The number of first-generation students on college campuses is rising, comprising 20% of new incoming students in higher education. First-generation college students (FGCS) do not access mental health treatment at the same rate as their non-first generation college student (NFGCS) peers and are at higher risk for leaving college early. The current study examines FGCS' presenting concerns for college counseling centers, their use of treatment, and degree of change relative to NFGCS through treatment. A sample of 7,160 students seeking individual counseling were selected from the 2012-2013 Center for Collegiate Mental Health (CCMH), a practitioner-research dataset, representing over 52 participating counseling centers. FGCS reported higher anxiety, academic concerns, and hostility but lower alcohol use concerns at first session, a similar number of therapy sessions, and greater change in hostility and eating concerns over a longer duration in treatment than NFGCS. Implications and future directions for this research are also discussed.