TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Ruth is shedding horribly and she’s going to get sheared here, I think. I’ve been brushing her and there is just tons of fur.

MOTHER: Oh, my goodness. She is shedding.

CLIENT: You’re not sleeping in your little house?

MOTHER: Well, Kevin, you’re going to have to find somewhere else to sit, apparently. [00:00:59]

CLIENT: Can I sit on the little mat? (pause)

MOTHER: Did you see my boots?

FATHER: I did. I assumed you had those.

MOTHER: Yep. Saver’s yesterday. $7. Three years ago when I bought my Ugg snow boots, they had those water boots I really loved. I said I can’t do that. I shouldn’t have gotten the Uggs to begin with, but I love them. [00:02:06] So it’s been three years that I’ve wanted them. That’s so sinful. You can’t find a brand on them.

FATHER: Are they lined or anything?

MOTHER: They’re thick leather.

CLIENT: I was just thinking of you today. I’ve actually been thinking about you a lot.

FATHER: In fact, he just got done thinking about you.

THERAPIST: Yeah, whenever I get in the bathroom it’s just like God . . . No. Two different occasions this week when I thought of you. Earlier today, as you see, Ruth has been shedding so I had her in my lap and I had her brush for an entire session. This is not even close to how much is in there. I was thankful that it was coming out, so I’m going through with that comb, which is really a pretty good comb. [00:03:04] And for a while, she was like “this is pretty cool.” And then I started taking fur out of her tail and stuff. “No.” And I’m like, “Yeah.” “No.” I’m like, “This reminds me of Kevin. I get a lot of fur out of her and finally she bites me. “You want another round to show Kevin? You want to demonstrate with Kevin.” This is just you. People want to do something good for you so you don’t make a mess everywhere, and then we’re brushing you and I’m trying to get you headed down the right path and they bite us. That’s my first Kevin epiphany today. It’s like, “I’ve got to tell Kevin about that.” If I brush her, she looks really nice, doesn’t she? [00:04:01]

MOTHER: It’s funny how she’s sitting.

THERAPIST: We call this sitting at the bar.

CLIENT: Or passed out at the bar.

THERAPIST: Yeah, that’s exactly right. She and her kitten both do this. They both sit like this. It’s weird. And they both go after your buttons. Bob has never seen Ruth do that. It just really suggests a predisposition.

MOTHER: So your other cat is named Bob?

THERAPIST: Bob, yep, from Minecraft. Bob is from Minecraft.

CLIENT: That’s what Albert named his cow.

THERAPIST: That’s Bob’s dog, yeah.

MOTHER: Seriously?

THERAPIST: Yeah, Bob.

[ ] (crosstalk at 00:04:29)

MOTHER: Look at that.

THERAPIST: It’s ridiculous.

FATHER: It’s too bad she doesn’t have any trust. (laughs)

THERAPIST: I get that brush out, man, and she’ll be running.

FATHER: That’s probably what she saw.

THERAPIST: She knows it’s good because she sits there and likes it for a while. And then you start brushing things she doesn’t like and she wants to bite. I’m like, “No, you can’t.” She actually bit me for real. (laughs) I have a little scratch here. She’s never done that. I thought Kevin, when he’s here that’s what we’re doing. You just have to remember we’re brushing you for a reason. [00:05:10]

Now the more horrifying story I had this week, was I had a young man in here that was about two years out of high school; and oh, my God, did he remind me of you. I just thought I’m going to really think through how we avoid this problem with you. The parents were telling me how he had gotten to high school and everything. They couldn’t tell him anything and they had to follow him around all the time and make sure he did everything. Then he got into college and would you like to guess his grade-point average for the first semester?

CLIENT: Probably good.

THERAPIST: I bet you couldn’t. Think low. Think below one.

CLIENT: Really?

THERAPIST: Yes. Think of below one, actually. That is correct. I believe it was a 0.0 the first semester. [00:06:02] I said, “Oh, my gosh. You used to have a zero grade point average?” And the mother said, “Actually, he got an A in bowling.” We talked about what they should have done differently, just to think back and figure it out. That is what we want to avoid with you. I realize we have a few years, but I thought “oh, my gosh” when they were talking about how many disagreements they had in high school and stuff.

MOTHER: Can I have their phone number? (chuckles) I want to talk to them. I’m kidding.

THERAPIST: Yeah, I think you’re heading where I was. They will be saying, “Oh, my gosh. We felt like failures,” but I actually think they did pretty well. I think that young man probably got his back up about some things, like medicine, for example. [00:07:00]

MOTHER: They obviously started a new semester and he’s coming home and doing homework. There’s only one late assignment so for.

CLIENT: And I did it, but I just left the book at home.

MOTHER: On the way in he said, “Yeah, I want to get stuff done.”

THERAPIST: You didn’t have the book?

CLIENT: No, I left it at my house and it had my assignment in it.

THERAPIST: You know what he needs? It’s a little tricky to pull off. He doesn’t have any IAP or anything, right?

MOTHER: Right

THERAPIST: Yeah. He needs a double set of books, if we can get them to do it,

FATHER: But he left his assignment in his book, though. Oops.

CLIENT: I take that book with me everywhere.

THERAPIST: The book is a textbook or a notebook?

CLIENT: It’s a little, small workbook and then there’s a textbook that I also keep in my binder. I haven’t gone to my locker yet at all.

MOTHER: Oh, really?

CLIENT: Yeah, it saves me so much time because I have everything in my binder.

THERAPIST: Yeah, I feel you. That’s a good way to do it. The locker is usually just a problem.

CLIENT: One time I was about to be late to class. I went to my locker and I was just going to cut through the library because there’s a hallway that comes out and then there’s the gym and then there’s a hallway right here and then there’s another door to the gym and then there’s the 6th grade hallway. But there is the library in that box area, so you can just walk right through the library. There was this one teacher’s room and she didn’t have anybody that hour. She was out in the hallway just watching the hallway. There were still people out there so I started to cut through the library. [00:09:02] I’m literally opening the other door onto this side, so I’m about to get out and I’m about to go into math, and she goes, “Kevin, what are you doing?” I said, “I’m just cutting through the library because I’m going to be late.” She goes, “No. You have to come and walk back around.” I was that close to opening the door and getting out. (chuckles)

THERAPIST: And you did it?

CLIENT: Yeah. I had to.

THERAPIST: But you don’t understand that, do you?

CLIENT: No. She said, “We don’t walk through the library.”

THERAPIST: We call this a shortcut. You had the literal version, but the figurative version can be quite a problem sometime.

CLIENT: I was so close.

THERAPIST: Yes.

THERAPIST: 2 Then I was late to the class.

THERAPIST: Well you made a valiant attempt to get there. That is actually such a good metaphor. This is why people speed when they’re driving. When you get this guy driving in the future, be sure you get him one of those Garmin GPS systems for a bunch of reasons. [00:10:00] Even if he’s super good with navigating, which he probably is, if you use it every time it teaches you better than anything the uselessness of speeding because if you’re going to county community college or something and you’re going to be late for class, it doesn’t matter if you go 85 miles an hour. You’re going to get there 90 seconds sooner. You begin to see that actually on the computer and you realize that it’s pointless. It’s surprisingly good cognitive refrain for people. Now if you’re driving from here to Milwaukee, you can actually get there sooner if you speed, but how many times are you going to do that? And how many times do you know, “Oh, my gosh. I only have eight hours and 15 minutes. I’m going to be ten minutes late.” (laughs)

CLIENT: The long drives aren’t as bad anymore because I went to [the lake] (ph?) five times this summer and I learned how to wakeboard and everything. We went down there all the time and last year I chose going to the lake over going canoeing, which I love.

THERAPIST: Canoeing is good, isn’t it?

CLIENT: Yeah. I’ve started to rent my own kayak so I can take my sister on it.

THERAPIST: So you don’t have to ride with mom and dad?

CLIENT: Yeah. Hey – they have the cooler and stuff so I sometimes . . . (laughing)

THERAPIST: Not beer.

FATHER: How do you know?

MOTHER: It’s our cooler. We filled it.

CLIENT: So I come up and I get stuff from them. But I took my sister on the kayak last year.

THERAPIST: It’s a two-person kayak?

CLIENT: It’s a one-person, but she just sits on the back.

THERAPIST: You just ride shallow. You’re not going through rapids or something.

CLIENT: Well, sometimes there are rapids, but not very often.

THERAPIST: My kid wants a kayak. I’m going to have to get one. [00:12:02]

CLIENT: They’re really fun. It’s a lot of exercise, too.

THERAPIST: Yeah, that’s very true, which we can use.

FATHER: But that’s another example of him being with us and kind of doing an off-on-his-own thing.

THERAPIST: That’s kind of a good example, because kayaking lends itself to that, particularly canoeing. You still have to work with the group, but you can also have your . . . Some day you need to go to Milwaukee and take the Milwaukee River Kayak Tour. I kid you not. They start off from right downtown and they kayak with a tour leader up and down the river and they stop and talk about the buildings and everything.

MOTHER: Wow.

CLIENT: That’s cool.

THERAPIST: I’ve seen it several times. You would love it. You have to be good enough at kayaking, but I bet you guys are. It’s not super rigorous. It’s not something I would do for my son’s first kayaking, though he is totally convinced we have to do that the next time we go to Chicago. [00:13:05]

CLIENT: And if you like fishing, too, it’s so much fun. You can go places a canoe wouldn’t be able to go.

THERAPIST: I bet that’s your version of heaven.

CLIENT: Jessica and I were kayaking and we found this little spring on the Black River. People had already started to go there so we turned and then Jessica and I started to go up this spring. It was really shallow water.

FATHER: Freezing cold.

CLIENT: Yeah, freezing cold.

THERAPIST: And her legs are hanging off in it?

CLIENT: She had her legs up like this.

THERAPIST: No doubt.

CLIENT: So we were going up and we found a turtle that was in the water and was missing a leg.

THERAPIST: It’s a rough world out there.

CLIENT: Yeah, and it was so slow. I went up next to it and grabbed it. It was pretty cool. [00:14:00]

THERAPIST: I thought you hated Jessica.

CLIENT: (laughs)

THERAPIST: That’s like a beautiful story of a young man and his sister in nature. I thought it was going to end like, “And then I pushed her off.”

CLIENT: (laughs) I probably would have done that.

MOTHER: No, you’re good in those situations.

CLIENT: In the situations where we’re outside, except at Aunt Mirna’s. That was bad.

FATHER: You get to the point where you’re frustrated with her and you say some mean things, but deep down inside, you love her because [I have such a good story.] (ph?) You go over to her the other day and say “I love you.”

THERAPIST: What prompted that?

CLIENT: (chuckles) I have no idea.

THERAPIST: You were in a random moment of joy?

CLIENT: I guess, yeah.

THERAPIST: Well that’s really nice, man.

MOTHER: That maybe is a good topic because their relationship is mostly antagonistic of each other. She is as guilty as he is.

THERAPIST: You guys have been fair about that.

CLIENT: I guarantee that she’s a lot more. [00:15:00]

MOTHER: But my point is that neither of them are going to stop antagonizing the other one and so it (cracking noises).

CLIENT: She watches probably eight hours of TV.

MOTHER: An [unearthly] (ph?) amount of time.

CLIENT: Two days.

THERAPIST: Does she watch the Disney channel a lot?

CLIENT: She watches everything. She watches so much. I probably watch eight hours of TV . . .

FATHER: A week.

CLIENT: What? I barely watch TV.

MOTHER: It’s on. She’s doing other things. But the time that she’s watching TV you’re doing . . . THERAPIST: They’re just saying that’s an equivalent entertainment.

CLIENT: Yeah.

THERAPIST: Does she have the ADD thing going on?

FATHER: We think she does.

THERAPIST: I think she does.

MOTHER: That’s interesting. We’re kind of wondering.

FATHER: They’re very similar.

THERAPIST: Because the way you always describe them, it’s like there are two ADD people in thing. [00:16:04]

FATHER: She can’t sit still and do something. She can’t sit still and eat. She can’t sit still and work on something. She’s walking around, standing up, she gets up.

MOTHER: And he wasn’t like that, but she is. And we used to think it was cute because when she talks she acts it out. She’s like “I went . . . I ran to the store and I saw a dog. . .” The whole thing was always so cute.

THERAPIST: That’s a great example.

MOTHER: And now we’re like, “Sit down.”

THERAPIST: Does she tell you . . . Does she rarely have a secret? Like everything she thinks comes out of her mouth?

MOTHER: Oh, yes. Nonstop.

THERAPIST: All the time, right.

CLIENT: She’s in that la-la-la not listening phase and “I’m telling” and “that’s a bad word.”

THERAPIST: How old is she?

CLIENT: Eight.

MOTHER: And she also acts younger than her age. [00:17:00]

THERAPIST: Boy, that sounds like the deal, doesn’t it?

MOTHER: We held her back, in fact. She did two years of kindergarten. She’s small.

THERAPIST: How old is she compared to her peers now in her class, younger?

MOTHER: No. She’s older. There are two girls that were held back at the same time, so the other little girl is a little bit older than Jessica, but there is a kid in the class that she’s an entire year older than him. They’re just turning eight where she’s already eight.

THERAPIST: She’ll be 18 or 19 when she graduates.

MOTHER: Her birthday is March 22, so she will . . .

THERAPIST: She’ll still be 18 barely. That’s where it gets dicey is if they’re 19 very long when they’re seniors, it’s harder to keep them in school which is why they don’t hold kids back much anymore.

FATHER: Her birthday is the day before school gets out?

MOTHER: It kind of varies every year, but it’s right at that time.

FATHER: She doesn’t get to celebrate her birthday at school a lot of times. She was super young when she went to kindergarten, so that’s the way it was. [00:18:02]

CLIENT: We wanted her out of the house. (laughs)

MOTHER: No, she’s awesome.

FATHER: By our mistake we let her go for a week to first grade and realized and we took her back. And, of course, everybody else is in the classroom across from her, “Why aren’t you in our class? Why did you go back?” It was a bad decision on our part.

MOTHER: It was the right decision.

THERAPIST: You’ll have an 18-year-old for the whole senior year. That’s where it gets dicey is that last year because they have the power.

CLIENT: In Language Arts today we were talking about how people in high school just drop out, even with the last year. I don’t understand why they would do that when they have one year left.

THERAPIST: We shall hold you to that, most assuredly, as you progress through school.,

CLIENT: I really don’t mind the school, it’s just the work part.

THERAPIST: (laughing) Kevin. I couldn’t have said that better myself. [00:19:01] Love the socialization.

CLIENT: Like today in P.E., I have P.E. first hour and in third hour it feels like the day is almost over because you’re so awake and it’s awesome. It will feel like you’re in sixth or seventh hour in third hour.

THERAPIST: Because you feel tired?

CLIENT: No, no, because I’m wide awake.

FATHER: You could use some endomorphins.

THERAPIST: Oh, because you get the activity at that time. What hour is that?

CLIENT: First. So I get there and I just go straight to gym.

THERAPIST: Well, we have seen that work before. That is probably really good. A lot of times the ADD people aren’t very zippity-do-dah in their first hour of school. They’re kind of out of it, so when you get in there and start playing something – sports or doing something – that’s probably a pretty handy thing. [00:20:05]

MOTHER: I think that worked out well.

CLIENT: Today we played dodge ball, which is my favorite thing to do, one of the best.

THERAPIST: It gets all your aggression out.

CLIENT: Yeah, it really does.

THERAPIST: I know you.

(laughing)

CLIENT: It’s kind of weird because my friend can be standing from that wall to me and he can throw the ball as hard as he can and I can still dodge it. I have cat-like reflexes.

THERAPIST: Well it helps that you’re a fairly small target, too. You’re not big in any direction except up. So okay, I’ve got a couple of questions. You had your medicine break over the holidays, right?

CLIENT: Yep.

MOTHER: I cursed you every single day.

THERAPIST: I’m sure it was painful.

MOTHER: Every day.

THERAPIST: Yeah, you’re going to love me when he can actually function in the semester now. (chuckling)

MOTHER: A weekend? I’m like, “I don’t care what he said, we’re going back on it. I don’t care what he said.” But we didn’t. [00:21:07]

THERAPIST: I understand. I personally, genuinely understand. (laughs)

MOTHER: I know, you’re right. I know. I thought of you.

THERAPIST: Really, when Evan and I go to Disneyworld next month, I will have him dosed just perfectly every day. He has to be dosed low enough that he will be fun and have a good time and not be too serious, and enough that he won’t just be lost. There’s a real sweet spot to hit. So I bet you were kind of annoying.

CLIENT: (chuckles) Yeah, probably.

FATHER: They fought a lot.

THERAPIST: What size patch is he on? I can’t remember.

MOTHER: 30. We’re up to 30. [00:21:58]

THERAPIST: And do you notice the difference that you’re back on it?

CLIENT: Today we forgot to put on the patch.

MOTHER: We?

THERAPIST: You’re off medicine today?

CLIENT: Yeah.

THERAPIST: Wow. You’re in pretty good shape.

CLIENT: I didn’t notice the difference. I felt like I was just the same.

MOTHER: I think he’s not feeling . . . he had a canker sore and he’s kind of been tired lately, so I think maybe that helped or something.

CLIENT: I have a big canker sore right on the bottom of my tongue.

THERAPIST: Oh, that’s a bummer. You know what has worked for me with that? Let’s all remember I’m not a tongue doctor, but I’ve been having a couple of those and I seem prone to them and I’ve found this thing they do for dry sockets for people who have their wisdom teeth removed, it seems to work for your tongue if you put some clove on cotton or something and jam it wherever the tongue is.

CLIENT: Really?

THERAPIST: Crazy. It’s really helped me out lately. I just got to thinking, “This hurts and I’m sick of it. What do people put in their mouths for that? Well they use a clove for . . “[00:23:02]

MOTHER: So just ground clove?

THERAPIST: Exactly. It actually tastes kind of good.

MOTHER: I just bought him some medicine today that he said didn’t work at all.

THERAPIST: I didn’t go to any of that stuff and I’ve had two of them in the last month and did that exact thing. I don’t know why, but maybe you should look that up; there’s some reason for it.

MOTHER: I’ll try that.

THERAPIST: You’re a Boy Scout, aren’t you?

CLIENT: I used to be.

THERAPIST: It seems like clove would be good in your pack or something.

CLIENT: You know what I found? You know that old Boy Scout knife that you used to have? It was a long one. It was a single-blade that wouldn’t collapse or anything.

FATHER: I don’t remember it.

CLIENT: I used to take that fishing with me all the time. It used to get rained on and stuff and it was really rusty. It was bent. The other night I took rust remover.

THERAPIST: This is a sharp knife?

CLIENT: No. It wasn’t that sharp at the time.

THERAPIST: Because any time we’re getting anything with rust and a blade, we want to be on medicine. There are too many points of failure.

CLIENT: So I started doing that and then I started sharpening it and it looks brand new now – not brand new, but it looks really cool, I think, and it works. I like it.

THERAPIST: You should be one of those American pickers where they go and find all the old things.

CLIENT: Grandpa pretty much is. I think grandpa is a lot like an American picker.

THERAPIST: So remember, medicine, you aren’t supposed to have a ginormous effect on it. It’s not supposed to knock your socks off, but it’s kind of okay if you don’t notice a huge difference.

CLIENT: I also noticed when I’m with my grandpa and I’m working, don’t you think that I’m a lot better than I am at home? [00:25:01]

THERAPIST: Better in which way?

CLIENT: I act a lot better. We’re moving everything out my dad’s warehouse. This friend is moving into his warehouse and my friend has come with me every single time. My friend has come every single time to help out and all we do is mess around with Sam, which is his employee.

THERAPIST: I think that’s an established fact with this guy, isn’t it? When he’s active and doing something and keeping his mind busy he’s a lot less difficult.

CLIENT: Like when I’m fishing, it’s what I love to do. When I’m hunting I’m not crazy at all because I know that I can’t be or else I’m going to scare something away.

THERAPIST: Isn’t that interesting.

CLIENT: And I have a gun, so I can’t be crazy with that, either.

MOTHER: And you’re medicated.

CLIENT: Not when I’m going hunting, no.

FATHER: I think it’s willy nilly.

THERAPIST: I think it’s almost, in that situation, he’s so intentional in what he’s doing that it’s like the idea meditative state for him. It really is. Whenever you describe it, that’s what it reminds me of. One of the things that’s actually pretty handy for the ADD people – you might want to get into – is doing mindfulness meditation. You have almost your own way of doing it.

CLIENT: Sharpening the knife really helped.

THERAPIST: I get it now. I get it. After you talked about it I got to thinking, yeah, this is relaxing for you and focusing for you. The problem is that frequently, that state will not come about like when you’re trying to do math or sitting in an English class.

CLIENT: It came to me once, and that was just the other day. [00:26:58]

THERAPIST: Oh, yeah? How so? I’d love to know how that happened.

CLIENT: Instead of the time thing, we’re doing it by assignments now, but I can have my phone with me and I’ve gotten everything done so far. I can have homework but it’s not so painful and boring because I still have my phone with me – but I’m still getting all my assignments done.

FATHER: [ ] (inaudible at 00:27:24)

MOTHER: Well, we tried something.

CLIENT: It’s worked.

THERAPIST: Can they trust that you bring all the assignments in?

FATHER: We can go on [Power School] (ph?)

THERAPIST: Is that accurate enough to . . ?

FATHER: Yeah.

THERAPIST: So the thing is you just work until you get them done, even if you get distracted?

CLIENT: Yeah. Well I didn’t get distracted much when I was doing it because I just wanted to get it done. I wanted to stay on top of it and I’ve been trying, actually, really hard to stay on top of it. [00:28:05] I think I’ve been doing pretty well.

MOTHER: Tell him what Candace, Mrs. Adler, said; your math teacher.

CLIENT: (chuckles) Today I forgot my assignment and I said, “I don’t have my assignment. I did it, but I just forgot it at home.” She gives me this look. She said, “Kevin, when you get on top of things the world needs to look out.”

MOTHER: And I took that meaning you’re doing a great job, right?

THERAPIST: I think we’ve had this conversation but I’m blanked out now. What phone are you operating?

CLIENT: iPhone 4.

FATHER: We were going to go into that at one point, different things that we wanted to lock and times it could go on and off.

THERAPIST: Well, yes. That’s doable. Let’s first talk about what good it can do for you. [00:29:06] I once had a client, this was very early in the days of Facebook, and she came in and she was like, “My friend got on my Facebook and changed my status to ‘I’m pregnant.’” She didn’t know that until her minister called her mom. I was like, “Oh, wow. Seems to me like this whole social media thing is a bad idea. Why don’t you get rid of it?” She said, “No, no way. Facebook is like a tool. It’s like a hammer. You can either hit a nail with it or put it in your forehead.” And that’s really pretty true. If you will use your phone well, it can be a great tool for you. For example, if you’ll just take a picture of every assignment you do, then you’ll have it and you can send it to your teacher and you can show her you did it. [00:30:01] We do that all the time. We just e-mail; we get the e-mail addresses. In fact, my daughter submits all of her work by e-mail and so she doesn’t lose things, then she doesn’t have that as an excuse. Now her paper documents, she still does by hand. If she loses something I don’t take any excuse because she has her iPad with her all the time. She can get a picture of it. So if I were you, every time I finished something I would take a picture of it, a nice, clean picture. They need to do a little student improvement stuff with him instead of having to [ ] (inaudible at 00:30:37) an IEP. If they think you’re thinking about an IEP, they’ll get all super helpful and just make it possible for him to submit something by e-mail if he needs to. See if you can get those duplicate textbooks. [00:30:56]

The other part of this, if I were you I would document everything I did. I don’t mean like eating lunch, but any work you’re doing, I would document front and back because you can always delete the photos later if they’re not relevant, but you guys are more interested in selfies than you are using it for something . . .

CLIENT: I don’t ever take selfies.

THERAPIST: What do you take pictures of with your phone?

CLIENT: I take pictures of what I do like hunting, I post pictures of what I shoot; stuff like that.

THERAPIST: Well then you’re in the right mood for this. You just need to take pictures of what you write down because anything you can make use of to make technology help you is good. So you guys want to block some stuff, right? Did you ever find that app?

MOTHER: You know, the [Mobiset] (ph?) or whatever, I did find out and what I was more concerned about – we haven’t put that on. We’re kind of slow at getting this stuff.

FATHER: We have questions, too. We were going to wait until we covered it and make sure that we were able to go through everything. [00:32:09] The app that we liked a lot, you have to break in.

THERAPIST: It’s a jailbreak? I can’t remember what one that was.

MOTHER: I forgot I had these.

THERAPIST: It’s good to have safety glasses when you’re here in case something bad happens.

CLIENT: My mom explodes. (laughs)

MOTHER: It could happen. Teen Safe, I think it is. Those are two different issues. One was Internet stuff, but I’m actually more concerned about the texting.

THERAPIST: Okay, so what is your worry about texting because that’s infinitely more difficult to address.

MOTHER: I don’t know why, but we have not been good at being those monitoring kind of people and we should be because back when he first got his phone we would get calls from friends’ mothers’ saying, “Do you know what your son wrote?” [00:33:07] We haven’t lately so I feel comfortable supporting this outcome.

THERAPIST: I remember that at one point, but I can’t remember what it was you were writing.

FATHER: The language, I think, was raw.

MOTHER: Fighting with friends and using language we don’t even use, that kind of stuff.

THERAPIST: You’re going to be in what grade this fall?

CLIENT: 9th. Freshman.

MOTHER: There have been several phone calls over the years about “this was on Instagram,” “this was this,” that kind of stuff.

FATHER: Facebook. That’s why we got rid of Facebook.

MOTHER: Facebook. And so now with him hitting this age with the hormones and that kind of stuff, there is a lot of secrecy, a lot of locked doors, behind doors, and I’m just very concerned knowing that history whether we’re in the sexting world and that kind of stuff. [00:34:17] We’ve had discussions with him and, at one point, told him that we wanted to get an app that we would be able to see it if we wanted to. I’ve told him over and over that I don’t really want to read your stuff. I really, really don’t, but I think a good parent needs to know what’s going on and if people are calling me, that means I don’t know what’s going on unless somebody tells me. He was okay with it for a while, but then we ran into this jail breaking problem and I didn’t want to jailbreak the phone because I don’t know what that really means.

THERAPIST: It is possible to surveil the phone. I can look up the app to do it. I was kind of surprised at how easy it is to do. [00:35:04] I think you kind of have to think through what’s public and what’s private and have some ethical guidelines around that. I always tell people that the manual that’s not in the box when you get your iPhone is the ethics manual. His ethics will differ slightly from yours, but you’ll have to figure out what is the limits of appropriate use. On all of the public devices or services like Instagram and Facebook and Twitter and all that, I think those should not be private because Facebook and privacy should never be used in the same sentence. What’s weird about kids, and it is so weird. I have my Twitter account that feeds lots of parenting advice out there and it’s so interesting to see the things kids say to one another about how “I hate it when teachers are on Twitter. [00:36:10] It’s like they’re stalking us.” I have bad news for people. That’s not how Twitter works. You don’t have to stalk anybody on Twitter. There it is. They sort of have this idea that it should be private unless they say you can look at it, except that anyone can look at anyone’s Twitter unless it’s protected, unless you turn the protection on. And nobody wants to do that because you’re trying to get more followers and you just don’t want the followers to be your parents. This is just a dumb . . .

FATHER: You don’t get to choose who your followers are?

THERAPIST: No, not on Twitter, unless you turn the protection on and then that person has to grant you permission, but nobody does that. It’s very rare.

CLIENT: I have my own Instagram. I have a private . . .

THERAPIST: You have the privacy thing turned on?

CLIENT: Yeah.

THERAPIST: So only people who are your – what are they called? [00:37:01]

CLIENT: Friends.

THERAPIST: They’re friends on Instagram? You can approve them? Okay, so this parent’s app should be on all of your social media. If you’re saying something on social media that your parents can’t read, you shouldn’t say it.

CLIENT: And I don’t because I have my cousins that follow me and Lyla follows me, too.

MOTHER: I thought you took her off because . . .

CLIENT: Oh, that was ridiculous.

THERAPIST: You can block people on Twitter, but that’s considered punching them in the face. It had better be a really good reason.

CLIENT: For ridiculous reasons, her friend’s daughter was following me and I posted an old picture of me at the lake and I said, “Anybody want to come swim?” [00:38:03] I said, “Anybody want to come swim in the bald pool?” and they took a screenshot, sent that picture to my mom, said it was a bad thing to post.

THERAPIST: Were you naked or something?

CLIENT: No.

THERAPIST: What was the problem, by the way?

CLIENT: I have no clue.

FATHER: This doesn’t ring a bell with me at all.

MOTHER: There were two situations and that one. One was you sent somebody a bunch of texts and you were laughing about how you sent them 10,000 characters or something like that and it jammed their phone for three hours. That’s what she was more upset about.

CLIENT: No, it jammed my phone.

MOTHER: Well it said hers and that’s what she was mad about.

FATHER: Well whoever sent it and received it.

THERAPIST: I’ve never heard that one.

MOTHER: On purpose.

CLIENT: Yeah, as a joke and she sent it.

MOTHER: So my sister was really mad about that.

THERAPIST: That’s smacking yourself in the forehead, frankly.

MOTHER: I can’t remember the bald one. She misunderstood that one. She took it as something bad and it wasn’t, but the first one she was upset about. Anyway, Nolan, just take her off.

THERAPIST: So all the public things, not only do I think you should have access when he’s this age, but I don’t know why anybody in social media shouldn’t have their parent as their friend or follower or whatever.

CLIENT: Because they live in the stone age.

THERAPIST: You don’t think they should be your friends or followers because they’re cave people?

CLIENT: (laughs) Because they have no interest in social media whatsoever.

THERAPIST: Well, too bad for them. If you’re going to participate in it, they’re going to have to bring up their technological skills a little bit. I get after those people on the radio all the time about how they have to catch up with you, so I’ll just get after them here. [00:39:59]

FATHER: All e-mail or all texting, I don’t have time in the day to sit and look at Twitters. [00:40:05]

THERAPIST: Well texting is going to be different in a second. You can follow him on Twitter without ever following him on Twitter. You just have to get on and go to www.twitter.com\his handle and it will show you on the Internet.

MOTHER: Do you do Twitter?

CLIENT: No. I only do Instagram.

THERAPIST: That’s probably best. I hate Twitter and I hate Twitter because it is the worst idea for the ADD people on the face of the earth because they have approximately 11 seconds between the time they think of something and the time it goes out to the whole universe and nothing is a worse idea than that.

MOTHER: The only thing worse than that is that picture thing.

THERAPIST: Snapshot.

MOTHER: Yeah. Do you still do that?

CLIENT: Yeah.

MOTHER: That’s the one I worry about. [00:40:58]

CLIENT: I don’t understand.

FATHER: Paris doesn’t understand either.

MOTHER: Paris has ADD as well.

THERAPIST: That’s your worry about Snapshot. The good news about Snapshot is more or less the image disappears. I just learned the other day that they’ve modified it so that if someone screenshots you, you know.

MOTHER: Oh, really?

THERAPIST: That’s new, yeah. That’s new and the rule is now amongst young folks that if someone screenshots something that you’ve sent, then they’re never getting another Snapshot from you because that’s considered a tremendous faux pas. So that’s new news as of the last week or two. We’ll get to the other thingies in a second because they’re ethically different than what’s public and I’ll explain what I mean by that. Anything he’s doing on social media, you guys need to keep an eye on. I don’t know that you need to every day obsessively get up and look at his Twitter feed. (chuckles) [00:41:59] It isn’t as difficult to do that as it sounds, but I have a bunch of kids around the country that I follow. I find that it’s really very interesting to see what they have to say and I used to have a list of kids I followed, and then I changed my mind and decided I just didn’t think I wanted everybody to see everything they had to say. They could go find it themselves, so now that’s a closed list. They say some pretty interesting stuff and I reTweet things that I like that they say. It’s about one in 50 things the average kid says that isn’t nutty. They fight on Twitter and they do all sorts of crazy stuff. Tumblr is where teenage girls store all their pornography. I’ve certainly learned that and that’s a popular thing to do.

CLIENT: I’ve never heard of Tumblr.

THERAPIST: Tumblr? You don’t know Tumblr? You don’t want to know Tumblr. Boys don’t do Tumblr very much but girls get addicted to that thing like nothing, like you get addicted to fishing. [00:43:05] Here’s the deal on the other things. Things that are private media, and this is somewhat of an imperfect solution, but the way kids communicate now is that texting is just the same as talking on the phone. In fact, they don’t ever talk on the phone. Do you ever talk on the phone?

CLIENT: I try, but . . .

THERAPIST: You can’t figure out how to do it? (all laugh) That was in the stone age.

CLIENT: I don’t know how to dial.

FATHER: I thought you were serious for a second.

THERAPIST: So here’s the thing, on one hand, when you’re talking on the phone they’re going to say all those things that they’re going to say. On the other hand, it doesn’t make a transcript and texting makes a transcript. People will have a document later this year they have to sign in my office that says they are agreeing to delete all texts that we exchange with each other because I can’t manage their phone and I need them to think about their privacy. [00:44:06] You will have to agree that if Kevin and I text that you are not monitoring his phone because that’s private communication. That’s one of these issues that we’re just now beginning to catch up to. In general, I think texting should be categorized as personal communication and here are the kind of exceptions: there is a 157% chance that Kevin will write a sext message to a girl in his life. There is no chance this won’t happen.

FATHER: I’m missing out.

THERAPIST: You are free. You are married and free to sext.

MOTHER: All he gets is “bring home milk, please.” (laughs)

THERAPIST: My wife is always so mad at me when I do that she’s like, “What if somebody sees that?” I’m like, “Delete it.” [00:45:00] Now pictures are a different matter and this has evolved a lot in the last couple of years. It is so – I almost can’t believe it, how much a part of the dating area it is at this point to text sexually explicit pictures to each other. It’s beyond whatever I even thought it would be. I thought people would get over this and be embarrassed about it; and they absolutely are not anymore. It shows up on TV shows; it is just the most common thing to do. This has actually created, when it comes to minors, a really complicated situation because that has absolutely been defined as child pornography and they’ve actually begun having to modify the laws on this. They’re all kind of puzzled about how to do this because otherwise, all teenagers would now be in prison. [00:46:00] This is such a complicated scenario. We used to just scare the crap out of people. Then there got to be this false understanding for a very brief time that this was somehow boys exploiting girls. Anybody who has sat in this office knows that isn’t true. Girls are not sitting around saying “no” in any way, shape or form. It is very typical. That I’ve yet to quite figure out what to do with because for minors, really that’s a bad idea. It’s not a great idea for young adults unless they don’t care who all sees their picture because the first thing a guy does when he’s mad at a girl is start sending those pictures around, which is unethical and evil – and that is a good reason to take your phone and never give back. That so violates the rights of others.

CLIENT: I could go to juvie for that, too. [00:46:56]

THERAPIST: You could, but apparently they’re realizing they shouldn’t prosecute that anymore, so let’s talk about from an ethical standpoint. If you use some picture you have of a girl you used to like and don’t anymore to hurt her, that’s a good reason for them to shut your phone down because you’re hurting a person, as opposed to being annoying or seeing naked pictures or whatever. You’re hurting someone. If you drive your care drunk, to me that’s a great reason to take somebody’s car away because you’re threatening someone by driving. So you have to sort of think where is the harm in gauging the response? People who arm people with those pictures, I think, deserve a huge consequence.

FATHER: Can’t something happen to me, since I own the phone?

THERAPIST: They’ve never gone that direction unless they know you’re complicit. What I’m really saying – I hate to say it but I also think it’s important to know – they’re moving away from prosecuting these things because, like I say, every kid would now be arrested because they all do it, with a very tiny exception of people who are embarrassed about their bodies and don’t want to take pictures and send them to everyone. [00:48:13] The difference in just the last five years is if Kevin sent a picture of his ex-girlfriend to all his friends five or six years ago, the girl would be embarrassed.

CLIENT: I know what happens.

THERAPIST: Right. And do you know what happens now?

CLIENT: The person kills herself.

THERAPIST: Right. Now what happens?

FATHER: Did you hear about Amanda Todd?

MOTHER: No.

THERAPIST: I know that name.

FATHER: I’ll tell you later.

THERAPIST: Now what happens is the girl goes up to Kevin and is like, “You know, that picture doesn’t belong to you,” and that’s the end of that discussion. There is so little – and a part of me thinks that I’m glad people are not going through this process of shame; and the other part of me thinks “wow, nobody cares enough about their exposure to get upset about it anymore?” I have about 500+ stories I could tell you, so I don’t think you should reinforce him from sending pictures around and if you want to tell him that’s a shutting off offense, feel free. But in terms of the word part of it, he’s going into high school. You cannot stalk his phone long enough unless you have reasonable suspicion to believe he’s doing harm with it. And in that case, maybe then he forfeits his right to freedom of texting.

FATHER: Can you text pictures?

THERAPIST: You can, absolutely.

FATHER: Yeah, so how is that different?

THERAPIST: The pictures?

FATHER: Yeah.

THERAPIST: Well, that’s why I say if you want to tell him that texting nude selfies is a shut-down violation, I think you’re well within your right. [00:50:01] I think the question, though, is who is it harming? That’s your tipping point. Do you want to say that’s a shut-down offense? If he’s texting someone else’s picture, that’s a shut-down offense.

FATHER: I would think either one because it’s a reflection of our family as well.

CLIENT: Like you didn’t do stupid things when you were a kid.

FATHER: We got in trouble for doing stupid things.

CLIENT: Because you didn’t have phones.

THERAPIST: Kevin, he did, in fact, do stupid things. I don’t have to ask him. He got in trouble for doing them, too, and that’s the point. You have to do kid things and they’ve got to do parent things. I’m saying it’s unquestionable that if he sends a picture to harm, that’s a shut-down offense and a monitoring offense. If he sends a picture of his John Thomas to a girl he likes, you’re probably going to have to study that on a need-to-know basis. That might mean sitting down and telling him this is tacky. It’s almost the new hickey, I kid you not. [00:51:01]

MOTHER: Interesting.

THERAPIST: I never have said that to anyone and the minute I said it, it makes a lot of sense. It’s the new hickey.

FATHER: Do you know what a hickey is?

CLIENT: Yeah.

MOTHER: How do you know what that is?

CLIENT: I used to give them to myself all the time.

FATHER: If somebody gave you one, who twisted his neck. Do you remember that? Somebody twisted him here at a swim meet or something, in the swimming pool.

THERAPIST: That person didn’t know how to give a hickey.

MOTHER: At least that’s the story we got.

THERAPIST: And, again, to me if the intent is to do harm, then I would crush him. If he’s saying to somebody, “You’re a stupid fucker,” and means it, that’s not a funny joke with his friends, then that’s to be hurtful. I’ve seen some guys – you wouldn’t do this, I hope – but I’ve seen guys lately, certain guys who have broken up with girls lately and almost bullied them. It’s weird. That isn’t normally what happens and lately I’m just seeing really cruel things. [00:52:01] That’s, to me, a shut-down offense. You really want to reserve those shut-down offenses for things that do harm to others.

MOTHER: Now we wouldn’t know about that, however, if we weren’t able to see the text.

THERAPIST: I think you’ll find out if it’s really harmful. (chuckling) You live in a town that’s small enough that that’s apparently boomeranging. My view is you ought to have privacy unless they have probable cause to remove it from you.

CLIENT: Yes, just like a search warrant.

THERAPIST: Right. That’s precisely right. The same is true for the room. You really ought to never ever go through kids’ writings or their diaries. I do suggest that if you wish to write your crazy thoughts, I strongly encourage you to do that on a computer and encrypt the document because (chuckles) you don’t want anyone to open it. [00:52:58] Like if you’re writing a story about murdering your family or something – you think I’m making it up? This totally has happened in the past. You need to make that your password-protected document, so you need to do some things to protect your own privacy. But until you have reasonable suspicion that something is problematic, he’s doing a drug sale or he’s at risk of self-harm or he’s bullying somebody in a serious manner, then they can invade your privacy just like you said, the search warrant. Try to use that exact analogy as probable cause. And you’ve got to watch out because some things are more serious than others. Like embarrassing your family, well, feel free to give him consequences, but don’t issue the death penalty.

MOTHER: I think what we mean by that, too, is his business is our livelihood.

THERAPIST: That’s a good point. Right. [00:53:59] I have to enforce that with my kids, too, but my kids have grown up with that idea so they just know if somebody talks to me in public they should assume it’s a client or something. That is a good point. I think the thing I would do in a situation like that is really sitting down and having a very serious conversation about that and say, “You understand? This is where our revenue stream comes from. We are seen in the community where we are relied upon as a business. People have to see the quality of our product and our service and if you’re posting your dick all over town or whatever it is you’re doing, in this situation it could hurt us.” If they said that to you in that situation, wouldn’t that appeal to you?

CLIENT: Yeah.

MOTHER: That’s been said to him without the word . . .

THERAPIST: There was no dick in it?

MOTHER: Do you remember? That’s been said several times. [00:55:01]

THERAPIST: Did you hear it? Did it make sense to you?

CLIENT: Yes.

THERAPIST: I think you’ve got to think about those things before you do them. Part of that is maturity, too. One hopes that Kevin is getting more mature as he ages. We’re excited about that possibility. Those things have to be repeated for the ADD crowd quite a bit.

FATHER: So not following texts, but looking at Twitter and that type of stuff. But there are also time elements that we need to – no texting after a certain time; shut off the phone at a certain time.

CLIENT: I think 9:00 is way too early.

THERAPIST: 9:00 is early and Kevin, I want to add to what your dad is saying that defending the privacy issue with you, then what you want to do is to let them prevent you from overuse of the phone. [00:56:11] There is some give and take here and we had this conversation several sessions back where I said if you’re not cool about this, I’ll tell them how they can watch every move you make. You’ve tried to be reasonable about it, so you don’t want to forfeit your privacy – so be reasonable in this discussion about it because they’re trying to be reasonable about it with you. What do you think is the right time for that?

CLIENT: I think probably 10:30 because that’s probably when I get to sleep anyway and I’m usually tired after I’m done texting.

THERAPIST: My concern about that – and I’m not looking at that yet because I don’t want to see their heads [fuse] (ph?) to see what they’re thinking. It’s like where you go in the soundproof booth. [00:57:02] As you continue forth, you’re going to have disagreements with people and you’re going to have a girlfriend or whatever, how is that helpful to your sleep to be texting right up to the time you go to sleep? Aren’t you going to be aroused and frustrated or something?

CLIENT: (chuckling) I don’t know. I’m sleeping. I have no clue.

THERAPIST: I mean just before. You’re telling me that you sleep so beautifully that if you’re upset about something you can just put the phone down at 10:30 and you’re like (snoring noise), like Ruth, for example.

CLIENT: (laughs) I usually end up waking up 30 minutes after I go to bed because I’ve had a really sore throat. I’ve had a really bad sore throat.

THERAPIST: You mean just since the sore throat?

CLIENT: Yeah, just since the sore throat.

FATHER: You usually get up every night and come back down and get something to drink. [00:58:00]

CLIENT: Well, yeah, I get something to drink. It’s been such a sore throat and so dry that I can barely swallow sometimes. I’ve got that canker sore under my tongue and it hurts like crazy.

THERAPIST: Let’s talk overall, not just recently, but overall.

CLIENT: Usually if I’ve had a bad night I would just rather go to sleep and try to forget about it because I’m not going to remember it that clearly in the morning.

THERAPIST: So 10:30 is a correct bedtime in your mind?

MOTHER: No. That isn’t.

CLIENT: Not to you.

MOTHER: Right.

THERAPIST: 10:00?

MOTHER: I would say 10:00 would be lights out.

THERAPIST: What time does he get up?

MOTHER: 6:30.

THERAPIST: 10:00 is about right.

CLIENT: The other morning, I thought, was ridiculous. She thought that I . . .

THERAPIST: Is this going to be a long story or a short story? (chuckles)

CLIENT: It’s kind of short. [00:59:01] She thought that I had moved her tweezers again and I do use them sometimes.

THERAPIST: For what?

CLIENT: Sometimes I miss when I’m shaving.

THERAPIST: Can’t you get your own tweezers? People don’t want you using their tweezers.

CLIENT: I haven’t gone to an actual store in how long?

THERAPIST: Can she wear your underwear if she needs some extra underwear?

CLIENT: She might need a diaper here pretty soon.

MOTHER: Stop it.

THERAPIST: That’s fine; if she needs extra underwear she can wear your underwear.

CLIENT: Sure. (laughs) Why not?

THERAPIST: I don’t believe you. You’re going to be back in here and be complaining that she uses up your underwear and God knows what she does with it.

FATHER: Getting a little too familiar.

THERAPIST: So anyway, you moved the tweezers.

CLIENT: I did not move the tweezers. She assumed that you did.

THERAPIST: You know zero teenage boys have ever raised this problem. You are the first ever to raise it. [01:00:03]

(laughing)

CLIENT: Dad, you use them all the time, too.

FATHER: I rarely use her tweezers.

MOTHER: Nobody is supposed to be using my tweezers. (laughs)

THERAPIST: Then get 3 pairs of tweezers.

MOTHER: I have.

THERAPIST: Are you tweezing your head? What is it?

FATHER: No, I don’t use her . . . I’ve used it maybe five times in the past year.

MOTHER: I can’t believe we’re talking about tweezers.

CLIENT: This is ridiculous.

FATHER: What would I use it for? I’m never up in her bathroom.

CLIENT: (laughs) Yes, you are. You were up in the bathroom last night.

THERAPIST: Maybe these people just take other people’s stuff and use it. Remember how I told you that if you don’t deal with this, your girlfriend of the future is going to beat your ass? This is exactly what I meant.

CLIENT: Okay. I’m going to get back to the story here. Done talking about tweezers.

THERAPIST: Good.

CLIENT: My mom woke me up at like 5:00; 5:30, is that right? She came into my room, knocked on my door and goes, “Kevin, where are my tweezers?” I was like, “I don’t know, mom. I didn’t move them.” [01:01:01] She goes, “Yes, you did. You always move them. You always move them.” I go, “Mom, I really didn’t. I swear I did not move them.” So she goes, “Okay, I know that you moved them,” and then she walked away. Ten minutes later, “Kevin. Where are my tweezers?” and then she does that exact same thing and then she walks away. She is furious with me because she thinks that I moved her tweezers. It’s probably around 6:00 now. She comes back again, knocks on my door and goes, “Kevin. I need to know where my tweezers are. You moved my tweezers.” She does the exact same thing – leaves. 6:30, comes back in. “Kevin, where are my tweezers?”

THERAPIST: This is her new way of waking you up.

CLIENT: Yeah, and then she didn’t even tell me what time it was.

THERAPIST: Did the tweezers ever turn up?

CLIENT: No.

FATHER: Yeah.

CLIENT: They did? Where were they?

FATHER: In mom’s bed.

CLIENT: Are you serious?

FATHER: But how they got there, we don’t know. [01:02:03]

MOTHER: Right next to where you study.

CLIENT: I didn’t take your tweezers, mom.

MOTHER: Just to put the finishing touch on this, this is the clincher. I can only use them with my magnifying mirror. My magnifying mirror is in my bathroom on the vanity right where they tweezers are. I don’t use them anywhere else.

THERAPIST: So there’s no way she took them someplace else.

CLIENT: Whose side of the bed were they on?

MOTHER: They were nicely put under . . .

THERAPIST: Oh, Kevin. You took her tweezers?

CLIENT: No I did not.

THERAPIST: Then how did they get there? How did they get there?

CLIENT: I don’t . . . Why would I know?

THERAPIST: I want you to be happily married. I want to come to your wedding and I want your girl to say, “I’m so thankful that found Kevin. He’s so organized and thoughtful.” I want her to say, “You know, unlike other boyfriends I’ve had, he’s never taken my tweezers.” That is what I want for you.

FATHER: “He gave me tweezers for my wedding gift.”

(laughing) [01:03:01]

THERAPIST: That’s right. “We each have a pair now.” You’ve got to not do that; and I know this is hard because both of you . . . I’ve told you the thing we hate about the ADD people, it’s your infinite tolerance for your chaos and then for anybody else’s – and that is as good an example as it comes. You’re like, “Oh, I need the tweezers. Now I’m done with them,” and then they end up in the bed, which is the definition of chaos – tweezers in the bed.

CLIENT: Okay.

THERAPIST: Did she solve that problem effectively? (laughs)

CLIENT: She did, but I don’t . . .

THERAPIST: No, but I don’t know how she’s going to solve it if she doesn’t ask you where they are.

CLIENT: Okay, besides all that she came and knocked on my door about six times – well, probably about five – and then she claimed that she came and knocked on my door again telling me to get up. She never did that. She never did that. She never told me to get up. I had no clue what time it was. [01:04:03] And then at 7:15 she texted me a long time ago and I was asleep. She comes up and she knocks on my door and she goes, “Kevin, are you going to get up? You’re going to miss your ride,” or something like that. I look and it’s 7:15 and we have to leave at . . .

THERAPIST: Do you think you should be able to be . . . I was just bragging on how you’re going into college and you’re mature enough to have privacy. Can’t you get yourself up now?

CLIENT: No because I forget to set my alarm.

THERAPIST: Get that app on your phone.

CLIENT: Can’t you get yourself up, dad?

MOTHER: Kevin, we’re talking about you.

THERAPIST: Oh, he’s not got his phone in there. We can’t do that.

FATHER: Yeah he does. He’s got his phone.

THERAPIST: You need to get that clock that when it goes off in the morning it has this loud alarm and there are two different ones. One of them falls off your bedside and rolls around on the floor.

CLIENT: We’ve got him . . .

THERAPIST: He can have one, too.

CLIENT: He does.

FATHER: I do.

THERAPIST: You have one? (laughs)

CLIENT: And he has the one that is a vibration thing that goes under his pillow. [01:05:02]

THERAPIST: Yeah, that’s another one.

CLIENT: He has that one, too, and it makes that noise and it flashes. He doesn’t care. He still sleeps through it.

MOTHER: Guess what his alarm clock is? I wake everybody up.

THERAPIST: Oh, no.

CLIENT: He has 20 alarms set on his phone like five minutes apart; and they keep ringing. And he can’t get up.

THERAPIST: Oh, my God.

MOTHER: I’m looking for the one that actually has an arm that comes up and goes “bam.” That’s the one he needs.

THERAPIST: Do you sleep through all of those? Holy cow. They’ve got an app that you have to stand up and turn around three times in order to get it to shut off. It knows what you’re doing.

MOTHER: Huh. Well he doesn’t even hear it, though.

THERAPIST: That has that really loud alarm. It’s like 130 decibels. It’s great.

MOTHER: The rest of us hear it.

CLIENT: 130 decibels?

THERAPIST: You’re going to have to – Oh, my God. I’m never going to get you married.

MOTHER: You have to get married or you’re going to live with us.

THERAPIST: I know. That’s part of my fear.

FATHER: We can bunk together.

THERAPIST: We’re going to have to work on this because you’ve got to be a better roommate than you are being. [01:06:06] All right. I’ve got to kick you out of here

CLIENT: [What are my parents going to do to me?] (ph?)

THERAPIST: What was the last part? I lost the last part of that.

MOTHER: Alarm clock.

THERAPIST: I don’t know what I would have done.

FATHER: Get yourself up.

THERAPIST: The tweezer dilemma is really a complicated problem because you really didn’t solve the problem by bugging him.

MOTHER: No, and I’ve had to replace them four times. This is my fourth replacement.

THERAPIST: Really? Four tweezers.

MOTHER: Yes, I use them twice a day and I know exactly where they are.

CLIENT: And she also said, “Kevin, I guarantee that they’re in your room. I’m going to come in there and check the whole room.”

THERAPIST: Well, she was only off slightly.

CLIENT: Yeah, it was on dad’s side of the bed, though.

FATHER: No.

CLIENT: (chuckles) Yeah, it was.

THERAPIST: I don’t think he was using it.

FATHER: How would you know?

CLIENT: How would I know?

FATHER: You just said, “It’s on dad’s side of the bed.” How would you know that?

THERAPIST: The four times you replaced them, Kevin had used them before? [01:07:03] You need your own tweezers, Kevin. When I marry you off the rule will be that you get to have your bathroom and your special space in your apartment and then the girl gets everything else and you don’t use her tweezers. You will be divorced in a week. All right, Ruth, hop up.

FATHER: I think we’ve found his new nickname.

MOTHER: Tweezer?

FATHER: Can we call you Tweezer?

THERAPIST: Yeah, that’s a good one.

CLIENT: We’re going to be playing a lot of pranks on you.

THERAPIST: Do we have one set?

MOTHER: I don’t remember.

FATHER: I think I did.

THERAPIST: You know what? My next person isn’t here. That’s odd. Maybe that’s what the texts were that came in.

MOTHER: I did to wake you up. Every morning. 6:30.

CLIENT: You did not. You’re so full of crap.

MOTHER: Yeah, so I would only wake your dad up and not you?

THERAPIST: We’re going to work on something to get him more self-sufficient on that. Maybe your husband . . . (laughs) [01:07:58]

MOTHER: Oh, my gosh. There for a while he was getting up. You were setting your own alarm and I don’t know why that stopped.

FATHER: Because it was his [ ] (inaudible at 01:08:10).

MOTHER: And you were. You were doing a good job of that, so let’s do that. Are these your kids in this room?

THERAPIST: Yeah. They are all mine. There is Evan and one of his kids. That’s not Bob, though.

MOTHER: They’re great pictures.

THERAPIST: Well, that is really strange. Let me see. I’ve got you on the 21st.

FATHER: That’s right.

THERAPIST: 4:30, is that all right?

MOTHER: Yes, that’s great. Did you say the 21st?

THERAPIST: Yes, the 21st at 4:30.

(chimes) [01:09:02]

THERAPIST: Ruth plays that sometimes. Sometimes she gets so into it that she just knocks it right off on the floor.

MOTHER: Do you have that written down somewhere, Wes, the 21st?

FATHER: What is the 21st?

THERAPIST: It is a Tuesday.

FATHER: You said 4:30?

THERAPIST: Yes.

MOTHER: Kevin, I’m going to text you the 21st and then just remind me to write it on the calendar.

THERAPIST: Is there somebody out there? No. They’re sitting out in their car.

MOTHER: Oh, they are?

THERAPIST: Okay, so we’re set. See you later, guys. Take care.

END TRANSCRIPT

TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: That is the fastest I have ever learned to use an electronic device. And having never tested it . . .

FATHER: Oh, is that the recorder?

THERAPIST: That’s it. So we’re going to put this right here in the dancing girl. Now, Ruth, you don’t need to say anything because I don’t think “meow” is going to be a part of the transcript. I will get the forms for you by next time to take a look at and, again, nothing is harmed if we record it tonight because if you want to do it, that’s the end of that – after I post it on Facebook. (all laugh) [00:00:59]

I’ve looked at your material here and today what we’re going to do is sort of figure out what brings you guys in, but let me get the note opened up here real quick, since we hand-filled it out. I have to type it in.

MOTHER: Could I have done that online?

THERAPIST: Almost. I’m close. You can download online and then type it in and bring it with you or you can do it here at the office.

FATHER: We can make you do it.

THERAPIST: I’m very close to having a – you have to have special encryption to do it and there is a company that can do that for me. What’s your date of birth, Kevin, so I don’t have to put this in?

CLIENT: December 24th, 2000. (pause)

THERAPIST: Okay. So you’re just now 13 and a couple of months. What do you think of being 13?

CLIENT: It’s pretty fun.

THERAPIST: Oh, yeah?

CLIENT: Yeah. I get a lot more responsibility. [00:02:06]

THERAPIST: Are you a super young eighth-grader or a super old seventh-grader?

CLIENT: Eighth grader.

THERAPIST: So you’re a super young eighth-grader? You’re like the youngest eighth grader possible.

CLIENT: Actually, there’s a girl that just turned 13, I think.

THERAPIST: Wow.

CLIENT: Yeah, she’s real young.

THERAPIST: Nobody ever has babies in the summer because I’m sure you remember what it was like to be pregnant in early July. (laughs)

MOTHER: Oh. We actually adopted, so we don’t know what that’s like.

THERAPIST: Now how did I miss that in the paperwork? Okay, so you are adopted. And at what age?

MOTHER: Newborn.

THERAPIST: So you just skipped the July pregnancy completely, just waived it.

MOTHER: Yeah, I saw how much misery people were in, so we just jumped. [00:03:01]

THERAPIST: Is the other girl that’s your age adopted?

CLIENT: No.

THERAPIST: Oh, man. Her mother had a bad pregnancy.

(laughing)

THERAPIST: All right. Kevin is 13 and let’s see here . . . This is the boring part of the session where I do the paperwork. (pause)

FATHER: I could pay to have somebody watch me work.

THERAPIST: Yeah, this is really bad performance art. And you’re Wes, right?

FATHER: Yes.

THERAPIST: And you have given me your name on here so I can’t cheat.

FATHER: Maggie.

THERAPIST: Wes Maggie. That’s cute.

MOTHER: It took a long time to find somebody that would work with my name. I didn’t see a slot for my name, I don’t think. [00:04:07]

THERAPIST: There is a flaw in my paperwork and that is it. You just figured it out. It asks a question. It doesn’t draw for that. It says “the family who raised you,” which is where your name would go, except there’s no place for your name. It just says “mom,” so go figure. And you are a full-time student in the eighth grade. And people are apparently frustrated with you. Were you aware of that? (pause) Uh-oh.

CLIENT: Well, like my parents?

(laughter)

THERAPIST: Yeah, I guess I wasn’t clear. I didn’t mean everyone.

MOTHER: He’s like “what did you put in that paperwork?” [00:04:59]

THERAPIST: Like the players and the coaches of the Miami Dolphins are probably not frustrated with you. But these guys are, apparently?

CLIENT: Sometimes. Not a lot, well, yeah. A lot. Mostly. Yeah.

THERAPIST: So what brings you all in? I’ll just let anyone respond, preferably in sequence, but I do have two ears so I can listen to two people at times.

MOTHER: I think . . . (chuckles) I was born in – no.

FATHER: [ ] (inaudible at 00:05:38)

(laughter)

THERAPIST: That will not be a good transcript.

MOTHER: We are struggling with some issues. Let me reword again. We have some school issues that we’re struggling with as far as getting the homework accomplished and trying hard and just not enjoying school, those kinds of things. That frustration brings out some other behaviors as well. [00:06:08]

FATHER: We have some anger issues, at times.

MOTHER: Aside from that, yes.

THERAPIST: With him or you guys?

FATHER: They go hand in hand.

THERAPIST: It spreads throughout.

MOTHER: I think there are several different issues. School issues is one. He has been diagnosed ADHD and we’ve been on medication, different kinds of medication, and it seems to work for his focusing and helping him control his behavior; however the stuff that we really like prevents him from being able to eat, so he loses weight on that.

THERAPIST: And which stuff is that?

MOTHER: The first thing we tried that we loved was Concerta and then he’s tried other things throughout the years, but what he’s on now is Focalin; and that was working fine for all of last year, I think, but just now he’s not liking how that’s making him feel. [00:07:11] He has tried a couple in between there. Vyvanse was one that made him violent, scary violent. We finally figured that out.

THERAPIST: Like how so?

MOTHER: He did not handle any kind of disappointment or anything well.

THERAPIST: Very irritable is what you’re saying.

MOTHER: Well, it was beyond that. He kicked holes in walls.

THERAPIST: That’s pretty irritable.

MOTHER: He’s a big fisherman and hunter and he ended up having all his fishing knives and everything taken away.

THERAPIST: Oh, that’s nice.

MOTHER: But I think that was due to medication.

THERAPIST: I don’t know what you guys know about meds, like from a what goes into them standpoint and I’ll talk about that in a second. Who is prescribing for him? [00:08:03]

MOTHER: Howard Keeps. You know who that is?

THERAPIST: Yep, his primary care physician.

MOTHER: Yes.

THERAPIST: When did you all first – and I have to use a pronoun, so I’ll use “he” but I know you’re here – when did he first take medicine?

MOTHER: Fourth grade. I’m sorry, do I have to do that math? Yeah, four years ago.

THERAPIST: The air is coming in. Ruth is hiding in her thing. Fourth grade, okay. And you’re in eighth, so that’s been four years. There are roughly two forms of medication for ADD and you’ve tried both of them. For lack of a better, more complicated chemical explanation, there are the Ritalin products and there are the Aterol products, or amphetamine products. [00:09:09] Focalin and Concerta are both Ritalin products. They’re identical except for how they get into your system. Vyvanse is more of an Aterol product, although it is kind of a complex designer form of Aterol. A lot of people who have problems on Aterol like you’re describing do not have problems on Vyvanse, so it is wise for you to avoid all products, given what you said, that are Aterol based or amphetamine based. That’s a good thing. What was wrong with the Concerta?

MOTHER: The Concerta was awesome. Loved it, but he could not eat. He was 90 pounds and ended up getting down to 81. He was thin and he looked it. [00:10:04] We loved it, so we kept trying. He just was not hungry. We ended up putting him on Intuniv also because we heard that that can help increase appetite, but then he became extremely lethargic.

THERAPIST: Right, because it’s a blood-pressure medicine.

MOTHER: We didn’t like that for him, either, because that’s not a fun way to live.

THERAPIST: Right, and it actually doesn’t seem to work for very long.

MOTHER: Oh, really? Well, it was expensive, too.

THERAPIST: Yeah. I’ve been down all these paths at some point in my life. Here is the worry I have. How is the Focalin operating right now?

MOTHER: I don’t know, to be honest with you, because – Kevin, what do you think?

CLIENT: I still don’t feel good during the days.

THERAPIST: What do you mean by “feels good?” [00:10:55]

CLIENT: My stomach growls. I feel like I’m hungry. I feel like I need to eat, but I just can’t.

MOTHER: As far as school goes and the focusing issues, I’m not sure that the dose might be high enough or I’m expecting too much out of the medication because we don’t seem to be – your time management skills don’t seem to be there, staying focused. A teacher just e-mailed me that he’s still easily distracted in school and that kind of stuff.

FATHER: I think it’s not as good as the Concerta.

MOTHER: He’s bigger now, too.

THERAPIST: All of these things. Do you remember how much Concerta he was on?

FATHER: By the day?

THERAPIST: No, it’s got to be . . . That’s very funny, Wes. I got it and you’re going to be surprised by how perfectly that joke fits into what I’m going to say in a second. [00:11:59] His choices would have been 18, 27, 36, or 54.

MOTHER: The last dose he was on was 36. He started out 27, I believe.

THERAPIST: Right. Entirely possible.

MOTHER: The most recent he was on Concerta – I actually did all of this – March of 2012, I believe.

THERAPIST: So what dosage is he on Focalin? I don’t know those doses real well.

MOTHER: Twenty, 20 mg. He did try another one. Can I just throw this one out?

THERAPIST: Sure.

MOTHER: Just recently, Focalin was kind of working, but he was starting to feel icky with it so Dr. Hughes prescribed methylphenidate.

THERAPIST: Right. That’s the same exact thing. That’s the formula which Focalin and Concerta are made of. So he gave him a booster at the end of the day to take, right?

MOTHER: No.

THERAPIST: When did he take that?

MOTHER: This was separate from the Focalin. We tried to discontinue the Focalin and he tried that methyl-whatever.

THERAPIST: Methylphenidate. [00:13:01]

MOTHER: He was going to take 10 mg for seven days and then up it to 20 mg. But he took one pill and became beyond angry and blamed it on the medicine.

FATHER: I think there’s a combination of that being part of it and having an excuse to be angry.

THERAPIST: There are a few things that are a little confusing about the generic terms for these things because methylphenidate is the ingredient in all of those medicines, but I think it’s possible – was that an extended-release methylphenidate? Do you remember that?

MOTHER: Yes, so it would be an all-day. Yes.

THERAPIST: All right. Because these are all the exact same medicine. There is no difference in any of them. It’s how it distributes into your system that’s different. And just for your edification and knowledge because we want Kevin to be highly educated in this, Concerta is what I call the nuclear bomb of Ritalins because it comes in a little thing that’s shaped like, if you’ve ever been in an Air Force museum, it looks like a tiny atomic bomb. [00:14:13] It leaks material out through a hole into your system and then you poop it out. You drop the bomb. Out it goes. Okay.

CLIENT: (laughs)

FATHER: So it’s time released?

THERAPIST: But it’s a special kind of time release because Focalin is time-released, too, and I think it’s more traditional like time capsules maybe. It’s in a capsule, isn’t it?

MOTHER: Yes.

THERAPIST: Yeah. Then this methylphenidate is what used to be Ritalin XR and that’s just another way of putting out a time-released formula. Of the several, the one that seems to cause people the least trouble is the Concerta because of the way it goes out. That’s why it’s so popular. It just goes into your system. [00:15:01] It doesn’t last as long as they want it to, but it lasts longer. So that’s why I was wondering if it was an extended release because if it was a 10 mg methylphenidate fast-acting, then he’s getting that all within four hours and that could have explained it. These weren’t generic for very long. All of these have just recently become generic.

FATHER: And the episodes usually are evenings, nighttime.

MOTHER: Right.

THERAPIST: And you’re telling me – how long was he on Concerta?

MOTHER: I actually didn’t finish doing all of this, but it looks like back in 2012 at least until March he was on Concerta; and I don’t have Focalin written down until January of 2013.

FATHER: He didn’t all summer.

THERAPIST: Didn’t what all summer?

FATHER: The Concerta all summer.

MOTHER: I was doing this and I kind of forgot to continue, so somewhere in 2012 he switched from Concerta to Focalin.

THERAPIST: So I’m almost scared to ask because I probably already know the answer. Since fourth grade how often has he taken breaks, I mean dead-cold breaks, from the medicine?

MOTHER: I think this past summer was the first time.

THERAPIST: Okay. So that’s good and bad.

FATHER: I don’t think he did the summer before, right?

MOTHER: He didn’t want to take it, but the family dynamics are better when he’s taking it. So although there wasn’t school, it was helpful.

THERAPIST: So here’s what apparently you don’t know. I can dig up the article for this. It’s in the Journal of Neuroscience; and I only say that because I don’t quite know why nobody knows this because those of us that do this a lot know it intimately. [00:16:58] These medicines hit the same neuro-receptor sites as things like caffeine and cocaine – not that you should be doing that – and if you think about your friend coffee, if you drink coffee once in a while, boy, it’s going to really give you a kick. If you drink it every day, the more you drink, it will be less of a kick it will give you. That is exactly what happens – and I have two kids with ADD, so I live with this here and at home. You have to have regular breaks from it, roughly quarterly or, what we do with students, is every school break.

Now I understand the dynamic of which you speak. And when he starts driving that will become another concern. But nevertheless, the research tells us that after two years of continuous use, the response of your brain, the level of effect will diminish to the point where you can’t tell you’re on medicine. [00:18:11] Some people have misread that to say that these medicines don’t really work. That is not at all correct. They work quite well and if you take them and give yourself about a 14-day break every so often, quarterly or so, then they will stay at their greatest flourish. In fact, when you go back on them, you will have a renewed effect. So if you’ve gone up between the periods that you’ve gone off, you’ll get hit pretty hard when you go back on.

My first suggestion right out of the chute before we get into a lot of the other things that I know are important, is you plan breaks on holidays. [00:19:00] They don’t have to be the whole holiday or summer, but what we usually do is if you want to have someone on medicine for behavioral reason or driving or work or whatever in the summer, you do two weeks at the beginning of the summer and two weeks right before school starts – off. And then you can be on it in between. You might say wow – and you can talk to Dr. Hughes about this and tell him that this is my recommendation – you might say how does one do that? And if you go down slowly off of it, it just takes you that much longer, so usually going off pretty fast shortens the amount of time you have to be off. In the first three or four days you go through a kind of withdrawal. I don’t mean that like heroin withdrawal, but your neuro-receptor sites are suddenly starved for dopamine and so whatever this gentleman is like in his wild state with no medicine, he will be about five times more so. [00:20:04] If he’s argumentative, he will be more so. The best thing to do during that time is to choose not to get into it very much. Don’t make any decisions; don’t go to Disneyworld.

FATHER: We could go on vacation though.

THERAPIST: Well if you wish to leave him on a desert island or something with sufficient entertainment, video games or whatever, and he’s amenable to that, I will not judge you. (all laugh) One of my kids sleeps for three or four days coming off medicine and one of them dances around the house and is Mister Lively. It just depends on what you’re like off meds. Then after about four days he will be his core person. It’s sometimes a little longer than that. By the end of the four weeks, he’s free of all the effects of the medicine. That’s not because the medicine slowly washes out – it’s gone. [00:21:05] It’s because the effect of the medicine, the built-up receptor sites continues for two or three weeks. That will help him be in the least amount of medicine and have it be the most effective. Now if he just started back on in the middle of August and you don’t feel like it’s working very well at this point, it’s more likely that he’s not on enough medicine, as you described.

FATHER: Or he doesn’t want to take it.

THERAPIST: Oh, we shall address that fascinating concept shortly.

FATHER: My opinion would be I don’t want to force medicine on him. I think that should partially be his choice. I don’t know how he feels when he’s on it, so I can’t judge “Kevin, you have to take this.” [00:22:05] Although it would help the family dynamics, I have a hard time saying “you have to take your pill today” because I don’t have that experience.

THERAPIST: I shall ask you your opinion about that in a second, Kevin. One thing I know is that it is not incidental that he is not hungry on medicine. If you’re hungry on medicine, then you aren’t on enough medicine. Hunger and focus just happen to go hand in hand, not because they’re controlled by the same part of the brain, but because the medicines that are the original Aterol medicines, amphetamines, were not originally designed in the late ‘50s for ADD. They were designed as weight-control medicines and they found that after, guess what, two years they quit working, the same thing we realized with the stimulants for attention. [00:23:01] It is somewhat of a necessity to not be hungry. One of the things that has worked well with my kids and the kids I see here, and it’s a little more complicated than I can explain, but there are ways with some medicines to control the dosage, with the agreement of your physician, in much more incremental amounts than what you can do going a step up.

FATHER: So you don’t have to go from 24 to 36?

THERAPIST: Correct. At some point I will explain that to you. It isn’t hard, but it sounds like algebra when I explain. (laughs) And it’s not. When it was first explained to me I was just like, “I don’t even want to think about this.” It’s not that bad and it has to do with proportion of the medicine. But there are certain medicines you can do this with and others you cannot. You cannot do that with Concerta because you can’t make the pills smaller. It’s inside, it’s gone, and it’s going do what it’s going to do. [00:24:01] All right, so what is your opinion about medicine, Kevin?

CLIENT: I like how it makes me focus and everything but everything else I just hate about it.

THERAPIST: So I know the eating part you don’t like. What’s the other part?

CLIENT: I’ve always wanted to eat things. I can eat a whole jar of peanut butter. I’m not bragging about this at all. (laughs)

THERAPIST: Well then I don’t see you having any problem with medicine.

CLIENT: No.

THERAPIST: So what is wrong with the medicine then with peanut butter?

CLIENT: I just like to eat and I don’t like not eating because it’s kind of embarrassing at school – like I don’t eat anything.

THERAPIST: There is a slight cognitive problem here with everybody. I’ve never quite run into this this way before. Actually I have had this argument with one person I can think of, my son. Now that I thought about it, I do remember this. [00:24:59] Eating isn’t a voluntary response. (laughs) You kind of have to eat whether you’re hungry or not. What happens when you do that?

FATHER: When you eat when you’re not hungry.

CLIENT: 2. I don’t know.

THERAPIST: You haven’t considered this before? Oh. We’re going to have to work on that because this is such a common problem we have to work around it.

FATHER: I was thinking you said at one time you would eat but you almost felt like throwing up.

CLIENT: Oh, yeah. If I do eat when I’m on the medicine, I want to eat but when I do it feels like I’m going to throw up. That’s exactly how it feels.

THERAPIST: Well, you can’t probably have a buffet. I understand that’s probably true. How late in the day does this problem happen for you? Aren’t you hungry by about 7:00 or 8:00 in the evening? [00:26:00]

CLIENT: No, not with the medicine.

THERAPIST: You guys agree? I mean by observation.

MOTHER: I think part of that, Kevin, is eating a bag of popcorn before dinner – that you might not be hungry for dinner, but you’ve eaten a bag of popcorn. You’ll eat that at least.

CLIENT: Not when I’m on the medicine, though.

THERAPIST: Well you surely are eating something or you’d be dead. You look healthy.

CLIENT: That’s because I didn’t take the pill over the summer and I went up to 134 pounds. Sometimes I can barely eat dinner. I have to force it down usually.

MOTHER: Okay, you just told me today that you had a ham sandwich at school.

CLIENT: Yeah, but that was a little square that had two slices of cheese on it.

MOTHER: Okay, but how did you feel when you ate that?

CLIENT: I still had to force it down. [00:27:04]

THERAPIST: That I believe. I don’t dispute that. What time do you take the medicine?

CLIENT: In the morning around 7:20.

THERAPIST: When do you eat breakfast?

CLIENT: Usually around 6:00.

THERAPIST: So you eat before you take the medicine?

CLIENT: Yes.

THERAPIST: Well that’s right. What do you eat?

CLIENT: Oatmeal.

THERAPIST: Yeah, you need that, brother. That’s the right thing to eat.

CLIENT: That’s pretty much it.

THERAPIST: Alright. That’s the ADD people’s best food. Would you care to guess why? There’s a very specific reason. Do you want to guess why?

FATHER: Easier to digest?

THERAPIST: No, that’s a good guess, actually. It’s because oatmeal is a slow-release carbohydrate and where people get into trouble with medicines, in part, is because if they don’t eat then their blood sugar drops and then they’re annoying. [00:28:07] And you think it’s medicine and it’s really low blood sugar. Oatmeal is a slow-release sugar, so that actually gets him through the morning. That’s the best news I’ve heard so far. o you can do that every day, huh? So that’s one meal down. The thing about Concerta – I know you’re on Focalin – is that on the outside of the bomb, it actually has methylphenidate painted on it so you start getting a hit from it pretty quickly. It’s better to eat and at the very end of eating, take the medicine with your food. So you’re doing that right. The with Focalin – you said how much is it?

CLIENT: Twenty.

THERAPIST: And we’re back on that now, right? That doesn’t make you violent or anything, right?

CLIENT: Not as violent as I used to be.

MOTHER: He still gets angry, but not violent, I wouldn’t say. [00:29:01]

THERAPIST: Can you track that for us? Maybe you already know the answer to this, this blood sugar drop situation I’m concerned about. Do you know what time of day this anger problem happens?

FATHER: Any time.

MOTHER: Well, I would say like he said, eight-ish.

THERAPIST: In the evening?

MOTHER: Yes.

FATHER: Always later in the day.

THERAPIST: Okay. That is really important.

CLIENT: Or when my sister gets home.

THERAPIST: Well, sure. How old is she?

FATHER: Eight.

THERAPIST: Oh. That’s pretty difficult, isn’t it?

CLIENT: Yeah.

MOTHER: He doesn’t seem to handle frustration or disappointment or annoyances very well, so he’ll be angry before that but later in the night is when it gets kind of . . .

THERAPIST: So that’s when the medicine is washing out. All of the medicines are washing out and I think I have a good idea that’s going to fix some of this that you can get on board easily with. [00:30:06] First of all, how’s your sleep? [00:30:08]

CLIENT: It’s really good. I’ve been going to sleep really early. Sometimes I’ll wake up in the middle of the night and get something to drink.

THERAPIST: What’s really early to you?

CLIENT: 4:00.

THERAPIST: To go to bed?

CLIENT: Oh – yeah. (laughing)

FATHER: 2:00, or maybe at 3:00.

THERAPIST: I was going to be like, “Surely not.” Okay. What time do you go to bed if it’s early? When you think about it being early?

CLIENT: Probably around 9:00.

MOTHER: I’m sorry. I have to disagree. It’s never going to be before 10:00, probably 10:30 or 11:00.

CLIENT: But usually I fall asleep doing my homework.

THERAPIST: Yeah. Huh. Interesting. What happens is you get into wash-out with the medicine and two things happen, depending on his eating. [00:31:03] If he didn’t eat very well, that doubles down on the medicine washing out; so he has a blood sugar drop and he has the medicine wash-out period, which is a classic problem with all but about one or two medicines.

FATHER: What do you mean “double down” if he doesn’t eat?

THERAPIST: If you ate good and your medicine is washing out, you’re going to be irritable and we call this in my home quiet time. Nobody bothers any minors when they’re having quiet time because they’re having wash-out. Their frustration tolerance disappears. They’re really at their most vulnerable because they’re sort of in their in-between state. There are kind of two theories about that, forgetting food for just a second. One theory is that your brain has just worked all day, stimulated by medication, and as the medication washes out you’re just sort of worn out, which is why I wondered when he’s sleeping, if he gets tired. [00:32:01] The other theory is that it’s just part of the withdrawal process each day because this medicine is gone by a certain time of the day and, like that four-day period I was talking about, this is the mini version of it. The good thing is people usually bounce back after about 40 minutes to an hour of that and then they’re kind of okay – okay being it’s 10:00 at night and they’re worn out so they go to bed, but they’re not belligerent usually. If you didn’t eat well during the day – let’s say you aren’t even taking any medicine. If you don’t eat during the day and you get home, you will kind of be irritable and annoying because you don’t have a good blood sugar. And those of us who are type 2 diabetic know this intimately. If you take both of those problems and put them together at the same time of the day you get the effect you’re looking at. That’s why I was so critical in a way. [00:33:04] I’m not saying there isn’t a frustration tolerance at other times because he probably does have problems with that, but that’s when the critical time is. You want to do as little during that projected period as possible. That’s not the right time of day to say, “Why didn’t you clean up your room?” and blah, blah, blah. There are fine times of the day to do that (chuckles) or during the week, but that’s just going to set off a chain reaction.

FATHER: So that just says homework when you get home from school would be preferred.

THERAPIST: That would be the preferred timeframe for that. I actually have some ideas about that. We may talk about it at some point. (pause) I’m thinking which way I want to go. (pause)

FATHER: Let’s go east. [00:34:01]

THERAPIST: Or there’s always west and north and south. There are four different issues to hit. He’s never been on Daytrana, the patch?

MOTHER: No. I’ve heard about it.

THERAPIST: I think I would be getting mighty interested in that for a bunch of reasons. I’m a big fan of it. I promise you I do not own any stock in it, but I do get the discount card which is pretty nice. Daytrana is a patch and you stick it on your back. That will bypass all of your gastrointestinal system, which is kind of nice. It’s exactly the same medicine you’re taking right now, but it’s on a sticker. The advantages are multiple. First of all, it lasts a long time and they tell you if you want to take it off at 4:00 in the afternoon you are free to do so. [00:35:02] It’s the only medicine you can take off so if you have a day – maybe a Saturday or something – and you want to take it off early, then you’re going to get hungrier in the evening and all is good. If you need to do homework you can leave it on. It isn’t like it gives you too much medicine because it goes up like this and then sits at a plateau across the day and it really doesn’t ever wash out until a couple of hours after you take it off, it drops off. [00:35:37]

FATHER: I’m wondering how long it would take to . . .

THERAPIST: It goes on a long time and the reason I asked him about his sleeping is because he isn’t getting any negative side effect of sleep. Some people with ADD sleep better. I went to a workshop at APA one time and they talked about using it at night for people with ADD (chuckles) to help them get up in the morning; so there is a somewhat odd effect with dopamine and the ADD people. [00:36:06] It sometimes helps them sleep. I’ve had people who can’t tolerate Ritalin products because they get sleepy on it. He isn’t having that much of a problem, but it’s also not messing with sleep. Here’s the other property of the patch; and let us all remember that I am not a physician so your physician has to okay this. The patch can be cut literally with scissors and the material that is the adhesive is also the medication, so it’s not going to leak out. If your pharmacist tells you that you can’t do that, this isn’t true. The drug reps taught me this. This allows you to tailor the size of the patch to be precisely the amount of medicine he needs. So if Dr. Keeps is willing to give him what he thinks he’ll need by the end of the semester – let’s say 50, I think, is one of the patch numbers – and then you start off and that’s too much and he’s like “I feel way over medicated” or “I’m jiggery” or you see anger, cut off a part of it next day and give him less medicine. [00:37:21] My son, he’s going to be ten, and since he was seven or eight he can tell you if you need to cut each patch down. He can tell. He’s very aware. As his great quote was once, we were on the way home and he goes, “You need to cut my patch tomorrow.” I was like, “Oh, yeah? How come?” Because we had just gone up. He said, “You need to balance my tolerance with my focus.”

MOTHER: Wow.

THERAPIST: And that is exactly what you need to know. You are balancing focus and tolerance. His eating is also impaired, but he’s learned that though it has been difficult, you have to eat, whether you feel like it or not. [00:38:04] You can also get Ensure and use that with him to get his calories in him. Put it in a milkshake or something. Do you like milkshakes?

CLIENT: Oh, yeah.

THERAPIST: Put the Ensure in a small milkshake.

CLIENT: I used to have a protein drink.

MOTHER: You did. Muscle milk, I guess.

THERAPIST: Was it good?

CLIENT: Oh, yeah.

MOTHER: Then we just kind of forgot about that, I guess.

THERAPIST: He’s just got to get a certain number of calories and if you’ve got to get him on Ensure – I understand eating at school is an issue. I heard you when you said that, but if you can eat a sandwich like that at school and drink – I don’t care if you drink it in muscle milk at the cafeteria or whatever you want to drink – that’s got calories and nutrients in it, you’re good to go. Which brings us to the other point. [00:38:56]

My view of this is we have to all work as a team. You have input, you guys have input. What I have is 21 years of experience and I know exactly how to succeed with ADD and I know exactly how to fail. I can tell you how to do both. I’m writing a book about this right now. The fastest way to fail is to not adhere to medication and to be very precise about it, like we’re talking about today. You don’t want to be on too much and you don’t want to be on too little and on breaks.

FATHER: And you want to be consistent.

THERAPIST: And you want to be consistent. And the only inconsistency and we haven’t talked enough about this so I’m really not telling you that you ought to think about this right now, but it is something we did discuss. If you go to the patch, some people are okay on the weekends not taking it. I’m not sure you’re one of them because then they eat more and they can kind of get caught up on that. [00:40:00] Alternatively what might be more possible here is to do – and we do this – a much smaller patch on the weekend; and then he’ll still be able to focus but not as medicated as the eating would be impaired. These are things you can’t do with these other medicines. You can’t cut the other medicines. Vyvanse you actually can cut, but there is a whole other way you have to learn to do that and since Vyvanse didn’t work for him, we won’t even think about recommending that. I’m not a big fan of being off on the weekends completely.

FATHER: I think that would spike it.

THERAPIST: It does. You get all the problems of taking a medicine break and none of the benefits. The only reason is for somebody to eat and I would say you would be better off going and dropping dose just for the weekends and not taking him completely off. I think you will like that better because you will have more hunger on the weekend, but you won’t be all zany. [00:41:06] What are his symptoms when he is off medicine? And I don’t mean in the first few hours, like when he’s been off for the summer.

MOTHER: It’s awkward because he’s sitting right here. It’s a little awkward with him sitting right here, but he knows.

THERAPIST: Well that’s because we’re all on the team, aren’t we, Kevin? We’re on the team.

MOTHER: He knows. He acts very young.

FATHER: Yep.

MOTHER: Very low frustration tolerance. Very quick to be annoyed with Jessica or just anything.

FATHER: Combative at times.

CLIENT: That’s really rare, though.

MOTHER: And that might be more on the medicine than not. [00:42:01]

FATHER: I’m thinking maybe frustration or disappointment or when he doesn’t get his way.

THERAPIST: The ADD people don’t like to be uncomfortable, so any of those things are really uncomfortable. None of us like to be uncomfortable, but the ADD people have no tolerance for it. Uncomfortable and boredom are two things they don’t have good tolerance for.

CLIENT: That’s why I hate homework.

THERAPIST: No doubt that is true, sir. Uncomfortable and boredom.

CLIENT: Because I’m at school for like eight hours and then when I come home I have another 3 ½ hours of homework.

THERAPIST: That’s probably too much homework for you. Are you serious about that?

CLIENT: Yeah, math and algebra. She has us work these problems that take five to ten minutes each and she gives us 20 of them. [00:43:00]

THERAPIST: You should have 80 minutes of homework and no more. What is your read on that?

CLIENT: My mom just says, “Every person in the entire world has done homework.”

THERAPIST: That is true, but they shouldn’t do three hours of homework in eighth grade.

MOTHER: I didn’t mean to do this to you. A large portion of this is he doesn’t get homework done so he has today’s homework to do plus the stuff he didn’t get done; so it’s actually like twice as much a night as he needs to be doing.

CLIENT: Because I have so much the day before.

MOTHER: And it’s a lot. There is a lot of homework. I don’t know whether it’s time-management skills during the day that’s getting it done at school, but there’s a lot of homework at night and every night there’s something that hasn’t been turned in prior that he’s having to try to catch up on.

CLIENT: And then when I come home I have so much pressure put on me because she’s always – like right when I get home she’ll just pressure me so much about turning things in. [00:44:07]

THERAPIST: In what way?

CLIENT: Like she’ll get mad if I don’t have something turned in and I’ll get in in the mornings. I get up and then she reminds me that I have to go in and talk to a teacher about something. I don’t know how to explain it, but there’s just a lot of pressure put on me. I’ve told her about it and, I’m sorry, but I don’t really think that she understands because there’s just so much of it. (pause)

FATHER: I don’t think the homework takes that long. The process may take that long so it’s suggesting when to start the homework, the resistance, the procrastination, the annoyances or distractions. [00:45:09] I’m the type once begun, the task half done, if you just start it and concentrate at the beginning and no bring out your emotions and feelings and “I can’t do this” and “I can’t do that” and “I don’t want to do this;” if you just start it, that’s half the battle and it won’t take as long.

THERAPIST: Well that’s because you don’t have ADD.

FATHER: Right.

THERAPIST: (chuckles) You just did a really good description of what it’s like for the ADD people in this situation. But I’m also not saying that as an excuse because ADD is only an explanation. It can’t become your master. How many days a week does he have homework.

CLIENT: Every single day.

MOTHER: I would say five. [00:46:00]

CLIENT: Yeah.

MOTHER: I think every night.

CLIENT: In math she gives us super long assignments.

THERAPIST: What math are you in in eighth grade?

CLIENT: Pre-algebra; and I don’t want to be in that class because it’s way too hard for me.

THERAPIST: What’s the next step down?

CLIENT: Concepts of algebra. That’s what I would like to be in.

THERAPIST: How did you end up in pre-algebra?

MOTHER: The school designated that and, at this point, to switch him it would change the entire schedule around. He struggled with math last year, as well.

THERAPIST: How did they end up putting him in that class if he already had problems?

MOTHER: I don’t know. I don’t know.

THERAPIST: That was an unfortunate situation.

FATHER: But again, he’s getting an A in it.

THERAPIST: Wait a minute – you’re getting an A in it?

FATHER: He’s getting an A minus.

THERAPIST: Oh, I didn’t even ask because I thought it was such a disaster I hated to ask.

MOTHER: It is a disaster and yet they grade differently these days. The assignments are you turn them in and if you did the work and make the corrections, then you get the full credit for it. [00:47:05] So it’s not a true – like when we went to school if you missed it, you missed it. It’s not like that.

CLIENT: But on the test I did get a 91.

MOTHER: He did.

THERAPIST: That’s really good, Kevin.

FATHER: He’s a smart kid. He’s really bright. It’s not turning in assignments, so there’s zero out of five points or things like that. That’s where he gets hit a lot. I mean he’s smart. He’s very smart.

CLIENT: If they graded it on how I did, I would definitely have an F in that class.

THERAPIST: Whoa, whoa. What?

CLIENT: Like if they graded on how good I did and how many I missed, I would probably have an F in that class right now.

MOTHER: And that is true.

THERAPIST: So the first run through you don’t get them right; and then you go back and you make corrections and that’s where you gain back the credit?

CLIENT: Yeah.

THERAPIST: That’s very self-aware of you, Kevin. You understand that. [00:48:00] And if that’s true, then how did you get a 91 on the test? You didn’t get to go back and correct that, did you?

CLIENT: It was the very first test, which was really easy. We had been starting out on stuff that we had ended off on last year and some of the stuff that we even learned in sixth grade. On half of it we couldn’t use a calculator, but you could show out your work. Half of it was easy because you were able to use your calculator, but she never lets you use your calculator. Twenty years from now we’re not going to be using paper and pencil.

THERAPIST: Right because you’ll have Google glass on your glasses. You’ll just look and think about things and they’ll just add up; but you’ve still got to learn the basics. [00:48:58] I have many thoughts about this and then we’re going to run out of time and we’ll pick up here when we get back together. My first thought is you’ve got to change up how you’re doing this because he’s only in eighth grade and he’s going to give up before he gets out of high school if we’re on the path that we’re on right now. The number is you’ve got ten minutes for every grade level you’re in and he’s in eighth grade. The maximum allowable dosage of homework per day is 80 minutes period. I think we need to change the name of this to Study Time. Normally I say that because one should never ask a boy whether he has homework or not. That’s like asking him if he’s having sex with that girl you hate.

CLIENT: It’s about as common, too.

THERAPIST: (chuckling) There’s no way that he’s ever going to answer the truth, so you just say it’s study time. It starts a certain time and it ends 80 minutes later. [00:50:02] You need about 80 minutes. You need about two breaks in the middle of that, so it’s going to take a little longer than 80 minutes, but you don’t have to work more than 80 minutes. You need about a ten minute break every hour.

CLIENT: Usually she’ll make me do all of it at one time, but I just can’t do all of it at one time so sometimes I go downstairs and that’s where she gets that I’m procrastinating.

THERAPIST: Well I believe that you procrastinate like a big dog, so I have no doubt that’s true. You’re right, also, that there is a limit; and your limit is 50 minutes in one sitting.

MOTHER: That’s not really accurate, okay?

CLIENT: I just know I do so.

MOTHER: Well whatever is accurate in the past, let’s change it. You come home and it is true, regardless of what medicine you’re on, though I think the Daytrana will help with this, you need to do homework fairly soon after school. [00:51:05] And then once you’re done with it . . . No, I see I used the word homework; that was terrible. Study time. I’m trying to get better. Study time you have in two parts, a 50-minute period and then you need about ten minutes to just run or whatever you do. And then another 30-minute period and you’re done. I don’t care what happens. I don’t care if he’s finished. He’s got to be done. By then it’s just too much. But he needs to do that every night of the week except – go ahead.

MOTHER: A large portion of the frustration is that the assignments that have not been turned in in the past. I don’t know how to handle that.

THERAPIST: By this you mean they weren’t done or he lost them? [00:52:00]

MOTHER: They were not done.

FATHER: Or he has them and hasn’t turned them in.

THERAPIST: That’s the one I’m looking at here.

MOTHER: It’s very hard to monitor whether or not they’re done. He might tell us they’re done and they’re not, so it’s really hard to monitor all that. Just, for instance, out of 14 assignments in math already, seven have been late.

CLIENT: Because it’s so long and so hard.

MOTHER: Okay. In this formula you’re talking about, he has work that hasn’t been done because he’s not done it plus he has the new stuff. I don’t know how to . . .

FATHER: Catch up.

THERAPIST: He may lose all that work. There’s no conceivable way he can do more than 80 minutes of work at a time. It just can’t be done. He’s going to go to pieces. And if we need to go to the school and have them do reduced homework, then that is what we will do. That is a perfectly fine idea because some people get the concept after three problems and some people aren’t going to get it after ten. [00:52:58]

FATHER: Well they get more frustrated.

THERAPIST: (chuckles) Exactly. And so he needs to tolerate exactly the right amount of frustration and no more and no less; and 80 minutes for an eighth grader is the maximum. And if you’ve got ADD you need to split it into two parts of 50 minutes, 10 minutes, 30 minutes – that’s it. I mean he’s got to be done. This can’t just turn into a meltdown fest because he’s correct, that’s a lot of time. And they’re going to have to make modifications. On your end of it, Kevin, my version of reality is that at this moment in your life you’re probably going to have to do the 70 minutes every night, seven days a week. If I were you, my goal would be to get less days doing homework and the only way you can accomplish that is to get them turned in. The turning in process seems to be quite a problem for the ADD people. Homework seems to end up stuffed in the couch and on the floor of the car and in your locker. I don’t know. Are there things you do that don’t get turned in? [00:54:05]

CLIENT: Not really. Usually I just don’t finish them because I’m either confused and the teachers don’t understand. Like today, for example, in Spanish there was this one assignment that I thought we had already done. It was pages two and three and, except the directions, everything is written in Spanish and it’s kind of confusing. I’m sure that we had already done this page, and so I got in and I asked her if we had already done this page and she said, “No. It looks exactly the same. Everything is the same, but we’re just doing it again,” or something like that. [00:55:01]

THERAPIST: The ADD people’s version of hell is having to do the same thing over again.

CLIENT: Yeah. Yes. And so when she comes around to look to see if we had done it – because we’re just starting out; she’s just taking completion grades to make sure that you tried – she sees that I only had one assignment done out of the two because I thought we had already done the other one. And before I could say anything she said, “Oh, it looks like you’ve chosen not to do your homework again.” And then she walks away without letting me say anything.

THERAPIST: People have decided that your goal in life is to be a pain in the ass and you’re going to have to convince people that this is not true because the secret of happiness is how you organize your life. A good way to do that is to make people like you and if people think you’re sketchy, they aren’t going to believe you when you say “I think I did this already. I’m confused.” [00:56:07] If people think you’re just being a pain in the ass they’re going to get back at you, right? She was real snarky with you.

CLIENT: Yeah.

THERAPIST: Because she thinks, “Oh, I see you’ve chosen not to be in our class.”

FATHER: It could have definitely been worded better.

THERAPIST: Well, yeah, but he’s selling the wrong product to you guys and to them and people don’t have appropriate empathy for your situation. Like you said they don’t understand. I actually knew where you were headed with that, even though you didn’t finish the sentence. People don’t have empathy for you because they think you’re being a dick and we’ve got to get that done because people aren’t going to help you and reach out to you. I have this really nice college girl I see and everybody loves to do things for her and she is as ADD as you will ever be. She is so good at making people like her that they will just do anything to help her out. [00:57:04] “Oh, can I take notes for you?” “Sure. Whatever.” She’s actually great. She’s a good student and everything; but she is so good and she didn’t used to be when she was in high school. She was very shy and quiet and she has really come out of her shell and learned how to get people to do things for her and be really happy about doing them. We shall have to teach you how to do this because you aren’t getting there yet, but we will get it.

MOTHER: Part of that frustration is they can get their homework online and so the teacher put on there what the homework was, so for kids to come in and say “I thought we had already done that.”

THERAPIST: He did not seem credible, did he? He didn’t seem credible at all.

MOTHER: And so that could be part of the frustration, too.

THERAPIST: He’s going to have to be more credible. Okay, so we’ve got to wind up and we’re now right at our hour point. [00:57:59] I’m going to have you meet up with Sara and get another appointment and go look into these long lists of things and then see what you can figure out. I think he would benefit from a switch over to the Daytrana. There is a coupon online for that. I get mine for $5 and under, at this point. (chuckles) You can get up to $60 off the co-pay.

MOTHER: We pay a lot more than that for the Focalin.

THERAPIST: Right. I like to keep your costs reasonable.

MOTHER: That would be lovely.

THERAPIST: These are medicines that are lifetime medicines and so you have to learn to consume them economically and I know how that is. I get my Vyvanse for $30 and my Daytrana for [ ] (inaudible at 00:58:47).

MOTHER: Great.

FATHER: A quick thing. You have 80 minutes of homework that you’re supposed to do, but that means you’re doing homework for those 80 minutes.

THERAPIST: Thank you, Wes. I actually forgot to mention that. By cutting down your timeframe, which I am wisely doing because I am on the team, you have to be on the team and then actually, in that 50 minutes, your goal is to get as much done as you can and then you have a ten minute break and then you have 30 more minutes. Your ultimate goal is to try to get this down to roughly four to five days a week maximum because you shouldn’t actually have to do this on the weekend, but your mother is telling me you’re behind and so we need to give you a chance. And then next year when you’re ninth grade it will be 90 minutes, but let’s not look ahead to that for now. All right. See if you can get in in a couple of week.

MOTHER: In a couple of weeks?

THERAPIST: Yeah, that would probably be a real good idea.

END TRANSCRIPT

TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

NO VOICE UNTIL 00:01:47

THERAPIST: Hello. Come on back.

FATHER: Were you checking on me to see if I was asleep? [00:02:04]

THERAPIST: (chuckles) No. I thought I heard everybody out there and I wanted to be sure you guys knew that it was at 4:30, but then I got out there and realized it was still just you, so I figured you knew that. I heard you talking on the phone so ...

FATHER: I knew that once I came here. I forgot it was 4:30. I thought it was 4:00.

THERAPIST: Oh, you actually thought it was 4:00? Okay, so I should have phoned you.

FATHER: No, she told me.

THERAPIST: I see. I'm going to have you turn the blinds there since it gets kind of a glare behind you. (pause) [00:03:15] Hang on a second. I'm having connection issues. Oh, I'm on the wrong network. You have to be on the right network in order to pick up my clients. There's a public network and a secret network that you guys can't see. (chuckles) This thing flipped over to the public network which, fortunately, doesn't allow me to access work files. We met on the 24^th and what have you guys discussed about your correspondence to me? [00:04:05]

FATHER: We have not had a chance to discuss. You just got it, she e-mailed it to me and I've read it; that's all we've done.

THERAPIST: So Kevin is not aware that you've corresponded with me.

MOTHER: He knows just from driving up that I sent the letter to you.

THERAPIST: Where do you guys want to begin? I'm full of thoughts. Hop in there, Wes. (pause)

FATHER: I think it's the anger issue that I'd like to address as one. I think that Maggie mentioned that when he gets his way he's great; but there are times that he gets very, very angry and over-the-top, uncontrollable-type angry. [00:05:04] And even though we try to keep our calm, sometimes it gets past that point. It's almost like Kevin you feel like we're against you, but we're not. We're all on the same team.

THERAPIST: Your letter definitely read that way.

FATHER: Yeah. And I can't stress enough that he's a great kid.

MOTHER: And I mentioned in there, too, I've read books. I've done all of this and still, when we get into the heat of it, I still resort back to the primal instinct.

THERAPIST: (chuckles) Which is what for you?

MOTHER: Not the right thing sometimes. We try to do the right thing, but then it doesn't always happen and the way I handle it is not, I'm sure, the correct way. [00:06:08] I can get to yelling and that kind of stuff, too, even though I know that is not the course of action.

FATHER: Kevin certainly is receptive to certain ways of reacting.

THERAPIST: You mean receptive like he actually gets better?

FATHER: I think if I were to get angry, that would make him angrier; so try to stay calm.

CLIENT: It seems when he handles the situation — I'm not being ...

MOTHER: Go ahead.

CLIENT: When he handles the situation I seem to be a bit calmer, but it seems like when my mom does it she has a lot of sarcasm and she'll repeat something that you say in a high-ear pitch. [00:07:03] She'll make you sound like you're doing a whole lot worse than you really are. Sometimes I'll answer the phone and I'll say, "Yeah?" and she goes, "Don't answer the phone like that." I ask her how I said it and she goes, (sarcastically) "Yeah." She sometimes resorts to that.

THERAPIST: Do you think this other thing was a little more serious than that?

CLIENT: Yeah, I do. I don't know how it gets that bad. The next day I'll be fine with her. I'll be kind of angry at her for how she handled it, but mostly I'll be angry at myself because of how I handled it.

FATHER: There are times, too, that right afterwards he'll come down and apologize or "I'm sorry, I was wrong." [00:08:04] After the fact, he realizes that he was wrong. I don't know that he realizes during because no matter how much you try to calm him down, it will not work.

THERAPIST: I said something to you in the e-mail and I apologize because I can't find anything anywhere that verifies this, so if I'm forgetting ... I have a number of intakes recently and so you are adopted or not? You are the guy that's adopted.

CLIENT: Yes.

THERAPIST: Okay, so I was right about that. I was totally pulling that out of my unconscious mind today because it just seemed right and then I didn't think so. So this, of course, enters us into a whole different set of circumstances. [00:09:00] He was adopted when?

MOTHER: As an infant; he was still in the hospital.

THERAPIST: Under what circumstances?

MOTHER: His birth mother was 15, being raised by her grandparents. Her mother abandoned her, so she had been raised for the last three years by her grandparents. She was going to keep the child for eight months of the pregnancy, but was towards the end of it the grandparents said — you know — she changed her mind. They were not going to be able to supportive. They couldn't raise great-grandchildren also.

THERAPIST: And she realized that she was 15.

MOTHER: Yeah.

CLIENT: She was 15 when she had me.

MOTHER: Yeah, she had several friends that had babies. Some had given them up and some had kept them.

THERAPIST: I've been down that path. My [brother] (ph?) had a foster daughter who had a child at 14, so I understand how difficult that can be. [00:10:01]

MOTHER: What's cool, though, is that we are still in contact with his birth family, not the birth mother. She's gone off to a d different part of the state.

THERAPIST: Do you know what has become of her mentally, et cetera?

MOTHER: She is married and she has a couple of other children, obviously younger, but it's rocky. It sounds as if there are a lot of ups and a lot of downs and rocky in that way, too.

THERAPIST: You don't have any allergic people, do we? Okay, good.

FATHER: Just to cats.

THERAPIST: When I get to know you, I remember. Go ahead.

MOTHER: He's allergic, but he loves cats.

THERAPIST: I have a number of those people and it's kind of nice because they enjoy the cat while they're here and then they don't have ... And I have good filters and things. Sorry, Wes. I just saw her jump up there and I thought I hadn't asked you that.

MOTHER: We love cats.

THERAPIST: Go ahead.

FATHER: I think what you're alluding to is she was a little bit of a handful growing up. [00:11:08]

MOTHER: There's some family background that you probably need to know. (laughs)

CLIENT: I know that — my cousin, right?

MOTHER: My second cousin, if it matters.

CLIENT: Yeah, my second cousin has really bad anger issues.

THERAPIST: He's how old?

MOTHER: I think he's ODD.

CLIENT: He's a year older than me.

MOTHER: A couple of years older than you, I think. He's being treated for ADD plus ODD and he's been institutionalized for years.

THERAPIST: Ohh. You said the age; say it again.

MOTHER: I think he's probably in his mid-teens.

THERAPIST: Explain to me the relationship again. He's a cousin? The mother's?

MOTHER: This is his birth mother's aunt, her son. [00:12:00]

THERAPIST: Let me talk about something for a second here. I don't know that there is a literature to prove this, but I literally wrote the book on foster care and adoption about the therapy they are in. I've done this a lot and I can tell you I met with a neurologist one time who was working with a kid and he said, "If I see someone is adopted I just assume they have either bi-polar disorder or ADD." And here is why: because in our society it is not reinforced to give children up for adoption. It's looked down upon. So if you decide not to have a child, you have an abortion — that's why a third of those teen pregnancies end in abortion — or you keep the child. [00:12:59] Rarely do people give children up for adoption. This is why there are so few children to adopt. The people who tend to do that tend to be people with ADD or bi-polar disorder because they can't, they just can't. It's easier for them. I think that's why the signal went on for me, so we have to be thinking about biological issues here, as well as behavioral issues. You're describing some family history and there is an old thing called a genogram that people used to sit down and do and build this giant chart of the family. That's super interesting and really expensive and tedious. If you would like to do that, that might be fascinating; but I don't know that we even have enough data. I'm a little concerned that you're starting to see some of that because this is the age where that urge is. Your explosiveness is not fully consistent with ADD. [00:14:00] Let me be clear, Kevin, I'm not just throwing you under the bus here. I understand that we need to make changes in the whole system, but we also have to understand sort of what goes on with your brain chemistry beyond what you may be aware of.

FATHER: And this is not the first time. So it's not right now, once he's become 13, that this is starting.

MOTHER: But it has gotten bigger as he's gotten bigger.

THERAPIST: Yeah, go back. You've seen this in childhood, you're saying, also, Wes?

FATHER: Not so much in childhood but ...

MOTHER: I would say the last year-and-a-half or so it has escalated to him putting holes in the wall.

FATHER: Well he did that before, though, kicked a hole in the wall upstairs.

CLIENT: That was because another person was making me really mad and was throwing rocks and hitting us with rocks and stuff.

MOTHER: That was fourth grade then. That would have been the first time that that happened. [00:15:04]

THERAPIST: If somebody is being attacked and they get angry and violent, that's different.

MOTHER: But he came home and was violent and angry.

THERAPIST: In response to an incident.

MOTHER: In response.

FATHER: I couldn't have told you what that was for.

CLIENT: That was because of those guys throwing rocks at us.

MOTHER: Right, but it has gotten bigger as he's gotten older, definitely. And the situation that just happened recently, that was a really bad one. The one before that, the anger was towards him that time. You remember that one?

FATHER: The one up in the room?

MOTHER: Yeah.

CLIENT: But that was because you sent him up get [ ] (inaudible at 00:15:52)

MOTHER: My only point in that being it's whoever delivers the news that you don't like to hear is the one who gets the brunt of what's coming out. [00:16:09]

THERAPIST: Do you think that's a fair assessment?

CLIENT: Yeah, yeah. Definitely.

THERAPIST: And that's mostly true at home or it happens at school, too, sometimes?

CLIENT: Never at school, except when somebody is attacking me. Like the other day — did I tell you about this?

(laughter)

THERAPIST: That's a great way to open.

CLIENT: This kid came up to me and he gave me a nipple twister. He's always acting really weird. He's into a lot of drugs. He's into pot. So he came up and he gave me a nipple twister and said, "Why? Don't you like it?" I had my Social Studies book and I hit him with my Social Studies book and he started cussing at me and stuff. The principal called me up. You know who I'm talking about? Right? [00:17:03] We've been at the lake with one of my friends and I've seen him smoking, drinking, chewing, just everything that he's accessible to. The new principal called me up and asked me, "So what's the situation?" because he's brand new; he's never done this before. I told him what happened and he said, "I want you to try to avoid this kid." I told him about everything that he does and he said, "Just keep doing what you're doing."

THERAPIST: Keep hitting him with books.

CLIENT: (sniggers) Yeah.

THERAPIST: That's a good example of a fairly normal junior-high person's interaction. I don't know about your dad, but I can imagine hitting someone with a book in that situation myself. We shall not ask your dad, (laughter) but it doesn't mean that's not a good idea. But it's not like what we saw in the breakdown the other day so it's important to kind of look at each of those situations. [00:18:05] Had he done that and you took a desk and threw it at him and then chased him down the hall when he was trying to escape — these are not ideas I'm giving you, by the way.

CLIENT: Yeah, and I've seen that happen before in fourth grade.

THERAPIST: That would be over the top, but you were still kind of within the zone. It's interesting how you were able to stay really normal in that situation, but you got so far out of hand with your mom the other day. When you went and wrote the letter, because it was quite a detailed letter ...

FATHER: It was well written.

THERAPIST: It was like a dissertation, yeah. What was happening to you during that time? What was happening and how long did it take you?

CLIENT: It probably took me about 15 minutes to do that whole thing because I was writing everything that came to my head and really everything I said just came off the top of my head. [00:19:03] It probably took me 15 to 20 minutes to do that.

THERAPIST: How do you sleep? Do you sleep pretty well?

CLIENT: Really well, yeah. Sometimes I wake up around 3:00 and then I just go back to bed and I'll wake up about 5:50.

THERAPIST: And did you just feel really energetic when you were writing that letter, because that's a lot of letter to write in 15 minutes.

MOTHER: It was well written.

FATHER: I think it was done that quick, too, because I was aware of the situation and he e-mailed the letter to me.

CLIENT: I called you and I read it to you.

FATHER: That's right.

THERAPIST: I'm kind of torn on this because I've got to give you credit. If we have the choice between storming around the house breaking things and writing an energetic letter, I'm going to go with the letter every time.

CLIENT: I think that would be a good way to handle it, too, just go upstairs.

THERAPIST: Well, yeah, except it was pretty hateful. (laughs) If you really feel that way, I appreciate you sharing it in a way that is not destructive; but words are kind of important, too. Let's try and troubleshoot this school issue. I'm not going to tell you that's going to solve everything, but I think if we will work on it we will learn more about the case. School is — what — not going very well right now?

CLIENT: Since my dad has started to help me with homework, I think things have been going a lot smoother, don't you think? Considering anger and everything like that, don't you think?

FATHER: (pause) Yeah, but I don't know that things are still getting ... [00:21:02] I think you're handling it better, but you're still not turning everything in.

MOTHER: Can I do a back story? I'm the one that's around and so I'm the one the teachers call, I'm the one who is there to maintain him doing homework and that kind of stuff, and I'm the one that he tells it's completed and then find out it actually wasn't the next day; so there is anger on my side and distrust on my side.

CLIENT: A lot of it.

MOTHER: Well, for a reason.

THERAPIST: What did you say, Kevin?

CLIENT: I said a lot of it. That's what makes me angry because there is no trust and I get angry and then I just don't want to do anymore of my homework because I'm so angry and that's all I'm focused on.

THERAPIST: What do you mean — that's a big word; and let's dwell upon it before we move through the story. What do you mean "trust"? What does that mean? [00:22:03]

CLIENT: When I do have things done she won't trust me. She wants notes from the teachers. I will legitimately have these signatures, even from subs, and when I get home she one time asked me, "Are you sure these aren't forged by friends?" and stuff like that.

THERAPIST: Has anything ever happened to give her that idea?

CLIENT: No. Not once.

THERAPIST: Because normally I don't let anyone talk about trust because it's silly. I really don't know any trustworthy teenagers. I met one who said she was trustworthy one time and then she went away to college and came back and I was kind of kidding her about it. I go, "Back when you were 16 and you were telling me you were so trustworthy," and she goes, "Oh, I just lied about that." (chuckles) They're not usually trustworthy. You guys are not wired to be trustworthy. If you were you'd just move out and get a job and get a car and everything would be great. [00:23:05] I can't quite figure it out. That word doesn't usually show up in this discussion about homework, so let me ask her what I've never asked any parent. Why don't you trust him? That didn't even sound right coming out of my mouth. It was weird.

MOTHER: History. It's things like "Do you have any homework tonight?" "No." "Okay, then you can go fish," and then the next day you find out he didn't turn in an assignment that he didn't do.

THERAPIST: And do you think that's happened, Kevin?

CLIENT: Oh, yeah.

THERAPIST: Oh. Do you think that impeaches your trustworthiness in any way?

CLIENT: Yeah, but sometimes — I know it sounds like I'm saying I'm an adult, but I'm not and I know that I'm not — but I think just a little bit more respect than I'm given.

THERAPIST: Uh — you used the second word I don't let anybody use. Can you find a third one? Maybe the duck will come down. (laughter) [00:24:04] Maybe your parents know what the duck is. Do you know what the duck comes down means?

CLIENT: Oh, yeah.

THERAPIST: Yeah, your dad does. On Groucho Marx's show, What's My Line?, there was a secret word that nobody knew what it was until somebody accidentally says it and then a rubber duck falls down from the ceiling. I'll find you a YouTube of that sometime. It's pretty funny. (laughter) So, yeah, you used the second one, but you used it in reverse of what people usually do. What does this mean, respect?

CLIENT: This all happened when I was writing it and I just wrote it so fast that I don't really remember what I was talking about.

THERAPIST: I believe you.

CLIENT: I'm really not too sure, but I know there's (pause) ... I know what it is in my head; I just can't put it into words. [00:24:59]

CLIENT: That's because it's not really a useful word because usually parents say "he doesn't respect me." Now to your mother's credit, I don't know if she's read my column or my books — I think it's not even in here — let me search and see if she used the "respect" word in here. She didn't. There's no "respect" in here. It doesn't usually come from the teenage boy, it comes from the parent and they go "He just has no respect for us," and I say, "Oh, just don't ever say that again," because teenagers aren't really wired to be respectful — but parents are. So if they were respectful to you, what would they be doing? What would they appear to be . . ?

CLIENT: (pause) Giving me more credit for what I'm doing. Like in schoolwork, I'll finish my work, I'll have everything done, and then we'll look at my grades. I'll have good grades and then I'll have an F in something, just in an actual assignment ... [00:26:00]

THERAPIST: So they would notice the good grades, not just the bad ones. That would be a sign of respect.

CLIENT: They notice the bad ones more than the good ones.

THERAPIST: Correct. I didn't say that very well. Showing you respect would be they would note the good grades, not just the bad ones?

CLIENT: Yeah.

THERAPIST: Okay. Anything else?

CLIENT: No. (pause)

THERAPIST: Okay. So I would just call that "noticing." That's a better word for it, that you would like them to be noticing these things.

MOTHER: As we're going through the grades we'll be like, "Oh, you got an A+ on that. Great. See what happens when you turn your stuff in? Look at that. That's great," so he does get credit for that. But where he is correct is that the majority of the time we'd be talking about what he didn't get turned in.

CLIENT: No.

MOTHER: So he does get credit. I don't know if he doesn't remember. [00:27:01]

THERAPIST: Do you want to just — this sounds like I'm making a joke and I'm not, but do you just want to be in charge of this for a semester and see how it goes?

CLIENT: Yeah.

THERAPIST: Oh, okay. Maybe we'll [ ] (inaudible at 00:27:14).

CLIENT: I think learning from the mistakes would be a lot better than being told what to do and then having a day to make it up.

THERAPIST: Let's just be clear. What would the mistakes be?

CLIENT: Not turning things in. My dad, to use this example, we used to have this pitching coach. I used to be a pitcher and I was pretty good at it. But every time I would mess up, like I would pitch one and maybe it was just a bad throw, maybe it just slipped off my fingers and I wouldn't throw it perfectly, and then the guy would go off on you and start yelling at you. He wouldn't give you enough time to learn from your mistakes. He would give you enough time to be yelled at pretty much.

THERAPIST: Just so we're clear, in that case you just don't learn to pitch very well. [00:28:01] What will happen if you are wrong about your ability to be in charge? Because I'm really, seriously headed this direction, so be careful what you wish for.

CLIENT: (pause) I'm thinking that if it doesn't work, just every other day we have a check-up on it.

THERAPIST: I think if you're in charge, you have to be in charge — and I'm not, I really am not being tricky here. If you're going to be in charge, you have to be in charge. I have something I want them to do, which I shall get to in a minute; but you can't have it both ways where they check on you a little, because that's just going to start the same thing up again, except it's going to be on Tuesday and Thursday instead of Monday, Wednesday, Thursday, Friday, Saturday, Sunday. That's going to be the same thing. Do you really think you can self-regulate?

CLIENT: I think if I work as hard as I can . . [00:29:04]

THERAPIST: Well that's a true statement.

CLIENT: ... then I can get it done.

THERAPIST: That's true.

CLIENT: One of my best friends has been doing so much work and she's getting really stressed out and she lost 15 pounds. That's how stressed out she's getting.

THERAPIST: Well you don't have 15 pounds to lose, do you?

CLIENT: No.

THERAPIST: That is an interesting example. I'm going to give you a similar one which, weirdly enough, originally came to me because that person lost a lot of weight. I was going to give you this example anyhow, but it's funny that you mentioned it that way. Many years ago I had this girl come in who was referred by the doctor because of low weight. That really wasn't the problem. The problem was she had, not only ADD, but anxiety and, to be honest with you, she wasn't very smart. We did all this testing on her and I had to sit her down one day and say, "You're not very smart," which was a very hard thing to say. [00:30:05] She said, "I know that. I'm aware of that." I said, "Thankfully, you're very sweet and a good person." Recently I went to her wedding and just before that I went to her college graduation, which is a real school. She took seven years, but she got through college with a Bachelor's degree and then — I'm going to change this a little to protect her confidentiality — let's say it was in nursing. Then she had to pass this exam and it took her three tries. It was just horrible. Every time she would take it she would fail. She would be in here sobbing that it was horrible. The last time she was like, "I'm not going to take it again." I said, "Yeah, you are. You sure are." "Why? You just want to make me suffer." [00:31:02] I said, "No. It's because you've come as far as you did." And then one day I get a text that she passed it. She didn't tell anybody she was going to take it again, she just went and did it and passed it. So here is this person — and she has a good job now; she does really important work. So what do you suppose this person who has an 87 IQ, [under it is average] (ph?), ADD and anxiety, how do you suppose she ever did this? I'll give it to you again. There was no cheating involved. What do you suppose allowed her to do this?

CLIENT: She's probably going to college, so she's probably on her own.

THERAPIST: She was self-regulating. Actually some of the opposite. She knew how to get help from everybody, her friend, her roommates, She would go up to the college and get special study skills and study groups. She actually knew how to use other people's help. What else do you suppose made it possible for her to succeed? [00:32:05] I'm amazed that you cannot figure this out because you actually mentioned it a minute ago on your own self. You said this was what it would take for you to succeed.

CLIENT: I don't know.

THERAPIST: She was the hardest working student I've ever met in my life. She never gave up. She wanted to lot, but she never gave up and she kept at it. Now if you can marshal that kind of energy in yourself, you'll be fine. Now she flunked a bunch of classes and had to retake them and it was hard at times, but she was a hard worker.

MOTHER: She had the desire.

FATHER: He's a really smart kid.

THERAPIST: Well then you have one point in your favor, huh?

FATHER: When he turns stuff in, it's all A's. It's the fact of not turning things in or forgetting to study for something. [00:33:01]

THERAPIST: What he hast to try hard at is not those things ...

FATHER: It's not that he's dumb.

THERAPIST: It's to be able to self-regulate.

FATHER: Correct.

THERAPIST: It all still comes in. I know. I have two or three kids that are in ivy league schools and one of them totally bombed out because he wasn't getting up and doing what needed to be done every day. It's easy to decide to go to college. It's hard to decide to get up every day and get it done or turn in your work. That's the hard part. And you're saying, though, that you understand this, that you would have to work, be self-regulating, and work hard. And who will be damaged if you do not do those?

CLIENT: Me. And my parents.

THERAPIST: Well, they will feel sad, but really you will bear the weight of this. Very interesting. So what if you guys changed and only structured his effort, not the outcomes? [00:34:02] You don't know what I mean yet, but I will be telling you. What if you guys did nothing but structured his effort? (pause)

FATHER: I think that's kind of what we do now.

THERAPIST: I think that you're halfway there. He and I do not think you have reached the high point of that yet. (pause)

CLIENT: You called me while I was mowing yesterday to ask me if I had gotten everything turned in and what my grades were.

THERAPIST: Kevin understands my point. That was my point. What I would do, and this is the part you may not see coming and I shall see what you think, Kevin. What I would do is decide that you are in middle school?

CLIENT: Yeah.

MOTHER: He's a little young for his year.

CLIENT: My birthday is in the summer, so I'm going to be the youngest all through the year. [00:35:05]

THERAPIST: Oh, lord. I think I commented on this last time, didn't I? Okay. So in your year people are expected to have 80-minutes worth of homework per day and rather than have a discussion about your phone or whether it's on or off or blah, blah, blah, you just need to decide to do 80 minutes of studying per day. And if you don't have homework, that's where they structure your effort. There are many fine things for you to work on in enriching your education. I want to be clear — in no way am I suggesting they punish you for not having homework. I'm saying that a young person of your age should be able to do about 80 minutes of homework a day; and if you're not, you're not being challenged enough. So your mom can find [ ] (inaudible at 00:35:59) school that provides some additional work for you to do. [00:36:02] Now if you have homework, if it were me I would do the homework during the study time because wouldn't that be a good way to get that done? I'm going to give you [ ] (inaudible at 00:36:18) on this; talk to the teachers and anything that he can turn in by e-mail, you guys need to switch over to e-mail. They will do it because they don't want to get him in IEP. He's not on an IEP, is he? They don't want to do it so they'll do any accommodation you want if they don't have to put it down and have him sign off on it; so try to get everything turned in by e-mail that you can get. And I mean get a scanner and put it on your computer and when he fills out a paper form, scan it and send it in. My daughter has an iPad and 100% of her homework is turned in on e-mail. [00:36:59]

MOTHER: I'm sorry. I'm not very smart. How does that help?

THERAPIST: Because he won't lose it then. The minute he hits send, then it's gone and he doesn't have to get between here and school.

CLIENT: And I wouldn't have to remember it when I get there.

THERAPIST: That's exactly right. You are with my, Kevin. We are down. I know I just combined two issues in the same picture, but make it easy as it can be. It's wrong to take the easy path and not the right one, but there's nothing wrong with making the right path easier. Any technology can help with that. If it weren't for that I don't know how my daughter would ever get homework in; and she has like a 3.4 GPA because she can do stuff like this. She has an iPad, so she can take pictures of the document for posterity in case it is lost. In fact, an iPad would be really useful. [00:38:01]

CLIENT: We have one and that's what I wrote the note on.

THERAPIST: Really? Does it have a camera on it?

CLIENT: Yep.

THERAPIST: Well your world is going to get a lot easier, boy. Use all that. Set him up; five days, 80 minutes a day. When you're done with 80 minutes, you're done. If you have something to carry over for the next day, carry it over. Do it.

MOTHER: Do you recommend that this 80 minutes is at the kitchen table, downstairs or up in his ...

THERAPIST: It needs to be roughly supervised, but not snoopervised.

FATHER: But it can't be in his room with the door locked?

THERAPIST: Sorry, Kevin. No.

FATHER: Or in the bathroom with the door locked.

THERAPIST: Not because I do not trust you, not because you're a psychopath, but because you're like a 13-year-old boy. It's just not a good study environment in one's room. There are too many other distractions, especially if we need him to use electronic devices to do things. [00:39:00] I know you don't realize this, but there are lots of other things you can do with electronic devices (laughs) that are not as helpful. You typed that whole thing out on your iPad? Wow. I have iPads and that's so ...

FATHER: With a keyboard? You didn't have a keyboard? You used the virtual keyboard?

CLIENT: Yes.

THERAPIST: He's not going to have any trouble following my idea. The 80 minutes, what I would do for a while is I would do that five days a week until he gets clearly underway; and if he gets clearly underway, you probably can let him off one of those days. I just don't know yet because we haven't tried it. That would be your goal is to make it so you only have four days a week for your homework. I'm not sure how that will interface with your school yet. And then your job — we're going to try to make it easier — your job is to use that plan productively. [00:39:59] Now until you're done with that 80 minutes, you don't have any other devices or any other games or whatever it is you do. What is it that you spend your time doing?

CLIENT: Texting.

THERAPIST: Yes. And girls like that quite a bit when boys text.

CLIENT: I have a girlfriend and she lives 45 minutes away.

THERAPIST: Well if you're a good texting boy, I bet she is really happy to be with you because girls, that's their number one complaint about boys is they don't text enough. Go ahead, Wes. We had to talk about texting in the framework.

FATHER: A lot of times (pause) he will want to use the phone for homework and I don't know if that needs to be.

THERAPIST: Why do you need the phone for homework?

CLIENT: Google drive. I'm a lot faster texter than I am typer, and so I can get things done faster on Google drive and I can save it to that account. [00:41:00]

THERAPIST: You can pull it off of Google drive on your iPad.

CLIENT: I know, but the things are further away; it's just in my thumbs, so I don't have to use all of my fingers. I don't have to memorize each key with each finger.

THERAPIST: It seems strangely like bullshit. (laughter) It has the unmistakable odor of bullshit and I know it's not Ruth's box because I cleaned it today; so I know that isn't it. I cleaned it just a few minutes ago. It was so weird. I looked over there just a few seconds ago and literally your dad and your mom and Ruth were all exactly looking at you the same way. It was the weirdest thing. (laughter) I didn't want to stop in the middle to mention that, but that's funny. And Ruth was almost looking over your mom's knee so she could actually see that; and you didn't notice. I thought, "God, you must really be [on stage] (ph?)." I think that is a really not-believable story. [00:41:59] And if you're doing it, you're just going to have to work around it because you can go onto Google docs. Google docs is where I find things are much easier than your iPad. And your girlfriend, you just need to tell her that this is my study time and I will pine away for you throughout the entire time. And you will find that when you miss her for an hour-and-a-half it's going to be way better when you get back on texting again. Doesn't she have study time? They don't have study time at her school? Where does she go to school?

FATHER: Doesn't she have to study at home?

CLIENT: Yeah.

MOTHER: That's our new term for homework.

CLIENT: Oh, yeah. Since she was gone, she had six hours of regular homework and then she still had make-up homework.

THERAPIST: Terribly painful. Yeah, I would think that she'll have plenty. Why don't you tell each other that's what you're going to do during that time because one of your generation's bad ideas is texting while you ... fill in the blank; do everything, go to the bathroom, drive, do study time, make out. [00:43:12] (laughter) You think I'm kidding. They really do. You don't want to do that, though; that's really a bad thing. So don't text during study time. You have to be focused. We're on which — Focalin or something? What are we on? Or are we on the patch now?

MOTHER: We went to the patch.

THERAPIST: We didn't get a chance to talk about that.

MOTHER: It seems to be decent. The only problem is — and here I am sort of micromanaging again — he has access to pulling it off when he shouldn't.

THERAPIST: Well, so does my 10-year-old. Do you pull it off wisely? When are you pulling it off?

CLIENT: When it starts to fall off.

THERAPIST: Whoops. (laughs) That's not supposed to happen.

CLIENT: Yeah, it will half come off. Sometimes that's when I pull it off. And then at the very end of the day it starts to itch a bit.

THERAPIST: Yeah, that's plausible. [00:44:07] What's the end of the day? What do you mean, what time?

CLIENT: Like seventh hour around 2:00. It gets out at 2:50.

THERAPIST: That's a little early.

CLIENT: But then I go to study hall until 3:19.

THERAPIST: Okay, so when are you going to do study time? Because you want to do it early enough that you have the rest of the evening to text pictures of different hairstyles to your girlfriend and stuff. (pause)

FATHER: I think that needs to be done when you get home. The more you delay, the less chance it's going to get done.

THERAPIST: Amen, brother, because the other thing is we need to rethink when you're pulling the patch off because it's okay if you're two hours away from the last important thing you're going to do. [00:45:06] Then you can pull it. I understand it feels weird and itchy because the ADD people don't like to be uncomfortable and that's the only down side to the patch. I don't know quite what to do unless you put something over it.

FATHER: Yeah, we've tried tape.

MOTHER: Yeah, we don't remember that all the time, but it works when we do remember it.

THERAPIST: If you can keep it on until — study time starts at what time do you think, Wes?

FATHER: 4:00.

MOTHER: I think it's usually about 4:30 that he gets home and has a snack.

THERAPIST: Yeah, you want a snack for sure. I'm all about that. 4:30 and then that means you'd be done at about 6:00 at the latest. You need a break. I forgot to mention that. You need to go about 35 minutes and then take a ten-minute break; maybe 40 minutes, take a ten-minute break, and you probably, if you need to, text your girlfriend during the ten-minute break. [00:46:10] Personally, I would go outside and run around, but whatever excites you; then the phone is out of commission again.

FATHER: Yeah, I think if you bring the phone in and let him text in between, then it's going to be harder to get it away.

THERAPIST: Well, I hope that you're wrong, but you're probably right. What do you think?

CLIENT: Probably not because ... Well yes and no because it's going to ...

THERAPIST: No.

CLIENT: Wait ... (laughter)

THERAPIST: Your dad's point is that it's unwise for you to take a ten-minute texting break.

CLIENT: Probably.

THERAPIST: Okay, thank you for your mature wisdom in that regard. So go outside and run around and just doing something outdoors is better for a break. Thankfully, you do not smoke cigarettes, so don't do that.

FATHER: Yeah, but do come back in, though. [00:47:02]

THERAPIST: Yeah, it needs to be just a ten-minute break. I know time management is not your thing, but whatever it takes, because you've still got to do the next 40 minutes. So you come in and then you do your second 40 minutes. This whole business of working and hour and taking a break, you need to grow into because it's the only way you're going to stay on target. So you're done by about 6:00. If you take the patch off at the beginning of study time, you'll be fine.

MOTHER: At the risk of sounding pessimistic — that's not what I mean, I'm realistic ...

THERAPIST: If you choose one it's going to be pessimistic, don't you think?

MOTHER: It's tough monitoring this. So let's say the 80 minutes was not utilized well. What are consequences to that then?

THERAPIST: What is the consequence of that, Kevin?

CLIENT: Making me work another ...

THERAPIST: Oh, I don't think so. You think, really? That's the consequence that you have to do another 80 minutes? [00:48:07]

CLIENT: If I'm going to be independent, then ...

THERAPIST: Ahh, now we're headed down the road. What do you think about that?

CLIENT: I think if I was independent I could handle it by myself. It makes me feel a lot better about myself knowing that my parents — because in everything else my parents are always right there with me. Like with my shooting, my dad is the coach now for the shooting thing.

THERAPIST: You like shooting, don't you?

CLIENT: Oh, yeah.

THERAPIST: Do you like homework?

CLIENT: No.

THERAPIST: Well there you go.

FATHER: It's not homework. It's study time.

CLIENT: It seems like I'm more responsible with the things that can kill somebody.

THERAPIST: But it's different, Kevin. I bet you're responsible with a video game, too, aren't you? Like you could play a video game without their help at all, can't you? [00:49:00]

CLIENT: Probably.

THERAPIST: This is the difference. You can't equate any of those things. Homework sucks and study time is the time to do it, so all I'm telling them to do is manage the study time so you are working during that time. You need that part. I do not think you're ready to handle it. The rest of it, I am willing to see you be in charge of. Here is the problem: It would be tempting to make you do additional time, but I think there's just a lot of diminishing return. I think that the real consequence is you're screwed. You're going to flunk out of school and be a loser. Does that worry you any?

CLIENT: Yes.

THERAPIST: Well I believe you. That's what it's going to come down to and, instead, the power struggle at this point is whether you're obedient to your mother or whether she's a crappy parent. Isn't that kind of a stupid discussion? Wouldn't it be more important to have the discussion about whether or not you are a giant failure? [00:50:03] And I don't really think you want to be a giant failure, so their job is to define the 80 minutes and shut off all of your distractions and your job is to use it to your best advantage. I have this thing where a person hits "Send" and their document is gone. That makes the ADD people so happy. You can't believe how happy they are. They're like, "Oh — it's gone forever. I don't ever have to see it again." They get more done that way.

CLIENT: That's kind of how I feel. When I turn something in I know that I'm never going to see it again and then it's off my chest.

THERAPIST: I know what I speak of, do I not? You say such nasty things about me in the paper. [ ] (inaudible at 00:50:45) and you told your mother that I said she didn't understand you. I don't remember saying that. It may be true, but I don't remember saying it. (laughing) Did I say that? [00:50:57]

MOTHER: I didn't remember it and he didn't remember it, but something you said ...

THERAPIST: I think it was "we can't understand somebody that has ADD." You don't understand them.

CLIENT: Yeah, that's how I interpreted it.

THERAPIST: Well, okay. The way you made it sound in your dissertation — I think it was you said it to her, actually. You made it sound like I was like, "You don't understand your son." Let me rock him on my lap. (laughter)

CLIENT: I think she has a good idea of how to handle things, but not the best in the world.

THERAPIST: And I saw that. That was in your dissertation where you said she has no idea how to raise an ADD child. Might that be because they've never had one before? (chuckles) Do you think we could help them learn how to do that better?

CLIENT: And that's exaction what they said, too. [00:51:58]

THERAPIST: Okay. Well that's pretty [fair.] (ph?) This is probably a better way to do that, but the bottom line is you can lead this horse to water, but you are the one who is going to have to drink it and, if you want to be educated and to go to college and to be something in life, that is what you'll do. Now I will say they have an investment in that because what happens to you if you end up working at Burger King and nothing else? Where are you going to end up living?

CLIENT: With my parents. (chuckles)

THERAPIST: Yes. So everyone in the room has an investment in that not being the outcome because therapists and parents are supposed to be fired by their best customers; and so if they're successful raising you, then you go off and are like, "I'm going to my dorm room now. I'm leaving you." And they're all like, "Oh, we're going to miss you so much. Come back at Thanksgiving." [00:53:00] None of that is every going to happen if you don't realize every day when you get up that you have to make a decision to do what needs to be done. Do you feel me?

CLIENT: Yes.

THERAPIST: All right. So now your mom has another thing on her list about pessimism. What is it? (laughs) No? There's no more pessimism? Or did I not really answer that one? You make the time and he is going to have to show us that he can make the effort.

FATHER: It will have to be in a place that he is not being disturbed, because I know it can't be down at the kitchen table.

CLIENT: No, it can't. No.

THERAPIST: You guys have got to find it and you understand, Kevin, it has to be monitored, but not snoopervised. I don't think I ever quite clarified that. Be sure he's not surfing the Internet for cat videos.

CLIENT: Those are pretty funny, though. [00:54:02]

THERAPIST: Right. (laughter) And if you wish to do that after study time is over, feel free. You can forward them to your girlfriend.

FATHER: Make it a day trip.

THERAPIST: That's you and Ruth for your girlfriend. But she's going to make the time and you're going to make the effort. Now if this doesn't work by the end of this semester — I mean if it works kind of okay, then we should try it another semester. If it's not working at all, then we have to start thinking how to crush the light out of you until you do what you're supposed to do.

CLIENT: I think we should start it next semester because this semester only has about ...

MOTHER: But we have a new quarter starting.

CLIENT: Oh, yeah. That's right.

THERAPIST: These are the big ones. Let's start it and we'll figure the second quarter out this fall because your quarter ends at Christmas break, does it not?

FATHER: Yes.

THERAPIST: And that will give us a really good picture. [00:55:02] Let's make sure this e-mail submission system works. I can't tell you how much that fits with what they do.

MOTHER: Are teachers pretty good about accepting that, because I've not really heard about it?

THERAPIST: You will be seeking it as an accommodation and, if they need to do a little student improvement plan or whatever, if they buck at all — your school historically has had a tendency to buck. But once the staff changed a couple of years ago, that got better. If they don't want to do that then we're going to start talking about having him tested for an IEP. My bet is they will be happy to do it.

FATHER: If worse comes to worse, we can e-mail it.

THERAPIST: Oh. Now I should know who that is because that's a ...

FATHER: She's a secretary there. Front desk. She is a good gal.

THERAPIST: I think the day will come in the next three or four or five or six years when this will be the system that they all use. If I were a teacher, I would much prefer to have it all just come to my computer and I can ...

FATHER: Can't lose it. [00:56:11]

THERAPIST: Yeah. Absolutely.

MOTHER: You know they do so much on the computer now. I should know with Power School and homework and then the teachers e-mail us and say there is a test on Monday so you're right, there is already a lot of it.

THERAPIST: If you have any trouble I will help you make that correction. In fact, the other day we were in an IEP meeting for my kiddo. She is a junior and one of her teachers said something to her about turning in an assignment. She said, "Oh. Well I just usually e-mail those in." (laughs) The teacher was like, "You do?" and she was like, "Yeah, I'll make sure they talk to you about it," and her gifted teacher made sure that was taken care of. But yeah, we've had no problems. She's at [ ] (inaudible at 00:56:55). That's a pretty good sized school. We don't have any trouble with that. [00:57:01] I don't know how much we've tested the system of taking a picture of it, but we have a program that converts the picture to a scan.

FATHER: I'm wondering, you take a picture and maybe you can't see it as well.

THERAPIST: It's pretty amazingly high resolution. (laughs) Give it a try. It's really high res. The main thing is if there is any problem with it, you have the document on file. If you check on there — I can't think what she uses, but I don't think we've actually converted one lately.

FATHER: You could probably just do it on the iPad and then just take a screen shot.

THERAPIST: You can. You can actually shoot the picture and if you want to do it within this document scanner, it will actually turn it into a paper document, make it not as large for a larger file. Any technology assist you can do, if he's open to that, will make it a lot easier and more able to be accounted for. [00:58:08] I just wrote this chapter in my book this weekend for ADD people, so I'm really at the top of thinking about that.

FATHER: Do you sleep?

THERAPIST: Do I sleep? That's an excellent question. (laughs) I do, but talk about having to fit things in.

MOTHER: Can you finish that book quickly?

THERAPIST: It is closing in. I have a focus group, ironically named Focus Group, coming up. We're going to meet and they're going to give me feedback on it so, hopefully, it will be out no later than March. We're trying to get it a little sooner than that.

MOTHER: I have a book on executive skills. Is that a good thing for me to continue looking into?

THERAPIST: What are they recommending in there?

MOTHER: I haven't actually picked it up for a while. I started reading it and then got sidetracked, but it's the organization and do you just have some ideas about how ... [00:58:59]

THERAPIST: Yeah, I hit that in one chapter but I'm looking, actually, for some good resources to add to that. You might send me the link to that.

MOTHER: I will. Our school psychologist offered those to me. I will because it's been very interesting but, like I said, I put it down and I've been reading other stuff.

CLIENT: The one problem with reading a book is it's not personalized for that person.

THERAPIST: That is such a good point, Kevin.

CLIENT: This is going to help a lot more than a book.

THERAPIST: Actually, if you don't say mean things in your dissertations about me. (laughs) You can say whatever you want.

FATHER: And you're right, I know exactly what you're saying. Sometimes it gives us ideas to pick up something that we may not have thought of.

THERAPIST: I guess that is true and you're both right, but I actually have said in talks I give that you can't really get a manual for how to parent. I know there are bunches of them because every kid deserves their own manual; and so I think your point is well taken, Kevin. [01:00:02] It's interesting because I was almost formulating the same point when Kevin said it. Those books are just as good as they can be if you pick out what works well strategically with the kid and some of that is trial and error. This particular organizational system I've had a lot of luck with in terms of getting out of the power struggle and into appropriate levels of self-regulation and oversight. We may have to tweak it a little bit. The other version of this is where we follow you around, drive you around like a little boat all the time and you wish to not go that route. I'm going to respect that until proven otherwise because I think if he doesn't start learning that now it ends up getting harder and harder. [01:01:02] We want to militate against that.

FATHER: So it's his responsibility ...

THERAPIST: Except for the time allotment. That is yours.

FATHER: Otherwise he's getting online and checking grades and homework assignments.

CLIENT: That one time where I really did have my phone, I was doing my homework and I was really focused on it just knowing that I wasn't pressured to finish it, knowing that if I didn't you would have taken my phone away.

THERAPIST: Say that again. I got lost.

CLIENT: Like if I knew that if I didn't get my things done ... like if I had one thing that wasn't turned in, my phone would be gone; for a long time. It's never gone for two hours, it's gone for weeks to months. [01:02:02] You may not understand this, but it makes me mad that I'm not going to be able to get it back for a while and then ... I don't know.

THERAPIST: I do understand why that would make you mad. Yes.

CLIENT: And then it makes me want to focus more on ...

THERAPIST: Being mad.

CLIENT: Yeah. Rather than doing my homework.

THERAPIST: Probably, that is a true statement; but they're trying to figure out how to not have you live at home and work at Burger King, so maybe they're overly worried about that. But who really does ultimately have the power to put their minds at ease? Who really does? Me? Jesus? Who has the power to put their minds at ease about your ability to succeed?

CLIENT: I think I do.

THERAPIST: That would be you. Amen. [01:03:00] One thing is I don't think teenagers are very trustworthy, but some have better judgment than others. If you want to prove that you have good judgment, you will run this plan well. Now one other thing I would do if I were you guys, is I would set up a payment system for him on his grades. I'm sure [ ] (inaudible at 01:03:23), Kevin. I almost forgot; how to set up a healthy payment system. I'll tell you what works best, but it's kind of impractical issue because you can't trust Power School. You can't trust it. If it were working accurately on a week-to-week basis, I would tell you to pay off on a week-to-week basis because the ADD people need pretty recent reinforcement.

CLIENT: It takes them a good two or three days to get the things turned in. Unless they're doing it for a completion grade, it's not going to get in for two or three days.

THERAPIST: I would not trust it.

FATHER: I guess you would owe less money then.

MOTHER: I like that. [01:04:01]

THERAPIST: Actually, that's sometimes done. You have two choices and I'm interested in — you may want to ponder this until we get together again, each of you, because each has a different implication. You either pay him for the grades themselves, which is outcome based, or you pay him for the effort. Since Kevin is a smart guy, he's capable of achieving the outcomes. I just don't know which is better in this case. Do you understand the difference, Kevin?

CLIENT: Yeah.

THERAPIST: And you need to pay him pretty well. My kids don't know anything about people getting stuff for free. They've never, ever heard of this before. They think everyone works hard for the money they earn. In fact, that's my daughter in the front office working right now doing billing this evening. I believe if Kevin's job is going to school, then pay him to go to school. You don't need to buy him a bunch of other stuff. [01:05:04] Sorry Kevin. Then that's his money. That's what he has for his economy and then when he wants an XBox or whatever crap you do, then he buys that from his money. I know right now how much money they have in their accounts. I just transferred it today.

FATHER: That's so interesting. I never thought that would have come out of your mouth.

THERAPIST: Make everything an economy. (pause)

FATHER: Because ... yeah ... well.

THERAPIST: And let me tell you how well this works. Ruth had kittens. I did not know she was pregnant when we found her. She had these four kittens and they really are the most amazing kittens I've ever had. We gave three of them away and we kept one. This is the nicest kitten and he's funny and plays catch, plays fetch, and plays all these games. The agreement was that Evan had to take care of this cat, blah, blah, blah. [01:06:01] Recently Evan came to me in the summer and he said, "Dad, I'm not going to be able to do my summer camp." I said, "Oh. Why?" He said, "I have to get him neutered." I said, "You're right, Evan. How much is that going to cost?" He said, "I have to get him declawed, too." I said, "Yeah, that's true, but here's how this works. We're your insurance company and you have a co-pay. You will have to pay the co-pay and we will cover the rest of it." He was taking this into account; and he was nine at the time. If you go this route from day one and they understand there is an economy here that they have to participate in, then just pay them for whatever you want them to do. I want Evan to clean my office, so he comes and cleans my office on the weekends and he gets paid. I don't care about grades because he does that without any problem. So if you really want to reinforce Kevin and give him salary for something that you think is important, go that route; but then don't also give him free money. [01:07:06] Do you get free money for stuff? Do your parents throw money at you?

CLIENT: No. I work at my dad's a store for $7 and hour and I work from 9:00 to 5:00.

THERAPIST: There you go, man. Your dad and I know about the tax benefit of employing our children. (laughs) Do they let you put him on payroll?

FATHER: Yeah.

THERAPIST: Because my accountant said I couldn't do that.

FATHER: They didn't think it was a good idea if it was full time, but he does it part time every once in a while. My accountant kind of suggested, she didn't think it was a great idea, but if he's not making a lot of money then it wouldn't be a bad thing.

THERAPIST: You and I will talk further about this.

CLIENT: And then I make even less with my grandpa. I like working with my grandpa.

THERAPIST: So you understand this idea that people earn a living? So your parents do not suck as much as you implied they do in your dissertation because if they've taught you that lesson, you are ahead by about a mile at this point. [01:08:05] They'll just add to your salary then. Figure out how they want to do that. That makes it way easier when you guys understand that. Too many people in this town rain money on their children.

CLIENT: Exactly. I know.

FATHER: And I know who you're talking about.

THERAPIST: There is an endless supply here of people who do this and then they wonder. I get frustrated with them because they wonder why their kids won't do anything, why they're entitled, why they expect things that they can't provide; and I'm like, "I wonder."

CLIENT: This person I'm talking about has six cars and it's a three-person family.

MOTHER: He has a job and he pays for his own stuff.

CLIENT: He gets to ride around on a mower, which he loves cars and stuff. [01:09:02]

THERAPIST: Now that's work, buddy. Just because you get to ride around on a mower (laughs). I've got a big old diesel mower I'll put you on. (laughter) Almost the biggest diesel mower you can get; not quite.

FATHER: I didn't even know they made them.

CLIENT: Yeah, that's pretty much a tractor with a big blade on it.

THERAPIST: That's a [grasshopper] (ph?). It's a big diesel. So that is what I would do. That will also incentivize him, but you'll have to think about which way you want to incentivize him; whether you want to do the effort or the outcome. It's the difference between whether his floor sweeping is good or his store hours are at present.

MOTHER: Yeah, we've never done allowance or anything like that.

FATHER: I just thought that was a no-no. [01:10:00]

THERAPIST: Here is the deal on that. Don't ever reinforce something that people have internal motivation to do. So if Kevin was in here and he was like, "Golly, I really can't wait to get to school. I love it so much. God, it's fun. I want to take AP classes," then we would not be having this conversation. You wouldn't pay him to fish, although I guess if the catfish were ...

FATHER: Oh, God. I'd be broke. (chuckles)

THERAPIST: There you go. So you wouldn't pay him to fish because he likes that, but school is not that exciting for him so you raise the stake. My dad did this when I was in high school because I needed to get a scholarship to go to college and I had to raise my grade point average. I had to get a 4.0 my senior year and little does my dad know — he's dead, so I never will tell him —he didn't need to pay me. (laughs) I understood the importance of this to the family. I totally got it.

FATHER: Trust.

THERAPIST: Well I was not about to tell him, "No, I don't want your filthy money." (laughter)

FATHER: And smart. [01:11:04]

THERAPIST: Yeah. I was happy to collect it. And I appreciated him. It was a good investment for him because that was thousands of dollars against his little few hundred. I was glad it happened. I don't think I ever told him. You know I may have eventually and he told me, "You know what? That's okay. It was worth it." I think we actually did have that conversation before he died. All right. You have plenty to work on. We didn't do as much on anger management this time, but I'm going to just say this. Kevin, try not to act crazy for the next couple of weeks and when you see yourself starting to act crazy, be like "oh-oh, there it is" and go into a calm place to do some meditation or something.

CLIENT: How about walking upstairs, writing another one of those letters and then deleting it right after? [01:11:59]

THERAPIST: I like that idea quite a bit. It's not even that you were wrong in any way to write the letter, I think it was healthy to do. I think the deleting or the saving privately may be the better way to handle that. Harry Truman actually used to do that. He would write these letters and then put them in a box and not send them. The one time he couldn't control himself he got into all sorts of trouble. (chuckles) His daughter had played this concert and she wasn't really that good a pianist, but she was the daughter of the President. Some critic in New York wrote how terrible the concert was and Harry Truman (laughing) wrote this horrible letter. Of course, I think he actually sent it to the New York Times and it was terrible. People made fun of him. When you read his biography you find out that he did this all the time, but he just didn't send the letters.

FATHER: Yeah, I like that.

CLIENT: When I wrote this one I looked over it and I looked over it again and I just felt like a total jerk. [01:12:59]

THERAPIST: I appreciate ... I think you're a person of good moral character. I think, as is common with the ADD people, your actions and words get ahead of your brain. We shall help you with that. I do not believe that is who you are in your heart.

FATHER: He is extremely a good kid because we noticed it this weekend. We went to a party that was outdoors. There were a lot of kids. He was around a kid there who had Down's Syndrome who Kevin took care of the whole time. People were walking through the woods. Kevin's friends were walking ahead. Kevin was having them wait for him because he had the child that had Down's Syndrome with him. They all took off and Kevin stayed with him the whole time and Weaver also commented about how he had to cleanest mouth of the kids that were out there.

MOTHER: We get a lot of good reports back for him, teachers ...

FATHER: There's a lot of good in him. [01:14:03]

THERAPIST: I think it's not going to be too difficult to get beyond that. I think that the other thing we're going to have to do, once we get this sort of settled and you're operating well with it, we're going to have to figure out whether your temper issues are simply outbursts from ADD or if you've got a little bit of a mood disorder going on there; but I'd like us to calm the world down a little bit and see how you respond to it first. Does that sound fair?

CLIENT: Yes.

THERAPIST: All right. Okay, guys. Let's make an appointment. There's that release document for you to sign out there. I think either of you can sign it. I just modified it. They sent us a generic one and I modified it to make it more specific so the release is only for the transcription usage. They had kind of a broad release and I didn't think that was necessary. [01:15:02]

MOTHER: Now would you mind — and I forgot this time — but would you mind if I tape the sessions because I have a bad memory and I'm a bad note taker? (chuckles)

THERAPIST: Or, since we happen to be recording them, why don't I just send you the file? That will be easy enough to do.

MOTHER: That would be great. You have a lot of good information, but I think I'm ADD myself which is why I understand him more than he thinks I do.

THERAPIST: Well the book will be pretty helpful because I cited a few of those ideas in here today. And actually, dear Kevin, buddy, if you're interested, you guys are going to have enough credit on your bill that I'll have to pay you. But if you're interested in reading my book and giving feedback, I will pay you a little credit on your bill for that because it's really designed for people with ADD. Now it's for teens and adults, but I'd be interested in your feedback; so it talks about dating and marriage and it talks about school and work and all sorts of things. [01:16:06] It's intended to be readable enough for ADD people because none of the other books ... I don't want to bring it up so ... Do you like to read at all?

CLIENT: Not really.

FATHER: I think that would be something that you would be interested in.

THERAPIST: That is my goal because I need someone who is not naturally trying to read everything; like my daughter will read the back of toothpaste if she can. She likes to read.

MOTHER: (laughs) He does not.

CLIENT: Yeah I try to stay away from reading as much as possible.

THERAPIST: But you're actually the right kind of person, I think, for that. So here are our options. The 26^th is a Saturday and I could see you on the 2^nd at 2:00.

MOTHER: We actually have one set up in two weeks from today, actually.

THERAPIST: That would really be better, wouldn't it? (laughs)

MOTHER: We made a couple there.

THERAPIST: Oh, yeah. You're in at 4:30. Great. Do you have another one after that? [01:17:03]

MOTHER: We don't.

THERAPIST: Let's just put one in.

FATHER: Bring it.

THERAPIST: Shall we just do two weeks after that on Wednesday at the same time?

MOTHER: That would be good.

FATHER: Those are good.

MOTHER: Is 4:30 good or 5:00?

FATHER: It's fine with me.

THERAPIST: I can't do 5:00, but I can do 4:30 or 5:30.

MOTHER: Okay. 4:30 would be great then.

THERAPIST: Wes was so happy to be here he showed up at 4:00.

MOTHER: I know.

THERAPIST: I think I have your t-shirt. I might have one in Ruth's office.

FATHER: I'm going to have to bribe you and bring you another one.

THERAPIST: Well I think if I don't have it, the one that I had here had reached the point where I used it to paint in, so that wouldn't be as good. I was somewhere and had it on and somebody commented to me that they worked for you.

FATHER: Oh.

MOTHER: Well thank you very much.

THERAPIST: All right. Kevin, I appreciate your participation today.

CLIENT: Thank you.

THERAPIST: Take care, guys. Thank you. See you later. That document; tell her it's in the printer.

END TRANSCRIPT

TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hello. Come on back. Ruth is so happy to see you, Kevin. No? Or is she? Ruth? What are you doing, Ruth? You're supposed to move. She came rushing over. She enjoyed sitting with you so much.

FATHER: You probably didn't feed her. She wants food.

THERAPIST: She went after someone's corndog the other day.

FATHER: Well we were going to bring our food.

THERAPIST: That's never a good idea. This college girl brings in her corndog and she's sitting there and I said, "I don't know whether that's safe or not," and she goes, "Why?" [00:01:00] Ruth runs over there and starts licking at it and she'll take it right out of your mouth.

MOTHER: We actually have parent-teacher conference at 6:30 in Baldwin tonight and so we'll need to leave 5:45, which should be a problem at all.

THERAPIST: That should be no problem because we're on 4:30 to 5:30 and we're actually running, by my standards, on time. (laughs) So yeah, we should be in good shape and we just need to hit the door at about 5:30.

FATHER: 5:45.

THERAPIST: Sounds good. So, parent-teacher conference. Are you all prepared, Kevin, for that?

CLIENT: Not really.

THERAPIST: No? Do they have you write up a little summary of your schoolwork and stuff for your parents to present?

CLIENT: No. I don't go in. They just go.

THERAPIST: Really?

CLIENT: Yes. Is that right? [00:02:00]

MOTHER: Yes.

THERAPIST: In my wife's school they make the kids do a presentation to the parents.

FATHER: That's smart.

THERAPIST: She was sort of the founder of this and they had these great kudos for that because then the young person is sort of having to be responsible for his learning.

MOTHER: Right. Wow, that's interesting.

THERAPIST: So what do you expect to learn tonight? Or ask or whatever it may be.

CLIENT: 3 From the parent-teacher?

THERAPIST: Yeah.

MOTHER: I went onto Power School and printed off the grades from the last two weeks and what I've got highlighted is what ...

THERAPIST: You came very prepared to answer my question.

MOTHER: Well. (laughs) Yeah.

THERAPIST: My goodness, Kevin. Have you seen this document? What thoughts do you have? [00:03:07]

CLIENT: I feel like I'm trying really hard, but it's just not working.

THERAPIST: Because you have a D in Science and F's in Social Studies, Intro to Spanish, Pre-algebra, and Language Arts. (pause)

CLIENT: And Science must be because I forgot my one article, but everything else I had like A+'s and stuff on.

THERAPIST: Now in our last installment a couple of weeks ago, you were going to be taking charge of your self-regulation, right? That was you.

CLIENT: I don't think we really did that this — did we?

THERAPIST: We didn't quite get started yet or were we going to get to the end of the ... ? [00:04:00]

MOTHER: What he's talking about is paying you for studying and us not being on your back about Power School and stuff. So yes, we did that these last two weeks.

THERAPIST: But I'm assuming that this is probably not a reflection of how you want things to turn out. Hmm. Okay. I wish that you were going to present to your parents tonight at parent-teacher conference so you can present what your plans are to sort of get things back into shape for the second nine weeks, which I believe you started or is it not?

MOTHER: This is the beginning of that.

THERAPIST: Oh, this is the beginning. I thought this was the tail of ... Oh, the first column is ...

MOTHER: Yes. Yes. So that's what he ended on.

THERAPIST: Oh I did not ... You made such a pretty highlighting that I jumped right to it and missed the first column.

MOTHER: I don't know exactly the date that it switched over. [00:05:00]

THERAPIST: So the data here do not reflect many days of work so far, just the first [three?] (ph?)

FATHER: It reflects everything.

THERAPIST: But it's a very small sample, you know?

FATHER: Right.

MOTHER: I think the quarter started like ...

FATHER: A week ago Monday?

MOTHER: I think it's been two weeks.

THERAPIST: Oh, dear. Okay. We have two weeks' worth of data.

MOTHER: Right.

THERAPIST: Okay. So this is under your command, now. I now understand what we're looking at, so give us your thoughts on where you've gone wrong. Let's go down the list here and what your plan is: Science, that was a D last time, right? And here it is, it was a D. What is the story there? [00:06:00]

CLIENT: I forgot to turn in one science article. We pick a science article each week and that was the only thing I forgot in that class. That's pretty much the only thing I've ever forgotten to turn in in that class.

THERAPIST: That must have been a big article.

CLIENT: Yeah. It's like 50 points, or something like that, each week.

THERAPIST: And when was that due?

CLIENT: I think it was due last week, but our classes were all shortened today and it was group two's article week.

THERAPIST: So is this one you've selected already and it's under your bed or . . ?

CLIENT: No. I forgot about it.

FATHER: All he needs to do is cut it out and hand it in.

THERAPIST: Okay. So do you need like a black magic marker or something to write on your hand or what? (chuckles) What method of reminding do you want to use for yourself?

CLIENT: I usually look on Power School every single day when I'm doing my homework and I do the 80 minutes. [00:07:02]

THERAPIST: Yeah.

CLIENT: And last time I didn't take a break because I just wanted to get it over with. I didn't take the ten-minute break.

THERAPIST: Theoretically it might work, but I'm a little worried about your focus.

FATHER: The 80 minutes is taken very literally. It's to the seconds, counting down.

THERAPIST: I don't blame him. I think when that clock rings I'd probably run.

FATHER: I don't know that it's pure homework during those 80 minutes.

THERAPIST: Oh. Then it's not really being taken literally.

CLIENT: It is. You just never ...

THERAPIST: But, Kevin, if you're working that hard, which is good, we should all be happy. I mean 80 minutes is 80 minutes, but why is this a problem because you just cut the article out during the 80 minutes? I'm not just trying to harangue you, I'm really trying to get you to think about where you — this is called metacognition. It's where you think about your learning process and where it goes wrong. Because if you had 80 minutes for roughly the last ten school days probably, cutting that article out is probably what — about a two-minute process?

CLIENT: Well I've also got to find it and sometimes they're pretty hard to find. But that was the only time I've ever forgotten one.

MOTHER: Now on these other pages, the front page of what I handed you is the overall grades; but then as you go, that will be each individual class and the class is highlighted over the top. So you can see that he did get A+'s on certain things and you can see his F there where that article was worth 50 points.

THERAPIST: Yes, Kevin, there is more data here. Except for one item, which is a chapter 16 worksheet, everything you turn in is pretty good. [00:09:05] There's the article, sure enough. There are some cute, little boxes and this compound models lab isn't due yet, apparently.

MOTHER: Correct. Right.

THERAPIST: This is very good. Daily work, Facebook, 24-hour extra credit. What was that?

CLIENT: That was just extra credit that you could log on Facebook; and I don't have Facebook.

MOTHER: We don't have Facebook.

THERAPIST: Oh.

MOTHER: Which is kind of a bummer. That's one thing I'm talking to him about tonight as well.

THERAPIST: I don't know any teenager who has Facebook. I thought they were all on Twitter.

MOTHER: I think you might be right. [00:10:00]

THERAPIST: No, they don't do that anymore. What do you do on Facebook to get extra credit?

CLIENT: You just Like his page. He updates it on reminders on homework and stuff.

THERAPIST: So that helps you stay connected to him? That's his reminder page. Okay.

CLIENT: But we rarely have homework except the articles in his class.

THERAPIST: So this page tells us that when you do and turn in the homework, you do pretty well. I'm not sure what happened on the Chapter 16 worksheet; you only got half of it.

CLIENT: I'm not too sure.

THERAPIST: Okay. But that one you turned in, so that's good. Will you get downgraded if you turn in that article late?

CLIENT: I think I can turn it in next Friday and I think he'll accept it because it will be my time to turn it in. [00:11:00]

THERAPIST: So when you're sitting down with your 80-minute homework, you're saying you get on here and look at what you have to work on and you see this. This is a straight print-out from the computer, all right? Every day did you look at this and see "that's that article"? Because it has this pretty orange and yellow box next to it that says [the article is missing.] (ph?)

CLIENT: But that's my first class that I look at and then I look down at all the other seven.

FATHER: So your dad thinks you were not, necessarily — he has a theory that you were not using all the — because he's thinking, "How did he miss getting that done if he had 80 minutes every day?"

CLIENT: Well he's never home. He got home at 2:00 the other night, so he's never home to actually see what's going on.

THERAPIST: He could Skype you and stare at you while you do that. [00:12:04] You think I'm kidding; I totally have people doing that to their college kids. That seems kind of creepy, so you probably don't want him to Skype you and stalk you. Okay. So this proves that when you turn things in you do pretty well. Let's see about the next one. So we have Social Studies and then — whoops — Constitution Scavenger Hunt. What was that?

CLIENT: That was looking through the Amendments and I didn't understand it at all. I worked on it and then when I got to school I didn't have it done because I was really confused on it.

THERAPIST: Did you talk to him about it?

CLIENT: No. That's what I forgot to do.

THERAPIST: Kevin, last time I commented on what a smart guy you are. [00:13:05] I also said maybe they don't need to drive you around like a little [bus] (ph?). This was the 15^th that it was due and what is today?

FATHER: The 23^rd.

THERAPIST: Surely you're not procrastinating, are you? That was sarcasm. You didn't notice that, did you? Hmm. Do you make a list of things to do? Do you have a to-do list?

CLIENT: No. I usually just look on there and check on it every now and then.

THERAPIST: Okay, but probably not while you're at school. Do you have an iPhone or something?

CLIENT: Yes.

THERAPIST: Do you have notes on it?

CLIENT: Yes, but we're not all owed to use it in school much, though. Like when you walk into the class she'll tell you to put it away even if the bell hasn't rung yet. [00:14:03]

THERAPIST: Do you need a paper list? iPhones are nice because then you always have it on you and you can check things. You were getting ready to say something.

MOTHER: That's a good point, actually. Before we bought a planner where, ideally, he would write down what he needed to do, but there was no follow through with that. But I do think that is one of the things that it would be great if he could write those things down. I didn't think about the iPhone for that, though.

THERAPIST: Yeah, technology is your best friend and your worst enemy. I had this case one time where this girl had Facebook, a college girl, and her friend got on it, just as a joke, and changed her status to "I'm pregnant." The girl didn't realize this until her minister called up and talked to her mom and said, "Is there anything I can do since your daughter is pregnant?" (laughs) [00:15:07] And the mom, of course, didn't know this, and so the girl is telling me this story and I looked at her and I said, "Wow, that seems like a good reason to get rid of Facebook." And she said, "No, Wes, you have to understand. Facebook is a tool. It's like a hammer. You can either drive a nail with it or hit yourself in the forehead." Your phone can either be distracting to you or it can be the most unbelievably helpful tool you will ever have, particularly an iPhone because it has a to-do list on it. Some people like that because they like to check off the thing which says "talk to Mr. What's-his-face." He doesn't have his name on here.

MOTHER: For Social Studies? "... about what the deal is with this here Amendments thing." Other people like to put it in as an event, so at 3:30 every day you look at your phone. I look at this and Other people like to put it in as an event, so at 3:30 every day you look at your phone. [00:16:05] I look at this and I say, "Oh, wow. Kevin is coming in at 4:30" or whatever and I know that's what I'm supposed to do. My to-do list, basically, is Kevin during this hour. Some people like to put it in as a little appointment so you go in after school, but it is probably desperately crucial that you learn to use that that way.

FATHER: I'm not trying to be funny, I just don't think he's got the organizational skills.

THERAPIST: I know. That's the whole issue that I'm pointing out, but he's got to find — the first thing he has to do is have a method. Now the follow-through on the method is tricky. But when you start giving them three or four different things, like a planner — I know that's the one everybody goes to — and/or a folder to carry around and a whatever, everything goes in that phone. This has been found to be so helpful that if you're on disability or voc rehab, which people with ADD can go on sometimes, they will give you a smart phone as part of your voc rehab because it is such a good tool. [00:17:15] Of course, it's useless if you don't feed it. My daughter has an iPad and part of what she is being told to do is to use the calendar to plug in events in advance so that we make sure we know what they are. You can use the calendar for that.

MOTHER: Does she take it to school?

THERAPIST: Yes, and she has it on her IEP. I think we talked about this. We talked about turning in work on e-mail. That's part of her IEP, but you don't have to have an IEP to make that happen.

FATHER: I don't think they will allow an IEP.

THERAPIST: I was reviewing IDEA today and there is something that has changed slightly in it. I did not believe they could refuse to evaluate somebody and it says on there that it's possible that you can file an appeal, but I didn't think they had the right to do that. So I've been reviewing that today. There is a book you can get on it, but even if they don't want to do an IEP with him, if you just go in and tell them you want it — they often call it a student improvement plan, and if they can find a way ... I guess somebody brought string in the other day for her and now everything she sees is string. (laughs) If you go in and tell them you just want to do a student improvement plan, they'll do that before they worry about it. The second thing is a 504, which is not legally binding, but the school will make sure he can access education. And having some form of organizer like if you provide an iPad, I bet you they would go for that; but then that's just one more device, so they really ought to just let him use his iPhone for that purpose. Now is he going to get on and surf God knows what? Kevin? [00:19:07]

FATHER: I think what's going to be helpful is the teacher conferences tonight and talking with the teachers.

THERAPIST: Yeah. Tell them we're trying to find some kind of organizational system. Our job is to figure out what system will work. Our job is including you, but none of us can follow Kevin around and say "did you put that in?" I do that a little bit with my daughter. I'm like "make sure and put that in your iPad," but we're not at school with him. Do you see the merit in this idea, that it would then tell you after school that you need to go talk to this guy; and so then you become accountable to you and your phone. And it may sound like a machine is controlling your life, but my machine tells me where to be and then that's where I go if I've fed it right. [00:20:05] I have someone to do that. Do you see the logic in that? We have to get you so that you and your iPhone calendar becomes like your second brain and you will be shocked at how well that works. But it doesn't work if you don't work it.

FATHER: Or if you abuse it.

THERAPIST: Well, right. That's the hitting yourself in the head if you're misusing your phone. You only need it out for a minute to check the calendar between classes and see "what am I supposed to do next?" That's it. He doesn't need an accommodation of it in class unless he's going to ... You can't really do homework very easily on it. I would talk to them about the e-mail theory to turn in the homework.

MOTHER: I did actually call and talked to the secretary about that and we'll ask them tonight, but she didn't think that would work. She mentioned the 504 — or you mentioned the 504. [00:21:03] We had talked about that and she thought he might qualify for that, but she didn't think ...

THERAPIST: She didn't think you qualified? I'm not teasing you, but you actually just talked to the secretary? She has no vague idea that this is a legal issue with the school and if you go in and tell them we want to get an IEP on him, they will immediately jump up and be like, "Well, let's try some other things first." And that's where you say, "Okay," and then you suggest those things. That's a principal conversation, but the place to start is the parent-teacher conferences. I guarantee you if you say anything to them really about it they can't make any policy changes, so this is more like you would talk to the school psychologist or something and tell them you want some minor accommodations. And you can even say to them that if we can just work it out informally, it's a minor situation, then they may hear what you're saying. They may understand that will be the easier way to go. I don't think he needs it out during class. [00:22:08] I don't know what he would do with it over the phone. For the e-mail, I don't know why they wouldn't accept it through e-mail. It hasn't been a problem any other time we've done it. Now I will admit your school district can be so funny about these issues. I'm really curious what they will do.

MOTHER: The phone is kind of an interesting issue because it's a source of huge contention anyway.

THERAPIST: Oh, yeah.

MOTHER: It's constant. It's like an extension; it's like another arm and he's never without it and when he needs to give it up for studying, he refuses to do that. We have to be "you don't get paid because this is part of the program that Doctor says."

THERAPIST: Why do you need it during studying, other than for the purpose I described? To hit yourself in the forehead with it?

CLIENT: Google Docs. I know I can do that on the iPad, too, but I'm a lot faster texter than I am a typer and iPad is more like a small computer. [00:23:07]

MOTHER: Kevin, be honest.

THERAPIST: This is sketchy.

MOTHER: You're constantly texting people all the time, so I can't imagine that ...

CLIENT: You asked me for my opinion so I was just giving my opinion.

THERAPIST: Do you constantly text people?

CLIENT: Not usually when I'm doing homework.

THERAPIST: Oh, Kevin. I don't like to turn your life into a technology nightmare. I'm almost hesitant to even say this, but you have to be more honest about this stuff with yourself. I can turn them onto an app that they have complete control over your phone and it's going to cost them a whole $13 a month, which is worth it. They can intercept everything you do and look at it on the computer and decide if they like it or not, like be big Nazis. That is the alternative here if you can't be radically honest about stuff. And it's easy. It won't even take a lot of their time. It will be cheap and easy to control you. Now do you really — and I'll show it to you; I'm not bluffing. It's kind of spooky and creepy, frankly. Oh, and they'll know where you are every minute. It tells them where you are on the screen.

CLIENT: Sounds like a stalker.

THERAPIST: Yeah, it is. It sure is. Why would anybody need to do that to you, sir? That's literally really a question. It wasn't rhetorical.

CLIENT: I really don't know.

THERAPIST: Because you would not giving them what you need to be doing and refusing to give up your phone at a time when you don't need it. And then they just push a button and it shuts itself off. If they get really mad at you they hit the "Like" (ph?) button and it just wipes out everything on your phone. [00:25:05] They have to get my written authorization to do that, so they don't go crazy. (laughs) You kind of get into a mood about these things and you think that you have a lot of power and you don't — just be doing your 80 minutes and then text your friends. I showed lots of faith in you last time that I do think you can do this and it may take a little more getting used to; and I think we owe you that. But I'm just telling you what the alternative is. They don't need to even take your phone. They can blow your phone to pieces with the push of a button if they want to. Does that sound like fun? This is getting worse; they can turn your phone into a bug and listen to what you're doing. You don't even like this. (chuckles)

MOTHER: No, I don't.

THERAPIST: It sounds horrible.

MOTHER: The control of it, that part of it, turning it off when I want it off doesn't sound bad; but yeah, I don't really want to know everything. [00:26:06]

THERAPIST: Well you can use whatever features you want, but once you have that power, if I were Kevin I wouldn't feel like I liked that very much. So the question is: I believe you can be more accountable, but when you say "I won't give you the phone," what's going through your head?

CLIENT: Yesterday I said "no" and then I ended up giving it to her. The other day — I haven't used my phone during the 80 minutes at all.

THERAPIST: Oh?

CLIENT: Have I? (pause) The phone is always downstairs right next to you.

MOTHER: I think we've only done that about three times, because the other times you had things to do.

THERAPIST: Which things, like taken it or . . ?

MOTHER: Studying. There has been refusal to actually study for 80 minutes and then there's also refusal to give the phone up, so I think it's only worked three times where he has studied and given his phone up. [00:27:00]

THERAPIST: Ohh.

MOTHER: And so the other times he'll lock himself in his room.

THERAPIST: Well this isn't going as well as I thought, Kevin. And when your dad pointed this out you said he wasn't there, but he was actually right, wasn't he?

CLIENT: That's not entirely right.

THERAPIST: What happened? Tell us about that.

CLIENT: I usually do give up my phone. There has been two times where I've locked myself in the room because I either took my patch off early because it fell off in gym and then I was angry. She's saying that there's only been about three times that I've studied; it's been more like four or five. I haven't gotten overly angry since the last one. What were you going to say?

FATHER: Overly angry — no. Defiant — yes. You may not be outwardly yelling, but you're still defiant. [00:28:09]

CLIENT: I haven't seen you in like three weeks.

FATHER: I was there with you Saturday when I asked you to do homework and you refused. You had locked yourself in the room the night before. When I asked you to open it up and you refused, I told you that you had to pick up all the walnuts because of that.

CLIENT: That's what I'm doing when we get home.

FATHER: And you still haven't done that and you refused to do that on Saturday. You said, "No, I'm not doing that."

THERAPIST: So you guys do understand why the specter of the phone-destroying machine pops into my head because that would be nightmarish for you and you're having a hard time complying with some small things. [00:28:59] What we're trying to give you a little more freedom to self-regulate and you're regulating yourself into a walnut festival. Why were you locking yourself in the room? This happened how many times, John?

FATHER: I know of three that he has ... The door is not supposed to be locked and I'll come up to talk to him and the door will be locked. I will ask him to open it and he refuses. It's been three or four.

MOTHER: In the last couple of weeks. It's been an ongoing thing. We've taken the door off the hinges before.

THERAPIST: Do you guys have a bathroom lock on it so you can pop it easily?

MOTHER: Yeah.

THERAPIST: That's a good way to do it. I think kids should have locks on doors. That's nice, but it has to be locks that are more about sort of symbolism than you literally cannot get in, so that's a good ...

CLIENT: And the reason I was locking my door because I was sleeping and my sister runs in and she opens up my door. Who knows? I could have been changing and she's done this three times, actually, she just runs right in without even knocking. [00:30:08]

THERAPIST: I don't think anybody that lets you have a lock on the door is saying you shouldn't use the lock, it's that you're refusing when you know it's them to open the door. That's sort of going beyond what the purpose of the lock is. That's the problem with that. Whenever we have locks on doors there is that sort of understanding that it's to keep little sisters and people out and it's to give parents some — to let the kid have some privacy. But if you're doing that to hide out from their authority, that's completely different.

CLIENT: I only locked the door when I was mad, haven't I? I've never been happy and gone up there and locked my door, have I?

MOTHER: Oh, yeah. It's locked a lot.

CLIENT: I usually open it to you because I usually forget that I locked it because it's just a habit.

MOTHER: That's true. When you're not angry you to unlock it. [00:31:00]

THERAPIST: And you were mad because you were — what? Coming off Daytrana or what?

CLIENT: No. It' s usually when I get mad at my mom sometimes and then she starts fueling it and then I go upstairs and I lock it until my dad gets home. He'll come up and he'll try to open it and I'm just so mad that I don't want to talk.

THERAPIST: Okay. Maybe you had better walk me through one of these incidents.

CLIENT: I really honestly don't remember any of them.

MOTHER: They typically start with homework. At 4:30 it's time to do homework, so going up and study and then hand your phone over. A typical situation is, "Nope. I'm not giving you the phone. You need to give me the phone." "No." And then ... (pause)

CLIENT: I've started to not do that anymore.

FATHER: Well, you did that Saturday.

CLIENT: I said "started," so ... [00:31:57]

THERAPIST: I think between now and our next session you had better ... I haven't told you this yet, but there are two words I really want you to ban from your vocabulary forever; and that's "try" and "want." Yoda says in Star Wars, "Do or Do Not. There is no try." And so you need to just decide this is what I intend to do. The phone thing, I think you had better surrender on that or prepare to be boarded. I really ... You hear how hesitant I am because I think that is such an invasion of your privacy, but you are kind of begging for it; and so my recommendation is that they give you two more weeks and you're supposed to be self-regulating. I don't think they ought to start up any arguments with you about study time. That's what they should not do. If you don't do it, you don't do it; and then we reconvene here and if you're not able to manage your own study time, then we're going to put the nuclear trigger on that phone. [00:33:06] I deeply encourage you not to take it to that point. And by this I don't mean okay, if you can pull it together for two weeks, then that's completely off the table. I'm saying if you can't ... This whole thing is based on you being able to make better choices, whether they're going to talk to this guy or putting stuff in your phone. That phone can be shut down and the calendar still works just fine. You don't need to upload the calendar to Google, it will work without that. Signaling, turn off, put it in airplane mode, lock it down. I think you should surrender on that. (pause) [00:33:59]

MOTHER: I do think he has a very good point about the medicine.

THERAPIST: The patch falling off problem?

CLIENT: That was because I wasn't using the tape.

MOTHER: He is in total control of when that patch comes off. He's supposed to wait for me but he doesn't. I don't think the patch works for him because he has the ability to do that — and this is kind of in your favor. These grades and what's happening at home, I feel, have a lot to do with him not being medicated like he's supposed to be, so I think maybe he's not a candidate for the patch.

THERAPIST: There is an early removal problem.

MOTHER: Right. And if it's itchy for him, then maybe he has an allergic issue or whatever.

THERAPIST: Well, (laughs) the biggest problem — and I'm working on this for my book and I'm sort of getting consumer product information — there are about three reasons to hate the patch and about 20 to like it; and one of the three reasons is because people with ADD can feel things that other people don't (laughs) and that patch is one of them. [00:35:06] They feel it. Girls don't like the Nuvaring for birth control because they're sure they can feel it.

MOTHER: Really?

THERAPIST: Yeah. And nobody else feels it. So that is the weird problem with it, that sensory thing.

FATHER: Have we tried different areas?

THERAPIST: Yeah, there's a good question.

CLIENT: And I use that KT tape and it hasn't been itching for a little while. Sometimes it will itch right when I put it on, but then ...

MOTHER: But not once have you come to us with it. The deal was I was to be in the know when the patch came off.

CLIENT: I did that today in the car.

THERAPIST: Okay, but Kevin, buddy, your answer for everything is "I did it once" out of 364 times. That isn't going to do it and I think — you're kind of inching personally. Do you not trust anybody but you to decide things?

CLIENT: No, I do but ...

THERAPIST: Really? (pause) Go ahead. I didn't mean to cut you off. Do you really? It just seems like you don't trust anybody but you. [00:36:13] (pause) If that's true, please do say it. Do you guys feel very trusted by Kevin to make any decisions?

MOTHER: I don't know if I ever look at it in that term.

FATHER: I have. I think he trusts me when he's in a good mood or when he is Kevin.

THERAPIST: Thinking; when he's in a thinking mood.

FATHER: Correct. And I've made the comment before, "Do you not trust me? Do you not think that I'm trying to do the best for you?"

THERAPIST: That is really the question. [00:37:04]

CLIENT: I trust my dad more than I do my mom because sometimes ... It hasn't happened in a little while because I just haven't been trusting her as much, but I trust my dad more because he's more like me and he trusts me more than my mom does. Like he'll trust me with driving the car out, like when we're coming back from hunting. He trusts me with driving the car and he trusts me with guns all the time. He'll let me go out hunting by myself when we're out, when it's just me and him; but my mom doesn't trust me as much as my dad does and I think that's one of the problems. I've noticed when I was doing my homework when my dad was helping me with it, I was feeling a lot more secure about it and with my mom, I was just mad all the time. Yeah. [00:38:11]

THERAPIST: And the purpose of our last session was to try to get her a little bit out of the nagging role. That just causes stress between the two of you and doesn't make too much product. That's all based on you nagging yourself. Do you know what I'm saying? I am banking on you being mature enough to do that at this point. I really am. I'm banking everything on that and everything is you being able to pass through junior high and into college. That's what we're banking here. That probably makes your mom a little uneasy, but it's you that has to make these decisions. So I'm actually putting a lot of faith in your judgment and we shall see if it is misplaced. [00:39:02] But so far, you're not off to a super great start. Would you like to argue that point? I'm really inviting you to. Okay. You don't trust her to decide when to take the patch off?

CLIENT: No. I was just saying that I trust my dad a little bit more than my mom because my mom doesn't trust me as much as my dad does.

THERAPIST: I hear you. Trust is a one-way street with parents and teenagers. And it sounds bad, but it isn't. Your parents have to act like mature adults. That is their job and you get the luxury of being a teenager and that makes you inherently not trustworthy. It isn't really a question of being trustworthy. Now your dad, with the gun example, what he's really saying is that he has faith in your judgment with guns; but in terms of trusting you to follow through on commitments and things, I think we're all a little worried about that. Do you understand the difference? [00:40:02]

He knows you can handle a firearm safely and will shoot only what you're supposed to shoot. Am I right? Is that about right? Okay. But all of us worry that you are not going to follow through on other commitments, so that's the difference. You have to be able to trust him. I understand it's hard for you. I totally respect that, okay? You get to trust them and they show that they're trustworthy. That's what's lucky about being a teenager. You just get to be a teenager. So I need to know why your mom isn't trustworthy enough to decide when to take the patch off because that seems to be ... You're going to blow this particular medicine-delivery system because you're taking it off too early.

FATHER: I don't know if it's the right dose as well.

THERAPIST: And that's the other thing.

CLIENT: I think it is. [00:41:06]

THERAPIST: The problem is we can (chuckles) [be pretty sure he's not following the protocol] (ph?) so it's hard to figure that out. You're on what — how much?

FATHER: The lowest, 20.

THERAPIST: So this is just your doctor's entry dose for you, but what's the problem with leaving it on until the agreed-upon time?

CLIENT: I have been leaving it on since I've gotten the tape and one day I completely forgot that I had it on.

THERAPIST: That will happen.

CLIENT: That happened today until I was in the car and it has pretty much happened every single time since I've started using tape.

THERAPIST: And the tape helps in keeping it smoother so it doesn't fall on your shirt or something?

CLIENT: Yeah.

THERAPIST: Okay.

FATHER: Do you notice a difference when you're wearing it?

CLIENT: Yeah. [00:41:59] Like the other day I forgot to put it on. I was tired and I wasn't aware at all. I didn't want to do anything.

THERAPIST: I think your dad is probably correct and it's something you're going to want to talk to your doctor about. This was the entry-level dose to basically be sure it doesn't make you zany and it hasn't if you feel like you're doing well on it. The wash-out is when they get irritable and I would normally stick up for you on going to your room at a certain time of the day because that's when the wash-out period happens and you need to kind of have quiet time, but I just feel like you're using that to your advantage. Lesson nine in ADD planned with Wes is practice radical honesty. You have to. I know it is harder, but you have to live an honest life with people or then they do this thing that you feel frustrated about, and that is not trust you and think your judgment is poor, whatever it may be. [00:43:03] So we've got to come to an agreement when the patch is supposed to come off. I don't think we ever talked about this and I don't want to forget.

MOTHER: I think you said at the start of homework, make it through and then ...

THERAPIST: Sam, he's got two hours to drift on it afterwards. Yeah.

CLIENT: So what's wrong with that idea?

FATHER: Do homework and then take it off?

MOTHER: No.

THERAPIST: What's wrong with that idea?

CLIENT: With taking it off during homework?

THERAPIST: Well, yeah. Or right after or whatever. Any of those.

CLIENT: I don't really think I have a problem with it.

THERAPIST: Can you commit to it? Can you do it?

CLIENT: Yes. I have every single time, but my mom, again, hasn't trusted me.

THERAPIST: [Taking off] (ph?) in front of her. Kevin, this is an argument I've never, ever had with my son. We are a team and we discuss medicine on a daily basis and I remind him if he needs to take it off or he asks me "should I take this thing off now?" We look at the rest of the day and we think, "Yeah, you've got some more work to do tonight. Why don't you leave it on a little longer?" [00:44:04] And he doesn't say anything like, "Well I don't want to do that." It's not because he's so perfectly obedient, but because he is on a team — and he just turned ten, so I know you can do this. Can you be on the team? It's your team, man. Nobody else's. It's not here for your dad or mom — well not directly here (laughs) for your dad and mom; but you're the man. So you have this grim look on your face. Are you really agreeing with me or are you just shutting us off?

CLIENT: No, I do understand. Yeah.

THERAPIST: Because we want you to have the right brain to do the work; and so you're going to surrender the phone, take off the patch, do 80 minutes, and then if he wants to lock himself in his room at that point, is there a problem with that?

MOTHER: As long as ... No.

CLIENT: Whenever we're at home ...

MOTHER: We don't like his door locked because we don't know what's going on, but it's typically because you haven't done those other things, so we do typically ask him not to lock the door. [00:45:10] But if that's what you're saying ...

THERAPIST: Well if he's in there smoking a bunch of weed, no, I don't think he should have his door locked. (laughs) What are you worried he's doing?

MOTHER: Honestly, we've had some issues. He opened a Facebook page against our wishes when he was told not to do it and he did it anyway. That all happened behind locked doors and then we kept getting phone calls from people about how inappropriate some of that stuff was.

THERAPIST: So you didn't just open a Facebook page, you put up inappropriate things on it?

MOTHER: Right. Bad language and that kind of stuff. Arguments with friends and that got ugly, so we always found out about this stuff because — we didn't even know he had a Facebook page. A lot of stuff has happened like that behind closed doors. I hardly ever go up and check on him, but when I do go up there ... It's hardly ever. He has so much freedom, which is ridiculous, but I don't check on him all the time and I don't check on his phone all the time. [00:46:16]

THERAPIST: If you want a Facebook page, why don't you just have them be friends on it?

CLIENT: Because they don't want to have a Facebook.

THERAPIST: Well you do that secretly.

MOTHER: Both of our kids are adopted and our daughter came from a bad situation.

FATHER: We didn't trust the father and we thought there would be some retaliation.

MOTHER: And so we want to stay under the radar. We don't know his birth father and they have shown some interest pursuant from that angle; and we just want to stay under the radar because we don't know about these elements. I don't know that a whole lot of good comes out of kids with Facebook pages anyway. You hear a lot of it; so we just said no Facebook. [00:47:01]

THERAPIST: Well that girl was sure right about the Facebook example I gave. It really is either a tool or a way to hit yourself in the face and because Facebook is a public document, it's like having your own super printing press. I absolutely think minors' parents should be friends with theirs on Facebook, and questionably so. I use this example on the radio (chuckles) because half of my radio shows, my mom is with me in the green room because we're going to an eye appointment. I schedule those on the same day, and so I have commented a time or two that I know my mom is listening to the show, right now. (laughs) And being cognizant of that is helpful for me in thinking about the little old ladies listening to me or whatever. We do some pretty heavy-duty content so some days that's a little bit uncomfortable. I was really glad she wasn't there — oh, wait, she was there for the show about pornography. [00:48:04] I can't tell you how happy I was that it was also going to be the [pledge class to help when they were pledging, so they turned down the speaker.] (ph?) Oh, God. I felt happy about that. You don't really want to put anything up on Facebook you don't want your granny to read. And that's not just because you're respecting adults, it's because anything your granny can't read probably shouldn't be published in your online newspaper. Same as with Twitter, although I follow a lot of teenagers around the world and I finally quit my subscription feed to people I follow that you could get on there because it had gotten so raucous. Those kids will say some amazingly great things and the next thing they'll say is some weird reference to cocaine that even I don't understand and you're just thinking "oh, God, no." [00:49:02]

FATHER: And I know of people that have tried getting jobs and bosses will go and look at Facebook pages.

THERAPIST: We talked about it this summer on the show. I had a couple of kids from [Lawrence] (ph?) that were actually a couple, a girl and boyfriend. It just happened that they were a couple. They both came in talking about technology and the boy is, apparently, going into computer science. He had quite a bit to say about that very issue and he said, "I don't recommend anybody post anything they don't want an employer to see." He said they're selling that information as part of the data vetting process, too. He had a lot more knowledge about this than I do. It's all public information. Facebook owns all that. They can keep it and there are laws they're trying to write in California that adults can expunge all of their crapola they put up as minors. And they are running into just tremendous problems implementing this law. [00:49:59] It's called the scrub the web law. They're trying to even respond to this because kids have such a tendency to do themselves in. I don't care if you all do a Facebook, that's an interesting concern you have, but if you do a Facebook you need to come to some peace about it together and agree on what the rules are going to be. When one girl was on there, she's moved all the way to college, she said that as soon as she's an adult, she's going to defriend her family. (chuckles) But she says, "I understand to this point why they felt they needed to be on there." I disagreed with her about that. I thought when you're in college if you don't want your parent to see something you ought not to probably be doing it and not posting it, but I understand. I respect the adult in her to differentiate. I don't know what she decided to do on that, but you have a lot of media issues, man. I'm going to tell you that in the next two weeks you get in charge of your media issues or I'll love you enough to crush you to death. [00:51:02] How's that? Fair enough? I'm pretty tech [oriented] (ph?) How's that? Do you want to know what teenagers think about? You just get on Twitter. You just get on Twitter and you will know what teenagers think about because they don't spend on second between here and Tweeting. It comes right out. It is the most powerful ethnography of adolescence in America today. I have learned so much and it gives me material to sort of talk with kids about things I'm not thinking is on their minds, and it absolutely is. It's really interesting. We have no idea what that whole system is doing. So you know your plan for the next two weeks. What is it? [00:51:57]

CLIENT: To turn in the phone, try to get everything turned in, do my homework.

THERAPIST: Get your list of things you need to do, to talk to the teacher and whatever it takes. And then take it off in front of her. Then she knows.

CLIENT: The patch?

THERAPIST: Yeah, the patch. (laughter) I'm sorry. I jumped over words that were important. Yeah, take off the patch in front of your mom so she knows the story; then there's no argument. Because I'm telling her not to nag you a bunch and I'm telling you to show her your good faith in taking the patch off before homework starts. Your mood will be better longer, too, the longer you can put off the wash-out period without harming sleep. In a perfect world, you would take the patch off at exactly the right minute that when it washed out of your system, you would hit the pillow. That's just the perfect scenario. [00:53:03]

FATHER: How long does it take to wash out?

THERAPIST: From the time you take it off or its total life span?

FATHER: From the time you take it off.

THERAPIST: About two hours. The problem is you may get a little longer drift on things like not sleeping or something, so you want to watch it. How is your sleep on this?

CLIENT: Pretty good.

THERAPIST: Okay. So so far, so good on that. For some people it makes them sleep better. Are you putting it on him in the morning before he gets up? We had that conversation.

MOTHER: Not before he gets up. A lot of times it's like right around breakfast time or whatever.

THERAPIST: There are two ways you can go at it. You can do it at breakfast. It was sort of back-and-forth with my son because I found he ate a little better if I let him wait on the patch, but I liked his functioning better if I put it on him before he got up while we were traveling this week. So those are your two possibilities; because if you put it on while they're still in bed they tend to operate better in the morning, but you may clobber his appetite. How has your appetite been? [00:54:12]

CLIENT: Good. Really good.

THERAPIST: You might get away with that then.

MOTHER: We've already touched on this, but I am curious about what time you do take it off. I know one day — it was probably unusual — he took it off at lunch. But I am curious at what time of day. Do you wait until you get home to take it off?

CLIENT: No. Since I've gotten the tape I've taken it off at home every single day.

THERAPIST: You just do it right when you're done studying? That can be your "I'm done" time. And then you get just enough medicine the rest of the evening that you can focus immensely on just the right text to the most beautiful girl in the school or whatever it is. Believe me, people on medicine text a lot smarter stuff. I know because I receive those texts. (laughter) [00:55:02] Seriously, there are some kids I know that are texting stuff and I text back, "Are you on medicine?" and they're like "no" because you're just like what are you talking about? So people will be like "wow, your texts are so meaningful." Yeah. And you don't have to tell them the secret. Go tell them it's like auto-correct or something. It's like existential auto-correct. It changes the depth of meaning in your texts. I might have to invent that. That seems like a really good idea.

MOTHER: It does.

THERAPIST: And don't be whiny about any of this this week. They're trying to give you freedoms here. You see them as taking them away. I see them as trying to sort of meet in the middle. The other thing about the door, the door locking isn't going to fix Facebook. I see where your theory is on that (chuckle) because he's doing it with the computer. Hmm. [00:56:03] Why don't you just have it so you lock the door but if they want to come in they knock and you unlock the door? That's normally how we do it. That gives you a sense of privacy.

CLIENT: I usually do that, but I usually don't when I'm mad.

MOTHER: We haven't talked a whole lot, but he seems to get angry and I think it's gotten bigger as he's gotten older, but angry quicker and more frequently; so things escalate very, very quickly.

THERAPIST: What was he on before the patch?

FATHER: He's not going back to that.

THERAPIST: No, that's fine. I'm not saying that.

MOTHER: It was the methyl-whatever. Sorry.

THERAPIST: That ended, yeah. That was [actually more than you realized.] (ph?) That's why they don't use that. They were going to call the Daytrana patch the Methyl patch, and I think they realized how bad that sounded. [00:57:08] What was it? It was the extended-release?

MOTHER: That was the generic methyl-whatever and before that. He's had the best luck with the Ritalin group. Before that he's done Concerta, which we loved, and then Focalin was before this methyl-whatever; but he was only on that a little bit when we found out about the patch and tried it. He didn't even use a whole month's supply of that end one.

THERAPIST: There was something I was going to ask you about that. (pause)

FATHER: Talking about anger?

THERAPIST: Yeah, that's it. Do you find when you're on medicine that you feel any different in your ability to manage your temper? Is it better or worse?

CLIENT: (chuckles) Not around my sister at all.

THERAPIST: Neither way is good?

CLIENT: No. If I have it on it's not good; if I have it off it's not good. [00:58:05]

THERAPIST: And what's wrong with her? I'm probably starting up a whole thing when we meet ...

CLIENT: She tries to annoy me.

THERAPIST: How old is she?

MOTHER: Eight.

THERAPIST: That is the best reason to have a lock, isn't it?

MOTHER: She's a great kid, but she will push buttons on purpose. (pause)

THERAPIST: Is that why you were mad the other night, because of her or you and your mom?

CLIENT: No. It's just me and my mom.

THERAPIST: Okay. And what's the worst that gets of late?

MOTHER: Well, like the other night we were driving home from and she wanted the radio on so I turned it on; and he turned it off, so I immediately turned it back on. It's just little things like that. It escalated from that and, as I'm driving down Highway 10, he's grabbing my arm and fighting me like that. [00:59:10] That was a bad one.

CLIENT: No. That was because you — I can't remember what you were doing because I was so mad — you — what were you doing?

MOTHER: I think I confronted you about when he's backed in a corner, he comes out fighting. I had called him on something, I can't remember what it was, but maybe it had to do with homework because I haven't been doing the homework thing, so that wasn't it. I apologize. I can't remember what that situation was. [00:59:59]

THERAPIST: So we have to send a recorder home with you guys so you can just record it. (chuckles)

MOTHER: I thought about that before. It might have been that he refused to pick up the walnuts. Maple Leaf weekend was last weekend and my father let him drive his Land Rover in the parade, he and her. And then we go back home and his friends showed up and I said, "You know you can't ride the Land Rover anywhere." I made him give the keys over. I turned around and I hung them where we hang the keys. I go to Maple Leaf and I come back and he's driving the thing, coming around the corner with a friend in it and so he had been driving it. It might have been that that came up in the conversation. I don't know. Somehow that all related and I think maybe it escalated in the car.

THERAPIST: The Land Rover isn't one of those things that's made in England, is it?

FATHER: No. This is a four-wheeler. He was carrying wood in the Maple Leaf.

THERAPIST: I just assumed that was the case. So here's what we're going to find out and this will be a good place to wind up. Get him up to the right dose of medicine and these things go away, then what we will have learned is that they are a product of indeliberative thinking; he isn't thinking things through before he does them. And so then he thinks them through and he thinks, "Oh, man. I want to drive the Rover really bad, but I probably shouldn't. I'm going to get in trouble." That's going to be one scenario. (chuckles) The other scenario would be he gets worse and then we're going to have to start looking at some different issues. If he doesn't get any better and he doesn't get any better with the anger thing, then we're going to puzzle over that a little bit more because it may just be oppositional defiance. [01:02:10] I tend to go to that last because it's sort of unproductive behavior for a teenager so it's usually driven by something else. But if that's it, then we're just going to have to go into lots of consequences. The worst part of the consequences for the oppositional people is you always look for the ones that are the most annoying. That doesn't sound very fun, does it? So you're going to do a couple of weeks. And the other thing I'm trying to figure out, Kevin, how often are you having your break time where you cool yourself off. I think that's a nice thing, but that should be about a tenor a 15-minute process; and if it's two and three hours, that seems like you're sketchy to me. [01:03:07] That's just the thought. I want to hear what it is you're angry about, what's triggering you and how you're handling it.

MOTHER: At some point, do we continue to come or do you see us individually?

THERAPIST: I love seeing all of you. We haven't gotten quite to it yet. There may be an occasion where I want to talk to Kevin for a while on his own, but that tends not to be as helpful with the oppositional people as it is with the just regular ADD people and they have their own private frustrations about how they get along in the world. Right now his main frustration is with you guys and your main frustration is with him, so I'm happy to see you all. Do we have an appointment set? [01:04:06]

MOTHER: We do. We went ahead and set four more up, I think.

THERAPIST: Well that's a happy day. So you know what your job is? Oh, is this your copy?

MOTHER: No. That is yours.

THERAPIST: Okay. Do you have the power to e-mail it to me?

MOTHER: I do.

THERAPIST: Because that will get it digitized so I can put it right in your file.

MOTHER: Okay. I can definitely do that.

[ ] (crosstalk at 01:04:24)

THERAPIST: Oh, my gosh. We need a nice Macintosh.

FATHER: Unfortunately, my business Pro Man doesn't work with a Mac.

THERAPIST: That is the one downside. Things like QuickBooks, they have one for Mac; but it's not very good. We have an emulation program that we run and it runs on the Mac; but it takes extra software.

FATHER: I've done that before.

THERAPIST: All right, guys. See you later.

MOTHER: Thank you.

THERAPIST: Take care. That's my daughter at the monument.

FATHER: Take care.

END TRANSCRIPT

TRANSCRIPT OF AUDIO FILE:

***Note: There were a total of four speakers from 00:00:00 to 01:13:55. Audio was excellent, but there were several blocked passages from people talking at the same time.

BEGIN TRANSCRIPT:

(door opens) (inaudible)/blocked

MOTHER: Hello!

THERAPIST: Nice to see you, too! Come into (inaudible).

FATHER: She’s aware it’s out here, right before you open the door?

THERAPIST: (laughs) I have... treats for her when she’s in here.

MOTHER: You can come see me later, kitty. There we go!

THERAPIST: She is kind of getting into a routine where she runs out and meets people, and then comes in. It’s kind of endearing!

MOTHER: Yeah, it’s very cute! Is she back in?

THERAPIST: What’s that? Yeah, she just came back in. Let’s see. Did she do her trick for you guys last time?

MOTHER: No. We haven’t seen a trick.

THERAPIST: (crumpling paper) One of her fancy tricks... “Do your trick!” (pause) “Can you do your trick? Wait! Oh, you’re not interested in the trick!”

MOTHER: I don’t have, I don’t have anything!

THERAPIST: You remember these people were your friends last time!

MOTHER: Look at that tail go!

THERAPIST: Okay. Now you can do your trick.

MOTHER: I want to see it, (inaudible).

(pause) (all respond with “Ooooh!”) [00:01:11]

THERAPIST: Good job! (all chuckle) (pause) I said it’s not a very fancy trick, but...

MOTHER: But a cat that does a trick is pretty fancy.

FATHER: I knew a cat that would retrieve popcorn! You’d throw it and...

THERAPIST: Her kitten, who’s about nine months old now, just got his operations done, will play fetch for time on end! I keep throwing the mouse, and he’ll keep getting it.

MOTHER: That is funny! I’ve only known one cat that did that.

FATHER: Did you do the tape recorder last time?

THERAPIST: Yup.

FATHER: Okay.

THERAPIST: See it?

FATHER: I didn’t.

THERAPIST: It hides right there in the...

FATHER: Oh.

THERAPIST: It’s like almost, you don’t even notice it.

FATHER: No. I didn’t. Obviously! Huh! I didn’t notice it last time, and I didn’t realize that you’d started...

THERAPIST: Well, I try not to remind you of it, not to be tricky, but just so we’re not thinking about it. The best way to do radio is, you just get in there and talk to people in the studio. You don’t think about the mic, so. [00:02:08]

Okay, Mr. Kevin! We’ll find your... information here. Would you say you have had a good couple of weeks?

KEVIN: Oh, yeah. I think it’s been pretty good.

THERAPIST: Really? I thought I would check you first today to see... You’re not wearing your glasses; you’re wearing contacts today or...?

KEVIN: No, I just forgot my glasses at home.

THERAPIST: I, too, have done this (inaudible). That’s why I have the, like an assortment of them laying around (inaudible). So, you think you had a pretty good couple of weeks. Tell me what you think was good about them.

KEVIN: Well, um, I’ve gotten all my grades up from F’s to D’s and C’s now. Um... I haven’t had any late work for a little while. Uh, well, I haven’t had any late work since the last time we were here. And then... [00:03:10]

THERAPIST: Because that’s two full weeks! That’s pretty good.

KEVIN: Yeah. And, um, I did pretty bad on my Science test, but that was the day that I forgot to wear the patch. And, um... (coughs) You know, I misunderstood a lot of the questions. Yeah. It was pretty bad.

THERAPIST: Normally, I don’t, I’m not like, “Oh, Kevin; I feel sorry for you,” but (chuckles) if you’re taking a test and you’re off your medicine for a day, unless it’s built up in your system or built up some resistance and you don’t have it, yeah, that’s not a very good day to take a test. (client affirms)

FATHER: That’s why it’s important to do it every day.

THERAPIST: Amen!

MOTHER: I think that day we...

KEVIN: Well, that day we were out.

MOTHER: We thought we were out, and I, yeah, like, “I didn’t know we were out,” “You have to tell me,” you know, that kind of thing. But, it turns out, we actually had some still, but that day, we... you know, we didn’t...

KEVIN: Yeah, I didn’t see any there.

THERAPIST: On your next batch, it’s probably a good idea to put one in like a pill bottle and you’ll have to show them... Like if you use one of the old boxes, it has the prescription on it? (mother affirms) Send that and the one in the pill bottle to the nurse’s office... [00:04:21]

MOTHER: Ooooh!

THERAPIST: He can put it on late. Because this medicine, this has the property of being able to be turned off, he can take it late.

MOTHER: That’s a good idea, yeah.

THERAPIST: All other stimulants, you can’t take late, because once you take them late, then you’re going to be up at night. So, that’s how we do it in my world. We make sure and have one at school. It’s an emergency back-up in case it falls off or someone forgets to put it on.

In your defense, yes, we, too, have had that problem in the past, and we are the patch applier, so... It does happen. Once you get into a really good rhythm with it, it’s just a natural part of the process. One of you will notice if it’s not happening. But... that will happen. That was a bad day to be off it. You noticed the difference, huh?

KEVIN: Oh yeah! A lot! Like, I was reading a book, and it was hard to stay on the same line. And then I, when I’d skip down the line, I’d realize I was reading the same line over again. It was really hard to focus. [00:05:23]

THERAPIST: That is a pretty good description. So...

FATHER: What about dosage?

THERAPIST: Hold that thought. That’s (chuckles), I wanted to ask about that, too, because he’s on a 10 or something, isn’t he? He’s on the lowest dosage? Okay. Let’s talk about that in a second. So does it feel like enough, or not?

KEVIN: It feels like the perfect amount, because I can still like, have fun with my friends and not be serious all the time. And... yeah. I mean... I can have fun with my friends, not be serious, not be 100% serious, but when I start doing work, I am really focused on it.

THERAPIST: Okay. Are you eating?

KEVIN: Yeah.

THERAPIST: Okay. So what else has been good, before I interrogate the parents about this? (chuckles)

MOTHER: I’ll pray for that (ph).

KEVIN: Getting up in the mornings... homework... Like the 80 minutes homework. [00:06:23]

THERAPIST: Is, that you’ve, you mean you’ve been doing it without trouble?

KEVIN: Uh, there was one time where I wanted to take a shower, but I didn’t have enough time, so...

THERAPIST: So you...

KEVIN: So I just, I put up a little... fight, but it didn’t last very long. It probably lasted like five minutes, and then I started doing my homework.

THERAPIST: Did you take a shower after the homework? (Kevin affirms) Did you what, not smell very good? Was this a problem?

KEVIN: (chuckles) No, I didn’t have my deodorant in Gym because somebody took it and smashed it on the floor. I didn’t tell you this, but (chuckles) somebody took my deodorant out of my locker and smashed it on the floor! So I walk in, and there is this one big blob of deodorant, sitting on the floor. [00:07:15]

THERAPIST: I presume this is a person who does not then have to sit next to you in class? (all laugh, Kevin affirms) It doesn’t seem very wise to me, for such a person to do that, so... All right. So this was a, you perceived that as sort of a minor disagreement. Then you did the 80 minutes of homework, then you took the shower? (Kevin affirms)

Do you think, as you look back, sitting in the “wise people’s chair,” because you always seem so wise when you’re in here! (Kevin chuckles) It’s like, I don’t know the Kevin that they’re talking about. So you’re in the “wise chair” now. Do you think, as you look back on this, that it was probably smart for you to go ahead and just do the homework for 80 minutes?

KEVIN: Yeah, I was really cold through the whole thing, though. I had to bring up a heater, but, yeah.

THERAPIST: Yeah, you don’t have any fat on your body, so I imagine you get cold easily. You might want to like, get a sweater. I have kind of a cool looking sweater here. (Kevin chuckles) Not like a weird sweater, you know. It’s like, just like a fleece kind of sweater, you might want to get one of those for that, because... (Kevin chuckles) [00:08:19]

FATHER: And not mine!

THERAPIST: And not his! (chuckles)

KEVIN: Yeah, he was just like, “You’re not wearing my jacket!”

THERAPIST: So, he like borrows yours, huh?

FATHER: Oh!

KEVIN: And I said, and it actually fit me now.

FATHER: Even after I’ve said not to.

KEVIN: Yeah, but then, he doesn’t wear it. Not...

THERAPIST: That doesn’t make it yours! (all chuckle). Once we get your brain right, then we’re going to start working on all the other... principles of life. One of them is that you practice radical honesty, and (inaudible), I’ve guess, talked a little bit about that. That means you also don’t borrow people’s things unless they give you express permission.

That will come in very important... I know you’re going to be like, “How did you get to this?” But in the dating world, when you’re with a girl, you need to be clear what your permission is for anything you do. It starts with knowing whose jacket not to wear (Kevin chuckles) and it continues on in life with knowing who not to kiss and when. So consent is important. [00:09:20]

All right, guys. Time to check out your thoughts on things. That was a very nice presentation you made, Kevin.

MOTHER: Well, can I fill in a few of his? When he’s talking about the shower, our house is cold and so he historically likes to, he did a lot of studying in the bathtub. He said shower, but he meant... right... you wanted to take a bath that day.

KEVIN: Like, yeah, like I usually read...

MOTHER: And do homework in the tub while he’s doing that.

THERAPIST: Well, that is the weirdest thing I’ve ever heard! (Kevin chuckles)

MOTHER: So, just, yeah, I don’t know, you didn’t, you didn’t ask him further about that, but there is that, so I just said, let’s, that’s you know, “Let’s do what you have told us to do,” and it was kind of a little, like he said, it was a short battle. He wanted to take a bath, he was mad there for a little while, but he got past it. I think he did was supposed to do, so that was just kind of... but that’s about...

THERAPIST: So he did actually... that would be like... like the regular teenage boys, that they don’t like something, and they’re upset, and then they go ahead and do it.

MOTHER: Right. Right. Exactly.

THERAPIST: Okay. If we can just get you up to the normal level of disagreeableness, that will be good! (all chuckle) I will defend you, if you just are as disagreeable as most teenage boys. Okay, so that’s good. So what, tell me your other thoughts on the last couple of weeks and all the things he mentioned and any you want to add. [00:10:28]

MOTHER: I think he made great strides these last two weeks. We, after our last meeting, we went directly...

THERAPIST: Way to go, Kevin!

MOTHER: ...we went directly to a Teacher-Parent Conference and...

THERAPIST: Yup. I remember you were on the way.

MOTHER: ...and they, instead of being frustrated, they were like, “Okay, (slapping sound) this is what we could do! Let’s do this! And I could do that! And Amy, you can do this.” I mean, they all five teachers, sat in one room and just brainstormed what they can do to help the situation. And so that’s...

THERAPIST: That’s nice to hear!

MOTHER: It was incredible! I mean, beyond what I expected at all. Rather, yeah. So anyway, they have pulled him out of PE. He has PE and then Strength and Conditioning. So two kind of PE-ish classes. So they pulled him out of PE, and during that hour, he goes to the Math class that he has, but it’s a different, it’s the same class, but different hour. And so he can sit... [00:11:27]

FATHER: With less distractions.

MOTHER: ...with less distractions.

THERAPIST: What’s, now what’s less distracting about that?

FATHER: The people in the class!

THERAPIST: Oh!

KEVIN: Well, like...

THERAPIST: Nice move, guys!

KEVIN: Usually, when I’m... they’re not... well, they’re distracting when the lesson hasn’t started, but like before class you know? Like, they’re talkative, but then when the class starts they’re, they all start working.

FATHER: Supposedly, too, it’s got students that are in there that didn’t pass it last year. So they’re in it again this year and they’re a little bit more bored and...

MOTHER: Angry.

FATHER: ...disinterested and angry.

THERAPIST: These would be the distracting people? (parents affirm) That makes sense. Now that was a good move. I did not have faith enough in (chuckles) your ability to make that happen, to suggest it. But it is always wise to look at those things and see if there are specific factors in a class. [00:12:18]

It’s a very tricky balancing act, because Kevin must not use things as excuses for why he is not succeeding, but if he will gain credibility with us, then you can believe that if he says this situation is really distracting, or this teacher really doesn’t instruct well, if you gain credibility, Kevin? Then people will listen to that, and make adjustments, like they’ve done here. (Kevin affirms) So, that is as good a scenario as I could imagine, and you’re just going to have to keep doing that, through the...

MOTHER: Well, we’d like to take credit for it, but it wasn’t us. The teachers came up with it! (chuckles)

THERAPIST: Well, yeah, chance favors the prepared mind, and you guys were ready to go. Chance came along and offered you a shot, and then you took it, so...

MOTHER: Well, what was more remarkable about that... And that was kind of the biggest change, I think, was we were a little bit fearful of how he was going to react to that.

THERAPIST: To the change? (mother affirms) [00:13:20]

KEVIN: I don’t mind it at all, because...

MOTHER: But he did, he came back (because we didn’t tell him; we let the teachers tell him), and he came back that next day and said, “Oh, I’m excited about this! It’s going to work out really...” He was totally onboard with it. So...

FATHER: Well, part of it was they... prepare a sheet with each day’s assignments on it and they sign off on it...

MOTHER: Has that been happening?

FATHER: ...every hour.

KEVIN: Yeah, it’s been happening. But I never really use it. I mean... like, I never look back at it, but I always get everything turned in, but...

MOTHER: Okay. I mean, they go through effort for that, so we need to make sure we look at that and make sure we have everything, okay?

THERAPIST: The only danger in that system is sustainability. The changing classes around, sometimes moving a person in the classroom (the ADD people tend to do better like, on the front row, just simply because there are not as much stimulus between them and the teacher), things like that tend to stick pretty well. Setting up study halls and things like that stick pretty well. [00:14:24]

That thing where they do the paper every day? If you can get them to stick with it, that’s great. But that sometimes is a bridge too far with them. They’ll say they’re going to do it, and they don’t follow through. In the end, it depends on you, Kevin, to be on the to-do list and all that stuff, because that’s an external system for doing what we talked about last time with your own like, to-do list. We did to-do list with you, didn’t we, and calendaring last time? Oh, wrong kid! (laughs) Ahh!

FATHER: I think it was that other guy!

MOTHER: Sounds good! We need it! That’d be great!

THERAPIST: Yeah, there are so many other guys in this situation! All right then, let’s actually talk about that for a second, because it fits right here.

KEVIN: Well, I think we did talk about calendars, like on my phone and stuff?

THERAPIST: That’s what...

MOTHER: Oh! Is that what you’re talking about?

THERAPIST: That’s what I’m talking about.

MOTHER: Oh, I’m sorry! Yes, you did talk about that. I’m sorry. [00:15:12]

THERAPIST: Great, okay. I so completely remembered having that. You know, I don’t listen to the tape, so (chuckles) I was sure. Sometimes, I have like these dream conversations with people. So you leave and then I go on, and I’m driving home or something, and I’m thinking, “Oh, yeah. I should say about calendars and to-do lists to Kevin.” And then I really think it happened! (chuckles) And so...

MOTHER: I’m sorry; you’re right! We did ask the teachers about if he could do that on his iPhone and they said, because once they have the iPhone or an iPad, then they can’t regulate whether they’re, or they can’t, they don’t know for sure if they’re using it for the right purpose. Once he does it, then everybody... So they were like, this... they did not want to open that door.

FATHER: And I’m sure that, yeah, if they let one kid, then others would want to start doing the same thing.

THERAPIST: That’s why it’s best to have some formal agreement, like an IAP or 504 (ph). They’re trying to sort of avoid that now by being helpful, which is great. But we’ve never had trouble where we’ve had those set up with the school. [00:16:13]

Phones are a little more of a problem, because they’re used for things sometimes that they shouldn’t be. IPads, it’s less of a problem because they’re big and easy to keep track of what the kid is doing. If we don’t want to move on that just yet, that’s fine. But that’s, they’re going to have to catch up. L.A. just bought an iPad for every kid in the classroom, so...

FATHER: IPad I can see...

THERAPIST: ...they’ve had nothing but trouble with them, by the way, but for whatever...

MOTHER: Oh, really?

THERAPIST: ...for other... their filtering software and everything, they didn’t deploy it very well. But they’re headed in the direction they should be. The iPad, you’re right, isn’t just as, you know, they can block the... service and stuff in schools pretty easily, so they’re just used for what they’re supposed to be used for. Like, there is no signal at Tonganoxie, inside the school? So it automatically logs into their wireless, and their wireless is filtered, so you can’t use Twitter and Facebook and all that stuff. So, Forrester may not be quite up to speed on the... [00:17:12]

MOTHER: Well, who has iPads? Somebody out there, they’re test... there is a group, a class out there that does that.

KEVIN: Every Social Studies class has one.

FATHER: I was thinking in the high school that they did that.

MOTHER: But I mean, that...

THERAPIST: I wouldn’t be surprised!

MOTHER: So it’s, it’s starting...

THERAPIST: That’s why I’m surprised there are any... Did you say iPhone or iPad? Because that could have made the difference.

MOTHER: Well... I definitely said iPhone. I don’t know if I said iPad also. But I definitely said iPhone.

THERAPIST: Because, you know, he can link his iPad and his iPhone so they calendar together. Yeah, through iCloud. These, this, I am firmly convinced... Ruth (the cat), if you knock that microphone off!

KEVIN: It was tilting, so I had to slide...

THERAPIST: No, no, Ruth! Um, if... This is really the golden secret for kids with ADD, is to have this organization structure, so all of their devices talk to each other, and they can keep a calendaring and all of that stuff. So we can kind of build towards that. By college, he’s going to just have to have mastered that.

Just being able to send appointments to kids from my calendar is critical in getting them here. (chuckles) They come so much better when they have a reminder in their calendar, so the things that are kind of annoying about technology, like it distracts eighth grade boys from doing what they’re supposed to do... Doesn’t it sometimes, Kevin, distract you? [00:18:33]

KEVIN: Not that often, no.

THERAPIST: Oh, right, and (chuckles) there is a good side to it that... and you have to deploy the good side and deal with the bad. I knew you were going to say that, that it wasn’t distracting!

KEVIN: Like, it doesn’t really when I’m, you know, when I’m driving back from... my dad let me drive back the other night, from, we just delivered a full cord of wood to this one guy, and he let me drive back.

THERAPIST: And you texted while you were driving the whole way?

KEVIN: No! No, I didn’t even... think about my phone at all.

FATHER: You didn’t turn the music on?

KEVIN: Not on my iPhone.

THERAPIST: I wish they’d just turn the music on, on the phone, and not do anything else with it. Yeah, texting. Let me tell you, texting and driving is super-dangerous for everybody and it’s like, ten times more so for you.

FATHER: He’s... he’s good at that. I mean, in terms of... he’s a good driver and he’s cautious and cognizant that you don’t do those things. [00:19:39]

THERAPIST: Um, did we talk about... You mentioned the forgetting the patch that one day. Did we have a discussion about those first two or three days off the patch, when you’re taking a break?

FATHER: We did.

MOTHER: We touched on it, but I was confused, when we were supposed to do that.

FATHER: During like spring break and...

THERAPIST: Yeah. When the... those first two or three days he’s off (and then I want to go back to dosage in a second), those first two or three days he’s off, that’s really a time you need to be extra careful about driving, because even people who are pretty good at driving lose focus. But that description he gave, of having trouble reading and all that stuff, that’s the initial rebound effect of being off the medicine.

Your body begins to build a tolerance to it, like we talked about and then when you go off it, you get kind of a zinger back. So until you’re really... I would actually say forever, those first three or four days, just be very aware of your driving. Driving is the only thing that worries me about those first three or four days. So... Because that’s when they really have trouble tracking, so. He may, the ten milligrams sounds good, I think he’s describing it the way it should be. What’s your observation, both of you, about where you think the dosage is at right now? Do you think it’s right? [00:20:52]

FATHER: Um... (pause) I still see anger issues. And, and... (pause) more like, just not positive... (pause) I’ll go up to his room, and I’ll knock on his door and it’s (irritated tone) “What?!” Instead of “Yeah?” “Why is your door locked?” “I’m (sarcastic tone) studying!” (pause) And it...

THERAPIST: I thought he was studying down in the common area.

KEVIN: Well, after the 80 minutes, sometimes I’ll make sure I get some more stuff done, so...

THERAPIST: Okay. Go ahead, now I know...

FATHER: Well, it... I’ve had a more difficult week or two. It just seems like... he’s locked up in his room, unapproachable.

THERAPIST: And this is what time of the day? This is about now or...?

KEVIN: No, this is like around... last night it was around 9:00.

FATHER: Well, from 7:00 till 10:00. [00:22:00]

THERAPIST: (pause) Okay, so now that we kind of are on track with medicine... Well let me add one thing to it, and then I want to come back to this. So, he probably will need to go up some before a break. I think he’s... this is my best guess, based on experience. I think he’s going to be fine getting to Christmas, because it’s fresh at this point, in his system. I would estimate that by spring break, you may be seeing diminishing effects of the medicine and you may be feeling it. The more appetite you have, probably the worse that problem is going to be.

FATHER: Well, I’m also not a great judge, because... I’m not there during the day. I’m not there when he’s actually on the patch. [00:22:55]

THERAPIST: Well then, that’s the best thing about deploying this information to all three of you, is each of you can watch it. So the farther forward in time he gets, the more his appetite will come back fully. He’ll get hungry. Like, my kid, at this point, is as hungry as he ever can be, because we are just at the tail end of his medicine cycle. We probably need to take him up one little notch, because we do a partial patch, and he’ll be okay until Thanksgiving. But you can just tell, because of how hungry he is. The medicine doesn’t have as high an effect.

So as you, that’s one visual cue you’ll have, it’s one cue you will have, Kevin, is you’ll be hungrier. Preferably, if you can work this out with the prescriber, then you might go to the next patch size and then cut it down. I think I talked to you guys about the advantage to trimming (ph) about that. So, that’s an off-label use that you’re prescriber can okay, and if he has any worries about it, I have some resources he can take a look at. It’s Dr. Keeps, isn’t it? (mother confirms) So, that will give Kevin an incremental increase, because I think the next patch up is 20 or something like that. That might be a little much for him. I think it’s 20; they go in kind of large jumps (inaudible)/blocked. [00:24:14]

FATHER: I think it is.

MOTHER: I don’t know about this, this patch.

THERAPIST: Yeah, I think the next one up is 20. That’s probably too much increase for him. So, let’s see where it looks at Christmas. Do you hear me about what you’re looking for in yourself?

KEVIN: Um, increased levels of...

THERAPIST: Focus and appetite, right. Now, anger issues. Because we haven’t ever established that there is a connection between his anger and ADD. It could be his frustration tolerance, played out in anger; it could be something else. Since he doesn’t... Do you think he’s worse on the medicine, better, or the same? Or any of the above.

FATHER: Again, I’m not the greatest judge, because I’m not around. It’s probably better, but...

KEVIN: I can tell it’s better.

THERAPIST: You think it’s better. I mean if Julie (sp) thinks it’s better...

FATHER: You know, if, if... If he and I are doing something and we’re going out, it’s great. If I’m at home, and I come home and I go up to see him or, I’ve come home at night and I’ll knock on his door, just to tell him I’m home; it’s just a negative response, it’s always defensive, and I don’t see him. [00:25:28]

THERAPIST: Okay. What time do you take the patch off? Time may vary a little bit, but...

KEVIN: Probably like, right around when I get home, don’t you think?

MOTHER: Yeah.

THERAPIST: Where did, did you get that fixed from last time, like if we were doing it, the (inaudible) waiting.

MOTHER: Because I think we have. I think... The problem with the dosage, I still am thinking that it’s probably a decent amount right now, because he’s leaving it on longer and we do... Like that week that he busted out all this homework and he was doing everything, he was great. I don’t think we really had many run-ins.

THERAPIST: Just to clarify how it works, because I think you’re right about something (inaudible). He doesn’t get more medicine by leaving it on longer. He gets the same medicine longer (mother affirms) and that’s actually a really critical distinction. So, I think what she’s saying is, you’re getting a longer period of functional-ness by leaving it on, which is good. Now, what you may be catching, Wes, and I don’t know this, but... [00:26:32]

FATHER: The come down.

THERAPIST: The come down. And... So there are two issues, and that may be one of them. The other thing you have to remember is, he’s halfway through his eighth grade year and they get a lot less... social (chuckles) at this point.

FATHER: And I get that. I understand that. I have a problem with not even being able to approach.

THERAPIST: Well, we probably should figure out how to troubleshoot that. Let me ask you this. Are you, as a person, Kevin, do you think... I don’t think I’ve ever asked you this before. Do you think you’re more of an introverted person or an extroverted person? Like, do you love to have a lot of friends, or do you like to have one or two friends and a lot of time for yourself? I do feel like I’ve asked you this. (Father denies)

KEVIN: I kind of feel like both. I like to have a lot of friends, but um... only if... only like a few like, true friends, but... like you know, Russell, Kevin, and Albert, you know then Jessie and people like that. (pause) But I also like to have a lot of time to myself. (pause) [00:27:44]

FATHER: For instance, if we go fishing, you’ll go by yourself sometimes. We’ll go off and he’ll go off on his own and... or even if he’s got friends, he’ll go off on his own and. I mean, I see a mixture of both. I don’t see you have a ton of... ton of friends that you’re very close with. (Kevin affirms)

THERAPIST: You do actually. That’s how I think of you. You strike me as someone who’s a little more introverted, which is fine. Half the population leans to the introverted side. You just seem like someone who’d like to fish over by himself, and then you could go see a friend or something, and that you would just sort of like that solitary time. Now, let me ask... Would you agree with that or do you want to argue the other? (Kevin affirms). Okay.

KEVIN: Like, we were at Roaring River and this guy... it’s a...like a fish hatchery and they let all the trout go into the river, but... There was this one guy that I was... I came down, I fish maybe, I mean, ten feet sound, doesn’t sound that far, but I mean, at Roaring River, it’s, it’s a nice distance because people are sometimes they’re like shoulder to shoulder, but... (parents laugh) [00:28:55]

THERAPIST: And you would not like that.

KEVIN: No, not shoulder to shoulder, but I wouldn’t mind ten feet, because, you know...

THERAPIST: Ten feet is about right for you, okay.

KEVIN: Yeah, but I had this one guy who followed me down the river and he was probably four feet away from me. I couldn’t stand it!

THERAPIST: That is a good story. That is exactly what I’m talking about.

KEVIN: But like, if I know the person, I mean, I wouldn’t mind it. And, um, like, with my friends, I’m not... so excited about just hanging out. I’d kind of want to go do something like... you know, I’ll, I’ll sometimes ask if a friend can come with us if we go hunting or fishing or shooting or something. But if somebody calls and asks if I want to hang out, sometimes I’ll say yes, sometimes I’ll say no, sometimes I’m just...

THERAPIST: So, is it easier for you to communicate with friends like, through texting and... I don’t know what else you use. What do you, what are your methods of communication? Texting and...? [00:29:57]

KEVIN: With all my close friends, I usually always call them.

THERAPIST: Oh, you actually speak into the box? (Kevin affirms) You actually hold this device (Kevin chuckles) to your face and talk to it? Wow, you’re an old-fashioned guy!

FATHER: I’ve never seen that! (chuckles)

KEVIN: Because you’re never home!

FATHER: Or you’re locked in your room!

MOTHER: I’ve never seen that either. I think of...

THERAPIST: But you do, you can communicate to them through phone and texting and all that, okay. Is that easier than face to face for you, or is it all kind of the same?

KEVIN: It’s all kind of the same, except texting is a lot easier, because you can say things that you usually wouldn’t say. Like you have more confidence, because...

THERAPIST: That’s what I’m looking for, right there. (Kevin affirms) And, just the way you said it, it would be like, if you want tell somebody to f-off, you’d text it to them. That’s not what you mean, I guess, right? Or is that what you mean? Like, would you say something ruder to someone in texting or...?

KEVIN: Well... probably not, but... if they were really getting on my nerves and they were insulting me and stuff... Like in person, I’d probably retaliate something like that, but not... [00:31:02]

THERAPIST: So, okay, so, when you were saying it’s easier to text than sometimes, do you mean it’s just, you can gather your thoughts and say what you mean easier in texting or...?

KEVIN: I really don’t know what it is about it, but I just find it to be easier to say... I just don’t know why, but... yeah.

THERAPIST: Girls are going to like that a lot. (Kevin chuckles) What were you going to say, Julie?

MOTHER: Well, I do think he texts a lot, but I, you’re right, I have heard voices coming from up in your room, so I think he does call more than I really was totally aware of. But I think the phone... when he’s locked in his room, I think that phone is kind a source of contention. I think that’s kind of the bud that everything stems from, because we, I think... I think he’s on the phone a lot and texting or calling, right Kevin? (Kevin affirms)

THERAPIST: But, and the contention is...

MOTHER: And I think without a phone, I think he’d be a human again. [00:32:03]

THERAPIST: Oh, see this is an interesting problem. Okay. Hold that thought, because I want to ask Wes something. So, you would consider a good like time with Kevin if you guys went fishing and you each had your space and it would be exactly ten feet...

FATHER: That’s what we do.

KEVIN: Yeah, like sometimes...

MOTHER: He goes that way, he goes that way.

KEVIN: Yeah, like sometimes, like this last time that I went dove hunting, I went off on my own and I was just dove hunting by myself. My dad, he was fishing probably, we... a mile away, we were probably a mile away from each other at the furthest. And... is there a problem?

MOTHER: Go ahead, go ahead.

KEVIN: Okay, but, um, I know that my dad would trust with me that type of stuff and... (pause) and then, so like, I’ll go off hunting on my, by myself, usually at my Aunt Mirna’s, usually not on public land. But... she has a lot of land, we both can cover a lot of land by ourselves. Sometimes, he’ll fish, and then I’ll fish with him, because we don’t get that chance to go at my Aunt Mirna’s a lot, but like when we go to places that we go to a lot, sometimes we’ll stray away from each other and then if we catch something, we bring it over to each other. [00:33:21]

THERAPIST: And so you would, at the end of the day, decide that was a pretty fun time with your dad, true?

KEVIN: Well, yeah, but like, at first we go out on our, by ourselves, don’t you think? And then at the end, we sometimes...

FATHER: There are sometimes we start out together, and then... go apart, but I mean...

KEVIN: Like...

FATHER: I consider it.

KEVIN: I think when we’re fishing, we go away from each other first, and then we start coming back. We’d say where we’re going, what we caught, and then we might go. If I had a better spot than him, then we’d go to my spot; and if he had a better spot than me, we’d go to your spot, right? We kind of scout around.

THERAPIST: So what would you like to be different with Kevin and your relationship right now, just that he isn’t so harsh speaking at night? (father affirms) Really that’s that simple.

FATHER: You know... my conjection(sic) is the door being locked and unapproachable, where we don’t have a communication. I... it’s not like I need to be up there and we need to be buddy-buddy, because I realize that’s not going to happen. [00:34:29]

THERAPIST: Well, I actually think you... I mean, maybe not at that time of the night, but that’s why I was asking about the hunting and fishing. It seems like you are. (father affirms) That’s like really pretty good at this age.

FATHER: Yeah. But it’s different at home.

MOTHER: He’s wonderful when he’s doing, getting to do what he wants to do; but anytime there is an ounce of frustration, or being told you can’t do that or this or that, that’s when it’s, that’s when it totally changes.

THERAPIST: Okay, and that part I’ve seen before. Now that we’re sort of in a good couple of weeks of you doing what you said you were going to do and all that, and I’m trying to sort of figure out what else is there. What worries you about the evening when he is unapproachable? What is your worry about that?

FATHER: I’m concerned there are things going on, on the phone, that shouldn’t be.

THERAPIST: Well, okay. Now I understand. (chuckles) So, because that’s a little different. What do you think he’s doing on the phone? Because this is really easy to figure out, I warned you about it, didn’t I? What do you think’s...

FATHER: Pornography. [00:35:34]

THERAPIST: Well, that’s actually really easy to fix. There is about a 99% chance that you’ve been looking at pornography on the phone, yup. I’m not going to even ask you.

KEVIN: That happened a long time ago and you know, that happened probably a year and a half ago.

THERAPIST: Was this on the phone or the computer?

MOTHER: The iPad.

THERAPIST: Oh, okay, because the pornography would be really little on the phone. (chuckles) That doesn’t seem like that would be worth your time. Okay so... short of the nuclear bomb I was proposing dropping on you, because you are working on it, and I’m going to not give him that yet... It’s very easy to get him a filtered browser on his iPad. I think it might cost you $20 a year or something.

The one I use is called Mobicip and you just shut off his Safari; it won’t work anymore. Mobicip takes the place of it and it has an app, or it has an interface online that you go in and set what you’ll allow him to look at. Now, I have to tell you (chuckles) it takes some tuning. I was on my daughter’s iPad once when we were travelling and I wanted to look up about Fort Washington, which is a fort outside of Washington. (Kevin chuckles) It was built after the Revolutionary, or after the War of 1812, because it didn’t go very well in the war of 1812, they just like burned the city. So they built this fort, set on the Potomac, south of the city. It’s never been used for anything, and now it’s a park. [00:37:05]

Well, so I’m on Mobicip and it’s like refusing to let me look at Fort Washington! And I could not figure out, like there are no naked women at Fort Washington that I’m aware of! And so I had to get on here and guess what blocked it? Weapons! I had not unchecked the weapons, and there are weapons at Fort Washington.

FATHER: Boy, that would kill you!

THERAPIST: Well, that’s why I (chuckles)...

KEVIN: I would literally die!

THERAPIST: That is why I’m bringing it up. You want to get in there and uncheck probably weapons. Look at anything else you in there, but it, it works great. The other thing, dear Kevin... they can set it shut off the Internet at 9:00. I just got a petition from my 17, almost 17-year-old, daughter the other day to make her iPad operate until 10:00. I was like, why do you need that? You’re supposed to be in bed at 9:00, 9:30! So I didn’t do it. But you can set it. [00:38:00]

I think it now has settings where you can change it on weekends and stuff, and that will take care of the filtering problem. You want to filter. Even though you’re not going to... he’s going to find... pornography is just too easy. I don’t know if you read, did you guys happen to read my white paper on this topic on my website? (parents deny) You might want to read it. It will blow your head off, believe me.

I did a radio show about it last month and... In order to make the radio show not itself pornographic, I (chuckles) wrote this paper and referenced it so people could read it. It’s got 12 pages that explain all of the issues of online pornography and teens at this point. So, that will give you a hint on that, but I’d go for Mobicip. Go ahead.

FATHER: I think it’s that, and I think he texts way past 10:00.

THERAPIST: Well, if you will... put that on there, you shut his stuff off at night, which I think... I think that you should have your stuff shut off at night, but I think that expecting you to self-regulate in not going to happen. There are no teenage boys and girls that self-regulate. They have to turn over their equipment at night and, if you just put that thing on there, you can have proper control over that. That’s not the spy software. That’s worse. This is just adding on/off switch for your Internet. [00:39:23]

KEVIN: So is it like completely turn off your phone?

THERAPIST: It turns off the... the ability to surf the Internet and I think it turns off your ability to get signal. I have to go back and study that a little bit, but you’ll figure it... it’s not very complicated to do.

MOTHER: Just (spells) Mobys...

THERAPIST: No, (spells) Mobicip. And I think you go to the... First you go to the store and download the app, and you... But the secret important thing is, you have to take over control of his own browser, so that you shut off Safari. You’ll have a passcode for restrictions, and you have to have your own passcode to do that, so that you can shut off every, you can restrict everything you want on there. Then you restrict Safari, but you won’t need Safari anymore, because Mobicip will do it for you.

It will take some tailoring, but you, because you are supposed to be a member of the team here. You sit down with them and say, “Listen, can you, this summer, can you add an hour to the end of the day?” Like, I would do that for my daughter in the summer. So they say, “Sure. We’ll do that.” [00:40:35]

I’m not 100% sure, but what you can’t shut it off for discreet periods of time during the day. Like if it’s study time, it’s off. I think you can do that, but just check out the Internet, because I haven’t modified mine in a while. They keep making changes to it. It’s specific purpose is exactly what we’re talking about today.

MOTHER: Well, my, more of my fear than that, I mean, that’s always a possibility, but is... like I said, when he, when things don’t go his way, he gets very angry. Not just mad, like we would get mad, but very angry: throwing things, just screaming horrible things...

KEVIN: That hasn’t happened in a while.

MOTHER: Well, Friday it happened.

KEVIN: Friday?

MOTHER: Just, just...

THERAPIST: What happened Friday?

MOTHER: But he gets violent and... (pause) Friday... I’m trying to think, why is that funny?

FATHER: Psst (ph) missed school.

MOTHER: Friday he... it was the day after Halloween. So I woke him up in the morning, he was like, “No, I’m sick.” Well, there are candy wrappers laying all around him. He has had a very bad cough lately, so I mean, I tried to be as fair as possible. [00:41:42]

KEVIN: It seems like you’re being more fair now. And Dad said that I couldn’t have any candy that night. And I didn’t.

MOTHER: Kevin... Okay. Then, so, I go to wake him up, there are candy wrappers all around him, you know, where his head is laying and all that kind of stuff. So, I said, “Kevin, there is, every kid in the United States doesn’t want to go to school today. I don’t want to go to school today. We’re going to school.”

You know, anyway, so I did not allow him to stay home from school, even though he didn’t feel well, because it wasn’t a flu-like thing or whatever. So that didn’t go over well at all, and it was just, you know, it was pretty ugly in the morning. Our mornings don’t go real well.

KEVIN: And then I... she finally... I finally got out of the bed, so I could go to school for her, so she wouldn’t be mad. I got up...

THERAPIST: You actually, Kevin, you really went to school for you, because your mother doesn’t have to graduate from the eighth grade.

KEVIN: No, I mean... I went so she wouldn’t be mad.

THERAPIST: Oh. [00:42:42]

KEVIN: So I got up, she said, “You can still catch a ride.” So I got up, I got ready as quick as I could, and then I go back upstairs to grab my phone. I come back down and she’s pulling out of the driveway. And then, so I... she made me...

THERAPIST: Because you were too late?

KEVIN: Well, she never warned me that she was leaving. I was going upstairs to grab my phone and just on my way back down, I looked, and there was nobody in the house. So I looked outside, and she was pulling out of the driveway, right as I had opened the door to go outside. And...

THERAPIST: Because you were so late? I don’t understand why she’s leaving. Because the time had come to leave? And you weren’t there yet or... she was purposely leaving early to leave you behind?

KEVIN: Sometimes it feels like that. And... I think she was trying to prove a point, saying that “you need to get up earlier,” but... I haven’t been late, except this morning, though I wasn’t that late this morning, but we don’t give out “Tardy’s” anymore. So I mean, sometimes it feels like she’s trying to leave me so she can prove a point. [00:43:51]

But that day, I really didn’t feel good at all. I had... I just recently went over to one of my friends and, um, Lynn, you know, she said, “Your cough sounds a lot like you have bronchitis.” That idea has been thrown out there a few times. One of my teachers thought that I did and um...

THERAPIST: You sound pretty good.

KEVIN: Well, I walked in the locker room the other day, this was... (pause) I can’t remember when it was, but... I walked into the locker room and I started coughing. I mean, I was gasping for air, I mean this was the hardest I’ve coughed. I was gasping for air, I couldn’t manage to get any. It felt like I was choking, but I was able to let air out, but I just couldn’t breathe any in.

THERAPIST: Well, that is actually symptomatic of something that’s been going around here, so... That sounds about right. [00:44:56]

KEVIN: Yeah, and so I kept coughing and coughing. I gagged and I nearly threw up.

THERAPIST: And you were at school? When did this happen?

KEVIN: Yeah, I was at school. This was my third hour.

THERAPIST: Okay, but... when you got up in the morning... So you’re saying you knew you were this sick in the morning.

KEVIN: Yeah, but if I told my mom, she’d just say, “No, you’re going to school.”

THERAPIST: Do you have a history of not being credible on that?

KEVIN: Not really. I mean...

THERAPIST: Does he have a history of not being (chuckles) credible?

MOTHER: Um, I think there have been some times when he says he doesn’t feel well, but he just doesn’t want to go to school and...

KEVIN: Isn’t that every day?

MOTHER: Um, yeah.

KEVIN: No, like, I mean seriously. Isn’t that every single day, I mean, nobody wants to go to school.

MOTHER: (sighs) But this day, it was, to me, it was... we had made an appointment at the doctor, just so you, I mean, he was coughing badly. We made an appointment for the doctor. I go pick him up after school, and he goes, “You know what? I haven’t been coughing today.”

KEVIN: But that wasn’t (inaudible)/blocked. [00:45:54]

MOTHER: So we go to the doctor anyway and we all decided, “Okay, he’s not coughing, he’s past it.” So... because I thought it might have been bronchitis. So this, so that was a day or so... before that?

KEVIN: After. Because that’s when it came back.

MOTHER: Well, anyway, so that (sighs), that morning, just let me just finish that. So that morning, there was candy wrappers all over, he didn’t feel well, I’m pretty sure what he was feeling was because of eating too much candy. So yes, I have to leave the house at a certain time to get him to school and then to get me to work on time. He knows, because this has been two years of this, or this is the second year of that.

THERAPIST: What time is that? What time...

MOTHER: 7:25 is when we have to leave to get us all where we need to go. And so...

THERAPIST: You would agree with that? (Kevin affirms)

MOTHER: And so he woke... I wake them up at 6:30, and he doesn’t come down. So I, that particular morning (I don’t usually do this, but for some reason that morning I did), I went up four times, or knocked on his door four times, to get him up. (Kevin attempts to interject) So by the time he came, let me finish, okay? [00:47:00]

By the time he came down, it was already past the time for me to be gone. It was 7:30, so at that point, he went to wash his hair or, and it was my time to go, so... but he was dressed. I thought he was going, going to walk, because he often will walk to school. So I went to school, thinking he was walking, and he didn’t go to school that day.

KEVIN: And then I woke up... Well, I heard Dad getting up, so I got up, and I went over, and I told him. And... He said, “Do you want me to take you to school?” I said, “No, I really don’t feel good.”

THERAPIST: What time was this, about? 7:00...

KEVIN: No, he, he works (inaudible)/blocked. It was probably around 9:00, 9:30.

THERAPIST: Oh! Later than that. School had already started.

KEVIN: Yeah. And... I was laying downstairs or something, I can’t really remember, but...

FATHER: You were in the bathroom.

KEVIN: Yeah, I was going to the bathroom, and then he asked me why I wasn’t at school. I said because I don’t feel good at all. He goes, and um... He said, “Do you want me to take you to school?” I said, “No, I really don’t feel good.” Then he said, “All right,” and walked out the door. That’s pretty much how it went. [00:48:17]

THERAPIST: How much school does he miss?

MOTHER: Well, he doesn’t miss... was that your second? (Kevin affirms) That was the second time I thought he had gone to school and he didn’t.

KEVIN: That’s... what happened.

THERAPIST: This year? Yes. Okay.

MOTHER: (under breath) I have a terrible memory. But you know... So I come home from work and he had built a fire in the fire pit in the backyard...

KEVIN: No. That was... that was when you went to... Where’d you guys go? You went to Auburn to watch Rose and... you got...

FATHER: Which was on a Friday, and that was the day you took off.

MOTHER: There, a pillow from the living room was out there...

THERAPIST: Took off from school or there is more to the story, when you ran off.

MOTHER: Say that again, I’m sorry.

FATHER: That’s the day he, he...

THERAPIST: He took off from... didn’t go to school.

FATHER: Correct.

THERAPIST: (chuckles) Okay. I thought you were going to tell me that he took off, like in a...

KEVIN: No!

THERAPIST: But you then built a fire pit?

MOTHER: And...

KEVIN: That was later that night, around 9:00.

THERAPIST: Okay, but what are we all thinking... [00:49:18]

KEVIN: Mom, you weren’t even there! At least... (mother “shhh!”)

THERAPIST: Wait, Kevin, what are we all thinking? You didn’t go to school, and then you went outside and did a strenuous activity, building a fire. What are we thinking?

KEVIN: I had gotten home, they had gotten home. I didn’t go to school. I didn’t feel good that morning, and... From about... I can’t remember what time, but they got home, my mom got home at around... 3:40, something like that. She had thought that I went to school. I didn’t want to tell her, because I knew that she would blow up on me and... I know my dad... you knew that I wasn’t going to school, right? (father affirms) But, he didn’t do anything to stop, because I think that he believed that I didn’t feel good. And I didn’t at all! And... so they got home...

THERAPIST: And you were going to try to practice some like, Indian medicine out back and make yourself feel better by burning a fire pit? [00:50:26]

KEVIN: No, I... that was later that night. They went to Auburn. What am I... (mother attempts to interject) How was I... How am I being wrong right now? You guys went to Auburn to watch Rose.

MOTHER: We did, we did. But Kevin, when I got home, the fire pit was smoldering, you had the pillow from inside outside on the bench, right beside the fire pit, the leaves in the front yard had been all snow-blowed or whatever, leaf-blowed. I mean, you had done all this activity outside, and there, the fire...

THERAPIST: You (inaudible)/blocked leaves during the day? (chuckling) Well, at least you were productive! (laughs) But, I mean, that is, that’s pretty good, but we’re all thinking, “If you were that well, why didn’t you go to school?”

KEVIN: (pause) I keep saying that I don’t feel good, but nobody in this room believes me.

THERAPIST: No, I’m just asking. If you didn’t feel good, how did you do such great, productive things, like...?

KEVIN: It was more of a cough and dry throat and just feeling like crap that day.

THERAPIST: Okay, so what is it you should do if you’re that sick? I agree that at least you didn’t like... like light the house on fire. (chuckles) You did something productive, but what should you be doing? You’re smart enough to know how to handle being ill. [00:51:36]

KEVIN: I don’t just like doing nothing. I mean, you guys know that, right? I want to mow the lawn all the time, I want to be outside, I don’t just want to sit inside and do nothing, except when I’m doing homework. I have to. But, I mean, blowing leaves doesn’t take that much work. You stand up, and you move this thing back and forth, and then...

THERAPIST: Did you make a nice pile?

KEVIN: Yeah, I let the dogs out, and let the cats out, and then I came back in. Then five minutes later, I went out and I let the dogs in and...

THERAPIST: So you guys don’t know what to, when to believe that he’s sick or not; but on the flip side, he hasn’t done a bunch of school skipping, where he would like to do it more, but you don’t let him. Which of those is true?

MOTHER: Um, it hasn’t happened a lot. That is absolutely true.

KEVIN: And you guys know that I don’t want to go to school every single day. I never want to go to school, so... That night, you think that I ate candy, but you told me not to. I didn’t eat candy that night. I went to bed at a regular time... [00:52:48]

THERAPIST: Where did the wrappers come from?

KEVIN: She thinks that there were wrappers that night, but she’s getting all mixed up with the next night. So... I’m pretty sure everything is mixed up around here, isn’t it? Like, around that time everything is mixed up, right?

MOTHER: I... I... I feel like I have it straight in my head, but...

KEVIN: I didn’t eat. I probably had... though, some other things, like little tiny pieces of bubblegum? That’s probably what I had, and I think that’s the only thing that I had.

THERAPIST: Those do have wrappers, that’s correct. Those do have wrappers, but... All right, so what... So you don’t skip a lot of school.

KEVIN: No, I’ve...

THERAPIST: You wish you could skip a lot of school.

KEVIN: I wish I could skip, but...

THERAPIST: Why don’t you skip more school?

KEVIN: Because I know I have to get work done.

THERAPIST: Well, that was a good answer.

KEVIN: But...

THERAPIST: Did you make up your work from your off day? (Kevin affirms) Or did you just offer to blow the leaves for your teacher, so that they would let you out? (Kevin chuckles) [00:53:41]

KEVIN: No! I just don’t like doing nothing. I don’t like just sitting and doing nothing. I actually want to do something that I don’t have to do later on, you know? But... I kind of like doing yard work, and it doesn’t take much effort to blow leaves, you know?

THERAPIST: So okay. So really, there are two issues here. One of them is you being ready to go on time. That seems to be an issue, more than...

KEVIN: Well, that was just the one time I didn’t get up because I didn’t feel good and...

THERAPIST: So that’s not a regular event (Kevin denies), where you miss the car? (Kevin denies) She said it happened twice in...

KEVIN: I mean, it isn’t any more.

MOTHER: Honey, it happens a lot.

KEVIN: Okay.

MOTHER: And then you’ll use...

THERAPIST: But normally when he misses the ride, he does walk to school (mother affirms), which is what you should do, and I wouldn’t sweat that. Now, you shouldn’t (and I’m not saying you do; he said it), so you shouldn’t leave (chuckles) early to prove a point. But if the time to leave is 7:25... And we have this in my house. The way it works at my house is, if I’m the one who makes us late (which doesn’t really happen very often, sometimes when I have radio in the morning it does), when I’m... [00:54:51]

MOTHER: I’m sorry. What are you doing?

KEVIN: Russell’s calling me; it’s just distracting.

MOTHER: I apologize. I’m sorry.

THERAPIST: That’s fine. So, if I’m the one who makes us late, then I will call in and excuse people; but if anyone else makes us late, I don’t (chuckles) call in an excused tardy for them. Then they have whatever punishment they get at school. It’s that simple. So, and it doesn’t happen very often. It’s probably, if it ever happens, about 90% of the time, it’s something that’s happened to me that we have a late radio show or something, so I call that in. So it’s kind of up to people to get out the door when they’re supposed to. So, do you think it’s fair if she leaves every day at 7:25 and you either walk to school or get in the car?

KEVIN: Yeah, but I usually wake up, she gets me up 6:30, I stay in bed until 7:00, I get up, there is no problems.

THERAPIST: She puts the patch on you off the bat, right? [00:55:47]

KEVIN: No, no, I put it on. I put it on when I get downstairs. But... I get up, she tries to get me up at 6:30 and she... Every morning, she says, “Kevin, if you don’t get up, you’re going to be late.” But every morning, I get up at 7:00, and then we leave at 7:25 with no problems. Don’t you agree with that?

THERAPIST: Can she just put the patch on you at 6:30?

KEVIN: That would be kind of awkward.

THERAPIST: It would?

FATHER: Can I do it? (chuckles)

THERAPIST: Can he put it on? Why?

FATHER: I don’t know.

KEVIN: Well, a lady walking in my room at 6:30 in the morning, pulling down my pants...

THERAPIST: I agree if a lady did that, if a lady walked in your room and pulled your pants down, unless she’s a lady that’s cute and your age, that would really be awkward. But (chuckles), it isn’t a lady, it’s your mother! (all chuckle)

KEVIN: I just think it’s kind of awkward...

FATHER: Maybe she doesn’t want to do it.

KEVIN: I think it’s kind of awkward, just, she walks in my room while I’m sleeping...

THERAPIST: Well, she shouldn’t even pull any pants down. It should be above your waistline, because of the rubbing issue. [00:56:44]

KEVIN: Well, we put something over it. We put a piece of tape over it, like a...

THERAPIST: Yeah. You can put tape over it. I just when it, so it’s on you earlier in the day, because it makes sure your (ph) morning is going to be better. I’m not trying to violate your precious underwear space or something (chuckles). I just know this works better.

KEVIN: I just like putting it on myself. I don’t want her to come in and do that. I just like putting it on by myself.

FATHER: Well, what about, what about if she came in in the morning to wake you up and handed it to you?

THERAPIST: And you put it on, and then you laid there for half an hour.

KEVIN: I think, when I get to school... by the time school starts and I’m in Science (which is my best subject; I know I might not look like it, but it really is my best subject) and I’m 100% there.

THERAPIST: I know you’re headed somewhere with this. What are you saying?

KEVIN: Like, I... like to put it on at 7:00. Um... [00:57:40]

THERAPIST: I wish you would try it my way for a couple of weeks and see, because I would be much more inclined for her to not worry about little things (like whether you’re sick once or twice a semester and stay home from school) if you would do what I want (chuckles) you to do! Because I think that would help your mornings a lot and I think if you have two bad mornings a semester, you should do a victory lap. If he skips school twice a semester because he doesn’t feel good, or lazy or whatever, power to ya! But if you would get the patch on earlier, and most of your mornings went better, I think that would be an improvement.

MOTHER: Because our mornings don’t go well. I, they...

KEVIN: You don’t think that they are, but you’re...

MOTHER: I don’t like to be late, and so I get panicky.

FATHER: Well, but I wouldn’t...

THERAPIST: That you must not do! I really think if you leave at 7:25 and he walks to school, that’s on him!

KEVIN: And I have no problem walking to school, except if it’s freezing cold outside, like it was...

THERAPIST: And that, too bad for you! (chuckles) That’s your decision right there! [00:58:41]

KEVIN: I know, but I just, I don’t like walking to school, but I know that I have to.

THERAPIST: Right, but you can’t be resentful of her, if... Now, if she tricks you, and leaves at 7:20, and you can take a picture of her leaving at 7:20, and timestamp it on your phone, and bring it in here and prove it, I will turn to her and say, “Don’t do that! That was mean!” But if she leaves at 7:25 and you’re not on the “Mom Bus,” then I don’t care if it’s 20 below zero, you’re a good outdoorsman, you can make it. Don’t you agree? (Kevin affirms) There you go!

MOTHER: Now part of this is going to be alleviated, because I just quit my job.

THERAPIST: Well, no...

KEVIN: She quit my job...

THERAPIST: You still should leave at 7:25. He shouldn’t get, be like, “Oh, I’m delaying everybody until 7:30.”

FATHER: Well, she had to be at work by a certain time, that’s why she’d drop him off.

THERAPIST: Oh, so that was an early drop off.

FATHER: Don’t get to sleep in then.

THERAPIST: Oh, oh, oh, I understand the difference now.

MOTHER: Right, right, right.

KEVIN: She quit her job because of that one time where I didn’t feel good. (mother and father deny) Okay, then why, that’s exactly what you told me...

THERAPIST: I love it when you (inaudible)/blocked sympathy (ph) pretty fast. Give me the super-fast version. What... [00:59:44]

FATHER: That’s not what Mom... It may have played into it, but I think our household is better with mom not working. I think the dynamics are better.

THERAPIST: So nobody’s blaming you for that. (father affirms)

MOTHER: Me working is just kind of a lux/stops/, you know, it’s just like, “Oh I’m not doing anything, I might as well work.” So I don’t need to. But I think my energy needs to be spent at home.

THERAPIST: Okay, so I agree with all that, as long as it’s not truly spent at home being anxious.

FATHER: No!

MOTHER: I like to be at home! (ph)

KEVIN: Mom, I really don’t like this because there were two things that really pointed to me today. One, you literally nearly pointed to me when you were talking to Mr. Smith. His two daughters are in my mom’s class, so...

THERAPIST: He (inaudible) same way.

KEVIN: He saw that there was a new spot open for a parent, so he asked me if my mom was quitting her job.

THERAPIST: (chuckles) What are you, her agent or something? [01:00:45]

KEVIN: I have, I didn’t even know about this until today. So she... was talking to Mr. Smith in the parking lot today. He asked why she’s quitting her job, and then she got real quiet. She started whispering to him, and I could see her doing this (pause), and then on the way in here, she told me that specifically because I skipped school that one day. That’s what you told me and (father attempts to interject) don’t, please don’t deny that, because that is what you said.

MOTHER: No, I... not because that one day, but because I went to work and I didn’t know you weren’t at school, and that’s the second time that’s happened.

KEVIN: But Dad did, and he didn’t do anything to stop that.

MOTHER: That... I think... I think we hit rock bottom. I think with you... and you’re not at F’s now, but with you being all F’s in your, in this semester, and then me not knowing that you weren’t at school... You were truant and, with me not knowing that, I don’t need to be working. I need to be at home, and make sure this is happening. [01:01:47]

KEVIN: I don’t get why you would choose to quit, when we’re going so good right now.

MOTHER: Well, we are, but...

KEVIN: Why wouldn’t you have chosen to quit when it was in a bad time? We’re in a really, a good time right now.

FATHER: I asked Mom... if she would quit a while ago, because I did not feel the dynamic of the home was as good. I...

KEVIN: You’re always sleeping in the morning, so you don’t know how the mornings are going.

FATHER: I hear everything that goes on.

THERAPIST: Well, I think he’s speaking on a broader issue than just the mornings, but I understand why you’re... I understand what you feel here, Kevin, because you feel like this is... Here is what I think you’re saying (but you said it very well), but here are what I think you mean. I think you mean that you’re going to get blamed for this at some point.

KEVIN: No. I don’t think that I will be, but I feel bad because... I’m also frustrated with her, because I know that we need the money. I know it doesn’t pay much, but some, I mean... [00:02:46]

THERAPIST: If you’re her agent, you could up the guy if he comes to you and he says, “Can I get your mom to work here?” You say, “That’s going to be about an $18 an hour job.” (mother chuckles) And you get 10%! (chuckles)

KEVIN: She shouldn’t have quit right now and that’s not your decision to tell her that she needs to quit or ask her, that she needs to.

THERAPIST: They are partners, and they...

KEVIN: I know.

THERAPIST: ...they do get to discuss that. But I still think it’s interesting that you’re concerned about this. So you’re saying you don’t feel guilty about it? Because you sound like you do.

KEVIN: I do feel guilty about it...

THERAPIST: Okay, I didn’t say it right when I said you’ll feel blame. It’s that you’re saying you feel somewhat responsible for this and you wish she would have held out, so that, that you could show her you’re making progress, and her not have to quit.

KEVIN: Well, yeah, but there is another part, is where... I think why, one of the reasons is, why she didn’t, why she quit her job, was because she doesn’t trust me enough to... I mean, she’s... [01:03:53]

THERAPIST: You have to say what you’re saying, go ahead.

KEVIN: She’s not open enough to really realize what’s happening. Like, I didn’t feel good at all that one day, and... she says... I can’t remember what she said, but she said, pretty much what she meant is, “You’re going to school and... I mean, you have to go to school today.” (pause) She’s not open enough to really realize how I’m feeling. She thinks that her opinion on how I’m feeling is right. She doesn’t listen to my, she doesn’t listen to why I’m not feeling good. I’ll tell her, and she says... she’ll sometimes come back...

THERAPIST: And you don’t think that you (and I’m really asking, it sounds like I’m leading you, and I’m not), you really don’t... you feel like you have not done anything to get her to think you’re not credible about things like this? [01:04:52]

KEVIN: I don’t see why she wouldn’t believe me, because I’ve never... purposely skipped school. I might not feel good at all in the mornings, and then feel better in the afternoons.

THERAPIST: And what’s your response to that, Maggie?

MOTHER: Um, I feel like it’s happened enough, and I can’t give you a number on...

KEVIN: Three times.

MOTHER: ...my hands or whatever, but I just sort of sometimes feel that if you don’t feel completely perfect, you can’t go to school. I think you know, if you feel sort of sick, you can kind of buck it up and go, unless you’ve thrown up or you have a fever.

THERAPIST: True, but if he have a pattern of that, I think you’re right. I would be the very first person to tell you, “It doesn’t matter, Kevin, if you’re uncomfortable. We all are; get up and do it.” But if he’s not usually doing that, then he feels like you’re sort of saying he is a malingerer, is the term you’re looking for there, that he’s like faking sick to get out of school a lot. [01:05:47]

He’s saying, “I don’t like going to school; (chuckles) you’re right! Every day I don’t want to go. But I’m going.” I mean, I’m pretty much paraphrasing what you said right there. So I think, I think (we’re going to have to quit), but this is actually an interesting point, because if you two are going to be spending more time together...

FATHER: ...it really won’t change.

THERAPIST: It really won’t (chuckles), yeah, it really won’t change.

FATHER: If she’s home by then...

MOTHER: Well then, I won’t be stressed about being late to work, though.

THERAPIST: Well, that will help, right? (ph)

MOTHER: That whole h***, because I don’t like to be late. (Kevin attempts to interject) So that part will just...

THERAPIST: Well I know what Kevin is about to say, right? Go ahead, Kevin. I know what you’re going to say.

KEVIN: Then don’t be stressed, just leave when you need to leave and if I’m not ready, then just... I’ll walk.

THERAPIST: That is correct.

KEVIN: That’s how easy it is. You don’t have to worry about me. All you have to do... [01:06:30]

MOTHER: Well, but you weren’t... My point is, I didn’t know where you were. I thought you were at school. So I am a mother that doesn’t really need to work, but I’m working, and because I’m working, I didn’t know you weren’t at school. So work interfered with me being a mom, is what happened and I don’t have to... I don’t have to work. But I want to be a mom, and being a mom means I know where you are; and I didn’t.

THERAPIST: So here is my answer, and then we have to quit. Kevin is right, in the sense that if this situation is only going to get you two into it more in the morning, in a bad way, then he is right. That isn’t going to be helpful.

She is right, if this is going to help make sure that you’re doing better in school, without the two of you just getting into it all the time. I don’t think any of us know which of the outcomes that’s going to be. Is everybody following what I’m saying here? (all respond) [01:07:30]

If every morning you two are just fighting, and now there are no deadline and no responsibility on him to go when he’s supposed to go, and it just turns into a power struggle? He is right. He should have just gotten to walk to school. And we’d have dealt with the no-shows at school or whatever. You get truant, you get detention, too bad for you. That’s the problems. He has to just deal with some of those consequences.

MOTHER: But I checked into that, because... (pause) I kind of wanted him to get in trouble, but they said it was going to be me that got in trouble.

THERAPIST: Who told you that?

MOTHER: The school.

THERAPIST: What are they going to do to you?

MOTHER: They said the police got involved, and the police would come to my house and say, “Why didn’t you know where your son was?”

THERAPIST: They’re just making that up. Those people made, they made that up!

MOTHER: They’re our... they’re our friends! (chuckles)

THERAPIST: There are state laws. I actually had that little talk with Tonganoxie about this one time, because they had some similar policies. The problem is truancy is a specific term of law. There has to be certain things present for truancy to occur. The school can define absences any way they want, and can punish the kids as they see fit. But for it to become truant, if you look it up and there is a specific set of guidelines that are required for it to be a legal action. This would be way short of that, so better that he gets a bunch of consequences. I don’t... yeah. [01:08:55]

MOTHER: Well, I... and I did... Oh, water there (ph)...

THERAPIST: That, don’t worry. It happened. But he needs to face those consequences, and one of those consequences cannot be you yelling at him. That does not have any effect. That harms your two’s relationship, and it makes him not... There is no consequence to that. It’s just he’s angry and you’re angry, and actually kind of feels bad about it, but that’s not driving him to do better. If he has to go to school, and serve detentions because he didn’t go to school, and you won’t excuse him, power to ya! That’s what I would do.

MOTHER: That’s what I wanted to happen.

THERAPIST: Sure. And I tell my kids, “If you don’t go to school and you get truant, or whatever...” (chuckles) My kids actually got a truancy letter one time, because I took them to Disney World; and that was fine. And then they had strep! And there is a sign on the door that says, “Don’t bring your people here if they’re sickly!” So I took them out and that exceeded the number of days! And they sent me a letter! [01:09:53]

I wrote them back and I said, “This is, these are excused absences for medical reasons.” They were saying, “(inaudible) for now on, you’ll have to bring a doctor’s note.” I said, “They were out for three days!” Well, that combined with the others. I said, “We need to go through the statute.” I sent them the statute and I said, “This is what truancy is.” They finally wrote me back and said, “We’re going to have to change our policy.”

So it’s a very specific set of circumstances. But, I said, “You can put my kids in detention if they have unexcused absences; have at it!” But they don’t. They can put you in detention; you can spend more time at school! Wouldn’t you like that? You could go to school and do like, I don’t know, Saturday school or whatever they do after school, you could stay there longer and then... [01:10:33]

KEVIN: If I’ve learned the lesson then... I mean, so like, if she leaves, she doesn’t have to worry about me going to school or not in the mornings. I have to worry about myself. I don’t think I said that right at all, but...

THERAPIST: I know what you mean.

KEVIN: Yeah, so... just have her not be stressed out at all...don’t worry about...

THERAPIST: Well, that may be easier said than done. You have some work to do to help her with that. Go ahead.

KEVIN: Like, don’t be stressed out. If she was still going to work, she doesn’t have to be stressed out. All she has to, I could even wake myself up.

THERAPIST: That would be beautiful, man. (Kevin affirms) I’d let you pick any dessert that you would pick, and I would get it for you on the last day of school. We would share it together, if you actually follow through on that. Any dessert at all, from anywhere in the world! We would have a dessert fest, right here. [01:11:26]

KEVIN: But like, I don’t think that she should be so stressed out in the mornings. I think that if she does leave me at home, you know, I’ve, I need to learn my lesson. If I do things right, I get my way, and I get to go to school, I’ll get to ride to school. I like to get to school earlier so I can talk to my friends. But if I don’t get up, if I get up too late, I have to walk to school, there is a consequence, and then I might be late to school, and there is another consequence, so... I’m not learning anything...

FATHER: So we’re putting it on you.

KEVIN: Yeah.

THERAPIST: I’m totally down with that.

FATHER: ‘kay.

MOTHER: You have, you end up walking a lot, I mean that’s what we do. You end up walking a lot, because you’re not ready. So, that’s already in place.

THERAPIST: If he doesn’t go to school, if he skips out, regardless of whether you’re going to excuse him or not, and you have a choice (you can think about it; you can think probably quite a bit; you don’t have to call in that day), then he would have to let you know that he did not go to school and why. He can send you a message about that. Then you decide if you want to excuse him or not. If it’s not legit (and I think we have to define what legit is, because we’re out of time, we’d better do that in the future), but then you can decide to excuse him or not. You can petition for why it’s legitimate. Maybe you’d better walk to the doctor if you’re that sick. (pause) The doctor isn’t that far away.

FATHER: Closer in school.

THERAPIST: There you go. All right. So this is an unfinished discussion, but we have to stop. What, let’s see what we need to put (inaudible) down here. Kevin you really did a very fine job of presenting yourself today.

KEVIN: Thank you.

THERAPIST: I am impressed with how you speak. When you’re in the “wise people’s chair,” you do really good. You need to try and do that in other places, too. (pause) What time? Okay, so, if we, can we do a 4:00 or is that too early for you guys?

FATHER: Depends when... you’ll be...

MOTHER: Well... I can do 4:00 now, if I’m...

THERAPIST: Want to do the 21st?

MOTHER: Now we already have some set up, actually.

THERAPIST: Oh, we have some? Never mind.

MOTHER: I think we have, we’re, I think we’re all...

THERAPIST: We do! We have 4:30 on Wednesday on the 20th. We’re good.

MOTHER: I think we’re all through the end of December.

THERAPIST: Okay! We are good! All right, guys!

MOTHER: Thank you!

THERAPIST: See you then! (pause) Remember to take the “wise person’s chair” with you, Kevin.

KEVIN: Okay.

THERAPIST: Not literally, but figuratively. (chuckles) Because I think it won’t fit. Take care!

MOTHER: Thank you!

(This therapy session ends at 01:13:55)

END TRANSCRIPT

Transcript of Audio File:

BEGIN TRANSCRIPT:

THERAPIST: (opens door) Hey guys! Come on back! Poor Ruth (the cat) is having a hairball issue or something (chuckles) today. Let me see... I will be back directly. (door closes)

FATHER: That�s a big computer!

(sound of chimes)

KEVIN: (chuckles) It�s just like...

FATHER: Kind of pretty!

MOTHER: Do you have my phone? [00:01:31]

KEVIN: No, you have it.

MOTHER: Can you turn your phone off, Wes?

FATHER: Yeah, why?

MOTHER: Well, I think last time, it rang a couple of times, you know...

FATHER: Maybe it was important.

MOTHER: I�m thinking the world can survive without you for an hour.

KEVIN: (non-verbal �I don�t know�), time to turn your phone down (ph).

FATHER: I did, Kevin.

KEVIN: No you didn�t.

(door opens) [00:02:38]

THERAPIST: Oh, ho, ho, ho!

MOTHER: Do you swim across the street? Well, not...

THERAPIST: I even swim farther than across the street! (Kevin �bad joke� groan), (chuckles) but yes, I...

MOTHER: That could be taken that way.

THERAPIST: I swim and so... (crumpling paper) I feel like I swam up and down all of the street today, a pretty hard swim. Okay, are you going to do your trick today, Ruth? Because you need a hairball (inaudible). Oh, good girl!

MOTHER: Awww!

THERAPIST: Now, here you go! You need some hairball medicine. (crumpling paper)

MOTHER: We used to have a longhaired cat and they are so pretty, but I�ve kind of forgotten about the hairball thing.

THERAPIST: Well, and we have a really good comb for that, but Evan, I don�t think he used it this week and she, we�re... When spring comes, I think I�m going to just shave her again. The vet told me she does that to her cat always.

MOTHER: Huh!

THERAPIST: And cats like it. We had to shave her last year, because she had such matted fur, and I kind of hate to, because everybody loves to pet her. (mother affirms) But that�s a lot of fur to be releasing in the spring and... [00:03:44]

MOTHER: It really is!

THERAPIST: ...I think the floor or Ruth�s stomach is going to probably like it pretty much. Okay! Well, I hear that you have had a rather, um (Kevin affirms), exciting week, shall we say.

MOTHER: Now he gets to be home with me!

THERAPIST: Yes, this does not seem to be strategically a wise choice on your part!

KEVIN: About the... school, or about school?

THERAPIST: Yeah (Kevin responds), and you end up at home with your mother (Kevin responds), where the two of you can have conflict.

KEVIN: It hasn�t been that bad at all. It really hasn�t.

THERAPIST: So you�d like to just go ahead and have her homeschool you for the rest of high school?

KEVIN: Um, probably not that, but... (mother laughs) It really isn�t that bad.

FATHER: A lot of people do that.

THERAPIST: I don�t know, either. I think that parents can be teachers and teachers can be parents, but the twain shall not usually meet. My wife is an excellent teacher and the last person on the face of the earth she wants to have to teach is our kids. That�s why they go. (Kevin chuckles) I just need to check something... [00:04:50]

KEVIN: We went the other day. For the...

MOTHER: Yes, you did.

KEVIN: ...football game.

MOTHER: He did do a lot of studying at home today. I don�t know if it was a full day�s worth of school, but...

THERAPIST: So I am interested in your account of what happened.

KEVIN: At school with George (sp)?

THERAPIST: Yeah, I have to go back and read your mom�s version here in a second, but I would like to hear yours before I do that. (pause) I can breathe; well, I�m still not quite over my swim. You guys probably think it�s like cold in here, though? [00:05:39]

MOTHER: Well...

FATHER: It usually is a little chilly in here (therapist chuckles), but you just worked out, so...

THERAPIST: You always come in right after that, and I have the fan and I think, �Oh, it must be like 80 degrees in here.� I�m beginning to realize that�s the problem, so... If it gets too, the wind gets to be too much there on the fan, we�ll fix it. Okay, so Kevin... �It was a dark and stormy night...� What happened?

KEVIN: (chuckles) Oh, is he asking me? (mother affirms) Oh, okay. Um, about school, like...? Okay, um, this kid, he�s been giving me a hard time since the very first day of school, but it�s been getting pretty hairy. So, he�s broken around 300, well, probably just about $300 worth of my stuff, don�t you think?

FATHER: The only thing I know, that I�ve actually seen a value on, was the inhaler, but...

KEVIN: The inhaler and the two pairs of shoes...

FATHER: Which I didn�t know about.

THERAPIST: He broke your inhaler??

KEVIN: Yeah, he sat on it. [00:06:36]

THERAPIST: I�m going to find your e-mail...

KEVIN: I�m not saying, that�s not a fat joke. He really did sit on it. (therapy affirms) (pause) So, he broke my inhaler, he threw it away, so that was about $50... (mother affirms) $50. Broke three of my deodorant sticks, so...

THERAPIST: What was the... Okay, this was over the course of the year? Or just all here, the other day?

KEVIN: All here, recently. It�s within, the inhaler was a few weeks ago, but he was suspended for... Well, he came back after suspension for like, five days and then he came back one day, and then was suspended again. One, he brought moonshine to school and I can�t remember (therapist stifles laugh)... yeah. (chuckles)

FATHER: Don�t hear that every day, do you?

THERAPIST: You�d think I did, but no. That is actually...

KEVIN: Yeah! It�s Baldwin, so... (mother chuckles)

THERAPIST: Oh, this is the one e-mail, okay. Go ahead. [00:07:36]

KEVIN: So, he brought moonshine to school and then... I can�t remember what the...

FATHER: Shoes.

KEVIN: ... second thing was. No, no. I�m talking about (inaudible)/blocked.

MOTHER: Has (inaudible). (therapist responds)

KEVIN: But then he was suspended again, for I don�t know why, the next day, when he got back, the day after he got suspended. Then, when he came back, he broke my inhaler, and then about two weeks later... wait... he broke my inhaler before he got suspended the first time, so I wasn�t able to like, confront him, ask him why he broke my inhaler and say that, �Hey I need this money back, so I can get a new one.� So when he got back, he... smashed one of my deodorant sticks on the floor, the locker room floor. Then the next... next, the week after, he smashed two more (which was just this week), smashed two more, filled both of my gym shoes with water, and flushed them. [00:08:39]

So I went up to him. I asked him why he did this, and I told him not to mess with my stuff anymore. To get the point across, I kind of gave him a little shove, make sure that he was listening to me. He turns around, puts me in a headlock, and punches me on the side of the head. I kick him while I�m in the headlock, and I come out and I punch him, right in the face. His nose and his lip were bleeding. That�s why I�m suspended for five days.

THERAPIST: (pause) Do you guys concur with that story?

MOTHER: We know, he did tell us a couple of weeks ago about the inhaler, and Wes even talked to the mother and she is, was...

FATHER: Going to reimburse.

MOTHER: ...was going to reimburse. So that�s docu/stops/, and he, you told the principal about that, back when it happened, I think.

KEVIN: Yeah, and he didn�t do anything.

MOTHER: Well, but I�m just... So there has been... Now, these other things, we haven�t seen the shoes, we, I don�t know anything about the deodorant. I mean... and I don�t mean anything against you, but that has not been visually confirmed by us. [00:09:45]

KEVIN: Yeah, it was... three of my friends said that they saw him do it. He took the deodorant, poured it out, threw it up on the ceiling, and when it came down, he started stomping on it and he squished it and it�s all over the floor. Then while I was walking down the hallway, when someone (sp) came to get me from the office, from Math (the office aide), he said, �By the way, George also put water in both of your shoes and then flushed them.� So I asked Kevin, when I got to Math... no...

THERAPIST: But did you document any of this with anybody else?

KEVIN: No, that was when I was, this was the same day that it happened, so...

MOTHER: So the shoes happened yesterday. (Kevin confirms) And this is when the fight happened, was yesterday.

KEVIN: Yeah. It happened... somebody told me in the hallway, while I was walking to Science, which is my first hour, I got into Science and then... I went over to George after Science, and I asked him why he did this, and that�s when that happened. [00:10:52]

FATHER: You had told? (Kevin denies) I thought you had told them about the deodorant and stuff in the gym.

KEVIN: Yeah, I told him...

FATHER: So that was documented, and so was the inhaler with the principal.

KEVIN: Yeah, but...

THERAPIST: So two things were documented.

KEVIN: Yeah, but that was way before the other two deodorant sticks and the...

THERAPIST: Well I�m going to, just making sure that as the lead up to this occurs, you tried other �paths of righteousness,� and then... So, um, where did this occur?

KEVIN: In the hallway. My intentions weren�t to go up and punch him in the face, but my intentions were to just to try to get him to stop. Then, with this comment, I realized that he�s going just keep doing it, so I gave him a shove to try to get my point across. He didn�t...

THERAPIST: But might one question whether that was the time or the place for this?

KEVIN: Well, that was the only time that I was going to see him through the day, so that was the only place I can see him through the day. [00:11:52]

THERAPIST: Mature people retire these things to after school, off the grounds of the school.

KEVIN: Well, but he rides the bus home, he rides the very first bus so he has to get there right after the bell rings.

THERAPIST: Well, what happened to him in this story?

FATHER: He got an in-school suspension.

KEVIN: Yeah, but he�s in, he�s still in school now, so... He�s...

THERAPIST: We, it does not appear you came out the winner in this situation.

KEVIN: Well, physically, definitely. I mean, he ran down the hallway, crying, so... But...

THERAPIST: And you�re quite certain that he posed sufficient threat to you, to respond that way? I�m really asking, I�m not tricking you.

KEVIN: Like, to put me in a headlock? Like when he put me in the headlock, was I scared?

THERAPIST: Well, that�s a good way to respond, but maybe, when, so exactly what happened? I mean, he then, in the middle of this, put you in a headlock, he responded in a fighting manner to you? (Kevin affirms) Did other people see that?

KEVIN: No, it just popped up out of nowhere. So everybody...

FATHER: Did other people witness it? [00:12:54]

KEVIN: Well, I�m sure they did, but halfway through it. Nobody saw the very beginning of the fight, but... He put me in a headlock after I shoved him, and I was trying to make sure that he was listening, trying to get my point across. He put me in a headlock, punched me, I came out of the headlock, slipped out of the headlock, and then punched him in the face. Truthfully, I think that was self-defense. I don�t think that was...

THERAPIST: You did start it.

KEVIN: Well, I mean, can�t he man up and just realize that he needs to stop messing with my stuff?

THERAPIST: Well, I actually see your point. It just seems like that was a strange time and place to start it.

KEVIN: But there was no other, I wasn�t trying to start a fight. I was trying to get him, to get my point across. There was no other place that I could do it.

FATHER: What I�ve tried to do is explain to him that, there is a way that you can get your point across without fighting, or a way... (pause) I�m trying to think of the way I want to word this, but... (pause) I could understand why Kevin did what he did, and if he didn�t have anger issues, I probably wouldn�t have... worried about it too much. I would have hoped that he would pick a different direction, but I can understand what led up to that direction. [00:14:13]

THERAPIST: That�s what I�m trying to figure out is, whether it was impulsive (and it does seem to be), or whether it was more the thing you�re saying, where you�re trying to prevent yourself from being bullied. That�s the part that is kind of an interesting question here.

KEVIN: I wasn�t... I guess it was trying kind of not be bullied anymore. He�s been picking on me for a long time. I mean, it doesn�t affect me at all. I mean, but it�s just annoying, you know? Um...

THERAPIST: If it doesn�t affect you, you certainly picked a rather large response.

KEVIN: Well, once he started doing the stuff, it, well, it affected me by annoying me, you know? I�m, that doesn�t really make any sense, but... How it affected me, it just...

THERAPIST: No, I understand what you�re saying, but...

KEVIN: ... it just... yeah. But I had tried to get help, nobody else was helping. It wasn�t, nothing else was going to work, so I went up to him and tried to confront him, tell him to stop. I didn�t want to start a fight. Why would I want to start a fight in the hallway, with teachers all around? [00:15:16]

MOTHER: (pause) He actually even told, like I said, he told me about it a while ago, about the inhaler. At the time, he said that the lock on his locker in PE doesn�t work and so, because I was going, �How did he get your inhaler?� �Well, my lock doesn�t work.� At that time, I told him we need to get him a lock and then I never remembered to do that. So there, there, he came to me for help, as well and I kind of dropped the ball.

THERAPIST: Well, I�m looking at the referral here and it says, �Kevin came up to this student boy (ph) to tell him to stop messing with his personal belongings, alluding to a previous situation. Student replied in the negative,� which I am not sure what that means, but I presume it means he refused to...

MOTHER: What did he say?

THERAPIST: What does it mean, he replied in the negative?

KEVIN: He turned around and he said, �Okay.� It wasn�t like, �Okay, I�ll stop.� It was just like, �Okay,� like I�m just going to keep doing it. So...

THERAPIST: Because I take this, that he did not, if he replies in the negative, it means he did not agree to stop.

FATHER: I think it was, he agreed, but in a sarcastic form.

KEVIN: Yeah. He was just going to keep doing it. [00:16:29]

THERAPIST: Okay, because (chuckles) it kind of matters. Like at that point, what happened and they don�t say it very well. So then, �unsatisfied, you kicked him and then he pushed you away, and you pushed back, and then he put you in the headlock.� Does that sound all right?

KEVIN: It... not really. I didn�t kick him first. He was not open to what I was saying at all. He was open to the concept of it, about, past the... um...

THERAPIST: Well, you�re more vague than what they (chuckles) are in here!

KEVIN: Well, but... It happened to me, so...

THERAPIST: Yeah, but what did he say, exactly?

KEVIN: He said... um... I can�t remember really what he said. I remember he said that I attempted to kick him first. I did shove him, to make sure that he was listening, but it wasn�t, it was a little push, I mean, it wasn�t necessarily a shove. Um... [00:17:35]

THERAPIST: Okay, so then jumping to a different thing, or I, let me look here and see if I understand this. So (sighs) when is this wall kicking or hitting (it looks like kicking to me) incident? That�s after this? Or right after it?

FATHER: That was before.

MOTHER: No, that was...

KEVIN: That was the day before that.

MOTHER: That was... Sunday. Yeah, that was the day before.

THERAPIST: What�s going that going on with that, Kevin?

KEVIN: I really have no clue! I really don�t remember what it was about. What was that?

MOTHER: That one was, (father interjects inaudible) Kevin and I got into a fight, and I�m not proud of that at all, but it was a day full of... (pause) Kevin is wonderful here, but there is this other side. He does not follow rules, he is able to get by with doing things he�s not supposed to be doing, and I had had a full of that. I was very irritated by the end of the day. So that�s when I walk into the living room and he has this chocolate. [00:18:34]

KEVIN: Little tiny bowl like, like this, probably halfway filled with chocolate.

THERAPIST: Like little chocolate bars, pieces?

KEVIN: No, no, just little...

MOTHER: Just little, like chocolate chips. It�s kind of a stupid thing, but... My point was, this was just one more rule that was broken. These guys eat a bunch of snacks and then, any time they want, they just rampage through the kitchen, then they�re not ready for dinner. So I had set the rule that, no more snacks unless you come through me.

So it was just a full day of all this kind of stuff, and then that was the final straw. He has this chocolate, he didn�t ask me if he could have it. So I, �Kevin, you�re not supposed to have chocolate, you need to give it to me.� So he wouldn�t give it to me. You know, it�s laying here and he did this with his legs, and I�m trying to get it, because... I didn�t handle it very well. So I�m trying to get the chocolate. He won�t give it to me. [00:19:22]

THERAPIST: You�re grabbing the bowl of chocolate?

MOTHER: I was trying to grab the bowl of chocolate, because...

KEVIN: And while she�s doing this, she�s holding onto the bag of chocolate, and she�s stomping on my foot, while she�s doing this. That did happen.

MOTHER: That, that came... later. I did tramp on him.

THERAPIST: This went on for a while?

MOTHER: Well, when I couldn�t get the chocolate, I said, �Well then, I�ll just take your phone.� So I grabbed his phone, and then he grabbed my hand around his phone, and squeezed very, very hard and...

KEVIN: I wasn�t squeezing that hard.

MOTHER: ...I was trapped there.

THERAPIST: So, I think you need to go in the waiting room. See you later, bye. (Kevin affirms) If you want Ruth to go with you, and you two can play with her...

KEVIN: I�d just like to say my story first, so...

THERAPIST: No, no. I�ll get your story.

MOTHER: Well, I was wrong here, Kevin, and so... I was not good there. (door closes) [00:20:11]

THERAPIST: Okay, so... He�s going to end up institutionalized if we don�t do something in a hurry. The first thing you have to do... I don�t know, maybe he has a bi-polar disorder (I told you that a few weeks ago), but you have to do what�s called a low expressed emotion environment. This is critical, or he�s going to end up in the hospital (chuckles), because these kinds are the things that escalate out of control. Now, nobody has any right to kick anybody�s wall in...

FATHER: But he feels like he does.

THERAPIST: Well, but (sighs)...

FATHER: He, he blames it strictly on her. Why did, why did you do that?

THERAPIST: That�s why we�re having this conversation privately. At no time, ever, does it make any sense to put your hands on him or anywhere near him, because that�s, there are nothing important enough (except if he has a knife or a weapon, in which case you really don�t want to put your hands on him; you just want to call 911) to put yourself in a physically confrontational situation. [00:21:21]

MOTHER: I agree.

THERAPIST: The chocolate can�t... If you don�t want him to eat chocolate snacks, that�s A-Okay by me (because especially with the medicine, he�s going to ruin his appetite and stuff), but (sighs) these kind of things aren�t important enough to get into that, this kind of a dangerous altercation.

MOTHER: Please understand, I do know that. And that�s when he�s going, �It�s just over chocolate!� It was not. It was, he breaks every... Let�s get... This is what we want to talk with you about, without him in here. It�s like he breaks every rule there is.

FATHER: �Don�t take the charger upstairs.� The phone charger.

MOTHER: Every rule. There is that violent side of him, so he gets away with a lot because, quite honestly, I don�t know how he�s going to retaliate. He gets away with a lot. And this was just that one time that day, and like, after...

THERAPIST: The premise of it�s like, I need to know like, what happened leading up to it. I�m trying to understand, when you say he breaks a lot of rules. The only rules that are really important in the world are rules that protect kids from harm. Those are the most important rules. Now there is different kinds of harm. There is harm, like failing out of school. (mother affirms) That�s harmful. [00:22:36]

But some things, like if he eats chocolate and doesn�t eat a good dinner... that�s just dumb. He shouldn�t do it, and you should say, �Well, that wasn�t very smart.� I sit there and tell my son, �Well, you�re going to get to take shots someday, just like me, because you�ll have diabetes.� And leave it at that...

MOTHER: Well...

THERAPIST: ...because I don�t like him eating junk food, either.

MOTHER: Again, it�s not the choc/stops/, I mean, it�s not, we eat chocolate, we eat crap all day long. It�s truly, that was just the symbol of what had happened all day. And it�s things like...

THERAPIST: And so walk me through that. And that was before the suspension, right? (mother affirms) Okay, so walk me through what led up to this.

MOTHER: So things such as...

FATHER: The doors were left open in the kitchen all week.

MOTHER: And it all sounds so stupid individually, but it is usually like, you don�t think... They walk into a room, they open a cabinet, and they walk out, and the cabinet is open because...

THERAPIST: Who is �they�?

MOTHER: Oh, I�m sorry. My daughter, as well.

THERAPIST: So both of them do that.

MOTHER: Yeah. So, those frustrations are all day and then there is, we have this riding mower that doesn�t work, as a mower. So he�s kind of taken it over as this little four-wheeling kind of thing that he gets to play with. Well, he...

THERAPIST: So it runs, but it (mother affirms) doesn�t mow, okay. [00:23:43]

MOTHER: Yes, yes. So this had happened, this is one of those things that happened earlier in the day. He asked if he could paint the wheels, and I said no. �Well, it�s mine!� �No, it�s actually not yours. It�s the family�s and I don�t want you painting the wheels.�

So, I come back in the house, I go outside, he painted the wheels! With the paint that I had already told him months ago, never use this, because I bought it for purpose, for this craft. So he painted the wheels and he used the paint he�s not supposed to.

So then, he goes, �Well, can I have the keys?� �No you can�t have the keys, because you were supposed to go work� (that�s what, he was supposed to work with you that day, but he was too tired, so he didn�t go to work). So I was disappointed with him from the get-go, for letting Wes down. So that�s kind of what started my attitude, was early in the morning.

So any way, he said he wanted to drive that thing. I said, �If you�re too tired to work, you�re too tired to play, so you can�t have the keys.� So I go back in the house and I hid the keys. So I go back in the house and an hour later, the thing started up! And I go outside, I said, �What are you doing?� [00:24:43]

It�s those kind of things. And he�s like, �Well, I�m just going to go do the leaves.� �Where did you get the keys?� He goes, �I found them.� So I hide things and he finds them. I have passwords on my phone and he finds them (chuckles)...

FATHER: He read... he read that e-mail.

MOTHER: He found that somewhere on my computer, and I hid it. (pause) So, any way, it was that kind of a day that led up to one more thing happening. He got away with all of that, (whispers) because I don�t know how to handle it. And I�m kind of afraid (regular voice) of what he�ll do; it�s just only Jessica and I at home. So he got away with all that. Wes was home at this moment. I felt like, �I don�t want him to win this battle.� And so I resort/stops/ I did absolutely the wrong thing. I know that. Just at that moment, I wasn�t thinking. So that�s what happened that day. Oh, and then also after that, he went upstairs... and kicked his wall in. [00:25:46]

THERAPIST: That wall, so this is upstairs? So that was...

MOTHER: Yeah, that is in his bedroom.

THERAPIST: ...in a different room than where the thing was.

FATHER: That�s his bedroom.

THERAPIST: So you finally got the chocolate away from him, or...?

MOTHER: Well, what happened? Oh, and then...

FATHER: Jessica went screaming upstairs. I came down.

THERAPIST: What�s going on with her?

FATHER: She was just scared.

MOTHER: She was just screaming and crying because...

THERAPIST: From the chocolate altercation.

MOTHER: We were wrestling. I mean, we... It wasn�t, it is kind of, but I was grabbing the phone and he had my hand, and it was this. (pause) I�m not proud of that at all. So anyway, he came down and it disintegrated at that point.

FATHER: I broke it up. I was the mediator.

THERAPIST: Oh! You were at home? (father affirms) Oh, I thought you were gone.

FATHER: I was gone throughout the day.

MOTHER: Well, he had gotten home...

THERAPIST: You just came in...

FATHER: I was home for maybe 15 minutes and that... that�s usually when I come home to.

MOTHER: That he had, he was upstairs.

THERAPIST: What luck for you, you have to have this...

MOTHER: Yeah, it�s always lovely. So he was upstairs when this happened and then finally, when I think... [00:26:45]

FATHER: Jessica went screaming upstairs, and she was scared, so I came down to figure out what was going on and...

THERAPIST: Now you and he don�t have these problems?

FATHER: I tried taking the phone from him one time and... actually tried to take it out from underneath his mattress while he was sleeping? No, he was awake and I tried, I asked him to give me the phone and he wouldn�t. I reached to grab it, and he and I... went back and forth. But it... (pause) I handle it different. I�m... I�m more calm, because I realize...

THERAPIST: You�re into the low expressed emotion environment.

MOTHER: Well...

FATHER: I know what�s going to rattle him. I know what it�s going to be, and so... A lot of times I will let him say his peace, he�ll argue, and I�ll leave it at that. [00:27:41]

MOTHER: And that�s true, but can I say... and I don�t mean any disrespect, but he�s not around a lot. So, it�s easier to be able to control that when you�re not with it all the time. Can I just add that part? And I�m calm half the time, and I�m not calm half the time. So I have some good moments. But I, I... I�m around it all the time. ...Like all day.

THERAPIST: Well, the problem that we�re really struggling with here is that, were I to poll him and we could play like, �The Family Feud,� where I guess and then I poll him, and we see if I�m right? But I�m kind of guessing that he has more faith in your judgment than he does yours. So, I think he does not respond very well to you.

MOTHER: No, he does not. [00:28:37]

THERAPIST: And... kids respond to... only one kind of power. There are many kinds of power. This comes from industrial psychology, but it�s really accurate for families. So there is legitimate power, which is, �I�m the parent and I said so.� Kevin and zero teenagers respond to that. It�s not especially...

FATHER: That�s not working, yeah.

THERAPIST: Yeah, okay. And I mean, that isn�t unusual. Kevin right now, some of this seems like Kevin is just like, an accelerated version of a normal kid, but we�ll get to that in a second. So, it doesn�t matter if you�re the parent. That isn�t why my kids listen to me, and it isn�t why anybody else�s kids listen to them.

Then there is expert power. I think you actually have this going with him, some. That kind of works with kids if they really see you as an expert on something they�re interested in, like when you guys go hunting and fishing, and you guys kind of fit together well that way. That works for him. [00:29:41]

Then there is coercive power. You can use coercive (and reward; they�re really kind of just opposites of the same), you can use those two forms of power with kids. You kind of have to sometimes, but you have to use them really sparingly, because that will only work if you have the most effective and important level of power...

...and that is referent power. That is the power we get from people wanting to be like us, not like us, be like us. So he more wants to emulate you and he is, I think, at the 180 degree opposite of wanting to emulate you. So you have no influence over him. So the only way to make that happen... You really cannot physically challenge him. I mean you probably still could a little bit, but not much.

FATHER: It wouldn�t go well.

THERAPIST: It wouldn�t go well. And then when they get to be 15 or 16, you know, people will all be like... It�s always kind of an interesting folklore in our culture about how back in the day, you just hit kids and then they got better. Every kid I know turned 15 and beat the living crap out of their parent! That was the (chuckles) last time you ever had that happen! It�s like a rite of passage. So, you sure can�t go that route, because he sure will get bigger (mother attempts to interject) at some point. And even you, Wes, will have to worry about it. [00:31:05]

MOTHER: But that doesn�t get to the, I mean, that was kind of a fluke, really. (therapist affirms) I mean, it�s, because he�s... yeah.

THERAPIST: But we�re, some of those things, like the painting of the wheels. Let�s back up for a second on that. Like, I know why you were upset with him for not going to work. I would be the same way. But, how do you, does he like, he like gets paid to work for you, doesn�t he?

FATHER: He had spent the night at someone�s house.

MOTHER: But they were counting on these bodies to help with this project that had been, you know, a couple of weeks in the planning.

THERAPIST: What? How did, how... I�ve kind of been there before. How did you decide not to push the issue with him on that?

FATHER: On going?

THERAPIST: Going, yeah. Just thought it would be more trouble than it�s worth or...?

FATHER: Yeah. I just, I didn�t want an argument, and I didn�t want him there if he didn�t want to be there.

THERAPIST: Yeah, I get it. That�s what I kind of (chuckles) thought you might be thinking. [00:32:00]

MOTHER: But, but... and see the different, the one reason he does resort, because...

FATHER: I�m not as strict.

MOTHER: I�m much more the disciplinarian and I don�t give in, and there is giving in over here, so I mean, it�s...

THERAPIST: Well, but if... So... You two are really at odds about this, more than anybody is with Kevin.

FATHER: We�re two different extremes, yeah. I think she picks on things that are... too nit-picky. I probably don�t address things that are more serious. I mean...

THERAPIST: So what I�d have done is the same thing you did, but I would have said, �Kevin, you�re either going to need to make up some work for me at some point or I�m going to find somebody else to get the job, and you�re not going to have anything.� Now, I don�t quite remember with you guys, how you have this set up for him economically. Because for my kids, if I cut them off financially, they don�t have (chuckles) anything to...

FATHER: We just started doing that.

THERAPIST: Yeah, they... Okay. We have talked about this, yeah? They don�t have anything. They have to earn their way and so, when Evan comes in and vacuums every weekend, you know, and cleans up, and empties the trash, and cleans Ruth�s box, and brushes her, and all that stuff, then he gets paid. If he doesn�t, then not only is he a little concerned, because he won�t enough money, but he (and he likes money), but may just find some other nice boy to do his job, and he doesn�t want that. [00:33:23]

So that would be way to just kind of calmly say, �Well, when are you going to make the time up for me?� I actually think Kevin probably would have made the time up for you. I realize you needed his help at that point, but both you and I are not just businessmen and employees. We are also trying to teach our kids, and we have a little more flexibility, and right we do. Like, if I say, Well, Evan, if you don�t come in Sunday, you�re going to have to come in early Sunday morning, get up early Sunday morning, because that�s the only other time I have to do it.

So, those are the, that�s kind of a training process. It�s way more important than whether my office gets cleaned, although I�m now, to be honest with you, I am kind of depending on you to do it. (chuckles) So, I am in the same boat, but I know at the end of the day, the more important thing is that Evan is participating in the economy and doing his work. So, I mean, with the wheels of the thingamajig, why didn�t you want him to paint the wheels? Well, not with your special paint! I understand that, but why didn�t you want him to paint the wheels? [00:34:28]

MOTHER: I think probably... starting out irritated to begin with, and so everything is going to be tainted, his attitude is that he�s entitled to everything, everything is his and it�s an attitude that I have a difficult time with. So he�s going, �Well, you know, why can�t I paint them? It�s mine!� It�s like, �Well, it�s not yours!� You know, and... �I�m the one who...�

THERAPIST: Ownership is a little unclear to me in this story. Is it or isn�t it his?

MOTHER: It�s not his, no! Absolutely! We bought it, it�s ours, he rides it, but it�s not his. You know, so, I mean absolutely it�s not his. If he bought it, it�s his and he can do whatever he wants to with it, but since it�s ours, it�s just not one of those days I wanted him to paint the wheels and... I didn�t think...

THERAPIST: Could you understand there is no way for him to interface with that? There is no way, Maggie. He can�t... if he, if you guys said, �You can ride this around and pop wheelies on it (or whatever and, you know, and I guess kind of tear it up, I assume; it has no other use), then he says, �Can I paint the wheels on it,� and you say �No, I don�t want it, I essentially don�t want you to do it today, because I�m mad at you,� this... it�s a shit storm from there on out. [00:35:38]

MOTHER: Well, but I don�t think he should be able to do whatever he wants. I have a problem with that. I don�t understand how that�s going to help fix him if he gets his way in everything he wants to do.

THERAPIST: You want to pick out the battles that have meaning. Like having, shutting his phone off when he isn�t studying, you go! You do that. You shut it off. You shut it off (chuckles) until he�s finished doing his work. You have the technology to do that now. If you want to... get rid of all snack food in the home (as soon as you get it done at your house, come to my house and you can get rid of mine, too! I�d like it all to go away), just get rid of it all! And too bad for him.

You have power to do that, and that is your dominion to do. But what Wes was saying is that you�re like picking on some things... I�m going to rephrase what Wes said; he can correct me if I�m wrong. You�re picking at things that don�t have any substantive meaning. Now if he uses your paint, yeah, that�s a problem. But if you say to him, �If you want to paint the wheels, you need to pick up a spray paint the next time you�re at the store with your money, and that�s fine by me.� [00:36:51]

Or �Only use the old paint that�s out in the garage; don�t use mine.� So he feels like you�re, you know, telling him, �This is a limit, don�t use my special things,� but also you�re not just doing it to be capricious. It just looks like you�re mad at him. Keeping your paint for yourself �totally your right. Telling him, �I don�t want you to paint it, because I�m mad at you,� (and I know you didn�t really say that, but he totally picked up on that)...

MOTHER: Well, and in fact, I probably, I don�t even remember, but I...

THERAPIST: You did say it!

MOTHER: ...really wasn�t terribly opposed to the paint, but it�s like, not at this time. And so then he calls �this is what he does �so then he�ll call Dad, and Dad says whatever, and he does it. And so, that, I think that�s what happened. But...

FATHER: Well, and... he did call me. I said, �I don�t care if you paint the wheels. Make sure you check with Mom.� And so then, I come home and they�re painted.

THERAPIST: With her special paint.

MOTHER: And I just don�t... yeah. And... yeah. Anyway. [00:37:52]

FATHER: Well...

THERAPIST: My thing is it�s not that any one of these things is important; you�re describing as an escalating curve toward the wall kicking. And again, it�s, you know, I would presume he�s going to have to repair the wall at this point.

MOTHER: (affirms) He actually even offered that today.

FATHER: Well, we�re not going to do that until this is... I don�t want to keep fixing it. I only want to fix it once.

THERAPIST: Keep fixing it again. I think it would be kind of amusing if Kevin had to fix the wall again and again, frankly, but... The quality of the repair (chuckles) would be degraded as time progressed. But I mean, I think there is actually an interesting, you know, will he kick a wall that he had to repair? Isn�t there an interesting question before us? I don�t know, but... it might be worth... I get your logic in that, but I would, you know, you can use his resources. They have those thing, see how big this is, but they have those small pieces of sheetrock down at Home Depot.

FATHER: I guess he�s exceeded that size.

MOTHER: Well, the two smaller ones would be fine, but this one is... [00:38:53]

THERAPIST: Well, and I think the question becomes... Then this takes us back to the school situation. That�s a particularly dicey problem, because on one hand, I don�t know if that expresses an anger problem on Kevin�s part. I would not have done it that way, if I were him.

FATHER: You would have?

THERAPIST: I would not have, not in that situation. But if it�s true (which is why I wanted to know the history of it, that there was an altercation going on, a bullying situation), Kevin handled it in a traditional manner. He just did it in the most ludicrous location you could do it.

FATHER: Well, and I think anytime you try to manhandle him...that�s what sets him off.

THERAPIST: I just, that�s why I wanted to try to figure out with him whether it was impulsive or he had a strategic objective, and it looks impulsive to me.

FATHER: Yeah. I don�t, he did not go up there with the intention he was going to hit him.

THERAPIST: You don�t think he did?

FATHER: No! No.

THERAPIST: That�s very interesting.

MOTHER: (whispers) I don�t know...

THERAPIST: Okay. I missed... I was going the opposite way. I thought maybe he thought he had... So you think he went in and fronted him to get him to back down, and the kid accelerated the situation. Kevin accelerated it, and it got where it got. (father affirms) [00:40:04]

Because the correct way to handle that from a young man�s standpoint is to say, �You meet me after school, mother fucker!� (chuckles) And if the kid doesn�t do it, if the kid doesn�t find a way to do it, then the kid is one down, and Kevin wins. It�s interesting to me that Kevin didn�t think of that solution. That�s why I�m trying to figure out how well he thought it through. But you�re saying he was sort of part way there and it got out of hand.

FATHER: I think any time you... push his heat button, that�s his reaction, is to...

THERAPIST: So you think when the kid went to put him in the headlock, that flipped the switch?

FATHER: Absolutely.

THERAPIST: All right. But you know, haven�t you been in that situation, Wes?

FATHER: (lowered voice) I don�t blame him.

THERAPIST: I know. I didn�t want to say it with him in here. [00:40:51]

MOTHER: Well, he...

FATHER: I know. I don�t... I�m... I hate to say it. I�m kind of proud of him.

THERAPIST: Well, I wasn�t going to say that either! (chuckles) I don�t think that was, I think he did not strategically think through the consequences to himself (father affirms), but if he doesn�t front the kid, he�s going, and the kid really was bullying him, he�s going to get bullied!

FATHER: Well, and...

THERAPIST: I have to ask this question. I was teaching this sweet little middle school, little Jewish middle school children the other day at, over on Park, in the Jewish school there. They, I am, when I go and do a presentation, and kids ask me questions, I answer honestly. They said, �Have you ever been bullied?� Oh, shit! I don�t really want to answer this! They said, �What did you do?� And I said, �Well, there were three guys, and I told them to meet me after school, and they all three jumped me, and I took them all out!� (chuckles)

I said, �Now! I�m going to teach you how to do that, without having to hit anybody, which is to form a social influence that will stop the bullying in your school. You have to be tougher than the bully.� You don�t have to be physically tougher, but, you know, that�s how guys do this. It�s just you, you�re going to get in trouble if you do it in the hall. I bet that kid probably won�t bully Kevin again! I bet a lot of people won�t! [00:42:08]

MOTHER: Well, even the mom, the mom called and she�s like, �Oh, I feel so sorry for you!� (meaning me), because her son�s in...

FATHER: I think that�s why he got an ISS, because he�s already had two out of school suspensions.

MOTHER: Well, and also the school said, �Once you draw blood, that crosses the line.� So Kevin drew blood. But...

THERAPIST: Which she couldn�t have known in advance, but I have to admit, if you punch in the face, logically he should have assumed that, but (chuckles) then when Kevin...

MOTHER: But the mom was going, �You know, I�m sure George deserved it!� You know, she was totally on that side. She goes, �I, you know, if Kevin, if he�s picking on Kevin, you know, he probably deserved it and ta da ta da.� And then, you know, some people, some of the teachers and office staff at school, like, �Yeah. You know, that kid, the kid�s in trouble a lot.� So he still got suspended. Then I had that very same conversation with him on the way in, and about �Who do you actually think won in this situation?� And he goes, �Well, I did!� You know, same thing, I said, �But... you�re the one that�s out of school!� [00:43:06]

THERAPIST: There is case to be made for Kevin�s position, because in the long run, this probably insulates Kevin from bullying down the road. In the short run, he lost. And that�s why I really was asking him, it was a sincere question. I think I see his position and I see ours. I think we have to stand up for solutions, but at the same time (and if he�s correct, correct, of the series of behaviors moving up to that), that is probably his best solution, not in that situation, where he can then be held accountable for it in the way he was. I suspect... of course, I think that kid might have shown up after school! I don�t that kid realized what he was getting himself into!

FATHER: I think he�s, the kid is, I had him in Scouts for years. (therapist responds) I don�t think he would have shown up.

THERAPIST: You don�t think he would have shown up? You know more than I do, Wes. You�re adding to my data set, so you think, if Kevin would have cast a strong shadow, the kid would have...

FATHER: He would have backed down.

THERAPIST: Kevin needs to probably think about that, because I see where you�re saying that (ph).

FATHER: God, yeah! [00:44:09]

THERAPIST: So here is the problem. We�re really trying to figure out, does Kevin have an anger problem, or do you and Kevin mix so poorly that you each express an anger problem with each other? Now, I�m really posing that. What do you think?

MOTHER: Well, I don�t think he has, shows anger just with me. But it�s... I�m definitely more there, because we�re there together all the time. But he has anger.

FATHER: They are a little salt and vinegar. Is that what, is that how you say it?

THERAPIST: Well, I don�t know if that�s the right analogy, but I totally get what you... I think you mean oil and vinegar (chuckles).

FATHER: Yeah, I didn�t think that sounded right.

THERAPIST: I could spend some time thinking through salt and vinegar; it might work! Okay, so...

MOTHER: It�s not like it�s all directed (father agrees)... I mean, you�ve had those battles with him (father agrees) when you�re home and you�re the one that took the phone away. I mean, I�m the one that�s there and having to do all that, so then that anger is at me... [00:45:03]

THERAPIST: And you all understand, I�m all for you shutting his phone off, but physically doing that... Now, I don�t know what he�ll do if you shut his phone off. Quietly, you say, �We�ll turn that back on whenever you get it together.� But, but... we�ll see. But I know (chuckles) that putting your hands on his chocolate probably isn�t the best move at that moment. And if you need to go, like... have your own self-calming time to not do that, get, go do it. Go... say, �Kevin, I�m going for a country drive,� or something.

(sighs) And if he, and if you want him to pay for your paint, by golly, you have him pay for your paint! Have at it! If you want to point out to him that he is violating your space, just say to him, �Kevin, you know, you used my paint when I asked you not to. When we go to the hardware store, please buy me some new paint for, to replace that. Don�t you think that would be fair, Kevin?�

I�d be really curious what he would say. Don�t you think he would say, �Fine. I�ll do that�?

MOTHER: Oh, yeah. Yeah. He definitely would.

THERAPIST: Okay, there you go! [00:46:05]

MOTHER: But again, it�s not one situation, I don�t know whether it was the culmination of everything and I, I...

THERAPIST: Right, because you not only have to do this 800 times a day, Maggie! (chuckles)

MOTHER: I know! I know!

THERAPIST: Constantly do it! Yes!

MOTHER: I... and I... don�t... (lowers voice) and he�s stronger than me, so I�m not that stupid that often, that I would wrestle him. (regular voice) So that was a fluke. (therapist affirms) I know, I knew it was wrong at the time, but it just, I was tired of him winning, you know, at every single thing. He�s getting away with everything, and I, I just don�t, I just am not sure...

THERAPIST: I�m not sure what he�s getting away with. I still don�t quite understand that. He painted the tires...

MOTHER: But it�s all the time, every time. It�s... like I hide his phone, he finds it and he�s using it. He, we ask him for his phone, he doesn�t give it up. He locks his door, we can�t get... it just...

FATHER: �Don�t wear my shirt;� he�ll wear my shirt. �Don�t use the charger for the phone;� he�ll take the charger for the phone and take it upstairs. [00:47:03]

THERAPIST: This phone thing is...

MOTHER: He has no rule...

THERAPIST: The phone is really...

MOTHER: (under breath) (sighs) Oh!

THERAPIST: You have to get your equipment lined up on that, because then that will end that discussion in a hurry.

FATHER: That will be lined up. We... found other things on there as well. He�s sexting.

THERAPIST: Well probably... Let�s talk about that for a second. Like, he... he�s going to do that. They all, 100% of all of them do it. Now, is he sending pictures or just words?

MOTHER: I think so, but I don�t know for sure.

FATHER: I wish it were words.

THERAPIST: Definitely, send pictures.

MOTHER: Well, I have...

THERAPIST: We need to just have a discussion about what a really unfathomably bad idea it is to send your penis to people. That really is producing child pornography, so we need to have a little talk about that. He�s going to... and we, do we know these girls? I mean, they�re local or...?

MOTHER: See, he doesn�t know I know, because I just discovered this.

FATHER: Just came out today.

MOTHER: So we haven�t talked to him about it yet.

THERAPIST: You have to... here is the deal. You have to think about this. I�m going to do a radio show about this at some point. I�ve done a couple of them. But you have to think about all of your materials that you know about, about what the purpose of any spying is. You have to first of all decide if you have a reasonable suspicion to spy. Reasonable suspicion means that you believe there is a likelihood of some harmful act being committed. [00:48:24]

Now, the harmful act of texting, actual text/sexting is only if somebody�s daughter is mad about it and tells her mom, or the mom catches her, because 100% of all of them do it. They just do not think of the difference between saying something in person, or over the phone, and creating a transcript (mother affirms) of their sexually explicit communication. They don�t think about it.

I have to, I have a document that kids will start signing soon (well, and adults), that they�ll, in order to use texting with me, they�ll have to sign this document. It says that they have a passcode on their phone, that they will delete every text that we exchange, and that... what�s the other one I came up with today? Um...

FATHER: And you get to know the password? [00:49:17]

THERAPIST: Oh, I�m talking about clients I see. (father affirms) That�s an interesting other question. A parent will have to certify that they are not going to read our communications because they are privileged communication for anybody 14 and above. There is some other thing I thought of today, about texting... (pause) but... it will come back to me. But that kids will have to certify that, because any communications we have are protected communications, or else I won�t let them use texting.

They don�t think about this! (mother affirms) Oh, I know! They have to put my name in the phone as something they don�t... like Sigmund Freud or something, you know, something that no one will know what it is. That�s... if they do all those things, then they�re protecting their privacy. I can�t protect them any more than that.

Well, kids don�t think about any of that! (mother affirms) They don�t put a passcode on their phones! So if I say, �I�m very concerned about you being sexually active with your boyfriend, we need to discuss this next week,� (which I wouldn�t do, by the way (chuckles) for that reason), then they leave the phone laying around, and sister reads it and tells mom, and the whole world comes to an end. [00:50:22]

That�s where Kevin�s thinking is right now. He doesn�t think about texting as a document. So needs to think about that. Now, the question is, if you have reasonable suspicion to spy on him, is he going to do harm. In sending sexually explicit images, yes, you have the right to, morally to say to him, �We�re going to interdict that and it�s a problem,� but you need to teach him why.

Just stopping him from sending his penis all around the world isn�t going to solve the problem. He�s got to understand what that�s about. Most kids don�t.

MOTHER: They hear the information, but they... they don�t...

THERAPIST: Yeah. And then the Snapchat is what you�re talking about. (mother affirms) We did a show about that in the summer. Snapchat is really only ten seconds long, except people can screen shot the phone and immediately keep it, so Kevin�s penis waves throughout the world. (mother affirms) So those are all things he needs to learn and he needs to learn the ethical use of technology. The problem is, because you�re in such a battle, then he�s not learning about the ethics of technology, he�s learning about how to, you know, piss you off. [00:51:29]

MOTHER: Well, but we have those conversations. And like we had a great conversation on the way in.

THERAPIST: Well, good!

MOTHER: And, so he, but... He still... you know, he knows what he knows and that kind of thing, but we did have a good conversation about that kind of stuff, without him really realizing what I was talking about.

THERAPIST: Well, when his penis gets plastered on someone�s backpack, then he�s going to decide that wasn�t a good idea. The problem is, it really is an illegal act. They�ve actually changed the laws about this, because it�s becoming so ubiquitous at this point and they don�t, nobody wants children to be on the sex offenders� registry because they took naked pictures of themselves. We�d have to be, we�ve been so slow to catch up the last five or six years.

By the way, my column is probably one of the first published documents to talk about sexting; we didn�t even have a word for it, because the minute kids got camera phones, (clap of hands) that�s what they did with them. I mean, a week later, we started getting this, and this was like, I don�t know, seven years ago (chuckles). It�s been that long (father responds) that we�ve been dealing with this, right at the beginning. [00:52:34]

FATHER: I�m trying to think when I took a picture of mine. What year was that?

THERAPIST: (chuckles) Yeah, there you go, yeah.

MOTHER: I know I didn�t get it.

THERAPIST: You can sext her...

FATHER: That was the other girl.

THERAPIST: You can sext her all you want, Wes. I hope that you will!

MOTHER: Please don�t! (laughing)

THERAPIST: Married couples should sext each other frequently.

MOTHER: Oh, God!

THERAPIST: I drive my wife crazy with that. I�ll text her little sexy messages. She�s like, the kids are going to find this and I�m like, You have a passcode. That�s the point! So... But they�re going to do that, and you have to be very calm in the response. It�s the safest sex they�re ever going to have (nobody�s ever gotten pregnant from a sext), but if you have a calm conversation with him, one of the best... I�ll give you a great example, of this. I�ve never told you this story. Oh, I know I haven�t, because Kevin�s been in here.

Your, I had this mom whose kid was annoying and she came in and she says, �I don�t know what to do.� I said, �What?� I see her. She said, �My son,� (he was, I think 15) �came to me with a dilemma. He said, �Mom, I need you to get Plan B.�� And the mom said, �Plan B won�t work on you!� (chuckles) And he says, �It will work on my girlfriend. I need you to get it for her.� And she said, �Well, my God, why doesn�t her mom get it for her?� �Her mom doesn�t know we�re having sex.� Well, neither did this mom! (mother and father respond) And the mom, she actually, you know, called me. She says, �It�s kind of an emergency.� She texted me and I called her. [00:53:59]

She says, I, you know, I�m, and the clock is running on Plan B (you have to get it within 72 hours). And she says, �What do you think I should do?� (chuckles) This was before, just before you could buy it over the counter at any age. Remember the FDA came in, they forced, the court forced the FDA to change the ruling. And I said, �You know this is really a dilemma, because on one hand, this isn�t your daughter; on the other hand, if your son has impregnated her, you�re going to be every bit as culpable in this.� And I, we went through both sides of it, and she finally went and bought the Plan B. (mother responds)

But here is the important part of the story. Oh, and by the way, her rule for this was, the girl had to talk to her mother then about birth control. I thought that was very wise. (mother and father agree) So, the moral of that story is, what horrifying mess might that couple of have been in, if that kid could not come to his mom? (mother affirms) And I think you�re not very far away on this, Maggie. It�s you and he have these nice conversations, and he drove up here today, had a nice conversation? If you will start trying to go down that tube more than the one of frustration and seeing him as (sigh) such a pain in the butt, I think the two of you will be okay. [00:55:15]

But you�re going to have to kind of go, I think I hate to side with Wes on this, and have you two start a fight with each other tonight, but I think Wes�s got this down, about being calm about it. You don�t need to let him get away with things. But don�t take them personally. This is where you get into trouble. You really take it personally. Would you like to argue that point?

MOTHER: I don�t know that would have considered it personally. I don�t like that... and what I understand is that growing up, you did what your parents said. And the normal things, discipline, don�t work for him. So, in my opinion, he does whatever he wants and he has this...

THERAPIST: Well, now did I hear you just, did I hear you correctly that normally kids do what their parents say?

MOTHER: Growing up.

FATHER: When we grew up.

THERAPIST: When you grew up.

MOTHER: Absolutely. Back in that era...

THERAPIST: How did they get you to do that?

MOTHER: They did! (chuckles)

FATHER: Scared us. (therapist chuckles)

MOTHER: Well, I mean you had your wild thing. I did not. We, it was a... yeah. [00:56:18]

THERAPIST: But see, I think you began to respect your parents after you were 25, and you just think you did when you were a kid.

MOTHER: I knew if I did something wrong, I would get...

FATHER: There would be consequences.

MOTHER: ...spanked, and it was the physical, you know, spanking. I think dad always says, we messed up like once or twice when we were little, we got spanked, and we never... That�s what he keeps telling us. But it was true. I knew that if I did something wrong, I was going to get it bad. Well, kids today, you know, we don�t do that anymore, and I don�t know. So I didn�t do things wrong. (chuckles) He did, but...

THERAPIST: Well I... You did things wrong, Maggie.

MOTHER: The stories come out around the campfire.

THERAPIST: No doubt. Yeah, I, my parents, I don�t want to say never spanked me (but maybe a couple of times), but that isn�t why I did anything for my parents, especially when I got to be, you know, 14 or 15. My dad was always a tall, thin fellow and weighed like 130 pounds, most of, he was like six foot (chuckles/(inaudible). And got all the way up to 145 at one point! [00:57:24]

And so, I don�t know that I�d want to try to take him (he�s a pretty strong guy), but it didn�t ever occur to me that that was an issue. I just, I did respect him, but I didn�t ever think of it that way. It would never have occurred to me, to think I respected my dad. And I also, you know, you know how I was respectful to him? I was really careful to sneak around, sneakily, so that I would never get caught and embarrass him.

My dad was a United Methodist minister in town, so I went out of my way (father affirms) to be very, very careful. But I absolutely was in places I shouldn�t have been, doing what I shouldn�t be doing. And I got caught a couple of times and I was really (chuckles) embarrassed. I had compunction about that, but it didn�t make me not do those things. (father affirms)

MOTHER: It maybe, and dad taught and mom had a business and I had older sisters that were, you know, good in the community and that kind of stuff. And I knew that what I did would reflect badly upon my family. And I... In fact, I remember going to junior high, walking to junior high one day. A van pulled up beside of me and asked if I wanted marijuana. I said, �No, my dad teaches Health.� And I kept walking! I mean, that�s how I respect/stops/, that�s what it meant to me, that that would be an excuse to these drug people that, yeah. So I never wanted to disappoint my parents. [00:58:44]

THERAPIST: Well, I think you had more a sense of referent power with them because you, you had faith in their judgment. I think you must have, if you were that supportive of them, the way I was with my parents.

MOTHER: Oh, absolutely.

THERAPIST: So, I didn�t, you know... That was a little different. I think you were a little more anxious than I was, because I was not a very anxious person, but I was detail oriented enough, that I knew that I could be sure not to embarrass my parents. But I think Kevin, I don�t think Kevin is that far off the mark on that. I just think he is a more normal kid than you are familiar with. The point of adolescence (whether it�s your adolescence, yours, mine, or his), is to do teenager things and to differentiate from your family of origin, so that you are an independent person.

The purpose of being parents is to instil in kids what we think is the correct way to treat others, and to behave, and to get ahead in life, and all that. Those things have to be in conflict! They have to be, because you can�t differentiate from you, if you just agree with everything he does. I mean, I know people who let girlfriends sleep over and smoke weed with their kids! What�s that kid going to rebel against? They�re probably going do a bunch of coke and heroin or something, because there is nothing to push against. [01:00:00]

So you have to stand up for what you believe in, but you have to have two sets of expectations. One of them are your internal expectations and one are your external expectations. The internal expectations are going to be easier. The external ones can be, �This is what we expect you to do.� I don�t know, �Don�t have sex until you�re married,� or whatever. I don�t suggest you shoot for that one because it... right. (father chuckles) That�s my... exactly, Wes! (chuckles)

But, you know, shoot for like, �I hope that when you have sex, it�s with someone you love.� That�s a good one to shoot for. Well, internally (sighs) that may not happen. But you kind of know that, but you uphold a standard, you teach him a standard that you believe is important. You know, you can pick a ton of those, but inside, don�t take them personally. If he has sex with a girl and, you know, he�s not in love with her, don�t take it personally. If he�s, you tell him you need to be respectful of old people, which he seems like he would be...

FATHER: Very. [01:01:00]

THERAPIST: Yeah. But if, whatever! If you tell him, �I expect you to manage your temper appropriately.� But inside, know that�s hard for him and that you�re going to hold him to the standard, but you�re not going to feel hurt or personally affronted. I don�t know if that�s a word or not, but... personally upset by it if he doesn�t. That�s where I think you two struggle. I think you don�t take these things nearly as personally and I think you take them personally. I think you feel hurt that he�s doing these things. I actually don�t think Kevin means to hurt you. I think he means...

MOTHER: I don�t think I feel hurt. Angry, but...

THERAPIST: Well, you come with... but if I were to poll Kevin... What did you say? Angry? If I was to poll Kevin, I think he would say that you probably get angry, but I think he�d say you take it too personally. We could try it. He would say some teenageboy version of that. He�s pretty articulate. He might say it just that way.

MOTHER: Oh, he is very... And it would be fine with me if you ask him. I never looked at this as if I�m hurt, because that to me is a different total emotion than how I feel. [01:02:02]

THERAPIST: You used, let me say one word for what you said. You used the term �disappointed� earlier. Just the word, I mean you said it in the context of after he had done something and you already disappointed that he hadn�t gone, I think with Wes, if I remember it. That disappointment is the word of hurt. And I... Think of that, just think about it this week, because I think that�s what connects to you, that you feel kind of like a failure at this sometimes.

That is not in evidence, Maggie. (chuckles) There is no evidence that you�re failing. He�s actually a pretty polite kid, he comes in here and speaks, I think, pretty articulately. If you can keep him channeled somewhat, having a will is helpful in our society, to be willful. I think he could use a little more personal responsibility. Anyone want to argue that point? (chuckles) But that�s something you work to help him evolve. I have a whole book about that. I�ll let you get a copy of here next month, or next year, in which I talk a lot about responsibility. He probably would like...

FATHER: It�s not (inaudible). [01:03:07]

THERAPIST: Not, I just did a focus group on it, an ironically named focus group on Sunday. We have a lot of good input on it, and I�m doing my revisions now, so I�m hoping it will be out either March or April; and Kevin will like it! I think Kevin would probably read it. It�s at a level he would probably enjoy, even though it�s for adults. I normally figure 15 and up for that, but I think he would like it.

FATHER: (inaudible)

THERAPIST: Does he read much?

FATHER: No. Maybe he�d read it.

MOTHER: What did you say?

FATHER: Does he read much. No.

MOTHER: He hates it.

THERAPIST: He might like this one. He might say Jesus is about me.

FATHER: Um... is he going to come back in today?

THERAPIST: Well, we�re out of time! I was wishing to do so, but this became so interesting that we just kept going.

FATHER: I do think that he will be angry that you sent him out of the room... and may rebel about coming back next time.

THERAPIST: Oh, well okay. Go grab him real quick. That�s probably a good idea.

MOTHER: Well, how I think, I think, you know, on our ride home, I�ll just tell him it was more about me (chuckles), because it�s true. [01:04:07]

THERAPIST: Well, I think, I think Wes�s right. Grab him a second and let�s just make sure we�re all good, because what he thinks is, we�re all in here bashing him. And we�re not! (chuckles)

(pause)

FATHER: Hi! (pause) (door closing)

THERAPIST: Okay. So, hello Kevin! We... we�ve reached a peace. So, the next time that you need to defend yourself, could you perhaps tell the person, �You better meet me after school, boy!� Or you can use other language quietly, if no one hears you. And he says, �You gonna make me?� I don�t know what he says. You say, �I will, after school.� And he says, �Why don�t you do something now?� You say, �Because I don�t want to get suspended again. So you meet after school.�

And he goes, �Well, I have to ride the bus.� And you say, �Well, just miss it, because I�m going to be out there after school waiting for you.� Off school grounds, over there, far away. We believe he will not show up, but if you do that, then he will be in the down position and you and he can take care of business, where you don�t get in trouble the next time. [01:05:29]

This is what I�m trying to figure out, if you have to, if you�re going to have to use aggression to protect yourself, think first. I actually don�t think you realized this was going to get as hairy as it did. (Kevin affirms) So, now you know, in the future, because we think defending yourself is appropriate, but choose your place and time. That makes you the superior man in the situation. (Kevin agrees) Fair enough? (Kevin affirms) (pause) How long are you, when do you get to go back to school?

KEVIN: Um, 20...

MOTHER: Tuesday.

FATHER: And then they�re off Wednesday.

THERAPIST: Is there any chance... I know I�m pushing it here (chuckles), but is there a chance that you and he could shake hands and you just tell him... Naw, I knew I was pushing it.

KEVIN: No. No way.

THERAPIST: Okay. I didn�t want you to shake hands in a like pussy way (Kevin chuckles), I wanted you to shake hands in like a strong way like, �Are we square now?� Because I think he�ll say, �Yes,� because he ran down the hall crying. (Kevin chuckles) But if you were to be the bigger man and try that, you might have more power; but I am not there, so I do not know. I�m just saying what I think about it. (Kevin affirms) The person who reaches out is the stronger person, because that person is not afraid. Just something to think about. [01:07:01]

Okay, so did you have any closing questions? I will give you equal time next time, Kevin, since I booted you out. I will boot them out next time (Kevin affirms) and give you equal time. Is that fair? (Kevin affirms) Good.

FATHER: Thank you.

THERAPIST: (sighs) Fair enough. Did you get to talk to the pretty girl in the lobby? (Kevin chuckles)

KEVIN: No, I just sat there and drank water.

THERAPIST: Oh, okay. Well, then I will see you on Tuesday. Yeah, you can talk to the pretty girl. She�s very nice. She�s probably (inaudible) and looks a little old for you, but... (chuckles) All right, Sir!

KEVIN: See you!

THERAPIST: I�ll see you the next time! Take care.

FATHER: Thank you.

THERAPIST: Good luck with your... sheet rock skill. (father chuckles) One of the things you might want to watch out for is that normally I do really good work, but if you could feel it there, you�ll see a bad seam and you want to...

FATHER: You haven�t been in our house! There is not a good seam in there!

THERAPIST: Yeah. You want to use three knives. (Kevin chuckles) You use the narrow knife and the bigger knife and the bigger knife (inaudible) you can go with as little sanding as possible.

KEVIN: I�ll just put some caulking on it, I guess.

THERAPIST: No. (chuckles)

FATHER: Paint it white?

THERAPIST: Learn if you�re going to break things, you learn how to fix them. See you later! (all respond)

END TRANSCRIPT

Transcript of Audio File:

BEGIN TRANSCRIPT:

THERAPIST: I am going to have to get me a little tea or something.

FATHER: It was an exciting story.

THERAPIST: It looked very good.

MOTHER: I don't think we're finished with it.

THERAPIST: You're going to get a chance, because I've got to hit the rest room. I don't think I need tea, I have my drink over here. Man, these days are getting shorter.

MOTHER: Yes, they are.

FATHER: Yes they are, and colder.

MOTHER: Hi, kitty, kitty. Hi, kitty cat.

THERAPIST: I shall return. You're nice to everyone, Ruth.

FATHER: Yeah, that's Ruth.

MOTHER: Hi, there. [00:01:00]

FATHER: So, everybody keeps — people keep their guns in a locker on campus, because they only have 15 minutes that they can take their guns, go to the gun shop and shoot. They only open it up 15 minutes before their practice.

MOTHER: Okay, right.

FATHER: So, some of the kids didn't want to do that, so they went off campus and did the locker, so they could get their guns whenever they wanted to shoot.

MOTHER: Oh, gosh.

FATHER: But he was lucky enough, that he was able to get his. A friend knew about a locker that somebody had just graduated. That vault was open, but it was $80 a month, so he got another guy to split it with him, so they're paying $40 a month, which is well worth the peace of mind of knowing that —

MOTHER: Well, with that $17,000 gun or twenty, or whatever it is.

FATHER: And it broke again.

CLIENT: Did it really?

FATHER: Mm—hmm.

CLIENT: What happened?

FATHER: I don't know, but he was going to shoot and it broke the day before, and they wouldn't let him shoot it, so he couldn't enter.

MOTHER: He didn't have a backup gun?

FATHER: I don't think he does. [00:02:01]

CLIENT: At least a Browning or something, you know?

FATHER: I mean he gave us just story after story after story.

MOTHER: I'm enthralled by a story via, you know. That's funny, wow.

FATHER: He got there at one and left at four. You left at quarter of four because you had called — had to get — they don't close at four.

CLIENT: I know, I just found that out, but I remember mom telling me that.

FATHER: I was going to — I called him up and I said (inaudible) had already gotten the car, to run out there before it closed.

MOTHER: He's saying I told him that but I don't know anything about the drop zone. I don't even know it existed, so I'm not quite sure why.

CLIENT: I remember you telling me that.

MOTHER: Okay.

FATHER: Wig out. So he was there from one until quarter of four.

MOTHER: Wow.

FATHER: Which I really do enjoy talking to him.

CLIENT: We need to have them over for dinner. [00:03:03]

FATHER: I just didn't have time. They sent a very nice text about mom, and they were thinking of us over Thanksgiving, and hopefully things are okay.

MOTHER: That's very nice.

FATHER: Yeah. I guess he had a stepfather. No, we had a stepfather.

THERAPIST: I think I owe you some time.

CLIENT: I think it's okay, he can stay in.

THERAPIST: Well that's very gracious of you. I appreciate that. I was not expecting that, so I can roll, regardless.

CLIENT: It was a really good week, it wasn't bad at all, I don't think.

THERAPIST: Well, you beat me to it, that was the next thing I was going to ask you, is your account of how things had been going for you and for your folks.

FATHER: I think we both, you especially, explained to him what we talked about last week, or two weeks ago, on the way home, you guys had a good talk. [00:04:05]

THERAPIST: Oh yeah, you two did? What did you guys come up with? I should have sent the recorder home with you.

MOTHER: I don't know that we had — I just was trying to explain to him, what we were talking about when he was asked to leave, because I didn't want him to think we were talking about him.

THERAPIST: Which we were, but he doesn't know. I think that was a good way to handle it, so you handled it.

MOTHER: Yeah, yeah.

THERAPIST: Sometimes, we just have to have a more free flowing discussion and sometimes that's with the young person and sometimes it's with the folks. Maybe I like to hear what they're going to say before they're going to say it to you, or vice versa. Well, okay, so what's next on our agenda today?

MOTHER: He's doing — just to kind of catch up, you know he was suspended and did a very good job of doing his homework and stuff like that, and he's now out of the F range in all of your classes, right? [0:05:11.1]

CLIENT: I have one D.

THERAPIST: Maybe you should get suspended more often.

CLIENT: I really did like it when I was home by my — alone with myself.

MOTHER: He did really good.

FATHER: And she really did a great job of getting him on track. They turned in papers during the week and the teacher made the comment, "I don't think we've ever had anybody turn in anything during a suspension before."

THERAPIST: You know it's interesting, I can't remember how much of this we talked about, but what I was trying to figure out with you, how introverted and extroverted you are, and it's sort of interesting because you seem very extroverted. I defined that for you before I can't remember. All right, so extroverted people get like lots of energy from being with others and introverted people get a lot of energy being with themselves. We did talk about this, because we talked about you guys fishing.

CLIENT: Right.

THERAPIST: It's interesting, because you seem to be really reaching out to friends a lot, which makes sense at your age, but then as soon as you get a week to yourself, you become way more productive. [00:06:14]

CLIENT: I wasn't really caught up on what was going on. I still had some communication because I have my phone, and when I was done, I'd do the work all day, then I'd do the 80 minutes, and then I'd have my phone. I got some communication but I didn't know what was really going on in school and stuff but� I really don't know.

THERAPIST: Do you think you need less time with other people or your 80 minutes is the way to get the time blocked out for just you, or what? What did we learn about how you work best?

CLIENT: I don't have much — well, except phone and stuff. I don't have much communication or interaction with friends, but I've had — like my friend's birthday, we went to his birthday and we did paintball, and we had so much fun. [00:07:25]

THERAPIST: Did you go over in like caverns?

CLIENT: Yeah, yeah. That was so fun and I just asked my dad if we could stop by Drop Zone Paintball after this. My friend, he actually has a paintball gun too, so.

THERAPIST: Do you have to have the guns or do they rent them to you?

CLIENT: You can rent them. It was $137 for seven of us, so it came with —

THERAPIST: With guns that you brought?

CLIENT: Guns that we rented.

FATHER: It's less expensive to rent a gun while you're there, than it is to bring your own.

MOTHER: They charge you.

THERAPIST: Well, that's interesting.

FATHER: That's what I thought.

THERAPIST: Because my kid has been wanting to do this and I hadn't learned enough about it, so that's pretty good to hear.

MOTHER: They played for hours.

CLIENT: I did nine times. I went nine rounds and I never — the first round, I ran out of ammo, and then the rest of the rounds, I probably shot ten times.

THERAPIST: Because you become more precise?

CLIENT: Yeah. It was so fun though. [0:08:26.5]

THERAPIST: This seems to have a lesson to teach us. So, if you — what did you learn, that made you more efficient in your ammunition usage?

CLIENT: There was a lot of teamwork, I think. There was a lot of teamwork.

THERAPIST: So you guys learned to work together after the — like you and your mom?

CLIENT: Yeah.

THERAPIST: Oh my gosh.

CLIENT: Well, we didn't —

THERAPIST: I don't mean in paintball, I mean have you and your mom learned to work together this week a little better, and stop shooting each other.

CLIENT: Yeah.

THERAPIST: Oh my gosh, teamwork is the secret.

MOTHER: If I could back up.

THERAPIST: Sure.

MOTHER: I think he is a healthy mix of both introvert and extrovert, because when he's saying he's not around his friends much, the circumstances prevent that. I think if his friends were available after school, he'd probably be with them, but he's not doing any of the sports after school and his friends are, so that's the separation. But when he's — you know, he is very social, he loves to be around his friends, and when he's not there, you're on your phone or texting them. So he is, it's not like he's in his bedroom doing nothing, having no social contact, those are the issues, but when he fishes, he fishes by himself.

FATHER: Right. [00:09:47]

MOTHER: So I think there is a healthy mix.

FATHER: He goes up to his room usually at night, every night, and stays away from us.

MOTHER: But he's on the phone, so he is connected.

THERAPIST: And are you on — I'm not so much prying, as trying to understand sort of you and then this question of introversion, extroversion. Are you texting to the same people?

CLIENT: It's usually a lot of people.

THERAPIST: Like a group text or just back and forth, different?

CLIENT: No, it's just back and forth with different people. Sometimes I play my X—Box. I don't play my X—Box much anymore. And then sometimes I clean, work on my room and stuff. I rearranged my room the other day and it looks pretty good. You know the — on my wall?

THERAPIST: What did you rearrange it to become?

CLIENT: There's this one big wall on the side of my room. I used to have a bunk bed and now it's just a big, blank wall, so I put pictures. Like, my dad got this one picture of me shooting a pheasant and it was right on impact, so you can just see the bird exploding in the corner and me aiming it, and it's a really cool picture. So I have that on one side and then a picture of the seven and half pound bass that I caught two years ago. In the middle there's a rabbit skin and on the top there's an antler. [00:11:12]

THERAPIST: Wildlife has a time in your bedroom doesn't it?

CLIENT: Yeah. (chuckles)

THERAPIST: So you just changed the pictures around?

CLIENT: Yeah, I moved it from one wall to the other and it looks really good.

THERAPIST: Wait, Ruth really likes you, because she has a thing for boys. I've come to this realization that cats can tell gender, and I did not know this until having her in here, and she has a clear preference for boys, which is very disappointing to all the girls I see.

MOTHER: Yeah.

THERAPIST: You are the first person, and there's one other person, on whose lap she sat this week and it was another guy.

MOTHER: Huh? That's funny.

THERAPIST: It is. I never would have known, like you don't really expose animals to that many people, to get a sample of that, but she sure likes you. I don't think that you should take a picture shooting her though, I don't think she would like that very much.

FATHER: We may take her home.

THERAPIST: Well, she'd probably like that. I think she has become very much attached to this. I tried to take her home the other day and she was so angry, she tried to bite us and stuff. She did not want to leave. [00:12:20]

MOTHER: Oh, wow, huh.

THERAPIST: She was not happy.

FATHER: Does she stay in this room the whole time?

THERAPIST: She goes out in the lobby and stuff but overnight, she stays here. So, that's pretty interesting. I have a question, then. I think I asked you this a while back but I can't remember. Some of these people are girls you're texting?

CLIENT: Yeah, most of them are like my guy friends, talking about our weekend. I was talking about my weekend with all the guys that I went shooting with, and I've kind of gotten my friend into it. He didn't go to the paintball but we started talking and I've kind of gotten him into it, and we've kind of arranged a time this week, where we can do paintball in the lot next to our house.

THERAPIST: So you have a whole cadre of people now, that you can do paintball with.

CLIENT: Yeah. I mean, there was eight guys that went and it's really fun.

THERAPIST: So, how has your temper been this week? [00:13:20]

CLIENT: I haven't had much temper. It's mostly been with my sister and she gets on my nerves a lot, wouldn't you agree? She tries to get on my nerves and she does a really good job of it.

MOTHER: They both fuel the fire and neither of them will stop and back down first, so it's incessant needling of the other person. I'm begging one of them to step up and help the situation.

THERAPIST: How old is she?

MOTHER: Eight.

THERAPIST: Yeah. My daughter is 16. I always tell her she's really lucky that her ten year—old brother is not annoying at all, because I don't think she would tolerate annoying very much.

CLIENT: Yeah.

THERAPIST: And you think your sister is on a pretty high scale of annoying?

CLIENT: Yeah, it's way up there. On a scale of one to ten, it's probably a fifteen.

THERAPIST: What do you mean tried to address this?

CLIENT: There's really no point in trying to address it anymore, because I don't even remember what she does. Okay, so this morning, no yesterday morning, she was really crabby. She was arguing about how it's harder, that my mom was doing the easier part in tying her shoes, and all she had to do is get them on, and she was arguing with that. That's kind of what she does with me. Like, I was eating Lucky Charms for breakfast the other day and she says, "You're not supposed to be eating those, those are mine, mom bought them for me." And I was just like, "I can eat these," and I was already halfway through it. She got really mad. She started crying at one point and then� [00:15:29]

FATHER: Why was she mad?

CLIENT: Because I was eating Lucky Charms and she thought that it was hers, but she just picked them out.

FATHER: Is it also because we wouldn't let her have some?

CLIENT: Well, yeah, but that's —

THERAPIST: Because you or he wouldn't? I didn't quite hear what you said.

MOTHER: We don't want them to eat Lucky Charms for breakfast before school, but it's not a good brain food. And so I do Jessica's breakfast, so I make her something different, and then he came down and got his own breakfast, which was Lucky Charms. So that caused part of the problem.

CLIENT: There was no argument in it. She just, she had never told me before, and I had just kind of forgotten about the rule.

THERAPIST: So you're not against the anti—Lucky Charms crap food rule?

CLIENT: Well, I like it.

THERAPIST: No, I know, but you recognize the unwiseness of this?

CLIENT: Yeah.

THERAPIST: What is the purpose of Lucky Charms in your home? Is it like a dessert or something or what is it?

CLIENT: I'll just — if we have like a good cereal, like all we have is this protein, K—special, mom's diet crap that we eat. [00:16:32]

MOTHER: This horrible healthy stuff.

CLIENT: Yeah, the actual healthy stuff. I mean I'm 13, do you really think I'm trying to eat healthy?

THERAPIST: Well, yeah, and you're not a very big guy, so unfortunately, it makes it hard to argue that you need to lose any weight.

CLIENT: I was 121 at the beginning of the year, now I'm — is that right, around 121?

MOTHER: I think so.

CLIENT: Now I'm 142, I've weighed myself.

THERAPIST: Really?

CLIENT: Yeah.

THERAPIST: I need to mark that down.

CLIENT: I've been doing weights and that's really helped. I can really tell the difference.

THERAPIST: How tall are you?

CLIENT: I was about as tall as five—nine, so around five—nine and a half.

MOTHER: No. I'd say —

FATHER: I'm five—nine.

MOTHER: I'd say he's five—seven.

CLIENT: No, five—eight, despite the difference.

THERAPIST: You may end up being fairly tall. If he's already that height at 13, that's pretty good.

FATHER: Sunday wasn't good, though.

THERAPIST: What happened Sunday? [00:17:32]

FATHER: Sunday, he was great. We were with my parents the whole day and when, he's around them, fantastic.

THERAPIST: Oh, it was good, Sunday was, but then it went downhill.

FATHER: Then it went downhill when we got home.

MOTHER: He's really great when we're around other people, really, really, and there was no medication that day.

CLIENT: I can't remember what happened that day.

MOTHER: We were going swimming. You were going to go swimming and didn't think the patch would stick on, so we didn't do the patch on Sunday. But when he's around people he's wonderful.

THERAPIST: Speaking of which, I want to come right back to that, but you just reminded me of something. Are you guys doing a break over the Christmas holiday?

MOTHER: If that's what —

FATHER: You had mentioned it.

THERAPIST: Yeah, because he's just been on it a short time, but I would say that's probably an okay idea, but that makes me think I'm even more interested on what happened Sunday night, so just to see. So, no medicine Sunday. So then you got home and what happened? You tell me your version.

CLIENT: I really have no clue what happened.

THERAPIST: You don't remember what they're —

CLIENT: I just remember my sister getting mad at me. I can't even remember why she was getting mad. What happened? [00:18:41]

FATHER: I don't know, you were angry the rest of the evening.

CLIENT: I was?

FATHER: Yes.

THERAPIST: In like a quiet, frustrated way, or like banging the doors and wanting to —

FATHER: Not banging the doors but loud and angry.

MOTHER: Like mean and — and I can't even remember, actually.

THERAPIST: Gosh, three of you.

CLIENT: I don't think it was that serious was it?

MOTHER: Well�

FATHER: It wasn't fun.

MOTHER: It wasn't fun, but I can't remember anything specific.

THERAPIST: It was more of a feeling.

MOTHER: Well, he gets mean.

THERAPIST: Like short, like he says like give me that? What does it mean to be mean?

MOTHER: I told him on the way here, it's kind of a good thing that nothing is fresh in my mind.

CLIENT: I don't remember what happened at all.

FATHER: You were angry and I started working on chores, the list of chores.

MOTHER: Can you remember what he was doing? Because it was, you know we immediately got home and it immediately turned on. [00:19:48]

THERAPIST: See, I think that's what we've got to figure out, is what happened in the transition there. Like, did he need to have quiet time for a little while or something?

FATHER: I think we should have separated ourselves.

THERAPIST: I wonder, because that's a lot of time spent together. I know when I come home from anything like that, and I'll be interested in your — you can think for a minute, in how your day went before that, at the grandparents did you say? But I know whenever we do anything like that, when we get home, the very first thing Penny wants to do is be by herself, and we do kind of separate, because that's a little too much stimulus for her, but she's more introverted than you are. So, what was your day like at grandparents, what do you remember about it?

CLIENT: I remember it was pretty fun, I really liked it. We went swimming, we played water basketball a lot. Mom and I had a really good time. [00:20:50]

FATHER: We kind of celebrated our Thanksgiving with them.

CLIENT: Yeah, and dad and his parents went to work out. Grandma worked out a little bit in the weight room and then my grandpa, he slept.

THERAPIST: Where were you?

MOTHER: At the nursing home

THERAPIST: Okay, yeah, the nursing home.

CLIENT: And he fell asleep on the bench, right next to the pool, which is kind of funny, because he never woke up once and we were yelling and stuff. But mom and I were playing water basketball for a little bit and it was pretty fun.

FATHER: Then we went back into their place but I can't remember what we did there.

CLIENT: We sat and watched the Chiefs game. And then I remember — yeah.

MOTHER: There were aunts and uncles and cousins, and it was wonderful.

CLIENT: We all spent a lot of time together, I think, don't you?

MOTHER: Yeah.

THERAPIST: I just wonder if that's not it, because it doesn't — go ahead. [00:21:53]

CLIENT: At the end, I did have a really bad headache from swimming. Did I ever tell you about that? I came down and I got aspirin.

FATHER: Well you said, on the way home, we had a very quiet ride on the way home, you had a bad headache.

CLIENT: Oh, yeah.

FATHER: Then, but you and mom fell — or Jessica and mom fell asleep on the way home and you said something about that's the quietest ride home we've ever had.

THERAPIST: How did he say that?

FATHER: No, Maggie said that.

THERAPIST: Oh, Maggie said that they were asleep. I thought Maggie was asleep.

FATHER: Maggie was asleep and Jessica was asleep.

CLIENT: I was asleep. I fell asleep too.

FATHER: I was asleep but I was driving.

THERAPIST: Yeah, well, that road is so good, you know, you don't even need to be awake any more.

MOTHER: It is.

THERAPIST: So Kevin was awake and Kevin said that's the quietest trip, or Maggie?

FATHER: Maggie said that's the quietest.

THERAPIST: Maggie is the one, that she slept through it.

FATHER: I think you said, that's the quietest trip you've had on the drive home for a long time.

CLIENT: That was the only one, but I was asleep.

THERAPIST: What time did you go to bed then that evening, do you remember roughly?

CLIENT: I woke up coughing, because I didn't have my inhaler. I ran out because my asthma has been acting up. I wake up coughing a lot and my inhaler is completely out. So I went downstairs to get — I had a headache too, so I went downstairs to get some stuff and then I got ibuprofen and then I came back up and I fell asleep. I don't even remember when. I don't even remember that night, so. [00:23:30]

MOTHER: As far as separation, he usually is up in his room. He's very seldom down with the rest of us, so was he down with us for a little bit?

FATHER: Yeah.

THERAPIST: He must have been for a bit. My guess is that even when that's like a really positive social time, that's probably taxing you about as much as you can do, and there's some letdown from that eventually, just a little much.

MOTHER: That's interesting.

THERAPIST: That fact that you said, we probably should have separated ourselves, I think is probably a pretty good observation, that this may have been enough social time for him.

CLIENT: I remember that night on the couch, remember? When I was laying on the couch, Jessica was in the other chair and you were in the middle of the recliner, and you were sleeping. Do you remember that?

MOTHER: Oh, right, got it, okay.

CLIENT: I went over and I woke —

MOTHER: I opened the door.

CLIENT: Jessica and I were watching TV, my mom was asleep. I got up and I made my sister and I hot chocolate. I came over and I put marshmallows in hers, I put marshmallows in mine.

THERAPIST: That was very nice of you. [00:24:37]

CLIENT: Yeah. And I started drinking and then a marshmallow got stuck in my throat and I couldn't breathe at all and I started coughing. I tried to cough and then I started coughing really badly and marshmallow came out. And then my mom woke up and she —

THERAPIST: Which is probably under the circumstances, fortunate that it came out.

CLIENT: I couldn't breathe at all, I mean nothing was going in. That night, my grandma was choking pretty badly too. But, so I was coughing, I was coughing really loudly, and I usually cough like that but not that severely. My mom wakes up and she goes, "Can you be a little bit quieter?" And I was just like, "Mom, I was choking, I couldn't breathe at all," and she goes, "Well you still need to tone it down a little bit," or something like that.

THERAPIST: If you're going to die in the TV room, do it quietly. (laughs)

CLIENT: Yeah, that's pretty much what happened.

THERAPIST: That's not it.

CLIENT: And then, so there was another time where I couldn't find my inhaler and I could barely breathe. [00:25:44]

THERAPIST: This is all the same evening?

CLIENT: Yeah. There was another time I could barely breathe, I needed my inhaler. I was getting kind of short because I knew — I don't like feeling that way at all, but I couldn't find my inhaler. Dad went down and he looked, he was trying to help, and then there was very little air getting out at all, and my sister, she goes down and she started helping a little bit. She came back up and dad came up and he said that it wasn't down there and I was just like, I remember it's down there, and I was getting kind of short. He was handling it well, until the very end, and I said dad it's — I can't remember what I said but I was just like, there was a possibility that I could have died from an asthma attack, I could stop breathing and he goes, (sarcastic) "You could have died," like he kind of laughed at my comment, thinking that it isn't true, I mean that it wasn't possible, and that made me really angry. [00:26:54]

FATHER: We revisit this a little bit?

CLIENT: Well, what I said was a hundred percent true.

THERAPIST: Except, they get to have their reality too. I'm going to come back to yours in a second, I'm interested in —

FATHER: You did start coughing and you were coughing a bunch, and so you were looking for your inhaler, and so I went downstairs, looked around, came back up, and you said the comment that I wasn't down there long enough. I said I couldn't find it down there, "Well you didn't look very long." Do you remember that?

CLIENT: Yeah, but you looked for maybe two minutes.

FATHER: I went down and looked, thinking that it was probably up in your room, which I did find it underneath the clothes that were asked to be washed two weeks ago.

CLIENT: Well, you were in the dirty clothes and then�

FATHER: My reaction was more of, it wasn't to make him angry, it was an honest� You thought that was a low probability scenario. [00:27:57]

CLIENT: Yes.

MOTHER: Well, and also, and if I could back up. I did get — I must have been tired, the swimming must have worn me out or something.

CLIENT: We were all worn out.

MOTHER: I did get down and I was asleep in the chair. He has this asthma allergy cough and instead of trying to go (coughing), it's (coughing much louder) really loud. And it's not just the one time, because if there was a marshmallow stuck, there wouldn't have been any noise, you know that kind of stuff. So it was that loud, over the top, and all I said — and Jessica even vouched for me. All I said was, "Is there any way you could cough a little quieter?" And, "What? I'm choking on — I hate you!"

CLIENT: I didn't say I hate you.

MOTHER: You did, you did.

CLIENT: Why would I —

MOTHER: And that was the first that I had seen, or that was the first that night, of you being angry for what seemed like no reason.

CLIENT: I was choking. I wasn't coughing while I was choking. If you're coughing, you know in the movies, where you can tell that the air is coming out? They aren't choking, that's just�

MOTHER: If there's any noise or air or anything. [00:29:01]

CLIENT: But you were asleep when I was choking.

MOTHER: Okay, but my comment wasn't about your choking, it was about the loud, obnoxious cough.

CLIENT: After the marshmallow came out.

MOTHER: And just, is there any way you can tone down a cough, like (coughs) something like that. It's over the top cough. Go ahead.

CLIENT: You know when you're coughing, I know you've probably — but when you're choking, you have air, like pressure building up, and then when it comes out, it's really loud. You know what I'm talking about, like pressure would build up, you're wanting to push out more, and then I cough, the marshmallow comes flying out, and then that's when I start coughing. So, I mean how could I prevent from�?

MOTHER: Kevin, that particular time, there was a marshmallow, but every other time that you cough, for this asthma cough, it's this loud, over the top cough.

CLIENT: I can't help that.

MOTHER: And I'm just suggesting that maybe there's a way you can tone it down. I believe you're coughing for real, I believe there's a real intention, but I believe that there's kind of a coughing etiquette, where you can tone it down a little bit or muffle it or something, so it's not over the top loud. Like I said with Joe's sneezing, it's over the top, loud sneezing, she can control that, is all I was saying. [00:30:27]

CLIENT: But when I'm coughing like that, I'm not focusing on being quiet. I'm focusing on trying to breathe again. If you're — I'm not saying that I would die if I didn't cough like that.

THERAPIST: Volume is not your main concern.

CLIENT: Yeah, volume isn't my only intention. I'm not trying to be quiet. I'm trying to be able to breathe a little bit better.

FATHER: I think it was just bad timing throughout, with her being asleep. She's a restless sleeper, doesn't wake up well. He was noisy, coughing, very noisy, coughing.

THERAPIST: There's one other little tidbit in here that I think is worth noting, that you ran into with him a little bit, and that is that you have never gotten this question from me, because you probably may not wear a bra, but one of my questions for girls that have ADD, it's a great diagnostic, is do you know where your bras are? And they think that I am — I hope they don't think I'm a perv, but they at least think I'm a magical being because they're like, how do you know about that? Well, because they all hate wearing them so much and they'll zoom home and rip them down their sleeves and hurl it across the room, and it lands like on a doorknob or under the bed or something, so they're always strewn all over the place. They just don't like how it feels. In fact, I've got several — this is probably more information than teenage girls want me to know, but I've several, if any time everyone is gone from the house, they just take off all their clothes. They just don't like the feeling, it's uncomfortable, and scratchy tags and things like that, and all that stuff, they hate that. [00:32:15]

FATHER: I think you're hitting a homerun here.

THERAPIST: Do you know someone like this? (laughs)

FATHER: A little bit. They can't get it off fast enough.

THERAPIST: Yes, so you understand.

MOTHER: Immensely.

CLIENT: I don't even want to talk about this, is what I say.

FATHER: Well it's, "Mom, put on a bra!"

CLIENT: It's gross, at least a cloth or something.

MOTHER: I cover up.

CLIENT: Yeah, in a skin—tight shirt.

MOTHER: Oh, no I — okay, let's move on.

THERAPIST: That's funny. That's actually in my book, so I didn't just make this up for you.

MOTHER: Oh, no. It's like you have a camera in my —

CLIENT: She has a severe case of ADD.

THERAPIST: One wonders. So with you, and what you guys are going to have to watch out for him, and see if I'm right about this, is I think when he's uncomfortable, then it just is intolerable. So, he's like thinking about the —

FATHER: It is.

THERAPIST: Yeah. He's thinking about the inhaler and it isn't rational in that moment for him to say, well thanks for looking dad, that was such a nice thing. Even Jessica was looking for you, that was very nice. [00:33:26]

FATHER: And he was irritated that I didn't look long enough.

THERAPIST: Right. That's his discomfort overwhelming him.

FATHER: That makes sense, that makes a lot of sense.

THERAPIST: And in that particular example, it's such an acute example, like I'm sure we could come up with some that aren't quite that immediate, but that one is about as bad as it gets. You're sitting there coughing and stuff's coming out, and you can't get it out or you feel that dryness or whatever it is. And this is why, I'll warn you about two or three other things and you tell me what you think. ADD people have just like no pain tolerance at all, and I am sure this is true because I've talked to so many of them, pain is tricky. When somebody says to you, you know, is it a six, is it a seven, you know how do you — it's all subjective. You have never been anybody else, so you don't know if it was a five for that person. Well, the ADD people have like a ten, it's unbearable, and they will request more pain medicine, I think, than other people, in my experience, and it's not because they're drug seeking but because they can't stand the discomfort.

FATHER: And it's probably a lot mental. [00:34:32]

THERAPIST: Absolutely, because the ability — you're exactly right. The ability to suppress pain is really a focus process. It's the ability to focus yourself elsewhere. And they will focus on their bra and the scratchy tag and the noises, some of them are noise freaks. I'm like nailing you today. Aren't you glad we didn't kick you out?

MOTHER: Why don't you step out, I'm going to talk to him.

FATHER: I think we're both leaving, Kevin.

THERAPIST: Kevin was right, that you should stay in here.

MOTHER: Oh, man.

THERAPIST: Like the chewing as a comment.

CLIENT: Yes. Oh my God.

THERAPIST: Yeah.

MOTHER: You have a camera in our house don't you?

FATHER: A ticking clock.

THERAPIST: I've done this for 21 years.

CLIENT: Oh my God.

FATHER: A ticking clock.

MOTHER: There's something wrong with me obviously, I'm not just weird.

THERAPIST: No, it's — yeah. It's probably true because maybe one of the problems with you and Kevin, that you two have a hard time, because I'll tell you, since we're on the topic, I'll tell you what I call the thing we hate about the ADD people, and the thing we hate about the ADD people, as you are probably aware, is that they have infinite tolerance for their own chaos and none for anybody else's. And this is where these two get into trouble, because the example of you going downstairs and looking for the inhaler, you know, he's in his chaos and it's like —

FATHER: More extreme. [00:36:04]

THERAPIST: Yeah. He's having this and you having your problem, not looking or whatever, no tolerance for that, but he can cough as loud as he wants to and he can blow phlegm out on the couch or whatever awful thing is happening, and I think when these two get together, it's just sort of competing frustration and having to learn, which you guys have done a lot better at, learn to have empathy for the other person's chaos, which means even though you're a 13 year—old boy, you have to sort of begin to think oh, this is probably like really hard for mom, this thing that's happening right now. And you have to think this is kind of part of why he can't pull himself together right now or he's having trouble tolerating something that hurts or whatever. I think that is probably where you two butt heads quite a bit.

CLIENT: Like, in the coughing and the choking situation, it was literally a life or death situation. If I didn't get that out, I could have died, and she was worried about me coughing too loudly. So, if there's life or death on my mind, I'm not going to worry about volume, I'm just going to worry about getting the thing out. And like you said with the intolerance about pain, you know? It sounds like I'm bragging here, but like today in dodge ball, I was jumping up to dodge a ball, and we have really bad balls, and it curved up and it hit me right in the chest, and it kind of knocked me back a little bit while I was in midair and my legs were up in the air and my arms were up in the air, and I landed right on my butt, like I mean right on my tailbone. I stood up, I started laughing, and I started yelling, and I just ran back and I got right back into the game. I honestly think that I have a really good pain tolerance, you know? Like after I crashed the four—wheeler, I just stood back up and looked around, saw what happened, laid back down and then got up, and I got back on the four—wheeler and then I just took back off. [00:38:25]

THERAPIST: There's also a social influence factor there too, because if you're in a game and stuff, it's (A) easy to get distracted on the game and get back in it, and (B) people are watching, and so you sort of were able to pull yourself together and compensate. What are you like when you're sick? Are you like a giant whiner?

CLIENT: Not really. I just sit there. I don't get sick that much, I mean I get sick sometimes but not much. I have an intolerance about feeling like crap, and I just know that I could feel better and I know what it's like to feel better, and I don't like the feeling at all. I'm pretty sure nobody does.

THERAPIST: Do you feel impatient about it or�?

CLIENT: This is going to sound really weird, but when I was sick, I would sleep in the bathroom. Do you remember that dad? I slept in the bathroom, next to the toilet.

THERAPIST: So you could get to the toilet?

CLIENT: Yeah.

THERAPIST: (laughs) I feel you.

CLIENT: And so after I threw up, I'd feel a lot better. Then I'd feel worse and all I wanted to do is throw up, you know, so I'd go over and I'd try to make myself throw up but it wouldn't work. That was kind of my intolerance about — but I mean, that's not a very good example.

MOTHER: He's not a baby at all when he's sick. [00:39:40]

FATHER: He's not bad when he's sick. I know where you're going. I think things irritate him more when he's sick, because he's dealing with that. He's a little shorter.

THERAPIST: Growing up, I didn't — your pain tolerance has gotten much higher as you've grown up.

CLIENT: I can definitely tell.

THERAPIST: Do you think there would be a difference? Not that I really want to do this to you, but I think it would be interesting. If you had to lay in the ER and have just sort of pain continuing, like how that would be different than being able to get up and run back into the game. I think that would get really irritating for you.

FATHER: And of course, he doesn't have anything else to concentrate on.

THERAPIST: Exactly, there's not a distraction. You did say something a second ago, Kevin, you're right. It isn't that other people don't hate bras and scratchy tags and pain and being sick and throwing up. Everybody does. It's the amount of ability you have to suppress the upset about it, the rest of us. Like being bored, I don't think you tolerate boredom as well as everybody. [00:40:48]

CLIENT: Like if I, if I'm sick, I want to be doing something. I'd rather be doing — which sounds weird, not many 13 year—olds like doing this, but I'd rather be mowing, doing yard work, doing leaves, burning leaves.

THERAPIST: You're pretty restless. You're the 13 year—old boy version of hyperactive. Not like you are running around all the time, but there's the sense of restlessness, that you always like to be moving. That's how the 13 year—old boys differ. That thing, when he was painting the wheels, and out mowing and all that, that's exactly what that is, that's restlessness.

FATHER: But yet, he can go up in his room for hours, but I guess he's mentally doing stuff, he's doing the phone.

THERAPIST: I think he's doing stuff.

CLIENT: Because it's dark outside.

THERAPIST: I don't think Kevin —

FATHER: In the summer, —

THERAPIST: Kevin, have you ever been to a beach?

CLIENT: Mm—hmm.

THERAPIST: What did you do?

CLIENT: Swam.

THERAPIST: You never sat in the chair, that's right.

CLIENT: Yeah, I never just sat down. Like even, everybody else would be in the hotel, in the apartment thing, and I'd be out fishing. [00:41:54]

FATHER: Well, here's a great example. We're all sitting there watching a basketball game Saturday or Friday or Sunday.

CLIENT: Oh, yeah.

FATHER: He went out on the four—wheeler the whole time.

CLIENT: I was out.

FATHER: He was outside the whole time.

CLIENT: Yeah, I was probably outside for about five hours that day.

THERAPIST: And again, that's not too unusual in this age group, but I think it is — that's what's always calling your name. That's called, I always want to be where I'm not. I think you like to keep moving and doing stuff.

CLIENT: Like if I'm tired, I can just sit down and watch TV, but it's not very entertaining. I'll be really active and then I'll sit down. I used to play X—Box a lot and I don't know why I played it so much, but it was in the summer, I'd sit in my room and I'd play X—Box for two or three hours. And then just one day, I kind of just snapped and I haven't — I've probably played X—Box three times this month, probably total, and I've probably played it maybe an hour. [00:43:13]

THERAPIST: You're a little unusual in that regard, because ADD, TV and videogames go together like two horses and a carriage, and it's just interesting to me. I'm fine, if you don't want to do a bunch of videogames, because it isn't very productive, but that's one of those things that's all give and no take, and your special power is being more investigative than that, like trying different things. That's kind of a throwback to an earlier era, of what it is to be a teenage boy, so I think you should stick with that. You should buy a bunch of crap like at an auction and tear it up. Have you ever thought about doing that, like old motors and stuff.

FATHER: Well, he's been doing that with the mower; taking it apart.

THERAPIST: You need more stuff to tear up. You should go to an auction and buy a couple of things and just tear them up and then throw it away or whatever. That's what you need, to be investigating things and figuring out how they work. Don't electrocute yourself or anything. Believe me, I speak of this from experience. [00:44:19]

CLIENT: When I'm playing videogames, I know I'm capable of the things that I play. I don't play like sci—fi games, I'll play like Call of Duty, Black Ops and stuff. I used to play Mind Craft a lot, and I know that I can go out and I can build stuff just like they do in the game, and then I can — like paintball, the reason I enjoyed paintball so much is because it was a lot like Call of Duty, you know? You were shooting at other teammates, you were doing maneuvers.

FATHER: Stimulus.

CLIENT: Yeah. There is so much concentration involved and there's so much communication, just like in the videogame, but the reason I don't play as much is because I know I'm capable of all the things outside, instead of just in this little box. I know I can go out and shoot guns. I know I can't shoot them at people.

THERAPIST: Well, I'm glad to hear that. I can mark that one down on my form here.

CLIENT: But I know I can go out and I could do paintball, that's why I love paintball so much.

THERAPIST: Because you get to shoot your friends or because it's adventurous? [00:45:28]

CLIENT: It's adventurous, there's a lot of communication and a lot of teamwork, and you can shoot your friends.

THERAPIST: What more could one ask for?

CLIENT: I know.

THERAPIST: Yeah, that's pretty good.

CLIENT: And when you get shot, it's just like ow, that hurt, haha, let's do it again.

MOTHER: He came back with welts.

THERAPIST: Yeah, you get beat up a little bit.

CLIENT: Yeah, it was —

THERAPIST: Paintball actually plays into the climax of a novel that I am finishing.

CLIENT: Really?

THERAPIST: Yeah.

FATHER: How many books are you working on?

THERAPIST: Oh, more than I can keep track of.

FATHER: All at the same time?

THERAPIST: Well, the novels are both done and just need to be edited heavily and reworked a little bit, that's how novels are. But I had to actually write this ADD book because there's so much demand for it and my platform, my media platform.

FATHER: Your audience.

THERAPIST: Yeah, is just really wanting that, and so I had to go back and write that and put off novels. But that's how I had to learn about paintball, was exactly for that reason. I needed to have that happen. All right, Mr. Kevin, this is really good. What are our goals for the next couple of weeks? [00:46:42]

CLIENT: Keep an inhaler with me all the time.

THERAPIST: That's a good one. Self—management with your inhaler, I like that.

CLIENT: Not be so short, I think that's the biggest thing.

THERAPIST: Think a little bit about mom and how she's feeling disorganized. Think, I know how that feels. I think what they ought to do is see if they can� how do I want to frame this? Like, recognize your weak moments and not choose those to have a profound discussion. Now, I realize that isn't what you did, Maggie, you didn't jump out of bed and think, this is the time that I've been waiting for, to talk about coughing. So, that wasn't planned.

MOTHER: Yeah, there was no warning sign associated with that obviously, I was asleep.

THERAPIST: But I think if you guys can — and I'm going to expect more out of them than you, but if you can do what I'm about to say, there's a slice of cheesecake in it for you eventually, or some sort of dessert, because it's harder for you, at your age. One of the things we've done is really learn to read not only the medication flow of the day, which for him, it's a little better, but also just sort of the ebbs and flows. Like coming home after school, depending on the point in the semester, but when medicine is toward the end of its cycle, they're in much better moods, but when it's really where it belongs, they're just not in very good moods. They are like Kevin after the long day of swimming and talking and being with people and doing all that stuff. My kids are done with having to think and having to interact with people, and so if I want to talk about, on the way home from school, oh you know, how did choir go today, I'm going to get one or two responses; I don't want to talk about it or it was horrible, the girls didn't sing and they're so annoying and just, I hate them, I hate them all. Well, okay, so I'm just going to get what I bargained for. And so if we head down any of those paths, I'm usually like, good time for quiet time. My kids have learned to self—disclose that, so they'll be just like, I don't want to talk about it, I just want to read. And then that's the time to shut up, that's the time to really think, they're communicating with me. Even if it's a little harsh, they're really saying to me, we need to be down. The place it gets dicey, which I am sure is true with you and Jessica, is not infrequently, one of them is interested in talking, particularly Evan, my son, and he always wants to do one of our stories together, where we tell a story to each other, and that, Penny is so sick of that. Even if it's a new story we make up together, she just hates it. This morning she was like, she told us this is the week before their concert and the whole week, we can't tell stories to each other because it will distract her and upset her too much. I seriously was like, I just want you to walk to school, but I just shut up. I thought, she's trying to tell me a way to interact with her and it's probably better just to roll with it. So, see if you can sort of observe some of those, see if you can be — I don't want you to learn to communicate with them like Penny does with me, try to do better than that, but the more you can sort of read, when is his weak spot, how do I find a better time to interact. These are the same tools. This isn't sort of like catering to him. It's exactly the same tools we teach couples on how to interact with each other, how to pick a time to talk about a conflictual subject, how to do what we call soft start, which is to say listen, there's something I want to talk to you about, is this a good time? It has to do with the dishwasher, you know couples fight about the credit cards, and try to start it up in really a very intentional calm fashion. That would be good things for you to work on this next week. I think you guys get an A—plus. Way to go. [00:51:16]

FATHER: I need to understand what he's feeling more in my reactions.

THERAPIST: Yeah.

FATHER: I need to put myself in his shoes.

THERAPIST: You may be setting an awful high standard in terms of understanding. You may just have to be a good observer and accept that maybe the most realistic� I never understand what's up with Penny half the time. I just like learn to roll with it and push her when I need to and back off when I don't, and I don't get that right all the time. It's so peculiar sometimes, I don't know what we're talking about, but that's a good way to gain. Okay, do we have one on?

MOTHER: I think we have one more left, that's already scheduled.

FATHER: But we can schedule past that.

MOTHER: Can I ask you something?

THERAPIST: Two weeks at four—thirty? Good. [00:52:18]

MOTHER: Not to talk about it during this session, but one of my concerns is the cell phone, and we don't do a good job of monitoring what's going on and that kind of stuff. We had a really great understanding, after our last session or whatever, and I said we were going to put — we discussed about putting an app on his phone, so I would be able to access the texts and pictures.

FATHER: Turn it off at a certain time.

MOTHER: Turn it off. The app that I found that I loved and I want it, and he would know about it, that it was on his phone, is called Phone Sheriff. I don't know if you've heard about it.

THERAPIST: I don't know that one but I can imagine it works.

MOTHER: Well, the problem with it is that we have iPhones, and so I'd have to jailbreak the phone, and I'm not real comfortable doing that. So I was wondering if you knew — I know you had Mobicip or whatever, but I want more, not necessarily the Internet. I'm more concerned with what might be going on in the conversations, that he seems very private. [00:53:19]

THERAPIST: All right, this is worthy of an entire session of discussion, and I think everybody needs to be in on it, because I have plenty to say about it.

MOTHER: And I agree. I'm sorry, I interrupted you.

THERAPIST: Well, my — do you have my parent routine books, did we get you those?

MOTHER: No.

THERAPIST: I think we have one teen book and several parent books left, and you might have Carrie sell you a couple of those, because I talk some about that in there and ironically, those books are only two years old and I think some of that information is getting dated. You know how that is. So, let's talk about that explicitly next time, and try and not have any crises between now and then, so we can have a really intelligent conversation of your phone, because the more you don't have crises, the more intelligent our conversations become. Have you noticed how that works? Like, I haven't threatened you once this week, have you noticed that, isn't it great? So that really helps, because it elevates the discussion to be about things that are going to be really relevant to you. That's why I was asking you about girls, because that's going to be a big issue as you're moving through middle school, and nowhere will that become more relevant than in the use of your electronic devices. Love, sex and electronics all go together like this right now, like a tight little band. It makes breaking up harder, there's all sorts of methods of transmitting your various private parts around the Internet, there's just a ton of stuff. So let's put that on our agenda and talk through it. I know we talked some about it a week or two ago.

MOTHER: Yeah. [00:55:03]

THERAPIST: Let's just discuss.

MOTHER: You don't know of an app, by any chance, that I haven't located, that could go on a phone that would do that, have that access?

THERAPIST: Let's have the ethics discussion before we —

MOTHER: Okay, okay.

THERAPIST: Because there's a number of ways to do that and I don't think the ways I would do it have to jailbreak the phone. I agree, because that violates your line.

MOTHER: Right.

FATHER: I talked to somebody about that today and their phone crashed.

MOTHER: Oh, really? Well, that would solve a lot of our problems.

THERAPIST: Do you want to plug one in for right after the 1st of the year?

MOTHER: Sure.

THERAPIST: Because we've got the one in two weeks. When are you back in school, Kevin?

CLIENT: I have no clue.

MOTHER: That's on a whole different barometer.

THERAPIST: Well, my kids are out the 2nd and 3rd, so I have to be off, but I could do anything after four—thirty on the 2nd, or three—thirty on the 3rd.

FATHER: The 2nd is a�? [00:56:04]

THERAPIST: Thursday.

MOTHER: So, is Wednesday, are you back on the 1st?

THERAPIST: Wednesday is the 1st.

MOTHER: Do you want to just, the next week, is that okay, or do you want it sooner than that?

THERAPIST: Okay, so two weeks from today we have the four—thirty and then oh, I'm off a week. Well, wait a minute now, yeah. Then two weeks after that would be the 2nd or 3rd, because the 1st is New Year's Day.

MOTHER: But you are not here on the 2nd and 3rd?

THERAPIST: Yeah, I am, I can do the 2nd or 3rd, afternoon, evenings. I'm gone during the day, even though I think he's out of school, because my kids are out of school.

MOTHER: Should we just keep like a Wednesday at four—thirty?

FATHER: Let's do Thursday that week.

THERAPIST: No, no.

MOTHER: Wednesday is the 1st.

FATHER: Let's do Thursday that week and then we'll go back to Wednesdays two weeks after that.

THERAPIST: That will be fine. So do you want to do like four—thirty?

FATHER: Yes.

THERAPIST: Okay, gotcha. You're a decisive man, that's what we like. [00:57:09]

MOTHER: He has to be, because I'm not.

FATHER: I'm going to start being more assertive, is that all right with you?

MOTHER: I'm sorry, I borrowed some of your paper, I came unprepared.

FATHER: Assert yourself with wisdom and all will be good.

END TRANSCRIPT

Transcript of Audio File:

BEGIN TRANSCRIPT:

�[00:05:10]

THERAPIST: So, has Ruth kept you entertained out here? Come on back. I assume she'll come too. She got locked out today, in the lobby, and was very upset.

MOTHER: Oh, really?

THERAPIST: She knows better.

FATHER: Julie doesn't even know if that's a soundproof door.

THERAPIST: It's an exterior door, so the seal is around the outside, so you can kind of hear the radio, also helps with that.

MOTHER: But the seal around the door helps with soundproofing?

THERAPIST: That's the main reason. You guys were debating that you made sure?

MOTHER: I wasn't — I'm taking his money too.

THERAPIST: What was your bet, Kevin?

CLIENT: I thought it was just, you got a bigger door or you got a smaller door, and you were going to build a space.

THERAPIST: Totally beat you in engineering today didn't she? [00:06:14]

MOTHER: Go to woodshop.

THERAPIST: This one and the other one are exterior doors and over the years, I have learned how difficult it is to create a soundproof seal around a door, and I decided, when I remodeled this office, I was going to try exterior doors, because they do that for weather stripping. And as you can hear, you can't hear the radio at all anymore.

MOTHER: Yeah, right.

THERAPIST: If you're really loud in here and a person puts their head right up against the door, you can hear, but it sure is better than the usual.

MOTHER: Oh, so next time, I'll bring those little cups and while we're out there, we'll just�

THERAPIST: And I'll have Ruth bite you. That's her other job, is to get the eavesdroppers. Yeah, between that and the sound, actually this wall is a little better. I debated, when we put the walls around theoffice, whether I should pack them with insulation, and if I had it to do over again, I would. The other thing you can do is put that fiberboard behind the sheetrock, and it probably would have done that, but I thought I got away with it. [00:07:25]

FATHER: We can't hear.

MOTHER: And we've tried.

THERAPIST: It's been the least sound problems I've ever had in an office.

MOTHER: Good.

THERAPIST: It's nice when you can design things the way you want them. Well, Mr. Kevin, it's been — oh, whoops, this isn't your chart. I'm like, why did I start writing notes on you, that doesn't make sense. How are we doing?

CLIENT: I had a pretty good week, except our dog died.

THERAPIST: Gracious.

CLIENT: But everything else. I kind of got mad because of the situation. That was my only really bad time that we had, which was this morning, because he died two nights ago.

THERAPIST: Did you have to euthanize him or did he die of�?

CLIENT: No. We were doing exploratory surgery. I don't really know the whole story, but he just didn't make it through the night.

THERAPIST: How old was he?

CLIENT: Nine, is that right?

FATHER: He'd swallowed a sock. [00:08:26]

THERAPIST: Oh, dear. And it got caught in the intestines?

FATHER: Between the stomach and the intestine, the entry into the intestine, so he couldn't — he wouldn't eat, he lost 20 pounds.

THERAPIST: So he was around much of your life.

MOTHER: I think you were five when we got him.

THERAPIST: Yeah, that's hard. Let's see, my son is ten, so about five years ago or so, I had a cat that we had for 22 years.

MOTHER: Wow.

CLIENT: Oh, wow.

THERAPIST: We got the cat — yeah — when we were married, and that was our first try at — and boy, that was really difficult. I had to euthanize her finally. My wife kept telling me you're a bad pet owner, because I kept the cat alive, and the cat was getting more feeble. [00:09:28]

MOTHER: It's hard though. Even if it's the right thing, it's hard.

THERAPIST: Yeah, it is. Did they know it was pretty risky going into the surgery?

CLIENT: Yeah.

MOTHER: Yeah, they did. He had been sick for a while, he had done it before, but we think he threw it up at that point.

THERAPIST: He'd eaten socks before?

MOTHER: Well just the month before.

THERAPIST: Oh, just recently, okay.

MOTHER: There was something that was going on, that he was starting to eat things. He never had done that before. So, it just, it took us too long to make the decision to have the surgery. We were hoping it would work itself out again and it took us too long to make a decision.

THERAPIST: Well that is very sad, Kevin. Was it a hunting dog or was it an indoor dog?

CLIENT: No, it was a German Shepherd.

THERAPIST: So it was a pretty good pet for you.

CLIENT: Yeah.

THERAPIST: Well, I'm sorry about that. It's a tough time. So, when you had your — you didn't have your breakdown right off the bat?

CLIENT: Well, I kind of did. I just went and asked my mom if she could take me out to the lake and I just sat out there.

MOTHER: The timing was, he died not last night, the night before, so during the night. Kevin didn't find out about it until after school yesterday, so it's fresh. [00:10:39]

THERAPIST: Oh, so that's why the delayed reaction.

CLIENT: Yeah.

MOTHER: It's fresh.

THERAPIST: Okay, I understand.

MOTHER: He had some alone time and that kind of stuff last night and didn't eat, you know did that whole thing last night, and then woke up this morning and didn't want to go to school.

THERAPIST: So you went out and had your lake reflection time, but then you got up this morning and were just feeling pretty bad.

CLIENT: Yeah, still the same pretty much.

THERAPIST: But took it out on us.

MOTHER: We were working with him. We were not being — he didn't need to get to school, but we were working with him, but he became angry.

CLIENT: Yeah, I just kind of wanted to be left alone and they kept bugging me I guess.

MOTHER: He admitted that he was wrong, which was very —

THERAPIST: You didn't do any property damage this time?

CLIENT: No. I was just angry.

THERAPIST: How did you express your anger?

CLIENT: I just laid down the whole time.

MOTHER: To us?

CLIENT: Oh, I just yelled, that was it. Not like — [00:11:43]

THERAPIST: Like leave me alone and stuff?

CLIENT: Yeah, stuff like that.

THERAPIST: Did you eventually make it to school?

CLIENT: No, I stayed home all day.

THERAPIST: What did you do?

CLIENT: I just laid in my room or I went downstairs and I watched TV for a little bit.

THERAPIST: Wasn't that kind of depressing?

CLIENT: Mm—hmm.

THERAPIST: Okay, so I'm just going to give you a little advice about this, because this isn't the first dead creature you're going to have to deal with, with me. These people are going to die eventually and maybe you have a friend die someday, and I promise you, there will be more pets dying. And so you do want to — I think that thing, where you went out and sat at the lake and all that stuff, that was great, I'm with you on that. And even being angry isn't unusual in these situations, especially at your age, where you're kind of learning and growing, but the more you lay around and think about things during the day, the more depressed you're going to get. It's okay, you're going to have that happen periodically because the dog was close to you and it's going to come back to you periodically in the next few days, and if your main coping is to sit around and get depressed, you're going to have a longer recovery time. So, take the time to be sad, but then you kind of have to push out and get going. You do have school tomorrow, right?

CLIENT: Yeah. [00:13:09]

THERAPIST: One more day before — or do you have two more days before?

CLIENT: We have two more days.

THERAPIST: Does that make sense, do you get my point about that?

CLIENT: Yeah.

THERAPIST: I don't want to diminish the seriousness of it, but you're making it a little worse if you just were —

CLIENT: Mm—hmm. And this was the first dog that I've had die, that I can really remember vaguely, because we had his bird dog and then our black lab that died. I just remember burying his dog, Ellie, but I don't remember burying Sam.

THERAPIST: Were you as close to those dogs as this one? This sounds like it was —

CLIENT: No, not very.

THERAPIST: — a much closer relationship.

MOTHER: He was young.

CLIENT: I was really young.

THERAPIST: Well this is how we learn. That's the reason I was kind of giving you that bit of advice, because any time you have a tragedy or crisis in life, you want to try and let it teach you something, so you can deal with the next one. I don't even know — I don't even think not going to school was a bad thing. It's just the moping tends to make one feel worse. [00:14:15]

CLIENT: Yeah. And another thing that made me kind of mad, because I saw him as family, no doubt.

THERAPIST: Sure.

CLIENT: The school said that I still had to go to school, because —

THERAPIST: Who said this?

CLIENT: The school. He said that the SRS would get involved if I didn't go to school.

THERAPIST: Whoa.

MOTHER: For an excused — we've gone through this. For an excused absence, it needs to be a family member, so a dog wouldn't qualify as that family member.

CLIENT: Yeah, that's what kind of made me mad.

MOTHER: But if you were unexcused, then you have enough of those, then SRS gets involved.

THERAPIST: Do you have any excused absences? With whom did you speak about this?

CLIENT: I didn't talk to anybody about it. I just talked about it with my mom.

MOTHER: I called the school this morning and it just doesn't fall under that spectrum.

THERAPIST: Except that you actually can excuse him for any reason.

MOTHER: Here's the problem though, with that. In and of itself, and I was telling Kevin this. In and of itself, I get it, because it does — you know, fresh, every time something comes up it hits you, you know I get that. However, he's had eight absences this semester already. [00:15:29]

CLIENT: But five of those were for being suspended, and I still did schoolwork at the house all day, during school hours. So technically, I've only had three absences.

THERAPIST: And that includes this one or prior to this one?

CLIENT: Yeah, prior to.

MOTHER: I think two classes, he has eight absences prior to this one, and then all the others were seven. I think he just missed — so this will be the eighth and ninth, right?

CLIENT: Yeah. Some, I've gone home at the end of the day, because I don't feel good at all. Somewhere, like our lunch line, usually we used to come in and we all just used to jump right into the lunch line, and everybody got through within five minutes. Now they excuse us by tables and it takes about 20 minutes, and we have about 30 minutes to eat. Usually, we're the last tables to be excused for some reason. It's not about how loud you are, it's just by choice.

THERAPIST: I know you're headed somewhere with this. [00:16:35]

CLIENT: Yeah. And so you have to eat really fast.

THERAPIST: And then that makes you not feel good?

CLIENT: Yeah, I don't know why.

THERAPIST: Yeah, Kevin buddy, one of the ten problems or twenty, the ADD people have, is you all just cannot stand to be uncomfortable, just like we were talking about with our fabulous bra discussion last time. I deal with this all the time with my kids, so it's not like it's unusual to me, but you've really got to try and fight through some situations. I think your need to stay home for the dog is a better reason than your tummy hurts because you ate too fast. The problem is, if you start going home for everything, then nobody takes you seriously when it's something serious like your dog dying and you feel really bad. Do you know what I'm saying? So, figure out where you're going to fight through on the hard days and then when you really need a mental health break, great. I agree with you, the suspension of five days is a different matter.

CLIENT: That was just the one time. [00:17:44]

THERAPIST: So she just advised you, like did she say okay Kevin, you just have to know this, you mom? Was she just saying, you need to be aware that if these are unexcused, eventually you could get a truancy?

CLIENT: Well, I know this one girl, it felt like she missed half the year. She was probably gone two out of five days, two out of the whole week the whole time.

THERAPIST: Ruth likes to play her musical instrument over there.

MOTHER: That's cute.

THERAPIST: Okay, so you figure you'll be okay or what?

CLIENT: I think I'll be okay, because I was suspended for more days than I have missed class.

THERAPIST: So, but when you were apprised of the unexcused absence, did your mom just say to you here's what you need to know, I called the school, or how did she handle it?

CLIENT: She was just like, I called the school and they said that a loss of a pet doesn't count as an excused absence, or something like that, and that kind of made me mad because she knew that I was hurting, but yet she called the school to see if I still had —

THERAPIST: She's got to inform them. [00:18:56]

CLIENT: What?

THERAPIST: She's got to inform them, she does have to let them know you're not there.

CLIENT: I know, but —

THERAPIST: You think she should have excused you, is that what you're saying?

CLIENT: Yeah. She made it sound a little bit worse than it was by saying that I've missed eight days of school. I have missed eight days of school but yet, five of those days, I was still doing the homework the whole hours of school, so I got just as much done, if more.

MOTHER: Kevin, I wasn't doing that for my benefit. I'm doing that from the school, looking at your record, saying that you have eight absences. Like I said, that goes in your record.

CLIENT: But also the suspension is going to go in my record, so that's going to show that I only had three excused absences.

MOTHER: I do think — I mean, this happens on several situations and it might be a good one to kind of nitpick about the defiance. There was no — and we weren't arguing and yelling. I think we did a good job of trying to calmly� [00:20:07]

THERAPIST: Right. That's what I was sort of figuring. I was asking if you had just kind of advised him. Go ahead.

MOTHER: I don't know what your perspective is, but I'm reading books and I'm learning different things, and so it was not a you get to school kind of thing, but it was, this is going to be an unexcused and this is what happens, you know those kinds of things. I understand why you're upset.

THERAPIST: It's informed consent, you're giving him informed consent.

CLIENT: But she always tells me if it's an unexcused absence, that the SRS is going to get involved. That's what she always tells me.

THERAPIST: Well, down the road, it could happen.

CLIENT: I know, but that —

THERAPIST: It's going to be more of not really SRS but there's a truancy, it's a juvenile justice issue and it's a truancy, and that is theoretically possible.

MOTHER: But that's what the school — so I'm giving you the information they're giving me. But the anger and the —

CLIENT: Couldn't you see where the anger was coming from? I kept saying that I wanted to be left alone. Dad kept knocking on my door every three minutes, saying —

FATHER: First, — [00:21:14]

CLIENT: Dad. Every three minutes, telling me that I needed to go to school, and repeated it maybe six times, and it was obvious that I've made up my mind that I'm not going to go to school, because I feel so crappy, but they both just kept knocking on my door and knocking on my door and knocking on my door. I had matches, because I went to the lake, to make a fire, and then I just sat by the fire, and so it's a teenage room, it smells bad in the room, so I lit a match, and then they come up and they're freaking out about what's going on. They asked me, "Why does it smell like matches?" And I was like, because I lit a match. Why did you light a match, and then I said, "I don't know."

THERAPIST: You don't think they found that a little odd do you?

CLIENT: Yeah, but I'm not going to be smoking. I have really bad asthma right now, that could kill me. I mean, I know it could kill me. [00:22:20]

THERAPIST: I mean, did you ask them what did you think I was going to do?

CLIENT: Yeah, I did.

THERAPIST: What did they say?

CLIENT: Okay, what did I ask then? You seem like you're disagreeing with everything and this is the exact story.

FATHER: You said we freaked out on you lighting the match. I calmly asked, "Did you light a match in there?" And you said yes and I go, "How come?" Then you got mad, you wouldn't let me in. We were both incredibly calm through this whole thing, and you had started out angry the second I knocked on the door.

CLIENT: Because you hadn't been —

FATHER: The second I knocked on the door, you were angry the very first time.

CLIENT: Did you not listen to the whole very first story I was saying, because you kept bugging me and I just wanted to be left alone. I had made that obvious the first time that you knocked on the door, and then you guys came in, and then you somehow unlocked the door from the other side. You got in, you both — you sat down, then mom came around, and then you started asking me the same question and then you go, "Why did you light the match?" I don't know. Did you light a match? Yes. Why did you light it? I don't know. Well, why did you light the match? I don't know. And you asked me that like five times and then I got angry, because you just — I don't understand why you would need to know why I lit the match. [00:23:47]

THERAPIST: Well, because what if you're so distraught, you decide to burn the house down?

CLIENT: Well, I mean it's, it's —

THERAPIST: It doesn't make a lot of sense, but your answer to the question is so bad that it just adds fuel to the fire, for lack of a better metaphor. If they said why did you light the match and you said — I don't know what a good answer would be frankly, it's smelly?

CLIENT: Well, if I said it smells in my room, they would just be like yeah, why did you light the match?

THERAPIST: They were probably like, why don't you get a deodorant spray.

CLIENT: Because my friend — not my friend, this kid, he broke all of them.

THERAPIST: Your friend broke your deodorant spray?

MOTHER: Not deodorant.

THERAPIST: Yeah, I didn't say it very well, I mean like the can of spray like I have in here. Why don't you just spray your room?

CLIENT: Simply because we don't have any.

THERAPIST: So in this situation, you're acting weird.

CLIENT: Because my dog just died, I mean I'm going to be acting weird.

THERAPIST: Sure, but if you start acting weird, the police or your parents or anybody in the universe, aren't going to ask you, gosh did your dog die? They're going to be like, you're coming with us. And so when you do like weird things, like light a match, like if you put a pillowcase over your head, I'd say have at it, whatever, if that's meaningful, if you're like whenever a dog dies, I put a pillowcase over my head, great. That can't hurt anybody. It just looks weird, it doesn't look dangerous, and when you're lighting a match, they have to wonder if you have ill intent. They have to, that's not an overreaction, because is it not true that when they overreact, I tell them that. This isn't an overreaction. And when you have no answer, because I can't think of a good answer, lighting my crack pipe? No, that's probably not a very good answer, so they can't figure out what you're thinking and guess whose anxiety goes up then? Right. So, I see where you guys were having a hard time. Now sure, you were distraught and feeling sad, but that actually adds to their worry, that you're maybe not thinking straight. [00:26:04]

CLIENT: Mm—hmm, but I mean I think it would have been as simple as did you light a match? Yes. Well, don't light a match. I mean, it could have been as simple as that. It could have then gone away and it wouldn't feel — that's just what I feel.

THERAPIST: So if you came in the living room �—

FATHER: And you smelled gas.

THERAPIST: Yeah. If you came in the living room and your dad had your mom around the throat and he was cutting off all her hair, wouldn't you wonder what was going on?

CLIENT: I would be so scared that I wouldn't —

THERAPIST: There you go, thanks. That's what I'm talking about.

CLIENT: I wouldn't even talk about it, I wouldn't even ask.

THERAPIST: Right, very good. And they're thinking the same thing. They're thinking, is he going to light the bed on fire, is he going to burn himself? Is he burning himself, is he so upset?

CLIENT: I mean, I know it's a dog and he meant a lot to me, but I don't think I would kill myself over that.

THERAPIST: I believe you.

CLIENT: That's too selfish. [00:27:04]

THERAPIST: I understand in the moment when you — I know you're fine and I know you're not going to light the house on fire, but in that moment, people are going to wonder what state of mind you're in, and if you go out there and your dad's got your mom around the throat and you say what's going on and he says, well the dog died and I just feel so sad. Does that make you feel better, the story I'm giving you? No, it is not. You're going to be scared and think he's crazy. I know it's a bigger example than what you did, but you have to remember, and you're a smart enough guy, Kevin, you have to think, how are people perceiving me. Even when you're upset, I know at 13 it's hard to believe, but the universe does not revolve around you and when you're upset, you still have to think, how is it going to look if I do this. I think you just let your emotions get to you. I understand how that is but this is part of why this is an opportunity for growth. [00:28:10]

FATHER: So, if we go in and knock on his door and say Kevin it's time for school. No, I'm not going today. We should walk away and not pursue that?

CLIENT: Well, I don't think you should pursue it 20 times after you ask me the first time, obviously.

THERAPIST: I think there's a contextual question here and if you said that without the dog part of the story, I would have said no, you've got to go to school.

CLIENT: Yeah, and I agree with that too.

THERAPIST: I don't think he should come home because his tummy hurts ever, throw up. Go throw up and then you can go back to class, that's what the rest of us do. The only good reason to be home this year, that I know of, other than being sick, is the dog dies. That's a legitimate reason to be home, but any other time, he's got to go to school.

MOTHER: We agree, we a hundred percent agree with that. He's so defiant that it doesn't always happen. [00:29:14]

THERAPIST: You mean in the non—dog situations? I do recall, this is not an infrequent problem.

MOTHER: Right.

THERAPIST: No, he's got to go to school.

CLIENT: And if he didn't die I would have been — I would have gotten up. My mom wakes me up at six—thirty, then I get up at seven, and then I get ready and I'm perfectly fine at school.

THERAPIST: Right. When you say he's defiant, what do you mean?

MOTHER: Absolutely will not� This morning example has the dog involved, but even if he weren't, if he doesn't want to do something he will not do it no matter what.

THERAPIST: But he is getting to school most of the time, except for the two days that he — or two to three days he hasn't gone.

MOTHER: Well, can you say —

FATHER: I think the issue is the amount of anger that comes out in such a short — it's immediate. There's nothing that grows and grows and then all of a sudden� [00:30:31]

THERAPIST: Is it always right at the moment he's still laying in bed?

FATHER: No.

MOTHER: No. The defiance is just any time that pretty much he's not — things aren't going his way or we're asking him to do something he doesn't want to do. You know, handling frustration is not a good thing with him. Can you think of situations that you know, just —

THERAPIST: Is it better when the medicine is on.

MOTHER: Oh, yeah. Yeah, so usually this happens after, at night maybe, or if he hadn't had his medicine.

CLIENT: You've also got to realize, I was really tired, didn't get much sleep last night. I couldn't go to sleep the whole time. I didn't have the patch on and I was mad, because it was six—thirty in the morning.

THERAPIST: But they're saying that there are other times that aren't dog death related.

CLIENT: Yeah, that's because it's usually in the morning or when my patch is off. [00:31:33]

THERAPIST: And I believe that we are all keeping the patch on correctly at this time, are we not?

CLIENT: Mm—hmm.

THERAPIST: No? People's heads are moving in different directions. You're saying yes you are and your dad is shaking his head.

CLIENT: Well he's never home, that doesn't even make any sense. You're not — you're never —

FATHER: The moment I talk.

THERAPIST: What?

FATHER: The moment I talk.

THERAPIST: Because we need to keep it on as long as we can and not interrupt your sleep.

MOTHER: I've asked that he let me in on when it comes off, that I'm there when that patch comes off, and that's never happened. So I don't know for sure when it comes off, but we can usually kind of tell by attitude or that kind of thing. I did notice, when he was home with the suspension, that he was very distracted, and so we did up that medication. I don't know if I mentioned that last time.

THERAPIST: Oh, I knew we were talking about it. I didn't know if they did or not.

MOTHER: It was quite obvious, so I learned a lot those five days, and we did up it to the 30, but I don't know when it comes off. I think he's been keeping it on lately actually, because he's been coming home and doing his homework. [00:32:45]

THERAPIST: Okay, see that's good. So it's later on. I wish I could know about when you're — the time of day when you're having the most trouble, and the span of time. If you can mark that on a calendar or something, it would really be good.

FATHER: It's usually nine o'clock on.

MOTHER: I don't know how I can't pull an example, because it happened� This has been a better two weeks and honestly, it's been a better two weeks.

FATHER: It's usually in the morning, before the patch goes on, it's usually at night, after the patch comes off.

MOTHER: Yes.

THERAPIST: And we never could get you to let him put it on you before you get up?

CLIENT: Oh, heck no, I would not.

THERAPIST: You are such a pain in the ass, I just want you to know that.

CLIENT: Well, she says the exact same thing.

FATHER: I've come in and kissed you while you're sleeping.

THERAPIST: What is your complaint, Kevin?

CLIENT: I don't get how I'm a pain in the ass when I don't want her to be touching my butt.

THERAPIST: Well, she can touch your back. She can put it higher on your back, man.

CLIENT: Well, whenever I do, then it stretches out.

THERAPIST: I don't want my mom touching my butt either but I don't care if she touches my back. [00:33:47]

CLIENT: It doesn't feel comfortable there.

THERAPIST: Stand up and show me where you're putting it.

CLIENT: I put it right there.

THERAPIST: Gee, that is low. That's below your beltline.

CLIENT: Yeah, I mean but there's more stretch in your back.

THERAPIST: No wonder you're having trouble keeping it on.

CLIENT: Well, we got the KT tape, the kinesiology tape, and it leaves it on there, but when it's that high it stretches out and it bugs me through the day.

THERAPIST: The reason I'm saying you're a pain is because if we could get that thing on you earlier, your morning will go so much better than it does. I see why you don't want to put it on your butt, I didn't realize it was that low.

FATHER: There's some examples of Lucky Charms in the morning.

CLIENT: We've already talked about that.

THERAPIST: He did what?

FATHER: I guess they've talked about it.

MOTHER: I think that was last session.

CLIENT: The Lucky Charms.

THERAPIST: Oh, the Lucky Charms, we talked about those. It just happened. I just wish we could get it on you earlier in the morning. Are you bathing in the evening? [00:34:51]

CLIENT: Most of the time, and then I usually wake up and I take a shower.

MOTHER: Sometimes you do but usually, you bathe at night.

CLIENT: (sighs)

THERAPIST: Some day, when you have a girlfriend, you'll let her put it on your butt, and I will be so happy.

MOTHER: Wait a minute, slow down there.

THERAPIST: Someday, he'll have a girlfriend, maybe in college or something, and then I'll be like, have your girlfriend put it on your butt, and you'll be like no, I don't want her touch around the butt, and I'll be like I don't care. But in this situation, I understand it's just — and you're saying you've tried it higher on your body, where mothers are permitted to touch.

CLIENT: Yeah. That's how we started and I always, every time I bent down to pick something up, it would stretch out and it bugged me, it annoyed me. At the end of the day it would be all crinkly, I mean even with the KT tape, and it wasn't comfortable at all. So, when I started putting it on my rear, it was a lot easier and usually, I can't tell that it's there, but sometimes it stings but it's not really that bad. [00:36:00]

MOTHER: Kind of on your hip.

CLIENT: Ish, yeah.

THERAPIST: Well, that would help, but we can't figure out how to get that done. There's some research even, where they're putting the thing on for people who — for the ADD people who actually get a little tired on it, they're actually having them put the patch on at night before they go to bed. I know that's bizarre.

MOTHER: Huh?

THERAPIST: I was ATA a couple years ago and they were talking about that. We were discussing this very issue and it was for particularly, people who don't get up easily. So, all right, then you think it's about after nine, because that actually makes perfect to me, for the washout period.

FATHER: Yeah, it's — yeah.

THERAPIST: What time do you go nighty—night?

CLIENT: I'm going to bed pretty early, probably around eighty—thirty now.

THERAPIST: You go in your room at eight—thirty and you don't go to bed until eleven?

CLIENT: If I go into bed at nine, I don't get to bed until one. [00:37:06]

THERAPIST: You're not falling asleep until one?

CLIENT: Not usually.

FATHER: It's hard to when you're playing games or texting.

CLIENT: Oh my God. I even notice you downstairs working, constantly, —

THERAPIST: Kevin, dear buddy, why do you have any electronic devices in your room at night?

CLIENT: Because, usually I listen to music.

THERAPIST: That was my radio show this morning, Kevin.

CLIENT: None of the radios come in.

THERAPIST: My radio, you should have listened to my radio this morning. I said that now that it's Christmas and all the little boys and girls in fourth grade are getting their smartphones, they should be taken back at night.

FATHER: We wanted to cover that today.

THERAPIST: Well, how lucky.

FATHER: From last week, where we have control and what's a good app.

THERAPIST: Does he have an iPhone, I can't remember.

CLIENT: Mm—hmm.

THERAPIST: Okay. Yes, Kevin, we're going to have more control over your little phone now.

CLIENT: I got a phone for privacy. [00:38:08]

THERAPIST: Yeah, and you can be super double private until about nine o'clock at night. Do I not totally defend your privacy until — remember this conversation? Where I said if you are handling it correctly, then I will defend your privacy a lot. You can text all sorts of cute things to girls but you can't do that at ten o'clock and ten—thirty. The research on this is as clear as it can be. I just posted it on my Facebook today. Just today, I put up an article about sleep deprived teenagers, and guess what the number one reason is they're sleep deprived? Oh guess, Kevin, do please. Screen time. When do you get done with study time?

CLIENT: I usually do it for about an hour and 20 minutes, and then I get my phone back and then I start working on some more homework. [00:39:09]

THERAPIST: You work on homework after study time?

CLIENT: Oh yeah, she's just like, "Kevin, you can't be done after an hour and 20 minutes." And then she — but then I have to agree.

THERAPIST: You're supposed to be done in an hour hopefully.

CLIENT: Yeah. Hear that?

MOTHER: Kevin, you need to —

THERAPIST: How can you not get done in an hour and 20 minutes? You should be done in 70 minutes.

CLIENT: Makeup work and stuff like that.

THERAPIST: Why do you have makeup work, because you stayed home?

CLIENT: It was part of the suspension, Spanish was going way too fast, it was hard for me, I was caught up on Spanish. Then, while I was working on Spanish, I was getting caught up in other assignments and then I just went crazy. She would say — the Spanish teacher would say half the things in Spanish, and like she'd say a sentence, she's explain what one word was in there but she wouldn't tell us what the word was until we got finished with the lesson.

THERAPIST: Okay, so what's your — you were getting ready to say something, what?

MOTHER: This quarter has been — you know, how it started out, with all the Fs and stuff, and he's having to work himself back from that, and so never completely got caught up until yesterday, and now he's gone again today. So he got caught up in everything yesterday.

THERAPIST: Well let's hope next semester, we can keep it to 70 minutes, or 80. You're in eighth grade? [00:40:29]

CLIENT: Mm—hmm.

THERAPIST: Because he just can't do more than that.

MOTHER: I'm not sure why he's saying that I'm making him do more, because that's actually not, in my experience.

CLIENT: It seems like you're so full of crap when you come over here.

MOTHER: So, he comes home, he has snacks, all that kind of stuff, then around four—thirty is when he's supposed to start.

THERAPIST: Is that right?

MOTHER: He's supposed to give me his phone, sometimes it doesn't work like this, like clockwork, but sometimes it does.

CLIENT: I always give you my phone.

MOTHER: Then he gets down around six, and then he'll come down and he'll say, I'm going to go up and work more on Spanish, and when he does that, I allow him to have his phone back, because he's already done his —

THERAPIST: He's done the time, absolutely.

MOTHER: But if he's going to do extra, I'm like you can have your phone.

THERAPIST: It's on him.

MOTHER: But it's suggestion, not my suggestion, that you go up and you do extra. Now, he's done a lot of —

THERAPIST: The fact she's giving you the phone does prove the point she's making.

CLIENT: Yeah, but I didn't think the agreement was an hour and 20 minutes without the phone. I thought it was an hour and 20 minutes, well yeah, obviously without the phone, but I didn't think —

THERAPIST: Help me Kevin, you're confusing me. What? [00:41:38]

CLIENT: An hour and 20 minutes without the phone and then this is how it used to work. I mean, she used to tell me to go up, and you need to work a little bit more, and an hour and 20 minutes.

THERAPIST: Kevin, you hate it when they go back in time and say remember how Kevin used to be. So, in the current reality, you're supposed to do — I don't think it's — it's not 120 minutes is it, it's 80 isn't it?

MOTHER: It's 80, 80 minutes.

THERAPIST: So you do 80 minutes. I don't want you to have to do more than you can do. Eighty is what you can do, and then it's your phone and if you're like mom, I just love Spanish so much, I'm going to study the rest of the evening. No one is stopping you Kevin, but you can have the phone, and then that's what I'm trying to figure out, your time span with the phone. So you get done at six, right, roughly?

MOTHER: Right.

THERAPIST: And then you have the phone for what, three hours?

FATHER: He's got it all night.

CLIENT: Oh my God, dad.

THERAPIST: Well, there's the problem. Isn't it true, you have it all night?

CLIENT: I usually get off of it and you came into my room and you said, "You need to be off by ten." You said that the other night.

THERAPIST: Okay but Kevin, why can't you just give him the phone back at whatever time we decide tonight, just give it to him. [00:42:44]

CLIENT: Because I listen to music and my radio doesn't come in. There's commercials on the radio and each commercial is around 20 minutes for the radio station that comes in.

THERAPIST: Well that's true.

CLIENT: And when I listen to Pandora or iTunes radio, it's nonstop.

THERAPIST: All right, that is a very good argument, because I use my phone similarly to that.

CLIENT: Mm—hmm.

THERAPIST: I have it monitor my sleep.

CLIENT: I don't know many teachers that use the radio.

THERAPIST: So you're fine with him going ahead and having it shut itself off for — oh, wait a minute, that's going to mess up� No, you could — hmm, I'm confused. Is Pandora an application, an app?

TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

Interview with Wes Crenshaw

Carlson: Can you please describe your approach to therapy for our readers?

Crenshaw: In addition to specializing my doctoral electives in family psychology, I was trained in Strategic Therapy in the late 1980s and early 1990s. As I noted in my book Treating Families and Children in the Child Protective System, the Strategic approach emphasizes four curative factors in psychotherapy, all of which are present in this case:

Personal Influence. Therapists have something valuable to offer clients beyond a kind presentation, empathic ear and willingness to give them what they state that they want. Thus, Strategic Therapy is directive and the effectiveness of the intervention is based in equal measure on the expertise and benevolence of the therapist. While some approaches deny or minimize the role of personal influence XE "Personal Influence", this position actually obscures the therapist's real juxtaposition to the client, the family, and the larger system. The Strategic approach contends that holding the therapist out as powerless or neutral is fallacious, disingenuous, and at times even dangerous to treatment and client best interests. Therapy is never truly value free, so the therapist must be clear and honest about the values he or she brings to the case. As a generic example, I am a strong opponent of substance abuse, yet I work with many clients who partake. All my clients know this about me and are able to make an informed consent. However, I am careful when giving a directive about substances, to base it on literature and reason, not my personal convictions.

Techniques of personal influence that appear in this case include: Speaking the language of the client; Finding common interest or experience with a powerful family member; Showing empathy for the family, a member of the family or some subset thereof; Reframing a set of behaviors in a more positive light; Providing a humorous alternative to an inappropriately grave situation; Normalizing frightening or upsetting situations as manageable problems faced by many people now and/or throughout history; Problematizing situations that cause trouble for the family or a member of the family, when they have become accepted as normal or unchangeable; Teaching from a position of experience and expertise about the nature of a problem from both the child and parent perspective.

Belief in Free Will: Strategic Therapy has traditionally held that free will reigns supreme over determinism from psychobiology, diagnosis, environment, and various systems of control. We acknowledge and teach about determinism, proposing for example, that a diagnosis (in this case ADHD) is not an excuse for some limitation, but an explanation that offers a roadmap for a better tomorrow. This goes well beyond an optimistic reframe. It is a core belief about how clients learn to change what they can about their lives by accepting and cultivating their own self-efficacy.

Utilization. A Strategic therapist becomes expert at learning what works with a given client and how to help the client execute it. By it's definition, the right strategy will vary from case to case as the therapist works to involve the client's environment, experience, patterns of response, and even resistance to treatment rather than make the client fit the therapist's conceptualization. In fact, therapy failure often derives from treating clients as less than unique, expecting them to respond to the therapist's limited understanding of what they should do. Utilization does not require positive regard for or acceptance of the client's worldview, as has been advanced in the post-modern interpretation. It does mean being ever responsive to that worldview and incorporating it into the intervention package.

Contextual Change. Strategic Therapists see the most meaningful and lasting change as coming from shifts in the client's larger life context, particularly when that client is a child or teenager. This necessitates an interactional perspective, seeking first to understand how people involve themselves with one another and the world around them XE "family injustice" . Client behavior can be seen as an encoded message to the natural environment requiring a determined effort on the part of the therapist to decode it and utilize it to render change. In this case, both the child and the family are asked to change their approach to one another to better manage the child and mother's mood, his behavior and his academic achievement. Interestingly, this young man did an unusually good job of decoding his own messages, leaving us to jump past a complex interpretation and move directly to changing the dynamic.

In terms of personal style and process in therapy, readers may be surprised at how much the sessions "sound" like conversation overheard in a coffee shop and how much humor plays a role in that process. We joke about my office cat. We discuss calendaring programs or the local business climate. We learn about fishing and hunting. This is all quite intentional, not superfluous to the aim of therapy and more than a social stage of therapy as Haley proposes in Problem Solving Therapy.The West Coast School of Strategic Therapy (Mental Research Institute, Fisch, Waztlawick, Weakland, etc.) held that the therapist needed to "speak in the language of the client" in order to achieve proper engagement and utilization. I concur. While I am teaching core principles for successful living with ADHD to both Client and his family, I am doing so in stories and illustrations so that they will be retained, understood and followed. This is true for any client I see, but it is especially so for people with problems of attention and focus. For them, therapy can't simply be useful. It has to be entertaining, or else they get bored and stop listening or coming back. I'm also using that conversation to learn more about how the family lives, interacts, and experiences their world, which in turn allows me to do good utilization.

This is also why I don't do any play therapy, even when I see kids in middle school (I don't see anyone younger than sixth grade). I find that these props are more a distraction, and that I can get even young teens involved in discussion by simply knowing what they like to talk about—usually relationships. Most people who come to therapy are really interested in learning how to love and be loved, and if the therapist is able to speak that language and apply it to the client's presenting issues, the therapist will make more progress in a quicker time frame than by following a manualized system of treatment^[1].

An example of how stories can create change in the therapy is Mom's realization that she too has ADHD based solely on my descriptions of what life is like inside Client's head. At no point do I mention my hypothesis that she has ADHD, until she and Dad brought it up. This may not be clear in the transcript, because the first moment of awareness comes non-verbally when we are discussing "the bra situation" as a matter of tactile sensitivity in girls with ADHD. This immediately resonated with Mom and Dad actually pointed at her and nodded while I was talking. Readers might note that Client is a teen boy and would have no awareness of how bras endlessly annoy many women with ADHD. But Mom recognizes this at once and it becomes a humorous way for her to identify with Client's discomforts and to begin to explain some of her own.

I often tell stories about other clients, as the transcript illustrates. This might be jarring to some readers, but in fact it is a technique that comes straight from the work of Milton Erickson, on whose work many modern therapies are based (Strategic, Solution Focused, Narrative, etc.). Readers can rest assured that these stories are (just like the transcript) made anonymous beyond recognition. Therapeutic stories can be general (e.g., "many of my clients find that X is helpful because of Y"). But they can also be specific (e.g., I had this client once who was having the same problem and she found Z helped"). Even if the story really represents a synthesis from several cases, I tell it as if it were about a single person or family. Several of the more popular stories appear in I Always Want to Be Where I'm Not. I even tell stories about my own children, both of whom have ADHD and are very successfully treated. This too may seem jarring, as if I'm sharing too much or working out my own issues. It is instead, a key tool in "selling" change to clients. I not only have the training to talk about ADHD (and a host of other problems), but also the personal experience to empathize. So, when the parents get frustrated with Client, I can say, "I know how you feel. When my kid did that, I was so pissed and I had to do [intervention]." Or when Client is frustrated with parents, I can say, "Yeah, my kid is always telling me that, and I say [something wise]."

I've often had clients tell me that storytelling is a core reason they kept coming back, that it makes them feel understood, and gives them hope. For quiet clients, nothing is worse than a therapist who won't carry the conversation—except for one that asks them how they feel. I am in fact known for being able to work with shy teens and young adults, and knowing how they feel, even though it is at times rather painful and difficult. A core element in that process is finding the right story, usually based on the most minimal cues, and telling it well, so the client doesn't have to. If there is any question as to the accuracy of the story, I usually end with "So, would you like to argue that point?" or at times more gently, "Does that sound about right?" Like the proverbial shoe, if the story doesn't fit, the client won't wear it, and even quiet clients will take issue when that happens, which in turn, gets them engaged. In fact, I sometimes intentionally get it wrong just to pull them into the dialogue.

Granted, this is a complex and intricate methodology and it takes time and energy to learn; but once mastered, it works. The critical factor is that one must NOT be working out his or her own issues, but instead speaking as an expert not just about psychology or in this case, ADHD, but about successful living in general. Clients respect this wisdom and intellectual intuition more than they do a PhD or Board Certification, as long as the stories represent solid psychological principals and fit the specific treatment goals.

I would argue that researchers and insurance companies have become quite enthralled with evidenced based techniques, but not interested enough in communicating with people. In fact, very few clients come in wanting to talk to a therapist. They come in wanting to talk to a person who knows something about therapy. That difference may seem subtle, but it is not, particularly where teens and young adults are concerned. For example, a great deal of what is done in the transcript is covertly cognitive behavioral, not only because the research supports it, but because it works in a clinical setting. However, except for those rare clients who are unusually interested in psychology, most don't like to be spoken to in CBT language that sounds bland and mechanical, even if it works pretty well. Clients want to talk in normal ways with normal words, and it is up to the therapist to figure out how to giftwrap a technique so the client will want to receive and understand it, without having to learn our strange jargon. Too many therapists buy in to the manual and surrender the humanness of a one-to-one relationship. The two can co-exist, and they must.

Carlson: Will you provide a brief description of your training and background?

Crenshaw: I have a bachelor's degree in political science, sociology, and history from Southwestern College, and a MEd in Counseling and School Psychology from Wichita State University, with emphasis in Marriage and Family Therapy. I received my PhD in Counseling Psychology in 1994 from the University of Kansas. I was Board Certified (ABPP) in Family Psychology in 2000. During and after my doctoral training, I studied with the founders of East Coast Strategic Therapy, Jay Haley and Cloe Madanes, at the Family Therapy Institute of Washington DC. I have additional training in forensic psychology in child custody evaluation, and twenty-two years of experience and 23,000 hours of client contact. In response to the increased centrality of sexuality and gender issues in the lives of teens, young adults, and the rest of the population, I am spending 2014-15 attaining AASECT certification as a sex therapist and sex educator at the University of Michigan.

Carlson: Can you describe the client and the surrounding issues/challenges for our readers?

Crenshaw: At time of intake and throughout the period of the transcripts, Client was 13-years-old and in the eighth grade. His birthday is in July, making him nearly as young as one can be for his grade level. He was adopted shortly after birth and his parents know little about his biological mother or his birth. He has a younger sister, also adopted at birth but from a different biological family. The family lives in a rural college community in the Midwest and attends a 6 to 8 grade junior high school with 110 classmates per grade. The town is about fifteen miles from a state land-grant college where Dad owns an iconic sporting goods store, and about thirty miles from a metropolitan area of 2.2 million people. Client has not been hospitalized or outplaced, nor has he any history of legal involvement.

Beyond this, the Strategic approach focuses more on the presenting problem than the client's history. History is considered only insofar as it informs the present. An exception is found in cases of family injustice (e.g., child abuse, family violence) or trauma, though none of these pertain to this case. If a client comes in very interested in his or her history, the therapist looks for ways to utilize this in the service of change. If the client has little interest in history, or is unhelpfully preoccupied with it, the therapist will stay focused on the presenting concern. This is why the first question I ask every client is "what brings you in to see me?" While it is possible (and even likely) that as Client moves through adolescence, he will grow interested in his origins, adoption, and biological family, that isn't the concern at this time and attempting to focus on it, is not likely to be productive and perhaps even distracting. If and when that history becomes important to him, Client will have established this relationship and can use it to explore it.

At intake, client was said to have problems with focus, concentration and anger. Asked why he is here, Client admitted that his family was frustrated with him and his behavior toward them. Mom added that they were struggling with school issues, most notably inconsistent academic performance, but also stated that problems with mood and behavior were far less significant at school than at home. Mom noted that Client's behavior "brings out some other behaviors with Dad," but when asked, these were limited to anger and frustration. It was my impression, later confirmed, that in fact the Client's issues appear to frustrate Mom far more than Dad, and lead to conflicts with her. Some of this is due to the greater time spent between Mom and Client, but other factors emerged that indicate a difficult match in personality styles in that dyad.

There was no indication of violence or corporal punishment. Both parents were appropriately concerned that Client spends a great deal of time on social media, phone, and in his room on the computer. They were concerned that he might be consuming pornography online and given that they had no filters on his devices, I suggested (without needing to confirm it with Client) that this was a near certainty.

Mom also hinted that she was afraid of client. It became clearer that this was true within a week of the intake (included as session #1 in this set of transcripts), when Client wrote a note on his iPhone note app entitled "My mom." I have provided it below sic erat scriptum, with identifying information redacted:

Yes I do things I shouldn't, like yell, punch holes in the wall when I am angry, cuss out loud, say things that I shouldn't say, sneak a sip of margarita out of the bottle about once every month, lie, not do my homework, break things, be violent, throw things, kick things, steal things, and much more. But what my mom doesn't realize is that she is the cause of all this and she needs to change. Here are some reasons:

My mom does not understand me. She says that I'm different. She is scared of me. She thinks I am going to shoot her. She does not know how to treat me. She does not help in my life but she thinks she does, but she only makes it worse. She does not trust me. She thinks she knows how to raise a child with ADHD but she does not. If she did, we would not go see a doctor every 1-2 weeks^[2] on how to control it. She thinks less of me. She points out many flaws that I have then rubs it in. She cares about my grades, but only the bad ones. She is very sarcastic and treats me like I'm stupid. She puts pressure on me if I do something wrong. She makes my life hell. She only points out the bad things that I do and makes me

feel like crap. She takes my phone whenever I do something bad and she only takes away my phone. She thinks it will help, but it makes me so angry then sad, then depressed, then it makes me not want to do my homework, but write things like this instead of doing what I'm pretending to be doing. She makes me want to kill myself without leaving a suicide letter addressed to her because she knows how I feel about her. I honestly hate her. She makes me want to run away. She makes me want to kill myself.

I don't think this will change her mind or change how she treats me but it's a damn good place to start...

Beyond it's eloquence and candor, this note offers a bit of a Rorschach test for a therapist's approach to a child and family. Some would find the language quite frightening, as did Mom, with commentary on self-harm, violent behavior and thinking. Some might even see it as grounds for hospitalization, and in past decades, it might well have been. Others, more in line with Dad's perspective, might see it as a manifesto in which Client is really trying to get out his feelings and frustrations with Mom, so they can be dealt with in therapy; that he is simply responding to my opening question, "What brings you in to see me?"

I fall into this latter category, particularly given that Client wrote the document a week after intake, references therapy, and ends the manifesto by noting that he does not know if such sharing will change how he is treated, "but it's damn good place to start." What better aspiration could a therapy intake have?

Having worked with teens for twenty-two years now, I've come to understand that many harbor disturbing feelings, almost by design. Not all can describe them as articulately and honestly as Client. When a teen does, one may have to listen with a calm ear, lest the therapist initiate or add to the emotional reactivity of family members. At the same time, the therapist does not want to miss one of the tiny fraction of teens prone to harm self or others, so I spent time trying to discern whether this note represented a frustrated young man whose mother is out of sync with who he is, a youth with a budding mood disorder, or the early stages of a disorder conduct. As we discuss early in the sessions, these sorts of issues are prevalent among American adoptees because adoption is not held in high regard for unplanned pregnancy in the US, and thus the very low number of available babies. Likewise without any genetic history on Client, we are left to consider him without any biological context. It was ultimately my conclusion that for now, Client was not a risk to self or others, though he did seem to pose an ongoing risk to drywall, as several holes appeared during the course of treatment.

Client was diagnosed in 4th grade with ADHD-Inattentive Type. There was some concern prior to and early in our sessions that Client might have an underlying mood disorder, but his mood fluctuation seems to stem more from family dynamics, poor frustration tolerance, irritable-ADHD symptoms, and medication washout late in the day. With regards to medication, Client has only been treated for ADHD. Several different medications are said to help, but may also produce side effects. I say, "may" because over the course of the transcribed sessions, it became increasingly clear that Client is no stranger to secondary gain, and capable of feigning or over-focusing on side-effects rather than the benefits of medication. This is an unfortunate situation in a young person for whom medication has been quite helpful, and in our clinic, it is far less common than readers might expect because we emphasize a team approach that affords the client great influence in how medication is managed. That is evident in the transcript, though it does not turn out as I might have hoped, as Client tends to instead manipulate the medication and exaggerate side effects. While the area of ADHD treatment is surprisingly controversial, the literature is clear that the best treatment across large populations is a combination of medication and therapy for both the child and family. Except in a minority of easy cases, that is easier said than done.

The family consistently found methylphenidate medications to be superior to amphetamine types for balancing efficacy and side effects. They particularly liked Concerta, but at the time of intake, Client was on Focalin. Asked, they claimed that Concerta caused Client to lose weight in 4^th or 5^th grade, dropping from 90 lbs and dropped to 80 lbs, which is substantial at this age. However, Focalin is the same medication as Concerta in a different delivery system, and the change may reflect a prescriber with limited experience in stimulant management rather than a logical treatment strategy. I consulted with the provider and we tried Daytrana, which had many properties that made it more tolerable

Asked at intake how Focalin is working for him, Client notes that he doesn't feel good—meaning his stomach growls and he needs to eat but he can't. This formed the first clue that Client might not have sufficient buy-in for medication management, a problem that continued through the ninth session and will probably continue thereafter.

Client had also been tried on Vyvanse, but Mom claims this "made him scary violent." Asked what this means, the family said that he was more than irritable, but when pressed to describe, they admitted that his violence had been limited to kicking holes in the walls and verbal barrages toward his parents, particularly Mom. Yet these same issues emerged during the therapy period, and he was never on Vyvanse at that time, so we again find a questionable feedback loop about how medication is really impacting Client, pro or con. The family also tried, non-stimulant Intuniv and predictably found Client became lethargic.

The reader can see throughout the process how much of an investigation and experiment medication management really is. Too often, in my experience, many clients and providers give up too easily. As I discuss in my book I Always Want to Be Where I'm Not: Successful Living with ADD and ADHD, the interaction of medication, family, attitude toward and oversight of medication, and client/family cognition is critical in improving compliance, minimizing side effects and improving outcomes. As noted, we talk a lot about clients being "on the team," meaning we take very seriously clients' input about medication or any other aspect of their case, and in return, they will agree to be compliant with the protocol we decide upon. In fact, I will not see any non-voluntary teen, nor is that actually legal after the age of fourteen in Kansas. Likewise I will not write a prescriber in support of medication if the client is not giving informed consent. The medication protocol can change based on our team effort and client input, but the client is expected to respect the process as much as I respect the client's input.

This seemed to be working quite well through most of our sessions, but in session 9, Client admitted non-compliance and the family became a bit confused as to what that meant and how to handle it. He also feigned (I believe) a side effect I've never encountered before with the Daytrana patch—extreme tactile pain just from wearing it. Moreover, at this time Client had been on the patch for several months and expressed no such symptom. Pressed about this, Client finally claimed that he does not "feel like himself" on it. This is fairly common among teen boys who were not started on medication earlier in life. Thus, the sessions included (and in the future will continue to include) a focus on trying to pin down the best compromise between medication usage and non-usage. As that unfolded, it became clear that the dynamic between all family members was severely strained and that medication management was both an impetus for conflict in and of itself and a metaphorical representation of other conflicts in the family.

ADHD played an additional and unforeseen role in the case. About three sessions in I came to understand that a great deal of Mom and Client's conflict is the result of the Mom also having ADHD. This emerged as it often does, from Mom getting a better understanding about her son and recognizing the same characteristics in herself. In fact, in the 9^th session she actually admitted to doing an unauthorized self-test using Client's leftover Focalin. As I note in I Always Want to Be Where I'm Not, ADD-ADD dyads are symmetrical and unstable in that neither party has tolerance for the other's chaos (what I refer to humorously as "the thing we hate about people with ADD." Both Client and Mom, upon hearing this, laughed nervously and agreed it fit pretty well.

Dad is a bit of an anxious-leaner^[3]. He is a stabilizing influence in the family and has a great deal more tolerance for both Client and Mom. He is able to walk away from pointless conflicts—which at intake, Mom simply could not—but he can set down boundaries as necessary. Dad also understands Client's introversion, as he shares it, and sees client's behavior as less deviant than Mom. This proved helpful repeatedly in the case as Mom overdramatized the seriousness of the Client's conduct, without empirical evidence.

Readers may wonder why I didn't see Client alone at any point in therapy. This too was utilization. In an early session, I offered to speak with him privately after his parents had insisted on speaking with me alone. Client graciously declined my offer, and said that there was nothing he had to say that his parents could not hear. I believe this underscores Client's conceptualization of the case as a family problem that he cannot solve by himself, and this is both accurate and quite sophisticated thinking for a boy of thirteen. This being Strategic Therapy however, if I saw value in seeing Client by himself I would do so, even over his objections, and I am currently planning to do that in the tenth session to have a bit deeper discussion of his medication objections.

Carlson: What is (was) your goal or hope for the sessions?

Crenshaw: My goals were as follows:

Clarify diagnosis of ADHD versus concurrent or differential mood disorder.

Educate family and child on the nature of ADHD in a language useful to everyday communication.

Set up more functional systems of contingency for client.

Run a series of trials in cooperation with prescribing physician to determine which medications create the highest gain and lowest side-effect profile, and to assess whether Client is using side effects as a way to avoid medication that causes him to do mundane things like study and complete homework.

Assess and reduce the dyadic tensions between Mom and Client and/or reframe it as a natural part of the normal parent-child interaction.

Create a more realistic and helpful perspective of the child's behavior (e.g., he is introverted not socially isolated; he has ADHD, he's not bad; he is in a period of medication washout late in the day, not defiant, etc.).

Create a more realistic and helpful perspective of the parent's behavior (e.g., parents are attempting to increase Client's probability for life success rather than just complaining and nitpicking).

Set some limits on the child's sense that he can act out without consequence, and at the same time…

Improve choice of battles parents fight with child, increasing useful winnable ones and decreasing pointless unwinnable ones; and to time those battles when medication is at its flourish not at it's ebb. A good example is in the session where we discuss Client's desire to paint the wheels on an old worthless mower he's allowed to ride around, and Mom's nonsensical (and somewhat retaliatory) response, which leads to him using her special paint to do just that.

Carlson: When do you know if therapy is successful? Is there a typical number of sessions? How did you feel about the sessions?

Crenshaw: I actually don't terminate with clients, though we may take breaks. I recently had a former foster care client return after five years, and I believe he waited a bit longer than he should have. Those breaks are usually taken when clients feel they are functioning better and have learned all they can for the time being. I try to leave that door open. I am a believer that effort is not enough to judge success, so I look for tangible outcomes. However, because this is Strategic Therapy, what is desired in a case is always unique to the case and there is no way to know how many sessions it will take to get there. For example, I see a cadre of clients who had parents die tragically (e.g., suicide, murder, etc.) and I expect to see them for many years to come because their problem is a lack of a parent and that's not changeable. It affects all their new relationships, their belief in their own futures, and their anxiety about existence. Those are not weekly sessions. Sometimes they are only a few times a year.

In terms of ADHD, some clients only need four or five sessions to get a diagnosis and get a brief skim of my principles for dealing with it. Others gain a lot from ongoing therapy for ADHD (which is a bit like a higher order coaching), particularly those attending college or who are in early careers. The generic goal is to learn to make more intentional decisions and take more intentional action.

In this particular case, the therapy was not over at the conclusion of the transcripts but it was clearly successful in reaching several of the above goals. Parents were far more understanding of Client's problems and had learned ways to sidestep or even embrace them. Client had greater empathy for parents' situation and came to see them as trying imperfectly to be helpful, particularly as Mom's tolerance for Client improved.

Client's ambivalence about medication could not have been fully revealed and studied had we not gone down the paths we already did, and eliminated some of the pointless conflict over things like painting mowers. Many clients, even some much older than this one, flirt with life off medication. If they are correctly diagnosed and treated however, that is usually a very revealing experiment—though it often comes at high cost. Natural and logical consequences are a pain, and sometimes irreversibly so. Here, Client is at the tipping point of that kind of learning, and at this time I believe he could go either way. My goal is to see that he requires as few trials in life and makes as few errors as possible, while giving him the breadth of opportunity to learn from the mistakes he makes. As a child becomes an adult, this can be a bit like trying to land a crashing plane. So a goal of this therapy is to succeed enough for now, and invite Client to return later for the next round.

Carlson: Can you point to the successes/breakthroughs, as well as any bumps in the road?

Crenshaw: I don't look for breakthroughs as much as I do moments of clarity. Parents, particularly Mom came to see (or at least state) that Client is not a bad or dangerous person, but that ADHD accounts for much of his struggle. Mom also came to see this same condition in herself. I expected that to be a bump in the road, but it turned out to be a moment of clarity and empathy and I actually plan to take further advantage of it. Though, in session 9, it created a bit too much (confused) empathy as Mom borrowed some of Client's medication and found it helped her a lot, but also found it gave her a sort of manic (my term) buzz. She noted, "I understood how it made him feel," leading her to over-identify with Client's concerns, even as she'd only taken it for a day and the effect would be incomparable. While it was kind of nice for them to have this in common, it actually created a hierarchy failure that I'll address in the next session.

Another bump was Mom's earlier insistence that Client was dangerous. This wasn't overtly stated as in "I think he's dangerous," but was implied several times and said he had gotten "scary violent" which was not empirically true. Dad proved very helpful in reframing this, without making Mom seem hysterical. Likewise, Mom has at least tentatively come to an understanding that some of her reactions to Client (e.g., the mower painting situation) were fueling his frustration with her, and that she doesn't need to be as interested in some things as she is. However, I'm a little concerned that she has yet to find a real discipline^[4] to follow with Client, leaving her inconsistent and unpredictable.

Carlson: What do you want to make sure that the readers notice when they are reading the transcript?

Crenshaw: There are three main points:

1) The client likes being there. Few clients are as inauspicious in therapy than a thirteen-year-old oppositional, ADHD boy. This one however, conducted himself very well. Of course this is in large part due to his excellent verbal and social skills, a bit of a surprise in an introverted teen boy. But, since chance favors only the prepared mind, I had to actually harvest that opportunity by being engaging, joining with Client in the context of the family, and helping him feel understood by me (easy), his dad (not difficult), and his mom (very difficult). Readers should recognize some good examples of this in the transcript.

2) Joining with the client and family is a lot more complex than being nice to everyone and pretending to agree with them. Empathy plays a role, but it is no substitute for authenticity. I once had a parent frustrated with me because I "validated" her daughter's views of things she did not agree with (like the mother's responsibility for many of their arguments). The daughter started laughing at the mom and said, "Wow. I don't think you know Dr. Wes very well. He's not exactly into ‘validating.'" And she was right. But what is interesting about this—or at least has been interesting to me as I've come to understand it over the years—is that most clients only feel validated when they think you're being honest with them and those who just want to be validated for the sake of maintaining a fragile "self-esteem," tend not to be very successful in therapy. Clients will not respect a therapist who is disingenuous, and they will not like working with him or her as much as they will someone who is honest and a little blunt. One can easily mess that up by becoming too high-handed, but with experience those errors become fewer and farther in between.

3) One needs an ally in the family. Very often that's the child, because without his or her support, things will not go so well. That is true in this case, particularly as I did not freak out about Client's manifesto but used it implicitly to inform my thinking. But I also found an ally in Dad, who proved exceptionally skilled at joining me in being honest and directive with both Client and Mom without getting himself in hot water. An example of this was after Client was "violent" at school, midway through therapy and got suspended for three days. Dad was very pleased when I finally noted that under the circumstances, the boy Client punched in the face probably deserved it for being a bully. This is a tricky situation because utilization does not mean agreeing with someone who does something objectionable. But the situation of injustice in this example, combined with the normalcy of playground fighting among boys did not justify Mom's pronouncement that this was a sign of Client's underlying violent tendencies. As therapists, we sometimes normalize problems. Sometimes we problematize them. I opted for the former here, and I believe I was correct.

Carlson: Can you provide a context for the therapy? Where did the session take place and how the client was assigned to your care?

Crenshaw: The clients were self-referred, I believe based upon our reputation in the community for working with these sorts of clients. I tend to see more girls than boys, particularly in middle school and one of my associates sees the boys, but the family wanted to see me and after the first session, I found them to be a good fit. As Client is more talkative than the average teen boy and his parents very dedicated to the process, we got on well. They are also good with humor and I find this an essential part of such cases, particularly with all the tension built up in this one.

All sessions were in my office. We did not need to do school meetings in this case or home visits. I used to do a lot more school meetings but increasingly found schools in the area—particularly the one Client attends—to be closed systems and increasingly resentful to work with, since drastic budget cuts have limited their services. At best they pay lip service to our goals. At worst they undermine them. Fortunately, other than his playground punch, Client's school behavioral issues were minimal.

END TRANSCRIPT