Practice GuidelinesCounseling Center

The role of the Gustavus Adolphus College Counseling Center is to provide brief mental health counseling and related services to help students identify barriers, improve coping, and achieve personal goals. Our services are available to eligible students whose concerns fall within our scope of practice. Those whose needs cannot be accommodated within our treatment model will be referred to community resources for care. Such referrals might occur immediately following an intake, or they might occur after some treatment and a further assessment of need has taken place.

Eligibility for Counseling Center Services

Students must be currently enrolled during any semester in which they receive services. Individuals who have withdrawn completely from the semester are not considered to be currently enrolled. Due to high demand and limited college resources, the Counseling Center does not meet with staff or faculty members for personal therapy. We will meet with any individual on campus for consultation and resource suggestions.

We can help most students, but we are not a full-service mental health clinic

Some examples of clinical issues that will likely be addressed through a community referral include, but are not limited to:

  • Individuals with chronic mental health conditions that require longer-term, ongoing care.
  • Clinical presentations, such as some personality disorders, that indicate short-term therapy may be ineffective and/or detrimental.
  • A need or desire to be seen more frequently than we can accommodate. Most of our clients are seen 1-4 times per month. 
    • Excessive utilization of crisis intervention services indicates that standard session frequency is inadequate
  • Chronic suicidality and/or recent history of multiple suicide attempts.
  • Severe and chronic self-injury.
  • A history of multiple psychiatric hospitalizations.
  • Issues that require more specialized care than can be provided at Gustavus, including:
    • Significant or chronic disordered eating symptoms posing a medical danger
    • Significant or chronic substance use/abuse which compromises therapy
  • Active symptoms of psychosis at risk for progressive deterioration

Sometimes a referral is the best option

In addition to the clinical reasons indicated above, some other reasons why we may need to deny services and/or refer individuals to community resources include but are not limited to:

  • Lack of motivation or engagement in treatment as evidenced by:
    • Unwillingness to provide information sufficient for clinical assessment
    • Inability to identify a treatment goal appropriate for brief therapy
    • Inconsistent attendance
    • Poor compliance with treatment recommendations
    • Failure to follow through with recommended treatment in the context of multiple crisis intervention sessions
  • Ongoing treatment relationship with another mental health provider
  • Inappropriate, harassing, menacing, threatening, or violent behaviors
  • Mandated or required treatment, including but not limited to:
    • Counseling ordered through legal proceedings, such as substance abuse treatment, alcohol education, anger management, parenting education, or domestic violence treatment
    • Counseling required by employers, government agencies, academic departments, or classes
  • Comprehensive psychological evaluations not available at Gustavus including:
    • Neuropsychological evaluations
    • Forensic assessments
    • Custody evaluation
    • Assessment and documentation for service or support animals
    • State/Federal benefit programs, including vocational rehabilitation and social security/disability
    • Fitness-for-duty evaluations
    • Pre-surgical mental health evaluations
  • Medication-management-only treatment plans, including following termination of short-term psychotherapy (please refer to Gustavus Health Service)

Service Denial/Referral Process

During the intake appointment or during any subsequent stage of treatment, a clinician may determine that a client’s needs appear to fall outside our scope of practice. In such instances, the clinician is encouraged to consult with colleagues and/or the Director regarding case disposition. If the clinician is a trainee, the supervisor must be consulted. 

When community referral is the most appropriate treatment option for a client, he/she should be provided with approximately three referral options. These options should, to the best of the clinician’s ability, address client circumstances regarding insurance, finances, and transportation. 

Clinicians are not case managers, and are not responsible for ensuring that clients follow up on referrals provided. Such contacts are encouraged, however, in cases with moderate or higher level of risk or instability. 

Policy Exceptions

Occasionally, a clinician may be able to provide services that extend beyond our scope of practice. Circumstances which may warrant such services include but are not limited to:

  • Appropriate management of a crisis
  • Coverage through upcoming graduation within the semester
  • Completion of treatment for clients making good progress, but needing limited extension of services
  • Supporting high-functioning clients with chronic conditions on well-defined short-term therapy goals
  • Longer-term therapy for committed and progressing clients comprising 5% or less of any clinician’s caseload, for training and diversity