Senior Art History and Archaeology major Casey lives with hearing loss and tinnitus caused by a traumatic event earlier in her life. During her sophomore year, she decided to book an appointment with the University’s Counseling Center to seek help in coping with her disability.
Casey spent her initial appointment at the Center explaining the event which led to her hearing loss and tinnitus, a process she characterized as emotionally taxing. However, she said her follow-up counseling meeting was “disappointing in ways I really can’t even begin to describe.”
Her therapist made recommendations which went against the advice of Casey’s other doctors and demonstrated a lack of basic understanding of the details from her initial appointment.
“She recommended me to my own audiologist, for the program that I had described in detail the meeting before,” Casey said.
Her counselor also referred her to group therapy, a medium which her doctors had specifically warned her against due to her tinnitus and post-traumatic stress. The doctors had told her that patients with these conditions tend to compound each others’ symptoms in group settings.
“I was very shocked that she was recommending this to me when I had been told just how unhealthy it would be,” Casey said.
Casey, who asked to be identified in this article only by her first name, is not alone in seeking out counseling services. Mental illness among students has taken on qualities of a national epidemic — while an estimated one in four students has a diagnosable mental illness, nearly half of these individuals never seek treatment for their conditions. In response, universities like Hopkins have created task forces, reallocated funding and updated their counseling systems. But in the case of some students like Casey, negative personal experiences lead to a decision to stop using university counseling services.
“The fact that I had put myself in this position to be very vulnerable and then she had completely not listened and misconstrued [meant] I did elect to not go back,” she said. “I experienced a very specific error with a person who didn’t listen and who took lightly how much their input on my experience would matter to me.”
Starting this semester, the Counseling Center has implemented a number of new policies to make it easier to access timely care. But while some patients described positive experiences and outcomes, many still find serious faults with the way the Counseling Center provides talk therapy and psychiatric medication to members of the Hopkins community.
The News-Letter conducted interviews with current and former patients of the Counseling Center. Students had a wide variety of experiences and opinions on the University’s primary mental health resource. The pseudonyms used in this article (Hannah, Rachel and Nick) represent individuals who requested anonymity to protect their privacy.
Mixed opinions
Senior Physics major Beatrice Lunsford-Poe recalled having positive experiences during her time at the Counseling Center. Lunsford-Poe sought help during her sophomore and junior years for test anxiety and felt that talk therapy was beneficial.
“In the end, the conversations I had with the psychologist were good, and my test anxiety is a lot better,” she said.
Lunsford-Poe’s impression of her own treatment at the Counseling Center was echoed by another student, Rachel. Rachel wrote positively of her experiences using the Center’s services as a freshman in an email to The News-Letter.
“The Counseling Center sessions definitely helped me work through the issue that was at the forefront of my mind at the time, and that was affecting my relationships at Hopkins,” she wrote.
Both Lunsford-Poe and Rachel, however, had reservations about recommending the Counseling Center to others based on friends’ stories and the reputation of the Center in general.
“I feel like people generally tend to have not the highest opinion [of the Counseling Center],” Lunsford-Poe said. “They definitely think it could be improved, but at the same time they’re like, ‘You’re struggling! This is a resource that is here, but also I personally didn’t like it, but you should go.’ I hear that a lot.”
“Is the Counseling Center better than nothing? I’d hazard for the most part, yes, probably. But there’s only so much it can do,” Rachel wrote.
Each student who spoke with The News-Letter repeated this sentiment in some form: While many saw some benefits from their treatment, all were aware of limitations on its services.
One such limitation was the large number of students that the Center attempts to accommodate at once.
Expanding access
With a total staff of 31 and a patient load of 1,548 last year alone, the Counseling Center was frequently described as “overwhelmed” and “understaffed” by some students who The News-Letter interviewed. According to Director Matthew Torres, many of the Center’s new policies are focused on reducing student wait times and expanding access to service.
“Many of our efforts this year, such as our drop-in first appointments and Chat with a Counselor program in Brody, are aimed at reducing barriers to access,” Torres wrote in an email to The News-Letter.
Senior Public Health major Taz Shah noted some positive changes in her Counseling Center experience as a result of these new policies. She explained that she has both referred friends to drop-in appointment hours and seen scheduling benefits for herself.
“One thing that has helped me is that my psychiatrist has doubled his hours at the Counseling Center, so I have a lot more flexibility with him now,” she said.
Torres emphasized that the Center will also be flexible when moving forward with policies that ensure its availability to new patients.
“It is true that we really struggled last Fall, and to a lesser degree in the Spring, to see students quickly enough,” Torres wrote. “But our new model is working well and we are prepared to make whatever adjustments might be necessary to stay on top of the situation.”
Many of the Center’s new programs aim to facilitate contact with new patients. However, its increased caseload has produced a pattern of less-frequent appointments that negatively affects returning patients.
Shah added that scheduling remains a challenge for returning students seeking more frequent appointments with their psychologists. This has led her to explore the Counseling Center’s group therapy services.
“I wasn’t able to see my therapist as often as we both agreed I should probably be seeing someone, but it was impossible because of her caseload, so we used [group therapy] as kind of way to fill in the gap and make sure I’m still checking in with someone,” she said.
Rachel echoed Shah’s experience, citing it as her reason for leaving the Counseling Center.
“A session once every two weeks just isn’t sufficiently frequent to work through a complex of intersecting problems, ones that reoccur and appear at the forefront of daily thought,” Rachel wrote. “I stopped using the Center’s services because once every two weeks was insufficient.”
Tailoring treatment
Another aspect of the Counseling Center’s new policies is a shift in scope of the services they offer, which Torres explained in an email to The News-Letter.
“We have shifted to a more goal-focused, solution-oriented approach in the counseling we offer, and the feedback from students is positive,” he wrote.
Torres provided The News-Letter with data collected from Aug. 31 to Oct. 15 which showed ratings in the mid 4s out of 5 in student satisfaction in categories such as wait time, follow-up plan and overall service.
Some students expressed skepticism, however, about the effectiveness of short-term treatments in a university setting. One student, Hannah, emphasized the need for both long-term and short-term therapy.
“You can’t just have a one-size-fits-all solution,” she said. “Let’s say that a student experiences the death of a parent. Are you going to deny that person long-term therapy?”
The Counseling Center’s current policy is to refer students in need of longer-term treatment to mental health resources outside the University. Some students argue, however, that the cost of outside treatment makes the Counseling Center the only viable option for many members of the Hopkins community.
“If this is an issue that, say, they’re not able to talk about with their parents or with whoever’s providing their healthcare coverage, then what are they supposed to do?” Hannah said. “They have nowhere to go.”
Torres responds that incidents in which cost poses an insurmountable barrier would be handled on a case-by-case basis.
“While the Counseling Center’s model emphasizes short-term counseling, we do our best to provide services to students who are in severe need for services but can’t afford services in the community, at least until suitable off-campus services can be arranged,” he wrote.
“Listen to students”
While some students who spoke to The News-Letter received long-term care from the Counseling Center, many noted that the Center is often unprepared to handle larger and more complex mental health issues in an empathetic and productive way. Rachel expressed frustration with how the Center has worked with students with disabilities.
“It’s incredibly clear that the Counseling Center has failed many students — and failed them egregiously,” Rachel wrote. “The stories that have come from the disability community are especially moving and outraging in the lack of consideration, substantial care and a real engagement with these struggles.”
Other students recounted similar experiences to Casey’s, wherein counselors seemed not to properly listen to patients’ concerns. Several recalled that their answers on the Center’s introductory questionnaire disrupted the conversations they had with their therapist.
After struggling with depression, senior Neuroscience major Nick found his treatment derailed by an overwhelming focus on one question response.
“One of the questions [reads], ‘Have you thought of harming yourself or others?’ And I put “a little” on there, and immediately the whole conversation went from ‘Are you depressed?’ to ‘Are you going to hurt someone?’,” Nick said. “There may have been something to talk about there, but at the same time that wasn’t really what I was really concerned about.”
Nick believes that the University’s priorities may have gotten in the way of the Counseling Center focusing on his more pressing concerns.
“I could tell their concern was... making sure they weren’t going to have another statistic to talk about,” he said. “But some of my depression never got addressed, and [during] the spring of my junior year my depression got the better of me, some bad stuff happened and I ended up having to take a medical leave from the University.”
Hannah echoed Nick’s experience. After facing a number of personal dilemmas, she approached the Counseling Center over Intersession last year.
Hannah is a survivor of sexual assault, a fact which she chose to disclose on her intake questionnaire. She quickly realized that this information drastically shifted the focus of her counseling sessions.
“All they wanted to do is talk about the sexual assault. I was being treated like a battered woman,” she said. “The way they were talking about it... was bringing back all of those negative emotions and stuff that I had worked so hard to be done with. So I ended up feeling worse walking out of there than I did when I walked in.”
Hannah explained that she had already made peace with her sexual assault and was disappointed that it had become a focal point of her therapy appointments. She was eventually able to resolve her personal issues on her own, but said that the Counseling Center made this process more difficult than it would have been had she not sought help at all.
Nick’s issues were eventually resolved in a similar way. Following his medical leave, he felt that his reinstatement process was complicated by miscommunication and unhelpful recommendations from the Counseling Center. He emphasized that he had improved significantly during his period on medical leave.
“Somehow it got misconstrued that I wasn’t actually doing that great, and the counselor recommended, actually, that I was not reinstated,” Nick said. “I actually got reinstated like a week before classes started. It was horrible.”
Despite this, Nick said that he does not fully blame the Counseling Center itself for his negative experiences.
“They’re understaffed, they’re not that large, there are a lot of students who are experiencing stuff, and the University is probably giving them pressure as to things they need to focus on,” Nick said. “So as frustrated as I am with them... I want to believe they’re trying their best regardless.”
Moving forward, Hannah emphasized that the new policies being implemented at the Counseling Center should address the issues of insensitive treatment that she, Nick and Casey all experienced.
“Students want to feel like it’s accessible — not just in terms of being able to get appointments but also in terms of having their issues be heard,” she said.
Casey echoed this sentiment, saying that the first step to improving care is to be more conscientious when listening to students.
“The biggest thing that I have heard my peers say is that they’ve felt like they were not heard,” she said. “I don’t share with people my experience often because I know that I don’t want to dissuade people from seeking out help. When people ask about the Counseling Center, I usually try to be as judicious as possible. But I do think it is important that we talk about ways that our system fails us.”
