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School Counseling

Promoting LGBTQ students’ well-being in schools

By Roberto L. Abreu, Adriana G. McEachern, Jennifer Geddes Hall and Maureen C. Kenny October 2, 2018

Research shows that LGBTQ youth are disproportionately bullied (whether in person or via cyberbullying), verbally and physically harassed, and assaulted in schools by peers and staff. Such hostility has been correlated to lower school performance and psychological and emotional distress, including suicidal ideation and attempt, depression and anxiety.

In the 2015 GLSEN (formerly Gay, Lesbian & Straight Education Network) National School Climate Survey, LGB students reported higher levels of verbal, physical and sexual violence and bullying than did their heterosexual counterparts. Specifically, 98.1 percent of LGB students heard the word “gay” used in a derogatory manner, 85.2 percent reported verbal harassment, and 34.7 percent reported being physically harassed in the past year. In addition, a 2017 meta-analysis (conducted by co-authors Roberto L. Abreu and Maureen C. Kenny) of 27 empirical studies on the effects of cyberbullying on LGBTQ youth revealed that compared with their heterosexual and cisgender counterparts, these students are disproportionately harassed online and through other technology-based means. Such harassment has been correlated to a range of behavioral and emotional difficulties, including suicidal ideation (with some studies suggesting rates as high as 40 percent among LGBTQ youth) and suicide attempts (with rates as high as 30 percent).

Many LGBTQ students identify school counselors as the one school staff member to whom they are most likely to disclose concerns related to their sexual and gender identity. Given this reality, school counselors are uniquely positioned to address myths about LGBTQ youth, to advocate for these students and to effect change.

Dispelling myths

Let’s begin by examining five myths that can have an impact on the identity, safety and well-being of LGBTQ youth. We’ll also look at specific strategies and interventions that counselors can use to address these myths and increase the safety of LGBTQ students.

Myth #1: Parents must be informed of their child’s sexual and gender identity. A 10th-grader discloses to her high school counselor that she identifies as a lesbian. Most of her friends know, but she has yet to tell her parents. She fears their reaction because she has heard them make derogatory remarks toward LGBTQ individuals in the past. Must the school counselor inform the student’s parents?

The American School Counselor Association (ASCA) National Model (2012) stresses the importance of parent and family involvement and its influence on the well-being of students. Although parent engagement is critical when working with LGBTQ youth, school counselors should consider several factors before disclosing to parents a student’s sexual or gender identity. Many LGBTQ students believe they lack parental support, and they may fear rejection, abuse and an unsafe home environment if their parents discover their sexual or gender identity.

Therefore, the counselor in this scenario should first discuss with the student her feelings about informing her parents and assess how they may react to this information. It would be important for the counselor to prepare the student for potential negative parental responses. Role-playing the conversation could be helpful for the student. It would be best to have the minor client make the disclosure to her parents with the counselor present to provide support. It is also important to have a plan in place to provide the client with a safe place to stay should the parents totally reject her and need time to adjust to the situation.

In certain instances, school counselors may have to break confidentiality. For example, what if the student also disclosed to the counselor that she was distraught over the situation and was having suicidal thoughts and feelings of hopelessness because she feared that her parents would never understand or accept her sexual and gender identity? In that situation, there would be potential harm and danger to the minor client. Therefore, the counselor would need to conduct a thorough suicide assessment, then inform the client of the legal and ethical reasons that confidentiality must be breached.

It is important for counselors to check their schools’ policies and procedures in relation to dealing with crisis situations such as suicide. School counselors can work with parents individually or in groups to foster awareness and acceptance of LGBTQ students and to promote understanding of their needs and the challenges these students face every day.

Myth #2: Gender-neutral facilities are a threat to school safety. A school district policy does not allow transgender students to use the restroom that corresponds to their gender identity. A transgender student has brought this to the attention of the school counselor, inquiring about what to do. The student says he often goes the entire school day without going to the restroom.

School counselors should use their role as staff and educators to speak to the school administration about this issue. In talking to school administrators, counselors can present research related to transgender students experiencing a lack of safety in schools and make the argument that forcing these students to use a bathroom that does not align with their gender identity only contributes to this presenting concern.

Some states have passed laws precluding gender-neutral facilities, imposing on the rights of transgender individuals to use the restroom that corresponds to their gender identity rather than their sex at birth. Some of these laws have been incorporated into school policy. The rationale given for these laws has been to protect public privacy and safety. However, there is no research evidence to support this claim.

In 2015, Media Matters for America conducted a survey of 17 school districts in 12 states encompassing approximately 600,000 students. The survey asked about cases of harassment or inappropriate behavior after transgender-inclusive policies had been passed in those districts. The survey results concluded that no incidents of sexual harassment or inappropriate behavior had been reported in those schools, debunking the myth that gender-neutral facilities are a threat to school safety.

Counselors, as social justice agents, must involve themselves in policy. This can be done at school meetings, where counselors can advocate for gender-neutral policies in schools and school districts. Counselors can inform school administrators of their interest in participating in these meetings and being involved in the decision-making process. They can volunteer to conduct information sessions for meeting participants about the academic, personal and career needs of LGBTQ youth. Counselors should actively seek to advocate for transgender youth so that these students can use the bathroom that best aligns with their gender.

Myth #3: School policies and laws protect all students. School policies and laws have focused mainly on reducing bullying but not necessarily on protecting LGBTQ youth and keeping them safe. The 2015 GLSEN report that investigated anti-bullying policies in the nation’s school districts revealed that out of the 13,181 school districts surveyed, 70 percent had anti-bullying policies. However, only 20 percent of these school districts had LGB-inclusive policies, and only 10 percent had LGBT-inclusive anti-bullying policies.

Although anti-bullying policies may be in place, LGBTQ students continue to report higher incidents of bullying and harassment than do other students. Often, these policies are not widely distributed to students and staff, and although most students and staff may be aware of district anti-bullying policies, they are not necessarily aware of LGBT-inclusive anti-bullying policies. 

Furthermore, policies and laws are often influenced by politics and societal opinions. Laws referred to as “no promo homo” involve efforts to prevent national LGBT education, mandate that administrators take a neutral stance on gender identity and prohibit providing specific services to these students. Although seven states (Alabama, Arizona, Louisiana, Mississippi, Oklahoma, South Carolina and Texas) had “no promo homo” laws as of January 2018, many states are working to develop LGBT-inclusive laws and policies that do not discriminate against these youth. For example, many states have developed LGBT anti-discrimination laws. These laws also permit transgender students to participate in sports congruent with their gender identity.

School counselors need to be proactive and work with school administrators to develop LGBT-inclusive policies. Counselors can assist in disseminating and discussing these policies regularly with students, parents and staff. Counselors should educate school administrators on bullying and “no promo homo” laws so they will better understand the detrimental effects of systemic oppression on LGBT youth.

In addition, school counselors should empower LGBTQ students to share with school staff their experiences with bullying and harassment within the school. This will open the door for school personnel to make a personal connection with these students and will help them learn more about the physical and mental health consequences of LGBTQ bullying and lack of representation.

Myth #4: LGBTQ students are safe around all school personnel. Many LGBTQ students do not feel safe at school — around either other students or school personnel. The GLSEN survey from 2015 reported that more than 50 percent of LGBTQ students heard homophobic comments from teachers and school staff. Many of these students believed that reporting harassment or assaults to school personnel would worsen the situation and that no action would be taken. Among those who did disclose bullying, harassment or assault to school staff, 63.5 percent indicated that their reports were ignored. In addition, when these incidents were reported, LGBTQ students faced harsher discipline than did their heterosexual and cisgender peers and were often blamed for the incidents (see research from Shannon Snapp, Jennifer Hoenig, Amanda Fields and Stephen Russell). This lack of support from school personnel places LGBTQ students at greater risk of being victimized.

In 2017, students in California’s San Luis Obispo High School published an edition of the student paper, Expressions, featuring LGBTQ issues. In response, a special education teacher at the school wrote a letter quoting the Bible and stating that those committing homosexual acts “deserve to die.” The school administration chose not to discipline the teacher for the action, stating that teachers as well as students “do not shed their First Amendment rights” at school. Although the teacher resigned soon after the incident, his statement remains a testament to the harassment and discrimination leveled against some LGBTQ students by school personnel.

School counselors need to advocate for and support LGBTQ students in the face of such victimization. Providing training to all students, parents and school staff is critical to reducing incidents of bullying and harassment and increasing awareness and sensitivity to the issues LGBTQ students confront in schools. A middle school in South Florida developed a monthlong program that focused on bullying prevention, including sexual and gender identity sensitivity training at various levels. At the high school level, counselors are forming LGBTQ support groups to provide outlets for these students to discuss specific issues and concerns. These groups provide one way to let these students know that they are valued and that their voices are important.

Myth #5: Sex education is inclusive of all students. Sex education that is LGBTQ inclusive is very limited or nonexistent in our nation’s schools. Often, this lack of inclusion is due to discomfort and lack of knowledge about LGBTQ sexuality on the part of school personnel, students and parents. Many teachers do not feel competent to teach on the topic.

Traditionally, sex education in U.S. schools centered on an abstinence-only curriculum. This ideology changed somewhat in the 1980s because of the AIDS epidemic, the increase in sexually transmitted diseases and teen pregnancy. The curriculum during this time focused on prevention and contraception, but no content was included on LGBTQ sexuality. In the 1990s, there was an effort to develop national guidelines for comprehensive sex education by the Sexuality Information and Education Council of the United States, a task force composed of educators and health professionals. However, these guidelines also lacked specific and clear directives on how to address the needs of LGBTQ students in schools.

Health care reform legislation in 2010 provided states with funding to draft comprehensive sex education in schools. One of the programs created from this initiative was the Personal Responsibility Education Program for young adults. Once again, however, this program
failed to offer educational content or policy language that was inclusive of LGBTQ students.

Given this reality, school counselors can take leadership roles in advocating to administrators and teachers on the importance of including educational information and materials about LGBTQ sexuality in the sex education curriculum. Counselors may need to ensure that the programs being used to teach sexuality are inclusive. Counselors can assist health educators by providing appropriate materials (see hrc.org/resources/a-call-to-action-lgbtq-youth-need-inclusive-sex-education for more information on LGBTQ-inclusive sex education). Counselors can also conduct psychoeducational workshops to dispel myths and misconceptions regarding LGBTQ students with all stakeholders, including students, school staff and parents.

 

A call to action

Clearly, the perpetuation of these myths indicates that something more needs to be done to better support LGBTQ students within school systems. School counselors, as outlined by ASCA, have an ethical obligation to support underserved and oppressed populations. Additionally, school counselor training programs emphasize the role of school counselors as agents of change within the school system and professional leaders who must act as allies and advocates for all students.

This role includes:

  • Being aware of the challenges that LGBTQ students face within the school system
  • Designing a developmental, comprehensive school counseling program to support the LGBTQ student population
  • Advocating for policies and practices that address inequities regarding academic, career and social/emotional domains for LGBTQ students 

Therefore, supporting LGBTQ students and promoting social justice initiatives should be done through large-scale, small-scale and individual interventions in an effort to create a positive school climate for everyone.

Readiness assessment

The first step is to conduct a needs and readiness assessment. This assessment should focus on gauging the school’s current climate related to LGBTQ students and the willingness of staff to make needed changes. Assessments should target students, faculty, staff and parents. Their openness toward acceptance and making changes, as well as the amount of education and training they have received related to LGBTQ populations, is important to assess.

Parents and school personnel may be reluctant to support LGBTQ youth in part because they do not feel prepared to respond to the unique needs of these students. School counselors will need to collaborate and discuss concerns with all stakeholders to comprehensively make appropriate systemic changes. These conversations also allow school counselors to gain awareness of current school policies and procedures related to the treatment of LGBTQ students.

Additionally, before changes can begin, school counselors should collect data that may be reflective of disparities and issues that LGBTQ students face within the school. Such data may include behavioral referrals, truancy rates and negative changes in grades and attitudes/behaviors. Behavioral referrals should be more specific and include incidents of verbal and physical harassment that LGBTQ students have endured as well as LGBTQ students who might be “acting out” in class in reaction to bullying or oppressive interactions.

LGBTQ students who are lacking support and involved with negative interactions often are truant, report somatic complaints and disengage from the learning process. It is therefore important that school counselors collect and examine data concerning absenteeism, visits to the school nurse, incidents of skipping class and dropping grades. This data should be saved and used as well during the measurement of formative and summative program success. This information will help inform what needs exist and how the school can best support LGBTQ students in dealing with their struggles.

It is important to note here that when collecting and analyzing data, counselors should look for patterns and then meet with students individually, regardless of their sexual or gender identity. At the time of this meeting, if the student discloses that their struggles are indeed related to their LGBTQ identity (for example, they are being bullied because of their gender expression), then counselors should move forward with interventions while making sure to protect the student’s confidentiality.

Intervention formulation

After school counselors have conducted a thorough assessment of their schools’ climate and needs, they can begin to formulate interventions and adjust policies to better support LGBTQ students. School counselors should include LGBTQ community members on their advisory boards to assist with inclusivity when promoting change and programming. Change and programming should include interventions at the schoolwide, small group and individual levels. 

Schoolwide interventions addressing bullying and diversity have been deemed most effective in promoting a more positive school environment for all students. These interventions should include procedures and programming specific to the LGBTQ population, such as staff training on LGBTQ issues, multicultural awareness and response procedures regarding victimization of LGBTQ students. Schoolwide strategies and policies to address LGBTQ-specific bullying and harassment must also be outlined.

Schools are also encouraged to provide educational workshops for parents that address issues related to sexual and gender identity, ways of talking at home about bullying (with both victims and perpetrators), and ways to discuss diversity and acceptance beyond the school setting. These conversations should include information that is pertinent and specific to LGBTQ students.

As a universal approach, teachers should be encouraged to incorporate LGBTQ-affirming curricula into their existing core areas of focus at the elementary, middle and high school levels as developmentally appropriate. School counselors also need to include examples of LGBTQ populations and the issues they face in classroom guidance lessons and when promoting positive behavior intervention and character education programs at their schools. Positive recognition of LGBTQ students, parents, staff and community members can also help to promote a more accepting environment overall. Additionally, it is beneficial to foster support from those involved in athletics and other extracurricular activities. This includes recruiting the active assistance and endorsement of coaches and athletes regarding LGBTQ students.

In addition to schoolwide interventions, schools can better support LGBTQ students by providing small group and individual services designed specifically for them. Safe zones/diversity rooms can be designated to serve as a resource for LGBTQ student needs or concerns. These spaces should be run by the school counselor or other trained staff and must respect the confidentiality of the students who use them. These spaces can serve as a safe, supportive environment for LGBTQ and other students to discuss issues they are facing. In addition, they can serve as resource rooms stocked with helpful books, flyers and other materials.

School counselors can also facilitate support groups specifically for LGBTQ students, allowing them to openly discuss their experiences, process their thoughts and feelings, and develop coping strategies. Group topics could include local and national resources available for LGBTQ individuals, LGBTQ role models, family relationships, intimate relationships, coming out, personal and professional issues that LGBTQ individuals encounter, and information about higher education institutions that are affirming of LGBTQ individuals.

Support groups for parents of LGBTQ students should also be offered. These groups would address ways for these parents to support their children. The groups would also provide a forum for parents to share their experiences and concerns with each other and with the school. In addition, many schools now offer a Gay-Straight Alliance (GSA), a student-led organization with a faculty adviser that typically meets to learn about issues that LGBTQ students are facing. GSA is meant to be a group that promotes acceptance, social justice and advocacy. 

School counselors also make themselves available to all students for individual counseling. In many cases, they may be the only mental health professional that students have easy access to for support. It is therefore imperative that school counselors demonstrate cultural competency and provide a safe, affirming environment that includes acceptance and respect for all students.

School counselors need to be aware that LGBTQ students may not present with problems related to their sexuality or gender identity. School counselors also need to consider other contextual factors such as family dynamics when counseling LGBTQ students. In addition to providing leadership toward systemic change, counselors need to have an understanding of issues that specifically affect LGBTQ students on an individual basis. This understanding is achieved through an ongoing process that includes communicating with the local LGBTQ community, participating in continuing education opportunities about LGBTQ students, reading the latest research related to this population and familiarizing themselves with the legal and ethical mandates surrounding LGBTQ students. Most important, school counselors must engage in ongoing self-examination of their own biases, stereotypes and blind spots concerning all students.

The role of school counselors in advocating for LGBTQ students in school is critical. It is school counselors’ professional and ethical responsibility to ensure a safe and harassment-free learning environment for all youth. Connecting with parents and educating them on the continuum of gender and sexual identity can also be an important part of the process. Given counselors’ expertise and skills in supporting diversity and communicating difficult topics, they can play a central role in helping staff, administrators and students create schools that empower LGBTQ youth.

 

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Recommended resources from the authors

  • A Queer Endeavor (aqueerendeavor.org): This site provides educators, school staff, families and students with resources (videos, lesson plans, curriculum development best practices, textbook recommendations) to help support and create an inclusive school environment for sexual minority and gender-expansive students.
  • GLSEN Educator Resources (glsen.org/educate/resources): GLSEN is one of the nation’s largest advocacy groups focused on providing resources that promote the well-being of sexual minority and gender-expansive students in grades K-12. This site provides tools for schoolwide advocacy programming and lesson plans that are LGBTQ inclusive.
  • It’s Pronounced Metrosexual (itspronouncedmetrosexual.com): This site provides online resources (worksheets, videos, articles, books) about privilege and oppression overall, with an emphasis on educating society about topics related to sexual and gender identity. The site serves as a source of information for social justice advocates, researchers and clinicians.
  • American Psychological Association (APA) Safe and Supportive Schools Project (apa.org/pi/lgbt/programs/safe-supportive/default.aspx): APA’s Safe and Supportive Schools Project partners with five professional organizations, including the American Counseling Association and ASCA, to provide training and educational resources. The goal is to help school personnel, leaders of community organizations, parents and students to build positive, supportive and healthy environments that promote acceptance, allowing LGBTQ youth to thrive as their authentic selves.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Roberto L. Abreu is an assistant professor of counseling psychology at Tennessee State University. His research agenda focuses on the well-being of LGBTQ people of color, with specific attention to parental, school and community acceptance of Latinx LGBTQ youth. Contact him at rabreu@tnstate.edu.

Adriana G. McEachern is a professor emerita, a visiting associate professor and the program director for counselor education in the Department of Leadership and Professional Studies at Florida International University. She is a national certified counselor, certified rehabilitation counselor and licensed mental health counselor in Florida.

Jennifer Geddes Hall is a clinical assistant professor at Clemson University and a licensed professional counselor. She has more than 15 years’ experience working with children and teenagers as a school counselor and clinical mental health counselor in various community settings.

Maureen C. Kenny is a professor of counseling at Florida International University and director of the university’s clinical mental health counseling program.

 

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Five strategies to develop mental health models in schools

By Dakota L. King-White March 12, 2018

Over the past 13 years, I have dedicated my career to developing mental health services and models within the academic setting as a school counselor, mental health therapist and now as an assistant professor in counselor education, where I engage in community action research to develop mental health models in schools from pre-K through 12th grade. From my research and experiences, I have observed that students’ ability to learn is significantly affected by their mental health.

Many of our nation’s students have been exposed to traumatic events and regular life stressors that act as barriers to their success. Exposure to violence and other traumatic experiences can have a lifelong effect on academic achievement. Within the school setting, this can be manifested in a number of ways, including trouble concentrating, low grades, a decline in test scores and students avoiding school or dropping out of school entirely.

Making an investment in prevention and intervention services can help to address students’ overall development and thus enhance their ability to succeed socially, emotionally and academically. The school setting is an ideal place to provide mental health support to students. However, it is extremely important for schools to align mental health support with academic achievement goals. This calls for greater collaboration among mental health professionals, teachers, administrators, parents, students, staff and other stakeholders in school settings.

Based on the work I have done in developing mental health models in schools, as well as guidance from the American School Counselor Association (ASCA) National Model, I believe that the following five components are key to effectively supporting both the mental health needs and academic achievement of our students.

1) Create mental health programming based on data-driven decisions.

2) Collaborate to address the mental health needs of students.

3) Provide a tiered system of mental health support.

4) Evaluate mental health services to ensure they are addressing the academic achievement gaps.

5) Communicate the outcomes to key stakeholders.

Make data-driven decisions

Developing mental health models in schools is a preventive measure by which mental health professionals analyze data ahead of time and design programming based on need. This approach allows stakeholders to assess the needs and develop services that truly address the academic, social and emotional gaps. Schools have an obligation to create programming based on their students’ needs.

When developing mental health models in schools, it is imperative to analyze data from several sources. One key component involves looking at data that focus on academic achievement. Report cards, test scores and other instruments that measure academic achievement must be considered. The main priority when addressing mental health issues in schools is to identify barriers that are affecting students’ academic achievement.

Once the needs have been identified, the next step is to create measurable goals to address the gaps. This step involves a collaborative approach that should include school counselors, mental health therapists, parents, teachers, administrators and students. Measurable goals provide a means for stakeholders to evaluate programming and help to ensure that it is supporting academic achievement.

Collaborate to address student needs

In a 2010 article for the Journal of Interprofessional Care, Elizabeth Mellin and colleagues identified collaboration among colleagues as being imperative when developing mental health models in schools. School counselors, mental health therapists, school psychologists and school nurses are the professionals most often tasked with delivering mental health services to students in schools.

School counselors are an excellent resource to support mental health models in schools. Quite often, however, school counselors are still labeled as “guidance counselors” in educational settings and are not always considered when schools are developing mental health services and models. Administrators and other stakeholders must be informed that the practice of school counseling has evolved, with “guidance” being only one component of the services that school counselors provide. According to the ASCA Ethical Standards for School Counselors, the school counselor’s role is to address all students’ “academic, career and social/emotional development needs.” School counselors must actively engage and advocate to inform stakeholders of their titles and responsibilities, which are based on their skill set and training. Their skill set and training include addressing many of the social and emotional barriers that affect the ability of students to succeed academically.

Mental health therapists are another valuable resource. When licensed as a clinical counselor or social worker, these professionals are able to diagnose mental health disorders and provide treatment to students. Another invaluable component of their skill set that often goes untapped is an ability to provide consultation to staff, teachers, parents and administrators. It is also important that mental health therapists collaborate with teachers, administrators, other staff members and families to demonstrate the correlation between mental health and academic achievement.

School psychologists are integral to the collaboration process when developing mental health models in schools. According to the National Association of School Psychologists, the school psychologist’s role includes providing assessments, providing interventions to address mental health concerns and working with teachers, staff, administrators and other stakeholders to create programming to address gaps. As noted by Joni Williams Splett and Melissa Maras in their 2011 Psychology in the Schools journal article, school psychologists who are trained as research practitioners offer a unique skill set that contributes to bridging the gap of research and actual practice of services to support academic achievement.

School nurses can also play a central role in developing mental health models in schools. Quite often, school nurses have mental and physical health records provided by school personnel, parents and outside health care providers. Because of the time these professionals spend with students addressing other health concerns, they are frequently able to screen for mental health concerns. This relationship provides school nurses opportunities to develop rapport with students. It is during these interactions that school nurses can detect changes in a student’s physical or mental health. School nurses can also provide insight to their colleagues about the mental health concerns they have observed within the school setting.

Teachers and administrators are additional important contributors to the development of mental health models in schools and must be equipped to identify mental health concerns in the school setting. In an effort to ensure that all school stakeholders are collaborating and properly equipped, regular meetings are essential. The more collaboration that takes place among the mental health team, teachers, parents, students and administrators, the more likely it is that students will succeed.

Provide a tiered system of support

Kelly Vaillancourt and colleagues described the benefits of a tiered system of mental health support in their 2013 article for the National Association of School Psychologists and the National Association of School Nurses. A tiered system of support for delivering mental health services also provides different levels of care to support students to succeed academically. Keep in mind that schools must use evidence-based strategies. This ensures that the most effective, empirically supported practices available are being used to help students succeed.

Tier one is the universal level of support in which all students have access to mental health services in a school setting. Within tier one, trauma-informed classroom methods are introduced to teachers, administrators and staff. Tier one includes implementation of a social/emotional curriculum for all students that is preventive in nature and that supports academic achievement by addressing social and emotional barriers. It is also imperative to use a strengths-based approach that looks at the positive attributes of the students and builds upon those attributes to provide services for the students. To further support students, families should be made aware of the services and information being taught at school.

Tier two is where targeted interventions are identified for students who need additional mental health support to eliminate barriers that are affecting them academically. Selective interventions are provided to students who exhibit behaviors that are hindering them. Mental health and other services provided at the tier-two level consist of small groups, classroom behavior management strategies for teachers and staff, individual counseling and additional professional development for stakeholders related to social and emotional barriers to academic achievement. Collaboration among the team is extremely important.

The third tier is the most personalized, with intensive strategies provided based on the student’s needs. Typically, this is done through a comprehensive process in which key stakeholders gather to collaborate and strategize about the needs of the student. The team should consist of the mental health team members, the student, the student’s parents or guardians, teachers, administrators and outside agencies that work with the student and family. As highlighted by Kenneth Messina and colleagues’ 2015 article in The Family Journal, family buy-in is crucial at this level because of the importance of collaboration between home and school to support the student’s academic achievement and to identify the student’s strengths. Mental health and related services at this level include, but are not limited to, individual counseling provided by a mental health therapist, crisis intervention, outside counseling services, small group counseling, behavior plans and additional professional development for stakeholders.

Evaluate and communicate

In an effort to improve academic achievement, mental health services provided in the schools must be based on data-driven decisions and evaluated to ensure that progress is being made to address the needs. Vaillancourt and colleagues noted that an effective mental health model includes consistent monitoring of student and program outcomes. This includes reviewing outcome data and analyzing the data to measure gaps, successes and areas of limitation. Evaluation of services is a continuous process.

Once programming or services are provided, it is critical to analyze the data and review the goals that were established for the student. It is imperative to have an outside reviewer provide feedback on the data and assess the outcomes of programming. The outside reviewer could be a mental health professional, teacher, curriculum director, administrator, local college professional or another professional within the district who has experience analyzing data.

Once the data are analyzed, it is vital to communicate the results to the stakeholders. Communicating the results to stakeholders has been found to build rapport and transparency among the team. Communication also allows for stakeholders to understand the impact and correlation between mental health and academic achievement.

Conclusion

There is a need to develop effective mental health models in schools because of the mental health challenges that affect students academically, socially and emotionally. Students will continue to be faced with these challenges, but it is important that schools address the barriers that affect students’ academic achievement. Mental health professionals, teachers, parents, students, administrators and school staff play a vital and collaborative role in the development, implementation and evaluation of mental health services aimed at maximizing students’ academic success. Through the five strategies discussed in this article, I believe that school districts will realize the success of mental health models being implemented within schools to support academic achievement.

 

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Dakota L. King-White is an assistant professor in counselor education at Cleveland State University in Ohio. She is a licensed school counselor and licensed professional counselor. Her areas of research include the development of mental health models in schools, children of incarcerated parents and 21st-century school counseling. Contact her at d.l.king19@csuohio.edu.

 

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

U.S. student-to-school counselor ratio shows slight improvement

By Bethany Bray October 20, 2017

On average, there is one school counselor for every 482 K-12 public school students in the U.S. This number has decreased slightly from the previous year’s average of 491-to-1.

The American School Counselor Association (ASCA), a division of the American Counseling Association, compiles a report each year on student-to-school counselor ratios, based on data from the U.S. Department of Education’s National Center for Education Statistics. ASCA’s latest report, released this week, included data on public K-12 schools in the 2014-2015 school year, which is the most recent information available.

“The work that school counselors do to support students’ academic, career, emotional and social development is absolutely critical,” says ACA President Gerard Lawson, an associate professor of counselor education at Virginia Tech. “In today’s schools, counselors are also relied on for their expertise in working with broader mental health needs. It is encouraging to see some improvements in the ratio of students to counselors, and we know that counselors can serve their students, schools and communities more effectively, when the ratio of students to counselors is lower and sustainable.”

The report highlights a disparity that exists across America. The highest ratio, with 924 students for every one school counselor, was Arizona, and the lowest, with a 202-to-1 ratio, was Vermont.

ASCA’s recommended student-to-school counselor ratio is 250-to-1.

“These counselor-to-student ratios are headed in the right direction, but they have a long, long way to go. More school counselors need to be hired, especially in states with the most egregious ratios,” says Nancy Carlson, a licensed clinical professional counselor and ACA’s on-staff counseling specialist.

 

Other highlights of the report:

 

  • States with the highest student-to-school counselor ratios were Arizona (924-to-1), California (760-to-1), Michigan (729-to-1), Minnesota (723-to-1), Utah (684-to-1), Illinois (664-to-1) and New York (635-to-1).

 

  • States with the lowest student-to-school counselor ratios were Vermont (202-to-1), Wyoming (219-to-1), Hawaii (293-to-1), North Dakota (307-to-1), Maine (315-to-1), Montana (319-to-1) and Tennessee (339-to-1).

 

  • California showed the most improvement over the previous year; the state’s ratio decreased 9 percent, from 822-to-1 (2013-2014) to 760-to-1 (2014-2015).

 

  • Alabama’s ratio also shifted 9 percent, but in the other direction. The state lost nearly 150 school counselors between 2013-2014 and 2014-2015, increasing its ratio from 417-to-1 to 453-to-1.

 

 

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ASCA’s full report, with a state-by-state breakdown, is available online: schoolcounselor.org/asca/media/asca/home/Ratios14-15.pdf

 

Read ASCA’s press release about this year’s numbers:  schoolcounselor.org/asca/media/asca/Press%20releases/ASCA-Student-to-SC-Ratios-Press-Release-10_2017-Final.pdf

 

The American Counseling Association’s School Counselor Connection page: counseling.org/knowledge-center/school-counselor-connection

 

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

 

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’13 Reasons Why’: Strengths, challenges and recommendations

By Laura Shannonhouse, Julia L. Whisenhunt, Dennis Lin and Michael Porter September 4, 2017

The Netflix series 13 Reasons Why has launched a national discussion regarding teen suicide, motivating a webinar response from professional organizations about how to shape the dialogue, dozens of editorials and millions of cautionary letters home from schools to parents across the country.

The series, based on a novel, is narrated by high school student Hannah Baker, who made a series of cassette tapes to be passed to 13 individuals she argues contributed to her reasons for dying. Her story is seen through the eyes of a peer, Clay, who listens to the tapes. He comes to understand Hannah’s perspectives about those people and events she claims motivated her suicide, which include Clay’s own (in)actions.

The series has been critically acclaimed for the acting and commended for addressing challenging topics, such as bullying/cyberbullying, sexual assault and teen suicide. However, school administrations, school counseling associations, suicide prevention organizations and counseling/psychology associations such as the American Foundation for Suicide Prevention (AFSP), the Suicide Prevention Resource Center (SPRC), the American School Counselor Association (ASCA) and the National Association of School Psychologists (NASP) have advised caution because of the graphic nature, revenge fantasies and potential contagion effect. This article highlights strengths and major challenges of the series. It also provides recommendations that have been underrepresented, though not absent, in the discussion.

 

Strengths

1) Raising awareness that suicide is a real problem.

According to the Centers for Disease Control and Prevention (CDC), suicide is a major public health issue. The most recent  statistics available note that among high school students, 17 percent have seriously considered suicide, while 8 percent have attempted suicide within the past 12 months. We know that for every suicide, there are many survivors, including the family and friends of the person and those who have experienced psychological, physical and social distress after exposure to a suicide.” The most commonly cited statistic is that each suicide directly affects six people; however, more recent research argues there are between 45 and 80 survivors per suicide.

In 2015, there were more than 44,000 reported suicide deaths, including 5,191 deaths by suicide among those ages 15 to 24. However, this statistic includes only those that were reported. Although there is no consensus on the rate of under-reporting due to stigma or ambiguous cause of death, the best analysis suggests that for each completed youth suicide, there are 100-200 times as many nonfatal suicide actions.

Combining CDC data with our current understanding of rates of suicidal ideation in youth, in this moment there are close to 15 million people in the U.S. who think of suicide in any given year. Suicide is a very real public health issue; when it is ignored, stigmatized or minimized, we as a community are missing the chance to prevent it.

2) Even professional counselors may not be ready to respond to a suicidal situation.

Because counselors often receive referrals of clients who are suicidal, counselors’ competency in identifying and intervening with those at risk is crucially important. However, the overtaxed counselor in 13 Reasons Why, Mr. Porter, is underprepared to face a suicidal student coping with complex trauma. Although he did not act in the scope of best practice, his failings are unfortunately not unusual among counselors, despite decades of advocacy for increased suicide assessment trainings in counselor education.

Mr. Porter missed several suicidal statements (e.g., “I need everything to stop”), made assumptions about contributing events and was uncomfortable talking about suicide (and other issues). We may easily judge Mr. Porter’s mistakes, but as counselors, we should take this opportunity to reflect and ask ourselves if we are ready to respond to a student at risk of suicide. The research is equivocal.

3) Suicide is complex and individual.

Although 13 Reasons Why portrays some known “red flags” that can indicate suicidal intent, the factors that contribute to individual suicides vary. Stressors that may influence one person’s decision to die by suicide may not have the same effect on others. For instance, we know that not all people who are depressed die by suicide (research shows the rate is from 2-15 percent) and that not all people who complete suicide are depressed. There is a variety of prevention programming regarding common warning signs. However, there is no perfect amalgam of warning signs or demographics (e.g., risk for transgender persons) that helps us differentiate who will decide to die by suicide. We need to go beyond just learning warning signs in order to help.

Livingworks, a suicide intervention training organization, focuses on three elements when assessing warning signs and risk factors. First, we must look for the meaning behind stressful events. For instance, in 13 Reasons Why, being listed “Best Ass” was highly distressing to Hannah because she felt objectified and was concerned people would misperceive her to be easy. However, another student, Angela “Best Lips” Romero, was flattered by such attention. The meaning behind the stressful event is more important than the stressful event itself.

Second, we need to know that warning signs can be, and often are, expressions of pain. When Hannah pushed Clay away, he recognized that something was wrong but did not see that her rejection was an indication of emotional pain. Third, we must trust our intuition. One peer recognizes Hannah’s poem as a cry for help but does not offer assistance. We need to pay attention to our gut feelings and act on them to take care of each other.

13 Reasons Why provides an opportunity to see Hannah’s experience of several traumatic events (cyberbullying, being stalked, public objectification, losing money, feeling responsible for a person’s death, witnessing rape and being raped) and does a good job of depicting the pain, shame and isolation she experiences as a result. The viewer has an opportunity to consider Hannah’s subjective experience and understand how the cumulative effect of these “reasons why” motivates her to suicide.

One model to help contextualize suicidality is the interpersonal-psychological theory of suicidal behavior developed by psychologist Thomas Joiner. Joiner states that the highest risk occurs when one feels like a burden to others, feels alienated or lacks belongingness and, crucially, has overcome the natural human inclination toward self-preservation. This model posits that suicide is a process — one gradually builds tolerance to the idea through self-injurious thoughts or behaviors (although each person’s path is unique). There are multiple points on that path at which others can intervene. The 13 Reasons Why series emphasizes those missed opportunities. As in Hannah’s case, every day there are suicides that happen as a result of those missed opportunities.

4) The central message is a positive one.

In the last episode, Clay says to Mr. Porter, “It has to get better, the way we treat each other and look out for each other.” Instead of feeling guilty or turning away, we can task ourselves with being more supportive community members.

All too often, we operate from a place of fear, which is understandable considering that schools have a legal duty to protect students from self-harm, and lawsuits are a potential reality (as shown in 13 Reasons Why). However, when systems or individual responders act out of fear, it focuses the interaction away from the needs of the person at risk. Even well-intentioned modern practices of “suicide gatekeeping” have substituted swift (and protocol-driven) identification and referral for the direct supportive intervention by community members proposed by John Snyder in 1971. Clay’s words echo those from Snyder half a century ago, when he said that most “who attempt suicide are victims of breakdowns in community channels for help.”

Although Mr. Porter clearly failed to proper identify Hannah’s suicidal ideation, perhaps even more troubling was his failure to hear her story and understand the factors behind her decision to die by suicide. Listening and demonstrating empathy to someone who is struggling was demonstrated to reduce suicidal ideation on calls to the National Suicide Prevention Hotline. Talking about suicide can help the person at risk to no longer focus on the past or feel alone and, instead, shift to the present moment, where the person can feel understood and cared for. If those in Hannah’s community who were witness to her emotional pain had actively engaged her and listened, it may have reduced her isolation and lessened her self-perception as a burden. This may even have prevented Hannah’s death.

Research indicates that our personal beliefs about suicide influence our responder behaviors. Therefore, gaining awareness of our beliefs and how our ability to intervene is affected by them is vital. Regardless of whether we can stop a suicide, we can control how prepared we are to try. We can make sure that our systems (in schools and elsewhere) are places where it is easy for someone to receive help.

After working through Hannah’s tapes, Clay now believes that we are, in a way, our brother’s keepers. Community-level response by direct intervention is a central theme in my (Laura Shannonhouse) research. It involves equipping “natural helpers” (e.g., teachers, bus drivers, resources officers, school counselors/psychologists) with the skills needed to perform a life-assisting suicide intervention at the moment it is needed most.

The producers and cast of 13 Reasons Why have underscored their desire for this series to start a conversation. Although that has certainly been accomplished, we hope the dialogue focuses more on how we can “look out for one another” and foster communities less at risk for suicide.

 

Challenges

1) Graphic nature and contagion

Viewers of 13 Reasons Why watch two rape scenes and Hannah’s suicide, which is shown in detail. Nic Sheff, one of the writers of the series, stated that the scene of Hannah’s suicide was intended “to dispel the myth of the quiet drifting off.” Some crisis texts suggest that we “deromanticize” suicide by helping our clients understand the unintended effects of trying to die by suicide, such as surviving but becoming disabled or alienating friends and family. Therefore, an argument could be made that a graphic, painful portrayal of suicide is warranted.

However, research does suggest that suicide portrayals can contribute to contagion by triggering suicidal behaviors in people — particularly youth — who are experiencing high levels of emotional distress. In fact, SPRC and AFSP have made recommendations for best practices in prevention of suicide contagion. A discussion of post-suicide intervention to prevent contagion is beyond the scope of this article, but as an example, the locker memorial portrayed throughout the series is against standard guidance (it should not last for weeks, as shown). Furthermore, when considering how media reaction to the series has often included sensational headlines, it is helpful to review these recommendations for reporting on suicide.

2) Survivor’s guilt and revenge fantasies

By assigning “reasons why,” the series sends a message that Hannah’s death is caused by other people’s actions. When Clay openly questions, “Did I kill Hannah Baker?” his friend Tony answers dramatically, “Yes, we all killed Hannah Baker.”

Although we suggested earlier that we all have a responsibility to create communities that help prevent suicide, Tony’s level of direct attribution can be counterproductive. Hannah experienced multiple losses, traumas and stressors caused by others, both intentionally and unintentionally. Placing responsibility for her death on those individuals instead of on Hannah’s action can exacerbate survivors’ guilt. Those viewers who have lost a friend, loved one or acquaintance to suicide may feel even more strongly after viewing the series that “It is my fault.”

These feelings are associated with lower functioning in comparison with survivors of accidents. Although undeserved, survivor’s guilt is a real phenomenon, and considerable research shows that even counselors who experience the death of a client by suicide can experience shame/embarrassment and emotional distress.

Whereas Clay may feel guilt for his part in Hannah’s story, the tapes could implicate others in criminal or negligent behavior, perhaps giving Hannah posthumous revenge. Some viewers who may have struggled with suicidal ideation themselves could get the message that if they take their lives, they can get revenge on those who have hurt them. This is an additional reason that schools across the nation and professional helping organizations have felt the need to do damage control for 13 Reasons Why.

 

Recommendations

1) Parents need to not just talk but watch, listen and connect.

Some school counselors argue that it’s harmful for children and teens to watch the series on their own without the support of a parent or trusted adult because the series depicts a graphic and romanticized portrayal of a teenager in crisis and does not identify competent resources capable of helping her. Accordingly, many experts encourage parents to talk to their children about the series. In addition to using talking points, we recommend that parents listen deeply and without judgment to what their children say. When people feel genuinely heard, they are more likely to talk about their true thoughts and feelings.

To accomplish this goal, parents can use active listening skills, such as open-ended questions, reflections of feeling, paraphrasing and encouragement. Also, we recommend that parents watch the series and risk being human — risk being impacted by the series and empathizing with their child. The construct of empathy is powerful, particularly if it is sincere. For a three-minute visual summary, consider watching Brene Brown on empathy. In our counseling skills courses, we often talk about “getting in the well of despair” and genuinely connecting with others. We know that talking about suicide paradoxically provides a significant buffer to suicidal action.

2) We need more than prevention programming in schools.

We know from a well-regarded U.S. Air Force study that we need suicide programing at all three levels: prevention, intervention and post-intervention. Many suicide prevention programs have been implemented in the school context, but there is mixed evidence of their effectiveness. From our clinical experience in crisis response, our scholarship and our history with training a specific model of suicide intervention, we need to acknowledge that we are biased about what types of programming should be implemented and when is the right time to implement. We feel that an appropriate first step for a school system is to implement basic screeners and gatekeeper trainings such as Signs of Suicide or Sources of Strength.

However, suicide prevention should not end with identification for referral. Optimally, the process continues by assessing level of risk, identifying reasons for dying and reasons for living, discussing alternatives to dying, enlisting the support of trusted loved ones and limiting access to lethal means or securing the person’s environment. Because youth who struggle with thoughts of suicide often seek out the support of those they trust rather than professional mental health providers, those teachers, coaches and others with open hearts and doors are the most effective gatekeepers for a system. Their nondirection and empathy are useful pedagogical qualities and vital to effective suicide intervention.

We endorse models that empower those “natural helpers” to provide a potentially life-saving intervention for students who are in suicidal distress. Although this may be augmented with the support and follow-up of a trained mental health provider, gatekeepers can implement the steps listed above.

3) Be intentional about identifying caregivers and shifting school culture.

My (Shannonhouse) research involves partnering with school districts and superintendents (in Maine and Georgia) to identify “natural helpers” and equip them with the skills to perform a life-assisting intervention in the moment (i.e., Applied Suicide Intervention Skills Training, or ASIST). These natural helpers are often teachers, resource officers, coaches, administrative staff, bus drivers and other people who are likely to be confidants to students who experience distress. Measuring suicide intervention skills and responder attitudes is easy for an academic. Identifying those school personnel in the trenches who would be first responders is more difficult — it requires the total involvement of administrators. Furthermore, such an approach requires schools to commit to a student-centered response model.

ASIST is relationship-driven and aligned with the values of the helping professions. It meets the needs of students who are at risk by focusing on responding to those immediate needs rather than referring the student (which can lead to further isolation and an increased sense of burdensomeness). Although the student is often referred for more long-term counseling, ASIST provides the student with a six-step intervention at the moment it is most needed and can be performed by anyone over age 18. Having natural helpers trained in ASIST or a similar protocol can dramatically increase a school’s responsiveness and effectiveness to help students in distress.

4) Use an intervention model backed by research.

ASIST is a 14-hour, two-day, internationally recognized and evidence-based model that has been adopted by multiple states and the U.S. Army. It has also been recognized by the CDC and used in crisis centers nationwide. Caregivers trained in ASIST consistently report feeling more ready, willing and able to intervene with a person at risk of suicide.

The program has been evaluated in a variety of settings (click to download), with pretest to post-test improvement noted in trainees’ comfort level at intervention and in their demonstrated intervention skills in response to simulated scenarios. Although outcome research is rare, research compared ASIST-trained counselors with those trained in other models through a double-blind, randomly controlled study of more than 1,500 calls to the National Suicide Prevention Lifeline. Those trained in ASIST more often demonstrated particular behaviors such as exploring invitations, exploring reasons for living, recognizing ambivalence about dying and identifying informal support contacts. Those trained in ASIST also elicited longer calls.

We found that ASIST can be applied to both university and K-12 settings. Our work measured increased suicide intervention skills and beneficial responder attitudes, which have been maintained over time. We have trained more than 500 people in ASIST and have received multiple reports of teachers disarming fully formed suicide plans with their new skills. More recently, we have conducted behavioral observations of ASIST responder behavior and have begun evaluating outcomes of students who have received ASIST intervention. Initial results have been promising, including better coping and commitment to follow-up and decreased lethality.

 

Summary

Although 13 Reasons Why gives us pause for its poor portrayal of effective suicide intervention, we feel that the series raises awareness and, at its core, advocates a community-level response to suicide prevention. This message to “look out for each other” is aligned with more intervention-oriented gatekeeping. We have explored the impact of one such model, ASIST, in several educational settings and found that it improves responder behavior. Furthermore, this approach comes with a mindset that systems can harness their strengths (i.e., natural helpers) to focus on responding to and intervening with the student rather than simply identifying and referring the student to the system.

 

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Please contact me (Laura Shannonhouse) should you have any questions about our research.

 

 

Laura Shannonhouse is an assistant professor in the Counseling and Psychological Services Department at Georgia State University. Her research interests focus on crisis intervention and disaster response, particularly involving social justice issues in this context. Currently, she is conducting community-based research in K-12 schools (suicide first aid) to prevent youth suicide and with disaster-impacted populations in fostering meaning-making through one’s faith tradition (spiritual first aid).

 

Julia L. Whisenhunt is an associate professor of counselor education and college student affairs at the University of West Georgia. She specializes in the areas of self-injury, suicide prevention and creative counseling. She is particularly interested in the relationship between self-injury and suicide and ways that mental health professionals can apply this knowledge to clinical intervention.

 

Dennis Lin is an assistant professor at New Jersey City University, with areas of expertise in play therapy, child/adolescent counseling and assessment, suicide prevention/intervention, quantitative research and meta-analysis. He is also a certified master trainer of Applied Suicide Intervention Skills Training (ASIST).

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Bringing the family counseling perspective into schools

By S. Kent Butler, Tony D. Crespi and Mackenzie McNamara May 8, 2017

Children in schools today come from increasingly diverse and complex families. As illustration, more than 1 million families are impacted annually by divorce. In fact, approximately 13.7 million single parents are raising 21.8 million children, and 1 in 3 Americans are stepparents, stepchildren, stepsiblings or part of a stepfamily. Furthermore, according to a 2009 article published in the journal Family Relations, it is estimated that only 31 percent of fathers who no longer live with their children maintain weekly contact with those children. It is easy to conclude that the issue of divorce alone has a profound impact on many millions of children in the U.S.

Now imagine that a young student and her mother walk into the professional school counselor’s office on a Monday morning. Mom explains that she and her husband are pursuing a divorce — he recently told her that he’s been having an affair and has decided to move in with his girlfriend. The daughter acknowledges feelings of depression and admits to having angry outbursts at home. Mom says she is concerned because her daughter’s grades have been dropping.

Considering the large number of children and adolescents coping with parental divorce, it’s not surprising that this fragmented family came to the school counselor’s office. In fact, it’s a good thing. Both daughter and mother need someone to talk to, and schools are a natural access point for services. However, many professional school counselors are not trained in family dynamics and are not familiar with key tenets that impact family counseling, so they may not know how to proceed.

A sample case

Susie is 15. A high school freshman, she knows only that her father left the house two months ago to move in with his girlfriend. Susie’s parents had been together for 16 years, getting married shortly after college.

Susie’s father hasn’t called since leaving. Susie is unaware that her father told her mother that although he loves Susie and her younger sister, who is in seventh grade, he hasn’t missed seeing them in the least. Mom decided not to share this comment with the children, but she does confide this secret to you, the professional school counselor.

Sitting in your office, Susie suddenly looks up and exclaims that she is scared she will have to move and change schools. She also says that she’s having a really tough time paying attention in class and explains that her grades are slipping. “I hate my dad for doing this!” she yells.

Suddenly, Susie starts shaking and breaks down in tears. After a few minutes, Susie tells you that she is spending a lot of time with her boyfriend, partly to stay out of her house. She acknowledges feeling depressed. After pausing for a moment, she looks at her mom and states, “I really hate Dad. His girlfriend is so young. She’s in her 20s. She’s not much older than me!”

Academically, Susie has been an A and B student, but her grades have fallen since her father left. Her mother acknowledges that things are tough at home and reveals that she didn’t learn about her husband’s affair until the day he moved out. “I really don’t know what’s going to happen,” she tells you. “I know we’re getting a divorce, but beyond that I just don’t know.”

Your school doesn’t have a social worker. However, you have a colleague who has been studying family counseling, so you knock on her door to ask for a consultation. After sitting down, you share a few thoughts.

You note that, fundamentally, Susie needs someone to talk to about these issues. Acknowledging that you are speculating, you openly wonder what type of impact the obviously poor communication in Susie’s family is having on her. After all, her father has not called in two months, her mother was completely unaware of the affair and her mother is keeping the father’s confession of not missing his kids a secret. These facets alone highlight poor family communication. In addition, Susie is scared that she might have to move and change schools. Clearly the issues are widespread.

Risk points

Here are some risk points to consider as you work with Susie:

  • Parenting after a divorce differs significantly from parenting prior to
    a divorce.
  • Single-parent families in the United States are increasing.
  • Children of divorce have more mental health problems in comparison with their peers.
  • Suicide is the third-leading cause of death among U.S. youth.
  • Brain regions responsible for decision-making are not fully developed in youth.
  • Changes in family structure can have an affect on school grades.
  • Anxiety, depression and behavior problems are elevated after divorce.
  • Children of divorce often feel a sense of instability.

An understanding of these risk points is essential for moving forward with children and families because the risk points can provide direction for the work that needs to be done. For example, knowing that mental health symptoms are elevated following divorce and impulsive decision-making is greater among youth, you should assess Susie’s level of safety. In this case, Susie also makes many “red flag” statements.

These are things that counselors know how to address but might not always consider without an awareness of the data. In addition, parents can become defensive, or they might blame themselves for their children’s difficulties. For this reason, it is imperative to educate parents on these risk points. It is also important to realize that family issues may require clinical supervision.

Supervision around work with families 

Susie is not alone. As your colleague notes, Susie is one of many children and adolescents who are coping with family stressors. With the prevalence of so many family issues, a growing number of states have enabled licensed marriage and family therapists (LMFTs) to work in the schools. Connecticut, New Mexico, Maine, Texas and Illinois have passed specific laws to allow LMFTs to work in schools, whereas Massachusetts allows LMFTs to work under a general mental health designation.

Schools clearly represent an important access point for mental health professionals. But with only six states utilizing LMFTs in schools, it is extremely important for professional school counselors and their supervisors to know how to manage these situations with families.

As you ponder your next meeting with Susie, you need information. Direct supervisors are often part of the structure of many agencies, but professional school counselors might need to seek support from a colleague with training in family counseling. Such supervision might come from a guidance director, a school psychologist, a consulting psychologist, a marriage and family counselor, or a local family agency.

Two popular family therapy models that might help Susie are presented below.

Symbolic-experiential family therapy 

This model, derived from the work of Carl Whitaker, addresses both individual and relational patterns. It is focused on both personal growth and family relations.

Fundamentally, the therapist helps dislodge rigid patterns and stimulates flexibility using a family’s natural pull toward growth. Focusing on the present, the therapist helps people recognize their real feelings, express those feelings and move forward, individually and as a family. Key points follow.

  • The “battle for structure” involves clients (a family) “sizing up” a therapist. There is no “identified patient”; rather, the family is the therapy unit. In this model, the therapist must win the battle and control therapy. For instance, if the therapist invites the entire family and one member does not show up to the session, the therapist may refuse to meet until everyone attends. In the case with Susie, you might note that you, Susie, her mother and Susie’s sister must all attend.
  • The family must win the “battle for initiative”; this involves their decision to take charge of their lives and decisions. Is Susie committed to resolving her feelings? Will she commit to six counseling sessions? Is she willing to confront her father about calling his children? Is she motivated to initiate change?

Therapy progresses through stages:

1) Engagement: This is the “meet and greet” phase. You have already started this stage with Susie and her mom.

2) Middle phase: Families are encouraged to change through confrontations, encouragement and interventions. Can Susie’s family meet to start this process?

3) Late phase: Increased flexibility is a focus for the family. Can Susie’s family talk through how the divorce will change their life?

4) Separation: As the therapist separates, the family takes responsibility.

Symbolic-experiential family therapy often advocates the use of co-therapy, making it a great model to use with a more “senior” therapist. In this fashion, supervision can be active and ongoing as you acquire firsthand skills in family counseling.

Structural family therapy

The structural approach, typically associated with Salvador Minuchin, views problems as being rooted in family interactions. Fundamentally, if we can help change the family’s organization (structure), its members typically find that they feel better and their symptoms are often relieved. Key points follow.

  • Enmeshment or disengagement: Family members may range from those who are overly connected to those who are disengaged. Enmeshment tends to prevent growing maturity, whereas disengagement may lead a child to feel abandoned. Most families are not one or the other but have subsystems that reflect their tendencies. For example, a disengaged father who is overly involved at work may neglect the family. In response, the mother may compensate by becoming overly involved. Is Dad really connected? What is the structure
  • Boundaries: Are parental boundaries rigid or flexible? Are grandparents a resource? Can a child visit Dad at work, or does the family maintain a rigid rule against it? Can Susie ask Dad questions? What are the boundaries? What is spoken? What is unspoken?
  • Alignments: Who joins together? Are children aligned against the parents? Did a parent resent and refuse to attend a child’s sporting activities? Did a parent require everyone to attend? What are the alignments?
  • Triangulation: The permutations of triangulation in families can be abundant. A child and parent may triangulate against another parent. A parent having an affair can create a triangle with the other spouse. Will Susie triangulate with Mom against Dad? What triangles exit?

The structural model also features several stages:

1) Joining and accommodating

2) Assessing family interactions

3) Monitoring dysfunction

4) Restructuring patterns

Summary and considerations

When a student walks into a professional school counselor’s office, we are presented with a rare opportunity. When a student and parent walk in together, we are handed an even rarer opportunity.

Family counseling offers unique and engaging ways of reframing problems. Rather than blaming an individual for a particular problem, family counselors look at the family system. Perhaps a child’s acting-out behaviors allow parents to avoid looking at their relational problems. Perhaps a child’s failing grades reflect more on family anxiety and stress than on individual issues. Fundamentally, family counseling takes a larger, more systemic perspective of presenting issues.

Professional school counselors possess wonderful skill sets. They understand rapport building. They understand relational dynamics. They understand problem assessment and the utility of interventions. The connection between families and school adjustment is undeniable. At the same time, school counselors will likely find continuing education and supervision indispensable in helping families.

In our experience, students and families can often benefit from a family counseling perspective. With so many students in the schools coping with changing family structures, it is vital that we expand our skill sets. Fortunately, there are multiple platforms through which we can provide help. Some of these options include:

  • Individual counseling from a family perspective
  • Co-therapy with single families
  • School-based divorce groups with multiple children
  • Single-parent support groups

This article is intended to stimulate thinking and provide a preliminary glimpse into two prominent family counseling theories. Our advice? Be available. Be sensitive. Consider finding a supervisor who is capable of expanding your knowledge and skills in this invaluable area. Truly, children, families and the community stand only to benefit.

 

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S. Kent Butler is an associate professor at the University of Central Florida. He is a licensed professional counselor, national certified counselor and national certified school counselor. He is particularly interested in mentoring, supervision and multicultural issues in counseling. Contact him at skbutler@ucf.edu.

Tony D. Crespi is a professor at the University of Hartford. He is a certified school counselor, licensed marriage and family therapist, and licensed psychologist. He is particularly interested in family counseling and legal issues that affect supervision.

Mackenzie McNamara is a doctoral student in the counseling psychology program at the University at Albany, State University of New York. She most recently worked for New London Public Schools in Connecticut.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.