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Exploring Outcomes and Initial Self-Report of Client Motivation in a College Counseling Center

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Title: Exploring Outcomes and Initial Self-Report of Client Motivation in a College Counseling Center
Language: English
Authors: Ilagan, Guy, Vinson, Michael L., Sharp, Julia L., Ilagan, Jill, Oberman, Aaron
Source: Journal of American College Health. 2015 63(3):187-194.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 8
Publication Date: 2015
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Counseling Services, Questionnaires, Correlation, Outcomes of Treatment, Mental Health, Health Services, Records (Forms), College Students, Student Attitudes, Pretests Posttests, Student Motivation, Behavior Change, Statistical Analysis
DOI: 10.1080/07448481.2014.1003379
ISSN: 0744-8481
Abstract: Objective: To explore the association between college counseling center clients' initial self-report of motivation and counseling outcome. Participants: The sample was composed of 331 student clients who utilized a college counseling center from August 2007 to August 2009. The college is a public, mid-size, urban university in the Southeast. Methods: Motivation was measured at intake by a self-report of change readiness item. A quantitative study that employed a 5-group, pretest-posttest design included 331 student participants. Counseling outcome was measured using the Outcome Questionnaire 45.2. Results: As assigned by the clients' self-report of change readiness, counseling outcome for 5 motivation groups differed significantly (p = 0.004; a < 0.05). Compulsory participation in counseling was treated as a possible confound and was not a significant factor in counseling outcome (p = 0.268; a < .05). Conclusions: Participants' initial self-report of motivation was significantly associated with counseling outcome.
Abstractor: As Provided
Number of References: 41
Entry Date: 2015
Accession Number: EJ1054948
Database: ERIC
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  Value: &lt;anid&gt;AN0101588268;acl01apr.15;2019Mar27.12:39;v2.2.500&lt;/anid&gt; &lt;title id=&quot;AN0101588268-1&quot;&gt;Exploring Outcomes and Initial Self-report of Client Motivation in a College Counseling Center.&#160;&lt;/title&gt; &lt;p&gt;Objective: To explore the association between college counseling center clients&#39; initial self-report of motivation and counseling outcome. Participants: The sample was composed of 331 student clients who utilized a college counseling center from August 2007 to August 2009. The college is a public, mid-size, urban university in the Southeast. Methods: Motivation was measured at intake by a self-report of change readiness item. A quantitative study that employed a 5-group, pretest–posttest design included 331 student participants. Counseling outcome was measured using the Outcome Questionnaire 45.2. Results: As assigned by the clients&#39; self-report of change readiness, counseling outcome for 5 motivation groups differed significantly (p =.004; α &amp;lt;.05). Compulsory participation in counseling was treated as a possible confound and was not a significant factor in counseling outcome (p =.268; α &amp;lt;.05). Conclusions: Participants&#39; initial self-report of motivation was significantly associated with counseling outcome.&lt;/p&gt; &lt;p&gt;Keywords: counseling outcomes; motivation; stages of change; college counseling&lt;/p&gt; &lt;p&gt;Increased demands for university mental health services as well as limited resources make it essential to improve the efficiency and effectiveness of clinical services delivery. According to The Association for University and College Counseling Center Directors (AUCCCD) Annual Survey, 2013, the number of students presenting with anxiety, depression, suicidality, and sexual assault is up from last year.[&lt;reflink idref=&quot;bib1&quot; id=&quot;ref1&quot;&gt;1&lt;/reflink&gt;] At a 4-year institution that has over 35,000 students, there are on average 20 paid clinical staff to meet the demand of these students.[&lt;reflink idref=&quot;bib1&quot; id=&quot;ref2&quot;&gt;1&lt;/reflink&gt;] Although the survey indicates that clinics are gaining staff at a higher rate than they are losing staff, they are not seeing an overall increase in their operating budget.[&lt;reflink idref=&quot;bib1&quot; id=&quot;ref3&quot;&gt;1&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;In addition, the National Survey of College Counseling Center Directors, 2013, indicated that 95% of directors of 4-year colleges believe that in the recent past, increasing numbers of students are continuing to present with ever increasing severity of symptomology.[&lt;reflink idref=&quot;bib2&quot; id=&quot;ref4&quot;&gt;2&lt;/reflink&gt;] Of these same directors, 35% report that they have problematic wait lists and 58% report that they are under increased scrutiny and pressure to disclose information due to the recent school campus tragedies.[&lt;reflink idref=&quot;bib2&quot; id=&quot;ref5&quot;&gt;2&lt;/reflink&gt;] Other researchers have found that this increased demand has created substantial obstacles for college counseling centers to providing adequate care to the student population.[&lt;reflink idref=&quot;bib3&quot; id=&quot;ref6&quot;&gt;3&lt;/reflink&gt;] This continued trend of more clients, coupled with worse symptom severity without a commiserate increase in resources, requires counseling centers to be creative in prioritizing client care, while still trying to maintain the safety and well-being of the student body.&lt;/p&gt; &lt;p&gt;To cope with the ever growing demand for college counseling services, researchers have endeavored to improve clinical service delivery such as looking at client factors that reveal the likelihood of clinical success including motivation to change.[&lt;reflink idref=&quot;bib4&quot; id=&quot;ref7&quot;&gt;4&lt;/reflink&gt;] The Transtheoretical Model (TTM), based on client motivation, describes specific stages of intentional behavior change.[&lt;reflink idref=&quot;bib5&quot; id=&quot;ref8&quot;&gt;5&lt;/reflink&gt;] This model offers valuable insight into whether a university student is likely to benefit from campus mental health counseling.[&lt;reflink idref=&quot;bib6&quot; id=&quot;ref9&quot;&gt;6&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;TTM offers the 5 stages of change as a means of assessing client motivation.[&lt;reflink idref=&quot;bib7&quot; id=&quot;ref10&quot;&gt;7&lt;/reflink&gt;] The stages represent an individual&#39;s readiness to make behavioral changes. As it relates to counseling, an individual approaches each of their concerns from one of the stages, indicating their motivation to address the concern.[&lt;reflink idref=&quot;bib8&quot; id=&quot;ref11&quot;&gt;8&lt;/reflink&gt;] A brief description of each stage is below.&lt;/p&gt; &lt;p&gt;&lt;/p&gt; &lt;ulist&gt; &lt;item&gt; &lt;emph&gt;Precontemplation&lt;/emph&gt;: A lack of perceived need or intention to make an intentional behavior change.[&lt;reflink idref=&quot;bib9&quot; id=&quot;ref12&quot;&gt;9&lt;/reflink&gt;]&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;emph&gt;Contemplation&lt;/emph&gt;: Ambivalence about problems or a need for behavioral change. Awareness of a problem without decisive action to accomplish the desired change.[&lt;reflink idref=&quot;bib10&quot; id=&quot;ref13&quot;&gt;10&lt;/reflink&gt;]&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;emph&gt;Preparation&lt;/emph&gt;: Individuals intend to take action in the next 30&#160;days and report small behavior changes and have experienced some reduction in problem behaviors.[&lt;reflink idref=&quot;bib6&quot; id=&quot;ref14&quot;&gt;6&lt;/reflink&gt;]&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;emph&gt;Action&lt;/emph&gt;: The plan devised in the preparation stage is implemented and revised so that the new behavior can be maintained for 3 to 6 months.[&lt;reflink idref=&quot;bib7&quot; id=&quot;ref15&quot;&gt;7&lt;/reflink&gt;]&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;emph&gt;Maintenance&lt;/emph&gt;: Stabilization of the desired behaviors and integration of the new behavior into the individual&#39;s lifestyle.[&lt;reflink idref=&quot;bib7&quot; id=&quot;ref16&quot;&gt;7&lt;/reflink&gt;]&lt;/item&gt; &lt;/ulist&gt; &lt;p&gt;TTM has received much research attention and has attracted strong criticism.[&lt;reflink idref=&quot;bib11&quot; id=&quot;ref17&quot;&gt;11&lt;/reflink&gt;] Armitage wrote that most criticism of TTM pertains to the stages of change.[&lt;reflink idref=&quot;bib11&quot; id=&quot;ref18&quot;&gt;11&lt;/reflink&gt;] He proposed that more research is needed to clarify the mixed findings for the concurrent validity of the 5 stages. Critique of the stages of change includes an assertion by West that although motivation exists on a continuum, the stages attempt to force the 5 separate entities into categories, as though they were discreet, stable variables.[&lt;reflink idref=&quot;bib12&quot; id=&quot;ref19&quot;&gt;12&lt;/reflink&gt;] Treating the stages of change as discreet variables leads inevitably to an arbitrary split among stages. He also described that the TTM stages offered no greater predictive measurement of successful smoking cessation than simply asking clients questions about their desire/intention to quit and assessing their level of nicotine dependence. West concluded that TTM did not offer a simpler or more advanced way to predict readiness to change and therefore should not be heralded as a useful scientific model.&lt;/p&gt; &lt;p&gt;Dare and Derigne offered a balanced criticism, stating that although TTM is of value in part because it addresses that client denial changes over time, the popularity of the model has left other models untested.[&lt;reflink idref=&quot;bib13&quot; id=&quot;ref20&quot;&gt;13&lt;/reflink&gt;] Armitage concluded that over-focus on the criticisms of the stages of change diverted attention away from valuable aspects of TTM, chiefly the processes of change.[&lt;reflink idref=&quot;bib11&quot; id=&quot;ref21&quot;&gt;11&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;With increasing demands for campus mental health services, university mental health clinics need tools and strategies to best allocate limited resources.[&lt;reflink idref=&quot;bib3&quot; id=&quot;ref22&quot;&gt;3&lt;/reflink&gt;] The reviewed studies suggested strategies including waiting lists,[&lt;reflink idref=&quot;bib14&quot; id=&quot;ref23&quot;&gt;14&lt;/reflink&gt;] triage systems and referral protocols,[&lt;reflink idref=&quot;bib15&quot; id=&quot;ref24&quot;&gt;15&lt;/reflink&gt;] time limited treatment/session limits,[&lt;reflink idref=&quot;bib16&quot; id=&quot;ref25&quot;&gt;16&lt;/reflink&gt;] and assessment of client motivation.[&lt;reflink idref=&quot;bib17&quot; id=&quot;ref26&quot;&gt;17&lt;/reflink&gt;] The literature identified potential issues associated with all of the aforementioned strategies except assessment of client motivation. Mental health counselors with knowledge of the relationship between client motivation and counseling outcome can improve counseling outcomes by early identification of clients with low motivation and implementation of strategies to increase those clients&#39; motivation.[&lt;reflink idref=&quot;bib18&quot; id=&quot;ref27&quot;&gt;18&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;Client motivation is relevant to university mental health clinic counseling outcomes because of the reported relationship between low client motivation and poor counseling outcomes for university students.[&lt;reflink idref=&quot;bib4&quot; id=&quot;ref28&quot;&gt;4&lt;/reflink&gt;] Norcross et&#160;al reported a meta-analysis of 39 studies, including 8,238 counseling clients, to assess the ability of stages of change to predict counseling outcomes.[&lt;reflink idref=&quot;bib6&quot; id=&quot;ref29&quot;&gt;6&lt;/reflink&gt;] The authors reported that significant effect sizes were found for the relationship between clients&#39; stage of change at counseling intake and subsequent counseling outcome (&lt;emph&gt;d&lt;/emph&gt; =.46). Concerning a practice implication, TTM proposes that when client motivation is low, rather than initiating counseling, clinicians may refer those clients to community resources,[&lt;reflink idref=&quot;bib19&quot; id=&quot;ref30&quot;&gt;19&lt;/reflink&gt;] offer precounseling interventions to bolster motivation,[&lt;reflink idref=&quot;bib20&quot; id=&quot;ref31&quot;&gt;20&lt;/reflink&gt;] or apply specialized counseling techniques to enhance client motivation.[&lt;reflink idref=&quot;bib6&quot; id=&quot;ref32&quot;&gt;6&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;Assessment of client motivation allows campus mental health counselors to determine clients&#39; readiness to make intentional behavior change. TTM also provides an understanding of how mental health counselors can allocate treatment interventions that are appropriate to the motivation level of each client.[&lt;reflink idref=&quot;bib6&quot; id=&quot;ref33&quot;&gt;6&lt;/reflink&gt;] Ultimately, how universities cope with increasing mental health center demands may depend on accurate and prompt assessment of clients&#39; change readiness. Formalizing measures to assess client motivation will help identify students who are more likely to engage in and utilize the therapy process effectively.&lt;/p&gt; &lt;p&gt;The purpose of the present study was to explore whether university mental health center clients&#39; motivation, as measured by a client self-report of change readiness item, based on the TTM, was a significant variable in campus mental health counseling outcomes. The null hypothesis was as follows: All motivation groups, precontemplation, contemplation, preparation, action, and maintenance, are equal in counseling outcome (difference in pre- and posttest Outcome Questionnaire 45.2 [OQ45.2] scores), controlling for the covariate of compulsory counseling.&lt;/p&gt; &lt;p&gt;The covariate of compulsory counseling was selected and controlled for because of indications that outcomes for college students attending compulsory counseling were potentially skewed towards lower symptom improvement.[[&lt;reflink idref=&quot;bib19&quot; id=&quot;ref34&quot;&gt;19&lt;/reflink&gt;]] Kiracofe and Buller asserted that the evidence for mandated counseling for college-aged clients did not support the efficacy of the practice.[&lt;reflink idref=&quot;bib19&quot; id=&quot;ref35&quot;&gt;19&lt;/reflink&gt;] Additionally, they suggested that future research should focus closely on the use of treatment readiness strategies and stage-based interventions by campus counselors. Morgan et&#160;al reported a need to explore college students&#39; precounseling change readiness in order to understand variances in counseling outcomes for clients attending mandatory counseling.[&lt;reflink idref=&quot;bib20&quot; id=&quot;ref36&quot;&gt;20&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;This present study addresses gaps in the literature in that it utilizes initial stages of change to predict treatment outcomes in a college counseling center. Before the present study, no studies existed for the application of the client self-report of change readiness item, which is in effect a brief measure of the stages of change. Furthermore, this adds to the body of literature by exploring the use of this brief measure to manage high demand in college counseling centers, as well as symptom improvement rates for college students attending compulsory counseling.&lt;/p&gt; &lt;hd id=&quot;AN0101588268-2&quot;&gt;METHODS&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;hd id=&quot;AN0101588268-3&quot;&gt;Participants&lt;/hd&gt; &lt;p&gt;All data were collected from existing mental health counseling records at the research site. The study received approval from the institution&#39;s Institutional Review Board. Participants consisted of 331 clients who attended counseling services at a campus mental health clinic during the academic years 2007–2009. The clinic was part of a medium-sized public university in the Southeast. Nearly one third of the students lived on campus and 65% were female, which matches the demographics of the research site clinic. The racial/ethnic demographics for the 331 study participants, per participants&#39; self-report and as indicated in the counseling record, were Caucasian 79.5%, Asian American 7.3%, African American 4.2%, Hispanic American 1.5%, other 2.7%, and no response 4.8%. The participants&#39; self-report of gender was 69.2% female and 30.8% male.&lt;/p&gt; &lt;p&gt;The investigator reviewed the site&#39;s existing mental health clinic data from the time period when the research site utilized the client self-report of change readiness item, the grouping mechanism for the study. There were 331 participants who met the study criteria, having been clients over age 18 who attended 3–7 sessions during the identified time period. The parameter of 3–7 sessions was determined because selecting a lower cutoff of 2 sessions would have allowed only 1 counseling appointment between the pretest and posttest. The lower limit of 3 sessions allowed outcome data to reflect the initial brief triage session and 2 full-length appointments. We selected the upper limit cutoff of 7 sessions in order to include the research site&#39;s mean number of sessions (&lt;reflink idref=&quot;bib6&quot; id=&quot;ref37&quot;&gt;6&lt;/reflink&gt;). Existing data were reviewed in the counseling case files. The participants were classified into 1 of 5 motivation groups by the client self-report of change readiness item corresponding to the TTM&#39;s stages of change.&lt;/p&gt; &lt;hd id=&quot;AN0101588268-4&quot;&gt;Measures&lt;/hd&gt; &lt;p&gt;In prior studies on client motivation, investigators measured motivation using the 32-item Stages of Change Scale.[&lt;reflink idref=&quot;bib21&quot; id=&quot;ref38&quot;&gt;21&lt;/reflink&gt;] The 32-item Stages of Change Scale employs a 5-point Likert scale for each of the 32 items. In the present study, we utilized a client self-report of change readiness item to measure client motivation. The client self-report of change item uses check boxes for respondents to endorse the statement that characterizes their current level of motivation to change.&lt;/p&gt; &lt;p&gt;In previous studies on mental health outcomes, investigators assessed counseling outcomes by comparing pre- and posttest administrations of the OQ45.2.[&lt;reflink idref=&quot;bib22&quot; id=&quot;ref39&quot;&gt;22&lt;/reflink&gt;] The OQ45.2 is a 45-item self-report questionnaire that assesses mental health symptoms.[&lt;reflink idref=&quot;bib23&quot; id=&quot;ref40&quot;&gt;23&lt;/reflink&gt;] We measured counseling outcome by considering changes in mental health symptom severity via pre- and posttest administrations of the OQ45.2. When used as a pre- and posttest, the OQ45.2 is sensitive to changes in reported distress, functioning in interpersonal relationship, and functioning in important roles.[&lt;reflink idref=&quot;bib24&quot; id=&quot;ref41&quot;&gt;24&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;The data were collected from the client self-report of change readiness item and from the OQ45.2.[&lt;reflink idref=&quot;bib25&quot; id=&quot;ref42&quot;&gt;25&lt;/reflink&gt;] The participants&#39; stage of change readiness was indicated via a single self-report item. At the time of this study, there were no documented reports on this self-report of change readiness item. The authorship of the client self-report of change readiness item is not documented. The item was adopted for use at the research site clinic in 2007 by a former research site director, who noticed it on the AUCCCD Listserv; queries to the AUCCCD Listserv about the authorship or use of the item were not successful.&lt;/p&gt; &lt;p&gt;The statements on the client self-report of change readiness item (Figure&#160;1) corresponded to the TTM&#39;s 5 stages of change: precontemplation, contemplation, preparation, action, and maintenance.[&lt;reflink idref=&quot;bib26&quot; id=&quot;ref43&quot;&gt;26&lt;/reflink&gt;] The client self-report of change readiness item existed on the research site&#39;s Counseling Intake Form, a self-report questionnaire that all clients completed prior to beginning counseling at the research site. The 5 statements within the scale indicate lowest motivation level to highest, corresponding to the TTM&#39;s stages of change, with the precontemplation stage indicating the lowest motivation to change and maintenance stage indicating the highest motivation to change. Collins et&#160;al asserted that formalizing brief measures to assess client motivation will help identify students who are more likely to engage in and utilize the therapy process effectively.[&lt;reflink idref=&quot;bib27&quot; id=&quot;ref44&quot;&gt;27&lt;/reflink&gt;] Another benefit of a brief motivation assessment, compared with the longer versions, is that it is less of a burden on the clinicians.[&lt;reflink idref=&quot;bib18&quot; id=&quot;ref45&quot;&gt;18&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;Graph: FIGURE 1. Client self-report of change readiness item.&lt;/p&gt; &lt;p&gt;The OQ45.2 is a 45-item self-report questionnaire that is used to assess ongoing changes in symptoms, as well as change at termination.[&lt;reflink idref=&quot;bib23&quot; id=&quot;ref46&quot;&gt;23&lt;/reflink&gt;] The primary counseling outcome of interest was symptom improvement, measured by the difference in pre- and posttest administrations of the OQ45.2. According to data on the OQ45.2, significant symptom improvement is evidenced by a posttest score of at least 14 points lower than the pretest score.[&lt;reflink idref=&quot;bib28&quot; id=&quot;ref47&quot;&gt;28&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;The 3 subscales of the OQ45.2 address individual, interpersonal, and social role functioning.[&lt;reflink idref=&quot;bib23&quot; id=&quot;ref48&quot;&gt;23&lt;/reflink&gt;] The OQ45.2 provides a total score based on all 45 items, as well as scores for 3 subscales. All items are on a 5-point Likert scale, with higher scores indicating higher mental health symptom severity.&lt;/p&gt; &lt;p&gt;Pre- and posttest administrations of the OQ45.2 provide an effective measurement of mental health counseling outcome.[&lt;reflink idref=&quot;bib22&quot; id=&quot;ref49&quot;&gt;22&lt;/reflink&gt;] To establish pre- and posttest OQ45.2 scores, mental health clients completed the questionnaire at each visit to the mental health clinic, or at the first and last counseling session.[&lt;reflink idref=&quot;bib29&quot; id=&quot;ref50&quot;&gt;29&lt;/reflink&gt;] The OQ45.2 has high internal consistency, Cronbach&#39;s α =.93, and test–retest reliability of.84.[[&lt;reflink idref=&quot;bib30&quot; id=&quot;ref51&quot;&gt;30&lt;/reflink&gt;]]&lt;/p&gt; &lt;p&gt;The participants who were referred to counseling on a compulsory basis, as part of a campus judicial proceeding, were identified by the presence of the referral letter in the counseling case file.&lt;/p&gt; &lt;hd id=&quot;AN0101588268-5&quot;&gt;Procedure&lt;/hd&gt; &lt;p&gt;Participants completed the client self-report of change readiness item during their first visit to the university mental health clinic. At the first visit, the participants also completed the pretest administration of the OQ45.2, and the Counseling Intake Form, as did all clients. The research site administered the OQ45.2 prior to each counseling session in order to receive more immediate feedback on client progress. The OQ45.2 from the final session was the posttest score.&lt;/p&gt; &lt;p&gt;The primary researcher collected data only for students attending at least 3 sessions and no more than 7 sessions. Selecting a lower cutoff of 2 sessions would have allowed only 1 full therapy session between the pre- and posttest; the lower limit of 3 sessions allowed the OQ45.2 data to reflect the initial brief triage session and 2 full-length counseling sessions. The mean number of sessions at the research site was 6.1. We selected the upper limit cutoff of 7 sessions in order to include the research site&#39;s mean number of counseling sessions and the mean number of sessions (6.2) for US university mental health clinics.[&lt;reflink idref=&quot;bib31&quot; id=&quot;ref52&quot;&gt;31&lt;/reflink&gt;]&lt;/p&gt; &lt;hd id=&quot;AN0101588268-6&quot;&gt;Statistical Analysis&lt;/hd&gt; &lt;p&gt;The difference in pre- and posttest OQ45.2 scores was the primary dependent variable for the study. The independent variable was motivation. Whether or not the student received compulsory counseling due to campus judicial sanction was controlled for in the analysis. Due to violations in the homogeneity of variance assumption, separate variances were estimated for each motivation stage. Follow-up tests were conducted using Fisher&#39;s least significant difference (LSD) to evaluate pairwise differences among the adjusted mean differences in pre- and posttest OQ45.2 scores among the 5 motivation groups. A significance level of.05 was used for all tests of significance. Statistical Analysis Software (SAS/STAT) was used for all analyses.[&lt;reflink idref=&quot;bib32&quot; id=&quot;ref53&quot;&gt;32&lt;/reflink&gt;]&lt;/p&gt; &lt;hd id=&quot;AN0101588268-7&quot;&gt;RESULTS&lt;/hd&gt; &lt;p&gt;This study investigated whether mean changes in pre- and posttest OQ45.2 scores differed among the 5 motivation groups, as determined by the client self-report of change item. The group with the largest number of subjects was the contemplation group (&lt;emph&gt;n&lt;/emph&gt; = 122, 36.9%). The data analysis revealed that the minimum difference between pre- and posttest OQ45.2 scores was −22, the maximum difference was 70, and the mean difference was 13.40. The precontemplation group had the lowest mean difference in pre- and posttest OQ45.2 scores. The preparation group had the highest mean OQ45.2 difference score (Table&#160;1).&lt;/p&gt; &lt;p&gt;TABLE 1. Unadjusted and Adjusted Group Means and Standard Errors for OQ45.2 Difference Using Compulsory Status as a Covariate&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;Unadjusted&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Adjusted&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Motivation group&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Percent&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;SE&amp;lt;/italic&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;SE&amp;lt;/italic&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Total&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;331&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;100.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;13.27&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.95&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Precontemplation&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;19&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.7&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;4.71&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.66&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.08&amp;lt;sup&amp;gt;a&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.81&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Contemplation&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;122&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;36.9&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;14.04&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.55&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;12.82&amp;lt;sup&amp;gt;bcd&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.90&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Preparation&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;82&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;24.8&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;17.24&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2.19&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;16.14&amp;lt;sup&amp;gt;be&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2.39&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Action&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;83&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;25.1&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;12.33&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.66&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;11.25&amp;lt;sup&amp;gt;cef&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.91&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Maintenance&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;25&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;7.6&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;6.10&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;3.45&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.14&amp;lt;sup&amp;gt;adf&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;3.58&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;10001 &lt;emph&gt;Note&lt;/emph&gt;. Means with the same letter do not significantly differ (Fisher&#39;s least significant difference, &lt;emph&gt;p&lt;/emph&gt; &amp;lt;.05). OQ45.2 = Outcome Questionnaire 45.2.&lt;/p&gt; &lt;p&gt;The adjusted group means of symptom improvement differed across the 5 client motivation groups (&lt;emph&gt;F&lt;/emph&gt;[&lt;reflink idref=&quot;bib4&quot; id=&quot;ref54&quot;&gt;4&lt;/reflink&gt;, 90.4] = 4.02, &lt;emph&gt;p&lt;/emph&gt; =.005). Table&#160;1 presents the groups sizes, unadjusted and adjusted means, and standard errors for the 5 groups. Adjusted means reflect the mean difference in pre- to posttest OQ45.2 scores for the model controlling for whether or not the student received compulsory counseling due to a campus judicial sanction.&lt;/p&gt; &lt;p&gt;Based on Fisher&#39;s LSD, the precontemplation group was lowest in average symptom improvement and differed significantly from the contemplation (&lt;emph&gt;t&lt;/emph&gt;[50.8] = −2.80, &lt;emph&gt;p&lt;/emph&gt; =.007), preparation (&lt;emph&gt;t&lt;/emph&gt;[&lt;reflink idref=&quot;bib73&quot; id=&quot;ref55&quot;&gt;73&lt;/reflink&gt;] = −3.56, &lt;emph&gt;p&lt;/emph&gt; =.001), and action (&lt;emph&gt;t&lt;/emph&gt;(52.2) = −2.24, &lt;emph&gt;p&lt;/emph&gt; =.029) motivation groups in the average change in OQ45.2 scores from pre- to posttest. The preparation group had the highest mean for symptom improvement (&lt;emph&gt;M&lt;/emph&gt; = 16.14, &lt;emph&gt;SE&lt;/emph&gt; = 2.39) and differed significantly from the maintenance group (&lt;emph&gt;t&lt;/emph&gt;[44.5] = 2.68, &lt;emph&gt;p&lt;/emph&gt; =.010).&lt;/p&gt; &lt;p&gt;Symptom improvement is evidenced by an OQ45.2 posttest score of at least 14 points lower than the pretest score.[&lt;reflink idref=&quot;bib28&quot; id=&quot;ref56&quot;&gt;28&lt;/reflink&gt;] Of the 5 motivation groups, only the preparation group showed mean OQ45.2 pre- and posttest difference scores greater than 14 points after controlling for the compulsory status of students.&lt;/p&gt; &lt;p&gt;The adjusted average symptom improvement for individuals attending compulsory counseling was 8.67 (&lt;emph&gt;SE&lt;/emph&gt; = 2.22), whereas for individuals not attending compulsory counseling the adjusted average symptom improvement was 11.50 (&lt;emph&gt;SE&lt;/emph&gt; = 1.14). The relationship between whether or not the student received compulsory counseling due to a campus judicial sanction and symptom improvement was not significant (&lt;emph&gt;F&lt;/emph&gt;[&lt;reflink idref=&quot;bib1&quot; id=&quot;ref57&quot;&gt;1&lt;/reflink&gt;, 76.3] = 1.24, &lt;emph&gt;p&lt;/emph&gt; =.268).&lt;/p&gt; &lt;p&gt;Concerning the covariate, compulsory status, the data showed that 43 (13%) of the 311 subjects attended mental health counseling that was compulsory. The precontemplation group (&lt;emph&gt;n&lt;/emph&gt; =19) had the highest group percentage (63%) of subjects attending compulsory counseling.&lt;/p&gt; &lt;hd id=&quot;AN0101588268-8&quot;&gt;COMMENT&lt;/hd&gt; &lt;p&gt;The purpose of this study was to examine whether university mental health center clients&#39; motivation, as measured by a 5-item Stages of Change Scale, was a significant variable in determining campus mental health counseling outcomes. The counseling outcome of interest was symptom improvement, as measured by the difference in pre- and posttest administrations of the OQ45.2. Clients&#39; level of motivation was found to be significantly associated with counseling outcome. Clients identified by the client self-report of change readiness item as being in the precontemplation group showed the lowest group mean for counseling outcome and therefore were least likely to benefit from the counseling sessions at the university&#39;s mental health clinic. The preparation and contemplation groups were the highest in symptom improvement and would thus be most likely to benefit from the mental health counseling sessions at the research site.&lt;/p&gt; &lt;p&gt;Additionally, the client self-report of change readiness item found that 3 groups (ie, precontemplation, action, and maintenance) did not achieve significant symptom improvement. Participants in the maintenance stage were not expected to show significant changes in pre-/posttreatment symptoms. DiClemente described clients in the maintenance stage as being already in the process of integrating the new behaviors into their lifestyles.[&lt;reflink idref=&quot;bib7&quot; id=&quot;ref58&quot;&gt;7&lt;/reflink&gt;] It would follow, then, that their symptoms would not decrease or increase, since by definition being in the maintenance stage indicates that a person is maintaining, not changing. One application of this finding, to help cope with high counseling center demand, is to offer less frequent appointments to clients who are in the maintenance stage.&lt;/p&gt; &lt;p&gt;The findings from this study are consistent with earlier research, which showed that the precontemplation group was lowest in symptom improvement as measured by the OQ45, an earlier form of the OQ45.2 used in the present study.[&lt;reflink idref=&quot;bib33&quot; id=&quot;ref59&quot;&gt;33&lt;/reflink&gt;] The brief administration and scoring time demonstrate the potential usefulness of a client self-report of change item. The use of a brief assessment, as opposed to one of the longer motivation questionnaires mentioned earlier in this paper, would mitigate the burden on university mental health clinics and support the counseling needs of students.&lt;/p&gt; &lt;p&gt;Universities in the United States make use of compulsory counseling.[&lt;reflink idref=&quot;bib34&quot; id=&quot;ref60&quot;&gt;34&lt;/reflink&gt;] College students may be compelled to attend counseling services as part of a judicial proceeding following a policy violation, or when students display behaviors of concern. Campus judicial officers work with students who have been accused of infractions ranging from violations of substance-related policies to conflicts with others and vandalism. Campus authorities may also require compulsory counseling for students who display behaviors that show a high risk of harm towards themselves or others. The present study shows that participants&#39; compulsory status did not significantly influence symptom improvement. However, participants in the precontemplation group, the group showing the least symptom reduction, were over 10&#160;times more likely to attend counseling on a compulsory basis, than those who were not in the precontemplation group.&lt;/p&gt; &lt;p&gt;As mentioned previously, before the present study, no studies existed for the application of the client self-report of change readiness item. This study demonstrated the ability of the client self-report of change readiness item to determine differences in counseling outcome in one university mental health clinic. A practice implication from the results of this study is that university mental health clinics should utilize a change readiness item or similar brief assessment of motivation to change, as part of the intake process for early identification of clients with low probability of treatment success. This easy-to-administer item could be offered electronically so that results are automatically stored for each client.&lt;/p&gt; &lt;p&gt;Assessing client motivation at intake allows university mental health counselors to determine the appropriate treatment interventions for university students seeking mental health services.[&lt;reflink idref=&quot;bib35&quot; id=&quot;ref61&quot;&gt;35&lt;/reflink&gt;] Mander et&#160;al asserted that TTM offers a way for therapeutic interventions to be adapted to the clients&#39; motivational stage.[&lt;reflink idref=&quot;bib36&quot; id=&quot;ref62&quot;&gt;36&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;Findings from this study suggest that if college counseling centers do not apply specialized counseling interventions to clients with low motivation, then compulsory counseling may not be effective. The precontemplation clients are less likely to experience symptom improvement than the contemplation groups. Therefore, therapeutic techniques that could move clients from the precontemplation to contemplation would increase symptom improvement for that client. Motivational interviewing (MI)[&lt;reflink idref=&quot;bib37&quot; id=&quot;ref63&quot;&gt;37&lt;/reflink&gt;] and TTM[&lt;reflink idref=&quot;bib7&quot; id=&quot;ref64&quot;&gt;7&lt;/reflink&gt;] offer a variety of interventions to bolster clients&#39; motivation to change. When seeing that a client&#39;s motivation to change is low, clinicians can utilize techniques to enhance client motivation[&lt;reflink idref=&quot;bib3&quot; id=&quot;ref65&quot;&gt;3&lt;/reflink&gt;] or offer precounseling interventions to bolster motivation[&lt;reflink idref=&quot;bib20&quot; id=&quot;ref66&quot;&gt;20&lt;/reflink&gt;]. Counselors can utilize MI and TTM strategies to help clients arouse concern, interest, or vision for addressing the status quo behavior.[&lt;reflink idref=&quot;bib7&quot; id=&quot;ref67&quot;&gt;7&lt;/reflink&gt;] Counselors can also employ strategies to move clients towards recognizing personal advantages to attending counseling.[&lt;reflink idref=&quot;bib9&quot; id=&quot;ref68&quot;&gt;9&lt;/reflink&gt;] Additionally, college counselors can divert precontemplative clients to pretreatment interventions, which can include having the clients view videos conveying the importance of motivation in symptom improvement, and requiring clients with low motivation to attend a pretreatment group session based on techniques aimed at increasing one&#39;s motivation to change.[&lt;reflink idref=&quot;bib38&quot; id=&quot;ref69&quot;&gt;38&lt;/reflink&gt;]&lt;/p&gt; &lt;p&gt;The results from this study indicated that students who attended compulsory counseling, who were also, on average, more likely to self-report a precontemplative stage of motivation, did not achieve significant symptom reduction. Similarly, Mun et&#160;al reported that students who attended compulsory counseling, or otherwise attended counseling under pressure from others, were more likely to be in the precontemplation stage.[&lt;reflink idref=&quot;bib39&quot; id=&quot;ref70&quot;&gt;39&lt;/reflink&gt;] The same was true for the present study. Using the rationale that sanctions alone can serve to heighten students&#39; awareness of the consequences of behaviors, Kiracofe and Wells suggested that instead of mandatory counseling following misbehavior, universities could allow students in the precontemplation stage to receive traditional punitive sanctions.[&lt;reflink idref=&quot;bib35&quot; id=&quot;ref71&quot;&gt;35&lt;/reflink&gt;] Conversely, this study revealed that compulsory status did not dispose participants towards poorer outcomes than noncompulsory participants, but stage of motivation to change was a significant factor to symptom improvement.&lt;/p&gt; &lt;hd id=&quot;AN0101588268-9&quot;&gt;Limitations&lt;/hd&gt; &lt;p&gt;Several limitations were identified. A limitation of the instruments was that client motivation data came from a 5-item self-report scale with high face validity. Subjects may have endorsed a motivation level based on image management, versus indicating the most accurate reflection of motivation to change.[&lt;reflink idref=&quot;bib40&quot; id=&quot;ref72&quot;&gt;40&lt;/reflink&gt;] Specifically, those students attending counseling as a result of judicial sanctions may have more cause to engage in impression management, indicating that they are in a higher stage of motivational readiness than their actual motivational stage.&lt;/p&gt; &lt;p&gt;In addition, due to a phenomenon called pretesting effect, the administration of a pretest on motivation may have served to enhance subjects&#39; motivation.[&lt;reflink idref=&quot;bib41&quot; id=&quot;ref73&quot;&gt;41&lt;/reflink&gt;] Experimental mortality, especially considering high dropout rates among university students at campus mental health clinics, accounted for a sizable limit of eligible participants.&lt;/p&gt; &lt;p&gt;Additionally, participant selection may not allow for generalizability, since the study examined 1 university mental health clinic serving a predominantly Caucasian, female, affluent student body. Additionally, the research site mental health clinic was part of a liberal arts, public university in the southeastern part of the United States. Research subjects at this type of university, and in this region of the United States, may not be generalizable to other university students at different types of universities and in other geographical regions.&lt;/p&gt; &lt;p&gt;Concerning ecological external validity, the study measured the dependent variable, differences in pre- and posttest administrations of the OQ.45.2, against the independent variable, motivation, regardless of the mental health therapists&#39; treatment modalities and personal characteristics. Since the research site employed mental health professionals and trainees with a variety of specializations, experience levels, and theoretical preferences, the subjects experienced different styles of psychotherapeutic services.&lt;/p&gt; &lt;hd id=&quot;AN0101588268-10&quot;&gt;Conclusions&lt;/hd&gt; &lt;p&gt;This study suggests that a client self-report of change readiness item is useful in identifying students who, by identifying themselves as &quot;precontemplative&quot; in motivation, are least likely to experience significant symptom improvement. Counselors in a university setting and those who train college counselors could benefit from future studies on brief motivation scales. A strength of the study is that it adds to the body of knowledge by reporting on client motivation and counseling outcome using a brief self-report of change readiness item that had not yet been studied. The scale is based on the 5 stages of change outlined in the TTM. Additionally, the study contributes to the body of knowledge by exploring the relationship of motivation and mental health counseling outcomes for college students who received compulsory mental health counseling due to a campus judicial sanction.&lt;/p&gt; &lt;p&gt;A useful future study would include a brief client motivation scale with less face validity than the client self-report of change readiness item used in this study. A revised client self-report of change readiness item with less face validity may decrease fear of stigma and subsequent efforts at impression management on the part of the respondents. It may also be useful to explore if the results regarding those clients mandated to counseling would apply in other settings, beyond the college counseling center (ie, mandated group/individual counseling following local or state legal mandate). Another direction for future study is to compare clients&#39; stage of change as revealed by the client self-report of change item against the stage of change yielded by the 32-item Stages of Change Scale.[&lt;reflink idref=&quot;bib21&quot; id=&quot;ref74&quot;&gt;21&lt;/reflink&gt;]&lt;/p&gt; &lt;hd id=&quot;AN0101588268-11&quot;&gt;FUNDING&lt;/hd&gt; &lt;p&gt;No funding was used to support this research and/or the preparation of the manuscript.&lt;/p&gt; &lt;hd id=&quot;AN0101588268-12&quot;&gt;CONFLICT OF INTEREST DISCLOSURE&lt;/hd&gt; &lt;p&gt;The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board of The Citadel.&lt;/p&gt; &lt;hd id=&quot;AN0101588268-13&quot;&gt;NOTE&lt;/hd&gt; &lt;p&gt;For comments and further information, address correspondence to Guy Ilagan, School of Education, The Citadel, 332-C Capers Hall, 171 Moultrie Street, Charleston, SC 29409, USA (e-mail: gilagan@citadel.edu).&lt;/p&gt; &lt;ref id=&quot;AN0101588268-14&quot;&gt; &lt;title&gt; Footnotes &lt;/title&gt; &lt;blist&gt; &lt;bibl id=&quot;bib1&quot; idref=&quot;ref1&quot; type=&quot;bt&quot;&gt;1&lt;/bibl&gt; &lt;bibtext&gt; Dr Guy Ilagan, Dr Vinson, and Dr Oberman are with the Counselor Education Programs at the School of Education, The Citadel, in Charleston, South Carolina. Dr Sharp is with the Department of Mathematical Sciences at Clemson University in Clemson, South Carolina. Dr Jill Ilagan is with a private psychotherapy practice in Charleston, South Carolina.&lt;/bibtext&gt; &lt;/blist&gt; &lt;/ref&gt; &lt;ref id=&quot;AN0101588268-15&quot;&gt; &lt;title&gt; REFERENCES &lt;/title&gt; &lt;blist&gt; &lt;bibtext&gt; Reetz DR, Barr V, Krylowicz B. The association for university and college counseling center directors annual survey. Available at: &lt;ulink href=&quot;http://files.cmcglobal.com/AUCCCD%5fMonograph%5fPublic%5f2013.pdf&quot;&gt;http://files.cmcglobal.com/AUCCCD%5fMonograph%5fPublic%5f2013.pdf&lt;/ulink&gt;. Published 2013. Accessed September2, 2014.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib2&quot; idref=&quot;ref4&quot; type=&quot;bt&quot;&gt;2&lt;/bibl&gt; &lt;bibtext&gt; Gallagher R P. National Survey of Counseling Center Directors. 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  Data: Exploring Outcomes and Initial Self-Report of Client Motivation in a College Counseling Center
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ilagan%2C+Guy%22&quot;&gt;Ilagan, Guy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Vinson%2C+Michael+L%2E%22&quot;&gt;Vinson, Michael L.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sharp%2C+Julia+L%2E%22&quot;&gt;Sharp, Julia L.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ilagan%2C+Jill%22&quot;&gt;Ilagan, Jill&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Oberman%2C+Aaron%22&quot;&gt;Oberman, Aaron&lt;/searchLink&gt;
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  Data: Routledge. Available from: Taylor &amp; Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
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  Data: 8
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  Data: 2015
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  Data: Journal Articles&lt;br /&gt;Reports - Research
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Counseling+Services%22&quot;&gt;Counseling Services&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Questionnaires%22&quot;&gt;Questionnaires&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Correlation%22&quot;&gt;Correlation&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Outcomes+of+Treatment%22&quot;&gt;Outcomes of Treatment&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Mental+Health%22&quot;&gt;Mental Health&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Health+Services%22&quot;&gt;Health Services&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Records+%28Forms%29%22&quot;&gt;Records (Forms)&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22College+Students%22&quot;&gt;College Students&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Student+Attitudes%22&quot;&gt;Student Attitudes&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Pretests+Posttests%22&quot;&gt;Pretests Posttests&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Student+Motivation%22&quot;&gt;Student Motivation&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Behavior+Change%22&quot;&gt;Behavior Change&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Statistical+Analysis%22&quot;&gt;Statistical Analysis&lt;/searchLink&gt;
– Name: DOI
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  Data: 10.1080/07448481.2014.1003379
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  Data: 0744-8481
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To explore the association between college counseling center clients&#39; initial self-report of motivation and counseling outcome. Participants: The sample was composed of 331 student clients who utilized a college counseling center from August 2007 to August 2009. The college is a public, mid-size, urban university in the Southeast. Methods: Motivation was measured at intake by a self-report of change readiness item. A quantitative study that employed a 5-group, pretest-posttest design included 331 student participants. Counseling outcome was measured using the Outcome Questionnaire 45.2. Results: As assigned by the clients&#39; self-report of change readiness, counseling outcome for 5 motivation groups differed significantly (p = 0.004; a &lt; 0.05). Compulsory participation in counseling was treated as a possible confound and was not a significant factor in counseling outcome (p = 0.268; a &lt; .05). Conclusions: Participants&#39; initial self-report of motivation was significantly associated with counseling outcome.
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  Data: 41
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  Data: 2015
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  Data: EJ1054948
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        Value: 10.1080/07448481.2014.1003379
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
        StartPage: 187
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      – SubjectFull: Counseling Services
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Correlation
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      – SubjectFull: Outcomes of Treatment
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      – SubjectFull: Mental Health
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      – SubjectFull: College Students
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      – SubjectFull: Student Attitudes
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      – SubjectFull: Pretests Posttests
        Type: general
      – SubjectFull: Student Motivation
        Type: general
      – SubjectFull: Behavior Change
        Type: general
      – SubjectFull: Statistical Analysis
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      – TitleFull: Exploring Outcomes and Initial Self-Report of Client Motivation in a College Counseling Center
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