My job as a Cognitive Behavioural Therapist

Read on as Charlotte Lowe explains her role, and how she is fighting to improve the support offered to school aged children.

My job is unique in the sense I work full-time as a Cognitive Behavioural Therapist (CBT) within a secondary school. Although most schools cannot afford a full-time counsellor or therapist, many schools do offer specialist mental health provision on a part-time basis.

In Scotland and Wales, it is statutory to provide counselling in all secondary schools. However, this is not the case in England, and huge variations exist as to the level of support schools can offer their students.

Finally, the Government has recognised the vital role schools play in supporting children’s emotional health and wellbeing, and investment in this area has begun.

My role in school involves delivering targeted interventions to children and young people (CYP) who are suffering from a range of mental health problems, from students who are feeling low in mood to those diagnosed with eating disorders. It is essential for me to carry out a thorough mental health assessment to define the nature of a student’s difficulties, and the level of support required.

I am always mindful of distinguishing between those students suffering from a diagnosable mental health problem as opposed to those simply experiencing the difficulties faced during the adolescent period.When delivering targeted interventions, I primarily work to a CBT model and find this to be effective with CYP.

However, I am skilled in the use of alternative therapeutic approaches which have also been found to be beneficial when working therapeutically with CYP; Solution Focused Brief Therapy (SFBT), Mindfulness, Dialectical Behavioural Therapy (DBT) and compassionate based approaches.

I am fully aware how no approach fits all, therefore it is essential for the approach to be tailored to the CYP or family wherever possible. As well as offering individual support, I facilitate therapeutic groups which focus on specific issues, such as low self-esteem or loss and bereavement.

Individual therapeutic support is provided for staff as well as students, demonstrating the importance the school places on emotional wellbeing overall.

Staff need to maintain their own wellbeing to effectively teach and provide any necessary support to students.

I maintain a whole school approach to mental health and wellbeing, following a mental health policy which I developed as part of my role. This whole school approach helps to ensure the mental health needs of students is everyone’s business.

The early intervention work I carry out in schools through assemblies and PHSE lessons, aims to raise awareness and understanding of mental health, reduce the stigmas attached to mental health issues, and promote positive mental health around school.

Students are made aware of signs and symptoms to look out for which may suggest they are struggling, as well as being informed of where to access further help. There are current discussions to make mental health and wellbeing statutory to a school’s PHSE curriculum, although there has not been anything definite decided.

Earlier in the year, I worked alongside the Shaw Mind Foundation to promote a petition calling for the Government to make the discussion of mental health compulsory to a school’s PHSE curriculum. This petition received over 100,000 signatures so is currently being considered for debate in Parliament. To ensure a young person’s mental health is supported, it is essential for health and education to work together.

Part of my role entails acting as a single point of contact with CAMHS, Children’s Social Care (CSC) and other external agencies. This collaborative work results in increased communication and consistent care for the child or young person.

In line with this, the Government has rolled out several pilot projects which focus on improving the link between CAMHS and schools.

These successful pilot projects are currently being developed in further schools across the country. By carrying out the mental health assessments in school, it reduces the number of students referred to CAMHS, which is essential given the long waiting times of many CAMHS teams.

Assessing a student in school ensures those with more serious issues are referred for more specialist provision, whereas those with lower level difficulties can be supported in school, such as anger management or low self-esteem. It is essential to be aware of all the external agencies and services available to schools as these can offer specialist support to CYP.

A large part of my role involves up-skilling the pastoral staff to build their confidence in supporting students with lower level mental health problems. In response to this, I have developed various resources to help guide staff which incorporates many of the principles of CBT.

I deliver full staff training to increase awareness of mental health issues and to help staff feel more confident when faced with any potentially difficult conversations or situations. However, teachers are not mental health professionals, and they should not be expected to be.

It is therefore essential school staff are made aware of how to access further support for a CYP they are concerned about. This has now been recognised by the Government as all school staff have been requested to receive Mental Health First Aid (MHFA) training to increase their awareness of how to recognise if a CYP is experiencing mental distress.

My journey to become a CBT therapist was not the usual journey an individual would take as my career began by studying Psychology.

Most CBT therapists tend to begin their career following the completion of a degree in mental health nursing or social work. However, from personal experience, I have found the previous careers of CBT therapists vary widely.