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Psychotherapy with Adolescent Girls PDF

268 Pages·1986·3.86 MB·English
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Psychotherapy with Adolescent Girls SECOND EDITION Psychotherapy with Adolescent Girls SECOND EDITION Doris Lamb, M.D. University of Southern California School of Medicine Los Angeles, California PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Lamb, Doris. Psychotherapy with adolescent girls. Bibliography: p. Includes index. 1. Adolescent psychology. 2. Adolescent girls-Mental health. I. Title. [DNLM: 1. Psychotherapy-in adolescence. 2. Psychotherapy-methods. WS 463 L218p] RJ503.L35 1986 616.89'14 86-12211 ISBN-13: 978-1-4684-5118-4 e-ISBN-13: 978-1-4684-5116-0 001: 10.1007/978-1-4684-5116-0 © 1986, 1978 Plenum Press, New York Softcover reprint of the hardcover 1s t edition 1986 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Foreword When I was getting my medical and psychiatric training in the late 1950s and early 1960s, the model of normal and deviant adolescent development was the white male. This was not surprising, since for every clinical or psychological study of adolescent girls done during the past 2 decades, there were seven studies on adolescent males. This tremendous discrepancy in actual clinical and research data between male and female adolescents led to the following myths: (1) Female adolescents are different only biologically from their male peers; they have similar psychosocial problems; (2) Adolescent girls have not been studied because their problems are not worth studying; (3) Studying adolescent girls might be dangerous to either the patient or therapist, or to both. In relation to the third myth, male psychotherapists were told that they should not treat female adolescent patients because erotic inter play could develop, which would be harmful to the patient and per haps impossible to resolve. Many clinics in the United States had a rule that young adolescent girls could not be treated by male therapists. It was thus difficult for girls to obtain treatment-for most therapists were males. It also intensified the feelings among parents, teachers, v vi Foreword community leaders, and the girls themselves that perhaps female adolescents were not worth treating. We still know very little about either the normal or the deviant psychological development of adolescent girls. Much more needs to be done before we will have a meaningful data base from which to com pare male and female, young and old, and normal and disturbed adolescents. There are some encouraging indications that we are en tering a new era of federally supported research where adolescents in general and female adolescents in particular will receive special atten tion (see, for example, The Presidential Commission Report on Mental Health, Washington, D.C., 1978). There is also a crop of young, vig orous, and interested female social and behavioral scientists, who have stated that they are specifically interested in studying female develop ment. Much new data will undoubtedly emerge from such research. Within the context of this momentum, Doris Lamb's book arrives as a timely contribution to a pressing current need. She writes from the perspective of a seasoned clinician who is obviously comfortable in her work with troubled adolescent girls and their despairing fami lies. There is a great deal of clinical wisdom in this book that will help all mental health professionals working with adolescent girls. The many vignettes will surely aid those of us who at times throw up our hands in frustration when trying to help a particularly difficult teenager. I am confident that this volume will also serve interested par ents and the public at large because of the wealth of sound clinical ad vice which the author shares with all of us. Although there are no simple or quick answers to helping a per son in trouble, Doris Lamb has demonstrated how different psy chotherapeutic techniques can be of great value to a variety of adoles cent girls in the midst of serious psychosocial crises. June, 1978 ADDENDUM The new, 1986, edition of Psychotherapy With Adolescent Girls by Doris Lamb is an expanded version of the earlier 1978 volume. It is extremely rich with clinical material, and its down to earth ' 'pragmatic psychology of adolescence" is both refreshing and enlightening. It is Foreword vii written by a psychiatrist who has worked extensively and intensively with adolescent girls over the past 2 decades, and in the process has become a leader in the field of adolescent psychotherapy. Her vast ex periences should help any mental health professional who works with adolescents: psychiatrists, psychologists, and social workers. There is also plenty in the book that should be of interest to teachers and, last but not least, to the parents of adolescents themselves. The past 8 years, since the first edition was published, has seen a major increase in studies of adolescent girls. The studies have fo cused mainly on normal psychological development. Books such as Gilligan's In a Different Voice: Psychological Theory and Women's De velopment are surely excellent examples of the above. These studies stress that women's development has to be studied in its own right not as part of the male life cycle. There is still a tremendous need to focus on particular psychiatric difficulties and specific therapeutic tech niques when working with adolescent girls. This is what the book does, and it does it brilliantly. DANIEL OFFER, M.D. Chairman, Department of Psychiatry Michael Reese Hospital and Medical Center Professor of Psychiatry University of Chicago January, 1986 Preface to the Second Edition Some years ago I wrote a book entitled Psychotherapy with Adolescent Girls. The book was well received. Many people bought it. Many wrote me complimentary letters indicating that reading the book was of value in their dealings with teenage girls. Yet, I was not satisfied that I had been altogether successful in communicating clearly my philosophy of treatment with adolescent girls, except through my case examples. In these intervening years I have further thought through what I was try ing to say, and in the process, I have become less fettered by tradi tional dogma that had gotten in my way. This book is the book I intended to write in the first place. I hope it will better explain that my treatment of adolescent girls is pragmatic and based entirely on the needs of the patient; it is not, in any way, an attempt to validate or practice a treatment philosophy based on my or any other therapist's previously learned theory of psychotherapy. Throughout the book there are many case examples of the vary ing needs of patients and how these needs are met. I begin by describ ing the effectiveness and urgency of setting limits on acting out, es pecially for the self-destructive, younger adolescent. I then describe cases where allowing and even encouraging the adolescent girl to be- ix x Preface to the Second Edition come dependent upon me, to feel that she is being cared for and nur tured, is extremely valuable in reducing the depression and despair of the adolescent until such time as she can mobilize herself to face her life with all its problems. In some cases, the therapist needs, from the onset of treatment, to encourage the girl to mobilize herself to act rather than passively give in to her depression. The therapist will prob ably need not only to offer encouragement but to make concrete sug gestions of what the adolescent girl can do that might be helpful, tak ing care that the suggestions are within her capabilities and will produce success experiences that contribute to her sense of mastery. If one looks through my references or though my annotated bib liography, it will be clear that I have acquired a psychodynamic orien tation. This orientation, however, is only a way of conceptualizing the adolescent, her interactions, her strengths, and her deficiencies. One must, it seems, have some way of conceptualizing the person and her problems. This does not mean that my treatment resembles psy choanalysis. For instance, I feel that insight, in its classic meaning interpretation of the transference and interpretation of unconscious fantasies-is of little value in the treatment of the adolescent girl, and can, in fact, be a detriment. I have added two chapters on the psychiatric hospitalization of adolescent girls. Indications for when hospitalization is necessary are covered in these chapters, as a timely decision of when to hospitalize the adolescent girl is often necessary to prevent a disastrous, or even fatal outcome. Case examples of how to use the psychiatric hospital effectively are also included. Much of what appeared in my previous book is used again in this book. It has been carefully reworked throughout to make clear what I think pyschotherapy with adolescent girls is all about. New cases have, of course, been added. Can one find any rationale in the psychotherapy of adolescent girls? Are there techniques that work? Can it even be done? I hope the reader of this book will conclude that the answer to all these questions is yes. DORIS LAMB Contents Foreword. . .. . . ... .. . . . . ... .. .. .. . . . ... .. .. . .. .. v Daniel Offer Preface to the Second Edition. . . . . . . . . . . . . . . . . . . . . . ix 1. Essential Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. The Younger Adolescent in Psychotherapy .......... 21 3. Depressed Girls in the Earlier Phase of Adolescence .. 35 4. Limit Setting on the Younger Adolescent . . . . . . . . . . . . 63 5. Depression in the Older Adolescent ................ 87 6. Acting Out in the Older Adolescent. . . . . . . . . . . . . . . . . 113 7. Therapeutic Use of the Psychiatric Hospital for the Depressed Adolescent Girl. . . . . . . . . . . . . . . . . . . . . . . . 135 xi xii Contents 8. Therapeutic Use of the Psychiatric Hospital for the Acting-Out Adolescent Girl. . . . . . . . . . . . . . . . . . . . . . . . 161 9. Problems of Transference and Countertransference ... 181 10. Advising Parents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 11. Guidelines for the Therapist . . . . . . . . . . . . . . . . . . . . . . . 225 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 Select Annotated Bibliography. . . . . . . . . . . . . . . . . . . . . 241 Index. . . . . . . . . . . . . .. . . . ... .. . . . .. .. . . . . . . . . .. . . 257

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When I was getting my medical and psychiatric training in the late 1950s and early 1960s, the model of normal and deviant adolescent development was the white male. This was not surprising, since for every clinical or psychological study of adolescent girls done during the past 2 decades, there were
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