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The Trouble With Tough Love

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Fortunately, the short-term residential treatment I underwent was relatively light on confrontation, but I still had to deal with a counselor who tried to humiliate me by disparaging my looks when I expressed insecurity about myself.

The trouble with tough love is twofold. First, the underlying philosophy -- that pain produces growth -- lends itself to abuse of power. Second, and more important, toughness doesn't begin to address the real problem. Troubled teenagers aren't usually "spoiled brats" who "just need to be taught respect." Like me, they most often go wrong because they hurt, not because they don't want to do the right thing. That became all the more evident to me when I took a look at who goes to these schools.

A surprisingly large number are sent away in the midst of a parental divorce; others are enrolled for depression or other serious mental illnesses. Many have lengthy histories of trauma and abuse. The last thing such kids need is another experience of powerlessness, humiliation and pain.

Sadly, tough love often looks as if it works: For one thing, longitudinal studies find that most kids, even amongst the most troubled, eventually grow out of bad behavior, so the magic of time can be mistaken for the magic of treatment. Second, the experience of being emotionally terrorized can produce compliance that looks like real change, at least initially.

The bigger picture suggests that tough love tends to backfire. My recent interviews confirm the findings of more formal studies. The Justice Department has released reports comparing boot camps with traditional correctional facilities for juvenile offenders, concluding in 2001 that neither facility "is more effective in reducing recidivism." In late 2004, the National Institutes of Health released a "state of the science" consensus statement, concluding that "get tough" treatments "do not work and there is some evidence that they may make the problem worse." Indeed, some young people leave these programs with post-traumatic stress disorder and exacerbations of their original problems.

These strict institutional settings work at cross-purposes with the developmental stages adolescents go through. According to psychiatrists, teenagers need to gain responsibility, begin to test romantic relationships and learn to think critically. But in tough programs, teenagers' choices of activities are overwhelmingly made for them: They are not allowed to date (in many, even eye contact with the opposite sex is punished), and they are punished if they dissent from a program's therapeutic prescriptions. All this despite evidence that a totally controlled environment delays maturation.

Why is tough love still so prevalent? The acceptance of anecdote as evidence is one reason, as are the hurried decisions of desperate parents who can no longer find a way of communicating with their wayward kids. But most significant is the lack of the equivalent of a Food and Drug Administration for behavioral health care -- with the result that most people are unaware that these programs have never been proved safe or effective. It's part of what a recent Institute of Medicine report labeled a "quality chasm" between the behavioral treatments known to work and those that are actually available. So parents rely on hearsay -- and the word of so-called experts.

Unfortunately, in the world of teen behavioral programs, there are no specific educational or professional requirements. Anyone can claim to be an expert.

Author's e-mail:

maiasz@gmail.com

Maia Szalavitz is the author of "Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids" (Riverhead Books).


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