The Assessment Process in Campus Community Mental Health Programs Thomas R. Brigante, Ph.D., S.M. in Hyg.
ABSTRACT: In developing campus community mental health programs, assessment is a more complicated and holistic process as compared with assessment within an individual therapeutic relationship. It includes a global assessment of the college as an ongoing social system, as well as an analysis of its present and past phases of evolution as an institution. Mental health staff must understand the way in which they affect others within the college community and the perceptions which others hold regarding the mental health program. They must also scrutinize their own dynamics as these affect their reactions to individual community members and to the core value orientations of the college.
As mental health professionals grow more enthusiastic about initiating community oriented programs on college campuses, the need to examine the complexities involved in developing such programs increases. Some issues which require careful consideration will be raised in this paper. At the outset, it is necessary to recognize that we understand only dimly how community oriented programs take shape and gain a college community's acceptance. Looking to nonacademic communities for leads, one finds only a few instances (Bindman, 5966; Karp, 5965; Rosenblum & Ottenstein, 5965) where program developers have recorded their observations about the ways programs have evolved. When successes do occur, it is difficult to know when they are the result of a fortunate combination of accidents and to what extent underlying principles of social change are being manifested. It is clear, however, that many variables must be carefully considered in planning a community program which might be regarded as quite unimportant in developing a more traditional campus mental health program. DIMENSIONS OF ASSESSMENT It is important to become attuned to significant dimensions of the assessment process within a community oriented program, in contrast to a traditional program. Assessment in the latter instance refers to Dr. Brigante, 219 N. Indian Hill Blvd., Claremont, Calif. 91711, is a practising psychotherapist and mental health consultant. Community Mental Health Journal, Vol. 5 (2), 1969
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assessment of the student by the counselor or therapist. The meaning of assessment when developing a community oriented program is much broader. It refers not simply to assessing the student but to assessing the position of the counseling center or mental health facility within the entire situation, as well as the impact of the director and his staff on the entire campus community. Personal attributes of the mental health professionals and their ability to establish comfortable informal relationships with those in the campus community become much more important in a community oriented program. Of crucial significance is the question of the director's access to institutional decision-makers and his opportunities for contact with them. If the mental health program is not only to survive but to gain community support, the director and his staff as well must have an opportunity to enlist the support of key decision-makers. This includes not only the college president but trustee board members and faculty members as well. In a time when students are making increasing use of the services of mental health professionals, the college president and trustees may not be abreast of such changes. Also, they may tend to regard the changes as quite undesirable in that they point to the need for increased expenditures for mental health staff, in addition to being a possible sign of increasing disturbance on the campus. It may be hard for them to regard such changes as a manifestation of constructive ferment or an indication of students' increased willingness to make their educational experiences personally meaningful to them rather than have them simply consist of the ingestion of factual material. In the process of assessing attitudes of decision-makers, mental health professionals must try to garner some realistic impressions of the nature of their role relationships with decision-makers. Realistic limitations upon mental health professionals' abilities to exert influence must be recognized, if major blunders are to be avoided. Mental health professionals typically are not empowered to make decisions about the institution itself. They are subordinates within a hierarchy, which imposes further limitations on their ability to exert direct influence over superiors. In addition, their professional role is by definition associated with change and this may be received in many quarters as a threat to the position of respect and esteem which institutional members feel that their college has come to command. In a later section, the implications of these facts will be discussed in order to evaluate the ways in which the influence process must proceed. Mental health professionals should also scrutinize their relationships to campus "gatekeepers." The dean of students and dean of faculty are especially important in this regard. If community support and participation are to be won, these gatekeepers must provide sanction for the mental health professionals so that they have wide-ranging contact with faculty members and dormitory personnel. Thus the attitudes of gatekeepers toward the director, his staff, and the aims of the program are of crucial importance. If a
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community oriented program is regarded as a subterfuge for empire building, it will not be possible for mental health personnel to have easy access to contacts with other campus personnel. In some quarters, a community oriented program may be misperceived as a kind of case-finding procedure which only causes more work and trouble. Charges may arise that the mental health professionals seek to turn the campus into a mental hospital. It is of vital importance that the entire staff of mental health personnel be alert to these perceptions and utilize every means at their command to correct them. Despite the fact that a community oriented program espouses the full utilization of the skills of all campus personnel in building a community and working with students, it may be perceived as an encroachment on the provinces of other student personnel workers. They may have come to regard their own roles and the roles of mental health professionals as quite fixed. Some may regard efforts to implement a community oriented approach as a way of criticizing their own efforts and of saying that in the ideal world it would be best if we had only psychologists, psychiatrists, and social workers to perform all student personnel functions. SOURCES OF RESISTANCE Resistances to community oriented programs may also arise from other quarters on the college campus. Faculty members may see a community oriented program as placing increased demands on their time and energies when they already feel that students take too much of their time. Faculty members who work comfortably with students and who enjoy this role may appreciate the support of mental health professionals. Sometimes, however, they are very resistant to any kind of collaborative attempts to help students and may subtly regard this as an encroachment upon their professorial roles. In situations where counseling services are unfavorably regarded, the faculty member may find it hard to envision himself accepting any kind of help from members of the counseling center staff in working with a student. The attitudes that faculty members take toward sharing their efforts with mental health professionals in working with students are to a considerable extent determined by the contract that they have made with the college regarding their professional roles. Where the college appreciates faculty interest in students but bases promotion upon research and publication, faculty members will not be eager to increase their involvement with students. It is important that mental health professionals appreciate the dilemma which faculty members face so that they do not increase faculty members' conflicts by being too confronting about their responsibilities to students. However, it may be possible for mental health staff to discuss such dilemmas with faculty members and to talk to the dean of faculty and the president about the difficulties that faculty members face in meeting their responsibilities to students.
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As mental health professionals move toward doser contact with deans, faculty members, and other permanent campus personnel, students may develop some discomfort about seeing mental health professionals in this role. Some students may begin to fear that their confidentiality is being violated and that the mental health staff are an arm of the administration, despite whatever assurances mental health professionals provide to the contrary. It is important that the mental health staff be sensitive to these issues so that they do not allow ambiguity to be created in the minds of students regarding their position on confidentiality. Because of the dual loyalties of mental health professionals on campuses to both the students and the administration, this may become an especially hot issue where the mental health professional has to make recommendations or take a stand of which students disapprove. In some instances, for example, the psychologist or psychiatrist has recommended that a student be discontinued at school so that he can seek treatment on a more intensive basis than is possible in a college setting. If a student happens to have difficulties which manifest themselves in any kind of antisocial behavior on the college campus or in the college community, such a student who does not wish to leave may enlist the sympathies of other students about his plight. He may suggest that the college is interested only in its good name and not in the students, and that mental health professionals are basically collaborating with the college and that their concern for the students' welfare is secondary. Such concerns of students must be met directly and should not be allowed to simmer and cause increased distrust and suspicion of the mental health staff. Where it becomes clear that other students are suspicious of the reasons for which the student is asked to leave school, the mental health professional may want to arrange a meeting informally with interested students so that there can be some general discussion of what has happened. It is especially important that this be handled in a way which does not violate the confidentiality of the student who had been asked to leave school. However, in such circumstances other students have a general awareness of what has been transpiring and the discussion can be carried on at this level. In instances where this kind of step has been taken, students have shown renewed confidence in the basic motivations and purposes of the mental health staff. In becoming increasingly involved with the life of the campus, mental health staff must be alert to the fears of administrative personnel that they will unearth problems that are best left alone. A community oriented approach is founded on a philosophy of relationships that includes the wishes of people for openness and for true collaboration with others in addressing themselves to significant issues. All of this assumes a full modicum of health on the part of the collaborating participants, which in the real world often does not exist. The fears of personal and professional exposure which such a program may generate should be recognized and appreciated. I t should also be recognized that mental health staff themselves as well as other cam-
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pus personnel may fear personal exposure. Relatively speaking, it is safe and cozy to work in an office situation where one's mode of functioning is observable only to an individual student, it is a different circumstance where one must demonstrate his competence and discuss significant issues with professional peers and superiors in public situations. In this circumstance, it is easy for the mental health professional to project his fears of exposure onto campus personnel and be especially angry with them when they are perceived as obstacles to the development of the mental health program. On the other hand, if the mental health staff can recognize their own fears of exposure, it will be easier for them to appreciate the fears of others. ASSESSING THE COLLEGE A related dimension of the assessment process is concerned with the college's present phase of evolution as an institution. Achieving a cogent grasp of the institution's present developmental level and historical evolution is a complicated matter that involves far more than learning a few historical facts about the institution's life. The basic value orientation of the founding fathers of the institution is of great significance, as well as the way in which these values have come to be regarded by present institutional participants. For example, institutions which started off with a strong religious denominational orientation may have shifted over the years to a more ecumenical and secular conception of themselves. The personalities and aspirations of the presidents of the institution are also important, as well as the ways in which they have been regarded by institutional members. If the institution has been in existence for some period of time, the conception of itself which it seeks to project to the outside world needs to be carefully weighed. A study of the college catalogue, along with publications and speeches of institutional members, is one useful way of gaining insight into the institution's self-image. A college which is proud of its tradition and feels that it is important to preserve this tradition might be markedly different from a new college which feels the lack of tradition and which is in the process of developing one. The latter kind of college may be more receptive to innovative programs such as a community-oriented mental health program, since it has no vested interest in a prior tradition. Mental health professionals who are identified with change programs may find that liaisons are easier to make with institutions which are change oriented than with institutions which are tradition oriented. It is both important and fascinating for a mental health professional to consider his own attitudes toward change and toward tradition as a basis for understanding how both kinds of institutions might perceive him. If he himself associates tradition with stultification, rigidity, and a repressive style of life, he may develop strong aversive reactions to the institution and its ritual systems which are symbolic of its basic attitudes, On the other
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hand, he may associate the change orientation of the newer, younger institution with his own outlook and may find it almost too easy to develop an identification with that institution's circumstances. Within the domain of psychoanalytic theory, we have come to understand the implications of countertransference as it affects the therapist's response to the patient. It is important that we also come to understand the implications of a community-oriented mental health specialist's attitudes toward the institutions he seeks to affect. In this connection, we must articulate the difference between counterreaction and countertransference, in the sense that countertransference implies some distortion on the part of the therapist in his response to a patient, whereas counterreaction implies an appropriate response, without neurotic complications, on the part of the therapist to the patient which is evoked by the patient's behavior. It is also useful to differentiate between institutional countertransference and institutional counterreaction. Institutional counterreaction and countertransference refer to the mental health specialist's response to the institutions as institutions, which is based upon the reactions they evoke in him and upon his own personal dynamics. In this connection, the participation of mental health professionals as change agents within the tradition-centered institutions is an important issue. It is typically the case that mental health professionals have marginal identifications and may often find it more difficult to develop empathic relationships with members of tradition-centered institutions. In fact, they may align themselves with marginal members of such institutions, partially out of natural affinity and partially as a means of lowering their own insecurity about being regarded as marginal themselves within the context of such institutions. Kurt Lewin has spoken of "leadership from the periphery." In other words, psychologists and psychiatrists as marginal members of society themselves find it easier to think of a model of change based upon personal marginality and identification with other marginal members of society than an alternative model where they are central to an institution's life and the institution itself is not marginal within the broader context of society. In community action programs, it sometimes happens that members of organizations such as Intercultural Councils select people who are marginal members of the community and do not include board members who embody the central value strains accepted by the community as a larger unit. All of this is not only fascinating to consider but has important implications for the process and mechanisms of social change. If the institution itself has phases in its evolution, then we must consider the meshing or constructiveness of fit between institution and its particular phase of development and the kind of mental health professional who becomes associated with that institution. For example, in a situation where an institution has established a firm tradition and where the mental health program to be instituted is perceived as rather markedly discrepant from that institutional tradition, per-
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haps the change processes require a change agent who is located in the center of the institution's power structure or who has the attributes of a charismatic leader. In the newer, less tradition-centered institution with a natural affinity between the mental health professional and the stage of the institution's development, it is not quite so necessary for the mental health professional to have a high degree of institutional power or to be charismatic in order to get his program off the ground. He needs simply to indicate his commitment to growth and change and his willingness to participate in the change and growth processes which are part of the institution's development. ESTABLISHING TRUST The kind of trust and the level of trust which need to be established in community oriented programs also differ from that required in the conventional program. In a conventional program, the existence of a trusting relationship between counselor and client is of course essential. Further, there must be enough trust between other members of the institution and mental health staff so that they accept the requirement of confidentiality in the therapist-student relationship and are willing to have the mental health center exist. Within a community oriented program these requirements do not go far enough. Caplan (~964) has discussed the importance of establishing trusting relationships as the basis for any effective community program. Mental health staff in a college setting must be allowed to do more than simply exist and work in parallel with other student personnel workers, faculty, and various members of the administration. A level of trust must accrue between mental health staff and other members of the college to the point where collaboration regarding students and regarding campus issues takes place. Within the past z5 years in various institutions of our society such as prisons, mental hospitals, and community clinics, there has been a wave of interest in team approaches to problems. It must candidly be acknowledged that over time, some have become jaundiced about the ultimate efficacy of such an approach by virtue of the problems that arise when such people do attempt to collaborate. In seeking to implement a community approach on college campuses, it is imperative that mental health staff have some grasp of the way in which team approaches succeed and the conditions which cause them to fail. Pious statements about working together are not enough to make such programs effective in the long run. There must be a common commitment on the part of collaborating participants to work out the disagreements and strains which inevitably arise when such efforts are undertaken. Commitment to such an approach can be facilitated when collaborating participants share the belief that the college, its students, and staff will all benefit from the results of such collaboration more than they might by separate efforts. Development of such attitudes occurs best when circumstances arise which naturally lead to this kind of collaboration. Although
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collaboration may generate feelings of personal threat and fears of exposure, people who choose to work in institutional settings often experience strong needs to work together rather than separately. Over time, mental health staff can be alert to specific instances in which collaboration might be undertaken and initiate such collaborative efforts without being unduly pushing or forcing in their wishes to collaborate. Gradually this may lead to closer cooperation. In such relationships, the professional competencies and personal characteristics of the mental health staff become more visible. There must be willingness to let others take the lead, to admit one's errors candidly, to give others credit where credit is due, and to be a responsible, competent, trustworthy, and fallible human being in such transactions. Mental health professionals' needs to play omnipotent roles often interfere with such cooperative efforts. Mental health professionals who feel that they alone know best how to get things done may subtly manifest patronizing attitudes toward those with whom they seek to cooperate. This is one of the worst things that can happen and is sure to lead to the demise of any collaborative efforts. AVERTING NEGATIVE STEREOTYPES Some may see mental health staff members as relishing an omnipotent role, whereas others may regard them as professional voyeurs. From this point of view, the initiation of any mass testing procedures may feed this perception which others have. A great deal of caution needs to be exercised in undertaking any large-scale testing program. In a time when students are exposed to numerous mass testings before they reach college, they are likely to be somewhat wary already and jaundiced about further testing which they confront when they begin college. Whenever possible, it is crucial for students to be offered group feedback and individual feedback about tests they have taken. In addition they should be given full and candid explanations regarding the purposes of testing, in order to dispel any latent suspicions about the hidden motives of the testers. The requirement of students in elementary psychology courses that they participate in experiments whether they choose to or not, and the use of "trumped up" situations to induce experimental variables in psychological experiments, has not helped to develop trust between students and mental health professionals (Kelman, "f967). Although colleges may be compartmentalized in their approaches to students, students do not live their lives in compartments. In the present discussion it is being suggested that others may have in mind various distortions and stereotypes regarding the aims of mental health staff and the mental health program. These stereotypes should be carefully weighed in order to be alert to finding ways of dispelling them. For example, some faculty members may see the mental health professional as a one-dimensional practitioner who has little appreciation for the merits of research, teaching, or scholarship. Connected with this may be a perception of the mental health program as having a "janitorial" or "repairman" function.
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Another related perception is that people in mental health programs do a lot of "hand holding," implying that much of their work within this delimited realm is unnecessary. In terms of these perceptions, various measures become important. It should be common practice for mental health staff to have teaching, research, and scholarship functions within the college community. They should sit in on faculty meetings and participate with full status in the academic life of the community. There is a special need for such mental health staff to have a broad orientation to their field in order to be able to participate effectively in the way that is described. It is not enough to participate, however. Participation must be accompanied by competency in the areas being discussed. Mental health staff must place repeated stress on the fact that they are doing short-term work and that students are seen no longer than is absolutely necessary. The stereotype that the mental health staff are janitors or repairmen is especially deleterious to the aims of the program because it relegates them to the sidelines of the educational arena. The direction which the mental health program takes must be quite the reverse, i.e., it must move toward the center of institutional life. Mental health staff must be involved in and knowledgeable about educational policies so that they can make intelligent statements and render valuable opinions about educational policy matters that fall within the realm of psychological knowledge. By not involving themselves in such a manner, mental health staff relegate themselves to the sidelines, In this connection it is important that mental health staff regard themselves as initiators and potential innovators of educational ideas which enhance the quality of the college. One of our burdens as mental health professionals is that we are associated with illness and all of its negative implications. The antidote to this negative stereotype is not for us to become platitudinous pollyannas, to make ourselves innocuous, and to brand ourselves as incompetent in order to gain acceptance. It is to take a position in which we accept major difficulties as part of the reality of life, while at the same time maintaining a continued interest in fostering and strengthening healthy behavior wherever it exists. Thus it becomes important for us to initiate ideas which are not simply ways of combatting already existing psychopathology, but are innovative and within the spirit of education as an exciting venture. REFERENCES Bindman, A. J. Problems associated with community mental health programs. Community Mental Health Journal, ~966, 2, 333-338. Caplan, G. Principles of preventive psychiatry. New York: BasicBooks,I964. Karp, H. N. Santa Barbara community mental health services. Community Mental Health Journal, 1965, I, 383-384. Kelman, H. C. Human use of human subjects: the problem of deception in social psychological experiments. Psychology Bulletin, i967, 67, I-~i. Rosenblum, G. R., & Ottenstein, D. From child guidance to community mental health: problems in transition. Community Mental Health Journal, i965, I, 276-z83.
ABSTRACT: In developing campus community mental health programs, assessment is a more complicated and holistic process as compared with assessment within an individual therapeutic relationship. It includes a global assessment of the college as an ongoing social system, as well as an analysis of its present and past phases of evolution as an institution. Mental health staff must understand the way in which they affect others within the college community and the perceptions which others hold regarding the mental health program. They must also scrutinize their own dynamics as these affect their reactions to individual community members and to the core value orientations of the college.
As mental health professionals grow more enthusiastic about initiating community oriented programs on college campuses, the need to examine the complexities involved in developing such programs increases. Some issues which require careful consideration will be raised in this paper. At the outset, it is necessary to recognize that we understand only dimly how community oriented programs take shape and gain a college community's acceptance. Looking to nonacademic communities for leads, one finds only a few instances (Bindman, 5966; Karp, 5965; Rosenblum & Ottenstein, 5965) where program developers have recorded their observations about the ways programs have evolved. When successes do occur, it is difficult to know when they are the result of a fortunate combination of accidents and to what extent underlying principles of social change are being manifested. It is clear, however, that many variables must be carefully considered in planning a community program which might be regarded as quite unimportant in developing a more traditional campus mental health program. DIMENSIONS OF ASSESSMENT It is important to become attuned to significant dimensions of the assessment process within a community oriented program, in contrast to a traditional program. Assessment in the latter instance refers to Dr. Brigante, 219 N. Indian Hill Blvd., Claremont, Calif. 91711, is a practising psychotherapist and mental health consultant. Community Mental Health Journal, Vol. 5 (2), 1969
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assessment of the student by the counselor or therapist. The meaning of assessment when developing a community oriented program is much broader. It refers not simply to assessing the student but to assessing the position of the counseling center or mental health facility within the entire situation, as well as the impact of the director and his staff on the entire campus community. Personal attributes of the mental health professionals and their ability to establish comfortable informal relationships with those in the campus community become much more important in a community oriented program. Of crucial significance is the question of the director's access to institutional decision-makers and his opportunities for contact with them. If the mental health program is not only to survive but to gain community support, the director and his staff as well must have an opportunity to enlist the support of key decision-makers. This includes not only the college president but trustee board members and faculty members as well. In a time when students are making increasing use of the services of mental health professionals, the college president and trustees may not be abreast of such changes. Also, they may tend to regard the changes as quite undesirable in that they point to the need for increased expenditures for mental health staff, in addition to being a possible sign of increasing disturbance on the campus. It may be hard for them to regard such changes as a manifestation of constructive ferment or an indication of students' increased willingness to make their educational experiences personally meaningful to them rather than have them simply consist of the ingestion of factual material. In the process of assessing attitudes of decision-makers, mental health professionals must try to garner some realistic impressions of the nature of their role relationships with decision-makers. Realistic limitations upon mental health professionals' abilities to exert influence must be recognized, if major blunders are to be avoided. Mental health professionals typically are not empowered to make decisions about the institution itself. They are subordinates within a hierarchy, which imposes further limitations on their ability to exert direct influence over superiors. In addition, their professional role is by definition associated with change and this may be received in many quarters as a threat to the position of respect and esteem which institutional members feel that their college has come to command. In a later section, the implications of these facts will be discussed in order to evaluate the ways in which the influence process must proceed. Mental health professionals should also scrutinize their relationships to campus "gatekeepers." The dean of students and dean of faculty are especially important in this regard. If community support and participation are to be won, these gatekeepers must provide sanction for the mental health professionals so that they have wide-ranging contact with faculty members and dormitory personnel. Thus the attitudes of gatekeepers toward the director, his staff, and the aims of the program are of crucial importance. If a
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community oriented program is regarded as a subterfuge for empire building, it will not be possible for mental health personnel to have easy access to contacts with other campus personnel. In some quarters, a community oriented program may be misperceived as a kind of case-finding procedure which only causes more work and trouble. Charges may arise that the mental health professionals seek to turn the campus into a mental hospital. It is of vital importance that the entire staff of mental health personnel be alert to these perceptions and utilize every means at their command to correct them. Despite the fact that a community oriented program espouses the full utilization of the skills of all campus personnel in building a community and working with students, it may be perceived as an encroachment on the provinces of other student personnel workers. They may have come to regard their own roles and the roles of mental health professionals as quite fixed. Some may regard efforts to implement a community oriented approach as a way of criticizing their own efforts and of saying that in the ideal world it would be best if we had only psychologists, psychiatrists, and social workers to perform all student personnel functions. SOURCES OF RESISTANCE Resistances to community oriented programs may also arise from other quarters on the college campus. Faculty members may see a community oriented program as placing increased demands on their time and energies when they already feel that students take too much of their time. Faculty members who work comfortably with students and who enjoy this role may appreciate the support of mental health professionals. Sometimes, however, they are very resistant to any kind of collaborative attempts to help students and may subtly regard this as an encroachment upon their professorial roles. In situations where counseling services are unfavorably regarded, the faculty member may find it hard to envision himself accepting any kind of help from members of the counseling center staff in working with a student. The attitudes that faculty members take toward sharing their efforts with mental health professionals in working with students are to a considerable extent determined by the contract that they have made with the college regarding their professional roles. Where the college appreciates faculty interest in students but bases promotion upon research and publication, faculty members will not be eager to increase their involvement with students. It is important that mental health professionals appreciate the dilemma which faculty members face so that they do not increase faculty members' conflicts by being too confronting about their responsibilities to students. However, it may be possible for mental health staff to discuss such dilemmas with faculty members and to talk to the dean of faculty and the president about the difficulties that faculty members face in meeting their responsibilities to students.
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As mental health professionals move toward doser contact with deans, faculty members, and other permanent campus personnel, students may develop some discomfort about seeing mental health professionals in this role. Some students may begin to fear that their confidentiality is being violated and that the mental health staff are an arm of the administration, despite whatever assurances mental health professionals provide to the contrary. It is important that the mental health staff be sensitive to these issues so that they do not allow ambiguity to be created in the minds of students regarding their position on confidentiality. Because of the dual loyalties of mental health professionals on campuses to both the students and the administration, this may become an especially hot issue where the mental health professional has to make recommendations or take a stand of which students disapprove. In some instances, for example, the psychologist or psychiatrist has recommended that a student be discontinued at school so that he can seek treatment on a more intensive basis than is possible in a college setting. If a student happens to have difficulties which manifest themselves in any kind of antisocial behavior on the college campus or in the college community, such a student who does not wish to leave may enlist the sympathies of other students about his plight. He may suggest that the college is interested only in its good name and not in the students, and that mental health professionals are basically collaborating with the college and that their concern for the students' welfare is secondary. Such concerns of students must be met directly and should not be allowed to simmer and cause increased distrust and suspicion of the mental health staff. Where it becomes clear that other students are suspicious of the reasons for which the student is asked to leave school, the mental health professional may want to arrange a meeting informally with interested students so that there can be some general discussion of what has happened. It is especially important that this be handled in a way which does not violate the confidentiality of the student who had been asked to leave school. However, in such circumstances other students have a general awareness of what has been transpiring and the discussion can be carried on at this level. In instances where this kind of step has been taken, students have shown renewed confidence in the basic motivations and purposes of the mental health staff. In becoming increasingly involved with the life of the campus, mental health staff must be alert to the fears of administrative personnel that they will unearth problems that are best left alone. A community oriented approach is founded on a philosophy of relationships that includes the wishes of people for openness and for true collaboration with others in addressing themselves to significant issues. All of this assumes a full modicum of health on the part of the collaborating participants, which in the real world often does not exist. The fears of personal and professional exposure which such a program may generate should be recognized and appreciated. I t should also be recognized that mental health staff themselves as well as other cam-
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pus personnel may fear personal exposure. Relatively speaking, it is safe and cozy to work in an office situation where one's mode of functioning is observable only to an individual student, it is a different circumstance where one must demonstrate his competence and discuss significant issues with professional peers and superiors in public situations. In this circumstance, it is easy for the mental health professional to project his fears of exposure onto campus personnel and be especially angry with them when they are perceived as obstacles to the development of the mental health program. On the other hand, if the mental health staff can recognize their own fears of exposure, it will be easier for them to appreciate the fears of others. ASSESSING THE COLLEGE A related dimension of the assessment process is concerned with the college's present phase of evolution as an institution. Achieving a cogent grasp of the institution's present developmental level and historical evolution is a complicated matter that involves far more than learning a few historical facts about the institution's life. The basic value orientation of the founding fathers of the institution is of great significance, as well as the way in which these values have come to be regarded by present institutional participants. For example, institutions which started off with a strong religious denominational orientation may have shifted over the years to a more ecumenical and secular conception of themselves. The personalities and aspirations of the presidents of the institution are also important, as well as the ways in which they have been regarded by institutional members. If the institution has been in existence for some period of time, the conception of itself which it seeks to project to the outside world needs to be carefully weighed. A study of the college catalogue, along with publications and speeches of institutional members, is one useful way of gaining insight into the institution's self-image. A college which is proud of its tradition and feels that it is important to preserve this tradition might be markedly different from a new college which feels the lack of tradition and which is in the process of developing one. The latter kind of college may be more receptive to innovative programs such as a community-oriented mental health program, since it has no vested interest in a prior tradition. Mental health professionals who are identified with change programs may find that liaisons are easier to make with institutions which are change oriented than with institutions which are tradition oriented. It is both important and fascinating for a mental health professional to consider his own attitudes toward change and toward tradition as a basis for understanding how both kinds of institutions might perceive him. If he himself associates tradition with stultification, rigidity, and a repressive style of life, he may develop strong aversive reactions to the institution and its ritual systems which are symbolic of its basic attitudes, On the other
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hand, he may associate the change orientation of the newer, younger institution with his own outlook and may find it almost too easy to develop an identification with that institution's circumstances. Within the domain of psychoanalytic theory, we have come to understand the implications of countertransference as it affects the therapist's response to the patient. It is important that we also come to understand the implications of a community-oriented mental health specialist's attitudes toward the institutions he seeks to affect. In this connection, we must articulate the difference between counterreaction and countertransference, in the sense that countertransference implies some distortion on the part of the therapist in his response to a patient, whereas counterreaction implies an appropriate response, without neurotic complications, on the part of the therapist to the patient which is evoked by the patient's behavior. It is also useful to differentiate between institutional countertransference and institutional counterreaction. Institutional counterreaction and countertransference refer to the mental health specialist's response to the institutions as institutions, which is based upon the reactions they evoke in him and upon his own personal dynamics. In this connection, the participation of mental health professionals as change agents within the tradition-centered institutions is an important issue. It is typically the case that mental health professionals have marginal identifications and may often find it more difficult to develop empathic relationships with members of tradition-centered institutions. In fact, they may align themselves with marginal members of such institutions, partially out of natural affinity and partially as a means of lowering their own insecurity about being regarded as marginal themselves within the context of such institutions. Kurt Lewin has spoken of "leadership from the periphery." In other words, psychologists and psychiatrists as marginal members of society themselves find it easier to think of a model of change based upon personal marginality and identification with other marginal members of society than an alternative model where they are central to an institution's life and the institution itself is not marginal within the broader context of society. In community action programs, it sometimes happens that members of organizations such as Intercultural Councils select people who are marginal members of the community and do not include board members who embody the central value strains accepted by the community as a larger unit. All of this is not only fascinating to consider but has important implications for the process and mechanisms of social change. If the institution itself has phases in its evolution, then we must consider the meshing or constructiveness of fit between institution and its particular phase of development and the kind of mental health professional who becomes associated with that institution. For example, in a situation where an institution has established a firm tradition and where the mental health program to be instituted is perceived as rather markedly discrepant from that institutional tradition, per-
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haps the change processes require a change agent who is located in the center of the institution's power structure or who has the attributes of a charismatic leader. In the newer, less tradition-centered institution with a natural affinity between the mental health professional and the stage of the institution's development, it is not quite so necessary for the mental health professional to have a high degree of institutional power or to be charismatic in order to get his program off the ground. He needs simply to indicate his commitment to growth and change and his willingness to participate in the change and growth processes which are part of the institution's development. ESTABLISHING TRUST The kind of trust and the level of trust which need to be established in community oriented programs also differ from that required in the conventional program. In a conventional program, the existence of a trusting relationship between counselor and client is of course essential. Further, there must be enough trust between other members of the institution and mental health staff so that they accept the requirement of confidentiality in the therapist-student relationship and are willing to have the mental health center exist. Within a community oriented program these requirements do not go far enough. Caplan (~964) has discussed the importance of establishing trusting relationships as the basis for any effective community program. Mental health staff in a college setting must be allowed to do more than simply exist and work in parallel with other student personnel workers, faculty, and various members of the administration. A level of trust must accrue between mental health staff and other members of the college to the point where collaboration regarding students and regarding campus issues takes place. Within the past z5 years in various institutions of our society such as prisons, mental hospitals, and community clinics, there has been a wave of interest in team approaches to problems. It must candidly be acknowledged that over time, some have become jaundiced about the ultimate efficacy of such an approach by virtue of the problems that arise when such people do attempt to collaborate. In seeking to implement a community approach on college campuses, it is imperative that mental health staff have some grasp of the way in which team approaches succeed and the conditions which cause them to fail. Pious statements about working together are not enough to make such programs effective in the long run. There must be a common commitment on the part of collaborating participants to work out the disagreements and strains which inevitably arise when such efforts are undertaken. Commitment to such an approach can be facilitated when collaborating participants share the belief that the college, its students, and staff will all benefit from the results of such collaboration more than they might by separate efforts. Development of such attitudes occurs best when circumstances arise which naturally lead to this kind of collaboration. Although
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collaboration may generate feelings of personal threat and fears of exposure, people who choose to work in institutional settings often experience strong needs to work together rather than separately. Over time, mental health staff can be alert to specific instances in which collaboration might be undertaken and initiate such collaborative efforts without being unduly pushing or forcing in their wishes to collaborate. Gradually this may lead to closer cooperation. In such relationships, the professional competencies and personal characteristics of the mental health staff become more visible. There must be willingness to let others take the lead, to admit one's errors candidly, to give others credit where credit is due, and to be a responsible, competent, trustworthy, and fallible human being in such transactions. Mental health professionals' needs to play omnipotent roles often interfere with such cooperative efforts. Mental health professionals who feel that they alone know best how to get things done may subtly manifest patronizing attitudes toward those with whom they seek to cooperate. This is one of the worst things that can happen and is sure to lead to the demise of any collaborative efforts. AVERTING NEGATIVE STEREOTYPES Some may see mental health staff members as relishing an omnipotent role, whereas others may regard them as professional voyeurs. From this point of view, the initiation of any mass testing procedures may feed this perception which others have. A great deal of caution needs to be exercised in undertaking any large-scale testing program. In a time when students are exposed to numerous mass testings before they reach college, they are likely to be somewhat wary already and jaundiced about further testing which they confront when they begin college. Whenever possible, it is crucial for students to be offered group feedback and individual feedback about tests they have taken. In addition they should be given full and candid explanations regarding the purposes of testing, in order to dispel any latent suspicions about the hidden motives of the testers. The requirement of students in elementary psychology courses that they participate in experiments whether they choose to or not, and the use of "trumped up" situations to induce experimental variables in psychological experiments, has not helped to develop trust between students and mental health professionals (Kelman, "f967). Although colleges may be compartmentalized in their approaches to students, students do not live their lives in compartments. In the present discussion it is being suggested that others may have in mind various distortions and stereotypes regarding the aims of mental health staff and the mental health program. These stereotypes should be carefully weighed in order to be alert to finding ways of dispelling them. For example, some faculty members may see the mental health professional as a one-dimensional practitioner who has little appreciation for the merits of research, teaching, or scholarship. Connected with this may be a perception of the mental health program as having a "janitorial" or "repairman" function.
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Another related perception is that people in mental health programs do a lot of "hand holding," implying that much of their work within this delimited realm is unnecessary. In terms of these perceptions, various measures become important. It should be common practice for mental health staff to have teaching, research, and scholarship functions within the college community. They should sit in on faculty meetings and participate with full status in the academic life of the community. There is a special need for such mental health staff to have a broad orientation to their field in order to be able to participate effectively in the way that is described. It is not enough to participate, however. Participation must be accompanied by competency in the areas being discussed. Mental health staff must place repeated stress on the fact that they are doing short-term work and that students are seen no longer than is absolutely necessary. The stereotype that the mental health staff are janitors or repairmen is especially deleterious to the aims of the program because it relegates them to the sidelines of the educational arena. The direction which the mental health program takes must be quite the reverse, i.e., it must move toward the center of institutional life. Mental health staff must be involved in and knowledgeable about educational policies so that they can make intelligent statements and render valuable opinions about educational policy matters that fall within the realm of psychological knowledge. By not involving themselves in such a manner, mental health staff relegate themselves to the sidelines, In this connection it is important that mental health staff regard themselves as initiators and potential innovators of educational ideas which enhance the quality of the college. One of our burdens as mental health professionals is that we are associated with illness and all of its negative implications. The antidote to this negative stereotype is not for us to become platitudinous pollyannas, to make ourselves innocuous, and to brand ourselves as incompetent in order to gain acceptance. It is to take a position in which we accept major difficulties as part of the reality of life, while at the same time maintaining a continued interest in fostering and strengthening healthy behavior wherever it exists. Thus it becomes important for us to initiate ideas which are not simply ways of combatting already existing psychopathology, but are innovative and within the spirit of education as an exciting venture. REFERENCES Bindman, A. J. Problems associated with community mental health programs. Community Mental Health Journal, ~966, 2, 333-338. Caplan, G. Principles of preventive psychiatry. New York: BasicBooks,I964. Karp, H. N. Santa Barbara community mental health services. Community Mental Health Journal, 1965, I, 383-384. Kelman, H. C. Human use of human subjects: the problem of deception in social psychological experiments. Psychology Bulletin, i967, 67, I-~i. Rosenblum, G. R., & Ottenstein, D. From child guidance to community mental health: problems in transition. Community Mental Health Journal, i965, I, 276-z83.
