Scope of Practice

Mental Health Counseling

Counseling is available to eligible students whose concerns fall within the following scope of practice and who reside within the state of Texas. Eligible students include individuals enrolled in degree granting programs that require the student to pay the usual tuition and student service fee.

Brief individual or couples counseling includes therapeutic assessment and treatment of mental health concerns reasonably addressed through short-term services.  Appointments are typically scheduled every two to three weeks.  Clinicians work collaboratively with students to determine an appropriate plan and length for treatment, with an average of 3-5 sessions.  To serve as many students as possible, the Counseling Center focuses on developing a plan to meet goals that can be accomplished within a brief therapy time frame.  Because treatment is goal-based, formal mental health diagnoses are not provided. 

Counseling groups are another form of services available to currently enrolled students and if appropriate, may allow longer term contact with Counseling Center services. Group sessions may be topic or theme based and are typically scheduled weekly.  Group leaders require brief consultations with all interested individuals to determine appropriateness for participation, considering factors such as group composition, client readiness, and presenting concerns.

Concerns commonly treated include, but not limited to:

• Academic-related issues: difficulty with attention, motivation, perfectionism, test anxiety, or self-management
• Adjustment problems: difficulty with transitions or new life circumstances
• Relationship problems: break-ups, interpersonal conflict, communication and assertiveness, family issues
• Mood or anxiety issues: depression, general or social anxiety, body image issues, low self-esteem
• Misuse or mild abuse of substances
• Grief and loss
• Developmental concerns: exploration or support focused on phase of life issues or concerns related to personal and/or community identity.
• Coping with interpersonal trauma and traumatic events

Crisis Intervention

Urgent appointments are available Monday through Friday from 10am to 4pm for students experiencing thoughts of harm to self or others or who have recently experienced a traumatic event. The purpose of urgent appointments is to provide immediate support, assess safety concerns, and discuss needs for ongoing treatment. Multiple crisis resources are available during non-business hours and can be found at the Counseling Center Website.

Concerns appropriate for use of urgent appointments include recent:

• Thoughts, attempt(s), plan, or intent to die by suicide
• Thoughts of wanting to physically harm others
• Sexual or physical assault
• Death or terminal diagnosis of a loved one
• Emergence of psychotic symptoms and/or mania

Urgent appointments are not intended for:

• Supplemental support between regularly scheduled sessions.
• Immediate treatment of panic attacks and/or anxiety. These concerns are typically addressed through routine appointments.
• Support around break-ups or other interpersonal conflicts when there is no threat to immediate safety.
• Psychiatric hospitalization discharge.  Staff at treating hospitals should work with students to connect with the appropriate level of post-hospitalization care.  This after care typically does not include the short-term counseling provided by the Counseling Center.

Reasons for Referral Outside of the Counseling Center

Often, students benefit from more frequent services, longer-term care, more intensive services, care beyond enrollment at the university, and/or services that extend beyond the end of academic semesters. Those needs which cannot be thoroughly or ethically served within our Center will be referred to community resources for care.  Referrals might occur immediately following the initial assessment or at any time during the treatment process based on assessed needs.  Referral assistance is available to help students connect to providers or resources outside of our Center.

Clinical issues that will likely be addressed through a community referral include, but not limited to:

• Assessed need or request for weekly or more frequent sessions
• Assessed need or request for long-term treatment
• Assessment that short-term services would not be adequate or appropriate for treatment of presenting concern(s)
• Reliance on crisis intervention services, indicating need for more frequent sessions
• Chronic mental health conditions that require specialized care including but not limited to:
• active eating disorders
• significant history of or ongoing substance abuse
• severe symptoms consistent with posttraumatic stress disorder, as assessed by the Counseling Center
• severe symptoms consistent with obsessive-compulsive disorder, as assessed by the Counseling Center
• severe symptoms consistent with bipolar disorder, as assessed by the Counseling Center
• psychotic symptoms with elevated risk of progressive deterioration
• History of longstanding, maladaptive interpersonal behaviors, which indicate short-term therapy may be ineffective and/or detrimental
• Chronic suicidality and/or recent history of suicide attempt(s)
• Severe and chronic self-injury
• History of extensive prior therapy in this or another setting
• History of multiple psychiatric hospitalizations with ongoing risk of harm to self or others
• History of violence or destructive behavior, behaviors that indicate characteristic violent patterns, destructive potential evident, and/or contact with police because of violent or destructive behavior
• Organic disorders (e.g., head injury, stroke) affecting client's use of talk therapy

Other reasons students may be referred to community resources include, but not limited to:

• Unwillingness to complete client data entry or provide information sufficient for clinical assessment
• Inability to identify a treatment goal appropriate for a brief counseling model
• Inconsistent attendance (clients are provided the Center’s attendance policy)
• Poor compliance or engagement with treatment recommendations
• Ongoing treatment relationship with another mental health provider
• Inappropriate behaviors towards any Center staff or within the Counseling Center
• Mandated or required treatment, including but not limited to:

Counseling ordered through legal or conduct proceedings, such as substance abuse treatment, alcohol education, anger management, parenting education, or domestic violence treatment

Counseling required by external entities, such as employers, government agencies, or campus departments/classes

• Comprehensive psychological evaluation of any type, including, but not limited to:
• Psychoeducational (ADHD, LD) or neuropsychological evaluations
• Custody or other forensic assessments/evaluations
• Assessment and documentation for emotional support animals
• Assessment for State/Federal benefit programs, including social security/disability
• Fitness-for-duty evaluations
• Pre-surgical mental health evaluations
• Individuals not enrolled in certificate or degree granting programs, or in programs that do not require the student to pay usual tuition and service fees (e.g., summer institutes, language training programs, distance learning, etc.)                                       
• Inflexible (or inappropriate) requests for specific counselor, counselor characteristics, or extremely limited/rigid schedule
• No staff expertise in the area of the client's concern (e.g., head injury, organic disorder, language processing concerns, etc.)
• Lack of available appointments, which tends to occur toward the end of academic semesters
• Any situations in which a clinician, in consultation with Center Leadership, determines that treatment within the Counseling Center would not be beneficial for the student, disrupt functioning of the Center, and/or pose a risk to the Texas State campus

Scope of Practice Questions

Thank you for reviewing this document.  We ask your understanding that the Counseling Center is working to provide the most appropriate services possible for our students and campus community while managing available resources.

Questions about this Scope of Practice may be directed to the Counseling Center by email counselingcenter@txstate.edu or by calling the Counseling Center 512-245-2208.  Please note that confidential information should not be sent via email.