Investigation of Clinically Significant Change by Severity Level in College Counseling Center Clients.

The authors investigated the number of sessions necessary for college counseling center clients of different levels of severity of distress at intake to achieve clinically significant change (CS) in therapy. The Outcome Questionnaire-45 (M. J. Lambert, N. B. Hansen, et al., 1996) was used to categorize 914 clients by severity of distress. Analyses of outcome indicated that clients with less and more severe distress needed 14 and 20 sessions, respectively, for 50% in each group to achieve CS. Implications are discussed. ********** In recent years, increasing attention has been focused on the severity of mental health issues among college students (Benton, Robertson, Tseng, Newton, & Benton, 2003; Erickson Cornish, Riva, Cox Henderson, Kominars, & McIntosh, 2000; Pledge, Lapan, Heppner, Kivlighan, & Roehlke, 1998). As a result, college counseling centers (CCCs) are searching for ways in which they can effectively address the changing needs of students in college and university settings. Recent events on campus, current studies about college students (Benton et al., 2003), and latest reports from CCC directors (Gallagher, Gill, & Sysco, 2000; Goode, 2003; Guinee & Ness, 2000; O'Connor, 2001; Young, 2003) suggest that CCCs are seeing more students with more severe mental health issues than ever before. Benton and colleagues (2003) examined the client problems of 13,257 college students who sought services at one CCC over a 13-year period. They reviewed each client's closing record, as reported by the closing therapist, and found that between 1988 and 2001, there were increases in 14 of 19 client problem areas recognized by the in-house Case Descriptor List (CDL), which measures the therapists' viewpoints of client developmental and relational problems as well as more severe issues. The CDL is a clinician report measure completed following the ending of treatment with a client. Guinee and Ness (2000) surveyed 62 counseling center directors, and 62.9% reported that the percentage of students seeking services had increased. Finally, in a poll of 283 schools for the National Survey of Counseling Center Directors (Gallagher et al., 2000), 17% of clients were reported to be using psychiatric medications, an increase from 9% in 1994. Others suggest that the increase in pathology may be related to a change in the student body. Rudd (2004) pointed out that there has been a vast increase in the overall numbers of young adults attending colleges and universities. Black and Sufi (2002) reported that the number of students from lower socioeconomic status attending colleges and universities is increasing as well. These trends support Rudd's suggestion that CCCs are in the process of becoming more like community mental health centers by having clients with "more severe pathology, marked comorbidity (both Axis I and II) and problems that require ongoing and longer term care" (p. 316). However, although students are presenting to CCCs with more significant pathology (Benton et al., 2003), many CCCs have implemented session limits (Stone & McMichael, 1996). It seems imperative to assess and improve client care in light of recent lawsuits directed at counseling centers and the level of accountability to which some CCCs are being held (e.g., lawsuits against the universities in the suicides of students at the University of Iowa, the Massachusetts Institute of Technology, and Ferrum College in Virginia). A review of the literature indicates that there is no research or discussion on why session limits are being implemented at CCCs (Stone & McMichael, 1996), what the limits should be, and how much psychotherapy is sufficient (Snell, Mallinckrodt, Hill, & Lambert, 2001). It is likely that session limits have been implemented at CCCs for a variety of reasons. First, it is most likely that session limits have emerged in order to meet the growing demand for mental health services (Stone & McMichael, 1996). …