The Center for Collegiate Mental Health: An Example of a Practice-Research Network in University Counseling Centers

The Center for Collegiate Mental Health: An Example of a Practice-Research Network in University Counseling Centers
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   PLEASE SCROLL DOWN FOR ARTICLE This article was downloaded by: [Castonguay, Louis G.]  On: 10 April 2011 Access details: Access Details: [subscription number 936121984]  Publisher Routledge  Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of College Student Psychotherapy Publication details, including instructions for authors and subscription information: The Center for Collegiate Mental Health: An Example of a Practice Research Network in University Counseling Centers Louis G. Castonguay a ; Benjamin D. Locke a ; Jeffrey A. Hayes aa  Pennsylvania State University, University Park, Pennsylvania, USAOnline publication date: 08 April 2011 To cite this Article  Castonguay, Louis G. , Locke, Benjamin D. and Hayes, Jeffrey A.(2011) 'The Center for CollegiateMental Health: An Example of a Practice-Research Network in University Counseling Centers', Journal of CollegeStudent Psychotherapy, 25: 2, 105 — 119 To link to this Article: DOI: 10.1080/87568225.2011.556929 URL: Full terms and conditions of use: article may be used for research, teaching and private study purposes. Any substantial orsystematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply ordistribution in any form to anyone is expressly forbidden.The publisher does not give any warranty express or implied or make any representation that the contentswill be complete or accurate or up to date. The accuracy of any instructions, formulae and drug dosesshould be independently verified with primary sources. The publisher shall not be liable for any loss,actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directlyor indirectly in connection with or arising out of the use of this material.   Journal of College Student Psychotherapy  , 25:105–119, 2011Copyright ©  Taylor & Francis Group, LLCISSN: 8756-8225 print/1540-4730 onlineDOI: 10.1080/87568225.2011.556929  ARTICLES  The Center for Collegiate Mental Health: An Example of a Practice-Research Network in University Counseling Centers LOUIS G. CASTONGUAY, BENJAMIN D. LOCKE,and JEFFREY A. HAYES  Pennsylvania State University, University Park, Pennsylvania, USA This article presents a model of a practice-research network that offers benefits for clinicians working at college and university counseling centers. We briefly describe the basic components of this  practice-research network, challenges in developing it, and some of the empirical studies that have resulted from this initiative. We also describe possibilities for future research that not only will fos-ter further collaborations between clinicians and researchers, but also will enhance our ability to understand and improve mental health services for college students. KEYWORDS practice-research network, university counseling centers  The majority of clinicians work in a stressful world. Not only are they accomplishing difficult tasks (i.e., assessing and treating individuals whoexperience high levels of distress and impairment), but they do so withindemanding schedules and while juggling a wide variety of responsibilities(e.g., case management, paperwork, meetings, incessant e-mail, and phonecalls) that frequently require substantially more than an 8-hour day. In addi-tion to coping with these intense and challenging work demands, many clinicians are now facing increased pressure to demonstrate their knowledgeof, and ability to implement, “evidence-based practices” (EBPs). Althoughprofessional organizations, such as the American Psychological Association,  Address correspondence to Louis G. Castonguay, PhD, Department of Psychology,Pennsylvania State University, University Park, PA 16802, USA. E-mail: lgc3@psu.edu105  D o w nl o ad ed  B y : [ C a s t o n g u a y ,  L o ui s  G .]  A t : 20 :00 10  A p ril 2011  106  L. G. Castonguay et al. have advocated for the recognition of clinical experience as one of the basesfor EBP, experimental research continues to be viewed as the best sourceof knowledge to inform this philosophy of practice. Despite this, it is clearthat a majority of clinicians are not substantially altering their clinical prac-tice in response to empirical findings published in research journals, nor aremost practitioners involved during their day-to-day work in research that isguided by and able to influence their own clinical practice. Hence, researchis frequently viewed as an irrelevant or intrusive source of pressure on topof already difficult work conditions—a state that simply widens the gapbetween researchers and practitioners.One could argue that this perception of research as intrusive or irrel-evant is in large part due to the fact that empirical studies have typically emerged from conceptually driven research programs of university faculty members who, even when they respect clinical work, spend few hours (if any) working with clients. As such, many of the studies published in peer-reviewed journals fail to directly address questions and concerns with whichclinicians are repeatedly confronted. To be sure, many of the studies con-ceived of and designed by academicians do involve clinicians. However,in many of these investigations the role of practitioners is often limited toanswering surveys, collecting questionnaires from clients, or administratingtreatment protocols. In the majority of such studies, both the questionnairesand protocols have been selected by the researchers to fit the specific variables of their interest. This unfortunate reality reflects what has beendescribed elsewhere (see Castonguay in Lampropoulos et al., 2002) as“empirical imperialism,” where the research findings of a few individuals, who see very few if any clients, are aimed at guiding the work of much moreclinically experienced practitioners. In other words, researchers are deter-mining what should be studied and how it should be studied, and the results(derived primarily from highly controlled clinical interactions) are frequently held as the ultimate source of knowledge driving our understanding of psy-chotherapy. Meanwhile, full-time, experienced, effective clinicians are toobusy managing complex clients, coordinating care, and getting paperworkdone to plan and conduct research that will influence the future of their field.It has been argued that an optimal way for clinicians to be, or become,interested in research findings is for them to conduct, or actively participatein, research (Castonguay, Boswell, et al., 2010; Elliott & Morrow-Bradley,1994). Needless to say, however, there are a wide variety of obstacles thatstand in the way of clinicians doing so. Most clinicians do not have thetime, resources (e.g., funds, space, and equipment), or help (e.g., graduateand undergraduate assistants) to generate and manage research projects.In addition, the breadth and depth of expertise (e.g., statistical analyses,research methods, empirical literature, and regulations for the protection of human subjects) that is required of psychotherapy studies make it difficultfor full-time practitioners to conduct research independently.  D o w nl o ad ed  B y : [ C a s t o n g u a y ,  L o ui s  G .]  A t : 20 :00 10  A p ril 2011  The Center for Collegiate Mental Health  107 The 1949 Boulder Conference attendees concluded that optimal trainingof psychologists should be based on a 50 / 50 split of science and practice. What the conference attendees were unable to foresee 60 years ago, how-ever, is that external pressures would force a rift to develop within thefield—a rift that distances the very ingredients required for ideal training.Today, academic researchers conduct research efficiently, publish papersas quickly as possible, and acquire grant funds—just to keep their jobs.Clinicians, on the other hand, have learned to cope with managed care pan-els, decreasing hourly fees, treatment limitations, and increasing amounts of unbillable time spent completing paperwork and coordinating care. They must work harder and longer to make the same living. In essence, moderndemands on the field of psychology have forced its participants to becomehighly focused niche players without time or energy to be concerned withthe activities of the rest of the team. There is a split between academicpsychotherapy researchers focused on their next study or publication andclinicians coping with economic pressures, client crises, and paperwork.One way of facilitating a meaningful and fulfilling engagement of clinicians in research and, in doing so, fostering the actualization of thescientific-practitioner model is the creation of “practice research networks”(PRNs). PRNs are based on the assumption that the optimal way to con-duct scientifically rigorous and clinically relevant research is to build a fully collaborative relationship between practitioners and researchers, which pro- vides the former the opportunity to be involved in all aspects of research,including the selection of questions to be investigated, the design and imple-mentation of the study protocols, the collection and analyses of the data,and the dissemination of the findings (Castonguay, Boswell, et al., 2010;Castonguay, Nelson, et al., 2010).To be successful, PRN infrastructures have to address the obstacles of time, resources, and expertise mentioned above. For instance, clinicians’engagement will be facilitated if studies are not overly burdensome in timeand effort (i.e., if they add minimally to, or fit seamlessly with, clinical rou-tine; Castonguay, Nelson, et al., 2010). Optimally, PRN studies should beconducted in environments where clinicians actually work as opposed to asite removed from their day-to-day practice, but also in a context where affil-iations with researchers can be easily established and maintained. In additionto these pragmatic issues, PRN infrastructures are most likely to take off, sur- vive, and grow if the studies they foster are relevant to therapists of differentorientations; if clinicians can have a voice in supporting, guiding, creatingand / or developing research programs; and if practitioners feel a sense of ownership of the data collected and the questions investigated (Castonguay,Nelson, et al., 2010). We also believe that clinicians will be more motivatedto collect data and conduct studies if they have assurance that the researchis supported by their administrators and that results can be used to improveservices. In other words, research is likely to be meaningful to clinicians if   D o w nl o ad ed  B y : [ C a s t o n g u a y ,  L o ui s  G .]  A t : 20 :00 10  A p ril 2011  108  L. G. Castonguay et al. it has both intrinsic implications for their work and advocacy value—if itinforms their practice or supervision, provides evidence of their worth, andpoints out what needs to be done to improve services.The goal of this paper is to present a model of a PRN infrastructure thatoffers the benefits discussed above for clinicians working at college and uni- versity counseling centers. We briefly describe the basic components of thisinfrastructure, challenges in developing it, and some of the studies that havebeen done so far. We also describe possibilities for future research that willnot only foster further collaborations between clinicians and researchers, butalso enhance our ability to understand and improve mental health services.First, however, we discuss why research conducted by and for therapistsmay be crucial for the health and growth of counseling centers. CONDUCTING RESEARCH IN COUNSELING CENTERS: CAN WE AFFORD NOT TO? Because a majority of college students are what used to be commonly known as YAVIS (young, attractive, verbal, intelligent, and successful) clients,it is frequently assumed that mental health professionals in university counseling centers are treating “easy” cases, helping students to resolve“developmental” issues (e.g., getting over a relationship breakup, dealing with body image issues, or addressing unrealistic standards of academicperformance). As an example, one of the authors vividly remembers an inter- view for a faculty position in a clinical psychology program during whichhe was questioned, several times, about how his internship at a counselingcenter might prepare him to supervise “complex” clinical cases, involving“real psychopathology.” (Sixteen years later, he is still working at this clin-ical program and, as far as he knows, graduate students judge his clinicalteaching and supervising to be satisfactory.) Although there may have been a time when college counseling was pri-marily focused on developmental issues, it is important to remember that thefield of college counseling was born from the demand for services follow-ing World War II, and that today’s college and university students struggle with the full range of mental illness, from major depression to schizophre-nia and personality disorders. As one example of the difficult issues facedby college mental health providers each day, it is estimated that 10% of college students seriously consider suicide each year, 1.5% attempt suicide,and 1100 students nationwide actually commit suicide, making suicide thesecond leading cause of death among college students (American CollegeHealth Association, 2008; Suicide Prevention Resource Center, 2004).The increase in severe and frequent psychopathology in college stu-dents was illustrated by Benton, Robertson, Tseng, Newton, and Benton(2003), who examined the rates of client concerns, as reported by counselors  D o w nl o ad ed  B y : [ C a s t o n g u a y ,  L o ui s  G .]  A t : 20 :00 10  A p ril 2011
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