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Starting college is an exciting transition, but it can also come with its share of challenges, from adjusting to a new environment, being away from parents, or academic pressure. Luckily, students have access to a wide range of free mental health resources at Dartmouth, one of which is the Counseling Center. To learn more about what the Counseling Center offers, I spoke with Heather Earle, the Director of the Counseling Center.

A photo of Heather Earle
Heather Earle, Director of the Counseling Center. Image from https://students.dartmouth.edu/health-service/people/heather-earle

Could you tell me a little bit about yourself and your role at the Counseling Center? 
I am the Director of the Counseling Center and have been for around 14 years. Prior to that, I was actually at Dartmouth from 1989 to 1994 as the first director of the Sexual Awareness and Abuse Program. Then I left to do my doctoral work at the University Wisconsin-Madison and spent the last year of the doctoral program at UC Berkeley before returning to Dartmouth in 1999.

What drew you to work in counseling? 
I was always drawn to this topic in high school. I took a bunch of classes and did really well in it because I really enjoyed it. I majored in psychology as an undergrad, took a year off and then started a Master's program in counseling psychology, then came here and then left to do my doctoral work. 

How would you describe the Counseling Center and the services it offers?
The Counseling Center is the place on campus where students come for mental health counseling for free. You don't have to pay to meet with us. Not only is it free, you do not need the Dartmouth Student Group Health Insurance to use our services. 

We focus more on the clinical work. I think of our counseling center as two pillars that overlap.

We do predominantly short-term individual counseling and consultations for students, as well as faculty and staff. When a student might need or want longer, our case manager helps them find a provider in the community, or we get them connected with UWill, which is a tele-therapy company we work with at Dartmouth. Students get unlimited free counseling through UWill. We also have a sports psychologist who works a lot with athletes, as well as two gender-based violence clinicians. We provide counseling in seven or nine different languages. In our staff, we have 17 clinicians, two of those are psychiatrists and one is a social worker. Around 60% of our clinicians self-identify as BIPOC. We also have providers on call 24/7. 

Additionally, we have a contract with a group practice called Therapists of Color New England. The reason we bring them and UWill on is we realize that some students might not want to go to the counseling center, or some students might want counseling on a day we're not open, such as Saturday or during evenings. However, UWill can provide counseling then. That taps into students who might not otherwise come into the counseling center, but might need counseling.

The other pillar is that we do a lot of outreach. There are students who don't need counseling, but they might need tools to help with their anxiety or to help with the low levels of depression or sadness. That's the reason we do outreach, to give students skills.

What are the benefits of counseling?
A lot, actually. Do I think everybody in the world needs counseling? No. Do I think some people really do? Yes. And do I think it's helpful for almost everyone? Yes. For example, if a student comes in with high anxiety, we'll really work with them to manage their anxiety. That can really start with, "Where does it begin?", looking at some cognitive thoughts they have that can work up their anxiety and then breaking that down. We really focus on helping students be the best they can and want to be, academically and socially. 

What are some of the most common reasons Dartmouth students have reached out to the Counseling Center? 
Students don't have to have a "serious" mental health issue or be in crisis to come in, though we certainly have crisis services. In fact, we prefer they come in prior to that so it doesn't turn into an emergency. Anxiety and depression are usually our top two that we see, but we've had students come in for eating disorders, stress, homesickness, and adjusting to college. 

For example, a student might come in and say, "I know I shouldn't be taking up your time because I'm just anxious when I take tests." That's fine. We can work on that because a large part of your Dartmouth career is going to be taking tests, and we look at how we can manage that. 

What specific mental health or adjustment challenges do you see particularly often among Dartmouth students? 
Dartmouth can be a very intense, high-pressure, fast environment. Students have worked really hard to get here. It's not uncommon for students to think they can step back and take some pressure off themselves once they're here, only to fall into that high-pressure environment again and forget to take care of themselves, forget that sleep is important, and forget that it's really important to interact with friends face-to-face. 

What does the process look like for a student who realizes they could use some help, but isn't sure where to start?
You can start by looking at our website or calling our front office at 603-646-9442. When a student calls for the first time and it's not an emergency, they'll first be scheduled for a triage appointment. It's a half-hour appointment, usually by phone, and students can tell us what they'd like to work on, what led them to call, their symptoms, etc. The triage helps us and the student figure out next steps, which might be anything from telling them, "It seems like you're doing great! You can come in if you'd like; just know we're here" to referring them to somewhere else on campus, such as Student Accessibility Services, to scheduling an hour-long intake to work with one of our clinicians for short-term counseling. 

Short-term counseling sessions are all in-person. The clinician and the student figure out what "short-term counseling" is together, and it usually ends up being 10-12 sessions. During the short-term counseling sessions, we usually try to focus on one or two things more intensely during the time period. Students can use short-term counseling more than once. Due to the D-Plan, it's not uncommon for students to be seen a couple times a term, leave for a couple of terms, and then come back. If a student says they would like to meet with someone long-term, or we realize their needs are better served in a long-term therapeutic relationship, we will help them find someone in the community. 

What should students know about confidentiality when using Dartmouth Counseling? 
We never reveal if anyone's been seen here unless we have a release. We can certainly talk with a parent about something in a general sense, such as what anxiety looks like in general. All of Dick's House is bound by confidentiality rules and regulations, so ethically, we don't reveal information to anybody unless the students sign a release. 

Say I'm seeing a particular student who has never signed a release, and their guardian calls us. We always refer these calls to the counselor on call. The counselor on call would talk in general terms about what the guardian is worried about with their student. We don't let parents, professors, deans, coaches, etc. know a student is being seen by us unless they sign a release. 

Signing a release is not a free-for-all. We really don't release much information. It's basically on a need-to-know basis, and as much as one would need to know. For example, if a student signs a release because their parent wants to talk to me, that conversation would still be very, very limited - "Yes, I'm seeing your child. They are doing well. I think they're going to be okay. I know they're feeling stressed because next term they're going to study abroad, and they've never been out of the country. So we're really focusing on how she can take care of herself while she's in a different country."

The only times we have to break confidentiality without a release are if a student says they're suicidal and we believe they are going to act on it, or if a student talks about and uses names of someone who is abusing a child or an elder. 

There can sometimes be a stigma around seeking mental health support. What would you say to a student who is hesitant to reach out to the Counseling Center? 
At almost any given moment, we're seeing about 25 percent of the student population. That percent is just what we see and doesn't include UWill or Therapists of Color. 

Students can come in for different reasons - things that are really, really hard or really not as hard, such as how to regulate their sleep. It can be scary coming in. What I encourage you to do is jump on our website and look at the pictures of us, which can help you see that the folks at the Counseling Center are people too. 

What is one thing you wish every incoming Dartmouth student knew about taking care of their mental health? 
The first couple things that pop up are sleep and social interaction. Don't pull all-nighters. Sleeping is really important. Really create friendships. You don't have to have 20 best friends. Find one or two people that you can really connect with, and be social, because that's so much a part of campus life. Do things outdoors, do things in the arts, go to the Hood Museum with friends, walk around Occom Pond. 

Dartmouth is intense and academics are definitely important, but learning about yourself outside of the classroom is also really important. We really learn about ourselves through our interactions with others. I really encourage students to find a place. It's not going to be the first term. It might not even be the second term. It might not even be the third term. But just because you didn't get into a certain singing group doesn't mean you can't find other groups to be in.

This interview has been edited for length and clarity. 

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