How Effective Are Tactics Used on TV Shows to Treat Troubled Teens?

 http://healthland.time.com/2013/01/25/how-effective-are-tactics-used-on-tv-shows-to-treat-troubled-teens/#ixzz2KC6AL0ve

Terrifying teens by making them lie in coffins, forcing them to spend a night on a frigid street or a bare prison cell— these harsh measures are used in reality shows in an attempt to put delinquents back on the straight and narrow.  But the strategies may make for better TV than treatment.

On A&E’s Beyond Scared Straight and Lifetime’s Teen Trouble, producers document some extreme methods to address adolescents who act out. The shows intend to educate while entertaining, and some of the tough love strategies certainly make for riveting TV. But unfortunately, decades of research show that such extreme measures are at best ineffective and at worst, harmful.

Take Scared Straight, a strategy that is supposed to deter juvenile delinquents from a life of crime by briefly placing them in adult prisons, where hardened prisoners confront them with the brutal realities of incarceration. A documentary on the original initiative, founded at Rahway Prison in New Jersey, won an Oscar in 1978.  A&E’s Beyond Scared Straight, now in its third season, follows teens through such programs, zooming in as inmates literally get in the teens’ faces and attempt to break them emotionally.

(MORE: Why Juvenile Detention Makes Teens Worse)

It’s not like there’s a shortage of data or any scientific controversy over Scared Straight’s actual results.  In fact, a Cochrane review — the gold standard for evidence-based medicine — concluded that kids sent to Scared Straight were 68-71% more likely to commit crimes than those randomized to receive no intervention at all.

Teen Trouble’s approach is similarly problematic.  Most of the adolescents who appear on the show have drug problems and some have mental illnesses like depression, but are not given treatment proven to work for these conditions. Instead, Teen Trouble relies on inducing fear through confrontation, supposedly to show teens the potential consequences of their actions: disfigurement, disability, homelessness, death.

In one episode, for example, a girl is forced to lie down in a coffin and touch dead bodies; in another, a boy is put in casts and a wheelchair.  A third episode includes a “make over” where a teen girl’s face appears covered with scabs and sores; another sees a young woman spend a winter night on the streets with the homeless. Afterward, many of the teens are sent to tough wilderness or “emotional growth” boarding schools.

(MORE: Does Teen Drug Rehab Cure Addiction or Create It?)

“Time and time again, research finds these approaches to be innocuous at best and traumatizing at worst,” says John Norcross, professor of psychology at the University of Scranton who studies the effectiveness of psychological treatments.

A 2007 review [PDF] of the literature on tough-love or confrontational strategies to deal with drug problems concluded “Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations.” Teens are one such susceptible group.

Studies on virtually all of the tactics seen on Beyond Scared Straight — from getting in people’s faces and screaming at them, to forcing them to view videos of themselves filmed when they were intoxicated— showed that these tactics have either no effects or negative ones on teens’ behavior. 
One study revealed that the more a counselor confronts an alcoholic, the more he or she later drinks.
Nonetheless, Josh Shipp, the host of Teen Trouble— who has no credentials in psychology or addiction treatment and relies on an unnamed group of experts to approve his extreme interventions — continuously relies on such confrontational tactics.  The show also sends teens to programs with questionable oversight that use unproven techniques.

(MORE: An Oregon School for Troubled Teens Is Under Scrutiny)

In one episode, for instance, he ships off a 16-year-old girl with a drinking problem to a program called Axios Youth Community.  Several weeks after the show was taped, the program was shuttered following allegations that an employee had sexually molested a 13-year-old girl. In another episode, a 16-year-old girl who was injecting heroin was sent to a “therapeutic boarding school,” Copper Canyon Academy,  which claims to help troubled girls but is not a specialized center for treating teens with the most serious addictions.

The mother of a former student at Copper Canyon recently told the New York Post that while she’d
expected a “top notch boarding school,” instead the program turned out to be a “Nazi concentration camp.”  Former students interviewed by the Post describe confrontational and humiliating tactics, such as being made to re-enact traumatic experiences, including rape, in front of their classmates.

The program at Copper Canyon, which costs $6,000 to $8000 a month, waives its tuition for Teen Trouble participants in order to be promoted by Shipp.  For licensed professionals, such an arrangement might be barred by ethical guidelines, which warn against “dual relationships” that could lead to a referral that is not in the best interest of the patient (in this case the teen), but in the interests of the contracting parties (the show and the treatment program).

Copper Canyon has denied the abuse allegations in a statement to the Post, saying “The reality is that our students come to us dealing with a variety of behavioral health and addiction issues, at varying levels of severity… We offer them a structured and nurturing treatment environment with professional staff who specialize in working with adolescent girls.”

(MORE: Treating Addiction: A Top Doc Explains Why Kind Love Beats Tough Love)

Copper Canyon is part of a network of teen programs run by Aspen Education, which also operated a
school known as Mount Bachelor Academy in Oregon.  TIME reported on Mount Bachelor’s use of similar tactics in 2009:  they included forcing girls who had survived rape or sexual abuse to do lap dances and participate in other sexualized role play.  The exposé helped spur a state investigation ultimately resulting in the school’s closure.  Aspen maintains that there was no wrongdoing but Oregon’s investigators said that they had “reasonable cause to believe that abuse or neglect had occurred.”

Now, teens and parents who say they were harmed by these programs are protesting Teen Trouble, creating an online petition to have it taken off the air and a website devoted to detailing problems with the show and with the programs in which Shipp enrolls adolescents.

Says Norcross, “The real process of psychotherapy tends to be slow, laborious and uninteresting to the external observer. It would be such boring TV, I appreciate that. While [producers] may protest,
‘No, we care about the kids,’ their behavior belies those public statements.” If they really cared, he says, “they would only select treatments for which we have scientific evidence of safety and effectiveness. Instead they do the exact opposite and focus on highly dramatic and largely discredited practices.”

(MORE: Viewpoint: Why Tough-Love Rehab Won’t Die)

TIME tried to reach A&E for comment, but did not receive a response. Of the 19 teens who appeared on Beyond Scared Straight and are not still in restricted environments like military school, the show’s website reports that at least 9 continued in sustained misbehavior, which mainly involved frequent marijuana use but also includes a teen who is in prison for robbery, one who was arrested for gun possession and another who was hospitalized for an overdose.

While dramatic confrontation may be entertaining, it is not therapeutic. Experts say shows like these that rely on discredited or questionable therapies legitimizes those who sell outdated and harmful treatments and could ultimately undermine the progress of evidence-based care to help teens with substance abuse or behavior problems get better.