Get stories and expert advice on all things related to college and parenting.
Finding a Mental Health Provider for Your Student, Part 1: What Do All the Letters Mean?Rob Danzman, MS, NCC, LCMHC
Anxiety and depression are WAY up among college students. Meanwhile, access to counseling services is super limited — most therapists are totally or mostly only seeing clients via phone or video conferencing.
Even as states loosen restrictions, many providers are likely to maintain minimal in-person sessions. And as more students are permitted to head back to campus (perhaps even 100% of students by Fall 2021), university counseling centers (CAPS) will likely have continued reduced availability and services.
This has been a tough year. When your student was home over winter break, or as you communicate with them now, your parental sixth sense might be nagging: "Something is not right." Maybe they've been acting differently from their normal chipper self. If they’re living at home with you, you may have gotten that vibe over dinner — or maybe they’ve totally disappeared into their room watching YouTube.
They may have less energy. They may be less engaging. They may even seem hyper-vigilant and worried a lot more but without a good reason.
It's pretty clear they're not doing well. It's time to reach out to a professional — but who should you call?
Let's start with a dilemma: Do you try to find a therapist around home or back at school?
Right now, nearly all counseling is virtual or by phone which means, technically, it doesn’t really matter where the therapist (or your student) is located — they just need a device and internet. It seems like we’ll return to providing in-person therapy within a year but there’s still nothing definitive.
But many providers are not permitted to provide counseling services out of the state in which they are licensed, so where your student is physically located will be a limiting factor.
Though most counselors generally have about the same type of training (eg. graduate school, internships, life experience), there’s a benefit from working with a counselor from your hometown or geographical area.
There are cultural considerations, colloquialisms and personality traits that may lend themselves to a faster and stronger rapport between the home counselor and the student, even if the counseling is over the phone or Zoom.
For example, when I get a call from a student or parent from the Philadelphia or New York area (which I’m from), there seems to be a quick, “Oh, you’re an East Coast guy!” which generally means I talk a bit faster (faster than I should), communicate with sarcasm (probably more than I should), and make lots of East Coast references or use them as metaphors. I’m not proud of all of this, just observing that folks from the mid-Atlantic region seem to connect more easily with me than my Midwest counterparts.
If your college student’s semester ends in mid-May and they’re heading back for the fall semester at the end of August, they’ll have 15 weeks of summer to work with a therapist at home. That’s a decent amount of time if the practitioner is available immediately and your college kid’s challenges don't require more intensive intervention. Getting weekly counseling for that chunk of time could make a big difference and set your college student up for a positive transition back to campus in the fall.
As with pre-COVID-19 recommendations, the following obstacles still apply and are important to consider when looking for a local (or any) therapist:
I also recommend clients ask therapists what their setup is for virtual sessions. Do they work from a professional office or home office? If they have a home office, how do they maintain professionalism and confidentiality?
There was an article from 2020 written by a counselor who casually mentioned that while she’s conducting her virtual sessions, her neighbor’s dog can be heard barking and she’s downgraded her wardrobe to a comfy T-shirt. While I appreciate her authenticity and transparency, I believe that counseling is more than just the information and processing we experience. I think that a therapist’s presence and performance (yes, performance) are important at creating an environment fertile for deep connection but with clear boundaries.
The benefits and challenges of finding a therapist near campus look a lot different than finding someone at home. One important consideration is to establish a relationship with a counselor before the start of a semester. This ensures you are likely to not get wait-listed. In my practice, I am typically full before the start of each semester.
Since most students leave spring semester with their fall class schedule nailed down, most students could conceivably get ALL of the counseling sessions scheduled through till the end of each semester. Therapists appreciate this sort of predictability, especially if they specialize in college student counseling.
This sort of planning also helps your student anticipate and plan accordingly if they want to join any clubs or if they will have a busy Greek life or athletic schedule. Some students may even have their syllabi for the fall and know that certain big assignments, projects or tests will make specific dates and times for sessions really challenging, which means they can move those sessions around to avoid those scheduling conflicts.
I had one student do this last year — they were at the business school and had massive projects listed on their syllabi that they knew from other students would eat up big chunks of time. They contacted me two months in advance to move our fall appointments for those weeks. Wow.
Virtual counselors could make getting a therapist at school much easier. Now, how the heck does someone find a therapist?
Regardless of whether you’re looking for a local therapist or someone near campus, I’ll go through some nitty gritty details now on how to do it. Even if you’ve found one in the past, you may have simply googled "therapist" or “counselor” and your zip code and found a list of random providers with offices nearby. They probably showed up on Psychology Today (the big daddy of mental health providers in the country).
Ok...I see the list
Ok...I see their head shots
Ok...I’m reading through their “About Me” blurbs. But wait! They all seem the same. How does someone actually figure out not only who is good or not-so-good, but which ones specialize or treat the symptoms my college student is describing?
One thing to start off considering is that it’s difficult for many reasons to verify a provider’s expertise. For instance, you will find therapists that claim to treat all ages, all diagnoses (eg. Depression, Anxiety, Substance Abuse, Eating Disorders) and have expertise in all modalities (eg. DBT, CBT, Motivational Interviewing).
I can assure you, they may have a basic understanding of those diagnoses and modalities, but they are far from deep experts.
Online databases are really good for two things:
Another good (okay, somewhat good) resource is the database kept by your insurance company. Most insurers have client/patient portals where you can look up all the therapists within a geographic area and, obviously, accept your insurance. They rarely have much detail about the therapist but at least you can confirm they are in-network.
A note on parental involvement: You may be wondering how often students find a therapist on their own, and how often parents are involved? And should you attend the first session with a prospective therapist? I've had students approach me directly (maybe 40% of the time) but I also have parents initiating or participating in the first session (60%). There are pros/cons to both and which is “better” really depends on a bazillion factors (eg. parent/kid relationship, clinical issues, complexity of the family/school situation, etc.). If I was forced to give a generic one-size-fits-all recommendation it would be for parents to have students make the initial call and then parents follow up and we talk through whether they should participate or not.
While searching you will likely see a whole bunch of letters after someone’s name. That’s not just egomania about how smart they are — many licensing bodies require clinicians to list their degree (Masters, Doctorate or Medical Doctorate) as well as their license.
In a previous blog post I detailed what the credentials mean. For our purposes here, I’ll highlight the most common types of professionals found at school and in the local community.
When I encourage folks to conduct background checks, I’m not talking about running their info through the FBI to find out if they are criminals. When considering whether to work with a therapist, google their name, look up their info on the state licensing board’s website (if the state has one), and ask for clients or colleagues that could provide a referral.
Asking for a referral is a bit unorthodox and many therapists won’t know how to respond but it doesn’t hurt to ask. When prospective clients ask for referrals, I explain that because of HIPAA rules, I can’t just hand over a previous client’s contact info. What I can do is contact previous clients and ask if they would be willing to provide feedback to the prospective client. It’s tricky since I want to protect privacy and not put any sort of burden on the client.
You can also do a deep google dive to check out social media, reviews, blog posts, etc. Strangely, most clients/parents NEVER google their prospective therapist.
When looking for a therapist, think of it like interviewing someone for a job (counseling). Make sure to take the time to ask good questions. Treat it like a hiring interview and have a plan.
Here is the list of questions you need to ask when considering whether or not to work with a therapist (print this out if needed):
First, make sure all the necessary intake forms and payment information is completed and the counselor has verified they received them.
Next, for the first and ALL virtual and phone sessions, I recommend clients check their apps/settings/login stuff 30 minutes prior to sessions.
For in-person sessions, show up early and come with any additional questions, concerns, goals or obstacles regarding your issues. I love it when parents show up with a page or more of thoughts, questions and random ideas. It’s also helpful if they email me prior to the first session so I have more context than just my online intake form. It not only helps me zero in on a diagnostic impression but also helps me understand how the family operates and what their values are.
If this is a session set up for your college kid, be confident and let the therapist know you want to sit in on the first 30 minutes to download some history and concerns from your perspective. It’s also a great time to sign a release of information so the therapist can legally speak with you between sessions.
One of the best uses of a therapist for summer or winter break is helping parents understand what's going on with their college student and what is the most effective intervention. Developmentally appropriate emotions and behaviors can often look similar to mental health challenges. For example, when is smoking weed just “normal college kid behavior” and when is it a clinical issue? Your college student's therapist can help differentiate between the two.
Consistently working with a good therapist over summer break can help your college student feel supported and stabilized and set them up for a great fall semester — while also helping parents feel more confident their kiddo is on a healthy path.
It’s time to celebrate with the perfect gift for your new grad!