said of the therapy she has received at CPS. “They’re extremely accommodating.”
Both CPS and Furman have procedures in place to match students with the appropriate counselors and to allow students to switch to a different counselor if they are unhappy with their initial experience.
“When you make an appointment with CPS, they do a phone appointment first, and that’s the way they match you up with the right person, which I think is really effective,” Moore said. “They do try to put you with someone who deals routinely with what you’re going through.”
“There is a lot of personal chemistry involved in the counseling process,” Richard Eichler, CPS director and executive director of Health Services said. “We pride ourselves on having a staff that is diverse in every way imaginable, from their approach to their age to their ethnicity, gender, sexual orientation—and that’s not by accident, because we understand that different students will do better with different kinds of therapists.”
Eichler urged students unhappy with their therapists to speak up.
“If you don’t like your therapist, you can always change. If you don’t like your second therapist, you can also change,” he said. “I don’t know if we’re always as aggressive as we should be in making sure students know that.”
As with any campus service, there are some complaints and concerns among students.
Jennifer, BC ’11, whose name has been changed by request to protect patient-doctor confidentiality, reported that on her first visit to Furman in February 2008, she was taken and admitted to St. Luke’s Hospital.
She said that while she had been experiencing some suicidal thoughts at the time, she had no intention of carrying them out.
“We talked about how I was feeling, which was very depressed at the time,” she said. “I had been having suicidal thoughts, but I was not suicidal, if that makes sense.”
After about an hour, she said, her counselor suggested that they go to St. Luke’s to obtain an emergency prescription for antidepressants, and Jennifer agreed.
While she was told there was a chance she would be admitted for observation, she did not realize she would be hospitalized. “I assumed I would discuss that possibility with a doctor there,” she said. Instead, she continued, “It was, you’re walking in to be admitted.”
Jennifer was hospitalized for two days and was not allowed to return to classes or campus housing until a committee had cleared her to do so, she said. Her student insurance covered $1,000 of the cost of her hospitalization, but her parents were billed for an additional $3,000. Because of doctor-patient confidentiality, Furman cannot comment on individual cases.
However, officials at both CPS and Furman emphasized that compulsory admission of students can occur only under exceptionally severe circumstances and that it rarely actually happens.
“If a student can’t keep herself safe or if she poses a risk to others, those are signs when we talk to them about being evaluated over there [St. Luke’s], and quite often they are agreeable,” Mary Commerford, director of Counseling Services, said. “In the six years I’ve been here, we’ve never had a student say no, she wouldn’t go.”
Involuntary hospitalization “is very rare in part because if you’re in a counseling center and seeing someone, you’ve chosen to be seen,” Eichler said. “People want help, but that doesn’t mean they’re not ambivalent about the help they want.”
In the rare situations in which students are hospitalized, “it is overwhelmingly because students have given us consent to,” Eichler said. “I understand that when students tell the story to other students, they may not want to tell it that way. Sometimes the stories are told a little differently than they actually transpire.”
Another common concern among students is the short-term model on which CPS and Furman operate, which means that students who need long-term counseling may be referred to resources outside the college after 10 visits, although this is not an absolute limit.
“There is a protocol for being referred out, but 10 sessions is an urban myth,” Eichler said. “We, like college counseling centers nationwide, are time-limited. There’s also not much point in duplicating services that are available to students off-campus. So we’ll refer a certain number of students who need longer-term, specialized services, and the expectation is that the services will be briefer here, but there’s not a limit.”
Eichler said that students tend to need either a few sessions or much longer and more intense treatment. “Students can accomplish what they want in a relatively circumscribed period, or else they need very intense treatment, so it tends not to be, ‘You need eight more visits,’” he said. Referrals made through CPS or Furman are often made to services with sliding-scale fees.
After a student has been referred out, “We often set up an appointment afterward with that student to see how it went,” said Calvin Chin, associate director of outreach and community clinical services at CPS.
Some students said that they find the short-term nature of these services less than ideal. Seeking outside resources often involves informing parents in order to get insurance coverage, and using mental health resources can be challenging enough even on campus where it’s convenient. Most, however, said that they understood its necessity given the high demand for and limited resources of campus counseling services.
The limit is “not policy so much as what makes clinical sense,” Commerford said. “If somebody comes in and they have a diagnosis of bipolar disorder, that’s a chronic thing, and they’re going to need treatment in an ongoing way.”
“If someone comes in presenting an issue that’s clearly long-term ... we will try to persuade that person to accept a referral straight out,” she added. This “makes clinical sense rather than if they start with us and open up and get attached.”
“One needs to look outside Furman and look at more long-term options in order to benefit from the therapy,” Caitlin said. She rated her experience at Furman a seven out of 10.
Moore encouraged students to take advantage of the resources available to them no matter what the severity of the issue.
“You’re getting this treatment for free from the school,” Moore said. “Why not keep going and make sure that everything is all fine?”