Periodically I join a group or run one when a therapist is absent. This is an opportunity for me to dip into the ongoing clinical work at Montana Academy, a therapeutic boarding school, and test the waters to see what our students are learning. Recently I sat with a boys' team. They spent the first half hour talking about their concerns and anxieties in preparation for the addition of a new student who was arriving that afternoon.

They were thoughtful, remembering their own arrivals with their attendant confusion and sense of being overwhelmed. They also valued the gains that they had made, the comfort that they took in their team which had not had a new member in some months and their worry that a new student would upset the cohesion of the existing group. Yet they were at pains to tell each other that it was important to set the tone of the team so that the new student would find them functioning well and discover a culture where he would be expected to do likewise.

We turned to the subject of therapy and I asked them what they thought that "therapy" actually was. One student said that he really didn't know, but that he was struggling just to be honest about what he was thinking and feeling. He said that his father didn't think much of therapy but that his mother "believed it was helpful." This was confusing as he began to have a better relationship with his father and cared what he thought. Another said that he saw his mother using therapy for advice and that he was skeptical about this approach.

One young man said that he thought that he was doing therapy all day long, not just with his therapist in the office, but with his friends in serious conversations and with staff that he had come to know. He was trying to increase his self-awareness, to say what was on his mind and to work on improving his relationships, knowing that this therapeutic milieu would help him to avoid "crashing and burning" as he had done at home.

A fourth, who had been in treatment for 18 months, said that he didn't really think about being in therapy or at a therapeutic boarding school any more, but that his therapist and team leader were so much a part of his everyday life that consideration of their thoughts and approach was integrated into everything he did and not separate from it. Not one young man referred to therapy as something which was done to him or as a set of learned skills. Each one was in his own unique way attempting to follow a path of mindfulness and improvement of day-to-day relationships.

Some months ago John Santa urged me to see the film "Lars and the Real Girl" in which a depressed, lonely and help-rejecting young man, Lars, orders a mail order blow-up doll which he insists on treating as though it were a real girlfriend. At first his relatives and larger community are shocked and confused about how to treat this fantasy relationship, but gradually they decide to suspend normal expectations for his social behavior and settle into an acceptance that this strange relationship must be important to him somehow and should not be denied.
The entire community behaves in an unusual manner. They go along with the fantasy. A compassionate physician deftly uses this imaginary relationship to treat the young man. When Lars is ready, he gradually lets go of his blow-up girlfriend and reenters the world of real relationships. Odd as this may sound, this is as moving and compassionate a depiction of therapy as I have ever seen. The community suspends judgment of strange behavior, loves and cares for Lars as he finds his way back to them.

Oftentimes our students need this same forbearance and understanding. One young woman developed a relationship with a plastic horse which she named and took everywhere with her, pretending to be its mother, feeding it, loving it and protecting it from all teasing and flippant hurtful horseplay. She took this parenting role very seriously and resisted all suggestion from our well-meaning staff to grow up and get over it. It turned out that this girl's parents had recently had a serious marital fight which had left her feeling scared and lonely. She sought refuge in her active fantasy life and acted it out, much as a younger child might do.

Many of our students tell outrageous lies and stories which serve to both hide and reveal their worries. While we regularly challenge students to move on from childish behavior, we also try to do this in the context of understanding what their behavior means and why they cling to it. We do our best not just to pay attention to the melody line of their chatter and behavior, but also to listen for the deeper sounds of the cords. There is, after all, an underlying meaning to most of human behavior and it is this meaning that we seek to understand in therapy, so that our staff can be in tune with our young people in more than a superficial manner.

Thoughtful therapy is not something that can be imparted from books or seminars alone and is much more than a set of skills which are delivered willy-nilly according to the adolescent's diagnosis. We are not simply in the business of instruction. It takes years to develop a "third ear," to hear the underlying themes of a person's life story and to help him or her to learn to pay attention to his or her own thoughts, so that eventually they can do this for themselves. The physician in "Lars and the Real Girl" is such a skilled therapist, who listens, understands, does not simply confront or instruct, but patiently helps Lars to ease his pain and to move on in his life. The first steps in healing are to be heard and understood.

This therapeutic milieu work of recognition is different from another aspect of work in a therapeutic boarding school. That is the push to grow up. We make this push explicit with our students. We challenge them to think not just about themselves, but about each other and the needs of their team or the larger community. We encourage them to distinguish between their own wishes and needs and those of others. We recognize that they do not yet share the values of adults, and that these are rarely instilled by lectures or coercion.

We attempt to create some discomfort with their childish narcissism. We ask them to express themselves honestly and clearly, but also to consider themselves in the context of relationships with teammates, staff and parents. We do not try to rescue them from the struggles of their own ambivalence about such tensions. Indeed, we are glad to watch them wrestle with their own selfish wishes, knowing that if they indulge these they may hurt those who love and care for them. This is the work of growing up and the chief work of a therapeutic boarding school.

We also do our best to create the kind of community exemplified in "Lars and the Real Girl"-one is which individuals can be heard and feel deeply understood and where idiosyncratic behavior may be tolerated while a young person works through pain and misunderstanding to find his or her way back to solid real relationships with peers, staff and parents. Such is the healing offered in our milieu.

Warm regards,
Rosemary McKinnon
Montana Academy