Harry Stack Sullivan1 had it right about the importance of interpersonal relationships. In 1953, he wrote about the need for a chum or a close friend for children.
A chum teaches about the reciprocity of relationships and fosters sensitivity to the needs of another person. The child learns what to do to contribute to the happiness and worthwhileness of his or her chum. Moreover, a chum provides validation of self-worth.
In my clinical practice, I often see children who have no friends. Most of these children want to have a friend, but they have been unsuccessful in forming a close friendship. They spend a lot of time at home on weekends with no interaction with age-mates. Family time can fill some of the void for these children, but it does not meet the same needs that are fulfilled by having a close friend. I can treat their depression or anxiety with medication and psychotherapy, but I cannot provide a friend for them. I find myself thinking, “Just one, if he had just one friend . . .”
With the start of a new school year, the issue of friendships becomes more acute. Many of these youths speak of their dread of going to school because they have no one to talk to and they believe that no one likes them. Lunchtime and recess can be particularly distressing because they have no one to sit with at lunch and no one to interact with during recess. One teenager spent the entire lunch period in the girls’ bathroom so that she did not have to eat by herself in the cafeteria.
Some teenagers have asked their parents that they be allowed to be homeschooled or to complete high school online because the school setting is too stressful for them. Frequently, parents accommodate this request despite my recommendation that the teenager remain in school. Isolation from peers limits a teenager’s capacity to improve the social skills needed to foster friendships. However, parents want to immediately reduce their teenager’s stress, which is understandable.
Adams and colleagues2 recently undertook an intriguing study to examine the role of a best friend in protecting against the effect of negative experiences. The study was made up of 103 public school fifth and sixth graders. Over 4 consecutive school days, students completed booklets 5 times a day. The students were instructed to write in the booklet about their experiences that had occurred 20 minutes previously. They were also to report who they were with at the time of this experience (eg, alone, with best friend, with friends, with teachers). Students were also asked to describe how they felt about the experience (eg, positive, negative). In addition, the students rated their global self-worth—“I like myself” and “I am happy with the way I am”—with responses ranging from really disagree to really agree. Saliva samples were also obtained each time the student completed a booklet, and salivary cortisol was measured.
