Multi-agency working to support vulnerable young people can be an important strand of extended school provision, says Lisa McClarence, who gives an overview of the counselling work she does in schools

I am a counsellor working two days a week in Kenton Secondary School in Newcastle upon Tyne. I commenced this role in 2003 and work with young people to support them in addressing the emotional and behavioural difficulties that are affecting their learning and quality of life. My role in school is funded partly by Connexions and partly by the school. I am actually employed by Streetwise Young People’s Service, a registered charity offering a range of confidential services (information, guidance and support around issues ranging from sexual health to mental health) for young people aged 11-25. Streetwise has a main base in the city centre of Newcastle upon Tyne and one day a week I work at this base alongside colleagues in the counselling and youth work teams. When I’m not in school, or at the Streetwise base, you will find me at the University of Teesside where I am studying towards my doctorate in counselling psychology.

My typical day in school

  • 8.30am – I arrive at school. Check my pigeon hole for any new referrals or messages. Check my emails. Look at my daily appointments and prepare any exercises and/or information to give to the young people I am due to see. Read my case notes from the previous session for the first two appointments of the day. I also text a young person who has requested a text reminder for their appointment.
  • 9.05am – My first appointment is an initial meeting with a young woman referred to me by her learning mentor. The referral form stated that she ‘came from a different school due to bullying and is finding it hard to cope in the new school’. I encouraged her to discuss her experience and feelings, and other support networks that she may draw upon. Towards the end of our session I asked if she would like us to work together to help her to feel less scared about coming to school and to explore coping and support mechanisms. She agreed to receive counselling and we arranged another session for next week.
  • 10.05am – I meet with a client for a review session. This allowed her and I to reflect on progress and to discuss when might be an appropriate time to end our therapeutic relationship. I arranged for her to attend a further three sessions.
  • 11.05am – Break time! I usually have a coffee and catch up with my colleagues in school. Young people can also drop in to arrange or rearrange counselling appointments. I normally spend some time reading case notes for my next appointment.
  • 11.20am – My next client did not turn up for her appointment. I have the young person’s mobile so I text her to inquire how she is, remind her that she has missed our appointment, and I advise her that I will arrange a new appointment for next week.
  • 12.20pm – I have lunch, take a few deep breaths, and catch up with dealing with queries from young people and/or any other agencies involved in supporting the same young people I am working with.
  • 1.15pm – Session four is with a young man suffering from bereavement. We spend time exploring his feelings. I arrange another session for him for next week.
  • 2.15pm – A CAMHS worker attended this session with my client to assess her levels of risk. This was arranged, with the young person’s knowledge, after she described hearing persecutory voices.
  • 3.15pm – Time to reflect and off load. I write case notes for each client, and write and send any appointment letters for the following week. I also deal with any new referrals and queries. Before finishing at 4.30pm, I plan for my next round of appointments.

Counselling support My practice is informed by the principles of counselling psychology. I practise as an integrative-relational counsellor and I feel I integrate aspects of the person-centred perspective, cognitive behavioural therapy (CBT), psychodynamic and solution-focused approaches in my work. I always try to adopt an integrative approach which is both proactive and creative. I adhere to the British Association of Counselling and Psychotherapy code of ethics and receive counselling supervision from an external supervisor. The information I receive prior to initial sessions with students is often limited. When I first meet a young person in school I always conduct an initial assessment. Initial sessions are an assessment in terms of risk, child protection, historical information, other agencies involved in supporting the young person and current support networks for the young person in school. I always ask the young person if their parents or carers are aware that they are receiving counselling and if not I encourage them to do so (for under 13-year-olds I require parental consent). In the initial session I will inform the young person about the service and discuss what counselling will entail. I will always make it clear that the service is voluntary. Then, together, we explore what work we can do together and what I can offer the young person. If the young person feels they would like counselling we arrange an appropriate time for our appointment the week after. During the course of counselling, a young person and I will have one or more review session. The reviews are extremely important to identify changes or movement since our initial appointment that may, or may not be, attributable to counselling. They also give the young person the opportunity to reflect on progress made. At this stage, I often gather feedback which I can later anonymise and use as evidence of positive work with young people. Towards the end of the counselling relationship with a young person, I always explain that setting an end date and working towards this is a very important aspect in counselling – an ending that clients do have some control over.

Partnership working

The nature of my work in school means that partnership working is something I do as a matter of course. I work with partners including the school nurse, psychiatrists, Child and Adolescent Mental Health Services (CAMHS), social services, learning mentors, teachers and the Connexions service. I receive referrals from colleagues such as learning mentors and heads of year in school, but I will also make referrals to CAMHS and other services if necessary. Sometimes a colleague such as an education welfare officer or a CAMHS worker, will, with the client’s consent, come along to one of the sessions and meet with the client. Communicating regularly with colleagues from different disciplines means we can also share experience and knowledge.

In order to give a more detailed insight into my work, and the sensitive nature of the issues I support clients with, I have summarised an example of a case I worked on (see below). The personal details of the client have been modified to protect confidentiality.

Case study

Background to referral
Paul referred himself to the school counselling service and gave his referral form to his head of year. Paul had disclosed on his referral form that he would like to talk to me about self-harm and attempted suicide. Paul’s head of year brought him to see me immediately as he was concerned about Paul’s risk to himself. Paul did not want his parents to know that he was attending counselling.

Presented issues – what the young person wanted to work on
Paul shared that, as a child, he witnessed his biological father being physically abusive to his mother. He also described having friendships currently which were stressful for him and spoke of a history of homophobic bullying in school. Paul talked about his experience of ‘coming out’ as gay at the age of 11; the discrimination he encountered from students and staff in school and the bullying from peers that followed. Our initial session was based on crisis intervention and assessing Paul’s suicidal ideation. When he shared that he had recently attempted suicide, that he regularly self-harms, and that he drinks excessive amounts of alcohol at weekends, we decided he must speak to his GP to ensure his had not inflicted any long-term damage to his body.

Partnership working
Due to the child protection boundaries presented to me, it was necessary for me to speak both to my manager and the child protection officer in school and throughout my time supporting Paul, I continued to work closely with the child protection officer, Paul’s head of year and with a teacher who supported Paul in between counselling sessions.

I encouraged Paul to speak with his GP and I accompanied him on a visit to meet a support worker from a local group for young homosexual men. During counselling Paul had a crisis card, my work mobile number and various staff in school to support him.

Counselling theory and practice

I employed an integrative-relational approach with Paul due to the range of issues he brought to counselling and based our counselling sessions on person-centred theory. This placed emphasis on the therapeutic relationship and employing the core conditions in counselling – unconditional positive regard, empathy and congruence. I also applied the philosophy of transactional analysis (TA – an aspect of this is recognising that everyone has the capacity to think about and decide their own destiny) which helped him to recognise that he had choices and control of his actions, and allowed him to develop a greater level of self-awareness. I used CBT to challenge Paul’s negative thoughts and used the TA drama triangle concept, and a range of other resources, to help Paul to further explore the games he plays in relationships. Various strategies were employed when we explored anger management.

Outcomes

Paul received 26 counselling sessions over the course of a year. In review sessions I used scaling questions to help Paul identify the progress he was making on coping with the issues he brought to me. He felt very negative when we embarked on the therapeutic relationship and ranked his feelings as two on a scale of one to 10 with one being ‘very negative’. When asked to do the same during our final session, his ranking was off the scale at 11. During our final counselling session he discussed coping better, feeling stronger, being in control, and having not had suicidal or self-harming tendencies for a long time. Paul said that the visual, practical exercises really helped him in counselling and that my congruence really made him question himself, which brought around positive change for him, especially in his relationships with others.

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