It's hard to assign a star rating to this book. On the one hand, I think that Wedge's message about the perils of over-labeling and over-medicating young children is an important one, and I appreciate that rather than simply sounding the alarm she also provides ample discussion of a viable alternative--family therapy. And I do think that many of the strategies and insights she notes as a family therapist could prove to be useful alternatives to drugs and psychiatric labeling in situations like those she describes. It's well known even to undergraduate psychology students that often when a child is labeled as "disturbed" the individual is merely the "designated patient," whose distress both draws from and distracts from the larger issues at play. Wedge explores this phenomenon thoroughly, usually without blaming the parents overtly, and demonstrates some ways to "trick" the family into backing off of this ruinous strategy.
On the other hand, I was bothered by several things about Wedge's proposed solution, and how she presents it. She seems to believe that family therapy is the cure for every ill, and if it doesn't work, well, either the parents weren't doing it right or they just didn't stick with it long enough. I'm not arguing that she shies away from medication too much. Rather, I believe she is somewhat blind to the bigger picture of a person's life. The family is huge, but it's not the only thing. School, work, social pressures, finances, and so many more things are also at play. Wedge seems to think parents are always in complete control of all these factors, that they can simply resolve to fix things and make it so. In one instance, a child is in distress because the family is about to lose their home, due to the prolonged financial downturn. The parents simply pluck themselves up by the bootstraps, ask for a little help from family, and all is well. Needless to say, it can't always work out like this. Wedge clearly works with a very privileged client base (the milieu of the sessions she describes is quite obviously California upper middle class to a T--I can just picture the white leather couch) but not just that, she presents herself as a kind of Perry Mason of therapy. She never loses one, if the examples in this book are taken to be representative, unless it's because her clients failed her.
I can understand wanting to portray more successful cases than discouraging ones for the purposes of this book, but it starts to come across as a bit dishonest and too good to be true. It would have helped me understand her methods even better if she had described a few more situations where it was NOT the appropriate approach, where she had to try something different or refer people out entirely. Wedge wants us to think family therapy is not just an alternative to labeling and rampant psychopharmacology, but THE alternative, and her tunnel vision begins to detract from her excellent points. While at the beginning of the book her enthusiasm merely made me slightly wary, by the end I felt her authorial voice was smug and arrogant. I imagined myself in the shoes of the parents she spoke to and found myself feeling rather manipulated (she is open about her practice of deceiving and misleading clients "for their own good") and cowed. Wedge's ideas are good, but she is inflexible about them, so convinced of their superiority it seems she will not countenance any other solution. This is what got us into the fix we are in, with psychopharmacologists instead of family therapists.
I felt many of her insights were also generalized too broadly. Like I am sure that in some instances--perhaps many, perhaps even the majority of instances--her adage that aggression in a child is a "metaphor" for hostility between the parents may turn out to be true. But she is insistent that it is ALWAYS true, and that's what ruined this book for me, and her credibility. She also is very rigid about other ideas, which seems counterproductive and judgmental. A child--even a very young one--being allowed to share a bed with parents is always a sign of marital troubles and enmeshment to her. A troubled child is always worried about one of her parents and trying to "help" by distracting them or caring for them. Parents must not only never argue in front of their children, they must also never complain about work (oh for crying out loud) or their aches and pains, or even let on about their chronic and severe illnesses. A mother crying in front of her 10 year old when mom's father died is "traumatizing" to the child, even. Wedge believes that children must be not just a bit sheltered but UTTERLY sheltered. She prescribes a stifling regimen of forced cheer for parents that is disturbing in and of itself, and seems to me to indicate more about Wedge's interior life than what's actually good for children. Parents are "assigned" to divert themselves and somehow work around real, overwhelming adult problems so they can contribute a daily "MY LIFE IS THE BEST!!! I PETTED A PUPPY TODAY!!!" spiel into their child's "therapy." Of course somehow she tells herself that children, who she otherwise believes to be emotional barometers so sensitive that a mother is even admonished that she is not to discuss her personal problems in her room, on the phone, with her voice lowered and the door locked, will not pick up on the weird fakeness here.
Given the revoltingly stereotypical...Californianness of that particular regime of repression and shame, it goes without saying that Wedge barely nods at diversity in families. Her clientele is clearly all relatively well-off, mostly but not entirely white, straight and married or divorced. The one mother with a disability is treated so dismissively it's shocking. Her pain and limitations are nothing but a burden for her husband and her child, apparently, and Wedge is all too quick to place the blame with her usual inflexible admonishments to sweep it under the rug and act as though all is well. Wedge shows a (likely unconscious) bias in favor of the fathers and against the mothers when there is a marital dispute, expecting women to humor husbands who sound like absolute tyrants in a couple of the stories--one of whom sounds like he may have actually been abusive. That's dismissed (upsetting to the child!) and the mother is instructed to give him what he wants to keep the peace. Of course there's barely a nod at the end towards families who might not even be able to afford the luxury of private therapy but who instead are fed into the Department of Human Services, the less well-funded schools, and the criminal justice system. Considering foster children are THE main demographic for overmedication with psychiatric drugs, this is more than just a slight oversight.
Finally, Wedge makes a lot of claims but offers little proof beyond the anecdotal. I would like to believe that family interventions are an effective alternative for children with mental health symptoms. But other than Wedge's own testimonials to her personal track record, there's not much here to assure us it is actually working as well as she claims. Having somewhat of a scientific bent myself, I'd want to see if it's her specific methods that make a difference (if, in fact, there is a difference being made) or the extra time and attention, or simply the passage of time (and with it coming maturity and the natural extinction of some problems). There are few citations and not a whole lot to go on as far as backing up her extraordinary claims. All told, a promising hypothesis, one which I hope a less biased author will work to test and explore more thoroughly.
