Download a document recently drafted by the school`s clinical team

August, 2010
Dear colleagues and referents:
This open letter was written with support of the clinical team at Carlbrook School in response to
recent inquiries regarding the reasoning behind the school’s use of the workshop format as one of its
counseling modalities. Please note that while this document incorporates references when appropriate, it
is intended to be neither comprehensive nor formal.
As with all counseling efforts at Carlbrook School, our explanation for the above topic inevitably
stems from a simple yet perplexing question: Why do some intellectually gifted adolescents fail to live up
to their apparent potential? Perhaps they have an undiagnosed biological vulnerability that interferes
with emotional and intellectual integration thus stunting normal development. Possibly they are
struggling with a deep psychological wound generated in early childhood that led to a profound failure of
attachment expressed through debilitating anxiety. Conceivably they have been inundated by the
demands of their culture and the dizzying array of the digital age that bombards their every waking
moment leading to an overwhelming sense of confusion and identity fatigue. Maybe their school or
family or community has simply failed to nurture them toward the potential we expect them to reach.
While there are many schools of thought that endorse different causes and therefore different answers to
the question, the most honest answer is that “we simply don't know.” However, it is fair to assume that
most impediments to an adolescent reaching his/her full potential are not caused by a single factor and are
most emphatically not the adolescent’s choice or her/his parents’ intent.
Not knowing the cause of the problem makes constructing an answer difficult but not impossible.
Turning to what we now know about adolescent brain development we can start with what adolescents
need - novelty, excitement, intense interpersonal relationships (both peer and adult), supportive families,
intellectual challenge, insight, consistency and love (White, 2010). When these needs are not met
adolescents bring this reality to the attention of the adults, often in unproductive ways. Unfortunately,
there are times when their behavioral expressions of unmet needs are so profound that they are not only
failing to reach their potential but also jeopardizing their personal well-being and the well-being of those
around them. It is under these circumstances that families select a school such as Carlbrook to not only
keep their children safe but to also get them back on an academic track leading toward personal success.
To provide these adolescents with an academically rigorous curriculum is necessary but not
sufficient to reestablish their positive life trajectory. The very notion that we can separate adolescent
intellectual expansion from their emotional growth and insight is both reductionist and naïve. Given the
personal complexities and challenges that each student and family brings to Carlbrook, a wide range of
modalities must be employed in order to take full advantage of the academic opportunities afforded to
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them. While family intervention and involvement are essential, it is each adolescent’s individual work
with a trusted advisor (therapist) as well as interpersonal group psychotherapy and milieu management
that are the necessary components to stabilize and return the adolescent to a healthy developmental
process. To best utilize these interventions, a series of unifying therapeutic experiences are employed by
the School to help focus the students’ clinical work while providing them with rites of passage which
bring novelty, excitement, support and healthy connection.
For better or for worse, Carlbrook School has chosen to label such unifying therapeutic
experiences as "workshops." The negative side of this terminology is the unfortunate baggage that the
word "workshop" carries – baggage that is anchored in a past era of over 30 years ago. This baggage in
the minds of some still represents marathon sessions, sleep deprivation, nutritional manipulation, shaming
interventions, frightening experiences and humiliating encounters which by definition are wholly
unacceptable. Carlbrook School has never employed such archaic and potentially-harmful tactics and
strongly condemns those schools or programs that have and do. In contrast to such negative connotations,
the positive side to the term "workshop" refers to an adolescent group working together over a defined
period of time on creative, collective projects while at the same time addressing personal challenges. The
key to a successful workshop for each student is to assess his or her readiness for such work and to
facilitate his or her experience by well-trained and caring adults. With all the attention given to the
workshops, which are groups, it is important not to forget "group psychotherapy for adolescence is a
specific clinical modality in which the adolescent is helped to define his/her identity – the major task of
adolescent development. Through the work of the group the adolescent becomes aware of new behavioral
possibilities in relationships with peers and authority figures" (Leader, 1991).
Taken as a unified whole, the series of Carlbrook workshops fulfill the basic steps of generally
accepted psychotherapy. These steps include clarification - helping students to more richly define aspects
of their past and present, thoughts, feelings, and moods so that themes may begin to emerge;
confrontation - allowing students to begin to recognize that their behavior is often in conflict with what
they think are deeply held beliefs about themselves and others; interpretation - guiding students to have
them identify the underlying, often unconscious issues that are at least part of the basis of the problematic
mood and behavior, and working through - returning to exploration of these revealed dynamics in various
modalities (auditory, visual, writing, drama, kinesthetic, etc.) as students begin to view not only newer
perceptions of themselves and others but the possibility of greater satisfaction in aspects of their lives
such as work, love, and play. The earlier workshops at the beginning of a student’s program concentrate
on the therapeutic aspects of clarification and confrontation, with the middle workshop geared toward the
interpretive aspect. The latter workshops, as well as the ongoing psychotherapeutic work on campus
(individual, group, and milieu) are geared toward the paramount importance of working through. The
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workshops thus function in a multimodal way. By themselves, they lead students through a therapeutic
process in which students learn to name - in fact do the identifying themselves - the core issues that have
been psychological obstacles in their lives and allows them to see a path to gain what they believe they
have lost or never possessed (for many students, the love of self and others). Interwoven within the other
psychotherapeutic modalities on the Carlbrook campus, the workshops identify a paradigm that can form
the basis for ongoing, more in-depth work that can then addressed in more traditional individual and
group therapy settings.
In an effort to move beyond the past and to embrace the positive aspects of workshops through
current science, Carlbrook School's workshop committee meets on a regular basis to continually review
both the process and the content of the workshop structure at the School. The general approach to
assessing the workshops has always been to establish the important components for group work with
adolescents and to make sure that all workshop activities and interventions involved proven techniques
such as modified interpersonal group psychotherapy, experiential interventions, discussion groups, gestalt
therapy, journaling, mindfulness, and psychodrama techniques. All of these techniques are specifically
endorsed by the American Group Psychotherapy Association (www.agpa.org). In addition, all workshop
activities and interventions at Carlbrook have been repeatedly scrutinized and are continually revised to
ensure the overall health of the school’s students as well as the efficacy of the practices employed. In
order to determine that these goals have been accomplished, anonymous student feedback is also solicited
from those who have completed the workshops.
Modified interpersonal group psychotherapy is a modality that took the early group work of Irvin
Yalom (1985) and modified it to be more applicable to adolescents and substance abusing patient
populations (Flores, 2008; Flores and Georgi, 2005). These modifications tend to lower the emotional
energy of the group, giving participants a sense of greater mastery over their affective world. Experiential
therapy/interventions are eloquently reviewed by Tian Dayton (1994) and artfully employed at the Onsite
training facility developed by Sharon Wegscheider-Cruse. When used appropriately with adolescents,
"experiential therapy offers us a safe stage on which we can do and know, allowing our inner selves to
come forward so we can examine what we have accepted as true about a situation or ourselves. We often
confine the idea of learning to a classroom setting; but from the point of view of how information is
stored by the brain all life is a classroom. Often it is the emotional content of a given event or teaching
that determines the impact of a particular learning experience… What we accept as true about ourselves
early in life becomes the foundation upon which we build beliefs about ourselves that we will carry into
adolescence" (Dayton, 1994). Experiential therapy techniques can literally help to change self-defeating
beliefs at a pre-conscious level, thus freeing adolescents to “re-invent” themselves.
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Gestalt therapy has particular utility for adolescents in that it is a humanistic approach that
focuses on helping them to gain awareness of their emotions and behaviors within a present context rather
than focusing on the past. Hence they learn how to deal with their emotions as they experience them in
the "here and now." In a paper written by Virginia Braddock (2007), she notes, "Much of what we do in
therapy relates to childhood memories, experiences, interjections. Many of us are still doing the things we
did as children -- those things which we needed to do to survive, to get through. They were the only
things we knew to do at the time. We may still be doing those things although they may now be
inappropriate and may greatly interfere with our living," (quoting Oaklander, 1988). Part of the beauty of
Gestalt therapy is that it provides adolescents with a sense of mastery over their internal world. It is these
unidentified and often uncontrolled conflicts within their internal world that can so distract adolescents,
making academic achievement, regardless of intellectual ability, extremely difficult. Workshops provide a
large enough emotional stage for adolescents to examine and change memories that are standing in their
way of taking the necessary risks that will allow them to reach their potential.
"Psychodrama” is an umbrella name for a series of techniques presented by the late J.L. Moreno
(see e.g. Blatner, 2000; Feasey, 2001). During a psychodramatic exploration, a client and facilitator can
precisely identify the moment at which maladaptive thoughts arise. But psychodramatic treatment does
not necessarily target the thought itself; rather, such action evokes the affective packaging of
accompanying emotional sequences that make the thoughts so durable. Because persistent thoughts coil
inexorably with their emotional imprint, they will often not easily be extinguished until the affect of
packaging shifts and reprints. Perhaps more simply put, psychodrama allows the adolescent to examine
maladaptive thoughts in a safe and respectful context. With appropriate guidance by well-trained adults,
adolescents address this context from a different perspective and the power of these maladaptive thoughts
is reduced. Psychodramatic techniques employed in workshops can thus move past the neocortical
defense of our consciousness and begin to heal the emotional wound “hidden” in our limbic system.
Through the work of Joseph Ledoux (2002), Thomas Lewis (2001) and others, we are coming to
learn that many of the issues with which the adolescent struggles gain energy not from their neocortical
interpretation but rather from their limbic expression. In a sense, the cognitive revolution is losing its grip
on the practice of adolescent psychology. This is not to say that Carlbrook School does not continue to
use cognitive interventions appropriately. Rational Behavior Training (RBT) developed by Albert Ellis
(1994) and Maxi Maultsby (1990) and adapted by Jeff Georgi specifically for Carlbrook School is now
available for students and integrated into the Advising faculty’s supportive toolbox. For the students who
enter Carlbrook with histories of substance use, depression, and/or eating disorders, all of which interfere
with academic performance, the task is to find more direct avenues to quiet the “dysregulated” limbic
system and allow the student to learn more effectively. "The trend is toward short term, cognitive-
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behavioral, interactive models often using manualized guides. There is acknowledgment that some shortterm models are not effective with very resistant disorders, (e.g. eating disorder, severe depressions, and
substance abuse). In such cases, multimodal models integrating group therapies with pharmacotherapy
may be indicated" (Asima, 1998). The workshops at Carlbrook School provide such models and are
congruent with the message that research is sending about adolescents and their development.
On a related note, it should be emphasized that psychiatric consultation has become an essential
aspect for many of the students admitted to Carlbrook and to similar schools. At least 50% of the
population may be on psychotropic medications at some point during their stay. Along with making
decisions regarding diagnosis and treatment, the psychiatrist must also be able to evaluate the success of
these interventions, and be alert to potential medication side effects and problems. One limiting factor in
the past has been the difficulty in evaluating the student in the office environment, even with supporting
information, as that venue does not accurately reflect the functioning of the student on campus.
Carlbrook has incorporated the psychiatrist into aspects of the workshops, including co-leading the first,
resulting in direct benefits to both the students and the staff. The psychiatrist is able to observe the
greater depth and breadth of the student’s mood and behavior. The child who appears withdrawn and
inhibited in the office, which raises the question of depression, may present with a much broader affect
during the workshop experience; thus observing the student’s capability may alter a treatment
consideration, e.g. deciding that treatment at that time with an antidepressant may not be necessary. The
psychiatrist is also able to observe the effects of ongoing care. A student who was placed on medication
for an anxiety disorder may feel a greater sense of stability and be able to discuss issues that previously
they found too overwhelming. Possible side effects of the medications, such as tremors, can be more
easily observed during a workshop that consists of a series of group meetings rather than depending on
observation from a one hour therapy session. Of course, some of this information can also be gathered by
staff over time on campus, but it is the unique depth of the workshops that allow the psychiatrist, who is
trained in these observations, to more fully and effectively make these determinations.
The workshops also provide the psychiatrist with the opportunity to better determine diagnosis
and potential therapeutic interventions. The psychiatrist is usually the only staff member who has
expertise in both the biological and in the psychotherapeutic domains. His observation of the student
during the workshop helps to determine the possible contribution of these factors, and generation of a
diagnosis that more accurately reflects the functioning of the student. Since diagnosis is a major
determinant of treatment, the workshop thus proves to be an important tool in the understanding of the
child, and how best to coordinate the various treatment modalities and the issues that need to be
addressed. The presence of a senior clinician during the workshop also allows the advisors and other staff
to discuss issues and questions across all domains that arise during the emotional work. This “in situ”
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opportunity for supervision and teaching, with the student being the focus of the discussion, again allows
for greater understanding and the opportunity to make adjustments during the workshop to more benefit
the student. Since the psychiatrist is observing and working with all the students in the workshop, these
discussions benefit not only those whom he is personally treating but the other students as well. More
generally, the workshops allow the psychiatrist, who has limited contact on campus, to observe and
interact with the students in a way not otherwise available. This promotes not only greater understanding
of students’ issues, but also students’ view of the psychiatrist as a trusted adult.
Lastly, it is important to point out that Carlbrook workshops do not take place in isolation and are
intentionally integrated into the life of each student and the community as a whole. For instance, by
exposing students to select works of literature, history and the sciences, the School’s strong academic
foundation provides intellectual and artistic examples of various workshop themes and becomes yet
another area where students can experience their own sense of mastery, often in areas where they have
encountered only failure in the past. Students also interact with affiliated professionals who themselves
often help facilitate workshops, thus connecting the workshop experience to a wide range of recovery
maintenance and transition services that actually begin early in each student's stay. And perhaps most
importantly, in yet other forums, students and their families grapple together with related concerns in the
Family Brain Defense Weekend, Parent Conferences, Transition Conference as well as multifamily and
individual family sessions with students and their counselor or advisor. All of these themes find
expression in the workshop structure. It is this systemic approach that provides the Carlbrook student with
not only a superior academic experience but also creates a supportive emotional environment which
allows them to take full advantage of the education they receive. To deny students involvement in this
workshop regimen based solely on old baggage attached to the term would detract from the rich and
colorful tapestry that is the Carlbrook experience.
Respectfully,
Tim Brace, M.C.
Gregory Braund, M.S.W., L.C.S.W., L.M.F.T.
Andrew Coe, M.S., B.C.P.C.
Jeff Georgi, M.Div., M.A.H, LCAS, LPC, CGP
Anna Gerard, M.S.W., L.C.S.W.
Jonathan Gurney, M.S.W., A.C.S.W.
Greta Lutman, M.A., LPC, LCAS
Denise Prendergast, M.S.S.W.
Kalyn Sherwood, M.S.W.
Gillan Smith, Ph.D.
Floyd Wiseman, M.D.
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References and Related Resources:
American Group Psychotherapy Association, New York, New York, http://www.agpa.org
Andreasen, Nancy C., Brave New Brain: Conquering Mental Illness in the Era of the Genome, New York:
Oxford Press, 2003.
Azima, Fern J. Cramer, “Group Psychotherapy for Children and Adolescents,” International Online
Journal for Advances in Relational Mental Health, Vol.2, No. 3, Aug., 2003.
Behrens, Alan and Satterfield, Kristin: “Report of Findings from a Multi-Center Study of Youth
Outcomes in Private Residential Treatment”, presented At the 114th Annual Convention of the American
Psychological Association, New Orleans, Louisiana, August 12, 2006.
Blatner, Adam, Foundations of Psychodrama: History, Drama, and Practice, Fourth Edition, New York:
Springer Publishing, 2000.
Braddock, Virginia, “Creativity and Gestalt Therapy: Working with Children and Adolescents,” 2007,
http://www.gestaltsydney.com/Vee%20Final%20Gestalt%20Paper.pdf, Retrieved on August 4, 2010.
Brizendine, Louunn, The Female Brain, New York: Random House, Inc., 2006.
Damasio, Antonio, Descartes’ Error: Emotion, Reason, and the Human Brain, London: Penguin Books,
2004.
Dayton, Tian, The Drama Within: Psychodrama and Experiential Therapy, Health Communications, Inc.,
Deerfield Beach, Florida, 1994.
Ellis, Albert, Reason and Emotion in Psychotherapy: A Comprehensive Method of Treating Human
Disturbances (Revised and Updated), Citadel Publishing, 1994
Feasey, Don, Good Practice in Psychodrama: An Analytic Perspective, London: Whurr Publishers, 2001.
Flores, Philip, Group Psychotherapy with Addicted Patient Populations: An Integration of 12 Step in
Psychodynamic Theory, New York: Hawthorn Press, 2005
Flores, Philip, and Georgi, Jeffrey M., Co-Chairs, Substance Abuse Treatment Group Therapy, A
Treatment Improvement Protocol #41, U.S. Department of Health and Human Services, Substance Abuse
and Mental Health Services Administration, Center for Substance Abuse Treatment, 2005
Kohut, Heinz, The Analysis of the Self, New York: International Universities Press, 1971.
Kohut, Heinz, The Restoration of the Self, New York: International Universities Press, 1977.
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Kou, Francis E., and Taylor, Andrea Faber, “A Potential Natural Treatment for Attention
Deficit/Hyperactivity Disorder: Evidence from a National Study”, American Journal of Public Health,
September 2004; 94: 1580–86.
Leader, Elaine, “Why Adolescent Group Therapy”, Journal of Child and Adolescent Group Therapy,
Vol. 1, pp 81-93, 1991.
LeDoux, Joseph, The Emotional Brain: the Mysterious Underpinnings of Emotional Life, New York:
Viking Penguin, 1999.
LeDoux, Joseph, The Synaptic Self: How Our Brains Become Who We Are, New York: Viking Penguin,
2002.
Lewis, Thomas, A General Theory of Love, New York: Vintage Press, 2001
Maultsby, Maxie, Rational Behavior Therapy, Appleton, WI: Seaton Foundation, 1990.
Nathanson, Donald L., Shame and Pride: Affect, Sex, and the Birth of the Self, New York: WW Norton
& Co., 1992.
Oaklander, Violet, Windows to Our Children: A Gestalt Therapy Approach to Children and Adolescents,
Gouldsboro, ME: The Gestalt Journal Press, 1988.
Pert, Candice B., Molecules of Emotions: the Science behind Mind-Body Medicine, New York: Scribner,
1997.
White, Aaron, Keeping Adolescence Healthy: Exploring the Issues Facing Today's Kids and
Communities, North Charleston, SC: BookSurge Publishing, 2008.
Yalom, Irvin, The Theory and Practice of Group Psychotherapy, 3rd Addition, New York: Basic Books,
Inc., 1985.
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