Adolescents typically dislike talking about their feelings to adults, and psychiatrists are often no exception. But asking youngsters about their favorite musicians, actors, or athletes puts them at ease and gets the conversation going.

"Adolescents are searching and struggling with issues of identity and use role models to understand who they are. As therapists, we need to understand this and draw upon this," said Eugene Beresin, M.D., director of child and adolescent psychiatric residency training at Massachusetts General Hospital (MGH) and McLean Hospital in Boston.

Beresin was one of three panelists at a workshop on using popular culture to engage adolescents in treatment at the recent annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP) in New York City. The other panelists were Caroly Pataki, M.D., medical director of the adolescent partial hospitalization program at the University of California, Los Angeles, and Jeff Bostic, M.D., Ed.D., director of school psychiatry at MGH.

"Lyrics in particular are a vehicle for adolescents to expose their vulnerabilities to us in a nonthreatening way," added Beresin.

Pataki commented that a female teenage patient of hers likes a song by popular singer Tori Amos called "Cornflakes." "Amos uses the raisins amid the cornflakes as a metaphor for feeling different from her peers and like an outcast. My patient said that she felt that way all her life," said Pataki. "That was my entrée to ask her more about what that meant and the impact that had on her life."

Other teenagers identify with lyrics that capture their need to persevere in spite of their difficulties. "A male teenage patient of mine relates to a song by the popular rap group DMX because it talks about slipping and falling, ‘but you got to get up, got to get up,’" said Pataki.

The lyrics to which teenagers sometimes relate reflect the personal struggles of musicians. "Mentioning a popular singer, like Fiona Apple or Sheryl Crow, who has struggled with depressive symptoms shows [teenagers] that even popular icons have faced this, and they are known for their talent rather than their symptoms," said Bostic.

When adolescents learn that they have a psychiatric disorder, they are extremely concerned that it will define and limit them, said Bostic. "We want them to recognize that psychiatric symptoms are peripheral to their lives and should not prevent them from fulfilling their dreams."

Bostic said that some teenagers relate more to celebrity athletes than to musicians. "A male patient of mine who plays on his school hockey team was humiliated by his obsessive-compulsive disorder [OCD]. When I mentioned that National Hockey League goalie Clint Malarchuk had grappled with OCD, he became more comfortable talking about it with me and eventually shared his problem with his small circle of friends."

Beresin said he discussed with an adolescent patient with OCD a scene from the movie "As Good As It Gets" that captures how hard it is to break old patterns. "Jack Nicholson’s character, a man with severe OCD, is trying to break his compulsion of turning the door knob seven times. When he turns it five times, the hair on the back of his neck stands up, and he breaks into a sweat," said Beresin.

Bostic has used biographical information about celebrities to help engage adolescents in treatment. "Patients who resist therapy complaining that it is not cool have become more receptive after learning that popular singer Carlos Santana or baseball player Mark McGwire have said they benefited from psychotherapy."

Beresin commented that when celebrities do reveal a personal struggle with symptoms of mental illness or substance abuse, it shows adolescent patients that despite the money and fame, they are real people like them.

"This also raises the issue of the responsibility of celebrities for conveying the right values to young people and the media for not mythologizing the celebrity," said Beresin.

However, celebrities are often not role models, and adolescent patients may say they like someone, like Kurt Cobain, who died from a self-inflicted gunshot wound. Such statements, however, can be a vehicle for talking about the singer’s struggles with depression, marriage, and fame, said Beresin.

The panelists recommended asking adolescent patients about their interests and then what music, movies, or sports they like and who their favorite artists or athletes are and why.

To learn more about celebrities and their personal histories, the panelists recommend reading Rolling Stone magazine, which features interviews with celebrities and viewing cable channels Biography, VH1, and MTV. Another resource on celebrity information is Lexis-Nexus, which is a large news database available at <www.nexis.com/research>. Click on "General News," then "Arts" and "Entertainment," and type in the person’s name and the specific mental illness.

More information on the workshop, including a list of celebrities with symptoms of specific mental illnesses or substance abuse, is in the December issue of AACAP’s journal under "Clinical Perspectives." The Web address for the journal is <www.jaacap.org>.