Psychotherapy with Adolescent Girls

268 Pages·1986·3.86 MB·English

by  Doris Lamb M.D. (auth.)

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
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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,
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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