Building positive relationships with students struggling with mental health



Interaction strategies that help teachers maintain positive relationships with students are important accommodations for students with mental health disorders. 


Few classroom teachers have much training in mental health counseling and support. On average, however, 49% of students struggle with a mental health disorder (Merikangas et al., 2010) that may impair their ability to perceive people’s actions accurately, stay regulated when stressed, or cope with typical classroom interactions. Further, given that these disabilities are often invisible or even undiagnosed, teachers can easily misperceive students’ intentions, understanding them to be disrespectful, noncompliant, or non-participatory when, in fact, there are other reasons for their behavior. In their frustration, teachers may also react to these students in a way that compounds the problem. For instance, students with some mental health disorders are often triggered by everyday occurrences like being told to move seats in class. For other students, a teacher’s sharp tone of voice can elicit a “fight, flight, freeze” response, resulting in defiance, noncompliance, absconding, or shutting-down behaviors. 

To succeed in school, students with mental health challenges tend to need a steady diet of positive interactions with their teachers. Otherwise, they may become uncomfortable, uncooperative, or withdrawn and may not be able to access the curriculum, sustain effort, engage in tasks, or even attend school at all.  

Clearly, some teachers have a knack for helping such students — that becomes evident when, say, a student has frequent detentions from all of his teachers except one, or when a teacher builds a reputation for “getting” students with oppositional behavior, or when a struggling student finally engages in reading instruction after being switched to a new teacher who has extensive experience with students who have anxiety disorders. Unfortunately, though, the strategies these teachers employ for building solid relationships and de-escalating student misbehavior are not instinctive for everyone. To learn them, teachers need explicit, intentional support and practice. 

Moreover, because student success shouldn’t depend on luck (e.g., the good fortune to be assigned to a teacher with a knack for meeting mental health needs), the entire faculty should learn some essential skills in this area. We all need to know how to interact positively and effectively with struggling students so they can feel safe and connected to their classrooms and schools. Effective interaction strategies — nonverbal and verbal ways of interacting and developing a relationship with a student, including tone of voice, proximity, use of humor, de-escalating responses to defiant behavior, and gentle ways of giving constructive feedback — are essential for these students’ success, and we need to prioritize them just as we do other essential accommodations, such as extra time on tests for a student with ADHD or access to a calculator for a student with a math disability (Minahan, 2014; Minahan & Rappaport, 2012).  

However, despite the proven value of interaction strategies, they are almost never written out and shared among colleagues. When students move on to a new classroom or grade, their previous teachers often pass along information to the new teachers, including notes on the student’s progress in math or reading, or advice on how best to reach their parents. Only rarely, though, do teachers tell their colleagues how, for example, they managed to help a given student feel safe, so that he no longer needed to check in with the social worker during class, or what they did to connect with him personally, so that he could tolerate being given directions. 

Interaction strategies are accommodations 

To see how interaction strategies function as accommodations, let’s consider James. James is a 7th-grade student with post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD) who was almost a year behind in math. The school principal requested a consultation due to James’ high number of office referrals and current failing grade in math, which was his favorite subject the previous year. When I arrived to observe James one day last spring, his school principal rushed me down the hallway to make sure I could observe him within the first 10 minutes of math class, explaining that he is usually kicked out of class for disruptive behavior by then.  

As I arrived, James was in the back row, and Mr. K was standing at the front of an almost silent class of 25. Mr. K broke the silence with the directive, “James, take off your hood.” James did not respond but looked blankly at him. Mr. K made two more equally loud attempts, getting physically closer each time, without yielding any response from James. On Mr. K’s last attempt, James shook his head. Finally, Mr. K told James to go to the office, and he stood up and left the room quietly. 

My advice to the team was to design accommodations for James — specifically, interaction strategy accommodations. James’ PTSD and GAD cause him to react and respond to adults in a way that other students may not, and if Mr. K had used a different approach to giving James directions, the whole incident could have been avoided. For example, James’ English teacher noted that when James walks into her class with his hood on, she simply moves into his eyeline and silently mimics the motion of taking off a hood. “James always takes his hood off immediately,” she reported. She knew that a public demand in front of peers would be too confrontational and lead James to shut down and become unresponsive, but she never thought to share that strategy with Mr. K. 

James’ anxious or defiant responses to commonplace adult interactions are a result of his PTSD, anxiety, and subsequent inflexible thinking. Providing accommodations related to the way teachers interact with James would allow him access to the free and appropriate public education he is entitled to. Interaction strategy accommodations are also important for students who behave well but are quietly struggling with depression or anxiety, which bring interfering and worrying thoughts that keep them from accessing and attending to the entire curriculum. 

Written, quantified, and specifically articulated 

Unfortunately, we are not used to thinking of interaction strategies as accommodations to be written, taught, and implemented. Further, many educators find it difficult to define and describe the interaction strategies they use. Effective counselors, psychologists, and other “child whisperers” often go on instinct rather than selecting from a range of known approaches; thus, they may have difficulty explaining precisely what they do and why. Why, for example, do they choose to sit across the table from, and on the same level as, a student with PTSD, rather than standing directly in front of him when giving directions? These comforting interactions may be part of the reason they are the “safe” adults in the building who students come out of class to see when upset.  

As with any accommodation, educators need to document, explicitly, what the student needs in order to access the curriculum successfully. 

These crucial accommodations can be defined and systematized, though, and every teacher can learn specific interaction strategies to support students in the classroom, allowing the teacher to be a “safe” adult as well. First, and as with any accommodation, educators need to document, explicitly, what the student needs in order to access the curriculum successfully. This will likely require planning time for teachers to meet at the beginning of the school year and consult with parents, school psychologists, and school counselors to figure out what accommodations the student is likely to need. Then, these accommodations can be written down in a shared “classroom strategies” document or, more formally, recorded in a student’s behavior plan, school success plan, or in the General Accommodations section of a student’s Individual Educational Plan (IEP). If the information is shared not only with the classroom teachers but also with other school adults — including specialists, recess monitors, substitute teachers, and cafeteria staff — then it becomes much easier for everyone involved to provide a consistent learning environment. Plus, the more specific and detailed the accommodations plan, the less likely it is to be misinterpreted or implemented incorrectly.  

Accommodations will vary for individual students, depending on their specific mental health, social, behavioral, and emotional challenges. Generally, though, they include interaction strategies designed to help teachers build relationships with the given students, give them praise effectively, and give them directions in a way that won’t lead to defensiveness.  

Relationship building 

At the start of the school year, teachers are often encouraged to build relationships with the struggling students in their classes, in order to start the year off on the right foot. But when it comes to working with students who need interaction accommodations, the suggestion to “build a relationship” may be too vague to be helpful — teachers need more specific information about effective ways to engage and relate. For instance, they might ask previous teachers or counselors what the student’s top three interests are (e.g., college basketball, superhero comic books, and marine biology). Greeting the student at the door and asking a question or commenting on one of these interests within the first five minutes of class can build a quick connection. 

Unfortunately, teachers get limited one-to-one time with students, so it’s important to sneak in time for those personal connections whenever possible. For example, if you have copies to make at the copy machine, bring a student needing attention with you so you can chat and have a shared experience. Counselors, administrators, and other non-classroom staff could facilitate relationship building by covering a teacher’s class so that the teacher can take a walk and chat with a student, especially in the beginning of the year or after an incident.  

The suggestion to “build a relationship” may be too vague to be helpful — teachers need more specific information about effective ways to engage and relate. 

Concrete examples of kindness help students know their teacher likes them despite any recent challenging behavior. Taking the time to have lunch with a student occasionally can go a long way in building trust. Students will remember these random examples of kindness. Building relationships in this way not only helps students feel more comfortable, it also makes it easier for teachers to read a student’s cues. If a student doesn’t respond to a question in class, it may not be rudeness or noncompliance. It may be that she gets quiet when anxious and will get even more anxious if the teacher demands an answer.  


All teachers give praise, and it can be a wonderful form of encouragement and reinforcement. However, most teachers are in the habit of giving praise publicly, even though that can be the most uncomfortable way for many students to receive praise (Minahan, 2014). When a teacher says, “James, hold up your graph, you did that perfectly!” he, like many students, responds by covering up his work, saying something negative about himself, or even sabotaging the praise by ceasing to work for the rest of the period.  

Students with low self-concept and social anxiety are particularly uncomfortable with public praise, so an effective interaction strategy for these students would be to avoid public praise and instead provide a nonverbal thumbs-up or a positive comment on a sticky note. Teachers could also find out the student’s preference by pulling them aside (when no other students are around) and asking, “When I’m proud of you, how should I let you know?” Providing a list of suggestions can help a student answer that question. 

The nature of the praise given also has an effect. Perfectionistic students or those with anxiety, depression, or low self-esteem may be inclined to dismiss praise they disagree with, so it can backfire to make a positive judgment about them, such as, “You’re a great writer” or “You’re a fabulous tennis player.” Often, these students are more likely to accept and internalize praise that’s factual in nature, such as, “You have been working straight for 10 minutes — great job.” Similarly, because these students are also prone to negative thinking that leads them to minimize and even dismiss past success, it can be effective to remind them of what they’ve done well in the past. If a teacher says, for example, “I’m still laughing at the essay you wrote last month. That was so humorous and well-written,” they’ll be less likely to recall it through a negative lens. 

Giving directions 

It can be extremely precarious to give directions to a student who tends to be oppositional or noncompliant. For instance, many teachers are accustomed to using blunt and authoritative language — such as “Take your hood off!” or “Sit down!” — to maintain order in the classroom. But with certain students, this approach is bound to touch off a power struggle.  

For oppositional students, there are other, much more effective ways to encourage compliance. For example, it’s often helpful to offer the student a choice (such as, “Do you want to be in the front of the line or the back of the line?”) rather than giving them a command (“Line up!”). Or, because some students escalate when given a direction, teachers can state their reasoning before issuing the demand, so the student will hear and understand it before the impulse to react kicks in — that is, instead of saying, “Pick that up! I don’t want to fall on your bag,” the teacher can say, “I would hate to trip on your bag and hurt myself, so could you please pick that up?”  

To succeed in school, students with mental health challenges tend to need a steady diet of positive interactions with their teachers.  

When interacting with a student who tends to filter information through a negative lens, such as students with depression, anxiety, or PTSD, it’s often useful to cushion a critique or redirection with positive statements: “I love how much you’re enjoying and participating in this activity. Could you lower your voice, though? Keep up those reflective comments you are making to the group.” Here, the teacher’s tone can make a big difference as well. Such students may interpret even a simple statement like “Could you lower your voice?” as being “yelled at” by the teacher unless it’s delivered in a soft voice, almost like one would use with a sleepy toddler at bedtime.  

Some students simply need time and space to comply. With these students, the teacher can use a nonverbal signal, such as a nod or a gesture, to let them know that they’ve overstepped a boundary, or they can write the direction on a sticky note, hand it to the student, and walk away. This can be especially effective for students (like James) who find proximity and public directives threatening and who quickly go into “fight” mode. Also, it’s often a good strategy to use with students who have social anxiety and do not want any public attention.  

Finally, for some students, especially those with trauma histories, inflexible thinking, and oppositional behavior, it may also be important to use extended time to create an opportunity to de-escalate the situation before they comply. While a demand like “Pick that up!” may trigger a power struggle, the simple addition of a time frame (“Pick that up before lunch”) may allow the student to calm down and think rationally.  

Putting accommodations to work 

Putting interaction strategy accommodations in place made a huge difference for James. When Mr. K began leaving notes on James’ desk with the direction, “Take off your hood please,” James cooperated. Mr. K also made time to take walks in the hallway with James one week and realized that he and James had a mutual love of college football, which they began talking about regularly. These may seem like small and inconsequential steps, but they significantly improved James’ access to and participation in math and other classes. 

If teachers want to build productive relationships with all of their students, it’s critical for them to understand how mental health disabilities can affect how children read social cues and interpret the words spoken to them. It’s neither difficult nor time-consuming to learn about the reasons behind some common behavioral patterns. Nor is it time-consuming to write up and adopt some interaction strategy accommodations tailored to their needs. However, the benefits are considerable. By taking out the guesswork, these strategies can make it much easier to build a comfortable learning environment where all students can learn and thrive.  


Merikangas, K.R., He, J.-P., Burnstein, M., Swanson, S., Avenevoli, S., Cui, L., . . . Swendsden, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the national comorbidity study-adolescent supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49 (10), 980-989.  

Minahan, J. (2014). The behavior code companion: Strategies, tools, and interventions for supporting students with anxiety-related or oppositional behaviors. Cambridge, MA: Harvard Education Press. 

Minahan, J. & Rappaport, N. (2012). The behavior code: A practical guide to understanding and teaching the most challenging students. Cambridge, MA: Harvard Education Press. 


Citation: Minahan, J. (2019). Building positive relationships with students struggling with mental health. Phi Delta Kappan, 100 (6), 56-59. 

JESSICA MINAHAN (; @jessica_minahan) is a licensed and board-certified behavior analyst and special educator, as well as a consultant to schools internationally ( She is the author of The Behavior Code Companion: Strategies, Tools, and Interventions for Supporting Students with Anxiety-Related or Oppositional Behaviors (Harvard Education Press, 2014) and the coauthor, with Nancy Rappaport, of The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students (Harvard Education Press, 2012). 

One Comment

  • Thank you for this insightful repot. I will take time to share this with all of my teachers. I am guilty of tell them to get to know the kids with no other specific suggestions as to how.
    Now I have the how.

    Chuck Sabo

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