Student Distress Identification, Intervention & Referral by Dr. John Hipple 2014 UNT Advising Conference #UNTAdv14 May 22, 2014 Collin College - Preston Ridge Campus

1. STUDENT DISTRESS
IDENTIFICATION, INTERVENTION & REFERRAL
John Hipple, Ph.D.
UNT Counseling Center
940-565-2741
John.Hipple@UNT.EDU

2. DEVELOPMENT ISSUES
&
COMMON ADJUSTMENT PROBLEMS
WHICH IMPACT ACADEMIC PROGRESS
OF.
COLLEGE STUDENTS
DEVELOPMENTAL ISSUES
WHO AMI?
WHEREAMIGOING?
HOW WILL I GET THERE?
WHO WILL IBE WITH?
STRIVING TO ACHIEVE:
INCREASE SENSE OFPERSONAL INDEPENDENCE
Listens to self before listening to others
SEEKING MAXIMUM CONTROL AND INFLUENCE
When in doubt attempt to "manipulate" others
COMMON STUMBLING BLOCKS FOR STUDENTS:
EFFICIENT TIME MANAGEMENT
Getting to class and having assignments completed
REACTIVE RATHER THAN PROACTIVE STYLE OF ACTION
Difficult to plan ahead. When in doubt, put things off.
DIFFICULTY IN HEARING CONSTRUCTIVE CRITICISM
May be use to hearing only positives from teachers
SEPARATION ANIETY (LONLINESS) FROM FAMILY
DIFFICULTY IN ESTABLISHING A SUPPORT NETWORK
Social skills may be marginal
EMOTIONALLY -INTERNAL AND PRIVATE
Especially for males: don't show emotions .
POOR COMMUNICATION AND PROBLEM SOLVING SKILLS
Il."1PORTANT TEACHING SKILLSNESSARY TOOVERCOME THESE ISSUES
CLEAR CLASSROOM EXPECTATIONS
Provided in written and verbal formats-often reminding students.
CONSISTANCY ON PART OFCLASSROOM TEACHERS
TEACHER PROVIDES A BALANCE OF POSITIVE AND NEGATIVE
FEEDBACK.
TEACHER IS WILLING TO 'KNOW THE STUDENT AS COMPETELY
AS POSSIBLE

3. SOME SIGNIFICANT INDICATORS OF CRISIS IN STUDENTS
Crisis can occur in all students regardless of age. Most frequently the student in crisis may attempt or commit
suicide. Some significant indicators of a student in crisis may include one or more of the following.
Significant Indicators
Suicidethreat
Verbal hints indicating self-destructive behavior
or that life would be better if student did not exist
Preoccupation with thoughts of suicide or death
Family member or close friend has attempted or
completed suicide
Making final arrangements, giving away possessions
Sudden unexplained cheerfulness after prolonged depression
Keeping guns, knives, or lethal medicines in student's
possession
Breakup with boyfriend or gidfriend and withdrawal
from other friendships
Family Indicators
Loss of family member (or anniversary of loss)
through death, separation, or divorce
Rejection byfamilymembers
Recent household move
Family discord
Change in immediate family or household membership
Alcoholism or drug use in the family
Student is a victim of physical, sexual, and/or emotional
abuse
Running away from home
Family history of emotional disturbance
School Indicators
Failing or drop in grades
Difficulty concentrating on school work
Loss of interest in extra-curricular activities
Social isolation
New to school
Frequent referrals to office because of behavior,
tardiness, truancy
Academic'leaming difficulties
Social and Emotional"lndicators
Noted personality change
Depression, feelings ofsadness
Withdrawal, does not interact with others
Agitation, aggression, rebellion
Sexual problems (promiscuity, identity, pregnancy)
Feelings of despair, hopelessness, helplessness
Feelings of being bad or the need to be punished
Unexplained accidents, reckless behavior
Recent legal involvement
,
Physical Indicators
Changes in eating or sleeping patterns
Weight gain or loss
Neglect of personal appearance
Lethargy, listlessness
Frequent physical complaints
Pregnancy
Prolonged or terminal illness
Drug or alcohol abuse
Significant Times of Danger, Rites of Passage
Graduation
Completion of parental divorce
Anniversaries of unhappy events (parental
deaths, severe losses)
Holidays, particularly family holidays
Vacation times, especially if child is isolated
Change of season
Custody disagreements

4. Early Warning Signs
Indicators of Difficulty in Coping
The stress reactions below are presented in categories so that they may be more easily recognized and understood. There is no magic
number of these symptoms that suggest difficulty in coping: rather it is the extent to which the noted reaction is a change, that is, different
from a person·s normal condition that makes a reaction potentially important.
It is the combined presence of symptoms that determines the potency of the problem. Indicators may be isolatJed reactions or
combinations among the three categories listed below.
Finally it is their duration (how long the symptoms have been present and how long they last), the frequency of such incidents (how often
they happen), and the intensity (strength) with which they are present that suggest the severity of the difficulty of coping.
Apathv
Emotional
Indicators
Behavioral
Withdrawal (avoidance)
Physical
Preocc11oa1ion with illness !intolerant of
dwelling on minor ailments/
• The "blahs"
• Recreation no longer pleasurable
• Sad
Anxiety
• Restless
• Agitated
• Insecure
• Feelings of worthlessness
Irritability
• Overly sensitive
• Defensive
• Arrogant I argumentative
• Insubordinate I hostile
Mental fatig11
•e
• Preoccupied
• . Difficulty concentrating
• Inflexible
Overcompensation
• Exaggerated I grandiose
• Overworks to exhaust
• Denies problems I symptoms
• Suspicious I paranoid
WorkIndicators
• Decline in performance
• Lower quality and quantity
• Negative changes in quality of
work group relationship
• Higher rate of absenteeism
• More use of sick leave and
annual leave
o Social·isolation
• Work related withdrawal
• Reluctance to accept
responsibilities
• Neglecting responsibilities
Acting out
• Alcohol abuse
• Gambling
• Spending spree
• Promiscuity
Desperate acting out /getting attention-cry
for help/
Administrative infractions
• Tardy to work
• Poorappearance
• Poor personal hygiene
• Accident prone
legal infractions
• Indebtedness
• Shoplifting
• Traffic tickets
• ChildIspouseabuse
Freq11enl illness(act11allvsick)
Physical exha11stion
Use o(se/fmedication
Somatic indicators
• Headache
• Insomnia
• Initial insomnia
• Recurrent awakening
• Early morning rising
Change in aPDetite
• Weight gain
• Weight loss (more serious)
• Indigestion
• Nausea
• Vomiting
• Diarrhea constipation
• Sexual difficulties
School indicators
• Failing or drop in grades
• Difficulty concentrating on school
work
• Loss of interest in extra curricular
activities
• Social isolation
• New to school
• Frequent referrals to office because of
behavior, tardiness, truancy
• Academic learning difficulties

5. DIMENSIONS OFDEPRESSION
Affective
Ambivalence
Loss of sources of gratification
Loss of sense of humor
Poorself-esteem
Feeling of inadequacy, worthless
Loss of emotional attachments (apathy)
Dejected mood, sadness
Excessive orinappropriate
Feelings ofpowerlessness
High or low emotional reactivity
Increased irritability, anger
Focus is primarily on depressed feelings
Loss of motivation
Anhedonia
Cognitive
Negative expectations (hopelessness)
Negative self-evaluation
Negative interpretation of events
Suicidal ideation
Indecision
Confusion
Primarily internal focus
Global thinking style
"Victim mind set (helplessness)
Cognitive distortions (erroneous patterns of thinking)
Rumination
Perceptual amplification orminimization
Rigidity
Physiological
Sleep disturbance (hypersomnia or insomnia)
Appetite disturbance (hyper-or hypophagia)
High fatigability
Marked change in body weight
Sex drive disturbance (hyper-or hypo sexuality)
Anxiety
Vague or specific physical complaints with
No apparent organic etiology
Magnification or persistence of physical symptoms
With a known organic etiology
Historical
History of significant losses
History of aversive, uncontrollable events
Inconsistent demands, expectations, and
Environments
Narrow range of personal experiences
Behavioral
Disturbance in activity level (hyper-or hypoactive)
Aggressive or destructive acts
Crying spells
Suicideattempts
Slow or slurred speech
Substance abuse
Generalized impulsivity
Behaviors inconsistent with personal values
Destructive compulsive behavior
Psychomotor agitation or retardation
"Acting-out" behavior
"Giving up" behavior
Perfectionistic behavior
Relational
"Victim" relational style
Marked dependency on others
High reactivity to others
Social secondary gains
Social withdrawal, isolation
Social avoidance, apathy
Excessive approval seeking patterns
Self-sacrificing, martyrish patterns
Over responsible for others
Inappropriate scapegoating of self or others
Passive-aggressive patterns
Diffuse or rigid personal boundaries
Power seeking or avoiding
Incongruent patterns of relating
Hypercritical of others
Narrow range of communication skills (identifying
And expressing feelings)
Contextual
Generalized, predictable, restricted response in particular situations
Depressogenic situational cues (anchors), involving:
specific people
specific places
specific objects
specific times of day (month, year)
Ambiguity regarding situational demands, responsibilities
Ambiguity regarding situational locus of control
Situational diffusion or rigidigying of boundaries
Situational violation of personal values, ethics
Symbolic
Destructive fantasies, images
Recurring nightmares
Bothersome images
Symptoms as metaphorical representations of inner experience
Interpretation of "meaning" of depression
"Healing"images
Spiritual involvements, interpretations.

6. WHEN IS SADNESS NORMAL??
It seems to me that the word DEPRESSION is much overused in our culture and our
counseling profession. It is quite common for people to be saying 'Oh, I am depressed
today". I wonder if they are 'just' sad.
A study by the Center for Disease Control (CDC) involving 166,000 people concluded
that feeling sad about three days a month was well within the realm of common
experience.
From a counseling perspective, it seems to me that sadness is a normal human emotion
typically appearing as a response to loss and/or change/transition. Learning how to
accept, adapt, and fill the void are the adjustment challenges.
The counseling task is to help the client clarify his/her feelings and determine if there is
'merely' normal sadness in operation or ifthe situation is depression-which I call
sadness gone haywire.
In my own clinical experience I have found that helping a client see that the feelings,
thoughts, and behaviors are quite normal and to be expected in the given circumstance of
loss or change can be very reassuring. Normalization as a counseling tactic can be quite
helpful. Additionally helping the client see that it takes time for sadness to 'heal' can
also be important. In our 'hurry up" society, many of our sad clients feel pressured from
their peers and families to get back to 'normal' very quickly. A little education can go a
long way in helping a client gradually become less and less sad. They don't have to
judge themselves as being weak or inadequate, just because their sadness sustains for a
time.
The same CDC study noted that active people tend to be less upset by their sadness.
Finding new ways to think and behave in the face of loss and change can go a long way
to feeling better.
Of course, the diagnostic challenge is to clearly differentiate the difference between
clinical depression and normal sadness. The problem, is that on the surface, the
symptoms look very much the same.
John Hipple, Ph.D., LPC
Counselor
Counseling & Testing Center
University of North Texas
Denton, TX

7. PROBLEMSFRESHMEN PRESENT
AS THEY ENTER THE UNIVERSITY
STUDENT COUNSELING CENTER
Selecting an academic major
Translating a major into a career
Loneliness---Not having a sense of connection
Sadness which can transition into depression
Loss of a love---the girl or boy back home
Frustration/irritation/anger
Poor communication with parents---different expectations
Homesick '
WELLNESS RESOURCE CENTER
Experimenting with alcohol and drugs
Binge drinking
Unrealistic expectations/perceptions about the level of alcohol use on campus---not all
college students drink
OFFICE OF STUDENT RIGHTS AND RESPONSIBILITIES
Not recognizing they are responsible for their actions
Not acknowledging their actions impact others
Distorting the truth in an attempt to avoid/deny
Plagiarism
Inappropriate response to diversity---low tolerance for differences
Ignorance is not an excuse-know the rules
Making assumptions---ask questions, don't guess
RESIDENCE HALLS
Lack of skills in conflict resolution: roommate difficulties
Low involvement in dorm life which leads to isolation: hard to initiate social contacts
Time management
Difficulty in accepting personal responsibility for actions
Poor setting of priorities-school, social, etc.
Low in adult help seeking
Inappropriate experimentation with alcohol and other substances

8. LEARNINGCENTER
Provides a broad base of academic skill support (including tutoring) to students
Taking essay examinations (#1 concern)
Time management-time to study, going to class
Making classroom presentations
Study skills
Test anxiety
Tutoring assistance, especially in math
Research skills
Lack of education goals
OFFICE OF DISABILITY ACCOMODATION
Appropriate academic goals
Appropriate diagnostic testing already accomplished
Career direction
Lack of assertive skills
Victim mentality
ATHLETIC DEPARTMENT
Appropriate academic goals
Study skills
Career direction
Lower sense of personal responsibility: Some are use to being "taken care of' because
they are athletes.
Anger problems/conflict resolution
Problem solving skills
My sport is too much work, no longer as much fun
Homesick
Overwhelmed by the athletic and academic demands
Keeping parents happy can be difficult
At UNT, women student athletes seem better prepared academically then our male
athletes
COLLEGE OF MUSIC
Overwhelmed by the amount of time required for practice, rehearsal, etc.
Unrealistic career goals
Performance anxiety

9. Unrealistic expectations
COLLEGE OF ARTS AND SCIENCES ADVISORY OFFICE
Of the 2000 freshmen students who enter the College of Arts and Science, 20-25% are
undeclared in regard to major.
Lack of motivation
Too much freedom which results in poor time management
Not attending class in a regular fashion. No one is telling them to go each class day
Don't ask for help from professors
Don't see out other resources on campus which might help them with their difficulties
Don't drop classes soon enough when they are clearly outclassed.
At the end of the 1999/2000 academic year, 8 Y, % of the Arts and Science freshmen
were academically suspended for poor performance. The Median SAT score for this
group was 1015. It appears that ability was not the only reason for the poor performance.
John Hipple, Ph.D.
Student Counseling Center
University ofNorth Texas
940-565-2741
hipple@dsa.admin.unt.edu

10. COMMON STUDENT STRESS PERIODS
SEPTEMBER Homesickness; especiallyfor first year students
Values crises - students are confronted with questions of conscience over value conflict areas of race, drugs, and alcohol
experimentation, morality, religion and socia] expectations.
• Feelings of inadequacy and inferiority develop because of the discrepancy between high school status and grades and
initial college performance.
• "In Loco Parentis" blues -students feel depressed because of real or perceived restrictive sense of confusion,
vulnerability, andlackof anyadvocatein power positions.
OCTOBER New or retuming students begin to realize that life at college is not aspeifect as they were led
to believe by parents, teachers and adniissions staff
Grief develops because of inadequate skills for finding a group or not being selected by one.
Mid-term work-load pressures are followed by feelings of failure and loss of self-esteem.
Pregnancies from summer relationships begin to show. Dilemma of Vhat to do.
Non-dating students sense a loss of esteem because so much value is placed upon dates.
Job panic for mid-year graduates.
NOVEMBER Acadeniic pressure is beginning to niount because of procrastination, difficulty of work, and
lack of ability
Depression and anxiety increase because of feelings that one should have adjusted to the college environment by now.
Homecoming blues develop because of no date and/or lack of ability to participate in activities.
• Economic anxiety - funds from parents and summer earnings begin to run out; loans come due.
Some students have ceased to make attempts at establishing new friendships beyond two or three parasitic relationships.
DECEMBER Extracurricular time strain; seasonal parties, concerts; social se111ice projects, religious
activities drain student energies
• Anxiety, fear and guilt increase as final examinations approach and papers are due.
Pre-Christmas depression; especially for those who have concerns for family, those vho have no home to visit, and for
those who prefer not to go home because of family conflicts.
Financial strain because of Christmas gifts and travel costs.
Pressure increases to perform sexually because of the approach of vacation and extended separation.
JANUARY Post-Christrnas depression at again being avay fro1n ho1ne security.
FEBRUAR
Y
Many students experience optbnisnz because second sen1ester isperceived as going "down hill".
Vocational choice causes anxiety and depression.
Couples begin to establish stronger ties or experience weakening of established ones.
• Depression increases for those students who have failed to establish social relationships or achieve a moderate amount of
recognition.
Social calendar is non-active.
MARCH Drug and alcohol use increases.
Pregnancies from Christmas vacation begin to show.
Depression begins due to anticipation of separation from friends and loved ones at college.
Academic pressures increase.
Existential crisis for seniors: Must I leave school? Is my education worth anything? Was my major a mistake? Why go
on? Where is God? Why am I not making it?
APRIL
•
•
•
Acadeniic pressures continue to increase because of 1nid-ter1ns
Frustration and confusion develop because of decisions necessary for pre-registration .
Summer job pressures.
Selection of a major.
Papers and exams are piling up.
The mounting academic pressures force some students to temporarily give up.
Social pressures -everybody is bidding for your participation at trips, banquets and picnics.
MAY
•
•
Job recruitment panic.
Anxiety develops because of the realization that the year is ending.
Senior panic about jobs (lack of them).
Depression over leaving friends and facing conflicts at ho1ne.
Finals pressure and anxiety.
From the NASPA Jounwl, published by NASPA: Student Affairs Administrators in !Iigher Education.

11. DEALING WITH THE ANGRY INDIVIDUAL
Anger is a combination of discomfort, tenseness, resentment, and frustration which
is often aroused by a real or supposed wrong.
Situations which cause the most dissonance:
1. Stress-overload
2. Frustration-helplessness
3. Loss
4. Change which is not understood
5. Confusion over complexities
6. Sense of violation/infringement/injustice
Other issues which 'feed' anger:
1. Moralistic thinking-right/wrong
2. Low tolerance for discomfort
3. Very extensive personal bonndries-easily infringed upon
4. Impatient
5. Self Centeredness
INTERVENTION ACTIONS
1. Remember anger is a response to something---not out of the blue
2. Show you are interested in hearing the person out.-Be calm & polite
3. Active listening is critical.
a. Emotional labeling-"I hear your frustration"-I language
b. Paraphrasing
c. Give time to talk things out
d. Minimal encourages to talk: "Isee'', "oh", 'Um"
4. Identify the specific problem as simply and quickly as possible
5. Clearly acknowledge the grains of truth in the anger
6. Apologize for the mistake/misunderstanding
7. Identify actions steps for them and you
8. Be willing to advocate if appropriate
9. Find a way to follow up on the conversation
10.Have someone higher in authority to refer to
11. Be honest and direct about what you can and cannot do

12. RESPONDING TO DISRUPTIVE
OR
THREATENING STUDENT BEHAVIOR
A GUIDE*
John Hipple, Ph.D.
Counseling Center
Suggestions of influencing how individual student behavior impacts the learning
environment:
Set and communicate standards in your syllabus
Personally model the behaviors students are expected to exhibit
Firmly and fairly address disruptive behavior
Hold students accountable for their actions
Examples of potentially disruptive behaviors which could be addressed in a class
syllabus:
Intimidation orharassing behavior
Inappropriate, disrespectful, or uncivil responses to the comments or opinions
of others in the classroom or transmitted electronically
Biased based behaviors (comments or harassment)
Threats/challenges to do physically harm (even when stated in a joking manner)
Use of obscene pr profane language in the classroom or electronically
Excessive talking
Late arrival to or early departure from a class without permission
Refusal to comply with faculty/staff direction
Taking Action
Give a Warning: Speak individually with any student who exhibits a pattern of
disruptive behavior
Involve Others as Appropriate: Always inform your supervisor of any situation.
Identifying and Referring the Distressed Student
Excessive procrastination and very poorly prepared work, especially
if inconsistent with previous work
Infrequent class attendance with little or no work completed.
Dependency (Student makes excessive appointments)

13. Listlessness, lack of energy or frequently falling asleep in class
Marked changes in personal hygiene
Impaired speech and disjointed thoughts.
Repeated requests for special consideration
Threats to others
Expressed suicidal thoughts-as a current option
Excessive weight gain or loss
Behavior which regularly interferes with effective class management
Frequent or high levels of irritable, unruly, abrasive, or aggressive behavior.
Unable to make decision despite your repeated efforts to clarify or encourage
Bizarre behavior that is obviously inappropriate for the situation
Frequently appears overly nervous, tense or tearful.
Responding to threatening or potentially violent students.
Encounters with students that leave you frightened and in fear for your personal
safety should be taken very seriously. Direct or implied threats of violence, challenges to
fight, shoving, physically attacks, stalking;threatening phone calls ore mails, acts of
harassment, and similar behaviors should immediately be discussed with your supervisor.
Students must be held accountable for such negative behavior. Itmust not be ignored.
Do not meet alone with an angry or hostile student without some advanced preparation..
Some Precautions to take:
Alert a colleague that you are meeting with an at risk student.
Keep the meeting room door open if at all possible
Position yourself so that you can exit the room quickly if necessary
Terminate the session immediately if your 'sixth sense" tells you something
is wrong.

14. Avoid body language that appears challenging such as placing your hands
on your hips or using aggressive facial expressions.
Slow your rate of speech and use a low pitch and volume.
Ifnecessary ask your supervisor to provide assistance in finding a resolution
As early as possible identify what is the student's major issue.
Use good listening skills in order to fully understand the situation.
Ask appropriate clarifying questions.
Avoid defensiveness and arguing.
Terminate the meeting if the student remains belligerent.
Never touch an outraged student or try to force him/her to leave.
Ifaweaponbecomes evident, leave.
Let the student know the consequences to any violent behavior.
Never agree to go to an unmonitored location.
*Adapted from "Responding to Disruptive or Threatening Student Behavior: A guide for
Faculty". Virginia Tech. 2007

15. CAUSES OF ANGER & AGGRESSION
JOHN HIPPLE, PH.D., LPC, NCC
COUNSELING & TESTING CENTER
UNIVERSITY OFNORTH TEXAS
hipple@dsa.admin.unt.edu
INJUSTICE
BEING LET DOWN
FEELING SOMEONE IS DELIBERATELY PUTTING OTHERS DOWN
HAVINO SOMETHING TAKEN AWA¥-PERSONAL DIGNITY
INVASION OF TERRITORY-NO SAFE PLACE
NOT BEING GIVEN RELEVANT INFORMATION
OTHERS BEING OFFENSIVE TOWARDS ME
ATTITUDE: RUDNESS: LITTLE THANKS: LOTS OF CRITICISM
BEING KEPT WAITING AND NOT KNOWING WHY
INEFFICIENCY: PEOPLE NOT DOING WHAT THEY SAY THEY WILL DO
EXPRESSION OF FEELING: 'NOW YOU WILL KNOW HOW I FEEL"
MANIPULATION
RETALIATION/REVENGE
HAS BEEN A LEARNED BEHAVIOR
NEED FOR ATTENTION
PEER PRESSURE
THREAT TO STATUS/POSITION----A FAILING GRADE MAY LEAD TO
SUSPENSION
CONTINUED WORK OVERLOAD WITH NO LET UP IN SIGHT
LACK OF DISPUTE-RESOLUTION I PROBLEM SOLYING SKILLS
SUBSTANCE ABUSE

16. WARNING SIGNS
LOSS OF TEMPER ON A DAILY BASIS
FREQUENT PHSYICAL FIGHTING
SJGNIFICANT VANDALISM OR PROPERTY DAMAGE
INCREASED USE OF DRUGS AND ALCOHOL
INCREASE IN RISK TAKING BEHAVIOR
DETAILED PLANS TO COMMIT ACTS OF VIOLENCE
ANNOUNCING THREATS OR PLANS FOR HURING OTHERS
ENJOYING HURTING ANIMALS
CARRYING A WEAPON
A HISTORY OF VIOLENT OR AGGRESSIVE BEHAVIOR
FASCINATION WITH WEAPONS
THREATENING OTHERSREGULARLY
TROUBLE CONTROLLING FEELINGS LIKE ANGER
WITHDRAWAL FROM FRIENDS AND USUAL ACTIVITIES
FEELING REJECTED OR ALONE
POOR SCHOOLPERFORMANCE
HISTORY OFDISCIPLINE PROBLEMS
FEELINGCONSTANTLYDISRESPECTED
FAIRLING TO ACKNOWLEDGE THE FEEINGS OR RIGHTS OF OTHERS

17. Tips for faculty & staff: Helping
students in distress *
This information Isprovided to assist you in becoming aware of signs of a distressed student, things that you might
do to help the student, signs of suicidal ideation, and when and how to make effective referrals for additional help.
Tips for Recognizing Troubled Students
Al one time or another, everyone feels depressed or upset. However, there are three levels of student distress
which, when present over a period of time, suggest that the problems are more than the "normal" ones.
Level 1
Although not disruptive to others In your class or elsewhere, these behaviors may indicate that something Is wrong
and that help may be needed:
•Serious grade problems
•Unaccountable change from good to poor performance
•Change from frequent attendance to excessive absences
•Change In pattern of interaction
•Marked change in mood, motor activity, or speech
•Marked change In physical appearance
Levell
These behaviors may indicate significant emotional distress or a reluctanc or an inability to acknowledge a need for
personal help:
•Repeated request for special consideration
•New or regularly occurring behavior which pushes the limits and may interfere with class management or be
disruptiveto others
•Unusual or exaggerated emotional response
Level 3
These behaviors may usually show that the student is in crisis and needs emergency care:

18. 2
•Highly disruptive behavior (hostility, aggression, etc.)
•Inability to communicate clearly (garbled, slurred speech, disjointed thoughts)
•Loss of contact with reality (seeing/hearing things that are not there, beliefs or actions at odds with reality)
•Overt suicidal thoughts (suicide is a current option)
•Homicidal threats
What You Can Do To Help
Responses to Level 1/Level 2 Behavior
•Talk to the student In private when you both have time.
•Express your concern in non-judgmental terms.
•Listen to the student and repeat the gist of what the student is saying.
•Clarify the costs and the benefits of each option for handling the problem from the student's point of view.
•Respect the student's value system.
•Ask if the student Is considering suicide.
•Make appropriate referrals if necessary.
•Make sure the student understands what action is necessary.
Responses to Level 3 Behavior
•Stay calm.
•Call emergency referral listed below.
Do's and Don'ts in Responding to Sulcidality
' •DOshowthatyoutakethestudent's feelingsseriously.
•DO let the student know that you want to help.
•DO listen attentively and empathize.
•DO reassure that with help (s)he will recover.
•DO stay close until help is available or risk has passed.
•DON'T liy to shock or challenge the student.
•DON'T analyze the student's motives.
•DON'T become argumentative.
•DON'T react with shock or disdain at the student's thoughts and feelings.
•DON'T minimize the student's distress.
When to Make a Referral

19. 3
Even though a student asks you for help with a problem and you are willing to help, there are circumstances when
you should suggest other resources:
•You are not comfortable in handling the situation.
•Personality differences may interfere with your ability to help.
•You know the student personally (friend. neighbor. friend of a friend) and think you may not be objective enough to
help.
•The student is reluctant to discuss the situation with you.
•You see lil11e progress in the student.
•You feel overwhelmed or pressed for time.
How to Make a Referral
To the student:
•Be frank with the student about the limits of your time, ablllty, expertise, and/or objectivity.
•Let the student know that you care and think (s)he should get assistance from another source.
•Assure them that many students seek help over the course of their college career.
•Try to help the student know what to expect if (s)he follows through on the referral.
Consider these questions before making the referral:
•What are the appropriate and available resources for the student?
•With whom would the student feel most comfortable?
• •Who will make the initial contact, you or the student?
Consultation isAvailable
If you have concerns about a student, counselors at the counseling Center are available for consultation. Some of
the ways we might help include:
•Assessing the seriousness of the situation
•Suggesting potential resources
•Finding the best way to make a referral
•Clarifying your own feelings about the student and the situation
The Counseling Center

20. COUNSELING THE SUICIDAL CLIENT
JOHN HIPPLE, PH.D., LPC
It can be said that all behavior has a purpose. From a simplistic perspective, suicide can
be seen as a way to cope or defend. One thing to remember is that it is important to NOT
take away a coping/defending behavior without first finding a replacement.
It is my belief that suicide can be seen as a way to communicate. It is a message to
someone.
Possible communication messages include: Help me!, Escape, Sad, Anger/Revenge,
Punishment, Manipulation, Crazy (thoughts in one's head commanding suicide).
The goal of counseling would be to help the client identify the purpose of suicidal
thinking/planning/acting. Ifcommunication is part of the purpose, going on to clarify the
message and to whom it is directed. One way to get at this is to ask: "Who needs to
know that yo! are thinking/planning suicide?" "If that person were here, what would
you say to them?" And then the task would be to find ways other than suicide to
accomplishthepurpose.
There are some primary characteristics which are in operation in suicidal individuals:
Helplessness, Hopelessness, Intellectual Confusion, Idealism, Isolation, and
Ambivalence.
Counseling can move along by responding to these characteristics. Helping the client
take new action steps in regard to his pain. Providing Hope and Encouragement. Talking
by itself can help reduce confusion. Finding ways to be more practical and less
idealistic. Identifying ways in which the client can make more constructive social
contact. Ambivalence is seen as-part of the client sees death as an option and yet
another part is hanging on to life. The counseling experience can focus on both aspects
of the client. What is going on in the life space which makes it easier to seek death.
What is going on which makes it easier to focus on life.
Other treatment considerations include:
1. Reduce the immediate pain
2. Find new and life sustaining ways to fill needs
3. Identify behavioral alternatives
4. Provide hope
5. Play for time. Suicidal impulses are typically transitory
6. Listen to the cry for help and involve others

21. 7. Invoke previous positive patterns of successful coping
8. Involve significant others
9. Keep building the relationship and sense.of rapport. This attacks the sense of
isolation and provides an anchor to live
10. Provide a permission to stay live. Many clients have not directly or indirectly
heard the message that they are important and deserve to stay alive. "I want you
to stay alive.
11. Establish a life line: Build contingency plans so the client knows who can be
contacted in time of stress
12. Be willing to take charge: In the stress of the immediate crisis, the client needs a
counselor to be active and directive.
13. Follow up on missed appointments. Suicidal clients can not be ignored
14. Ifattempts occur during treatment. Debrief carefully
15. Pick up immediately after hospitalization: The periods immediately following
hospital discharge are especially dangerous.

22. Suicide Among College Students
• The rate of completed suicide for college students, according to a major study of suicides on Big Ten
college campuses (1997) was 7.5 per 100,000.
• It is estimated that there are more than l,000 suicides on college campuses per year.
• One in 12 college students have made a suicide plan.
• In 2000, the American College Health Association surveyed l 6,000 college students from 28 college
campuses.
o 9.5% of students had seriously contemplated suicide.
o 1.5% have made a suicide attempt.
o In the twelve month period prior to the survey, half of the sample reported feeling very sad,
one third reported feeling hopeless and 22% reported feeling so depressed as to not be able to
function.
o Of the 16,000 students surveyed, only 6.2% of males and 12.8% of females reported a diagnosis
of depression. Therefore, there are a large number of students who are not receiving adequate
treatment and/or who remain undiagnosed.
• Of the students who had seriously considered suicide, 94.8% repo11ed feeling so sad to the point of not
functioning at least once in the past year, and 94.4% reported feelings of hopelessness.
• Two groups of students might be at higher risk for suicide:
- Students with a pre-existing (before college) mental health condition, and
- Students who develop a mental health condition while in college.
Within these groups, students who are male, Asian and Hispanic, under the age of 21 are more likely to
experience suicide ideation and attempts.
• Reasons attributed to the appearance or increase of symptoms/disorders:
o New and unfamiliar environment;
o Academic and social pressures;
o Feelings of failure or decreased performance;
o Alienation;
o Family history of mental illness;
o Lack adequate coping skills;
o Difficulties adjusting to new demands and different work loads.
• Risk factors for suicide in college students include depression, sadness, hopelessness, and stress.

23. Changes in sleeping habits
Chronic fatigue • Exercise -Get a regular Cultivate and collect
Irritability or restlessness
Difficulty with concentration
period of vigorous exercise,
and then use exercise to drain
off your tension.
positive images of
success situations and
encouragement, to renew
Managing Anxiety The first step is to explore the • Consnltalion -Seek
causes of anxiety. There may be some consultation with peers,
More than 19 million genuine external reasons, such as
instructors,- or-other, -Americans -suffer-from debtiitatifig tlrreatening·or-strelfsfui SiruafiOiiSiiiOilr
anxiety, making anxiety difficulties the work or relationships. There will professional counselors.
most common mental health concern in almost certainly be internal sources of • Facing Anxiety- Better to
the United States. Therefore, anxiety which will affect the way we acknowledge the anxiety
recognizing and understanding our respond to the external causes. Ifwe than hide it back; it is
personal anxiety is especially important think we are unable to change the
normal, and it may be·
for us in order to maintain our stability situation, or believe that we cannot even
and objectivity. if we wanted to, then the anxiety will good basis for personal
likely be perpetuated by these beliefs. motivation and problem-
Anxiety is part of our natural We can easily become locked into a solving; do something
defense system, and the process of vicious cycle of behavior which only about excesses, and then
.anxiety triggers our "fight or flight" serves to reinforce, rather than lesson
go on wilh your tasks and
response. When we are faced with our feelings of anxiety.
threatening situations we need to be life.
aware of the dangers they represent. Methods for reducing anxiety: • Success Reviews -Review
The way we typically recognize your accomplishments
situations as dilngerous is by our • Self-Assertion -Do a realistic and yourpositive
feelings of anxiety. Itcan be thought of review of the situation, and
qualities, savor them and
as a call to action, warning us that decide on a course ofaction
something is wrong, and prompting us and carry it out; assert build up your self-
to act. yourself, take charge of your confidence.
life. • Thought Control -When
The most common symptoms • Sleeping Habits -Cultivate you feel down, "stop"
of anxiety include: methods that enable you to get
yourself, relax with
enough goodsleep-let
• Changes in appetite or weight yourself wind down first, and "calm", and switch into a
• Muscle Tension then make an attempt for some task or positive activity.
•
•
•
•
• Lightheadedness or dizziness
good rest. • Positive Imagery -
• Nausea • Relaxation -Learn peaceful and relaxing
• Shortness of breath physical and mental settings, and use these to
• Tremors relaxation, and then take help allay anxiety.
• Increased use of alcohol, notice wheu you are • Success Steps -Focus on
tobacco, or drugs anxious or tense, and small achieveable tasks
The "fight or flight" mechanism is
attempt to relax. and view them as
much like a light switch. Itcan only be • Quiet Time- Cultivate and "success steps".
"on,, or "off." When we become overly use a "quiet time" to • Self-Reinforcement -
anxious the system is "on". Once we review your situation, to Congratulate yourself and
perceive the danger has passed, the compose yourself, or to
give youn;elf a reward for ·
system is triggered to restore normal
function to our minds and bodies. prepare for a project, or your success steps and for
Because the system can only be on or situation for the day. staying on track.
off we don't need to control all the • Friends -Talk to one or • Self-Acceptance -you
symptoms of anxiety at once. We can't two friends a day for really are a good person,
be half anxious any more than a light support and maybe just not
bulb can be half on. Fortunately, all we perfect. ..but who is?
need to do is control one or two key
symptoms and the rest will fall into your self-confidence and
place. morale.

24. SELF MUTILATION
SOME BASIC THOUGHTS
JOHN HIPPLE, PH.D.
By definition, self mutilation is a volitional act to hann one's self, without any suicidal
intent. It most often has a repetitive component. A temporary relief of internal tension
most often occurs.
A common underlying cause centers on a difficulty in verbalization ofimportant feelings
and thoughts. There is often a lack of 'maturity'.
Results of SelfMutilation
--Mounting anxiety and unbearable tension arereleased
--A sense of normalcy returns; There are reports of'feeling real again'.
--Selfcontrol isreestablished.
--A sense of security and uniqueness is achieved. When all else fails I can always cut.
--Cutting can help me manipulate people to love and care forme.
--Can be an expression of self hatred. I am so bad I deserve to hurt.
--Sexual feelings can be enhanced or diminished.
--Selfhann can bring about asenseofeuphoria
--Anger can be vented
--Alienation may be relieved.
--A wide range of feelings may be temporarily be reduced
--There is often a copy cat or experimental component to these behaviors. Others are
doing it, I will try it out.
Implications
---Self mutilation can be thought ofas a way of self helping

25. ---It may be a fonn of communication. Saying something to someone
--Critical to help identify what is the 'trigger' and what other more constructive behaviors
can be implemented.
--General provision of support and general encouragement can be helpful
--Medication may be helpful. ---Often anti-depressants
--Counseling which leads to a more positive understanding of the behaviors and feelings
sets the stage of change

26. GENERAL THOUGHTS ON GRIEF
The personal impact of loss is typically quite variable. For some, loss will be especially
troublesome. For others, not so much
The response to a loss is different for everyone. In general there are emotional responses,
intellectual/cognitive responses, physical reactions, and social responses. However these
are highly variable in intensity and how long they last. In our culture it is usually
expected that one will feel sad and sometimes scared after a Joss. But being angry over a
loss is often less understood in spite of it being normal
For a few individuals, the responses will be so unusual and so intense they will think they
are losing their minds. But, of course, they are not.
There is no 'correct' or even predictable time frame for recovery from a loss. Some
research indicates it can be as long as several years before a person is back to 'normal'.
This flies in the face of our 'get over it quickly' culture.
Because death and loss often do not seem 'fair', it is not unusual for individuals to have
their spiritual world turned upside down.
Losing someone important to death can often increase your own personal sense of
vulnerability.
A current loss can also revive thoughts and feelings from past losses.
SOME THINGS TO DO FOR SELF AND OTHERS
Be patient
Be gentle, kind, tender, forgiving
Have reasonable expectations.
Ifyou are one who 'talks things out', keep doing this as long as it is helpful
Ifyou are one who is more private and internal, don't feel 'badly' because you don't
want to talk.
However, if you think someone might want to talk, don't hang back from extending
yourself to them. But ifthey don't want to respond, that is ok.
Another way of saying this is: Don't be afraid to ask for 'help' or offer 'help' to
someone who is going through a loss. It is ok to want comfort.

27. While it may be important to 'provide some slack' (say at work); the show has to go on in
some form or fashion. It may take a while to find the right balance.
Ideally when in the midst of a loss, it would be best to avoid stressful and highly stressful
situations for atime. Carefully track you total load of responsibilities and obligations.
Remember, you are not alone; others do have some sense ofloss and it's impact.
Take time to eat, sleep, and exercise as best you can. The physical engine has to have
fuel.
Don't be surprised if little cues and clues and reminders will bring on an emotional
response.
Be prepared for reactions during special times: holidays, birthdays, etc.
Be ready for some to have delayed griefreactions: a sudden onset of upset feelings,
thoughts, and behaviors which seemingly come out of the blue.
Itmaybehelpful totalk toaprofessional: pastor, doctor, counselor.
But family and friends arethere to help too.

28. Calculating Lethality
**Threats ** Strangling ** Constant Jealousy ** Forced Sex **
Note: The top five risk factors for domestic violence homicide usually don't bleed! In fact, these high
risk factors often don't leave any visible marks at all. The only sure way to determine the presence of
these high risk factors is through careful, comprehensive victim interviews.
The Top Five Risk Factors
The numbers in parenthesis indicate the factor by which a domestic violence victim's risk of homicide
is increased relative to other domestic violence victims.
I. Has the abuser ever used, or threatened to use, a gun, knife, or other weapon against
victim? (20.2x )
2. Ever threatened to kill or injure victim? (14.9x) Document complete and accurate quotes
of the threats
3. Ever tried to strangle (choke) the victim? (9.9x)
4. Is abuser violently or constantly jealous? (9.2x )
5. Has abuser ever forced victim to have sex? (7.6x)
The numbers in parenthesis indicate the factor by which a domestic violence victim's risk of homicide
is increased relative to other domestic violence victims. For example, if the abuser has used or
threatened to use weapons, the victim's risk of domestic violence homicide is 20.2 times that of the
average domestic violence victim.
• Always Keep in Mind: All Domestic Violence Victims Are at Heightened Risk of
Homicide.
• Don't dismiss threats to kill and maim as ''lust words''. All victims should be asked about
threats, and all threats should be quoted accurately and in detail. Also, threats to kill or maim
are a crime in California, PC 422.
• Even victim advocates often fail to ask about sexual violence in the relationship. Sexual
violence is serious trauma, and, is a high risk factor for domestic violence homicide.
Don't be shy. Always ask!
• The USDOJ lethality scale deals only with factors inside the relationship. Other studies have
found that factors outside the relationship - such as the quality of prior Jaw enforcement or
court response - correlate with future lethality. But again, the key to uncovering these risk
factors is the same; a careful, comprehensive victim interview.