Child Counselling Referrals

The Children’s Commissioner has reported that almost one million children and young people had active referrals for Children and Young People’s Mental Health Services in England in 2022-23 and that the most common reason for a referral for mental health treatment is cited as anxiety. Children and young people can feel anxious about different things at different ages, and many of these worries are a normal part of growing up however, anxiety can become a problem for children when it starts to get in the way of their everyday life. Other possible issues relating to children and young people’s mental health and wellbeing, that may require referral for mental health treatment such as counselling include but are not limited to:

• Bullying
• Eating difficulties
• Sleeping difficulties
• Family tensions
• Family breakup
• Bereavement
• Socialising and friendship difficulties
• Self-esteem and confidence issues
• Managing exam stress
• Phobias
• Abuse
• Domestic violence
• Behavioural issues including anger management and conduct disorders
• Attention-Deficit Hyperactivity Disorder (ADHD)
• Autism Spectrum Disorder
• Obsessive-Compulsive Disorder (OCD)
• Identity and gender dysphoria
• Self-harming and / or suicidal thoughts

Mental health and wellbeing is as important to a child’s safety and wellbeing as their physical health. Poor mental health often impacts children’s attendance and attainment in school, which may have a bearing on their future life prospects, so it is crucial that children and young people have access to the appropriate mental health support and treatment that they need to lead happy, healthy and fulfilling lives.

There are lots of different types of support and treatments available for children’s mental wellbeing and to help with mental health issues, amongst them counselling and therapeutic services. Children might be referred to and go to counselling for all sorts of reasons related to their emotional, mental, or behavioural well-being such as those highlighted above. In this article we will explain what child counselling is, look at some of the reasons why and when a child might be referred for counselling and some of the benefits that can be gained from making a referral to counselling for a child or young person.

What is child counselling?

Counselling and psychotherapy involve talking about or exploring feelings, thoughts, and experiences. Child counselling can help a child or young person to make sense of what is going on in their life and help them to find ways of coping when things are difficult. Counselling services are available to help children and young people with their mental health, their emotions or to help with their behavioural issues. These services can include helplines, one-to-one counselling and / or therapy sessions in person, online or by phone, and specialist online chats and forums.

Counselling can provide a safe and confidential space where children can express their thoughts and feelings, develop coping strategies, and work through issues affecting their well-being. It helps children to understand and manage their emotions such as anxiety, anger, sadness, or confusion.

Although similar to adult counselling and therapy, child counselling has significant differences in how a therapist works with children. Counselling for children is designed to be engaging and effective for their unique needs, is tailored to their developmental stage and can begin as young as pre-school age (3 – 5 years).

Child counselling often involves a mix of talking, play, and also the use of creative materials. Child therapists have trained extensively to develop a range of child centred techniques in working with children and young people. This is because for some children, talking is not the most appropriate way for a therapist to address the issues that they are experiencing, so the therapist will often uses other tools such as creative materials, or enters into play with the child or young person. The therapist will direct this play and the sessions to help the child to connect more with their emotions and process difficult experiences.

Many younger children do not always have a full understanding of what counselling / therapy is, and will therefore view their sessions as a time to play and talk with an adult. Other children will be very aware of the issues that they are finding difficult, and these children are likely to view counselling as a safe place to be themselves, and to work through their difficult and / or traumatic experiences. For some children, all they need is a listening ear or someone they can talk to, without feeling judged, offering them an opportunity to offload about issues that may be causing them emotional difficulties.

Some child counsellors or therapists will share the child’s background or experiences, or they have lots of experience working with children and young people who are like them, for example specialist child bereavement counsellors, counsellors specialising in eating disorders or counsellors from particular ethnic backgrounds.

This might help the child feel more comfortable and understood if the counsellor has shared their life experience. However, the most important thing is for the counsellor or therapist to be qualified to work with children and young people, and that they are experienced in using specialist child centred techniques to help children and young people to make sense of what they are experiencing, feel less distressed, become more self-aware, heal and develop resilience.

Counselling children and young people does not involve making decisions for the child or young person, lecturing them, or imposing opinions or beliefs on them but, instead, it is about helping them to find new ways and insights to understand their feelings, problems or difficulties constructively, allowing the negative impact of their experience to be reduced.

The most important aspect of any counselling, especially child counselling is the relationship that the child or young person forms with their therapist. It is a non-judgemental, confidential relationship that is child centred and tailored to be entirely unique to the child or young person.

It is one in which the child or young person can feel heard, acknowledged and seen for who they really are. By providing consistency, the therapist helps to build trust which is essential for the success of the counselling.

When might a child be referred for counselling?

It can be difficult for parents and / or caregivers to recognise when a child or young person is struggling mentally. Children’s emotions can be volatile and their behaviour can change in different circumstances. However if these moods and behaviours persist for a few weeks continually, are causing the child or young person distress, and / or are having an impact on the child or young person’s day-to-day life, there may be an underlying issue. Being attentive to a child or young person’s mood and behaviour can help to highlight patterns that suggest that they may need professional counselling support.

There may be physical signs that a child or young person might need to be referred for counselling, such as the child’s eating habits have changed, for example, they could begin excessively eating or excessively dieting, or they are becoming very controlled in their eating. The child may be sleeping more than usual, or struggling to get to sleep, or they may be often waking in the night.

Noticeable changes to sleeping habits which become persistent could be a sign that the child is struggling with something and may benefit from counselling. Bedwetting is something that most children and young people will grow out of however, if it is out of character, persistent and not related to a medical issue, it can be another physical sign that a child may be experiencing stress at home or at school and would benefit from being referred for counselling.

Sometimes one of the most obvious changes to notice in children or young people is in their behaviour. For example, if they are becoming more argumentative or aggressive, or if they have had more tantrums than usual and may be displaying more destructive behaviour, or if they seem particularly unsettled and restless, or perhaps they are isolating themselves, becoming more withdrawn or timid and avoiding social interactions.

There may be a change in their relationships where they begin to find friendships more difficult or they withdraw from friends completely. Although many of these behaviours can be common in children and young people in the short term as they grow up, persistent changes in moods and behaviours and / or if the child seems distressed, it may be a sign that they are struggling with issues and would benefit from being referred for counselling.

Some of the most difficult signs to recognise in a child or young person who is struggling with difficulties in their life can be the emotional signs, although it is possible identify them. The child or young person may begin to lose interest in the hobbies and activities that they used to love, or they may begin to become overly critical of themselves and their self-esteem may progressively get worse.

Teachers might report that a child is having difficulty concentrating or focussing on tasks at school, this may in turn see a decline in their academic performance. Maybe the child or young person is displaying persistent negative mood or emotions such as worry or sadness. Any of these may be signs that they are struggling with issues and would benefit from being referred for counselling.

Although many of these things highlighted above can be common for children and young people to experience as they grow, and may not be an indication of something deeper is going on, it is important to take notice if any of these signs seem to be persistent, distressing and having an impact on the child or young person’s life. Talking with the child or young person is the first way to begin to see how they feel and to understand if there is something that is bothering them or not.

There may however also be events in a child or young person’s life such as following a bereavement, or family break-up, or some other potentially traumatic event, when the child or young person might benefit from pre-emptive early intervention of child counselling to help them to process the occurrence so that it has a less negative impact on their mind and body.

There is never a right or wrong time or reason for a child or young person to attend counselling, sometimes it is just good to talk to someone objectively, at other times more support may be needed from a counsellor.

Benefits of counselling for children

Regardless of the age of the child or young person, the benefits of counselling can be substantial, and early intervention can prevent the escalation of issues. It can also provide the child or young person with the tools and support that they need to navigate life’s challenges. Counselling for children helps them to manage difficult life problems and isn’t just about exploring solutions to problems, it can also help them to develop as a person.

Benefits of child counselling can include improved emotional regulation, enhanced communication skills, and better coping strategies for dealing with stress or anxiety, and can help children to develop problem-solving skills, and to build their self-esteem. When a child is struggling, counselling can help them to understand why they feel this way and help them to develop tools to help them cope with any challenges they may be facing.

Place2Be, a children and young people’s mental health charity, found that children and young people’s mental health consistently improves following receiving one-to-one counselling, with children and young people’s wellbeing improving by 72%, according to their parents or carers and 64%, according to their teachers.

One-to-one counselling can help support children and young people in a safe, confidential environment, allowing life issues or painful and uncomfortable memories to be confronted, and enabling them to heal from difficult experiences. It can help children and young people to develop self-control and direction, and to learn creative and resourceful ways to confront problems, whilst making independent, positive choices. It also helps the child or young person to develop a positive attitude to life, to respect themselves, and to accept their feelings and to express them responsibly.

Research suggests that in time, counselling can improve a child or young person’s academic attainment. Children and young people struggling with emotional or social issues often experience a decline in academic performance and a disengagement from educational activities. School and college counselling services can uncover factors impacting academic performance, such as anxiety about test-taking, bullying, relationship issues or difficulties with focus.

They can play a crucial role in promoting positive outcomes for children and young people, not only in their immediate years in education but also throughout their lives. By providing a space for children and young people to address their mental health concerns, develop coping mechanisms, and build resilience, school counsellors can contribute to a wide range of socioeconomic benefits. They can help children and young people set realistic academic goals, develop study skills, and stay motivated throughout the academic year, leading to a more positive learning environment.

Giving children and young people early access to counselling and therapy services is vital to reduce the number of adults suffering from entrenched mental ill health in future generations.

Can parents and carers be in child counselling sessions?

In most cases, parents or carers are involved in the initial counselling assessment session, as they can provide important background information about the child or young person’s emotional, behavioural, or mental health concerns, and about the family context, the child or young person’s developmental history, and any specific issues that the child or young person may be experiencing or facing. Parents / carers and therapists will usually work together to set therapy goals for the child or young person, discussing what they hope to achieve from the sessions.

Although the therapist will work primarily with the child or young person during counselling sessions, parents / carers, and potentially other family members can and should also be involved to some degree as they can play a key role in reinforcing the counselling process. The degree of involvement for parents / carers, and / or other family members can depend on the counselling approach or the counselling model being used. Some forms of counselling focuses solely on the child or young person, and although the session itself remains confidential, the parent(s) / carer(s) are invited to meetings with the counsellor to discuss the child or young person’s progress and to impart any recommendations for supporting them at home.

The therapist may recommend family therapy sessions in which parents /carers and or other family members play an active role as these sessions focus on improving family dynamics, communication, and relationships to support the child or young person’s mental and emotional well-being.

The therapist may ask parents / carers to participate in some way in a younger child’s counselling sessions, especially for pre-school or early primary school-aged children, as younger children may feel more comfortable in counselling sessions with a known trusted adult nearby.

Therapists often work with older children to strike a balance between maintaining their confidentiality and involving parents when necessary. Parents / carers may be involved in some sessions, or may only have involvement in review sessions where the therapist will provide feedback on the child or young person’s progress, and will discuss how they can support the child or young person at home, adjusting goals if needed.

There will of course be instances where there is significant conflict or dysfunction in the parent-child relationship, for example where there is abuse or serious family breakdown, so family involvement might be limited or managed carefully in these circumstances with the therapist choosing to work solely with the child or young person for some sessions.

Can you refer your own child for counselling?

There are a number of different ways that you can get a referral to counselling for a child or young person. Speaking to your GP is often the first step to accessing counselling or therapy through the NHS however, depending on where you live you or your child may be able to self-refer instead. Child and Adolescent Mental Health Services (CAMHS) are services that support children and young people under 18 years who are experiencing poor mental health, or difficult feelings or experiences. Normally you will need a referral from your doctor, but some CAMHS services also accept referrals from:

• Schools and school counsellors
• Social workers
• Youth offending teams
• Parent / carer or the child or young person themselves depending on their age and what their local service allows

To find your local CAMHS, to see what support they offer and to find out how to get their help use the NHS search tool.

Charities such as Young Minds, Place2Be and Barnardo’s can offer guidance to services, advice and resources for parents and carers to help support their child or young person’s wellbeing. Barnardo’s also offer counselling services in some areas, you can search here for local Barnardo’s counselling services.

Private vs NHS counselling funding

The factors that affect the choice of deciding between private and NHS funded child counselling can seem very obvious, however the decision isn’t only about affordability versus waiting times, there are some other important factors to consider too. NHS waiting times for referrals and appointments for child counselling can be long, depending upon the area in which you live. According to the charity Rethink Mental Illness, for the 305,000 children who entered treatment in 2022-2023, the average wait time for therapy was 108 days, but some waited even longer. However not all areas face the same challenges, with some services averaging just a four-day wait time.

Although NHS counselling is free, within the NHS services, funding for mental health services for children and young people hasn’t matched the rise in demand. There is also a shortage of children and young people’s mental health professionals in the NHS, making it difficult to meet the growing number of referrals.

Some, but not all schools and colleges have a counsellor who is a qualified professional employed by schools or colleges to work with children and young people who are experiencing issues that are impacting their emotional or psychological wellbeing. Most school / college counselling is offered one-to-one, and is confidential. These counselling services are free, and are often funded by local authorities.

Private child counselling services operate outside of the public healthcare and education systems. They are provided by qualified counsellors or therapists and can offer a range of mental health and emotional support to children and young people.

The main difference in using a private child counselling service is that you can usually access the help you need within a few days versus the current long waiting times that you currently have with the NHS. They offer an alternative to or supplement the NHS or school counselling services, providing quicker access and more tailored support. The cost of private counselling can vary from around £50 to £250 per 50 min session. Several online directories list private counsellors across the UK, these include the British Association for Counselling and Psychotherapy (BACP), the UK Council for Psychotherapy (UKCP) and the Counselling Directory.