Dr. Anthony Rao
by Christine LaCerva
(Click here to access this article in Chinese.)
A few weeks ago, I participated in a fascinating panel discussion in midtown Manhattan called “Breakthroughs in Child Psychology.” Joining me was child psychologist Anthony Rao, Ph.D. and Lois Holzman, Ph.D., director of the East Side Institute for Group and Short-Term Psychotherapy, who interviewed both of us on how we work with children and families.
Dr. Rao is a cognitive behavioral therapist who works with young boys experiencing learning and emotional problems. He is a strong challenger of traditional approaches in the field, as am I. Although our approaches are quite different, we share a humanistic outlook and a belief in the innate capacity of children to develop if put in environments (in this case therapeutic) that are nurturing, loving and challenging – without first resorting to medication. Dr. Rao has just published an excellent book about his work with boys, entitled The Way of Boys: Raising Healthy Boys in a Challenging and Complex World. It’s a great read by a caring (and daring) clinician, one that I can’t recommend highly enough to parents and colleagues alike.
The growing trend of diagnosing and medicating our children is of great concern to me as a therapist. I think it’s outrageous that drugs have become the first line of response to kids in trouble. The standard protocol is to see a child for a one-hour consult, to decide on treatment. Most of the time, medication is offered immediately. To make matters worse, parents are typically told that if they wait before giving their child the meds, they will be harming the child. Any other possibilities — of getting to know the child over time, of making an assessment of what kind of support the child and their family need — are few and far between. I regularly speak with parents who are in a panic — worried that their children are being given a label that will stay with them for the rest of their lives, and bewildered to discover that agreeing to a diagnostic label seems to be the only way to get the resources and help they need.
Here are some alarming facts:
- Between 1987 and 1997 there was a 4000% increase in diagnosing young boys with ADHD (attention deficit disorder with hyperactivity).
- In the last ten years, there was a 600% increase in prescriptions for behavior medication in children under 12 years old.
- And perhaps the most astonishing: between 1994 and 2003 there was a 2000% increase in diagnosing four-year-olds with bipolar disorder.
Is anyone really getting helped by all this diagnosing and medicating? Isn’t there another way to go?
As a social therapist, I’m sure there is.
Social Therapy, founded by my mentor and colleague Dr. Fred Newman some 40 years ago, is a group therapy that doesn’t rely on prescriptions and labels and coercion. What we do rely on is human creativity and the joyful activity of play.
Let me show you what I mean. Here’s an excerpt from a transcript of a multi-family Social Therapy group session composed of children ages 8-12 and their parents. (I’ve changed the identities of the participants to protect their privacy.) You’ll see that we don’t relate to children as problems to be solved but as active participants in figuring out how to relate to their diagnoses, their emotional pain, their lives, their parents and (hint: this next part is the key) to each other. I’ll call this particular session “The Hamburger Syndrome.” You’ll see why.
Therapist (me!): How are you all?
Group (answers at the same time): Fine, pretty good, OK.
Therapist: I received several calls this week from parents and schools. I had conversations with school psychologists, teachers, and some of the moms in this room. As you all know, I don’t keep these conversations secret. I think you need to know about them, including what I’m saying about you.
Mary (Larry’s mom): I called Christine, Larry, because of what happened at school. I told Christine that the school psychologist is saying that you have Attention Deficit Disorder with Hyperactivity. The school said you should be evaluated and maybe take some medication to help you focus. (Turning to me.) Christine, do you think it’s okay to have this conversation in group?
All the children at once, very loud: We’re Larry’s friends and group-mates and we want to know what’s happening!
Mary: Well, I’m not sure that Larry can handle it.
Larry: I can handle it, mom.
Therapist: Mary, I think it’s very important for all of us to be involved in what you’re raising; you can get support and feedback here from everyone. What does the group think?
Emily: I don’t know, Christine. Our family has always handled this sort of privately.
Therapist: Emily, I think the group needs to be a part of deciding and creating whether to address this here and if so, how. We’ve never discussed the issue of diagnosis, but it’s a part of everyone’s life. Each person in the group knows of a family member or friend who is dealing with some kind of label. I agree with you — it’s usually kept secret. But I think it can be growthful to speak openly about it. No secrets here! What do others think?
Alan (age 10): What’s attention deficit disorder with hyperactivity?
Tameka (age 9): It has something to do with having difficulty paying attention and focusing.
Larry (yells): I DON’T CARE WHAT IT IS! I DON’T HAVE IT! I DON’T WANT A DISORDER!
Ely (age 9): I’m not sure what that is but I have something called Asperger’s syndrome.
Larry: Is that a disorder?
Ely: I don’t know about disorder — maybe. It’s a diagnosis. It means that you sometimes don’t have feelings about other people and that you’re kind of smart and you’re a little bit weird.
The group is taken aback by Ely’s comments. He is relaxed and matter of fact. Parents and kids alike say that the description kind of fits Ely. He is a little weird — and they love him. Ely responds by saying that if they were really being honest, they would admit that they are all a little weird. Everyone cracks up. I add that, of course, that includes me, the therapist.
Larry (laughing): Yeah, definitely you, too!
Everyone laughs.
Therapist: Larry, do you have trouble paying attention?
Larry: I kind of do. I can’t focus and I am always daydreaming. Maybe I’m bored. It feels confusing to me. I can’t always tell if I am paying attention. Sometimes I think I am. I get spaced out.
Larry has become increasingly upset realizing there are some things that are not going well for him. He now screams.
Larry: I DON’T HAVE IT! DON’T TELL ME THAT I HAVE IT. NO ONE GETS TO TELL ME ANYTHING!
Ely (interrupting Larry): I don’t know if you have this attention deficit thing but I do know something about what you do have. You have “Mr. Know-It-All Syndrome.” It makes it really hard to be your friend and play games or have fun because YOU are always telling people what to do!!!
The groups nods and begins to explore how Larry “knows” everything, and then it’s really hard to be close to him.
Ely: I liked the group today and I have decided I want to change the name of my diagnosis. I want to call it Hamburger Syndrome because I love hamburgers and so do all the other kids. (Everyone laughs and applauds Ely.) And Larry, you need to think about how you are doing this whole thing and the impact on your friends and even your mom. Maybe we can help you focus better or something.
Larry: Maybe. Thanks Ely.
Ely: Yeah. Think about it Larry.
End of session
It’s true — in Social Therapy, we even play with serious diagnosis to help children overcome the onslaught of changes in how people (even well-meaning ones) relate to them when the labeling activity begins, when they are related to according to their diagnosis. At the Social Therapy Group, we are playing and performing our way to a growthful and developmental life.
I am interested in having a dialogue with you about your thoughts and experiences on this topic. Please write to me!
I believe this topic of play, presenting, and pretending can have an influential stature in children and even adults lives. It can provide a safe haven in order to create an environment that can be comforting and accepting of an issue that might trouble an individual. The result of these aspects can help develop, move the issues to growth, and initiate possibilities to grow. In my own experience with speech delay I could not speak in a coherent manner, however the initial thought that it was autism inability conceive mental processes. They had begun to speak of different medications I could take to ease my struggles. But luckily obtaining the right diagnoses in a short period of time it was ruled out. It was not thought of discussing a developmental alternative to establish different ways of dealing with my situation when I was thought to be autistic. Though they were wrong later finding I was extremely shy and had issues talking in groups and people who I did not know. So as for group therapy, that is what it provides, an alternative to drugs and medication that do not do much benefit to an individual.
Thanks so much for your reply here. Play and performance for human development whatever age we are! Groups can play with diagnosis, emotionality, our histories and teach us so much about who we are and what’s possible.
Christine
After my own child had her first psychotic break at 17, her first psychiatrist decided that she was molested by her own grandfather after meeting with her just one time.This based on a picture she drew, where she drew herself without a mouth. Then, the psychiatrist asked who she was afraid of. My daughter was hesitant, no names came to mind directly. It was then determined that it was my father who molested her. (I need to add that my father is somewhat of a loudmouth, and not easy to get along with.)
This turned our lives upside down. As the psychiatrist held to her duty to report to social services, they came to our home and investigated our living conditions. Interviewed our 15 year old son, and sent a letter to my parents home to inform them of the accusations made. It was not acceptable to me the letter arrive without them knowing so I made the trip to my parents home to explain to my father that this letter was coming. These accusations were unfounded, and had my own daughter questioning whether or not she was molested and just didn’t remember. As it turned out, the picture where she did not draw her mouth, was simply an oversight on her part. She felt rushed by the psychiatrist to complete her drawing. She now states she felt she HAD to come up with a name when the psychiatrist asked for one. This rush to diagnose setback my daughters recovery for months. At this point, my daughter is doing much better with proper therapy and a psychiatrist who is treats her symptoms.
Thank you so very much for sharing this very difficult story about your family. I am deeply moved by our willingness to speak out on this topic. And yes the institution of psychology is intepretative and explanatory and can do great harm in the absence of creating the conditions helping young people and those that love them grow and develop. Thetagedy of oyur story has everything to do with why we are building a new psychology -social therapy –that is collaborative and relational rather than indvidualistic and interpretive.
Christine LaCerva
cool blog! I’m so happy I wandered onto it through yahoo, i’m gonna definitely need
to add this one to the old bookmark list.
I look forward to continuing to hear from you. Welcome.
[...] We’re looking to create an environment in our groups where people can play with diagnosis, says LaCerva. [See: The Hamburger Syndrome.] [...]
Kudos, Christine!
I am so impressed with this work – I always wanted to be a “fly on the wall” in family groups and now I can see how they work!
It is also astonishing to me how much the kids’ conversation is just like OUR groups’ conversations! Especially regarding how when we act like we “know it all” it is difficult to get close to one another and really develop!
Thanks so much for sharing!
Disconnecting the perception of “how children behave” from their greater ecological niche under danger through a mad driven speculative post modern, neoliberalism willing to kill our specie for short therm social disconnected profits, is maybe not recognising the message this children address to us about the situation. Maybe all the “well behaving” in a mad system is the true “disorder”.
Suggest maybe reading amongst plenty of other critical minds thinking inclusive, Arno Gruen “the Betrayal of the self” explaining the mechanism.
[...] a blog I highly recommend—The Community Therapist. It’s written by Christine LaCerva, director of the Social Therapy Group and of the [...]
You’re singing my song! Intelligent and highly creative children are the ones who get zapped with ADHD etc diagnoses. Winston Churchill would have been drugged into oblivion. Enough with doping up our children. All God’s children got a place in the choir, some sing lower and some sing higher. Let them be who they are, please.
How wonderfully radical that your groups are creating an environment families can play around with diagnoses — and in that process learn to accept our quirks and craziness without the heavy stigmas that do so much damage.
I wish my nephew, who is now 25, had social therapy when he was a boy and was diagnosed with ADD and put on meds. My brother was under a lot of pressure from school psychologist. My nephew’s entire life has been over determined by one diagnoses or another. It’s quite painful as meeds, not development, have been the “cure”. This work to socialize and play with these labels is so important and touchig to read about. Thanks for this posting Christine.
I think this is really terrific work. Right now, we’re in the midst of an uptick in incidents of bullying, and there’s a great deal of handwringing going on. I think that the practice of labeling kids is one of many factors that create an environment that is all too conducive to bullying. It seems to me that if the powers that be (both in and out of school) are so ready to slap a label on a child without particularly taking the trouble to get to know the individual, then what kind of message does that send? At least in part, it devalues kids, reducing them to a diagnosis.