Cultic Studies Review, Vol. 5, No. 2, 2006, Page 97
Perhaps doing that would have been overkill because Szalavitz certainly makes a clear case
for the unholy marriage of intensive adolescent treatment à la Straight Incorporated and the
controversial methods employed by LGATs and the strong-arm confrontations and group
coercion employed by Synanon. Szalavitz also presents a cogent and fascinating discussion
of how the troubled teen industry on which she reports usurps Alcoholics Anonymous‘
Twelve Steps, twisting them so perversely that they meet Lifton‘s criteria for thought-
reform programs.
The problems with the TTI, according to Szalavitz, are many. They include the lack of
external, independent regulation and the barest (if any) oversight by clinical professionals
the planned use of misinformation to literally ―scare up‖ clients the employment of highly
dramatic, manipulative, but unproven interventions and reliance on the kinds of marketing
and sales strategies that have given rise to consumer protection laws in many states. As an
example of the lattermost problem, Szalavitz points out that many parents who testified to
the effectiveness of the TTI programs received a covert ―kick back‖ in the form of reduced
fees for their own children for successful referrals of new parent clients. Teenagers may be
diagnosed in absentia by TTI staff who have little or no clinical training and credentials and
who do not use established diagnostic procedures. Parents desperate for help and frustrated
by conventional treatments such as family therapy (or who may not even have attempted
them) may be subjected to well-orchestrated scare tactics to induce compliance with the
TTI staff‘s intervention plan.
Szalavitz, an investigative reporter, is at her best tracing the main players in the TTI, how
they share similar backgrounds (e.g., in large-group awareness-training programs) and how
they close or abandon one indicted or otherwise legally troubled program only to start
another one under a different name, almost identical tutelage, and, typically, only nominally
different leadership. Their failure to change their methods or learn from their mistakes
raises the ongoing question of whether these ―treatment specialists‖ are delusional and
narcissistic ―true believers‖ or sociopaths just out to achieve power, fame, and wealth.
Veteran cult-watchers will recognize this debate as one that perennially engages journalists,
researchers, and former cultists alike.
While many of her statements might seem controversial, I suspect the sections in which
Szalavitz reviews the research on adolescent drug use and psychosexual development will
cause the greatest uproar among readers who know or have troubled teenagers. Szalavitz is
clearly in the camp that believes that the country‘s drug policies are determined by political
and cultural agendas that ignore science. She eschews the histrionics of the drug war
advocates and "Just Say No" campaigners, and attacks their uninformed and superstitious
views on drug abuse and addiction. She documents how scare tactics (such as the claim
that minor drug experimentation or even listening to ―druggie‖ music or wearing ―druggie‖
tee-shirts will inevitably lead to active addiction) have led to ineffectual and even
destructive drug-abuse programs. Szalavitz also documents, in sometimes scathing terms,
how the TTI employs parents‘ testimonies of miraculous changes, and the supportive
statements of respected leaders such as former President and First Lady George H. W. and
Barbara Bush to proselytize potential new clients. These ―facts,‖ often presented by TTI
―professional‖ staff with no addictions training or clinical credentials, may be used to
overwhelm frightened parents into enrolling not only the identified problem child but his or
her siblings, as well. As Szalavitz correctly notes, in reality the vast majority of teens who
experiment with drugs and other forms of self-destructive behaviors do not become addicts
and, in essence, ―grow out of it.‖ Even among those who do become fully addicted, the best
studies indicate that most who eventually recover do so without any formal treatment, and
without becoming involved with Twelve Step programs such as AA or Narcotics
Anonymous.1 A number of large, well-designed studies have clearly shown that supportive,
client-centered counseling approaches such as Motivational Enhancement (aka Motivational
Cultic Studies Review, Vol. 5, No. 2, 2006, Page 98
Interviewing) are the treatments of choice for young and older drug abusers (Miller, 1989
Miller &Rollnick, 2002 Miller, Zweben, DiClemente, &Rychtarik, 1995 Project Match
Research Group, 1997). We now understand that the ―shock and awe‖ approaches used by
highly confrontational addictions and delinquency treatment programs are ultimately
unsuccessful at best and often harmful at worst.
Chapters seven and eight are largely devoted to a fascinating and disturbing recounting of
Lulu Corter‘s civil suit against KIDS of Bergen County, successfully prosecuted by New
Jersey attorney Philip Elberg. (Elberg currently serves as president of the International
Cultic Studies Association.) Rather than attack KIDS as a ―cultic‖ organization, Elberg took
the innovative approach of claiming malpractice. In essence, Elberg convinced the jury that
KIDS had violated established and well-known guidelines for the competent and ethical
practice of medical and psychiatric treatment. Nevertheless, according to Szalavitz, the jury
concluded that ―KIDS was more a cult than a clinic—and that such treatment had no place
in a healthcare system‖ (p. 246).
Szalavitz ends her book with a useful appendix, ―For Parents of Troubled Teens,‖ which
contains information about how to obtain appropriate treatment for defiant, oppositional,
antisocial, and addicted youth. The information is presented in a reasoned, undramatic
manner with references to several well-known Websites for additional information. One
section is an especially helpful ―questions parents should always ask‖ format that is concise
yet reasonably comprehensive.
Szalavitz is understandably puzzled that residential treatment for children (TTI) is a
multibillion-dollar industry, while proven treatments such as multisystemic family therapy
(MSFT), motivational interviewing (MI), and cognitive-behavior therapy (CBT), ―which are
actually cheaper than long-term residential care ...are largely unavailable‖ (p. 259). She
notes that the United States also has a gross shortage of child psychiatrists. While I agree
with her general points here, Szalavitz neglects to mention the harsh reality that, while
MSFT, MI, and CBT have indeed been proven to be significantly more effective than other
treatments, including residential treatment, the success rates for these interventions are
still disappointingly low.
This minor failing aside, Help At Any Cost is still a must-read for those interested in
adolescent treatment in general, and in how an iatrogenic therapy program can degenerate
into a therapy cult.
Note
[1] Of course, similar statistics apply to those who are exposed to, experiment with, and eventually
participate in, cultic movements. Contemporary cult interventionists (exit counselors and thought-
reform consultants) now realize that noncoercive, empathy-based interventions, as lacking in
immediate impact as they may seem, ultimately work best with cultists. The information-based and
psychoeducational approaches used by thought-reform consultants, or the strategic-interaction
approach advocated by Steven Hassan—while typically slow, methodical, and undramatic intervention
strategies—appear to be the best choices in the long run for intervening with cultists.
References
Miller, W.R. Increasing motivation for change. In: Hester, R.K., and Miller, W.R., eds.
Handbook of Alcoholism Treatment Approaches: Effective Alternatives. New York,
Pergamon Press, 1989. pp.67-80.
Miller, W.R., and Rollnick, S. (2002). Motivational interviewing: Preparing people for
change. New York: Guilford Press.
Miller, W. R. Zweben, A. DiClemente, C. C., and Rychtarik, R. G. Motivational
Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating
Individuals With Alcohol Abuse and Dependence. Project MATCH Monograph Series,
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