These Teens Got Therapy. Then They Got Worse.

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From The Atlantic: “You have to admit, it seemed like a great way to help anxious and depressed teens.

Researchers in Australia assigned more than 1,000 young teenagers to one of two classes: either a typical middle-school health class or one that taught a version of a mental-health treatment called dialectical behavior therapy, or DBT. After eight weeks, the researchers planned to measure whether the DBT teens’ mental health had improved.

The therapy was based on strong science: DBT incorporates some classic techniques from therapy, such as cognitive reappraisal, or reframing negative events in a more positive way, and it also includes more avant-garde techniques such as mindfulness, the practice of being in the present moment. Both techniques have been proven to alleviate psychological struggles.

This special DBT-for-teens program also covered a range of both mental-health coping strategies and life skills—which are, again, correlated with health and happiness. One week, students were instructed to pay attention to things they wouldn’t typically notice, such as a sunset. Another, they were told to sleep more, eat right, and exercise. They were taught to accept unpleasant things they couldn’t change, and also how to distract themselves from negative emotions and ask for things they need . . .

But what happened was not what Harvey and her co-authors predicted. The therapy seemed to make the kids worse. Immediately after the intervention, the therapy group had worse relationships with their parents and increases in depression and anxiety. They were also less emotionally regulated and had less awareness of their emotions, and they reported a lower quality of life, compared with the control group.

Most of these negative effects dissipated after a few months, but six months later, the therapy group was still reporting poorer relationships with their parents.

These results are, well, depressing. Therapy is supposed to relieve depression, not exacerbate it . . .

But for people who study teen-mental-health treatments, these findings are part of a familiar pattern. All sorts of so-called universal interventions, in which a big group of teens are subjected to ‘healthy’ messaging from adults, have failed. Last year, a study of thousands of British kids who were put through a mindfulness program found that, in the end, they had the same depression and well-being outcomes as the control group. A cognitive-behavioral-therapy program for teens had similarly disappointing results—it proved no better than regular classwork.

D.A.R.E., which from the ’90s to early 2000s taught legions of elementary-school students 10 different street names for heroin, similarly had little to show for its efforts. (The curriculum has since been revamped.) The self-esteem-boosting craze of the ’80s also didn’t amount to much—and later research questioned whether having high self-esteem is even beneficial. Anti-bullying programs for high schoolers seem to increase bullying.

Reading these findings, haters of high-school assemblies might tingle with schadenfreude. But the consistent failure of these kinds of programs is troubling, because teen mental health is now considered a crisis—one that has so far resisted even well-considered solutions. From 2007 to 2016, pediatric emergency-room visits for mental-health disorders rose 60 percent. Most teen girls—57 percent—felt ‘persistently sad or hopeless’ in 2021, up from 36 percent in 2011. That figure is a still-not-great 29 percent among teen boys. Nearly a third of teen girls have considered suicide, according to the CDC . . . The kids are not all right, and frustratingly, we don’t really know how to help them. It feels like we should be able to just sit the teens down and tell them how to be happier. But that doesn’t seem to work, and sometimes it even backfires.”

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23 COMMENTS

  1. “These results are, well, depressing.” “we don’t really know how to help” the children, or anyone, of any age.

    For goodness sakes, the entire “mental health” industry’s billing code “bible” was debunked as scientifically “invalid,” over ten years ago, by the head of NIMH.

    https://psychrights.org/2013/130429NIMHTransformingDiagnosis.htm

    And given the fact the “we” / “mental health professionals” “don’t really know how to help” the children, nor anyone else. Perhaps it’s time to get the “depressing” and incompetent “mental health professionals” out of the schools?

    “Of course, there’s not a huge risk that American public schools will apply mental-health treatments to ninth graders without their parents’ consent. School boards can barely agree on which books to allow, so I don’t anticipate mandatory therapy coming to our shores anytime soon.”

    Um, the forced psychiatric treatment of young people, I think, is the primary goal of the entire “mental health professions” already. At least a systemic ELCA child abuse covering up psychologist told me he thought it was A-okay for social workers to psych drug the best and brightest American children, to “maintain the status quo” / the “pedophile empire.”

    https://pedoempire.org/wp-content/uploads/2021/01/PedoEmpire-Flyer-One-Page.pdf

    But unnecessarily psych drugging innocent children is morally repugnant behavior. And that has been going on in our schools, on a massively inappropriately manner, for way too long.

    Let’s save the children! We need to get the scientifically “invalid,” forced psychiatric drugging, “professionals” out of the schools! And that does include the non-medically trained psychologists.

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    • Yes and Amen. Let’s start by getting rid of gaming and phones. All teens and adults do is scroll. We have other things to do to be creative functioning people in society. So much is list. I saw it coming with www and tried to say NO! People are start g to
      Listen know. We are creating a very dysfunctional next generation who are supposed to carry us through.
      I remember when I had to take my daughters devices at night and we didn’t
      Even gave www, it at least we didn’t have internet service then. Now parents are having to watch kids screen time. Let’s do something about the screens. Maybe if the kids had to work for them and pay the monthly fees.
      I worked in the school district as a counselor for 20 years, getting out 10 years ago due to administration demands, vs students.

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    • I would add that it is not only invalid, it is illogical.

      The premise that symptoms for mental disorders are based on pathological process is false, based on 2, two, paragraphs of the DSM.

      That, given it is in the DSM, is authoritative. And it is thus in the sense that it admits:

      1.- There is no disease process known for mental disorders. No “pathological process” in DSM speak.

      2.- There is no way to distinguish “symptoms” for “pathological processes” from normal. I guess “normal symptoms” is the unspoken in those pararagraphs.

      3.- The severity of said symptoms, called “pathological symptoms” in those two, 2, paragraphs, does not correlate with anything. Obvious from number 2, two, above. So a severe symptom is, according to those 2, two, paragraphs of the DSM, indistinguishable from normal. That makes the criterion that ANY mental disorder has to be severe enough useless…

      4.- There is no test, no gold standard, no reality, objectivity, etc., to mental disorders. If there was a reality to it, a test, with a microscope, a chemical/physical apparatus would pick it up. It is in the American Psychological Association definitition of “external reality”.

      5.- Those are still facts, despite, psychiatry has been searching for more than 150yrs. That is not in the 2, two, paragraphs of the DSM. But it is in the history of psychiatry.

      So, adding to the comment and summing up, any argument, and any experiment designed and executed based on the premises that mental disorders, diseases and spectrums are real. OR, that mental symptoms are real, will be false.

      Since the premises are false, any argument AND experiment built on either or both of those premises will, by necessity, by force, be false.

      So, for me, it’s not just the invalidity, it is the falsity in simple logical terms.

      Any argument based in false premises, and the experiments planned and executed on those arguments will be false. Some will be circular, some will give positive results, some will be negative, some will be inconclusive, some contradictory, etc. But all, false…

      Just like psychiatry, and arguments based on false premises without experiments.

      The paragraphs are quoted in:

      https://madincanada.org/2023/10/maid-and-mental-illness-an-interview-with-dr-jeffrey-kirby/

      And my partial analysis is in:

      https://www.madinamerica.com/2023/10/maid-and-mental-illness-an-interview-with-dr-jeffrey-kirby/

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  2. Kids are smart and are able to perceive that stuff is messed up in the world, the economy sucks, Covid was traumatic for a lot of people, and there’s less of a sense of community.

    They feel hopeless because the ability to go get a career that’s at least partially fulfilling and pays commensurate to experience and education isn’t possible.

    They eschew (rightfully so) hustle culture and they see the delusion behind “be proud of your country” as the past decade has stripped the artifice from the structure of so-called democracy.

    And instead of telling them “be okay with the things you can’t change” while their world and future ability to simply sustain themselves (not thrive, just survive) is in severe jeopardy? Of course that’s not going to work.

    Corporate “mindfulness” seminars do the same thing! Instead of actually fixing bad policy and addressing low morale and poor retention, they tell us to fill out mindfulness journals and color in mandalas etc, and tell us to accept the changes.

    Do we teach people in abusive relationships to just practice acceptance and mindfulness? No! We support them getting out as much as possible, then work through the trauma in a supportive rapport-heavy environment.

    These kids see through the same bullsh*t, and clinicians throwing their hands up in the air, acting like this is a mystery is hilarious and sad and illustrates how out of touch they are.

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    • I don’t know any clinicians throwing their hands up in the air “acting like this is a mystery”. In fact most clinicians in schools I know, are hamstrung by parents who don’t want their kids to engage with therapy, school district policies and the psychotherapy board regulations in each state. It’s not that we don’t know how to treat issues and help, it’s that we are given a little bit of space to work with, and this is about the amount of stuff we are allowed to actually do. Mindfulness alone won’t do much, it might help some folks, other folks it actually might hurt more than help. PTSD for example, mindfulness meditation is actually really counter-productive as sitting in silence paying attention to your breath can be a huge trigger for trauma and make issues worse. I do agree there is a lack of training for specifically school counselors that could be significantly improved, but my point is that you’re acting like therapy can’t and won’t help. It can and would if it was given the full ability to do so and the right clinicians to put it in place. However, the field is massively unrewarding. Therapists are asked to do the impossible, and criticized when they can’t. We are underpaid and overworked, which a lot of people assume it pays well… in 90% of cases, it absolutely does not. It is also a failure of customized treatment planning in schools where individuals can actually receive proper, tailored treatments to them. These broad strokes “treatments”, which they aren’t treatments at all and shouldn’t be seen or used as such, but rather they are coping skills that when combined with individual therapy can be extremely useful. When they are just taught to everyone at once, it is anyone’s guess as to how they will land for each individual.

      All that said, yes the world is messed up right now. Kids do not have opportunities for economic success, bachelor’s degrees don’t count for much these days, home prices are impossibly high, cost of living anywhere with economic opportunity is too high for the offers of pay at reasonable jobs. Therapists cannot fix any of that. I would also never tell anyone to just accept the issues, I would tell them we need them to help us all change it. To make their voices and their needs heard. However, I also do teach them to be able to accept the difficulties and manage their emotions so they CAN take reasonable actions. I work with people in abusive relationships as well. I help them manage their emotions so they stop engaging in the pattern that keeps them stuck. I help them accept that their situation IS abusive and probably won’t or can’t change because the other person is unable or unwilling so that they can see they have to leave. I help them by offering resources and developing plans. I drive suicidal clients to in-treatment programs and talk them off the ledge. Stop pretending like therapists and clinicians don’t actually help and know how to help. The limitations to what we can or are allowed to do, client expectations that are unrealistic, societal messaging and politically biased messages that therapy is a joke or all therapists are awful or that all you need is God, all of these are the issues keeping clinicians from actually being able to help. Yes, there are bad therapists out there, just like any profession. Maybe even actually higher than other professions because of the perceived power that comes from the position, however, the vast majority, are people that really genuinely want to help. At the end of the day, the BEST therapist in the world, can only help as much as a client is willing to fully engage with the process. All it takes is a client that doesn’t want to go there, or doesn’t want to participate, for it to be rendered completely useless.

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      • You are assuming, without proving, that some/any form of psychological intervention is beneficial for teenagers, and as for the phrasing, that it depends on how, the details, is THE imporant thing. Despite you mention abstract, uninstantiated for the teenagers in the reviewed study, potential harms when PTSD MIGHT, might, be present.

        There is no mention of PTSD in the reviewed study. You have no “technical” basis to invoke it without making an instance, a relevance for teenagers here. Same as, without further ado: it was the weather, the cosmic background radiation, etc.

        Assuming SOME form of DBT might be good, or by extension, ANY form of psychological intervention might be good for teenagers is actually against what the paper reviewed in the linked article says or would suggest: In the average of the aggregate, what the researchers DID was BAD for teenagers.

        And the text quoted in this MIA reference actually quite clearly questions extending psychological “ideas” in minors. It gives several examples of botched, useless cackomamie of psychology on them. Based on the text quoted in this MIA piece, this is a latest form of that…

        Those doing the research are EXPERTS on DBT in TEENAGERS. So, implicitly, with all due respect, and not trying to offend, you’d have to be better than them to recur to your experience without anything else, like no other published research, to do the claims you do. They are specific experts and failed by harming teenagers.

        So, your claims seem like a red-herring and a missdirection that appeals to emotion for the difficulties that “therapists” experience in their contact with teenagers. That part seems fallacious. An appeal to EMOTION and AUTHORITY.

        Without proof. The proof is in the pudding, and the pudding says it is bad for teenagers to do DBT for ALL, for the aggregate. And that has happened before, as clearly suggested in the quoted text in this MIA piece.

        If your experience, with all due respect and sympathy for your feelings and opinions is that good, publish a paper and then MIA can review it if it passes muster.

        As for your speech of clients, CLIENTS!: the teenagers, in THIS study, were not clients, they were research subjects and GOT HARMED.

        So your rethoric about the “clients” “limitations” I find offensive AND innapropiate to what is being reviewed.

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    • What has changed from 20 years ago is most kids live in a virtual world. They no longer socialize personally; it is now one step removed. Social media wants to keep people on the site as long as possible. Being engaged in the real world is difficult. Kids find the virtual world is preferable to dealing with the complexity of real people.

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    • Actually my hypothesis/interpretation was that DBT increased narcicisstic abuse against teenagers that were “changed” by DBT and that created at least 6months’ conflict for teenagers.

      CBT might cause the same kind of harm: narcicisstic/psychopathic abuse against teenagers undergoing CBT…

      And even if they were are few teenagers, given, if I am not missremembering, the original academic published article didn’t said why scores indicated more conflict, I am guessing the “conflict” scores with family are “bad” because 5% of teenagers got way worse scores that brought the average down enough to be picked up by the researchers.

      And 5% is around what the prevalence of “narcicistic” behaviours of bad enough “quality” are present in the population.

      I have not done the math, but assuming average narcicistic abuse increased “conflict” by 10pts in a single teenager, then 5% times 10pts MORE would be 50 pts more in 100 teenagers. If the average is say, 10pts in all teenagers then 95% times 10 is 950 pts in 100 teenagers, plus the “normal” 10pts in THE 5% of teenagers under narcicistic abuse. Plus 50 pts, is 1050pts, divided by 100 teenagers comes to an average of 10.5 pts per teenager. A 5% difference in score after the intervention.

      A 5% difference in the aggregate of TWICE the increase in suffering in JUST 5% of the teenagers.

      Researchers could have figured that one out IF there was a number of how much DBT increases narcicistic abuse against a teenager undergoing DBT therapy, from OTHER published research.

      Which given narcicistic abuse is SO common, and 50% of teenagers in a clinical psychologists office APPEAR to be victims of it, they should have been AWARE, and take it into account when planning and doing the research.

      But I am guessing no such number exists published. But the scores of teenagers with and without narcicisistic abuse might give a ball park number.

      And, if I would be correct, if proves/suggests DBT is woefully innadecuate to DETECT/DIAGNOSE narcicisstic abuse by FAMILY, at least in teenagers. And the researchers are experts at DBT…

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      • Then, I can make up another quasi-explanatory narrative:

        Maybe the teenagers who got worse became therapists, DBT providers to their families, and that, predictably, was received with agression from the family.

        Given teens did not have status, their obvious agression as DBTeed behaviour, when not paired with status, was less than welcomed.

        Which would suggest, DBT providers, are actually aggressive, and it is the status that blesses, that hides, covers-up the agression as…therapy…

        Like a teenager Woody Allen character that goes psychoanalyzing his or her relatives, only to be met not with a wow! of improvement, but with the now, obvious at least hostility. At least the intromission of analysis feels aggressive, I can relate to that…

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  3. There are no sources cited for any of this ‘study’, as a therapist using mindfulness and CBT therapy (DBT therapy, mentioned in the article, is an offshoot of CBT) with teens, I have seen it work first hand more often than not. However, the point of therapy is not to never feel depressed or anxious or struggle with issues, it is to build resilience, coping mechanisms that help us deal with stressors and to feel more comfortable and accepting of what we cannot change. The idea that therapy should make us feel great all the time or fix our issues, is a westernized version of medicine. That we treat symptoms to rid ourselves of pain and dis-ease.

    As another commentor said, the world is in a right effed up place. We have never been more disconnected, forced to consume unhealthy media, faced with danger in schools, politically abhorrent and the rest of the things we are confronted with on a daily basis. If you aren’t depressed and anxious, you aren’t paying attention. Again, therapy will NOT solve your issues. It will not make it so you never feel depressed or anxious, it might not even make you feel good for a while because it takes a lot of effort to wade through the issues that root us in unhealthy ways. It might feel way worse for a time if it is your first time digging into your past and current issues. It WILL (or should* with the right therapist), given enough time and engagement, help develop a strong sense of self, a deeper sense of meaning to life and teach us how to set proper boundaries and how to regulate our emotions in the moment so we can be better equipped to handle difficult situations in healthier ways… It is not a failure of therapy, but rather a failure of therapeutic portrayal and expectations on behalf of pop-psychology, psychiatric approaches to medicating uncomfortable feelings away and a culture which teaches us we should feel good all the time so we move from addiction to addiction throughout the day trying to numb out the difficulties we face.

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  4. Interesting how you cut off the article just before they explain WHY the study didn’t work. You do provide a small link that most people won’t click on so, good on you. But ultimately you are taking advantage of today’s pension to write sensationalist and misleading headlines and creating “tension” in an article by waiting until the end to reveal the facts of the case. If you want people to truly understand a situation, give them all the facts up front. Please read on with the link at the bottom “Article”.

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  5. Introducing adult junk like this to kids as young as thirteen is a BAD idea; they’re too young to have developed either the emotional or cognitive apparatus necessary to process it objectively BECAUSE THEY’RE KIDS, FOR GOD’S SAKE! So, is it any wonder you wind up with kids more self-conscious than self-aware? Nope. At least not in my humble opinion.

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  6. “You have to admit, it seemed like a great way to help anxious and depressed teens.” you have to be kidding Ms. Olga Khazan: reading the comments in MIA from victims of DBT, that is actually the OPPOSITE conclusion I came up with…

    Maybe I am just crazy and proud of it…

    “I don’t suffer from insanity, I enjoy every minute of it”, by a famous chess player a long time ago…

    “These results are, well, depressing.” Not, really, they are saddening, proper english, poorly.

    ‘All sorts of so-called universal interventions, in which a big group of teens are subjected to “healthy” messaging from adults, have failed.’, yeah, and “they” keep trying, I am sure they have BETTER “theories” why NOW it should work, sarcasm…

    As a corollary and a side note, a footnote, and above note on doing research on humans is that the average of an heterogenous population regarding hidden variables that could skew the results in WAYS not deduced from a theory that is beyond doubt, objective, falsifiable, predicting, etc., is bound to give results like thise one:

    An intervention with reputation of being “good” in some “experiments” is “bad”.

    Narcicistic abuse, ocurring in 5% of the population sounds like a “hidden variable” not described by the “theory”, model of DBT. And the harm might actually have been strong enough to be picked up by the lower/higher average of “conflict” with family, depression, anxiety, whatever in ALL teenagers in the study.

    From just 5%, perhaps, of teenagers harmed by it…

    And that could explain the apparent “contradictions”: hidden variables BECAUSE no one KNOWS, beyond doubt, how DBT works.

    And therefore, how it harms. Most important fact: no one knows, not even the experts doing the experiment, unless they kept for themselves the WHYS. (!?)

    And to me, speaks AGAINST doing experiments in HUMANS, let alone MINORS, without knowing scientifically, not empirically!, how ANY intervention works.

    Be the intervention psychological, medication, wellness, etc., or just spanking them with the ol’ wooden board…

    The second part of the Atlantic article is bonkers!:

    It is saying, little is bad, more is good!. That is against reason and common sense: if little is bad, more is worse. And it does not explain why little is bad, other than vague, abstract “self awareness” on teenager suffering is bad, when caused by DBT. Ironically…

    Which is actually, alas, what the intervention tried to achive: more self awareness, like little is bad, more is worse. So… more so… more would be worse…

    Mr Miygagi said something like that!: Nothing is good, a lot, ahh, either way, the middle BAD!.

    And it is making excuses for the fact that voluntary treatment cannot be recommended when NO ONE is going to take it, no one is going to do it, because it is bitter, burdensome, or, unstated, USELESS or HARMFULL…

    Take the example the Atlantic piece gives about antibiotics (god knows where the analogy came from, or how it is relevant): nowadays no practitioner would prescribe an antibiotic treatment IF the patient is not going to do it full course: it generates microbial resistance and that is BAD for ALL of US.

    So, even following the analogy, therefore no expert in DBT would prescribe it to a TEENAGER, just under 14yrs of age that is not going to do it, full course, IF IT WAS HARMFULL NOT DOING IT FULL COURSE!. What kind of crappie-pappie argument is that?.

    That’s what could be called evily apologetic, misleadingly apologetic, harmfully apologetic.

    “the instructors might have had to dilute DBT beyond the point where it was actually helpful”, that is a concealed way of saying teenagers are DUMB. And a way to conceal it was HARMFULL…

    I was a teenager and NO ONE of my peers was dumb, they were reckless, impulsive, we all ignorant, teenagery human nature, but not dumb.

    Tell that to the teenager that baby-sits for your kids, bubba, what kind of parent/guardian leaves a small child with a DUMB teenager instead of a “smart” adult?. Hum?.

    Assuming it is better for teenagers that FEEL worse, like in: “But the teens in this study weren’t, on average, clinically depressed or anxious to begin with.”, it’s the same little is bad, more is better. Like saying, implying, DBT ONLY, somehow, works for “sick” people, and not dumb, somehow…

    Where is the proof of that when it harms NORMAL KIDS!, per the study.

    Does it not make more sense if it harms NORMAL kids, it harms MORE frailery kids?. MORE suffering kids?. Isn’t that logical and common sense?. That is why harmfull treatments are not studied in sick people: if they harm “normal” people, unless it’s cancer, they are not used in sick people.

    Just for that, this study advocates for BANNING DBT: Even in small doses harms NORMAL KIDS!!!!!. It’s poison!. If it were a pharmacological agent it would have never left, never progressed beyond phase I studies (to prove it is not harmfull phase): in normal people. It would have been shelved by a pharma company.

    Now, the part where it says pointing out one’s suffering ARGUES AGAINST ALL FORMS OF PSYCHOTHERAPY!. A simple: Oh, don’t worry, it’s normal, should work for EVERYONE. Or it works better for more suffering people?. Or less suffering people?. How does that work?.

    Why would it work only for SUFFERING KIDS?. That’s really, what one could call dumbfoundery dressed in psychobabble, mine included. Like a kid with a broken arm is going to feel better with: “Does this hurt more when I press MORE than when I don’t?”, sillyshery…

    And, uuuh, now the kicker: “Harvey, the study author, thinks the fact that the intervention didn’t include the parents might have created a gap of sorts between the parents and their kids.”, yeah, so… now… in bizarro world, the better off are bound to feel worse. That just creams my corn…

    “gap of sorts”, shouldn’t, like, the Groucho would have said: “a sort of gaps”?. Sorts, means? gaps?, what does that mean?. Sort off… or is it sort of?.

    “Of course, there’s not a huge risk that American public schools will apply mental-health treatments to ninth graders without their parents’ consent.” praise ye the lord!… except for narcicisstic/psychopathic researchers/parents/guardians/teachers/etc…

    “The upshot of all of these failed experiments, from the cheesy D.A.R.E. to the trendy mindfulness, is the old chestnut that you can’t change people who aren’t ready to change.”, yeah, I totally agree:

    At least proponents for DBT in minors can’t be CHANGED if they aren’t ready to BE, be, changed, by the research results of THEIR STUDY!!!!. See, that’s what they called projection…

    “Teens can make poor choices, but they are smart…” and yet, somehow, DBT had to be diluted for them…and how could be “poor” when they do it will ALL THEIR RICHNESS?. Is teenager not enough?. Does that not point to dumbness somewhere else?.

    “… and, on some level, know themselves.” or knew themselves well enough before the study.

    Better, apparently than the researchers and, possibly, Ms. Olga Khazan. But I admit, Ms. Olga Khazan, might have been under editorial constraints.

    And I retry puting the gravity of the situation: These teenagers were HARMED by a research ON THEM, brought by the researchesr with/without? parent and/or school consent…such bravery in publishing…

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  7. Jon, I appreciate your comments, and mostly agree– though I’d be more cautious about this idea: “All it takes is a client that doesn’t want to go there, or doesn’t want to participate, for it to be rendered completely useless.” Well, yeah, but there are lots of other reasons why therapy can be ineffective or rendered useless. Therapists do screw up, and using overly structured interventions is one of many ways we make mistakes.

    If you listen to your clients, and what you’re doing isn’t working, refer or discharge. I’ve gotten calls from young people I only saw four or five times years later who said they found the brief work we did very helpful. I’ve also had young people return after going on hiatus for over a year.

    I think working with 13-to-15 year olds is very different from working with 16-to-24 year olds. For younger teenagers, sometimes a hybrid of play therapy and adult therapy is more helpful. Like Jon says, some settings will not allow therapists to do what’s most likely to work. For example, set aside 10 or 15 minutes during early weeks of therapy to play video games with clients– or watch them play games– and then engage in authentic intersubjective dialogue about what was going on. Don’t be afraid to make an idiot out of yourself. Try to engage their imagination– how would they redesign the game? What do they get out of the game, and what in the brick-and-mortar world gives them a similar sense of satisfaction w/o the crash, the distraction?

    The idea that all therapists always take the expert position, or are inextricably bound up in DSM diagnositc constructs is a real howler. I don’t know anyone who practices that way, though we do use diagnoses for insurance purposes. Frequently, I am the one who explains to a young adult client that a DSM diagnosis is completely different from a physical health diagnosis. Most of use it just as a common language for describing symptoms– that’s all. Yeah, if I’m getting a referral, I want the last therapist’s opinion on whether, say, they feel the client’s distraction looks more like OCD or ADHD, and why they think so. But that’s not what’s going to determine what intervention I use!

    It is true that there is a baked-in power differential. This should always be addressed, and therapists should avoid giving advice. If we do, we better have a very good reason.

    My own feeling is that therapists who work with teenagers and young adults should be eclectic, and have a working knowledge of psychodynamic, humanistic, postmodern, and CBT-behavioral modalities of treatment. (Of course, behaviorism doesn’t really work except in very, very specific contexts, or for selling us shit we absolutely do not and never needed. All our dogs are laughing at us because we think behaviorism works. ‘Return the ball and you’ll give me a cookie? You are such a riot, primate! How about this time you chase me around the yard, and next time we jump in the pool?”)

    You’ve got to be ready to switch treatment modalities if what you’re doing doesn’t work. Sure, if a young person is dealing with substance use, eating disorders, and many other issues, you might want to try a more structured theoretical orientation, like CBT.

    And you might have to refer students to someone else if what you’re doing isn’t working. It’s one thing to feel momentarily worse after an appointment where difficult feelings came up, but another if the process is just taking them in the wrong direction, or a direction they don’t want to go.

    Or suggest they take a break for a while, try working things out on their own, and let them know you’re available if they want to try again later. If there’s no authentic sense of safety, there isn’t a lot of therapy that’s even possible.

    If therapists do screw up, we should take responsibility, not make excuses. Some young adults have never seen anyone over 30 do that– like, EVER. That can be a really powerful intervention. Mistakes can usually be repaired, but therapists have to be honest, and have to move fast. Rationalizing or justifying an intervention that backfired? THAT is the kind of mistake that can be very hard to repair.

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    • “The idea that all therapists always take the expert position, or are inextricably bound up in DSM diagnostic constructs is a real howler. I don’t know anyone who practices that way, though we do use diagnoses for insurance purposes.”

      A “real howler”, ehh??? It sounds like you haven’t been reading the personal stories here on MIA, so let me assure you the authors of these aren’t laughing ONE DAMN BIT. And one more thing: if what you say is true, THERE’D BE NO NEED FOR MIA —

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    • Well, I get the impression you’re expressing a criticism.

      But, the teens in the study were not clients, they were research subjects.

      As admitted by the published paper and at least one author claim in the linked Atlantic paper therapy was at least inadequate, probably, because of its shortness, and lack of “compliance”, uuugh.

      Inadequate client therapy on a non-client, a minor, and a research subject sounds so… put a word…

      So, that phrasing that tents to point away from the single word: inadequate, is misleading and dishonest on the researchers and the quoted author of the paper. I think, as my uninformed opinion.

      Then there is the no one listens to the DSM, only for billing purposes.

      That sounds kind of fraudulent?, and if the DSM is useless for diagnosing people, recurring to even MORE subjectivity and LESS grounding in science, objectivity, reproducibility, falsifiability, beyond doubt theory, that NO clinical psychological theory has, seems worse than using the DSM, which as phrased is already useless.

      So, stop messing with the kids until there is real science based on a theory that is made of facts that are true beyond doubt, objective, empirical, falsifiable, general and predictive, I think.

      Criticicism without openly and clearly stating AND probably admitting ALL the relevant problems is arguing about Angels dancing on a pinhead. Just like the published paper authors and the, partially, reviewer, interviewer of the Atlantic, in my ignoramus opinion.

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  8. DBT is an intensive outpatient treatment, four hours/day, four days/week, for four months with properly trained skilled helpers. “Research” using an 8-week shortcut is hardly conclusive and potentially harmful. Ideally, participants are first tested, diagnosed, and then treated with DBT or DBT-SUDS only if indicated. It’s not indicated for every diagnosis.

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