The Impact of Prior Counseling on Predictors of College Counseling Center Use

Path analyses revealed that one's tendency to conceal distressing information, social support, psychological distress, and attitudes toward seeking help predicted intended use of counseling services for college students who had and had not previously been in counseling, Prospective analyses revealed that attitudes toward seeking help predicted actual use of the campus counseling center. These findings have implications for campus outreach programs and in-session work with clients. ********** Counselors working in university settings have long been aware that only a minority of students who experience psychological distress actually seek professional help (Clary & Fristad, 1987; Kushner & Sher, 1989). The literature suggests that the students most likely to use counseling services are the ones who are experiencing some degree of psychological distress (Halgin, Weaver, Edell, & Spencer, 1987), lack adequate social support (Rickwood & Braithwaite, 1994), and hold positive attitudes toward seeking help (Clary & Fristad, 1987; Deane & Todd, 1996). There are individual difference variables that represent barriers to seeking help. Individuals who tend to conceal distressing information from others may be reluctant to seek professional help because they anticipate the level of disclosure required in counseling to be aversive (Kelly & Achter, 1995). Among college students, a willingness to self-disclose to a counselor has been found in some studies to be positively associated with a willingness to actually go to a counselor (Hinson & Swanson, 1993). However, not all research has found this link between low concealment and help seeking. Using a self-report measure of concealment, Kelly and Achter (1995, Study 1) found that college students who tended to conceal personal information reported being more likely to seek counseling than students who did not regularly conceal information, and Cepeda-Benito and Short (1998) did not detect any difference in the intended likelihood of seeking counseling between those who tended to conceal personal information and those who did not. The relationship between a student's tendency to conceal distressing personal information and tendency to seek help is not necessarily straightforward. Cramer (1999) suggested that concealment tendencies have an indirect effect on help seeking through social support, psychological distress, and attitudes toward seeking help. Specifically, individuals who typically conceal distressing information do not develop strong social support networks, and this combination of concealment tendencies and low social support leads them to experience higher levels of distress. Higher levels of distress, in turn, lead to a greater likelihood of seeking counseling. Concealment tendencies also influence help seeking through one's attitudes toward seeking help. In particular, individuals who tend to conceal personal information have more negative attitudes toward seeking help, and these negative attitudes inhibit help seeking. Thus, students who conceal distressing information are drawn to counseling because of their weak social support and high levels of distress, but they are also repelled by counseling because of their negative attitudes toward seeking help. Cramer's model fits Kelly and Achter's (1995) and Cepeda-Benito and Short's (1998) data, suggesting that the relationship between concealment tendencies and help seeking is too complex to examine without accounting for students' levels of social support, psychological distress, and attitudes toward seeking help. Cramer's (1999) model may help practitioners understand processes that lead individuals to seek counseling, but two questions remain. First, students who have been in counseling at some time in the past would likely have different expectations about counseling than do students who have never been in counseling, and the process of deciding to seek professional help may therefore be based on different factors for these two groups of students. …