She sits sullenly looking at the floor. They all do, the teenagers roped into therapy by angry parents. “It isn’t enough that she isn’t doing her homework; it turns out she’s online with boys behind my back,” growls Mrs. Portnoy. “She’s only 14 and I’m scared to death what she’s getting into.”

Sylvia continues to stare at the floor. Not a sign of life.

Mrs. Portnoy continues, “I’ve pleaded, I’ve argued, I’ve yelled…”

Sylvia suddenly comes somewhat alive, remarking, “‘Screamed’ is more like it.” For some reason, the teens seem to have found the subtle distinction between yelling and screaming. I’m always impressed with that—and saddened, too, that they should have had so much exposure to the two forms of expressed anger that they can make such fine distinctions.

“Yes, that’s right,” glowers Mrs. Portnoy, “because nothing I say or do works.”

“We both try,” Mr. Portnoy pleads, perhaps slightly embarrassed by his wife’s forcefulness.

There I sit, compelled to be diplomatic towards the poor Portnoys who truly want the best for their child, are clueless how to get it, and—worst of all—are causing much of the problem their child is facing. I must be loving and gentle with the Portnoys in helping them because if I’m the least bit challenging, the least bit confrontative, the least bit offensive (and people can take easy offense when hearing that they did something wrong), they’re out the door and Sylvia will be resigned to an awful life: a life of self-doubt, low self-esteem, confusion, and self-hate. She may also get involved in drugs, gangs, or early pregnancy. This is not an exaggeration. I wish it were.

I begin delicately, and, depending on the context, I say something like, “Have you attempted any trust building?” I know that if I start out totally vague and confusing, I get their interest and, best of all, I don’t raise any defenses.

The Portnoys predictably look dumbfounded. “I don’t trust her at all,” Mrs. Portnoy remarks. “Is that what you mean?”

“Yes, exactly,” I reply, knowing that I must start with something she can relate to, even if it isn’t exactly what I did mean.

“For you to trust her,” I nonchalantly lower the boom, “she has to first trust you.”

The Portnoys, predictably, look very uncomfortable, but I have raised Sylvia’s level of interest.

“What do you mean?” Mr. Portnoy asks.

Definition of Trust

“Maybe if I define what I mean by trust, it will make my question easier,” I reply. “Trust is the belief that things will be all right even when we screw up. In other words, trust is not dependent on our actions. We can screw up and still know that the world won’t come to an end for us; we didn’t mortally ruin our lives. A good example of this is the relationship we should believe we have with God. We believe that although we mess up, sometimes badly, He still loves us and is there for us.

The Portnoys are quiet, absorbing all this.

“So,” I conclude, “in your case, my question becomes: Does Sylvia know that she can screw up and not get her head handed to her? Does she trust you enough to be vulnerable, wrong, foolish, or mistaken—in short, herself, being human—and still get love, warmth, and respect?”

It’s at this point that one or both parents usually get honest. They start to assume responsibility for the mess confronting them.

Mr. Portnoy heaves a deep sigh. “No,” he says. “She can’t trust us not to yell.”

“You mean scream,” Sylvia interjects.

The Portnoys sigh.

“So, we have to create trust,” I say. “Okay. Sylvia, suppose I got your parents to 100% guarantee that they would not scream at you—“

She cuts me off saying, “I don’t believe you can do that.”

“For argument’s sake, let’s say I could,” I go on, “would you be willing to cooperate in some of the things they want from you?”

“Oh, sure, but—“ Sylvia starts to protest.

At that moment, Mr. Portnoy, a bit annoyed, points out the obvious: “Excuse me, Doctor, but you’re forgetting that the only reason we lose our patience with her is because she’s not doing what she’s supposed to. You’ve got cause and effect mixed up.” He settles back in his chair, pleased with himself for his well-made point.

The Contract: No Screaming Even If She Screws Up

“You’re absolutely right, of course,” I always say. “Unfortunately, however, in her mind, cause and effect did somehow get mixed up. Now, we’ve got to fix that. So, can you name the top three things that you would want from her that she will make a major effort to do? In return for that effort, you will not yell or scream at her—even if she screws up.”

Mr. Portnoy is becoming increasingly annoyed. “What do we gain if she doesn’t end up cooperating and we don’t yell at her anyway?”

“Trust, Mr. Portnoy,” I reply. “Trust is the building block of the parent-child relationship. Make every effort to coax, remind gently, give rewards if you want, but whatever you do, don’t allow that trust to be broken. I promise you, if you can restore that trust, eventually, she will not only cooperate, but better, she will want to cooperate.”

“Jack, she’s right, you know,” Mrs. Portnoy says.

“I know,” he replies.