From state governance to professional practice : a study of Swedish school counsellors' health promotion, prevention and remedial work

This dissertation analyses how welfare policy goals and national guidelines, linked to the overarching mission of student health services to promote health, prevention, and remedial work, shape school counsellors’ professional experiences and practices in Sweden. Although legislation highlights the importance of health promotion and prevention, school counsellors often perceive their mission as unclear and dominated by on-call duties, raising questions about local interpretations and implementations. The dissertation includes four studies using qualitative and quantitative methods. Study I analyses national policy with Bacchi‘s WPR approach (“What ‘s the problem represented to be?”). Study II examines how school principals describe school counsellors’ work in job advertisements. Study III is a survey that maps school counsellors’ educational backgrounds, work experiences, and professional practices. Study IV analyses free-text responses from the survey to explore how school counsellors describe their work in health promotion, prevention, and remedial efforts. The findings reveal discrepancies between government guidelines and the professional practice of school counsellors. Although the Education Act emphasises health promotion and prevention, school counsellors’ work is primarily remedial. School principals often frame school counsellors’ roles according to the school's educational goals rather than specific student health goals. School counsellors maintain strong ties to social work but are weakly integrated into pedagogical activities. Furthermore, a tension emerges between individual-focused remedial work, which offers greater professional autonomy, and collaborative health-promoting efforts, which require integration with other professions. A key conclusion is that the relations between welfare policy goals, organisational demands, and professional logics shape the professional practice of school counsellors. These relations result in a practice that oscillates between health promotion and remedial work, potentially rendering the professional role unclear and jeopardising students' access to equitable psychosocial support.