The Ten Best-Ever Anxiety Management Techniques
By Margaret Wehrenberg
Facing Our Worst Fears: Finding the Courage to Stay in the Moment
By Reid Wilson
Nightmind: Making Darkness Our Friend Again
by Rubin Naiman
Sleepless in America: Making It Through the Night in a Wired World
By Mary Sykes Wylie
The Anxious Client Reconsidered: Getting Beyond Symptoms to Deeper Change
By Graham Campbell
Confronting the New Anxiety: How Therapists Can Help Today’s Fearful Kids
By Ron Taffel
Therapists, social workers, counselors and others found these articles helpful in learning more about causes and management of fear and anxiety; medication versus therapy as part of an anxiety treatment program for adult patients as well as teenagers and children. People searching for information on the following terms and concepts found these articles helpful:
…What is it about anxiety that's so horrific that otherwise high-functioning people are frantic to escape it? The sensations of doom or dread or panic felt by sufferers are truly overwhelming--the very same sensations, in fact, that a person would feel if the worst really were happening. Too often, these, literally, dread-full, sickening sensations drive clients to the instant relief of medication, which is readily available and considered by many insurance companies to be the first line of treatment. And what good doctor would suggest skipping the meds when a suffering patient can get symptomatic relief quickly?
But what clients don't know when they start taking meds is the unacknowledged cost of relying solely on pills: they'll never learn some basic methods that can control or eliminate their symptoms without meds. They never develop the tools for managing the anxiety that, in all likelihood, will turn up again whenever they feel undue stress or go through significant life changes. What they should be told is that the right psychotherapy, which teaches them to control their own anxiety, will offer relief from anxiety in a matter of weeks--about the same amount of time it takes for an SSRI to become effective.
Of course, therapists know that eliminating symptomatology isn't the same as eliminating etiology. Underlying psychological causes or triggers for anxiety, such as those stemming from trauma, aren't the target of management techniques; they require longer-term psychotherapy. However, anxiety-management techniques can offer relief, and offer it very speedily.
From Psychotherapy Networker magazine, September/October 2005
…Insomnia. Almost everybody has it at one time or another. Some poor souls live (or barely live) with it. It's hard to know exactly how widespread it is—prevalence rates are all over the map. As many as 30 percent of the population, or as few as 9 percent (depending on the source of the statistic, or how insomnia is defined, or what impact it has), suffer from some form of it at least some of the time. Critics maintain the higher estimates are overblown, partly by insomniacs themselves, whose suffering leads them to overestimate the time they spend lying awake (10 minutes of lying wide-eyed in bed feels like an hour) and by the pharmaceutical industry (that all-purpose villain) in order to sell billions of dollars in sleeping potions.
Definitions of insomnia are loose to the point of inanity. DSM-IV defines "primary insomnia" as "a difficulty initiating or maintaining sleep or experiencing nonrestorative sleep that results in clinically significant distress or impairment in functioning." Insomnia has been divided and subdivided into a bushy tree of overlapping categories: primary, comorbid (occurring with a boatload of mental and physical health problems), idiopathic (lifelong inability to sleep), psychophysiological (somaticized tension), paradoxical ("sleep-state misperception") childhood ("limit-setting sleep disorder"—parents don't enforce bedtime), food-allergy related, environmental, periodic (internal clock problem), altitude related, hypnotic, stimulant-dependent, alcohol-dependent, toxin-induced, menopausal, and age-related, among others.
Chronic insomnia is linked to a multitude of physical and psychological ills: increased risk of cancer, hypertension, heart disease, obesity, diabetes, infertility, miscarriage, depression, anxiety, irritability, dementia, impaired cognitive and reasoning skills, lowered immune-system function, heightened awareness of pain, and who knows what else? Probably bunions, dandruff, and pinkeye. But while insomnia apparently contributes to, results from, or is comorbid with the ailments on this laundry list, why we get insomnia, which parts of the brain are most implicated, and how it actually hurts us, even what it is exactly, all remain largely a mystery, as does sleep itself. Thus researchers summed up a lengthy 2005 National Institutes of Health report on insomnia with deadpan succinctness: "Little is known about the mechanisms, causes, clinical course, co-morbidities, and consequences of chronic insomnia."
What's undisputed, however, is that sleep is as necessary to physical and mental health as air and water, and that, without it, we suffer—often severely. So, those annoying world-beaters, who brag about needing only four hours of sleep a night (the better to forge multimillion-dollar start-ups and do their Nobel Prize–winning research) are perhaps not being entirely candid. According to sleep expert Thomas Roth of the Henry Ford Sleep Disorders Center in Detroit, "The percentage of the population who need less than five hours of sleep per night, rounded to a whole number, is zero."
From Psychotherapy Networker magazine, March/April 2008
Site Map is coming soon.
by: Martha Straus
Lucy begins talking before she even makes it into the office. By the time she takes her seat, I'm hearing the details of her day. She floods me with vivid descriptions of friends and enemies in her school, and, without prompting, I learn about the fight at dinner the previous night with her elderly grandparents, who are now, somewhat unwillingly, her guardians.
I draw a sociogram as she speaks, frantically trying to make sense of what she's pouring out, and also trying, in vain, to slow her down as I scribble a schematic who's who of her world. My arrows and jagged lines illustrating relationships in all directions resemble a web built by a spider on hallucinogens--a chaotic mess.
When she's done, she exhales sharply, studies my drawing for accuracy, grabs my pen to embellish one big conflict, and glances up at me triumphantly. Yes, that's everyone--that's her life. My intake questions, the usual provisos about confidentiality and scheduling, are all postponed as I follow her compelling agenda.
All the while, Lucy has been sorting out the contents of her large purse. She spreads them on my couch as if they were science specimens: four notes passed to her from class, folded in carefully-tucked triangles; three other odd little pieces of paper with doodles and phone numbers on them; a pack of Marlboros; a fistful of loose change; a small, pink, bulging wallet; a guitar pick; an accordion of photos held together by a frayed rubber band; crumpled class assignments; a jumble of makeup tubes, brushes, and compacts; aspirin; a few receipts from places in town; a movie stub; and a sheath of detention slips.
I inquire about whether I can ask about the items she's organizing. Even though it seems obvious to me that she's handing me literal pieces of her story, I want to be respectful. Still, I'm curious: what's in those notes, that wallet, those detention slips? How does she apply so much makeup? Lucy is amused and, grinning for the first time, agrees to let me write down the inventory of her purse for future reference. She tells me the name of her lipstick, and the color of her nail polish, waiting patiently while I write. These details suddenly matter. And happily, she carefully brings the pocketbook in with all these items again the next week in case I've lost my list, adding two green condoms, and a CD of music from a girl band, "who aren't really lesbians, but pretend to be." She's off and running again and I'm back sucking wind trying to keep up.
What's she telling me, in this deluge of words and things, about her feelings, I wonder? About the dark places that include her mother's abandonment, the father she's never met, the depressing apartment with ailing grandparents, about the screaming matches in the halls at school, about how such a bright girl can be failing every subject, including gym? And when do I begin to ask my intake questions about her childhood milestones and illnesses, struggles in elementary school, special interests and talents, goals for treatment? I'm clear that all of this must wait. Lucy's pocketbook is wide open for me, and I'm going in.
And, anyway, this is what therapy is like with adolescent girls: an unpacking of metaphoric bags, some long locked up, some spilling over, some ripping at the seams, some like Lucy's, all out there. In my attention to the details of their baggage, I'm not just a therapist; I'm part valet, part archaeologist, and part synthesizer, too.
What's the Difference?
The popular assumption is that girls are easier therapy candidates because they've been encouraged to express their feelings, while boys have been stifled. Girls emote; boys stuff. Girls have a range of affect available to them; boys are only entitled to their anger. Boys just know how to grunt, hit walls, and shoot hoops, while girls are relational, processing events endlessly with their friends and raging at their mothers.
Some of this overgeneralization may even be true some of the time, though if you do therapy long enough, you'll meet more than your share of sensitive, articulate boys and incoherent girls. But would the work we do be different if our theories of change were specially designed for boys or girls? After all, research clearly shows that the divides of race and class are even greater than those between boys and girls on practically every measure of difference. And taken as a generational concern, we seem to be giving a pretty intractable cultural raw deal to all kids. As psychologist Ron Taffel suggests in his recent book Breaking Through to Teens, the compelling issues faced by boys and girls today are substantively the same: they're starving for passion in their lives and for authentic and enduring relationships with compassionate adults.
Still, for me, working with girls is what I do with the greatest interest and passion. Like many female therapists who have this specialty, I had my own tough times as a teenager. I have wells of empathy to draw on, and can stay attuned with them more easily than with males, or females of other ages. Our bond is implicit, and by being as fully authentic, connected, and present as I know how, I help them make it explicit.
I really was curious about the contents of Lucy's pocketbook; it was fun to explore them together. Like Lucy, other girls seem to carry around pieces of a coherent personal story with them, and there's something particularly compelling about being able to help them identify the pieces and then put them together. I know the fundamentals of good therapy help boys, too, but I have to work harder with their "otherness."
Thus the thoughts that follow are largely informed by my 20-odd years of experience treating adolescent girls and their families. They synthesize what's helped me forge alliances with them quickly and inspire change.
1. Make and Keep Promises
Adolescent girls often come to therapy without much experience with real adults. One bright 15-year-old contending with the relentless narcissism of her divorcing and dating parents observed to me recently that I was "the only grown-up" she'd ever met. It was an exaggeration, I think, but not much of one. Because therapy isn't usually a daily event, we have an opportunity to build trust more quickly when we find ways to make promises to girls, and then deliver the next week. I may ask them to bring in music, for example, so I'll promise to provide the CD player. Or when I go to the Networker Symposium, I'll promise to send a postcard of the Capitol. If we're doing a crafts or collage project, I'll promise to bring supplies we need and have them ready when a girl returns to my office. I promise to go to school meetings, to say certain things in family sessions, to remain hopeful, to keep confidentiality. And then I deliver on all these promises.
Being consistent by doing what we say we will is important for adolescent girls because they experience so little predictability, internally or externally, in their lives. Kept promises give girls rapid feedback that they're important to you, even when they are not in front of you. This sort of object constancy sets a tone of trust and safety that may otherwise be harder to establish. And it sets you apart in a landscape marked by self-involved and forgetful adults who may not promise much nor keep the promises they do make.
For example, 13-year-old Hilary had grown up in the foster-care system, and knew precious little about adult follow-through. Developmentally, she was a young teen, still into horses and puzzles. Early on in our work, I suggested that I might get a horse jigsaw puzzle for us to do together. She seemed mildly interested, so the following week, when she returned, I had it for her. Looking astonished, she said, "You got this for me?!" We took it out and spread the pieces on a table in the corner of my office to work on from week to week. When we'd completed the puzzle, we covered it in jigsaw glue, and the next week, she took it home--a symbol of me and our time together. This may sound like a fairly small example of promise keeping, but, for Hilary, it provided some vital glue for the pieces of our relationship.
2. Admit Your Mistakes and Apologize
Most adolescents have precious little experience with adults apologizing to them. But like anyone else, young girls appreciate it when we admit that we've made a mistake. It helps level the playing field and demonstrates a level of respect that adults seldom feel like offering. It builds empathic attunement and gives them the chance to forgive us. I've found, when I've apologized for messing up, that adolescent girls can be surprisingly forgiving, even if often not of themselves. This fact can also help therapy along. They'll forgive you readily for a mistake you made and later, when they're being relentlessly hard on themselves, you can compare their sterner self-judgments with their kindness to you when you goofed up.
Some of my greatest therapy moments have come out of screw-ups. A couple of years ago, I gave appointments to two girls named Jessica at the same time. The moment I opened my office door, I realized my stupidity. Jessica One reached into her back pocket and flashed her appointment card, as though it were a front-row ticket to a concert. "It's my time, and I can prove it," she laughed. I asked her to hold on for a moment, and met sheepishly with Jessica Two, to touch base and reschedule. I apologized profusely, and when we met later that day, I apologized some more.
My work with Jessica One had a little spike of energy that day (she was the youngest of five sisters and enjoyed the sweet waiting-room victory for a few giddy minutes), but Jessica Two and I made a connection after I made a mistake, admitted it, and apologized to her. That subsequent hour of therapy with Jessica Two was the turning point for us, maybe because the playing field had suddenly leveled, and maybe because I was working hard to make repairs to this rupture. It's common wisdom that greater intimacy follows from a repair to a relationship. This isn't to suggest that I advocate wearing mismatched socks or showing up late on purpose. But these mistakes and missteps inevitably happen. And when they do, we get to say we're sorry, and figure out what we'll do differently the next time.
3. Hold Hope
Somewhere between their Cinderella-like rescue fantasies and the hard truths of their lives, many girls get lost in hopelessness and despair. They live so much in the present and in their feelings about what's going on now that they don't know how to feel confident about the future, to plan for it, or to envision it as a reality. This envisioning problem compounds their damaged sense of personal efficacy.
When I'm with a girl who's floundering, seeming desperately lost and unable to take hold, I often intervene with a bold hopefulness. For these girls, I feel one of my most important jobs is to be a holder of hope for the future. I've come to understand that my confidence in my young clients and in their ability to heal is central to their developing the ability to believe in themselves.
Seventeen-year-old Marianne was in tremendous distress when we first met. She'd been at boarding school and had repeatedly gone to the infirmary to have her hearing checked and then her eyes, feeling she was hearing and seeing the wrong things. She felt tormented by horrible voices, and was afraid to go to sleep.
She called her parents one day in the middle of the fall term almost incoherent with fear, and they brought her home, not knowing what was wrong, but perceiving she was at the breaking point. I met with Marianne and her parents that day. I soon determined that she needed to be hospitalized for her safety and to get stabilized on medication. Before she left my office, I told her, "It won't always hurt like this. You'll feel better. I know you're not hopeful right now, so I'll hold the hope for you. Tell me when you can share in it with me. Until then, I'll be our holder of hope."
Marianne made rapid gains as an inpatient, and returned for several months of work with me afterward. When we were terminating and looking back on our work together, she recalled that she'd used my hope to get through the nightmare of being hospitalized and having to conquer the voices inside her head. She said, "I always remembered that you said you were hopeful that it would get better. That made a difference when I didn't know if I could keep going on."
4. Trust the Process
With adolescent girls, our impatience to do something to make a change in someone's life--to be transformative in a big way--can come across as criticism and disrespect. After all, if their problems were so easy to solve, they'd have done it already. And sometimes girls interpret our agenda-setting ideas as power moves; we're then like other adults in their lives who think they know best and tell them what to do.
It's often a benign intention, wanting so much to be helpful, that can get both novice and seasoned clinicians in trouble. Before we rush to intervene, we need to breathe deeply and attend closely to less conscious and intentional matters in the therapy room--what it feels like to be there (for both of us), what else is happening beneath the surface--to get into that limbic resonance that connects us, and deeper still. It's fundamentally important to trust the process, and to find a way to stay connected to girls during the hours that we're with them. The course of therapy can't be reduced to a series of plans and goals; it also takes place in tiny moments and crevices of a relationship. The "process" is happening even when (or maybe especially when) we're doing nothing at all.
Attending to the process is an idea that's become almost my mantra in my clinical supervision of graduate students. In this age of presto-chango technique and managed care, the process is too often a casualty of the pressure to make therapy as brief and problem-focused as possible. We forget that there's meaning everywhere, if we have the pluck and luck to discover it, and that it often flows out more freely when we're patient, honoring a girl's agenda over our own, sitting a while longer with our own uncertainty and discomfort. Regardless of whether adolescent girls are oppositional and challenging or sweetly contented with us, we are too often tempted to take over and act rather than allowing the flow of the session to dictate what we'll do next.
One day just a few weeks into our meetings, Lucy and I were sitting together companionably. She was doodling on a big pad perched on her lap, not saying much to me, just occasional idle chatter accompanying her curlicues and the three-dimensional rendering of the word "Matt," a boy she was madly pursuing. I was beginning to squirm, and my personal demons were telling me that I ought to be "doing real therapy" with her now that we'd "established a relationship."
So I began to speak, quietly wondering about how I could be helpful to her, about whether we might now talk about some goals, about some problem-solving strategies she might like to learn. When I was done, Lucy looked up at me horrified, her lip quivering. For the first time since I'd known her, she silently began to cry. She regained her voice after a couple of interminable minutes and said, "This is the only place I have that I can just be me. Why do you have to fix that?"
I backpedaled fast, supporting her determination to be herself in other situations, too. I breathed deeply and leaned forward into the space between us. I reached for a colored pencil, and asked if I could color in a letter of Matt's name. As the sound of pencils scratching on paper filled the room, I realized anew that Lucy's healing depended in good part on my ability to trust our unique (if at times slow and seemingly dull) process in the therapy room. I don't always know what is, strictly speaking, "therapeutic"; sometimes all it takes is just being present. And sometimes just being present is harder than providing big-time interventions.
5. Identify Choices, Ask for Choices, Take Joy in Choices
Many teens feel that they have precious little say in their lives--it feels to them that someone is always telling them to go to school, do chores, eat dinner, do their homework, turn down the music, and get off the internet. They're told to go to therapy, too--something else they didn't choose. Yet, self-control, which comes from the ability to make and follow through on our own choices, is the scaffolding that holds up so much of our lives.
With a sense of self-control, girls can develop self-esteem, have safe and intimate relationships, figure out how to succeed in school and work, and learn how to negotiate with their parents more effectively. Adolescent girls need to see themselves as capable of making choices, and caring adults need to help them choose and notice when they do.
Donna was 18, drinking too much, and cutting herself. She was doing poorly in her first year of college and was feeling increasingly desperate about whether she'd ever be successful. She'd come into therapy and tell me about all the regrettable things she'd done the preceding week. It was quite evident in the narrative that she didn't see herself as proactive in any sphere in her life; the only control she believed she had involved choosing self-harm.
So I framed all the events she reported as choices. I asked, over and over again: Is this what you want? Is this how you want to show up in the world? What happens when you do? What happens when you don't? How true are you being to yourself in making this choice? How does it help you get the love and care you need and deserve? When she drank less, I congratulated her for making a good choice, and asked her how she was able to do it. These questions stemmed from my heartfelt belief that Donna had more control over her life than she thought she had. They steered her in the direction of finding the strong voice that she could identify and distinguish as her own.
6. When She's at a Loss for Words, Guess and Guess Again
Even though girls are supposed to be verbal and emotional, they're often surprisingly lost when describing their internal lives. Many girls, well into adolescence, remain concrete in their reasoning and have a limited vocabulary for describing their feelings. Cut off from anger, impelled by culture and family to present a smiling facade, they often really don't know how they feel. Therapists are often frustrated when they get the usual responses to the inevitable inquiry about how a teenage girl feels about something: "Fine," "I don't know," or strained silence.
At this juncture, I no longer think girls are being defensive or withholding when I receive one of these responses. Instead, I plunge ahead and guess. I frame my musings in general language: "Some girls I know might feel pretty angry about something like that." "I think I'd be pretty frustrated if I had to deal with this." "I know a girl who said she felt like crying an ocean when that happened to her." "I wonder if you might feel a little confused by this." Such reflective dialogue about deeper feelings and what they might mean helps girls. They see me trying and when I guess right, they feel felt. They also begin to learn to draw meanings from feelings themselves. Guessing is a kind of foray into helping girls develop their own emotional intelligence and "mindsight," so they become increasingly able to know what they think and feel.
7. Base Expectations on Developmental Level, not Chronological Age
If girls develop at different rates along so many concurrent lines in their physical, emotional, social, and cognitive paths, how do we know what are reasonable expectations and where to set the bar? One of the great challenges of work with adolescent girls is that they often enter treatment for adult-sized problems that they've attempted to solve with child-sized strategies. I believe that I'm treating an increasing number of anxiety disorders because our expectations for girls exceed what they're capable of delivering.
This issue is particularly compelling when safety is concerned. We have hugely unrealistic cultural and societal aspirations for adolescent girls--wanting them to function independently and wisely long before they have the tools to do so. By the time a girl is 11 or 12, we may expect her to be able to be alone for many hours a day, organize her school work, get dinner started, and manage herself in public with poise and maturity. Adults may become annoyed by a girl's "ditziness" or emotionality, express shock or dismay at her poor choices and judgment, or take her irritability as a personal affront. Because girls look like young adults, and can sound like them, too, we're too apt to forget that they're frequently overwhelmed by expectations that they can't consistently meet.
A few weeks ago, I met Margaret for the first time. She's an angry, unhappy, 13-year-old girl, who came to therapy with her father, her 9-year-old half-sister, Izzy, and her stepmother. Her family members had a long list of changes they wanted Margaret to make--to lie and argue less, be more respectful, do her chores, stop blaming Izzy for everything, and stop stealing from her stepmother. When I asked Margaret the "miracle" question about how she'd know her own problems had gone away, her answer surprised me: "I wouldn't have to pick up Izzy at the bus stop after school and watch her every day until 6:00, so I could maybe do karate again. And I'd only have to get dinner ready a couple of nights a week." I realized then that the family expected Margaret to function as an adult and parent; they didn't see how these high expectations were causing this young, confused child to feel overwhelmed and frustrated.
When I meet an adolescent girl for the first time, I assess her cognitive, social, emotional, and physical development, and consider what level of independence and responsibility--for herself and others--she can handle. I set the bar a little low at first, to be sure she's safe and competent to get over it. I educate the parents, who see an almost-grown woman before them, about the fact that this girl is still just a child. Girls benefit from the temporary "loan" of an adult's executive functioning while their own brains are still undergoing major renovation--and so much of their behavior is controlled more by emotion than by reason. Even when girls say they're capable of behaving more independently, or deny wanting such support, adults should not take these statements at face value. The fact remains that evolution has given young humans a long period of dependence and that this simply can't be rushed, no matter how much adults may need girls to grow up faster.
8. Build Teams
In today's America, the nuclear-family model is inadequate for raising adolescents. Parents are unable to function in all the roles needed by girls to develop safely into women or provide everything--supervision, nurturance, role-modeling, initiation into the adult world, education, and counsel--required to launch them into womanhood. With the powerful second family of pop and kid culture all around, girls need lots of adults to hold and support them--adults who can function as parents, friends, mentors, and elders. Clearly, a therapist who sees the girl for 50 minutes a week can't provide all the nonparental adult time she needs.
From the onset of treatment, I view myself as part of a team, adding adults as we go. One of my favorite team stories is about a funny and maddening 14-year-old named Megan. She was diabetic, learning disabled, truant, and recently adopted by her long-term foster family. Megan had adults scrambling in all directions to support her, and we added more when she was hospitalized for medical problems, and then still more when she attended a residential school.
One day a few months into treatment, she was bemoaning the fact that she had no one on her side, "Everyone is against me," Megan wailed. I glared at her, handed her my clipboard, and asked her to write down the names of people who'd tried to help her just in the past two weeks. We began with a truant officer, added the nurses on the inpatient unit, extended family, school personnel, her adoption worker, and myriad others. Megan counted happily to a team of 24 adults. She seemed quite pleased and laughed as I admonished her to carry this list with her at all times, so that she could never again say she was alone. Even in less complicated situations, girls need more adults in their lives, now that they so seldom have nearby extended families or a cohesive community to back them up.
9. Empathy, Empathy, Empathy
It isn't easy, when an adolescent girl aims a verbal bomb at us, to remain empathetic, but when we do, we run less of a risk of taking things too personally. Girls, even big, tough ones, have limited strategies for getting their needs met. They come to therapy following years of struggle and failure in relationships. We need to try not to be wounded or disappointed when they aren't good at the therapy relationship either.
Sally, a pistol of a girl, was 13. With hair she'd cut herself one afternoon, broad shoulders, and a fierce scowl, she was the terror of her suburban middle school. People, got out of her way when she walked down the hall. Teachers disliked her because she continually and relentlessly challenged their authority. She was sent to therapy after she swore at her English teacher one too many times and was suspended. The school hoped I could "help her be happier." I suspect they hoped I'd sedate her somehow, too.
Sally was a bright enough girl who had a couple of critical older brothers and parents who were overworked and exhausted. Her parents had trouble making it to therapy appointments together, but, separately, both expressed bewilderment and frustration about their angry kid.
Because I prefer a girl who has pizzazz, I immediately liked Sally, and told her so the first chance I got. I admired her determination to be true to herself and to have a voice. So even after she used that voice to let me know I was wearing the "ugliest-ass pair of shoes" she'd ever had to look at, I still liked her. And when she told me I was wasting her time and that her cat understood her better than I ever could, I still liked her. Ditto following the comment about feeling that she was talking to drywall one day when I wasn't immediately responsive; I told her no one had ever compared me to drywall before. Even after she put her muddy boots on my couch and told me to "just shut up for a change," I was in there with her, liking her. I scowled affectionately, and mutely waved her feet off the furniture. And then I asked another question about the "emo" music she had on her iPod and listened hard to her answer.
Sally's actions were, I believe, creative attempts to share with me how rotten she felt, and I held (clung, really) onto my empathic connection and didn't let her push me away. I've finally learned, after years of being hurt and worried in such situations, that what's transpiring isn't about me at all. My job with Sally, and other girls who use insults or verbal aggression as a way to get personal, is to reflect back a better way of staying connected.
Sally probably wanted a relationship with me more than most girls I've worked with. I had to keep remembering that her oppositional strategies were in the service of engagement. By doing that, I was able to tell her, "I love your spirit. When you talk like this, I know that there's someone in there worth fighting for. I admire that so much. The last thing I want to do is to send another shut-up woman out into the world. Promise me you'll fire me if I do that." Then, to try to engage her in the work of smoothing her rough edges so others would want to be there for her, I added, "But we need to do some work on your style and figure out together a way for you to develop a voice that people can hear. I can help you become a better Sally advocate."
Like many girls who aren't used to people responding as I did, Sally redoubled her rejection of me, just to be sure I was sufficiently indefatigable. For a few weeks, she became even more adamant she didn't need some "nosy shrink" in her business, and challenged me still some more. But over time, her comments became part of our way of being together: I'd I go to the waiting room and hear about my shoes, then wait patiently while she read a magazine, and she'd eventually wander in, sighing with ennui. Then she'd get down to work. Several months after I terminated with Sally, I got some high praise from her: she sent a friend to me for therapy (who told me she had instructions to check out my ugly-ass shoes).
10. Don't Underestimate Your Role
One of the biggest mistakes we can make is to devalue ourselves, or at least our importance, to the girls we treat. Maybe adults come to therapy to fix particular problems. Adolescent girls don't; they want to be seen and heard. They want to feel felt. They usually want a relationship with you, even (or especially) if they say they don't.
Fifteen-year-old Marissa was a "multidiagnosed" girl I saw just three or four times, before losing her back into the system in which she'd spent her entire life. She came to me drug-addicted, with years in and out of foster care, a police record, and suicidal ideation. Her current placement was unstable because she wouldn't follow even the most reasonable rules in the home. Her foster parents had just about given up.
I hospitalized her to keep her safe when her despair grew so acute that she seemed a danger to herself. During her stay in the hospital, I sent her a silly greeting card, telling her I'd really enjoyed meeting her, and noting her strength to endure. Then I lost touch with her. I know now that Marissa wound up in juvenile detention until she turned 18.
Three years later, I was summoned out to my waiting area to greet a smiling young woman, who claimed to know me. She introduced herself as Marissa, the kid I'd hospitalized a few years back. She told me she'd always planned to see me when she got out of detention, because she'd kept the card I had sent her and she wanted to let me know how important it had been for her.
I've learned these simple, vital lessons through the years, and I relearn a few of them every week. I'm still discovering who I am as a therapist for adolescent girls, honing that growing edge of attunement to myself and to the girls I treat. So when the loquacious Lucys of the world bring their volatile social connections and overstuffed pocketbooks to me--metaphoric and otherwise--I now know that my job is to show up with my most patient, empathic, creative adult self, and help them unpack them.
Martha Straus, Ph.D., is a professor in the Department of Clinical Psychology at Antioch New England Graduate School in Keene, New Hampshire, and adjunct instructor in psychiatry at Dartmouth Medical School. She's the author of No-Talk Therapy for Children and Adolescents . Contact firstname.lastname@example.org. Letters to the Editor about this feature may be sent to email@example.com.
by Adam Cox
A therapist's first steps can make an indelible imprint on his or her sense of calling, shaping the career to follow. My own first steps included counseling "troubled" boys in several rural Pennsylvania high schools. Most of the boys had grown up in harsh circumstances; their case histories were litanies of abuse, neglect, and conflict. Nonetheless, most viewed counseling as a form of punishment, perhaps slightly worse than detention.
Fueled by enthusiasm, some prior success teaching art to impoverished inner-city kids, an academic education in psychology, and a few supervised clinical experiences, I felt ready to go. I imagined myself teaching tough, sullen kids to open up--the long-suppressed wordsof their pain gushing forth, as they "got real" with me and began their journey toward self-discovery and healing.
Early each morning that cold winter, I'd toss sandbags into the back of my pickup and wind my way up ice-slicked roads past the corrugated mountains, slate quarries, and swift river waters that flowed through Mauch Chunk and Lehighton. As the sun rose, the snow fell against the treeless, shale mountainsides. This austere, stark, yet ultimately beautiful landscape foreshadowed the kids I'd come to know. These boys seemed to long for the hills--a place where life was more visceral and action oriented than the pastel-hued guidance office where we met, ostensibly to discuss their lives and feelings. Many came to school decked out in camouflage and boots, as if anticipating the deer-hunting season; its first day was an official school holiday.
My initial idea was that offering a receptive ear and verbalizing positive regard would be the key to helping these kids. I thought I could transmit the hope, optimism, and encouragement they needed by expressing unwavering trust and belief in their potential.
There was only one problem with this plan: it didn't work. Nothing changed. I asked them questions like, "Tell me more about what it felt like to be yelled at by your dad?" or "What would it take to feel safe opening up?" But our conversations remained superficial. They responded to my efforts to help them with bored monosyllables or sarcastic quips. Here were boys facing expulsion or even incarceration, whose lives were chaotic and full of conflict, and yet they conveyed no palpable sense of urgency to deal with their problems. And my anxiety grew as I reflected on the ticking clock of their adolescence.
As I drove home at the end of the day, the boys' resistance weighed heavily on me. Lying awake at night, I tried to put my failure into perspective. Maybe these kids weren't the right clients for me? Maybe they weren't the right clients for anybody. Then it dawned on me that maybe I was going about things the wrong way. I'd been so busy trying to give their most limited words and gestures some kind of positive spin that I hadn't paid much attention to their most obvious "symptom"--the difficulty they had communicating about virtually anything, much less expressing their feelings. The few responses they seemed to have were primarily angry, sullen, or glib.
For instance, here's a fairly typical exchange that happened when I asked one boy, "Why did you fight that student?"
"The kid's an asshole and he deserved it."
"But why did he deserve it?"
"Just because he did. Forget it."
"Okay, well how did you feel after the fight?"
"I don't know, good I guess."
"What do you mean good'?"
"You know, like he fucked with me and got what he deserved."
"Do you have any feelings of regret or guilt?
"Nah, I don't know what you mean about regrets and shit. He had it coming and that's it. End of story."
As I thought more, it became apparent that these boys couldn't yet respond coherently to important life situations, because they couldn't describe how they felt, what their experiences meant to them, or what they hoped to accomplish--the basic building blocks of therapy. The only terms they had for describing their rich, if chaotic, inner lives were sledgehammer words and phrases--"I'm pissed," "It sucks," "Who cares?" As they used those phrases repetitively, their emotional lives were effectively flattened, their individuality lost.
If therapy with these kids was to be effective, we needed more and better words, and we needed them to be readily available so they could be used as tools to complement the sledgehammers they already had. I began to think about how I might be a conduit for the emergence of those words. If they felt more comfortable with me, I wondered, would they feel more comfortable adopting the kind of communication I modeled for them?
It was worth a try, so I took off my counselor hat, threw out the scripted language of therapy as I knew it, and just started talking, cajoling, joking--low-key, but definitely insistent. My inquiries were mixed with casual banter about girls, football, and, of course, hunting. Rather than setting an agenda for the therapy, I engaged the topics that emerged, focusing more on talking with them than asking them to talk like me. I asked fewer leading questions and made my comments shorter and more pointed.
I became more sensitive to how much the starkness of their feelings affected their psychological lives. In a way, the frustration of being limited to a narrow range of descriptive words like "awful" and "excellent" intensifies what you're feeling, and your emotional life can feel more extreme and polarized. As I mirrored this perspective by forcing myself to phrase things in black and white terms --"So are you gonna fight this kid or walk away?"-- it was amazing to feel the therapy develop a pulse.
Slowly the boys let me see that, in their minds, they were waging near-mythic battles--against peers, a parent, the school principal, or all of the above. Yet these battles were being waged without any coherent narratives, only jumbled images, words, and feelings, all whirling around like a washing machine stuck on the spin cycle. Their minds were too tossed and roiled to make either emotional or cognitive sense of their experiences, and this confusion ultimately led to a complete breakdown in the ability to take constructive action to solve even the most basic problems.
They had many more words for permutations of anger than they did for virtually any other kind of emotion. So we worked on expanding their awareness of words to describe more complex feelings, such as guilt, regret, or satisfaction. To accomplish this, it was critical to focus on concrete situations and to make my emotional work with them a kind of multiple-choice interchange. "You gotta admit, when Darryl Â¥ratted you out' to the principal, you were pissed, but you also felt regret for what you did--it seems like you wish you could take it back."
The emergence of better communication not only enriched the therapy, but also fostered real accomplishment. Our sessions became more goal directed, highlighting the relationship between cause and effect in their lives. "If you want to be admired by others, you'll have to give them a reason why. Let's talk about how to earn their respect." "I know you want a good job, so let's figure out the steps to make it happen." "If you want your grandfather to take you hunting, he needs to see that you're ready. How could you show him that?" By the end of the year, every boy I worked with had established a tangible plan for gaining something that was important to him. Their goals had lived in their minds all along, but they needed to put them into words to have any chance of achieving them.
The Gender Divide
My year treating high school boys taught me a lesson that still guides my work: if words are the currency of most interpersonal exchange, many boys are on the verge of social bankruptcy. When it comes to communication challenges, gender discrepancies are staggering. Boys make up 75 percent of special-education classes, are far more frequently diagnosed with syndromes ranging from AD/HD to autism that involve social-learning problems, and account for nearly 80 percent of children identified as emotionally troubled.
Our world is increasingly driven by communication and the need for emotional intelligence--attributes that generally don't come easily for boys--and they're clearly falling behind. In spite of the still-potent icon of the silent male in the American psyche, there are far fewer life options today--whether academic, career, or relational--that can accommodate a boy (or man) of few words.
The schism between the communication skills of males and females has lifelong implications. In education, for example, males are a dramatically shrinking proportion of college enrollments; in marriage, poor communication is cited as the most common precipitant of divorce; in career and professional life, social awareness and communication skills are indispensable to effectiveness and opportunities for advancement. Today's business and professional leaders aren't, by and large, Silent Sams. Furthermore, probably more than at any time in our history, the health of our society depends upon the intricate web of language and communication that binds us together--a kind of interlocking neural network of words that gives us individual access to the collective mind of our culture.
There's also a biological imperative to the deficits in male communication. Our society has seen men's health suffer as the result of stress and underdeveloped coping skills. We know, for example, that men who are divorced in middle age tend to have health that fails much more dramatically than that of women in the same situation. When we talk about building communication skills, therefore, we're also talking about building psychological resilience.
As therapists, we have the tools to build resilience, if we can find flexibility in how to use them. Reframing our approach to treating boys isn't about "dumbing down" therapy, or dishonoring other ways of approaching personal growth. It's about building a platform of safety on which a therapeutic alliance can be constructed.
Therapists may be on the front lines of working with communication challenges, but I suspect few of us are eager to spend our days with verbally disinclined males of any age. The nature of psychotherapy--the "talking cure," still, even after all these years--seems antithetical to the inclinations, and perhaps even the values, of many silent men and boys. Once, I asked a 14-year-old to describe how he felt about his father's death. He looked at me blankly. "Why?" he replied, without intending irony or sarcasm. We were clearly on entirely different wavelengths. But, in therapy, as elsewhere, communication can't happen unless it finds a common frequency--a mental loop that can entwine two minds, or many minds, for the sake of connection.
Uncommunicative boys are often labeled "treatment resistant," but their lack of fluency in the language of therapy may not be because they're consciously antagonistic to therapy, but because they, literally, don't know what to say to a therapist or how to go about "communicating," even when prodded. For youths who don't know what to say, like the high school boys in Pennsylvania, self-expression doesn't initially feel like healing--it feels like coming apart. Withdrawal and silence are unconscious reflexes deployed to prevent destabilization and confusion, which most boys can't tolerate, no matter how much these states are touted by the culture of therapy as necessary to "personal growth."
For those of us who pride ourselves on being able to translate our inner world into words, the expressive void within even emotionally stable and healthy boys may be almost inconceivable. We cannot help but posit "causes." One mother of a quiet but otherwise well-adjusted 16-year-old asked me incredulously, "How can he be so disconnected from us, off in a silent universe of his own? What does he get out of being this way?" She shook her head in bafflement. "I alternate between being worried that he's carrying some intolerable psychological burden all by himself or, on the other hand, that he just doesn't care much about anything at all! Sometimes it feels like he's trying to punish us in some way."
Indeed, it's easy for parents to regard communication resistance as an act of revolt, a sign of adolescent contempt for all things adult. But it's better understood as confusion or anxiety. One reluctant, but insightful, teenager finally managed to find the words for his own anxiety about making his inner life known to others: "If I think about it too much, it's like standing at the edge of a cliff. I can't stand to look. I just want to back away." For other boys, what looks like resistance may actually be a different tempo of thinking and feeling. Behind the blank stare, there's a world of processing going on, but, unfortunately, not at a pace that follows the rhythms of other minds.
In the 12 years since I first began working with boys, awareness of the neuropsychological factors responsible for the development of the brain's capacity for social and emotional awareness, and for the difference in communication skills between males and females, has increased. For example, we've learned that the corpus callosum, the anatomical "bridge" that spans the brain's left and right hemispheres, is generally larger in females. As a result, information can be exchanged between hemispheres more efficiently. This finding becomes particularly important when considering the extraordinary contributions made by the right hemisphere to social perception: this hemisphere is where we make sense of nonverbal communication, and where we detect the nuances that shape deeper interpretations of another person's communication.
Neuroimaging technology has shown us that the male brain tends to process language almost exclusively in the left hemisphere--the seat of logical thought and linear thinking--while the pattern is much more diffuse for females. When boys don't get it, when we see stone faces and shoulder shrugging, we can reasonably conclude that something doesn't compute. Imagine hearing a song in a language you barely understand. You may detect that emotion is being expressed, but you can make little sense of it. While those around you tune in, you opt to tune out, because it's anxiety provoking to exist in a world whose terms and meanings evade you.
The consolation prize for boys who feel deeply but can't express or even decipher their own emotions is the universe of "electronica," a womb of all-encompassing stimulation provided by video and computer games. Here they feel safe and excited at the same time. Electronica is a great alternative for dealing with confused feelings about communication, except that these games are reprogramming the way brains work, making boys even more vulnerable to neurodevelopmental syndromes like AD/HD. This is the conundrum that frames the social lives of many boys, even though few of them have any inkling of it.
The Big Impact of Small Differences
In spite of these distinctions in verbal processing among males and females, several decades of research also highlight that the biological differences between the genders are relatively small. The very fact that the genders are more alike than different makes brain differences significant, and proximity makes those differences even more visible. Imagine a visitor from a distant galaxy, hovering above a busy freeway in a spacecraft. Looking down from several thousand feet, our alien can see many red cars driving to and fro. Some may be slightly bigger or smaller, and there are different shades of red, but from an alien's distance, they look very much the same--the differences seem trivial. Yet from the perspective of an earthling on the ground, those differences take on significant meaning. The difference between a Lexus, Ford, and Hyundai may have important implications for reliability, economics, and social status. Even subtle differences in the shade of red may have profound emotional implications for a car's owner! The closer we are to these differences, the more apparent and meaningful they'll be. Important differences in the communication skills of some males, from an inability to initiate friendships in childhood to a hesitancy to express feelings in adult relationships, also become more noticeable through close proximity.
Further, even though boys' innate neuropsychological disadvantage at communication may be small, social and environmental factors certainly contribute to the divide. At my son's school Halloween parade, almost all the boys were superheroes, traditionally men of much action and few words. Metaphorically speaking, many will be wearing those same costumes well beyond kindergarten.
However, the astounding growth of a vast electronic/media culture has had a far more corrosive effect on boys' ability at verbal communication than the influence of social stereotypes. Their senses are steadily dulled by overindulgence in the "drugs" of images and sounds, their capacity for attention and focus undermined by the speed and fleeting nature of constantly renewing images and continual staccato bursts of sound. It's probably no coincidence that the stratospheric increase in diagnosed learning and attention deficits correlates with the advent of the electronic playground.
The fragmented syntax that's evolved from these media--the fast-paced blasts of sound and light bytes of films, television, e-mail, and computer games--ring loudly in boys' minds, more urgently than ordinary conversation. Of course, there's real creativity in many electronic means of expression, but, unlike reading and listening to stories, the blitz of electronica doesn't build deeper listening skills or a greater range of emotional expression.
Can't Get Me Out of My Head
Although some communication is purely instrumental--"Pass me the sugar," "Can I have $20?" "Are we there yet?"--social communication is about connection. On a basic level, relating to others is the antithesis of self-absorption. Boys aren't easily dissuaded from pursuing thoughts or activities that effectively put walls up around them. They feel justified in their deep infatuation with personal interests, even when it borders on obsession (trying to collect every Yu-Gi-Oh! card ever made) or narcissism (trying to achieve the perfect body through compulsive, punishing workouts).
Arguably, the single greatest social liability of electronica is the risk of self-absorption. It's tempting to see the internet--e-mail, chat rooms, instant messaging, blogging--as an exception to that risk. Surely, here, boys are comfortable expressing themselves, and can more easily learn how to escape the prison of themselves. Here they can share ideas and thoughts with other people, make new friends and acquaintances, learn to get along with a wide variety of people. Unfortunately, this isn't so. In fact, it's usually just the opposite: the internet expands the potential for self-absorption. While keyboard communication may help a reserved child "get his feet wet" in the social realm, or give an impulsive boy a chance to consider and edit his comments, there are just as many pitfalls.
For many, the ability to develop an electronic alter-ego seduces them into an alienated world of fantasy and projection, without providing the reciprocity that spurs personal growth. Resolving a conflict with a friend, going on a date, and interviewing for a job rely on senses that are largely irrelevant to online communication. In fact, the care and nurture of an internet-created alter-ego--cooler, sexier, tougher, less vulnerable and awkward--fuels the descent into self-absorption. Enthralled with his own projection of an ideal self, a boy becomes less aware of other people as complex individuals in their own right, let alone of the need for any interaction with them in the real, unscripted world.
Why are boys so drawn to this poisonous self-absorption? Not only does withdrawal into electronica enable them to bypass the confusion and pain of trying to give their emotions some coherence, it also helps them avoid the realities of being a flawed, vulnerable, ordinary human being. This internal drama is being played out among boys everywhere, every day, with varying levels of intensity.
The Story of Evan
One morning, the principal of a small high school called me about Evan, a ninth-grader who'd intimated to a female classmate that he was going to hurt himself. Specifically, he'd dramatically told the girl that she could have the music scores he'd written, because he wouldn't need them anymore. The school had contacted Evan's parents, advising them to bring him to see me following a hospital evaluation. I met Evan, at 9 that evening, escorted by his worried and exasperated parents. He was a thin, serious-looking teenager with straight, dark hair just long enough to be pulled back into a ponytail.
"I guess you've had a pretty intense day?" I offered.
His father quickly interjected, "We need some answers. He won't tell us anything."
Evan's mother added, "It doesn't seem like he knows what to say. I keep asking him why he did this, and he just shrugs or says he doesn't know. What are we supposed to do?"
During the course of the next hour, Evan's story began taking shape. When therapy with boys feels uncomfortably tense, my favorite default is to talk about their interests, suspending judgment, no matter what those interests might be. By keeping things low-key and conversational, I learned Evan had three passions: computers, music, and martial arts. He'd recently developed an interesting and novel project--translating some of the movements from karate into musical notes. For example, a specific type of kick might translate to the musical note C, therefore a certain sequence of moves might be translated as C, B, E, etc. These sequences would be programmed into the computer and he'd synthesize music from them.
The previous week, Evan had presented his idea to a group at school. His teacher had been very encouraging, but some students wanted to know how he could ever turn this into "good" music. One girl had matter-of-factly suggested that he write the music first and then adapt the karate moves to the score. This had infuriated Evan, who explained that there was a particular sequence to the karate moves and that he couldn't change the order. Afterward he sullenly withdrew from his classmates and continued morosely ruminating about the girl's "stupid suggestion," feeling as though his creativity had been totally invalidated.
Like many boys, Evan covered his feelings of vulnerability with anger--overall a more manageable emotion, because these boys equate expressions of anger with power, the commonly preferred antidote to embarrassment or humiliation. He'd already learned to use anger to ward off "invaders," people who might try to penetrate the protective veneer he'd constructed to conceal his emotional self.
This time, however, the anger was too overwhelming for him to conceal for long. Feeling hurt and unappreciated, he needed to expunge those feelings by acting out to the person he felt was the source of his emotional injury. So he dramatically presented his project notebook and music score to the girl who'd made the suggestion he couldn't stand, telling her he'd never live to hear it played. He'd taken her comment as a deep form of rejection, and lacked the verbal skills to navigate a resolution.
"Does anybody get you?" I asked.
"I don't know, should they?" Evan retorted defensively.
His answer indicated the question had hit home. I learned that Evan was attracted to activities and interests in which there are formulas and structure--mathematical rules that helped him wade through an otherwise confusing world of verbal nuance, shifting perspectives, and diverse groups. He fantasized about creating a musical formula to describe different feelings. His major problem was that he couldn't make music that sounded good to people.
It was obvious that my best chance of connecting with Evan was through his music. At my request, he began to bring in his compositions recorded on a compact disc, which could be played on my office computer. He'd narrate these listening sessions with indications of what emotions he was trying to represent. "Check out this part coming up--it's like what I felt toward Noelle. Now can you understand?" It was clearly engrossing for Evan to observe the emotional impact his music had on others. It was as if, as he presented his music, he was unraveling the code of his own emotional life.
I asked him why he never wrote any lyrics to his music. The question initially surprised him--it had clearly never occurred to him, and he reacted as if the suggestion was almost illogical. At first, he dismissed the idea, but I could tell there was a part of him that was intrigued. We jump-started the process by playing with lyrics in my office. He seldom liked anything I suggested, but my offerings seemed to catalyze his own creativity. It felt to me that Evan needed something concrete against which he could mold and define his own thoughts. I've come to see that this approach is valuable with most boys--give them a tangible thought or idea, and then let them find themselves in relationship to that perspective. For me, the approach recalls how helpful it is to have an identifiable landmark, when you're lost in the woods, to know which way you want to go.
Evan made the leap to working on lyrics between sessions, an important sign that he was taking personal responsibility for working on his communication skills. With much prompting, he eventually produced these lines about his irritation with his parents' worries about him:
I see faces that are angry.
But they can never own me.
Leave me alone. Leave me alone.
I just want to be alone.
When Evan insisted the lyrics reflected what he felt, I suggested they described only the tip of his emotional iceberg. "I hear your anger, Evan, but I think there's more. I still can't find you in those lyrics. Anybody who can figure out how to translate karate into musical notes has got a seriously complex brain. Let's hear it!"
This challenge engaged his natural competitiveness. For the next several weeks, he brought in lyrics that incrementally became more expressive. There were moments of clarity and confusion, yet an overriding sense that Evan was moving closer to learning how to share himself with others. With lots of hard work--perhaps coming from an unexpressed desire to win my admiration--Evan's feelings toward his parents were transformed into a song Evan titled "Growing Up":
It's hard for me to know just why you love me so.
I can see it in your eyes. It cannot be denied.
But there's a part of me that's gone.
It can only live in songs.
On this you can rely.
The lyrics helped Evan define what he felt, but perhaps most important, helped him see that the world wasn't a unidirectional place, where people and events only acted on him: he, too, had a role in how his life played out. He began to realize that his actions, his words helped shape his parents' incessant worry. He still often walked along the edge of an emotional precipice, conveyed by his scores for "Tower of Babble" and "The Void," but there was a dawning realization of a larger world of thought and feeling. Through meeting the challenge of putting lyrics to his own music, Evan learned that words could transform some of his most troubling emotions and help him find new ways to regain his balance when life got difficult.
So Many Ways to Connect
Connecting with boys in psychotherapy requires an open mind about the approach to use. One practical way that works for me is tossing a softball back and forth in my office. (I used to go outside and play catch quite often, but was never able to adequately steer the conversation toward topics that brought us closer.) After just a few tosses, I start talking about world records, and how many consecutive catches it would take to get in the Guinness book. The prospect of being the best at something is a major hook for boys of all ages.
From there, the conversation can segue into topics of more personal significance: "How are things at home?" "What's your new school like?" "How will you handle it if she says no?" It's a simple thing, but is typical of what gets boys engaged in therapy. Just getting their heart rate up seems to intensify thinking and communication, making it more likely that the words exchanged will stick in a boy's memory.
I find it valuable to demonstrate this technique in front of parents, often during the initial interview. I want parents to see that involving boys in a physical activity helps reduce their feelings of vulnerability, and actually turns their brains on. Also, first impressions are important, and I want boys to leave that first session with a memory of fun, action, and rapport--quite the opposite of the uncomfortable stillness that often results from direct inquiry into their thoughts and emotions.
The Men They'll Become
We think and feel in words. The silent, sullen boy stalking the mall's game store may be next in line for an underemployed, lonely adulthood if we don't teach him how to maintain effective social contacts with others. The need for a social evolution--one that expands our understanding of boys' potentials and supports a broader vision of masculine expression--flows not from political correctness but from sheer necessity. Therapists who work with boys are on the front lines of facilitating this evolution.
As we raise and support the next generation of boys, it's vital that we give them the tools to be full participants in society by helping them find the words to define themselves and relate to others. To do so, therapists and parents alike must explore new means of engaging silent youngsters, going beyond the business-as-usual inquiries about thoughts and feelings to discover activities or conversational approaches that stimulate a real connection and encourage them to open up to a broader range of verbal expression. By doing this with dedication and determination, we can help boys of all ages cross the communication divide.
Adam Cox, Ph.D., is clinical director of Lehigh Psychological Services, a group mental health practice specializing in the neurodevelopmental needs of children. He's also the author of Boys of Few Words: Raising Our Sons to Communicate and Connect. Contact: firstname.lastname@example.org. Letters to the Editor about this article may be e-mailed to email@example.com.
by: Mary Sykes Wylie
Some weeks ago, The New York Times reported on a group of Amazonian Indians--the Nukak-Maku--who wandered, nearly naked, out of the jungles into a small Colombian town and declared their intention of settling down there. The Nukak, the article said, had no last names, no concept of money, property, government, the future, or the existence of a country called "Colombia," the nation they inhabited. They were amazed by the buildings, streets, and paved roads. They wondered whether the planes they saw flying overhead were moving on some sort of invisible highway. "The Nukak don't know what they've gotten themselves into," said a physician who'd been working with them.
Like most adults who grew up before computers, I feel like the Nukak when confronted by the entire youth pop culture scene, particularly its cybernetic components. I know there are all these entities beginning with "I"--iPod, ICQ, iMac, IMing, iTunes, IRC--but I don't really know what they are, what they do, or how you use them, and I don't much care if I never find out. It's enough excitement for me just to be able to go online and listen right there at my own computer to Fresh Air, with Terry Gross. Actually, it was pretty exciting for me just to learn how to go online.
And then, there's MySpace.com. I can't say that I hadn't heard of this site before (or its kinfolk, Facebook.com, Friendster.com, etc.) but I can't say I had, either. It sounded vaguely familiar, like a stray wisp of the zeitgeist wafting at the periphery of consciousness--an aspect of the strange mass internet/pop/techno/youth market that means no more to me than the weird names of rap/hip hop/post-punk/hard rock bands proliferating like millions of mutant sound spores in the atmosphere. MySpace was just another one of these peculiar life forms that inhabit an alien universe--possibly benign, possibly not, but forever beyond my ken.
However, in the interests of investigative journalism, I was asked to take a look at MySpace. Founded in late 2003 by an internet marketer and a musician with a master's degree in filmmaking, MySpace was originally intended to be a site where musicians could post their music online and fans could listen. Since then, it's morphed into a vast social networking site drawing in nearly 82 million people--mostly teens and young adults--and growing literally by the thousands every day (by the time you read this, the number will be creeping up to 100 million, unless the whole bubble has burst).
Now, the world's fourth most popular English-language website (according to Alexa Internet, a subsidiary of Amazon.com, which studies web traffic), it was bought out last year by Rupert Murdoch's News Corporation for $580 million dollars. Clearly, Murdoch et al. hope that those tens of millions of users will translate into advertising dollars. Already MySpace displays more pages (one billion a day) than Yahoo.com, thus more room for ads. But it might not pan out--kids' taste is notoriously fickle, the pop culture is notoriously shifty, and the fortunes of internet companies are notoriously unstable.
Nonetheless, while it lasts, MySpace is the undisputed Godzilla among networking sites, mostly for the teen, twenty- and thirty-something crowd. But even some of the elderly (past 35) hang out there, though their profiles--the individual homepages each member sets up--tend to be modest, unembellished, and unvisited, and, it seems to me, have an air of uncertainty, as if their proprietors don't quite know what they're doing in this mosh pit. Once entering the MySpace maw, you have, besides the 81-plus million individual profiles, access to nearly 700,000 forums, 2.5 million interest groups, and close to 17,000 public blogs, not to mention probably about 2 million different pop bands of every conceivable and inconceivable genre--all of which are linked in one stupendous, ever-expanding superweb of possible interconnections.
Getting on this bandwagon isn't really hard, but for somebody not young and not used to the internet ethos of unbridled exhibitionism, the process raises qualms right away. Do I really want them to have my full name? My e-mail address? They promise my real name will remain private and my e-mail address will not be shared, but still . . . . I set up a new e-mail address at Yahoo.com, one remove from my true cyber home, as a kind of buffer.
In the creation of my profile, I'm asked for a photo (no nudity allowed, though given the many profiles featuring pix of buff and almost entirely uncovered young bodies, this rule is very elastic), a user name (the name appearing publicly on your profile), plus a long list of biographical categories--marital status ("swinger" is listed), sexual orientation, religion, body type, hometown, income, interests, favorite movies, music, whom I'd like to meet, my heroes, etc. This all makes me queasy and I log out--I'm not ready to share myself so totally on the first date.
Of course, I could also fake everything--pretend to be a 22-year-old female bisexual swinging Latina bodybuilder, claim that my favorite band is the post-hardcore rock group My Chemical Romance, submit a smoldering picture represented as myself--and who's to know? With such potential for personal shape-shifting, there must be plenty of people among the 80 million who bestow on themselves new, cool, more glamorous, more dangerous identities than the nerdy selves they wake up to every morning.
Myself, I just tippy-toe in, adopt the user nom de plume Zoe, after my recently deceased cat (joining 11,000 other Zoes), pass on the picture, and leave most of the rest blank. I confirm my account at Yahoo and (voila!) I have a profile among the vast hordes of other MySpacers.
As soon as I register, I get an e-mail from my first "friend" in my own personal "friends" network at MySpace. It's Tom, who I later discover, just happens to be Tom Anderson, the cofounder and president of MySpace. I also learn from his profile that he likes The Doors, Bruce Springstein, and the movie Blade Runner. I kind of like those things, too. LOL! I'm a little crestfallen to note that Tom's profile notes he already has 81,660,889 friends, but it turns out that he welcomes every new person to the site; he's literally the central node, the lynchpin, the hub of the cosmic wheel connecting all MySpacers to each other in one gigantic, gigabyte-sized family.
Tom welcomes me and in the same cyberbreath tactfully offers me the opportunity to tell him to buzz off, if I want, by clicking "edit friends," thereby removing him from my "friends space," just as I can drop any other friends who no longer entertain me. Would that all tiresome human relationships were as easy to delete! This is the first lesson of MySpace--friends giveth and friends taketh away.
Apparently, this facile acquirability and deletability of "friends" can be a source of anxiety, heartburn, and downright fury among MySpacers. Each profile allows the listing of the Top 8 friends in the profiler's life (who have to give their permission to be listed)--a changeable clique of favorites that might include your mother, oldest pal, girlfriend/boyfriend, or somebody who just caught your eye on MySpace itself. Anybody can be dumped at will, or blocked from your homepage, though the dumpee can also counterdump, sometimes leading to hard feelings all around. And don't think nobody will find out who's now in or out on your friends list--there's probably more interprofile spying on MySpace than ever dreamt of by the most feverish agents at the National Security Agency.
Finding my way into the labyrinth, I "browse" MySpace to see whose profile I might want to visit. Though I can specify lots of criteria--and later I play around with different genders, ethnicities, ages, sexual orientations, drinking/smoking habits, etc--this time, I basically open the search to any and all comers: whatever you've got, MySpace, bring it on!
Plunging into the maelstrom--it's like the mother of all singles mixers--I encounter the first hurdle for anybody who, like me, still lives in the primitive premodern world of dial-up connection. Bandwidth insufficiency.
MySpace imposes a plain format on the profile homepage, and there are plenty of members who don't elaborate much on the basic package--their homepages are as plain, dull, and uninformative as mine, suggesting their creators aren't quite ready to get down and boogie. But within those same pared-down, monastic-sounding format rules, all hell can break loose.
Loads of profiles are tarted up extravaganzas of colors, graphics (black backgrounds and Day-Glo lettering much favored), animation, videos, flash movies, interactive features, special effects, cartoons, photos, music, and whatnot all jumbled together in an often unreadable, blinding mishmash that can take half an hour to download or cause my computer simply to freeze up in defeat. It's maddening to find cobwebs growing between my head and my screen as I wait for these obese kilobyte loads trying to squeeze through my pitiful little telephone wires.
Pornography is banned outright at MySpace (though simply following various profile threads can lead quickly to outside porn sites). But crudity, raunchiness, world-class vulgarity--cleavage and thong shots for women; spread-eagle, unzipped jeans shots (lots of pecs, delts, lats, abs showing) for men; fart, penis, and boob humor; aggressive in-your-face sexual posturing--seem to be one, if not the only, lingua franca at MySpace.
Still, for all their self-conscious 'tude and sexual mojo, some of the profiles seem to be case studies for dissociative disorder. The same hot babes and studs showing their stuff may also, on the same page, render with diabetically sweet cuteness apparently sincere homages to childhood innocence, religious faith, and family values. A typical profile of this genre--display name something like "SexiStacy"--showcases a 25- or 27-year-old bombshell, with numerous pictures of her busty, sultry, mostly unclad, heavily tattooed self, salacious visual animations and jokes, encomiums to her own sexual prowess, and . . . images of puppies and kittens, an appreciation of Harry Potter (lots of people's favorite books), loving tributes to her family, affirmations of her faith in God, and, finally, a photo of herself, her husband, and her two small children all beaming happily and wholesomely into the camera.
MySpace gives new meaning to the term all-inclusive. There are profiles of beach bums, ski bums, anarchists, Marxists, libertarians, free-market conservatives, social activists and committed do-nothings, car buffs, poetry lovers, and philosophers cheek and jowl with proud nonreaders and the barely literate. There are Christians, Buddhists, Jews, Sikhs, Hindus, atheists, agnostics, black people, white people, red people, yellow people, and all variant shades. There are the many profiles of very nice people in their 40s and beyond. "Sue," for example, from New Mexico, 62, mother of two adult children and the former owner, with her husband, of an RV park, loves country and western music, and just wants to make a few more friends.
There are, of course, millions of college kids on MySpace, probably doing what millions of college kids always have done--think, drink and party, not always in equal amounts. Take "Holden Caulfield," a 23-year-old college philosophy student, whose hero is his dad and who blogs about Aristotle's theory of scientific explanation, the nature of reality, and what it was like to stay drunk for 35 days straight. Or 19-year-old "J," a female college student in the UK. Her blog entry for March 27, 2006, cryptically but instructively reads: "si o im cquite drunke mrigth now,. no rmoe mo=dnay night ous forf me!!!!!" (Translation: I am quite drunk right now, no more Monday nights out for me!!!!!)
There are the ANA (anorexia) profiles, as well as anorexia groups and forums, featuring young women who post "thinspirations" to others of their religion--photos of impossibly thin models and of themselves posed to accentuate their concave stomachs, severely jutting hip and collar bones, skeletal rib cages, and sharply protruding vertebrae.
While I come across salespeople, marketers, truck drivers, engineers, firemen, military people, musicians, teachers, and the occasional "entrepreneur," I see no lawyers, scientists, or professors, though I'm sure there must be a few among the tens of millions. I do, however, come across many individual "profiles" of the same famous people--Brad Pitt, Sarah Jessica Parker, Tom Cruise, Renee Zellweger, Hillary Clinton, Condoleezza Rice (motto: "I'm running for DICTATOR"). There are 62 "Bill Clinton" profiles (motto of one: "Can I run again if I get a sex-change operation), several dozen of "George Bush" (sample motto: "Kill em all and let Haliburton sort it out"), 518 of "Jesus Christ," and 4,239 of "God" (another sample motto: "Lucifer is my homeboy.")
Many of these profiles are almost transcendently kitschy, utterly ridiculous, frequently funny (not always intentionally), strangely addictive, and clearly meant to knock your eyeballs out of your head. The plainer ones (like mine), which include no more than name, rank, and serial number so to speak, seem like pathetic little whimpers in this pulsating wilderness, with no real reason for being. The true MySpace profile is pure, exuberant, pull-out-the-stops performance, show biz at its brassiest, nearly reaching out from the screen to throttle you into paying attention. HERE I AM, DAMMIT! LOOK AT ME! LISTEN TO ME!
Which makes it all the odder that these laboriously constructed megawattage paeans to the personal uniqueness of the individual self borrow so much from the endlessly repeated, hackneyed, mass-produced artifacts of pop culture. Much of the space on any given homepage is taken up with lists--favorite pop bands, prime-time TV shows, blockbuster movies, big-board sports, fast foods, bestseller books. Their photos often look like homemade knockoffs of those in celebrity fanzines. Their blurbs might grace high-school yearbook pictures: "I'm outgoing, love to meet new people.....Kinda Shy, Fun, Friendly, Open Minded, Sociable, love to laugh, Dance, Eat, Drink, Laidback, Easygoing, not too picky, not too demanding, but WHAT girl DOESN"T like THE good THINGS in LIFE??"
And yet, beneath all these strangely anonymous, frequently adolescent (even in chronological grown-ups) self-presentations often lurk wrenching cries from the heart. A woman in her mid-twenties, with the display name "Love is a flame that can't be tamed," describes in her blog the excruciating details of her recent public humiliation by a man she has a crush on. Another profile--a girl who admits to being 13, "Lashes" (not her "real" display name)--plaintively opens her blog, "If you read this can you comment so that i know people hear me!" Thereafter follow two sad, even disturbing, blogs about her life: she hates her stepdad, she thinks her real dad hates her, she drinks a lot (Smirnoff), she worries about her sister who "moved in with my dad who is on speed and heroin and shes letting him watch my 2 year old nephew," she gets "closer every day to snaping because of the lies i have to tell my family," she "thinks about death a lot . . . for me." She seems like a small, lost kitten, and I wonder if I should turn her in for being underage--isn't she vulnerable to the peeping perps out there?--or write back or try and stage some sort of mental health intervention. I don't, but take some comfort from the fact that she has eight reasonable-sounding friends who've written nice things about her on her page.
Clearly, one of MySpace's main draws is its appeal to the joiner in all of us--the desire to belong, to be part of some kind of "in" crowd. MySpace has squared the circle by creating a site that celebrates both wide-open democracy and the illusion of "in-ness"--letting people belong to a private club that just happens to have nearly 82 million other members. Indeed, some people in various MySpace forums allude to the possibility that if you don't exist on MySpace, you don't really exist at all; if you aren't in here, you're really out.
But if the biggest product MySpace hawks is some sort of mass-produced, wildly attenuated dream or idyll of friendship, connection, tribal belonging, a cozy nest of buddies, or a huge fan base of admirers, how does the vision pan out in reality? It all depends. Shortly after joining MySpace, I find at my Yahoo address an invitation, with photo, from an attractive-looking young woman named, "Sarah," asking me to join her subgroup, "Face Buddies" (18,046 members when I join). Why don't I post on the topic, "Am I hot or not?" she asks. I don't think I'll post, Sarah--thanks just the same. But a lot of people do. The "hot or not" phenomenon seems to perfectly capture the crude, sexually hyped-up informality of pop culture--the cyber equivalent of a packed bar on Friday night--and not for the delicate of ego or faint of heart.
Can this ploy possibly connect people any better than the bar scene does? I notice, once I get to the subgroup, that many of those who did solicit an answer to this loaded question received no answer at all. There's something poignant about all these souls earnestly putting their photos and themselves out there before the MySpace multitudes, imploring judgements on their personal appeal, only to find nobody cares enough to even respond--the equivalent, I guess, of going to a wild party and standing there alone and ignored, while everyone else is getting it on around you.
Trolling further, I click on the photos of some of these anxious truthseekers whose "hot or not"question was posed in vain. In fact, behind their public expressions of either world-class bravado or yearning self-doubt, there's often a genuinely sad back story. "Reecemoney," for example, a smiling young black man, looking gently goofy wearing his billed cap sideways, admits defeat right away, titling his "hot or not" post, "I know I'm not hot." He then writes in his message, "But am I at least cute?" This appeals to me and I click on his photo, which takes me to his full profile. There he writes that he's a "chilled out person that just likes to have fun . . . a relaxed type person . . . that's willing to try anything new and just have fun. . . ." But, "fun" doesn't seem to be the real message, as he continues to write that he's very religious, doesn't "do every woman I see," and confesses that, next to Jesus, he'd like to meet his daughter, Brianna--"she passed away during delivery and her mom (my-ex) didn't call me at work to inform me what happened until everything was said and done and so all i have left of her is a picture and a half of her baby hat. Don't worry I will meet you one day precious. . . ." I want to e-mail Reecemoney and tell him, "Forget about ´hot or not,' Reece. Get out in the real world, get more involved with your church, have your minister introduce you to a nice woman, settle down, raise a family."
On the far extreme from pathos, the "hot or not" group evokes this more or less typical internet exchange among the radically unthoughtful, inarticulate young. In a group titled "Is Ashley hot?" led by Ashley herself, 16 (whose user name is spelled, "^@$h!vr0$vv"--the "vr" are little heart and spade icons in the original). The first message is posted by "Mark," who presumably knows her. The exchange, somewhat redacted, goes like this:
"Mark": if u think she is hot just say yes under this. thank u.
"^$!vr0$vv": she's not!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!woohoo!!!!!!!!!!!!!!
(Ashley herself): hahahahahahahahahah jk [just kidding] im just to hot for everyone
"Mark": - ash hole u r way hot and im not just saying that I want to do u lol jk im not laughing.
"Kay_lin: - she's bangable if that's what your asking . . .
hot . . .
Then, Jimmy comes back, writing, "that jimmy kid Wrote," followed by a reprise of his earlier "SHIT" chorus and the statement: "i don't know no why i wrote that" Neither do I, for sure.
I find this kind of thing appalling, but also weirdly appealing, like an absurdist, comic poem, even if all it really reveals is the severely underutilized teenage brain. True, a little of it goes a long way. But, absurdism in the more or less conscious existential sense, as well as a great deal of unconscious absurdity, are big players in MySpace, particularly among the thousands of various forums and groups. In one high-minded and densely packed discussion about political philosophy among several people in their twenties and thirties, one free soul, obviously bored with the ponderousness of it all, broke in with this little impromptu, not entirely nonsensical, riff:
"Capitalism? Nationalism? Imperialism? Libertarianism!
Capital? National? Imperial? Libertarian!
CA? NA? IM? LI?
Make the right choice(s)."
To which another participant responded: "That was a beautifully cryptic rant. I feel like falling into a sheep-like trance and donating all my worldly goods to you. Possibly even investing them in any pyramid schemes you have."
If this doesn't race your motor, you have hundreds of thousands of other individual groups and forums to choose from. Some of those have thousands of members; many only a few, or perhaps only one lonely member, who tried and failed to get a conversation started. There are also many groups whose membership is recorded in minus numbers, whatever that means. There are what you might call "normal" groups like "American Civil War Re-enactors, "Dancers and Choreographers," "Conservation, Biodiversity and the Environment." There are more off-beat groups--"!Tatooed and Pierced! (18,660 members), "punk parents and punklings," "Magazines don't count as reading." And then there are those that are frankly strange--"Obscure Ramblings of a Mindless Woman" (one member listed), "God hates Jim Cult," and "Army of Bob" (with -27 members).
Within these groups and forums, there seems to be a huge amount of imbecilic dreck, but also some intelligent, thoughtful, and serious exchanges. Flaming is an ever-present possibility, as it is in any online chat room or forum. One discussion about ancient Persia that began reason- ably enough with slides of ancient Persepolis quickly degenerated into an insult-hurling, obscenity-spewing screaming match about the exact location of the old borders between Iran and Iraq. And the screamers aren't entirely anonymous--you can simply click on their profile, see their photos, the names of their towns, the photos of their kids and puppies or neo-Nazi support group, as the case may be, read their blogs, and generally get some sense of how they see themselves, whether any of it has anything to do with reality or not.
What does it all mean? Is MySpace a fabulous thing, as tens of millions of members appear to think (not to mention Rupert Murdoch)? Is it a terrible thing because it's so easy for underage kids to fake their ages, slip by the various safeguards MySpace has in place, and leave themselves open to online sexual predators? (I wonder why people don't seem more concerned about what MySpace is doing to American literacy--if grammar and spelling on MySpace are any indication, the nation's educational system is in much, much worse shape than we thought.) Even though there are rules in place for members--against porn, hate speech, harassment, violence, spam, commercial activities, providing personal contact information, and so forth--the sheer size of MySpace and the fact that it doesn't prescreen content means that probably almost anyone or anything can get online there for virtually any purpose, whether legal, illegal, sublime, or satanic, at least for a while until found and deleted.
While MySpace may seem to some critics the epitome of vicious excess and unbridled, civilization-destroying license, there are plenty of MySpacers darkly convinced that the site is already falling victim to the tyranny of encroaching censorship. One member, "copyright," in his group, "MySpace is the Trojan Horse of Internet Censorship," muttered that Rupert Murdoch's takeover was all part of a plot to turn the Internet "into a mass surveillance database and marketing tool."(Actually, that doesn't sound farfetched at all.) Another, "Purveyor of Truth,"complained vehemently in a forum and in his own profile that MySpace had taken down his anti-immigration postings for alleged racism. He denied the racism charge and then printed in large, red type, "FUCK YOU MYSPACE NAZIS," thereby demonstrating, I guess, that the MySpace administrators still know the difference between "offending speech" and a temper tantrum.
But as in so many areas, the bad news is also the good news. For all its nastiness, vulgarity, commercialism, potential danger, and mind-bending dumbness, there's a vast, untrammeled sense of exuberant freedom about MySpace, imperfect as that freedom may be. Like the internet in general, it offers opportunities for people to express themselves, to make and remake themselves, to say their piece, in ways never experienced before in human history. In a subgroup of "Existential Phenome-nological Psychology," called "MySpace, shifting identities, fictional truth," a 49-year-old woman, whose display name is "Stephanie," said it well. "Identities are created, masquerade is the name of the game, fictions are woven and believed by others . . . there are at least 3 Patti Smiths, pages hosted by the dead, men and women over 100 years old, celebrity lures, conjurers of cool, and lecherous fools. . . . the territory of the self expands as far as the imagination is able to generate images, stories, wisps of identity, likes and dislikes. . . . Free from corporality, I can be anyone or anything I want. Radical freedom? Do we have a responsibility to present the truth[?] I don't think we do as the ultimate creators and destroyers of values, selves, gods, worlds. What do you think?"
And, of course, to her last question, she got plenty of online answers.
Mary Sykes Wylie, Ph.D., is senior editor of the Psychotherapy Networker .
by Ron Taffel
For decades before and after World War II, children all over the United States hung out, had slumber parties, made crank phone calls, and played sports unsupervised. They didn't need the help of adults to set up play dates or hand out certificates of participation. As we know all too well by now, we no longer live in that world. What's less apparent is that, despite the appearance of greater parental involvement and psychological sophistication, most adults are just as clueless about the "second family" of their children's peer group and adolescent pop culture as they ever were.
A fundamental psychological shift further separates the experience of today's children from that of previous generations. Decades ago, most kids carried parents around inside, whether they wanted to or not. Through endless channels, parents constituted a deeply felt, internal presence, however neurotic and oppressive it might sometimes have been. But what I encounter again and again in my practice is the startling reality that many parents have become psychically extruded from the inner lives of their children. While helicopter dads and soccer moms have become more and more adept at managing the logistical challenges of 20th-century family life, they're often too frenetically busy to exert an emotionally magnetic presence in the internal landscape of a child's world.
Increasingly, kids feel the fabric of connection tearing. From an early age, they've learned that most of the time they spend with their families could best be described by the old movie line "Hello, I must be going!" They "get" that life with mom or dad is a series of transitions, interrupted conversations, and moments hurried along so that the next activity can go on as planned.
But obvious overscheduling and invisible disconnection from parents is only part of what's changed. While at first glance, 21st-century adolescents appear impossibly cool--cooler than we could have ever been ourselves--teens today are running hot. They're not just hormonally hot, but hot with cultural forces that have redefined the nature of their consciousness and experience of selfhood. Millennium kids live in a context that spawns fragmentation, what I call a "divided-self" experience: cool and often cruel on the surface, they hide surprisingly healthy passions beneath.
The Fast and the Furious
Most of the kids I see are buried under a crazy quilt of digital connections every single moment of every single night. A typical evening can be spent on the computer engaging in five online discussions at once, talking on a cell phone while waiting those interminable nanoseconds for a response, listening to a burned CD, with a TV on in the background, and, naturally, focusing on homework at the same time.
"Hey mom, don't get all unhinged, can't you see I'm doing my work!!!" yells 12-year-old John, looking very cool as he effortlessly moves from one screen to another. But talk to John the next day and he's depleted by his conversations of the night before. Trying to return every instant message, he's gotten into several arguments with friends that'll need to be tackled throughout the schoolday. It happened so fast, John doesn't really know what hit him.
Thirteen-year-old Dawn says to me: "We were hanging out in the schoolyard. All of a sudden, Perry started screaming at me. She said I was obviously bi,' my best friend is a man-whore,' and, anyway, how could anyone want to be friends with a slut like me?"
"Did anything go on just before, between you?" I ask.
"No. It came out of nowhere. But this is what happens all the time. Don't you know that, Dr. Taffel?"
I do know. Every day in my practice, I hear about such sudden bursts of unmediated anger or acting out. While parents do logistical somersaults on the margins of connection, their children surf down the slopes of media-stimulated consciousness, habitually split off from their own feelings. When emotions do cross the divide into awareness, the experience is often jarring and white hot. With a hundred friends bumping into each other on MySpace or e-mailing each other on AIM, all of a sudden, some spaghetti of interpersonal energy sticks to the wall and splatters everyone around.
Listen to the dialogue between 21st-century kids and you can't help but be affected by split-second shifts from cool-sounding inanities--"wazzup, g2g, lol"--to hair-raising accusations and eruptions of raw bile, seemingly coming out of nowhere. Self-regulation or even an awareness of their easily triggered emotions isn't the strong suit of a "just do it" generation outfitted with cool fiber-circuitry that transmits instantaneous heat.
Sex and the Great Divide
Sex play is another way that 21st-century kids experience the divide with their deeper emotions. Casual sex is no longer reserved for "bad" girls and boys. Elementary and middle-school kids show me astonishingly graphic text messages every day. In city and suburban neighborhoods, middle-school "cum parties" are a weekend occurrence, the meaning of which needs no explanation. "Rainbow contests," however, might require clarification: girls wear different color lip gloss, and the boy who ends up with the most colors on his penis is declared the winner. "HJ" is a commonly used elementary and middle-school term for hand-job, which is replacing quaint bumping and grinding on the dance floor. Same-sex permutations--with girls experimenting with the "L word" (for teen boys, homophobia is more rampant than I've ever seen)--are becoming a common rite of passage, again with no relationship necessary. Sexual encounters are frequently recorded and blogged, making a once-intimate experience into mass-marketed public property.
As disconcerting as all this may be, the combination of impulsiveness and emotional flatness with which many 21st-century kids express their sexuality makes a great deal of sense. Girls feel freer to be casually active if they can avoid removing their clothes and publicly revealing a far-from-thin-enough body. Commitment-shy kids loaded down with anxieties about "safe sex" flock to instant action that requires no clumsy, time-consuming protection. And the increased use of SSRIs among teens may inadvertently disconnect sexual drive from passion, just as it does with many adults. Regardless of exact cause, the result is the same: more teens doing more kinds of sex at earlier ages, but without the deep-down, desperate yearning we often equate with adolescence.
Good Night and Good Luck
Hundreds of parents have told me how their teenagers go to sleep: they need mom or dad lying by their sides or they stay online under the sheets, with cell phones nestled on their chests or watching TV with a buddy miles away. "It seems like my kids have no ability to amuse themselves, even for a few moments," says one discouraged parent after another.
Kids are divided not only from their emotions (until they're engulfed by them), they're often split off from their internal fantasy lives. Imagination mediates and regulates emotional experience. But why should 21st-century children even need an internal world of self-soothing or self-stimulating fantasies? After all, from the second they get up until late in the evening, kids have an endless stream of readymade, fantasy-rich, interactive images to play with.
This is one of the simple but unarticulated reasons that many parents have such trouble getting 21st-century kids to go to bed at night. From the moment kids put down their heads, they don't know what to do with themselves. They're bored. This is the first time all day that they've had to endure a moment without external stimulation to fill their minds and fuel their fantasies
The End of History
Some years ago, after gazing at far too many blank faces, I stopped asking children in initial interviews: "So where do your parents and grandparents come from?" I don't know why I hung on for so long, except that decades ago, my supervisors had instilled in me the belief that drawing a genogram was a sacred rite of the consulting room.
Parents aren't just far off in the sense of harried daily connection. They're far away in terms of their own children's knowing any deep background about them. Knowledge of family history caused a lot of heat between previous generations. Many of us vehemently disagreed with our parents politically. We heard endless oral histories of their adventures ("Please, not that story again!!!"). And we may have expended enormous energy trying to get away from their oppressive authority or dysfunction. But there was at least a nascent understanding of who they were and where they came from; for better or worse, their life struggles had historical depth.
Except for that random first- or second-grade assignment to "interview" parents, most kids haven't got a clue as to their roots, and parents are so used to their own historical irrelevance they hardly even notice. Generally, kids have no more interest in the history of their family than they seem to have in the history of the world, if declining scores in this academic area are an accurate indicator. The distant past is yesterday or last week, especially for teens. This gives kids little understanding of who they are from a longitudinal perspective, making it more difficult for them to maintain a coherent sense of self within the moment-to-moment shape-shifting that's so natural to them today.
Ask kids what their parents do for a living and they'll most likely mention job titles they don't understand. The majority of kids today haven't got the foggiest idea of what their parents do that enables them to afford the iPod, mp3 player, and cell phone their children so crave. This isn't because 21st-century kids are craven and selfish. It's a superficiality fostered by the abstractions of modern living, as well as by the misguided attempts of many enlightened parents, at all ends of the socioeconomic spectrum, not to burden their children with knowledge about what's required to earn a living. Instilling deep gratitude for the efforts made by the adults who provide for them has been sacrificed to a widespread fear of inflicting pathological guilt on children--the great bugaboo of modern-day parenting. This leaves children disconnected not only from their parents' common work struggles, but also from the perseverance and determination that daily survival requires.
The Loss of Passion
It's sometimes been almost unbearable for me to realize how scary it is for many kids to reach down and connect to an idiosyncratic passion that might separate them from the crowd. With a constant eye on pop culture, kids of all ages are "scared straight" into cultivating a veneer--to dress right, get the right stuff, and become voracious consumers. They're seduced into worshipping physical perfection; to create at all costs, a flawless body "to die for." They're slowly intimidated out of talking about internal experience, which would be soothing, and instead dispense the hollow wisdom or cruel wit of mass-market psychobabble. They're increasingly bullied by national legislation to measure up on standardized tests, from preschool through high school, often without understanding the material and without acquiring a love of learning.
The real teen secrets I learn about in therapy aren't about sex, drugs, or rock 'n' roll, which are often already "blogged" in cyberspace. They're about nonpop-culture passions: secret journals, drawings, and art that no one has seen, or a stash of fantasy stories.
The kid culture itself has defined passion--to be enthusiastic about some activity or topic--as uncool. Kids with idiosyncratic passions are widely portrayed as geeks, and are rarely found in the popular crowd. The Johnson Institute followed thousands of children and found that they tend to give up personal interests during the transition between elementary and middle school. Kid-cool is often a facade hiding interests left behind--passion that can't be expressed.
When looked at in this way, some of teens' most troubling behaviors become more understandable. What do kids do in the often persecutory, competitive world of the 21st century as a result of being divided from themselves? Well, they demand from insecure parents endless supplies, with a sense of entitlement so unmodulated, it can be breathtaking. They diss and humiliate without much warning or empathic care for their impact on the other. They try to break through to internal numbness with the heat of binge-drinking--10 drinks ("pregaming" as it's called) aren't unusual before the evening begins. They push their estranged body-as-commodity to raging excess: starving, purging, and criticizing themselves mercilessly. They cut--carving up an arm or leg while expressing an anger so submerged it isn't even felt. They gleefully submit to tattoos: imagination and internal imagery writ large for the world to see. They pierce--a searing penetration toward the inside core that simultaneously makes a hard-edged statement of cool to the ever-watchful eye of the peer group and the pop culture.
Strategies for Breaking Through
Our job as helping professionals, then, is daunting but within our reach. It's to feel the passion beneath the cool, to recognize how split off 21st-century kids are from themselves, and to understand that therapy with adolescents needs to change fundamentally. We may not have the power to alter the techno-pop culture that defines so much of teen experience today, but by focusing treatment squarely on how to engage adolescents in a vital relationship, we can make an enormous difference in their lives.
If we can truly connect with the children we work with, the impact can be infectious, spreading outside the office and helping to heal the inner divide that keeps them cut off from themselves and others. To engage these 21st-century kids, though, we must go far beyond what we were officially trained to do and move closer to what we secretly say and do, often beyond the gaze of supervisors and even our colleagues.
Working with teens is difficult enough, but we're too often our own worst enemies in the treatment room. For starters, the blandly modulated tone of therapist-speak is destined to make even the most well-meaning practitioner shrink into a tiny speck on the multiplex screen of an adolescent's mind. To put it bluntly, most models make us way too boring to be noticed by a generation in love with special effects, let alone remembered once they leave our offices. With adolescents, the "edge of relatedness," as psychoanalyst Darlene Ehrenberg calls it--the place where two people feel and touch each other emotionally--must be particularly edgy for them to even register your presence.
Our training too often works against this, smoothing out our edges, inhibiting our genuine reactions to the outrageous stories we hear from teens every day in our practice. For instance, Peter is planning a date in an abandoned garage with a complete stranger he met in cyberspace. Theo, who's 10, is teased relentlessly for being "gay." Louis and friends regularly smoke pot in the bathroom at his middle school, next to kids who purge themselves as a group activity.
It would seem impossible not to react to descriptions of such activities with a full range of feelings: outrage, sadness, shock, fear, relief, and so on. Yet, most of us are constrained by our training from expressing edgy feelings to clients. To stay three-dimensional and get kids' attention, however, you must go against those invisible constraints and in a responsible way--using your own beliefs, style, and words--respond in a fashion your teen client absolutely can't miss. Anything less is just static in a gigahertz, high-tech world. For most of us, learning to respond in a real manner to today's teens means engaging first in a quick, internal dialogue between what we feel like saying and the voice of our therapy training.
When Peter first told me about his online dating scheme to meet someone in an abandoned garage, I yelled (silently berating myself for worrying too much), "Are you out of your mind?!" To Louis, who smoked up in his middle school, I instinctively commented (though not without hesitating several moments), "Are you trying to drive me insane?" To Ernie, who told me that he really liked a girl and that every adult he knew had warned him that high school relationships are doomed, I said in a hushed voice (all the while concerned about the intensity of this message), "With all my heart, I believe there's a chance for you and Chloe to make it. It really is possible."
The words aren't unusual; it's the strength of the emotions they carry that's important. But regardless of differing approaches, we consistently flatten our feelings because we consider them unprofessional or nontherapeutic. Yet, in every one of these situations, I finally got kids to hear me.
Sometimes words, no matter how dramatic, aren't enough, though. In this hyperkinetic world, physical movement loosens lips and is often necessary to get kids' attention. Again, treatment constraints make this easier to say than do--most of us are "participant-observers," stuck on our own clinical thrones.
It took me almost two decades to get up from my chair and out of the constricting habits of my practice. I was working with a withdrawn, young adolescent girl, Lisa, who mumbled the few words she said. Failing in school, she was diagnosed as ADD, oppositional, and selectively mute. Partly to prevent myself from going mad, I suggested that we walk around the room a bit, just to shake things up a little. I thought maybe our stuck psychical positions might be loosened by a physical change.
Lisa liked the idea, and I found myself trailing behind her with my notebook. She'd mumble and I'd yell, "What? What did you say?" The more I yelled as I walked behind her, the more she began to laugh and yell back at me. This ambling approach to therapy made a far greater impression on me than on Lisa, who took to it naturally, as have dozens of other kids with whom I now move about the office, as if we are on a psychological road trip.
Many times I've gotten across my feelings by leaving the consulting room--another therapy taboo. When Brian repeatedly told me, with a grin on his face, about prank-calling older people, I said: "Brian, you seem unable to think about the effect you're having on these people. You know what? This sickens me a little; I have to take a break from you for a minute." When I returned a few minutes later, Brian was finally willing to talk about the mean way he often treated his parents and friends.
Humor, a therapeutic tool mostly unexplored in clinical training, can provide a lightning bolt of connection to sophisticated 21st-century teens. Given the endless menu of cartoon comedy-- The Simpsons, Family Guy, South Park --and the everyday banter of adolescent life, it's a wonder that we do not get how necessary this is to create engagement that leads somewhere. Fourteen-year-old Adam came to his therapy session with a glum look. Rudderless much of the time and an aficionado of nonstop television, he looked even flatter than usual, and with good reason--he'd just returned from the doctor, who'd said that one testicle was enlarged. Fearing the worst, we proceeded aimlessly through the session until I wondered out loud ( Should a therapist be joking about this, I thought? ) whether an enlarged testicle might require a change in his TV-viewing habits. Maybe he'd need to switch to a new kind of couch, with a cutout section so he'd feel more comfortable. Instead of getting angry, Adam seized on this and began to speculate that he might soon require a wheelbarrow to move through the wide hallways of his suburban school, or even might need to call ahead to announce his arrival. I joined in and we were off to the races, with Adam jumping up and down, doing improv about how everyday living might be affected by this new challenge--routines that had us both rolling on the floor.
The crisis passed, thankfully with no health consequences, but the stand-up part of our sessions became a connecting ritual--a means for Adam to start expressing his feelings about his lack of popularity at school and discomfort at home. While discussing serious issues, we continued to make each other laugh, and the pleasure he got from his hysterical impersonations of celebrities and everyone in his life, including me, ultimately led him to seek out roles in his town's theater group--no small step for a coarse, pop-obsessed adolescent. Adam still needed to learn the boundary between humor and empathy, especially with friends and parents, but the jokes that punctuated our sessions helped break through his emotional divide.
The sanctity of session length is another artificial encumbrance that works against kids' ability to hear. Teen consciousness is so fragmented that it's simply grandiose to believe they remember a thing we say even two minutes after our most "important" pronouncements. So, if you're trying to make a point you don't want to get lost, why stick to the sacrosanct 45- to 50-minute session? As long as we fill out insurance and agency forms accurately, charge less, or make up the lost time, there's nothing inviolate about the "treatment hour." Especially with teens, cutting the session short to let a comment sink in or lengthening it to let a situation play out, helps grab their attention.
Aiden, a 16-year-old, was stuck on the notion that his girlfriend had to give him oral sex. If she didn't, it meant she really didn't care about him. More important, he was not getting what he thought every other guy was getting, casually or from girlfriends. "If she's not going to give me head, I'll break up with her!" he kept saying. He simply couldn't get past this thought, and his already damaged self-esteem was plummeting.
I let Aiden know that, although I understood, his wish was the exact opposite of what was involved in becoming a man. The debate became very heated, but I wasn't worried about the fireworks. I wanted one message to get through: that Aiden needed to go for an entire weekend without turning oral sex into a huge fight with his girlfriend.
Every aspect of creating engagement described here became part of this session--I was emotionally expressive about my beliefs, we moved around the room a lot as we talked, I left twice to get my bearings, we yelled at each other, and we joked around. Finally, I moved closer, sat on the floor, and spoke to Aiden very, very quietly. At last, he seemed to "get" how this artificial pressure was impacting him and his girlfriend. I immediately stopped the session. I didn't want this hard-won insight to be buried by the next inevitable distraction.
Instead of finishing the session, we scheduled a 15-minute meeting before the weekend, so we could discuss the importance of this decision again. To my surprise, I found out at the brief follow-up that Aiden had just talked to his father about sex for the first time ever, initiating an essential adult connection that helped him navigate the high-risk teen choices that came up every day for years.
The Fascination of Boring Detail
Creating genuine engagement with teens often requires paying attention to exactly the kind of mindless detail we've been taught to think of as "avoidance." But in work with adolescents, the nitty-gritty nonsense of everyday life is the most direct pathway to a meaningful connection. "I can't believe you're interested in this stuff," one teen after another remarks to me. Even though I've learned the clinical value of the most seemingly trivial conversation, it took every bit of faith in this viewpoint to stick with the following interaction.
Amanda, a 14-year-old told me, "I just hung out this weekend. Maggie snuck out in this really cool black tank top. Her parents haven't seen it. And Alice wore these new pants, like around her hips, with a big belt."
Restraining myself from moving toward significant issues, I said, "What about you? What did you wear?"
"I had on these new shoes. I have them on today. You wanna see them?"
I fought my impatience with this clinical dead-end as Amanda displayed her new shoes, pointing out their various features--color, the height of the heel, the special laces.
Far from being the neutral observer, I reacted to each aspect she remarked on, ending with the shallowest observation I could muster, "It sounds like you guys wanted to look pretty good."
"Yeah, there's this new girl," Amanda responded. "Kelly. She's a real bitch. All the guys like her."
Instead of asking, "How do you feel about this new girl?" I remained just as deeply grounded in the superficial, replying, "Oh. Who else was there?"
Amanda mentioned a few of the boys.
Reigning myself in from the inevitable therapeutic query about feelings, I stooped to: "So what was everybody else wearing?"
To my surprise, Amanda perked up even more and said, "Well just about everybody had on stuff that showed off their tattoos and piercings, because that's what Kelly's into. She's got a few that her parents don't even have a clue about. Her mom knows about her belly-button ring, but Kelly's also got her nipple pierced."
Now I was in a real clinical dilemma: I could barely resist the temptation to explore the therapeutic gold of mother-daughter relationships, secrets, etc. But I held firm and stuck to the trivial, asking, "So where did you guys go?"
We continued on this road to nowhere, discussing the mall, its new stores, and which tattoos Amanda thought were the best. Spurred on by my unflagging interest in the details most adults shut off, Amanda unexpectedly opened up about a serious decision. "Well, there's one tattoo I was thinking of. I'd get it on my hip. It's really small and my mom would never see it, because, even if I was wearing a thong, it couldn't really be seen."
I veered once again from inquiring about thoughts or feelings and instead asked Amanda to describe the tattoo.
All of a sudden the discussion, which I'd certainly have kept a secret from that imaginary supervisor on my shoulder, took a turn. Amanda said, "But just when I was about to do it, I got in a fight with Maggie. She said I was being a poser, and I was getting a tattoo just because Kelly is now the queen and I'm trying to be like her." Amanda then added, "The big thing is she had her tongue pierced."
Finally, my first traditional therapeutic response: "Do you think that's a good idea, this tongue piercing?"
Amanda was then eager to talk. "Well, she can do it, but I'm scared. For her, it's all about hooking up. The boys really like it. But I'm just not ready for that, I don't think, so I'm just going to go for the tattoo instead."
We were now engaged at a very different level. In a not-so-subtle nod to her motivation I asked, "Are you going for the tattoo to look better, so you can find someone to hook up with, or to pose? Maybe Maggie was right. What's the tattoo for?"
"I don't know," Amanda sadly replied. "I have to think about what Maggie said. I don't know if I'm just doing it so Kelly will let me in. She's got everybody else . . . it feels like I don't have the friends I used to."
"You're right," I responded, genuinely moved. "Who don't you have anymore? Who's gone?"
The talk had moved from the truly trivial--malls, clothes, and shoes--to tattoos, hooking up, connections with other kids, and all the way to issues of abandonment and betrayal. It turned out that what was really disturbing Amanda was the friends she'd lost. Over the next two weeks, the core of our work became everyone who'd moved into a tight circle around Kelly, leaving Amanda behind. Our discussions then began to center on her losses in general, and the decisions she needed to make about how to stay true to herself.
We need to challenge another barrier to engagement, opening the walls of therapy to the superficialities of teen life--e-mails, video games, music, magazines, photographs, and television. If dreams were the royal road to the unconscious according to Freud, pop culture pursuits are the road to the split-off inner world of today's teens. By inviting their interests into therapy, you create a theme for sessions and set the stage for the development of real engagement that can lead to passion and depth.
Juliet was 14 when I first met her. She was dealing with an affective/anxiety disorder. Being physically magnetic and haughtily cool, she was a lightning rod for her small-town teen drama and gossip. At the same time, she was angrily fixated on the popularity pecking order; enough so that she "delicately" cut herself to alleviate her emptiness and despondency.
After I encouraged her to do so several times, Juliet arrived with printouts of recent e-mail arguments. It was clear to me at once how well she was able to express herself in writing. As we pored over these e-mails, I reacted to the style as well as the content of her communications, and writing became a theme of our relationship. Against my better clinical judgment, we read articles from pop magazines. Soon I learned that these stories reminded Juliet of her friends' secret issues, as well as her own. Then, she began bringing in her friends to meet me; secondhand written descriptions had turned into three-dimensional people about whom I could now truly engage.
As writing moved from a hidden to a central pursuit, Juliet joined the school newspaper, focusing on real-life adolescent issues "that adults had better face." She didn't immediately become a model teenager; she went through years of frightening ups and downs as she learned how to regulate her sharply shifting moods. But throughout the bumpy process, writing became the vehicle for containing her emotions and expressing her previously buried, true self.
Another incorrect notion that ties up clinicians and parents is that unconditional love means accepting everything teens say, or their self-esteem will suffer a profound injury. Quite the contrary, healing engagement requires that teens emerge from their self-centered world and learn what it means to empathize with adults. Although this is a reversal from the mantra of post-World War II childrearing and treatment, decades ago, psychoanalyst D. W. Winnicott stated that empathy toward adults (moving beyond blame of one parents) was a sign of maturity.
The psychological establishment has recognized Winnicott's wisdom, but mostly in a horizontal direction. Schools focus on peer-to-peer empathy--a major component of anti-bully programs and social-emotional modules. However, they still largely ignore the idea of empathy toward therapists or parents. Seeing the adults around them as alien, two-dimensional beings without feelings leaves kids feeling mean and out of control, oblivious to the hurtful impact of their words and actions. The therapeutic relationship is an opportunity to create empathic engagement, which is also a means for teens to recognize their own buried humanity and passion.
Sixteen-year-old Mike's "me-first" behavior got him into trouble every day, reaching a climax as graduation from middle school increased his usual self-preoccupation. He wanted the celebration to be held in his home. His mother initially agreed, but as the day got closer, she started freaking out about having so many people in her small house. She began talking about renting a cheap space in a nearby community center--which infuriated Mike because he was afraid his friends wouldn't think it was cool enough.
In our meeting, I told Mike that I agreed with his mother. Not unexpectedly, he howled about the unfairness of it all.
But then I shifted the focus, surprising myself by saying, "I want you to understand what graduation felt like from my side."
Mike considered this a violation of 21st-century teen rights. "What about my side. You're not getting it!"
I responded with unexpected intensity, "I do understand. I was so self-conscious about how I looked to my friends that I didn't even want pictures taken at my graduation. But I lost that one, just like you're going to lose this one, too."
Mike responded: "That's totally different. You can rip up pictures afterwards. I'll have these memories my whole life."
"Look," I insisted, "I want you to try to see it from my perspective; what it felt like for me." And here's where I really moved away from the training I still hold sacred: "Hey, it's never just about your feelings. In here, mine count, too!"
Around and around we went for the entire session. But the focus was now entirely different; we'd made a drastic U-turn, so Mike might empathize with me and how self-conscious I'd felt as an adolescent. After we parted, I was filled with doubt about this change of therapeutic direction. A couple of days later, I received a surprising call from Mike's mother. "I don't know what you did," she said, "but for the first time, Mike let me explain how frightened I was; that I just couldn't handle this party at home. He didn't agree to the other location, but at least he tried to hear me."
No wave of emotional intelligence swept over Mike; we continued to struggle as I worked to get him to treat me and others more empathically. But this episode created a beginning awareness that he wasn't the absolute the center of the world and was the start of his slow crawl out of the loser-outcast group.
My father died when I was 22--still an adolescent in today's terms. His passing was so sudden that I went cold, so numb I didn't shed a tear. One night several months after his death, I dreamt about him. "Ronnie," he said to me, "do you remember when I sculpted circus animals for you?" He reached out with his hand, tenderly giving me the soft clay it held. I could see his heart in his eyes, and I touched his face. I woke up in tears, and continued to cry every morning for months after.
The next day, I bought some clay and began sculpting. Two months later, I fell in love for the first time, with a girl who mysteriously came over to me offering a sip from a container of milk. The sudden connection I experienced in that dream and the burst of creativity that followed were no accident. It's also no accident that the vast majority of kids I engage in the ways I've described here fall in love for the first time or discover an enduring passion.
Engagement is the essence of what we must create in therapy. These fragmented times call for nothing less than consulting rooms filled with life. Although overcoming the constraints in our treatment approaches isn't a simple matter, it's clear to me that no treatment model--whether psychodynamic, systemic, cognitive, dialectic-behavioral, or goal directed--can long ignore the human engagement our kids so desperately need.
We can help adolescents to heal. Without even knowing it, super-cool 21st-century teens are waiting to discover the genuine heat of their own inner lives--yearning to feel the heart and passion just beyond the divide.
Ron Taffel, Ph.D., is chairman of the board of the Institute for Contemporary Psychotherapy in New York. He's author of Breaking Through to Teens: Psychotherapy for the New Adolescence and The Second Family: How Adolescent Power Is Challenging the American Family . Contact: firstname.lastname@example.org. Letters to the Editor about this article may be e-mailed to email@example.com