Put Therapists in the Dorms

Regina Ray’s commute to work as a mental-health counselor at Virginia Tech is a three-minute walk.

Ray isn’t your typical campus therapist: She’s an embedded counselor in the university’s residence halls. “Living around your clients” does make for a unique experience, she said. “Having to give that disclaimer has been very interesting, especially when I’m like, ‘Hey, by the way, we do live on campus, so you may see us.’”

Hiring embedded counselors like Ray had a two-fold purpose for Virginia Tech. Administrators wanted to make it easier for students to access mental-health services. They also wanted to take some pressure off resident assistants, or RAs, in responding to their peers’ mental-health crises. In recent years, RAs have increasingly tended to students’ complex psychological issues late at night when other resources are unavailable, even though they lack professional training.

At Virginia Tech, the majority of the 10,000 students who live on campus are first-year undergraduates in the midst of transitioning to college — a stressful time when mental-health concerns often surface.

In the fall of 2021, Virginia Tech reorganized its residential-life program to focus more closely on student well-being and to incorporate other departments in student affairs, including the counseling center and living-learning programs. The overhaul included reimagining the RA role as “residential well-being student leaders.” Instead of being assigned halls within a dorm, student leaders were organized into trios serving between 110 and 150 students.

The university also created the embedded-counseling program. Ray and three other professional mental-health counselors started in the fall of 2022.

The counselors live in one of the dorms assigned to them and work at a central office in the residential part of campus. They offer drop-in consultation, crisis response, and short-term individual and group therapy after hours. And they serve as connective tissue to the Cook Counseling Center, where students can receive more services.

Embedded counselors have become more common over the last five years. A handful of institutions have created such positions in athletic departments and particular academic units, hoping to target support toward specific populations.

Tapping therapists to work in residence halls, as Virginia Tech has done, is a newer approach.

With embedded counselors, the university is expanding its “tool belt” of mental-health services available to students, said Rebecca Caldwell, director of residential well-being.

“It’s a huge support to RAs because they have so many more easy resources to refer a resident to,” Caldwell said. “If a student comes to an RA, it’s 7:45 on a Tuesday evening, and the student’s saying, ‘I’m really struggling,’ the RA can say, ‘Hey, we’ve got some counselors right here, just two buildings over, who are here just to work with students in the residence halls.’”

As the embedded-counseling office operates from 2 p.m. to 11 p.m. Monday through Thursday, and 8 a.m. to 5 p.m. on Friday, many students show up once they’re done with class. Some come in their pajamas, Ray said.

One goal of embedding therapists, Caldwell said, is to add a “second shift” to the counseling center, which closes at 5 p.m.

“Folks hang on during the day and then start to get shaky at the end of the day,” she said. “And all of the sudden, they’re showing up at your counseling-center door at 4:55. Or they don’t make it … And then they’re struggling in the early evening, and only residential life on call and RAs are there.”

The late spring is an especially stressful time for students, who are gearing up for final exams and preparing to bid their friends adieu for the summer. Bad grades, burnout, and breakups dominate the caseload.

At the end of an appointment, the counselor will ask the student what they’re looking for going forward. Students can continue individual therapy through the counseling center or TimelyCare, a telehealth platform Virginia Tech contracts with, or they can seek care off campus. There’s also the option of staying on the embedded counselor’s caseload, Ray said.

On average, students are seen one to three times, said Ellie Sturgis, director of the Cook Counseling Center. Most of the appointments take place between 5 and 10 p.m.
The program has been well received so far: According to Sturgis, embedded counselors have met with 1,183 students this academic year. She said she was unable to determine from the center’s metrics how many were referrals and how many were students seeking services on their own.

Ray estimated that about 60 percent of students schedule appointments, while 40 percent drop in. But the program is starting to see an increase in students dropping in, “which is what our true nature of the work was about — doing away with as many barriers as possible to treatment.”

Often, students just want someone to talk to at a moment’s notice, to hear them out and help them problem-solve.

Kevin Shollenberger, vice provost of student health and well-being at the Johns Hopkins University, said colleges that want to embed counselors in dorms should first think through what the role of the counselor is and then clearly communicate that to students.

In 2021, Hopkins embedded a counselor in its athletics center to support athletes and coaches. The university is also looking to place a counselor in its graduate school for drop-in hours.

“I personally am more in favor of the drop-in versus providing the ongoing therapy model because otherwise … people at some point will have trouble getting appointments,” Shollenberger said. “If the goal is to decrease the barrier to care, you do want to make sure folks are as accessible as possible.”

On top of essentially extending the hours of the counseling center, embedded counselors play another key role: alleviating pressure on student RAs.

Historically, an RA’s main role has been to build community in the dorm and connect students to campus resources, Shollenberger said.

“But with the increase of mental-health issues nationally and on college campuses,” Shollenberger said, RAs “are finding themselves more on the front lines and being confronted with difficult mental-health issues.”

During the pandemic, RAs also found themselves with an unexpected set of responsibilities: policing how and where students gathered and the kinds of precautions they had to take. “We talk about community development being at the core of their role and them being a resource,” said Steve Herndon, assistant vice president for student living at Syracuse University. “That changed dramatically,” he said, as RAs were expected to enforce public-health policies.

In that taxing environment, at least one institution recently decided to do away with RAs altogether. In 2021, George Washington University replaced RAs with live-in staff members to deal with crises in dorms. The more ho-hum parts of the job — front-desk duty, move-in day, and so on — were reassigned to students as part-time work.

Similarly, Virginia Tech doesn’t want RAs to be directly managing students’ mental-health challenges.

With counselors available in the residential area, it is easy enough for an RA to just walk a student over instead of counting on them to call the counseling center the next day. “That student may not follow through,” Shollenberger said. “Whereas here, the RAs have a better sense of the support and can do a more seamless handoff.”

Alex Sing, a residential well-being student leader at Virginia Tech, took advantage of the new embedded-counseling program when one of his residents expressed mental-health concerns related to a poor grade. Sing filed an incident report and later scheduled a time to walk the resident over to the counselors’ office.

“We’re not certified therapists,” Sing, a sophomore, said. “We’re here to listen to residents … But ultimately, it’s not up to us to give them advice. That’s where embedded counselors come in.”

Embedded counselors can also be a resource for RAs themselves, who may want to talk through roommate conflicts or other problems in their halls. At Virginia Tech, there’s a designated support group for student leaders, and the counselors sometimes go on rounds with student leaders.

“I see a lot of burnout within them because they’re so compassionate, they have so much to give everyone,” Ray said of the RAs. “And then it’s like, ‘Hey, you also have to take care of yourself.’ So it feels good to be able to pour back into their cups as well.”