Challenges in the Transition to College: The Perspective of the Therapist Back Home

Introduction

Many high school graduates go off to two and four-year colleges (Ginder, & Kelly-Reid, 2012). Some of them, perhaps the majority, are successful academically and socially. They tend to be well-adjusted young people who, though nervous when they leave home, manage to find some friends and get along with a roommate. They break through the wall of October papers and exams, and survive past Thanksgiving until the Christmas break.

Some students cannot do this. These are the ones who may access mental health professionals, either in student health services on campus or in private offices and clinics. Sometimes an initial assessment and brief treatment on campus serve to act as “ego glue,” and the student settles down. These students manage to get from one term to another by relying on either their own inner strength or that of the adults, friends, parents or teachers who offer them help. This fits with the idea that intra-or extra-familial support may influence outcome in this age group when they are under significant stress (Dillon, Liem, & Gore, 2003). Others may seek help from a local practitioner, typically someone whose practice sees students having difficulty making it through college. And, in this population of highly stressed (often freshman-year) college students, there are some who leave school either mid-semester or at the end of the winter break. The decision to leave school is fraught with difficulty, but sometimes is concluded to be the best choice by therapist, teen and family alike. The alternative can be worse.

Often a clinician who sees a youngster who has failed at the attempt to stay at a residential college will meet him or her for the first time just after the return home. The story of the drop-out is colored by how the teen and family view this “failure.” The word connotes loss of self-esteem, friends, and position in society. As clinicians, we may be hard-pressed to reframe the situation as an opportunity for growth rather than a failed opportunity to leave home. However, especially for child and adolescent clinicians, seeing children or teens during periods of developmental crisis is nothing new.

The period between 18 and 24 years of age represents the time in the life cycle during which there is the highest incidence of mental illness (Kessler et al., 1994). Because of our knowledge of development, child and adolescent clinicians can play a substantive role in treating adolescents and helping them adjust to psychiatric problems during this period. We frequently tell teens who falter on their way out of high school (failing to “launch”) that if they had not experienced difficulties transiting this particular phase of life, they might have experienced similar problems at another moment of developmental transition—starting a job, getting married, having children, etc. As clinicians, we believe that a developmental crisis holds within it an opportunity to mature in ways that the child or adult has been unable to accomplish. This point applies even if the situation at hand is quite serious. Understandably, what is foremost in the student’s mind is his suffering; however, the clinician must always see the potential for growth, even in these challenging situations, and be able to communicate that stance to teens and parents.

Once a teen is in serious psychological trouble—either having stayed in school or having returned home—the most helpful clinical attitude to take is that the teen has slowed down the process that is hurtling him towards adulthood. It is important for the clinician (and family) to see him as in transition to adulthood. At least part of the motivation for seeing his struggle as a variant of normal is to engage the teen in working towards a healthier adaptation to stress. If the teen can feel that he is able to successfully navigate a pathway toward more independent functioning, he is more likely to tolerate the potential suffering and social isolation that is likely to ensue with less loss of self-esteem. To help him with this pathway towards adult functioning, clinicians sometimes need to suggest putting on the breaks. This can occur as the teen who has returned home begins to feel better. The impulse to return (prematurely) to school often reflects a lack of understanding about the powerful forces (in the adolescent, family or both) that have been interfering with forward movement, or may reflect a strong degree of denial and resistance to more substantive change.

Demographics of Emerging Adults

The demographics and life activities for older adolescents in industrialized societies today are far different from when Erikson or Blos wrote about this developmental period in the early 1960s. The United States Census Bureau in 1997 reported that in 1970 the median age for women to marry was 21 years and for men, 23 years; in 2010 the median age for marriage was 26.1 years for women and 28.2 for men (United States Census Bureau, 2010; Arnett, 2006a). The period from 18 to 25 years has changed during the past 50 years “from being a time of settling down into adult roles of marriage, parenthood, long-term work and a long-term residence to being a time that is exceptionally unsettled …” (Arnett, 2006a, p. 7); Arnett (2000) reported that the rate at which high school seniors went to college was at its highest rate ever. It is possible that the choice between continuing on to post-secondary education versus working post-high school is less influenced by the particulars of the activity and more by the adolescent needing to feel that he is moving ahead with his life (Aseltine & Gore, 2005). It does not appear that “emerging adults” (Arnett, 2000) feel that the attainment of a stable career, finishing school, or getting married is what will make them into adults; they seem to feel that “accepting responsibility for one’s self … making independent decisions” is what will finally make them feel grown up (Arnett, 2000, p. 326).

Having a sense of forward motion is particularly relevant for the subset of students who do not complete high school. In a study of individuals who dropped out of high school, Dillon, Liem, & Gore (2003) discuss the role of the loss of a peer cohort. The study highlights individual characteristics that will be called upon for the adolescent to make a successful transition to better options, such as having more energy, being active rather than passive, and the ability to both accept help from and give credit to others for helping them. This study notes that because the support of the group is missing, “(A) more active coping style is needed for these youth to establish themselves” (p. 438). The study stresses the importance of the connection to and involvement of parents and supportive adults (as well as individual strengths of the teen) that can enable the teen to successfully transit back to high school and increase the likelihood of moving forward successfully.

Epidemiological data reveals a high prevalence of psychiatric problems—on the order of 37%—during emerging adulthood (Arnett, 2006), higher than for any other age group (Kessler et al., 1994). Literature emphasizes that the shift in expectation, experience, stability, and supervision in the post-high school period influences the potential for mental health problems (Arnett, 2000, Arnett, 2000b, Aseltine & Gore, 2005). Alcohol and substance use increase in the teen years, peaking in young adulthood, and spanning college and the first years after graduating from a four-year college (Staff et al, 2010; Maggs & Schulenberg, 2004; Cleveland et al, 2012). Substance abuse can shape the course of emerging adulthood.

Race and ethnic issues are relevant to the transition out of high school. In a study of early family formation (teenage or young adult pregnancy with or without marriage), researchers found a higher incidence of nonmarital births at or towards the end of high school among African American and Mexican American young women than for non-Hispanic white females. The lower birth rate is moderated by several factors: higher socio-economic level of families, a two-parent home, and degree of involvement in high school or college (Glick, 2006, p. 1402). For those young adults who enter college, perceived devaluation based on race has an impact on adjustment (Huynh & Fuligni, 2012).

Developmental Considerations

Adolescent Development

According to Erikson (1963), adolescence is a time during which issues of identity vs. role confusion hold sway, and self-concept is vulnerable to the opinions of others. Many a mediocre role model occupies the podium for some time before the adolescent sorts out who he is and whom he would like to resemble. Peer groups and friendships take on a renewed and important role as regressive urges towards dependency and wanting to belong to a group announce themselves, much as in the earlier latency period. Conflicts with parents, so characteristic of this age, can serve to assist the eventual separation from the family or to mask deeper issues of unresolved dependency on either side. The adolescent shifts in his sense of his body, significant others and interests; these all have an impact on self-image. The role confusion that Erikson cautioned about speaks to concerns that the teen has about being satisfied with his sexual identity or eventual occupation, or perhaps concerns that he will find neither (Erikson, 1963). Erikson felt that less stable teens (unsatisfied with or confused about identity) were more likely to face additional challenges in preparing to meet the demands of the outside world.

King (2007) outlines tasks of adolescence from early (10 to 13 years) through late adolescence (17 years and older). He writes that acquiring a body image based in reality, having relationships with others outside the parental relationships, drive control and self-concept (including a sense of one’s professional future) are tasks of the adolescent years. Like most authors who write on the subject of adolescent development, King is clear that this late phase of adolescence—at least in our modern world—is attenuated. It is often not until the 20s (or beyond) that intimacy, a more mature relationship with parents, and the abilities both to project oneself forward in work and to conceive of having a family of one’s own are established.

Blos describes a phase of post-adolescence, writing that “personality development by no means comes to a standstill with the termination of adolescence” (1962, p. 149). Similar to the latency years, in which the real world plays an increasingly important role in the day-to-day life of the school-age child, real life in the post-adolescent years is formative. Postadolescence is a time in which still-unresolved issues for the teen are played out in the real world—in relationships and in life choices. Blos (1962) writes that an “operational principle” must govern this last phase of adolescence, a phase that consolidates interests, defenses, sexuality and a sense of self, before the teen turns toward the outside world that governs much of adulthood. He suggests this interval not simply as a way to add some time in between adolescence and adulthood proper; he believes that there are specific tasks of this phase, the most important of which is to “come to terms with parental ego interests and attitudes” (p. 156), and for the adolescent to recognize and invest in identifications with parents. The post-adolescent needs his parents, not only to react to and rebel against, but also to help him integrate what it means to become an adult. The post-adolescent reminds us that psychological issues that cannot be resolved by this time period are carried through to adulthood; when these are resolved earlier, self-esteem profits. Goals that have been incompletely achieved have a way of being dealt with in a less conflictual manner: defenses such as sublimation have the added benefit of moving the older adolescent forward into adult roles as well as contributing to societal values of stability. However, although defenses such as sublimation allow activities such as school or work to help maintain the psychological integrity of the post-adolescent, it is still the capacity for intimacy that remains central to the psychological health of the post-adolescent.

More recently, Arnett (1994; 2000; 2006a; 2006b) has contributed to elucidating the time period. Like Blos, he proposes a new—and separate-—phase of development, which he refers to as “emerging adulthood” (my emphasis), to be placed squarely between adolescence and young adulthood. A time of exploration and societally accepted lack of constraint by definitive career choice, “emerging adults often explore a variety of possible life directions …” (Arnett, 2000, p. 469). Blos (1962) writes that during post-adolescence, adulthood has begun, even as adolescence is ending: both phases of life have a stake. Arnett agrees: he describes its occupants as having a foot in one time period and one in the next.

Impact of Attachment on the Transition to Adulthood

Attachment theory can contribute to an understanding of the transition from high school to college or other activities. Lopez and Gormley (2002) reviewed the impact of attachment on handling “normal” stressors in life, such as going to college. They found attachment style to be moderately stable during the first year of college. Secure students had greater selfconfidence and could self-regulate in the face of stress. If students maintain their “secure” status through the year, they are better able to self-regulate as well as seek and use available support systems. Those who became less secure, or did not shift in a secure direction through the year, fared worse, tending to experience more distress as a result of their inability to self-regulate when things got tough. They seemed not to learn or to improve in their capacity to manage stress; they did not achieve a sense of mastery as they progressed. The authors’ cautionary note was that it was hard to know what the future would hold for those who had a change in their attachment status through the year, whether or not these changes would last, or if they would be for better or for worse. This fits with the original follow-up literature on attachment security in early childhood by Mary Ainsworth and colleagues (Ainsworth et al., 1978). Attachment security in childhood is consistent through time only when outside factors, such as family dynamics and structure, remain the same.

For all college freshmen, the stress of transition from high school to college is a relevant outside factor. Park, Edmundson & Lee (2012) studied changes in self-regulation markers during freshman year at a large Northeastern university. As with the previous study by Lopez and Gormley, some students improved in the ability to self-regulate, but many either did not change in this ability or worsened. The specific markers they studied were constructive thinking, emotion regulation and mastery in order to gauge changes in maturity through the year in more detail. They concluded that the demands of the transition to college and freshman year challenge coping skills that students come to college possessing, and that some were less up to the task. Self-regulation ability has an impact on symptoms of anxiety, depression, stress and adjustment to college in freshman year.

The connection has also been explored between strong parental relationships and the adolescent’s ability to self-regulate and successfully transition to college. Strong relationships between adolescents and parents and “authoritative parenting” have shown a positive impact on (particularly social) competence (Putnick et. al., 2008; Kazemi, Eftekhar & Solokian, 2010), well-being (Slicker & Thornberry, 2002), and substance abuse (Baumrind, 1991). In a study on the effect of relationships with parents on adaptation of college students, Wintre & Yaffe (2000) measured the impact of “parenting style,” “parental support,” “mutual reciprocity,” and the student’s “well-being” on students’ adaptation to college. The authors found that both well-being and relationships with parents had an impact on subsequent social and academic adjustment. Kenny and Donaldson (1991) explored the attachment of first-year college students to their parents and found that not only were women students more attached to their parents compared to young-adult men, but also that students who were more attached felt more competent and had more feelings of “well-being.” In a study attempting to dissect the relative impact of parental attachment and psychological development to adjustment in college, Paladino, Schultheiss, and Blustein (1994) emphasized the effect of an individual teenager’s development on his adjustment in college. Lakey (1989) discussed attitudes and behaviors of students that elicit responses from others in their environment. He reported that those with low self-esteem either devalued or misinterpreted the ability of others to help. Moreover, an adolescent’s “distress” made him unaware of available support or unable to discern that his attitudes and behaviors could “turn off” prospective social contacts. Over and above psychological distress, social competence predicted future perceived support: “… certain individuals may be at risk for developing insufficient levels of perceived support during major life transitions” (Lakey, 1989, p. 517). Putnick (2008) found that whereas parental acceptance related to the adolescent’s feelings of being accepted, the adolescent’s self-concept related much more to how he actually interacted with peers.

Cases

Teen Stays at Home and Works

Jacob was a physical boy born into an academic family. When Jacob was in middle school, his parents divorced. He remembers everything shutting down. At a time when having a father to identify with might have helped Jacob enter adolescence, he was too angry and disappointed with his father for having hurt his mother to have a relationship with him. He could not identify successfully with his passive, disappointing father, and was left to wrestle with an over-controlling, though loving, mother.

Academically, Jacob was a C or C-student at best, and he did not do anything to excess—including studying. It was probable that he completed his secondary education with both an undiagnosed learning disorder and attention-deficit disorder. Although in his late teens, he had accomplished little in the way of mastery of the adolescent tasks that one would expect. Had he been born in an earlier era, Jacob might have stayed home after high school and gone to work or trade school; a two-year community college away from home proved to be too much. While he was blissfully content away at school, with having escaped his home and having a good time, he had been unprepared for the academic load and unready to structure his time so that he could pass his classes. He was asked to take an academic leave and return home. He found himself back in the one place he had wanted to escape.

Treatment with Jacob consisted of helping him manage both his tendency towards impulsivity and his difficulty in realistically assessing options and considering consequences. Treatment was eclectic in nature, as these sorts of treatments tend to be—at times more psychodynamic, at times more resembling the ministrations of a camp counselor, and at still others, dedicated to (somehow) helping his family work on reasonable communication. He increasingly recognized the importance and helpfulness of having a solid, though, at times, vulnerable, relationship with his parents. After many bumps in the road, Jacob began to act in a more age appropriate manner and to take some personal responsibility. Although the outcome was not necessarily comparable with others of his age, he was able to hold down a job and take courses, and was in the process of saving to hopefully someday have a place of his own.

Teenager Stays Home and Attends a Four-Year College

Borderline pathology and difficulties in her relationship with a volatile mother characterized Stacey’s junior-high and high-school years. She had a hostile-dependent, tumultuous attachment relationship with her mother; Stacey became an expert in dissociating during untenable fighting with her. Not atypically, she used what was at her disposal to numb the pain—non-suicidal self-injury became an escape, which would later be replaced by drugs. Stacey’s tendency towards the paranoid negatively affected her social relationships. She thought that she was too “stupid” to learn much at school. Because Stacey’s family was inclined towards a hard-work ethic, Stacey always took on jobs at home, and, as soon as she was old enough to work, found someone in the community to hire her so that she could become a wage earner. The end of high school was calamitous. Several college options failed, she had multiple ill-advised romantic relationships, and impulsive, self-destructive behaviors led to several hospitalizations and attempts at treatment with medication.

Stacey’s individual treatment, begun in high school, as well as work with her parents over many years, allowed her to begin to address her relationship with her mother and the multiple losses and developmental arrests that had ensued. Not having been able to “make it” in school away from home, Stacey eventually chose to matriculate at a local college, which she attended while living at home. Although at times Stacey continued to be symptomatic because of the generally vulnerable nature of her character structure and defenses, she was able, finally, to embrace the family work ethic while simultaneously begin to acknowledge herself as a good student, and eventually begin to consider post-graduate education and a possible career ahead.

Teenagers Attend Four-Year Residential College

Kevin

Kevin was an interesting, bright, overly sensitive teen. Plagued with self-doubt from childhood, he was a middle child set between an overachiever and a social butterfly. Despite treatment for a dependent relationship to his mother, Kevin had difficulty separating from home; episodes at sleep-away camp were tolerated, but multiple phone calls home were required. The transition to college was overwhelming.

He felt that there was no one he could turn to at college, but his personal drive and work ethic was to shoulder through, somehow. After developing panic attacks, and very nearly leaving school, he became engaged in a private psychodynamic psychotherapy after a brief consultation with his college mental health service. His parents were encouraged by the therapist to understand and accept that Kevin needed time to work through issues that had not allowed him to mature during his high school years. Kevin, though having great potential academically, was immature and vulnerable; he needed the ego support of the therapist to get him through the rough patches during the college years. Eventually, Kevin began to make some friends and think about a career.

Fran

Fran was a beautiful young woman who had difficulties since childhood with fragile self-esteem and significant sibling rivalry with her even more beautiful sister. Much like the queen in Snow White, no matter what Fran did, her sister seemed to prevail at winning attention from boys, affection at home, and a privileged position in the family pecking order. Through the biological coincidence of the growth cycle and burgeoning puberty, one day she found herself almost as beautiful as her sister. The development in high school of some symptoms of an eating disorder served to both keep Fran thin and keep her anxiety in check.

Fran turned to other forms of non-suicidal self-injury for mood regulation. Psychotherapy during her high-school years focused on self-understanding as well as affect-regulation. Periodic parent sessions helped her parents to accept the amount of time necessary for Fran to establish trust in the treatment in order to reveal her difficulties. Individual treatment also addressed Fran’s separation issues in an enmeshed relationship with mother.

Despite treatment in high school, transition to college was rocky. Continued phone sessions and direct contact over vacations and holidays were able to build on work that had been done in high school. Away from home, the Fran was finally able to disclose more about her eating disorder, and she began to work on it in earnest. She considered the option of seeking therapy closer to college. She also began to consider a post-college career and a graduate degree.

Discussion: Adjustment after High School for Teens and Families

Each of the cases described above represents an adolescent who faltered in transitioning out of high school. They differed in economic background, home environment, and priority given to academics in their upbringing. They represent a range of psychiatric diagnoses, and as a group, they represent high school students at risk to not “launch” easily to college. The outcome of an adolescent in terms of the level of academic achievement post-high school is only one issue in these or similar cases; productivity, happiness, and the ability to have satisfying relationships concerns us even more as child and adolescent mental health practitioners.

Looking at them through a different lens, all of the cases cited in this paper can be seen as having variants of an anxious attachment. For example, Stacey’s increasing—and then debilitating—difficulties in affect regulation and her self-destructive actions can be seen as related developmentally to an ambivalent attachment. However, despite serious difficulty between Stacey and parents, her home was at the very least a known quantity. Moving away taxed her ability to accurately perceive her environment, self-regulate and access support. These cases represent a longitudinal way of thinking about young adults traversing one of the more challenging episodes of separation built into the life cycle; those who have weakness in their attachment style will have greater challenges navigating this time period and leaving home.

In the cases presented, there are examples of limitations in authoritative parenting and the result of these limitations on self-concept. When a young adult is trying to separate from home, dealing with over-or undercontrolling parents may force him into feeling that he has already accomplished the work of separation (prematurely), or cripple efforts to see himself as separate from parents. It is the experience of this author that, despite the age of these youngsters, work can still be done with the college student who needs to return to the parental home (or the one that remains in school) that will allow forward movement in the relationship between parents and teen. However, involving parents, particularly working in the context of college mental health services, is complicated by legal issues (see “Family Educational Rights and Privacy Act”-FERPA). If parents are unavailable, or if either the student or parents are unwilling to participate in working together with the therapist, the therapist can work individually with the student to address ways in which his immaturity may reinforce parental behaviors, or to help him cope with parental behaviors that make it challenging for him to grow up and separate effectively. Work on attachment may also assist vulnerable students not only with establishing the level of support needed from the adult community, but also with whether—and how well - they can “metabolize” the support. Knowing both how much support to offer a student and the student’s capacity for using that support are factors a therapist may use in helping parents make plans with their vulnerable, late-high school student. What should be emphasized in clinical consultation with patients and families facing difficulties during this critical phase in the life cycle is the amount of time required to allow for the transition to adulthood after it has been derailed. True developmental growth requires time; as adults who wish to welcome these “emerging adults” into our midst, we need to offer them our time, patience and dedicated treatment.