It is the ultimate parental nightmare: Your affectionate child is transformed, seemingly overnight, into an out-of-control,
drug-addicted, hostile teenager. Many parents blame themselves. "Where did we go wrong?" they ask. The kids, meanwhile, hurtle through their own bewildering adolescent nightmare.
I know. My descent into drug addiction started in high school and now, as an adult, I have a much better understanding of my parents' anguish and of what I was going through. And, after devoting several years to researching treatment programs, I'm also aware of the traps that many parents fall into when they finally seek help for their kids.
Many anguished parents put their faith in strict residential rehab programs. At first glance, these programs, which are commonly based on a philosophy of "tough love," seem to offer a safe respite from the streets -- promising reform through confrontational therapy in an isolated environment where kids cannot escape the need to change their behavior. At the same time, during the '90s, it became increasingly common for courts to sentence young delinquents to military-style boot camps as an alternative to incarceration.
But lack of government oversight and regulation makes it impossible for parents to thoroughly investigate services provided by such "behavior modification centers," "wilderness programs" and "emotional growth boarding schools." Moreover, the very notion of making kids who are already suffering go through more suffering is psychologically backwards. And there is little data to support these institutions' claims of success.
Nonetheless, a billion-dollar industry now promotes such tough-love treatment. There are several hundred public and private facilities -- both in the United States and outside the country -- but serving almost exclusively American citizens. Although no one officially keeps track, my research suggests that some 10,000 to 20,000 teenagers are enrolled each year. A patchwork of lax and ineffective state regulations -- no federal rules apply -- is all that protects these young people from institutions that are regulated like ordinary boarding schools but that sometimes use more severe methods of restraint and isolation than psychiatric centers. There are no special qualifications required of the people who oversee such facilities. Nor is any diagnosis required before enrollment. If a parent thinks a child needs help and can pay the $3,000- to $5,000-a-month fees, any teenager can be held in a private program, with infrequent contact with the outside world, until he or she turns 18.
Over the past three years, I have interviewed more than 100 adolescents and parents with personal experience in both public and private programs and have read hundreds of media accounts, thousands of Internet postings and stacks of legal documents. I have also spoken with numerous psychiatrists, psychologists, sociologists and juvenile justice experts. Of course there is a range of approaches at different institutions, but most of the people I spoke with agree that the industry is dominated by the idea that harsh rules and even brutal confrontation are necessary to help troubled teenagers. University of California at Berkeley sociologist Elliott Currie, who did an ethnographic study of teen residential addiction treatment for the National Institute on Drug Abuse, told me that he could not think of a program that wasn't influenced by this philosophy.
Unfortunately, tough treatments usually draw public scrutiny only when practitioners go too far, prompting speculation about when "tough is too tough." Dozens of deaths -- such as this month's case of 14-year-old Martin Lee Anderson, who died hours after entering a juvenile boot camp that was under contract with Florida's juvenile justice system -- and cases of abuse have been documented since tough-love treatment was popularized in the '70s and '80s by programs such as Synanon and Straight, Inc. Parents and teenagers involved with both state-run and private institutions have told me of beatings, sleep deprivation, use of stress positions, emotional abuse and public humiliation, such as making them dress as prostitutes or in drag and addressing them in coarse language. I've heard about the most extreme examples, of course, but the lack of regulation and oversight means that such abuses are always a risk.
The more important question -- whether tough love is the right approach itself -- is almost never broached. Advocates of these programs call the excesses tragic but isolated cases; they offer anecdotes of miraculous transformations to balance the horror stories; and they argue that tough love only seems brutal -- saying that surgery seems violent, too, without an understanding of its vital purpose.
What advocates don't take from their medical analogy, however, is the principle of "first, do no harm" and the associated requirement of scientific proof of safety and efficacy. Research conducted by the National Institutes of Health and the Department of Justice tells a very different story from the testimonials -- one that has been obscured by myths about why addicts take drugs and why troubled teenagers act out.
As a former addict, who began using cocaine and heroin in late adolescence, I have never understood the logic of tough love. I took drugs compulsively because I hated myself, because I felt as if no one -- not even my family -- would love me if they really knew me. Drugs allowed me to blot out that depressive self-focus and socialize as though I thought I was okay.
How could being "confronted" about my bad behavior help me with that? Why would being humiliated, once I'd given up the only thing that allowed me to feel safe emotionally, make me better? My problem wasn't that I needed to be cut down to size; it was that I felt I didn't measure up.
In fact, fear of cruel treatment kept me from seeking help long after I began to suspect I needed it. My addiction probably could have been shortened if I'd thought I could have found care that didn't conform to what I knew was (and sadly, still is) the dominant confrontational approach.
Fortunately, the short-term residential treatment I underwent was relatively light on confrontation, but I still had to deal with a counselor who tried to humiliate me by disparaging my looks when I expressed insecurity about myself.
The trouble with tough love is twofold. First, the underlying philosophy -- that pain produces growth -- lends itself to abuse of power. Second, and more important, toughness doesn't begin to address the real problem. Troubled teenagers aren't usually "spoiled brats" who "just need to be taught respect." Like me, they most often go wrong because they hurt, not because they don't want to do the right thing. That became all the more evident to me when I took a look at who goes to these schools.
A surprisingly large number are sent away in the midst of a parental divorce; others are enrolled for depression or other serious mental illnesses. Many have lengthy histories of trauma and abuse. The last thing such kids need is another experience of powerlessness, humiliation and pain.
Sadly, tough love often looks as if it works: For one thing, longitudinal studies find that most kids, even amongst the most troubled, eventually grow out of bad behavior, so the magic of time can be mistaken for the magic of treatment. Second, the experience of being emotionally terrorized can produce compliance that looks like real change, at least initially.
The bigger picture suggests that tough love tends to backfire. My recent interviews confirm the findings of more formal studies. The Justice Department has released reports comparing boot camps with traditional correctional facilities for juvenile offenders, concluding in 2001 that neither facility "is more effective in reducing recidivism." In late 2004, the National Institutes of Health released a "state of the science" consensus statement, concluding that "get tough" treatments "do not work and there is some evidence that they may make the problem worse." Indeed, some young people leave these programs with post-traumatic stress disorder and exacerbations of their original problems.
These strict institutional settings work at cross-purposes with the developmental stages adolescents go through. According to psychiatrists, teenagers need to gain responsibility, begin to test romantic relationships and learn to think critically. But in tough programs, teenagers' choices of activities are overwhelmingly made for them: They are not allowed to date (in many, even eye contact with the opposite sex is punished), and they are punished if they dissent from a program's therapeutic prescriptions. All this despite evidence that a totally controlled environment delays maturation.
Why is tough love still so prevalent? The acceptance of anecdote as evidence is one reason, as are the hurried decisions of desperate parents who can no longer find a way of communicating with their wayward kids. But most significant is the lack of the equivalent of a Food and Drug Administration for behavioral health care -- with the result that most people are unaware that these programs have never been proved safe or effective. It's part of what a recent Institute of Medicine report labeled a "quality chasm" between the behavioral treatments known to work and those that are actually available. So parents rely on hearsay -- and the word of so-called experts.
Unfortunately, in the world of teen behavioral programs, there are no specific educational or professional requirements. Anyone can claim to be an expert.
* Maia Szalavitz is the author of the best seller "HELP AT ANY COST: HOW THE TROUBLED TEEN INDUSTRY CONS PARENTS AND HURTS KIDS" (Riverhead Press February 2006)
"The Trouble With Tough Love" Reprinted With Permission of the Author.
R E S O U R C E S F O R P A R E N T S A N D T E E N S
PARENT RESOURCE CONSULTANTS: What Are They and How Can Parents Protect Themselves Against The Potential For "Exploitation in the Name of Salvation"?
The selling of private (meaning parent funded) for-profit specialty schools and programs is big business and getting bigger - thanks in large part to the Internet where for a few bucks virtually anyone can set up a blog or website and claim to be an expert at connecting parents with safe and effective treatment options or "resources" for their children.
Research indicates that the most effective treatments, even with very difficult youth, are programs and treatments that arefamily basedand multisystemic. That means treatment that involves the adolescent and his or her family, and that also addresses other aspects of their lives, such as the school system, the neighborhood, peers, juvenile justice system, and even employers. In other words, it is treatment that focuses on all the parts of the youth's life that shape how he or she views the world, emphasizing family and parental support. (1)
Are we in the grips of a teen crisis, a developmental emergency that requires expensive intervention? Not exactly, say experts in adolescent psychology. Statistics show that teenagers aren't really acting up or out more than they have in the past. Instead we are more likely in a crisis of parenthood that has created a lucrative new market for specialty schools and educational consultants. If there is a serious problem here, it may be one of parenting and perception, not bad kids.
Teens Are Getting the Blame for Their Parents' Failures
ANALYSIS & VIEWPOINT
A Cato Institute Book Forum featuring the author Maia Szalavitz, Senior Fellow, Stats.org; and with comments by Evan Wright Contributing Editor, Rolling Stone Author, Generation Kill: Devil Dogs, Iceman, Captain America, and the
Post Traumatic Stress Disorder can occur when a teenager experiences a shocking, unexpected event that is outside the range of usual human experience. Learn the warning signs and find out where to seek professional help.
This Page and All It's Contents Copyright 2006 by Teen Advocates USA and Barbe Stamps. All Rights Reserved.
Excerpt from The Prophet
By Kahlil Gibran
Your children are not your children.
They are the sons and daughters of Life's longing for itself.
They come through you but not from you,
And though they are with you, yet they belong not to you.
You may give them your love but not your thoughts.
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow, which you cannot visit, not even in your dreams.
You may strive to be like them, but seek not to make them like you.
For life goes not backward nor tarries with yesterday.
You are the bows from which your children as living arrows are sent forth.
The archer sees the mark upon the path of the infinite, and He bends you with His might that His arrows may go swift and far.
Let your bending in the archer's hand be for gladness;
For even as he loves the arrow that flies, so He loves also the bow that is stable.
Words of Inspiration sent by J.R a survivor of residential treatment abuse
who is now married and raising a family of her own
Parents' obsession with their children's self-esteem plus profit-driven diagnoses create a dangerous prescription
In our zeal to help our children feel better about themselves, are we really doing them any favors, or could we actually be hurting them? It's counter intuitive, but our worries over our children's self-image and self-esteem may be unwarranted and unintentionally lead to unnecessary medical intervention and possible harm.
There are more than 30 privately run schools for troubled youth operating in the state of Montana. They employ more than 600 people and pump an estimated 4 million into the state income taxes. It's an exploding industry, but strangely, most Montanans have no idea the schools even exist. This program explores a lucrative industry praised for its novel approach to reforming youth, yet shrouded in disturbing allegations of abuse and neglect. Click Here to view this exceptional 1 hour documentary
at no charge.
WHO'S WATCHING THE KIDS?
Produced by Montana PBS
All Children Have The Right To Constitutional and Statutory Protections
Unfortunately, in their haste to save valuable time or money parents can fail to take into account the inherent (meaning ever-present) risk that comes with placing their trust and ultimately their child 's safety and well-being in the hands of strangers who do not have the professional credentials or training to properly assess the behavioral or emotional needs of children much less the safety and efficacy of the schools and programs they recommend as resources.
Second and equally problematic is the fact that many parents who rely on the Internet as their primary (or only) source for placement referrals are often in a state of panic and under great emotional stress. This can leave them especially vulnerable to errors in judgment and being pressured into making hasty decisions resulting in the placement of their child into a program far from home or one they have not even seen.
As a parent and a children's rights advocate with nearly 10 years experience monitoring the care and treatment of youth (and their parents) by the troubled teen industry, I can not emphasize enough how vital it is for parents to maintain a healthy skepticism about anyone who is not a child or adolescent behavioral healthcare professional yet claims to have a special "calling" or "talent" for helping teens or families-in-crisis.
This isn't just a red flag that should prompt parents to think twice about relying upon the advice of self-proclaimed teen help consultants it also raises troubling questions about parent resource companies who tell parents their "consultations" are free, then charge the "pre-screened" specialty schools and programs they recommend thousands of dollars for the referral and placement of their child.
While this practice of "cash for kids" isn't illegal it is clearly unethical and even dangerous given the inherent potential for conflicts of interest arising as a result of the competition between programs for placements (AKA "heads in the beds") and unscrupulous consultants steering parents toward choosing programs who pay the highest, most lucrative finder's fees.
"It is not uncommon for the operators of these programs to lie about the fact they are receiving fees. There are also no federal laws requiring ‘parent resource experts’ or agents to reveal child abuse or neglect that has occurred at the programs they have just referred someone to — it’s buyer beware, at its height. One program may refer to another, with the parent not understanding the connection between the two companies. The sites all look very different from one another, giving the appearance they are independent of one another. This is an obvious conflict of interest. We know of cases where owners are up on criminal charges or in the middle of criminal investigations for child abuse, but the ‘expert or agent’ turns a blind eye because they may be friends with the owners and they have been paid. It’s very dangerous for children." - Shelby Earnshaw [ISAC]
"Once you're being regularly paid by a program, it’s hard to be objective about its quality. This is why codes of ethics in psychology and psychiatry typically bar such "dual relationships." - Maia Szalavitz (see "Tough Love and Free Speech)
While parent awareness is a good way parents can protect their children and themselves from "exploitation in the name of salvation"-- it's not foolproof. Parents must also be mindful of the sophisticated and highly seductive marketing tactics and techniques (or as some might say "tricks of the trade") commonly used in the teen help referral industry to sell everything from wilderness therapy programs and therapeutic boarding schools to teen-escort-transport companies and financial lending insitutions.
Professional-looking websites, free consultations, glossy brochures, "cry & buy" (get out the tissue box) personal stories, glowing testimonials, scary sounding statistics, self-promotional press releases and infomercial-style videos can be hard to resist by anyone but especially desperate or frightened parents who are an easy mark for smooth-talking but hard-selling referral agents.
"So what's a parent to do?" comes the inevitable question posed by parents seemingly at their wits end with a child who can not (or will not) comply with the expectations and/or demands of their parents no matter what the consequences.
First and foremost, parents need to be aware that currently, the only information available about most of these programs comes from their own marketing efforts rather than systematic, independently collected descriptive or outcome data to prove their safety and efficacy.
Second, parents must also consider that contrary to what a parent resource consultant may tell them about the features and/or benefits of long term residential schools and programs research clearly shows that community-based treatment and support is effective and indicated for most youth and families, even those with serious problems who need intensive support.
To learn more about what does work for teens and how parents can empower themselves to better understand and support the individualized needs of their children without sending them away to a facility that may do more harm than good, parents should read "What Works for Troubled Teens" by Maia Szalavitz.
As underscored in this article the most effective treatments for troubled teenagers have three things in common: they use family-based therapies; they treat adolescents with empathy, dignity, and respect; and, except for very short periods of emergency stabilization, they keep teens at home.
"Since most problems involve fractured family relationships, recovery requires repairing those bonds — connections that can be harder to rebuild if a child spends years away from home. Youth will modify their dangerous behavior in response to practical, problem-solving, behavioral therapies—if they feel respected and cared for by the therapist," explains Charles Huffine, a child and adolescent psychiatrist in private practice in Seattle.
"Getting youths to change their behavior often takes longer than parents realize (or hope for)," says Dr. Huffine who recommends avoiding programs that promise too much, as well as those that exaggerate the danger of problematic but common teen troubles such as poor grades, bad attitudes, and experimentation with drugs. "Such programs" says Huffine, "exploit parents who feel desperate".
In the case of a child who is at risk of harming themselves or another or is psychotic, parents should heed the advice of behavioral mental health experts and use resources such as local mental health centers, mobile crisis units, or hospitals in their own community to reestablish a safe environment for their child and family and give them time to make a careful and well-informed decision that truly is in their child's best interest - not someone in cyberspace who specializes in child referrals for profit.
Written by Barbe Stamps
Better known as "parent resource consultants" these Internet-based for-profit businesses are open for referrals 365 days a year, 24 hours a day and cater almost exclusively to middle-to-upper-class parents who can afford the hefty price tag attached to specialty schooling.
Indeed, with tuition costs in the range of $30,000 to $70,000 a year and more, speciality schooling is not an inexpensive option - an important consideration which helps to make no-fee-referral services seem that much more beneficial to parents who turn to them in the hope of finding "the best program at the best price".