Consultation and therapy in the boarding high school setting

The tasks of a psychiatric consultant in the boarding high school setting are complex and require a particular set of tools. A thorough familiarity and comfort with the psychology and psychopathology of adolescence are necessities. In my view a psychodynamic point of view is most helpful. I have emphasized that students attending boarding schools are different from all other high school students in that they are experiencing a radical and more or less permanent separation from their homes a full developmental epoch earlier than their nonboarding peers. Whether this separation is helpful and growth promoting or traumatic and disruptive needs to be evaluated for each individual whose family seeks psychiatric opinion about such matters. Broad generalization is not possible. What is required is a careful evaluation of the developmental state of the particular teenager and an assessment of the psychologic meaning of the experience in terms of that child's psychic reality. To this formulation I add that a knowledge of the particular boarding schools under consideration, their cultures, mores, personnel, and administrative and academic styles can be of great additional help in making a decision. In addition to their radical and early separation from home, boarding students find themselves integrated into tightly knit school communities, each with its own unique group and institutional dynamics. The best consultation work will include an understanding of what is occurring at the interface between individual and school community. These interactions can be as critical in determining the fate of a boarding student as can be the interactions between a student living at home and interacting with his or her family. Separated from home and emotionally hungry for new objects to replace the ones left behind, the boarding student may have passionate and intense interactions with the institutions and members of the school community. In this article I have provided a recent example (Ted) of such an intense interaction, albeit one with a terrible and tragic outcome. Such anatomies of suicides as the one I have tried to reconstruct in this case can provide a realistic basis for optimism that a future recurrence can be prevented. Another case (Bob, discussed first) illustrated the potential for profound and far-reaching positive results of the consultation and treatment processes.