Empirically Supporting the Increasing Severity of College Counseling Center Client Problems: Why Is It So Challenging?

Since the late 1980s, college counselors have reported seeing increasing numbers of students who present with severe forms of emotional and psychological disturbance. However, little direct evidence has yet to demonstrate any trend in the level of severity of presenting problems. In this article, the authors explore methodological challenges for researchers who attempt to examine the question of increasing severity of client problems. Implications for college counseling centers are discussed. ********** Growing concern about the prevalence of mental health problems among today's college students has been the subject of attention in national media (Kirn, 2003; Shea, 2002; Young, 2002) as have high profile cases of college student suicide (Sontag, 2002; Tavernise, 2003). Concern about the impact of student mental health problems on college campuses has even led to legislative action. The Campus Care and Counseling Act (2003, 2004) was introduced in the U.S. House of Representatives (H.R. 3593) and in the U.S. Senate (S. 2215) to amend the Higher Education Act in order to include a program to support college campuses that provide mental health services to students. The bill was subsequently incorporated into the Garrett Lee Smith Memorial Act ([H.R. 4799] 2004a, [S. 2634] 2004b), which was recently signed into law by President Bush. Funds were appropriated by Congress for 2005 authorizing competitive grants for colleges to strengthen or increase student access to mental health services. Is all of this concern justified? Have the mental health problems of college students become increasingly more severe over the past 2 decades? Results from Gallagher's national surveys of counseling center directors over the past several years, including the most recent one (Gallagher, 2003), suggest that most college counseling center practitioners would probably answer yes to these questions. For many years now, college counselors have contended that they are seeing growing numbers of students presenting with problems of a much more severe nature than traditional developmental or adjustment struggles. Severe problems have been defined as ones that cause significant disruption to a student's ability to function within the college environment or require mental health care beyond the capacity of the average campus counseling service (Sharkin, 1997, 2004). It is interesting that college counselors' claims of increasing client problem severity have not been supported by research. Sharkin (1997) previously noted this in a review of the research available at that time. According to Sharkin (1997), a primary reason that research failed to demonstrate a trend in the severity of presenting problems was because of methodological limitations. For example, previous studies did not always clearly define psychopathology or differentiate normal (developmental) problems from more severe problems. Since Sharkin's (1997) review, three studies have examined the trend of increasing severity of student problems. Findings from two of the studies (Cornish, Kominars, Riva, McIntosh, & Henderson, 2000; Pledge, Lapan, Heppner, Kivlighan, & Roehlke, 1998) did not provide any empirical support for the purported trend. Findings from a more recent large-scale study (Benton, Robertson, Tseng, Newton, & Benton, 2003) were believed, by many, to provide support for the trend, but this conclusion has been challenged due to methodological shortcomings (Sharkin, 2004). How do we understand this failure to empirically establish a trend reported for several years now by college counselors? It seems unlikely that the reported trend is simply based on distortions or misperceptions, given the large numbers of college counselors who seem to hold the perception of increasing severity. As counseling center practitioners with many years of college counseling experience between us, we too believe that increasing numbers of students have been presenting with more serious problems than in the past. …