Q. My friend's teenage daughter is in a long-term treatment facility for drug abuse and other issues. She is not under any medication and is not bipolar. She has been in the facility for a year and a half. She also had in the past what they call low boundaries because she had sex with several guys mostly while she was under the influence.

Do you think those in charge of her treatment should confront her by telling her that she is a slut? The people who want her to admit this are not psychologists or psychiatrists but counselors and family liaison who probably and hopefully have a psychology degree. What is your advice?

A. My view is that no competently-trained mental health professional would try to get a female patient to "admit that she is a slut". Of course, there are respectful and helpful ways of getting disturbed adolescents to take responsibility for their actions, and for adapting more constructive ways of behaving. Reducing someone's self-esteem by hitting them over the head with an insult is not such a way!

I would suggest that your friend discuss this matter with the director of the facility--though I am a bit puzzled as to why you, and not your friend, are writing to me. If the facility director sticks to the "admit you're a slut" position, I would recommend seeking other professional help for this young woman.

By the way--you seem convinced that she is not bipolar, but this is certainly a question to re-examine if this individual has not been evaluated by a competent psychiatrist. Many adolescents with undiagnosed bipolar disorder manifest their illness in the form of substance abuse, promiscuity, and other inappropriate behavior.

October 2003

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