A 15-year-old treated by me many years ago is a good example of one of the things that parents need to provide their children.
I’ll call him Ike (not his real name), a slender, silly kid with sandy hair. His family was middle class, hard working, and honest. Unfortunately, Ike lacked the latter two qualities. He was a minor league juvenile delinquent, prone to shop lifting, cutting classes, curfew violations, and occasional drug use. Ike was a poor student thanks to a lack of effort, an Attention Deficit Hyperactivity Disorder condition that featured notable impulsivity, and the unfortunate fact that he wasn’t very bright. This teenager treated school as diversion from his major life tasks of having fun and causing trouble. He rarely thought of the long term consequences of his behavior, instead choosing to do whatever felt right in the moment and whatever action seemed likely to produce some immediate payoff, the future be damned. Outpatient therapy had failed to make a dent in any of this, so his parents ultimately brought him in for whatever a psychiatric hospital could do to redirect Ike’s life and get some control over things.
Years ago it was often possible to keep a teenager in the hospital for several weeks or months if he needed it. Insurance policies were different and more generous then. And so, given the total control over someone’s life that a psychiatric adolescent treatment unit provided, you could produce changes in some very rebellious, out of control kids. Ike was like that. Eventually he figured out that the only way to get out of the hospital was to conform his behavior to the required standard.
While his parents participated in family therapy during his hospital stay, they remained uncomfortable with the job of setting limits on Ike. Neither one was very secure or self-confident and Ike fueled that insecurity by his behavior. Both parents were prone to feeling guilty when they punished him because of their own unresolved childhood issues, and Ike knew how to “play” them and get them to back off of threats and attempted punishments. These adults needed their son’s approval and good will too much for his, and their, good. Ike was running the show before his hospitalization. He knew it, they knew it, and his “will” was stronger than their wills were. If he complained and pleaded long enough, one or the other parent would typically break down and give him what he wanted. Despite the fact that family therapy hadn’t succeeded with the parents, Ike ultimately behaved himself in the hospital and had to be discharged even if his parents didn’t seem to have a better handle on how to deal with him in the real world. So, I crossed my fingers and hoped for the best.
As often happens after an adolescent is discharged from a psychiatric hospital, Ike and his folks went through a honeymoon period. But after a couple of months, he resumed his misbehavior and things weren’t much different from the way they had been the moment that Ike had first stepped into the hospital. So it was on the first day of his second stint in confinement (yes, his parents took him back and readmitted him), that I recall having the following conversation with Ike:
GS: “So, Ike, how does it feel to know that you can pretty much do anything you want when you are at home? How does it feel to know that your parents really can’t control you?”
Ike: “Terrific!” (Said with a big smile).
Silence ensued. I was quiet and just sat there with Ike for perhaps 30 seconds. Then, Ike spoke again and surprised me.
Ike: “And scary.”
This was the truth of it. Even Ike, who was one of the least thoughtful and least self aware patients I’ve ever treated, realized that if he could get away with anything he wanted, that wasn’t a good thing. Even Ike knew that if he was driving the bus, the bus was in trouble. Even Ike knew that he needed someone to rein him in, to set a good example, to steer him in the right direction, and to prevent him from doing some of the things he would do impulsively, recklessly, and thoughtlessly.
What then do children need? Parents with the will power, strength, consistency, motivation, intelligence, resilience, and the self confidence to set and stick to limits, take charge, and make sure that the combination of a child’s poor judgment and impulsive or rebellious behavior doesn’t rule the day. Ike was the problem, but without his parents getting a grip on their own lives and finding the strength and confidence to assume the proper role in the home, Ike wasn’t going to get better any time soon. And even though Ike would have and did resist a more assertive, consistent, and confident approach from his parents, he knew that he needed it.
Some children are easy, some more challenging for parents. It is our job in the latter role to figure out what each of our children need and provide it. Not all children are the same and not all of our children need an identical approach from us. Ike would continue to misbehave until his parents figured this out.
The strength that I’m talking about isn’t the only thing that children need from parents, and from time to time I’ll write about some of the other requirements. The good news is that if Ike, at age 15, was able to figure out what he needed, nearly all adults can too. From that point on, good things are possible.
Dr. Gerald Stein 