ERIC EJ1153557: Differences between Students with and without Disabilities in College Counseling

2017·0.4 MB·English

by  ERIC

Journal of Postsecondary Education and Disability, 30(2), 173-184 173
Differences Between Students with and without Disabilities
in College Counseling
Lindsay C. Varkula1
James D. Beauchemin2
Sandra D. Facemire3
Emily C. Bucher4
Abstract
This study examined differences between college students with and without disabilities who utilized college
counseling center services. Although we found no differences between students with (n = 234, 9.2%) and with-
out (n = 2,308, 90.8%) disabilities on number of counseling sessions attended, significant findings included:
students with disabilities were more likely to self-terminate and more likely to be referred out than students
without disabilities. Results suggest that students with disabilities are a diverse group requiring special consid-
eration in college counseling settings. Recommendations for college counseling practice are discussed.
Keywords: College counseling, disability, diversity, multicultural counseling
Over the past decade, college counseling centers Assessment of Psychological Symptoms ([CCAPS];
have reported increased demand and increased symp- Center for Collegiate Mental Health [CCMH], 2013)
tom severity among students seeking psychological and the Outcome Questionnaire-45 ([OQ-45]; Lam-
services (Locke, Bieschke, Castonguay, & Hayes, bert et al., 2006; Romans et al., 2010) are examples
2012). Utilization tracking and outcome evaluation of objective client feedback instruments that assist in
have become necessary to prove the utility of college monitoring a client’s progress in treatment. Research-
counseling centers and improve the ability of centers ers (Lampropoulos et al., 2009) have also analyzed
to serve clients (American Psychological Association the number of attended sessions and rates of prema-
[APA], 2005; Goodheart, Kazdin, &Sternberg, 2006). ture or self-termination (“drop-out”), which occurs
The International Association of Counseling Services when a client and counselor do not mutually agree to
([IACS], 2010) standards state that “an integral re- end counseling (Hatchett, 2004). Approximately 20-
sponsibility of the counseling service is to conduct 25% of the students who attend a first appointment at
ongoing evaluation and accountability research, to college counseling centers do not return (Bean, 2006)
determine effectiveness, and to improve the quali- and approximately 50% of clients self-terminate
ty of services” (p. 5). Furthermore, ethical codes of (Hatchett, 2004). This is of concern, as premature ter-
psychology, social work, and counseling emphasize mination correlates with poorer outcomes, risk of sui-
the importance of utilizing research to inform treat- cidality, and a potential lack of clinically significant
ment (American Counseling Association, 2014; APA, change (Hatchett, 2004).
2010; National Association of Social Workers, 2008). In addition, IACS Standards (2010) required
Researchers (Lampropoulos, Schneider, & Spen- college counseling centers to consider the needs of
gler, 2009; Romans et al., 2010) have employed a vari- minority students and tailor services accordingly. Re-
ety of methods to investigate utilization and outcomes searchers (Kearney, Draper, & Barón, 2005; Levy,
of college counseling services; psychometrically-sup- Thompson-Leonardelli, Smith, & Coleman, 2002)
ported instruments including the Counseling Center found differences between minority and non-minority
1 The Center for Balanced Living; 2 Boise State University; 3 The Ohio State University; 4 Columbus, Ohio
174 Varkula et al.; College Counseling
students seeking college counseling center services. Despite supportive legislation and increased en-
For example, Kearney et al. (2005) found that Afri- rollment, college students with disabilities continue
can American, Latino, and Asian American students to face a variety of barriers and stressors. In general,
attended fewer sessions than European American stu- students with disabilities might experience chronic
dents; Levy et al. (2002) found that African American stress due to discrimination; specifically, they might
students tended to terminate counseling prematurely. encounter both overt discrimination and microaggres-
Locke et al. (2012) demonstrated that racial/ethnic sions (Keller & Galgay, 2010), subtle discrimination
minority students may present in greater distress. Ad- based on distorted assumptions/beliefs. Research-
ditionally, minority status (racial/ethnic minorities or ers (Murray, Lombardi, Bender, & Gerdes, 2013;
low socio-economic status) has predicted counseling Sanford et al., 2011) found that issues of access and
dropout (Lampropoulos et al., 2009; Owen, Imel, adjustment to university life are reflected in higher
Adelson, & Rodolfa, 2012). Taken together, these course failure rates, lower retention rates, and lower
studies indicate that monitoring of utilization and graduation rates. Furthermore, individual abilities and
outcomes of minority students is critical in order for disabilities can provide specific barriers and needs
college counseling centers to adapt services to meet based on the type of disability. For example, students
needs better. with physical disabilities commonly face environ-
The proportion of college students with disabil- mental and accessibility challenges across multiple
ities has increased since 1990 (Sanford, Newman, realms including built environment, outdoor campus
Wagner, Cameto, & Knokey, 2011), possibly due to environment, social and recreational services, and
the Americans with Disabilities Act of 1990 (ADA) technological aids (Schreuer & Sachs, 2014). Simi-
and Americans with Disabilities Amendments Act of larly, college students with visual impairments face
2008 (ADAA) and resulting shifts in perceptions and environmental challenges including difficulties with
accessibility (Burgstahler & Cory, 2008). According transportation, poor access to computer-based mate-
to the ADA, the definition of disability is twofold: rials, social challenges, and limited accessibility of
an individual must have a physical or mental impair- information and communication strategies (Fichten,
ment, and the severity of the impairment must result Asuncion, Barile, Ferraro, & Wolforth, 2009; Reed
in a substantial limitation of one or more life func- & Curtis, 2012). Students who are deaf and hard-of-
tions (APA, 2012). These laws granted equal access hearing commonly experience difficulty in carrying
to information and services to people with disabilities full course loads and dissatisfaction with social life
in higher education. Holicky (2003) included disabil- (Lang, 2002).
ity as one category of diversity requiring consider- There is significant overlap in the research when
ation in counseling. discussing mental health-related disabilities. For ex-
A review of the literature yielded few empirical ample, ADHD may be categorized separately, as a
studies of psychotherapy effectiveness for adults— psychiatric disability, as a learning disability, or as
especially college-aged adults—with disabilities. a “hidden disability” (Wolf, 2001, p. 387) in the lit-
Glickman and Pollard (2013) suggested that the lack erature. Estimates of the prevalence of psychiatric
of research may be due to the paucity of specialized disabilities on college campuses are as high as 30%
professionals and financial resources, the extent to (Hartley, 2010), while an estimated 86% of individ-
which these professionals must dedicate their time to uals who have a psychiatric disorder withdraw from
providing services directly to individuals with disabil- college prior to completion of their degree (Collins &
ities, and their lack of remaining time and resources Mowbray, 2005). Barriers faced by college students
to complete quality research. Although researchers with psychiatric disabilities include difficulty main-
(Dorstyn, Mathias, & Denson, 2011; Idusohan-Moiz- taining concentration, remembering important details,
er, Sawicka, Dendle, & Albany, 2015; Weiss et al., screening out distractions, and meeting deadlines un-
2012) studying Attention Deficit/Hyperactivity Dis- der pressure. Additionally, issues with test anxiety,
order (ADHD), intellectual disabilities, and physical executive functioning, managing stigma, interacting
disabilities found that individuals with disabilities within a group, responding to negative feedback,
benefit from psychotherapy, no research exists de- self-esteem, and acting appropriately with classmates
scribing the experience of college students with dis- and faculty can impact academic performance and
abilities in college counseling. personal well-being (Mowbray et al., 2006). Students
Journal of Postsecondary Education and Disability, 30(2) 175
with ADHD and learning disabilities (LD) tend to Hypotheses
have lower grade point averages and more academic We tested two hypotheses in this study. First, par-
issues; only 28% graduate (Connor, 2012; Costello & ticipants with disabilities would have attended a sta-
Stone, 2012). These students may struggle due to defi- tistically significantly lower number of counseling
cits in attention, planning and organization, memory, sessions than participants without disabilities. Second,
higher order conceptual thinking, self-esteem, and so- there would be a statistically significant difference in
cial skills (Wolf, 2001). Hartley (2010) demonstrated termination condition between participants with dis-
that counseling services are an effective support for abilities and participants without disabilities; specifi-
this population. A close relationship with a counselor cally, that participants with disabilities would be more
has been found to act as an anchor, helping students likely to self-terminate than participants without dis-
with psychiatric disabilities to remain in college; re- abilities. Due to the lack of research on college students
tention rates for undergraduates seeing counselors with disabilities, we based our hypotheses on the work
were 14% higher. of researchers (Lampropoulos et al., 2009; Owen et al.,
As the proportion of college students with disabil- 2012) who have found differences between minority
ities continues to increase, there is a greater need for and non-minority students in the number of sessions
research examining college counseling services for attended and in the termination condition.
this minority population. In an effort to assist college
counseling center professionals in improving services Method
for students with disabilities, and to increase aware-
ness of students with disabilities as a diverse group Participants
with unique needs, the authors of the present study In this study, we utilized secondary data from a
sought to answer the following research questions: (1) sample of college students (N = 2,756) who sought
Do significant differences exist between students with services at a large, public, urban, Mid-Western college
and without disabilities related to the number of coun- counseling center between August 2012 and August
seling sessions attended, and (2) Is there a statistical- 2013. To utilize services, individuals were required to
ly significant difference in termination condition be- be enrolled as undergraduate or graduate students at
tween students with or without disabilities? Based on the university. Table 1 illustrates demographic infor-
the findings of previous studies (Kearney et al., 2005; mation for study participants, types of self-identified
Lampropoulos et al., 2009; Levy et al., 2002; Owen et disability, as well select demographic information for
al., 2012) which demonstrated dissimilarities between overall enrollment in the university based on avail-
minority and non-minority students seeking counsel- ability of data.
ing center services, we hypothesized that there would Compared with the overall university enrollment,
be significant differences between students with and female, African American, Asian American, Hispan-
without disabilities on the number of sessions attend- ic, Multi-racial, international, graduate, and disabil-
ed and the termination condition. ity groups were overrepresented in the study due to
higher rates of presentation at the counseling center.
Research Design Male, European American, and undergraduate stu-
We based this non-experimental research study dents were underrepresented due to seeking services
(Kerlinger & Lee, 2000) on analysis of secondary at slightly lower rates.
electronic medical record (EMR) data. We identified
two pre-existing groups in an archived data set--in- Measures
dividuals who self-identified as having one or more Self-report of disability status. For each partic-
disabilities, and individuals who self-identified as ipant, we categorized disability status by examining
not having a disability--and compared them based on the EMR. During the intake process, students were
termination condition and number of counseling ses- asked to self-report disability status and type(s) of
sions attended. We used a chi-square test for indepen- disability. No similar studies of college counseling
dence to make comparisons. centers were identified, thus, no precedent is estab-
lished in the literature regarding how to distinguish
between college students with disabilities and college
students without disabilities.
176 Varkula et al.; College Counseling
Number of sessions attended. For each partic- sessions attended, reason for termination, self-iden-
ipant, we determined the number of individual and tified disability or non-disability status, and dis-
group counseling sessions attended via review of the ability type, as extracted from the EMR. To ensure
EMR. We created the following categories to summa- anonymity of participants, we retained de-identified
rize the total number of sessions attended by partic- data only for analysis.
ipants: one kept appointment (n = 467, 18.4%); two All clients during the 2012-2013 academic year
or three kept appointments (n = 629, 24.7%); four to were included as study participants for demograph-
six kept appointments (n = 587, 23.1%); seven to ten ic analyses. We conducted a chi-square test for inde-
kept appointments (n = 429, 16.9%); and 11+ kept pendence to examine relationships between disability
appointments (n = 430, 16.9%). Modal number of status, number of kept appointments, and termina-
appointments attended by students with and without tion condition. We excluded participants if data were
disabilities was two-to-three appointments. These missing in any of these categories.
categories were selected because the average college
counseling center client attends less than five coun- Analysis of Data
seling sessions (CCMH, 2014). In addition, we chose We performed inferential statistical analyses to
this method of categorization because group coun- evaluate differences between participants with dis-
seling appointments were included as part of partici- abilities and participants without disabilities based
pants’ total sessions attended, and due to differences upon the number of counseling sessions attended (M
in limits for the total number of individual counseling = 1.89, SD = 1.34) and termination condition. We
sessions students could attend. For example, students conducted a chi-square test for independence to ex-
were eligible for either 11, 21, or more sessions de- amine relationships between disability status, number
pending on enrollment in the student health insurance of kept appointments, and termination condition (Hy-
plan for the college. Lampropoulos et al. (2009) used potheses 1 and 2).
the number of sessions attended as a means of assess-
ing college counseling center utilization. Results
Reason for termination. We obtained each par-
ticipant’s reason for termination via EMR review. We evaluated utilization of counseling services
Possible categories of termination included: ongoing through descriptive statistics as percentage of stu-
(counseling was not terminated and continued with- dents self-identifying as having a disability (9.2%)
out interruption into the following academic year; n and percentage of students self-identifying as not
= 580, 22.8%), self-termination (n = 1,142, 44.9%), having a disability (90.8%). Hypothesis 1 stated that
mutually agreed-upon client-counselor decision (n = participants with disabilities would have attended sig-
277, 10.9%), client left school due to graduation (n = nificantly fewer counseling sessions than participants
158, 6.2%), client left school due to dismissal or with- without disabilities. Chi-square test for independence
drew (n = 68, 2.7%), client left school for the sum- revealed no statistically significant differences in to-
mer (n = 133, 5.2%), client was referred outside the tal number of sessions attended based on disability
college counseling center for additional services (n = status [χ²(4) = 0.02, p = 0.84]. Hypothesis 2 stated
63, 2.5%), session limit was reached (n = 55, 2.2%), that there would be a significant difference in termi-
or other (n = 66, 2.6%). In this study, we described nation condition between participants with disabili-
premature termination using the category self-termi- ties and participants without disabilities. Specifically,
nation. Researchers (Hatchett, 2004; Lampropoulos participants with disabilities would be more likely to
et al., 2009) have utilized premature termination to self-terminate than participants without disabilities.
evaluate counseling outcomes. Chi-square test for independence revealed statisti-
cally significant differences in termination condition
Procedure based on disability status [χ²(8) = 16.37, p = .04]. Ta-
After gaining approval from the Institutional Re- ble 1 indicates percentages based on disability status
view Board, we analyzed records from all enrolled in each termination condition. The effect size for this
college students who sought services at the college finding (φ = 0.1) is small according to Cohen (1988).
counseling center during the 2012-2013 academ-
ic year. These included total number of counseling
Journal of Postsecondary Education and Disability, 30(2) 177
Discussion We found that students with disabilities were
more likely to self-terminate or “drop-out” of coun-
In this study, we examined differences between seling. Specifically, 49.6% of students with disabili-
college students with and without disabilities who ties self-terminated, whereas only 44.5% of students
utilized college counseling center services. Students without disabilities self-terminated. Because prema-
with disabilities comprised 9.2% of total students who ture termination correlates with poorer outcomes,
utilized counseling center services at a large, public, risk of suicidality, and a potential lack of clinically
urban, Mid-Western university during the 2012-2013 significant change (Hatchett, 2004), this discrepancy
academic year. Participants with disabilities identified appears to be important. Although we found differ-
that they fit into one or more of the following cat- ences between students with and without disabili-
egories: ADHD (n = 88, 36.6% of participants with ties, the reason these students chose self-termination
disabilities), deaf or hard of hearing (n = 7, 3.0%), is unknown.
learning (n = 24, 10.3%), mobility (n = 6, 2.6%), neu- In this study, only 6% of students with disabili-
rological (n = 11, 4.7%), physical (n = 21, 9.0%), psy- ties terminated counseling because of a mutual cli-
chological (n = 36, 15.4%), visual (n = 12, 5.1%), or ent-counselor decision, while 11.4% of students
other (n = 29, 12.4%). without disabilities terminated because of a mutual
Results did not support our first hypothesis that client-counselor decision. While the reason for these
participants with disabilities would have attended differences is unknown, students with disabilities
fewer counseling sessions than participants with- might have stopped attending sessions due to satisfac-
out disabilities. Therefore, regardless of ability sta- tion with services; students may have experienced re-
tus, university students might attend approximately duction in symptoms. Conversely, the 5.1% discrep-
the same number of counseling sessions. This result ancy between students with disabilities and students
might indicate that college counseling centers are without disabilities might indicate that students with
serving students with disabilities similarly to students disabilities were less satisfied with the services they
without disabilities. Furthermore, the extent to which received, or might have been less comfortable speak-
college counseling centers are helpful to students may ing to their counselors about issues in their treatment.
not vary based on whether a student has a disability. If students with disabilities did self-terminate due
Researchers who have examined treatment of to dissatisfaction, several factors might affect the in-
adults with specific disabilities (ADHD, intellectual creased likelihood of self-termination. They might
disabilities, physical disabilities) outside of college have chosen not to return because of barriers to phys-
counseling have found that individuals can benefit ical space or barriers to written information. In addi-
from short-term therapies such as cognitive-behav- tion, self-termination might have been indicative of
ioral therapy ([CBT]; Dorstyn et al., 2011; Iduso- issues in the therapeutic relationship; issues such as
han-Moizer et al., 2015; Weiss et al., 2012), which lack of agreement on how to address important as-
are frequently offered at college counseling centers. pects of counseling predict poorer outcomes (Duncan,
Results of the current study might align with this re- Miller, Wampold, & Hubble, 2010). Meta-analysis
search; college students with disabilities might bene- suggests that the weaker the therapeutic alliance, the
fit from brief treatment in college counseling centers. more likely individuals are to drop out of psychother-
Results of this study supported our second hy- apy (Sharf, Primavera & Diener, 2010). In addition,
pothesis, that there would be statistically significant counseling center staff might have engaged in inad-
differences in termination condition between partic- vertent microaggressions (Keller & Galgay, 2010),
ipants with disabilities and participants without dis- subtle discrimination based on distorted assumptions/
abilities. This result aligns with findings by research- beliefs, against students with disabilities. Microag-
ers (Lampropoulos et al., 2009; Owen et al., 2012) gressions may manifest in a variety of ways including
on other minority groups, indicating that minority counselor attitudes, language, minimization of ex-
students were more likely to self-terminate. Despite perience, and failure to implement universal design.
statistically significant findings regarding differences Additional research is required to determine the actu-
in termination condition, the effect size in this study al reasons for self-termination.
was small, and accounts for only 1% of the total vari- Finally, we found that counselors referred 5.1%
ance in outcomes. of clients with disabilities to external sources, where-
178 Varkula et al.; College Counseling
as only 2.2% of clients without disabilities were re- not be interpreted in the same manner universally,
ferred. We did not, however, examine the reasons for each individual might perceive and define disability
referring clients in this study. Clients might have re- differently.
quested these referrals, particularly if they were hop-
ing to see a therapist specializing in a particular popu- Recommendations for College Counseling Practice
lation, the discrepancy might have been coincidental, Increase awareness. College counselors could
or there might have been difficulty accommodating serve students with disabilities better by maintaining
large numbers of students at the counseling center. an awareness of their minority status. Understanding
Counselors might have determined that the needs of and acknowledging that students who identify as hav-
these students could not be served adequately with- ing a disability are a minority population on college
in a short-term therapy model. It is also possible that campuses should influence and inform treatment. For
counselors might have referred students to outside example, validating students’ disabilities and explor-
providers because the counselors felt unprepared or ing associated strengths and challenges, being aware
less competent at meeting the needs of this unique of microaggressions, developing therapeutic alliance,
population. Additional study is required to determine and implementation of universal design (discussed in
the reasons for these discrepancies. detail in the following section) can help to establish
and maintain an awareness of minority status. All col-
Limitations lege counselors must be aware that assumptions (e.g.,
assuming an individual does not have a disability if a
Because no other studies have examined differ- disability is not visible) and microaggressions (Keller
ences between college students with and without dis- & Galgay, 2010) are examples of discrimination. As
abilities who utilized college counseling center ser- recommended by IACS (2010) standards, counselors
vices, conclusions based on this study are limited. In should use ongoing evaluation of services in order to
addition, the generalizability of this study might be determine the specific needs of this diverse group.
limited because data came from only one college in Development of a positive working alliance be-
one geographical location and because of the small tween the counselor and client is one of the best pre-
effect size. Due to limited power, we were not able to dictors of outcome (Duncan et al, 2003). Moreover,
refine results based on disability category or by other because client ratings of therapeutic alliance have
demographic factors (e.g., sexual orientation, gender). a larger impact on outcomes than counselor ratings
In addition, type of counseling provided (individual (Duncan et al., 2010), counselors must pay particu-
versus group) was not separated in this study; lack of lar attention to the therapeutic alliance and monitor
separation might impact usefulness of this study for its quality regularly (Duncan et al., 2003). This is es-
counseling centers. Furthermore, we explored neither pecially important when working with minority stu-
student presenting concerns nor the therapeutic mo- dents who are more likely to self-terminate (Sharf et
dality counselors utilized to treat clients in this study, al., 2010). Self-termination is correlated with lack of
which might impact results. clinically significant change, fewer positive outcomes
Self-report was relied upon to determine disabil- of therapy, and increased risk of suicide (Hatchett,
ity status in this study. Therefore, we could not be 2004). Using instruments such as the Session Rating
certain whether some students chose not to disclose Scale Version 3 ([SRS], Duncan, et al, 2010) college
disabilities, and/or whether some students had disabil- counselors can monitor the quality of the working al-
ities but were unaware of them. Additionally, reliance liance on a session by session basis.
on self-report precluded the authors from discerning Advocate for universal design in college coun-
whether students disclosing disability status had been seling centers. According to federal law, students
diagnosed by professionals. Lack of a professional di- with disabilities must have equal access to physical
agnosis could account for the discrepancy in the num- space and information, also known as universal de-
ber of study participants who self-identified as having sign (Burgstahler & Cory, 2008). To provide equal
a disability (234), but who were not registered with access, websites, physical office space (including re-
campus disability support services (179). Thus, there ception areas, waiting areas, counselor offices, and
is potential for error in categorization of student abil- restrooms), verbal communication, and written infor-
ity status. Finally, because the term "disability" might mation must be accessible to students with a variety
Journal of Postsecondary Education and Disability, 30(2) 179
of disabilities. Counselors should develop increased lize national and/or international samples from a va-
understanding of universal design and advocate for its riety of universities and could examine intersections
implementation. College counselors must recognize of multiple minority statuses (e.g., African American
that failure to implement universal design, because students with disabilities). Larger participant pools
of the relatively few students with disabilities who would allow researchers to refine results by disabil-
utilize the services, results in the microaggression of ity category and type of counseling provided (indi-
Second-Class Citizenship: denying the right to equal- vidual versus group). Future studies could consider
ity because it is inconvenient, expensive, and unnec- the extent to which other client variables, such as the
essary (Keller & Galgay, 2010). presenting problems of clients, might impact out-
Increase multicultural training. Goad and Rob- comes. The therapeutic modality counselors utilize
ertson (2000) reported that, if college counseling to treat clients could also be explored to determine
centers offer training related to college students with whether there are any differences in outcomes. Be-
disabilities, they tend to provide this training only to cause of the link between premature termination and
students and interns. Goad and Robertson recommend working alliance, future research could explore the
that all staff receive regular training on working with working alliance and specific reasons for premature
this minority population, similar to the focus college termination. To address the needs and challenges of
counseling centers might put on racial/ethnic minori- counselors working with students with disabilities,
ty students or international students. The APA (2012) future research could explore academic preparation,
Guidelines for Assessment of and Intervention with knowledge of lived experiences, and clinical experi-
Persons with Disabilities, information about univer- ence with college students with disabilities.
sal design (Burgstahler & Cory, 2008), and education Finally, because of the extensive gaps in the lit-
about subtle discrimination (Keller & Galgay, 2010) erature on college students with disabilities, qualita-
are examples of important training content for coun- tive studies might provide insight into experiences
selors. of students with disabilities, and those of the coun-
Strengthen on-campus relationships. Goad selors who work with them. Additionally, qualitative
and Robertson (2000) recommended creating and/or research could explore any barriers to utilization of
strengthening liaison relationships between college college counseling services and explore reasons for
counselors and campus disability services. On-cam- self-termination among this student population.
pus disability services offices are rich in knowledge
about the lived experiences of college students with Summary
disabilities and can often connect counselors with
resources, provide training, and respond to specific In this study, we examined differences between
questions. College counselors can benefit from consul- college students with and without disabilities who uti-
tation with campus disability services regarding how lized college counseling center services. Students with
to assist students with disabilities best. Additionally, disabilities comprised 9.2% of those seeking services
counselors can reach the greater campus community during the 2012-2013 academic year at one college
by providing targeted outreach that models disabili- counseling center. Although we found no differences
ty-affirming language and universal design. College between students with and without disabilities on the
counselors are in a unique position to advocate for number of sessions attended, we found differences in
students with disabilities by providing training and termination condition based on ability status. Specif-
education to other university employees, through both ically, students with disabilities were more likely to
formal training and informal interactions. self-terminate and less likely to terminate counseling
because of a mutually agreed-upon client-counselor
Suggestions for Future Research decision. Finally, we found that counselors referred
clients with disabilities to external therapeutic re-
Although results of the present study can begin to sources more often than students without disabilities.
inform college counseling centers of potential differ- Taken together, these results suggest that students
ences between students with and without disabilities, with disabilities are a unique group and require spe-
additional research is required to capture the nature cial consideration by college counseling center staff.
of this diverse group fully. Future studies could uti-
180 Varkula et al.; College Counseling
References
American Counseling Association. (2014). ACA code Duncan, B. L., Miller, S. D., Sparks, J. A., Claud, D.
of ethics. A., Reynolds, L. R., Brown, J., & Johnson, L. D.
American Psychological Association. (2005). Policy (2003). The session rating scale: Preliminary psy-
statement on evidence-based practice in psychology. chometric properties of a “working" alliance mea-
American Psychological Association. (2010). Ameri- sure. Journal of Brief Therapy, 3, 1, 3-12.
can Psychological Association ethical principles Duncan, B. L., Miller, S. D., Wampold, B. E., & Hub-
of psychologists and code of conduct. ble, M. A. (Eds.). (2010). The heart & soul of
American Psychological Association. (2012). Guide- change: Delivering what works in therapy (2nd
lines for assessment of and intervention with persons ed.). Washington, DC: American Psychological
with disabilities. American Psychologist, 67, 43-62. Association.
Bean, M. C. (2006). Choosing not to return: Diverse Fichten, C. S., Asuncion, J. V., Barile, M., Ferraro, V.,
students' intake experiences at a university coun- & Wolforth, J. (2009). Accessibility of e-learning
seling center. Dissertation Abstracts Internation- and computer and information technologies for
al: Section B. Sciences and Engineering, 66(7-B), students with visual impairments in postsecond-
3938. ary education. Journal of Visual Impairment &
Burgstahler, S., & Cory, R. (Eds). (2008). Universal Blindness, 103, 543-557.
design in higher education: From principles to Glickman, N. S., & Pollard, R. Q. (2013). Deaf men-
practice. Boston, MA: Harvard Education Pub- tal health research: Where we’ve been and where
lishing Group. we hope to go. In N. Glickman (Ed.), Deaf mental
Center for Collegiate Mental Health (2013). Clini- health care. New York, NY: Routledge.
cian’s guide to the counseling center assessment Goad, C. J., & Robertson, J. M. (2000). How univer-
of psychological symptoms. University Park, PA: sity counseling centers serve students with dis-
The Pennsylvania State University. abilities: A status report. Journal of College Stu-
Center for Collegiate Mental Health. (2014, January). dent Psychotherapy, 14(3), 13-22.
2013 annual report (Publication No. STA 14-43). Goodheart, C. D., Kazdin, A. E., & Sternberg, R. J.
Cohen, J. (1988). Statistical power analysis for the (2006). Evidence-based psychotherapy: Where
behavioural sciences (2nd ed.). New York: Aca- research and practice meet. Washington, DC:
demic Press. American Psychological Association.
Collins, M. E., & Mowbray, C. T. (2005). Higher ed- Hartley, M. T. (2010). Increasing resilience: Strategies
ucation and psychiatric disabilities: National sur- for reducing dropout rates for college students
vey of campus disability services. American Jour- with psychiatric disabilities. American Journal of
nal of Orthopsychiatry, 75, 304-315. Psychiatric Rehabilitation, 13, 295-315.
Connor, D. (2012). Helping students with disabilities Hatchett, G. T. (2004). Reducing premature termina-
transition to college: 21 tips for students with LD tion in university counseling centers. Journal of
and/or ADD/ADHD. Teaching Exceptional Chil- College Student Psychotherapy, 19(2), 13-27.
dren, 44(5), 16-25. Holicky, R. (2003). Counseling people with physical
Costello, C. A., & Stone, S. L. (2012). Positive psy- disabilities. In N. A. Vacc, S. B. DeVaney, & J.
chology and self-efficacy: Potential benefits for M. Brendel (Eds.), Counseling multicultural and
college students with attention deficit hyperactivity diverse populations (4th ed., pp. 209-229). New
disorder and learning disabilities. Journal of Post- York, NY: Routledge.
secondary Education and Disability, 25, 119-129. Idusohan-Moizer, H., Sawicka, A., Dendle, J., & Al-
Dorstyn, D. S., Mathias, J. L., & Denson, L. A. (2011). bany, M. (2015). Mindfulness-based cognitive
Psychosocial outcomes of telephone-based coun- therapy for adults with intellectual disabilities:
seling for adults with an acquired physical dis- An evaluation of the effectiveness of mindfulness
ability: A meta-analysis. Rehabilitation Psychol- in reducing symptoms of depression and anxiety.
ogy, 56, 1-14. Journal of Intellectual Disability Research, 59.
Journal of Postsecondary Education and Disability, 30(2) 181
International Association of Counseling Services. Murray, C., Lombardi, A., Bender, F., & Gerdes, H.
(2010, October). Standards for university and col- (2013). Social support: Main and moderating ef-
lege counseling services. fects on the relation between financial stress and
Kearney, L. K., Draper, M., & Barón, A. (2005). adjustment among college students with disabili-
Counseling utilization by ethnic minority college ties. Social Psychology of Education, 16, 227-295.
students. Cultural Diversity and Ethnic Minority National Association of Social Workers. (2008). Code
Psychology, 11(3), 272-285. of ethics of the National Association of Social
Keller, R. M., & Galgay, C. E. (2010). Microaggres- Workers.
sive experiences of people with disabilities. In D. Ohio State University, Institutional Research & Plan-
W. Sue (Ed.), Microaggressions and marginality: ning. (2012). Statistical summary.
Manifestation, dynamics, and impact (pp. 241- Owen, J., Imel, Z., Adelson, J., & Rodolfa, E. (2012).
268). Hoboken, NJ: Wiley. ‘No-show’: Therapist racial/ethnic disparities in
Kerlinger, F. N., & Lee, H. B. (2000). Foundations of client unilateral termination. Journal of Counsel-
behavioral research (4th ed.). Belmont, CA: Cen- ing Psychology, 59, 314-320.
gage Learning. Reed, M., & Curtis, K. (2012). Experiences of stu-
Lambert, M. J., Smart, D. W., Campbell, M. P., Haw- dents with visual impairments in Canadian High-
kins, E. J., Harmon, C., & Slade, K. L. (2006). er Education. Journal of Visual Impairment and
Psychotherapy outcome as measured by the OQ- Blindness, 106, 414-425.
45, in African American, Asian/Pacific Islander, Romans, J. S., White, J. K., Harrist, R. S., Boswell, D.
Latino/a, and Native American clients compared L., Sims, W. D., & Murn, L. T. (2010). Predicting
with matched Caucasian clients. Journal of Col- attrition from counseling in a university counsel-
lege Student Psychotherapy, 20(4), 17-29. ing center sample using the Outcome Question-
Lampropoulos, G. K., Schneider, M. K., & Spengler, naire-45.2. Internet Journal of Mental Health, 7.
P. M. (2009) Predictors of early termination in a Sanford, C., Newman, L., Wagner, M., Cameto, R.,
university counseling training clinic. Journal of Knokey, A., Shaver, D. (2011). The post-high
Counseling & Development, 87, 36-46. school outcomes of young adults with disabilities
Lang, H. G. (2002). Higher education for deaf stu- up to 6 years after high school: Key findings from
dents: Research priorities in the new millennium. the National Longitudinal Transition Study-2
Journal of Deaf Studies and Deaf Education, 7, (NLTS2) (NCSER Report 3004).
267-280. Schreuer, N., & Sachs, D. (2014). Efficacy of accom-
Levy, J., Thompson-Leonardelli, K., Smith, N., & modations for students with disabilities in higher
Coleman, N. (2002). How client race, present- education. Journal of Vocational Rehabilitation,
ing concern, and time on the waiting list relate 40, 27-40.
to attrition after intake at a university counseling Sharf, J., Primavera, L. H., & Diener, M. J. (2010).
center (p. 265). Counseling center research report, Dropout and therapeutic alliance: A meta-analysis
University of Maryland, College Park. of adult individual psychotherapy. Psychotherapy:
Locke, B. D., Bieschke, K. J., Castonguay, L. G., & Theory, Research, Practice, Training, 47, 637-645.
Hayes, J. A. (2012). The Center for Collegiate Weiss, M., Murray, C., Wasdell, M., Greenfield, B.,
Mental Health: Studying college student mental Giles, L., & Hechtman, L. (2014). A randomized
health through an innovative research infrastruc- controlled trial of CBT therapy for adults with
ture that brings science and practice together. ADHD with and without medication. BMC Psy-
Harvard Review of Psychiatry, 20, 233-45. chiatry, 12. Advance online publication.
Mowbray, C. T., Megivern, D., Mandiberg, J. M., Wolf, L. E. (2001). College students with ADHD and
Strauss, S., Stein, C. H., Collins, K., Kopels, S., other hidden disabilities. Annals of the New York
Curlin, C., & Lett, R. (2006). Campus mental health Academy of Sciences, 931, 385-395.
services: Recommendations for change. American
Journal of Orthopsychiatry, 76, 226-276.
182 Varkula et al.; College Counseling
About the Authors
Lindsay Varkula received her B.A. degree in psycholo- Emily Bucher received a degree in political science
gy from Case Western Reserve University, M.A. from from Denison University in 2012, and a master's de-
the University of Akron, and Ph.D. from Cleveland gree in social work from the Ohio State University in
State University’s APA Accredited program in Coun- 2014. Since then, she has worked in community men-
seling Psychology within the Department of Urban tal health and more recently in private practice in Co-
Education. Her experience includes working in univer- lumbus, Ohio. Her clinical interests include: college
sity disability services and in several college counsel- mental health, women's issues, survivors of violence,
ing centers. She is currently a licensed psychologist at PTSD, depression, and anxiety. She is a licensed inde-
The Center for Balanced Living in Columbus, Ohio, a pendent social worker, and has been a member of the
not-for-profit, CARF accredited treatment center. She National Association of Social Workers since 2014.
provides evidence-based treatment to individuals with
eating disorders in partial hospitalization and provides Acknowledgement
outpatient therapy for ED and general mental health is-
sues. She can be reached by email at: lindsay.varkula@ This research was conducted at Counseling and Con-
thecenterforbalancedliving.org. sultation Services in the Office of Student Life at The
Ohio State University, Columbus, Ohio.
James Beauchemin received his M.S.W. degree from
the University of Vermont and Ph.D. from The Ohio
State University. His experience includes working as
a Senior Staff Therapist at the university Counseling
and Consultation Service, teaching for the Colleges of
Social Work and Kinesiology, and working as a subject
matter expert for the American Council on Exercise.
He is currently faculty in the School of Social Work at
Boise State University. His research interests include
college student wellness, mental health, and integrated
body-mind-spirity interventions. He can be reached by
email at: [email protected].
Sandra Facemire, M.S.W., L.S.W. received her
M.S.W. degree from the College of Social Work at
The Ohio State University. She is currently a Senior
Staff Clinical Therapist at Counseling and Consul-
tation Service at The Ohio State University. Her re-
search interests includes mindfulness and wellness
practices in psychotherapy and examining barriers
to help-seeking by minority student populations. She
can be reached by email at: [email protected].