Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids Hardcover – February 16, 2006

This important book takes the troubled-teens industry to task, exposing the "extremely harsh, perhaps even brutal tactics [companies use to] keep [kids] in line." For $2,000 a month and more, a program will take an oppositional teen to a lockdown facility or a wilderness boot camp for however long it takes to break him or her. Parents pay more than an Ivy League tuition for their children to undergo some "out-of-line" punishments (use of "stress positions," brainwashing, etc.), and, says Szalavitz, there's no evidence that these facilities cure anything. Indeed, many teens suffer post-traumatic stress disorders for years; some actually die in these facilities. Szalavitz, a freelance journalist and senior fellow at Stats.org, has written a courageous—if horrifying—study of the tough-love industry, focusing on four key players: Straight Incorporated, North Star Expeditions, the World Wide Association of Specialty Programs and the KIDS program. These hugely profitable businesses are largely unregulated by legal, medical or ethical codes, avoiding accountability for failure by blaming the victim. With a useful appendix discussing when and how to get responsible help for a troubled teen, this book, filled with first-person accounts, should be required reading in Parenting 101. (Feb.)
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In 1958 a residential treatment program for heroin addicts, called Synanon, initiated a radical methodology to break the addiction cycle. Using "attack therapy"in an environment of "tough love," counselors forced drug users to alter their self-destructive behaviors. Such methods became so popular that in 1982 counselors Phyllis and David York argued in their bestseller Toughlove that families should also embrace harsh measures. Hundreds of tough love–style residential programs have since emerged. Yet no scientifically supportable evidence has ever shown that these methods are effective. In fact, some data suggest they may do harm.

In Help at Any Cost, Maia Szalavitz, a senior fellow of the Statistical Assessment Service at George Mason University, shows how "abusive, dehumanizing practices that reformers of mental hospitals and prisons have attempted to stamp out for centuries" have been repackaged and sold to desperate parents. "Thousands of well-meaning, caring, and intelligent parents have been taken in by a business that uses exaggerated claims of risk to teens to sell its services." All of this has amounted to a multibilliondollar industry. This is a story, she says, "of splintered families; of parents convinced by program operators that extreme, even traumatically stressful treatments are their children’s only hope." Homing in on several leading programs, Szalavitz carefully documents cases of reckless punishment that physically and psychologically hurts youths. Military-style boot camps and wilderness programs that pursue extreme "rehabilitation" measures have left teens dead of illnesses and dehydration, spawnin numerous lawsuits. Such "professional" programs operate nationally and charge college-equivalent tuitions. Yet there is no regulatory oversight or medical or legal evaluation of the quality, competency or effectiveness of such programs, even though they assume responsibility for the lives of minors.

Citing a draft consensus report by the U.S. National Institutes of Health, among other studies, Szalavitz says such programs simply do not work. The evidence that exists "offers no reason to believe that group detention centers, boot camps, and other ‘get tough’ programs do anything more than provide an opportunity for delinquent youth to amplify negative effects on each other."

Szalavitz concludes her book gently with practical guidance for parents of troubled teens, including ways to get more sophisticated help. Ultimately, she urges parents not to yield to desperation and to recall the leading principle of medical ethics: "First, do no harm."

Richard Lipkin