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Integrative Wellbeing Services: Expanding and Diversifying

The Record published a two-part series on Integrative Wellbeing Services, Williams’ counseling/mental health services program. Given that this is one of my favorite Williams-related topics, I’m excited to pick out a few interesting bits. Article 1, and Article 2.

On the name and philosophy:

PCS [Psychological Counseling Services] is now known as Integrative Wellbeing Services, a change that [Wendy] Adam [the director of IWS] says represents a substantive shift in the College’s philosophy toward mental health. The therapists at the time were already well-prepared to treat mental illness, according to Adam, so her approach centered around broadening the range of services to include options aimed at fostering students’ general wellbeing in addition to providing clinical psychological services.

To me, this has some pretty clear upsides, but the downsides should certainly be acknowledged; for me, those downsides were pretty clear as a student.

The benefits, of course, are making therapy/counseling more accessible to all students and de-pathologizing therapy. Therapy can benefit everyone, and belief that you have to have a mental illness to seek therapy is a detriment. Says Adam:

“In my private practice, if someone came to see me, I had to justify their appointment to their insurance company using a diagnosis,” she said. “One of the things I love about this job is that you don’t have to have a serious diagnosis to work with us. I don’t have to worry that, if you’re having a hard time but you don’t meet all the criteria for depression, I’d have to stop seeing you after a certain time even if it would have been more effective for you to stay longer.”

“We’ve got tons of groups and offerings, where we want to meet students where they’re at,” Adam said. “That’s why there are so many ways of inviting students in. We don’t want that old story of ‘You have to be mentally ill to see a therapist’ to get in anybody’s way.”

The downside—which I experienced—is that, if you do have a genuine mental illness and need specific treatment for a mental illness, Adam’s statement that the school was “already well-prepared to treat mental illness” might have felt like a pivot away from that treatment. “Broadening the range of services” doesn’t have to mean decreasing the efficacy of mental health treatment, of course; in practice, however, given that IWS is training the new clinicians (and students in the two-year training program make up a large amount of the staff, after all), the likelihood that you’ll start therapy and see someone who’s been trained in more of a “holistic” way than a “mental-illness-focused” way is pretty high.

The effect of that can be seen from quotes in the second article:

“Charlotte Jones ’22 started seeing a clinician at IWS last year while continuing to regularly check in remotely with the therapist she has worked with for several years at home. She hoped to use the IWS sessions to process recent traumatic life events, but both of the therapists she was paired with took approaches that she found unhelpful.

“At times, it felt as though they were babying me,” she said. “It could be very demeaning… Maybe they would have been fine for a smaller issue, but for me, they were not ready to handle what I had.”

She said that she does not plan to try again at IWS – “Two times was hard enough,” she said – though she has found the crisis call line helpful for instances when she could not get in touch with her therapist from home.”

The article, and clinicians during therapy, make clear that switching therapists is always a possibility and is encouraged to find the right fit for you. But two times is hard enough! It can be really hard to keep divulging your trauma over and over, trying to find the therapist who’s most helpful in processing it.

The articles also discuss some programs that are new this year at IWS. We talked about those earlier here on EphBlog with a post by DDF (http://ephblog.com/2019/09/12/welcome-and-new-year-updates/),  namely, new therapy options through the online platform TalkSpace, and new non-emergency transport options including twice-daily shuttles to get prescriptions from Rite Aid. At the time he wondered if these were the best uses of Williams’ money, or if we should “prioritize matching financial aid packages from places like Harvard first.”

My comments at the time were responding to this thought specifically, but are relevant to my general defenses of spending on IWS more generally:

Sure, in terms of optics of making Williams more appealing to prospective students, spending on matching financial aid packages from places like Harvard might be better. But I believe this is spending on making Williams actually more competitive with placed like Harvard in terms of actual student experience. In Cambridge there are places within walking distance, or using public transit options, where you can get things like x-rays and blood tests on the school’s insurance. In Williamstown, if you don’t have a car, the one bus most likely doesn’t go where you need it to, to get those medical services done…so you’re absolutely reliant on the medical transport system run by the college, which helps bridge the gap of accessing medical services resulting from Williams’s location.

As for the twice-daily pharmacy runs…I am incredibly jealous. I wasted so much time, up to my very last week at Williams, finding solutions to what should be the very simple issue of picking up prescriptions at Rite Aid. There’s prescription delivery to the health center, but the health center is open fewer hours than Rite Aid is; moreover, prescription restrictions exist. I remember one particular situation where I was prescribed a new medication that was restricted in such a way that I had to pick it up in X days, and they would not let me have it delivered; I had to pick it up in person. So I walked in single-digit weather to Rite Aid, taking a couple of freezing hours during a particularly busy week. Not a life-threatening situation, no, but one that, after a few times, definitely found me wishing I went to a school that wasn’t so darn remote.

Is this the sort of thing that prospective students will think about when debating Harvard and Williams? No, of course not, so if that’s your metric then sure, this is a waste of money. But it’s absolutely something that helps bring quality of life up to par with places like Harvard, and for that I see it as immensely valuable.

At what point do improvements to IWS become a selling point for the college? As knowledge and perception about mental health shift, I’m hopeful that a strong offering of counseling services becomes much more of a plus. And, as the Record article highlights, we really are fairly top-of-class:

“According to Klass and Adam, the ratio of students to therapists across higher education nationally — including both colleges and universities — is around 900:1, while the College’s peer institutions tend to be closer to 400:1. In contrast, the current ratio at the College is slightly lower than 145 students per therapist.

Last year, there was no waitlist for accessing therapy through IWS.

Meanwhile, the total number of scheduled psychotherapy session hours has grown by 260 percent over the last decade. That increase is due in part to the fact that students can schedule as many visits to IWS as they need. “Unlike other colleges and universities, we don’t cap our sessions,” Grinnell said. “I love that about Williams. We can really spend time building relationships with our student population. Therapy may not always feel linear — it might take some time to feel like consistent progress is being made.”

This is all really good, important stuff.

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