Connections Over Counseling
Why schools should focus on climate, not clinicians
This semester in my Lifespan Psychopathology course, I assigned my graduate students YA novels featuring protagonists with DSM diagnoses. The assignment was designed to help them think critically about how mental illness is portrayed in popular culture and how those portrayals might reflect—or distort—clinical realities.
One of the books was Highly Illogical Behavior by John Corey Whaley. The story follows Solomon, a teenager with severe agoraphobia who has been completely isolated in his home for years. Then, he is visited by Lisa, a former classmate, who wants to "cure" Solomon's agoraphobia as part of a college application essay about overcoming mental health challenges. Through their developing friendship, Lisa's amateur psychological interventions prove more effective than any professional treatment Solomon has received.
My students were not having it. They argued that it was completely unrealistic that a peer with no training would be more effective than an actual clinician in treating mental illness.
Unfortunately for those of us who work in the mental health field, the book is much more realistic than my students wanted to believe. In fact, it may represent the most likely trajectory for a case like Solomon's.
Research demonstrates that mental health outcomes are most strongly determined by ecological factors—family relationships, community connections, and broader societal influences. Therefore, medicalized therapeutic approaches—the kind that focus primarily on individual pathology rather than social context—are only moderately effective at best. Instead, interventions that strengthen social bonds and community connections show stronger, more lasting effects. When someone is profoundly isolated, as Solomon is, nurturing peer relationships can be transformative in ways that individual therapy often isn't.
This research has profound implications for how we approach mental health in schools. I've written before that schools are inappropriate sites for psychotherapy, but I want to take that argument a step further: when school mental health efforts focus on reactive counseling services rather than prevention strategies, they fundamentally misuse resources.
The most effective thing schools can do to protect student mental health is to foster a school climate based on mutual respect, connectedness, inclusivity, and dignity for everyone: students, families, staff, and faculty. Fortunately, there are several empirically-supported programs that help schools create these positive environments. Most are built on a framework called Schoolwide Positive Behavior Support, which emphasizes tiered interventions, data-based decision making, and ongoing consultation to support teachers.
The most effective programs share several key characteristics:
Explicit rules and clear behavioral expectations that are taught, practiced, and consistently reinforced across all school settings.
Meaningful rewards and logical consequences that help students understand the connection between their choices and outcomes.
Teacher modeling and active participation in creating the positive culture.
Regular progress monitoring to ensure interventions are working and adjust strategies as needed.
Consistent communication with families to extend positive approaches beyond school walls.
Universal screening and referral to outside services if a kid is struggling.
Schools must shift from a medical model focused on treating individual problems to a public health model focused on creating environments where all students are supported. They must understand that the most powerful mental health intervention is fostering a school culture where every student feels valued and included.
This doesn't diminish the importance of clinical expertise or suggest that friendship can cure all mental illness. But it does mean that, if we're serious about supporting mental health, we need to invest in creating the conditions where positive relationships can develop.
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I really, really love Rachel Bay Jones!