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A puppet, some crayons, a doll’s house, and a heap of sand. Not the first objects that come to mind when you think about the contents of a counselling room. But for young children they can become tools to express troubling feelings which would otherwise stay locked inside them.

Counsellors have been working in secondary schools for a long time, but there is a growing belief that primary school children could also benefit from their skills. Children’s minister Margaret Hodge recently described counselling as "a lifeline" for children - although the Department for Education and Skills has no record of the number of schools offering a counselling service, and has no plans to insist that they do so.

Provision inevitably is patchy but in some areas counselling in primary schools is already well established. In Dudley in the West Midlands, for example, a counselling service for children and young people has been operating in local schools for 30 years.

The team of eight counsellors, all trained teachers with additional counselling qualifications, go into the schools which buy in their services, sometimes for just a few hours per week. The 35-minute counselling sessions take place during lesson time, with primary school children benefiting from an average of between 12 and 15 meetings.

From the outset, the counsellors seek to ensure that the child understands what is going on and agrees to the "counselling contract".

"You have to have children and young people come with informed consent. They need to know that they want to do it. It just doesn’t work unless they are on board with the process," says Janette Newton, head of the service. And in terms of confidentiality, it is made clear to the child that if they or anyone else is at risk, then other adults will need to be told.

Most of the referrals to the service come from the school staff, and not surprisingly, the child’s behaviour is the most commonly cited cause. But this is often not the real problem. "Once counselling starts, the child does the leading. We help them to explore their feelings but where they take us is where we work," says Newton.

Among the issues that emerge most often are family separations, bereavement, anxiety and bullying.

Unlike older children and adults who tend to talk about their problems, younger children often also use non-verbal means such as play with dolls and sand to express themselves. They also explore issues indirectly using metaphors, which the counsellor will encourage.

"We keep up the metaphor and do not link what they are doing to their actual life. Using metaphor enables them to work through issues," explains Newton.

A different model of counselling is used by The Place to Be, a voluntary sector group offering counselling to children in 92 primary schools across the country.

As well as one-to-one sessions with children referred by teachers, a lunchtime drop-in service, the Place to Talk, is open to any child in the school. This service has proved popular, and around half of the children attend.

No stigma attached
"A whole range of children get to know about it and as it’s not just for ‘bad’ children - there is no stigma. The children all want to come and even ask when it is their turn," says Lily Smith, Croydon area manager for charity.

Being able to go to a dedicated room and use special equipment helps make counselling sessions more attractive to the children. "Word gets around that it’s quite nice in there," says Smith.

While the children cotton on to the Place to Be’s benefits straight away, it can take their parents a little longer. Parents are invited to take part in the referral and review processes and because the support is available in the school, parents are less reluctant to be involved than they might be with social services.

Like adults, children are more likely to use services if they can just turn up ad hoc. In light of this, Dinah Morley, acting director of charity Young Minds, says school counsellors should always keep time aside for drop-in sessions.

"Children should feel able to approach somebody without having to go through a bureaucratic process to get an appointment. Sometimes schools make it hard for children to drop in but that service is important," she says.

Having the resources to offer such services can be a challenge for schools, and as with anything, you get what you pay for. But it is essential that school counsellors are suitably trained, and also have good connections with specialist child and adolescent mental health services.

"It’s one thing to be an active listener and to be there to hear their worries, but it’s hugely important to know when a child is in real distress and in need of specialist help. An unskilled worker could make things worse," says Morley.

Sue Kegerreis is course director for the MSc in psychodynamic counselling with children and adolescents at Birkbeck College, University of London - one of very few specialist child counselling courses in the UK. She says: "School counsellors need to have a sense of belonging to the child and adolescent mental health community rather than being split off and disconnected because they are in education."

Specialist training
She says that counsellors who work with this age group need to be specifically trained - counsellors who have been trained to work with adults would lack key skills. Working with children requires specialist skills as counsellors need to be able to decipher their play. Also, the counsellor must have expertise concerning children’s main stages of development.

"A problem in a six year old manifests itself differently in a 10 year old. Each stage has its own particular things. People who have done an adult training course who are working with children do pick this up, but it is better if they have a thorough grounding in it before they start," says Kegerreis.

On top of this, counsellors who work in schools must also be in tune with the organisational dynamics of the school.

"The relationship between counsellors and teaching staff can be complicated and teachers sometimes feel undermined and envious. If a child comes to counselling but there are underlying problems between the teacher and the counsellor then it can be difficult," she adds.

Providing high quality counselling in every primary school would not be cheap, even if sufficient staff could be recruited. But there is plenty of support for the idea that children’s learning and behaviour - and long-term mental health - would benefit from the opportunity to share feelings and experiences with counsellors.

Best counselling practice

• Make sure the counsellor is fully qualified and accredited, and has specific training for working with children.
• Do preliminary work with the school before the service starts to iron out any concerns that teachers may have.
• Agree clear protocols for referral, confidentiality and feedback so that things aren’t being made up as the service develops.
• Make sure there is an appropriate room which is quiet. It can sometimes be hard to find such places in schools.
• For more advice on setting up a service contact the chair of the Counselling in Education division of the British Association for Counselling and Psychotherapy: markdavidprever@yahoo.co.uk, www.theplace2be.org.uk