When his family was referred to me, 13-year-old Jimmy was on the verge of being expelled from eighth grade because of his obvious, but heatedly denied, pot-smoking habit. Almost worse, according to his horrified parents, he intended to make the ultimate fashion statement by having his ear, eyebrow and lip all pierced and various items of punk jewelry inserted. Jimmy's parents seemed to agree with the unanimous diagnosis presented by his various therapists and counselors. The boy's problems, they had all said, could be traced to classically dysfunctional family dynamics: father was distant and insufficiently involved with his son, mother tended to be overindulgent and intrusive. Together, they had not set enough rules and limits for the boy's behavior. In short, Jimmy suffered from an archetypal inadequacy in the family hierarchy.
Jimmy's father acknowledged that he had not had much of a relationship with his son since the boy's early childhood, and his mother admitted that he had been "emotionally spoiled" she had gone back to work when he was a toddler and was always guiltily trying to make up for lost time with him. When Jimmy was a young child, mom said, he used to confide in her, but, since the age of 8 or 9, he had gradually been moving out of her orbit. During the last couple of years, she didn't think he'd said five words to her that weren't requests to buy him something, give him money or grant a new privilege. When Jimmy and I met, he was pleasantly uncommunicative neither loudly belligerent nor silently sullen. He answered questions politely, but with maddening vagueness, as if he were talking to a slightly less intelligent life form from a distant world.
Since Jimmy had grown disengaged from his parents some time ago, I asked who had been the significant adults in his life, his role models, confidants, friends or advisers. It soon became obvious that Jimmy hadn't experienced any significant connection with a grownup including his parents since middle childhood. Beginning in about the third or fourth grade, he had almost completely drifted away from the adult world into the closed society of the kid pop culture communing mostly with his TV; Nintendo, Sega Genesis, CDs and "action" comic books. Friends came to hang out none of whom his parents truly knew, except for brief sightings as the kids slunk from front door to Jimmy's inner sanctum and out again.
The other therapists had been partially correct there was no meaningful authority or hierarchy in Jimmy's family. More to the point, however, there was little significant connection in the family. Insidiously, without his parents quite noticing, Jimmy had, over the years, been completely engulfed by a voracious, commercially driven youth culture. Beginning in preadolescence and certainly by now, the "second" family of his peers had, in fact, become his primary family, the one that really mattered to him.
Unquestionably, Jimmy's parents needed help there were no rules in the family but there was little they could do in the way of good parenting as long as they lived in such separate worlds. And of what use would classic family therapy interventions be when the fundamental assumption upon which they were based the parents' central importance to the child's life hadn't been true for quite some time?
When it comes to millions of kids like Jimmy, family therapy has not kept pace with several decades of massive social upheaval. The world of an adolescent is now so powerfully defined by systemic forces other than home the peer network, pop culture, school and neighborhood ethos that working with the family alone is rarely powerful enough to effect change in the life of a troubled teenager. This "second family" of peers and pop culture has developed such force it is time to publicly acknowledge what many therapists have privately long understood. As we move into the 21st century, there is compelling evidence of the need to significantly redefine how family therapists work with adolescents and children.
Today, the disintegration of the first family, for decades bleakly apparent in urban populations, has finally become palpable at all socioeconomic levels. Trends begun in the '70s have dissipated the gravitational force of the first family. Jimmy is not an unusual case. As we all recognize by now, divorce (50 percent of marriages), mobility (up to 20 percent of the population moves every year) and economic pressures that generally require both spouses to work ever-longer hours have undermined the old stability of the family. The "traditional" configuration of male breadwinner and wife at home fits only 11 percent of today's households. Time-squeezed parents even in intact, dual-earning families have few moments to spend with their children. MIT economics professor Lester C. Thurow wrote in The New York Times last fall that parents now spend 40 percent less time with their children than they did 30 years ago, and 2 million children under 13 have no adult supervision either before or after school.
Furthermore, the family's informal support systems the extended kin networks, church and community organizations, PTAs and neighborhood ties that buttressed family life have gradually disintegrated. For example, PTA membership since 1964 has fallen from 12 to 7 million. And while Main Street, with its network of well-known shopkeepers and familiar customers greeting one another every day, is too often deserted and half boarded up, huge, impersonal malls on the fringes of town are the real center of urban and suburban life in America.
Into the void left by the withering away of adult community life has rushed the vast wave of adolescent peer groups and pop culture. Their influence has been hugely expanded and energized by a technological explosion that has proven its power to blast into every home. Two-year-old children, without developed language ability, can recite the McDonald's jingle; indeed, researchers have found that eighteen-month-old kids are already capable of brand-name recognition. And despite what your friends may admit, the average high school graduate has spent 15,000 hours of his or her life in front of the TV, compared with only 11,000 hours spent in school.
Today's child has more than likely already been pried out of the family long before adolescence by the grasping tentacles of the pop culture. At a time when external systemic forces peer groups and mass culture are at least as powerful in defining the adolescent's world as the internal family system, the old primary family system, once figuring so dramatically in therapy, has become a shadow of its former self, often exerting less pull on the teen's heart, mind and hormones than the second family of the peer group. For therapists, the consequences of this tectonic shift are enormous; we can no longer focus only on the first family in the therapy room. It isn't enough, it doesn't work and it's time to admit it.
From this wider perspective, it would have been pointless to try to create hierarchy in Jimmy's primary family without first bridging the great divide between parents and peers. For this, body piercing seemed as good an issue as any. The idea of multiple decorative flesh-piercings on a 13-year-old raised my own hackles, too, but I told dad that, rather than rant and rave with a futile show of authority, he should use this event to get to know his son better to find out about Jimmy's world and to begin establishing the kind of connection that might actually give him some protective influence over Jimmy's life.
So, restraining his gag reflex, Jimmy's father offered to join him on exploratory rounds of various body-piercing establishments; Jimmy of course refused, but his father, with my coaching, quietly pointed out that it was his duty as a parent to make sure he did it somewhere safe and hygienic. After a period of sulky resistance, Jimmy relented and said not without pride that "if it mattered so much," he would show his father the whole piercing scene. During this rather idiosyncratic definition of "quality time," father and son eventually compromised on two relatively chaste earrings in one ear. The piercing was done at a respectable shop using fully sterilized implements.
This foray into Jimmy's world did not end the boy's problems, by any means. But it both rekindled dad's interest in parenting he had been hurt and deeply demoralized by his son's rebuff and set the stage for further rapprochement. Because Jimmy had a hard time getting to sleep at night, I suggested that his father sit with him for just a few minutes each evening. Over the course of several weeks, Jimmy began, for the first time in 10 years, to talk about his life, his girlfriend, about his troubles concentrating in class, about his best friend's abusive father. One day, he finally admitted the obvious he was "experimenting" with pot.
It was only after three months of these gradually unfolding efforts at connecting with his son that the father had built a sufficient relationship and the mother had let go of her resentments about being the only caretaker in the family to now adequately support a workable family hierarchy. When a fight erupted because Jimmy was not keeping curfew, his father and mother had both earned sufficient parental authority to successfully demand that it was time for him to see a drug counselor.
Not only is the "second family" of today's peer and youth culture at least as influential as the primary family in the adolescent's life, it is likely to be just as dysfunctional. First, consider the values expressed in the universal role models and fads of pop culture anorexically thin teenage fashion models, endless consumerism, hypersexualized and violence-saturated entertainment and an ethic of sophisticated hipness that makes kids seem old in spite of their obvious immaturity.
Second, since the peer group is essentially rudderless, it exemplifies Murray Bowen's concept of the "undifferentiated ego mass." Once in the group, individuals are implicitly forbidden, under pain of ostracism, to develop their own independent interests and values; if the old family hierarchy kept adolescents from ever leaving home, the new second family discourages them from going home, or anywhere else away from the pack.
Finally, like the alcoholic or abusive parent who implicitly organizes and controls a dysfunctional family, so the teen leader often one of the most disturbed kids in the group sets the mores and behavior patterns for the rest. This is, of course, nothing new. Young people have always admired and emulated charismatic group leaders. But today the stakes are much higher. Instead of showing other kids how to inhale cigarettes, a 13-year-old might be introducing them to smoking pot and now, increasingly, smoking heroin; instead of making fun of an unpopular teacher, a 15-year-old with learning disabilities will use his charm and verbal wit to get other kids to spend the night spray-painting graffiti on the sides of the school building or engage in life-threatening sexual behavior.
Usually, though, we therapists will see, not the charismatic dysfunctional leader of the peer group, but another less socially skilled adolescent who plays the traditional family therapy part of the "symptom bearer" for the second-family system of peers. In these cases, it may be critical that the family therapist not only take into account the second family, but actually bring those "family members," including the leaders, into treatment, if possible. The question is, how? I often find out who my teenage clients' friends are relatively early in treatment because I ask every child I see (first grade and up) to draw a sociogram the social equivalent of a genogram of their peer group. This identifies second-family members and lets me know something about their influence and also the kinds of problems they are having in their own lives.
Some years ago, before I really understood the power of the peer group, I began to see 15-year-old Peter, whose history included shoplifting, selling drugs and fighting over graffiti turf. After including his parents in therapy for a few sessions, I saw Peter alone. Actually he didn't come by himself, but always brought along his buddy Kevin, who sat patiently in my waiting room during each session. Several weeks later, it suddenly dawned on me that Kevin was behaving much like the parent of any troubled child seeing a therapist. Might this be a way of announcing his own relationship to Peter, as an ersatz family member who also needed help?
One day, I asked Kevin if he would like to come in also. "Okay," he said, without hesitating, then walked in, sat down and began talking about his own truly terrible problems. He lived with a single, alcoholic mother who brought different men home with her. Kevin said he often stayed out all night because he was repulsed about going home. Peter seemed relieved that someone else besides him knew about Kevin's bad situation. After seeing this small "family" of two for several weeks, I encouraged Kevin, a chronic substance abuser himself, to come clean with his parents and join a drug program. (To find out whether or not you must advise the parents before seeing a child's friend, check your state requirements.)
As always, changes in one part of a system can have a pronounced ripple effect. When Kevin stopped doing drugs, so did Peter; after Peter quit, so did his girlfriend. With these barriers down, Peter later could move closer to his parents, revealing to them for the first time how far into chaos his life had drifted. We were now in a position to address some of the family's internal dynamics marital fighting, dad's workaholism that had remained hidden.
Now more alert to second-family dynamics, when I began seeing Julia, a 14-year-old girl with bulimia, I asked her if she would like to invite her best friend, Laurie, to visit for a couple of sessions. She was glad to. (Whether you work in a clinic setting or privately, if you plan to see a second-family member for more than one or two sessions, it's important to get the I.C.'s parents' permission, since they may be paying for the treatment.) While Julia was withdrawn, secretive and shy, Laurie was gregarious and talkative, a natural leader. Actually, however, Laurie was in more serious trouble than her friend, with multiple sexual partners, and in the middle of a savage custody battle between her separating parents. It was obvious, too, that Julia was actually taking care of Laurie acting as confidante, even receptacle, of Laurie's insatiable need to spill her guts.
Two weeks later, when Laurie's mask of bravado cracked, she asked if I could help her. After several phone calls to her parents emphasizing the truly perilous state of their daughter's situation, I persuaded them to enter divorce mediation, rather than battling it out via lawyers. Once Laurie's parents had moderated their hostilities, she felt less frantic and could begin to put some emotional energy into improving her own life drinking and sleeping around less, attending a support group for girls with eating disorders. Because I had taken Laurie's problems seriously and freed Julia from the burden of saving her friend, Julia began to trust me and started talking more freely about her own difficulties.
To cross rigid peer group boundaries, therapists often must get permission from an important second-family member. Sometimes neither the rigidity of the boundary nor the identity of the key peer group member is immediately apparent. We're easily duped because most media-obsessed kids are highly sophisticated users of pop-psychology they've seen hundreds of therapists, counselors and assorted mental-health gurus on TV and can easily pass an hour glibly talking and "relating" without saying anything at all. Jared, for example, a 15-year-old with no known connection of any importance to an adult, was ordered into drug counseling at his school, as a condition of probation. As is often the case, the counselor, Erica, thought everything was going well; Jared was polite and agreeable. And, though he didn't actually tell her much, she felt hopeful that once they "connected," he would open up until he suddenly dropped therapy without warning or explanation.
Several months later, caught smoking marijuana, Jared was once more forced into therapy. At this point, Erica asked my advice and I suggested she call his girlfriend, Jenny, treating her exactly as if she were a family member whose permission and cooperation were needed for therapy to continue. As the counselor soon found out, Jared and Jenny were absolute soulmates, mutual caretakers and protectors, best friends, lovers, quasi-siblings. Jenny had been deeply jealous of and anxious about Jared's first therapy; she could not tolerate an adult female's getting so close to Jared.
But on the second try, when Erica asked Jenny for her "permission" to see Jared, showing her the respect she deserved as the person most central to Jared's life, Jenny lost her defensiveness. Holding Jared's hand, she told Erica how Jared, who seemed exceptionally smooth and self-confident, was often so lonely at night that he could not sleep and turned to pot for relief. So that they might both cut down on pot-smoking, Jenny said, she had taken to calling him every night and talking until they dropped off with the phones in their hands.
Jared is still struggling with his drug problem and some long-ignored learning difficulties. But he has accepted his parents' idea of random drug testing as a way to keep himself on track a major step for someone who had lived his life in secretiveness and hiding. Both he and Jenny are less isolated in the closed little world of each other's company; they are talking more openly to their parents and beginning to experience themselves as individuals, separate from each other.
Many of today's parents feel that they stand alone, trying to hold on to their kids in a vast undertow that inexorably drags youngsters under and away. And compared to previous generations, they do stand alone. Mothers and fathers are certainly less likely to know the parents of their children's friends than they used to be. Far fewer adults engage in school activities (keep in mind the decline of PTA membership), and the school itself is more likely to be a huge, centralized learning factory located some distance from many of the areas that feed it. But if parents are separated by geography, unforgiving work schedules, a hodge-podge of custody arrangements or simply an energy deficit for extracurricular activities, their kids operate under no such disability. In one quiet, suburban neighborhood, for example, about a half-dozen 9-year-old boys were sneaking into a neighbor's basement after midnight and watching pornographic films. What struck me was that every fourth grader in the school knew about this after-hours cinema club. But when parents finally caught on, it took several days for the word to spread among them.
Or consider "raves" and loft parties popular forms of adolescent dance events throughout the country. With no adults permitted, they often start at midnight and continue into the wee hours of the morning. Usually featuring grunge or heavy metal bands, these events make alcohol and drugs freely available to hundreds of mostly unacquainted teens. When the panic-stricken parents of a 13-year-old came to me about how to handle an upcoming loft party, it was shocking that not one other set of parents knew about it. Again, just about every kid in school knew the details and were plotting how to go.
If they want to regain any control before a crisis, mothers and fathers have to be privy to some basic knowledge about their kids' lives. Like it or not, parents won't get the information they need without establishing some form of mutual intelligence system to compensate for the loss of traditional adult community. This is an important way family therapists must move out of the consultation room and into people's lives.
Recently, I was called in by an activist mother who was organizing a group of sixth-grade parents to establish a set of common guidelines regarding their kids' burgeoning social lives. It included a "safe house" contract, signed by each parent, attesting that an adult would always be present when adolescent friends got together in their homes, that no child would ever leave alone, that no alcohol would be served or drugs tolerated. Enough parents agreed to the contract to form the nucleus of a parent community that could share information of common concern about their children. The very fact that each parent or set of parents knew that the guidelines they supported would be backed up by other families gave them a sense of strength in numbers that reinforced their own authority.
Without some compensating network of their own, parents are usually defeated by the impenetrable barrier that frequently exists between them and their kids, kept rigidly in place by a draconian code of silence enforced by the adolescent network. Violators of the code suffer the worst torment imaginable in the adolescent idea of hell: ostracism from the pack.
With the threat of exile hanging over their kids, parents often feel that they are held hostage to the peer group, unable to report to other parents something they have learned about a child's friend that he or she is anorexic, using drugs, drinking, etc. The "phone tree" is another community-wide intervention family therapists can support. Phone trees consist of the names of a group of parents who all have one another's numbers (their work numbers, if possible, so kids are less likely to hear incriminating telephone conversations). This provides a kind of witness protection program, with reasonable assurance of anonymity for parental tipsters.
When kids first hear about these plans, they are often furious. "What right do parents have to find out what is going on in our lives and monitor our whereabouts," demanded a group of 14- and 15-year-olds in a midwestern Quaker school. To which the parents, strengthened in resolve by their new solidarity, could say without anger or defiance: "It's our job to protect and take care of our children; we'll do whatever is necessary."
When parents communicate, the kids can less easily play the adults off against each other, or finger anyone as the informer. For example, Alice, the mother of a 14-year-old girl, found out about a party without supervision. She immediately activated the phone tree and, within a few hours, just about every parent in the grade knew about it in time to discourage or direct their own kids not to go. Family therapists have long been light on this no matter how energetic their initial resistance, kids are often deeply relieved when parents regain their authority. In fact, most adolescents will want their mothers and fathers to be part of the network. Thelma, the mother of a 13-year-old, told me that, after I encouraged her to begin a parents group, one of hers son's skinhead friends swaggered menacingly into her kitchen in full regalia boots, chains, tattoos and demanded to know why his mom hadn't been invited to the group. "Next time, don't leave her out!" he ordered, before stomping out of the kitchen. Kids, even those in chains, feel better when we help create a neighborhood of parents a "there" to hold and protect them.
Therapists must help parents get to a teenager's friends and peers, if they want to have any insight about the pressures, values, ideas, desires, fads and events that define what is important to their child. But how do you do this apparently impossible task, when all kids seem intent on creating a permanent safe space between them and their hopelessly out-of-it parents? When fathers and mothers directly ask their own kid about the peer group, they are making a child feel triangulated, torn between divided loyalties to both the primary and secondary families. But there are other, more direct, ways to get to know what's going on. Jesse, for example, a 15-year-old sophomore, had been inviting about a half-dozen friends over to his house on weekend nights. They regularly hung out together until 2 or 3 a.m. Despite incriminating evidence in the garage cigarette packs, the odor of old pot and tobacco his parents, Katherine and George, avoided doing anything until a small fire in the garage triggered a call to me. Holding Jesse accountable for his friends' actions was hopeless. I felt stymied and finally suggested that we forget their internal family dynamics and talk directly to the second family the kids themselves.
Katherine, George and I planned, scripted and rehearsed what they would say no moralizing sermons, no expressions of outraged authority. The next time Jesse and his friends met, the parents took courage in hand. "We are not here because we want to make you do something 'for your own good,' or to 'build character' or to 'show you who's boss,'" Katherine and George said, "but because we are so worried ourselves that we can't sleep. We are terrified that there will be a fire, that you might be injured or even killed, or just that somebody might drink too much, or smoke too much pot and be unable to get home safely. These are risks we cannot have." If mom and dad found, on weekly inspection, that the behavior continued, the garage would immediately be locked up.
Because the message was delivered with dead seriousness and without appeals to morality or hierarchy, the kids did not protest. In fact, months later, Jesse admitted that he had been enormously relieved the garage/night club evenings had gotten out of hand. But he didn't know how to change things without being accused of wimpiness by his friends. In the meantime, Jesse's friends continued to come over, but because there was no particular reason to confine themselves to the garage anymore, they began drifting into the living room and kitchen. I asked Jesse's parents to make a point of being available and unshockable by the details of the kids' lives that had begun to emerge in the natural course of ordinary conversation. George and Katherine learned that one boy felt utterly rejected by his divorced mother, whom he never saw because she worked such long hours, that another had been beaten by his abusive father and that a third suffered from severe learning difficulties, making his school life a living hell.
Over the course of a year and a half (no sudden transformation here), Katherine and George slowly began to make contact with the other parents, talking about their common problems, mentioning that they themselves were getting some counseling for the family "just to get us through Jesse's adolescence." One by one, each in their own way, the other families followed suit. At the 18-month anniversary of the original garage discussion, most of the kids, either with families or alone, had entered some program or counseling.
With the adult infrastructure so fragmented, today's family therapist can't rest until parents are talking to the schools where children spend the lion's share of their waking lives. Teachers and parents are often still as isolated as other neighborhood adults and still inclined to mutual suspicion. Many teachers feel overworked and unappreciated; they complain that parents are too busy to spend time monitoring kids, and then blame them for their Ds and Fs. Parents regularly complain that teachers are either too strict or too lenient, don't really try to know the children individually or rarely understand their particular difficulties. This shifting of blame between home and school is yet another symptom of the already fragile nature of adult authority in kids' lives and another glaring reason therapists must move from working with the nuclear family to reorganizing neighborhood systems.
A classic problem at school is the child who is taunted, and even physically harassed, by schoolmates. School authorities often do nothing and parents either feel too cowed by the school bureaucracy to complain or ignored by teachers when they do. Many parents (and therapists) try to deal with the problem at home advising their child to "ignore the other kids" or, the classic therapeutic tack, defining the child's predicament as a symptom of buried family dynamics. The road less traveled is that we must help parents and schools deal with the problem as a coordinated team.
Twelve-year-old Jason had just moved into a new school district, and, being insecure, tried in all the wrong ways to get himself noticed and make friends. Unfortunately, Jason was noticed, but by the tough school bullies. These boys made Jason's life a torment taunting him nastily every day, threatening him and, on several occasions, roughing him up during breaks. Over the course of several months, Jason lost all interest in schoolwork, began having nightmares and moped around the house, lonely and friendless.
Just working with the family's dynamics had little impact on Jason's situation. Finally I suggested what should have been at the top of my agenda that we create an alliance with the school. Approached directly, being asked to assist, not criticized or blamed, Jason's school responded quickly and effectively. The principal called every tormentor in, one by one, and said: "You don't have to like Jason, or even talk to him. But you may not in any way insult, harass or attack him. Anyone doing so will be suspended from school."
The other boys were initially furious at Jason for getting them in trouble, but because there was nothing to do about it, they left him alone. Just having some peace was such a relief to Jason that, within a month or two, he settled down and began doing his schoolwork. One day, Jason got on the school bus and, finding no other seats available, had to sit next to one of the less central members of the gang. During the course of the ride, the two began hesitantly to talk and discovered a common interest in computers. The exchange turned into a tentative friendship. Jason's mother encouraged him to have the boy over to their house and, eventually, a second and third classmate began turning up, as well. Jason now has a small circle of friends some of them his former enemies with whom he eats lunch, plays and enjoys a normal, happy social life.
When adolescents are in trouble in any way that involves the school, the family therapist is in an unequaled position to restore the crumbling adult network by acting as facilitator or liaison between teachers and parents. Lauren, a 13-year-old eighth grader with an unaddressed reading disorder, attended school only about half the time, and, no matter what Margie, her mother, did or said, she could not get her daughter to attend regularly. Margie, in desperation, was taking her child to school daily, hanging around outside for an hour or so to make sure she stayed; not only did this put her own job in jeopardy, but it proved ineffectual since Lauren regularly skipped out as soon as Margie left the scene anyway. Parent and school were, once again, like estranged marriage partners, blaming each other for this scenario.
I spoke to Margie, the principal and Lauren's teacher, telling them to put aside their mutual distrust and pointing out that it would hardly help the girl's academic life, not to mention her psychological state, to ignore the problem. With responsibility being equally divided, and with Margie not viewed as an adversary, the principal applied herself to the problem with energy and imagination: "What if we let Lauren know that it is as important to us as to her mother that she go to school?" The principal then astonished me by giving Lauren a wake-up call. "Get yourself out of bed," she told Lauren, "and out the door to school where I will meet you and your mom. If you don't come, I will come and walk with both of you," the principal promised serenely.
Lauren felt so stunned by the knowledge that mother and school were watching over her that she showed up and stayed the first day. We could now create a more coordinated effort to help Lauren, mom and school work together on her learning disorder. Six months later she is struggling to keep up with homework assignments (which are monitored weekly by a teacher-parent checklist) and has missed virtually no school.
Looking for other structured ways to create cohesion between disconnected parts of the adolescent context, I have since encouraged schools to establish a confidential hotline that allows kids to anonymously get help for friends in trouble. Even as I lobbied school administrations to become involved, I privately wondered whether secretive teens would make use of the service. I was, in fact, surprised kids immediately began calling. Recently, for example, one nameless 14-year-old girl called the hotline to report the severe bulimia of a friend, Beth (who, obviously realizing she was in trouble, had told several buddies about her hinging, vomiting, laxative cycle). The counselor called Beth in and said that, "A lot of your friends are very worried about you, and we are, too." Because Beth was hesitant about speaking, and obviously afraid of telling her parents, the counselor asked her if it would be easier to talk with her best friend, Lenore, present. After a few meetings with the two girls discussing the social pressures to be thin, the feeling of self-hatred if they gained weight Beth felt confident enough to give the counselor permission to call her parents. Mom and dad were enormously relieved they had suspected problems, but did not really know how to approach their increasingly distant child.
Eventually, as Beth and her family began to deal with the bulimia, the school, with Beth contributing behind the scenes, initiated an educational program about eating disorders, involving kids, teachers and parents. It included films and presentations by experts in the area. As a result of the program, several other girls in the same grade went to the counselor admitting to their eating disorders. What had been the terrible problem of one, isolated teenager, shrouding her second family of peers in deepest secrecy, had become a shared community issue.
Creating this Synergism isn't glamorous, but more a matter of stitching together the ragged systems making up the life of a troubled teen. This is what the new family therapy which many of us have been privately doing is all about. But it doesn't happen easily, nor is it the stuff of dramatic therapeutic pyrotechnics. On the contrary, I know I'm doing the job right just when it feels as if I am on the edge of failure, just when I think I can't take it anymore. The work is so demanding I've come to the conclusion that none of us should, or even can, see more than a few adolescents at a time. Grueling as it is, however, little else we do draws so deeply from the well of theory, experience and skills constituting our field's history. Treating adolescents challenges us to rethink and enlarge fundamental definitions of "family." Our young clients, with all their outrageous behavior and exuberant vitality, make us realize that the old vision of parent and child as family is much too circumscribed for the multi-layered realities of today's world.
To do therapy in the old way under the illusion that the family, regardless of its configuration, is still a self-contained unit contributes to the centrifugal forces in our society that are already driving kids into a huge postmodern army of semi-homeless nomads. On the other hand, embracing these disparate systems gives us a shot at helping them achieve what they have the potential to become: a complex but integrated and nurturing extended family. To some degree, this work is nothing less than social reconstruction. At the same time, it is very traditional reinventing an updated '90s version of the village community that once surrounded every child. For all its difficulty, the rewards of working with adolescents and their interlocking systems are very great. We not only help these children grow up now but also pass on a legacy for the future. In the end, we hope our kids will learn to create families, schools and neighborhoods that are stronger than the ones they inherited.
This article originally appeared in the March/April 1996 issue of Psychotherapy Networker.
Ron Taffel, PhD, is director of Family and Couples Treatment Services at the Institute for Contemporary Psychotherapy. He is the author of Parenting by Heart and Why Parents Disagree and What We Can Do About It.