the school psychologist's role seen from the child guidance clinic

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A SCHOOL PSYCHOLOGIST VIEWS HIS OWN RESPONSIBILITIES 19 along with family, religious institutions, public and private agencies, and the state or federal government, for fostering good mental health of all individuals who comprise its membership? The usual monies available to education cannot be stretched indefinitely. If public schools should be elected to provide psychotherapy in addition to their many other responsibilities, funds must also be provided from other than the usual school tax sources. THE SCHOOL PSYCHOLOGIST’S ROLE SEEN FROM THE CHILD GUIDANCE CLINIC1 ALAN 0. ROSS Pittsburgh Child Guidance Center My task on this symposium is to attempt to answer the question, “Shall school psychologists conduct psychotherapy?” from the point of view of a psychologist working in a community child guidance clinic. Because the position of school psy- chologist is held by people with a variety of qualifications, this title may mean different things to different people. Let me say, therefore, that I shall consider the question of this symposium only in terms of the best qualified, clinically trained school psychologist who, as an individual, is prepared to conduct psychotherapy with a high degree of competence. If my answer to the question, “Shall school psychologists conduct psychotherapy?” is “No’, in terms of this highly restricted definition, it follows that it would be “No” in terms of less qualified school psy- chologists. Let me give you my answer to the question at the outset. It is indeed “No”; I believe that school psychologists should not conduct psychotherapy. What follows is my attempt to give you the reasons or, if you will, the rationalizations, for this point of view. We live in a highly specialized society and for better or worse we seem to become more specialized each year. Where specialization exists the most rational use of specialists lies in coordinated collaboration and not in a duplication of efforts where services become competitive rather than complementary. An approach to the problem of the mental health of children must take the form of a coordinated collaboration between the school and the child guidance clinic. Each of these institutions is equipped to deal with a very special task and the most effective use of available resources requires that each institution concentrate on its specialized task while coordinating its efforts with the specialized tasks of the other institutions. When one institution tries to do the work which is the specialty of the ‘Paper presented as part of a symposium, “Shall School Psychologists Conduct Psychotherapy?” at the American Psychological Association meetings in St. Louis in 1962, sponsored by Divisions 12, 13, 15, 16 and Psychologists Interested in the Advancement of Psychotherapy.

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Page 1: The school psychologist's role seen from the child guidance clinic

A SCHOOL PSYCHOLOGIST VIEWS HIS OWN RESPONSIBILITIES 19

along with family, religious institutions, public and private agencies, and the state or federal government, for fostering good mental health of all individuals who comprise its membership?

The usual monies available to education cannot be stretched indefinitely. If public schools should be elected to provide psychotherapy in addition to their many other responsibilities, funds must also be provided from other than the usual school tax sources.

T H E SCHOOL PSYCHOLOGIST’S ROLE SEEN FROM THE CHILD GUIDANCE CLINIC1

ALAN 0. ROSS

Pittsburgh Child Guidance Center

My task on this symposium is to attempt to answer the question, “Shall school psychologists conduct psychotherapy?” from the point of view of a psychologist working in a community child guidance clinic. Because the position of school psy- chologist is held by people with a variety of qualifications, this title may mean different things to different people. Let me say, therefore, that I shall consider the question of this symposium only in terms of the best qualified, clinically trained school psychologist who, as an individual, is prepared to conduct psychotherapy with a high degree of competence. If my answer to the question, “Shall school psychologists conduct psychotherapy?” is “No’, in terms of this highly restricted definition, it follows that i t would be “No” in terms of less qualified school psy- chologists.

Let me give you my answer to the question a t the outset. It is indeed “No”; I believe that school psychologists should not conduct psychotherapy. What follows is my attempt to give you the reasons or, if you will, the rationalizations, for this point of view.

We live in a highly specialized society and for better or worse we seem to become more specialized each year. Where specialization exists the most rational use of specialists lies in coordinated collaboration and not in a duplication of efforts where services become competitive rather than complementary.

An approach to the problem of the mental health of children must take the form of a coordinated collaboration between the school and the child guidance clinic. Each of these institutions is equipped to deal with a very special task and the most effective use of available resources requires that each institution concentrate on its specialized task while coordinating its efforts with the specialized tasks of the other institutions. When one institution tries to do the work which is the specialty of the

‘Paper presented as part of a symposium, “Shall School Psychologists Conduct Psychotherapy?” at the American Psychological Association meetings in St. Louis in 1962, sponsored by Divisions 12, 13, 15, 16 and Psychologists Interested in the Advancement of Psychotherapy.

Page 2: The school psychologist's role seen from the child guidance clinic

20 ALAN 0. ROSS

other the result can only be confusion and waste of resources. Historically the task which society has assigned to the school is education

while the task which the community child guidance clinic has assumed is diagnosis and treatment. The school psychologist is the mental health expert in the school and from my point of view he should function as a consultant to teachers and ad- ministrators. As far as the individual child with emotional problems is concerned he should limit his activities to early identification and referral. Once referral to an appropriate diagnostic and treatment resource has been made the school psycholo- gist should further fill the vital function of coordinating the efforts of clinic and school.

In child guidance clinics we are only too well aware of the frustration and re- sentment of teachers and school administrators because we fail all too often to communicate with them about the children who have been referred to us. They eagerly await help in dealing with these children in the classroom but when they do receive a report it often fails to be useful to them in their everyday responsibilities.

While this failure in communication is primarily the fault of the clinic the situa- tion could be greatly improved if the school psychologist, who should, after all, be able to talk the language of both clinic and school, could maintain liaison and co- ordination.

You might ask whether collaboration around the treatment of an emotionally disturbed child would not be easier if therapy were conducted at the school and by the school psychologist. To answer this objection we must for a moment look at the premise which underlies the child guidance approach to therapy. The central con- cept on which the operation of child guidance clinics is based and which seems to have been pragmatically verified during the last four decades is that the treatment of the emotionally disturbed child must involve the child’s parents. We have found that except in rare cases treatment of the child alone becomes a self-defeating and hopeless task.

If the child were to be treated by the school psychologist in the school setting this could only be effective if the school were to duplicate the child guidance team and involve the parents in the treatment of the child. The school should never put itself into a position where, in effect, it says to the parents, “We will take care of your child’s emotional problems.” A child’s emotional difficulty is almost always a family problem and if one were to encourage parents to abrogate their responsibilities for the child’s emotional health to the school one would set up a condition neither conducive to effective therapy nor to the maintenance of mental health.

Even if a school system were to provide a facility where both child and parents could be treated, that is if the school were to set up its own child guidance clinic, such a clinic would have to be highly selective in the type of case it might take on in order to maintain its availability to as many children as possible. Where a school clinic has completely open, non-selective intake the available treatment time quickly becomes filled with the most difficult, long-term cases with the result that the facility can no longer be viewed as an effective resource for the school system it had hoped to serve. Considering the position of the school system in the body politic I do not see how a school clinic can refuse to make its services available to every child in need of help but the political implications of this will lead us further than time or topic will permit.

Page 3: The school psychologist's role seen from the child guidance clinic

THE SCHOOL PSYCHOLOGIST’S ROLE SEEN FROM THE CHILD GUIDANCE CLINIC 21

Let me merely say that the school psychologist who engages in psychotherapy must soon find his time taken up by a relatively small and finite caseload which keeps him from filling other important functions for which he is uniquely equipped and situated.

From my point of view the most important function of the school psychologist is that of a consultant to the school administration and to the teaching staff. In this role the school psychologist should deal with matters involving the mental health of the children in general and of individual children in particular. He should be in- strumental in the early identification of emotional problems for it is by now well known that the earlier such a problem is recognized and dealt with the more likely it is to be quickly alleviated. When a child with an emotional disorder is identified the school psychologist should work toward referral which in itself is often a task calling for clinical skill and sensitivity.

To repeat, I do not think that the school psychologist should become involved in the treatment of a child, instead once referral is under way he should help the teacher reach a better understanding of this child’s difficulties, recommending such situational manipulations as he or the clinic sees indicated. By being available to individual teachers as a consultant on emotional problems the effectiveness of the school psychologist would go far beyond the individual child about whom he is con- sulting. The teacher could benefit from this consultation and apply some of the under- standing gained in this case to the cases of other children whom he might encounter in the future. Working through the teacher the school psychologist thus becomes a catalyst whose effectiveness is far greater than the actual investment of his pro- fessional time would reflect. Where he might spend one hour in the individual therapy of one child and helping only that one child, the same hour spent consulting with a teacher can conceivably help every child with whom that teacher will hence- forth come in contact.

One prediction which we can make with great confidence is that the man-power shortage in the mental health professions will be with us for many years to come. Until such time as we have enough therapists to treat every child in the school who is in need of help (and this includes treating his parents) the most rational use of the few highly skilled school psychologists we now have would clearly seem to be in con- sultation, early identification, referral, and liaison with treatment facilities in the community. Even in communities where such facilities are non-existent the school psychologist should not engage in psychotherapy. He can render a far greater service by calling the need for appropriate resources to the attention of relevant authorities. Since he is in a position to collect data on the number and types of children in need of help he can educate community leaders to the need for adequate mental health facil- ities. If instead of doing this he conducts psychotherapy as a stopgap measure he tends to mislead the community into believing that adequate services are being rendered, supporting the denial of the need for expanded treatment facilities.

Psychotherapy is all too often viewed as a panacea and many people believe that if we can just get psychotherapists into the schools most of the problems of the schools would be solved. Where the school psychologist succumbs to these pressures he vitiates his potential effectiveness for I strongly believe that he has far more vital things to do with his valuable time than to undertake psychotherapy with emotion- ally disturbed children.