by Spencer Biel and Katie Lewis
In December 2021, Surgeon General Dr. Vivek Murthy declared a youth mental health crisis associated with the coronavirus pandemic, pernicious effects of social media on self-esteem, and sluggish progress on issues like racial justice, climate change, and income inequality. More recently, he stated:
Our epidemic of loneliness and isolation has been an underappreciated public health crisis that has harmed individual and societal health. Our relationships are a source of healing and well-being hiding in plain sight—one that can help us live healthier, more fulfilled, and more productive lives. (U.S. Department of Health and Human Services 2023)
These sobering advisories have special application to college students, whose developmental tasks include transitioning from being a child in a family to an adult in the world. This process involves forming meaningful relationships, trusting in social structures, and cultivating community belonging. However, many students feel isolated, overwhelmed, and unsure whether the adult world is even worth joining. In this post, we consider emerging-adult loneliness through the lens of attachment theory. For those with histories of early adversity, trauma, and disrupted attachment, we propose that a psychodynamic systems approach can be especially helpful to address underlying drivers of loneliness and isolation and enhance belonging.
Loneliness is unavoidable. However, for people who have enjoyed safe, secure formative relationships, it tends to be bearable and temporary. In part, this is because when they are alone and stressed, they can call to mind experiences of being soothed by caring others. Further, loneliness signals a need for connection, and people who are optimistic about receiving help are more likely to reach out and to embrace what is offered.
In contrast, consider the experiences of Sophia, Brian, and Janice. Sophia is a college freshman who excels academically, leads several clubs, and rarely spends time alone. For Sophia and others like her, merely being in the presence of others isn’t enough to increase her capacity to build trust, express vulnerability, and invest in others emotionally. She feels both drained by her social performance and invisible, but the prospect of facing and sharing herself more fully and unguardedly fills her with dread. Brian, a sophomore, digitally cocoons himself in his dorm room and uses marijuana to mask his feelings. Janice, another sophomore, describes annihilating internal emptiness that she expresses through self-destructive behavior. Brian and Janice both feel horribly alone, but they worry that responding to friendly overtures will leave them open to exploitation.
To address the complex and debilitating loneliness experienced by such students, it’s essential to help them work through their mistrust, and this takes time, trained attention, and skillful coordination of dyadic and social learning. Implementing this sort of treatment on college and university campuses is a serious challenge, given resource limitations, pressure to provide short-term care, and overall strain on clinicians. However, through strategic partnership, it’s feasible. In November 2021, Austen Riggs Center launched a remote access Intensive Outpatient Program (IOP) for college students. In collaboration with on-campus counseling centers, we provide accessible, affordable, outstanding clinical care to students who require more than brief therapy, peer wellness support, skills-based approaches, or crisis stabilization. By working with insurers and delivering treatment remotely, we keep costs down (roughly 70% of the students who have participated in our program are on financial aid at their schools) while increasing access to care.
Our psychodynamic systems approach uses a reflective, integrative treatment model to grasp, bear, and put into perspective what patients struggle unsuccessfully to manage internally and in their relationships. The depth of engagement in twice weekly psychotherapy, typically over several months, helps patients address the mistrust, wariness, and dissociation they developed as protective measures in environments riddled with chaos, impingement, or other obstacles to trustworthy relationships. One patient described her experience as follows: “Getting to the root of problems was really important. It helped me feel validation in my struggles.” Another patient said: “How I interact with my emotions has really shifted. I am still an extreme person and that has not changed. But I do not have the same pain and suffering around those reactions. It’s also how I now interact with others and allow others to help.”
The intensity of individual psychotherapy is balanced by peer support and enhanced by social learning. Coordinated interpersonal environments (intensive therapy, medication management, process group, yoga and meditation, and coping-skills group) illuminate ways an individual’s expectations of others interact with social pressures, constraints, and opportunities. A former patient explained: “Being in groups helped me learn more about my own emotions…and not react the same way as before when I get emotional.” She went on to say: “It also helped me see some issues that I was having or have had in the past from a different perspective. It helped me feel less alone.”
Thanks to this more sustained and multidimensional approach, Sophia discovered that her exaggerated caretaking role in groups, which kept her invisible, had roots in her early experience of having a sibling with medical needs that demanded and often overwhelmed parental resources. She understandably harbored resentment, which in turn induced guilt that was channeled through damaging self-sacrifice. Sophia’s peers let her know that her constant busyness and visible exhaustion made them feel unable to reach her, which Sophia could now connect with memories of how she had experienced her beleaguered parents in childhood. This kind of supportive learning, facilitated by staff and peers, can create space to experiment with new ways of relating that can later be applied back at college.
We hope that Riggs’ partnership with colleges and universities can serve as a model for expanding services to under-resourced students while ensuring that treatment is of the highest quality and tailored to specific needs. The grim alternative these days is the proliferation of profit driven, time-limited individual services that, at their very best, offer convenience, a sympathetic ear, and rote coping skills—with little lasting efficacy. To address the epidemic of loneliness, individual suffering must be engaged within relevant social contexts rather than insulated within perhaps more immediately comfortable but ultimately more isolating “self-care.”
 In the interest of privacy, pseudonymous composite cases are used to illustrate a range of experiences we have heard from patients.
 The Riggs IOP is currently providing treatment to college students and emerging adults in Massachusetts and New York.
Office of the Surgeon General. 2023. Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. Department of Health and Human Services, Washington, DC, May 2023.