Counseling and Psychological Services

Responding to Distressed Students     

Working With the Emotionally Distressed Students - A Faculty/Staff Guide

The following materials have been developed as a result of the combined efforts of counseling centers which comprise the Organization of Counseling Center Directors in Higher Education (OCCDHE). They are designed to assist faculty and staff in identifying and intervening with students who are in distress.

Informational Handouts

• Making a Referral to CAPS
• Characteristics of Distressed or Distressing Students
• Responding to Distressed or Distressing Students
• Responding to Student Emergencies

Contents

1. Faculty and Staff Role in Helping the Emotionally Distressed Student
2. Specific Guidelines for Helping Distressed Students
   1. The Verbally Aggressive Student
   2. The Violent or Physically Destructive Student
   3. The Student in Poor Contact with Reality
   4. The Suspicious Student
   5. The Anxious Student
   6. The Demanding, Passive Student
   7. The Substance Abusing Student
   8. The Depressed Student
3. The Suicidal Student
4. Warning Signs of Potentially Suicidal Behavior

I. Faculty and Staff Role in Helping the Emotionally Distressed Student

College years bring fond memories to many, yet thinking back carefully, we may also remember those days as having been quite stressful. Financial worries, leaving home and being on our own for the first time, and trying to do well academically contribute to stressful transitions to college life. UCSC students also experience these struggles. Students are involved, to varying degrees, with their development as independent adults. Most are in the process of developing careers, relationships, life goals and their own individual identities. Situational and developmental problems frequently interfere with academic performance. In the college community, about 10 percent of the students may be distressed by depression, acute anxiety, drug or alcohol abuse, or more serious conditions. We have developed a campus resource list that addresses many of these issues.

Many students realize that stress is interfering with their personal and academic goals and seek counseling services on their own. However, faculty, teaching assistants, and university staff are often the first to recognize that a student may not be functioning well academically and/or emotionally. Students may turn to you because of your position and the respect they hold for you as a faculty or staff member. Faculty/staff often handle these difficult situations themselves. While the number of such contacts may be small, their significance is not.

You are in an excellent position to spot the emotionally troubled student. This may be as a result of your position as department secretary, dean, receptionist, or faculty. You may observe that at certain times of the year, particularly during examinations and holidays, students experience increased anxiety. The student's behavior, especially if it is inconsistent with your experience of him/her, could well constitute an inarticulate attempt to draw attention to his/her plight, a "cry for help."

Signs Of Distress

• Nervousness
• Agitation
• Increased irritability, undue aggressive or abrasive behavior
• Excessive procrastination, poorly prepared work
• Infrequent class attendance, little or no work completed
• Depression, lack of energy
• Marked change in personal hygiene
• Withdrawal, fearfulness
• Dependency (e.g., the student who hangs around you or makes excessive appointments to see you)
• Indecisiveness, confusion
• Bizarre, alarming, or dangerous behaviors

Guidelines For Interaction

Openly acknowledging to the students that you are aware of their distress, that you are sincerely concerned about their welfare, and that you are willing to help them explore their alternatives can have a profound effect. We encourage you whenever possible to speak directly to a student when you sense that he/she is in academic and/or personal distress.

1. Request to see the student in private.
2. Briefly acknowledge your observations and perceptions of their situation and express your concerns directly and honestly.
3. Listen carefully to what the student is troubled about and try to see the issue from his/her point of view without necessarily agreeing or disagreeing.
4. Strange and inappropriate behavior should not be ignored. The student can be informed that such behavior is distracting and inappropriate.
5. Your receptivity to an alienated student will allow him/her to respond more effectively to your concerns.
6. Involve yourself only as far as you are willing to go. At times, in an attempt to reach or help a troubled student, you may become more involved than time or skill permits. Extending oneself to others always involves some risk but it can be a gratifying experience when kept within realistic limits.

Consultation

If you are unsure how to respond to a specific student, consult with one of the professional staff at Counseling and Psychological Services (CAPS). Suggestions will be made for approaches you can take with the student. The CAPS Staff can also assist with the referral process.

CAPS is committed to helping students increase their skills and resources in meeting their academic and interpersonal challenges and in becoming responsible and productive adults. The professional staff consists of psychologists, marriage and family therapists, social workers and predoctoral interns with diverse backgrounds and training.

Our services include individual, group and couples therapy, as well as numerous workshops on topic such as stress management, assertion skills and confidence-building. Staff also offer training and consultation services to student organizations, academic departments and other university agencies that have a high degree of contact with students.

Making A Referral

If you feel that professional counseling might be beneficial, refer the student to Counseling and Psychological Services. Be direct in letting the student know that you believe a psychologist would be of help in this situation. Inform the student that the service is both confidential and free of charge. A mutual decision is best. Don't force the issue if the student takes a defensive posture - simply restate your concerns and recommendations. If the student is receptive, you can suggest that he/she call for an appointment at 459-2628. You may even offer to contact a CAPS staff member and provide background information. If the situation seems urgent, you can call the CAPS receptionist and request to speak with the staff member on call.

II. Specific Guidelines For Helping Distressed Students

A. The Verbally Aggressive Student

Students sometimes become verbally abusive when confronted with frustrating situations which they perceive as beyond their control; anger and frustration become displaced from those situations to you. Typically, the anger is not a personal attack, although it may be directed at you.

Do:

• acknowledge their anger and frustration, e.g., "I hear how angry you are."
• rephrase what they are saying and identify their emotion, e.g., "I can see how upset you are because you feel your rights are being violated and nobody will listen."
• allow them to ventilate, get the feelings out, and tell you what is upsetting them
• reduce stimulation; invite the person to your office or other quiet place if this is comfortable
• tell them that you are not willing to accept their verbally abusive behavior, e.g., "When you yell and scream at me that way, I find it hard (impossible) to listen."
• tell them they are violating your personal space and to please move back (if they are getting physically too close), e.g., "Please stand back - you're too close."
• help the person problem-solve and deal with the real issues when he/she becomes calmer

Don't:

• get into an argument or shouting match
• become hostile or punitive yourself, e.g., "You can't talk to me that way!"
• press for explanation or reasons for their behavior - "Now I'd like you to tell me exactly why you are so obnoxious."
• look away and not deal with the situation
• give away your own rights as a person

B. The Violent Or Physically Destructive Student

Violence related to emotional distress is very rare and typically occurs only when the student is completely frustrated, feels powerless, and is unable to exert sufficient self-control. The adage, "An ounce of prevention is worth a pound of cure," best applies here.

Do:

• prevent total frustration and helplessness by quickly and calmly acknowledging the intensity of the situation, e.g., "I can see you're really upset and really mean business and have some critical concerns on your mind."
• explain clearly and directly what behaviors are acceptable, e.g., "You certainly have the right to be angry but hitting (breaking things) is not O.K."
• stay in open area
  divert attention when all else fails, e.g., "if you hit me, I can't be of help."
• get necessary help (other staff, University Police, Health Center, Counseling and Psychological Services.)
• remember that student discipline is implemented by the Dean of Students Office
  

Don't:

• ignore warning signs that the person is about to explode, e.g., yelling, screaming, clenched fists, statements like, "You're leaving me no choice."
• threaten, dare, taunt, or push into a corner
• touch

C. The Student In Poor Contact With Reality

These students have difficulty distinguishing fantasy from reality, the dream from the waking state. Their thinking is typically illogical, confused, disturbed; they may coin new words, see or hear things which no one else can, have irrational beliefs, and exhibit bizarre or inappropriate behavior. Generally, these students are not dangerous and are very scared, frightened and overwhelmed.

Do:

• respond with warmth and kindness, but with firm reasoning
• remove extra stimulation of the environment and see them in a quiet atmosphere (if you are comfortable in doing so)
• acknowledge your concerns and state that you can see they need help, e.g., "It seems very hard for you to integrate all these things that are happening and I am concerned about you; I'd like to help."
• acknowledge the feelings or fears without supporting the misconceptions, e.g., "I understand you think they are trying to hurt you and I know how real it seems to you, but I don't hear the voices (see the devil, etc.)."
• reveal your difficulty in understanding them (when appropriate), e.g., "I'm sorry but I don't understand. Could you repeat that or say it in a different way?"
• focus on the "here and now." Switch topics and divert the focus from the irrational to the rational or the real
• speak to their healthy side, which they have. It's O.K. to joke, laugh, or smile when appropriate.

Don't:

• argue or try to convince them of the irrationality of their thinking, which may lead them to defend their position (false perceptions) more ardently
• play along, e.g., "Oh yeah, I hear the voices (or see the devil)."
• encourage further revelations of craziness
• demand, command, or order
• expect customary emotional responses

D. The Suspicious Student

Typically, these students complain about something other than their psychological difficulties. They are tense, anxious, mistrustful, loners, and have few friends. They tend to interpret minor oversights as significant personal rejection and often overreact to insignificant occurrences. They see themselves as the focal point of everybody's behavior and everything that happens has special meaning to them. They are overly concerned with fairness and being treated equally. Feelings of worthlessness and inadequacy underline much of their behavior.

Do:

• express compassion without intimate friendship. Remember, suspicious students have trouble with closeness and warmth
• be firm, steady, punctual, and consistent
• be specific and clear regarding the standards of behavior you expect
• be aware that humor may be interpreted as rejection

Don't:

• assure the student that you are his/her friend; agree you're a stranger, but even strangers can be concerned
• be overly warm and nurturing
• flatter or participate in their games; you don't know the rules
• challenge or agree with any mistaken or illogical beliefs
• be ambiguous

E. The Anxious Student

These students are highly anxious about the unknown and may perceive danger is everywhere. Uncertainty about expectations and interpersonal conflicts are primary causes of anxiety. High and unreasonable self-expectations increase anxiety also. These students often have trouble making decisions.

Do:

• let them discuss their feelings and thoughts. Often this alone relieves a great deal of pressure.
• reassure when appropriate
• remain calm
• be clear and explicit

Don't:

• make things more complicated
• take responsibility for their emotional state
• overwhelm with information or ideas

F. The Demanding Passive Student

Typically, the utmost time and energy given to these students is not enough; they often seek to control your time and unconsciously believe the amount of time received is a reflection of their worth.

Do:

• let them, as much as possible, make their own decisions
• set limits on the time and energy you are willing to spend with the student

Don't:

• let them use you as their only source of support
• get trapped into giving advice, "Why don't you, etc.?"

G. The Substance Abusing Student

Given the stresses of university life, students are especially susceptible to drug abuse. A variety of substances are available that provide escape from pressing demands. These drugs soon create their own set of problems in the form of addiction, accident proneness, and poor health. The most abused substance--so commonplace we often forget that it is a drug--is alcohol. Alcohol and other drug-related accidents remain the greatest single cause of preventable death among college students.

Do:

• be on the alert for signs of drug abuse: preoccupation with drugs, inability to participate in class activities, deteriorating performance in class, periods of memory loss (blackouts)
• share your honest concern for the person
• encourage to seek help
• get necessary help in instances of intoxication

Don't:

• ignore the problem
• chastise/lecture
• encourage the behavior

H. The Depressed Student

Typically, these students get the most sympathy. They show a multitude of symptoms, e.g., guilt, low self-esteem, feelings of worthlessness, and inadequacy as well as physical symptoms such as decreased or increased appetite, difficulty staying asleep, early awakening, low interest in daily activities. Depressed students are frequently lethargic, but sometimes depression is accompanied by agitation.

Do:

• let student know you're aware he/she is feeling down and you would like to help
• reach out more than halfway and encourage the student to express how she/he is feeling, for he/she is often initially reluctant to talk, yet others' attention helps the student feel more worthwhile
• tell student of your concern

Don't:

• say, "Don't worry," "Crying won't help," or "Everything will be better tomorrow."
• be afraid to ask whether the student is suicidal if you think he/she may be

III. The Suicidal Student

Suicide is the second leading cause of death among college students. The suicidal person is intensely ambivalent about killing himself/herself and typically responds to help; suicidal states are definitely time limited and most who commit suicide are neither crazy nor psychotic. High risk indicators include: feelings of hopelessness and futility; a severe loss or threat of loss; a detailed suicide plan; history of a previous attempt; history of alcohol or drug abuse; and feelings of alienation and isolation. Suicidal students usually want to communicate their feelings; any opportunity to do so should be encouraged.

Do:

• take the student seriously - 80 percent of suicides give warning of their intent
• acknowledge that a threat of or attempt at suicide is a plea for help
• be available to listen, to talk, to be concerned, but refer the student to Counseling and Psychological Services, the Student Health Center or other appropriate agency for professional help
• administer to yourself. Helping someone who is suicidal is hard, demanding, and draining work

Don't:

• minimize the situation or depth of feeling, e.g., "Oh it will be much better tomorrow."
• be afraid to ask the person if they are so depressed or sad that they want to hurt themselves (e.g., "You seem so upset and discouraged that I'm wondering if you are considering suicide.")
• over commit yourself and, therefore, not be able to deliver on what you promise
• ignore your limitations

IV. Warning Signs of Potentially Suicidal Behavior

If you observe any of the following warning signs that might indicate suicidal risk, communicate them to a mental health professional as soon as possible.

• Expression of desire to kill him/herself or wishing to be dead
• Presence of a plan to harm self
• Means are available to carry out a plan to harm him/herself
• Suicide plan is specific as to time, place, notes already written
• High stress due to grief, illness, loss of new job, academic difficulty, etc.
• Symptoms of depression are present, such as loss of appetite, sleep, severe hopelessness or agitation, feeling of exhaustion, guilt/shame, loss of interest in school, work or sexual activities, change or deterioration of hygiene
• Intoxication or drug abuse (including alcohol)
• Previous suicide attempt by the individual, a friend or a family member
• Isolation, loneliness or lack of support
• Withdrawal or agitation
• Preparation to leave, giving away possessions, packing belongings
• Secretive behavior
• Major mood changes, e.g. elation of person who has been depressed, extroversion of previously quiet person
• Indirect comments implying death is an option, e.g., person implies he/she may not be around in the future