Customer Reviews

Treating the Unmanageable Adolescent: A Guide to Oppositional Defiant and Conduct Disorders

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I was startled to read an earlier online review of this book becasue it was so much at varience with my own thoughts about Dr. Bersteins book. I am a psycholgist with a Ph.D. and 25 years experience working in clinical settings and I have never before encountered a book on conduct disorders that was so clearly the work of an experienced clinician and so deeply rooted in his experience. Bernstein's clinical examples could have come from my office or those of other psychologists I know and work with. His suggestions and illlustrations of his work with his patients was both reassuring and familiar as well as stimulating and provocative. If you chave to go out and work in the trenches with oppositional and conduct disordered, Dr. Bernstien's book is a very handy item to have along

Dr. Neil Bernstein's useful work on the counseling of oppositional teenagers is noteworthy in its humility, for a start. Clinical success, in the author's view, is established the old fashioned way: you have to work for it. In his introduction Bernstein confesses to a basic distrust of quick fixes for teenage problems, particularly those promulgated on the lecture/workshop circuit. He keeps a balanced head on the etiology of oppositional defiance, recognizing that disorders of mood, substance abuse, and dysfunctional families of origin, to name a few factors, must be given their day in court during the diagnostic phase of treatment. He is well read in adolescent development and recognizes that the teen years are inherently about distancing and defiance, in some way, shape, or form.

If one were to label the author's clinical approach, perhaps the Rogerian style comes closest to capturing this practitioner's persona. Without losing sight of the nuts and bolts, Bernstein seems to find his success in establishing empathy and trust with his young clients. The "opposition" of teenagers is directed against the systems that they perceive as having failed them: family, school, and the peer community. The defensive attitude of such youth is both a mask for their pain and insurance against further hurt. It is encouraging to see that a lengthy chapter has been devoted to family intervention [though some family specialists will inevitably argue that the family organism is the whole enchilada where childhood disorders are concerned.]

Bernstein's clinical examples-and they are numerous-appear to be drawn primarily from individual therapy sessions, i.e., without parents or others in the process. If this reflects the demographics of his paying clientele, then he must have a remarkable gift for developing engagement with his young clients, and he would apparently have enough leisure to plumb his clients' psyches at a pace that does not engender defensiveness. But aside from the wearisome issue of whether managed health care or the client's own limited resources put limitations on a style that calls for protracted contact and trust building, the one nagging question left hanging in this work is the role of the parents in the client's treatment. In Chapter 12 the author provides a substantive commentary on family therapy, noting among other things that parents frequently repeat the mistakes of their own mothers and fathers, implying that many oppositional clients have plenty at home to be oppositional about. Is such therapy without the parents the clinical equivalent of rowing with one oar? I would summarize Bernstein's position on parental participation in therapy as "optimal but not necessary." As a practitioner myself, unless I have compelling reasons to the contrary, I subscribe to the philosophy of the seasoned general who brought a long time rival into his inner circle on the grounds that "I'd rather have him inside my tent [urinating] out than outside my tent [urinating] in." Somewhat surprising to me is the desire of many of my ODD clients to have a parent in therapy with them, perhaps their way of telling me why they are so angry.

In the final analysis, this is a work from the traditional psychoanalytic school that extols the time proven methods of human respect and client interaction. It is an excellent didactic exposition, an opportunity for a practitioner to ask himself, "Do I sound like that?" There is an abundance of common sense and a minimum of psycho-jargon that makes this work accessible to teachers and many parents as well.

I've been working with difficult teenagers for over ten years and read this book hoping to gain new insights and skills into working with this population. By far, it is the best book I have ever read on this topic. It is explicit, practical, and offers numerous suggestions for addressing the multiple problems that this population faces. I have found it extremely useful in my practice because of the easily applicable techniques Dr. Bernstein presents, and his concrete suggestions about how to implement them. Dr. Bernstein shares many examples from his clinical practice which parents and clinicians alike should find helpful. Susan Gordon, Ph.D.

I purchased Dr. Bernstein's book as part of some fact finding for my master's thesis in Special Education. I did not expect the book to have all the answers, but was hopeful that there would be a good body of information that would prove helpful.

I was very disappointed. I found the introductory chapters to be a cursory tratment of the disruptive disorders. Seldom was there a delineation between conduct problems and normal development. There was little information of how antisocial behavior differentiates from conduct disorder. There were many blanket statements that were not sufficiently supported with evidence. The case studies were one sided, and I believe, not fully representative of the intracies of the personalities of children.

I was particularly dismayed at the suggestion that the population of conduct disordered children was "likely to have a narrow range of interests" and spending a few minutes a week glancing through "People" and "Rolling Stone" was a sufficient way to be informed of their culture. The greatest disservice to these children is to take their minds for granted in such a way.

As for the information on the theraputic process and treatment, I did not find this helpful. Most of the principles discussed here are presented in a great book, "The Skilled Helper" by Gerard Egan. A book which takes a much more compassionate, humble approach to the helping process.

I had hopes for this book. I went into it with an open mind, willing to learn. I was bitterly disappointed with it's myopic approach to this population of special needs children and youth. I could not recommend it even as an introduction to the subject.