Humanistic school-based counselling

1. Introduction

Version followed: School-based humanistic counselling (SBHC) as defined in the ETHOS Clinical Practice Manual (Kirkbride, edited by McGinnis and Cooper; file dated 18 Nov 2016) for the ETHOS trial (University of Roehampton, Mick Cooper chief investigator), together with the BACP (2014) competence framework for humanistic counselling with 11–18-year-olds (Hill, Roth and Cooper), on which the manual is built. Where the two differ, the ETHOS manual is followed for structure (up to 10 sessions) and the BACP framework for the wider list of methods. BACP's later (2019) children-and-young-people competences are not drawn on [uncertain].

Note on naming: "humanistic school-based counselling (Cooper)" refers to the same approach. The sources use "school-based humanistic counselling (SBHC)". Cooper led its development and trials; the clinical manual's author is Rebecca Kirkbride [source: ETHOS manual; ETHOS project page].

SBHC is a brief, individual, person-centred counselling service delivered in secondary schools for young people with emotional distress. It does not target a specific disorder. The counsellor listens actively, reflects empathically, helps the young person reach and express the emotions and needs underneath their difficulties, helps them make sense of their experiences and behaviour, and supports them to weigh their options and choose what is most likely to help [source: ETHOS project page; ETHOS manual].

How change happens (the manual's SBHC process model): the counsellor offers qualities the young person experiences as accepting, caring, friendly, trustworthy, dependable and confidential, and the activities of listening and communicating empathy. This lets the young person explore and express their real concerns, experiences and feelings. The manual names five pathways to change: (1) better relational skills (honesty, assertiveness, listening) and improved relationships; (2) expressing strong feelings, which reduces anger and anxiety; (3) more acceptance of self and of one's own experiencing; (4) insight into self, others and the situation, leading to new actions or perspectives; (5) new coping strategies, helped by the counsellor's suggestions and guidance. The theory rests on Rogers's conditions (psychological contact, empathy, acceptance, genuineness), with links to attachment theory and the humanistic view that distress grows from conditions of worth [source: ETHOS manual, process model].

2. Framework

Format [source: ETHOS project page; Cooper 2021 (GWG); ETHOS manual]

Individual, face-to-face sessions in the young person's school, about 45 minutes, weekly where possible.
Up to 10 sessions. In ETHOS the number could not be extended; leftover needs were referred back to the school's pastoral team.
ETHOS clients were 13–16, had at least moderate emotional distress, could understand and speak English, and had capacity to consent. The BACP framework covers 11–18 and excludes play therapy, children under 11 and online counselling.
In ETHOS, young people at risk to self or others when they were referred were excluded and screened out by pastoral staff. Risk that emerged during counselling did not end counselling; it started the risk procedure [source: ETHOS manual]. Outside a trial, that exclusion rule is a service decision, not part of the model [synthesis].
Counsellors: qualified to at least diploma level (about two years' part-time training), in ongoing clinical supervision, with audio recordings audited for adherence [source: ETHOS project page; Ryan et al. 2021].
Session-by-session measures: the Outcome Rating Scale (ORS) at the start of every session; the Current View form after the first session, updated as needed, and finalised at the end [source: ETHOS manual]. ETHOS also used goal-based outcome measures; how they were used in session is not confirmed [uncertain].

The manual calls itself a "boundary around the intervention" rather than a rigid protocol. Counsellors must adhere to the model but keep their clinical judgement. It gives no fixed session-by-session agenda. Work runs in three phases [source: ETHOS manual].

Phase 1: Beginning (usually session 1, may run into 2)

Goals: explain the humanistic rationale in accessible words so consent is informed; begin a collaborative assessment; agree a focus and, if possible, goals; contract (attendance, confidentiality limits, number and timing of sessions, what happens after a missed session); assess risk; complete the first ORS and the Current View form [source: ETHOS manual; BACP 2014].
Move on when: the young person has heard and accepted the rationale and the contract, risk has been assessed (and acted on if needed), and there is at least a provisional focus. Some young people arrive with a clear focus. Others need help to find one, and that search can itself be the early work [source: ETHOS manual; criteria phrased as synthesis].
If the young person seems unsuitable or declines: invite them to think it over and come back the following week. If counselling looks inappropriate, discuss it with the supervisor and the young person before acting [source: ETHOS manual].

Phase 2: Middle (roughly sessions 2–8)

Goals: the main exploratory and emotional work. The young person explores and expresses concerns. The counsellor helps them reach, put into words and make sense of emotions and experiences, and supports new understanding, choices and coping [source: ETHOS manual §7; BACP 2014].
Each session opens with a check-in: the ORS, a look at the score and how it links to the young person's concerns, a reminder of how many sessions are left, and a check on whether the focus and goals still fit [source: ETHOS manual].
Assessment continues throughout. The Current View form is updated when new information emerges [source: ETHOS manual].
Move on when: the agreed number of sessions is nearly reached, the young person feels ready to stop, or the counsellor is confident the work is no longer helping [source: ETHOS manual, ending criteria].

Phase 3: Ending (last 1–2 sessions, prepared from session 1)

Goals: negotiate how the ending will happen; review progress and what helped; look ahead to future difficulties and sources of support; plan how to keep gains (action plans, e.g. a journal); work with feelings about ending, including echoes of earlier losses; assess risk after discharge with pastoral staff; refer on where needed; finalise the Current View form [source: ETHOS manual §6; BACP 2014].
The time limit is named from the first session and counted down each session, so the ending is never a surprise [source: ETHOS manual]. BACP also allows for planning booster sessions [source: BACP 2014]. ETHOS did not allow extra sessions.

3. Guiding principles

Humanistic principles named in the manual [source: ETHOS manual]:

Experiencing is central: the young person's felt experience is the main material and a source of wisdom. Stay with what they feel, not only with the story.
The actualising tendency: young people are inherently oriented towards growth. Trust their direction instead of steering towards your own idea of what is healthy.
Freedom and self-direction: young people can choose and direct themselves. Help them weigh options; don't decide for them.
People are relational: distress and recovery happen in relationships. Attend to family, peers and staff, and to the relationship in the room.
Diversity is valued: don't impose your cultural assumptions. Ask how the young person's culture, community and context shape the problem and what supports them.
Multiple perspectives and the whole person: hold the young person's view alongside others' without taking sides, and attend to every area of their life, including school, home, body and identity.

Therapist stance [source: ETHOS manual; BACP 2014]:

Collaborative, not expert: assessment, focus, goals and endings are agreed together.
Accepting and non-judgemental: value the young person consistently even when you disagree with what they do. This is not the same as liking them. If they stir rejecting feelings in you, notice and reflect on them (including in supervision); don't act on them.
Genuine and open: no professional façade. Disclose about yourself only when it clearly serves the young person.
Active but non-directive: be engaged and responsive, but follow the young person's agenda.
Offer hope: convey that emotional relief is possible.
Empathic curiosity about the young person's frame of reference: respond from inside their world view, not yours.
Keep an independent viewpoint: empathise without over-identifying or colluding.
Diagnoses are not expertise about the person: if a diagnosis comes up, explore what it means to the young person [source: ETHOS manual].

Alliance behaviours [source: ETHOS manual]:

These build the alliance: flexibility, respect, warmth, openness, honest self-reflection, trustworthiness and understanding the young person's perspective. Use them deliberately.
These weaken it: rigidity, criticism, inappropriate self-disclosure, distance or aloofness, distraction and inappropriate silence. Watch for them in yourself, especially silence (see §5).

Metacompetences (judgement about when and how to use everything else) [source: BACP 2014]:

Flexibility: respond to this young person at this moment. In the framework's words, "Metacompetences signal that therapy cannot be implemented in a mechanistic fashion."
Holistic attention: attend at once to inner, interpersonal and cultural experience.
Balance non-directiveness against the need to direct: become more directive when risk is significant.
Accept the person without condoning harmful behaviour.
Be emotionally engaged while also standing back to reflect on the process.
Match developmental level, not age: chronological age and developmental stage may not line up, so adjust language and methods.

Other principles:

Measures serve the young person: explain why they are used, discuss the answers, read them alongside other information, and don't insist if the young person is too distressed or objects [source: ETHOS manual; BACP 2014].
Time-limited work is explicit: name the session limit from the start and keep it visible [source: ETHOS manual].
Safeguarding overrides confidentiality where serious harm is likely, but involve the young person as far as possible [source: ETHOS manual].
Take the young person's preferences seriously: Cooper argues that a request for more direction or strategies should not be dismissed as a sign of an external locus of evaluation, and that this counselling is one option among several, not a cure-all [source: Cooper 2021, GWG].

4. Intervention inventory

The BACP framework separates basic humanistic competences, used with every client, from specific competences chosen to fit the presenting issue; not every method below is used with every young person [source: BACP 2014]. The order roughly follows the course of therapy. All example wording is illustrative unless it is quoted and cited.

4.1 Explaining the rationale

Purpose: lets the young person make an informed choice and shapes their expectations. Misunderstanding what counselling involves is one route to dissatisfied dropout [source: ETHOS manual; BACP 2014; Pattison & Cooper 2024].
Steps: (1) In session 1, before deep exploration, say in everyday language what will happen: they lead, you listen and help them make sense of things and of their feelings, you won't tell them what to do, but you will work with them on what might help. (2) Say what the sessions are for: a space to talk about whatever is troubling them. (3) Name how this may feel: sometimes quiet, sometimes emotional, and it is fine to say if something isn't working. (4) Check what they understood and what they expect, and correct misconceptions (for example "you'll fix me" or "you'll report everything to teachers"). (5) Come back to the rationale whenever there is confusion or strain [synthesis of the manual's requirement].
Example language (illustrative): "This is your time. You choose what we talk about. My job is to really try to understand how things are for you and help you make sense of it. I won't hand out a list of rules, but if you want ideas, we can think them through together. Does that sound OK? What were you expecting?"
Watch for: a young person who expected advice or a quick fix, or was "sent" by staff. Ask about this directly. Working: they can say in their own words what counselling is for.

4.2 Contracting

Purpose: sets clear, safe boundaries suited to school [source: ETHOS manual; BACP 2014].
Steps: (1) Agree weekly attendance and punctuality, and explain what happens after a missed session (agree with the school beforehand how a young person is collected or reminded). (2) Explain confidentiality and its limits plainly: what is said stays private unless someone is at risk of serious harm, and then you would usually talk with them first about who needs to know. (3) State the session limit (up to 10) and agree day and time with the timetable in mind. (4) Agree what happens if they need to leave early or are upset at the end of a session. (5) Check that they understood and agree [source: ETHOS manual].
Example language (illustrative): "Most of what you say here stays between us. The exception is if I'm worried you or someone else could be seriously hurt. Then I'd need to share it, but I'd talk to you about it first wherever I can."
Watch for: a young person who goes quiet after hearing the confidentiality limits. They may be holding back a risk issue (see §5). Working: they can repeat the limits back to you.

4.3 Collaborative, ongoing assessment

Purpose: to understand the problem from the young person's point of view, how they handle emotion (blocking it or being overwhelmed by it), their strengths and resources, and the effect on daily life. It starts in session 1 and continues throughout [source: ETHOS manual].
Steps: (1) Use open questions sparingly; let the young person's account lead. (2) Gently cover the main areas over the first sessions as relevant: family, self-worth, anger, bereavement, school, peer relationships and bullying, sexuality, anxiety, mood, self-harm and suicidal thoughts, risky behaviour. (3) Use visual aids if they help: a drawing, a genogram, a diagram of relationships at home and at school, a map of school subjects and staff (who and what feels OK or difficult), or a life-story timeline. (4) Look for protective factors (support, extended family, community) and stressors (overcrowding, housing, harassment, gangs) without imposing your cultural assumptions. (5) Ask about strengths, including through someone else's eyes. (6) Notice whether your own judgements are getting in the way of empathy [source: ETHOS manual].
Example language: the manual's strengths prompt asks what the young person's best friend would say about them [source: ETHOS manual]. Illustrative: "If we drew your school day as a map, which lessons and which people would be the easy bits and which the hard bits?"
Watch for: assessment turning into an interrogation. Make sure exploration stays the main activity. Working: you can describe the problem as the young person sees it, and they agree with your description.

4.4 Current View form

Purpose: a clinician-completed summary of presenting problems and contextual factors (a CORC tool) that tracks the picture over time [source: ETHOS manual; tool not reproduced].
Steps: (1) Complete it after the first session from what you have learned. (2) Update it when significant new information comes out. (3) Finalise it at the end [source: ETHOS manual].
Watch for: it is your record and does not replace asking the young person. Outside ETHOS, use whatever case-formulation record your service requires [synthesis].

4.5 Agreeing a focus and goals

Purpose: gives the work direction while staying client-led [source: ETHOS manual; BACP 2014].
Steps: (1) Ask what they would like to be different by the end. (2) If they have a clear goal, put it in their own words. If not, use the first sessions to explore until one appears; don't force one. (3) Write goals down if they want to. (4) Revisit them regularly; the young person decides whether they still fit, need changing or are done. (5) In the ending phase, review progress on each goal [source: ETHOS manual; BACP 2014]. ETHOS rated personal goals with a goal-based outcome tool; its in-session procedure was not confirmed [uncertain].
Example language (illustrative): "If these sessions went really well, what would be different for you, at school or at home?" "We said last time you wanted to argue less with your mum. Is that still the thing, or has something else become more important?"
Watch for: goals that belong to a teacher or parent, not the young person; ask whose goal it is. Working: they can say what they are working towards and notice movement.

4.6 Outcome Rating Scale (ORS) at each session

Purpose: brief session-by-session feedback on wellbeing, used to discuss progress, not to diagnose. The ORS is licensed; using it outside ETHOS needs permission. Its items are not reproduced here [source: ETHOS manual].
What it covers: four visual-analogue lines for personal, interpersonal, social-role (school and relationships outside home) and overall wellbeing, totalled out of 40. The manual cites a clinical cut-off of 28 for 13–17-year-olds [source: ETHOS manual].
Steps: (1) First time: explain why it is used. (2) At the start of each session, give the young person the form and read the instructions. (3) Score it in front of them with a ruler and plot the total on a graph. (4) Discuss the result and link it to what they have been bringing. Ask what pushed it up or down. (5) Don't insist if they are too distressed. Treat scores as one source of information, not absolute truth [source: ETHOS manual].
Example language (illustrative): "Your 'school' line has dropped quite a bit since last week. What's been going on there?"
Watch for: ticking boxes to please you, or the scale feeling like a test. Working: they start using the graph to reflect on their own week.

4.7 Session-opening check-in

Purpose: keeps focus, goals and the time limit visible [source: ETHOS manual].
Steps: (1) ORS (4.6). (2) Say how many sessions are left. (3) Ask whether the focus still fits or something new has come up. (4) Then follow their lead.
Example language (illustrative): "So this is session 6, which leaves four after today. What feels most important to bring today?"
Watch for: the check-in eating into exploration time. Keep it to a few minutes [synthesis].

4.8 Empathic reflection from the young person's frame of reference

Purpose: the core activity of SBHC. It helps the young person feel understood and deepens exploration. Rated by PCEPS-YP items 1 (client frame of reference) and 3 (empathic resonance) [source: ETHOS manual; Ryan et al. 2021].
Steps: (1) Listen to the explicit content and to implicit cues: tone, posture, pauses. (2) Reflect what they mean and feel as seen from inside their world, without adding your meaning or softening it. (3) Match the intensity of the feeling; don't dilute it. (4) Offer reflections tentatively so they can correct you. (5) Use the correction to adjust your understanding [source: ETHOS manual; BACP 2014].
Example language: the manual's model of matching intensity is "I get the sense you're feeling very angry right now." [source: ETHOS manual]. Its frame-of-reference example is to reflect that school feels frightening to the young person rather than reassure them that it isn't. Illustrative: "Walking in through those gates every morning feels really scary."
Watch for: minimising, reassuring too early, or reframing into your own view (low frame-of-reference ratings). Working: the young person says "yeah, exactly" and goes deeper, or corrects you and goes on.

4.9 Tracking

Purpose: stays close to the young person's moment-by-moment thoughts and feelings and keeps revising your understanding (PCEPS-YP item 2) [source: Ryan et al. 2021; ETHOS manual].
Steps: (1) Follow the thread they are on rather than jumping to a topic you think is more important. (2) Check your understanding and update it when they correct or extend it. (3) Leave topics alone if they don't value them (the manual warns against steering towards what the counsellor thinks matters) [source: ETHOS manual].
Example language (illustrative): "Hang on, I think I've got that a bit wrong. It's not that you don't care about the exam, it's that you care so much it feels unbearable?"
Watch for: pursuing your own agenda, which was a factor in dissatisfied dropout [source: Pattison & Cooper 2024].

4.10 Communicating acceptance

Purpose: unconditional valuing, which counters conditions of worth and supports self-acceptance (pathway 3). PCEPS-YP item 4 (accepting presence) [source: ETHOS manual; BACP 2014; Ryan et al. 2021].
Steps: (1) Respond to disclosures, including about behaviour you disagree with, without judgement in words, tone or face. (2) Separate the person from the behaviour: accept them without condoning harm. (3) If you feel irritation or rejection, note it, reflect on it and take it to supervision instead of acting on it [source: BACP 2014].
Example language (illustrative): "You hit him, and part of you is still furious and part of you feels pretty bad about it. Both of those make sense to me."
Watch for: a young person testing whether you will judge or tell on them. Working: they disclose more and talk about themselves more kindly.

4.11 Genuineness and appropriate self-disclosure

Purpose: a real, person-to-person presence without a professional façade, which is especially important for adolescents wary of adults (PCEPS-YP item 5) [source: ETHOS manual; BACP 2014; Ryan et al. 2021].
Steps: (1) Speak naturally, not in therapy jargon or in a patronising way. (2) Be non-defensive when challenged. (3) Disclose your own reactions only when it serves the young person's progress, briefly, then return to them [source: BACP 2014].
Example language (illustrative): "Honestly, I'm not sure I've understood. Can you help me get it?"
Watch for: inappropriate self-disclosure (an alliance weakener) or over-familiarity [source: ETHOS manual].

4.12 Developmental responsiveness

Purpose: fit language and methods to the young person's developmental level (PCEPS-YP item 9, added specifically for young people) [source: Ryan et al. 2021; ETHOS manual; BACP 2014].
Steps: (1) Use the young person's own words and slang where natural. (2) Keep reflections short with less verbal or younger-presenting clients. (3) Offer visual or creative alternatives to talking (4.21). (4) Judge by developmental stage, not age [source: BACP 2014].
Example language (illustrative): "Would it be easier to draw it than say it?"
Watch for: long, abstract reflections that leave the young person blank or monosyllabic.

Emotion work (manual §7; PCEPS-YP item 6, emotion focus)

The manual asks the counsellor to be as interested in the emotional process as in the story. The aim is an optimal level of contact with feeling: neither too little nor overwhelming [source: ETHOS manual §7; BACP 2014]. Methods 4.13–4.17 are the manual's ways of helping young people access and express emotion.

4.13 Focusing attention inwards

Purpose: moves the young person from narrating events to noticing what they feel now. Use it when they talk about a charged event in a flat or factual way [source: ETHOS manual].
Steps: (1) Slow the pace. (2) Invite them to check inside, right now. (3) Wait. (4) Reflect whatever they find, even "nothing" or "don't know".
Example language: "I wonder if you can tell me what's going on inside you right now?" [source: ETHOS manual].
Watch for: if it brings up too much, slow down and ground (see 4.18 and §5). Working: their talk shifts from "he did" to "I feel".

4.14 Bodily focus

Purpose: emotions young people can't name are often felt in the body [source: ETHOS manual].
Steps: (1) Ask where in the body they feel it. (2) Ask what it is like there (tight, heavy, fizzy). (3) Reflect it and, if it fits, invite a word or image for it (4.17).
Example language (illustrative): "When you talk about your dad, where do you feel that in your body?"
Watch for: young people with trauma or body-image distress may find a body focus unsafe. Offer it as a choice and be ready to drop it [synthesis].

4.15 Empathic attunement to non-verbal cues

Purpose: brings implicit feelings into awareness by naming what you notice as it happens [source: ETHOS manual].
Steps: (1) Notice a cue (a sigh, nail-biting, looking away, a laugh at a sad moment). (2) Name it lightly and ask whether they noticed it. (3) Follow their response; don't interpret it.
Example language: the manual's example reflects a "Big sigh as you talk about Nan" [source: ETHOS manual]. Illustrative follow-up: "Did you notice that?"
Watch for: self-consciousness at being watched. Use it sparingly with very self-aware adolescents [synthesis].

4.16 Empathic conjectures

Purpose: offers a tentative guess at a feeling that is implied but not said, often a less acceptable feeling under the one shown [source: ETHOS manual].
Steps: (1) Offer the guess tentatively, as a possibility. (2) Make it easy for them to reject it. (3) Accept a "no" without defending your guess.
Example language (illustrative): "I might be wrong, but I wonder if there's a bit of anger in there too, alongside the hurt?"
Watch for: guesses driven by your theory rather than their cues. Working: they correct it, refine it or take it up.

4.17 Articulating emotion: images, shapes, colours, metaphors

Purpose: helps a young person find words for hard-to-describe feelings (PCEPS-YP item 7, emotion symbolisation) [source: ETHOS manual; BACP 2014; Ryan et al. 2021].
Steps: (1) When words fail, invite a description: what it would look like as a shape, an animal or a colour. (2) Elaborate the young person's own words and metaphors in their own style rather than replacing them with yours. (3) Check the fit and refine it together.
Example language: "I wonder what that feeling might look like if it was a shape or an animal?" [source: ETHOS manual]; "What colour is it?" [source: ETHOS manual].
Watch for: imposing your metaphor. Working: the image changes as they talk, or they reuse it in later sessions.

4.18 Containing and matching strong emotion

Purpose: stays with intense feeling without being overwhelmed or rejecting, and helps the young person contain arousal when it blocks the work [source: ETHOS manual; BACP 2014].
Steps: (1) Reflect the intensity accurately (4.8). (2) Stay steady and present. (3) If the young person is becoming overwhelmed, slow down, shift to describing the feeling from a little distance ("if it had a size…"), or to the here-and-now room and breathing. (4) Before the session ends, make sure they are settled enough to return to class. (5) Skip the ORS if they are too distressed [source for 1, 2, 5: ETHOS manual; 3–4: synthesis; BACP notes that arousal may need containing].
Example language (illustrative): "That's a lot of feeling all at once. Let's slow down a bit. Can you feel your feet on the floor? We've got ten minutes left, and I want to make sure you feel OK going back to lessons."
Watch for: dissociation, panic, or disclosures that raise risk (4.26).

4.19 Reflecting on emotions and developing new meanings

Purpose: helps the young person understand what an emotion is about, where it comes from and what it implies (pathway 4) [source: ETHOS manual; BACP 2014].
Steps: (1) Explore the meaning of the feeling and its origins. (2) Help them tell apart feelings that fit the present situation from feelings tied to the past or that cover a more basic emotion. The manual's example is exam panic that reflects a threat to the young person's sense of self. (3) Notice when one emotion stands in for another (fear or sadness showing as anger; anger showing as tears). (4) Explore what the new understanding means for what they want or need [source: ETHOS manual].
Example language (illustrative): "So the panic isn't really about the maths paper. It's more like a voice saying if you fail, you're not good enough?"
Watch for: intellectualising. Bring them back to the felt sense (4.13). Working: a shift in how they see themselves or the situation (PCEPS-YP item 8, facilitation of self-development) [source: Ryan et al. 2021].

4.20 Making sense of confusing or distressing experiences

Purpose: for reactions that puzzle the young person ("I don't know why I kicked off") [source: BACP 2014].
Steps: (1) Go back to the specific moment. (2) Explore, step by step, what they noticed, how they read the situation and what they felt. (3) Link the reaction to how they read the situation. This is more than retelling the story [source: BACP 2014]. The source does not name a specific structured task, such as evocative unfolding [uncertain].
Example language (illustrative): "Let's go back to just before you walked out. What did you see on his face? What did that mean to you in that moment?"
Working: "Oh, it's because I thought everyone was laughing at me."

4.21 Creative and symbolic methods

Purpose: helps young people express, reflect on and make sense of experience when talking alone is hard. They are especially suited to younger or less verbal clients [source: BACP 2014; ETHOS manual competences list].
Methods named in sources: art materials and drawing; play materials; sand tray; life-story work, including a lifeline that places events on a timeline and projects it into the future (BACP 2014); genograms and diagrams of relationships at home and at school; school mapping (ETHOS manual). The manual's §7 section on creative methods is [uncertain].
Steps: (1) Offer materials as an option, not a requirement. (2) Invite them to make something about the issue (for example a drawing of the family or a lifeline from birth to now). (3) Ask them to tell you about it. (4) Keep a non-interpretative stance: they explain what it means; you reflect [source: BACP 2014]. (5) For a lifeline, invite them to mark high and low points and then extend the line forward to where they hope to be [source: BACP 2014; steps phrased as synthesis].
Example language (illustrative): "Would you like to draw a line from when you were little to now, with the ups above it and the downs below it? Then you can tell me about the bits that matter."
Watch for: interpreting their images for them; older adolescents finding materials childish (offer, don't push). Working: material appears that hadn't come up in talk.

4.22 Active expression and dialogue methods [uncertain for SBHC]

Source status: the UCL adult humanistic framework (Roth, Hill & Pilling) includes methods that encourage active expression, such as a dialogue between conflicting parts of the self when the client shows a marker such as conflicting wishes, drawn from gestalt and emotion-focused therapy. The sources do not confirm these methods in the young-people framework or the ETHOS manual [uncertain].
If used: only with clear consent, an explained rationale and adequate training, keeping the PCEPS-YP stance (client-led, non-interpretative) [synthesis].

4.23 Supporting choices and coping strategies

Purpose: pathway 5 of the process model is new coping strategies supported by the counsellor's suggestions and guidance. The ETHOS description includes helping young people weigh options and choose what is likely to help [source: ETHOS manual; ETHOS project page].
Steps: (1) Once the problem and feelings are understood, ask what they have tried and what helped. (2) Explore options together, including pros, cons and feelings about each. (3) If they ask for ideas, or seem stuck, offer suggestions tentatively, as things to consider, not instructions. (4) Let them choose, and review the choice the next week [synthesis built on the manual's pathway 5].
Example language (illustrative): "You've said you want to stop bottling it up but don't want to explode either. What are the options as you see them? Can I throw in an idea or two as well?"
Watch for: advice that overrides their direction. Young people who want more direction often find pure reflection frustrating [source: Cooper 2021 GWG]. Working: they try something and report back.

4.24 Applied relaxation

Purpose: an additional intervention in the BACP framework (also in the ETHOS competences list) for anxiety that escalates through cycles of bodily arousal [source: BACP 2014; ETHOS manual].
Steps (per the source): (1) Build awareness of the early bodily signs of anxiety and their triggers. (2) Teach a relaxation response. (3) Practise it in situations that provoke anxiety [source: BACP 2014]. The specific relaxation techniques and schedule are not given in the sources. Use a standard applied-relaxation protocol you are trained in [uncertain].
Example language (illustrative): "Let's notice what your body does in the minute before the panic hits. That's the moment we want to catch."
Watch for: using it to bypass feelings the young person wants to explore. Offer it when they ask for help managing anxiety [synthesis].

4.25 Self-help materials

Purpose: an additional intervention: stand-alone or guided self-help with a stated rationale and a clear target problem [source: BACP 2014].
Steps: (1) Agree the target problem. (2) Explain why the material might help. (3) Agree how it will be used and reviewed next session.
Watch for: material that is unused or a poor fit. Review it, and drop it if it isn't helping.

4.26 Risk assessment and safeguarding response

Purpose: risk assessment runs through the whole course of therapy. Risk that emerges does not end counselling, but it starts an immediate conversation about risk and the safeguarding procedure [source: ETHOS manual; BACP 2014].
Areas: harm to self (suicidal thoughts, self-harm, eating difficulties, substance misuse, impulsivity), self-neglect, harm to others, and harm from others (domestic violence, abuse, neglect, a parent's mental ill-health or substance misuse). Think of risk factors as static (history), dynamic-chronic (e.g. deprivation) and dynamic-acute (e.g. access to weapons, current family or peer conflict) [source: ETHOS manual].
Steps when a concern arises: (1) Explore it calmly and directly, using standard risk-assessment questions about thoughts, intent, plans, protective factors and access to means. Lethal-means counselling covers only safe storage and removal [synthesis, consistent with current standard practice]. (2) Explain why information needs to be shared. (3) Share only what is relevant to the risk. (4) Involve the young person and seek their consent, including about who is told and how. (5) If they don't consent but serious harm is likely, tell the appropriate member of school staff (usually the designated safeguarding lead) without consent. (6) Inform your supervisor. (7) Record it and follow the school's safeguarding policy and national guidance (in England, Keeping Children Safe in Education and Working Together to Safeguard Children) [source: ETHOS manual]. (8) Reassess capacity to consent if it may have changed, for example through alcohol or drugs [source: ETHOS manual].
Example language (illustrative): "What you've told me makes me worried about your safety, and I care about that. I can't keep this one just between us. Can we work out together who needs to know and how we tell them?"
Watch for: the BACP metacompetence of becoming more directive when risk is significant [source: BACP 2014]. Also watch for a young person who withholds risk because they don't trust what you will do with it (see §5) [source: Pattison & Cooper 2024].

4.27 Working with the school, parents and other services

Purpose: SBHC sits inside a school system, and practical arrangements decide whether sessions happen [source: ETHOS manual; BACP 2014].
Steps: (1) Before you start, agree with the school: how access and referral work, how confidentiality is managed, when sessions happen in the school day, what happens after missed appointments, how students get to sessions (appointment cards or runners), what happens if a student leaves early, and a suitable private room. (2) Learn the school's culture, staff roles, exam and assessment timetable and student groupings. (3) Communicate clearly, in speech and writing, with students, staff, parents and other professionals about what counselling is. (4) Work with the pastoral team, CAMHS and local services, and refer on when needs exceed your competence [source: ETHOS manual]. (5) Engage parents and carers within the confidentiality agreed with the young person. Neither the ETHOS manual's visible sections nor the BACP framework gives a specific model for parent work beyond generic competences for engaging parents and carers [uncertain].
Example language (to a referring teacher; illustrative): "I can confirm Sam is attending, but what we talk about stays confidential unless there's a safety concern, which I'd raise with the safeguarding lead."
Watch for: staff expecting reports on content; sessions clashing with tests; a run of missed sessions caused by timetabling rather than motivation [synthesis].

4.28 Monitoring the alliance and talking openly about strain

Purpose: alliance strain (lateness, reluctance to attend, silence) needs addressing, not ignoring. Counsellors take appropriate responsibility for ruptures [source: ETHOS manual]. Not talking openly about relationship difficulties may contribute to dissatisfied dropout [source: Pattison & Cooper 2024].
Steps: (1) Notice signs of strain. (2) Raise them sensitively, without blaming the young person. (3) Check that you share an understanding of the goals and of how counselling is meant to work (4.1, 4.5). (4) Own your part (for example "I think I've been asking too many questions"). (5) Agree an adjustment and check how it lands [source: ETHOS manual for 1–4; 5 synthesis].
Example language (illustrative): "I've noticed it's been harder to get going the last couple of weeks, and I wonder if these sessions are feeling the way you want them to. It's completely fine to tell me if something I'm doing isn't helping."
Watch for: polite compliance that hides dissatisfaction. Working: the young person says what they want and engagement picks up.

4.29 Planned ending

Purpose: ends the work in a way that consolidates gains and becomes a positive experience of ending [source: ETHOS manual §6; BACP 2014].
Steps: (1) From session 1, keep the session count visible. (2) A session or two before the end, negotiate how to end (for example what to cover and whether to bring the lifeline or ORS graph). (3) Review progress: look at the ORS graph and goals together, and ask what helped and what didn't. (4) Plan for afterwards: strategies and action plans (e.g. a journal, a confidence-building plan) and how to handle likely setbacks. (5) Invite anything not yet said, and explore worries about managing without counselling. (6) Link the ending to past losses where relevant, and let feelings about ending be expressed. (7) Identify future support (people, pastoral staff, services). (8) Assess risk after discharge with pastoral staff. If difficulties remain and extension isn't possible, refer back to the pastoral team [source: ETHOS manual; BACP 2014]. (9) Finalise the Current View form.
Example language (illustrative): "Next week's our last. When you look at your graph from week one to now, what do you notice? What do you want to take with you?"
Watch for: a young person who isn't ready to end. Explore how they will manage what remains, rather than extending sessions (ETHOS) [source: ETHOS manual].

4.30 Managing premature or unplanned endings

Steps: (1) Explore why the young person wants to stop. (2) Check whether the decision is theirs or influenced by family or peers. (3) Explore whether their concerns about counselling can be addressed. (4) Assess risk. If confidentiality might need to be broken, discuss it with them and, where possible, with your supervisor first. (5) Discuss the ending in supervision [source: ETHOS manual; BACP 2014].
Example language (illustrative): "It's your choice whether to carry on. Before you decide, could you tell me what's not working, in case there's something we can change?"
Watch for: the drivers of dissatisfied dropout (see §5).

4.31 Supervision and self-monitoring with the PCEPS-YP

Purpose: keeps practice adherent and responsive. Discuss any risk concern (even below the threshold of serious harm), referrals outside your competence and adverse events in supervision. Consult before breaking confidentiality or changing the plan [source: ETHOS manual].
The PCEPS-YP has nine items, each rated 1–6: client frame of reference, tracking, empathic resonance, accepting presence, genuineness, emotion focus, emotion symbolisation, facilitating the client's self-development, and developmental responsiveness. In ETHOS, two raters scored 20-minute audio segments from the first and second halves of therapy (excluding the first and last sessions and the first and last 5 minutes). A mean of 3.5 or below indicated unacceptable adherence or competence [source: Ryan et al. 2021]. The ETHOS supervision manual and the short PCEPS-YP-S are not drawn on (Word files) [uncertain].
Steps for self-use (with consent to record): (1) Record a session. (2) Pick a 20-minute middle segment. (3) Rate yourself on each item. (4) Bring the lowest-rated items, with clips, to supervision [synthesis, adapting the ETHOS procedure; Ryan et al. propose a self-report version].
Watch for: low ratings on emotion focus and frame of reference, which are common signs of drift into advice-giving or chat [synthesis].

5. Handling problems

Sourced guidance is tagged. Everything tagged [synthesis] is my own clinical guidance, consistent with the model but not found in the sources.

Long or repeated silences

Source: in ETHOS, 10–20% of young people found silences too long and awkward [source: Cooper 2021 GWG]. Inappropriate silence weakens the alliance [source: ETHOS manual], and repeated silences were a factor in dissatisfied dropout [source: Pattison & Cooper 2024].
Response: don't leave an adolescent in an unstructured silence for long. Name it lightly, and offer choices: a topic from last week, the ORS graph, drawing or mapping (4.21), or a short check of how the silence feels. Ask early in therapy how they feel about pauses [synthesis].
Example (illustrative): "Sometimes quiet's useful and sometimes it's just awkward. Which is this one? Would it help if I asked a few things, or we drew something?"

"I don't know what to talk about" / stuck sessions

Response: go back to the focus and goals (4.5) and the ORS lines that dropped (4.6). Use a structured, still client-led entry point such as school mapping, a relationship diagram or a lifeline (4.3, 4.21). Ask what a good session would look like [source for tools: ETHOS manual; BACP 2014; sequencing: synthesis].

The young person wants advice or strategies

Source: some ETHOS clients wanted more active input: strategies, techniques, direction [source: Cooper 2021 GWG]. Cooper advises taking stated preferences seriously, and the process model includes coping strategies from counsellor suggestions (pathway 5) [source: ETHOS manual].
Response: explore what they are hoping for, offer options tentatively (4.23), consider applied relaxation or self-help (4.24, 4.25), and, if they clearly want a structured skills-based approach, discuss a referral or alternative. Cooper says SBHC is not right for every young person [source: Cooper 2021 GWG].

Hesitancy or ambivalence about talking about feelings

Source: client hesitancy and ambivalence about discussing feelings was a dropout factor [source: Pattison & Cooper 2024].
Response: reflect the ambivalence itself without pushing. Lower the emotional intensity (talk about situations first, use images and colours, 4.17). Let them control pace and depth. Explain again why feelings are worked with (4.1) [synthesis].
Example (illustrative): "Part of you came today, and part of you would really rather not get into feelings stuff. That's OK. We can go at your speed."

Resistance, "sent" clients and alliance ruptures

Source: lateness, reluctance to attend and uncommunicativeness signal strain. Check shared understanding of goals and rationale, raise concerns sensitively, and take responsibility for ruptures [source: ETHOS manual]. The counsellor pursuing their own agenda, a weak alliance and not talking openly about relationship difficulties all fed dissatisfied dropout [source: Pattison & Cooper 2024].
Response: use 4.28. With a young person referred by staff, separate what the school wants from what they want, and make the choice to attend real. They can say no, and you won't report the content of sessions back [synthesis, consistent with the manual's guidance on reconsidering and on confidentiality].

Overwhelm and dysregulation in session

Source: manage strong emotion without becoming overwhelmed or rejecting. Help the young person reach optimal, not overwhelming, contact with feeling. Don't insist on the ORS when they are very distressed [source: ETHOS manual; BACP 2014].
Response: use 4.18. Slow down, reflect, ground in the room, contain the material ('we can come back to this'), and leave enough time to settle before they return to lessons. Agree with pastoral staff where a young person can go if they are not ready for class [synthesis].

Non-attendance

Source: explain the missed-session protocol at contracting and agree with the school in advance how missed appointments are handled [source: ETHOS manual].
Response: first check practical causes (timetable, tests, runner not sent). Then raise attendance openly as possible alliance strain (4.28). Count missed sessions honestly within the session limit, and agree with the young person how you will contact them [synthesis].

The young person wants to stop early, or others want them to

Use 4.30: explore reasons and whose decision it is, address concerns, assess risk, and take it to supervision [source: ETHOS manual].

Withheld risk, or loss of trust after a disclosure

Source: one dropout factor was the client not feeling able to trust the counsellor with a risk issue [source: Pattison & Cooper 2024].
Response: explain the confidentiality limits clearly at the start, and repeat them when risk topics come near. When sharing is needed, involve the young person in what is shared, with whom and how. Afterwards, name the impact on the relationship and repair it explicitly (4.28) [source for involvement: ETHOS manual; rest: synthesis].

Suspected psychosis, eating disorders, needs beyond competence

Source: seek immediate supervisor advice if psychosis is suspected. With eating disorders, work alongside other professionals (GP, psychiatrist, dietitian). Refer on, with the pastoral team and supervisor, when needs exceed your competence [source: ETHOS manual].

A diagnosis dominates the conversation

Source: don't treat the diagnosis as expert knowledge of the young person; explore what it means to them [source: ETHOS manual].

Changing capacity to consent

Source: capacity can change (for example after alcohol or drugs) and must be reassessed [source: ETHOS manual]. Response: if a young person arrives intoxicated, keep the session brief and safety-focused, follow safeguarding procedures and rebook [synthesis].

Work unfinished at the session limit

Source: no extensions in ETHOS. Explore how remaining difficulties will be managed and refer back to pastoral care [source: ETHOS manual]. BACP allows for booster sessions [source: BACP 2014].
Response: outside a trial, decide any further contract or booster sessions with the service and your supervisor before the final session, not during it [synthesis].

Pressure from staff or parents for information

Response: refer back to the confidentiality arrangement agreed with the school before counselling started (4.27). Give attendance information but not content unless there is a safeguarding concern. With the young person's consent, you can agree a joint message [synthesis, building on the ETHOS manual's requirement to agree confidentiality management in advance].

Counsellor drift

Signs: drifting into advice, chat or problem-solving and losing the emotion focus, or the opposite, rigid reflecting that ignores a young person's wish for input.
Response: rate a recorded segment with the PCEPS-YP dimensions (4.31) and take it to supervision. Hold the BACP metacompetence of balancing non-directiveness with responsiveness [source: Ryan et al. 2021; BACP 2014; application: synthesis].

Over-identifying or rejecting reactions in the counsellor

Source: keep an independent viewpoint and don't over-identify. Notice rejecting feelings and reflect on them in supervision rather than acting on them [source: ETHOS manual; BACP 2014].

Sources

Sources: