Don't let tears, tantrums, or promises to do better stop you. Begin with a physical exam and psychological evaluation. If the physician recommends hospitalization, do it. People die from these disorders, and sometimes they need a structured time out to break entrenched patterns. If the counselor asks you to participate in family sessions, do so.
Children spend only one or two hours a week with their counselors.
The rest of the time they live with their families. You need as many tools as you can get to help your child learn new ways of coping with life. Even though it would be hard, consider telling your friend's parents why you are concerned. If you cannot bear to do this yourself, ask your parents or perhaps the school nurse for help. Nevertheless, reach out.