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The
Community
Psychologist

Volume 53, Number 4 Fall 2020

International Committee

Edited by Douglas D. Perkins, Vanderbilt University and Olga Oliveira Cunha, NOVA School of Social Sciences and Humanities.

This and the international column in the last issue are intended to introduce readers to representative work by the new editors of the column. We invite those doing either collaborative international work, such as the prior example, or those based outside of the U.S. or Canada doing a local community psychology project, such as the following, to send a detailed paragraph proposal for a future article for this column to d.perkins@vanderbilt.edu and cunhaolgaoliveira@gmail.com.

Psychological Intervention in Higher Education — From the Biomedical to the Ecological Model: Contributions from Community Psychology

Written by Olga Oliveira Cunha, NOVA FCSH – NOVA School of Social Sciences and Humanities, Lisbon, Portugal APPsyCI – Applied Psychology Research Center Capabilities & Inclusion (ISPA-IU)

Attending college is a milestone representing major life changes for most undergraduate students. Most of the questions that these young adults bring to psychological counseling are mostly related to feelings of low self-esteem, anxiety, difficulties in adapting to a new routine and regarding their future.

The demand for psychological support services occurs with a meaningful event: unaccomplished assignments, anxiety about evaluations, concentration difficulties, doubts about the chosen course and about personal skills, relationship problems with parents, family and friends, difficulty meeting expectations, or with behavioral supervision and controls, whether due to the lack of support and/or monitoring. On the other hand, they also referred to experiencing difficulties in love relationships, either ending a relationship or difficulty initiating or establishing one. When explored in counselling we find that the requests made by these students are commonly linked to their development as a young adult, particularly considering their complex life histories, sometimes dysfunctional or non-existent family environments or intolerance towards their sexuality.

Many authors have devoted themselves to the study of the development of young people. For example Erikson (1972), one of the pioneers in the field with his theory of psychosocial development, highlighted the importance of a period of time in late adolescence, called by the author “psychosocial moratorium” (Dias, 2006), set aside to solve identity-related tasks or issues. On the other hand, Blos (1979) emphasized the importance of intrapsychic development, focusing on development throughout adolescence. Also, Bowlby's (1988) attachment theory is important for understanding the struggles of this age group when building relationships (friendship and loving) with the fear of rejection, dependency, but also in the development of autonomy and independence from parents or guardians (Dias, 2006).

When we dialogue about career development and feelings towards changes in employment opportunities, these are often felt as threatening. Savickas (2001) argues that career should be conceptualized as a continuing process of individual discovery. In the core of career development, vocational guidance emerges as a psychological process of searching, exploring, asking questions, and examining data for the purpose of obtaining personal and professional goals (Pinto et al., 2016). This process involves carrying out activities that seek to relate the self-knowledge of each individual to their perception and knowledge of the world, constituting themselves as interactive with that world and involving the reproduction and transformation of mental structures (Cohen, Duberley, & Mallon, 2004).

Despite the existing counseling and community psychology literatures, the biomedical paradigm is still one of the most used models for intervention in higher education. However, there are some circumstances for which this model is no longer considered suitable, with special relevance in the educational context. Thus, there is a need for new paradigms that, in the educational (and community) context, reside in decreasing reliance, or expanding, on the medical model and adopting an ecological understanding of human functioning (Gutkin, 2012).

When attributing mental health and educational difficulties to internal states of disease and pathology as a principle, the medical model inadvertently generates a system whose most important factors are emphasized by Gutkin (2009, 2012). These factors are: a) promotion of services for individuals at the expense of services for the community in general, which discourages systemic intervention and the comprehensive resolution of problems; b) emphasis on remediation at the expense of early prevention and intervention (the exclusion of individual services is not advocated, but their reduction and support of their complementarity with other approaches that reduce the impact of, and/or prevent, those same problems); c) a shortage of service providers-- that is, the medical model promotes, even if unintentionally, the disempowerment of caregivers more accessible to young adults, such as parents and teachers, whose participation in students’ mental health is essential (Gutkin, 2009, 2012); d) by giving little emphasis to prevention and early intervention, it promotes treatments that are specialized and professionalized, and so harder to provide and obtain, approaches to mental health; e) reliability and validity of the diagnoses and consequent validity of the treatment; and f) separation between the information collected for diagnosis and the information needed for effective treatment.

The medical model collects detailed information on subjects' psychopathologies. When we consider the procedures that are particularly considered for students, we realize that most of these are environmental manipulations (e.g., curriculum change, behavior management strategies). Although they may help in the short-term, they are often ineffective long-term as they fail to recognize the essential role that environments/contexts play in maintaining psychological and psychoeducational dysfunction. Thus, according to Gutkin (2009, 2012), when the emphasis is almost exclusively on individual psychopathology, the medical model discourages systemic and community intervention and the resolution of problems that are more contextual. Although remediation and treatment services for people should always be available when necessary, relying almost exclusively on these strategies can constitute a deficient approach, especially when the main objective is to prevent pathology and suffering and promote mental health (Albee, 1999).

Where Are We Going? Changing to an Ecological Paradigm

Recent investigations point clearly to a reciprocal interaction between the biological characteristics of people and the nature of the environments/contexts that surround them (Greenleaf & Williams, 2009; Schensul & Trickett, 2009). It can be argued that the ecological model does not answer all the above issues, but it is a significant step. Gutkin (2012) argues that Bronfenbrenner’s (1979) concentric systems model is particularly consistent with intervention opportunities in educational institutions and communities.

Micro-level intervention, for example, in a classroom allows for the possibility of achieving a more comprehensive impact (e.g., involving parents of students). Changing the emphasis on individual intervention to contexts, interventions can be developed with “general” (e.g., all first-year undergraduate) populations, “selective” (e.g., students in a transition period or a particular program) and “referenced” (students who developed adaptation problems). On the other hand, prevention and early intervention assume a very important role since human behavior is greatly influenced by the meso, exo, and macro contexts, so an intervention in these contexts can prevent the emergence of many different problems. Once the context is modified at any level, teachers, peers, parents, and others can successfully intervene in students’ lives, becoming empowered actors in prevention, intervention, and remediation.

Regarding “effective” treatments, the ecological model seeks to determine how to optimize the fit between students' needs and contextual characteristics, emphasizing context-person interactions and the phenomenon’s complexity. It also encourages professionals to carry out evaluations and diagnoses in a contextual manner. Ecologically focused services pay attention to changes in college, home, and community contexts to solve student problems and prevent the dysfunction’s development.

Community psychology (and community psychologists) can make an important contribution to this field of primary, secondary, and higher education intervention with an ecological perspective, such as the principles of Kelly (2010). These principles are as follows: interdependence, which recognizes the multiple interactions and influences between the various components of a system; cycling of resources, which is based on the first law of thermodynamics according to which all energy is neither destroyed nor created, but is transferred; adaptation refers to the adjustment between individuals and social systems as well as the adjustment of systems to changing conditions; and succession reflects the evolutionary nature of social environments with one group replacing another over time. In fact, these are all dynamic principles that must be understood in terms of patterns of interaction and change.

The ecological perspective implies a holistic view that goes beyond the individual, implying that “communities are open systems, with several levels of interdependent analysis and recognizing the multiple transactions and mutual influence between individuals and the environments with which they interact” (Ornelas, 2008, p. 151). We found that the “medical” approach is still very intrinsic in the expectations of the various actors across many different settings. Changing attitudes and paradigms is something that takes time, but is possible if we have a medium- and long-term strategy and objectives, and try to be available and involve all stakeholders-- students, non-teaching staff, teachers, and administration-- in our interventions.

The time spent on individual interventions still exceeds what would be ideal in the higher education context (70% on average of the time available from our staff each month) but the promotion of projects in which other members of the educational community have been involved has shown that we can have interventions early and more contextualized. As examples, we can hold group sessions dedicated to Ph.D. students (as they struggle in “the last kilometer” of their educational “marathon”) where it is intended to promote and develop emotional management skills during this stage of their journey (e.g., fighting social isolation); information sessions with 3rd-year undergraduates; running workshops for non-teaching staff according to the needs presented by them and in collaboration with the various departments of the faculty (e.g., training sessions for non-teaching staff who provide assistance to students to raise awareness of warning signs); sessions for students on several psycho-pedagogical themes (e.g., Educational Special Needs, Asperger’s syndrome, among others) in collaboration with various student groups; extension of training sessions/workshops with colleagues who work in the various psychological support offices in higher education institutions in order to continue to develop skills, deepen knowledge and debate the challenges that are posed to professional practice.

References

Albee, G.W. (1999). Prevention, not treatment, is the only hope. Counseling Psychology Quarterly, 12, 133-146.

Blos, P. (1979). The adolescent passage: Developmental issues. New York: International Universities Press.

Bowlby, J. (1988). Developmental psychiatry comes of age. The American Journal of Psychiatry, 145, 1-10.

Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.

Cohen, L., Duberley, J., & Mallon, M. (2004). Social constructionism in the study of career: Accessing the parts that other approaches cannot reach. Journal of Vocational Behavior, 64, 407-422.

Dias, G.F. (2006). Desenvolvimento Psicológico dos Jovens: Tarefas Desenvolvimentais. In Dias, G.F. (Org.), Apoio Psicológico a Jovens do Ensino Superior: métodos, técnicas e experiências (pp. 85-108). Lisboa: Ed. ASA.

Erikson, E. H. (1972). Adolescence et crise: La quête de l'identité. Paris: Flammaion.

Greenleaf, A.T. & Williams, J.M. (2009). Supporting social justice advocacy: A paradigm shift towards an ecological perspective. Journal for Social Action in Counseling and Psychology, 2, 1-14.

Gutkin, T.B. (2009). Ecological school psychology: A personal opinion and a plea for change. In T.B. Gutkin & C.R. Reynolds (Eds.), The Handbook of School Psychology (pp. 463-496). New York, NY: Wiley.

Gutkin, T.B. (2012). Ecological Psychology: Replacing the Medical Model Paradigm for School-Based Psychological and Psychoeducational Services. Journal of Educational and Psychological Consultation, 22(1-2), 1-20.

Kelly, J. (2010). Ecological thinking: Four qualities. Análise Psicológica, 28(3), 389-393.

Ornelas, O. (2008). Psicologia Comunitária. Lisboa: Fim de Século.

Pinto, J., Faria, L., Pinto, H. & Taveira, M. (2016). Identificação de necessidades de intervenção psicológica: um estudo-piloto no ensino superior português. Psicologia USP, 3(27), 459-472.

Savickas, M. L. (2001). Toward a comprehensive theory of career development: Dispositions, concerns and narratives. In F. T. L. Leong & A. Barak (Eds.), Contemporary models of vocational psychology: A volume in honor of Samuel H. Osipow (pp.295-320). Mahwah, New Jersey: Lawrence Erlbaum Associates.

Schensul, J. & Trickett, E. (2009). Introduction to Multi-Level Community Based Culturally Situated Interventions. American Journal Community Psychology, 43, 232-240.