At Menlo-Atherton, the door to mental health is open At Menlo-Atherton, the door to mental health is open (November 12, 2003)

Counselors-in-training sharpen their skills on teen angst

By David Boyce
Almanac Staff Writer

When inner demons come calling, we humans seek relief. Some of us turn to physical exercise, some to meditation, some to the bottle. There are many choices. In an ideal world, we'd have a wise counselor nearby, someone with whom we could talk things over.

For teenagers, talking things over can be a necessity during those years when parents can seem to morph into know-nothing adversaries and hormones can turn one's mind into a haven for depressing thoughts and bad ideas.

At Menlo-Atherton High School, conversation is invited at the office of Adolescent Counseling Services, a Palo Alto-based nonprofit group that offers free on-campus psychotherapy. The therapists-in-training are graduate- and post-graduate students working under the supervision of a licensed therapist, who also practices at the school.

The program at M-A is nine years old, and students do take advantage of it. The stigma attached to seeking such help is extant at M-A as much as anywhere. To reluctant students who think they might be labeled as crazy, program director Liz Schoeben has a simple answer: "Crazy kids can't find us," she says. "We tell them right up front 'You're not crazy and weird. You're doing the right thing.'"

The program at M-A is the only one in San Mateo County offered by Adolescent Counseling Services. The main office is located in the Cubberley Community Center on Middlefield Road in Palo Alto, with branch offices in middle and high schools in Palo Alto.

Woodside High School approached ACS regarding a possible office there, but the service doesn't have the funding needed to expand and there are no plans to do so, Ms. Schoeben says.

"I don't know how a high school could function" without such a service, she says.

Asking for help

In the 2002-03 school year, Adolescent Counseling Services saw 659 students at M-A, including 373 who made their first contact with the office. Most come through teacher referrals, though word gets around from friend to friend, Ms. Schoeben says.

Two-thirds of the visiting students are from low-income families, program statistics show, and the ethnic breakdown tends to mirror that of the school, with most students coming from Latino or Caucasian households.

The most common complaint is inability to communicate with parents, followed by depression, academic stress, self-esteem problems and grief. Given the range of stresses, the therapists function as case managers as much as counselors, Ms. Schoeben says, sending students to the school's career center or to an outreach coordinator as appropriate.

Not all students are deeply troubled. Some are "highly functional" and come in to "normalize" their feelings after events such as a romantic break-up, Ms. Schoeben says.

But it can get serious, with students showing obsessive-compulsive and bipolar disorders and suicidal tendencies, she says. "You can point to almost any disorder in the DSM" and you'll find it at M-A, she says, referring to the "Diagnostic and Statistical Manual of Mental Disorders."

Almost three times as many girls as boys made first contact last year, reflecting boys' strong avoidance of counseling. Boys have a cultural disinclination for emotional expression, Ms. Schoeben says.

When boys come in, the first thing she says she tells them is that they're not in trouble just because they've been referred to her office. She tries to reassure them. "People here at the school are concerned about you," she says is a typical example. "We're only here to make your life better and easier."

But after two or three visits, many boys stop coming and the office doesn't have the time or resources to follow up with them, she says.

All of M-A's intern practitioners are women. Of the 20 interns employed by the counseling service this year, only one is a man, the same ratio as last year, says Ms. Schoeben, who has three sons of her own.

Intern Elizabeth Bowden-Smith has a bookshelf full of miniature figures in her office and a shallow box awaiting a load of sand. Students will be encouraged to pick out figures and create a scene in the sand, a device she says she has used in her private practice because it is particularly effective in getting boys to express themselves.

"It will give us something to externalize," she says. "It's not quite so personal. Some kids have a hard time opening up and this is just a way to bridge that."

Brass tacks

M-A's program functions as a daytime clinic, of sorts. There are no weekend, evening or holiday hours. Kids in real crisis are referred to external agencies such as Your House South, a crisis center in Redwood City.

To schedule a session, students typically have to sacrifice lunch time, a study session or a physical education class. Sometimes there's a waiting list, which raises the pressure to address problems as soon as possible. The therapeutic relationship tends to start by setting goals and frequently ends when goals are seen to be met, Ms. Schoeben says.

Learning to cope is a key goal for many students, she says, frequently because students have no choice but to go home every night. "They need to learn to survive for two or three years," she says. "Our goal is to get them to be able to take care of themselves."

There are signs that indicate progress. When a student comes out with something like: "I was given s----y parents, but you know what? I'm going to make the best of it. I'm going to be OK," Ms. Schoeben says she sees that as a sign of emerging self-sufficiency.

Parents play an obvious role in a child's therapy, whether in the background or by making visits to the office. All parents are invited to participate, she says, but some stay away, saying: "I can't come in. I'm really busy. Can you just fix them?" With attitudes like these, she says, a kid's need to talk with a therapist is hardly surprising.

Trust is vital to parent-teen relationships, says Ms. Bowden-Smith. Once it's broken by a kid telling a lie, parents are often reluctant to trust again, she says. "Parents really want to trust their kids and it's very fragile. In the end, all you have is trust," she says. "It's the most valuable treasure in a family."

Some of the most nurturing and loving parents come from low-income families, Ms. Schoeben says. Some even find the time to come in alone to talk, despite holding down two and three jobs to make ends meet. "It's really hard for them," she says.

Who's listening

For therapists in training, M-A is an environment rich in psychological trauma, Ms. Schoeben says. Sexual and physical abuse is not uncommon, anxiety and depression are "very common," and the counselors occasionally saved lives.

In the last school year, 20 kids presented themselves at the office with suicidal feelings, program statistics show. "You can do a lot of good, powerful, great work here," Ms. Schoeben says, adding: "We're not losing any kids. If they come through our door, they're going to stay alive."

Ms. Bowden-Smith is in her 50s and has a graduate degree in marriage and family therapy. She's been an intern at M-A for five years; two other interns there are in their second year.

Reassuring teens about their feelings of craziness and chaos is a particular joy, says Ms. Bowden-Smith. "I think what kids really need is to be heard," she says. "They're nearly adults. They need to have boundaries clarified. They're about to go out into the big world. ... I really like the work that we're doing."

The interns work 16 to 20 hours a week in individual and group settings, in sessions lasting anywhere from five minutes to an hour. One of the interns also serves as a Latino outreach contact.

M-A's interns come from Santa Clara University, San Francisco and San Jose state universities and the Institute for Transpersonal Psychology in Palo Alto. They receive small stipends that help pay for gasoline.

At M-A, interns experience both individual and group therapy situations. Parents are included whenever possible and are usually glad to have the counselors involved in their kids' lives, Ms. Schoeben says.

Group sessions are particularly effective for teens, she says, since kids are sensitive to peer pressure and given to calling each other to account for violations of publicly made commitments.

A popular example is Mi Vida Loca (My Crazy Life), a Latino girls' group at M-A that deals with issues such as pregnancy and substance-abuse problems.

There are adjustments to be made for teens. Unlike group therapy for adults, student groups at M-A must have a common problem, such as grief after the death of a relative.

Helping students with their problems takes its toll. The interns put in long hours to earn their licenses. For particularly troubled students, they stay with them until they're sure they're stable, sometimes skipping lunch.

"It's really, really exhausting, but I really love it," says Ms. Schoeben. "If I didn't do it, the problem would still be here. You can't hide from it."

"It's a privilege to sit with somebody in their pain and confusion," Ms. Bowden-Smith says. "It's pretty humbling."