School-Based Mental Health vs. Traditional Therapy

It is common to think of counseling services as being the same regardless of location (school-based or traditional/office). However, there are a number of differences that you should know when comparing the two. Some concerns may be effectively met in either setting, but that is a decision you should consider with input from your family, school staff, and an outside provider.

Here are a few of the main differences I have noticed when it comes to school-based counseling.

Diagnoses

Schools may not use a formal diagnosis as much as an outside provider. Traditional therapy benefits from diagnostic criteria to help (1) focus treatment and interventions and (2) submit to insurance companies for billing purposes. There may be other uses for a diagnosis, but those are two primary reasons I have seen.

In a school, it is much more useful to understand how a particular students’ needs shows up during the school day (e.g., constant movement, excessive worries, shutting down emotionally). These ‘behavioral manifestations’ are what a teacher will SEE, regardless of what the DSM-V TR says. Therefore, diagnoses may be helpful but not required since the support is based on the observable behaviors.

Treatment Planning

Treatment plans are useful in structuring a client’s services over a long period of time. This is a key way in which providers confirm whether or not clients are improving and the treatment is effective. When there is a lack of progress (or new concern), the treatment plan may be adjusted to better match the current needs.

In schools, treatment plans are less common and not usually referred to in the moment. Teachers are often managing 25 students (often more), each needing something unique to support their learning. This may be solidly in a teacher’s wheelhouse; however, there is a higher reliance on experience, classroom management techniques, and good judgment instead of a specific treatment plan for one child. There are support personnel who WILL make good use of a child’s treatment plan (e.g., School Counselor, School Psychologist, Social Worker), but this requires collaboration and clear communication within a building.

Format and Timing

School-based counseling is often provided informally, individually, or in a group setting. Session lengths can be 30 to 60 minutes – depending on the provider and their program. This often differs from traditional therapy which can occur in much longer time periods (~50 minute sessions, at a minimum) and in various formats (in-person or virtually). At schools, our services are competing with instructional time – which is a big priority in school buildings, for good reason. Therefore, it is important to consider the degree of need when engaging with school-based counseling services. This is not to say that it is less effective for all students, but there are real limitations for certain concerns that must be understood regarding school-based vs. traditional counseling services for your child.

Keywords: school-based mental health, counseling, therapy, services, adolescent, child, teen, mental wellness

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