In England, approximately one in seven young people meet the criteria for a “mental disorder”, with prevalence rates rising over the past two decades. Schools, as recognised by the UK government, may provide an ideal environment to try and address this problem. They provide young people with unparalleled access to services; alleviating barriers such as time, location, and cost.
One of the most common forms of school-based mental health intervention is counselling. School-based counselling is well established in more than 60 countries around the globe, and mandatory in at least 40, including Wales.
In England, approximately 60 per cent of secondary schools provide some form of on-site counselling, with 70,000 to 90,000 young people attending it every year in the UK.
School counselling in the UK most commonly takes a humanistic (aka “person-centred”) form. Here, counsellors provide clients with an empathic, non-judgemental and supportive relationship to find their own answers to their problems. This form of counselling is not targeted towards specific mental health disorders (such as depression), but adopts a more general orientation.
This may make it particularly appropriate as a “first line” intervention within a school context, where a diverse array of mental health challenges may exist (for instance, bereavement, bullying, or problems with parents/carers).
But does this form of school counselling actually help?
In 2016, a team led by the University of Roehampton, with the National Children’s Bureau, the universities of Manchester and Sheffield, the London School of Economics, Metanoia Institute (London), and the British Association for Counselling and Psychotherapy, was funded by the Economic and Social Research Council to answer this question.
The Effectiveness and Cost-effectiveness Trial of School-based Humanistic Counselling (ETHOS) was conducted in 18 state-funded secondary schools in London.
A total of 329 young people, with at least moderate levels of emotional symptoms, took part and were randomly assigned to one of two conditions: school-based humanistic counselling (along with access to the school’s usual pastoral care provision) or access to the usual pastoral care alone.
Counselling sessions were delivered on an individual, face-to-face basis, and lasted about 45 minutes. They were scheduled weekly over a period of up to 10 school weeks.
So, was the counselling effective?
The main finding was that 12 weeks from assessment, those who had participated in counselling reported significantly less psychological distress than those who had not. These differences were still present 12 weeks later and were not affected by factors such as the pupil’s gender, age or ethnicity.
The study also found that counselling brought about improvements of the clients’ individual goals (for instance, feeling more confident, improving their relationships with their parents/carers, or controlling their anger), and boosted self-esteem; and there were small improvements in wellbeing and psychological difficulties after 12 weeks.
However, the counselling had no significant effect on symptoms of anxiety and depression. It also had no effect on the young people’s willingness to engage with school or on other educational outcomes, such as attendance and exclusion rates, number of disciplinary proceedings, and predicted grades.
What did the young people make of the counselling?
When asked to rate, overall, whether the counselling was good or not, around two-thirds said that this was “certainly true”, 30 per cent said that it was “partly true”, and about five per cent said it was “not true”.
How did the counselling ‘work’?
So how might the counselling have had positive benefits? A preliminary analysis suggests four main “pathways of change”.
First, for about three-quarters of the clients, counselling seemed to be of value because it helped them get things off their chests. “It was getting all the negativity out of me,” said one young person.
Second, about two-thirds of the clients said that the counselling was helpful because of the advice that they had received. This was mainly with respect to relating to others (for instance, advice on ignoring bullies), or learning ways to deal with stress (for instance, making a timetable).
Third, for about 60 per cent of the clients, the counselling seemed to have been helpful because the ways they had developed of relating to the counsellor – in particular, trusting and opening up – were then generalised out to significant others in their lives.
Finally, around 40 per cent of the clients said that the counselling had helped them to develop insight into themselves and their situations, which then helped them identify – and choose – more effective ways of behaving.
What does this mean for school counselling?
The findings suggest that, on average, school-based humanistic counselling can help young people, with effects that persist for at least three months after the end of counselling – but it is not a silver bullet. Rather, it is likely to help some young people some of the time, and should be offered to young people as one out of a range of possible interventions.
What is most important now is to carry out equally rigorous evaluations of alternative programmes in the UK and to develop some understanding of which interventions are most likely to be helpful for whom.
- Mick Cooper is professor of counselling psychology at the University of Roehampton.
Further information & resources
For more details about the ETHOS study, which was published in January 2021, visit http://bit.ly/3bt81YU