Treating the Disruptive Adolescent: Finding the Real Self Behind Oppositional Defiant Disorders

496 Pages·2000·22.17 MB·English

by  Eduardo M. Bustamante

Treating the
Disruptive Adolescent
Finding the Real Self Behind
Oppositional Defiant Disorders
Eduardo M. Bustamante, Ph.D.
Jason Aronson Inc.
Northvale, New Jersey
london
This book was set in 11 pt. New Baskerville by Pageworks of Old Saybrook and Lyme,
CT, and printed and bound by Book-mart Press, Inc. of North Bergen, NJ.
Copyright© 2000 by Eduardo M. Bustamante
10 9 8 7 6 5 4 3 2 1
All rights reserved. No part of this book may be used or reproduced in any manner
whatsoever without written permission from Jason Aronson, Inc. except in the case of
brief quotations in reviews for inclusion in a magazine, newspaper, or broadcast.
Library of Congress Cataloging-in-Publication Data
Bustamante, Eduardo M.
Treating the disruptive adolescent : finding the real self behind
oppositional defiant disorders I by Eduardo M. Bustamante.
p. em.
Includes bibliographical references and index.
ISBN 978-0-7657-0235-7
1. Oppositional defiant disorder in adolescence. 2. Attention
deficit disorder in adolescence. I. Title.
RJ506.066B87 1999
616.89'00835-dc21 99-37817
Printed in the United States of America on acid-free paper. For information and
catalog write to Jason Aronson Inc., 230 Livingston Street, Northvale, NJ 07647-1726, or
visit our website: www.aronson.com
Contents
Preface IX
Acknowledgments XV
Introduction XVII
I:
PART UNDERSTANDING OPPOSITIONAl DEFIANT
DISORDER (ODD)
1 Thinking Developmentally 3
UNDERSTANDING OPPOSITIONAL STATES 7
RESOLVING OPPOSITIONAL STATES 8
THE NEEDS OF THE OPPOSITIONAL PHASE 11
THE NEED FOR A PARADIGM SHIFT 13
THE SHIFT TO A PARADIGM OF NATURAL DEVELOPMENT 15
THE NEEDS OF THE MAsTERY PHASE 16
ENCOURAGING MASTERY STATES 17
iv Contents
18
ENTERING MAsTERY STATES
19
EDUCATION AND MASTERY STATES
20
SUSTAINING THE GAINS
20
THE KEY TO HEALTHY DEVELOPMENT
21
THE GOODNES5-0F-fiT HYPOTHESIS
22
GooDNEss AND PooRNEss OF F1T
2 ODD as Two Minds at Odds 27
32
OuR Two MINDS
33
THE WISDOM OF THE EMOTIONAl MIND
35
Two MINDS AT ODDS
THE IMPACT OF DISTRESS OR TRAUMA
38
ON THE MIND
40
THE DECLINE oF MoRAliTY
42
THE IMPORTANCE OF INTEGRATION
43
TREATMENT TO INTEGRATE THE Two MINDS
II:
PART AssESSMENT
3 Evaluation: A Strategic Approach 53
55
GETTING PAsT THE ODD TO AssEss CoMORBIDITY
56
REFRAMING ODD AS Two MINDS AT ODDS
67
A NovEL APPROACH TO INTERVIEWING ODD ADOLESCENTS
75
A PREEVALUATION TRIAl INTERVENTION
82
WORKING WITH THE ABSENT ADOLESCENT
4 The Assessment Proper 85
85
COMORBID CONDITIONS
96
CASE CONCEPTUALIZATION
102
TYPES OF SYMPTOMS
103
KEY DIAGNOSTIC QuESTIONS
108
DIAGNOSING ODD
Contents v
Ill:
PART TREATMENT
5 Step 1: Taking Failure to the Limit 117
119
THE THERAPEUTIC SIDE OF FAILURE
122
NATURE's REMEDY FOR ODD
123
WHEN TO PRESCRIBE F AllURE
126
How TO PRESCRIBE F AlLURE
130
RECOVERING FROM lARGER F AllURES
6 Step 2: Turning Failure into Growth 133
135
THE DIFFERENCE BETWEEN CHANGE AND GROWTH
139
ENCOURAGEMENT AND DETACHMENT
140
ARRANGING CoNSEQUENCES TO PRoMOTE GRoWTH
142
THREE SOURCES OF CONSEQUENCES
145
PARENTS AS AlliES AND PROTECTORS
164
PARENTS AS ENFORCERS OF CONSEQUENCES
166
ENFORCER vs. ALLY: WHICH HAT TO WEAR
169
MANAGING THE TEENAGER'S "IN YOUR FACE" TACTICS
169
EMPOWERING PARENTS TO FACE PERSONAl ATIACKS
171
BLUEPRINT FOR A SuccESSFUL EscAPE
181
How YOUTHS CAN HANDLE UNREASONABLE AUTHORITY
7 Step 3: Addressing the Two-Mind Split 185
185
ONE YEAR LATER: A CASE STUDY
198
THE TIMING OF THE INTERPRETATION: A CASE STUDY
THE PATH OF WANTS: KNOWING, VOICING,
201
DOING, MASTERING
203
CATCHING AND EXPOSING THE WEAKNESSES OF THE SYMPTOMS
210
GETIING AROUND THE RESISTANCE
220
COGNITIVE THERAPY: PROBLEMS AS OPPORTUNITIES
vi Contents
IV:
PART SPECIAL PROBLEMS
8 Special Problem 1: School Failure 227
THE TRAUMA HYPOTHESIS 232
THE PROBLEM OF AuTOMATICITY 232
lACK OF A DEVELOPMENTAL PERSPECTIVE 234
THE CoNSEQUENCES oF ScHOLASTIC TRAUMA 236
ADDRESSING DEVELOPMENTAL NEEDS TO COUNTER
SCHOLASTIC TRAUMA 240
9 Special Problem. 2: Parental Neurosis 275
THE MAKE-SURE BRAIN 280
THE HiDDEN CAusE oF MosT CHILD-REARING PROBLEMS 2 80
DYNAMICS 290
THE CAUSE OF PARENTAL NEUROSIS 291
RECOGNIZING PARENTAL NEUROSIS 294
RESOLVING PARENTAL NEUROSIS 299
THERAPY WITH THE NEUROTIC PARENT 302
THE FAILURE PHASE 303
TURNING FAILURE INTO GROWTH 305
ADDRESSING THE RESISTANCE 308
PROVIDING OPPORTUNITIES 309
10 Special Problem 3: Excessive Aggression 313
CHARACTERISTICS OF THE EXCESSIVELY AGGRESSIVE TEENAGER 313
REFRAMING RONNIE'S CONDITION 316
THE INTERVENTION STRATEGY 318
UNDERSTANDING NARCISSISTIC RAGE 321
COUNTERING NARCISSISTIC RAGE 327
THE INITIAL TiCKET: FIVE STEPS TO NARCISSISTIC DEFLATION 328
REVERSING THE NEGATIVE CYCLE 333
ESTABLISHING FAMILY fAIRNESS 337
CASE ILLUSTRATION: A CLINICIAN TURNED POLICE OFFICER 337
Contents vii
11 Special Problem 4: Negative Peer
Influences 353
357
THE VALUE OF PEER ATTACHMENTS
358
THE PosiTIVE SIDE OF PooR PEER SELECTION
359
THE CONSEQUENCES OF SUSTAINING A DEVIANT ATTACHMENT
361
ADDICTION: A MISGUIDED QuEST FOR FREEDOM
361
ADDICTION TO PEERS
362
THE ADDICTIVE CYCLE
364
TALKING TO TEENAGERS ABOUT THEIR ADDICTIONS
366
IDENTIFYING UNMET NEEDS
368
ESCAPE VERSUS FREEDOM
369
REVERSING THE ADDICTIVE CYCLE
12 Other Special Problems and
Contraindications 395
397
lAcK OF PARENTAL SuPPORT
399
INCREASED ACTING Our AT THE START OF TREATMENT
40 1
MISQUOTING SESSION MATERIAL TO CHALLENGE AUTHORITY
404
INCOMPETENT CUSTODIAL PARENTS
MEDICAL COMPLICATIONS 4 12
421
SERIOUS TRAUMA
Epilogue 427
Appendix A: The Prevalence and
Prognosis of Disruptive Behavior
Disorders in Children 429
430
DISTINGUISHING FEATURES
431
ASSOCIATED FEATURES AND OUTCOMES
43 1
PEER AND ScHOOL DIFFICULTY
432
MOTHER-CHILD DYSFUNCTIONAL RELATING
434
THE COERCIVE CYCLE
435
SUBSTANCE ABUSE AND PARENTING STYLE
436
HYPERACTIVITY AND ADOLESCENT OUTCOME
437
RESEARCH SuMMARY
viii Contents
438
EXISTING TREATMENTS
443
CONCLUSIONS AND RECOMMENDATIONS
445
Appendix B: Family Ticket
445
VIOLATED PRIVILEGE(s)
446
REPARATION
446
PRIVILEGE Loss
447
References
455
SUPPLEMENTARY READINGS
459
Index
Preface
This book characterizes oppositional defiant disorder (ODD) as a
disguised and misunderstood version of a common psychiatric
problem, namely alienation. Modern psychiatry has described a
variety of syndromes that involve alienation from the true self.
Some theoretical schools informally refer to these conditions as
mind-body splits, manifestations of which range widely from the
most common syndromes, such as anxiety and depression, to the
most complex, such as disorders of the self, identity disorders,
eating disorders, and narcissistic personality disorders.
The existential dilemmas that result from a split between an
individual's ego and his true self have received extensive attention.
Many treatments have been developed to address these conditions.
Pioneers in the mental health field have developed primal scream
therapy, gestalt therapy, Tavistock group therapies, and a host of
others. Founders of these movements have produced landmark
works dating back to the early 1960s that have addressed the prob
lems of alienation, and the phenomenon of the mind-body split.
Some of the most popular works are those of existentialists such
as Fritz Perls and R. D. Laing, and humanists such as Carl Rogers