Staff Q&A with William Alexander

On his way to becoming a choral music teacher, William Alexander took a detour down guidance counselor road to work with middle school students, and ended up in the land of psychology.

“I think always working with young people was the central theme,” he says about his career, “so I navigated my interests from teaching to psychotherapy and psychology.”

For the past 14 years, Alexander has worked with young adults at Counseling and Psychological Services (CAPS), first as deputy director before he was appointed director in 2009.

Housed at the corner of 36th and Walnut streets, CAPS provides free and confidential mental health services to all Penn undergraduate, graduate, and professional students, especially those whose emotional or psychological distress is interfering with their academics.

Alexander says the CAPS staff treats everything from minor issues—such as trouble adjusting to going away to college for the first time—all the way up to serious mental illness.

“All of the above would fall into our category of concern,” he says. “We do psychotherapy, individual and group, and family and couples. We provide outreach and training. We provide seminars and workshops. We do a wide range of activities all in the service of helping Penn students become better Penn students.”

The Current sat down with Alexander for a conversation about treating mental health on a college campus.

Q: Is there a particular mental health issue among students that is more prevalent than others?
A: The No. 1 issue why students come to CAPS has to do with concerns about their academics. They may not have identified that they are depressed or anxious; they don’t put those kinds of labels on it. They come because they say, ‘Something is bothering me and I can’t concentrate on my studies,’ or ‘I’m not as sharp in my exams as I used to be,’ or ‘I’m just so tired that I can’t make it to class.’ They might not understand what is bothering them, but they are aware that something is getting in the way of their studies. That’s the No. 1 reason students come to CAPS. No. 2 is depression, some kind of mood issue, which could be related.

Q: What sort of specialists does CAPS employ?
A: The three main categories of clinicians—psychiatry, psychology, and social work—all function on multidisciplinary treatment teams. Within those teams, our staff has different interests or specialties. We have people who are interested in the treatment of eating disorders; we have people who are working specifically with international students. We have a psychologist who serves as our research director and helps us out with understanding populations better. We have some people who are interested in the treatment of drugs and alcohol abuse, and people who are more trained in the treatment of sexual trauma. We encourage members of our staff to pursue their own individual interests so we get a more diverse staff within those three disciplines—psychiatry, psychology, and social work.

Q: What is the difference between a psychiatrist and psychologist?
A: A psychiatrist went to medical school and prescribes medicine and a psychologist does not. A psychologist went to graduate school, has a Ph.D., and does psychotherapy. There are psychiatrists who are also trained in  psychotherapy, and there are psychologists who are very knowledgeable about medication. But by and large, psychologists may not prescribe medication.

Q: Is a problem only a problem if it interferes with everyday life?
A: If you’re having a problem, you may be aware of it because it impacts your daily function, or it causes you distress, or you’re uncomfortable with it yourself. But it’s also true that you might be having a problem that you’re not even aware of, that you may not have considered a problem. It’s possible to have some kind of a minor issue impact your daily life—maybe your social functioning, maybe your relationship with your friends, or maybe it’s even impacting your academic functioning—and you’re not quite aware of it. Maybe you’re aware something is going wrong, but you might not know what it is and you can’t figure it out. That’s a good time to check in with CAPS. Usually students are aware when they’re in distress, but sometimes they don’t and they should check it out.

Q: CAPS also offers couples counseling. Do college students come in for couples counseling?
A: Yes, they absolutely do. We get more graduate students who are married, but we get everything from undergraduates and graduates who come because of their relationship issues. Maybe they want to bring their partner with them and just talk about their relationship. We have people who come because they’re getting into a serious relationship for the first time or maybe they’re even thinking about getting married and want to talk about their
relationship and make sure they’re on firm ground. It’s not a common thing, but it certainly does happen.

Q: Is mental health treatment something that is becoming less stigmatized?
A: Certainly as professionals in mental health, we have been working on the problem of stigma for decades. I think those of us in the field think we are seeing an impact. While stigma is still a serious issue and prevents many undergrads and grads from seeking services, it is better than it used to be. More students are coming. There are more small groups on this campus that are advocating for mental health treatment. You have student groups within the student government organization and student affairs who are working toward reducing stigma and educating the population about mental health issues and treatment for mental health. We still have a long way to go, but it’s definitely making an impact. We see it here. The number of students that we treat and help at CAPS rises every year.

Q: Why do you think there are fewer stigmas regarding mental health treatment?
A: I think for two reasons. One, mental health professionals have been trying to educate the general population about the benefits of treatment, and trying to de-stigmatize mental health issues, generally speaking. But also, young people are entering into helping relationships and counseling earlier. More and more, we see students who are coming to college who have already been in treatment for quite a few years. Maybe they saw a counselor when they were in junior high school. The concept of seeking help for some kind of emotional distress—not necessarily mental illness, but just some kind of distress—has been introduced to a younger and younger age group, so by the time they get to college, they want to sign up and keep it going. That, and the reduction of stigma generally, helps a lot.

Q: CAPS has a number of health and wellness partners throughout the University. With whom do you partner?
A: We partner with so many offices. We have a program at CAPS called our liaison program in which we identify a person in probably 60 or 80 offices and departments all over the University—faculty, staff, academics,  extracurricular, athletics, Greek—to partner with. On a day-to-day basis, we work extremely closely with academic advising in the four undergraduate schools. We work with Vice Provost for University Life and especially Student Intervention Services. We work very closely with Student Health Service. Student Health Service has just initiated a really wonderful program in depression screening, and CAPS is working very closely with them to identify and treat students with depression. We work incredibly closely with the College House system and the house deans, the RAs, GAs, on a daily basis. I think one of the benefits of working with college students at Penn is you’re not at all isolated. The University is unbelievably supportive of the counseling center, and we are part of a much bigger team in helping Penn students.

Q: There has been some debate about making people’s mental health records less confidential for public safety reasons. How important is confidentiality to your work?
A: People’s medical records, generally, and mental health records specifically, are very, very confidential, and need to be so. The term under the law is ‘privileged relationship,’ so the relationship you have with your therapist is a privileged one. In Pennsylvania, it’s exactly the same as if you were talking to your lawyer, and it’s to ensure that people will, in fact, come to get help. There are limitations under the law. Psychologists and social workers and psychiatrists have well-understood guidelines for when they can break somebody’s confidentiality, and that most often occurs if someone is going to be dangerous to themselves or others. I explain to people when they come to counseling that it’s totally confidential unless I believe you’re going to harm yourself or others. Beyond that, it is very confidential. That’s an important part for college students because they don’t want to come to counseling if they think you’re going to be talking to the adviser. It’s a no-brainer. If you want people to come, if you want them to get help, you need that guarantee in order to do it.

William Alexander