COUNSELLING IN HIGHER EDUCATION
All but two universities have counselling services as do the vast majority of Colleges of Higher Education. The total (including full and part time) student: counsellor ratio in the higher education sector (both colleges and universities) is about 4650: 1. In HE Colleges the average ratio is one FTE counsellor per 2500 FTE students: in universities the ratio is higher and the average is one FTE counsellor for about 3500 FTE students (AUCC 2001).
Information on requirements and guidance for good practice can be found in BACP’s Ethical Framework for Good Practice in Counselling and Psychotherapy (BACP 2002) and AUCC’s Guidelines for University and College Counselling Services (BAC 1998).
(There are some counsellors in HE who are not members of BACP; they would subscribe to the Codes of Ethics of other professional bodies such as BPS, UKCP or BCP.) There is a comparatively new AUCC Counselling Service Assessment and Recognition Scheme, details of which can be found on the HUCS website. The scheme is too new for many services to have been through the process yet but the documentation gives some indication of current thinking about acceptable levels of provision and practice.
There are many broad similarities between counselling services in different HEIs as well as some local variations. Similarities are in requirements for training, qualifications and supervision, in the reliance on a therapeutic (not an advice and guidance) approach, in the adoption of theoretical models which are systemic and developmental in emphasis and in involvement with the educational context. There are also some differences - in levels of funding, in staff experience, expertise and training, in theoretical orientation and in the emphasis on different aspects of the work.
Counsellor qualifications.
Recent feedback from the HUCS mailbase indicates that the vast majority of university counsellors are graduates, many with higher degrees, trained in counselling and/or psychotherapy and with a substantial amount of post qualification experience. Counselling tends to be a second or even third occupation and it is common for counsellors to have extensive experience in other relevant fields before training in counselling; common backgrounds include lecturing and teaching, psychology, social work and nursing. Some services employ clinical psychologists and cognitive therapists; many have psychotherapists.
Regular and ongoing clinical supervision with a more experienced practitioner in a related field is a requirement for all BACP members who are practising counsellors (BACP 2002). Continuing professional development is seen as necessary for maintaining competent practice (BACP 2002). BACP offers its members a scheme for further voluntary self regulation through accreditation with BACP and registration with the UKRC. Some university counsellors are registered with BPS, UKCP or BCP. The most recent AUCC survey (AUCC 2001) reports 75% of HE counsellors as accredited/registered, 51% of those in new universities and 68% of those in old.
(There have been questions about accreditation and why not all counsellors are accredited. Accreditation is not a qualification but an additional undertaking, one that is not yet a statutory requirement. Some counsellors may still be acquiring the necessary post qualification experience while others who are eligible may have other CPD priorities.)
What clinical work is undertaken ?
Most counselling is of individuals although many services offer group counselling as well. Work currently undertaken in counselling services is very varied. All HE counselling services offer what one NHS document defines as counselling: ‘ a systematic process which gives individuals the opportunity to explore, discover and clarify ways of living more resourcefully, with a greater sense of wellbeing. -- concerned with addressing and resolving specific problems, making decisions, coping with crises, working through conflict or improving relationships with others’ (Department of Health 2001) but many also offer what the NHS might be more likely to define as psychological therapy.
All services attend to the pressures on their clients caused by the demands of the student role; they are aware of the therapeutic possibilities of harnessing work on the issues thrown up by the educational context with young people’s maturational drives in order to promote development. A range of interventions is offered: from short-term focused work – perhaps to deal with a crisis, life event or current conflict - to the exploration of more complex developmental issues and therapy for deeper seated and longstanding emotional and psychological problems.
Depression is by far the most prevalent presenting issue in all HEIs (38% of new clients in new universities, 49% of clients in old universities) with figures for anxiety also high (23% in universities). About 5% report self-harm in every kind of institution; 6-10% report suicidal ideation; 2-5% drug or alcohol misuse. About 6% of university clients reported anorexia or bulimia (AUCC 2001).
The majority of counselling in universities and HE colleges is short term (the
average number of sessions in HEIs is 4.5) although this does not necessarily imply the issues dealt with are simple and easily resolvable. A number of factors may contribute: services operate an open door policy; HE counsellors have developed their consultation and brief work skills; adolescents tend to be wary of prolonged dependency. However there has been an increase in the proportion of student clients in longer term counselling in HE Colleges and new universities. Overall 13% of clients had between 8-15 sessions and 7% had 16+ (AUCC 2001). This shift may suggest that there has been an increase in the complexity of the issues students are bringing for counselling. The proportion of clients with difficulties rated by counsellors as ‘severe’ has increased in HE colleges and new universities (AUCC 2001). While a number of services have staff appropriately trained and experienced to offer longer term/specialised help, few have the resources to offer these interventions to all students who might benefit.A recent HUCS survey suggested a variety of approaches to students with more severe difficulties. In response to the question ‘How does your service see its role in relation to severe mental health problems?’ the following answers were received from university services (multiple responses were permitted):
No work 9%
Emergency sessions 49
%Short term or occasional supportive work 73%
Long term supportive work 49
%Remedial therapy in conjunction with medical treatment 51%
Other 18%
The differences indicate differences in resourcing, expertise and philosophy.
No service would undertake the diagnosis or treatment of severe mental illness but all would consider it important to be sufficiently well informed to recognise the various forms of mental illness and to know when referral to psychiatric services is necessary.
Many services seek feedback by inviting all completing clients to give a written evaluation of the service they have received and the impact that counselling has had on them. Some services use the CORE evaluation system as a way of measuring the effectiveness of their work.
(The working party raised the question of why students might be reluctant to use counselling services. There are a number of possible explanations:
Services aim to reach those reluctant to use personal counselling by training other staff and students in helping skills and by ensuring there is a spectrum of support and information available by the provision of - for example- preventative sessions on study and examination anxiety, material on websites.)
Links with other professionals.
The establishment of links with local medical and psychiatric services for consultation and referral is seen as an essential part of the work of a counselling service in an institution of higher education. (AUCC 1998). Counsellors value ease of access to medical and psychiatric opinion, consider it important to familiarise themselves with local NHS and voluntary services and essential to refer those for whom counselling is not appropriate or sufficient alone.
Most services have some contact with local community mental health teams (HUCS 2002). A number of services have a part time psychiatrist either on their team or as a consultant. Counsellors tend to discuss more cases with psychiatrists than they refer for assessment or treatment.
About half of university counselling service respondents to a HUCS survey were able to access on campus psychiatric assessment for their students while one third had access to on campus psychiatric treatment. 62% of university counselling services reported themselves as broadly satisfied with existing arrangements for psychiatric support.
Counsellors often work in conjunction with their university’s health centre doctors and nurses when dealing with students with, for example, severe depression, eating disorders, self harming behaviour.
Some counselling services operate within student services frameworks but all services would, when appropriate, liaise with academic and halls staff, chaplains, student unions and other student support services and would be involved with them in a number of policy making and training activities.
What institutional work is undertaken?
All university counselling services see their responsibilities as wider than the provision of clinical work. The majority (86%) offer training in mental health issues to other staff (HUCS 2002) and many (58%) to students. More training is being offered as part of institutions’ response to the CVCP Guidelines. All university counselling services are available for consultation to staff concerned about students’ well being and many are represented on relevant committees and working parties.
References and Further Information
A good place to start is the Heads of University Counselling Services website – http://www.hucs.org/ . where one can find, inter alia, the text of Degrees of Disturbance, information about the AUCC Service Recognition Scheme and the forthcoming HUCS conference – Beautiful Minds? – Students, Mental Health and the University and links to the websites of individual University Counselling Services and other relevant organisations in education and mental health.
AUCC (1998) Guidelines for University and College Counselling Services, Rugby: BAC
AUCC (2001) Annual Survey of Counselling in Further and Higher Education 1999-00, Rugby: AUCC
BACP (2002) Ethical Framework for Good Practice in Counselling and Psychotherapy, Rugby: BACP
Bell, E. (1996) Counselling in Further and Higher Education, Buckingham: Open University Press
Bell, E. (1997) ‘Counselling in Higher Education’ in S.Palmer (ed) Handbook of Counselling, Rugby: BAC
Department of Health (2001) Treatment Choice in Psychological Therapies and Counselling, London, Department of Health
HUCS (2002) Survey on Medical, Psychiatric and Counselling Provision in HE, www.hucs.org
Lees, J. and Vaspe, A.(eds) (1999) Clinical Counselling in Further and Higher Education, London: Routledge
Rana, R. (2000) Counselling Students, London: McMillan
Smith, E. (ed) (1997) Integrity and Change: Mental Health in the Marketplace, London: Routledge
Eileen Smith 26/4/2002
Acronyms
AUCC: Association for University and College Counselling (This is a division of BACP)
BACP: British Association for Counselling and Psychotherapy
BCP: British Confederation of Psychotherapists
BPS: British Psychological Society
CORE: Clinical Outcome Routine Evaluation
CPD: Continuing Professional Development
CVCP: Committee of Vice-Chancellors and Principals, now renamed UniversitiesUK
FTE: Full-time equivalent
HE: Higher Education
HEI: Higher Education Institution (Includes universities and colleges of Higher Education)
HUCS: Heads of University Counselling Services (This is a special interest group of AUCC)
UKCP: United Kingdom Council for Psychotherapy
UKRC: United Kingdom Register of Counsellors