While we all continue to raise our voices and advocate for better provision for the mental health of children and young people, we need to talk about what is already happening. It may be that we can make what is there even better, even more effective. Many organisations are suggesting we need a play therapist in every school – and don’t get me wrong, it would be a great step in the right direction – but there are certain things we need to talk about when it comes to therapy provided in school. 
Many schools around the country have taken the courageous decision to employ a qualified play therapist at least 1 day a week. Many schools know it is important and have fought to retain that provision through the crazy current budget situations. Many schools don’t realize what they have really done by doing that! What do I mean? Well beyond the obvious ‘we have employed a qualified mental health professional to work with a few of our children’ is hidden something else. It is this:
‘We have brought into our school, a mental health professional who works in a different way, with different priorities, different processes and a whole different way of thinking.’
Many schools and therapists actively say they value diversity, however, it is a common phenomenon across the country, that when therapists start working in schools, these differences, between their culture and school culture, if not handled proactively, can bring confusion, frustration and quiet animosity on both sides. Understanding the main points where these two cultures clash can bring real insight and when openly addressed actually improve the quality of the mental health provision for each child.
Closed doors.
In a school a closed door is frequently hardly noticed (apart from the door to the Head’s office?) and is opened and often walked through without acknowledging it even existed. Any message it may be giving is unheard, un-acknowledged and not respected. Closed doors have little-to-no meaning, and whatever a person needs on the other side of the door, whatever activity is happening there that they will interrupt, they are allowed to proceed to their agenda. That is common door culture in schools. In the world of therapists a closed door is imbued with profound meaning. It is a sacred way of protecting a client. Helping them know they are safe here; there will be no interruption, intrusion or any distraction. It lets them know that this room, this space is for them. It lets them know that they are important, they are valuable. It reassures them that the often hideous things they have experienced that may have them feeling worthless and vulnerable, will not happen here. A respected closed door communicates to the hurting child that they, and the things they may need to concentrate on in this session, are IMPORTANT, will be HONOURED and are worth PROTECTING.
Making changes
In schools change is the one constant. Room changes, timetable changes, lesson changes (curriculum changes and government focus changes!). One of the qualities of a proficient teacher is to be able to ‘go with the flow‘ be spontaneous and keep the learning agenda high whilst juggling, being flexible and creating ‘on the hoof’. In the therapy world consistency is another sacred way of showing respect for the client and the journey they need to make. Therapists will resist change and it is important that they do. Sessions need to be at the same time, on the same day, in the same place each week. Children learn very quickly when their session is, and that time and day becomes an anchor for them in their often turbulent weeks. Keeping things looking the same, and in the same place in the room (without items suddenly missing or being added) helps children develop relationship with the room as well as the therapist. It is a big part of helping a child feel safe and trusting this space. I will never forget the child who made a card to stick on the cupboard before he left his last play therapy session before the Christmas holidays. What did he write on it? ‘Bye room. See you next year.’
Accessing sessions
In school playing with toys, or doing anything that is not timetabled or sitting in the classroom with the rest of the class can be seen as a ‘treat’. If a child isn’t in school then they don’t get to go swimming, they don’t get to see the pantomime, they don’t go to Lego club, and they don’t get Golden Time; they don’t get their ‘treats’. Therapy is a mental health provision. It is there to support a child as they try to survive and heal from the challenges that life has thrown them. Therapy is often very hard work. It may seem like fun to an outsider, because a client gets to choose what they ‘play with’ but really a child is just choosing their safest way to express what has happened to them in the past, what they are dealing with in the present or what the are scared about in the future. Going there, thinking about that stuff, is rarely fun. Therapy is not a treat. Even though it may happen on the school premises it is not ‘school’ ie education, it is a mental health provision. If a child is unwell they will obviously miss a session. If a child is excluded however, they will still need to attend their session (and they now have even more to process) and then go home again.
Assessing progress
In school any educational process is governed by the progress and outcomes that are provable. Each lesson, intervention group, and module of work is assessed and evidence is gathered that progress is being made in lines with already pre-determined markers. Progress in these terms is more-or-less a straight upward trajectory. If there is evidence that things are getting better then ‘it’ is working. In therapy assessing ‘progress’ is an altogether different scenario. General tick box-assessments (SDQs etc) are made regularly (probably termly). However, in between these tools, which are only 1 element to a wider review process, ‘progress’ may look different to the therapist than it does to school staff. A child who has been shut down, possibly in freeze following earlier life trauma will always hit into the massive survival energies of the fight/flight physiology as they start to feel safe enough to ‘heal’. As I explain in detail in GROUNDED, this is a particular area where staff can easily mistake behaviour that is more challenging for no-progress or things getting worse.
5. Endings
In school extra educational provision can stop on a whim. Heads are under intense scrutiny from higher powers to line up budgets, to justify spending, to use the little money they have for the greatest return. They think big picture. What’s best for everyone, and make most of their decisions of success inline with section 4 above. If something isn’t seeming to them to be ‘working’ they are used to having the power and autonomy and (internal sense of responsibility) to make a decision and stop it swiftly. In therapy endings are INCREDIBLY important. The child is likely to have already had a collection of losses in their life – possibly leaving them with self-beliefs like ‘people always leave me’, ‘don’t trust people- they will go’, ‘people don’t want to be with me’, ‘people don’t like me and go away’. If a child has been through a deep healing journey with a therapist they will need a long run of sessions to process all their thoughts and feelings as their relationship and their access to their safe space comes to an end. 6 weeks of counting down with the child enables them to do what they need to, say what they want to and have a positive ending experience that leaves a good deposit in their life. They are part of the process and empowered by it. Ending a child’s therapy should be a joint decision made by the therapist, school, parents AND the CHILD. Any deviation to this procedure and the therapist will likely challenge the decision. They will advocate for their client. It is their job. It is important for that child’s mental health that they do. Of course, emergencies happen, and will be managed as best as possible by the therapist, however as a rule they should be the rare exception. Suddenly imposed endings cause damage to a child’s mental health. No one wants to be responsible for that.
Common Ground
Schools and therapists both long for happy children. Schools and therapists agree that there are oceans of unhappy children currently swirling through schools. Therapy can absolutely be a life raft for them, but only when the school and therapist work hard to communicate. Communicate needs. Communicate expectations. Communicate about communication! Communicate with curiosity, respect and with a desire to understand each other. We only manage to build bridges and work together with those from other cultures when we can first acknowledge we are not the same. Supporting our children’s mental health and supporting effective therapeutic provision in schools is going to challenge, test and grow us all! Are these children worth it? I believe we already know the answer to that… 
Claire Wilson is the Clinical Director of CHEW Initiatives and has many years experience as a teacher and subsequently an accredited play therapist. She is now a therapeutic adviser to schools, and is the author of GROUNDED: Discovering the Missing Piece in the Puzzle of Children’s Behaviour written for parents and all professionals working with and around children (www.groundedbook.net)
