Distressed and Distressing Students
Working With Students With Psychological Disorders,
Learning Disabilities and Medical Problems
Dan Jones Ph.D., ABPP
Faculty & Staff as Helping Resources
• Faculty & staff members at ETSU have the
unique opportunity of having ongoing, direct
contact with students and can identify
students who are struggling.
• To support your efforts, here are helpful
practical tips about assisting students most
effectively and referring them to other helpers
when needed.
What to Look For
• Marked changes in academic/personal
performance or behavior.
• Unusual behavior or appearance.
• References to suicide, homicide or death.
Marked Changes in
Performance or Behavior
• You find you’re spending more time with the
student doing “counseling” rather than advising.
• Marked decrease in performance and/or
preparation
• Withdrawal from others
• Excessive absence or tardiness
• Repeated requests for special consideration
• Excessively anxious when called upon in class
Marked Changes in
Performance or Behavior
(continued)
• Dominates or avoids discussion
• Disruptive behavior
• Problems with roommates or family
• Exaggerated emotional response inappropriate
to the situation
Unusual Behavior or Appearance
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Depressed or lethargic mood
Marked increase or decrease in activity
Outbursts of anger
Unexplained crying
Conversations that do not make sense
Marked decline in personal hygiene
Unusual Behavior or Appearance
(continued)
• Dramatic weight loss or gain
• Coming to class or events intoxicated or
high/smelling of alcohol or drugs
• Difficulty concentrating
References to Suicide or Homicide
• If a student talks or writes about suicide or
homicide ALWAYS take it seriously.
• Overt references to suicide
• Expressed thoughts of hopelessness or
helplessness
• Expressed plan for suicide/homicide
• Isolation from friends and family
• Giving away possessions
What Can You Do?
• If you talk with a student you are concerned
about, or if a student approaches you directly for
help…
 Talk
 Listen
 Communicate
 Give Hope
 Maintain Boundaries
 Refer
TALK
• Talk to the student in private when both of you
have time and are not rushed or preoccupied
• Give the student your undivided attention. Often
a few minutes of effective listening may be
enough to help the student feel cared about and
more confident about what to do
• If you feel anxious, keep your door open or meet
the student in a public place
LISTEN
• Listen to the student’s thoughts and feelings in a
non-threatening way
• If you have initiated the contact, express your
concerns in behavioral, non-judgmental terms.
For example “I’ve noticed you’ve been absent
from class over the last two weeks and I’m
concerned,” rather than “You keep skipping
class. You’re going to fail if you don’t watch it.”
COMMUNICATE
• Let the student talk. Your job is to listen.
• Communicate understanding by repeating back
the essence of what the student told you.
• Try to include both content and feeling for
example “It sounds like you haven’t made new
friends since you’ve been here and you’re
feeling lonely and worried.”
GIVE HOPE
• Assure the student that things can get better.
• It’s important to help them realize there are
options and things won’t always seem hopeless.
• Suggest resources: family, friends, clergy or
professionals on campus.
MAINTAIN BOUNDARIES
• Maintain clear and consistent boundaries and
expectations. You are the professor/advisor/etc.,
not their counselor, parent or friend.
• It is important to maintain the professional nature
of the staff/student relationship and the
consistency of academic and other expectations,
such as exam schedules, etc. If the student
cannot maintain these expectations, they should
look at options such as withdrawing from the
course, taking an incomplete, etc.
REFER
Refer to other resources, such as Personal
Counseling, when…
• The student asks for assistance with a problem
that is outside your range of knowledge
• You are very busy and don’t have the time to
give the student the time they need
• The problem is more serious than you feel
comfortable handling
REFER
(continued)
• Helping the student would compromise your
relationship, e.g., asking for money, a place to
live or your home number to call in a crisis
• The support you’ve already provided doesn’t
seem to be enough
• You feel overwhelmed, overly responsible for
or worried about the student’s safety
REFER
(continued)
• You think your personal feelings about the
student will interfere with your objectivity
• The student admits there’s a problem but
doesn’t want to talk about it
• The student is disrupting others
Referring to the Counseling Center
• Approach the student you are concerned about in a
gentle, caring, and non-judgmental way.
• State specifically why you are concerned. Describe
behaviors, then suggest a visit to the Counseling Center.
• Normalize the process of seeking help.
• When referring students to Counseling Services, suggest
it as a possible resource rather than telling a student to
go because he or she “needs help” or is “causing
problems” for others.
Referring to the Counseling Center
• Present the Counseling Center as a resource
used by hundreds of students a year.
• Receiving counseling can be like “taking a
course in yourself.”
• Remind students that they don’t have to have a
“deep dark” problem nor does the problem need
to reach crisis proportions for them to benefit
from professional help. We’d rather have
someone come in with a small problem than wait
for it to become a big one.
Referring to the Counseling Center
• Reluctant students might also be relieved to
know that they can just come in for Walk-in and
speak to a counselor on a one-time basis
without making a commitment to ongoing
therapy.
• If you want to offer extra support, you can have
the student call the Counseling Center from your
room or office, and/or you can offer to
accompany the student to his or her first
session.
Referring to the Counseling Center
• Remind the student that the services are free
and the same service in the private sector can
cost between $75 and $125 per hour.
• Inform the student that Counseling Center staff
try to help people help themselves.
• Remember that many students will feel
ambivalent about seeking help from any source
including the Counseling Center. You may need
to remind them that, “What you’re doing to solve
your problems isn’t working.”
Referring to the Counseling Center
• The ambivalence can often be characterized by
statements such as, “I don’t want to go there because
my problem isn’t that serious.” Or, “I don’t want to go
there because I think my problems are too serious and
they can’t help me.” In either of the two preceding
cases, the person you are trying to refer may be fearful
of the unknown. A direct response to such objections
can sometimes be helpful. “If your problem is not
appropriate for the Counseling Center, they can make
sure that you are directed to the right place.”
Guilt Inducing Students
• In addition to teaching our students the
humanities, math and science we must
also help students to develop a sense of
personal responsibility.
• Holding people responsible is constructive
helping and empowering instead of
enabling and rescuing.
Guilt Inducing Students
• Negative enabling stops the student from
experiencing the consequences of his or
her behavior.
• Some ways in which we “enable”.
 Carrying incompletes for more than one semester
 Allowing excessive absences
 Inflating grades
Guilt Inducing Students
• Some ways in which we “enable”.
(continued)
 Allowing students to frequently hand in papers or
take tests late
 Not clearly stating problems for fear of upsetting
someone.
 Allowing students to circumvent appropriate
channels for problem resolution
Guilt Inducing Students
• We in the Counseling Center, usually
believe that suffering the natural
consequences of one’s actions is at times
the most therapeutic thing that can happen
to a student.
Guilt Inducing Students
• Most of us in the health, counseling and
student development fields went into this
work because we like to help others.
Unfortunately, some of our efforts that
come out of kindness, compassion and a
desire to give people what they want may
in the long run cause more harm than
good.
Guilt Inducing Students
• Researchers have found that holding
people responsible for their actions with
appropriate sanctions is important in
treating and managing impulsive
individuals.
Guilt Inducing Students
• Some students have little perspective
about future consequences of their
behavior and consider what happened in
the past to be irrelevant. Only what is
happening now matters. And what does
happen is often viewed as someone else’s
fault.
Guilt Inducing Students
• Impulsive students view themselves as
victims who demand satisfaction, thus they
lash out at resident assistants and
university officials feeling they should be
able to do anything they want.
Guilt Inducing Students
• “Do” is the key word since their actions
often bring impulsive students to the
attention of university officials.
• Therefore, to understand these students
staff must focus on what they do, NOT
what they say. Rely more on observations
of behavior than on explanations or
promises.
Guilt Inducing Students
• When we try to hold impulsive students
accountable they will often accuse us of
being unfair, rigid, insensitive and uncaring
– accusations that trouble most of us.
• Impulsive students often try to shift the
focus from their behavior to legalistic
issues.
Guilt Inducing Students
• They will often promise to change as
another strategy asking for leniency
promising to change if “given a chance”.
• Increased degrees of freedom and
responsibility should be based upon the
demonstration of a consistent pattern of
behavior not upon promise of change.
Guilt Inducing Students
• What happens when university
representatives reduce sanctions due to
impulsive students’ explanations? Each
successful manipulation reinforces the
student’s belief that the goal should be more
skillful manipulation rather than personal
change. These students may try to reduce
or eliminate sanctions as just another game.
Guilt Inducing Students
• Sometimes university representatives
reinforce denial by sending students to a
counselor without imposing other
sanctions.
Guilt Inducing Students
• Counseling intake imposed as a sanction
is sometimes viewed by impulsive
students as them having succeeded in a
con game; their actions have no
consequences because they need only to
go through the motions at the counseling
center.
Guilt Inducing Students
• Students may say, “How would you like to
be forced to do this?” Staff often feel they
should not sanction a student because
they would not want to be sanctioned.
They would not be going by the golden
rule and would feel unfair and mean.
• The students underlying message is if you
were nice your wouldn’t sanction me.
Guilt Inducing Students
• Staff members have not hurt anyone the
student has. Such students hurt themselves
or others by their actions, which is why they
go before the judicial board. By trying to
make the staff feel guilty they avoid feeling
guilty themselves over the way they treat
themselves or others. Staff members
impose limits not to hurt those students but
to stop them from hurting others.
Guilt Inducing Students
• Other students say, “I’ve been through so
much lately”. My grandmother died this
year, my girlfriend broke up with me and
my goldfish died. You are making me
suffer even more.
Guilt Inducing Students
• Staff members have done nothing. The
student has. Disruptive students put
themselves through the judicial process for
doing something disruptive, then try to
reverse the responsibility.
Guilt Inducing Students
• Staff are not responsible for the actions of
impulsive students; the students are
saying “Don’t hold me accountable given
my mental conflict.” Staff members often
feel guilty sanctioning people with
emotional problems believing they aren’t
responsible for their actions or that their
illness is.
Guilt Inducing Students
• Setting sanctions and limits is a caring act.
The firm adherence to sanctions is the
single most important therapeutic strategy
for impulsive students.
Manipulative or Time
Demanding Students
• Will tell you how wonderful you are.
• Will induce guilt when you let them know you
can’t be available when they want you.
• They tell you that no one understands them
like you do. They don’t want to talk about their
problems with anyone but you and perhaps
others in their circle of support.
Manipulative or Time
Demanding Students
• Some such individuals will have a history of mental
health treatment and will tell you of the many
mental health professionals that have let them
down or treated them poorly. Ask yourself, are
most counselors, therapists, and psychologists
really that bad and uncaring?
Manipulative or Time
Demanding Students
• You may find that the student has gone through
a succession of roommates, hall mates, R.A.’s,
coaches, or teachers, etc., frustrating the best
efforts of each to help the student feel better or
solve problems, and requiring on-going and
expanding amounts of time and energy.
Manipulative or Time
Demanding Students
• They tend to view people or situations as good
or bad with all or nothing thinking.
• The utmost time and energy given these
students will not be enough. They can be like a
bottomless well.
• They often seek to control your time and
unconsciously believe that the amount of time
received is a reflection of their worth.
• Can have broad shifts in moods and emotions.
Manipulative or Time
Demanding Students
• Often engage in impulsive behaviors (e.g.,
spending, sex, substance abuse, binge eating,
self-mutilation, etc.)
• Will often hint at being suicidal without making a
direct threat.
• Often create conflict between others. (Lets you
and him fight.)
Manipulative or Time
Demanding Students
• May have a new crisis (“crisis du jour”) almost
daily or weekly (e.g., roommate conflict,
romantic relationship breakup, conflict with
parents, etc.)
Don’t let them use you as their only source of
support.
The ETSU Counseling Center
• The ETSU Counseling Center (439-4841)
only serves STUDENTS
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Individual and couples counseling
Psychiatry
Crisis response
Preventative psycho-educational programming
Case management
Career exploration
Current Mental Health Realities
on College Campuses
• Suicide is the 3rd leading cause of death
among adolescents and the 2nd among
college students
• Approximately 1100 college students die
each year by suicide.
• Females are 3 to 5 times more likely to
attempt suicide, but males are 4 to 5 times
more likely to complete suicide.
New Challenges for Faculty
• Knowing the network of student support
services is imperative.
What Has Changed
• Without question, campuses are seeing
more individuals with significant mental
health issues.
• The community resources for mental
health have been greatly diminished.
• More students have anger management
issues and violence is increasingly
common on campuses.
Syllabus Suggestions
• General policy on eating, drinking, smoking in class.
• General policy regarding children and visitors in class.
• General policy regarding breaks, and leaving and
entering class at other than break time(s).
• General policy on plagiarism.
• General policy regarding cell phones, pagers, laptop
computers, PDAs, etc…
• General policy regarding attendance, punctuality and
tardiness, including consequences.
De-Escalating Verbally
• Do NOT
– Engage in defending yourself or debating
– Engage in a power struggle
– Tell the individual what they should do
– Ask them “why”
– Threaten or challenge the individual
– Use put-down or insults
Hostility and Verbal Abuse
• It is acceptable and sometimes necessary
to simply ask the person to leave.
• Understand the goal(s) of the person
– To get what he/she wants
– To be heard
– To gain control
– To provoke a reaction (pick a fight)
Why are Some People Difficult
• Emotional wounds and/or self-esteem
Recognizing the Troubled
Student: Level 2
• Repeated requests for special
consideration
• Unusual or exaggerated emotional
responses to situations
What Stops Faculty and Staff
from Intervention
• Fear of harming the psychologically fragile
student
• Fear of legal or physical reprisals
• View of discipline as a negative process
What Can You Do to Help Our
Students
• File a CARE Report
(Jeff Howard, Dean of Students,
Dean of Students, 439-4210)
Making a Counseling Referral
• Do not attempt to make a referral when the
student is so upset they can’t listen to you. Wait
until they’ve calmed down enough to be able to
respond to your suggestions.
FAQs
What if I’m uneasy about a student?
• Call the Counseling Center for advice (423) 439 4841 before you meet
• Do not ignore your uneasy feelings
• Try to identify what specific behavior makes you
uncomfortable and ask the student to change
that behavior
FAQs
What if I’m uneasy…(continued)
• Do not confront the person, but don’t give in to
inappropriate behavior to help feel safe. Set
boundaries immediately, e.g., “I’d like you to
lower your voice.”
• Stay in a public place or keep your door open
and make sure colleagues are around
• Offer to listen. Ask what the student wants to
accomplish
FAQs
What if I’m uneasy…(continued)
• Involve a third party; tell student “I’ll get . . . To
help me understand how we can help you.”
• Have a code word for calling a colleague or
Campus Police if you feel threatened, e.g.,
“Please call Dr. Thomas to help me understand
what I can do for this student”
• Call Campus Police beforehand 423-439-4480 to
stand by in the vicinity if you feel frightened or to
intervene in the early stages if the person acts out.
FAQs
What if I’m uneasy…(continued)
• You can and should take disciplinary action with
respect to the student. Often informal mediation
will help. The Dean of Students Office can also
contact other professors to find out if there is a
broader problem. Often, what is perceived as a
psychological problem, is a discipline issue.
FAQs
How can I best help a student with
problems?
• The best thing you can do is call us (423) 4394841 and consult. Faculty and staff are here at
ETSU because they care about students. The
best way to show you care is to ask for advice
early on. We can consult with you about
maintaining your professional role while still
helping the student.
Finally
• The counseling staff strives to provide services to
help students that will enable them to succeed
academically and personally. We know that
faculty and staff have the same goals and we
believe we can accomplish these goals most
effectively, the closer we work together.
Counseling Center Website
• http://www.etsu.edu/students/counseling/
• “Prevention may be a matter of a caring
person, with the right knowledge, being
available at the right time.”
– American Foundation for Suicide Prevention