Another family brings by the "problem child" and drops them off for me to fix. She* is the oldest child of five and has been exposed to severe domestic violence, physical abuse and substance abuse. And she is responding to it as any teenager would - by acting it out.
The family's first attempt to treat the child was, of course, to take her to the psychiatrist who diagnosed her with "Bipolar Disorder" because of her "mood swings" and put her on Risperdal to tranquilize her in an attempt to reduce acting out behaviors at school. I'm still amazed at how many teens are diagnosed with Bipolar Disorder because of mood swings. Isn't that the definition of adolescence? Mood swings? Geez, they must all be Bipolar then. Naturally she continued to act out. So they are now trying therapy.
Most parents want to drop off the "problem child" to be fixed. I don't do this. I insist on seeing the entire family - together. Many therapists don't do this and I really have to wonder why. Is it because it makes it harder for them? Or they just don't know how to deal with that many people in the room and all the dynamics which come into play? Or have they not been trained in family therapy? Seeing the entire family together puts the "problem" child's behavior into context. She is clearly being scapegoated. The entire family ostracizes her because of her "anger problems". Her only problem is that she is clearly carrying the anger for all the other children at the situations and conditions of violence and chaos they have experienced. Like a typical scapegoat she is the truth teller, complaining vociferously about her mother's boyfriends and the problems they create for her and her siblings. She confronts Mom. She says what the other children stay quiet about. This allows the other children to sit and smile and look like angels by comparison. She grabs her sword and shield and does battle against the things that are wrong in her family. She openly defies her mother and the two of them are locked in a power struggle. She is able to do this because her mother puts her boyfriends ahead of her children and this compromises her children's respect for her. The oldest daughter steps up to the plate to claim some of this power, and the struggles begin. The second oldest child is clearly the caretaker. She totally gives of herself to all the other children and provides the nurturing and care that the mother does not. She gives away her food, her turn, her toys, whatever, to keep the peace and please the others. The third child in line is the comedian who makes everyone laugh when things get too tense. Everyone has their role. But you can't see this unless you have the entire family in the room together interacting with and reacting to each other.
If this family can be educated about the parts everyone is playing and change those roles there is hope that the "problem child" won't have to keep acting out the dysfunction of the system. Whether or not that will happen remains to be seen. But that is what will actually "fix" this situation and this child. Fixing the dysfunction of the system fixes the "behavior problems" of the child.
If you have a "problem child" I really encourage you to face the fact that the problem may not be the child. It's most likely your parenting or the family situation. Find the courage to enroll the entire family in counseling if possible instead of scapegoating one child. If there is a boyfriend or stepmother or grandparent closely heavily involved in the family dynamic be sure to invite them to come too. I once worked with a family who had a grandmother living with them who was the major source of much of the family dysfunction. But she refused to come to therapy. What a surprise. We were still able to do a lot of good work about establishing and maintaining healthy boundaries and strengthening the parental bond so that grandmother wasn't able to jerk the parents' chains quite so much and that made a huge difference in the family's interactions.
Search until you find a therapist who specializes in family counseling. Therapists trained in dealing with the entire family may use words like, "Bowenian", "structural", or "systems" therapy to describe their specialty - which is the family as a system.