Help Teens Develop Strong Sense of Self

When providing care for troubled adolescents, a series of progressive steps can be undertaken. Such interventions prove helpful for many teenagers. But for others, things don't get better, and community intervention begins.

The teenager might be transferred to a special classroom or continuation school. Behavior might bubble over to one or repeated emergency department visits. The teenager might be admitted to an inpatient psychiatric ward, or law enforcement might be involved because of substance use, violent behavior, or criminal acts.

Eventually, the family might ask you about whether they should consider a placement out of the community in a specialized school or camp to see whether a change of setting and a tightly structured environment might help. Often, parents at this point are frustrated, angry, hopeless, guilty, and even punitive.

Encourage the family to ask several questions, including: Have family interactions become so strained as to become at least temporarily estranged? Are resources available for boarding school tuition or an Outward Bound– type experience? Perhaps most importantly, can such a move be cast as an opportunity for a fresh start for all–rather than as a punishment?

A rancorous history of punishment and push back can seriously jeopardize the possibility that such a placement will be successful, particularly if it is viewed by the teenager as the final straw in a pattern of attempted control by the parents. After having been repeatedly grounded, deprived of allowance and driving privileges, removed from activities, and perhaps even thrown out of school, a teenager whose behavior continues to escalate is unlikely to differentiate between punishment and treatment. He or she is likely to resist any imposed authority or intervention.

Despite all of their alienating behavior, teenagers do not want to face being rejected and considered worthless.

A key step, then, is to get the family and the teen to acknowledge that nothing they've tried so far is working. You might be in a unique position to frame the conflict as a shared problem demanding a shared response. Made in the context of love and caring, decisions should have the goal of making the teen's life better.

Sometimes families have trouble stepping back and seeing that they are in a mutual choke hold that needs to be loosened for any positive solutions to emerge. Such discussions might recast the decision as an opportunity, rather than a forced march to the next level of teen purgatory.

If finances are a problem, then broach the idea of their proposing a cost-sharing arrangement. Such a suggestion might be welcomed by a school district unable to meet the educational needs of a disruptive teen, or an insurance company that has already paid for a hospitalization or two.

In some cases, an ultimatum from the court system or school might make the decision less of a choice. Still, families often have some choice in the setting or location of a residential program offered as an alternative to incarceration and/or a criminal record. When helping a family decide what school or camp makes sense for a given teenager, try to help the parents let go of old angers and presumptions and consider what is best for their child. Automatically deciding on the most restrictive setting might be interpreted as punitive and counterproductive.

Emphasize that the decision about what to do should be a thoughtful one. An educational specialist, psychologist, or psychiatrist experienced in school placements can make recommendations based on cost, structure, goals, program duration, and professional support. As a physician, it's important that you are confident that any potential school or camp has enough professional expertise to ensure the teen's physical safety and emotional well-being.

The long-term goal is for a teenager to establish a firm sense of self. Treatment should continue when teenagers return home and include family therapy that allows for rebuilding of trust and accommodation of revised perceptions of the teen's new reality.

When providing care for troubled adolescents, a series of progressive steps can be undertaken. Such interventions prove helpful for many teenagers. But for others, things don't get better, and community intervention begins.

The teenager might be transferred to a special classroom or continuation school. Behavior might bubble over to one or repeated emergency department visits. The teenager might be admitted to an inpatient psychiatric ward, or law enforcement might be involved because of substance use, violent behavior, or criminal acts.

Eventually, the family might ask you about whether they should consider a placement out of the community in a specialized school or camp to see whether a change of setting and a tightly structured environment might help. Often, parents at this point are frustrated, angry, hopeless, guilty, and even punitive.

Encourage the family to ask several questions, including: Have family interactions become so strained as to become at least temporarily estranged? Are resources available for boarding school tuition or an Outward Bound– type experience? Perhaps most importantly, can such a move be cast as an opportunity for a fresh start for all–rather than as a punishment?

A rancorous history of punishment and push back can seriously jeopardize the possibility that such a placement will be successful, particularly if it is viewed by the teenager as the final straw in a pattern of attempted control by the parents. After having been repeatedly grounded, deprived of allowance and driving privileges, removed from activities, and perhaps even thrown out of school, a teenager whose behavior continues to escalate is unlikely to differentiate between punishment and treatment. He or she is likely to resist any imposed authority or intervention.

Despite all of their alienating behavior, teenagers do not want to face being rejected and considered worthless.

A key step, then, is to get the family and the teen to acknowledge that nothing they've tried so far is working. You might be in a unique position to frame the conflict as a shared problem demanding a shared response. Made in the context of love and caring, decisions should have the goal of making the teen's life better.

Sometimes families have trouble stepping back and seeing that they are in a mutual choke hold that needs to be loosened for any positive solutions to emerge. Such discussions might recast the decision as an opportunity, rather than a forced march to the next level of teen purgatory.

If finances are a problem, then broach the idea of their proposing a cost-sharing arrangement. Such a suggestion might be welcomed by a school district unable to meet the educational needs of a disruptive teen, or an insurance company that has already paid for a hospitalization or two.

In some cases, an ultimatum from the court system or school might make the decision less of a choice. Still, families often have some choice in the setting or location of a residential program offered as an alternative to incarceration and/or a criminal record. When helping a family decide what school or camp makes sense for a given teenager, try to help the parents let go of old angers and presumptions and consider what is best for their child. Automatically deciding on the most restrictive setting might be interpreted as punitive and counterproductive.

Emphasize that the decision about what to do should be a thoughtful one. An educational specialist, psychologist, or psychiatrist experienced in school placements can make recommendations based on cost, structure, goals, program duration, and professional support. As a physician, it's important that you are confident that any potential school or camp has enough professional expertise to ensure the teen's physical safety and emotional well-being.

The long-term goal is for a teenager to establish a firm sense of self. Treatment should continue when teenagers return home and include family therapy that allows for rebuilding of trust and accommodation of revised perceptions of the teen's new reality.

When providing care for troubled adolescents, a series of progressive steps can be undertaken. Such interventions prove helpful for many teenagers. But for others, things don't get better, and community intervention begins.

The teenager might be transferred to a special classroom or continuation school. Behavior might bubble over to one or repeated emergency department visits. The teenager might be admitted to an inpatient psychiatric ward, or law enforcement might be involved because of substance use, violent behavior, or criminal acts.

Eventually, the family might ask you about whether they should consider a placement out of the community in a specialized school or camp to see whether a change of setting and a tightly structured environment might help. Often, parents at this point are frustrated, angry, hopeless, guilty, and even punitive.

Encourage the family to ask several questions, including: Have family interactions become so strained as to become at least temporarily estranged? Are resources available for boarding school tuition or an Outward Bound– type experience? Perhaps most importantly, can such a move be cast as an opportunity for a fresh start for all–rather than as a punishment?

A rancorous history of punishment and push back can seriously jeopardize the possibility that such a placement will be successful, particularly if it is viewed by the teenager as the final straw in a pattern of attempted control by the parents. After having been repeatedly grounded, deprived of allowance and driving privileges, removed from activities, and perhaps even thrown out of school, a teenager whose behavior continues to escalate is unlikely to differentiate between punishment and treatment. He or she is likely to resist any imposed authority or intervention.

Despite all of their alienating behavior, teenagers do not want to face being rejected and considered worthless.

A key step, then, is to get the family and the teen to acknowledge that nothing they've tried so far is working. You might be in a unique position to frame the conflict as a shared problem demanding a shared response. Made in the context of love and caring, decisions should have the goal of making the teen's life better.

Sometimes families have trouble stepping back and seeing that they are in a mutual choke hold that needs to be loosened for any positive solutions to emerge. Such discussions might recast the decision as an opportunity, rather than a forced march to the next level of teen purgatory.

If finances are a problem, then broach the idea of their proposing a cost-sharing arrangement. Such a suggestion might be welcomed by a school district unable to meet the educational needs of a disruptive teen, or an insurance company that has already paid for a hospitalization or two.

In some cases, an ultimatum from the court system or school might make the decision less of a choice. Still, families often have some choice in the setting or location of a residential program offered as an alternative to incarceration and/or a criminal record. When helping a family decide what school or camp makes sense for a given teenager, try to help the parents let go of old angers and presumptions and consider what is best for their child. Automatically deciding on the most restrictive setting might be interpreted as punitive and counterproductive.

Emphasize that the decision about what to do should be a thoughtful one. An educational specialist, psychologist, or psychiatrist experienced in school placements can make recommendations based on cost, structure, goals, program duration, and professional support. As a physician, it's important that you are confident that any potential school or camp has enough professional expertise to ensure the teen's physical safety and emotional well-being.

The long-term goal is for a teenager to establish a firm sense of self. Treatment should continue when teenagers return home and include family therapy that allows for rebuilding of trust and accommodation of revised perceptions of the teen's new reality.