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Journal of College Student Psychotherapy, 24:284–294, 2010 Copyright © Taylor & Francis Group, LLC ISSN: 8756-8225 print/1540-4730 online DOI: 10.1080/87568225.2010.509225

Mandatory Counseling: Clinical Beneficence or Malevolence?

GERALD AMADA City College of San Francisco (Retired), San Francisco, California, USA

Mandatory counseling is a widespread and commonly accepted practice on college campuses throughout the nation. This prac- tice bestirs heated controversy and ethical challenges when col- lege administrators require students to undergo counseling in instances of misconduct that pose little danger to self or others. Apparently many counselors actively and approvingly under- take mandatory therapy with students; others take exception and decline to undertake involuntary counseling; and still others acquiesce by undertaking mandatory counseling with students despite their ethical objections to this coercive clinical practice. This article will highlight the rationales for ethical objections to mandatory counseling.

KEYWORDS coercive clinical measures, ethical challenges, ethi- cal compromises, mandatory counseling

The massacre that took place at Virginia Polytechnic Institute and State University on April 16, 2007, sent shock waves throughout the college cam- puses of our nation. In the wake of this heinous crime, repeated reference has been made to how this staggering shock to our collective psyches will be a “wake-up call” to empower us to take the right and sensible mea- sures to make colleges and universities safer institutions. Many colleges have made evident progress in the aftermath of Virginia Tech in marshalling a multiplicity of on-campus strategies and resources (such as risk-assessment teams comprised of clinical, instructional, judicial, and administrative staff) to identify and quell the insubordination of highly disruptive and potentially dangerous students.

Address correspondence to Gerald Amada, PhD, 185 Mt. Lassen Drive, San Rafael, CA 94903, USA. E-mail: [email protected]

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At the same time, however, increasing numbers of nervous colleges have arbitrarily engineered their students into mandatory counseling and psychotherapy without due regard for the constitutional rights of these students. For example, the Foundation for Individual Rights in Education (FIRE) investigated and reported the case of a student at Valdosta State University (VSU) in Georgia who was expelled for being “a clear and present danger” and was mandated to submit certifications of his men- tal health and ongoing therapy as conditions of his readmission to the college because the student peacefully protested the school’s decision to construct two new parking decks on campus and posted flyers detail- ing potential alternatives. The University of Georgia System’s Board of Regents reversed the expulsion of the student after he filed a federal law- suit against VSU for violating his constitutional rights. Although the student was officially reinstated, he refused to return to the campus, considering the university to be a hostile environment (Foundation for Individual Rights in Education, 2010).

Similarly, the Review Panel of the Governor of Virginia in its document titled Mass Shootings at Virginia Tech recommended: “The troubled student should be required to participate in counseling as a condition of contin- ued residence in campus housing and enrollment in classes” (“Report of the Virginia Tech Review Panel,” 2007, p. 54). This sweeping, generic use of the term “troubled” could serve as grounds for shanghaiing into counseling virtually any Virginia college student who evinces the slightest unconven- tionality in speech or behavior that just happens to upset a thin-skinned instructor or administrator.

Mandatory college counseling and assessment has become com- mon practice on college campuses. According to the National Survey of Counseling Center Directors (Gallagher, 2009), 34% of the centers accept mandated referrals from judicial boards or administrators for both assessment and counseling. Based on my own observations I tend to believe that many of these colleges conflate the terms “assessment” and “counseling”; in other words, mandatory assessments are often extended and transformed into mandatory counseling sessions because many colleges, wishing to carefully monitor the ongoing progress of mandated students and thereby minimize their risk potential, prefer to keep them in open-ended counseling sessions as long as necessary. It is worth noting that this survey also reports that 64% of counseling directors are ambivalent about mandatory counseling but acknowledge that some students can be helped in this way. This par- ticular statistic raises some fascinating questions of considerable heuristic value. If some counseling center directors are accepting mandatory referrals despite their ethical qualms, it would be worth knowing what political, insti- tutional, and clinical factors have compelled them to make quiescent ethical compromises of this kind. Identifying and elucidating these factors might in time enable college counselors to discover and assert effective alternatives

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to the practice of accepting ethically questionable demands for mandatory counseling.

I believe it is fair and necessary to forewarn readers that this article is a polemic, a set of rationales and arguments used to debunk, combat, and, if at all possible, abolish the practice of mandatory psychotherapy on college campuses when it is enlisted by administrators to deal with students who pose no imminent danger to self or others—an administrative practice that has become quite prevalent throughout our nation’s colleges.

INVOLUNTARY COUNSELING: WHY IT’S UNNECESSARY

I will here begin by stating the obvious: no counselor with an ounce of sense can legitimately object to the practice of mandatory counseling and assess- ment for persons who pose an imminent danger to themselves or others or are gravely psychologically disabled. However, I am entirely convinced on the basis of consultations I have had with over 130 colleges and universities nationwide that the imposition of mandatory therapy on college campuses is most often used to deal with students who have engaged in some form of nondangerous misconduct, such as disruptions in the classroom or dormi- tory. For the remainder of this paper my remarks about mandatory therapy will exclusively relate to nondangerous cases of disruptive misconduct rather than those that pose an imminent danger to self or others, the former clearly constituting the majority of cases referred for mandatory counseling.

Administrators Passing the Buck

The institutional source of referrals for most cases of mandatory counseling is most often the office of a college administrator, who usually has not referred the student because he or she is demonstrably dangerous but rather because the administrator is attempting to avoid the use of a disciplinary sanction in dealing with a disruptive student. The reasons administrators turn to col- lege counselors with requests for the imposition of mandatory therapy are many and certainly require analysis and elucidation. Some administrators are averse to administering discipline—even though this unsavory task is an integral part of their job—because they feel guilty or anxious about a disciplinary procedure they mistakenly believe is inherently punitive. As a result, they refer the disruptive student to a counselor in the fanciful belief that counseling is necessarily a kinder and gentler procedure while casu- ally disregarding the strong possibility that many students, especially highly disruptive, “externalizing” students who are being shunted into treatment under a disciplinary cloud, are in great dread of undergoing a counseling experience that requires a requisite capacity for intimacy, self-disclosure, introspection, and psychological sophistication. Clearly, many disruptive

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students would much prefer incurring a one-time disciplinary sanction such as a warning than undergoing intensive counseling.

Some administrators request that counselors carry out mandatory coun- seling because they fear that disciplining the student will cause him or her to wreak revenge on the college with a lawsuit or an act of retaliatory violence. Although their fears may not be entirely unfounded, this motive—the avoid- ance of litigation or violence—is clearly not a sufficient or legitimate basis for relinquishing their administrative authority to carry out warranted discipline, and, therefore, this practice strongly deserves the derogatory appellation that has been widely applied to it: CYA (cover your ass).

Administrators Unqualified to Determine Who Needs Counseling: Ethical Dilemmas

When administrators require students to meet with counselors and coun- selors to meet with students, a generally overlooked and misunderstood institutional anomaly takes place. These administrators are, ipso facto, car- rying out the clinical role of determining when, how, whether, and for how long a student should participate in counseling, a role that normally requires extensive clinical training, skills, and acumen. Regrettably, most administrators have not acquired this set of skills during the course of their career. Its counterpart in the corporate world is the situation of having clinically untrained gatekeepers working in managed care who dictate the duration and modality of treatment to professionally trained psychothera- pists. As well, when administrators determine that disruptive students must undergo mandatory counseling, they are unilaterally and often quite illog- ically redefining a behavioral problem into a mental health or psychiatric problem. After all, behavioral problems presumably require disciplinary measures; psychological problems are apt to require treatment. Nothing other than the administrators’ power and authority gives them the right to use such sleight-of-hand measures to effect a transmutation of a behavioral problem into a psychological problem simply to avoid the use of legally based disciplinary measures.

College counselors who receive directives from administrators to under- take mandatory counseling with disruptive students are faced with a formidable ethical challenge. First, if they surmise that the directive is moti- vated by the administrators’ intention to divest themselves of disciplining the disruptive student by transferring the disciplinary role (in the form of mandatory counseling) to counselors, counselors may question whether the assumption of such a quasidisciplinary role is compatible and consistent with the ethical codes of their profession. In other words, can counselors reasonably expect to fulfill their primary professional obligation to heal and guide students while at the same time wielding the weapon of disci- pline (in the form of a threat of expulsion for a student’s noncompliance

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with the requirement of mandatory therapy) without making serious ethical compromises? Second, counselors who assume a quasidisciplinary role by undertaking mandatory therapy with a disruptive student may also question the matter of their own basic professional loyalties. They might legitimately ask themselves: Am I, by carrying out an administrative directive to under- take mandatory therapy, truly serving the student, or am I largely serving the administrator and the institution? Can I really serve all three equally well in this endeavor or will one of them—the student, most likely—get a short shrift by having his or her civil rights abridged? If his or her rights are being abridged in counseling, how do I justify being actively complicit in such a scheme?

Many years ago, Thomas Szasz (1973) raised this very point in his article titled “The Psychiatrist as Double Agent.” Szasz had created a straw man by positing his argument in a way that ineluctably situated college therapists in the cross fire of a nasty clash between students and college administrators that inevitably led to serious ethical compromises on the part of the thera- pists, at times to the detriment of students. I was determined to not let this happen to me in my college work, and I discovered there really was a quite navigable pathway I could use in my college practice to avoid such a con- sequence. I took a quite intransigent stand against mandatory counseling and made it known to all segments of the campus community—students, academic counselors, administrators, and instructors—that our clinic would not be accepting such referrals (except, of course, in cases of demonstrable imminent danger to self or others). At the same time I persistently expressed to anyone making such a referral my eager willingness to meet with them, as often and as long as necessary, in order to discuss effective alternatives to mandatory counseling, such as the use of proportionate and clearly war- ranted disciplinary measures. This tack—respecting and actively fostering the rights and prerogatives of instructors and administrators to use essen- tial disciplinary sanctions rather than relinquish them to counselors who could not execute mandatory therapy without straying into serious ethical compromises—became a highly serviceable and respected paradigm that worked splendidly for many years, just not at first, of course. Several of the old guard, benighted administrators, many who were trained and educated at authoritarian colleges, took umbrage with me over my refusal to follow their orders to conduct mandatory therapy. On several occasions I was even informed that I was not doing my job, and there were even intimations that my employment at the college might be in jeopardy. But over the ensuing years the old guard was eventually replaced by a more enlightened coterie of administrators who embraced the concept and practice of cleanly separat- ing the psychological service from the college’s disciplinary system, and the result was an exemplary mutual respect and a clear and effective delineation of respective responsibilities between college therapists and administrators in the handling of disruptive incidents.

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Pitfalls for Counselors

College therapists who accede to administrators’ directives to conduct manda- tory therapy are wont to justify their acquiescence on several rather spurious grounds. For example, one of the pitfalls of mandatory counseling is that it is usually not confidential. (I used to naively think that confidentiality was an essential cornerstone of standard psychological treatment.) The referring administrator ordinarily requests or requires some form of feedback from the therapist following a mandatory session (“Did the student show up? Is he dangerous?”). Ordinarily, the therapist then arranges for the student to “vol- untarily” sign a form consenting to mandatory counseling and the therapist’s release of “pertinent” information to the administrator regarding his or her counseling sessions, especially his or her attendance record. This, such ther- apists argue, is a humane and voluntary procedure. Unfortunately, therapists who make this argument are either extraordinarily naive, ethically tone deaf, or are disingenuously lying. When students are confronted with the “choice” of signing or not signing such forms they are being offered a “Hobson’s choice” (referring to Thomas Hobson [1541–1631], an English keeper of a liv- ery stable who required that customers take either the horse nearest the stable or none at all). In other words, students are given a “choice” offering only one option—the student will either sign the confidentiality-breaching form or, like Mr. Hobson’s customers, hit the road on foot (suffer an ignominious suspension or expulsion). In such an entrapping situation the entire matter of choice is clearly illusory and dishonest.

A rather curious defense of mandatory therapy that is sometimes advanced by its proponents is based on the fact that psychotherapists in this country are prevalently providing treatment to their clients on a mandatory basis in prisons and under mandates imposed by the criminal justice sys- tem in such programs as anger management, alcohol treatment, and spousal abuse. Proponents who enlist the specious argument that widespread prece- dents for these compulsory programs within the criminal justice system provide the imprimatur of legitimacy for establishing them on college cam- puses are, to put it bluntly, perpetrating a nasty hoax on their clients. The last time I looked, colleges were not prisons (even though some administrators and counselors arrogate to themselves wardenlike prerogatives and tactics), nor did they have the legal authority to adjudicate cases of criminality. Yes, they certainly are endowed with and wield considerable disciplinary author- ity, but in no wise are colleges and universities allowed to serve as a proxy for the criminal courts of our country. It is very interesting, I think, that some exponents of mandatory counseling would actually enlist as their clinical guide and model a practice that is endemic within the authoritarian culture of prisons and criminal justice systems. Is this perhaps a stark, albeit uncon- scious, acknowledgement and reflection of their own authoritarian values and clinical philosophy?

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Gore Vidal, the noted playwright and novelist, in a television interview many years ago on the topic of pornography, was asked to recommend remedies for the harmful effects of pornography. He replied, “I think it might be more socially beneficial to study the psyches of the rabid censors of pornography than its alleged harmful effects.” Analogously, I would suggest that it is more socially and clinically productive to comparatively study the psyches of college counselors and administrators who support or oppose mandatory counseling, particularly with respect to their respective levels of authoritarian beliefs and personality traits, than to assume that mandatory counseling is both ethically acceptable and socially beneficial.

Another argument adduced by advocates of mandatory counseling relates to its supposed unimportance when compared with other forms of ethical infractions and compromises that abound in our venal society. Of all the arguments used to defend and prettify mandatory counseling it is this one that I find most offensive. If college counselors are knowingly compro- mising their ethical principles by resorting to mandatory counseling simply because it is not as monumental a moral transgression as, say, a massive Ponzi scheme or CIA waterboarding, they should undertake some serious soul-searching to repair their malfunctioning moral compasses.

This discussion of ethical relativism is evocative, for me, of a scene in the film Judgment at Nuremberg in which Burt Lancaster, playing the role of a convicted Nazi war criminal, asks Spencer Tracy, playing the part of one of the trial judges, how he (Lancaster) could have known as a trial judge himself under the Hitler regime that his judicial rulings might lead to the horrors of the Holocaust. Tracy, somber in mien and voice, says (I am paraphrasing), “You should have known the first time you sentenced an innocent person to prison.” I am not suggesting, of course, that mandatory therapy will be a precursor to such cataclysmic events as a Holocaust. I am suggesting, however, that proponents and purveyors of coercive counseling have no control over how much their willingness to violate the rights of students to refuse therapy will ultimately result in greater, more egregious ethical abuses at some indeterminate point in the future. It is a historical truism, I believe, that almost all large-scale human rights abuses are the culmination of a natural, inexorable trajectory that begins with small-scale, seemingly innocuous rights’ violations and ends with horrifically catastrophic ones.

Invalid Justifications

Another argument that is sometimes adduced in favor of mandatory therapy is that it is unconscionable for a college or university to expel untreated, violent students who will, on their return to society, prey on unwary members of their community. When I first came across this argument I thought it merely laughable. Upon further scrutiny, I have come to the regrettable conclusion that this argument, when translated into pragmatic

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institutional practices and policies, often becomes a potent engine of odi- ous and ungovernable outcomes. For example, my extensive research of the pivotal events leading up to the 2007 tragedy at Virginia Tech clearly shows that the preponderance of faculty and administrators who had been continu- ally frightened by the conduct of Mr. Cho, the perpetrator, habitually leaned in favor of shoehorning him into counseling as the preferred remedy for his frightening misconduct while decelerating the use of such disciplinary measures as an expulsion from the college. As we now know, Mr. Cho pre- dictably eschewed counseling and gained a grandiose and dangerous sense of entitlement from the cowed deference of the college staff.

Of course it could be argued that, had Mr. Cho learned he would be expelled, he might have sought retribution even sooner by wreaking even greater devastation. But we must face the fact that colleges and universi- ties are definitely not sanctuaries for violent students whose very presence on campus poses an imminent danger to staff and students. We also must face the fact that counseling sessions (whether conducted on a voluntary or mandatory basis) with truly dangerous students are definitely not a panacea or safeguard that provides the campus with adequate protection from their victimizing behavior. It is extremely irresponsible for college counselors to provide mandatory counseling to disruptive or dangerous students if at the same time they are fully aware that their colleagues and other students are deeply suffering from the consequences of these students’ continued enroll- ment on campus, enrollment that is based, in many cases, on the very fact that the student’s counseling sessions are administratively treated as a mit- igating and protective extenuation. There is much that colleges can do to help such expelled students (and the community to which they will return) by reaching out to the students’ families and community agencies. Such efforts require considerable creativity and resources, but they can provide worthwhile results.

Therapy Is Not a Substitute for Judicial Process

Administrators and counselors who opt to use mandatory therapy rather than the college’s judicial system to deal with disruptive students are disregarding and denigrating (probably unwittingly) the essential value and efficacy of the college’s disciplinary system. A sound judicial system is ordinarily prepared to deal immediately and effectively with acts of misconduct. Disciplinary sanctions will need to be proportionate and just, and they should be meted out only by those persons who are bureaucratically authorized to adminis- ter discipline—designated administrators and/or judicial affairs officers, not counselors. Ordinarily, students who are disciplined through the use of sanc- tions that deprive them of their academic privileges, sanctions such as a suspension or expulsion, will, or should, learn that their acts of serious mis- conduct will entail dire consequences and that failure to respect the rights

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of others is not an acceptable way to matriculate or live one’s life. These are the values that undergird a just code of student conduct and a sound disciplinary system. When students are required to undergo counseling in lieu of a disciplinary sanction a very different moral message is usually con- veyed. The message, if it were transmitted to the student in writing, might read as follows:

We will not use the code of student conduct and its undergirding values to discipline you. Instead, we will force you into counseling by semanti- cally morphing your disruptive behavior into a psychological disorder of some kind, whether you like it or not. We do this in your own interest, of course, in order to help you avoid a harsh and blemishing disci- plinary sanction and because we believe counseling is a kinder and gentler approach to your problems. We ask that you see it our way even if we are using coercive measures to achieve our goals. We also request that you regard the consent forms we ask you to sign that enable us to violate your confidentiality to be a legitimate means of providing you with a fair and reasonable choice, even if the “choice” is a palpable sham.

If we can accept that the characterization in this mock letter reasonably reflects the deeper, labyrinthine dynamics of a typical mandatory therapy arrangement, we should be able to infer from it some of the salient values that undergird mandatory counseling and easily distinguish them from the values undergirding the judicial system of a college. The values underlying mandatory therapy are, inter alia, “might makes right” (the might of the insti- tution and its administrative minions), due process procedures protecting disruptive students’ civil rights are largely irrelevant and need not be par- ticularly respected, the goal of this involuntary endeavor is not reasonable conformity to the code of student conduct but rather some amorphous but identifiable form of psychological progress, and, finally, involuntary clients must find ways to blind and inure themselves to the sham aspects of this procedure if they are to remain in college and derive any benefit from the unwelcome help they will receive. Should college therapists be complicit in any clinical enterprise that advances such values?

Mandatory Counseling Encourages Subpar Counselors

Mandatory therapy by definition requires that students must see therapists with no particular regard for any lamentable misalliance that might take place between them. I hope my colleagues will agree that there are psy- chotherapists working in colleges and other settings who have atrocious clinical skills and judgment. The comedian George Carlin once made the tragicomic gag that in our country there is a worst doctor and at this very moment there is a patient in his or her office. By the same token, there is

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assuredly a worst college psychotherapist on a campus somewhere and at this very moment a student is being mandatorily treated in his or her office. What happens to students there on a mandatory basis? Will such students be given another bogus choice to remain with that therapist or leave the college? What if students refuse to enter mandatory therapy because they understandably believe that any therapist who is willing to engage in this questionable practice is not someone they can trust?

Therapy Is Not the Sole Solution

Based on my experience as a visitor to many colleges and universities, I have repeatedly come across a rather disquieting pattern of concerted effort to coerce disruptive students into psychotherapy rather than simply and pro- portionately discipline them for their behavioral infractions. The pattern is usually as follows: A highly disruptive student will, for example, be fright- ening roommates with her repeated threats of suicide. For understandable reasons the student is referred to a campus therapist on a voluntary or involuntary basis. In many, if not most such instances, the student is not threatened with a disciplinary sanction for behavior that is frightening and undermining the welfare of her roommates. Intensive efforts are made by the clinical staff to protect the suicidal student from herself, but little effort is put into protecting her roommates from her toxic presence in the dorm because her suicidal behavior is not deemed unacceptable or actionable under the code of student conduct. The student then conscientiously keeps her therapy appointments but because her suicidal misconduct was never deemed interpersonally sanctionable she returns to her room each night to repeat her suicidal threats with impunity. Why? Because the student oppor- tunistically chooses to meet the college’s sole stated and explicit expectation: mandatory therapy. This scenario is an all-too-common one and reflects the tendency of many colleges to lavish attention and services on the identified patient in crisis while neglecting to protect the rights and emotional well- being of other students. It is perfectly understandable that such students can remain in therapy for extended periods of time while they continue to be a public nuisance in the residence halls and elsewhere on campus. I can only hope that colleges that use mandatory counseling will not abandon dis- ciplinary measures as an alternative when counseling has failed to protect other students from the interpersonally destructive behavior of the individual in treatment.

CONCLUSION

Why do some college therapists agree to undertake mandatory therapy with students? Well, I assume some therapists simply savor power and have no

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ethical compunctions about using it in this manner. Far more common, how- ever, are cases of college counselors who agree to undertake mandatory counseling with students because they have been asked or ordered to do so by administrators who exercise control over their budgets and their very jobs. Such administrators feel more protected, physically and legally, if they can transfer the responsibility for evaluating the disruptive student to college counselors. I have spoken with hundreds of college counselors who have been placed in this position, and most seem to resent and object to it on ethical grounds, yet most acquiesce because they do not wish to risk a con- flict that might jeopardize their program and their job. It is important, then, to recognize that the ethical dilemmas wrought by the taxing demands of college administrators for mandatory therapy are more a political than clini- cal phenomenon. The quintessentially political nature of mandatory therapy is based on the power imbalance between college administrators and coun- selors. This means that those who seek to abolish this practice (except in cases of demonstrably dangerous students) will need to meet this challenge by generating the requisite moral courage to say no to those administra- tors who seek to impose such ethical compromises on them. Otherwise, I’m afraid we will have to wait until some disgruntled students lead the way by successfully suing colleges for violating their civil rights with the despotic ferule of mandatory counseling.

REFERENCES

Foundation for Individual Rights in Education. (2010). [Home page.] Retrieved from http://www.thefire.org/.

Gallagher, R. P. (2009). National survey of counseling center directors. Pittsburgh: School of Education, University of Pittsburgh.

Report of the Virginia Tech Review Panel. (2007, August). Presented to Timothy M. Kaine, Governor, Commonwealth of Virginia. Retrieved from http:// www.vtreviewpanel.org/report/index.html.

Szasz, T. (1973). The psychiatrist as double agent. In Anselm L. Strauss (Ed.), Where medicine fails. New Brunswick, NJ: Transaction Books.

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