Cook - Transforming teen behavior: parent-teen protocols for psychosocial skills training

1. Tables in Chapter 3

1. Figures in Chapter 3

Mary Nord Cook

Department of Psychiatry, Colorado School of Medicine, Childrens Hospital Colorado, Aurora, CO, USA

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To Mary, Sam, and Nateforever holding me accountable, tethering me to a course of lifelong growth and learning.

To Seanour steadfast anchor, protector, and fixer of all things.

Mary Nord Cook , Department of Psychiatry, Colorado School of Medicine, Childrens Hospital Colorado, Aurora, CO, USA

Patrice S. Crisostomo , Intensive Outpatient Programs, Bay Area Childrens Association, Oakland, CA, USA

Douglas A. Kramer , University of Wisconsin School of Medicine and Public Health, Middleton, WI, USA

Jocelyn N. Petrella , Parker Pediatrics & Adolescents, Parker, CO, USA

Tess S. Simpson , Department of Rehabilitation Medicine, Children's Hospital Colorado, Aurora, CO, USA

Douglas A. Kramer, MD, MS, Middleton, Wisconsin

I wish I had thought of that! That was my first thought as I read Transforming Teen Behavior, by Mary Nord Cook, MD. My second thought was, I am learning things here. Thats a nice experience for someone who will begin his eighth decade before Transforming is published. Dr. Cook is a physician specializing in child and adolescent psychiatry with special expertise in treating families. To my mind, her work is not in family therapy, but in family psychiatry. She brings to her work and to this book the medical background of a physician, beginning with dissecting a human cadaver as a first year medical student, later seeing patients in the emergency room, the operating room, and the delivery room. In the latter, she goes into the procedure with one patient and emerges with two, the mother and infant, and ideally the father and perhaps older siblings. This represents the essence of child psychiatry, the true patient being the relationship between the parent(s) and child, the life-giving, nurturing, and loving relationship that results ultimately in a healthy independent adult.

As a child and adolescent psychiatrist, Dr. Cook brings to this project her knowledge of child and adolescent development, including physiological, psychological, and relational development; her knowledge and experience with child and adolescent psychiatric disorders, including the developmental processes that underlie these disorders; and her knowledge of child and adolescent counseling, individual psychotherapy, group psychotherapy, family psychotherapy, and pharmacotherapy. Bringing all of these areas of expertise and experience together creates a family psychiatrist. Notice that the last area of expertise listed is pharmacotherapy, because with most disorders affecting adolescents this is the least important and ideally the last utilized modality.

Child and adolescent psychiatry began in Chicago in 1909 in what is known today as the Institute for Juvenile Research (). It was the first of hundreds of child guidance clinics. From the first day in this first clinic, the child guidance model involved both the child or adolescent and his or her parents. Typically, the child or adolescent would be interviewed and counseled by a child psychiatrist or child psychologist, and the parents would be interviewed and counseled by a psychiatric social worker. This model persisted into the 1940s, increasingly informed by the prevalent theory of the timepsychoanalytic theorywith an associated decrease in parent involvement. The childs intrapsychic conflicts became the target of treatment efforts.

In the early 1950s, a group of child psychiatrists, along with clinicians and theorists from other disciplines, began exploring the idea of treating whole families. The initial advocates were Nathan Ackerman, MD (), when an initially gradual, but rapidly accelerating, emphasis on medication treatment emerged. The childs synapses and neurotransmitters were the new target of treatment efforts.

Thus, child psychiatry began in the child guidance clinics with parent and child treatment, moved into university centers and private practice settings with a primary focus on the individual child, and finally to an even more reductionistic worldview when the medication era became paramount. The treatment of families, with a number of theoretical orientations, remained multidisciplinary as the field matured over the second half of the twentieth century. In addition to Drs. Ackerman and Whitaker, two other child psychiatrists were instrumental in the foundation of family psychiatry, John Bowlby, MD ().