Tag: mental-health

Adolescence – School Episode – Take it Personally

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I watched episode two of the Netflix series Adolescence last night. 

It’s the episode that takes place at school, and it’s easy to see what’s wrong with the school depicted. It’s something I’ve often seen in real life.

The problem is that the school staff is not taking it personally. 

Many illustrative examples of this follow throughout the episode as they roam the hallways and classes, but the first time it got my attention was early. One student steps into another student’s personal space, aggressively backing him against a wall, and demanding money. A teacher walks by and tells him to stop. The bully stops. The teacher continues on to their destination. 

The teacher has achieved something close to nothing with this interaction, because the teacher didn’t take it personally.

It’s not nearly enough for teachers and school staff to simply tell students to follow rules in a technocratic and impersonal manner. While it is necessary to maintain basic rules, that is a very low bar for what we can expect from school staff. It cannot, on its own, engender a healthy and safe school culture.

Now, there is a certain way in which I encourage school staff to take it personally, and it is not in the I/ego sense. When it comes to their own personal ego and vulnerabilities, school staff often need help with not taking it personally. Not taking things personally, in this ego-based sense, is one of the greatest gifts one develops when becoming a mental health professional, and I strongly encourage teachers to develop this.

What we must take seriously and personally is the authority vested in us as school staff. In an effort to remain safe and secure, the students have a narrow range of options and no authority. School staff, on the other hand, have many options and are part of a whole network of adult authority.

The students are counting on us to keep their school environment safe. What you should take personally is any assumption that you might abdicate such a responsibility. -That you would look away, whether they are acting out, or in danger.

The bully demanding money is taking their aggression out on their target, which is very personal to both the bully and their target. (And to be clear, the interaction is not about money, it’s about dominance.) That personal aggression is intense and will not simply evaporate. The school staffer’s job is to get the bully to transfer their sense of conflict to the school staffer, who is standing in for the expectations of the entire school institution. You transform the conflict from existing between the bully and the target (who has no or limited options in protecting themselves), to the conflict existing between the bully and the institution of school (which has many options and a network of supporting adults).

When you are a school staffer, the authority vested in you means you are “on watch”, and the vibe about behavior that threatens a safe learning environment should be “not on my watch.”

I also encourage teachers and school staff to pay attention to not just the obvious incidents, but also to the sense of threat in the environment. This is something teachers should largely trust their personal sense about, maintaining classes that are safe-enough and also feel safe-enough. Sometimes, I see the bar set so low that nothing is considered an offense or worthy of concern unless a student is getting injured. This is a desperately low bar, and we must aim much higher than that. We can’t have a real learning environment otherwise.

More teachers and school staffers should add incredulity to their mix of available responses to school behavior. Violence is both terrible and absurd. It is an absolutely horrible way, and an absolutely ridiculous way, to address a need or challenge. I find it helpful to respond with incredulity to students who are threatening violence. In doing so, I am projecting onto them the basic requirements of civilization. Your response to threatening language may be as simple as “No, you’re not.” The vibe, which usually goes unsaid, is: The idea that you would act out violently on my watch, in the school where I work, is absurd. I take it personally that you would imagine I would stand for such a thing. 

In addition to shutting down the idea of violence, we must have empathy for our students and be prepared to work with them in developing and accessing non-violent ways to address their needs and challenges.

Student-centered Group Counseling in K-12 Schools – An Online Learning Session

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On Sunday, May 4th I’ll be providing an online learning session where you can earn CEs, through the American Group Psychotherapy Association. Groups are a very popular form of providing counseling in schools.

Groups also can be a source of frustration for school counselors, with a sense of missed opportunity.

In this session, I will share about effective group counseling in schools.
-Groups where students will develop self-regulation and build social ability, while remaining organized around the concerns of the students. Student-centered.

I’m excited to share what I’ve learned and developed with school educators, counselors, and other specialists who run groups in schools.

Registration link: https://portal.agpa.org/commerce/store?productId=commerce-merchandise%23AGPA-AU20250504CE

Therapeutic Program Community: Where Is Everybody?

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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?

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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.

The Importance of “We’re All In This Together”

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When you hear “that’s not in my job description” it’s a discouraging indication regarding staff morale and staff’s ability to work as a team.

I’m writing from a place centered on inclusive school programming for students with significant social, emotional, and behavioral difficulties. These programs are sometimes called “therapeutic programs.”

What our students need most from staff is reliability and adults who work together. The best way to provide this dependably is through the overlap of staff functions. When the abilities of staff members largely overlap, a resilient and flexible net is created, with the security provided by redundancy. By “redundancy” I mean that if one staff member is out sick or otherwise unavailable, other staff members are capable of doing the same work.

I visualize this as overlapping circles of ability and responsibility. This is what we want, as opposed to unique staff abilities and responsibility gaps that make a program rigid and unreliable.

So, what does healthy staff overlap look like in more specific school situations? Here’s a concrete example of what I mean: If a therapeutic program has a counselor and a special education teacher, the special education teacher will be doing plenty of counseling, and the counselor will be educating. They will often work side by side. I advocate for referring to them both as “therapeutic educators.” 

Naturally, over the course of their time and experience, they will both become better teachers and counselors. We should continue to respect their individual expertise and leadership within their unique roles, while adopting a flexible approach toward responding to the needs presented by the students.

Supervision is an important part of the program model I advocate for, which is an essential support to anyone doing therapeutic work – counselor, teacher, and paraprofessional included.

Similarly, when therapeutic program staff supports inclusion in a general education classroom, the ‘all in this together’ mentality makes all the difference. The general education teacher is responsible for educating all the students in the room. The therapeutic program staff member is responsible for providing needed support and accommodations to program students so that the general education teacher can deliver instruction.

Without losing sight of these clear priorities, there is room for overlap and flexibility, making for a much richer and more collaborative experience. The therapeutic program staff member can be supportive of the entire classroom. If the general education teacher and therapeutic program staff member are both sufficiently skilled they may trade roles at times, with the general education teacher providing specialized support while the program staff member holds and teaches the classroom group. In practice, this can be quite fluid. (If you’ve ever played basketball, it’s a lot like switching your defense assignment on the fly in person-to-person defense.)

Every staff member in the school is ultimately responsible for doing what they can to make the whole school function the best that it can. This mindset mutually supports the inclusive mindset we must have with the students. Alternately, when program staff has a siloed mindset, the program students experience siloing as well.

As a staff member of a therapeutic program, helping students and staff during the random opportunities that come up in a school day supports your prime responsibility of helping your program students receive non-stigmatizing, appropriate, inclusive education. I suggest seizing any opportunity that doesn’t actively interfere with your ability to attend to your primary responsibilities. 

As far as your job description/contract goes – I do think it’s important to maintain your lunches and preps, and to keep your work within your paid hours. That is part of avoiding burnout, staying with the work long-term, and building program stability.

When you’re ‘on the clock’, and not in your prep or lunch times, just do whatever you can to help the school. It will pay off in a better experience for your students and your school community.

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