Introduction

Having worked within a number of local authorities in various capacities, I have identified some important issues in Counselling within the care system and also the educational establishment. Many children who come into care arrive either as young babies or children or as adolescence around the ages of 12 upwards. Many would have experienced some kind of abuse be it emotional, physical or sexual. Attachment issues are one of the main problems, contributing to a variety of mental health issues in children and young people. These issues manifest if not dealt with appropriately during the transitional stages and can result in these children developing further mental health problems as they mature into adults. Unfortunately, the care system does not assess every child that comes into the care of the local authority for mental health issues and therefore existing mental health problems are not identified early enough.

Mental health problems in the general population appear to be increasing with up to 10% of 5 to 15 year old students experiencing mental health issues (DFE 2015). Children are also affected by depression and 'Research suggests 20% of children have a mental health problem in any given year and about 10% at any one time.' (Halliwell et al 2007). There is evidence to confirm that attachment issues during the early years between parent and child can contribute to mental health issues later on in life (Bowlby 1979). Development of irrational thoughts and negative reinforcements by parents or carers can cause low self esteem and lack of confidence, leading to feelings of worthlessness and the inability to enjoy life, creating an ongoing pattern of destructive relationships (Hough, 1998). During the adolescence years, studies have found that there is a rise in the amount of depression related disorders affecting young people, sometimes leading to suicidal attempts. Epidemiological studies have previously indicated that depressive disorders tend to become more frequent during the adolescence years (Rutter & Rutter 1993).  Therefore as these children mature, their mental health problems can become more prevalent leading to further neurotic symptoms later on in life. So how can these mental health issues be identified and addressed in the early stages and preventative measures put in place?

This essay will take a brief look at the role of Counselling children and young people using creative therapy through play and whether it could be a more effective intervention if undertaken within the school environment?

Content

Research undertaken by BACP highlighted that children and young people’s mental health, covers a wide range of issues and reflects the need for them to have the relevant support from a therapist to help them work through feelings of anguish and distress. Many of these issues are common to adults as well and may get acted out at school in the form of school phobia, school refusals, bullying and behaviour problems in the classroom. Children and young people experience a variety of psychological problems and there is evidence to suggest that a proportion of young people with serious chronic difficulties have risen from 11 % to 20% over the past 14 years (BACP 2010). More concerning is that Depression in adolescence is vast and there is a 70% increase in anxiety and depressive disorders in adolescents since the millennium, with 40,000 children taking prescribed anti-depressants and an increase in suicides by young people.

With the increasing demands of life, many people are hiding behind masks, designed to conceal different sets of feelings. Our defensive systems keep these turbulent emotions hidden, afraid to show fear, pain and anger and to prevent anything else causing further wounds. They therefore tend to get acted out in anti-social behaviours, resulting in further compounded behavioural issues. With the influence of social media, young people's issues have increased in secondary schools to include things like cyber bullying. During the adolescence years puberty influences cognitive changes in behaviour which can led onto other mental health issues creating low self esteem, self harming and eating disorders.  Physical as well as emotional changes are taking place as young people become more preoccupied with how they look and how they are perceived by others. The education environment is the ideal location to identify children’s emotional issues and anti-social behaviours relating to their problems, whether they are at home, at school or within the family. Teachers are in a prime position to recognise these symptoms, however what they do with the information is crucial. 

he important aspect of Counselling is that it provides the opportunity to explore feelings, understand them and try and find a way of dealing with them more effectively. If this is achieved, the child or young person is much more able to relate in a realistic way to other people both now and in the future. Counselling involves a therapeutic relationship between two people. It involves trust and respect by both parties to ensure all those involved in the relationship, is aware of their responsibilities to the Counselling sessions. Counselling encompasses various communication skills to help the client present issues, which may be affecting their life. These skills involve listening, facilitating and providing the skills of helping, something most teachers already use within the educational environment. Some children and young people may show signs of anger, which may be projected onto them by their parents. Although these parents may be suffering in their own way, the child/young person is not yet able to deal with these feelings appropriately and may reflect these feelings of unresolved emotions, onto the teachers. However, Teachers also come with their own baggage and currently do not receive compulsory clinical supervision, which could be an issue for some teachers and their students. Separating the roles is therefore very important to avoid issues of professional malpractice.

Using imagination and storytelling, children and young people can tell their stories using metaphors. A story can enable them to fully participate with imagination and feelings. Talking about feelings is good but being able to play it out enables one to be fully involved in the process. Professionals are all aware that play is the language of the child and a vital stage of their development. Children often communicate through play and this is where the term ‘play therapy’ probably derived from. Play therapy is a good therapeutic tool for children although it can also be used creatively with adults. It provides access to the right creative side of the brain and allows unconscious thoughts and feelings to surface within a safe therapeutic environment. There are a variety of items that can be used to access unconscious thoughts and feelings through play and they include using art, visualisation, symbols, drama, music and sand play to name but a few.

Art can take on different forms including drawing, painting, pasting and sticking and most children and young people enjoy being creative. It can be a purposeful representation for understanding the conflicts and issues that may be disturbing a child or young person. For most it is a natural form of development and children tend to draw symbolic pictures that replace words but still convey meaning.

 Symbols such as miniature figures, animals, trees, buildings, vehicles, jewels, stones and various other items can be used to represent part of ourselves as our inner meanings are projected onto them. The symbols stand out for individuals because something inside resonates with it. Children and young people can use symbols to act out a scenery or use symbols metaphorically.  Symbol work on the other hand is directed and normally has a specific theme or focus like being asked to choose an item from a selection of natural objects. By encouraging a client to explore with the symbols, the Counsellor would then discuss and explore the specific situation with the client to establish how they feel about it. It is good for gaining information from the client to assist in moving the process forward.

 

‘Sandplay is a method of Psychotherapy based on practical, creative work in the sand tray’ (Ammann 1991). It can be used with adults, adolescence and children and enables the individual to create various three dimensional pictures in the sand. Sand play appears to reconnect the body, soul and spirit, enabling blocked psychological or out of touch imaginative powers to flow again. The deeper the emotions and feelings, the more distanced from conscious memories they become. Sand pictures created by either adults or children; represent a continuing practical confrontation with the unconscious, a bit like dreams. It is a more undirected therapeutic method that utilises the therapeutic advantage of free play and is designed to allow the unconscious to emerge at its own pace although it can also be used directively.

 

Visualisation enables children and young people to develop imagination to positively transform any given situation throughout their lifetime. It enables a form of Mindfulness to take place as its power becomes real when the idea of creating a reality becomes experience rather than theory. Visualisation is one of the most important tools for achieving optimum performance and has been used for Olympians to improve their routine. Conscious creative visualisation enables the creation of positive thoughts and images, to be communicated to our bodies instead of negative ones. The key is the imagination, which is a powerful tool linked to our natural creative side. 

 

It is important to note that play itself does not constitute the therapy but provides a form of communication whereby the toys or art lends themselves to expression of feelings and ideas. Play therapy has four dimensions to enable change. This involves ‘Active utilisations’ and ‘Non intrusive responding’ which are both non directive. The counsellor will occasionally give interpretation of the play to assist the change process and only indulge in the play if invited by the child. Open discussions and exploration and co-facilitation are more directive methods where the counsellor uses their tuition to facilitate the play.  There are eight principles for play therapy with children which are consistent with Dr Carl Rogers person centred approach. The main difference would be the need for the therapist to establish ‘only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of his responsibility in the relationship’ (Axline, 1989). Person- centred therapy deals with the here and now and Dr Carl Rogers looked at the relationship being of equal parts and the counsellor relying more upon the client for direction (Thorne 2002). School based person- centred Counselling allows the young person to feel contained, nurtured and free, whilst at the same time providing them with equality of power. The empathy and nurturing aspect can create attachment and transference issues. Therefore it is extremely important to ensure the counsellor does not become another ‘anxious attachment’ object, which could result in separation anxiety at the end of the sessions.

 

 Children need to feel safe and unfortunately, they may not always be in a place of safety. With an increase in the number of children being taken into care, due to bad parenting practices, abuse or neglect, there is an increasing number of people suffering with mental health problems. More young people are becoming concerned about how they look and being accepted by others resulting in anxieties, depression, eating disorders and many others as previously mentioned. Some appear to be searching for their secure base and continue to search for others to provide it for them and this may entice them into gangs and child sexual exploitation. Trying to explain or express how they are feeling may be difficult, so could creative play therapy assist here? We could consider the work of Eric Berne (1961, 1966, 1972) who constructed Transactional Analysis theory which he referred to as the ‘ego-state’. Ian Stewart (1996) defines it as being ‘a set of consistently related behaviours, thoughts and feelings’; how one experiences themselves in the world at any given moment, and how this is then manifested externally in behaviour. There are three types of ‘ego states’, Parent, Adult and Child. The ‘Parent ego-state’ is where the child uses behaviour, thoughts and feelings ‘borrowed’ uncritically from their parent/carer. The ‘Adult ego –state’ is when a person is thinking, feeling and behaving in response to what is happening in the here and now, using all the resources available to him as a grown up person. When a person regresses to ways of behaving, thinking and feeling which he used as a child, then he is said to be in a Child ego-state. When an adult is in a ‘Child ego-state’ it does not mean they are being childish, but that they are replaying thoughts, feelings and displaying behaviours first used at a specific age in their own childhood. This could be in the form of acting out because they cannot get what they want. Different types of therapy therefore may be relevant to work with the young person and what they are currently experiencing in the here and now.

 The need for children to be supported throughout learning is essential and can be acquired by obtaining certain abilities to control their emotions. There are three additional learning necessities within the education curriculum that children and young people need to acquire as essential qualities, resilience, reflection and resourcefulness. This will enable them to obtain the ability to accept setbacks, reflect on what is being learnt when dealing with challenging experiences and be able to look for information relating to these experiences, to help them throughout their life. Without the ability to have resilience certain issues, such as bereavement, family separation even bullying at school may have a major effect on their future.

Conclusion

Having looked briefly at the types of mental health issues children and young people are currently experiencing it is easy to understand how common mental health problems contribute to disabling effects on individuals within the United Kingdom and affects 15% of the population any one time, including children and adolescence. By implementing play therapy in schools, Counsellors can help children and young people recognise unhelpful patterns of behaviour and develop better ways of coping to build more supportive and resilient relationships that contribute to their overall health and well being. Children do not necessary have the relevant language to express feelings, therefore play therapy enables a connection to what is unconscious and can support emotional Healing and personal development. Linking our inner and outer selves is important for one to bring meaning to the way we live our daily lives as well as assisting in the shredding of inherited emotional burdens. Pearson and Wilson 2011 identifies how this works by stating ‘as we work with the symbols our issues, feelings, longings, fears and hopes can emerge, take tangible form and become clear to us..

 In March 2015, following the introduction of the Government’s children and young people’s mental health and wellbeing Taskforce, The Department of Education produced ‘Counselling in Schools: a blueprint for the future’ document to provide advice for school leaders and counsellors to assist schools in setting up and improving Counselling services in both the primary and secondary education establishments.  It provides practical help and models of delivery amongst other useful information. The recommended delivery includes one to one Counselling work within both secondary and primary schools. However, in primary schools the Counselling work incorporates play or art based methods and might include group or family work whereby, in secondary schools most Counselling will be humanistic based utilising the Carl Rogers person centred approach. Some young people may find talking about their feelings a bit difficult and may work better with the creative methods of play therapy. Therefore it may be good to include this as an option within the secondary school Counselling provision and not just recommend it for primary schools.

 Currently Place2Be offers Counselling for pupils in primary and secondary schools using creative intervention. Their Core Model works with children and young people to help them understand address and manage their emotional reactions and the challenging situations they may face. The core elements involved are the Relationships, self awareness, play and change. The relationship is one of the most accurate predictor of outcomes and evidence states. 'It is the experiencing of unconditional acceptance from the counsellor that particularly enables the client to begin this process of self acceptance which will enable change to take place' in due course (Dryden 2011). Although their involvement in primary and secondary schools are now growing throughout the UK, Schools have to buy in this valuable resource. Additionally Place2Be offers a flexible option to incorporate a school based mental health service with a dedicated Counselling service for parents/carers to complement the work they are dong with the children. They also provide support to staff and teachers as well as training programmes. Some schools have decided to implement their own School based Counsellor, but there may be issues of autonomy that cannot be met by the Counsellor if their employer is the school.

The Government task force should also consider funding creative therapeutic intervention through play as part of every school’s program as this was not currently taken into account when producing the Taskforce document. Every child matters and if we really want to improve society we need to make access to therapeutic intervention much easier for everyone.

 

Bibliography

Ammann, R. (1991), Healing & Transformation in Sandplay; Creative Processes Become Visible, USA Open Court.

Axline, V (1989). Play Therapy, London: Ballantine Books. (original 1947), [p73-74].

 BACP, 2010, Explanation of theoretical approaches.[online]Available at:http://www.bacp.co.uk/seeking_therapist/theoretical_approaches.php.[Accessed 25 January 2012].

Bowlby, J., 2002, The Making & Breaking of Affectional Bonds, Hove: Brunner-Routledge.

Dryden, W. 2011, Counselling in a Nutshell, Second Edition. London. SAGE.

Halliwell, E. Main, L and  & Richardson C, 2007, The Fundamental Facts: The latest facts and figures on mental health. London: Mental Health Foundation.

Homeyer L.E. & D.S. Sweeney, (2011). Sandtray Therapy; A Practical Manual 2^nd Edition, London: Routledge.

Hough, M. 1998, Counselling Skills and Theory, London: Hodder Arnold.

NICE, 2015. DfE, Counselling in Schools: a blueprint for the future, Departmental advice for school leaders & counsellors. Manchester: NICE

Pearson, M & H Wilson, (2011). Sandplay & Symbol Work: Emotional Healing & Personal Development with Children, Adolescent & Adults, Melbourne: ACER Ltd.

Rutter, M & M., 1993, Developing Minds, London: Penguin Books.

Rutter, M. (1982. Helping Troubled Children; Reading. Cox & Wyman Ltd

Thorne, B., 2003, Person Centred Therapy in Dryden, W. (Editor), Handbook of Individual Therapy 4th Edition, London: SAGE.