Recognizing Troubled Students
What can you do?
How do I make a referral?
When do I make a refferal?
How do I approach a student with seeking couseling?

Recognizing Troubled Students (back to top)

At one time or another, everyone feels depressed or upset. But we can identify three general levels of distress which, when present over a period of time, suggest that the problems the person is dealing with are more than "normal" ones.

Mild Distress
These behaviors, although not disruptive to others, may indicate that something is wrong and that help may be needed:

• Serious grade problems, or a change from consistently good grades to inexplicably poor grades
  
• Excessive absences, especially if the student has previously demonstrated good, consistent class attendance
  
• Unusual or markedly changed patterns of interaction, including: social isolation, avoidance of class participation, excessive
  
• anxiety when called upon, dominating discussions, excessive agitation or hyper-activity, speaking extremely rapidly, falling asleep in class
  
• Significant difficulty concentrating, making decisions, or answering simple questions
  
• Depressed, lethargic mood
  
• Disruption in regular habits, such as sleeping too much or too little; substantial increases or decreases in food intake; physical complaints such as severe headaches, stomach trouble, or chronic fatigue
  
• Unusual physical appearance including: swollen, red eyes; a marked change in personal dress or hygiene; sweating (when the room is not hot); a significant increase or decrease in weight

Moderate Distress
These behaviors may indicate significant emotional distress, and perhaps also a reluctance or inability to acknowledge a need for more personal help:

• Repeated requests for special consideration, such as deadline extensions, especially if the student appears highly uncomfortable or emotional about disclosing the circumstances prompting the request
  
• New or regularly occurring behavior that pushes the limits of decorum, and which interferes with the effective management of your class, residence hall, or work area
  
• Unusual or exaggerated emotional responses to situations
  
• Expressed hostility toward you, friends, parents, classmates, or others [

Severe Distress These behaviors are obviously inappropriate and/or indicate a crisis, which needs immediate attention:

• Highly disruptive behavior that is hostile, aggressive, or violent
  
• Inability to communicate clearly (garbled, slurred speech; unconnected or disjointed thoughts)
  
• Loss of contact with reality (auditory or visual hallucinations, beliefs or actions that are greatly at odds with reality or probability)
  
• Disorientation to time, place, or people
  
• overtly suicidal or homicidal thoughts

Working with A Distressed Student (back to top)

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.
  
• avoid letting the student usurp your resources or time, (e.g., "Excuse me, I need to attend to other things.")

Don't:

• let them use you as their only source of support.
  
• get trapped into giving advice, (e.g., "Why don't you, etc.?"). This behavior often triggers our "parental" responses.

The Anxious Student

The characteristics of anxious students include constant worry about many things but nothing in particular. Danger is apparently everywhere, even though what makes students anxious is often unknown. Not knowing what is expected and conflict are primary causes of anxiety. Unknown and unfamiliar situations raise their anxiety; high and unreasonable self-expectations increase anxiety also. The anxious student often has trouble making decisions.

Do:

• let them discuss their feelings and thoughts - this alone often 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.

The Depressed Student

Typically, these students get the most sympathy. They show a multitude of systems, 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. They show low activity levels because everything is an effort and they have little energy.

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:

• Minimize the student's feelings, (e.g., "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

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. They are much more frightened of you than you are of them.

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 misperceptions, (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 Do 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 for it makes them defend their positions (false perceptions) more.
  
• “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

The Suicidal Student

Suicide is the second leading cause of death among college students. Most people who contemplate suicide are ambivalent about killing themself and typically respond to help. Suicidal students usually attempt to communicate their feelings prior to attempting suicide.

High risk indicators include:

• feelings of hopelessness, helplessness, and futility
  
• a severe loss or threat of loss
  
• a detailed suicidal plan
  
• history of a previous attempt
  
• history of alcohol or drug abuse
  
• feelings of alienation and isolation

Do:

• take the student seriously - 80% 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 the counselor (1226) or the Dean of Students (2123)
  
• take care of 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."
  
• over commit yourself and, therefore, not be able to deliver on what you promise.
  
• ignore your limitations.
  
• make promises you can’t keep (promise confidentiality if the student is at risk)

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 most of their behavior. They seem capable and bright.

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

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
  
• be cute or humorous
  
• challenge or agree with any mistaken or illogical beliefs
  
• be ambiguous.

The Violent Student

Violence, because of emotional distress, is very rare and typically occurs only when the student is totally frustrated and feels totally unable to do anything about it. 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.")
  
• get necessary help--other staff, University Police (911), Counseling & Psychological Services (45220)
  
• stay in an open area
  
• divert attention when all else fails, (e.g., "If you hit me, I can't be of help.")

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

What Can You Do? (back to top)

Severe Distress
These problems are the easiest to identify, and specific procedures for helping students in crisis have been defined:

o stay calm

• know who to call for help.
  
• Find someone to stay with the student while calls to the appropriate agency are made.

Counselor (2123)
Campus Security (2500)

Mild or Moderate Distress

In dealing with a student who shows mild or moderate levels of distress, you have several choices.

o You can choose not to deal with it at all;

• You can deal directly with the request or disruptive behavior in a way that limits your interaction to the immediate issue at hand;
  
• You can deal with the situation on a more personal level.

o Talk to the student in private when neither of you will be rushed or preoccupied.

• Give the student your undivided attention. It is possible that just a few minutes of effective listening on your part may be enough to help the student feel comfortable about what to do next
  
• If you initiated the contact, express your concern in behavioral, nonjudgmental terms. For example, you might say, "I've noticed you've been missing a lot of class lately, and I'm concerned"
  
• Listen to thoughts and feelings in a sensitive, non-threatening way. Let the student talk, and communicate that you understand
  
• Avoid judging, evaluating, or criticizing unless the student specifically asks for your opinion. Such behavior is apt to close the student off from you and from getting the help needed. It is important to respect the student's value system, which may be undergoing challenges or change, even if you do not agree with it
  
• Explore what the student has done previously to resolve the problem. Encourage implementation of strategies that have been helpful before, or help them think of new ways of handling the problem. If necessary, work with the student to clarify what she or he perceives to be the costs and benefits of their options for handling the problem

When to Refer (back to top)

Even though a student asks for help with a problem and you are willing to help, there are circumstances that may indicate that you should refer a student to another resource. Some of these situations include:

• The problem or request is beyond your expertise
  
• Personality differences will interfere with your ability to help
  
• You know the student personally, and do not believe you could be objective enough to help
  
• The student acknowledges the problem, but is reluctant to talk to you about it
  
• After working with the student for some time, little progress has been made and you do not know how to proceed
  
• You are feeling overwhelmed, pressed for time, or otherwise are at a high level of stress yourself
  
• There is immediate danger to the student or someone else (i.e. suicide, homicide, abuse, assault, harassment, etc.)

How to Make a Referral (back to top)

Some people accept a referral for professional help more easily than others. When proposing a referral, it is best to do so in a direct and positive manner.

Faculty have found the following referral processes to work best for them and their students…

• If the student agrees to be referred for counseling, suggest that she or he call to make an appointment while in your office/room. The student should make the appointment, if possible. You can increase the chances that she or he will attend the appointment if you tell the student that you would like to hear how the meeting went and request that the student let you know about it.
  
• Walk the student to Student Services and introduce them to the counselor (If the counselor is unavailable see the office Manager to schedule an appointment)
  
• Consult with the Counselor prior to making the referral
  
• If a student is completely resistant to counseling, contact the Dean of Students.

How do I approach the student with seeking counseling? (back to top)

Here are some ideas on how to approach a conversation with a student:

• It is usually best to be frank with students about the limits of your availability to assist them - limits of time, energy, training, and objectivity (i.e. “I want you to receive the best care and I don’t have the training to help you”)
  
• It is often reassuring for students to hear that you respect their willingness to talk to you, and that you want to support them in getting the assistance they need (“I am so honored that you chose to speak with me about this and I support your choice to seek appropriate assistance.”)
  
• Depending on the situation, have the student consider seeking help from appropriately trained resources (such as, clergy, community agencies, and campus offices, especially those in the Student Services Department). (“Have you met the university counselor, yet”)
  
• Tell the student what you know about the person or referral service, being as specific as possible about the kind of help the student can expect
  
• Assure students that seeking help does not necessarily mean they have serious problems. It is possible that their concern is one of the common reasons that college students seek help from another person. These include
  
• feeling down or low on energy and motivation;
  
• experiencing difficulties in relationships with their family, friends, or romantic partner;
  
• feeling anxious or depressed;
  
• and having concerns about future goals or plans. (“Seeking help is a sign of extraordinary strength—being willing to face adversity is admirable.”)
  
• Confused students may be comforted to know that they do not necessarily have to know what is wrong before they ask for help (“Sometimes, it is difficult to know where to start solving problems—a counselor can help you sort al that out.”)