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Book Review - Help At Any Cost

 Cultic Studies Review, Vol. 5, No. 2, 2006, 327-332.

Help At Any Cost

By Maia Szalavitz

New York: Riverhead Books, 2006. ISBN 1594489106 (hardcover), $16.35. 326 pages with one appendix

Reviewed by Steve K. D. Eichel, Ph.D., ABPP


There is a strong tendency for each older generation to look back at its own adolescence with a mixture of nostalgia and embarrassment, and at each new generation of teens with a combination of fear, disdain and jealousy. Whether we consider the flappers of the 1920s, the beats, protesters and hippies of the ‘50s and ‘60s, the punks and stoners of the ‘70s and ‘80s, or the slackers of the ‘90s, every generation’s parents insist they have the most ill-mannered, lazy, rebellious, promiscuous, drunken or drug-ridden teenagers ever. And as surely as these teens grow up and have children, they invariably give rise to the next really worst crop of teens, who grow up and birth the truly worst teenagers, and on and on. Just as every new century heralds the apocalypse, every fresh crop of teenagers serves as the harbingers of the fall of Western civilization.

The 1980s saw a dramatic shift in the American zeitgeist. Former hippies and radicals were clamoring to join the same middle class they once abhorred. Having lost faith in big federal social programs, government bureaucracies, and "bleeding heart" psychotherapies, they seemed to welcome an invigorated free market that moved quickly to satisfy their increasing need for quick answers and strong responses to difficult social and family problems like sexual experimentation and drug abuse. If the first half of the 20th century had its juvenile courts, social workers, and Boys Towns, the second half, and especially the last quarter, would have its own set of “cures” for the common teenager: the “therapeutic” boot camp and wilderness programs. These programs claimed nearly miraculous effectiveness with the most difficult and destructive adolescent behaviors. By mixing techniques liberally taken from the human-potential movement with old fashioned “tough love,” they appealed to a generation of parents that came of age in the ‘60s but were no longer enamored with free love, mind-expanding drugs, or permissive parenting.

Help at Any Cost provides a much-needed and, at times, scathing indictment of the troubled-teen industry (TTI) that grew out of this need. While not a cultic study per se, Szalavitz’s work nevertheless delineates distinctly cult-like processes.

Szalavitz uses a journalistic approach to her material. The book begins with well-documented individual stories of families subjected to a high-intensity sales pitch and convinced of the immediate necessity of sending their children to residential “boot camps” and wilderness programs. After the parents agree to enroll their children (usually at considerable cost), the teens are taken to their programs by physically intimidating “escorts,” who sometimes surprise them in the middle of the night to avoid resistance. The programs then use extreme tactics, including forced marches and prolonged food and sleep deprivation, to shock and induce their clients into giving up destructive behaviors. Staffed by grossly undertrained and nonprofessional staff, and devoid of any ongoing medical supervision, these camps abuse the adolescents in the name of “treatment” while their programs seem primarily interested in generating more business and increasing profits.

Szalavitz has done her homework well, especially in those sections in which she traces the roots of the troubled-teen industry to Synanon, the “tough love” movement, and large-group awareness-training (LGAT) programs such as est and Lifespring. Early TTI programs such as The Seed and Straight Incorporated are discussed in enough detail to give most readers a good picture of their modus operandi. Szalavitz does not discuss these programs’ philosophical or methodological connections to Dianetics and the Church of Scientology, even though Scientology was a strong influence on the creators of both est and Lifespring. Perhaps doing that would have been overkill because Szalavitz certainly makes a clear case for the unholy marriage of intensive adolescent treatment à la Straight Incorporated and the controversial methods employed by LGATs and the strong-arm confrontations and group coercion employed by Synanon. Szalavitz also presents a cogent and fascinating discussion of how the troubled teen industry on which she reports usurps Alcoholics Anonymous’ Twelve Steps, twisting them so perversely that they meet Lifton’s criteria for thought-reform programs.

The problems with the TTI, according to Szalavitz, are many. They include the lack of external, independent regulation and the barest (if any) oversight by clinical professionals; the planned use of misinformation to literally “scare up” clients; the employment of highly dramatic, manipulative, but unproven interventions; and reliance on the kinds of marketing and sales strategies that have given rise to consumer protection laws in many states. As an example of the lattermost problem, Szalavitz points out that many parents who testified to the effectiveness of the TTI programs received a covert “kick back” in the form of reduced fees for their own children for successful referrals of new parent clients. Teenagers may be diagnosed in absentia by TTI staff who have little or no clinical training and credentials and who do not use established diagnostic procedures. Parents desperate for help and frustrated by conventional treatments such as family therapy (or who may not even have attempted them) may be subjected to well-orchestrated scare tactics to induce compliance with the TTI staff’s intervention plan.

Szalavitz, an investigative reporter, is at her best tracing the main players in the TTI, how they share similar backgrounds (e.g., in large-group awareness-training programs) and how they close or abandon one indicted or otherwise legally troubled program only to start another one under a different name, almost identical tutelage, and, typically, only nominally different leadership. Their failure to change their methods or learn from their mistakes raises the ongoing question of whether these “treatment specialists” are delusional and narcissistic “true believers” or sociopaths just out to achieve power, fame, and wealth. Veteran cult-watchers will recognize this debate as one that perennially engages journalists, researchers, and former cultists alike.

While many of her statements might seem controversial, I suspect the sections in which Szalavitz reviews the research on adolescent drug use and psychosexual development will cause the greatest uproar among readers who know or have troubled teenagers. Szalavitz is clearly in the camp that believes that the country’s drug policies are determined by political and cultural agendas that ignore science. She eschews the histrionics of the drug war advocates and "Just Say No" campaigners, and attacks their uninformed and superstitious views on drug abuse and addiction. She documents how scare tactics (such as the claim that minor drug experimentation or even listening to “druggie” music or wearing “druggie” tee-shirts will inevitably lead to active addiction) have led to ineffectual and even destructive drug-abuse programs. Szalavitz also documents, in sometimes scathing terms, how the TTI employs parents’ testimonies of miraculous changes, and the supportive statements of respected leaders such as former President and First Lady George H. W. and Barbara Bush to proselytize potential new clients. These “facts,” often presented by TTI “professional” staff with no addictions training or clinical credentials, may be used to overwhelm frightened parents into enrolling not only the identified problem child but his or her siblings, as well. As Szalavitz correctly notes, in reality the vast majority of teens who experiment with drugs and other forms of self-destructive behaviors do not become addicts and, in essence, “grow out of it.” Even among those who do become fully addicted, the best studies indicate that most who eventually recover do so without any formal treatment, and without becoming involved with Twelve Step programs such as AA or Narcotics Anonymous.[1] A number of large, well-designed studies have clearly shown that supportive, client-centered counseling approaches such as Motivational Enhancement (aka Motivational Interviewing) are the treatments of choice for young and older drug abusers (Miller, 1989; Miller & Rollnick, 2002; Miller, Zweben, DiClemente, & Rychtarik, 1995; Project Match Research Group, 1997). We now understand that the “shock and awe” approaches used by highly confrontational addictions and delinquency treatment programs are ultimately unsuccessful at best and often harmful at worst.

Chapters seven and eight are largely devoted to a fascinating and disturbing recounting of Lulu Corter’s civil suit against KIDS of Bergen County, successfully prosecuted by New Jersey attorney Philip Elberg. (Elberg currently serves as president of the International Cultic Studies Association.) Rather than attack KIDS as a “cultic” organization, Elberg took the innovative approach of claiming malpractice. In essence, Elberg convinced the jury that KIDS had violated established and well-known guidelines for the competent and ethical practice of medical and psychiatric treatment. Nevertheless, according to Szalavitz, the jury concluded that “KIDS was more a cult than a clinic—and that such treatment had no place in a healthcare system” (p. 246).

Szalavitz ends her book with a useful appendix, “For Parents of Troubled Teens,” which contains information about how to obtain appropriate treatment for defiant, oppositional, antisocial, and addicted youth. The information is presented in a reasoned, undramatic manner with references to several well-known Websites for additional information. One section is an especially helpful “questions parents should always ask” format that is concise yet reasonably comprehensive.

Szalavitz is understandably puzzled that residential treatment for children (TTI) is a multibillion-dollar industry, while proven treatments such as multisystemic family therapy (MSFT), motivational interviewing (MI), and cognitive-behavior therapy (CBT), “which are actually cheaper than long-term residential care ... are largely unavailable” (p. 259). She notes that the United States also has a gross shortage of child psychiatrists. While I agree with her general points here, Szalavitz neglects to mention the harsh reality that, while MSFT, MI, and CBT have indeed been proven to be significantly more effective than other treatments, including residential treatment, the success rates for these interventions are still disappointingly low.

This minor failing aside, Help At Any Cost is still a must-read for those interested in adolescent treatment in general, and in how an iatrogenic therapy program can degenerate into a therapy cult.
References

Miller, W.R. Increasing motivation for change. In: Hester, R.K., and Miller, W.R., eds. Handbook of Alcoholism Treatment Approaches: Effective Alternatives. New York, Pergamon Press, 1989. pp.67-80.

Miller, W.R., and Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford Press.

Miller, W. R.; Zweben, A.; DiClemente, C. C., and Rychtarik, R. G. Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence. Project MATCH Monograph Series, Vol. 2. NIH Pub. No.94-3723. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, 1995.

Project Match Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH Posttreatment drinking outcomes. Journal of Studies on Alcohol, 58(1), 7-29.

[1] Of course, similar statistics apply to those who are exposed to, experiment with, and eventually participate in, cultic movements. Contemporary cult interventionists (exit counselors and thought-reform consultants) now realize that noncoercive, empathy-based interventions, as lacking in immediate impact as they may seem, ultimately work best with cultists. The information-based and psychoeducational approaches used by thought-reform consultants, or the strategic-interaction approach advocated by Steven Hassan—while typically slow, methodical, and undramatic intervention strategies—appear to be the best choices in the long run for intervening with cultists.