Tag Archives: adolescents

The Submission

When I first submitted Working Through for review at the The Therapist, I waited. I waited patiently. Over the previous year, I’d been writing prolifically, completing two books, one a novel whose basic plot I strain to describe in less than a paragraph, but whose themes cover the bases of a therapist’s sphere of influence: addiction, depression, psychosis, and most crucially, the good news: empathy. My other book, my expose of drug treatment and adolescents, fully entitled Working Through Rehab: An Inside Look at Adolescent Drug Treatment, is an ambitious, sprawling memoir cum essay that has been variously thrust at agents, publishers, and indulgent peers, though getting people to read it feels a bit like peeling wet leaves off a driveway in the dead of winter. I take my readers one at a time.

A colleague, a good friend whom I do not shame into reading my material, suggested I take advantage of membership in the statewide association of Marriage and Family Therapists, and submit my non-fiction to its flagship journal, The Therapist. The magazine, which is published quarterly, or thereabouts, features a section in which members can volunteer to read submissions and then provide a review. It seemed like a good idea to take advantage of a service that is a privilege of membership. My friend is good at having ideas that obscure his lack of effort. Anyway, what could I lose? I thought, especially after I’d just waiting six months waiting fruitlessly upon a publisher to study WTR, express enthusiasm for its content, but ultimately reject its content. They don’t publish memoirs of non-famous people, said an executive editor, gratuitously pointing out that I wasn’t famous. Fair enough, I thought. However, he could have told me this earlier, rather than having me wait with bubbling hope that a fantasy writing contract was forthcoming. In the end it was a flat e-mail that delivered the publisher’s verdict—an afterthought, really—by a deputy editor who had forgotten to reply to my last message. A flattering response, “well-written and compelling”, was quickly followed by the word, “unfortunately…” rendering the compliment a consolation.

So I submitted WTR to The Therapist in January 2014, thinking it might be advertised in the next issue, and possibly reviewed in the issue following that (as suggested by the editor). March was the next issue, and my fresh-looking book was there in print, alongside several other titles, looking eager like playful children, but also like bags on an airport carousel waiting to be collected. I was pleasantly anticipating, thinking my book an important work. As far as I could tell, no one else was writing about what really happens in drug treatment, and I feel in my gut that there’s a readership for subject that’s slightly off-center: it’s comprised partly of parents concerned with the impact of drugs upon kids, which is what publishers might presume the book is about. There’s a faction of society that is more broadly concerned with mental health, and with the problems of poorly attached individuals, the famous and non-famous, who are collapsing around us, killing themselves with addictions, violently attacking others in schoolyards and movie theaters, or just plain killing themselves. And there’s a faction of workers in this field, who aren’t necessarily readers, who are slated to work with all these people and somehow help figure out all of their problems: they are therapists, social workers, drug and alcohol counselors, for the most part, and they—not the adolescents or their families, actually—are the heroes of my story.

At least some of them are, and that’s what’s potentially controversial about my book, because it’s not exactly a tribute. You see, I write about some of the things people expect to learn about drug treatment: like what leads kids and their families into drugs and addiction, and how treatment and therapy can help claw them out. But I’m not writing a how-to guide for parents, or any other consumer of the industry. I’m more of a critic of the process; the only kind of critic this business could really have: that of an insider, versus, say, a peripheral insider, such as a policy maker, or even most physicians. I’ve worked several positions within a hospital-based treatment setting, as a counselor and later as a supervisor of therapists. I was a manager of a six-bed group home for teens for three years; a leader of an intensive outpatient program for another three, and have seen patients across several divides in private practice for about twenty years. I’ve tracked the dialogues between the addicted and their families. I’ve been a part of and witnessed the back and forth arguments between patients and helpers, administrators and clinical professionals, and I understand the context of treatment’s limited resources, the conflicts many do not understand. I know the Gordian Knot that is drug addiction and the continuum of drug treatment, and the strained efforts to untie it.

As for the feedback process: I’d written the book, had it appear in black and white, and learned that it was selected by a volunteer to read. Again, I waited. When it didn’t appear in the next issue I sighed and reasoned that the book was long (350 pages) and dense, and was perhaps demanding more time and effort from a committed reader than I’d accounted for. But when a review didn’t appear in the issue after that (another two and half months on), I wondered what was happening. I e-mailed the magazine’s editor, a man who had cheerfully written that WTR had been selected six months earlier, and asked the question. Seeming like the deputy editor of that unnamed publisher, he wrote back that he hadn’t yet received a review from the volunteer, and didn’t know why. With curious incuriosity, he added that I might re-submit a copy such that the book could be advertised again as available for review, and that I might implicitly begin the cycle of waiting all over again. It was: oh yeah, I forgot, followed by an attempt to sweep the matter aside. Waiting and writing: years ago, when I started practicing this pleasing craft, I had no idea there would be this much waiting. What was I submitting myself to? Coolly, I replied to the editor, modeling the curiosity the situation compelled: Was there a problem? Is the volunteer no longer willing or able to provide a review? Did they get bored after reading a chapter and burn the copy? Or were they so engrossed that they couldn’t take their eyes off the material, even when driving, and thus died in a fiery crash. The sheepish editor, to whom I did not share these fantasies, wrote back that he’d pursue my inquiries. A week later, after I again solicited information, he replied that he still had none to give. He vaguely apologized on someone’s behalf, perhaps his own, for being inattentive. He excused the magazine by pointing out that this event—this phenomenon of neglect—seldom happens, and once again invited me to re-submit a copy.

Which I have done, and I am waiting. It is June of 2015: enough time for topical subjects to come and go; happily, or not, addiction isn’t one of them. And as I wait, I will continue to ruminate on my work, and perhaps inflate its importance, thinking that someone is out there waiting to snatch up another copy for review, but then blocking its exposure by abandoning the task. Or maybe I’ll be rewarded for my patience, and my raw message on this subject will be read, perhaps even in numbers, and a fair critique will come back at me finally. In the meantime, I will remind myself that while the culture continues to seek and develop tools for immediate gratification, the writer must endure the slowest, most excruciatingly elusive feedback system ever known.

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Saving Thunder Road

In a recent article in the Contra Costa Times, journalist Malaika Fraley writes that Thunder Road Adolescent Treatment Center in Oakland is scrambling to stay open. She reports that TR’s longtime operator, Summit Medical Center, has been planning to sever ties with the program for two years, due to annual running costs of the residential drug rehab and plus facility in excess of $6 million, yearly deficits of $800,000, and declining admissions. Well, I think that conversation’s been happening for much longer, actually.

I worked at Thunder Road for fifteen years, between 1996 and 2011. I chronicled my time, what I observed, what I think treatment for substance abuse and teens entails, both from a research and personal perspective, in a book I published in 2013, entitled Working Through Rehab. Among other things, I remember that threats to the program’s viability started around 2004, and continued periodically thereafter. When I left TR in 2011, I’d worked most clinical positions in the program, seen various changes to program structure, tweaks of philosophy and methods, etcetera, and held the view that TR had been “scrambling” for some time. I am sympathetic to its latest bid for survival, and for the prospect of retaining “the only program of its kind” for Bay Area, and especially East Bay, Alameda residents.

But what is the meaning of this latest, perhaps most threatening of crises? If the community wants drug treatment for youth; if it believes that drug abuse, gang violence, physical and sexual abuse, child abandonment, are ills damaging the community, where is the ongoing support for programs like Thunder Road? Why were admissions declining? Where is the city leadership, the rally of business sponsorship that would spare a thirty year old institution from this desperate position? At the risk of disparaging efforts that may yet come to fruition, I wonder if there is enough conviction to save Thunder Road; if there exists a muted rejection of drug treatment in the community as a whole.

An overview survey from 2014 by the National Institute on Drug Abuse (NIDA) reveals some interesting trends. Use of illicit drugs has generally declined over the past two decades: decreasing use of alcohol, cigarettes, the misuse of prescription pain relievers; stable rates of marijuana use among teens, but perhaps more importantly, changing attitudes about the perceived risk of harm associated with marijuana use. 36% of adolescents say that regular use puts users at great risk compared to 52% just five years ago. In other words, a majority of teens no longer think marijuana use is significantly harmful, which begs the question: what becomes the pretext for treatment, especially a residential admission, if this attitude prevails? Aundrea Brown, who runs Alameda County’s public defender’s juvenile division, states that Thunder Road is an essential placement alternative to juvenile hall (according to the Times article). The Save Thunder Road petition site says something similar. But I suspect many citizens of Alameda, the county that TR now dominantly serves, might reject the implied dichotomy. They’d surely rebut that neither alternative should exist; that a society moving towards legalization of currently illicit drugs, and that deems K2/spice, painkillers, e-cigarettes (according to NIDA, the only major substance whose use is on the rise) as effective, acceptable mood-altering substances, should leave well enough alone.

I hope the county is able to broker financing for a provider (or coalition of providers) to take over care of Thunder Road from Sutter. On balance, I believe what the program brings is a valuable service to the community, though it undoubtedly needs reform. But a broader question needs to be aimed at the community, in schools, churches, within board meetings and without: what do you really want to do about drug use?

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More on that law

So the dialogue continues on the new law AB1775, the surreptitious addendum (from the POV of therapists and others who will actually have to follow it) to the Child Abuse and Neglect Reporting Act, which decrees that “certain persons” who fail to report to police or a department of social services those who “access, stream, or download through electronic or digital media (material) which depicts a child engaged in obscene sexual conduct” are committing a misdemeanor. Obscene sexual conduct is defined in California Penal Codes 311.2, 311.3, 311.4, and 288.2, among others, and refers to various sexual acts, including the broadly termed “lewd and lascivious acts”, which is in turn defined as that which touches intimate parts of the body (sexual organs, buttocks, breasts of a female) and is “intended to arouse, gratify the lust of another”.

Most of those chiming in on my association list-serve are commenting on the absurdities of this law, pointing out (rightly) that this law will disrupt therapeutic episodes, ruin the lives of people unnecessarily, while doing little to prevent the proliferation of child pornography–the supposed purpose of the bill. The most ardent of critics argue that advocates of the bill lack compassion for those who struggle with porn addiction. Their opponents respond, without apology, that critics are supporting the wrong people (versus victims of child sexual abuse) while delivering motivational harangues about the scope and seriousness of the child porn problem. We are informed of cults, divisions of government–the CIA–who are perpetrating ritual sexual abuse of thousands of children; recruiting children for an army of sex…anyway, something like that. Advocates of AB1775 employ the logic of demagogues: in the 50s they would have justified blacklisting suspected communists by pointing out how many people Joseph Stalin was killing.

I think the issue is not so much one of compassion as common sense. Despite three months of asking, advocates of the bill are yet to give a sensible answer as to how the reporting and subsequent persecution of individuals viewing obscene material will stop those who produce the material. We are told isolated anecdotes of hard drives confiscated, images discovered, and through those images, the locations of victimized children are determined. Really? I wonder how many times this sort of intervention has occurred, and who gave the tip-off(s), which begs the question, why do authorities need therapists to provide the tips. And does it occur to anyone governing sex offender treatment that if someone is referred to said on the back of an episode in which a mental health professional tipped off police about child pornography use, why should such an individual thereafter trust the therapeutic process?

In deference to my esteemed colleague and crusader against ritual abuse, I declare that I’d actually be happy to report the CIA for sexual abuse to my local offices of Child and Family Services, though I don’t suppose the investigation would get very far. Meanwhile, I should get back to my office and prepare for some sessions with adolescents (wrong people) who present with more commonplace habits. You see, I need to explain to them the new law. I need to explain that the law specifies “child” as a minor, and so if they look at pornographic material depicting persons of their age group, I have to report them to authorities. However, if they look at a pornographic image of someone ten years older, then it’s all good. Also, I must warn that if they insist on sending pictures of their junk, breasts, zits on inner thighs and so on, then I might have to report that behavior also. Welcome to the new world order. I hope their generation is smarter. I doubt it.

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Full Metal Self

Had a few ideas recently, after watching the film Whiplash; made a few links, reignited certain determinations, sighed and resigned to my fate on a few other matters. The film stirred hope and–dare I say, inspiration–on many levels: firstly, I learned that the film had been out for nearly a year already, though it was only recently making a splash in theaters. I am reminded that promoting a film, like promoting a book, takes time, hard work, and no little amount of salesmanship. This parallels the story of Whiplash somewhat. Miles Teller plays Andrew Neyman, a young would-be jazz prodige, a drummer in a prestigious music conservatory band. Scouted and then selected by the school’s jazz maestro, Terence Fletcher, he joins a band that is further elite, and is initiated into rehearsals in a manner that is at once predictably brutal, yet also fascinating and entirely gripping. Actually, more so than any thriller or action flick I can think of, this film had me gripping my seat for almost its entire length, such was the tension created between the quietly narcissistic hero and his near sociopathic mentor. In scene after scene, I watched with mounting angst as Fletcher alternately seduces and then terrorizes the naive yet ambitious Neyman. He flatters him, telling the class he’s found his Buddy Rich; then, minutes later, he is tossing cymbals at Neyman’s head, mocking him for not keeping tempo, threatening to “rape him like a pig” if he fucks up his band. For my part, as non-musician, I had no idea drummers were this important.  Meanwhile, the Fletcher character brought to mind a few teachers from my past, sort of morphed with that terrifying drill sergeant character from Kubrick’s Full Metal Jacket.

About two thirds into the story, we get Fletcher’s rationale for being the way he is: modern jazz, like modern society, is in a sorry state, he says. The words “Good job” constitute the most harmful phrase in the English language (I’m paraphrasing). He’s an advocate of tough love, obviously; of the belief that teachers must push people beyond expectations in order to get the best out of them. The ends, as in the preservation (or growth) of standards, justifies the brutal means. The film’s counterpoint is to indicate casualties: a former prodige whom Fletcher had allegedly driven to suicide; the girlfriend whom Neyman dumps so as to focus on his drumming. Neyman’s father, a loving but feckless man, voices opposing values, decrying Fletcher’s abuse, challenging his son’s obsession, imploring him to slow down lest he (literally) die on the drumstool. Ultimately, the story seems a celebration of going for it; of not compromising standards. It’s just that it doesn’t ignore the costs.

Again, the film brought up a lot for me. I wonder how much of Neyman and Fletcher’s drama is transferrable to the world I inhabit. If you’re a would-be client of mine reading this, don’t worry. I have no plans to emulate Fletcher or the drill sergeant from Full Metal Jacket. However, I reflect on the opinions I expressed in Working Through Rehab, my book about adolescent drug treatment; sympathetic views about the dinosaur-like, similarly tough-love ethos of the much maligned Therapeutic Community Model. This week, I shall be teaching a short-term class on the Masterson Model at a community service agency in Marin, and espousing the value of, among other things, therapeutic confrontation, the importance of having boundaries, a therapeutic frame in which consistency, self focus–striving beyond expectations–are at least analogously observed. The dialectic I anticipate will mirror the drama of Whiplash, and maybe FMJ: principled agreement about driving people to their best, tempered with compassion for those who, for a variety of reasons, fall short.

As for myself, I go for it in my own way. Inspired by Andrew Neyman and the indelible image of his blood-stained drumkit, I might stay up late tonight, working on my latest manuscript: tightening the prose, adding pieces of subtext, changing a character or a plot point, correcting sundry mistakes in punctuation and spelling. I am well read with respect to my own books. I read them over and over again. It’s like combing the text, looking for tiny bugs. Sometimes I am satisfied; more often, I am not. Figuratively, I bleed. I have expectations.

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In Working Through Rehab, my non-fiction about kids and drug treatment, I feature a chapter entitled “Play Gone Wrong”, which draws attention to the corrupted pleasure-seeking that leads thousands, even millions of people into drug rehab programs each year. Life is full of games, games in which the rules break down and become bad games, play gone wrong. The phrase makes a cameo in The Situation, as the proposed and later rejected title of a book Bryan “Weed” Tecco has once written on the subject of role-playing video games: his area of expertise. Another cameo is that of an eight year boy, an abandoned child drifting in a hallway of an Oakland apartment building, playing old-fashioned games of cops and robbers, good guys and bad. In both The Situation and its predecessor, Crystal From The Hills, this child makes an appearance, calls for troubled adults to drop adult pretense and play his primitive games, on his terms and by his rules. But those games don’t last long. This kid is likely a future gamer; a drug user, or dealer, perhaps. Alone yet adult-seeking, he’s an attachment disorder in progress, a beta element in a bigger, darker game.
Halfway through The Situation, Weed takes a minute to describe his book, which he imagines—God bless him—that some will be moved to read. His literary polemic is a twenty-something’s take on a tired social commentary: that youth are becoming consumed by newfangled electronica, or worse, that a core of youth is desensitized by repeated exposure to violent themes in games like Grand Theft Auto, Call Of Duty, the Battlefield series, and so on. These games are becoming more popular than film or music, the previous major exponents of desensitization, the media reports. Violence continues to sell, but now it’s more interactive. The fourth wall is penetrated; the audience, once passive and merely ticket-purchasing, is seated at the console, in charge like it’s never been or felt before. Bryan Tecco is as skilled as anyone in this medium, and as such, has earned the right to say a few things, to disapprove from within the ranks. Well, within a speech aimed at Jill Evans, more or less the novel’s embodiment of feminine disapproval, he outlines the way things ought to be in the world of play: there ought to be more room for creativity, interaction…building things, performance. Killing is not where it’s at, where he’s at, he declares to her mild and pleasant surprise.
It’s a curious outcry from Weed, arriving as it does just before a watershed passage in which he pulls a firearm on one of his followers, and ultimately pistol whips him. Moments after, he’s performing donuts in a stolen vehicle, reveling in the kind of reckless driving that would belong in something like Grand Theft Auto. It’s the kind of hypocrisy that prevails when action films conclude with a hero’s plea for peace. For the record, I’d not grudge astute readers calling me out on the same duplicity. However, Weed, you might gather from the outset, has an edgy side to his character: not just pleasure seeking, not even profiteering, but something vengeful, something violent which subordinates a peaceful sensibility. In this way he still realizes his heroic potential, because the audience—his audience that is Jill or his peers, and perhaps you the reader—still like violence. Really. You don’t mind it, so long as it’s not entirely self-serving; as long as it stands up for something, for someone else, presumably someone weaker or less privileged, and doesn’t gratuitously inflate bank accounts. That’s how I cheated, in case you want to know. That’s how I wrote it, thinking you’d accept violence if you saw it in these terms, followed these rules. But please read until the end, because that’s where I change the rules
It also helps if my protagonist is an underdog, and a surprise underdog at that. Transcending his limitations—his un-athletic girth, his lack of Krav Maga knowledge, a reader’s prejudice borne of unflattering characterizations in CFTH—Weed shows that he is poised and capable in a fight; so much so that he inspires the supportive partnership of Jill who, despite her own nurturing front (she’s a nurse and habitual caretaker), activates her own aggressions (and she does know Krav Maga). That’s what circumstances often call for. That was the situation. That is the situation. But it’s not the way play ought to be.

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A Day in Symposium, Part Two

As I listened to several speakers champion the apparently threatened cause of drug treatment at the 2nd Annual Addiction Symposium in San Francisco, I wondered to what degree I was hearing cutting edge opinion. Conventional wisdom is that drug treatment should be thriving, with Parity Laws, Affordable Care Acts, and so on paving the way for expanded services: more spaces in outpatient programs; increased number of beds in hospitals. Third party payers must now think of addiction, or substance use disorders (as they are termed in the APA’s DSM V), as a disease, and therefore pay accordingly for its treatment. But programs aimed at specific professionals, such as doctors and nurses, are under threat, apparently. At least so-called “diversion” programs are threatened, though speakers thought the term “diversion” ought to be threatened (for reasons I didn’t really understand, I should add). Meanwhile, I wondered about the implications for a particular corner of the drug treatment industry, one in which I worked for fifteen years: namely, adolescent residential treatment.

When speaking of access to treatment for doctors, airline pilots, nurses, as well as adults in the general public, advocates tend to speak against discrimination issues: the problem of individuals being discharged from treatment programs because they relapse on drugs, or because they otherwise break program rules, fail to comply with medication regimens; because they exhibit the symptoms of their disease. The mocking that is directed at such intolerant discharges—the would you turn away a heart disease patient who has a heartattack? arguments—remind me of the similar yet more detached observations of journalist/physician Lonny Shavelson in his book Hooked. He likewise decried the strict rules of Therapeutic Communities, and lauded drug courts for working more flexibly with society’s most difficult cases, its most inveterate users. However, it’s strange to me that given the ubiquity of sanguine opinion at the level of medical leadership, that principals of adolescent programs, especially residential programs, don’t weigh in with some counterarguments: most notably, that relapsing substance users don’t just disaffect themselves as they continue to use drugs or refuse to take pills or go to therapy. Sometimes they spread drugs in a program, or threaten people, physically hurt people; harass people, verbally abuse people, staff and peers. Problem? Of course it’s a problem—a problem of safety. And it’s not a problem that can be resolved with a brief course of motivational interviewing, and so discharging—that “discriminating” act against the incorrigible—is not only appropriate for some, it’s necessary.

This issue of how to make treatment safe for everyone (especially kids) is one of the most important topics in my book, <em>Working Through Rehab: An Inside Look at Adolescent Drug Treatment</em>. Who am I to offer opinions? Who do I need to be? I am not a physician. I’m not a recovering drug addict, nor am I a long-suffering parent of a troubled teen. But I am a psychotherapist, and I worked for fifteen years in this complex rehab business that defies soundbites, pat summaries of phenomena. I compiled memories and opinion, and now offer for a concerned readership a nuanced view of what really happens in an average drug rehab.

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Adolescents and brain development: “Naming an emotion can calm it”


Putting aside for now questions confidentiality and containment, matters of how to confront or otherwise engage kids about addictive use of substances, let’s turn to some research about human development which helps us understand child development and the implications for drug treatment. Last year, Daniel Siegel, renowned psychiatrist and neurobiologist at UCLA, published Brainstorm: The Power and Purpose of the Teenage Brain, a book seemingly aimed at an adolescent readership.
Siegel’s book touches on many subjects which affirm assertions I make in my own book, entitled Working Through Rehab: An Inside Look at Adolescent Drug Treatment. Firstly, Siegel explains the adolescent’s susceptibility to such things as novelty seeking, risk taking, the seeming observance of positive outcomes of behavior, coupled with the seeming disregard of negative consequences—all of which are characteristics of an addictive personality. He points out that during adolescence there is an increase in the activity of the neural circuits utilizing dopamine, a neurotransmitter central in creating drive for reward. A drug, alcohol for example, can lead to release of dopamine, and users may later feel compelled to drink further so as to re-trigger a dopamine release (the addictive cycle). When alcohol wears off, dopamine levels decrease, and those who become addicted experience withdrawal symptoms, and are then driven to use more of the substance that spiked the dopamine circuits (tolerance). Through phenomena such as pruning and myelination, humans are able to integrate functions of various areas of the brain—the cortex, limbic system, and brainstem—render it more efficient, and in particular consolidate skills around that which is repeatedly experienced.
And therein exists the problem for many who become addicted or otherwise troubled. Alluding to problems of attachment in early childhood, as well as social conditions that exacerbate feelings of disillusionment and disconnection, Siegel observes that many seem to become arrested in survival modes of thought and behavior, and therefore strain to develop skills that serve collaboration: so-called pro-social behaviors, reflective thought, and above all, empathy. They become prone to what psychoanalysts call psychic equivalence—the inner sense of conviction as to what others are thinking, leading to impulsive action. For the individual lacking what Peter Fonagy calls mentalizing skills (the ability to reflect upon another’s mind), even another person’s neutral responses are filled with hostility. Therefore, not only must those individuals not be trusted, they must be defended against, at all costs.
These were among the qualities that I observed repeatedly over my fifteen years working in adolescent drug treatment, in kids and sometimes parents; especially at Thunder Road, the Oakland facility wherein I worked until 2011. There were distinctive patterns of thought, feeling expression, and behavior that I observed, and which I depict and chronicle in my book. Siegel writes about many of these phenomena from a largely theoretical point of view. He describes the tendency for troubled kids to avoid their feeling states, to feel anxious but “get rid of the feeling”, rather than being open to learning about those feelings. In the dynamic between parent and child, he reminds us of feedback loops: the cycle wherein kids act out in some manner, producing negative consequences; adults react severely, exacting consequences that further stifle adolescents, who in turn rebel against the restrictions with further, perhaps even more egregious behaviors (BTW: I see this playing out with adult couples, also). Implicitly, Siegel affirms the premises of both drug treatment and psychotherapy (sometimes compatible entities, believe it or not) by indicating that in the brain, naming an emotion can help calm it. Here the psychiatrist is encouraging something that many resist. Indeed, hardly a week goes by without someone in my practice asserting that the problem is not so much “not talking about it”, but rather “talking about it.” The solution, according to the addict not in recovery, is not a sustained emotional release, but rather the opposite: silence and isolation.
Dan Siegel’s book, Brainstorm, is a useful affirmation of several ideas promoted in Working Through Rehab, though don’t get me wrong. I’m hardly claiming originality. In keeping with my sense of being a droplet in huge reservoir of information, my book contains well over a hundred references and endnotes. In the fourth of these articles devoted to adolescent drug treatment, I shall explore the territorial battle between theories of psychotherapy, and in particular, upbraid the narrow-minded, cynical, and even corrupt disregard of long-term, psychodynamic models of psychotherapy. As a preview, I’ll return again Siegel’s thoughts. In Brainstorm, he challenges the adolescent reader to reflect upon his or her past—the early attachment experiences—which are a staple of long-term, psychodynamic (as in psychoanalytically-derived) practice: “It makes sense for you as an adolescent to make sense of your life history so you can be as fully present as possible in your relationships. What this means is reflecting on your relationships in the past in your own family life and asking yourself how those experiences influenced your development.”


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