Counseling a Student Presenting Borderline Personality Disorder in the Small College Context: Case Study and Implications

This case study examines the dynamics and challenges associated with counseling a client experiencing borderline personality disorder in the small college institutional context. The work of counseling centers at small private institutions has been relatively unexplored in the extant college counseling literature. To help fill this gap, the current case study explores a counselor's work with a student at a private, Catholic women's college. ********** The purpose of this case study is to examine and illustrate two unique challenges sometimes facing college counseling professionals: working within the small college institutional context and providing services for clients who fall into the special population of students with severe concerns such as borderline personality disorder. We not only examine the client's diagnosis and response to treatment but also review the community's response. We offer suggestions for ways in which small colleges and counseling services can work together to address intervention and provide support. Small College Institutional Context Early on, May (1988) emphasized the influence that a higher educational institution has on its campus counseling center. According to May, a counseling center's mission, roles, professional practices, boundaries, and constraints all are influenced by its institutional context. However, little has been published specifically examining the influences of the small college institutional context on counselors. In other words, substantial literature does not yet exist that focuses narrowly on the unique work experiences of counseling professionals at small colleges. For example, Thomas (2000) discussed the special professional challenges experienced by counseling centers at small colleges with smaller staffs; however, campus counseling services with fewer staff members exist at 2- and 4-year colleges and universities of all sizes, not just at small institutions. We believe this conversation is important because, on the basis of our experiences, a small college's constituencies (e.g., students, clients, parents, administrators) tend to differ somewhat from their counterparts at larger institutions and therefore present unique challenges for counselors. First, we have found that for students, the college experience at small private institutions is notably different from that at the large university experience. Specifically, being part of a far smaller and more intimate population, receiving greater personal attention, having more opportunities for relationship building, and expecting higher staff member involvement set unique environmental conditions. For residential students on campuses of small colleges, a close-knit, familylike atmosphere is often established Our experience has been that some students thrive especially well in this interpersonally close environment; on the other hand, some students encounter unexpected difficulties related to the close proximity to peers, higher scrutiny from others in their community, and lack of opportunity for anonymity or privacy. That is, some students thrive in this intimate relational context, whereas others experience this atmosphere negatively or ambivalently; some students will have positive adjustment experiences, whereas others may face negative consequences. In particular, students with social difficulties and psychological concerns seem to have a mixture of experiences. On one hand, the increased attention and more personalized experiences of the small college provide greater support, more responsive services, and other benefits that often promote adjustment, retention, and success. On the other hand, because of the smaller population size and greater community intimacy of the small campus, students' behavioral problems and manifestations of psychological distress have a potentially greater negative effect on the college interpersonal environment than they might elsewhere, such as in a large, public university setting. …