This article reviews the literature dealing with problems brought by student-athletes to college counseling and mental health centers. Among the issues discussed are fear of success; identity conflict; social isolation; poor athletic performance; academic problems; and career or vocational concerns. In addition, the authors examine the paradox that although athletes experience as much or more psychological distress as nonathletes, research indicates that athletes use professional services less often than nonathletes. Finally, the authors review approaches to psychological intervention, including short-term psychotherapy, very brief interventions, cognitive behavioral therapy, and career/vocational counseling, and discuss special considerations for conducting therapy with athletes.