As a psychiatrist who specializes in working with teens, I hear "it" discussed often - quietly, tentatively at first, until the teen decides that I am "OK." Usually the words are whispered until the teen feels more trusting . . . Does this doctor really want to hear what I have to say about this or is she going to give me a lecture? Can I ask her my questions or will she think I'm stupid? I bet she never had this problem. In fact, I bet no one has every had this problem, but maybe I could tell her it was some other kid, not me . . . never me.
All teens have stories to tell, stories that need to be listened to, stories from which we can learn a great deal. Listening closely, I have realized that teens want to talk about sex, but with adults they trust. They want to be listened to, and they want nonjudgmental conversations. Conversations about sex are unusual among adults, so it is not surprising that they are even more rare between adults and teens. Often, adults have to start these conversations; at the very least, they have to be ready to pick up the teen's clues and listen.
Discussing Sex at Camp
It has been my experience that camp counselors and staff are willing to listen to teens and that conversations about sex are taking place. Many teens have told me that camp offers them a place to try out new things, and this includes the sexual arena. They take risks - both healthy and unhealthy - and test parts of their personality that they have kept hidden. Experimentation with sexuality is a vital part of camp for many kids.
What do camp staff members need to know about this important area? Will they recognized the teens clues? Will they be ready to listen when the topic is raised? Will they ask for help if they need it? Will they recognize that they have done a good job?
The following stories illustrate some of the challenging ways that sex can come up at camp.
Case Study: Rachel and Monica
Eighteen-year-old Rachel, a camp counselor at a California wilderness camp, came to see me after she had just finished struggling with a thirteen-year-old camper, Monica. Miles into the California wilderness, on the first night of a week-long trek, Monica, stimulated by the physical and emotional warmth of the campfire, told her fellow campers and counselors that she was being sexually abused by her stepfather. Rachel and her fellow counselor met and talked nervously after the girls climbed into their sleeping bags. What could they do about this? How should they handle it? Radio back to camp, yes, but pack her out? The trip was just starting. This was the first time Monica had every spoken about this to anyone. She seemed OK, but then how would they know? What was really going on inside her head? She was probably fine.
Monica was fine, for the night. By the next day, she seemed anxious, hands shaking, and at that evening's campfire, she appeared frozen, sitting and staring. The other girls on the trip were worried about her and privately told the counselors their fears. Rachel and her co-counselor were worried, too.
The next day, although the temperature was over ninety degrees, Monica was shivering and could not say a word. Rachel found herself spending all of her time with Monica, rubbing her back and trying to comfort her with soothing words. Late in the afternoon, Rachel and her fellow counselor made the decision. They would have to get Monica out and work with the other girls, who had also been affected by this. They called the base camp for help and got it.
Rachel decided to leave with Monica, staying with her until she was hooked up with a trained social worker from Child Protective Services. Then Rachel, although exhausted, went back to the wilderness site and rejoined her group.
Two weeks later she came to see me, believing she hadn't done enough for Monica. She had lots of questions. She and her fellow counselor should have seen what was happening that first night and stopped it, shouldn't they? Rachel believed that they had made it worse for Monica by keeping her with the group. Maybe the campfire conversations had been too stimulating, just what had the group been talking about, anyway? Should they have stopped Monica at the beginning of her story? Rachel had experienced a funny feeling in her stomach when Monica had begun to speak. She had known what was coming.
I asked Rachel what the directors of the camp said about how she had handled the crisis. Reluctantly, she admitted that they had told her she had done a good job; they were proud of her. In fact, one of the senior staffers had told Rachel that she couldn't have done everything that Rachel did for Monica and the other campers. But, Rachel didn't believe what they said. Monica needed even more help than she had given
her . . . it wasn't enough.
I agreed. Monica needed more help than anyone could give her at this tough point in her life. Rachel had done as much as she could. When I questioned her, she remembered that one of the directors had asked whether Rachel should rejoin the group and commented that it was a lot to take on after just dealing with Monica.
Helping campers cope in a changing world
Rachel's and Monica's story is dramatic, but it highlights much that camps are facing in the area of adolescent and child sexuality. First, many teens tell me that they feel their camps are safe settings. Feeling safe, at least during the moment, Monica chose to disclose something about her stepfather, something frightening and deeply painful. Monica was like many teens. Sexual abuse is only one of the many secrets teens hold; fears that they have a sexually transmitted disease or are pregnant or bisexual or gay or even asexual are also common. Their myths and misconceptions about sexuality are often shyly volunteered, usually with a disguise: "I have a friend . . . ."
It is also important to understand that the pace of teen sexuality is stepped up in today's world, running faster than it did thirty or even ten years ago. Teens are developing physically two years faster than they did twenty years ago, due to improved nutrition and less frequent disease, but their minds are not any more advanced. This results in children's minds inhabiting fully developed sexual bodies. There are many consequences to this. It clearly impacts the early age, now sixteen on average, when teens have their first experience with sexual intercourse. It might also be affecting higher rates of sexual abuse.
Our culture's view of adolescent sexuality has also changed. Though still largely restrictive, it is primarily confused, alternating its message between restrictive and permissive (promoted by the media) and violent as well. Violence, or at the very least, coercion, is a component of sexual abuse. One third of all girls and 15 percent of all boys will be abused during their teen years or even younger.
Although Monica's story reminds us of the frightening aspects of teen sexuality, we also see Rachel, another teen, identify and care for her. It is more than Rachel can handle, but it shows the potential strength and courage of young people struggling with an impossible problem.
Case Study: Experimentation
The same summer I was contacted by Rachel, I was called by a camp owner who was grappling with an even more common situation. One hot, summer evening, three fifteen-year-old boys and two girls had sneaked out of their cabins and met at the camp's swimming pool. Not surprisingly, they had gone swimming, but that was only part of the story. One of the girls and two of the boys had had oral sex. They had sneaked back to their cabins undetected, but the next morning one of the girls, the one who didn't have sex, told.
Things at the camp went smoothly at first. The camp had a protocol, which was followed. When he phoned me, the camp director sounded frustrated though. The father of the girl who reportedly had had oral sex with the boys was threatening to sue. He had also obtained the e-mail addresses of all the camp parents and had sent them an unflattering account concerning the camp's handling of the matter. The camp director and I had several discussions, following his steps as he met with and calmed the parents, consulted an attorney, and struggled with what he could do with his campers. Eventually, he decided to have campsite discussions in small groups led by individual counselors and the camp nurse. In preparation for this, he scheduled training for his counselors and all the staff, including himself. He learned many important things, among them that many of the teens attending his camp had participated in little or no sexual education. Complicating this even further, they saw camp as a place to experiment.
Addressing myths and misconceptions
One of the most important changes in the sexual landscape during the past twenty years has been the advent of HIV, the human immunodeficiency virus. The lethal risks associated with HIV have been frightening for adults and teens alike. One quarter of those infected with HIV acquire it as teenagers; one-half of those who contract the virus acquire it during adolescence and young adulthood (up to age twenty-four). The crisis has encouraged the United States to begin examining its attitudes about sexuality.
In a recent interview I did with Dr. Joycelyn Elders, the former U.S. Surgeon General, she said that she believes that HIV has done more to change attitudes toward sexuality and sex education than anything else in the past decade. It has forced the United States to look at an area of taboo. Conversations about teen sexuality have started. However, Dr. Elders also said, "We need to know what our teens are doing in the backseats of cars, and we don't." She's right about that, and of course it's not just what is going on in cars. Teens are sexually active everywhere - most commonly in their homes. Before we find out where teens are doing what sexually, we need to be able to both listen and talk with them about sexuality.
Kids have misconceptions about HIV. The camp director at the camp mentioned earlier discovered that many of the kids believed that they could not get HIV from oral sex, which they thought of as good protection. The campsite discussions addressed this myth. The director also discovered that the strong and narrow gender roles that existed in the 1950s - macho boys and passive, objectified girls - are alive and flourishing in 2000. Earlier puberty, women's position in the culture following the feminist struggle, media images, and lack of sexual guidance all contribute to these limited roles for both boys and girls. This, too, was a topic for campsite discussion.
The director feared that parents would protest his efforts. They did not. They were more in the dark than he was, and he informed and educated them about the process. He also feared that it would stir up sexual risk-taking among the campers. Here again, his fears were unfounded. He recognized that teenagers have sexual lives, whether they're