Monday, June 29, 2015

The Therapeutic Special Education Teacher: Methods: The Working Relationship

The golden key to any kind of therapeutic work -- or "helping" -- is relationship.  For physicians, it is bedside manner.  For psychotherapists, it is the therapeutic alliance.  For special education teachers, it is the working relationship.

Although a working relationship between teacher and student is not imperative, it is most certainly helpful to the student's well-being, academic success, and behavior.  And, it makes teaching more rewarding for the teacher who also benefits from the relationship and the gratifications it provides.  Here, I will attempt to describe the most salient attributes of the working relationship, which include teacher (1) effective listening, (2) warmth and empathy, (3) support for behavior, and (4) collaborative involvement.

Listening Skills

Effective listening has much in common with mindfulness.  It involves paying careful attention to the student and concentration upon whatever it is he or she is saying and doing.  The student's nonverbal behavior may be as (or more) important than what the student is saying.  "Listening" therefore requires the teacher to "hear" what the student is communicating through body language.

Teachers can develop their capacity to attend to and concentrate upon student communication through the practice of meditation or mindfulness meditation.  An excellent introduction to mindfulness meditation may be found on YouTube right here:  Mindfulness with Jon Kabat-Zinn.  There is a growing body of literature on the subject, and other helpful videos, I am sure.

In my own work as a psychologist, practicing mindfulness meditation at home makes it almost effortless to listen to clients in my office; and, to later remember in great detail what they have said to me and how they have behaved.  Mindfulness meditation permits me to absorb my clients' communications in a way that I could not when I was just starting out in my profession.

Do yourself a favor and start practicing mindfulness meditation.

Warmth & Empathy

Real listening is a volitional act: by which I mean that to be helpful, the teacher must truly want to listen and to be engaged with the student in communication.  If a teacher is busy or otherwise preoccupied with schedules, personal or professional problems, it is probably best that the teacher not try to listen unless a student is in dire need of help.

Assuming the teacher is willing and able to attend to and concentrate upon the student with a concern, the teacher should project warmth by smiling and welcoming the student to communicate.  A relaxing environment is helpful but not critical.  Teacher empathy, however, is another matter.

Empathy is critical to developing the student-teacher working relationship.  It is through empathizing with the student that the teacher shows (1) concern and (2) understanding.  The techniques of paraphrase and reflection along with appropriate nonverbal behavior on the part of the teacher may prove very helpful.

Because the website linked to (above) describes paraphrase and reflection well (as "reflecting") I will not elaborate upon those techniques here, but will say this about them:  they require practice to be used in a maximally effective manner, but are also self-correcting if misused.  So, consider this brief dialogue between student and teacher:

STUDENT:   I hate math!  Every time I try to solve a problem I come up with the wrong answer!  I really, really hate math!"
TEACHER:  You don't like math, I know.  I think you must try harder.
STUDENT:   You just don't get it, do you!  I really hate math, and I don't want anything to do with it!
TEACHER:   I see.  You absolutely hate math, don't you, and you'll never like it.
STUDENT:   You got it.  I hate math!

At first, the teacher failed to support the student's exclamation that she really hates math, and gave the student advice that was quickly rejected.  Then, the teacher corrected herself, reflecting the student's genuine feeling about math.  As a result, the student told the teacher that she "got it."  The working relationship between teacher and student was then reinforced.

Here is a short video featuring a teenager talking about the importance of listening with empathy.




Support for Behavior

The teacher who keeps a close watch over a student can often tell if the student is becoming distracted, frustrated, or more interested in socializing than in completing assigned work.  Teacher can then intervene, providing support for appropriate behavior.  To the extent that the teacher has built a working relationship with the student, the intervention will prove more (or less) effective.

As long ago as 1952, Fritz Redl and David Wineman described Surface Management Techniques that have proven their usefulness over decades of teaching.  These techniques -- which generally move from less obvious to more intrusive -- provide the teacher with brief, useful interventions supporting the working relationship.  More on how to support student behavior later!

Collaborative Involvement

Big Picture Schools (Littky & Grabelle, 2004) have shown themselves to be highly successful in addressing the educational needs of adolescents who have become disenchanted with the instructional methods that typify public schools.  Big Picture Schools are student-centered institutions that -- as Littky describes them -- are about "the three R's":  Relationships, Relevance, and Rigor.  They support "personalized learning" or instruction that is driven by student interests, and designed by teachers, students, an parents in a collaborative manner.

Of course, it may be difficult for a teacher in a traditionally-run to school to permit students to design their own curricula as is the case in Big Picture Schools, but it is certainly possible for any teacher to draw upon student interests and concerns when framing a unit or lesson.  Even the interests of very young children can be worked into the lesson plan.  It is the teacher who uses a "top down" approach to instruction who risks making learning irrelevant -- and therefore unappealing to -- students.

Citations 

Littky, D., & Grabelle, S. (2004).  The big picture:  Education is everyone's business.  Alexandria, VA:  Association for Supervision & Curriculum Development.

Redl, F., & Wineman, D. (1952).  Controls from within:  Techniques for the treatment of the aggressive child.  New York:  Free Press. 



Friday, June 26, 2015

The Therapeutic Special Education Teacher: Overview

Note:  The following represents my attempt to define the characteristics of a therapeutic special education teacher.  It has long been a "work in progress" and is subject to modification.  When it comes to effective therapeutic teaching I definitely do not have all the answers, however, and welcome any input you may give.  Incidentally, although the title suggests the post applies only to special education teachers, I am well aware that many "regular" classroom teachers function in a highly therapeutic manner with students.  The emphasis upon special education reflects my own background and training.



                                                                  Introduction

The idea that a teacher of special education can serve a therapeutic role with students may seem unusual, but in fact the very best special ed teachers (as well as "regular" classroom teachers) routinely provide therapeutic services to their pupils, often without realizing it.  The purpose of this post is to provide a structural model of therapeutic practice for classroom teachers, and to compare that practice with how non-school-based professionals (psychologists, social workers, mental health counselors) function with kids.  My hope is to engage teachers in discussion of how they approach students with personal and behavioral problems, with the over-arching goal of improving educational practice.

Since my professional life has taken me in and out of school and clinical settings, I believe I am qualified to draw some distinctions and parallels between the therapeutic goals, orientations (focus), methods and desired outcomes of clinicians and special ed teachers.  


Central to the entire endeavor is my belief that all therapeutic work must consider the student within the physical and social environments that influence his or her life:  the "life space" that Fritz Redl and so many others have described.  Clinicians must give consideration to the child's behavior at home, neighborhood, and school.  And school principals and teachers "[must] ask themselves, what is it about the school that is contributing to the student getting into trouble?" (Littky, 2004)

I will start by outlining the therapeutic functions of clinicians, this with the understanding that my approach to therapy -- while integrative -- is at base Adlerian and/or humanistic.  I will then turn to the therapeutic functions of special education teachers, especially those who work with ED/BD students, emphasizing the importance of dealing with student problems in the "here and now" while recognizing the myriad factors that impinge upon them.

The (Non-School) Clinician

Goals

Although there is likely much disagreement about the matter of therapeutic goals for clinicians practicing outside of schools, and working with school-age clients, for me they boil down to two:
  • To develop the child's understanding regarding conscious and unconscious motivation(s) for behavior, including his or her irrational beliefs, and how they affect his or her relationships at home, school, and within the community; and,
  • Through understanding of motivation for behavior, to effect meaningful and lasting changes in behavior.
The emphasis is upon self-understanding in the service of behavior change, not mere compliance to social norms.  Of course, such self-understanding must take into account the developmental characteristics and intellectual resources of the child.

Orientations/Focus

Although self-understanding of motivation for behavior involves cognition, it is understanding the interplay between intellect and affect ("head and heart") that the clinician strives for in therapy.  So, the focus is often upon . . .
  • The child's beliefs and emotional or "inner life," and the management of emotions; and,
  • The child's subjective reality, including his or her wishes and fantasies, mechanisms of defense against "bad" thoughts and feelings.
Exploration of emotions often leads to better understanding of thought processes (cognition) and therefore, motivation.  It is the child's subjective reality that the clinician seeks to understand. The clinician's ability to empathize with the child is of paramount importance.

Methods

Clinicians employ several techniques to bring about attitudinal and behavioral change in their school-age clients.  Here are three of the most general (but essential) methods:

  • Development of a therapeutic alliance, or working relationship between therapist and child towards mutually agreed-upon goals;
  • Collaborative examination of beliefs and motivation for behavior, as well as the impact of that behavior upon self and others; and,
  • Management of the transference:  thoughts and feelings the child has involving the therapist, and that the therapist has involving the child.  (These transference issues may or may not be verbalized to or discussed with the child.)
It is important to note that the goals a child initially expresses may not be the "real" goals that the client seeks to realize.  For example, a child may state that he or she wants to do better in school when in fact, all evidence indicates that the child actually wants to fail, perhaps to punish herself or some other person (perhaps a parent).  The therapist would help the child to understand the contradictory nature of her expressed goal and her actual behavior, providing emotional support while dealing with the child's perception of the therapist as a parental figure. 

It is also important to note that many times, it is the parent of the child who has a goal in bringing the child to see a therapist.  In that case, the parent's goal must be acknowledged, but it is the child's goal -- if any is stated -- that is central to therapy.

Desired Outcomes

The clinician seeks to help the child understand how his or her behavior has been motivated by irrational beliefs and emotions that have been damaging to relationships as well as the child's self-perception and self-esteem.  Desired outcomes of therapy are therefore most generally . . .
  • Development and maintenance of productive and mutually gratifying relationships with others; and,
  • Enhanced self-understanding and self-esteem.
Please note that while the clinician may be concerned about the child's achievement in the school and classroom, that  concern is usually secondary unless it has been specifically targeted for intervention.  Generally speaking, however, if the desired outcomes above are attained, improvement in scholastic functioning usually follows.

The Therapeutic Special Education Teacher

The therapeutic goals, orientations, methods and desired outcomes of special education teachers are somewhat different than those of the non-school clinician, for the teacher's main concern is with instruction, and because he or she typically has less of an opportunity to interact with the individual child.  Of course, teachers are trained in a qualitatively different way than are clinicians, so the knowledge base for each of those professionals is necessarily limited.

Goals

As I see it, the therapeutic special education teacher has two main goals:
  • To help the child maintain emotional equilibrium in order to accomplish academic tasks independently and in collaboration with others; and,
  • To develop feelings of mastery and self-efficacy in the child, fostering continued self-development.
Most (if not all) children classified for special education have emotional ups and downs, and if they go unnoticed they may stand as obstacles to learning and social acceptance by peers.  By helping a child stay on an even keel, the child stands a better chance of mastering academic tasks, and in so doing, of developing the self-confidence needed to tackle additional academic challenges.

Orientations/Focus

The therapeutic special education teacher is not a "therapist," but does have the task of helping the child learn that which is appropriate to a given curriculum, meanwhile supporting the child's social development.  The orientations of the therapeutic special education teacher involve . . .
  • Intellectual life ("thinking") and the inculcation and creation of knowledge; and
  • Objective reality, including understanding and acceptance of one's role as a contributing member of society.  
Schools exist to help children gain the knowledge and skills not only to achieve independently, but to work productively in collaboration with others. Helping children become "good citizens" remains an important function of schools and schooling.

Methods

The methods employed by the therapeutic special education teacher are many, but here I have had to distill them down to just a few, understanding that future posts will elaborate upon them.  Key methods involve:
  • Development of a highly supportive and working relationship with the child;
  • Provision of support for the child's scholastic success through individualization, effective group lesson-planning, and (social-emotional as well as academic) problem-solving; and,
  • Management of behavior as it impacts the child, peers, and his or her learning environment
The therapeutic special education teacher is perhaps more concerned with the individual child than are "regular" classroom teachers who -- after all -- typically have classrooms containing many more students.  It is the advantage of smaller classroom size that permits the therapeutic special education teacher to develop the working relationship with the child that is so critical to the enterprise, and the individualization in instruction outlined on the child's Individual Education Plan (IEP).  For the therapeutic special education teacher, management of behavior is again individualized: "disciplining" and punishing a child in a wholesale manner is patently unhelpful.  As Dennis Littky notes in The Big Picture:  Education is Everyone's Business (2004),  
  
A student's misbehavior has to be viewed not as a behavior that needs to be punished, but rather as a behavior that   needs to be changed.  The idea is to help a student be involved in changing his behavior, not just to punish him or try to change the behavior for him.  In most cases you really don't have to "teach kids a lesson." (p. 89). 

Desired Outcomes

The desired outcomes of the therapeutic special education teacher are in some ways the same, and in other ways different than those of the non-school clinician.  They include . . .
  • The child's ability to identify, locate, and use resources for completing intellectual and work-related tasks; and,
  • The child's capacity to function as a productive member of society.
The emphasis is upon the child's ability to establish and pursue his or her own goals successfully, and to work in a cooperative manner with others.

Conclusion

The words "therapy" and "therapeutic" may scare some people away, but in fact what they mean is simply to be helpful to (or supportive of) an individual's successful growth and development as a fully-functioning human being!  It is the role of the non-school clinician to help the child understand how he or she thinks and feels, and to help the child understand how thoughts and feelings play out through behavior in different social environments.  It is the role of the therapeutic special education teacher to provide the emotional and instructional support a child needs to develop self-control, healthy self-esteem and ultimately, to become a productive member of society.

Citations

Littky, D. & Grabelle, S.  (2004).  The big picture:  Education is everyone's business.  Alexandria, VA:  Association for Supervision and Curriculum Development.

First posted June 26, 2015


 

 

Saturday, June 20, 2015

Racism and Mental Illness: Dylann Roof



The cold-blooded murder of nine human beings by 21 year old Dylann Roof in Charleston, South Carolina, within the past week has led many to claim that Roof is "sick," "insane," "schizophrenic," or otherwise mentally ill.  I sincerely doubt that is the case, and predict that he will be found sane and fit to stand trial.  Here is why:

First, it is clear that Roof planned to murder Black people at the Emanuel African Methodist Episcopal (AME) Church in Charleston.  He conducted research about "historic" and important gathering places for Black people and chose an institution with a prominent Black American as Pastor, Rev. Clementa Pinckney, a South Carolina State Senator, as the place to target his victims.  Traveling to Charleston from his home town near Columbia, South Carolina, Roof carried with him a .45 caliber automatic and seven clips filled with bullets.  He entered a prayer group and waited for several minutes before committing his heinous acts, sparing one person because he wanted someone to tell his "story" to the world.

Second, it is clear that Roof has long held racist beliefs, these recently revealed in a manifesto he published on a website.  In his manifesto, Roof writes,

I have no choice. I am not in the position to, alone, go into the ghetto and fight. I chose Charleston because it is most historic city in my state, and at one time had the highest ratio of blacks to Whites in the country. We have no skinheads, no real KKK, no one doing anything but talking on the internet. Well someone has to have the bravery to take it to the real world, and I guess that has to be me.
The website features several photographs of Roof holding a Confederate flag, other racist emblems, and a photographs of his firearm. 

Third, it is evident that Roof has shown no regret or remorse for his actions, even when confronted by the families of his victims and offered forgiveness for his savagery.  He shows no emotion, period.  To use a term I learned when working with psychiatrist Dr. Ralph Rabinovich at Hawthorn Center in Northville, Michigan, in the late 1970's, Roof is "empty," or devoid of conscience.

Now, it is likely that Roof will be found to have a personality disorder, specifically Antisocial Personality Disorder, and he may also be found to have a Narcissistic Personality Disorder . . . and, it is likely that his substance abuse and depression may garner additional diagnoses.  But, from a legal perspective personality disorders do not constitute "mental illness" or insanity, and neither substance abuse nor depression explain why Roof slaughtered nine innocent people.  The bottom line is that he acted with intention, malice and forethought in committing what is a hate crime and possibly, an act of terrorism.  His racism does not constitute mental illness, although one can aptly apply the term "sick" to him.

If I am correct about Roof being "sane," and not mentally ill, what explains his behavior?

Well, I am reasonably certain Roof has had learning difficulties and poor self-esteem for much of his life (he left school at age 14, was unemployed and likely was unemployable), that he had few close friends, and that he grew up within a group that sanctions racist attitudes and behavior.  (As I write this it is too soon to question Roof's parents' attitudes, but I think he may have had a home situation encouraging bigotry.)   In any case, he was headed towards a life of failure and had the presence of mind to realize that.  He had real or imagined support from racist groups such as the KKK, with which he strongly identified.  Like Charles Manson and many other losers, he found a way to make himself a "success," in his own eyes and in the eyes of people who -- like him -- are hateful and racist.

Of course, his fifteen minutes of fame came at a horrible price.

Monday, February 10, 2014

Heroin

Heroin is in the news again, and for good reason:  Increasingly, young people are moving from the more expensive (and difficult to obtain) prescription pain killers -- opiates like hydrocodone and oxycodone -- to less expensive and more readily available options.  Heroin -- an opioid called "horse," "smack," and other names on the street -- has also recently reached celebrity status, adding to its appeal:  the death of Philip Seymour Hoffman by heroin overdose led immediately to a flood of Ace of Spades branded heroin on the streets of New York City and elsewhere, alarming law enforcement and medical authorities.  Of course, heroin has long been associated with rock stars such as Dee Dee Ramone (Ramones), Paul Gray (Slipknot), Sid Vicious (Sex Pistols), making it attractive to kids who are fans of their music, or who want to emulate them. 


Heroin may be snorted, smoked, or injected subcutaneously (skin-popping), intramuscularly, or intravenously (mainlining).  The initial rush with use is followed by feelings of euphoria that are relatively short-lived.  Heroin dependence may be rapid and with increased use comes increased tolerance, leading the user to need more of the drug. The lethality of the drug -- which was first synthesized in 1874, and which in the past has had legitimate medical applications --  depends both upon its purity and means of use.  Heroin may be cut with other drugs such as fentanyl, enhancing or diminishing its effect. Deaths by overdose are typically caused by depressed respiration leading to anoxia (oxygen deprivation).  Use of needles carries its own risks including skin infections, hepatitis, and HIV/AIDS (the latter often due to sharing of needles, or "works").

Heroin use among children and adolescents appears to be increasing.  The New York Daily News (February 10, 2014) reports, for example,

National data from the Substance Abuse and Mental Health Services Administration shows that the number of teens dying from heroin abuse has skyrocketed. In 1999, 198 people between the ages of 15 and 24 died of a heroin overdose, compared to 510 deaths in 2009, the latest year data was taken.  More teens are seeking treatment for heroin abuse, too — the figure jumped from 4,414 to more than 21,000 (about 80 percent) between 1999 and 2009. Ninety percent of teen heroin addicts are white, according to the data.

Kids may be blind to the addictive nature of heroin or think heroin use is no big deal.  There is also evidence that parental neglect and domestic violence contribute to use.  Rejection of conventional values and anomie -- a term coined by sociologist Emile Durkheim which is analogous to social alienation -- have also been offered as explanations for heroin use.  Explanations for heroin abuse using the term "addictive personality" are fraught with difficulty, for no reliable individual characteristics have been identified.

After all is said and done:  Are we creating a nation of junkies?  Probably not, but it does seem that many youth are at increased risk for heroin dependence and the health risks associated with it.  Responsible adults need to be alert to signs that a kid has been using, and to take appropriate action if use is suspected.  Behaviors of concern (from Healing Addiction in Our Community) include:


Of course, we also need to fight for more and better treatment options for youth who use heroin and other substances.  Treatments are outlined by the National Institute on Drug Abuse (NIDA), but at the time of this writing are inadequate to meet anticipated needs. Drug Strategies, a nonprofit research agency, may prove to be a helpful resource.

Tuesday, January 21, 2014

The Common Core



Once again the effectiveness of the United States public educational system is being questioned, and government has answered the call by generating uniform goals for student learning and objective criteria to determine through assessment if those goals have been met.  The "common core" (Common Core State Standards Initiative) dominates discussion in education these days, and the matter has become quite divisive. On one side of the issue stand those who believe common learning standards will help the nation remain economically competitive with other countries, and who believe our children are currently underachieving relative to their global peers: especially in math, science and technology. On the other side stand those -- like educational reformer Alfie Kohn -- who fear that if students are expected to learn essentially the same things, instruction will become standardized and tedious, sapping students of their enthusiasm for learning. 

Teachers and parents are concerned.  Teachers fear that their ability to determine what is important instructionally will be compromised, that they will be given scripts and recipes for teaching students, and are worried they will be held accountable for student failure.  "Teaching to the test" has become a phrase used commonly in schools and elsewhere to describe how the tail wags the educational dog.  Many teachers -- and parents as well -- think evaluation of student progress involves far too much testing and not enough learning.  In some cases, parents have refused to let their children sit for state-constructed tests.  Some school districts have honored parent demands that testing be minimized or curtailed.

The matter has become politically charged.  Conservatives resent the fact that the "big government" and the states have mandated Common Core standards, and fear that local control of education is slipping out of their hands.  They hold that our educational system is working well enough and does not need bureaucrats involved in fixing it.  Liberals tend to favor common standards and see little wrong with government involvement in the educational process.  Many more moderate people don't know what to think, or view the Common Core as just one more bandwagon careening its way through the educational system.  Confusion reigns, and with no end in sight.

The unfortunate thing is that the matter of learning standards has taken the form of an either/or, black/white, divisive debate.  In my opinion there is no good reason for it.  Should there be some commonly-agreed upon learning objectives?  Of course: and that is nothing new!  And, should teachers be granted flexibility in teaching to those objectives?  Again, the answer is "Yes, without a doubt."  Great teaching has always been more art than science, and if teachers are made to think and act like automatons little in the way of learning will take place in their classrooms.  Moreover, truly gifted teachers will head for the hills, not wanting to participate in robotic instructional routines.   Students will suffer their loss.

Evaluation of student learning is important, of course, but excessive evaluation is unnecessary and detracts from student time on task.  In fact, tests should minimally interrupt instructional activities:  a creative approach to evaluation might involve random sampling of student progress across instructional domains, in a manner similar to the way polling occurs.  Ideally, evaluation should involve observation of student application of knowledge, not just on paper-and-pencil tests, but in "real life" situations, enactments or performance. 

I also believe that student performance on tests is a poor indicator of quality teaching, for there is much student learning that goes on outside of the classroom, and teachers have little to do with it.  Moreover, student learning is cumulative in nature, so to try to separate the impact of one teacher on a student or students is unfair and frankly, impossible.  I think that teaching proficiency may be best assessed through direct observation of instruction and application of objective criteria for performance.  (I do think the time has come for cameras to be installed in classrooms so such observation can be conducted without interruption of instruction, but strongly suspect teacher unions would not support that idea.)  Most districts would also need additional administrative staff to assess teacher competence well.  

There are a few matters embedded within the debate about Common Core standards that involve the question, "What is important to learn, and therefore to measure?"  These matters are almost never discussed in the popular press, but have been bandied about for years.  For one thing, those who once favored the "back to basics" movement continue to have a real problem with more progressive educators who believe students should be taught creative ways of solving problems.  To simplify the matter: The former group holds that students should learn facts and codified routines for solving problems, whereas the latter group believes that although fundamentals are important, the real goal of education should be to help students think and learn how to learn.  Of course, the differences between conservative and progressive educators bear upon the role of the teacher in the classroom as well as assessment.

The importance of the arts in education sometimes gets lost in the debate over Common Core academics, and that is indeed unfortunate.  Life is more than about reading, math, and science, and school should be preparing students for it.  We should acknowledge that visual arts, dramatics, and music add tremendous value to the lives of students, and require our continuing support.  And, we should admit that while measuring precise academic outcomes is important, tests cannot measure everything -- particularly creative thinking -- and so are limited.  The arts permit students to express their individuality in a way that academics simply cannot.  We should not permit too many uniform goals and standards of any kind to stand as obstacles to artistic expression and innovation. 

Revised June 22, 2015

  

Friday, March 29, 2013

School Shooters

It has been a long time since I've added anything to this blog, but there have certainly been some horrendous acts of school violence that deserve close attention, chief among them the carnage inflicted on innocent children by Adam Lanza in Newtown, Connecticut.  A long time ago I taught in the Newtown schools -- specifically in the high school -- so the shootings had special meaning for me.  I remember Newtown as a quiet and peaceful town, but now it is irrevocably changed.

   
Before the shootings occurred I had been looking into research regarding school shooters, only to find that there is a paucity of information about them and what makes them tick.  Perhaps the only thing we can say with assurance is that they are male.  Otherwise, common characteristics frequently appear in lists that are frustratingly general in nature and questionable in their utility.   The Federal Bureau of Investigation (1999), for example, provides no fewer than 28 characteristics of a possible school shooter, enough to confuse almost anyone trying to determine if a student may be a real threat to others.  As PBS's Frontline puts it,

A review of the [available literature] shows loose consensus around a number of warning signs for potential youth/school violence: chronic feelings of isolation or rejection, frequent angry outbursts, social withdrawal or depression, fascination with or possession of weapons, alcohol or drug dependency, history of bullying behavior, and lack of interest in school or poor school performance. Then there are items common to several lists, but not to all, like cruelty to animals and gang affiliation. And then there are some items that appear only on one or another list -- "dresses sloppily," is a "geek or nerd"; "characteristically resorts to name calling, cursing, or abusive language" -- that seem to be only marginally useful as warning signs . . . .

The lack of understanding regarding school shooters seems due to the fact that information about shooters is collected after the shooter or shooters are dead and the victims have been buried.  Then, it is typically the press that investigates the shooters, their early lives and parenting, friendships or lack of same, all with an eye to selling papers or presenting a story on the evening news.  "Psychological autopsies" are conducted by well-meaning researchers and writers of various stripe.  The water gets muddier and muddier.

Perhaps the biggest obstacle to our understanding of school shooters like Lanza is that we have little or no basis to compare them psychologically with other students.   We need to conduct comparative, psychological studies of students over time to determine how -- and why -- some turn out to become violent while others do not.  It is only through such longitudinal research grounded in potent psychological variables that we may finally determine ways we can prevent shooters from killing.  Although it is true many shooters reveal their plans to others before they murder, such information may not be taken seriously or reported to people who will take appropriate precautions.

In Lanza's case there was little or no warning.  His mother was thoughtlessly stoking his violent fantasies by providing him with firearms and ignoring the fact that her son was increasingly withdrawing from society.  One wonders if Lanza had any relationship with his father, and how mother and son related to one another.  I suppose as time goes on we will know more, but in the end there will likely be more questions than answers.

Wednesday, February 29, 2012

Another School Shooting

Well, it has happened again. This time, a young man with significant family and academic problems who had arguably been bullied went to school with a .22 handgun and shot five kids at random. As I write this, three kids are dead. Parents and family members are devastated. The community in Ohio where the shootings took place is reeling. Many are questioning how the situation could have been prevented, or if. On the day of the shootings, one student claimed to have contacted a local news station in advance of the incident, presumably to foil it. I have heard nothing more of that over the past few days, so it is difficult to know if any warning was given.

I will be writing more about violence in school in the coming days, but it is clear to me that we ignore children's mental health needs at our peril. Community mental health services are helpful, to be sure, but we must identify students in need of help before they become violent and locate highly skilled service providers in school buildings. If we do not do that, we risk even more incidents like the one we have seen. We cannot afford to remain idle.

Saturday, July 16, 2011

Problems with Special Education


In recent years I had the dubious pleasure of serving as head honcho of special education for a rural school district. I say "dubious pleasure" because while I learned a great deal, and liked my colleagues, the job was impossibly stressful and frustrating. I left the position voluntarily after I concluded that at the governmental level, the special education system is ridiculously mired in red tape. The legal system has effectively trumped the educational system when it comes to program delivery. Actual instruction of students with disabilities is at the tip of an unnecessarily bureaucratic, legislatively-driven and expensive iceberg.

Not only that, but even after several decades, special education remains the bastard child of the educational system. The shuffling of kids with disabilities into the mainstream, then back into special classes and schools, then back into the mainstream again, seems less a function of their educational needs than it does a reflection of State budgets and backroom politics. Student placements are rationalized as "good for the child" depending whether the bucks are available.

I admit to being cynical about this matter; but, I do believe special education as we know it will collapse under it's own weight unless certain problems are addressed. Here are some of them:

Administrators & General Education Teachers
  • The majority of school administrators and general education teachers have little or no training in special education. Many administrators view special ed students as thorns in their side, detrimental to standardized test results and as "discipline problems." Many general educators -- and particularly secondary education teachers -- resent the fact that special education students are placed in their classes. That is because they have not been properly prepared for inclusion of special education students, and because increasingly, they are being held accountable for test-outcomes.
  • Students with disabilities should never have been thrust upon general education teachers who have not been adequately prepared to deal with them, or who do not want them. Such teachers may do more damage than good to a student with disabilities. Most general education teachers require extensive, additional training if they are to work effectively with students with disabilities. Even then, close administrative supervision is necessary.
Special Education Teachers
  • It is also true that -- through no fault of their own -- most special education teachers are insufficiently trained. Special educators are unrealistically expected to be "experts" in cognitive, affective, social and physical disabilities, as well as child development and instructional technique. Many feel overwhelmed by the needs of the student population. Special education teachers are often responsible for a high number of students with disabilities, each one of whom has his/her own Individual Education Program (IEP). For these reasons, many special education teachers leave the field after only a few years.
  • Students with disabilities often have significant mental health issues, but few special education teachers have sufficient understanding of the psychology of students with disabilities. Even though most states require teachers to hold a Master's degree, even that doesn't cut it. Special education teachers need advanced training in child psychology. Mental health professionals also need to be housed in schools so they may provide direct and indirect services to students with disabilities.
Delivery of Special Education Services
  • Some educational classifications (for example, Emotional Disturbance) are so broad as to be nearly meaningless. If special education teachers are to truly meet the needs of students with disabilities, student concerns must be given greater definition. Concerns for student mental health should be given equal footing with scholastic concerns. In addition to instructional needs, attention should be given the emotional and psychological needs of students with disabilities.
  • Since the Individualized Educational Program (IEP) determines the "curriculum" a classified child receives, and since each student has his/her own IEP, it is difficult for teachers to provide coherent, group classroom instruction. Differentiated instruction is difficult to deliver, given individual student needs and the limited preparation time provided to most teachers.
  • Although most students do receive the special education services listed on their IEPs, a significant minority of kids gets many more services than they need. Those who get more than they need usually have parents who are insisting upon certain services, thinking "more is better," and threatening districts with legal action.
  • Significant funds are expended by districts trying to ward off what are often frivolous lawsuits. Unscrupulous attorneys needlessly initiate legal action against districts, knowing the districts will not waste time and money fighting them.
  • Some "student advocates" are nobly committed to their work, and perform an important service for students with special needs. But, some work for attorneys and care more about a pay check than about kids' needs. A hard-core few have an ax to grind, and are out to "get" school districts or administrators. Parents may have a hard time telling the difference. There is a need for certification of student advocates to ensure they meet standards supporting quality instruction.
  • At base, special education is legally-driven, not educationally-driven. Special education law has been drafted by attorneys, not educators. IEPs are legal documents that often bear little relationship to classroom realities. The law changes constantly, and it is humanly impossible to keep up with it.
  • Many services rendered to classified kids have no empirical basis, but are provided because (a) they have historically been available, or (b) parents want them. "Hippotherapy" (horseback riding) is but one example of such a service. Behavioral optometry or "vision therapy" is another. And, many services that have only temporary impact are provided for the same reasons: Applied Behavior Analysis (ABA), for example.
  • Even "useful" services may be provided long past the time they are effective. For example, some kids receive occupational therapy (OT) or physical therapy (PT) while making negligible progress. Special education administrators may provide such services on a student's IEP simply to keep the legal wolves away from the door.
I think we need to take a long, hard look at special education and -- as a society -- at what comprises a "disability." Everyone involved in the education of students with disabilities needs more sophisticated training. We need to wrest control of special education from the grip of lawyers and return it to educators, where it belongs, in the meantime cutting red tape. Furthermore, we need to develop more (and better) instructional and vocational programs for kids who do not benefit from traditional, academic fare. Finally -- since child mental health concerns have reached crisis proportions -- we also need to integrate mental health into schools to a far greater degree.

* * *

Wednesday, September 1, 2010

On the Misdiagnosis of ADHD


I have been avoiding writing about Attention-Deficit Hyperactivity Disorder, but I suppose the time has come to talk about it. That is because one recent study conducted at Michigan State University, and published in the Journal of Health Economics, indicates that immaturity has been mistaken for ADHD in about one million children nationwide. The results imply that nearly one in five children has been incorrectly diagnosed, and many children have been treated with stimulant medication for a disorder they do not have.

The findings may be startling to some, but not to me. I have long thought ADHD is over-diagnosed, and am reluctant to diagnose ADHD until several other factors have been ruled out. Rule-outs for ADHD include depressive disorders, anxiety disorders, psychosis, myriad neurobiological disorders, certain sleep disorders, dietary factors, poor socialization, immaturity, and differences in temperament. Some parents -- usually those who are young, stressed out, or narcissistic -- seek a diagnosis of ADHD for their own convenience, and may exaggerate problems they have with their child. Most parents are surprised to discover that I am not going to render a diagnosis of ADHD without first having interviewed them, and before I have met with their child on several occasions.

I have not been happy with the authors of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) (currently in its fourth manifestation), because over the years they have reduced diagnosis to a formulaic process, and DSM to a cook book, diminishing the importance of clinical judgment as they have done so. One of the reasons ADHD is over-identified, I believe, is because -- thanks to DSM -- anyone who can read can "diagnose" ADHD based upon observable behaviors, overlooking the fact that the same behaviors are common to the disorders enumerated above. A diagnosis of ADHD is easy to make if one simply looks at the criteria listed in DSM, but many times that diagnosis will simply be . . . wrong.

The diagnosis of ADHD is a subjective one even if done correctly, and that has also led to misdiagnosis. It is all too easy to see what one wants to see. Adults who are otherwise well-intentioned -- but have little patience for the hi-jinx of children -- are likely more prone to think a child has ADHD than those who are more accommodating. Although there are numerous checklists that purportedly compare the behavior of a child with that of his or her peers, they are also susceptible to bias on the part of a parent, teacher or professional. The phrase, "Perception is reality" has all too often held sway when it comes to diagnosis of ADHD.

Finally, and although it may make me unpopular with some practitioners, I should mention the fact that ADHD is big business. The Center for Disease Control and Prevention estimates that the social cost of ADHD ranges between 36 and 52 billion dollars per year. Some practitioners not only diagnose ADHD, but also run treatment groups and derive a significant portion of their income from children and youth so diagnosed.

Now, having made remarks about the misdiagnosis of ADHD, I can say that when properly diagnosed, medical and psychological treatment for those with the disorder can be life-changing. I have seen kids who were totally "off the wall" and failing in school make dramatic gains in behavior and scholastic achievement once they were treated, and know adults who have been able to improve their relationships and vocational situations when helped. There are times when ADHD should be the primary diagnosis for a given individual . . . but, probably not as many times as has been true in the past.

Tuesday, August 24, 2010

Bullies & Bullying, Part Two


Shortly after I finished writing the first part of Bullies & Bullying, a 15 year old girl named Phoebe Prince, originally from Ireland, and living in Northhampton, Massachusetts, hung herself. Her suicide followed incessant bullying inside and outside of school. Phoebe herself asked school personnel for help. Her parents also contacted school authorities on at least two occasions about their daughter's predicament. Little or nothing nothing was done about it.

A few weeks later, a second suicide took the life of an 11 year old boy who had been taunted by peers for supposedly being "gay." The child hung himself using an extension cord. Again, the school district was implicated for having done nothing, despite the fact the boy's mother had filed several complaints with the district for inaction.

Although the schools may not have legal responsibility for stopping bullying behavior, they certainly have the moral and ethical responsibility to do so. But, when they are unresponsive to student and parent pleas for intervention, or when bullying programs are clearly ineffectual, how is one to proceed? Although many do so, why should a child have to transfer from one school to another to avoid being a victim? Or, should a child continue to suffer at the hands of other students due to the failure of adults to provide a safe and secure environment at school?

I think not.

In my private practice, I have found that many children and youth strive to do what teachers and administrators tell them to do with respect to bullies. Most kids are told to simply ignore bullies: Good policy when it comes to verbal abuse, perhaps, but ignoring someone who is pushing you, or tripping you, or hitting you . . . that's damn tough! But, many kids do try to ignore physically aggressive peers, with the result that they get victimized again, and again, and again. The continuing victimization only feeds feelings of helplessness and hopelessness, the cornerstones of depression.

In the first part of Bullies & Bullying, I suggested that school personnel may do little or nothing to help kids who are being harassed and victimized by their peers, this despite the fact that many districts have zero tolerance policies and bullying programs to prevent student aggression. But, zero tolerance policies are of little utility, for they often target the student who is victimized as well as the student who is the bully. Children who fall prey to bullies may be unfairly disciplined for having done nothing!

As a psychologist there is little I can do to promote change in the many schools and school districts my young clients attend, but I have developed a somewhat controversial way of helping students cope with bullies and bullying. It consists of "going by the book," and if that fails, falling back on the "law of the jungle," a phrase I use that harks back to Evan Hunter's book, Blackboard Jungle, and the movie classic of the same name.

Playing it By the Book

When a child reports that he is being bullied by another child or children, and if it is a continuing problem --and assuming he has done nothing to provoke aggression -- I first recommend he (1) report it to his teacher. If the bullying continues, or the teacher fails to respond, or if after teacher intervention the bullying continues, the next step is to (2) report it to administration, typically the assistant principal. If the bullying still continues, or if the administrator fails to respond, the next step is to (3) involve parents if that has not already occurred. The parents should then request a conference with teacher(s), guidance counselor(s), and administrator(s) in attendance to see if the matter can finally be resolved.

Most of the time -- but not always -- involvement of parents puts school personnel on high alert, and the bully soon feels the heat and ceases his or her aggressive behavior. That is especially true if the parents are influential in the community or otherwise have pull. In some cases, however, school personnel continue to look the other way, or worse, find fault with the student who is being victimized. It also happens that things get better for the victimized child for a time, then fall back into their previous pattern.

The Law of the Jungle

If reporting bullying to teachers and administrators falls on deaf ears, and if parental involvement with school administration fails, and only in the case that no weapons are involved, the time has then come for the child who is being victimized by a bully (or bullies) to take the matter into his or her own hands. The Law of the Jungle comes into play. The child must stand up to the bully, and be ready to fight back.

Preparations are necessary.

First, the parents of the child must be informed that because no civilized remedy seems possible, a more aggressive approach to bullying -- "taking a stand" -- must be considered. Although the potential legal consequences for taking a stand are likely small, these should be discussed with parents. In my experience, most adults readily endorse a more aggressive approach. That is especially true of fathers when it comes to sons.

Second, the child and parents must accept the real possibility that the child may be injured in an altercation. Most children are pleased to have adult permission to take a stand, and many are fearless.

Third, the child must understand that if a fight occurs in school, he or she may receive disciplinary sanctions. This usually involves a brief suspension. Again, most are accepting of this, particularly when parents signal their acceptance.

Fourth, the child must be instructed to wait for provocation, then confront the bully verbally. Physical force should be used only if the child is threatened directly. (Some bullies will back down once a child confronts them verbally, but most will not).

Fifth, the child should be shown how to block and throw a punch, especially a jab. A jab has the greatest chance of landing successfully.

Finally -- and this is most important -- the child should be told that he or she need not win a fight in order to succeed in thwarting a bully. Most bullies are cowards, and will soon find another victim who will not fight back. Taking a stand is more important than being a fighter.

Now, I understand many psychologists and educators will find fault with what is clearly politically incorrect guidance on my part. The reality is that the Law of the Jungle often holds sway in schools and certainly in neighborhoods, however, and that is particularly true when adults have abdicated their responsibility to enforce sanctions.

I would welcome any feedback to what is a somewhat controversial position.

Tuesday, March 9, 2010

Bullies & Bullying, Part One

Many of the kids I see in my private practice are boys, and a healthy percentage of those are middle school students in grades six, seven and eight. More than a few of them are tormented by bullies, and do little or nothing to "invite" bullying. The kids I see are simply trying to keep their heads above water academically while negotiating the perils of puberty. Most are short in stature, or overweight, or both. Most are neither athletic nor troublemakers. Many -- but by no means all -- have poor self-esteem made worse by bullying. All of them are suffering.

The school districts they attend have zero tolerance rules in place, meaning that the administrators have developed unthinkingly even-handed-- and sometimes harsh -- ways of dealing with student fights and aggression. In literally all districts, unless the instigator of a fight can be identified, all students involved in a fight are given identical discipline, usually (but not always) in-school or out-of-school suspension (ISS or OSS). All students are advised to report aggressive peers to teachers or administrators before matters get out of hand or a fight erupts. This would be a sensible policy if it worked, but the kids I see say to a person that it does not work, and most have lost faith in the policy and the adults who are empowered to enforce it.

All of the boys who have been the victims of bullies tell me they have informed responsible adults they are being targeted, but that the adults so informed do little or nothing to prevent bullying from happening again. Only today, one boy told me he told the Assistant Principal in his school several times he was being pushed and hit by another student, and that the Assistant Principal spoke to the offending student, then let him go . . . to push and hit the targeted student yet again. Another boy told me that when he reported a bully, the administrator told him that he "must have done something" to provoke the other child. Yet another boy was effectively abandoned by his district with the recommendation he enroll in a private school, which he then did. Blaming the victim allows some school personnel use to avoid the problem of bullying altogether, presumably relying upon kids to determine the pecking order or reasoning "boys will be boys."

Now, it is certainly possible that the boys I have seen are lying to me, and that in fact, they are doing something to provoke the bullies involved . . . but I sincerely doubt that. It may also be true that in some respects the boys I see act or look like "victims," but even if so the abuse they suffer lacks justification. In my mind, to say that some kids deserve to be bullied -- because they look or act a certain way -- upholds a standard of brutality that we should not tolerate in our society, much less in our schools. It is roughly analogous to the warped belief that because a women dresses provocatively, or acts flirtatiously, she deserves to be sexually harassed or assaulted.

Please do not think me naive: Having been a teacher and a school administrator, I am well aware of the difficulties posed by monitoring student behavior. But, it is also true that many teachers and administrators ignore the problem of bullying, or assume bullying programs and character education will win the day. Adults must step up to the plate and intervene swiftly to stop bullies from acting aggressively. It is also true that application of zero tolerance rules misses the point, for the bully and the bullied are given similar discipline for dissimilar behaviors. Fairness goes out the window in the quest for equal treatment of students . . . more on that later!

Tuesday, June 23, 2009

Cutters & Cutting


A cutter is a person, usually an adolescent and most often a female, who cuts herself in what is typically a private ritual. Razor blades, knives, compass points, shards of glass, or any sharp implement may be used in a self-injurious, but rarely lethal, manner.

Cutters usually do not want to commit suicide. Many talk about cutting as providing relief from emotional "pressure" they feel. Most try to hide scabs and scars left by this self-injurious behavior, and some will go to great lengths to avoid detection. Many feel guilty about their behavior. Cutters may target any part of the body for self-injury, but arms, legs, and torso are perhaps most common. In some cases, cutting is accomplished as part of a ritual, and may be associated with a certain song, incantation, or object that has special meaning to the cutter. A few cutters openly seek attention, and may even post photographs online or elsewhere. Cutting has been associated with depressive disorders, post traumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, and Borderline Personality Disorder (BPD).

It is difficult for most people to understand why a child might want to cut herself, or how drawing of blood might relieve feelings of stress or pressure, but cutters do derive certain gratification from the behavior. Sadie, a 15 year old girl who has cut her thighs with an Exact-O knife for nearly a year, put it this way:

When my father yells at me, I just can't take it sometimes . . . . So I go up to my room, lock the door, turn on my IPod real loud, then get my gear from my closet, take down my pants and find a place I haven't cut. It's . . . somehow, it feels good to cut, not too deep . . . and it's important to get it all in a straight line, so I have parallel lines, maybe two inches . . . and I use tissues to blot the cuts or sometime just let them scab up . . . .
The website http://www.selfinjury.com/ has posted graphic representing different motivations youth have for engaging in cutting behavior. Some youth cut to relieve the great stress they feel in their home, school, or peer group environments. The behavior is triggered by a particularly stressful life event, and leads -- paradoxically -- to a feeling of relief. Other youth feel alienated, detached, or isolated, and engage in cutting to feel "real" or alive, in the way that a tired person might throw cold water on his face to wake up. In fact, some therapists persuade cutters to use ice cubes rather than sharp implements on their skin.


Successful treatment of cutting typically involves more than dealing with the specific behavior, however, for that does not resolve underlying problems. The successful therapist must help the youth who is cutting identify stressful life situations and to develop strategies for eliminating or reducing them. The reasons for a youth feeling alienated or detached from her environment must also be explored. The youth must be encouraged to access and express difficult emotions, many of which may cause her to relive painful experiences. In some cases, and especially when abusive situations are present, a youth must be removed from her dysfunctional home environment. Collaboration between therapist and youth -- a therapeutic alliance -- is essential.

Teachers and parents often suspect a youth is cutting, or see the evidence directly. Cutting should not be ignored, or regarded as a "stage," because it signals that a child is in trouble. Rather, the youth should be addressed privately, non-judgmentally, and calmly. The adult should communicate concern to the youth, and suggest that the youth seek treatment. Teachers may also want to tell parents in confidence if they suspect their son or daughter is cutting, and offer to find help through the guidance department, school psychologist, or social social worker.