Frankly, I’d rather you didn’t have to read this book, let alone buy it. However, it’s new, it’s sensational and it’s well packaged – and bound to confuse more than a few readers. My hope is through this review, you can become familiar enough with it to allay the many misconceptions it reinforces. The subtitle How the Troubled-Teen Industry Cons Parents and Hurts Kids quickly establishes its lack of objectivity. What is more difficult to establish is whether a hidden agenda or personal grudge might explain why Maja Szalavitz, an otherwise seemingly respectable journalist and senior fellow at the media watchdog group www.stats.org, felt compelled to produce such a one-sided, sensationalized piece.
Help At Any Cost is billed as a book that “uncovers” cases of inexcusable abuse, neglect and malpractice within the teen help industry. In reality, the vast majority of the cases described occurred within the most poorly managed and disreputable residential teen help programs, some dating back more than 30 years. Sadly, the heartbreaking stories described are for the most part, factually correct, though fortunately most of the perpetrators have been driven out of business by bad press and vigorous litigation. The book also claims to “expose” serious incidents even within model programs. In reality, the very few tragedies experienced thus far in otherwise exemplary programs have been due to inevitable human error, carelessness or simple bad luck. They have however served to remind us of the dangers of complacency; the resulting aftershocks caused many to review and revise their emergency procedures.
The cases Szalavitz discusses were reported in mainstream media along with Woodbury Reports, so you will encounter very few surprises in that regard. What is surprising however is the author’s utter dismissal of the troubled teen industry as a whole. She fails to acknowledge that the vast majority of programs and industry professionals are ethical, knowledgeable, compassionate, dedicated and successful at helping teens and families in times of turmoil and crisis. Her book devotes several chapters to the controversial chemical addiction programs of the 1960’s, 70’s and early 80’s: Synanon, SEED, Straight, KIDS, etc., that were designed for youth and adults. Most have imploded over time due to poorly managed growth, delusions of grandeur from their leadership and a tendency to attract fanatical, inflexible staff. While Ms. Szalavitz is properly horrified by some of their treatment techniques, she fails to notice that other now-controversial methods were actually in line with the community standards of the time.
The book has some technical and stylistic quirks. The sheer number of pages devoted to the older and controversial detox programs seems incongruous, especially given the target audience. Yet presuming she felt a need to recreate the development of the industry, why does she make only the briefest of references to key long-running programs which were foundation pillars of this industry: Anasazi, Aspen, Brown Schools and CEDU (surprisingly, she barely even mentions their recent corporate bankruptcy – a missed opportunity if ever there was one), De Sisto, Elan, etc. Instead, she positions the WWASP programs as the primary “model” from which most programs have spawned, which leads her down a very different path.
Of similar concern is the book’s heavy footnoting, which looks impressive especially to a less sophisticated reader. But beware: while some footnotes link correctly to primary resources, others represent third-party comments or anecdotes (hearsay or even gossip). Still others contain insufficient information to check the validity of the supposed source. However, I found the most troubling and offensive aspect of Help at Any Cost was the generalization that residential therapeutic programs for troubled teens were unnecessary, money grubbing, deliberately deceptive, and often physically and emotionally damaging to those they purport to help.
Ms. Szalavitz’s argument runs roughly as follows (subtitles are my own):
Blame it on Reagan, Bush and George W., etc.
Society’s preoccupation with the safety and well-being of its youth around drugs, alcohol, promiscuity and acting out is the product of self-serving manipulation by far-right elements in the Republican party in concert with reactionary, back-to-basics Bible-waving lobby groups.
A Boot Camp by any other name…would probably just be a cult
Ms. Szalavitz appears unaware of the distinctions between behavior modification-based placements, and the wide range of therapeutic and treatment settings that are based on family systems, natural consequences and positive peer culture. In her eyes, teen help programs are either all “boot camps” of the blame and shame variety, or cult-like centers practicing the most subversive mind-control techniques perfected by the North Koreans (her words, not mine).
Bye for now…see you in a few years
She seems completely oblivious to the frequency and extent of the contact required and often elaborately organized between family members and teens many in such programs.
Dumb and Dumber
The author says today’s families are led by self-absorbed, disempowered, harried adults who are unable and unwilling to work at being parents. Fed on a steady diet of alarmist messages from those in Premise 1, they mistake normal teenage experimentation and differentiation (necessary for healthy maturation and separation) for dangerous behavior or symptoms of clinical or pathological concern.
Apparently, Ms. Szalavitz finds parents so unsophisticated, lazy and easily intimidated that, despite the deeply ingrained fear she outlined above of exposing one’s children to outside influences, they instantly transfer custody of their (pain-in-the-behind but otherwise normal) teens to virtual strangers in far corners of the continent without a second thought. Then the very same parents willingly pay what she considers obscene fees for these “unnecessary services” without question. Again, a rather unlikely scenario.
Never mind the testing, just sign ‘em up!
She claims residential therapeutic programs rely on scare mongering as their primary marketing tactic. She says admissions staff, who are only expected to generate revenue, must press for immediate enrollment regardless of the relative severity of behaviors or presenting symptoms. Parents are told with dramatic flourish that their child will die, end up on the street or become irreparably alienated from family, school and community in short order without their particular residential program. She concludes all this despite never apparently placing even one test inquiry call to a program herself. Additionally, she seems unaware of the admissions protocol that requires separate clinical, educational and financial approvals.
If you can’t fool all of the people all of the time, go for most of the people…
Since her belief is that residential therapeutic teen placement is usually unwarranted, any “progress” participants and families claim to have made must be either wishful thinking or a con job by program staff. Dissatisfied families see no progress because they are the realists who resisted brainwashing. With this premise, she attempts to discredit all parent testimonials and participant self-reports in one fell swoop. She also fails to acknowledge the many reasons for premature withdrawal from programs and resulting dissatisfaction.
We’re all part of the big, bad machine…
Ms. Szalavitz similarly dismisses educational consultants, escorts and program therapists as potential resources. While she grudgingly acknowledges that Educational Consultants could be useful given their exposure to a large number of programs, we are too expensive (compared to what?), and states there is no way to identify those who are knowledgeable, honorable and not operating on a kickback for referral system. Her view on teen escorts is no better. She calls them hired bullies who get non-compliant teens from home to program by ripping them from their beds terrified and disoriented without benefit of explanation from family. She says they use physical and chemical restraints as a matter of course rather than last resort.
As for the therapists employed within residential programs, this author says they are either poorly trained, casually supervised or practice a dangerous mix of trendy psychobabble without benefit of short- or long-term treatment planning. Instead Ms. Szalavitz then touts the virtues of weekly outpatient treatment on a one-hour basis (though never if the teen doesn’t want to go, of course).
While there are families, programs, escorts, therapists (and even a few consultants!) who fit the above descriptions – they are neither the majority nor the norm. In reality, the vast majority of families in crisis have, as one father so aptly put it, “already been to Hell and are not quite back yet in search of solutions.” Teens that are out of control and terrorizing their families are self-medicating or self-harming with substances rather than just partying or having a good time. They are acting out aggressively or acting “in” internally—not experimenting with new identities and feelings. They may be exposing themselves to high-risk sexual activity and exploitation repeatedly, rather than healthily exploring their newfound sexual identity. Some are committing anti-social or full-scale criminal activities that without doubt go far beyond rebelling against authority. In sum, these are not ordinary children with typical teenage problems.
These teens, their families, and those who work to help them get back on track deserve our support, understanding and compassion, rather than pity, scorn and derision. Fear-mongering and reactionary narrow-mindedness are what Ms. Szalavitz supposedly opposes and tries to expose. Ironically, her book is guilty of the very same charge. She has exploited every parent's worst nightmare of residential treatment gone wrong, without even acknowledging the mainstream reality that solid, reliable and effective help is available, let alone how to access it.
Had Ms. Szalavitz truly wanted to damage those questionable programs while helping struggling teens and families, she would have included user-friendly information giving parents the tools and supports to identify good programs, evaluate the match with their particular child and monitor progress thereafter. Instead, her Appendix For Parents of Troubled Teens appears to be a hasty add-on, perhaps an editor’s attempt to show some balance – but contains very little of practical use. Her brief nod to those so foolhardy as to pursue residential treatment despite her dire warnings begins with, “if a child is so ill as to require hospitalization or any form of residential care...” Ten basic questions and the answers she believes parents must receive follow. The section concludes with the caveat, “even if you ask all the right questions and get all the right answers, this cannot guarantee that you have found a good program…as program providers (commonly) mislead parents about their services, complaint procedures and treatment philosophies.” Most reassuring.
So if not residential treatment, what options does she suggest? She ends her book with a reading and research list, and a few real gems that reflect her level of understanding of the issues at hand. For instance, she says, instead of sending these kids away, why can’t we just talk to them? With enough love, understanding and open communication, surely these conflicts would simply pass and all parties would emerge healthier and wiser form the experience. She concedes that the most troubled of teens might benefit from a mainstream (not at-risk) Outward Bound course – but only if they choose to go voluntarily. Reading this suggestion, one mother scoffed, “I couldn’t get my (addicted and oppositional) daughter to do gym class since 6th grade, or see a dentist or doctor for the last 3 years. How does this lady think I would sell her on a course filled with perky, health-conscious outdoor enthusiasts – and why would they want her? Her sole focus would be to stay high, steal from the others and self-mutilate while they’re busy experiencing nature!" Ms. Szalavitz’s very last suggestion is perhaps the most amusing. Families might duplicate the major breakthroughs made in wilderness programs themselves she says, simply by taking a good old-fashioned family camping trip, followed by a few volunteer excursions to the food bank. Now why haven’t we ever thought of that!!??