First in a series of blog posts by child and adolescent psychiatrist Peter Cohen

 

An artistic, gifted-and-talented 15 year-old girl with a history of truancy and fist-fighting with peers has stopped those behaviors, but now has daily temper tantrums. In her poetry, she writes about heartbreak, parental abandonment, and getting high.

A restless 17-year-old boy with exceptional athletic abilities and significant learning challenges frequently arrives at school stoned. He wants to improve his grades so that he can graduate, but refuses to meet with the psychiatrist. He says, “I don’t want to go on no medications…they make me worse.”

A hardworking parent is ready to hand custody of her child over to the state because of persistent taunting and punching holes in the wall that may result in eviction. The student, who admits to marijuana use, rarely misses school, but has major mood swings and can’t sit long enough to complete school work.

 

The above vignettes are composites of adolescents attending the therapeutic high school where I work. But these stories haven’t changed over the 35 years of my practice in psychiatry.

No, it’s never been easy to help teenagers and their families learn how to lead positive, productive lives. But how does a professional manage an adolescent’s habitual substance use, behavior that can throw a monkey wrench into the uneven-but-expected path of normal development?

Our field has made some critical breakthroughs. We’ve accumulated more scientific knowledge, adopted more research-informed treatments, and practiced more effective skills.

I think we know what works. So why aren’t we doing it? Why aren’t we doing it consistently? And why aren’t we doing it in a setting where teenagers spend a significant amount of their time, the school? Over the course of this series of blog posts, I’ll address these questions.

I’ll talk about how we can make an impact on both the “wild and woolly” and the “meek and mild” student. I’ll also share ways I think that you–as a counselor, social worker, or other professional who works with youth–can use the expertise of a psychiatrist to make your work more effective.

Sometime along the way, I’ll tell you about my first day at the therapeutic high school, about how and why I chose to work there. I’ll also talk about the big picture: how we practice and fund mental health and substance use disorder care in the United States.

Finally, at the end of each piece, I’ll answer three QIWYWA’s (Questions I Wish You Would Ask) or QYA’s (Questions You Asked).

As background, I am a board certified child and adolescent psychiatrist with additional certification in addiction medicine. Over the past 34 years, I have worked in hospitals, residential programs, and outpatient clinics. In addition, I have served as the medical director at the county and state level, focusing on policy and quality assurance for behavioral health programs. I am now semi-retired; I’ve spent the last three years working part-time at a therapeutic high school in suburban Maryland.

 

The Three Questions

Q: I don’t feel comfortable working with drug-using teens, but I should. What’s the first skill or therapy I should learn?

Learn how to do motivational interviewing because it comes close to what appeals to adolescents: it’s positive, non-diagnostic, non-stigmatizing, empathetic and respects the viewpoint of the teenager. Once you’ve mastered that skill, ask me what to learn next.

Q: What books or films have influenced you the most in working with teenagers?

Haim Ginott’s Between Parent and Teenager, The Catcher in the Rye, and The Wire, Season 4 (on HBO).

Q: What definitely doesn’t work with teenagers?

Talking above them or over them, losing your temper, shaming, lecturing, hogging the time, never letting them blow off steam, arguing, ignoring, starting off by talking about problems and diagnoses, wishing you could be his or her parent, spending most of your treatment planning time discussing the intricacies of the child’s inappropriate hijinks.

All of these are what I call “chasing the behavior” rather than engaging the teenager. Whenever I fall into these traps, I repeat the following mantra: “Be quiet. Good, now look and listen. Refocus on the teenager’s most cherished goals.”

That’s all for today. And remember, if you can’t keep your sense of humor with an adolescent, you’re in deep trouble.

 

Peter Cohen headshotPeter R. Cohen is a board certified child and adolescent psychiatrist with additional certification in addiction medicine. For the past 34 years, he has worked in hospitals, residential programs, and outpatient clinics. Between 2004 and 2012, he served as the medical director at the county and state level, focusing on policy and quality assurance for behavioral health programs. Now semi-retired, Dr. Cohen works part-time at a therapeutic high school in suburban Maryland.

Want to submit a question to Dr. Cohen? It may be answered in future blog posts! Email Jessica Williams at jessica at ireta dot org. If you submit a question, you will remain anonymous on our blog.