Canadian Schools are rightly concerned with the importance of considering our students mental health and well-being. Students’ mental health needs are ever changing and growing. As a school counsellor, I have seen this growing need firsthand. What I have also seen is a growing need to address the reality that several students face mental health related challenges and fall through the cracks. Specifically, I experience students facing mood and personality related challenges who are under supported because they are often undiagnosed or waiting on a diagnosis. In this four-part series, I hope to shed some light on how we can work together to better support undiagnosed students facing mood and personality challenges from my perspective as school counsellor.
School counsellors work in what I sometimes call a distinct clinical space. By working in a school setting, we experience different clinical realities than we would if we were somewhere else – which in turn often require a distinct approach. One of these realities is working with undiagnosed students, who are often on waitlists to be diagnosed but still need support at school. The challenge with these students is it can throw us off our typical training, where we assess, treat, and monitor outcomes. It can also pose additional challenges when we need to consecrate extra time to supporting these students which can often be seen as a “waste of resources” or “inefficient” by our colleagues who are not trained in counselling. In a system where there is often a focus on results or efficacy in services, devoting time, humility, patience and resources to undiagnosed students can be hard to justify. If we do not have access to a psychologist for clinical assessment, sure we do the best we can to assess the problem, but we can easily be thrown off as school counsellors. In this article, I will share my own reflections and growth around navigating this challenge of working with students who are undiagnosed and are often on long waitlists. Within this part of the continuing series, I will lay the groundwork on what it would look like if we switched gears from a diagnosis heavy approach to one rooted in responding to students’ needs in our schools. My belief is that once this foundation is in place, we can concentrate on the needs of undiagnosed students presenting mood and personality challenges, so that we can develop intervention tools which will respond to these students’ needs. Though written from a school counsellor’s perspective, I am confident the information can also serve educators and administrators in seeing what student mental health support can look like from our viewpoint.
BEYOND THE DIAGNOSIS: PART ONE OF FOUR
Introduction
The purpose of this article is to provide an understanding and resources to school administrators and educators to address growing mental health challenges in our students; I share my perspective as a school counsellor in learning to work beyond the diagnosis of students with mood and personality challenges. As a school counsellor, I recognize the importance of providing adequate support and care for students on waitlists for services such as psychological assessment.
With students on waitlists and still requiring support from school counselling departments, it is easy to get discouraged. As school counsellors we work with and intervene with these students who have changes in mood, struggle with maintaining stable relationships, avoid stress and perceived stress like the plague, and other behaviors or challenges that can affect their success at school. Numerous times I have seen myself or colleagues get stuck when we are working with a student who is starting to have complex problems and behaviors at school. We try to identify the problem, but it is not easy, so we refer to a psychology service for diagnosis so that they can tell us what the problem is so we can address it at school. So, our student gets on a waitlist, and we hope things happen fast so we can figure out how to support this student. The issue is waitlists for psychological diagnosis are becoming less and less fast – especially in rural areas such as where I currently work. In short, this older model of doing things is starting to be less effective for educational settings as far as I see it. This means that one way or another, we need to find a different approach in these cases so that we do not feel stuck waiting while our students still require support at school. We need to find a way to offer proper support without a clinical diagnosis – something that we are not always trained to do.
What has helped me is looking at ways to change my approach with students on waitlists. If not having a diagnosis is the problem, then developing an approach and skills which move beyond diagnosis is relevant. In my own wrestling with this challenge and research, I noticed two things which helped me to make the needed shift.
Remembering that a diagnosis is a tool not a cure. At the end of the day, having a clinical diagnosis does not automatically fix anything in a school context, and relying on it has its limitations. For example, Irvin D. Yalom calls us to avoid diagnosis, as it can sometimes be counterproductive to what we are trying to achieve in counselling (Yalom, 2017). What supports students is not necessarily diagnosis, but the care and support we provide. Thus, we do not need the diagnosis right aways to provide evidence based and competent support.
Several therapeutic modalities do not rely on diagnosis to function. The more I research different counselling theories to find the right fit for school counselling, the more I realize how many of them do not rely on diagnosis. For example, in Solution Focused Brief Therapy (SFBT), diagnosis is not really used much. “In our approach, we overtly say there is no need to diagnose your clients. That tactic doesn’t produce change. Although the symptoms of the various disorders may be present (and, therefore, a diagnosis may be relevant), Treatment from and SFBT perspective is not contingent upon understanding the presence of the symptoms or relevant diagnosis” (Connie and Froerer, 2023). This does not mean we do not discern or asses our client’s needs, it just means that we don’t need a clinical diagnosis to think critically about how to support clients (Connie and Froerer, 2023). SFBT is not alone in this position, and the hope is to share some of these other theories in future articles in this series. Thus, learning from these modalities and evidence-based approaches can help us in school counselling regarding undiagnosed students.
To me it is clear, working and supporting undiagnosed students is a reality which requires a bit of a mindset shift for us as school counsellors. A large part of that shift involves a change in the way we approach care and counselling. It is challenging work as it causes us to reflect and think critically about the way we do things in our schools, which is uncomfortable. Yet it is necessary to have effective solutions to address undiagnosed students presenting complex challenges.
A Need-Based Approach
Part of the shift for me was – considering some of the theories mentioned above – moving to a need-based approach rather than an assessment-based approach. What do I mean when I say a need-based approach? Well, I mean that in school counselling regardless of what is going on, our role is to respond to student needs. This is true on a basic level where we offer the opportunity for students to learn, grow and build relationships. Whether it is giving the student who forgot their lunch a snack or teaching a student math, schools are all about providing students with what they need to grow and develop. Thus, our approach in school counselling can also focus on student needs.
But how do we describe needs, as that word can be used to mean a lot of things? In the words of Richard Dayringer, “Every person has certain inherent needs… these things are not optional; they are necessary for survival and well-being” (Dayringer, 2008). This is a powerful reminder to me that we can do things differently as school counsellors. We can use classic tools such as Maslow’s hierarchy of needs to help facilitate our understanding and our shift in approach as well (Dayringer, 2008). Or, if we need something a bit more robust, we do well to remember that Maslow is not the only person to reflect on the psychology of need. Richard M. Ryan and Edward L. Deci also remind us of the power of focusing on satisfying basic psychological needs. For Ryan and Deci, the basic psychological needs of autonomy, competence and relatedness are essential to supporting well-being and facilitating healthy psychological development and function (Ryan and Deci, 2018). All this to say, there is an evidence base to paying less focus on diagnosis, and more energy on discerning our student’s needs. Making this switch I believe is an essential first step to working with undiagnosed students, and it has proven helpful in my school counselling work thus far.
Back to Basics
In many ways, using a needs-based approach is about getting back to basics in counselling and psychosocial care. I know when I started trying to shift from needing a diagnosis to a more need-based approach, I felt a little off kilter. I felt like I was not treating the problem. Though that is the point, isn’t it? If I am focusing on responding to my students’ needs through counselling and other support, then I may not be treating the problem, but I am responding to their request for stability or improved function in their life and at school. Thus, a need-based approach is responding in hope to requests for stability and function in our students, and we do not need a diagnosis to do that. This means I am doing a lot of basic counselling skills, empathetic listening, asking good questions, being non-judgmental, and focusing on bringing hope into my counselling with students. If in doing this I look out for needs which are unmet and work to respond to those needs, I have found that to be more fruitful in working with undiagnosed students – and in fact, students in general.
Perhaps you are unsure about switching to a more need-based approach in your school counselling practice. If so, that is perfectly natural, rethinking is challenging after all. That said, going back to basic counselling skills when working with undiagnosed students is also a great strategy to help get unstuck, or to provide effective care while our students are on the waitlist. Basic counselling skills are not basic in the sense that they are supposed to be surpassed by advanced techniques after all. Basic counselling skills are called such because they are both simple and essential to all psychological care. Thus, even if we are unsure about switching to a need-based approach, a strategy we can use with working with undiagnosed students is going back to basic counselling skills.
Making the BEDS
I recognize that the first part of our series is more general and really trying to lay the groundwork which will help make sense of some of the concrete interventions I use with undiagnosed students moving forward. Working with students who present complex challenges, or challenges surrounding their mood or personality can be particularly scary if we rely heavily on diagnosis to work with these students. Yet, it does not have to be scary, and I have found switching to a need-based approach to be particularly helpful for working with students having mood and personality challenges.
On a more practical note, however, having a starting point to identify potential student needs facing mood or personalities challenges is helpful. Thus, I share the following as a starting point moving forward. Though not scientific by any means, I noticed that students facing mood and personality challenges also have common needs. That is why I developed a quick list to help me identify them quickly in the counselling room. This list is not exhaustive, but it is a start on the road of identifying possible needs these students may experience and allow us clarity in reflecting on how to satisfy those needs in future articles in this series. In acronym form, these students tend to need BEDS:
- Boundaries
- Emotion regulation
- Decision making
- Safe compassionate space
Between now and our next article in this series, I encourage us to reflect on our students who are undiagnosed and their needs. I encourage us to reflect on BEDS when we are working with students experiencing mood or personality challenges and see if this helps us not panic so much when we do not have a diagnosis right away. The goal is not to try to solve problems but respond to needs ethically to support our students who are undiagnosed.
Conclusion
In this article we begin to reflect on a challenge we face as school counsellors, working with undiagnosed students. We have explored some of the shifts we can make as school counsellors to facilitate working with undiagnosed students. We also ended this article by briefly describing the BEDS acronym as we begin to look at the needs of undiagnosed students experiencing mood and personality challenges. The goal in future articles is to unpack the BEDS acronym in more detail and reflect on some strategies and interventions I use with students presenting mood or personality challenges using the need-based approach described in this initial article. I believe that in school counselling, we are working in a distinct clinical space which faces distinct challenges and thus requires a distinct approach. Focusing on student needs for stability and function is a way we as school counsellors can respond to all students, even those who are undiagnosed.
BEYOND THE DIAGNOSIS: PART TWO OF FOUR
Introduction
In the second part of our series, our goal is to describe mood and personality-related challenges and how we can respond to students facing these types of challenges. We will first briefly describe what I mean when I use the language of mood challenges or personality challenges, and what these understandings imply for supporting students in school. Then we will briefly return to the BEDS acronym I shared in our first article and go a bit more in-depth on how this acronym helps me remember significant ways to support students facing mood and personality challenges while they are on the waitlist for psychological assessment and other services.
Mood challenges
When considering students experiencing mood-related challenges, terms such as depression, bipolar, and mania may be among the first we think of. Yet, looking at student needs and a need-based approach, I like to use a broader understanding of the term mood provided by Samuel Gladding, who describes mood as “an emotional state of mind. The pervasive way a person feels most of the time.” In using this slightly broader definition, we can reflect on those students in our schools who stay stuck in one emotion. When these students stay stuck, they can begin to experience things like stress or a lack of motivation to persevere with school. Not to mention all the other challenges they may be facing in learning how to manage their emotional states or ruts. This means that a good first step in identifying students with mood-related challenges is trying to see where they feel stuck, what emotional or mindset rut they are fixed in, and working collaboratively with them to navigate or strategize through that rut.
Personality challenges
Personality-related challenges are also a term that merits defining. Similar to mood challenges, the term “personality” is often associated with personality disorders, which is understandable. As school counselors, we are trained to observe symptoms to assist in the assessment process when students are referred to psychological services. However, since counselors typically cannot diagnose students and must work with teams of teachers and other specialists who also cannot diagnose, using the term “personality challenges” can be more inclusive and effective in addressing individual student needs within the school setting. This again means that by personality we’re referring to a more general definition, such as proposed by Gladding, “A global concept that includes all of the physical, mental, emotional, and social characteristics of someone that make that person unique.” With this broader understanding of personality, I prefer to examine personality-related challenges from a developmental perspective and identity formation lens. For instance, when considering a student experiencing difficulties with emotional regulation or forming stable friendships at school, their needs and support can be assessed through the perspective of their identity formation. This means that personality challenges can be anything that impacts a student’s ability to have a clear sense of self, of meaning, or of purpose in their life. Thus, I can focus on providing students the information, strategies, and skills needed for them to have a more stable sense of self, of personality, of their identity. We see this movement towards supporting identity formation in recent counseling texts, such as one written recently by Sandra Smith-Adcock and Catherine Tucker, who, in their discussion of adolescence, emphasize the importance of identity formation and its relationship with well-being. Moreover, Smith-Adcock and Tucker discuss the importance of counselors in community and school settings to provide care that aids and supports students in developing who they are, especially when they’re facing challenges related to their personality and personality development. what this means for us as school counselors is that our students experiencing personality challenges can benefit from counseling interventions catered to help them discover their sense of who they are and their identity formation-related needs.
What next?
Now that we have identified and cleared up a bit what we mean by mood and personality-related challenges, we must begin talking about what we do next. As school counselors, we need practical stuff. Now that we have talked about how to identify mood and personality challenges in the general sense, we need to talk about what we can practically do to support students facing those challenges. In the first part of this article, I mentioned an acronym that I used to help me work with students presenting personality and mood-related challenges. As I shared before, this acronym is by no means scientific, but if my simple ways I use to try and support students using evidence-based research are helpful for me, I find it valuable to share them in case they benefit others, and that is why I share them with you now. The Acronym is BEDS:
- Boundaries:I found that students facing personality and mood challenges sometimes need information, psychoeducation, and skills training with boundaries – both in placing healthy limits in relationships, but also healthy relationships with themselves. When students feel confused or lost in their relationships, they sometimes seek strategies to clarify these relationships, communicate effectively, and understand when and how to say no. This is a type of support we can provide through counselling interventions.
- Emotional Regulation: I also notice that students facing mood and personality challenges sometimes need help understanding the purpose of emotions and developing emotional regulation strategies as well as validation around which emotions are natural to experience and when. In the language of Matthew McKay, some students need support learning how to surf the waves of strong emotions instead of trying to fight or avoid them.
- Decision Making: Based on my experience, students frequently benefit from decision-making support. This can include instruction on decision-making skills or counselling to assist them in navigating and reflecting on their choices. Since part of personality and identity development is growing through decisions, students challenged with making decisions through stress, pressures, strong emotions, or feeling stuck, can benefit from our interventions.
- Safe and Compassionate Space:In my experience as a counsellor in academic training, every student facing mood or personality challenges has needed a place where they are heard, listened to, understood, and not judged or labeled. School counselling is not always about what we are able to do or achieve with our students, but what and who we can be for our students – a safe and compassionate person.
What does all this mean for Educators and Administrators?
As an educator or school administrator reading, you may be wondering how all this can apply to your role in supporting students. That is a fair question, and I hope to provide a few avenues for reflection to respond to your needs and viewpoint. I hear often from my educator and administrator coworkers that they are easily overwhelmed and anxious in the face of growing mental health concerns in our students. To that concern, I respond with the following: Breathe. Yes, navigating these complex needs are not easy and there are no quick fixes that look good on a spreadsheet or grade. But that does not mean that there is no hope if we are patient, consistent, and focus on responding adequately and professionally to our students’ ever-changing needs. Also, trust your school counselling coworkers because we often have one thing which can help, a pulse of the student’s inner life and an action plan to support them based on that pulse. Trust our recommendations, trust our suggestions, trust that if we work together our students’ mental health will improve. Moreover, please be patient with us and give us the time to trust you and what you can do to support students in your spheres of control. Our students facing mood and personality challenges need all hands-on deck. If we work together professionally, ethically, and collaboratively, I am convinced we will see a positive change in Canadian Schools.
For administrators, I encourage you to consider the following. Know that working in supporting students’ mental health, especially with mood and personality challenges, take time and patience. It can take me sometimes daily check-ins with students facing these challenges to help them stay motivated at school, and that is often what they need to keep the BEDS made in their school life. Don’t be afraid to allow your counsellors to take the time necessary to offer this support, even if it means that some other administrative tasks (like planning field trips, that extra administrative meeting, or other tasks which can keep counsellors from counselling) may not get done as fast. I firmly believe that if we want to truly support our student’s mental health, including students with personality and mood challenges, we need to take things slower than we currently do. We need to take the time to make the BEDS in our students’ lives. But if we do take that time and invest those resources, I think we will be surprised by the positive changes we will see.
Conclusion
In this second article in our four-part series on working with students while on the waiting list, we briefly described mood and personality-related challenges so that we can support students’ needs for boundaries, emotional regulation, decision-making skills, and a safe and compassionate space. In the end, as school counsellors, we aim to support student development and identity formation by responding to their needs. As a school
team, educators and administrators have roles in supporting students. It’s a collaborative process, not a competition. In our forthcoming article, we will examine several targeted interventions that I employ and deem beneficial when working with students experiencing mood and personality challenges. Until then, I trust that our discussion on supporting students through a need-based approach proves as valuable in your practice as it does in mine.
Bibliography
Gladding, Samuel T. 2018. The Counseling Dictionary. 4th ed. Alexandria: Amarican Counseling Association.
McKay, Matthew, Patrick Fanning, and Patricia Zurita Ona. 2011. Mind and Emotions: A Universal Treatment for Emotional Disorders. Oakland, CA: New Harbinger Publications, Inc.
Smith-adcock, Sondra, and Catherine Tucker. 2023. Counseling Children And Adolescents; Connecting Theory, Development, and Diversity. 2nd ed. Thousand Oaks, California: SAGE Publications, Inc.
ABOUT THE AUTHOR:
Justin Bertrand is a counsellor in academic training at the high school level in Quebec, with over a decade of counselling experience across diverse settings. He holds a Master of Divinity and is currently a candidate for the MA in Counselling and Spiritual Care at McMaster Divinity College.
