Whether one sees the ages 13-18 (the adolescent years) as Erik Erickson’s search for identify, a “crisis,” “emerging adulthood,” a “time of transition” or a “stage of becoming,” there is little doubt that it is a time of severe disruption developmentally as the boy or girl experiences major bio-psychosocial change along with cognitive growth, leading to significant alterations with regard to the role of the family accompanied by an enhanced focus on the social and cultural milieu.
When we recognize the depth of the change we can understand and not be surprised by the increase in acting out behaviors, such as extensive use of drugs or inappropriate sexual activity (both of which are self destructive and can be considered to be suicidal equivalents) or the internalization and significant increase in overt suicides and automobile accidents (some of which are clearly suicides).
What, therefore, is needed to decrease the incidence of such pathological behaviors? If we look at the overall picture we see efforts to increase mental health services such as counseling and psychotherapy as well as efforts to expand the use of medications.
Is that enough, particularly for those of high risk with problems such as Asperger’s, learning issues, physical handicaps, drug additions etc? It is not surprising that a study published in the Journal of the American Medical Association and reported in the New York Times states that “most adolescents who plan or attempt suicide have already received at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled youth.”
There are many causes for behavioral disorders in youth and the efforts to prevent them are not simple. With youths’ advancement in cognitive functioning that broadens their perspective outside the family, we need to be aware of the social and cultural contexts in which they find themselves.
Are we offering opportunities that foster growth outside the family where they are valued, rewarded and adequately compensated? What do we see? In some cities there is 50 percent unemployment among youth. Many activities labeled “internships for youth” are really scut work. In order to save money, companies sometimes try to employ youth to do an adult job at a lower wage. What is seen is a society that is in recession–unstable, with social institutions disintegrating or offering discontinuity, lack of structure, intense competitiveness and violence presented as the solution to conflict.
We need to ask: Are we doing enough by increasing access to mental health services for youth or should we also actively seek an increase in access to opportunities, more specifically positive work experiences that can set directions for their futures? Can psychotherapy compensate for the lack of concrete activities in the work milieu or is more needed?
The author was part of a comprehensive vocationally oriented psychotherapy program (meaningful jobs, tutoring and psychotherapy) for chronic delinquent adolescent school dropouts that showed documented success in a 15-year follow up, with a significant decline in acting out
As a clinician I have witnessed the importance of jobs in a number of youth that have Asperger’s syndrome and, thanks to the local, state or federal government, are in good jobs while they are receiving psychotherapy and counseling.
I have observed the effect of employment of a large group of young people, mostly minority youth, who are employed in a geriatric continuing care community and struggle to juggle work, family and school responsibilities. They easily talked about their efforts to plan for the future and the meaning of the work experience.
Such a perspective does not diminish the value of psychotherapy, but broadens it. In so many ways it sets directions in the young for the future and makes living worthwhile. Including employment as part of the process of change broadens our scope and challenges us as mental health workers. When properly implemented the result should be a significant decline in self-destructive suicidal and homicidal behavior in the young.
Milton F. Shore, Ph.D., is a former member of the Board of Examiners of Psychologists for Maryland. He is in private practice in Silver Spring, Md. He may be reached at 301-649-3345.