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It’s been another fantastic few days of Family Weekend at New Haven, the residential treatment center where I work. It’s my favorite time! I love being with each family in group sessions as they work on their issues. It’s an honor.

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

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

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

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

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

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

This has important implications for treatment.

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

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

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

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

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

A few houses ago, my next-door neighbor was a heroin addict. It was a frequent experience for me to come home from work and see a police car and an ambulance in front of his house, his children sitting on the front steps crying. I’d peek in the open front door and see paramedics working on his limp, clammy body, trying to revive him from yet another drug overdose.

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

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

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

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

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

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

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

I flew kites with my two young sons. Michael was doing fairly well with his kite, but Cam, my five-year-old, struggled with his.

“Higher, Daddy!” Cam said. He could feel the kite straining against his little hands, and thought the best way to help the kite move higher was to walk toward his kite. The line would slacken, and the colored fabric kite would dip toward the ground.

It reminded me of when my nine-year-old, Hadley, was Cam’s age and informed me that her kite was like a helium balloon. “I’m going to let it float up to the sky!” she’d said. Before I could stop her, she’d let go of the string. It immediately lost altitude, but sailed an impressive distance, over the park, over three rows of houses, then crashed in a driveway, narrowly missing a small yapping dog! She’d been surprised that letting go of the string didn’t help the kite rise higher.

“Stand still!” I called to Cam. But he moved forward. Predictably, his kite soon crashed into the turf.

Michael was laughing. At first I thought he was laughing at Cam, but he wasn’t. He was excited because he’d found that if he pulled gently on his string, the kite would respond and dance on the wind. Unfortunately, he began yanking too hard, which caused the kite to dive and spin out of control. Soon, Michael’s kite had impaled the sod, a few feet away.

Kite flying is a fitting analogy for parenting, isn’t it?

The thing that seems to restrict and bind the kite is the very thing that enables the colored fabric to dart high among the clouds. Some teens have difficulty balancing their emerging independence with their dependence upon their parents. These teens want more freedom. They want adventure on their own. Like kites, they strain against the line their parents hold, pulling toward the clouds.

Teens sometimes fail to realize that it’s their family ties that allow them to fly ever higher. After all, it’s counter-intuitive. Everywhere else in the world, if something is tied down, it’s more restricted – not more free.

And yet, the way parents hold the line with their kids is important. If we jerk too hard and too quickly, teens may react like Michael’s kite. If we move in too close like Cam did, we run the risk of over-protecting them. They won’t learn to navigate life’s currents on their own. If we let go of our teens altogether, like Hadley did, never guiding or directing, then our kids will never even have a chance.

Sometimes it’s appropriate and necessary to gently pull back. It’s our job to guide our kids from one shifting wind to the next. It’s important to keep our hands firmly on the line in case a huge gust of wind knocks our teens from their equilibrium. Frequently, however, the key to coaching teens is for parents to set clear family traditions, values, rules, and consequences and then stand still.

Here are some ways that parents can practice standing still:

1. Establish (and then follow through with) family traditions for holidays, birthdays, summer vacations, celebrations of success, etc.
2. Gather everyone together as a family at least once weekly to coordinate, plan, and review.
3. Have one-on-one time with your teen at least weekly. (Daddy-daughter dates and mother-daughter outings are great ways to stay connected.)
4. Hang a copy of your family values in a prominent place in your home.
5. Decide on a family symbol that represents what your family stands for. Obtain a trinket for each family member to carry with them. (One father bought pewter acorns and attached them to key rings for each family member – their family symbol was the Oak Tree.)
6. Create rational rules that support and teach your Family Values.
7. Decide on a few “zero tolerance” rules. (These usually involve issues of safety: no drugs; curfew set in stone; no boys in her bedroom; etc.)
8. Agree upon natural and logical consequences to reinforce your rules. (Wise parents include teens’ suggestions about appropriate consequences.)

I hope you’ll take a moment to post your thoughts about your successes and failures at standing still. It’s helpful for us all to hear what has worked/not worked for other families!

“I messed up,” the text message began, “and I just wanted you to know that I cut myself today.  But I’m back on track.”

Is this a relapse?  She’d been free from self-harm for over 13 months.  How would you have responded to her?

In my mind, there is a big difference between a momentary lapse and a full-blown relapse.  I had the following conversation with parents at a Family Weekend years ago, an event we hold for three intense days every other month of the year.  All of the parents in my group that weekend had girls who were coming home soon.

“I can’t wait for my daughter to come home,” one father said.  “New Haven has been wonderful!  All of her problems are fixed.”  I find that all too often parents expect their kids to be “fixed” when they return home.  Even after spending time at New Haven, arguably the most systems-focused residential treatment center in the country, they still believed that treatment is an event and when it’s over, they were done working.  “Oh, no,” I told him.  “Your journey has just begun!”

“What happens when your daughter returns home and you find her spending hours on the internet? What happens when she skips her curfew?  What happens when you find pot in her backpack?”  He began to sweat.  He stewed.  Finally, he couldn’t take it anymore.  He lunged across the room at me, red-faced and yelling.  “What is the point of this?  I came here to feel better about my daughter!”  He accused me of doing “poor therapy”, then sat down.

“I’m trying to prepare you for the inevitable,” I said.  And we had a robust discussion about how his daughter, in particular, was going to bring home a young man he didn’t like, was going to accelerate into sexual behavior faster than he would be comfortable, and they would have to deal with it.

“I’ll kick her out on the street!” he said.  “I won’t tolerate it.”

“But what if it’s not a relapse?  What if it’s a one-time screw up?  I doubt you’d kick her out if you knew it was an honest mistake.  She might ‘lapse’ but not ‘relapse’. So how will you define the difference between a ‘lapse’ and a ‘relapse’?” I asked.

In the end, the group decided together that a lapse is a one-time event which is reminiscent of past behavior.   A relapse, on the other hand, is a persistent pattern of the behavior we thought we left behind.

It’s easy to recover from a lapse.  Yet it’s also easy to allow a lapse to become a relapse.

So, what stops a lapse from becoming a relapse?  They wanted to know!

Two things will keep a lapse from becoming a relapse:  #1) consistent, healthy relationships with parents and friends; #2) parents unified and consistent about implementing rules and structure in accordance with established family values.

We spent the balance of that Family Weekend session outlining ways  to keep their relationships with their daughters fresh and alive.  We outlined rational rules and boundaries which were neither too permissive nor too restrictive.

About ten months later at another Family Weekend, the angry father returned.  He sought me out during a parent group and apologized for his attitude.  “You were right,” he said .  Turning to the other parents in the room, he laid out his daughter’s lapses and how he’d helped her keep them from becoming relapses. He never “kicked her out on the street” and she was doing reasonably well.

He’d realized the truth:  our journey does not stop with the end of treatment.  We continue on, we fall down, we scrape our knees.  It’s how fast we get back up that matters.

So here’s how I responded to the text I mentioned at the beginning of this post:  “Thanks for staying connected.  As long as you are back on track, that’s what matters.  Call if you need to talk.”  After all, it was just a lapse.

What influence do men hold over you, and why?

I ran a group therapy session yesterday.  One young woman began the conversation by speaking eloquently about her obsession with five college-age men who had sexually assaulted her.  ”Why can’t I let it go?” she asked.  ”What is it about me that clings to them, even when I know they are bad for me?”

Another girl chimed in:  ”I feel ashamed that I sexualize all males.  Even the staff here.  I objectify everyone, and I can’t stop.”

I had the girls and the staff (18 in all) place themselves in the room based upon how much influence they allow males to have over them.  We established a range; one wall and its couch became “100% influence” and the opposite wall was “0% influence”.  I was not surprised to see most people place themselves between 50% and 100%.  One girl said, “I’m sitting at 105%!”

We talked at length about the power that males have over us:  fathers, brothers, boyfriends, men we don’t even know.  The girls and adult staff identified their reasons for granting this kind of powerful influence to the men in their lives.  ”I like to feel protected,” one said.  ”I wanted to be accepted – that’s all I cared about,” another said.  ”Love is the bottom line for me,” one of our staff members added.

None of these desires/needs is bad in and of itself.  We discussed taking the shame out of wanting to be protected, accepted, or loved, and decided to more productively focus on what we do with the overpowering need for acceptance, protection, and love – especially from males.

The Lead Supervisor of our staff spoke up quietly and said that after she lost her sister in a car accident, her teenage brothers and her father all became very protective.  She described a healthy relationship with them as a leading influence for good in her life.  A young woman who just arrived at New Haven piped up and said that her father is someone she wants to please, and she knows he loves her very much.

We all decided that even though we are influenced to varying degrees by men, we should acknowledge how much we are influenced, discover what need it fills for us, and then seek a more healthy and productive way of obtaining that need.  Being influenced by males does not need to be a bad thing.  Shaming ourselves doesn’t work – we need to recognize that they underlying need for male connection or approval is not always bad.

By the end of the group, the young woman who said she “objectifies” the men in her life committed to practicing healthier relationships with the male staff we employ.  The one who started the conversation decided to end a flirtatious relationship she began on a recent trip home, since she was “using” the young man and not really interested in him.

I imagine we’ll continue this discussion in group next week.

Photo by Jed Wells

Aspiro – a wilderness adventure therapy program for boys and girls – came to visit last week. I was impressed and pleased with their approach to their students. They made this comment during their presentation: “Because we take our students into more ‘public’ ares such as Arches National Park, we have been accused of only being able to treat ‘softer’ kids – kids who won’t run away.”

I was struck with how similar our approaches are, and how similar the criticisms levied against us were during our first five years in business. New Haven has been around for 15 years this month. In our first five years, much like Aspiro, we were refining a more relationship-based model of residential treatment for girls. (We were tired of working in places that just applied a boot-camp or behavioral model to the treatment of teen girls.) We were questioned repeatedly about being able to treat “harder” girls – but what our critics really were wondering is if we would be able to “contain” girls who didn’t want to be in treatment.

How ironic that, 15 years later, our model is the most copied by new startups in the world of private teen treatment for girls! “Relationship-based”, “family therapy”, and “values” – all terms which were never spoken together in 1995 – are now tired old buzzwords in our industry. Even though it means competition for us, I’m glad. Girls deserve better treatment.

Why is Aspiro able to take its students into public places? Why is New Haven able to operate on 31 acres without magnetized steel doors? It’s because our students realize quickly that we love them and want the best for them. What’s more, we won’t constrain, abuse, or coerce them into doing what is best for them.

The beauty of a relationship-based model is that “tough” kids CAN be treated. No, Aspiro and New Haven don’t take highly violent kids. But we do take the very ill family systems, the kids who have internalized their problems to the point of suicidality, and the kids who have failed treatment time and again.

All good therapy begins and ends with a strong therapeutic relationship.

Illustration by Aidan Jones

I get asked a lot how to know if you can trust someone, especially boys. Here’s a little formula I came up with a few years ago. Let me know your thoughts on it.

T = bottom line, you need TIME with a person before you can trust him. I’m fairly confident it takes longer than 3 months to know if you can really trust a guy with your deepest emotions and thoughts.

R = RESPECT is paramount. If he’s not respectful to you, to the waitress at your favorite restaurant, and to his mother, then you have a problem.

U = UNCONDITIONAL LOVE. He needs to accept you as you are. If he’s telling you to “lose some weight” or he makes you feel stupid, you are heading for a train wreck relationship.

S = you need to feel SAFETY with him, both emotional and physical. If he pushes your physical boundaries – in any way – get rid of him immediately. If he is overly sarcastic, rude, or argumentative with you, then he’s not emotionally safe, either, and doesn’t deserve your time and attention.

T = this one may be obvious, but you’d be surprised how many girls let it slide: TRUTH. He must be truthful at all times. If you catch him in a lie, no matter how small, he’s done! There is no excuse for lying to a friend.

So, bottom line, if you’ve spent time with him, he is respectful of you, he is unconditionally loving towards you, you feel safe with him, and he tells the truth, then your decision to risk trusting him is more likely to be a good decision.

Is this foolproof? No. But a majority of the time you will make a good decision.

Photo by Sidewalk Flying

I met with a young woman this week who was having difficulty giving up her boyfriend.

He told her he had a “commitment problem” and that they should just be “friends” for a while. Then he went out and got laid. Of course, when she wanted to get back together, he was willing, as long as she didn’t call him her “boyfriend”.

Many men are proponents of this kind of behavior, but they call it different things: Friends with Benefits, FriendSex, Sex for Fun, Free Love, a “no strings attached” relationship, etc.

I call it ridiculous.

When did we start convincing ourselves that we could have sexual relationships without emotional consequences?

I have long hated the television show “Friends” because of its portrayal of casual sexual relationships and its light treatment of the emotional consequences to women that inevitably follows these acts. Somehow, entertainment media’s message that sex doesn’t carry emotional baggage has permeated our belief system. And then, when we try it, we think that there is something wrong with US because it didn’t work out like it always works out before the “cut to commercial break” on TV.


Just finished a book by Daniel Amen, MD called Change Your Brain, Change Your Life.  www.amenclinics.com He discusses what happens in the brain when two people make love.  After having conducted thousands of brain scans, he asserts that it is impossible, especially for women, to “just have casual sex”.  Sex lights up the deep limbic system in our brains, and women’s limbic systems are larger than men’s (on average).  The deep limbic system is also where attachment to other human beings is formed.  Thus, it is next to impossible to have sex without attaching.

Sex is emotionally charged by design. We should respect that and act accordingly.