Working with Students in Distress
Working with Students in Distress: A Guide for Faculty and Staff.
As faculty and staff, you come into contact with students on a daily basis. You are on the “front lines” and, as such, are in an excellent position to observe students, identify those who may be in emotional distress, and offer assistance. While your concern and support may often be enough to help the student, there will be times when you may feel a referral for additional professional assistance is warranted. This document is designed to acquaint you with the services of Counseling & Psychological Services (CAPS), to assist you in helping students in distress, and to guide you in making referrals to helping professionals.
Behavioral changes and stressful events in student’s lives which may warrant counseling are outlined in “When Counseling May Be Needed,” while subsequent sections address specific types of emotional concerns or psychological problems that you my encounter when working with students (providing suggestions for dealing with specific types of emotional problems). It is critical to bear in mind that while you may be a key source of support for a student, you can’t be expected to do it all. When you feel particularly concerned about a distressed student, please feel free to consult with CAPS clinical staff, or encourage the student to seek help through our services. We can be reached at 207.786.6200.
If you are concerned for a student’s mental health, please refer them to CAPS. Students can stop by the office (31 Campus Ave) between 9:00 – 11:45am and 12:45 – 5:00pm to schedule an initial assessment in person. Students can also call 207-786-6200 to schedule over the phone, or e-mail firstname.lastname@example.org. If students are in crisis outside of our normal business hours (Mon-Fri 9:00am – 5:00pm) they can call our office number and press “0” to be connected with our after-hours crisis service.
The staff of Counseling & Psychological Services (CAPS) are required by law and professional ethics to protect the confidentiality of all communication between counselor and student (client) except in cases where harm to self or others is indicated. Consequently, CAPS staff cannot discuss with others the details of a student’s situation, or even indicate whether the student has visited or is being seen at CAPS, without the express, written consent of the student. It is therefore suggested that you ask a student directly if they followed up on your recommendation to make contact with CAPS.
Observe. A first and very important step, in assisting a student, is to be familiar with the symptoms of distress. Pay close attention to direct communications, as well as implied or hidden feelings.
Initiate Contact. Don’t ignore strange, inappropriate or unusual behavior. Talk to the student in question privately, in a direct and matter-of-fact manner, indicating your observations and concerns. Early feedback, intervention, and/or referral can prevent more serious problems from developing.
Offer Support and Assistance. Your interest, attentive listening and concern may be pivotal in helping a troubled student. Avoid criticism or sounding judgmental. Summarize the essence of what the individual has told you as a way of clarifying the situation. Validate feelings while also encouraging positive action by helping the student to define the problems and generate coping strategies.
Consult with CAPS Clinical Staff. If you feel “in over your head,” it may be helpful to call CAPS and talk to a counseling professional about your concerns. The counselor can give you feedback regarding the best way to help the student, as well as suggestions for initiating a referral to CAPS or other appropriate resources.
Refer to CAPS. Know your limits as a helper: Only go so far as your expertise and resources allow. When a student needs more help than you are able or willing to give, a referral is appropriate. The following may be helpful in making an individual referral to CAPS:
1. Talk to the student about the services and procedures of Counseling & Psychological Services. An initial appointment can be made by phone (207-786-6200) or in person (31 Campus Ave.) It is important to let the student know that services are confidential and are provided at no cost to Bates students.
2. It is important to provide the individual with a sense of control about his/her decision to follow your recommendation. In most cases, encouraging the student to initiate his/her own appointment with CAPS is preferred. Sometimes, however, offering the use of one’s phone or walking the student to CAPS may be beneficial.
3. In rare cases, a student might be in crisis or may demonstrate behavior that elicits concern about personal safety or ability to function (impaired judgment/rationality). In such cases, you are urged to make telephone contact with CAPS while the student is present and/or accompany the individual to CAPS during office hours. (If it is after 5:00 PM M-F or during the weekend, contact Security and/or call 207-786-6200 and press “0” at the prompt, to speak to a licensed crisis counselor). If a student is not compliant, consultation with CAPS counseling staff is strongly recommended. A counselor can help determine whether emergency treatment is necessary.
4. It is important to follow up with a student after you have made a referral. This conveys your interest. You can also help reduce the stigma associated with counseling by not avoiding the topic, though such discussions should be held privately.
When Counseling May Be Needed
Trauma or Crisis in Relationships
- Recent significant loss or rejection
- Loss or illness of a family member or close friend
- Conflict with roommate, friend, or family
- Victim of assault or domestic abuse
Unusual Behavior or Marked Change in Behavior
- Depression or marked anxiety
- Listlessness or frequently falling asleep in class
- Disruptive or threatening behavior in classroom or residence
- Changes in appearance, including weight and hygiene
- Extreme mood changes or excessive, inappropriate display of emotion
- Sudden withdrawal from social contacts
- Insomnia or excessive sleep
- Hyperactivity, chronic irritability, or excessive anxiety
- Confusion, disorientation, or bizarre behavior (loss of touch with reality)
Problems with Academic Performance
- Poor performance/preparation (esp. if represents a change from prior functioning)
- Repeated requests for special accommodations
- Test or speech anxiety
- Confusion over low performance
Choice of Major or Career
- Indecision about interests, abilities, or values
- Lack of alternatives, especially when failing
- Poor performance in major
Harmful Statements or Behaviors
- Overt references to suicide or statements of helplessness or hopelessness
- Indications of persistent or prolonged unhappiness
- Extreme risk-taking behavior
- Evidence of excessive and/or increased use of alcohol or other drugs
- Impaired daily functioning secondary to use (e.g., not attending classes/work)
If a student approaches you to discuss a problem or concern, you obviously have already set the stage for good communication (otherwise, the student would not have approached you). Below are some general tips regarding effective listening. Depending upon the situation, added to this would be to make certain the physical environment or location is conducive to effective communication (e.g., in most cases, it would not be appropriate to engage in an emotional discussion within a classroom with several other students present).
Physical Attending Behaviors
- Facing other squarely.
- Good eye contact.
- ‘Open’ posture.
- Leaning toward the other.
- Remaining relatively relaxed.
- Your posture reflects or communicates your willingness to respond to the student.
Psychological Attending Behaviors
- Attend to nonverbal behaviors and cues (i.e., what is the student’s behavior and appearance telling you about his/her health, energy level, feeling state, etc?).
- Listen to verbal behavior (both what is said, and the tone in which it is stated; are these congruent?).
1. Provide an open invitation to talk, showing concern and interest.
2. Listen carefully.
3. Use open questions and minimal encouragers.
4. Avoid criticizing or sounding judgmental.
5. Summarize or repeat back the essence of what the student has told you.
6. Connect to resources as necessary (e.g., suggest the Counseling Center as a resource and discuss this with the student).
Know your Boundaries
- Know your limitations. If you feel “in over your head,” you probably are.
- Responsibility to student includes responsibility to refer when appropriate.
- Assist students in identifying and utilizing available resources. When individuals ‘own’ their decisions, they are much more likely to follow through with them.
- Regarding confidentiality: Do not agree to secrets you cannot keep. If students ask for your confidence, state you will treat what they say in a professional manner.
- Consult with colleagues, CAPS staff, and area professionals as appropriate.
The Student Who Is Depressed
Because we all experience some of the symptoms of depression at one time or another, we all have some personal knowledge of what the student who is depressed is going through. A student who is depressed is likely to be experiencing some of the following:
Signs and Symptoms
- Deep feelings of sadness and hopelessness.
- Difficulty performing simple daily activities like getting out of bed and getting dressed.
- Loss of interest in usual activities, even pleasurable activities (e.g. good student stops attending class).
- Insomnia or hypersomnia.
- Overeating/weight gain or loss of appetite/weight loss.
- Difficulty concentrating and remembering.
- Decreased energy (everything is an effort).
- Feelings of worthlessness or inadequacy.
- Guilt or anger at him/herself.
- Thoughts or comments about death/suicide.
- Let the student know you’re aware they are feeling down and that you would like to help.
- Reach out more than halfway and encourage the student to talk about their feelings.
- Tell the student of your concerns.
- Talk about suicide if that’s on the student’s mind.
- Refer if suicidal (CAPS: 207-786-6200, After hours support available by calling CAPS main line and pressing “0”).
- Daily contact, even for a few minutes, may relieve feelings of isolation (encourage the student to be in contact with family, friends, counselor).
Less Helpful Responses
- Saying “don’t worry,” “crying won’t help,” or “everything will be better tomorrow,” may only make the student feel worse (and unheard).
- Becoming overwhelmed by the student’s problems may only provide evidence that the student should feel helpless.
- Assuming too much responsibility for the student and their problems.
- Trying to ignore or minimize feelings.
- Being afraid to ask whether the student is feeling suicidal (if you believe they may be).
- Individuals who commit suicide typically give many clues or warnings of their intent.
- Asking a person directly about suicidal intent does not lead to an attempt (in fact, it may minimize the anxiety and tension surrounding the feeling and, thereby, act as a deterrent to suicidal behavior).
The Student Who is Suicidal
Suicide is the second leading cause of death among college students. The student who is suicidal is typically intensely ambivalent about killing himself or herself, and usually responds to help. Suicidal states are definitely time-limited and most who commit suicide are neither crazy nor psychotic. High risk indicators include: feelings of hopelessness and futility; a severe loss or threat of loss; a detailed suicide plan; history of prior attempts; history of alcohol or other drug abuse; and feelings of alienation and isolation from others. Students who are suicidal usually want to communicate their feelings and any opportunity to do so should be encouraged.
- Taking the person seriously; 80% of suicides give warning of their intent.
- Acknowledging that a threat of suicide (or attempt) is a plea for help.
- Asking the individual directly whether they are considering harming themselves (e.g., “You seem so upset and discouraged that I’m wondering if you are thinking of suicide?”).
- Being available to listen, to talk, to be concerned; but refer to Counseling & Psychological Services (207.786.6200).
- Consulting with CAPS as necessary.
- Taking care of yourself. Helping someone who is feeling suicidal is hard, demanding, and draining work.
Less Helpful Responses
- Minimizing the situation or depth of feeling (e.g., “Oh, it will be much better tomorrow”).
- Being afraid to ask the person if they are so depressed or sad that they want to hurt themselves.
- Over committing yourself and, therefore, being unable to deliver on what you promise.
- Ignoring your limitations (i.e., not consulting with available resources).
Suicide Risk Factors
1. History of suicidal behavior.
2. Family history of suicide.
3. Specific plan for harming self (the more developed the plan, the greater likelihood of an attempt).
4. Means to carry out plan (lethality of implement increases risk).
5. Drug or alcohol abuse.
6. History of impulsive behavior.
7. Lack of interpersonal/social resources.
8. Lack of intrapersonal/coping resources.
The Student Who is Aggressive
Aggression can take many forms, from very subtle, passive acts to violent outbursts. It often results when a student perceives a threat, feels frustrated and/or out of control. Some people who are aggressive express hostility immediately without regard for their circumstances or the people around them. Others deny their anger and frustration until their hostility builds to the point of an explosive outburst. Many times, persons who are verbally or physically aggressive feel inadequate and use hostile behavior as a way to build up their self-esteem.
Often these individuals feel that you will reject them so they become hostile and reject you first to protect themselves from being hurt. They may see you as attempting to control them and lash out to try to gain a sense of control. It is important to remember that the student is generally not angry at you personally, but is angry at his/her world and you are the handy target of pent-up frustrations. Overall, dealing with a student who is aggressive will be facilitated if you set up your environment to be as safe as possible (e.g., a physical barrier, etc.) and maintain firm, consistent and calm control in the situation (i.e., know what you are doing and what your goals are).
- Acknowledge their anger and frustration (e.g., “I hear how angry you are”).
- Rephrase what the individual is saying and identify the emotions.
- Allow the student to get the feelings out (within limits), and tell you what is upsetting them.
- Tell the student that you are not willing to accept abusive behavior (e.g., “When you yell and scream at me, I find it difficult to listen”). If you need to, explicitly state what behaviors are acceptable.
- Stick to the limits you set.
- If the person begins to get too close to you, tell them to please move back.
- Reduce stimulation. If you are comfortable doing so, invite them to your office or another quiet place. If you sense some threat, arrange for a colleague to be nearby.
- Help the person problem-solve and deal with the real issues when they become calmer.
- If necessary, get help (your supervisor, Campus Security, CAPS).
Less Helpful Responses
- Getting into an argument or shouting match.
- Becoming hostile or punitive yourself (e.g., “You can’t talk to me that way!”).
- Pressing for explanations about the student’s behavior.
- Looking away and not dealing with the situation.
- Physically restraining or grabbing the individual.
- Giving away your own rights as a person.
The Student Who is Anxious
We have all experienced anxiety in response to a perceived stressful situation. Anxiety becomes heightened, as the situation becomes vaguer and less familiar. A panic attack is an overwhelming sense of dread and fear, and is the extreme result of feeling anxious. Some of the physiological components of general anxiety and a panic attack are rapid heart palpitations, chest pain or discomfort, choking, dizziness, sweating, trembling or shaking, and cold, clammy hands. The student may experience feelings of worry or fear and may anticipate some misfortune. They may complain of poor concentration, being on edge, being easily distracted, memory problems and/or fitful sleep. The student may also indicate unreasonably high self- expectations, and be very critical of their performance. This student may constantly think about and discuss their problems and possible solutions, but be too fearful to take action.
1. Inability to relax
2. Unrealistic or excessive worry
3. Difficulty falling asleep
4. Rapid heart rate
5. Feelings of dread or fear of losing control
6. Shortness of breath
7. Feelings of detachment
11. Excessive sweating
- Let them discuss their feelings and thoughts. Often this alone relieves a great deal of pressure.
- Help them if possible to define their stressors and their ineffective and effective coping strategies.
- Encourage them to break down tasks into workable steps in order to feel less overwhelmed.
- Relaxation techniques, deep breathing, meditation and enjoyable exercise (e.g., walking) can all be helpful in reducing anxiety. Encourage them to engage in these behaviors or to seek professional help to learn these and other coping strategies.
- Be clear and explicit about what you are expecting from them, and what you are willing to do. It may be helpful to have them repeat what you have said to ensure that they understand.
- Be calm and reassure him/her as appropriate.
Less Helpful Responses
- Taking responsibility for her/his emotional state.
- Trying to solve her/his problems as if they were your own.
- Becoming anxious or overwhelmed along with them.
- Overwhelming the student with more information or ideas (instead, keeps things ‘bite size’).
The Student Who is Demanding
Any amount of time and energy may simply not be enough for some students. Such students often seek to control your time and unconsciously believe that the amount of time received is a reflection of personal worth. In many situations, these individuals feel incompetent to handle their own lives. Usually they are immature and very self- absorbed.
- Set clear and precise limits with the student.
- Stick to the limits no matter how much s/he protests.
- Let the individual make their own choices and decisions, clarifying the logical consequences of such choices.
- Refer the student to other students in class, their friends or campus/community resources.
Less Helpful Responses
- Taking responsibility for the individual.
- Letting the student “trap” you into solving their life problems.
- Allowing them to use you as a sole source of support.
The Student Who Is Suspicious
Usually these students complain about something other than their psychological difficulties. They are tense, cautious, mistrustful, and have few friends. These students tend to interpret a minor oversight as significant personal rejection and often overreact to insignificant occurrences. They see themselves as the focal point of others’ behaviors and everything that happens may seem to be interpreted in a suspicious light. Usually they are over-concerned with fairness and being treated equally. They project blame onto others and may express anger in indirect ways. Many times they feel worthless and inadequate.
- It is important to send clear, consistent messages regarding what you are willing to do and what you expect.
- Express “reserved compassion,” mindful that a suspicious student may have trouble with closeness and warmth.
- Be firm, steady, punctual and consistent.
- Be aware that humor may be interpreted as rejection.
Less Helpful Responses
- Being overly warm or nurturing, or assuring the person that you are a friend. Let the student know that you can still be concerned without being intimate.
- Trying to flatter them, or to be cute or humorous to try to relieve your own anxiety. This will probably distance the student from you.
- Challenging or agreeing with any mistaken or illogical beliefs.
- Being ambiguous in your response.
The Student in Poor Contact with Reality
This student may have trouble distinguishing fantasy from reality. To some extent, this person will appear confused or illogical. As you talk to this student, you may notice that their speech jumps from one topic to another with little or no logical connection between the topics. The individual may also pay a great deal of attention to some unimportant detail that is being discussed or may be generally scattered and incoherent. The student may coin new words and expect others to understand their meaning or may put words together because they rhyme, not because they make grammatical sense. Such individuals may make inappropriate emotional responses. For example, they may overreact to their feelings, or be very “flat” emotionally. Many times the person knows that their emotions are inappropriate, but just feels overwhelmed and cannot control them.
Persons in poor contact with reality may experience themselves as especially powerful or important, or may believe that people are attempting to harm or control them in some way. They may also feel that certain actions have special meaning for them (e.g., when people in a small group begin to laugh, they are laughing at the student). Such students may experience hallucinations, usually auditory, although hallucinations can be experienced through any sensory modality. Generally, these individuals are not dangerous, but are scared, frightened and overwhelmed.
- Respond to them with warmth and kindness, but with firmness.
- If you are comfortable in doing so, remove extra stimulation from the environment and see them in a quiet atmosphere.
- Acknowledge their concerns and state that you can see they need help (e.g., “It seems very hard for you to integrate all these things that are happening and I am concerned about you; I’d like to help”).
- Acknowledge their feelings or fears without supporting the misperceptions (e.g., “I understand how you think they are trying to hurt you and I know how real it seems to you, but I don’t hear the voices”).
- Reveal your difficulty in understanding them, as appropriate (“I’m sorry, but I don’t understand. Could you repeat that or say it in a different way?”).
- Focus on the ‘here and now.’
- Switch topics and divert the focus from the irrational to the rational or real.
- Speak to their healthy side, which they have. It is okay to joke, laugh, or smile when appropriate.
Less Helpful Responses
- Arguing, disputing their illusions, or trying to convince them of the irrationality of their thinking. This typically just makes them defend their position (false perceptions) more ardently.
- Playing along (e.g., “Oh yeah, I hear the voices”).
- Encouraging further revelations of delusional thinking. It would be more helpful to switch topics and divert focus from delusions to reality.
- Demanding, commanding, or ordering them to do something to change themselves.
- Expecting customary emotional responses.
The Student Who is Abusing Substances
Given the stresses of college life, students are especially susceptible to drug abuse. A variety of substances are available that provide escape from pressing demands. These drugs soon create their own set of problems in the form of addiction, accident proneness, and poor health. The most abused substance is alcohol. Alcohol and other drug-related accidents remain the greatest single cause of preventable death among college students.
- Be on the alert for signs of drug abuse: preoccupation with drugs; inability to participate in class activities; deteriorating performance in class; periods of memory loss.
- Share your honest concern for the student.
- Encourage the student to seek help.
- Get necessary help in instances of intoxication.
Less Helpful Responses
- Ignoring the problem.
- Chastising the person; lecturing.
- Subtly encouraging the behavior.
The Student Who is Violent or Physically Destructive
- Prevent total frustration and helplessness by quickly and calmly acknowledging the intensity of the situation (e.g., “I can see you’re really upset and really mean business, and have some critical concerns on your mind”).
- Explain clearly and directly what behaviors are acceptable (e.g., “You certainly have the right to be angry, but hitting (breaking things) is not okay”).
- Stay in open area.
- Divert attention when all else fails (e.g., “If you hit me, I can’t be of help”).
- Get necessary help (other staff, Campus Security).
- Remember that student discipline is implemented by the Dean of Student Affairs Office (Student Support and Community Standards).
Less Helpful Responses
- Ignoring warning signs that the person is about to explode (e.g., raised voice, quickened speech, clenched fists, statements like, “You’re leaving me no choice”).
- Threatening or taunting behaviors.
- Physically cornering the person.
- Touching the student.
- Subtly encouraging the behavior.
Managing Students Who are Disruptive
Disruptive behavior is behavior that interrupts or interferes with daily functions of the College or the educational process. Students who are disruptive may resist corrective action or intervention. Examples of disruptive behavior – when a student:
- verbally intimidates others
- is excessively demanding of faculty or staff
- interrupts in class by:
- making hostile remarks out of turn
- aggressively taking over the lecture
Interventions for Disruptive Behavior
- Request that the student stop the disruptive behavior.
- If the problem continues, ask the student to leave the area or class.
- Speak with the student privately, preferably in the faculty or staff member’s office.
- Apprise the student of the inappropriateness of the behavior.
- Explain the consequences if change does not occur.
- Document the content of the meeting.
- When indicated, provide the student with a written copy of the requirements and consequences.
- If the behavior continues, consult your supervisor about your next step.
Setting classroom norms at the very beginning of a class is one of the best methods of classroom management. Hang a flip chart or poster, or dedicate a section of white board if you have the space, and list expected classroom behaviors. Refer to this list when disruptions occur. Using a flip chart or white board can be especially useful because you can involve students in the construction of the list on the first day and in that way get buy-in. Start with a few of your own expectations and ask the group for additional suggestions. When you all agree on how you want the classroom to be managed, disruptions are minimal. Your list of norms may look something like this:
- Start and end on time
- Be open to new ideas
- Turn off or silence cell phones
- Resolve differences calmly
- Save texting for breaks
- Stay on topic
Saving Questions for Later
It’s always a good idea to address questions of any kind when they occur because curiosity provides wonderful teaching moments, but sometimes it just isn’t appropriate to get off track. Many teachers use a flip chart or white board as a holding place for such questions to ensure they’re not forgotten. Call your holding place something appropriate to your topic. I’ve seen parking lots and flower pots. Be creative. When a question being held is eventually answered, mark it off the list.
Managing Mild Disruptions
Unless you’ve got a student in your classroom who is completely obnoxious, chances are good that disruptions, when they do occur, will be fairly mild, calling for mild management. We’re talking about disruptions like chatting in the back of the room, texting, or someone who is argumentative or disrespectful.
Try one, or more, if necessary, of the following tactics:
- Make eye contact with the disruptive person
- Remind the group of the agreed-upon norms
- Move toward the disruptive person
- Stand directly in front of the person
- Be silent and wait for the disruption to end
- Acknowledge the input, put it in your “parking lot” if appropriate, and go on
- “You may be right…”
- “Thanks for your comment…”
- “How about if we park that comment and come back to it later…”
- Ask for help from the group
- “What does everyone else think?”
- Rearrange the seating if you think it will help
- Call for a break
Handling Persistent Disruptions
For more serious problems, or if the disruption persists:
- Speak with the person privately
- Confront the behavior, not the person
- Speak for yourself only, not the class
- Seek to understand the reason for the disruption
- Ask the person to recommend a solution
- Review your expectations of classroom behavior if necessary
- Try to get agreement on expected norms
- Explain any consequences of continued disruptions
Faculty and staff often fear for their personal safety when confronted by threatening behavior from a student. Examples of threatening behavior, when a student:
- makes a direct threat or implies harm to others or themselves
- displays a weapon or firearm
- physically attacks someone
- harasses or stalks a faculty, staff member, or another student
- sends threatening correspondence (letters, emails, text messages, etc.) to others
Interventions for Threatening Behavior
The top priority is the safety and well-being of the campus community
- Immediately contact Bates Campus Security at 207-786-6111
- Notify the Senior Associate Dean of Students at 207-786-6220