So reported the Wall Street Journal today in an article titled “So Young and So Many Pills“.

But the most alarming thing?  ”‘Most medications that could be prescribed to children on a chronic basis haven’t been tested specifically in kids,’ says Danny Benjamin, a Duke University pediatrics professor,” Anna Matthews reports.

I see this all the time, unfortunately.  Young women come to my facility swallowing every imaginable cocktail of psychotropic drugs.

There’s a drug to help them manage their mood – and then a drug to help them sleep to cope with the side effects of the drug designed to manage their mood.  And let’s not forget the drug designed to lower their craving to eat themselves into a carbohydrate coma – also a side effect of the drug designed to manage their mood.

By the time our nurses are done dispensing the meds, some kids could make a breakfast of it.  In fact, some kids’ morning medication regiment involves pills of all sizes and colors – reminiscent of Lucky Charms cereal’s wacky marshmallow shapes.

Now before those of you who have children who need drugs get offended, let me say that there is a place for medication.  Some bodies and brains don’t work the way nature intended.  I’m a believer that God gave us plants from which to make medicines to help us help ourselves.

All I’m saying is this:  Apply a portion of the Hippocratic Oath.  ”First, do no harm.”  Let’s use some common sense and apply some wisdom.  If a kid NEEDS a medication, so be it. My nephew absolutely suffers without his ADHD meds.  My friend’s son absolutely suffers without his OCD medication.  I know a girl who has terrible nightmares – without her meds she’d remember every one of them.

So, I’m far away from my wife’s friends’ perspective on meds.  They won’t take aspirin if their lives depended on it.

But – and it’s a BIG but – we need to stop overmedicating kids!  We have no idea of the fragility of a developing teen brain.  We have not tested adult medicines on young children nearly thoroughly enough.  When the number of pills in the pillbox designed to treat side effects outnumber the pills designed to treat the main problem, someone has to say STOP.

What can be done?  We can apply talk therapies, experiential therapies, relational therapies, cognitive behavioral therapies.  We can apply patience and wisdom.  We can marshal the combined knowledge of therapists, doctors, herbalists, occupational therapists, parents, and priests.

Let’s not buy into the ease of a biological answer for every ill that besets today’s children.

I am concerned that occasionally some women in our world lose sight of their worth and divinity.  I am concerned that in the face of continual bombardment by negative media and degrading media-driven philosophies about femininity some of our sisters falter in their assessment of themselves.

Shame is toxic.  Women become poisoned with self-pity, inordinate guilt, and feelings of inadequacy. We can and should help the women and girls in our lives to thwart the debilitating effects of shame by encouraging them to engage in three rejuvenating, shame-alleviating activities:

1) developing healthy relationships with other women with like values;

2) cultivating spirituality through activities that re-connect them with their higher power; and

3) teaching them effective ways to self-nurture, then allowing them time to do it.

Women and girls don’t “need a man” to feel better.  They don’t need a chocolate sundae.  They need relationships of trust which inspire a sense of love and hope in their souls again.  That’s why the three suggestions above deal with the three most important relationships a woman can have:  female friends, higher power, and self.

The verdict, based on a character from Lewis Carroll’s “Alice’s Adventures in Wonderland” states that every psychotherapeutic theory is equal, and no one theory reigns supreme.  In the words of Carroll’s Dodo (after judging a foot race):  ”Everybody has won and all must have prizes.” This verdict asserts that there are common factors among therapists which, if adhered to, will result in successful therapy no matter what model or technique the therapist applies to treatment.

I’ve recently been involved with a group called the International Center for Clinical Excellence (ICCE).  Scott D. Miller, it’s founder, used to be one of the most ardent proponent of the Dodo Bird Verdict.  In fact, in one of my recent posts entitled “What REALLY Causes Change in Teens“, I outline the common factors of therapy that Miller introduced me to.  The common factors are:  1) things that happen outside of the therapy office; 2) the client’s orientation toward hope for change; 3) the strength of the client-therapist relationship; and 4) the therapist’s applied technique.

These four key common factors give us a descriptive sense of what is similar across the vast world of psychotherapy success. However, it is not a model of therapy in and of itself.  In other words, if we were to focus our efforts around strictly enhancing the four common factors in our work with clients, we would find that we never improve beyond where we are today.  Why?

The “Red Queen Principle” bears the answer.  Again taken from a character in Carroll’s book, the Red Queen tells Alice, “It takes all the running you can do, to keep in the same place.”  Evolutionary theorists use these words from the Red Queen to elucidate the Red Queen Principle.  The Principle explains the necessity of all organisms to adapt or become extinct.  In other words, if a predator does not adapt, but its prey does adapt, then eventually the predator will cease to exist.  For example, if rabbits become faster and foxes don’t, then foxes will eventually become extinct.  The Red Queen Principle states that while groups of organisms must do “all the running [they] can do” just to keep up with other organisms and avoid extinction, individual organisms within those groups often exceed the evolutionary advances of the group.  For example, one fox may become exceedingly fast and cunning and it will pass those genes on to its offspring.

So what does this have to do with therapy?

Well, if the common factors are true of every successful treatment outcome, then it doesn’t really matter which model of therapy you use, does it?  It would follow that every therapist who focused on those factors would have similar successful outcomes, wouldn’t they?  But research shows that this simply isn’t true.  Some therapist are vastly more skilled at inching their clients toward health than other therapists.  Why?  What is different about these “supershrinks“?  (Click on the “supershrinks” link. Read the article.  You won’t regret it. In fact, it may change your life.)

The difference, according to Miller, lies in the work of K. Anders Ericsson.  Internationally renowned as the “expert on expertise”, Ericsson’s research shows that the truly great in any field have things in common – they improve themselves through deliberate practice.  And they do much more deliberate practice than other relatively “good” performers – up to as much as 10,000 hours more!

Expert therapists know where they are weak.  This means that they are measuring themselves constantly.  They are following up with their clients.  They are soliciting feedback.  They know exactly what they need to improve upon. And then they act to improve it.

In evolutionary terms, supershrinks adhere to the Red Queen Principle.  They far exceed the psychotherapeutic advances of their time.  They adapt and improve and reach and stretch far more than groupings of their “adequate” peers.

The truly excellent are humble enough to know they are limited, smart enough to seek feedback, passionate enough to act on that feedback, and stubborn enough to engage in deliberate practice over and over and over again.

Looks like I have some work to do.  How about you?

It smells so sharp heady and musky
of lavender, and the hue of only
lavender is all my garden up
into the gray rocks.

So begins Paul Goodman’s poem “I Planned to Have a Border of Lavender”. http://en.wikipedia.org/wiki/Paul_Goodman_(writer)
Sometimes in my work with teens (and my own children) I make the mistake of overcompensating for what I perceive to be my weaknesses.

For example, I spend as much time with my kids as I can when I get home. I want them to know I am around, because I feel like I work a lot.  Guess what my 7-year-old uses to manipulate me? Yep. “Daddy, you don’t spend enough time with me!” He knows my hot-button.

Sometimes I am so focused on overcompensating for my guilt of not having spent enough time with my kids, that I let other important things slip: one-on-one time with my wife, chores around the house, time for myself, etc. I am well-intentioned, but “my whole crazy garden” becomes overrun with my focus on how I’m going to compensate for what I perceive to be their need to have me around.

This has application at work, too.  I feel like I don’t have enough time to spend with the teens we treat at New Haven. So, what do some of my clients say to me?  You guessed it:  ”Dustin, why are you never around?”  It cuts me to my core!  I have to be careful not to give in to my own narcissism and self-importance.  Will they be okay without me?  Sure.  We have loads of experienced, caring staff – some of whom are even more skilled than I.  If I’m not careful, I can forget that my job is to make it possible for my co-workers to be unencumbered by the things that might stand in the way of their serving the needs of our girls. If I let my guilt at “not having enough time” for our teens rule me, then soon my focus on time with the girls can, like the lavender in Goodman’s poem, get all the way “up into the gray rocks”. I’ll find myself more frustrated because I end up without time to accomplish the important things that allow others to do their jobs more effectively.

I’m not saying I shouldn’t spend time with our clients.  Rather, there must be a balance and I must use wisdom. Even when I was working residential shifts years ago I experienced these feelings.  How would I have time, for example, to spend quality time with each of the 14 students within the confines of my 8 hour shift?  It seemed daunting.  Many times I punched the clock at the end of a day thinking, “I failed.  I didn’t get to talk with Suzie or Sally or ….”

In times like this I need to practice moderation and “guilt-management”! I say guilt-management because I have to watch myself carefully. Sometimes I experience good guilt, but other times the guilt is more like shame – poison to my soul.

Two things that help me manage my guilt (shame): 1) If I’m with my kids (or my teens) out of love and not shame, I’m on the right track; 2) If I can voice my shame to a trusted friend (or colleague), I’m more able to manage it.

In what areas of parenting or work with teens do you overcompensate?

I heard Dr. Yvon Gauthier say this at a Child and Adolescent Psychiatric Conference and it struck me as if with physical force. What an encouraging thought!

In the teen treatment industry we often hear of the “untreatable” child. I think this is totally false. The untreatable child is just the child we haven’t figured out yet! But heaven knows I’ve run into a few in my lifetime.

I was on a conference call yesterday and one of the participants said that her mantra is “behavior problems are indicative of unmet needs”.

When my wife and I adopted our son, Michael, who is turning 7 next month, I was nervous about whether he’d be able to attach or not. He did just fine and over time I relaxed. The truth was, I had figured out how to connect with him.  Now that he’s almost seven, I still take the “temperature” of our relationship every night when I tuck him in bed, just to see if we’re still connected.  Last night he wanted to cuddle three times before he’d go to sleep. I think he’s connected!

One of my former New Haven students had a child she thought was Autistic. She wasn’t connecting well with her at all, and then she was diagnosed with Autism. I suspected the diagnosis was misguided. Over time, as my young friend worked to engage her daughter in the way her daughter wanted to be engaged, this perceptive mother discovered that the child’s speech and physical abilities improved. The misdiagnosis fell by the wayside.

Contrast the relatively easy time my alumna friend had with the experience of one of my former co-workers, whose first sonmost definitely has Aspergers. After years of behavioral work, she is finally getting him to eat on his own, hug her occasionally, and so on.  He’s thriving.

I realize now that attachment is not about the child’s capability. It’s about ours.  The only children who can’t attach are the children whose caregivers give up trying.

This may sound like I’m blaming parents or professionals.  Not so.  What I’m trying to illustrate is the immense hope I feel. Think about it:  we’re not dealing with a deficiency in the child, rather we’re dealing with our own lack of knowledge or skill. And we know where to get knowledge and skill: our own experience and the shared experiences of others.  That’s incredibly empowering.

What challenges have you any of you had in connecting with your own children or the children you serve? What knowledge or skills have you developed that you could share here?

In my experience, loneliness is best predictor of relapse.  If a young woman finishes treatment successfully but returns home to no friends, even if her parents are “there” for her consistently, she will relapse within a very short amount of time.  Teens need a support system outside of their immediate families.

Think about it:  if someone loves you and wants to be around you, and they are not required or expected to do so, doesn’t that make you feel good?  Parents and siblings are supposed to love us.  But friends are not.  Once we experience love and validation from others outside of our immediate families, something within us changes. We begin to believe that we DO have value and that the nice things our parents have been telling us about ourselves could possibly be true.

Mother Teresa went on to say, “There is a terrible hunger for love. We all experience this in our lives – the pain, the loneliness. We must have the courage to recognize it.  The poor you may have right in your own family.”

Residential treatment centers have fallen short. We have not incorporated teens’ friends into treatment and transition as well as we should.  Well before they transition – even from as early on as admission – we need to provide teens with ways of connecting with good friends.  We can provide them with easy ways of keeping in touch with the friends they make in treatment through creative use of social media, such as Facebook and Ning, cell phones and instant messaging.  We can help them determine more effectively – on their own – which friends at home are supportive and helpful.  And then we should get them to connect with those friends in creative, non-electronic ways.

One young woman went home during treatment and invited her friends to a “non-alcoholic party”.  She was nervous that they would think it was dumb.  She was even more nervous that no one would show up, because she planned it for a Friday night – a night when “everybody goes out to party”.  Well, she had a great turnout and she led them in a game of “supermarket relay”. She formed teams of two, each team filled a cart in the supermarket with goods, they all switched carts, and the first team to put the goods back on the shelves in the correct places won.  Her friends had a blast and many commented that they didn’t know they “could have fun without getting drunk”.

Many teens think that being “clean” means being lonely.  This young woman returned to finish treatment with a new confidence that she could be successful without having to be lonely.

These weekends always cause me to wonder: What is it that really causes change in struggling teens?

Scott Miller, Ph.D., (www.scottdmiller.com) and his colleagues have researched this topic ferociously over the past decade. They’ve studied over 6,000 research articles. What they came up with surprised me at first. After I thought about it for a while, though, it began to make sense.

Miller says that 40% of change is attributable to “extra-therapeutic” factors. These are things that happen outside of the therapy office. Unforeseen changes in the economy, in families, and in the environment can spur people to change. I call these things “acts of God”.

The next 30% of change can be attributed to a person’s orientation toward hope and change. Do they believe they can change? Do they have hope the change can last?

15% of change is due to the relationship the client has with the therapist.

The last 15% can be narrowed down to the therapist’s particular skill and style.

This has important implications for treatment.

Extra-therapeutic Factors
For example, the residential staff, shift changes, room changes, cats, horses, activities off-campus, intensive days, family weekends, campouts, hikes, family phone calls, and so forth, are our attempt to have some effect on the “extra-therapeutic” factors. John Stewart calls this “shotgun therapy”. We try a lot of different things to see if we can get through to a girl. Like a father said this weekend in a group session, “New Haven will even throw ‘the book’ out if it will work for a kid.”  This doesn’t mean we run around willy-nilly, of course.  We just try a lot of things until something works.

Hope
We try to focus on strength rather than condemning weakness. We fiercely protect a person’s ability to choose – it’s our effort to foster an internal locus of control. When a person takes me by the hand and expresses kindness to me and confidence in me – even challenges me – I am more likely to rise to the occasion because he or she has faith in me. That give me hope. Our experiential therapy approach is designed to give students successful experiences that they can point to later, when they feel down.

Relationship with the Therapist
I require each therapist to measure how well each student connects with that therapist. Every session, every student rates how well she felt the therapist did during the session. We make sure that the student/therapist relationship is a match.

Skill and Style
I welcome a wide range of skills and styles of therapy here, as long as the therapists we hire are able to be effective during family therapy. It’s my feeling that family therapy which encourages every member of the family to do his/her part is the most effective way to ensure that the change in the adolescent lasts.

So how well are you doing at taking advantage of the extra-therapeutic factors?  How effective are you at instilling hope in those who feel hopeless?  How much influence are you able to marshall, because of the relationship you have with those you serve?  Do you possess the set of skills necessary to help the client who is seated in front of you?

MySpace and Facebook are increasingly popular with our teens. The attraction makes sense – teens of all generations have sought to connect with their peers in ways that their parents can’t understand. They are on an constant search for who they are, and so many of them try to differentiate themselves from the crowd. The great adolescent irony is that they also seek for belonging. MySpace and other social networking sites offer both the ability to differentiate and express oneself, while connecting and socializing with peers.

The danger of virtual relationships and the virtual expression of self is that there are virtual consequences which can quickly become real. If a young woman, for example, experiments with her sexuality on her MySpace page, she may not immediately experience the same consequences she otherwise would if she were to experiment in “actuality” in the real world. This provides a false sense of safety, as the consequences are soon to come. For example, employers are increasingly including MySpace and Facebook searches in their vetting process during hiring. Predators roam social networking sites under disguise, seeking vulnerable teenagers. Online bullying has reached new lows in the last few years, and you may have heard of one high-profile case where a teenager last year committed suicide because of it.

It’s imperative that parents keep tabs on their daughters’ online activities. Among other things, parents ought to check their daughters’ social networking activities weekly.

Do you know how your daughter is expressing herself online?

One day I caught him sitting on his front porch, smoking a Marlboro and nursing a broken foot. I stopped to chat, and he told me he’d been welding a steel riser on the third floor of a new building and had fallen down the elevator shaft, landing on his leg, which shattered his foot. I asked if he’d been high. He said no. Of course, he was lying. I asked him if he were still attending his Narcotics Anonymous Meetings. He said yes. Again, lying. I asked him when he was going to stop using. What he said struck me: “Well, you know. My wife wants me to do it and my kids want me to and I just feel bad about it. But, as a therapist, you must know that people only change for themselves. Nothins gonna work until I do it for myself, right?” It was at once an admission that he would not stop using, and a challenge – no one in his life had arisen who was more important to him than the heroin.

David Kelley, famous designer and founder of IDEO (arguably the world’s most innovative design-thought company), recently gave an interview in Fast Company magazine. He talked of his devastating fight against stage four cancer. After nine months of chemo, surgery, radiation, and losing 40 pounds, he finally beat it. What motivated him to keep going? “At first, you think, ‘I don’t want to miss her growing up.’ [referring to his daughter] That’s motivating, but not that motivating,” he says. “It’s when you manage to get out of yourself and start thinking of her that you get the resolve to continue. When you think, I don’t want her not to have a father — then you want to stay alive.”

David’s point is important, and not just semantics. The most difficult task I face in my line of work is motivating young women to want what is best for them, even when it hurts terribly or scares them to death. I’ve found that appealing to their sense of self rarely works. They hardly ever “do it for themselves”, at least at first. We know from research about change that people – teenagers included – are more likely “do it for someone else” first.

This presents a fantastic opportunity for us to build relationships with suffering young women, and then use the resulting trust and love to help motivate them toward healing.

One young woman shut herself in her room this week. She wanted to give up. She was disappointed and disgusted with herself. In that state of mind, there is no way she was going to keep working on her issues “for herself”. Thankfully, I have a relationship with her, built over the last few weeks. A brief visit and short conversation with her brought her spirits up, and helped her return to participation in the House. Why? Because she didn’t want to disappoint me, and she could cling to my confidence in her, even when hers was low.

So, all of this begs the question: How can we use our relationships with those we love to encourage, motivate, and support them in their struggles to change for the better?

Perhaps even more important is this question: What are we avoiding changing within ourselves, and for whom will we do it?