Source: Ben Locke
“All this one-on-one counseling is a waste of time. For every hour you spend on an individual level, you’re missing out on thousands of people.”
Consulting psychologist Ben Locke still remembers how insulted he was to hear this from a respected professor while interviewing for a doctoral program. It was as if all the future counseling she would be doing with people in hospitals, group homes, community clinics, and even wilderness therapy was now meaningless. How can the people responsible for the promise of teaching counseling be so cynical?
Despite his beard and Xennial status, Locke still has the boyish nature of a perpetual student. Retelling the story, he is crushed again, imagining thousands of students falling through the cracks and slipping away from a clinician’s tender care.
When he rose to director of Penn State’s counseling center and founded the Center for College Mental Health (CCMH), a startup-inspired consortium of college counseling centers that uses real-time data from counseling centers to track and describe mental health trends in higher education, Locke slowly began to see a different picture.
Counseling centers were in trouble, seeing increasing levels of demand and ever-increasing pathology in their students. Consider more students with prior risk of suicide, hospitalizations, and medications combined with ever-increasing work, academic, and family demands.
But the more you threw at the system to support it—the more therapists you put in offices and on call, the more prevention programs you created to catch challenges early, the more you covered dormitories and classrooms—the more sinking remained .
For nearly two decades, CCMH data illuminated a surprising new reality: Kids weren’t doing well, but they weren’t the only ones. It was us and our either/or view of these very issues.
Two calls to action became clear to Locke. First, we need to address college mental health as a complex public health problem at the population level, rather than just focusing on how many students you can get into therapy. Second, there is no one-size-fits-all solution for all campuses, rather a broad set of strategies that go beyond simple, old, or/or fixes.
Building on the thinking of management professors Wendy K. Smith and Marian Lewis—embracing the paradox of leverage for more innovative results—Locke began to see a way to undo the quick and mindless either/or thinking operating everywhere in the college.
Locke’s research found that, while intuitively compelling, hiring more advisors simply cannot solve the entire problem. The words of that omniscient professor echoed in his ears again. The CCMH study found that each additional counselor could support an average of about 125 students per year, perhaps up to 300 students in the worst case scenario. But if you’re on a campus with 50,000 students and 20,000 need treatment, one extra counselor is a drop in the bucket. It’s always a matter of both—growing your clinical staff and programs while targeting population-level solutions in innovative and imaginative ways.
Either/or thinking just won’t do, but so much of it is hiding in plain sight. The students’ relentless energy around identifying psychological disorders effectively exacerbates the very imbalance the students seek to resolve. They assume a very personal scenario such as suicide or a severe eating disorder – what statisticians affectionately call it n of 1 sample—and inflate it as if everyone had the same experience, which is simply not true.
Another either/or trap is found in the destigmatization of mental health. Some benefit greatly from alleviating the shame around going to counseling, while others respond by unintentionally pathologizing their healthy anxiety, sadness, and grief, making their problems much worse. Locke jokingly describes this as the “I don’t have butterflies in my stomach, I have a phobia of public speaking” phenomenon. These people may have been fine in years past or resolved their problems with simple support, but are now being targeted by an overtaxed treatment system.
More recently, the either/or idea has come up in the debate over whether and how much to outsource college counseling. Many well-intentioned college counselors are concerned that this weakens and undermines college mental health, while devaluing the unique community of college counseling itself.
Locke’s latest project seeks to address all of these legitimate concerns. Drawing on the both/and thinking that has defined his career as a researcher, psychologist, and educator, he answers tough questions: Is there a way to overcome the zero-sum game of not enough counselors and too many students? Can you simultaneously make a breakthrough at the population level while serving the most vulnerable sample of young adults? Is it possible to harness the scale and benefits of technology while protecting against its toxic side effects?
Locke discovered this in an anonymous online community accessible to more than 3 million students at over 350 institutions. Peers have 24/7 access to support, advice and connection, while being closely monitored and protected by a background of mental health clinicians.
It’s the best of both worlds, a place where members can access the choicest benefits of group and individual therapy—hope, perspective, empathy, affirmation, problem-solving skills, altruism, and group belonging—and more -well, by the most qualified and invested people of all: their peers. Trained counsellors, nurses and psychiatrists are on call 24/7 if people need them, but mostly operate in the background, carefully shaping the community and keeping a close watch to make sure everyone is benefit the community and that the needs of each individual are visibly noticed.
See both working here?
Instead of focusing only on how few counselors you have, why not change that and encourage your students to seek out and provide support to each other while you also increase your counseling capacity? Are you concerned about ensuring that the always online digital generation is safely supervised by experts in the field? Build a strategically designed global group of clinicians to shape, support, monitor and intervene when needed to ensure the self-sustaining community thrives. Worried about trolling and an addictive echo chamber from yes-men? Build a community of people who are invested and moved by the hopeful possibility of genuine help and connection, and then use technology to help achieve that goal at scale.
Like any good paradox, this professor was both right and wrong, and Locke found creative ways to reveal exactly how. The challenge of working with the vast scope and changes facing college counseling is based on mixing conventional truths with unconventional applications, embracing new technologies alongside traditional modalities, and being willing and foresight to be wrong and let the data guide you. the way to be straight.
When many of us consider the problems that beset colleges today, we too often focus on simple arithmetic and a zero-sum game that we inevitably lose, and badly. Using both/both thinking allows us to recognize the calculus hidden in this new game we’re playing and recognize it for what it is: not insurmountable problems, but achievable opportunities that we can continue to build on if we’re self-reflective , understandable, and strategic.