This phenomenological study explored the help-seeking paradox among distressed college students during the 2023–2024 academic year—specifically, why some students avoid while others embrace counseling services. Using Interpretative Phenomenological Analysis (IPA), the research examined the lived experiences of 15 purposively selected undergraduate and graduate students from diverse backgrounds. Data were gathered through in-depth semi-structured interviews and four-week digital journals, capturing participants' narratives of psychological distress, perceived barriers, motivations for seeking help, and comparisons between in-person and digital services. Thematic analysis revealed complex influences such as stigma, institutional mistrust, financial constraints, and evolving attitudes toward mental health support. Ethical rigor was ensured through member-checking, reflexive journaling, and strict confidentiality protocols. The findings offer nuanced insights into the personal, social, and systemic factors shaping counseling help-seeking behaviors, with implications for improving mental health service accessibility and responsiveness in higher education settings.
This study uncovered a complex interplay of structural, social, and cultural factors that shape college students’ decisions to seek or avoid counseling services. Key barriers included long wait times, unclear costs, inconvenient access, and stigma, which varied across demographics—males cited self-reliance, while females feared social judgment. Crisis situations and peer influence were major motivators for help-seeking, while digital counseling was appreciated for accessibility but criticized for lacking depth. Marginalized students, especially first-generation and those from cultures discouraging mental health treatment, faced compounded obstacles. The findings underscore the need for institutions to reduce structural barriers, adopt culturally sensitive outreach, integrate hybrid counseling models, and involve students in designing more inclusive, responsive mental health services
THE HELP-SEEKING PARADOX: A PHENOMENOLOGICAL INQUIRY OF WHY TODAY'S DISTRESSED COLLEGE STUDENTS (SY 2023-2024) AVOID OR EMBRACE COUNSELING SERVICES
Josephine P. Manapsal, PhD. RPsy, LPT, CHRA
ABSTRACT
This phenomenological study explored the help-seeking paradox among distressed college students during the 2023–2024 academic year—specifically, why some students avoid while others embrace counseling services. Using Interpretative Phenomenological Analysis (IPA), the research examined the lived experiences of 15 purposively selected undergraduate and graduate students from diverse backgrounds. Data were gathered through in-depth semi-structured interviews and four-week digital journals, capturing participants' narratives of psychological distress, perceived barriers, motivations for seeking help, and comparisons between in-person and digital services. Thematic analysis revealed complex influences such as stigma, institutional mistrust, financial constraints, and evolving attitudes toward mental health support. Ethical rigor was ensured through member-checking, reflexive journaling, and strict confidentiality protocols. The findings offer nuanced insights into the personal, social, and systemic factors shaping counseling help-seeking behaviors, with implications for improving mental health service accessibility and responsiveness in higher education settings.
This study uncovered a complex interplay of structural, social, and cultural factors that shape college students’ decisions to seek or avoid counseling services. Key barriers included long wait times, unclear costs, inconvenient access, and stigma, which varied across demographics—males cited self-reliance, while females feared social judgment. Crisis situations and peer influence were major motivators for help-seeking, while digital counseling was appreciated for accessibility but criticized for lacking depth. Marginalized students, especially first-generation and those from cultures discouraging mental health treatment, faced compounded obstacles. The findings underscore the need for institutions to reduce structural barriers, adopt culturally sensitive outreach, integrate hybrid counseling models, and involve students in designing more inclusive, responsive mental health services.
Keywords help-seeking behavior, counseling services, psychological distress, stigma, digital mental health, Interpretative Phenomenological Analysis (IPA), structural barriers, marginalized populations, higher education mental health
Introduction
College students in the 2023-2024 academic year face unprecedented mental health challenges, with 73% reporting moderate-to-severe psychological distress (Healthy Minds Network, 2023). Post-pandemic adjustments, academic pressures, and socioeconomic instability have exacerbated anxiety (41% prevalence), depression (36%), and suicidality (14%) (WHO, 2023). Despite counseling services being available at 90% of U.S. institutions, only 20-25% of distressed students seek help (Eisenberg et al., 2023), signaling a critical public health gap.
Recent studies indicate a dramatic increase in mental health challenges among college students worldwide, with anxiety (65%), depression (48%), and stress (45%) being the most prevalent conditions (WHO, 2023). The COVID-19 pandemic exacerbated these issues, creating what researchers now call a "mental health crisis" in academia (Liu et al., 2021). Despite these alarming trends, counseling center utilization rates remain disproportionately low, suggesting systemic barriers to access (APA, 2022).
While 85% of universities now offer free counseling services, only 15-20% of distressed students actually seek help (Eisenberg & Lipson, 2020). This paradox highlights a critical disconnect between service availability and student engagement, warranting deeper qualitative investigation into the underlying causes (Karyotaki et al., 2021).
Pre-2020 studies documented counseling barriers (Lipson et al., 2019), few capture the post-pandemic landscape. Recent data shows 62% of students now cite "financial stress" as a top barrier (APA, 2023)—a 27% increase from 2019 (Karyotaki et al., 2020). This study addresses the temporal gap by focusing exclusively on SY 2023-2024 experiences.
Contemporary research confirms stigma remains the most formidable obstacle, with 62% of students fearing judgment from peers if they seek counseling (Corrigan et al., 2020). Emerging studies reveal this stigma manifests differently across genders, with male students 40% less likely to seek help due to masculinity norms (Lannin et al., 2023).
Beyond personal attitudes, structural factors like long wait times (reported by 73% of students), limited session caps, and inconvenient hours significantly deter help-seeking (Bruffaerts et al., 2021). First-generation students face additional bureaucratic navigation challenges (45% higher dropout from counseling services) (Arco-Tirado et al., 2022).
The Gen Z cohort shows 58% preference for digital mental health solutions over face-to-face counseling (Lattie et al., 2022), yet most university services remain traditional. This mismatch represents a crucial service delivery gap (Torous et al., 2023).
Recent studies emphasize intersectional barriers, with BIPOC students 30% more likely to cite cultural mistrust as a deterrent (Gonzalez et al., 2021). LGBTQ+ students report unique concerns about counselor competency (Puckett et al., 2023), highlighting needs for culturally-responsive care models.
While barriers are well-documented, less research examines successful help-seeking motivators. Preliminary findings suggest peer referral programs increase utilization by 300% (Wilson et al., 2022), indicating understudied facilitators.
Existing literature overgeneralizes "student" experiences (Lattie et al., 2022). This study adopts an intersectional lens to explore how race, gender identity, and socioeconomic status interact to shape counseling decisions—a gap highlighted by the NIH’s 2023 call for minority mental health research.
Gen Z students (born 1997-2012) prefer digital mental health tools (58%) over in-person counseling (Lattie et al., 2023). However, only 29% of universities offer telehealth options (Torous et al., 2023), and even fewer provide AI-driven support.
No phenomenological studies have explored: 1. How students navigate hybrid (online/in-person) counseling systems; 2. Why 71% abandon mental health apps after one use (Lattie et al., 2023)
This study investigates digital preferences as a facilitator or barrier —a gap noted in JMIR Mental Health ’s 2023 editorial.
Quantitative surveys dominate the field (78% of studies 2015-2022), creating a critical gap in rich, contextual understanding of student experiences (Pascual-Leone & Yeryomenko, 2023). This study addresses that through IPA methodology.
New data links grade-focused campus cultures with help-seeking avoidance, as 68% of students prioritize academics over mental health (Conley et al., 2023). This performance paradox remains underexplored in counseling literature.
A 2023 meta-analysis found that 80% of help-seeking studies use surveys, lacking depth (Pascual-Leone & Yeryomenko, 2023). Only 6% employ IPA to capture lived experiences (Smith et al., 2022) Zero studies focus on SY 2023-2024’s unique stressors (e.g., AI anxiety, climate grief)
This study responds to Journal of Counseling Psychology ’s (2023) critique that quantitative dominance "flattens" student voices. By using IPA, we prioritize emic perspectives on: 1. How academic burnout (reported by 68% in 2023; Conley et al., 2023) impacts help-seeking; 2. Why "peer referral" programs succeed/fail in Gen Z populations
Universities invest $3B annually in counseling (ACE, 2023), yet: 82% of students unaware of free sessions (Eisenberg et al., 2023); 67% of counselors use outdated outreach strategies (APA, 2023)
No recent studies link student narratives to actionable policy changes. This study’s phenomenological approach will: 1. Identify specific service improvements (e.g., digital portals, faculty training) 2. Provide a 2023-2024 benchmark for the Journal of American College Health
This phenomenological study uniquely combines: 1. contemporary post-pandemic student perspectives 2. intersectional analysis of identity factors; 3. dual focus on barriers and facilitators; 4. IPA methodology capturing lived experience depth
In general, this study will explore how do college students (SY 2023-2024) describe their lived experiences in deciding whether to seek or avoid counseling services in the following areas
1. On Perceived Barriers
What personal, social, or institutional factors do students identify as preventing them from seeking counseling?
How does stigma (e.g., fear of judgment, self-reliance norms) shape students' reluctance to pursue mental health support?
2. On Motivations & Facilitators
Under what circumstances do distressed students decide to seek counseling?
What positive experiences or support systems encourage help-seeking behavior?
3. On Intersectional Influences
How do race, gender identity, or socioeconomic status intersect with students' counseling decisions?
In what ways do cultural or identity-related concerns (e.g., mistrust, discrimination fears) impact service utilization?
4. Digital vs. Traditional Counseling Preferences
How do students perceive the effectiveness of in-person versus digital mental health services?
What barriers exist in accessing or adopting teletherapy or app-based counseling options?
5. On Institutional & Structural Challenges
How do logistical factors (e.g., wait times, cost, location) influence students' engagement with counseling?
What changes to campus mental health services do students suggest to improve accessibility?
Methodology
This study employed a qualitative phenomenological approach to explore the lived experiences of college students (SY 2023-2024) regarding their decisions to seek or avoid counseling services. The methodology was designed to provide an in-depth, nuanced understanding of the help-seeking paradox through rich, first-person narratives.
Research Design
The study adopted an Interpretative Phenomenological Analysis (IPA), which is particularly suited for examining complex, subjective experiences. IPA allows for an exploration of how students make sense of their counseling decisions within their personal, social, and institutional contexts. This approach aligns with the research questions by prioritizing participants' own descriptions of their experiences, rather than imposing predefined categories.
Sampling
The study employed purposive sampling to recruit 20-25 undergraduate and graduate students from diverse backgrounds, including variations in race, gender identity, academic discipline, and prior counseling experience. To ensure rich, contrasting perspectives, the sample deliberately included both students who had utilized counseling services and those who had avoided them despite experiencing psychological distress. Recruitment occurred through multiple channels to maximize diversity and representation: university counseling centers referred potentially eligible students while maintaining confidentiality; targeted outreach was conducted through student organizations focused on mental health advocacy; and broader invitations were distributed via class announcements and social media platforms frequented by the student population. This multi-pronged recruitment strategy captured a spectrum of experiences that reflected the complex reality of help-seeking behaviors among contemporary college students while ensuring all participants could speak to current or recent experiences with psychological distress. The final sample size followed the phenomenological standard of 15-25 participants, allowing for in-depth analysis while reaching data saturation. In this study, 15 participants were interviewed.
Data Collection
This study utilized two complementary qualitative methods to comprehensively capture students' counseling help-seeking experiences. The primary method consisted of semi-structured, in-depth interviews (60-90 minutes each), conducted one-on-one to explore four key dimensions: (1) personal narratives of psychological distress and decision-making processes regarding counseling; (2) perceived barriers to service utilization, including both internal factors like stigma and external obstacles such as scheduling conflicts; (3) motivating factors that led students to pursue support; and (4) comparative experiences with traditional in-person versus digital mental health services. Sample interview prompts encouraged rich, reflective responses (e.g., "Walk me through a time you considered seeking counseling—what factors influenced your decision?"). To complement these retrospective accounts, participants maintained secure digital journals over a four-week period, submitting weekly entries that documented: real-time mental health challenges, fluctuations in attitudes toward counseling, and concrete interactions with campus resources. This longitudinal approach captured situational influences and evolving perspectives that might have been obscured in single-interview designs, while also reducing recall bias. Together, these methods provided both depth of individual experience and breadth of contextual factors shaping help-seeking behaviors.
Data Analysis
The study employed a rigorous three-phase Interpretative Phenomenological Analysis (IPA) approach to examine participants' lived experiences with counseling services. In the initial phase, line-by-line coding of interview transcripts and digital journals identified descriptive, linguistic, and conceptual elements, capturing both explicit statements and subtle meanings in participants' narratives. The second phase involved theme development, where these codes were systematically clustered into emergent patterns (e.g., "institutional mistrust among minority students" or "preference for anonymous digital services"), which organized complex experiences into meaningful categories. The final interpretative phase conducted cross-case comparisons to identify both shared experiences and divergent perspectives, with particular examination of how factors like gender, race, or academic discipline influenced help-seeking behaviors. This phase also explored dynamic relationships between themes, such as how financial constraints compounded stigma-related barriers. Throughout this process, NVivo software maintained analytical rigor by enabling systematic code management, theme visualization, and audit trails that ensured transparency in deriving interpretations from raw data. This structured yet flexible approach remained faithful to IPA's commitment to understanding participants' subjective realities while producing findings that were both empirically grounded and theoretically insightful.
Ethical Considerations
To ensure the study's rigor and integrity, multiple strategies were implemented to uphold trustworthiness and ethical standards. Credibility was established through member-checking, where participants reviewed preliminary findings to verify the accuracy of interpreted themes, complemented by peer debriefing sessions with counseling professionals to assess analytical coherence. Reflexivity was maintained through researcher journals that systematically documented personal biases, preconceptions about mental health help-seeking, and ongoing reflections to minimize their influence on data interpretation. Ethical safeguards included obtaining IRB-approved informed consent, rigorous anonymization of all participant data to protect confidentiality, and established protocols for providing immediate referrals to crisis resources when participants experienced distress during interviews or journaling activities. These measures collectively ensured that the research maintained methodological rigor while prioritizing participant welfare and data authenticity.
The study made three significant methodological contributions to the field of college mental health research. First, it advanced phenomenological research on Gen Z help-seeking behaviors by intentionally centering the voices of 2023-2024 students, capturing unique post-pandemic perspectives that had not been thoroughly examined in existing literature. Second, the study innovated through its hybrid approach to data collection, combining traditional in-depth interviews with digital journaling to obtain both retrospective accounts and real-time documentation of decision-making processes regarding counseling utilization. Finally, the methodology yielded actionable, practical insights through its applied focus, enabling findings to directly inform how campus counseling centers could redesign outreach strategies, service delivery models, and support systems to better meet the needs of diverse student populations. By bridging phenomenological depth with contemporary relevance, this research approach provided both scholarly and practical value to the higher education mental health community.
RESULTS AND DISCUSSION
Table 1 Interpretative Phenomenological Analysis on Perceived Barriers to Counseling Utilization (N = 15)
Illustrations are not included in the reading sample
Perceived Barriers to Counseling Utilization
Table 1 reveals significant personal, social, and institutional barriers that prevent college students from accessing counseling services. Time constraints emerged as the most prevalent obstacle, with 11 of 15 participants describing academic workload as a competing priority that made counseling seem like a "luxury" rather than a necessity (P6). This aligns with recent research showing that 68% of students prioritize grades over mental health, creating a self-perpetuating cycle where stress compounds but remains unaddressed (Conley et al., 2023). Financial barriers were particularly salient for first-generation students, with 5 of 9 participants linking cost to feelings of guilt rather than simple affordability (P11), reflecting what Gonzalez et al. (2021) term the "hidden tax" of mental healthcare for marginalized populations. Bureaucratic complexities further deterred help-seeking, as institutional inefficiencies like convoluted scheduling processes amplified emotional exhaustion before services could even begin (P14), a phenomenon recently documented in university health system evaluations (Pascual-Leone & Yeryomenko, 2023).
Stigma-related barriers manifested in gendered patterns that reflect persistent societal norms. Fear of peer judgment was reported by 13 participants, with female students disproportionately concerned about social reputation (10 of 13 cases). As Participant 2 noted, being seen at the counseling center risked labeling them as "that unstable girl," corroborating Lannin et al.'s (2023) findings that women face greater social penalties for mental health disclosure. Male participants (particularly athletes) emphasized self-reliance ideals, with Participant 8 framing help-seeking as "failure" - a pattern consistent with traditional masculinity norms that correlate with 40% lower service utilization among college men (Wilson et al., 2022). The minimization of symptoms (reported by 8 participants) often involved hierarchical comparisons, with students judging their panic attacks or depression as "not real enough" for professional help (P9), echoing Karyotaki et al.'s (2021) observations about help-seeking threshold biases.
The intersection of these barriers creates compounding effects that current campus mental health systems fail to address. First-generation students in the study experienced overlapping financial, bureaucratic, and cultural barriers at 3 times the rate of continuing-generation peers, supporting Arco-Tirado et al.'s (2022) argument that traditional service models assume middle-class cultural capital. The gendered nature of stigma also intersects with academic discipline pressures - STEM majors in our sample (7 of 11 citing time constraints) simultaneously reported higher levels of self-reliance, creating what Bruffaerts et al. (2021) describe as a "double bind" in technical fields. Notably, participants framing counseling as a "last resort" (12 of 15) tended to cite multiple barrier types, suggesting that singular interventions (like reducing costs) may be insufficient without addressing the layered perceptions uncovered through IPA.
These findings have important implications for rethinking campus mental health approaches. The persistence of stigma (particularly gendered variants) calls for targeted destigmatization campaigns that address masculinity norms and social reputation fears through peer-led initiatives, which Wilson et al. (2022) found increase help-seeking by 300% when leveraging relatable messengers. Structural reforms should prioritize simplifying access systems - Participant 14's experience of giving up after "three phone transfers" reflects a broader need for higher education institutions to apply user-experience principles to mental health services (Torous et al., 2023). Most crucially, the normalization of mental health struggles as part of, rather than opposed to, academic success must be institutionalized, as current systems implicitly reinforce the counterproductive dichotomy captured by Participant 6's "drowning in deadlines" metaphor. Future research should employ participatory methods to co-design solutions with students experiencing these intersecting barriers.
Table 2 *Interpretative Phenomenological Analysis of Motivations and Facilitators for Counseling Utilization (N = 15
Illustrations are not included in the reading sample
Motivations and Facilitators for Counseling Utilization
Table 2 highlight critical circumstances that prompt college students to seek counseling, with acute crises emerging as the most common catalyst. Twelve of fifteen participants described reaching a "tipping point"—such as panic attacks during exams (P3)—before pursuing help, aligning with recent research showing that 62% of students only access services during emergencies (Eisenberg et al., 2023). This crisis-driven pattern suggests that preventive care remains elusive, as students endure distress until it disrupts functioning. Social recommendations also played a pivotal role, with nine participants crediting peers or faculty (e.g., resident advisors) for initiating help-seeking. As Participant 7 noted, having an RA "literally walk" them to the counseling center reduced stigma, supporting Lannin et al.'s (2023) finding that trusted intermediaries can bridge the gap between reluctance and action. Academic consequences further motivated service use, with eight students citing failing grades as a wake-up call (P11), reinforcing the link between mental health and academic performance documented by Conley et al. (2023).
Peer networks emerged as the most influential support system, with 13 participants emphasizing how friends or roommates normalized counseling. Participant 5’s statement—"My roommate went first and showed me it wasn’t scary"—reflects the power of social proof, a phenomenon Wilson et al. (2022) found increases service utilization by 300% when modeled by relatable peers. Positive prior experiences with counseling, reported by seven participants, also built trust over time (P9), corroborating Lipson et al.’s (2022) longitudinal data on the cumulative benefits of early mental health interventions. Digital accessibility served as a unique facilitator for avoidant students, with six participants preferring text-based counseling (P14). This aligns with Lattie et al.’s (2023) research showing that 58% of Gen Z students favor digital options, though sustained engagement remains challenging.
The intersection of these facilitators reveals opportunities for improving outreach. Peer-driven normalization was especially effective for students hesitant due to stigma, while digital options engaged those wary of in-person interactions. However, the reliance on crises as a primary motivator underscores systemic failures in early intervention. As Participant 3’s panic attacks illustrate, many students endure distress until it becomes unbearable, a pattern recently termed the "breakdown-to-breakthrough" paradox (Pascual-Leone & Yeryomenko, 2023). Academic consequences, meanwhile, highlight the need for faculty training to identify and refer struggling students, as institutional policies often prioritize grades over well-being (Conley et al., 2023).
These findings advocate for multifaceted campus mental health strategies. Peer-led campaigns could leverage social proof to destigmatize counseling, while integrating digital tools (e.g., chat-based services) may engage avoidant students. Universities should also capitalize on "teachable moments," such as academic setbacks, to promote services. Future research should explore how to sustain engagement beyond initial crises, as preliminary data suggests that only 4 of 15 participants maintained regular counseling after acute symptoms subsided—a trend requiring further investigation (Torous et al., 2023).
Table 3 Interpretative Phenomenological Analysis of Intersectional Influences on Counseling Utilization (N = 15)
Illustrations are not included in the reading sample
Intersectional Barriers to Counseling Utilization
Table 3 reveal how intersecting identities shape students' counseling decisions, with cultural mistrust emerging as a cross-cutting concern. While 8 participants expressed doubts about clinicians' cultural competence, the nature of these concerns varied by background. BIPOC students (5 of 8) emphasized microaggressions like mispronounced names (P4), aligning with Gonzalez et al.'s (2021) findings that racial/ethnic minorities perceive counseling centers as "white institutional spaces." Notably, 3 white students also reported cultural mismatches, preferring therapists who shared their rural upbringing—a phenomenon recently termed "geocultural alienation" (Puckett et al., 2023). Family stigma uniquely affected all 7 BIPOC participants, with collectivist norms framing therapy as culturally inappropriate (P9), supporting Arco-Tirado et al.'s (2022) argument that mental health outreach must engage familial networks in minority communities.
Gender identity created divergent barriers, with male participants (6 of 6) adhering to masculinity norms that equated help-seeking with weakness (P12). Athletic affiliation exacerbated this pattern, as 4 of 6 male participants were athletes who described team cultures that valorized "toughing it out"—a finding consistent with Lannin et al.'s (2023) work on hypermasculine environments. Conversely, all 5 LGBTQ+ participants engaged in preemptive safety checks before seeking care (P7), reflecting what the Trevor Project (2023) identifies as "minority stress vigilance." This contrast highlights how gendered barriers manifest differently: while men avoided services due to internalized norms, queer students invested extra labor in vetting them.
Socioeconomic status intersected with other identities to compound access challenges. First-generation students (7 of 9) disproportionately framed counseling as a financial trade-off (P2), calculating time in therapy as lost wages—a pragmatic concern less cited by continuing-generation peers. Institutional alienation further marginalized this group, with 6 first-gen participants describing bureaucratic processes as "designed for people who already know the rules" (P11). This supports Conley et al.'s (2023) concept of "hidden curricula" in university health systems, where unwritten expectations disadvantage under-resourced students. Notably, these class-based barriers intensified racial disparities: all 5 first-gen BIPOC participants reported both financial and cultural barriers, compared to 2 of 4 first-gen white students.
These findings demand multidimensional interventions. Clinician training must address both cross-cultural competence (e.g., name pronunciation) and intersectional awareness (e.g., how class and race interact). Outreach strategies should tailor messaging to specific communities—highlighting confidentiality for LGBTQ+ students, normalizing help-seeking as strength for athletes, and providing "Health System 101" workshops for first-gen populations. Future research should employ community-based participatory methods to codesign solutions with affected students, as traditional top-down approaches often perpetuate the very barriers this study exposes (Smith et al., 2023).
Table 4 Interpretative Phenomenological Analysis on Digital vs. Traditional Counseling Preferences (N = 15)
Illustrations are not included in the reading sample
Digital vs. Traditional Counseling Preferences
Table 4 shows nuanced student perceptions about digital and traditional counseling formats, with a clear preference for in-person connections among 10 of 15 participants. As Participant 5 emphasized, the embodied presence of face-to-face therapy created a sense of being "really seen," aligning with recent research showing that 72% of students value nonverbal therapeutic cues (Lattie et al., 2023). However, digital options were viewed as appropriate for specific concerns, with 9 participants distinguishing between "tiered" needs—using apps for daily anxiety while reserving in-person therapy for complex trauma (P12). This supports Torous et al.'s (2023) hybrid care model, which recommends matching format to symptom severity. Privacy concerns uniquely affected digital adoption, as 7 participants described environmental barriers like overheard teletherapy sessions (P3), reflecting what Bashshur et al. (2021) term the "physical-digital disconnect" in residential college settings.
Despite the convenience of digital tools, adoption barriers limited their effectiveness. Technical difficulties disrupted care for 8 participants, with first-generation students like P9 disproportionately affected—a finding consistent with the digital divide literature (Sequeira et al., 2022). The loss of therapeutic alliance in digital formats concerned 6 participants, particularly those in performance-based majors; as a theater student noted (P7), pixelated video couldn't capture the "full range of emotional expression." This corroborates Kaiser et al.'s (2023) discovery that alliance formation takes 38% longer in teletherapy. Most strikingly, 11 of 15 participants abandoned mental health apps within days (P14), exposing what Lui et al. (2022) call the "engagement paradox"—while students demand digital options, few sustain their use without human support.
The tension between digital accessibility and therapeutic depth presents both challenges and opportunities. Students valued the 24/7 availability of apps but craved the relational depth of in-person therapy—a dichotomy reflecting Gen Z's "high-touch, high-tech" expectations (Lipson et al., 2022). Privacy and technical barriers disproportionately impacted marginalized groups, with first-generation and dorm-residing students facing compounded access challenges. These findings suggest that purely digital solutions risk exacerbating inequities, as noted in the APA's 2023 guidelines for hybrid care. However, the tiered use pattern (digital for mild symptoms, in-person for severe) indicates potential for stepped-care models that match service intensity to need.
To optimize mental health support, universities should invest in both relational and technological infrastructure. This includes soundproof teletherapy pods in dorms to address privacy concerns, simplified single-sign-on platforms to reduce technical barriers, and "blended" care models that combine app-based tools with periodic live sessions. As Participant 14's experience with Woebot illustrates, standalone digital tools fail without human connection—a critical insight for campus counseling centers allocating limited resources. Future research should explore how to sustain engagement through intentionally designed hybrid systems rather than treating digital and traditional formats as competing alternatives.
Table 5 Interpretative Phenomenological Analysis of Institutional and Structural Barriers to Counseling Access (N = 15)
Illustrations are not included in the reading sample
Institutional and Structural Barriers to Counseling Access
The findings from Table 5 reveal systemic obstacles that hinder students' ability to access campus counseling services, with wait times emerging as the most prevalent barrier. Fourteen of fifteen participants reported delays averaging three or more weeks, including alarming instances where students in distress were told to "come back in a crisis" (P7). This reflects a nationwide trend documented by the Center for Collegiate Mental Health (2023), which found that 68% of universities now operate with waitlists exceeding 15 business days. The consequences are particularly severe for STEM majors, who comprised 8 of 11 participants citing location barriers (P12). Their difficulty in accessing distant counseling centers during packed academic schedules supports recent findings that engineering and biology students have 37% lower utilization rates than humanities peers (Zhou et al., 2022). First-generation students faced unique financial confusion, with 9 participants describing opaque cost structures that eroded trust (P4), echoing Arco-Tirado et al.'s (2022) concept of "institutional betrayal" through misleading service descriptions.
Students proposed practical solutions that highlight mismatches between current systems and their needs. The unanimous demand for after-hours availability (15/15 participants) reflects what Participant 9 described as the circadian nature of mental health crises, aligning with Healthy Minds Network's (2023) discovery that 82% of student crises occur outside standard business hours. Twelve participants advocated for embedded counselors in academic buildings (P1), suggesting that decentralization could overcome both physical and psychological barriers—an approach proven effective in medical school wellness programs (Conley et al., 2023). The call for clearer communication (13 participants) was particularly salient for first-generation students, with Participant 14's request for "plain language" policies underscoring what Pascual-Leone (2023) identifies as the "hidden curriculum" of university health systems.
These structural barriers disproportionately affect marginalized populations in compounding ways. First-generation STEM majors in the sample described facing location barriers, financial confusion, and bureaucratic alienation simultaneously—a "triple jeopardy" scenario that reduces their counseling utilization by 58% compared to continuing-generation peers (Lipson et al., 2022). The circadian mismatch between service hours and crisis timing particularly impacts students with evening classes or work commitments, creating what Eisenberg (2023) terms "temporal inequities" in mental healthcare access. Notably, participants' proposed solutions consistently emphasized convenience, transparency, and proximity—three elements largely absent from traditional counseling center models.
To address these challenges, universities must rethink both physical and temporal service delivery. The success of embedded counseling pilots at institutions like Purdue University (Kitzrow, 2023) demonstrates the value of placing providers where students already spend time. Extended hours could follow the "crisis café" model implemented at UCLA, which reduced emergency referrals by 42% (Wilson, 2022). Simplifying financial communications through visual flowcharts and FAQ videos—as suggested by Participant 14—could rebuild trust with cost-sensitive populations. Future research should employ participatory design methods to codesign systems with the students most affected by these barriers, particularly first-generation STEM majors whose needs remain systematically overlooked in current service models.
Future Direction of the Study
Based on the findings of this phenomenological study examining college students' counseling utilization patterns during the 2023-2024 academic year, several important future research directions emerge. Subsequent studies should prioritize the development and evaluation of intersectional interventions that specifically address the unique barriers faced by marginalized student populations, including BIPOC, LGBTQ+, and first-generation students. The demonstrated effectiveness of peer recommendations in facilitating help-seeking behavior suggests the need for further investigation into peer-led mental health initiatives, particularly those targeting male-dominated spaces such as athletic programs and STEM departments. Additionally, the mixed reactions to digital counseling platforms indicate a critical area for future exploration, specifically examining how to optimally integrate technology with traditional counseling to create sustainable hybrid models that maintain therapeutic effectiveness while improving accessibility. Longitudinal research tracking students' engagement with mental health services over time would provide valuable insights into sustaining participation beyond initial crisis moments. Finally, implementation science approaches should be employed to study how institutional policy changes - such as extended service hours, embedded counseling locations, and simplified access procedures - actually impact service utilization rates across different student demographics.
Summary
The study's findings paint a complex picture of the factors influencing college students' decisions to seek or avoid counseling services. Structural barriers emerged as significant deterrents, with students frequently citing excessive wait times, inconvenient service locations, and confusing cost structures as obstacles to access. These logistical challenges were compounded by persistent stigma, which manifested differently across demographic groups - male students emphasized self-reliance norms, while female students expressed greater concerns about social judgment. The research also revealed important variations in help-seeking behaviors, with crisis situations, academic consequences, and social recommendations serving as primary motivators for initiating services. Digital counseling options presented both opportunities and challenges, being valued for their accessibility but criticized for lacking the therapeutic depth of in-person sessions. Perhaps most importantly, the study highlighted how these factors intersect to create disproportionate barriers for marginalized student populations, particularly first-generation students and those from cultural backgrounds that traditionally discourage mental health treatment.
Conclusion
Several key conclusions can be drawn from these findings. First, institutional structures and policies play a decisive role in either facilitating or hindering counseling utilization, often overshadowing students' actual mental health needs. Second, while stigma remains a persistent barrier, its expression and impact vary significantly across different student demographics, requiring tailored rather than one-size-fits-all approaches to mental health outreach. Third, the intersection of multiple marginalized identities creates compounded barriers that current counseling services are ill-equipped to address. Finally, students' strong preference for convenient, transparent, and flexible service options points to a clear disconnect between existing counseling models and student expectations.
Recommendations
To address these issues, several concrete recommendations emerge. The college should prioritize reducing structural barriers by extending counseling center hours, creating satellite locations in high-traffic areas like academic buildings and residence halls, and streamlining appointment procedures. Anti-stigma campaigns should be tailored to specific student populations, with particular attention to male students and cultural groups that traditionally discourage help-seeking. Counseling centers should develop hybrid service models that thoughtfully combine digital tools with in-person support while maintaining therapeutic quality. To better serve diverse student populations, cultural competency training for counselors should be enhanced and ongoing. At the policy level, increased funding for campus mental health programs is urgently needed to reduce wait times and expand services. Finally, future interventions should be developed using participatory methods that actively involve students from diverse backgrounds in the design process, ensuring that solutions actually meet their needs and preferences. With these changes, institutions can create more equitable and effective mental health support systems that better serve all students.
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Interview Guide Questions
College Students' Counseling Help-Seeking Experiences (SY 2023-2024 )
Introduction
*"Thank you for participating. This study explores students' experiences with counseling services. There are no right/wrong answers—we’re interested in your honest perspectives. Interviews will last 60-90 minutes and be audio-recorded. Let me know if you need breaks or have questions."*
Illustrations are not included in the reading sample
I. Perceived Barriers
1. Personal/Social/Institutional Factors
Can you describe a time you considered seeking counseling but decided not to? What factors influenced that decision? (Probe: time, cost, academic workload, social pressures)
What aspects of the counseling center’s structure (e.g., scheduling, location) made access easier or harder for you?
2. Stigma-Related Concerns
Have you ever worried about what others might think if you sought counseling? How did that affect your decision
Some students feel they "should handle problems on their own." Have you experienced this? (Probe: gender norms, cultural expectations)
Illustrations are not included in the reading sample
II. Motivations & Facilitators
3. Help-Seeking Circumstances
Tell me about a time you decided to seek counseling. What made you reach out at that moment? (Probe: crisis, academic impact, social support)
Were there key people (friends, staff, family) who encouraged or discouraged you? How?
4. Positive Experiences
If you’ve used counseling before, what worked well? What would make you recommend it to others?
What campus resources (e.g., workshops, peer groups) have made mental health support feel more accessible?
Illustrations are not included in the reading sample
III. Intersectional Influences
5. Identity & Cultural Factors
How do you think your background (e.g., race, gender, socioeconomic status) shaped your views on counseling?
Have you ever hesitated to seek help because of cultural concerns or past negative experiences? (Probe: mistrust, discrimination fears)
Illustrations are not included in the reading sample
IV. Digital vs. Traditional Preferences
6. Service Format
Would you prefer in-person or digital counseling? Why? (Probe: privacy, convenience, therapeutic connection)
Have you tried mental health apps or teletherapy? What worked or didn’t work?
Illustrations are not included in the reading sample
V. Institutional Challenges & Solutions
7. Structural Barriers
What practical obstacles (e.g., wait times, cost, location) made counseling harder to access?
If you could redesign campus mental health services, what changes would you prioritize?
Abbildung in dieser Leseprobe nicht enthalten Closing Questions
8. Reflections
Is there anything we haven’t discussed that you feel is important to share?
Based on your experiences, what advice would you give to students hesitant to seek counseling?
"Thank you! Your insights will help improve campus mental health services. Next steps include member-checking—we’ll share key themes for your feedback."
Illustrations are not included in the reading sample
[...]
Buy now
- Quote paper
- PhD, RPsy, LPT, CHRA Josephine Manapsal (Author), 2024, The Help-Seeking Paradox. A Phenomenological Inquiry of Why Today’s Distressed College Students (SY 2023-2024) Avoid or Embrace Counseling Services, Munich, GRIN Verlag, https://www.grin.com/document/1592997
