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Psychotherapy with Adolescent Girls and Young WomenReview - Psychotherapy with Adolescent Girls and Young Women
Fostering Autonomy through Attachment
by Elizabeth Perl
Guilford Press, 2008
Review by Minna Forsell
Jan 27th 2009 (Volume 13, Issue 5)

How can therapy encourage individuation as well as the capacity to cultivate mutually supportive relationships? Which aspects are especially important when working with adolescent girls and young women?

Psychotherapy with Adolescent Girls and Young Women centers around these question, albeit the narrative style allows for a lot more than that. Reading it does not provide you with a manual for dealing with a specific patient group; rather, you get a sense of the way Elizabeth Perl thinks and works, as well as an insight into the principles that have proven effective in her pursuit of good treatment for young female patients.

Nine neat chapters make up this 188 pages long book. It is not difficult to read. The tone could accurately be described, I believe, as 'affectionate'. Perl wants good for her patients and readers alike, she wants her thoughts, intentions and suggestions to be well understood, and the notions of 'reassurance' and 'holding' are reccurent. The text is at times somewhat repetitive, but not more so than a person who has given a lot of thought to a subject may be. Repetitio est mater studiorum. Some things deserve to be returned to, and in Psychotherapy with Adolescent Girls and Young Women, Perl returns to themes such as the mother-daughter bond, a girl's struggle to separate, social and intimate attachments, anger, rejection, expressions of self, separation, resistance and closeness between patient and therapist. 

In order to illustrate the particular importance of heeding attachment when treating adolescent girls and young women, Perl uses experiences from her 25-year long practice. Her patients are depicted with care and concern; the wish to provide them with an opportunity for growth is ever-present. It is certainly inspiring to read someone so genuinely keen to help. The approach to therapy that is presented is grounded in the belief that patients should be allowed to approach therapy on their own terms, not, e.g., be pushed to terminate the therapy without possibilities of checking in at a later date. Perl models her ideas about young women's therapeutic needs on the teenage girl's need to return to her parents to refuel emotionally every now and then, and the uneven process of individuation. Maybe the therapist should be more like the parent who is there when he/she is needed rather than focusing on achieving regular meetings up to a point of termination? "In keeping with her efforts to exercise autonomy, an adolescent might need to regulate whether and how she uses therapy in response to her changing needs. She may remain in therapy until she feels less distressed, return at a future point to check in, meet a few times to deal with a particular problem or issue, or resume even more intensive and extended work. It is possible that she may use therapy sporadically, as needed, for years." (p 172). The willingness to create an arena for growth and the wish to nurture development in a positive direction are the driving force of this book.

Perl does not belong to the writers who are afraid to use the word 'I', and the patients she tells about are presented as subjects, not objects. However, the more spontaneous, difficult aspects of her own reactions, the ugly parts of her work, are mostly left out of the discussion. There is, regrettably, little exploration of the therapist's struggle with countertransferences, which could have been a source of deeper understanding for the reader. On the back flap the book is described as "jargon-free"; nevertheless the style is typical of respectable therapists. Trustable, patient-focused and well-meaning in the good sense of the word, teeming with 'may', 'can', 'could' and 'might'. Despite the theoretical descriptions, what actually happened in the therapeutical processes remains dim. While reading the book I became increasingly more curious about how these patients would have described their experiences of therapy – what aspects were important to them? In what words would they tell? Such a narrative would have been the perfect complement to this book.

For someone working as a therapist, Psychotherapy with Adolescent Girls and Young Women is an excellent addition to one's bookshelf. It is a dependable source of encouraging support and clinical wisdom. Besides reflecting on the specifics of working with girls and young women, Perl also discusses more general issues such as the limits of therapy. What does a therapist do when he or she wants to go further with treatment than the patient migh be inclined to do? How do we know if it's an expression of autonomy or a sign of resistance? Even though this book may not expand your horizon or make you exclaim 'eureka', the themes Elizabeth Perl brings up in this book are never enough worked through.

© 2009 Minna Forsell

Minna Forsell is a psychologist, recently graduated from the University of Stockholm. She currently works in a psychiatric health care center in Volda, Western Norway.


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