Students and counselors navigate challenges of tele-mental health care

Anticipating new anxieties the realities of Covid-19 might impose on students, Parton Health Center overhauled its counseling program in the first week of an elongated spring break to provide therapy remotely for the remainder of the semester. 

The counseling center has what Counseling Services Director Gus Jordan calls an “obligation to provide continuity of care”— that is, when students departed campus, Parton committed to ensuring that those who needed counseling would continue to receive support remotely. While spring break is usually a time when the health center quiets down, this year counselors spent that time educating themselves about remote counseling: learning Zoom therapy guidelines and studying ethics and risk-management practices for tele-mental health care. 

However, they immediately faced a bureaucratic mess of state health department laws that restrict therapists in practicing outside of their state of licensure. While counselors on Middlebury’s staff are licensed to provide counseling in Vermont, licensing requirements for therapists vary from state to state, and call for different levels of certification ranging from Ph.D. to counseling certificates. 

Some state officials recognized the need for quick access to tele-mental health services during the pandemic and changed their guidelines quickly (states like Mississippi and Illinois quickly offered “temporary licensure” for this purpose), but others did not. This meant that even as Middlebury counselors were available, they were in some cases unable to keep providing counseling over Zoom to students who had moved away from Vermont. 

“The moment students scattered all across the country, we had to get looking at what the laws were that allow or prohibit providing counseling to students,” Jordan said. 

Instead of continuing to provide therapy to every student, counselors divided their approach. They have held Zoom counseling sessions with the students whose home states permit it, while simultaneously taking a “case management” approach with those residing where regulations prevent continuity of care directly from a counselor in Middlebury. In these cases, counselors worked with student patients to locate a licensed therapist in their area who might be a good fit using Psychology Today’s Therapist Finder tool. 

Jordan said that counselors have shifted from helping some students with pressures shaped by Middlebury’s environment—academics, social dynamics, feelings of not belonging—to new anxieties: fear of returning to unstable homes, in some cases, but more broadly the uncertainty of the pandemic. Counselors who have continued meeting with students have helped them work through that uncertainty—worry over finding employment during an emerging recession, concern about the health of family members and simple questioning of whether to make plans in the murky weeks ahead—alongside the usual worries that come with the end of a semester. 

Brigett Weinstein ’20, who lived in Fairhaven, Vt. with her boyfriend during spring break before returning home to New Jersey, was able to meet twice with her Middlebury counselor via Zoom while she was still in Vermont. During those sessions, she said that discussions with her therapist focused on stress around future plans. 

“Probably most of the anxiety is shifting towards looking towards the future, job stuff, and what that will look like in a pandemic,” she said. “I think that that's kind of natural—I wouldn't say that that's happening now because we're off campus, but also probably because we're just getting closer to graduating.” 

Weinstein said that she did not initially assume she would be able to keep receiving care from her counselor once she left campus. She was surprised and grateful when her counselor reached out, and when they later offered to help put her in touch with a therapist in New Jersey. (She already had a therapist she is familiar with at home with whom she felt she could meet if necessary. New Jersey, according to Jordan, was a state that quickly changed its licensure rules so that therapists from out-of-state could meet with patients there.)

“My [Middlebury] therapist did the best she could with what she had,” Weinstein said. “I'm really grateful to her and grateful that Midd is still somewhat offering some things to help.”

Madeleine Ciocci ’20 had to stop seeing her Middlebury counselor, with whom she had been meeting regularly for two years, when she returned home to New Hampshire. But the two were able to meet several times over Zoom during spring break, and like Weinstein, Ciocci said that many themes of conversations they had had at Middlebury shifted in the face of uncertainties posed by the pandemic. 

“All of us are trying to reconcile this huge life shift that we're trying to make with no warning or preparation,” she said. “At the same time dealing with all the stressors that come with graduating college and trying to make a huge life transformation while all these things are thrown into question.” 

Ciocci said that the last session she had with her counselor, when she was told that they would no longer be able to meet, was “devastating.” Still, she was grateful for the efforts her counselor made to connect her with a new therapist in her area. 

Technology has become a defining feature of remote mental health support, both in how it shapes the experience of interacting with a therapist and in how it dictates who is able to receive care (not every student has a stable internet connection or a private room in which to speak with a counselor). Using Zoom meetings as a primary communication method over the past two months has also led to what Jordan terms "Zoom fatigue"—people are simply tired of sitting in Zoom meetings at this stage of the semester. And, students said, speaking to a therapist over Zoom can lead to facial expressions, gestures and mood shifts not being picked up as readily as they are in person.

"Zoom definitely adds a weird dynamic where the body language isn't always there, and that's really important in therapy," Weinstein said. 

Beyond therapy sessions with counselors, Jordan said that Parton has seen a “dramatic” increase in the number of students seeking guidance from Parton-run support groups, which the counseling department has held over Zoom in the past weeks. These groups included a weekly meditation series and a four-part workshop focused on college life called “Riding the Wave of Emotions: Being in College during Covid-19.” 

Counseling appointments have been in high demand at Middlebury over the past few years. Still, Jordan said that on average when compared to past semesters, the number of students enrolled in counseling has decreased this semester as students are connected to providers in their home areas. 

“If a student calls in and says ‘hey, I need help,’ we will have an appointment for them today, tomorrow...we can get them connected to a counselor right away,” Jordan said. 

Students seeking counseling support may call Parton’s 24/7 counseling support line at (855) 465-5013. 

Update 5/14/20, 11:00 A.M.: this article was updated to include more specific information about state-by-state counseling rules.