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The action shots on Karen Tang’s social media accounts match the public image she tried to project. In them, she’s wearing a University of Maryland gymnastics leotard, a smile plastered across her face. The snapshots capture perfectly executed vault routines. For those viewing from the outside, Tang exudes joy.

But those photos obscure the truth. Tang was struggling. Her anxiety levels would spike during the vault. Subconsciously, she says, the event scared her. A bad practice would ruin her day, and she didn’t know how to express her feelings to her coaches. 

It took seeing a sports psychologist for Tang to identify and uncover those issues. By that point, she was more than halfway through her senior season.  

“I think growing up I always had anxiety,” she says. “I never really identified it until college. I come from a very traditional Asian household. My mom doesn’t believe in mental health issues. I always thought normal people didn’t have mental health problems. When I was in college, I had a variety of challenges: mentally, emotionally, physically.”

Like most collegiate programs, Maryland did not have a full-time sports psychologist in the athletics department. Tang, who finished competing at the collegiate level in 2015, can’t recall the team ever bringing anyone in to talk to the athletes about mental health. The psychologist she visited worked in the counseling center, located over a mile away from the Maryland athletics department on the sprawling College Park campus.

But some universities, including local programs in recent years, have taken steps to respond to the student-athletes’ needs. Tang hopes that means situations like hers will be spotted sooner.

“I wouldn’t change my experience,” she says. “Yes, I went through some mental health issues, but if I had the support I needed from the beginning, like freshman year … I think it would have just made me better if I had those resources in the beginning.”

***

In 2014, the NCAA released a 120-page handbook, entitled, “Mind, Body and Sport—Understanding and Supporting Student-Athlete Mental Wellness.” Brian Hainline, the governing body’s chief medical officer, said in the introduction that the primary challenge from a health and safety standpoint for student-athletes is mental health and wellness.

“Only recently have we begun to fully understand the mental health component of being a student-athlete,” he wrote.

The resources seldom match the demand for sports psychologists at the collegiate level, including at the major Division I universities in the D.C. area. While athletic programs often have multiple physical trainers working fulltime, “the sports psychologist’s role in college sports has evolved more slowly than student-athletes’ needs,” psychologists Chris Carr and Jamie Davidson noted in a blog post written for the NCAA in conjunction with the release of the 2014 handbook. 

Few programs have a full-time sports psychologist or mental health professional on staff, and others rely on the school’s counseling center or a part-time consultation model, which can present hurdles for student-athletes.

American University works with Brian Levenson, a mental performance coach who has a master’s degree in sports psychology from John F. Kennedy University, but he defers clinical help to the school’s counseling center. The George Washington University also relies on its counseling center to provide mental health services for its student-athletes.

“If you have somebody in-house, that’s always helpful,” says Chris Hennelly, the associate athletic director of student-athlete health, well-being, and performance at GW, “but we’re very fortunate to have a very good system in place with trusted and valued campus partners.”

Other local schools in recent years have incorporated the NCAA’s ideal model—and the one Tang, now 26, wishes she had: a full-time athletics department sports psychologist. 

Maryland hired Dr. Michelle Garvin, the director of clinical and sports psychology, to its athletic staff in the summer of 2017, and Parker Tims, a licensed clinical professional counselor, joined the Terps last year. Both work within the athletics department inside XFINITY Center.

At Howard, Dr. Lisa Haileab has been the athletic department’s sports psychotherapist since October 2017. She has a PhD in counseling psychology from Howard and is working on getting certified to become a licensed sports psychologist. 

“I’m positive about the growth,” says Garvin, a licensed psychologist in the state of Maryland. “Colleges are recognizing this, and creating positions, which is really encouraging.”

Georgetown University has an embedded head of athletics counseling service that works fulltime within the athletics department, according to Shawn Hendi, the associate athletics director for student-athlete health and wellness. The sports psychologist position, which the school recently filled, is overseen by the Counseling and Psychiatric Services (CAPS) on campus.

Having someone housed within the athletics department can be critical.

“Proximity is a huge factor for two reasons,” says Garvin. “Time demand, walking across campus could take 15 minutes … Also being housed in athletics allows us to build relationships with student-athletes that we aren’t even meeting with. It helps with stigma reduction, and then the culture of athletics, it helps to have someone who understands what that looks like. That’s really important as well.”

***

Daniel, a sophomore on the Howard football team, went into his first meeting with Haileab with low expectations. He had never been to therapy before and his attitude toward it had been shaped by images of someone sitting in a chair, quietly listening, but not offering much help. 

He soon discovered that wasn’t the case.

“I guess the stereotypical [thinking of] this is just a person who’s going to write down my problems and then do nothing about it,” says Daniel, “but Dr. H, she’s really helped me a lot since I’ve been at Howard. I’m greatly appreciative of her.”

(City Paper is identifying the player with a pseudonym because he spoke on the condition of anonymity.)

Student-athletes are expected to excel in their sport in addition to dealing with the challenges of being a full-time student. Players in high-profile revenue sports like football and basketball have the added pressure of being recognized on campus. They are, in some cases, teenage celebrities. 

Not everyone can handle this role successfully, and the feeling can be isolating.

“I’m a football player so I’m supposed to be seen as tough, barely go to class,” Daniel says, “but that’s not what football is all about. We actually go to class, and we actually struggle with day-to-day activities outside of football.”

Social media can also play a role, as it did for Tang. The photos of a happy, healthy athlete may serve as a mask for unspoken problems. 

“People always feel like they need to put their best selves in front,” says Tang. “I think it’s harder to stand out. I think social media tries to help, but is also a bad influence.”

“Everyone is just advertising the best versions of themselves,” adds Haileab. “It can contribute to the development of anxiety, that you’re only celebrated if you’ve won.”

In recent years, professional and high-profile athletes like NBA star Kevin Love, NFL wide receiver Brandon Marshall, and Olympic swimmers Michael Phelps and Allison Schmitt have opened up about their mental health struggles, helping to destigmatize mental health disorders.  

Their stories may encourage athletes at all levels to realize it’s OK to seek help, that it doesn’t mean you’re weak.

“I just think it’s very important to look at the pedestal in which we may place student-athletes or different teams, where they can constantly be held to such a high standard that it’s unrealistic, and they have to adhere to these perfectionistic norms,” Haileab says. “It’s important to help them see it’s OK to make mistakes. It’s OK to have issues, and it’s something that can be worked through.”

By working with Haileab, Daniel says his performance on the field improved as a result of a boost in self-esteem. It made him look at football, and his stature on campus, with a different perspective. He started playing with more confidence. 

“I always speak about how we provide mental health and sports performance services, but can’t separate those two, they’re intrinsically linked,” says Garvin, the Maryland sports psychologist. “There doesn’t have to be something wrong to work with us. We’re here to enhance performance and mental health and life experience.”

Having Haileab accessible at Burr Gymnasium also made a difference for Daniel. The counseling service, where Haileab also has an office, is a seven- to eight-minute walk from the athletics department. He now meets her about once a week, including during the off-season, and has no plans to stop.

“Being at Howard became easier after I started seeing Dr. H more,” Daniel says. “I meet with her for a one-hour session. I get everything off my chest, and after that I just feel good.”

***

Working with a sports psychologist changed Tang’s life. Her communication with her coaches improved, and she felt more confident while performing under pressure. The need to prove herself on social media subsided.

She competed on the vault at 13 meets her senior year and tied a school record and set a personal best twice on bars in 2015 during her fourth year on the team. (Tang did not compete her freshman season.)

Tang is inspired by the fact that Maryland athletics now has a full-time sports psychologist. It’s a step in the right direction, she believes. But one person, Tang adds, can only do so much. She points out that she didn’t connect with the first psychologist she tried. That doctor worked in D.C. and didn’t have a deep understanding of gymnastics. 

If money wasn’t an issue, she says, a student-athlete would be able to meet with someone who played their sport. “My sports psychologist understood what my mental block was, understood skills I was doing,” Tang says.

Garvin is hopeful more change is coming.

“I’d ideally love to see sports psychology as integrated as sports medicine and strength and conditioning,” she says. “I don’t know what that looks like in terms of numbers, but we plan to continue growing.”