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Decisions under Uncertainty

Saturday, September 13th, 2014

Last night this message came from two exhausted parents who had just toured recommended schools for their son: “We’ve seen three schools in two days. Each great. But, which will be best? Need more time to process. Boarding plane now and home at midnight. Can we talk to you Sunday?”

These parents created an elaborate color-coordinated spread sheet which compared the size, location, tuition, single sex or coed, academic programs (traditional classroom or online), substance abuse treatment program, activities (athletics, drama, etc.) for each school. The spread sheet was a good visual comparison of the schools.

Now the parents have toured each school and decision time has come. Despite having all this information in an organized form and having been on all three campuses, the parents could not make a decision. Did they need more information? No. They didn’t.

An important business lesson my husband learned at the Harvard Business School and taught me is that one must make decisions under uncertainty and with less than complete information. Waiting for complete information means you can wait forever; big decisions are made in the midst of uncertainty.

Then how do you make them? Once the facts are gathered, rely on your gut. Last night I heard Tim Cook, Apple’s CEO, tell Charlie Rose that when he took the job at Apple, there were few signs that Apple would succeed. It was a down time for the company; many pundits were predicting its failure. Tim Cook went with “his gut” and went with Apple.

The parents need to do the same. They should sleep on what they’ve experienced and go with the school that “feels” right. Adding columns on a spread sheet, calculating pros and cons will not get them where they need to be.

When parents are really torn between two schools, I suggest that they flip a coin. If they feel disappointed with the coin flip, that’s a good indication of where their real preference lies.

For more on “going with your gut”, read Malcolm Gladwell’s book, Blink.

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Why Wilderness?

Wednesday, July 16th, 2014

This morning I was on a call with parents whose 21 year-old son is in a therapeutic wilderness programs. These parents have been worried about their son for over ten years. From middle school, he began having academic problems in school and behavior problems at home. They consulted several psychiatrists and for a time the boy was heavily medicated for bipolar disorder. They enrolled him in special schools. He received outpatient therapy from the same therapist for these ten years. Last fall the parents even enrolled him in a supportive and expensive college program. In the spring he was asked to leave. Nothing seemed to work.

At home simple requests of taking out the trash, washing his own dishes and walking the dog were ignored. At night he brought friends home. The partying kept his parents awake. They hated to ask his friends to leave because they realized he needed friends. Still, they were unable to sleep and get the rest they needed to start a new day

The boy was easily irritated and the irritation could escalate to shouting and shoving. He learned his parents’ vulnerabilities and became an excellent negotiator, even to the degree of intimidating them. His parents began to walk on eggshells.

They started to wonder if he would ever become independent. Would he ever be able to hold a job? Get along with an employer? Have peers who liked him for more than his home or what he had? Find a partner? Start a family? Be a caring son? Would they need to be responsible for him for the rest of his life? And what would it look like?

When I talked with the parents about ways to intervene, I strongly suggested starting with a therapeutic wilderness program. Why? Taking young people out of their comfort zones and into the woods takes them a bit off balance. It requires them to adapt to a completely different setting. They become more open to suggestion and change. One cannot recreate this in outpatient therapy.

Within a therapeutic wilderness program, we would each recreate the roles we play at home. If a person is especially helpful at home and does other people’s work, he will do that in the program. If a person is especially kind and subjugates his needs to the wishes of others, he will repeat that pattern in the woods. Against the backdrop of the beauty and starkness of the wilderness and in the company of therapists, field staff and peers, our young man came across as a self-centered bully with a good sense of humor. After two or three weeks, his behavior had elicited a negative cycle from his peers which was very much like the cycle the boy had created at home and at the college program.. Everyone needed a break.

The therapist suggested that the boy take some time away from the group and go on a short customized trek with two members of the field staff. The therapist realized that the young man’s behavior could be explained by something he saw in the results of psychological testing. The boy had very slow processing speed. This does not mean that he wasn’t smart. It means that it takes him longer to process what others say (or he reads or sees) than it does for most people. In the relatively long time span it takes for him to process information, he can feel anxious and inadequate. To relieve it and to get the upper hand, the young man learned that lashing out kept others off balance and vulnerable. While on the customized trek, he had the time and space to begin to understand how the slow processing speed has affected him and to try new ways of responding. In short, his therapist advised him to “slow down”. The boy was able to start practicing listening and waiting to respond rather than jumping in and alienating his peers.

He started journaling and writing letters to his parents and siblings. He explained to them what he was learning. He wanted them to know that he cared about them and that he could see how his quick trigger had pushed them away.

Of course, it will take time for him to practice new ways of being with his family and friends and later in the world of work. He’ll go on to a supportive program for that very reason. We didn’t start with a residential program because we could not have had the beginning of a transformation as rapidly or as effectively as was possible in the wilderness with a perceptive therapist, observant field staff and peers who cared enough to give honest feedback.

Too Much Experience?

Tuesday, May 29th, 2012

Ron, my husband’s college roommate, was a heart surgeon.  He’d see former patients in town and he’d call out, “How long’s it been?”  He was asking, “How much longer have you lived because of the surgery?”  Ron was the best heart surgeon for miles around.  He had years of experience.  Did his surgical expertise just keep getting better?

No.  Ron’s surgical expertise grew at a time when he had excellent physical dexterity and precision.  He perfected his skills by performing hundreds of surgeries.  His expertise reached a high level of performance and plateaued over a period of several decades. A tipping point came when his physical agility could not execute at the level his patients needed.  He told me that most professionals reach a time when experience is not enough.

The practice of educational consulting follows the same arc.  In its building phase, consultants need to gain an understanding of kids’ needs and know which schools fit the needs.  Hundreds of schools are visited. Hundreds of children are placed.  A plateau of expertise is reached.  A list of diagnoses is compiled and matched with schools known to treat the conditions.  At this point the process can lose its vitality.  While consulting does not require physical agility, it does require a nimble mind which seeks out current treatment and isn’t content to stay with what worked in the past. Targeting the right therapeutic school for a child is too important to be boiled down to the formulaic.   Too much reliance on past experience can miss new and better options.

This is especially true now when therapeutic schools and programs are in a period of dramatic change.  They are becoming more specialized.  The length of treatment is becoming shorter and the therapeutic modalities more specific.  There is an increased ability and willingness to adapt curriculum and activities for kids who need “out-of-the box” attention.  Ed consultants must be aware of these changes and have the clarity to sort out what’s valid from what’s simply trendy.

With these changes I see more and more parents reclaiming the dreams they’ve had for their children.  The increased advocacy of ed consultants has resulted in the programs’ increased willingness to customize.  Experience alone does not make the good consultant.  Experience is the foundation, but good consulting must come from a nimble mindset which is open to suggestions from the family.  The most successful placements are the result of a dynamic partnership with parents, not a formulaic list of matches.

To Alienate or Not?

Thursday, May 17th, 2012

To Alienate or Not?

Janet, Mike’s mother, got a call from the school counselor on the night before the start of summer vacation. Another student had submitted an anonymous note expressing concern about Mike’s drug use.  Of course, the call worried Janet.  She knew she needed to do something, but didn’t want to do anything that would alienate her son.  She called me for traditional summer camp recommendations. I urged her to enroll Mike in a therapeutic wilderness program with a focus on substance abuse and agreed to meet Mike and talk to him about going.

            At our meeting, Mike made it clear that he had no interest in summer camp or much of anything else. He was a frightened boy slated to graduate from high school in two years and worried that he couldn’t make it in college.  He had nothing on which to “step out on”.  The comfortable life of a coastal California community had lulled him into a state of ennui.  He cautioned me that anything longer than a week away was “way too long.”  “Two or three weeks is way too long to be away from home.”

  I spoke again with Janet and repeated the recommendation of a therapeutic wilderness program. Her son needed an experience to help him explore his goals for himself and devise a plan leading to the goals.  

He needed to meet difficult challenges from which he could gain a sense of achievement.  And this achievement needed to be the result of his own efforts.  Janet was unconvinced, “I’ll sleep on it and call you tomorrow,”

The next morning there was a message on my voice mail, “I cannot ask my son to do something he doesn’t want to do.  I haven’t alienated him.  I cannot alienate him.  I think we’ll take a short trip together, maybe go gliding together or take flying lessons. Or maybe an intellectual or studio experience.  He likes pottery and photography. What he really wants is an apartment and to be on his own.  What do you think?”

I thought not.

A year later, Mike’s mother called again.  Mike was in juvenile hall after having been convicted of selling drugs.  Still Janet comforted herself that she had not alienated her son and that they were geographically close to each other, although he was under lock and key.  She, too, was in a locked and gated community, but one quite different from juvenile hall.

Mike finished his sentence and Janet set him up in the apartment. He was a senior in high school, but he didn’t have the credits to graduate.  Before GED studies could be arranged, Mike had a relapse. To his credit, he didn’t want to go downhill again.  He asked his mom to find a treatment center.  Though she was capable of affording private treatment, she refused.  She didn’t want her son away from her.  She stalled.  Mike voluntarily readmitted himself to the juvenile detention facility.

Janet didn’t alienate Mike.  But what might have happened, if she had…for awhile?

1.              Mike might have had the benefit of therapy which uncovered the root of his need for drugs.

2.              In the course of treatment, Mike might have been introduced to something which interested him and ignited a passion or love which would have made drugs less attractive.

3.              Mike might have completed high school or the GED as a part of treatment.

4.              Mike might have matured through an emotional growth curriculum to the point that he genuinely could make his own way.

5.              Mike might have individuated, become his own person, and returned to establish a satisfying and mature relationship with his mother.

None of these possibilities happened.  As Henry Ford said,  “If you need a machine and don’t buy it, then you will ultimately find that you have paid for it and don’t have it.”   Janet paid a price for Mike not having treatment.  Was it worth it?

Desperate for Help

Sunday, May 29th, 2011

We’’ve just had a serious health diagnosis in our family and I’ve found myself once again a stranger in a strange land.  Like the worried parents with whom I speak everyday,  I’’ve been thrust into a world of confusion.  It’s similar to those times eighteen years ago when we were deeply worried about our  son’’s struggles.  We did not know where to turn.

Yesterday after returning from the doctor’s office,  I turned to Google.  I was desperate to learn about the disease and its treatment.  What could we do before things get worse?  How could we avoid mistakes that can’t be rectified.  We didn’t want the horse to get out of the barn.  We wanted to turn over every stone.  We needed a sound plan.

I found pages and pages of information on the Internet.  How could I separate marketing and pie-in-the-sky hope from sound and applicable information?  We needed expert medical advice to walk us through the options.

Suddenly, our crisis has brought me closer to the parents with whom I talk everyday.  I have a raw and fresh understanding of their fears.  Our paths are different and our fears are different, but the steps in the process of finding solutions are similar.   We need unbiased expert medical advice.  Parents considering residential treatment for their children need unbiased expert advice on therapeutic schools and treatment centers.

I am going to try to help.  In that vein, I plan to make regular additions to this blog.  The additions will include comments and observations on developments in the treatment and guidance of struggling children, adolescents, and young adults.

I hope you’ll feel I’’m by your side.