Effectiveness of College Counseling Centers

This blog is a summary of a CCMH study on the effectiveness of treatment in college counseling centers published in 2019.


McAleavey, A. A., Youn, S. J., Xiao, H., Castonguay, L. G., Hayes, J. A., & Locke, B. D. (2019). Effectiveness of routine psychotherapy: Method matters. Psychotherapy Research, 29(2), 139-156.

Prior research has shown that many psychotherapies are more effective than placebo controls for various psychological disorders. However, most of these studies were conducted in controlled settings, and therefore the conclusions cannot necessarily be generalized to routine care conducted in naturalistic settings, such as college counseling centers.

Two commonly used methods to assess treatment outcomes are benchmarking routine psychological treatment outcomes and normative comparisons. Benchmarking routine psychological treatment outcomes compare the aggregate effect sizes derived from routine care to the benchmarks (usually are randomized controlled trials) to determine if the amount of change observed in routine care is roughly equivalent to what might be expected in randomized controlled trials (RCTs). However, the amount of change is only one aspect of treatment outcomes. Another meaningful information regarding treatment outcomes is an individual’s post-treatment functioning. Normative comparisons examine clients’ end-state distress level in comparison to the distress level of the general population in order to determine if the client leaves routine care with a “healthy” level of distress comparable to a “normal” level of distress.

The Current Study

Using a 2010-2012 CCMH data set consisting of 9,895 clients seen by 1,454 therapists at 108 university counseling centers (UCCs), McAleavy et al. (2019) assessed routine psychological treatment offered in college counseling centers across the U.S. They addressed two main research questions:

  1. Do clients treated within UCCs experience significant change across a broad range of presenting concern?
  2. Is the amount of change experienced by students who received care in UCCs equivalent to that seen in RCTs?
  3. Are clients’ post-treatment scores similar to a non-clinical level of distress?

The study used the Counseling center assessment of psychological symptoms (CCAPS) to measure change during treatment and to capture end of treatment distress. The CCAPS cut points were used to categorize client distress as low, moderate, or elevated on each subscale. Clients were also categorized as experienced reliable or clinical significant and meaningful change on each subscale based on the subscale’s reliable change index (RCI), the amount of change needed for it to be considered statistically significant.   

Study Findings

Across all CCAPS subscales, greater changes from pre- to post-treatment were observed among those students with higher severity of symptoms when they entered treatment. The percent of students with elevated distress who reliably improved during treatment ranged from 24.1% for the Alcohol Use subscale to 49.5% for Depression in the elevated subsample (see table below). 

CCAPS – 34 Subscale

Percent of Students Who Reliably Improved



Generalized Anxiety


Social Anxiety


Eating Concerns




Alcohol Use



Overall, more than half of all clients (52.6%) in the study showed reliable improvement on at least one CCAPS subscale. 

Students who entered services at UCCs with elevated levels of Depression, Generalized Anxiety, Social Anxiety, Eating Concerns, and Hostility experienced equivalent improvement in symptoms to clients treated within RCTs.  However, while students treated within UCCs demonstrated substantial change, those students initiating treatment with elevated levels of distress, on overage, did not return to a non-clinical level of distress at the end of services.  

Implications of the Findings

This study examined the effectiveness of counseling services provided by UCCs. The following takeways were noted: 

  • Clinicians working at UCCs are very effective in treating clients who enter treatment with elevated levels of distress across broad range of concerns (Depression, Generalized Anxiety, Social Anxiety, Eating Concerns, and Hostility), producing equivalent improvement levels to clients treated within RCTs. This equivalency to RCTs is particularly remarkable given UCCs operate in a naturalistic setting, frequently treat students with complex comorbid problems, and intersect with institutional/center policies (short-term treatment models, treatment limits, etc.) that can impact services.  
  • Students who initiate treatment with more severe symptoms are more likely to experience improvement than those with moderate levels of symptoms, with over half of clients showing clinically meaningful change in 1 or more areas on the CCAPS. 
  • This study highlights the effectiveness of UCCs in treating a wide spectrum of presenting concerns, while also showing that students generally do not return to non-clinical levels of distress upon receiving services. Clients continuing to experience elevated symptoms at the end of treatment could be a function of center policies pertaining to treatment limits, clinical models and EMR sharing practices, as well as increased clinician caseloads

 This blog post was written by CCMH Business Team member, Fanghui Zhao, M.A., a Doctoral Student in Counselor Education and Supervision at Penn State.


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