Announcing Tuesday Group – A Therapy Group for 10 to 12 year-olds.

Tuesday group is a weekly therapy group for 10 to 12 year-olds, led by me, launching on January 7th, 2025.

Tuesday Group will meet on Tuesdays from 4pm to 5pm at my office in Porter Square, Cambridge.

While the aims of the group can be understood in many ways, the main aim is for members to accumulate positive experience being in a group through collaborating with each other and myself.

Children who have struggled to be members of groups (classes, family, social activities, etc.) are good candidates.

It’s possible to address a range of clinical and sub-clinical issues in a group therapy format. Whether your child is a good fit is best determined through conversation with me, on an individual-by-individual basis.

The group will launch with six members, and I am currently accepting placements. Please contact me if you are interested in more information.

How We Learned to Start Worrying and Forget the Unconscious

In times of anxiety, we reflexively reach for certainty. 

In our current anxious times we seek certainty by collecting and parsing data. -As if we could evade human biases, and unlock the code of human behavior with the right numbers. We say “data driven” and hope to assuage our audience’s anxiety.

Another recent trend in creating illusions of certainty is leaning on neuroscience to sell ideas. Neuroscience is often referenced to categorize people, and explain all kinds of human phenomena, to the same effect as a plot device in a science fiction piece. 

In Back to the Future, time travel is possible, and Marty and Doc can do it because of the flux capacitor. If we want to enjoy the story, we are wise not to ask too much about the flux capacitor. In our current cultural moment we are sold the idea that humans are easily understandable through neuroscience. Of course neuroscience is a valuable and vibrant field of study, my point is simply that neuroscience is often rhetorically used in this manner.

How fitting is it that the unconscious has seemed to slip out of cultural awareness?

Developing and popularizing our understanding of the unconscious was a major cultural contribution of Sigmund Freud and his contemporaries in the first decades of the 20th century. A basic understanding of unconscious motivations crossed over into mainstream culture in the following decades and informed how we think about relationships, dreams, individual behavior, and mistakes – such as Freudian slips.

An understanding of the unconscious remains fundamental to a sophisticated understanding of psychology, but in my experience, it has largely receded from popular culture. When I ask teachers whether they consider unconscious motivations when trying to understand their student’s behavior, I am generally met with blank confusion. I find it similarly absent in conversations with parents, and unconsidered within organizations. 

The vexing thing about the unconscious is that it is unknowable. It always remains a known unknown. We can agree that it is there, but we cannot be certain of what it contains. Any responsible and thorough effort to understand an individual or group must account for the unconscious, but we also must accept that we cannot verify our hypotheses. This is exactly the kind of paradox that is very unappealing, if not intolerable, in our times.

In keeping with the theme of unconscious factors, I would argue that as a culture we are largely fooling ourselves by pretending we can supplant healthy uncertainty with a false certainty offered by oversold data, or simplified “neuroscience”.  (In quotations here because I am referencing a rhetorical device, not the actual field of study.) And, I hypothesize that our awareness that we are fooling ourselves is repressed into our unconscious, and that the effects of this are manifested in growing generalized anxiety and rampant imposter phenomenon. 

Take a moment to reacquaint yourself with the unconscious – in yourself, in others, and in groups. I mean, slipping out of sight from the culture and stirring up our anxiety, resulting in surprising and neurotic thoughts and behaviors?  -Classic unconscious, am I right? While we can’t do an inventory of the unconscious, our awareness and consideration of it always make our understanding of self, others, and groups richer.

Practices, Policies, and Laws: Why We Must Differentiate Between Them in Special Education

I’ve come across a recurring issue in IEP meetings, special education meetings, and professional conversations: Many professionals don’t make clear distinctions between laws, policies, and practices. 

At first glance, I can see how this might not appear important, but the distinctions are of great importance. 

The rights of students and families, and the professional freedom of school staff, are impacted very differently depending on which category of constraint is being applied.

It’s taken some years of experience to see this, and it has helped to incorporate relevant lessons from my work. -Things I understand better now than I did toward the beginning of my career, about 20 years ago. Stick with me and we’ll put it all together.

One lesson is that the best way to understand or predict the behavior of a group of people within a system is to look at their incentives and disincentives. I’m by no means a behaviorist, and I am deeply interested in the complex motivations of any individual, but there is no better way to understand the behavior of an otherwise anonymous class of people.

Laws, policies, and practices are efforts to apply logic to our work with students and families. Another lesson from my therapeutic work is that the benefits of logic are limited. Still, we should endeavor to get as much benefit as we can from it. This requires us to make distinctions between laws, policies, and practices. From what I can perceive, many people group these three things together in a conceptual category called something like “rules.” 

I will break them down briefly.

Practices can be defined within an organization simply as “what we usually or always do.” 

Policies in the context of schools are the written organizational directives and limitations set forth by school administration.

Laws are rules set forth by the government at local, state, or federal levels, and are enforced through consequences delivered by those same entities.

Pretty simple, right?

Why are the distinctions important?

A school’s practices may or may not be consistent with their policies. A district or school’s policies may or may not be consistent with law. And various parts of special education law are subject to different interpretations. You can see that it really matters what category is being discussed in any given instance. They draw on very different levels of authority and are therefore more or less subject to negotiation in the collaborative special education process.

It’s easy for anyone involved in special education to feel overwhelmed, bulldozed, inadequate, and other unpleasant experiences. This includes students, families, teachers, paraprofessionals, administrators, and counselors. It is the responsibility of school staff to be aware of the distinctions between practices, policies, and rules. We cannot expect the same of students and their families. In fact, we have a great responsibility as paid professionals to make these distinctions clear to parents and guardians, and students as developmentally appropriate. 

I will illustrate with the example of a parent of a child who is in the special education eligibility determination process.

The parent feels that an autism screening should be included in the eligibility evaluations. The special education administrator tells the parent that the district cannot include one. The special education administrator does not indicate whether their position is based on their opinion of what is appropriate, a school or district policy, or a law. (For the record it’s a position based on their opinion, which is up for discussion and negotiation among the team including the parent.)

The special education administrator is in a position of great power relative to the parent. Meetings generally take place on the administrator’s home turf, they are experienced with these meetings, and they are the experts on special education. The parent on the other hand enters the administrator’s turf for the meeting, may have never had any experience with special education meetings, and is not trained and experienced in special education. We can generally assume that the parent is under stress in this situation, and not in a good position to challenge the declarations of the school administrator. In most cases, the parent is likely to assume that what the expert school administrator says are simply “rules.” 

Given these circumstances, when the school administrator says “the district cannot include an autism screening” without explaining whether this is based on opinion, practice, policy, or law, I consider this an abuse of power. In the collaborative process of special education, district employees have a responsibility to delineate the scope of their authority in any given instance.

Unfortunately, this example is not the worst of it. I’ve certainly heard school officials make reference to non-existant “rules”, which they probably believe exist somewhere. This is hilariously and poigniantly described in this article about Cambridge Public Schools serving cold cheeseburgers to students with autism. It becomes more problematic as we incorporate my lesson regarding incentives and disincentives, and consider conscious and unconscious motivations as we must in order to account for the behavior of individuals and groups.

While the example offered previously is clearly sympathetic to the parent, I am also sympathetic toward the school administrators. They are almost always under a lot of pressure to preserve the resources of the school district by keeping spending on special education as low as possible. Depending on their district and superiors, their job security is either largely or entirely dependent on their ability to restrain services/spending. The risk of losing their job threatens not only their income, but also their membership in their work community, and their identity as school officials. Those are the big and easy incentives to understand but there are also more gradual incentives, such as making decisions that keep the school administrator in the good graces of their boss and make their next meeting with them more pleasant.

Addressing sometimes unconscious motivations, the school administrator is not particularly motivated to delineate between practices, policies, and law. In fact, they may not be especially motivated to even understand the differences between practices, policies, and laws. Having a fuzzy understanding may actually be a better position for them to restrain spending from, and therefore maintain their income, employment, and good graces of superiors. And, increasing my sympathy for the school administrator, they are often pressured and expected to behave as if special education laws are clear and coherent, despite the fact that they often are not. These pressures leave school administrators, teachers, and counselors exquisitely primed for imposter phenomenom, as described in a previous column (Where Special Education Law Meets Imposter Phenomenon).

One path toward increased personal freedom and agency is in becoming more aware of our motivations. That’s a kind of growth that can happen on both individual and group levels. It frees us up from our habitual reactions, and liberates us to consider a wider array of possibilities. If you work in special education, it’s your responsibility to understand and clearly delineate between practices, policies, and laws. It will also make you better and more free in your efforts to serves students and families.

Therapeutic Program Community: Where Is Everybody?

This is the last in a series of 10 opinion articles about inclusion and mental health in schools.


By my estimation, there are thousands of programs in school districts across the United States for students with significant social, emotional, and behavioral challenges. Many programs are segregated from general education, while others practice inclusion models. Due to budget imperatives and least restrictive environment rules, this has been true for many years. These programs exist internationally as well, which is even more difficult to enumerate.

Laura Balogh and I had significant experience to draw on when we were tasked with designing a new therapeutic inclusion program in 2019. On top of our experience, we looked for published resources we could use to draw inspiration and to reference in support of our ideas.

But, having looked for relevant resources before, I knew there were very few. The lack of professional discourse about our work was, and continues to be, a subject of great puzzlement for me. In the early days of our program Laura and I decided to write The Therapeutic Inclusion Program so that there would be at least one reference specific to therapeutic inclusion programming for others to use, and hopefully prompt further conversation and writing in the community.

So, where is everybody? I have found I am more likely to meet and have a conversation with someone who works in a therapeutic education program at a random event like a concert than I am in seeking professional exchanges online.

There are vibrant and active professional communities and conversations around psychology, and education, taking place online and in the publishing world. Why is it that in these same arenas, people do not want to talk about the important work of educating students with significant social, emotional, and behavioral challenges?

The work of inclusive therapeutic education is endlessly interesting and deeply important. Furthermore, significant budgetary resources are at stake. To me, these factors and others indicate that inclusive therapeutic education is well worth talking about, and in fact needs to be talked about. 

The work of inclusive education for this group of students is deeply interesting. In school, our students must grow their way through academics, social demands/opportunities, their orientation toward authority, and that’s just scratching the surface. The challenges and opportunities of being employed in inclusive therapeutic education are no less dynamic and interesting. 

The work of educating students with significant social, emotional, and behavioral challenges could hardly be more important! In our roles as inclusive educators we have a tremendous and exciting opportunity to have a positive impact on students and families that are struggling. This opportunity has always been the most energizing part for me. We meet students and families at a critical juncture in their lives, where it is possible through our work to support a more positive trajectory. The impact of our efforts potentially resonate far into the future. The work is as rewarding as it is challenging, and well suited to those of us who thrive under these conditions with the right support. 

Regarding the budgetary concerns, school districts are spending a lot of money on out-of-district placements, and in-district programming for our population of students. The expense of out-of-district-placements, in Massachusetts for example, easily average over $100,000 per year, per student (Murray & Balogh, 2023, p.136). Creating programming in-district is also expensive, as far as hiring and maintaining staff. The well-being of program children, staff, and families are more than enough reason for robust professional conversation. However, if anyone needs something more measurable, how about dollars? While districts spend big money on programming for students with significant social, emotional, and behavioral challenges, they have almost no idea and very few resources to draw on regarding what actually works.

We need to talk about what works and what doesn’t seem to work in inclusive education for students with significant social, emotional, and behavioral challenges. What should we measure? What is the value of our measures? And, what is immeasurable? Like any arena of work, we should be developing and revising best practices in robust conversation in person, online, and in published material. 

Tell me, what do you think?

References 
Murray, M.A. & Balogh, L. (2023) The therapeutic inclusion program: Establishment and maintenance in public schools. Routledge.

What Happened to Therapeutic Work In Schools?

Given that you are reading this, the term “school counseling” is probably familiar. What about “school therapy”? This is not a term that people use. Why not?

Our word choices signal cultural concerns and priorities. While counseling and therapy are not clearly distinguishable, “counseling” connotes a goal-oriented, problem-solving approach with a relatively predictable arc, while “therapy” connotes deeper, exploratory, holistic, and less predictable mental health care.

Our culture has chosen the word “therapy” when we want to communicate depth in areas where some underappreciate the seriousness of the work: speech and language therapy, occupational therapy, physical therapy. 

We don’t say “occupational counseling.” We have physical therapists, occupational therapists, and speech and language therapists. Using the word “therapy” reinforces for practitioners, students, and families that the work at hand is significant. 

“Psychotherapy” is therapy for the psyche. But generally, we don’t call therapy in schools “psychotherapy,” and we don’t refer to school counselors as therapists.

We know the psyche is powerful, complicated, and of great consequence to our development and lives. However, we don’t understand it as confidently as speech and language, or the mechanical workings of the body. So, we use the word “counsel” to reassure the fearful that we won’t be venturing too deeply into this unknown territory from school.

This same fear drives the types of mental health and behavior interventions prevalent in schools. Behaviorism dominates, -an explicitly and intentionally surface-level approach. After that, we find “strategies and toolboxes”, with their bases in cognitive behavioral therapy (CBT). 

Behaviorism addressed behavior (unsurprisingly). CBT can help a student try different ways of thinking, but only if the student cooperates with the therapist sufficiently to perceive the same issues and is willing to try what the counselor suggests.

Outside of schools, we find a wider array of mainstream mental health therapies. Among the important differences, we find therapists and therapies that acknowledge the importance of the unconscious in individuals, families, and groups. And, we find therapists and therapies supported by the long and mainstream tradition of ongoing supervision for mental health clinicians. 

Our schools imagine that they can address the complex and deep mental health issues and crises in schools without core concepts and supports from mainstream mental health care. As you probably are aware, this isn’t going well.

I can’t confidently account for why school’s responses to mental health concerns have diverged so significantly from mainstream approaches in mental health care. But, I can identify some of the forces at work. 

One is budgetary. The cyclical nature of school budget growth and cuts pushes relentlessly for efficiency. Despite clinical supervision being a core component of mainstream mental health care, it was cut from the budget for school counselors long ago, and no clinical supervision for school counselors has long been the norm. With no supervision, the scope of work that is possible narrowed toward simpler and more surface-level interventions.

There is also the economics of working on a large human scale. To be efficient, the schools must find the smallest interventions that are effective for the largest number of students. This naturally steers schools toward surface interventions and away from more sophisticated work.

Additionally, there is the force of fear on which this article opened. 

There are benefits to these tensions. Minimal effective interventions are a good thing, and preserve time and resources for other learning concerns, from both the school and student perspectives.

The problem is that school mental health has developed over decades under these forces, and has diverged from mainstream psychotherapies to the point where schools no longer have the knowledge reservoir or practice familiarity needed to effectively address many mental health presentations. 

CBT is a valuable approach and helpful to many people. Regarding behaviorism, it’s crucial to understand and apply the lessons of behaviorism in interventions concerned with behavior. However, the insights of behaviorism should be integrated into a larger relational and humane approach.

To better provide support for student’s mental health, we must provide clinical supervision for counselors and introduce concepts and approaches from mainstream and effective mental health care. This will benefit the school population at large, and especially those students with significant mental health concerns for whom CBT and behaviorist approaches are often ineffective. 

Frequently, these students are removed from their familiar home school communities and sent to much smaller private therapeutic schools that do not have the breadth of resources of larger public schools. These private therapeutic school placements are extremely expensive for the school district.

What do these private therapeutic schools offer? Many have a clinical supervision structure, and familiarity and comfort with more sophisticated mainstream mental health concepts and interventions. If school districts want to expand their capacity to serve students effectively in their home communities, and avoid expensive private therapeutic school placements, naturally they will have to build their capacity to do similar therapeutic work.

References 

Murray, M.A. & Balogh, L. (2023) The therapeutic inclusion program: Establishment and maintenance in public schools. Routledge.

Stone, M. (2023). Why America has a youth mental health crisis, and how schools can help. Education Week, https://www.edweek.org/leadership/why-america-has-a-youth-mental-health-crisis-and-how-schools-can-help/2023/10.