Treating Teens with Compassion

An Interview with Mike Bulloch, Clinical Director of the Aspen Institute for Behavioral Assessment

It’s hardly a secret that, for many young people, the teen years are particularly trying times.

When the stresses and pressures of these already difficult years are exacerbated by an emotional disorder or mental health issues, the transition from adolescence to adulthood can transform from a path of growth and potential into a minefield of pain and frustration.

Unfortunately, many struggling young people express their internal struggles by engaging in dangerous or destructive behaviors, such as substance abuse, self-injury, sexual promiscuity and open displays of anger or hostility.

Perhaps even more unfortunately, some “experts” believe that the best way to deal with kids in these situations is to take a hard-line approach (think tough love without much emphasis on the love part). While a little discipline may be the ideal remedy for a teen whose only problems are an excess of free time and an absence of supervision, kids whose true problems run far deeper need a more nuanced intervention.

Enter Mike Bulloch and his colleagues at the Aspen Institute for Behavioral Assessment.

Bulloch, who co-founded the Aspen Institute and serves as its clinical director, is an unabashed advocate for a treatment philosophy that views unacceptable behaviors as symptoms of underlying issues, and which places a premium on providing comprehensive care in an environment of compassion and respect.

In a recent telephone interview, Bulloch described the innovative ways in which the Aspen Institute helps struggling young people and their families to emerge from a disordered past with newfound clarity and renewed hope.

Q: What’s the problem with trying to treat young people by changing their behaviors?

Adolescent psychiatric issues manifest themselves very differently than do similar issues in adults. Kids with psychiatric issues commonly exhibit them from a behavioral standpoint.

In some cases, labeling a kid as having a behavior disorder is like telling someone with the flu that they’ve got a runny nose disorder. You’re focusing on the symptoms, not the cause.

We don’t start with a preconceived notion of a behavioral problem. Our goal at the Aspen Institute is not to get preoccupied by the behaviors, or fall into a pattern of merely reporting symptoms, but to really focus and uncover what is causing these behaviors.

Q: What are the advantages of using a non-punitive approach while dealing with teens who are in crisis?

Our philosophy is that kids aren’t coming to us as a punishment or as a negative consequence of their behavior. They’re here because they’re in emotional pain.

If your child went to the hospital for dialysis & we said he’s going to have to spend the night, but he’s going to have to earn the right to watch TV, the implication is that he’s done something wrong.

When you look at all the misconceptions that already accompany psychiatric treatment, why would we want to imply that the kids we’re working with have done something wrong?

What we do is take a non-punitive, non-consequence based approach, & provide a comprehensive therapeutic assessment. We work toward developing an understanding of what the kids are experiencing so that we can help alleviate their pain, and so we can empower families with an understanding of the challenges that they’re dealing with.

In short, the Aspen Institute is a place where kids are treated with respect and compassion, and where their emotional pain can be alleviated.

Q: What types of underlying disorders do you see that lead to behavior problems?

The diagnoses that we see most often are anxiety disorders, mood disorders, and autistic spectrum disorders.

In many cases, these types of disorders have been incorrectly observed from a behavioral perspective and, as a result, labeled as Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) or Bipolar Disorder.

With some kids, their emotional difficulties have affected their academic performance, and may have caused them to withdraw from peer interactions, but they’re not acting out yet. We can help those kids before things progress to a more dangerous level.

Q: What is the Aspen Institute doing that is different from many other programs for teens in crisis?

At some programs, evaluations are done on limited bases by personnel who are contracted from outside agencies.

With us, the evaluator is here & the evaluator knows the child. The evaluation isn’t simply a psychological evaluation, but is multi-disciplinary. And the testing is done when it’s optimal for the child, and is conducted in the context of day-to-day functioning here in the facility.

We do case formulation, rather than symptom reporting. How the client responds to therapy, the therapeutic milieu, the classroom and medications — all of this comprises the therapeutic assessment.

We really like the term “a therapeutic assessment.” Our kids are getting three individual therapy sessions a week, & five group sessions a week. We’re not just sitting around watching them. We’re really going after things from a therapeutic standpoint.

The members of our treatment team are out playing basketball with the kids. They’re sitting in the cafeteria eating with them. They’re in the classroom observing them.

Q: How long is a typical stay at the Aspen Institute for Behavioral Assessment?

Kids are usually with us an average of six weeks, though the exact length of stay for each child depends upon their specific case.

In a traditional community-based hospital, the average length of stay is five to seven days. We’re still in the baseline period when a traditional hospital is discharging the child with a diagnosis and medication.

Q: What is your program’s philosophy about medicating young people?

We approach all treatment options thoughtfully & conservatively to find the ideal approach for each individual.

We’re not a place where you just send your kids & we’ll put them on meds. We will look strategically at what meds these kids really need, and which ones we can take them off. I believe that many kids are either over-medicated or on the wrong meds, so we take a close look to make sure that what they’re being prescribed is appropriate.

If we’re using meds, we want to be sure that we’re approaching things cautiously, carefully and strategically.

It’s about matching the right approach and the right intervention with what’s truly going on. But if you don’t know what’s truly going on, what’s really fuelling the problems, you’re much more likely to choose a less optimal intervention.

Q: When you determine that a previous diagnosis is incorrect, does this mean that the previous therapist was not doing his or her job?

Absolutely not. One of the hardest jobs out there is outpatient therapy. Without question, that’s the most difficult job for a therapist — outpatient therapy with kids.

Because so much of a kid’s world is unobserved, because they’re not always the best self-reporters, because they may be hostile to the process, they may end up with an incorrect diagnosis or being prescribed incorrect meds.

We have the advantage of observing kids for an extended period of time, and of interacting with them on a daily basis. That gives us insights and opportunities that just aren’t possible in outpatient therapy.

But outpatient therapists do great work under difficult conditions, and they provide a valuable service in the right circumstances.

Q: When parents send their child to the Aspen Institute for Behavioral Assessment, what can they expect as a result?

At week 5, we conduct what we call a multi-disciplinary review. The parents come to our campus for this review, the child is present, and in some cases prior treatment providers participate, either in person or via teleconference.

We go through things from a therapy standpoint, from a psychological standpoint (what the testing is showing) and from a medical standpoint. We want to tie all of these components together and provide recommendations for moving forward.

Basically, we want to answer three questions:

1. What are we dealing with?
2. What do we need to move toward?
3. What do we need to get away from?

We put together an integrated report, that’s bound together like a book, that threads all these various pieces together in order to provide accurate individualized diagnoses & recommendations.

Q: Can you summarize the benefits of the Aspen Institute in the dreaded “50 words or less” format?

We recognize that we are working with young people in a fundamentally important time in their development. We don’t want them leaving here just being aware of what’s “wrong” with them, but what’s right with them.

When kids complete our program, they have a lot more doors open to them.