Last week, I took part in a panel on confidentiality in college mental health at the annual meeting of the American College Health Association  in Boston. John Miner, Co-Director of the Williams College Counseling Service  and a former Riggs staff member, organized the panel, which also included Daryl Lapp , an attorney at Edwards, Wildman, Palmer, LLP. and counsel for Williams. There was quite a large attendance - close to 300 people - and they seemed very interested in the issues we were discussing. John spoke passionately about his learning over the years about this topic, some of that learning coming from discussions in the Erikson Institute’s annual college counseling service conferences. He spoke to the basic educational and developmental mission of colleges and argued for integration of counseling and health services. Daryl offered a clear, compelling legal framework for thinking about confidentiality as well as his experience actually dealing with lawsuits. I spoke to ways one might think about working as a therapist with the clinical dilemmas one encounters, especially with "students of concern." For example, the student who wants a guarantee that what she is about to say will be kept in the office, the student who reports something dangerous going on with other students, and so on.
One thing that struck me was how much each of these moments is an opportunity to work at exactly the developmental task the student is struggling with: namely, negotiating the boundary between her authority and the other person's, whether that be her parent's or her therapist's. It seems to me to be a primary site for the work! But the second thing that struck me was how hard it is to think clearly in the heat of the moment. Our panel offered much help with that - most of which can be found on ACHA's website, and one aspect of which is an exercise college personnel can organize at the beginning of the year to anticipate and develop their thinking about the sure-to-come dilemmas that confuse us, fragment our work, and may leave the student without the help she needs.
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