Chapter One Blog



Teachers & adolescent psychological development

From the August 28, 2015 Psych Central World of Psychology blog.

How Teachers Make a Difference by Jeffrey Deitz

In clinical practice, psychiatrists, psychologists and therapists are usually so consumed with treating psychopathology they don’t often get the chance to prevent it.

A dear friend, a teacher visiting from the Midwest, explained how she turned a potentially explosive situation with one of her students into a story with a wonderful ending.

Claire Keller is a sixth-grade reading teacher from Evanston, Illinois. She’s the kind of teacher everyone had once in their lives; or if not, they wished they had. Claire’s the enthusiastic encourager who relishes seeing her students “get it.” She sees teaching as a privilege, not just a job. She makes reading exciting; encourages you to use your imagination and write down your ideas; to believe in yourself and your power of communication. Decades later you might not remember a single book you read in her class, but you remember she made you feel special, and that you finished the year feeling reading could be fun, not just a drudge.

Teachers like Claire didn’t just forcefeed books because that’s what the school system selected. She found stories that were relevant and made discussions lively. By the time you finished a year in her class, you knew yourself better

Many of Claire’s students in Illinois came from families temporarily assigned to the big city, uprooted from rural America into an alien culture. RJ (short for Rosemary Jane), one of Claire’s transplants, was a gangly 11-year-old girl from Louisiana. Back home she was a tomboyish Becky Thatcher. She and her Tom Sawyer of a best friend loved shooting Coke cans at fifty feet. In Chicago, however, RJ tried too hard to be included. Between the way she dressed and her hunting and fishing stories, she put people off. The more she tried, the worse it got.

Claire had her students work in foursomes using a password-protected computer platform. One morning, a popular clique of girls collaborating on a one-act play opened their file to find graphic threats, the content so disturbing the police were notified.

Techno-savvy investigators traced the hacker to RJ’s home Wi-Fi. With expulsion and criminal charges pending, RJ’s parents were summoned to meet the authorities, a conference Claire attended. RJ’s parents knew something was wrong — to them, her personality had deteriorated almost overnight — but trying to engage her about what was upsetting just made her more monosyllabic and brooding. They didn’t know what to do.

Claire did. She took RJ aside. At first, RJ denied everything. Then Claire grasped her hands and looked her in the eye. “I know what’s been happening,” she told her. “I understand.” RJ broke into tears, recounting overhearing the popular crowd trash-talking her for being a country hick. She felt crushed, which is why she struck back. She was ashamed and mortified she had upset so many people.

Claire prevailed on the authorities to back off on expulsion proceedings long enough for her to work with RJ on friend-making; on how Chicago was different from home. Claire coached RJ about local mores, and enlisted someone from the popular crowd to mediate her acceptance into the group.

Amazingly — and this really happened — a year later, RJ had turned into a happy camper, cavorting with her new buddies like nothing happened. She even taught her new best friend how to shoot!

Without Claire’s empathy and intervention, which most people would consider exceptional, someone like RJ easily could have been saddled with stigmatizing diagnoses such as oppositional defiant disorder or antisocial personality disorder and banished to a therapeutic school. Imagine what would have happened had life taken that tack.

This is what happens when individuals like Claire, on the front lines, are tuned into their students’ emotional issues. Parents, pediatricians, daycare providers, teachers, coaches, guidance counselors, clergy, dorm supervisors, camp counselors and the police — everyone in position to spot danger signals in youngsters — needs education about psychological development and its disorders. Were a child seizing or vomiting, he would be sent to the nurse, someone trained to differentiate health from illness. The same should hold with emotional distress.

National Education Association President Dennis Van Roekel is on board. “Educators must see that students aren’t neglected or mislabeled, that every student gets specialized attention,” he said, adding, “that means extensive coursework in adolescent development and psychology prior to entering the classroom, as well as professional development throughout one’s career.”

Would RJ’s life have spiraled downwardly out of control? Fortunately, we’ll never know. The Hebrew Talmud says that to save a life is to save the world. Claire Keller did her part. Let’s do ours.

Note: details were altered considerably to preserve confidentiality.

It’s Your Turn #5; Limit-Setting Adolescents

It’s your turn #5 is a situation that often perplexes parents of adolescents. You’ll find a typical example in the subplot of my novel Intensive Therapy: A Novel.

Your teen-aged fraternal twin son and daughter want to spend several weeks of their summer at music camp. Even though you can afford it, you think it would be good for them to pay for part of it with money they earn during the school year, but they claim they’re too stressed by all their activities, homework, and community service work to take on a job. The children have adopted a “divide and conquer” strategy that has you and your spouse arguing about what’s best for the children. What next?


Marylou Porras The parents have to be one in mind regarding the future of their children. I would think that the education goals would be a priority,and if adding music camp to their already full schedule is of great benefit then they should consider the investment as well spent. The children do need to learn responsibility, it seems to me that they are showing absence of responsibility by acknowledging the fact that they have a full and stressful schedule.maybe doing some compromise regarding their community involvement might allow them some time to work and earn some of the funds needed

Anthonette Lee I most certainly would let them know that although it may seem right now that dad an I are divided , we are on the same side. Dont try to divide us. Been their done that. And while Im giving the kids that part of my mind my husband would look at my face and say to himself , oh shit I think I better agree with her right about now or My ass is grass. Then we would pay for camp, like parents should but they would pay for the extras

Response to and from commentators:

Jeffrey Deitz: Parents are unanimous: don’t let the children play one of against the other. It can be tough to say, “No” to your kids, but parents aren’t there to be friends.

Children must learn to pitch in and compromise, attributes needed to form stable and enriching relationships. The family unit is the breeding ground of these life skills. It’s great to do community service, but as is often said, “Charity begins at home.” When parents don’t model saying, “No,” or “We need to find a workable compromise,” children don’t learn how to say, “No,” to themselves or come to terms with the notion that compromise is not a win-lose situation.

In my practice, when parents say, No,” I don’t often hear teenagers respond in the moment, “Thank you for setting limits and making me a more responsible young adult!” But it is remarkable how they internalize their parents’ strength of character and are able to say, “No,” to temptation and use compromise to enrich their long-term relationships. It may not be until years later, when they have matured or become parents themselves, that these youngsters thank their parents for teaching them these skills of a lifetime.

One of the most ego-enhancing, self-esteem building activities a youngster can do is have a successful experience doing a summer job. It teaches responsibility, impulse control, and relationship skills. I’m all for developing artistic proclivities, but I know that the developing teenager will work harder and learn more at art camp when they’ve paid for it themselves.


Laicindia Curtis You have hit on the head . Kids don’t get it until they become parents them selfs but as children we the parents are the bad one.

Paulette Jackson Exactly these kids don’t need a friend they need a old fashion mom and dad in their life and don’t forget the strong grandma,granddaddy. also when we was little it took the whole community to watch their kid. but now today you tell someone that their children or child doing this and
that they don’t believe you at all when you go and tell the grow up that you see their children doing something first thing they tell you oh you lie on my child i believe in old fashion we problem need to go back old school a teach these young parent how too be parents and not a friend only when in need too be a friend but right now these parents need to get it together because we is lose a lot of children with guns today and it’s very sad we got too pray harder


Look for “It’s Your Turn: #6 coming soo. Thanks everyone for your thoughtful comments.

For more about Intensive Therapy: A Novel visit Twitter: @JDeitzMD  #Itsyourturn

See you soon.


IR’s 5 Star Review: Intensive Therapy

Indie Review Top Book Pick: Intensive Therapy


Transformation over twenty years in: INTENSIVE THERAPY: A NOVEL

By Jeffrey Deitz

Rating:  star star star star star

IR Verdict: INTENSIVE THERAPY: A NOVEL is an excellent read with very good pacing; so much so that at times it’s difficult to put down.

“Author Jeffrey Deitz, a psychiatrist and psychoanalyst himself, uses language and terminology that is credible and illuminating.”


Book Reviews, IR Approved, Literary Fiction  •  Aug 07, 2015

“INTENSIVE THERAPY: A NOVEL follows the relationship of a doctor and his patient from their first therapy sessions in the 1980s, then shifts to 20 years later to demonstrate how that therapy has transformed and affected them both.

In the story, a young beautiful woman in her twenties named Victoria Schone comes in for treatment to help her cope with being bi-polar, and to deal with her parents, mainly her demanding mother, Lorraine.   She receives treatment from Dr. Jonas Speller, a young handsome doctor of similar age, who is refining his treatment skills that include aspects of breaking the barrier between patient and therapist.  The treatment is so successful that not only is the patient helped by the therapist, but the therapist is helped by the patient.

This aspect of people helping each other through their contact with one another is the crux of this family novel.  Throughout the novel the reader sees examples of how the various close interactions with others helps one to make or remake themselves.  In the novel there is an exchange between Victoria and Jonas, which seems to sum this up completely:

“You changed my life, Jonas,” Victoria said. “I wouldn’t be me if it weren’t for you.”

“You changed my life, Victoria,” Jonas echoed.  “I wouldn’t be me if it weren’t for you.”

INTENSIVE THERAPY: A NOVEL focuses on this interplay that occurs between people throughout life, and the type of effect this interplay has on them.  Author, Jeffrey Deitz, a psychiatrist and psychoanalyst himself, uses language and terminology that is credible and illuminating.  The reader gains a great understanding of what goes on in the mind of a therapist as they’re listening to the thoughts and dreams of a patient as recounted by Dr. Speller through his analysis.  It’s quite an education in itself of just what comprises psychotherapy.

The author’s use of description is quite vivid, as in the example that occurs when recounting an accident in which a young man receives brain damage from a head injury; it is both enlightening and frightening at the same time.  The pacing in these scenes is quite intense and believable.  It’s also gratifying to see doctors at work, and doing their best to save a patient under extreme circumstances. Dr. Jonas Speller’s philosophy of life and psychotherapy are exactly what one would hope for from a doctor, caring and hopeful.

INTENSIVE THERAPY: A NOVEL is an excellent read with very good pacing; so much so that at times it’s difficult to put down.


It’s Your Turn #1 Cutting Behavior in adolescent girl July 2, 2015


July 2, 2015

Welcome to the page’s new interactive feature called “It’s your turn,” where you get to be the therapist. FYI, all the situations are hypotheticals; no one’s confidentiality is compromised. Here’s the situation: you’re treating a 17 year old girl with cutting behavior and poor impulse control who “fired” her last therapist for telling her mother that she (the patient) was planning to snort heroin. Today, she (the patient) says she’s planning on seducing one of her teachers who she thinks has a crush on her.
You’re the therapist. What would you say or do?

There’s no one right answer. Most imaginative response wins a signed first edition of Intensive Therapy: A Novel. Feel free to share with your friends.



Jeffrey Deitz

It’s Your Turn #1 Response July 6, 2015

Thanks everyone your comments; it’s obvious that you really took time to think through and communicate your ideas. I’m thrilled to say that “It’s Your Turn” has a future on our page.

The comments in this case focused on two important and related questions:

1) What issues within this young woman’s mind that are driving her to ‘act out’?


2) To what degree is a therapist obligated to intervene should he or she decide that the patient’s mental state renders him unable to control him or herself and act in his own best interest?

To the first point, one hopes that a skilled therapist’s probing, understanding, listening skills and empathy reduce the pressure to ‘act out’ and create an ambiance conducive to ‘talking things out.’ Here is where exploration and discussion of past traumatic experiences and inner motivations such as a poor self esteem, past history of trauma, body image issues, family-of origin issues and unresolved conflicts belong. Encouraging youngsters to put their feelings into words can be remarkably therapeutic. Can talking things out prevent self-injurious behavior? Yes; but, unfortunately, not always. That’s where clinical judgment comes in. So for example, if the acting out with the teacher was an attempt to turn the tables psychologically on someone who sexually abused the patient earlier in life, talking that trauma through may not only stop the patient from acting out, it could form the basis of a powerful therapist-alliance: the most desirous outcome possible.

To the second point, if the patient is too impulsive or psychologically disturbed to respond to the therapeutic dialog that reassures the therapist that pressure to act out is relieved, the therapist has an obligation to intervene in the patient’s life. Warning the potential victim of the patient’s schemes has a role. So does involuntary institutionalization if the patient is completely out of control. Sometimes a patient is literally pleading for restraints (limit setting) to keep her safe from self destructive behavior, and needs her therapist to be strong enough to take matters firmly in hand to prevent harm. A young woman like this could easily be under the influence of drugs or in a hypomanic state where talking things out would not be enough to prevent acting out.

I urge therapists-in-training to get families involved right from the beginning as a parameter of starting treatment, and make it clear to the patient that requests for confidentiality will be honored up to the point that no one’s well-being is in danger. After that therapists need do everything in their power (including institutionalization if necessary) to keep a situation from deteriorating. It’s the therapist’s job (not the patient’s) to set the ground rules for treatment.

I’m contacting the “winners,” although everyone deserve kudos for such thoughtful responses.

Great job everyone. We’ll do this again soon.

Creativity for Better Performance

Creativity for Better Performance

cultivate_creativityA long term-patient told a fascinating story a couple of weeks ago which points to the power of creativity in strengthening critical thinking. The person’s identity is well-disguised so no confidentiality is breached.

For several years I have been treating a young man (we’ll refer to him as Collin) with psychostimulants for chronic ADD and psychotherapy to address his perfectionism. We’re also working on finding a work environment conducive to combining his entrepreneurial proclivities and his considerable technological savvy. (He taught himself to code a complicated computer program that would benefit his industry.)

Therapy is going well, in the sense that Collin has extricated himself from both a relationship and a job that were going nowhere. For the time being he has landed in a better, although not perfect, work situation. It both pays the bills and affords him time to develop his project, which he and several associates are beta-testing and rolling out in the coming months.

With extra time on his hands, Collin decided to take one of a series of tests which would prove valuable in credentialing him in his profession. True to his personality — he would never take such a test unprepared — Collin took a comprehensive review course in preparation for the exam. In therapy we discussed the mentally exhausting hours he spent cramming for the test, trying to outlast the voluminous material by memorizing page after boring page. His study sessions lasted hours upon hours, during the last of which he hardly remembered a thing.

“You can probably find a more productive way to study,” I counseled.

“Huh,” he replied. “What are you talking about?”

“There must be a way to work study breaks into your schedule,” I said. “It’s like athletes who take a few minutes off to give their muscles time to reconstitute between exercise sets.”

“What would that do?” Collin asked.

“Give your brain chemicals a change to replenish themselves,” I said. Even with psychostimulants on board, one could temporarily deplete the neurotransmitter dopamine. (Dopamine is essential for optimal function of brain circuits involved in sustained attention, focus and concentration.) Trying to process too many facts is like overwhelming a sieve with too much liquid to filter.

Neuroscientists understand that material such as Collin was trying to process (known as declarative knowledge) has to be funneled through a brain structure called the hippocampus. It didn’t evolve to cram information in the way Collin was trying to get it to do. “There must be some kind of brain-refreshing pursuit you could employ for a few minutes each hour. Everyone has some,” I said.

“I’ll work on it,” Collin said, as the session ended.

The next time we met he proudly presented a sketchbook he had begun to bring with him to study sessions. His sketchbook was replete with interesting pen and ink renderings of buildings around New York City. At first the drawings were very literal; then, as he got better, they became more abstract and impressionistic.

“I didn’t know you drew,” I said.

“Oh yes,” he responded. “Back before college I was always drawing something. It cleared my mind.”

Most of the drawings were enclosed by a sharp border around the edges. But in one of the most recent, the content spilled over beyond the border.

“Look at this,” I said referring to that drawing. “This tells us you’re beginning to think outside the box!”

The idea made Collin smile. “There’s something else,” he added. “It has to with using pen and ink as opposed to charcoal and pencil. You can’t erase ink, which means you are committed to every line or shape you draw.”

“That’s interesting,” I said. “I don’t draw, so I never thought about it.”

“Being committed, like I feel when I’m drawing, helped me during the test.”

“How so?” I inquired.

He replied, “Usually, when I take multiple choice tests like the one last week, I second-guess myself about the answers, waffling back and forth wasting time. This time was different. Once I made my decision about an answer I stuck with my first impression. I had more belief in my convictions, which reminded me of what it felt like drawing in ink.”

“As far as your performance on the exam … ?” I probed.

“I’m not worried about it. My mind was clearer. I feel I did well. I did the best I could.”

Isn’t it refreshing to hear how creativity synergizes with learning? Some people’s best ideas sprout when they’re relaxing or being creative. Grade schoolers are encouraged to spend hours drawing or playing music. Then in middle school and beyond, their creativity is drubbed out with mind-numbing math homework or essays on topics that would put a gazelle to sleep. Collin’s experience is a wonderful example of how using one’s creativity improves performance and the sense of well-being.


About Jeffrey Deitz, MD

Jeffrey Deitz MD is a psychiatrist and psychoanalyst in Connecticut and New York City. For years Deitz, who teaches medical students and supervises psychiatrists-in-training, wrote for the professional literature about psychotherapy, conducting seminars about the role of psychotherapy in treating PTSD and Bipolar Disorder. In 2010, he began publishing in the New York Times and Huffington Post about sports psychology, the power of psychotherapy, and the public health risk of sleep deprivation. Deitz’s first novel, Intensive Therapy: A Novel, a fiction about the life-saving relationship between a psychiatrist and patient, has recently been published. For more information visit:

Inside “Inside Out”

Inside Inside Out Jeffrey Deitz MD

My wife and I spent rainy day watching the new Disney Pixar movie Inside Out, an animated feature that takes movie-goers inside the mind of an eleven year old girl named Riley. Riley is overwhelmed with anger and sadness when her family uproots her from an idyllic life in Minnesota and moves to the strange environment of urban San Francisco. To make matters worse, Riley’s father’s business begins to fail and the high cost of living necessitates living in a dreary fixer-upper. As if nothing else could go wrong, the moving van gets lost and Riley is disconnected from the comforts of home that might help ease the transition.
In the movie—and this is something that animation can present extremely effectively—the core of Riley’s inner life is represented as place within Riley’s mind aptly named Command Central. Five basic emotions, each embodied by a character, jockey for control: “Joy” (who looks and acts like a bossy Tinkerbell) is used to controlling of Riley, whose parents need to see her as Happy Girl. They either don’t get, or cannot accept, that Riley—like all youngsters—is a mixture of emotions.
This is a powerful and imaginative way to portray the relationship between a person’s outside, and what’s going on inside their deeper emotional life.
As a result of the abrupt change in Riley’s life, Joy—who is used to dominating Riley’s inner life—loses control. Up until this point in Riley’s emotional development Joy is the protagonist, who sees Sadness as an antagonist whose very existence is a threatens Riley’s emotional stability.
The dramatic tension in the movie arises as Joy recognizes the importance of Sadness (who looks and acts like Lucy Brown with a permanent puss), Anger, Disgust, and Fear, all of whom want their say in controlling Riley’s dreams and behavior. As Riley sinks into depression, Joy and Sadness become separated from Command Central, and Riley’s inner world—represented by islands of good coping such as friendship (Riley’s best friend from home makes her jealous when it looks like Riley can be easily replaced), athleticism (Riley’s an excellent ice-hockey player who loses her confidence and temper om the new hockey team), and family ties (Riley’s father misinterprets his daughter’s sullenness and punishes her for having a bad attitude), crumbles piece by piece. In effect, she loses herself.
What makes the movie ring true emotionally is Joy’s poignant realization that she needs Sadness if Riley is to come to terms with the emotional chaos she faces. What a paradox!—and one whose implication all children (and their parents) need to accept: that in order in to meet the challenges inherent in life’s travails, Joy and Sadness must learn not to just coexist, but to cooperate. Without them, adaptation to change becomes impossible.
Long time ago in 1914, Sigmund Freud penned a classic paper entitled Mourning and Melancholia, in which he took up the subject of grief and depression. Although his theory of depression was misguided, he was right on in recognizing that grief—the feelings of sadness about the loss of a deeply cherished, unambivalent attachment (or in Riley’s case several attachments)—is as central to mental well-being as is scab formation to wound healing. Grief hurts; but it also heals. To avoid the pain of grief is to invite depression and despair. In Inside Out, it is only when Joy lets Sadness take the lead in a moving scene where Riley and her parent share their sadness with each other, that Riley’s psyche reconstitutes, and we see Riley calling on her Inside strengths, to give her confidence that she can meet the challenges coming from without.

Jeffrey Deitz MD is a psychiatrist and psychoanalyst in Connecticut and New York City. For years Deitz wrote for the professional about psychotherapy; he also conducted seminars at international conferences about the role of psychotherapy in treating PTSD and Bipolar Disorder. In 2010, he began publishing in the New York Times and Huffington Post about sports psychology, the power of psychotherapy, and the public health risk of sleep deprivation. Deitz’s first novel, Intensive Therapy: A Novel, a fiction about the life-saving relationship between a psychiatrist and patient has recently been published. For more information visit:

Being and Becoming: Learning to love learning

Friends, family and patients often talk about what they want to be. “I want to be rich. I want to write a book. I want to be a better parent.” Children are often asked by their parents, “What do you want to be when you grow up? I think there’s a better way to approach the subject. Why not ask, “What do you want to become when you grow up.”  It is so easy to get involved in wanting to be that one loses sight of the processing of becoming. For if people don’t find the joy in becoming they’ll never be who they want to be.

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