Adolescent Therapy - Is there an elephant in the room?

By Stephen C. Schultz


Over the last year I have received about one call per month from different allied health professionals trying to get a student admitted to Oxbow Academy that is 18 yrs old or about to turn 18 in a few weeks. This is a problem because once a student is 18 yrs old, Oxbow cannot admit them because they are technically an "Adult". This last weekend I was communicating with a family that has a boy turning 18 in two weeks. He has some cognitive functioning deficits and functions at the level of a 13 yr old. He has a history of previously attending a wilderness therapy program where they addressed some substance abuse and depression. There was knowledge and a history of sexual concerns, but they were not addressed in the wilderness program. This family was set to bring him to Oxbow next week…he ran away. Should he end up in the adult legal system it will not be a good outcome for this boy or his family.

We recently had a student come to Oxbow Academy from another residential treatment center. This particular program called us for some insight pertaining to the process of getting a Psycho-Sexual evaluation done on a student enrolled in their program. This student too had some sexual concerns, but he was admitted to work on his anxiety and depression. They wanted to do the testing at their facility and simply needed the names of Psychologists. This treatment program knew the student had some sexual issues to the point of other students feeling uncomfortable, but there was some resistance on the part of the family to address the sexual concerns head on. The program kept trying to work with this boy. He eventually went on a pass with his parents, did some inappropriate things and found himself in legal trouble.  Parents then had to hire an attorney at an additional expense and he was then transitioned to Oxbow Academy a couple of weeks later after a stay in the local detention center. At Oxbow, because it is an emotionally safe environment, he disclosed some pretty serious sexual issues within a week or so.

At the Oxbow parent seminar, I heard these parents talking with Shawn Brooks about their disappointment in the previous program as well as their educational consultant for not encouraging the transition sooner. They felt the previous placement was a waste of time and money. (The other placement did mention a transition, but the parents were showing resistance and the program relented.) Shawn did a great job of helping the family to understand that the other treatment wasn’t a waste of time and that his previous placement actually contributed to his ability to open up and disclose so early in the process. None the less, resources had run thin and these parents felt time had been wasted.

Allied health professionals can play a key role in early intervention. It’s important to realize that a “single event” doesn’t just happen. Whenever there is an “event”, there have been warning signs leading up to that event. As professionals, we simply need to know where to look. Because of the secrecy and shame associated with sexual issues, clinicians and consultants need to be deliberate in connecting the dots. Too often, professionals look at an "incident" and try to figure out if that one instance is serious or simply "Boys Being Boys", without asking further questions!

You know, all too well, that by the time a parent has contacted you, they have already had some pretty uncomfortable conversations with schools, neighbors, therapists etc. The below questions can be asked in a professional, consultative and sensitive way. These can be used at your first meeting or with parents and their clinicians in programs if issues start to surface while in treatment.

Questions like;

·         Tell me about his friends and social activities.

·         What are his friends like?

·         Does he spend time with friends or isolate?

·         Are his friends age-appropriate? Younger? Older?

·         What is his computer use like? School work? Gaming? How much time spent?

·         Is there anything you have noticed about his sexual development that has concerned you?

·         Have you noticed anything of a sexual nature that you just thought was “normal teenage behavior”? Doodling on notebooks? Viewing pornography? Sexual talk with friends?

·         Is there anything, as a parent, you just know in your gut isn’t right about his boundaries with others? Communication with others? If so, please share.

As this type of conversation takes place, parents generally share more information. They are actually relieved to be discussing things they didn’t think they could discuss or that others wouldn’t understand. As an educational consultant, clinician or health care professional, it will provide other avenues of exploration.

What should we share with parents when there are concerns about sexual issues and their teen?

My message for parents:

·         While the “stigma” of sexual issues is difficult, denial is worse.

·         There is hope. There is help.

·         Early intervention is the key to healing and successful outcomes.

·         Don’t rationalize…it wastes time and resources.

·         A Psycho-Sexual evaluation is only as good as the information that is known. *

·         Let’s get to the truth, stop the guessing, create a plan and move forward with healing.

This information has been on my mind for a while. I hope you sense my motivation for this post. My heart goes out to these families who are struggling to make sense of their world when dealing with these emotionally charged, clinically complicated issues.

Please don’t hesitate to contact me anytime, even if it’s just to “run a situation by me”. I’m happy to assist any way that I can.

*Often, in general therapeutic settings, a therapist will “feel” there is more to the story. They will then schedule for an outside psychologist to come in and do a “Psycho-Sexual Evaluation” While this has been the standard for many years, it is not the most efficient or conclusive way to gather "disclosure" information. No matter how skilled the psychologist is, a teen will NOT make a FULL disclosure to a stranger. And, if a therapist “feels” a Psycho-Sexual Evaluation is needed, that is generally evidence that they DON’T have a full disclosure and are looking for a method to provide more information. If you have a “feeling in your gut” there is more, there usually is! The most effective way to get all the “cards on the table” is for the student to be in an emotionally safe, homogeneous group setting. There is not one student who has come to Oxbow, having completed a previous “Psycho-Sexual Evaluation” that did not disclose additional information while at Oxbow. Usually the information is clinically significant enough to alter the boys treatment plan.