Integrating Career and Mental Health Assessment and Treatment
By Brian Calhoun and Seth Hayden
Jackson: A Case of Connected Career and Mental Health Concerns
Jackson, a senior psychology major, is considering post-graduate options (i.e., graduate school vs. entering the workforce). As deadlines for accepting graduate school admissions offers approach, his career adviser (Abby), who works in the university career center, is concerned that Jackson’s anxiety is negatively impacting his ability to make decisions. Abby does not have a basis to judge his level of anxiety so she wonders what, specifically, she can do to assist Jackson with his increasing level of distress. Abby wants to help Jackson address both his anxiety generally as well as with regard to his career concerns, so he can effectively navigate this process.
When providing career services, it can be easy to identify instances in which clients’ mental health concerns impact their career progress. Unfortunately, the way in which career and mental health services are structured and separated, most notably in educational settings, results in a disconnect between the reality of career concerns and the mechanisms of support. These different perspectives on career and mental health services arbitrarily divide the work and complicate efforts to provide an integrated response for those in need. In order to provide the right services at the right time for students seeking career-related help, researchers must broaden their perspectives to consider the overlap between mental health and career to better inform practice. The discussion about the challenges confronting career counselors requires increased discourse (Niles, 2003).
The Growing Importance of Counseling
In a 2017 survey by the American College Health Association, 21.6% of undergraduate students reported being diagnosed with or treated for anxiety problems during the previous year. This represents an increase from 10.4%, in 2008. More and more, career services centers are becoming another access point for students who need help. Career counselors can treat co-occurring career and mental health concerns, particularly when career choice and implementation are affected. Within the specific domains of assessment and treatment, research indicates the potential for an integrated approach to career and mental health concerns, perhaps especially for students. There is evidence that career assessments offer indications of mental health functioning. For example, Harris and Rottinghaus (2017) found that the General Occupational Themes and Personal Style Scales of the Strong Interest Inventory accounted for significant variance in the subjective well-being of the respondents.
Career Assessments Can Help Identify Mental Health Concerns
Dieringer, Lenz, Hayden and Peterson (2017) found that certain scales of the Career Thoughts Inventory (CTI) were positively correlated with the Beck Depression Inventory II and the Beck Hopelessness Scale. Dipeolu, Hargrave, and Storlie (2015) examined potential for the CTI subscales of Decision Making Confusion and External Conflict and the Career Maturity Index-Revised, Attitudes subscale to suggest possible attention-deficit hyperactivity disorder (ADHD) and learning disabilities (LD) in young adults.
Though a developed focus on mental health within practice may not be feasible for some practitioners, all must possess a degree of understanding regarding associated mental health concerns. Using available indicators within career assessments can ensure that holistic career support is being provided.
Revisiting Jackson’s Concerns
Abby consulted her supervisor who agreed that administration of the Career Thoughts Inventory would be useful. Results of the CTI showed that Jackson had elevated levels of negative career thoughts and would benefit from addressing beliefs related to effectively making decisions. In addition, the assessment suggested that Jackson lacked confidence in his ability to make appropriate choices and did not have a clear process through which to examine his options. With this information in hand, Abby’s treatment goals were clarified. She helped Jackson to focus on past times when he had been successful in making decisions. This enhanced Jackson’s confidence. Together they worked on developing a process for examining and weighing whether to attend graduate school or enter the workforce. Abby’s willingness to examine Jackson’s concerns in this way decreased his anxiety and enabled him to take tangible steps towards determining his post-graduate options.
Interconnectivity is Key
Career practitioners positively impact clients’ functioning in many ways. For example, they help clients by increasing knowledge and confidence, and by decreasing the anxiety associated with career decision-making (Osborn, Hayden, Peterson, & Sampson, 2016). Mental health challenges certainly complicate matters. Thus, career planning self-determination interventions for young adults with mental health concerns help them achieve better career and life outcomes (Sowers & Swank, 2017). There has been a call to embrace more holistic approaches to career counseling that include consideration of mental health issues (Blustein, 2008; Hayden, 2016; Hinkelman & Luzzo, 2007; Krumboltz, 1993; Lenz, Peterson, Reardon, & Saunders, 2010). Framing career assessments and interventions with this in mind will contribute to better identification and remediation across all aspects of career concerns. Resources such as the recently released A Comprehensive Guide to Career Assessments (7th ed., Stoltz & Barclay, 2019) provide information on the multi-faceted dimensions of career assessments.
We want to encourage and create partnerships between mental health professionals and academic career centers. Collaborative and interconnected support among career and mental health providers can be key to effectively supporting those in need. Continued discussion and more research will aid in making this an important action item, instead of an afterthought. Research-informed practice emphasizing the interconnectivity between career and mental health support is key to the provision of effective career services.
American College Health Association. (2017). National college health assessment spring 2017 reference group sata report. Retrieved from https://www.acha.org/documents/ncha/NCHA-II_SPRING_2017_REFERENCE_GROUP_DATA_REPORT.pdf
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Dipeolu, A., Hargrave, S., & Storlie, C. A. (2015). Enhancing ADHD and LD diagnostic accuracy using career instruments. Journal of Career Development, 42, 19-32.
Dieringer, D. D., Lenz, J. G., Hayden, S. C. W., & Peterson, G. W. (2017). The relation of negative career thoughts to depression and hopelessness. The Career Development Quarterly, 65, 159-172.
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Hayden, S. C. W., Kronholz, J., Pawley, E., & Theall, K. (2016). Major depressive disorder and Career Development: Link and implications. Career Planning and Adult Development Journal, 32, 19-31.
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Niles, S. G. (2003). Career counselors confront a critical crossroad: A vision of the future. Career Development Quarterly, 52, 70-77.
Osborn, D. S., Hayden, S. W., Peterson, G. W., & Sampson, James P.,,Jr. (2016). Effect of brief staff-assisted career service delivery on drop-in clients. The Career Development Quarterly, 64, 181-187.
Rottinghaus, P.J., Eshelman, A., Gore, J. S., Keller, K. J., Schneider, M., & Harris, K. (2017). Measuring change in career counseling: Validation of the Career Futures Inventory-Revised. International Journal for Educational and Vocational Guidance, 17, 61-75.
Sowers, J. A., & Swank, P. (2017). Enhancing the career planning self-determination of young adults with mental health challenges. Journal of Social Work in Disability and Rehabilitation, 16, 161-179.
Stoltz, K. B., & Barclay, S. R. (Eds.). (2019). A Comprehensive Guide to Career Assessment (7th ed.). Broken Arrow, OK: National Career Development Association.
Brian Calhoun, Associate Professor of Practice at Wake Forest University
Brian teaches classes with the College to Career series in the undergraduate college. His professional interests include career counseling and development, and he and serves as the co-chair of the National Career Development Association research committee. Mr. Calhoun’s research agenda focus is on career interventions that assist students with developing and learning more about their career options in the world of work. He is a Licensed Professional Counselor – Associate in the state of North Carolina, and a nationally certified counselor. email@example.com
Seth C.W. Hayden, Assistant Professor of Counseling at Wake Forest University
Seth and has provided career and personal counseling in community agencies, secondary school, and university settings. His research focuses on the career and personal development of military service members, veterans, and their families. Dr. Hayden is a licensed professional counselor in North Carolina and Virginia, a national certified counselor, a certified clinical mental health counselor, and an approved clinical supervisor. Dr. Hayden is a past-president of the Military and Government Counseling Association and currently serves as president-elect of the National Career Development Association. firstname.lastname@example.org