In the coming weeks, months and years professionals who work with adolescents will no doubt be confronted with questions and comments generated by Maia Szalavitz' new book, Help at any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids. Ms. Szalavitz' is not a clinician, but she has written for The New York Times and Washington Post and is currently senior fellow at STATS. So I thought I'd bite the bullet, read the book and report back in this format.
I was prepared to not like Help at any Cost. The title alone indicates something of a slant that I wouldn't necessarily agree with. However, the book is actually quite entertaining in the manner of watching Dateline, NBC or 20/20. You know it's inaccurate and one sided. You know it's got an agenda and a bias, and is probably motivated by someone's lawsuit, but for some reason, you can't stop yourself from the prurient voyeurism that this genre encourages. The comparison is apt in that, just as with sensationalistic TV, Ms. Szalavitz' book relies on a handful of examples to cast a wide set of accusations on an entire industry. In fact, one of her contentions is that there is no research to support the claim of success at treatment programs in the United States. It is ironic that she uses nothing but other people's accounts to validate her claim that these treatment programs are detrimental. Essentially, she tells a story that those of us on the inside of the industry already know: There are several programs that currently and historically have used methods and tactics that are questionable at best and down right abusive and traumatic at worst. Fair enough, and this is extremely helpful in that some parents may now steer clear of the facilities that use unethical sales and marketing techniques to prey on desperate and vulnerable parents.
The interesting thing about this book is that she takes the reader through what she views as the shady side of the industry from its inception to its current practice in places such as the World Wide Association of Specialty Programs and Schools (WWASPS). The connection to Synanon, EST, Tough Love and Alcoholics Anonymous is fascinating reading. However, Ms. Szalavitz' conclusion that virtually ALL programs for at-risk adolescents are ipso facto bad and that "hundreds of programs in the U.S." utilize these abusive "tough love" methods is wholly without merit to those of us working in this industry. She asserts that "treatment programs" should only be used when grades have fallen dramatically, the child has demonstrated an inability to quit drugs on his or her own and other outpatient methods have been exhausted without success. In other words, she supports the notion of residential treatment only when it is demonstrably needed, and with that, we wholeheartedly agree. There is an extraordinarily naive, sophomoric quality to Ms. Szalavitz' advice. She continuously exhibits her outsider status and lack of knowledge about the current world of special needs schools and treatment programs. It's as if she believes parents resort to treatment programs when Johnny brings home his first B- or smokes his first joint. She has virtually no empathy for or understanding of what the vast majority of parents truly go through, often for years, in their attempts to address problems and avoid residential placement.
I fear she is casting such a wide net across an entire industry that it will discourage parents from considering residential options when, in fact, they may be the only remaining safe option when all else has failed. Ms. Szalavitz misses the opportunity to reassure parents that there are, in fact, many reputable facilities with qualified staff, appropriate licensure, and track records of success through compassionate, sophisticated, research-supported treatment. The "scare of the week" tactic as employed by Dateline, NBC et al. does a considerable disservice to those parents who are truly desperate for answers and are willing to accept guidance and coaching through one of the most stressful and challenging processes a parent will ever endure. Fortunately, there are so many success stories to call upon that one-sided books like this will ultimately be drowned out by the chorus of parents who say that the program their student was in saved their life.
Adapted from the Bodin Exchange Newsletter, Volume II, Issue II, May 2006 and published with permission of Douglas Bodin.