chapter 9 INDIVIDUAL COUNSELING Scoot psychologists are often called on to do individual counseling with students However, school psychology preparation programs vary in the level of training in this area. I remember when I firse started out in the schools, I was often sent the most chal- lenging students for counseling, and I was probably the least experienced mental health professional on-site, I also remember that I had way more referrals for individual coun- scling than I could possibly cake on, especially with my testing caseload. I constantly found myself ill-prepared for the crisis situations that would arise in counseling, espe- cially when it came to reporting suspected child abuse and when students reported dangerous situations, Not only thar, but I was busy creating consent forms, gathering therapeutic materials, finding a confidential space, learning about limits of confidential- ity and mandated reporting, managing the practical aspects of which students to sce and when, and trying to find supervision from a more experienced clinician, Even after many years in the profession, I am still constantly challenged in my role of counseling students. In some schools, I have had to learn how to help students cope with serious community violence and threats of safety. In other schools, I have had to learn how to help students not freak out when they get an A-, while their anxious par- ents hover over the process, demanding to know what their child has said in sessions and e-mailing their concerns to me at three in the morning. Each counseling case presents its own unique challenge! This chapter will highlight the types of counseling roles you may be faced with, describe the primary theories that inform school-based counseling, and 137The School Paychologiet Survival Guide 138 provide you with practical tools to use for individual counseling. Ie will also cover the “sticky situations” you are most likely to encounter in your role as counselor. COUNSELING ROLES Mental health and counseling delivery systems in the schools are ambiguous at best. ‘There are often several staff members who might fit the bill as someone who can do counseling—school counselors, school social workers, marriage and family thera- pists, clinical psychologists (rarely, but it happens), and school psychologists. Within cach of these professions, there are often interns performing counseling duties as well. Pare of your first challenge in taking on the role of counselor is to figure out which men- tal health professionals are on-site, what their roles are, how they get referrals, and what types of students they see. I remember one year at a rather large (and chaotic) middle school, we held a coordinated services team meeting and discovered that one child was receiving counseling from three different providers! Yikes! Not only is chat a triplication of services, but from a therapeutic standpoint, it must have been hard for the kid to talk. about her problems with three different people. This is why participating on a school intervention team is important. You can get a sense of the referral process so that you dont duplicate services or end up letting students who are in need of counseling fall through the cracks. After you figure out who provides mental health services at the school site and what their referral processes are, it is important to consult with these providers so that you know which students each of you will be seeing for counseling. The type and number of referrals for counseling you receive are contingent on many factors, including your state and district regulations, your caseload and available time, and your school’s service deliv- ery model. Some school psychologists are forbidden by state regulations to do any indi- vidual counseling. In some districts, school psychology counseling services are written into the IEP as a service needed to address the disability (sometimes called a Designated Instruction and Service, or DIS). It is written into the IEP the same way speech ser- vices or occupational therapy services would be written in. In other districts and schools, counseling services by the school psychologist are provided at the discretion of the school psychologist, depending on whether he or she has time in between completing other nec- essary activities. There are also special situations where schools have set aside money for school psychologists to spend more time at the school site doing counseling (“buying” psychologist time). ‘One thing that I have found to be consistent across all these situations is that there are often more referrals for counseling than there are openings for the school psycholo- gist. Deciding on which students to see first is often a challenge, and one to be nego- tiated with your support staff and administration, perhaps at a coordinated services intervention team meeting, In some schools, I have been assigned only students who do not have health insurance, as we had a counselor on-site who could bill health insurance for counseling services. I have also been given cases in which I have rapport with the par- ent from testing the child for special education, or in cases where the parent is unlikely to have the resources (emotional or financial) to access community-based services.Individual Counseling In general, when you have a high referral rate, you want to refer out to community-based services when you can, and reserve your time for students who wouldn't normally have access to mental health services. A student also will be pushed higher on your counseling, priority list when there is an immediate safety concern or emergency situation, and refer- ring a family out to services would rake too long. Finally, you may use your own discretion regarding which cases you accept, depend- ing on your comfort level with the referral question, When you are first starting out, you might want to begin with less complex cases to get your feet wet in the counseling role, instead of putting yourself in a position where you are dealing with issues beyond your expertise and comfort level. You can, however, elect to take more complex cases if you have a great supervisor with whom you can consult on an ongoing basis. ‘TYPES OF SCHOOL-BASED INDIVIDUAL COUNSELING There are many theoretical orientations and approaches to counseling, Your training program and subsequent professional development will likely guide your approach and methods, In some training programs, there is a heavy emphasis on counseling, and in others, i is not a focus at all. In general, there are four main theories of counseling that Thave had experience with in the schools: psychodynamic therapy, play and art therapy, cognitive-behavioral therapy (CBT), and solution-focused brief therapy. As a school psy- chologist, you may pull from all of these models in an eclectic approach, or wed yourself to one particular model. I find that most people initially work with the model they were trained in, but chen expand their counseling techniques to incorporate other models that are appropriate for the situation, Each model is described in the next sections, and a resource list is presented in Exhibit 9.1 if you want to further explore a model or improve your tools and skills in a particular orientation. Psychodynamic (“Insight-Oriented”) Therapy I know what youre thinking. You are trying to imagine where the lite couch is going to fit in your tiny school psychologist office to practice psychodynamic therapy. Well, Thave news for you—there’s definitely no room for couches and no time for full-blown psychoanalysis in che schools! Psychodynamic therapy does not necessarily mean tradi- tional psychoanalysis, in which the process is completely nondirective, the focus is on the past to explain the present, and the goal is to reveal unconscious conflicts. What school- based therapy incorporates from psychodynamic therapy is that the relationship is the most important part of the therapy process. The student may experience transference— a reaction to you based on who you remind them of. I have had children relate to me as though I were 2 mom, and have had teens relate to me as though I were a peer. I have had angry children relate to me as they do with their teachers. You may in turn experi- ence countertransference (treating the child as a mom, peer, or teacher would). Your job in this role is to notice and explore the relationship the student is having with you and others. You may or may not explicitly interpret it for the child, but you are aware of it. Your role may also include helping, in a nonjudgmental way, the child develop insight 139