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.