College is a highly emotional transition, yet most college health centers can only offer triage
In our therapy with college students, we often see young adults who are struggling turn to their schools’ health centers for mental health care. As writer Sofia Barnett argues in a recent Teen Vogue editorial, college students frequently find these centers coming up short in their support.
The limitations of college health centers are, in some ways, understandable. Health centers are overwhelmed with young adults in need of therapy and most can only offer triage and short-term help. College is a huge developmental leap for young adults and because of this, a young adult can benefit from seeking deeper, more thorough care separate from their school’s offerings.
Colleges want the best for students but are also driven by performance metrics
Colleges generally want the best for their students. They especially want their students to manage their academics so they can graduate. One of the most important metrics for colleges is the ratio of students who matriculate to students who graduate. This impacts a school’s priorities in terms of the mental health help provided to students. A college wants to get students stable so they can complete their work and move ahead in school.
If a student is in much deeper emotional trouble than not being able to keep up grades, the school is frequently motivated to counsel that student out rather than work with them internally. At Tribeca Therapy, we frequently work with students who have been placed on a leave of absence and one of the conditions of their return to school is therapy. Colleges likely aren’t going to examine questions beyond: Is this college the right college right now? (Or is college right at all?).
College is a period of sudden development and reflection
Yet, there are many questions to be examined for young adults. College is an intense time emotionally for students, which can mean young adults need more help than a college can provide in the short term. Early in college, most traditional students make a huge transition from a relatively dependent relationship with parents through high school to a sudden independence in college. This independence brings new pressures and responsibilities, including the need to self-guide, set one’s own limits on activities like socializing and drinking, and know when and how to ask for help (rather than help being close by from a parent or other family member).
The first year or so of college can also be a period of intense reflection. For the first time, young adults evaluate who they are, what practical and emotional skills they have, and where their emotional weaknesses may be. The period of being newly at college is akin to receiving a kind of report card: How did your life so far—your childhood—prepare you?
Older emotional struggles are often made manifest in this transition
In college, we often find the holes in this emotional preparedness. Therapy for college students is usually initially sought to stabilize a shaky situation. Young adults seek therapy for a depressed mood, social isolation, or difficulty going to class or completing homework. What we frequently discover is that these are old struggles, including depression, ADHD, and autism, that have been compensated for while still at home.
For instance, depression in college, which typically shows up in loneliness, homesickness, and gaps in self-care, is rarely new depression. Instead, it’s often a processing of sadness or grief that has been latent and made manifest in the developmental rupture of the transition away from home.
Parents of students too can overlook how much they did to support the now-college student, whether socially or with fulfilling tasks. While still at home, a parent may consistently remind a young adult to charge their phone, finish their homework, or remember appointments. When that scaffolding falls away in college, limitations like ADHD are exposed. Likewise, now that social life is more self-directed in college, autism, perhaps in the form of social struggles or being misunderstood in more demanding dynamics with peers and professors, can come up.
Sexuality also becomes more prominent in college in terms of identity and histories with sex
While high schoolers certainly have sex, college is often a big jump in terms of people engaging in—and notably not engaging in—sexual activity. Because it’s often the first separation from home, college students explore their values free of the prohibitions (or perceived prohibitions) of their parents, as well as grapple with sexual competence and confidence.
College students are also immersed in a culture of self-exploration. While sexuality can take many forms, orientation and identity are part of this exploration. Sexuality is a profound experience, full of energy, as well as internal and cultural pressures. When such profundity is confronted, young adults open up parts of themselves, including family histories of sex and sexuality, as well as conflicts, desires, prohibitions, and experiences of abuse, assault, and other experiences of sexual rupture.
Therapy for college students separate from school encourages everything to be on the table
If this sounds like a lot for young adults to navigate, it is. This is in large part why it is so helpful for students to seek therapy separate from their school. Therapy for college students outside of the health center allows for everything to be on the table, from the decision to remain in a particular school (or in school at all) to looking at the historical basis of their emotional struggles beyond triage.
The treatment is also fully private, which means a college student and their therapist can decide together what—if anything—is shared with the Dean of Students Office. There is also an advantage to having therapy take place with a useful remove from campus and all of its many complications.