March 13, 2025 Read Time: 10 min
Mental Health
Find the full series of Craig's blogs here.
In this article, we’re going to move beyond mapping what we have and instead focus on what supports are available. To start with, we’re going to discuss two general mindsets for counseling services in schools. The first is that everyone involved–the student and staff alike–have to be crystal clear on what they’re working on. The second is that schools must prioritize strengthening student skills, rather than soothing negative emotions if they want students to eventually gain independence. I will also discuss several specific evidence based practices that are relevant to schools.
Counseling Mindset 1: “What Are We Working On?”
When I started working with a student, one of the most revealing things to learn about was their previous encounters with counseling or therapy. I often asked them what they had learned or what had helped. Way too often I got a blank answer: “I don’t know. We just talked.” Generally, they liked the person they were working with, but they had no concept of the work itself.
I really didn’t intend for it to be a trick question or one that was so difficult to approach. I thought maybe that they were shy or we just hadn’t developed enough of a rapport to talk about these things clearly. But when I asked the same question to students I had been working with for a long time and had built great relationships with, I surprisingly got an identical response most of the time: “I don’t know.” Even with some scaffolding and prompting, it was hard to get a response. It was shocking, because I thought I had been super clear about what strategies we were using!
This really crystallized for me when a student explicitly told me that they liked talking to me, but they really wanted some sort of help making decisions on their own. They asked if I could give them a structure for thinking through problems and a way to practice it. This was especially a shock to me because I thought I had been doing Cognitive Behavioral Therapy (CBT) the entire time which revolves around that exact type of metacognition (thinking about thinking).
To me, that’s a red flag. Now I’m not expecting students to sound like a psychology treatment manual and be able to rattle off theories or case conceptualizations. But it seems like they should at least have a general idea of the following:
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what area our work was focusing on
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what skills they were bringing to bear to deal with their problem
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how they were doing
For example, say a student was having panic attacks whenever they had to speak in front of others during class. The opening sessions should be a collaborative conversation to agree that, while other issues may arise, regulating social anxiety is the primary goal of this work. The student should be able to understand what their anxiety is both on a cognitive and physical level, work to define antecedents to when they feel this way, and historically what their reaction has been. (As an aside, too many students with anxiety with years and years of previous therapy were unable to tell me a basic definition of anxiety or how it manifested for them; instead they used it as a synonym for worry. Not great!) Note that this does not mean you have to be doing CBT or other manualized approaches as an intervention. Defining the problem is just a foundational first step that often we assume everyone is on the same page about.
The student should then be able to discuss exactly what they’re going to try, in detail, when they get anxious. If they are not able to do this in a safe place with a trusted adult, how could they possibly be expected to do this when emotionally dysregulated? Furthermore, there has to be some way to track progress. Often I had students who were able to rattle off a list of generic coping strategies like “take a deep breath” or “take a break”, but when I asked how it worked for them I either got the standard I-don’t-knows or they admitted they didn’t really work. When I dug deeper and asked if they had made any adjustments, students said they’d never tried–their counselors had just told them to keep trying the same strategies without any individualization or practice. I couldn’t imagine a better way to alienate students from the therapeutic process than for them to be given tools that don’t work for them and then go on to be ignored or blamed for doing it wrong. The only way to avoid this is to focus on skills and actually track whether it’s working or not so adjustments can be made.
This process also has a greater importance. If our goal is for our students to eventually be able to problem solve on their own, they need to have the problem-solving process modelled for them and be supported through it. Having students be able to do this in a developmentally appropriate way is essential to their ability to collaborate in their own treatment and create independence.
Counseling Mindset 2: Soothing vs Strengthening
The second realization I had early on in my programs was that I was doing a lot of soothing with my students. I had several students with significant anxiety and/or panic symptoms; nearly every day I was called out of a meeting at least once to meet with a student that was having a meltdown. My initial response was that this was good–this is why we had a therapeutic program in place! I felt useful and the student was often very relieved to have someone sit with them and help go through calming strategies. We got through the moment and they could return to their day.
After a while, I began to notice that my students didn’t seem to be improving; in fact, a few got more anxious. I first rationalized this away. I told myself, “We’re bringing tough things to the surface. Surely they’ll improve once we get past this rough spot. And I’m showing them school is a safe space with caring adults!” Yet time went by and they still didn’t improve.
Now I need to qualify this a bit–because of the therapeutic program and the work we were doing, their grades generally got better and with the quick response they tended to get back in the classroom faster than when they didn’t have my soothing counseling support in place. The students and parents were also a bit happier generally because there was a process to help them, instead of leaving them completely to their own devices. However, the Big Question loomed over me–are my students learning how to better cope with their anxiety so they can do this independently? I had to say no.
It was jarring to understand that I had been only soothing my students, instead of also strengthening them. By soothing, I mean responding to them when they had immediate emotional symptoms in order to lessen those symptoms in the moment. Due to the finite amount of time in my day, this ultimately meant I ran out of time to do the more important work of helping my students to strengthen their ability to cope with the world. I was also inadvertently reinforcing to my students a problematic idea – that if they wanted my immediate attention, they could get it by breaking down. I was reinforcing that school was a dangerous place that required the support of a qualified therapist to navigate and that they did not have the resources to solve their own problems. (To all the behaviorists and probably 90% of counselors reading this–you can stop facepalming right about now, I’ve learned my lesson. It’s easy to see in hindsight.)
My point and plea in talking about all of this is that schools are often stuck in soothing–how do we stop the crying student right now and get them back to their seat, happy to learn? Too often we’re bouncing from task to task and it’s undoubtedly easier to respond to what’s in front of us. It can also feel more gratifying as a counselor–how often do we get to solve the problem in a single session, starting with a distraught child and ending with one that you can usually get a half smile out of by making a bad joke? But we have to keep in mind that the work we do when a student is not in a crisis is often many times more valuable. I’ll also say that this isn’t one or the other–of course we need to soothe our students at times. Of course there’s valuable work that can be done with addressing immediate emotions. I’d just ask that we take a good look at ourselves and ask without judgment–what’s the balance between soothing and strengthening at your school? With your services?
The following questions might be helpful for a discussion with your SST:
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Is our focus on soothing or strengthening our students? If you had to estimate, what percentage of your time is spent soothing students versus strengthening student skills?
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Is your system set up to focus on strengthening skills? Are students being sent down to counseling for every emotional issue or are they expected to practice their skills independently?
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Do staff members have a toolbox of skills ready to go for their students, as well as a way to understand if their students are successful?
Evidence Based Practices for Schools
Let’s pivot from counseling services mindsets and instead talk about some specific practices that work well for the school environment:
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Cognitive Behavioral Therapy
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Exposure Therapy
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Solution Focused Therapy
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Dialectical Behavioral Therapy
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Motivational Interviewing
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Trauma Therapy
As a note, I want to say that all of these are from my personal experience and I have no financial or other stake in any of these programs or resources. When I have specific resources or programs I recommend, I have included them as links.
Cognitive Behavioral Therapy (CBT)
CBT is the 800 pound gorilla in evidence-based therapies. It has 60 years of incredibly strong evidence of efficacy in just about every setting. It has gotten a reputation for being robotic or not trauma-informed. However, it doesn’t have to be–as with all modalities, it depends on the sensitivity and creativity of the practitioner. CBT is fantastic for foundational skills, psychoeducation, and developing metacognition. The amount of resources out there makes this a great choice to give students a structure they can understand and hold onto. Remember, if there’s not homework assigned in between sessions, it’s not CBT!
Resources/Programs out there:
Trails to Wellness: Free high quality group based curriculum
Coping Cat and CAT Project: The gold standard of anxiety interventions
Exposure Therapy
As an intervention, exposure therapy should be one of the things schools do better than anyone else. The basic idea is that a repeated, controlled exposure to a source of anxiety eventually reduces anxiety. This is the opposite side of an avoidance cycle. Schools actually have an advantage compared to outside therapists performing this intervention; normally outside therapists can only do so much to control exposure trials as they have a limited ability to change the exposure environment. Schools have a large amount of control over the environment for students and therefore can change the difficulty of exposure trials so students are challenged without being overwhelmed. Schools can also do an exposure trial and immediately debrief with the student to understand what went right and how to improve for the next time.
Exposure therapy is especially valuable when working with school avoidance students, especially when they have generalized the school building as a source of anxiety with limited insight into why that’s the case. Usually it’s because they have engaged in an avoidance cycle for so long that the anxiety is behaviorally based and requires a behavioral intervention to address.
Resources/Programs out there:
School Avoidance Alliance: Gives a good overview of exposure therapy for school avoidance
Solution Focused Therapy
Solution Focused Therapy is a great short term therapy model as a first line intervention. It helps to focus intervention and can give fantastic results quickly.
Resources/Programs out there:
Solution Focused Counseling in Schools Fourth Edition is promoted by the American Counseling Association (ACA) as the essential text for solution focused therapy
Dialectical Behavior Therapy
DBT is an excellent fit for adolescents. It gives structured skills to work on and explicitly incorporates feedback processes on a foundational level. There’s also a lot of resources around interpersonal skills from an emotional regulation perspective as opposed to a social communication focus, although it ably covers both areas.
Resources/Programs out there:
DBT STEPS A: A Social Emotional Learning curriculum covering areas of DBT in a manner accessible to both staff and students.
Motivational Interviewing
Motivational Interviewing grew out of the addiction treatment world, but quickly gained traction in all areas because of its focus on gaining buy-in from the client first above all else. Its primary question is “Do you want to make a change? If so, why?” Anyone who’s worked with adolescents could benefit from motivational interviewing skills! I found it particularly helpful for students who were being referred from disciplinary infractions as it shifted the locus of change from me as a counselor back to the student.
Resources/Programs out there:
Helping People Change and Grow (Applications of Motivational Interviewing Series): The foundational book on motivational interviewing
Building Motivational Interviewing Skills: A Practitioner Workbook (Applications of Motivational Interviewing Series): A great workbook on developing motivational interviewing skills with concrete practices. Would be a good focus for professional development.
Trauma Therapy
While there are limits to what we can do to treat trauma in school, we are constantly dealing with the symptoms of trauma. That means we can’t just ignore it as an area. Good boundaries and outside referrals are a must. Possible therapeutic approaches that are a good match are mindfulness-based, such as Acceptance and Commitment Therapy (ACT), DBT, and Trauma-Focused CBT (TF-CBT).
Resources/Programs out there:
CBITS: An evidence-based TF-CBT that was designed from the ground up for schools.
Bringing it all Back
We’ve talked about finding the students who need the most support, what services your school offers, and mindsets/practices to help them. This sets up our right students and right services. It will also pinpoint how to get students the service they really need in the least amount of time possible by clarifying and simplifying systems of referral. Now we can begin to focus on the next question: are we doing what we set out to do? That, in turn, will help us understand if what we’re doing is working and adjust so we can serve students for the right amount of time. This is a tightrope to walk–we have to make sure we’re spending enough time with each student to make a real change, while also making sure that we’re allowing them to grow independence by shrinking supports over time. From a systemic point of view, we also want to grow capacity by celebrating successes and moving students off of caseloads when they improve, so we can then focus on a new batch of students. For that, we’re going to tackle ‘what is the right amount of time?’ by using progress monitoring to enhance services and determine when they can be faded in the next article. That’s the other side of this equation–as we durably grow student skills, we build health and capacity throughout the system. With the right services, we can decrease the amount of time our students are in crisis, which just might allow us to move out of crisis mode ourselves.
Questions for SST Discussion
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How much do you think your students understand what they’re working on in counseling?
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Where on the spectrum do you think you fall in soothing vs strengthening your students? What about your school support system as a whole?
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What practices tilt your system towards soothing students? What practices tilt your system towards strengthening students?
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What’s one step you could take towards increasing strengthening practices in your school?
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What evidence based practices are used already in your school?
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Looking back at your resource maps from last article, are there gaps in evidence based practices that you can see in your school or district?
