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By Allison Torres Burtka

November 2025

The traditional model of college counseling may no longer be a good fit on many campuses. A few years ago, the counselors at Old Dominion University (ODU) in Virginia had long wait lists and caseloads of 50 to 60 people each. That was “totally unmanageable,” says Joy Himmel, PsyD, LPC, RN, director of counseling services. “There were some students who never even got seen a whole semester.”

As more college students have sought help for mental health in recent years, counseling centers have struggled to keep up. And staffing shortages have worsened the problem.

In response, some centers have redesigned how they interact with students initially — providing more rapid access — and the counseling itself. Solutions include walk-in triage systems, drop-in or same-day sessions, single-session therapy (SST) or one-at-a-time therapy (OAAT), and a flexible-care or stepped-care model.

Some schools, including ODU, have completely overhauled their counseling. “I got the staff together, and we did some brainstorming about how we can reimagine how we do business,” Himmel says. A student typically attends three sessions, she says, “So does it make sense to have a traditional outpatient model where you spend the first session or two gathering information and treatment planning and they might only come back one time?”

Also, not every student wants in-depth psychotherapy, Himmel says. “We know that there’s a percentage of students out there that just want coping skills. They want a listening ear.” And they’re interested in quicker fixes.

ODU counselors changed their treatment approach, adopting a flexible care model that offers same-day appointments and sessions of various lengths. They take an abbreviated history in the first session. “We get information as to the history of that presenting problem, we do a risk assessment, and then we get right into a plan of care,” including recommendations for the type of sessions, whether that’s individual counseling, group counseling or self-paced wellness modules, Himmel says.

With SST and OAAT, the assumption is that the student wants to talk to someone once, for starters — not necessarily to begin long-term counseling. Sessions are typically shorter. “The idea is to right-size therapy to get the amount of therapy that the person needs at that time, with an open door, so they could come back later for more if they want,” says Michael Hoyt, PhD, a psychologist in Northern California and author of the 2025 book Single Session Therapy: A Clinical Introduction to Principles and Practices.

According to the Center for Collegiate Mental Health’s 2024 annual report, about 63% of counseling centers said a student’s first clinical contact is usually a full assessment of 45 to 60 minutes. About half said routine individual counseling appointments usually occur weekly.

North Carolina State University (NC State) shifted its approach to a triage model and walk-in hours, so students can schedule an access appointment or be seen that day. Traditionally, a student who was struggling would wait a couple of weeks for an initial appointment and then another week for their intake. “Some of them have lost their semester by then,” says Monica Osburn, PhD, LCMHCS, executive director of the Counseling Center and Prevention Services at NC State. Rapid access was needed to prevent students from dropping out.

Same-Day Access

Some counseling centers offer walk-in or drop-in spaces where students can be seen almost immediately. Several years ago, Louisiana State University’s (LSU) counseling center had walk-in crisis shifts, but students not in crisis waited for months. “We kind of took an old concept that they had been using in a way that wasn’t really effective, and we just retooled it for our walk-in or same-day access,” says Raime Thibodeaux, LPC, director of LSU’s Mental Health Service. All students were directed through the walk-in system.

Initially, staff worried: “Are we just going to be opening the floodgates if we open this up to both crisis and non-crisis appointments?” Thibodeaux says.

But it worked. “It nearly instantly reduced our wait time for new appointments from that three- to four-month stretch down to two weeks,” Thibodeaux says. Now, when students come in, counselors “get a sense of what brings the student in and what would be the best match for service that we offer based on what they’re saying that they need.” All the clinicians have a half-day shift for same-day appointments, and students are usually seen either immediately or within an hour.

NC State created “let’s talk” drop-in spaces in which counselors are embedded across campus at students’ home colleges. In these sessions, counselors sometimes find students need help with food insecurity, dropping classes or other issues. Counselors can point them in the right direction for help, and the students don’t need further counseling, Osburn says. Sacred Heart University in Connecticut revamped its services, introducing same-day counseling and switching from weekly counseling to biweekly appointments. This eliminated its once-long wait list.

“The students that they were seeing sooner really needed fewer appointments,” says James Geisler, PhD, NCC, LPC, executive director of wellness services at Sacred Heart. A student going through a relationship breakup, for example, who would have waited several weeks for an appointment, now can talk to a counselor right away, get strategies and skills, “and then they can feel like they have a better handle on their mental health,” he says.

Sacred Heart streamlined its intake forms “so that we have a better read of who the student is and what they’re coming in with before we even see them, and that helps us to home in on exactly what it is that we’re dealing with,” Geisler says.

Along with ODU’s other changes, it implemented rapid-access scheduling, in which students can schedule same-day and next-day appointments. After that, the next move is up to them — they decide whether and when to schedule future appointments. “The only exception we make is if the student endorses significant risk factors,” which involves scheduling them a few days out and monitoring them until they’re more stable, Himmel says.

Why It Works

“College students are notorious for wanting things to be at their fingertips in a timely manner. So when a student is struggling with anxiety, depression, situational stressors, academic distress, trauma, they want help now. They don’t want help two weeks from now,” Himmel says.

Even if students still have to wait for their first full appointment, being able to talk to someone in the short term is helpful. The rapid-access appointment is “a way for them to get a touchpoint more immediately, and then it makes the two-week wait for their full-length appointment a little bit more manageable because they’ve already had contact with a human. They already feel like their concern has been heard and that there is a plan of action for them being tended to,” Thibodeaux says.

Sacred Heart has found that, with less frequent appointments, students are “better adhering to clinical homework assignments and things of that nature because they realize that they have a significant amount of control over their well-being outside of the therapy office,” Geisler says. “Our model definitely has changed to helping students realize maybe they don’t need ongoing therapy. Sometimes they may just need to come in for a check-in.”

Giving students easier access helps demystify counseling, Osburn says. “Even in 2025, students still don’t really understand what it is and are often nervous about what’s going to happen. So when we create an environment where they can ask questions and be curious … we’ve found that they can connect with the process a little bit better,” she says.

More rapid access can make counseling services more equitable. It avoids a situation where “a few people are getting seen for the semester or the year, whether they really need to or not, and other people are waiting and waiting and waiting,” Hoyt says.

Challenges in Moving to Rapid Access

Balancing counselors who are available for drop-in and regular caseloads can be tricky. Because of the demand for drop-in appointments, NC State found it had to schedule drop-in times — they couldn’t truly be “drop-in.” Students sign up and say when they will come by. “We didn’t want to create a situation where folks were dropping by and then there was a long wait,” or have drop-in spaces with low attendance, Osburn says.

To avoid that problem, Geisler created a social worker position for someone who could both see students for same-day services and handle some of the counseling center’s administrative duties, so if students don’t show up for same-day counseling, the social worker has other work to do.

At smaller colleges, some of these approaches just won’t work. At Thiel College, a small school in Pennsylvania with only two full-time counselors, drop-in access isn’t feasible. “That would certainly be ideal, but with there only being two of us, our days are pretty booked. But we are flexible enough that if somebody has an urgent need, we will make sure that it is tended to,” says Melanie Broadwater, LPC, NCC, director of the counseling center.

This includes making sure to quickly assess students who might be at risk. Counselors can usually see students within a day or two, and they sometimes use telehealth to provide access to more students, Broadwater says.

In shifting to rapid access, getting staff to support that model may be a challenge. “Clearly, we weren’t trained this way. We were all trained in a traditional outpatient model,” Himmel says. “You’re getting into treatment with session one because that might be the only session you see that student.” This requires a shift in the counselor’s mindset, she says.

Adjusting to 30-minute sessions may take practice. “As clinicians and therapists, we are really trained to help open people up and talk a lot,” Thibodeaux says. A 30-minute appointment “forces them to be super focused in the conversation, and that’s just a different muscle that they don’t necessarily practice otherwise.”

Risk Assessment

In a rapid-access model, risk assessment may need to adjust. “All of our clinicians need to be prepared to do a risk assessment no matter what. For us, that needs to be a foundational skill, regardless of if you’re doing a ‘let’s talk’ session or triage or anything else,” Osburn says. This means helping early-career clinicians understand how to do a risk assessment in a brief therapeutic intervention style, rather than an entire psychosocial history, she says.

Mental health professionals often worry they’ve missed something, like someone who is suicidal or is experiencing domestic violence, Hoyt says. In shorter sessions, he says, it’s important to ask: Is there anything else you think is really important for me to know about today, before we talk about dealing with this particular problem? Counselors should also continue to practice ethically according to the �ֲ���ýCode of Ethics and follow all legal mandates.

Getting college students the support they need is vital. “From a developmental perspective, this is when so many developmental shifts happen,” Osburn says. “College students want the individuation but don’t always have all of the tools.”