How has therapy helped your defiant teen?

I notice a lot of parents referring therapists and I would like to hear specifically how therapy has helped their teen and/or family. We have had therapy for/with our teen for over 2 years now and all the problems remain, we are in no better place, only completely broke. The issues are defiance, opposition, extreme disrespect, substance use/abuse (and other programs, including wilderness, have been used), anger, troubling choice of peers, poor self esteem, barely getting through school and with constant behavior problems, etc etc. We did switch therapists once (before these 2 years) and the newer one seemed competent and our teen liked him, so we stayed. I would like to hear how, or what, in therapy has helped other families. thank you. anon

Trouble with teen daughter's hostility/anger

I am having a lot of challenges with teen daughter's hostility/anger. Difficult for me to not get provoked when she addresses such hostility towards me. Anybody else that might want to meet/talk/give mutual support through this horrible stage?

Making time for non-hostile conversation is good. Driving kids places is one opportunity. Walks in the dark is another. Both are non-eye contact.

Here's another trick. Questions, even if necessary for logistics, drove my daughter wild, so I learned to make statements like: ''If you need X this weekend, better tell me now.''

But if you're experiencing nuclear bitchiness, maybe family counseling would be appropriate; maybe darker stuff is going on with her than you know? And maybe both of you need to feel heard.

Hang in there. It gets better.

Don't want to be around teen son

Our son has become so difficult, selfish, narcissistic, demanding, critical, etc., etc., I don't want to be around him. He just doesn't stop these behaviors, and we can't figure out how to get him to stop because no consequence seems to make a difference to him. What can we do? Has anyone been through this? He has always been difficult but we are now fed up. anon

If this is a HUGE change in attitude, however, family counseling could help, and you should be alert to possible drug use or other changes in friends, school, and behavior.

In my son's junior year of high school, he was so obnoxious that my husband was ready to move out! We dug into savings to pay for the kid to live away from us for the summer-- at CAL, in the dorms, where he took one summer class (which anyone can do) and worked on his summer AP work. It worked out beautifully for us. Good luck!

Teen's angry outbursts, running away, volatility

16 yr old daughter hitting very steep slippery slope in last ten days: escalated marijuana use, volatile, angry outbursts, running away, all in last week. Cutting classes at BHS, even with attempts at supervision. We don't want to do Utah away therapuetic camp but need temporary place to help her get her feet on the ground. She has therapist, singing lessons, church youth group, basketball, etc and two loving and very supportive parents, and she is going haywire. Any ideas? Much thanks. need ideas soon

17-y-o daughter is negative about everything

I'd value some feedback on the following topic: Our daughter is just 17, is a junior at a local private school, is smart, literate, self- reliant, independent, excels in the humanities and the classics, plays an instrument, knows some of four languages. Reads voraciously. Loves theatre. Here is the issue: she always takes, with the occaisonal exception, a negative spin on things. If she's in a play, she wishes she had another part. If she in the crew of the play, she wishes she was in the cast. If she's in one class, the other is probably better. If she sees a play, the cast wasn't as good as the last time she saw the same the same play. She's a bit like Linus with a little melancholy dust cloud following her. Sad you wonder? I wonder too, and recently found a great local therapist and had the whole thing lined up and told her her dad and I each benefitted enormously from therapy and want and want for her the same; I said that we want to provide her with the best tools to lead her most fulfilling life before she leaves for college, and she just flat out refused. ''I don't need therapy and I would never pay to talk to a stranger.'' And we said, well, the therapist is specially trained and that's why he/she costs so much and she said, well I'm just not going. Our daughter has a few friends, is ostensibly content to spend a lot of time alone, looks forward to college, is not overtly miserable, but just seems a bit downcast and responds in the negative so much of the time. She is rarely invited out, enjoys the company of a few close friends, but hardly ever initiates anything. So the questions are: what to make of this? Will she ''outgrow'' it? Is it a function of being 17? What can I do to support her? Is it best to leave her be and let her work things out on her own? I find myself wanting to talk her out of her negative twist on things - I want to honor her experience but show her the positive side and celebrate the wonderful blessings of health and wellness and life here in Berkeley and the great school she goes to and the farmer's market right nearby on Thursdays and the intact loving family that she is a part of and all the goodness in our small world. We're disappointed she missed the opportunity to go into therapy and are wondering what to make of things. We love her dearly and are sad to see her feeling disappointed and negative all the time. Suggestions appreciated

You don't need the greatest therapist in the world to tell you the obvious truth. And that is you've got a daughter who works off her frustration by playing a little game with you - you extol the blue bird flying by, and she quickly takes her little barbed tongue and shoots it down. And she wins. Right?

Perhaps you should start by not playing her game. You can't win, you know. She's going through a small-minded phase right now. Frankly, your daughter is childish and selfish and very unpleasant. And she won't change until it matters. Let her be. Shut up with your ''everything is beautiful'' mantras. Ignore her. Work on your own projects. Delegate things related to your daughter to others. Look at the blue birds and the sunny skies and love them for yourself! Stop being the punching bag for an immature brat. Eventually she'll get bored and start acting reasonably. Someday she'll notice you're not happy - it may be a long while - and she'll go ''Mom, look at the blue birds - aren't they beautiful''.

And you will know - she really did hear you. She just had to grow up a little. Another Mom of a Negative Teen

She doesn't want or need you to ''talk her out of it'' and the more you try, the more resistance she'll put up and the more she will think that you don't understand/value her. When she talks negatively, ask her open ended questions, but don't offer your opinion. Answer with, ''I see what you mean,'' or ''I understand,'' or ''You're smart, I'm sure you can figure it out,'' that kind of thing.

In your post you say so many great things about her. Focus on that. Let her know that you think she has a lot of stellar qualities. After all, you want her to focus on what's good, so you need to too. mom of ''1/2 empty'' teen too

#1. When DOES your daughter feel completely satisfied? At a very deep, fundamental level, what is it about those times/circumstances/things/activities that make her feel joy''full''? (e.g. is it feeling challenged? is it feeling in community? is it having a WIN? is it feeling loved (perhaps by a man)?) Understanding her sources of joy can help you find ways to show her how she can find more joy and happiness by CHOOSING to see things in the most positive light, rather than dwelling on what wasn't right about something.

#2. I am not surprised that she rejected the idea of a therapist. The suggestion might have made her feel that you thought there is something 'wrong' with her, that she needed to be fixed. Especially given her current way of seeing the world, your suggestion just fed into her way of seeing things as 'broken'. (not to say it wouldn't have been helpful!)

#3. How much of a practice of gratitude do you have in your household? Without talking to her further about her attitude, you might just want to express gratitude openly yourself more often, especially in her presence. There may be no visible change in her right away, but by LIVING a practice of appreciating the good in things, even very small things, and allowing her to witness you in that, you will be giving her the best possible example of how to feel positive about life. Just make sure you increase your gratitude practice gradually, so she doesn't get turned off by seeing sudden, unexplained changes in you!

#4. The fact that she sees things in the negative may have something to do with a void or unexplained yearning (conscious or unconscious) she is feeling. How much has she consciously entered womanhood? Has her transition into womanhood been acknowledged and honored, e.g. in a family ceremony? Has she ever been in love? Does she long for love, but may not have shared it with you? Finding the answers to some of the questions above, and more, may help you guide her gently and gradually towards an outlook on life in which she sees the fullness of it, rather than the lack of 'wholeness'.

Need help with teen's oppositional defiant disorder

Hello, I am searching for help with my 15 yo son who was diagnosed with oppositional defiant disorder at age 10. We have been through every conceivable avenue - neuropsyh evals, lots of therapy, special schools, wilderness camp and residential treatment. He's graduated successfully through all programs, but once back at home he backslides. I work full-time and am a single parent. I cannot provide the 24/7 care and attention that are provided by staff at the programs. I have a younger son as well, and our home life is dominated by my older son's constant defiance and arguing. Does anyone have experience in dealing with this successfully? I need help. desperate

16-y-o daughter is easily agitated, has explosive temper

My daughter is easily agitated, and has a very explosive temper. She is desperate to prove she is ''an adult'' (will turn 17 next month), and often feels like she is not getting the respect and autonomy that she ''deserves.'' Then she gets so mad that she slams doors, yells obscenities, and sometimes just storms out of the house. I don't really expect her to be able to ''get it'' that at almost 17 she is NOT AT ALL an adult, but I would like her to at least learn some better ways of coping with her anger. The door slamming and obscenities are annoying and dis-respectful, but maybe i could learn to live with; my main concern is leaving the house at night, which feels really dangerous. Recently she was backpacking with her dad, and got so mad she stomped off into the woods by herself, which feels REALLY dangerous. I'd just like her to find a way to express her anger that also encompasses keeping herself safe. Is this an unrealistic expectation for her age?!?

We have worked with two different therapists, I liked them both, but she thinks therapy is ''stupid,'' ''boring'' and ''doesn't work.'' Our last session, she explained to the therapist that she wouldn't have to get so mad if other people just would stop being so annoying; in other words, it's not HER fault, it's OURS.

I thought maybe a class or a peer group might be a better fit for her. Any ideas? She is hoping to get her driver's license soon, and I don't want her driving on her own until she gets a better handle on her anger management! Mom concerned with explosive anger

I have two daughters, one 22 and one almost 17. My oldest was very explosive. I learned some parenting techniques that really helped. One, do not stick around if your teen is speaking to you in a disrespectful way. I have my mantra statement, ''I respect myself too much to allow anyone to speak to me in an abusive way''. I state the above and then turn around and leave, immediately. I go to my bedroom and if my teen follows, I take my keys and leave for 15 to 20 minutes. Do not stand there and be yelled at and do not engage an angry teen in the moment. Come back to issues when all parties are no longer upset. Take control of your house again. My oldest used to slam doors too. After a warning, I removed the door to her room for a week. That made an impression and put an end to slammed doors. You must give your teen the idea that you will not tolerate her explosive behavior. For one, it could really put her at risk, with the wrong person and/or with the law. Then too, is this how you want your teen to act in other relationships and is this the model you want to give your daughter for how adult women are treated?

My oldest also refused therapy, until I made a statement that I meant. Go to therapy if you wish to remain in this house. She knew by my tone that I meant business. I recommend Terry Trotter, in Albany, marvelous with teens. Just think, would you allow your 17 year old to not seek cancer treatment? Then why do so now? Be firm, quiet and non-negotiable about consequences, and fair. I would also explore any mental health reasons why your daughter is so explosive. My youngest was put on a particular medication that caused a side effect of raging. Once the med was discontinued, the rages stopped.

As for leaving the house at night without permission, call the police. In form your daughter that this is what you will do if she is missing late at night; you will call the police 1st and ask questions later. They really can be very good with teens. By the way, my relationship with both of my daughters improved dramatically once I set firm limits and meant them. Good luck anon

Remember, until she's 18 (or has had a driver's license one year) she has to drive with an adult in the shotgun seat. You should be prepared to order her to pull over and give you the keys, if she misbehaves. If she won't obey such an order, why give her the car keys in the first place?

My mom taped a sign to the dashboard when we were teens: ''You are driving a lethal weapon.'' It was quite sobering.

Sorry, I don't know of anger management groups, although it sounds like family counseling might be a good idea too-- you must be very frustrated, and a therapist can help you learn how to talk things out with each other.

The ''dashing outside'' stuff sounds more dangerous. Either go after her and haul her back, or call the cops, or get her to a police league self-defense class for girls.

I have a 15 yr old girl who is sometimes emotional and disrespectful. Most of the time it's not about me, so I find it useful to respond mildly with, ''I don't deserve that tone of voice'' or ''I didn't do anything to you.'' Good luck

I have used a workbook called Anger Management for Women with clients; it is written for adults, but I did have one 18 year old client who really liked using it. I also want to suggest that your daughter's behavior and frustration and irritability may be a symptom of a mood disorder, such as depression. Substance abuse or traumatic experience are also things that can be related to this type of behavior. Also, just because a teen protests about therapy doesn't mean they are not benefitting.

Best wishes to your family. Ilene

15-y-o daughter is belligerent, yells, and has meltdowns

Any recommendations for local therapists in Lamorinda, for a 15 year old girl? She is continually in conflict with us, the parents. She is belligerent, yells everyday and has meltdowns when she's told to knock it off. She pushes all the wrong buttons, provokes, demands, screams and cries every day. Everything we say is an attack on her, she can't stand her family . She would like it if we sent her to an expensive boarding school. She feels she should have a lot of rights but frankly, with a poorly behaved child, I am unwilling to spend big $$.

. . My daughter is very ungrateful and has a real sense of entitlement. She is very smart, does pretty well at school though she puts in minimal work, has some friends. She has a high sense of entitlement. She has become, over the last 6 months even more outrageous and ''hormonal''. She has no medical problems is just a ''brat'' unfortunately. We, her family needs help, she is verbally abusive, and we are not willing to continue to be doormats. I am truly thinking, that she needs some medication on a regular basis to calm her down. I do not believe ''talking'' with her, giving rules etc. will really result in much improvement. She appears to be totally out of control... help I can not even stand to be around her. In fact, we have a ''rule'' that if she walks out of the house and goes off our property, I have told her that we will call the local police and say that she is a runaway. I have told her that she can spend a few days at the local juvenile hall. She has not walked away and I do not prod her or goad her to do it, although, frankly, it would be enlightening, I am sure for her, in a very negative way. I don't say things like- it's our house, our rules. I believe she should respect her parents and should behave in a reasonable way that is respectful to her family. I am exhausted, mentally from her bs. We are willing to participate in some sort of family therapy. I am at the end of my rope. anonymous

I work with teens and know how difficult these years can be - you're not alone. I have referred families to Bodin and have seen tremendous progress. Bodin's website is http://www.thebodingroup.com/ I wish your daughter, you, and your family the best. Nancy

There are many excellent family therapists in the Bay Area. If you have more than one choice see if you can talk to them on the phone - sometimes there is an over the phone ''in take'' brief interview. Even if everyone is totally uncomfortable, often there is a great relief of tensions after one or two visits. Having insurance coverage - even partial - can mean that you can afford longer therapy to work on family communication and dynamics.

People should not be afraid of therapy or what it may mean to see a therapist. If someone were in physical trouble you would be dialing 911, and rightfully so.

Society and families are complex, seeking help to live a great life should be the norm. I wish more people sought therapy simply to live a happier more productive life.

Good luck and best wishes -- encouraging you to make the appointment

Second - you do need to talk to your child. Each parent separately and together. It does work. A teenager seesaws emotionally between being a child and being an adult and it gives the adults around them whiplash watching them. Definitely, get a family counsellor to help you if you can. If that's not possible, take a deep breath and find a new way to communicate. A good one is to go through photographs. Kids of all ages are fascinated with photos of themselves. Maybe make copies of photos of hers that she likes, so she can have her own album. It will help remind her and you of when she was younger and you had a better relationship.

Third - listen to her. Really listen without interjecting. Really, really listen. Tell her you actually want to know what she's feeling about things, and about your relationship. You may be astonished at what's going on inside her head.

Fourth - Tell her you love her.

Fifth - talk to her friends' parents. They may know if something else is going on that's making her miserable. Also talk to your partner and get clear what unrelated pressures may be pushing you two over the edge.

Sixth - have a family meeting and set out clear rules for what each person (including yourself) contributes. Repeat the above list as necessary. Fiona

One, when you have an argumentative, tantruming teen, do not try to engage her in talk in order to reason, discipline, or lecture her. The above will just fan the ''flames'' of an argument, one you will not win. When your daughter is being disrespectful, yelling etc. disengage rather than engage. I developed a phrase that became my mantra.... ''I respect myself too much to allow anyone to speak to me in an abusive way''. That said, I turned on my heels and went to my room, other part of the house, or to my car keys if need be. Important rules, health, safety, education, were enforced quietly, no lecture or discussion. All other rules (like a clean room, etc.), were simply dropped. I kept firm, quiet, and unflappable, no emotion. The above really helped. Try this with your teen. Referral: Coyote Coast in Orinda for teens, families, etc. This type of problem is their specialty.

Book: The Explosive Child by Ross Greene. Look at his technique. Talk to your teen when she is not upset and you are not upset. Try a family meeting and listen to what your teen has to say, if she says it politely. Set the ground rules beforehand and tell her you want to try to hear her when you are not fighting. Try to give some. Set a place where your daughter can go to diffuse that is hers alone. Ditto for you. My now 16 yr old, my youngest, has gotten used to mom's statement, ''I need a time out''.

The trick with teens is not to get emotional, argue, lecture, or go back to past ''crimes''. Stay matter of fact, firm and quiet. Do not engage in arguments. Try to work on your own anger, although I ''get'' why you feel angry. She still needs to feel you are on her side. Remember, it is not fun to argue with ''the fresh air'', so don't stick around if your teen is speaking to you in a disrespectful way, make your statement and leave immediately anonymous

In Berkeley: Pamela Zelnik, MFT 510-527-0274 pamzmft@gmail.com

In Oakland: Claudia Sieber, M.A., MFT Licensed Marriage and Family Therapist 3637 Grand Ave., Suite D Oakland, CA 94610 (510) 238 0741 www.claudiasieber.com www.suddenlossgriefcounseling.com http://therapist.psychologytoday.com/47373

hildy

Daughter is withdrawn, hostile and negative

Hello, It seems these days, my teen daughter is often withdrawn, hostile, and/or negative in her interactions with the world--within the family and toward others. Her life is basically good, so am saddened by her armor plate.

She says she wants to do things, but everything in her body language and interactions with the people around her screams she doesn't. It seems like she isn't aware of how her stance will put folks off. They try, but she doesn't often let them in. When I talk with her she doesn't want to listen. She covers her head, plugs her ears.

I'm scarred she's creating a path that will dictate her future in ways she won't be able to change. Any advise on how to talk so they will listen. Feeling helpless. Anon

13-year-old's daily rages, may be bipolar - boarding school?

Since fourth grade we've been trying to deal with a kid who is very angry on a daily basis, who steals, lies, does whatever possible to stir up trouble within our family. We've seen a host of mental health professionals: psychiatrist, evaluator, therapist, group therapist, family counselor, peer counselor, pediatrician specializing in ADHD, tried Depakote and Zoloft, spent thousands of dollars and seen no change or improvement in his behavior. (All of these appointments were researched and made by me; my husband has no faith in mental health professionals and I have to admit none of them so far have been effective.) At this point, I'm ready to get my son out of our home and into a boarding school or therapeutic boarding school. My husband doesn't want to send him away. I realize he's only 13 and that's really young but our family life is hell. He's not ''happy'' unless he's making everyone around him miserable, his daily rages make me cower, literally, and I have no idea what steps to take to change things. I'm open to advice but am especially hoping to hear from parents who have been through this. Could a boarding school improve my son's outlook and behavior or will it make him even harder and less cooperative? Anonymous

Because of the possibility that he would need to attend such a school that is not here in the Bay Area, it would be my advice to consult with the Bodin Associates in Lafayette. They specialize in just the situation you are experiencing. Been There, Done That - with Relative Success anonymous

my son fell apart in high school, and i can definitely relate to wanting to find some relief from the rages, acting out, all the drama in the family.

my husband and i also had a lot of anxiety and differences of opinion about what would help. far before i was willing to consider sending my son away, my husband was talking about that. i had to try various other things -- and it sounds like you have tried many things already.

have you considered consulting an educational therapist? we used bodin associates in lafayette [i think they also have an office on the peninsula], and it made a world of difference having outside people assess the situation and make a variety of recommendations.

bodin has lots of contacts will all sorts of programs -- local and away. we appreciated that the counselor we worked with had visted every place she recommended we consider, and knew people there. the assessment of our son was very individualized -- even though he was not very cooperative, they got records and talked to a lot of people who had worked with us and our son.

the whole process was kind of scary, but not as scary as continuing to live in the disaster our lives had become, and worrying constantly about how much worse it could get. [and it was really bad by the time we went to the consultant -- our son had 3 ER visits for substance problems in the previous year, and an involuntary psych commitment; he was nasty, and regularly went into rages where he tore up the house -- threatening us, kicking holes in walls, breaking things; was escorted home by police and detained by transit police; had bombed out of rehab; run away from home overnight a couple of times; stole from us; was caught with paraphrenalia at his new school; etc.]

the educational consultant recommended that we start with a very good therapeutic wilderness program -- not a boot camp, but a place where the kids learned self-reliance and to begin talking about stuff. even my son thinks that program was excellent. the staff was well trained. he was seen by a great therapist weekly; we exchanged mail via fax weekly; and his dad and i talked to the therapist for an hour weekly. after a few weeks, when he'd calmed down and adjusted, he had a battery of psychological tests. between that excellent report, his work with his group and his therapist, we got a better picture of what would help him along.

when our son was ready, my husband and i attended a ''transition camp'' -- an overnight trip to the wilderness with other kids [and parents] who were ''graduating.''

the educational consultant was in close touch with us and our son's therapist during the wilderness program, and came up with a lot of good recommendations about what to do next. we chose a therapeutic boarding school that was really good for our son's needs. he is not as enthusiastic about that choice, but it was really good for him -- he completed high school there, learned a lot, had a lot of fun, was able to keep up with his interest in music. he became himself again, only more mature. now he is a functioning, working adult of 19, a decent guy and holding his own. [we had expected he'd be in college, and i think one day he will be -- but he's alive and doing well, and we feared quite a lot that we would lose him, in the dark days.]

long story -- but try an educational consultant. they have so much more access to options than we mere mortal parents do, and it is truly a relief finding some options anonymous mom

If you feel that your child *may* be a danger to himself or others (you included) get in touch with a mental health professional immediately.

I can't judge the situation from here and realize this may sound alarmist. But I am absolutely serious. Given your child's age, the issues of violence and suicide are absolutely real. As someone once said to me, ''it may only be a slight risk, but no one is only slightly dead.''

Now to where I began writing: I deeply sympathize with your plight. I have personal experience with your situation. This parenting experience is terrifying, baffling, emotionally exhausting and endlessly painful. What follows is based on knowledge I'd rather not have acquired. Please bear with its length if you can.

The problem with this kind of advice is the implicit assumption that one knows enough to offer specifics. I will try only to offer information, point out some relevant considerations, and describe what I believe is the best way to get help. There are no absolutes. Every step, every decision, is a judgment call. In particular cases, everything I will say could be dead wrong. With that caveat, here is my advice:

Sending your son to a boarding school will not solve his problems. To do so may be necessary, for reasons of safety or the well-being of your family as a whole. But regardless of where he is, your son's central issue is diagnosis. And placement decisions warrant caution. A wilderness program, for example, could be great for a kid with one set of problems but horribly destructive for a different one.

Thus, diagnosis is the first and critical step. But diagnosis means much more than labeling with a DSM-IV number. It requires a proper understanding of the individual child and the surrounding circumstances, careful observation, and thoughtful, experienced insight.

Without proper diagnosis, treatment is nothing but a random shot in the dark. ''First, do no harm,'' is the physician's maxim for very good reasons. Keep it foremost in your mind. With your child, compassion and tenderness is more likely called for than is ''tough love'' or blind adherence to social norms about how to raise children.

I know you've tried to crack this problem, and I know the financial and personal costs involved, but I strongly believe that you should try again and take a systematic, committed approach to diagnosis and treatment. To me, the fact that you've already tried so much only means that you face a tough problem, need excellent help and need to stay with it over time.

The situation you describe could have many origins, some psychiatric, some not -- an example of the latter is that the impact of neurocognitive or ''learning'' problems could lead to a secondary psychiatric condition like anxiety. Treating the anxiety is a palliative that alone doesn't solve the problem. These conditions are very difficult to understand, and understanding develops over time. Thus, it is better to stick with one team than to keep trying new players. Now some specifics:

1. ''Bipolar disorder'' is not the question, nor is it the answer. At best it is a mere label of convenience, as are all DSM-IV categories. These problems are not one-dimensional. They may involve genetic, biological, physiological, cognitive and social factors. That's why a really good diagnostic team is essential.

2. Fish oil? Please... Your child's life deserves more than voodoo medicine and home remedies. A supplement, maybe... An answer? No way.

3. This IS rocket science. You need to find and work with a team of two highly skilled and specialized professionals: a clinical psychologist and a psychiatrist.

4. The clinical psychologist is critically important to diagnosis -- even more than the psychiatrist. That is where to begin. Psychiatrists have a valuable set of skills and knowledge, but they aren't the best place to begin in the search for understanding. That's why in-patient units (like UCSF's Langley-Porter Institute) use a team approach that places the psychologist on an equal footing with the physician.

5. Treatment: I'm certainly not prescribing. All I can say is this... good treatment plans are multi-dimensional. In serious cases, mental health treatment includes a mix of individual and family therapy as well as medications, if called for. When physiological, neurocognitive or learning problems are involved, other components are needed as well.

6. Don't rule out medications just because you've tried some that didn't help. Meds are no panacea, but can be tremendously helpful. Even moderate improvement in your child's condition can make a huge difference in your life and his. But your physician, if competent, will be cautious. A medication regime frequently involves several drugs, and getting the dosages and balance right is complex. Watch closely for side effects. Remember also that the right meds prescribed for the wrong condition can exacerbate rather than alleviate symptoms.

7. Educational consultants? Yikes! This is way premature for the reasons above. Beyond that, and without commenting specifically on the one(s) mentioned (of whom I have no personal knowledge), I advise you to be cautious. I've heard more than one story about consultants who knew less than the parents who were paying them.

8. ATesting is the clinical psychologist's job, not that of an educational consultant. It is folly to rely on an ed consultant for diagnostic work.

9. I suspect your child may be having problems in school. Ask your school district for an evaluation of your child for special ed. You have that right even if he is in a private school. If you disagree with the district's evaluation you have the right to an independent evaluation at the school district's expense. This is a little-known right, but important for diagnostic as well as financial reasons. Special ed professionals will admit -- off the record -- that they don't have the tools or the time to do a full evaluation in difficult cases. Since an evaluation and simple report by a clinical psychologist runs $1500 to $3000 and up (well worth it), you may as well get the district to bear some of the burden. You've already spent tens of thousands, I suspect.

10. Some fear that special ed status stigmatizes their child. I disagree -- the impacts on self-esteem and social relationships of the problems that get children to special ed are far more harmful than any stigma that results. Special ed is by no means a perfect system, nor is it easy to navigate, but you can get significant financial help, including payment for a residential placement, if you work your way through the system. Here too, a clinical psychologist can help tremendously.

Finally, I can't say strongly enough how important it is to get top people on your child's team, especially given your description of the situation. Here are some recommendations to get you started. These are people I know and have confidence in. Obviously, there are others:

Clinical psychologists: Michelle Horton, Ph.D. (985-2958); Terry Doyle, Ph.D. (594-1926).

Psychiatrists: Robert Epstein, M.D. (848-0900); Shane MacKay (540-1746).

If it would be helpful, you may contact me through the Parents of Teens moderators -- Anonymous for now.

one point, though, was a ''yikes!'' about finding an educational consultant. i'm one of the parents who suggested an educational consultant, and it was truly a turning point for us.

but i want to clarify, that is not where we started -- i made that suggestion because the parent asking about options for her son had already tried a lot of things. we tried talking to teachers, a family therapist, adolescent rehab, a new school that was very focused on students. we found a great adolescent psychiatrist -- but could not find a way to make our son go see that great doctor.

a year's worth of self-help yielded: 3 ER visits, one involuntary psych hospitalization, failing grades in 2/3 of our very bright son's classes, a 30 day inpatient rehab, his failing the outpatient rehab followup, several brushes with the police, being caught with paraphrenalia at his new school, being fired from the band he founded with good friends some years earlier, etc. the screaming. the holes in the walls. stuff he stole. the runaways. it was a complete nightmare. and i have a smart, very decent kid -- he lost himself, and we could not bring him back without serious help.

we turned to educational consultants when we had no more decent options, and it opened doors. we could not even get a good assessment of what was going on with our son, because he would not comply or cooperate on an outpatient basis. and our family life was in flames for quite a long time -- the worst part lasted a full year, even with the best interventions we could invent and patch together.

there is no down side to talking with an educational consultant. they have heard it all. there is no way for parents to easily navigate the local or away options without some help from people who know about programs -- and one piece of the programs they can suggest involves getting a handle on diagnosis.

to answer another issue -- the ed consultants do NOT do diagnosis themselves. they can recommend appropriate people, or see that a kid gets the appropriate evaluation at where ever he or she goes.

my own son had two kinds of very excellent evaluations at his therapeutic wilderness camp, where he spent 9 weeks -- one from a therapist who saw him weekly, was in close contact with the people who saw my son constantly, and also consulted with us -- and probably the best psychological evaluation based on testing that i've ever seen [and i see quite a few in my work]. the wilderness place was extremely supportive. i still feel that we could have struggled for years more, and never gotten as decent an assessment at home. my son, too, feels the therapeutic wilderness experience was really, really good for him -- he sees it more as a chance he had to grow and to believe in himself. [he was NOT happy about going there, but was VERY happy with how far he had come by the time he left, 9 weeks later.] anonymous mom

My step-daughters, 13 & 17, are angry and violent

We have 3 teen daughters, 13, 15, 17. My bio daughter, 15, is 60% here and 40% with her Dad. Good Dad. My 2 stepdaughters, 13 & 17, live with us full time, have been and continue to be abandoned by their mother. She has no custody of the 17 yr old, and every other weekend of the 13 yr old, for which she often doesn't show. Or suddenly brings them back after 2 hours. They are very angry, screaming, throwing things, violent, have left bruises on me. We told them they would have to attend anger management classes (yet to be found) (we would go too). They refused, screaming ''make me'', grabbing my arm and even trying to force me out of the house. My husband backs me up but the situation is untenable. We need help fast. Have called the police once already. It mostly seems like huge power struggles. Groups for teens for anger management/blendedfamily issues? Thanks. Waiting for the next time. Things are calm at this moment, but cycles of anger. Any advice or suggestions for classes, groups, therapists very much appreciated.

Although this person is talking about Ohio, I'm betting it works similarly here. You might want to research it a bit. If you can avoid the criminal justice system, you are more likely to have a successful outcome and get your family the support it needs. Good luck and hang in there. Diane

15-year-old is angry, depressed and fat: help!

We live in Marin and my son is a l5 year old H.S. sophomore. He is opposed to any kind of intervention and gets extremely angry when any suggestions are sent his way. He's been diagnosed with depression and takes lexapro. His psychiatrist went to Kaiser last year and my son will not see anyone else. His grades are poor and he was recently caught cheating at school. Has anyone had experience with psych. testing or neuropsych. testing - would it provide some useable information about my son? I already know what's wrong: just not how to engage him into making things better. He defines the word ''resistant''.

She did have psychological testing and I think it was most UNHELPFUL. In my opinion, it doesn't help to have a disinterested outsider add some labels to an already difficult situation.

What does help? Well, if you can find an adult (teacher, religious leader, school counselor, life coach) that your son does trust, perhaps even bribe or cajole him to see a couple, that would be great.

Exercise---is there anything or anyone he likes to get outside with? (dogs, horses?) Teen meditation at Spirit Rock (a very accepting environment).

My daughter really resented the notion that she needed ''therapy''. Perhaps a good ''life coach'' if your son reacts positively to the notion of ''coaching.'' Good luck. Hang in there. Keep him safe. Try not to judge him. Love him. Love yourself. We mostly all make it through the teenage years---painful as they may be.

Wish there were an instruction manual