When Kyra* is in class, her therapist is sleeping. When she sits down to eat dinner, her therapist is just beginning to wake up for the day.

Although Kyra studies at Penn, her therapist lives in their shared hometown in Korea. Philadelphia is eleven hours behind Korean time, so when Kyra Skypes her therapist at 8:00 a.m., it’s 7:00 p.m. in Korea.

Kyra and her therapist have been working together since 2011, when Kyra was still in high school. Now, she is a College junior, and they communicate mostly through Skype video calls and occasionally over the phone. Even though Skype isn’t an ideal way to communicate—the video is often blurry and glitchy—their relationship works.

"You're not seeing someone at CAPS with the intention of sticking with them for however many years you need in order to feel better."

Kyra is among an assortment of Penn students who seek therapy outside of the school–provided Counseling And Psychological Services (CAPS). Although CAPS is prominently promoted by Penn for anyone experiencing mental health concerns, some students decide to use other resources.

On two separate occasions, Kyra sought help at CAPS. The first time, in 2012, the wait to see a clinician was almost a month long, and she did not attend the appointment. The second time, a CAPS practitioner referred her to another therapist in Center City, but Kyra found the transportation too daunting to continue going.

“If I’m struggling going to class two minutes away from my room, how do you expect me to make my way all the way to 16th Street every week?” Kyra said. “If I can make my way there, I think it already proves I am better—which I was not.”

Because they've known each other for more than five years, Kyra and her current therapist have an established relationship. When Kyra decided to take a leave of absence from Penn, her therapist coached her through the process and her subsequent return to school.

Because CAPS uses a briefer model of therapy—generally a few sessions per semester—to accommodate for its high demand, students usually have to find other outlets for more sustained treatment. CAPS has a network of referrals that they use to place students with other doctors in Philadelphia for specialized or longer–term treatment.

“Some people come and they may have had a therapist before. They are interested in a long–term relationship, maybe for several years,” Dr. Bill Alexander, the Director of CAPS, said. “And we say that they’re better off finding someone in the community.”

“They're kind of temporary,” Kyra concurred. “You’re not seeing someone at CAPS with the intention of sticking with them for however many years you need in order to feel better.”

"Every time you switch, you have to start over...I didn't want to recount things that were traumatic to me, over and over again."

Like Kyra, Elly* decided to continue seeing her therapist from high school when she enrolled in Penn this fall. She takes a forty minute–long train ride to her hometown for her monthly appointments. Elly also cited the benefit of continuing an established relationship with her therapist.

“It’s really hard to develop a connection—it took me a year and a half to get there with Eileen,” Elly said, “so I didn’t want to abandon that when I had the option of taking a five dollar train ride and seeing someone who knew my history.”

Even though the train ride routine can be inconvenient, Elly prefers continuing her long–term therapy rather than completing a shorter stint at CAPS.

However, Melanie* didn't have a therapist from home who she could see in college. She went to a few sessions at CAPS, but decided to go someplace else after she didn’t get along well with the therapist she was assigned.

“To be honest, I felt like she was very judgey,” she said of her CAPS practitioner.

She now sees a different CAPS–recommended therapist in Center City, whom she is fond of. Although CAPS allows students to switch therapists, Melanie was apprehensive after her initial bad experience. Private practices allow clients to sample many different therapists in short phone conversations to see which one is the best fit.

“Every time you switch, you have to start over, basically,” she said, “and I didn’t want to have to recount things that were traumatizing to me, over and over again.”

However, many students at Penn don’t have the ability to go outside the CAPS system. For students who would prefer that their parents don’t know they’re seeing a therapist, or do not have the financial resources to afford the copay, the only option is CAPS. According to Melanie, CAPS–referred therapists cost between $120 and $180 per session, which is obstructive for some students.

Referrals are essential to make sure the CAPS waitlist is short for incoming students. Currently, it is eight days long—although Dr. Alexander says it traditionally gets longer as finals approaches.

* indicates name has been changed