The World of Adolescent Girls

Fourteen-​year-​old Brandi was marched into my office by her mother, a tired-looking landscaper from a nearby town who insisted she come for at least one session. While Brandi rolled her eyes and grunted, her mother explained that Brandi had been sexually assaulted by an alcoholic neighbor.

Brandi interrupted her mother to say that the assault was “no big deal.” She said that other problems bothered her a lot more than the stupid neighbor. She complained of her mother’s nagging about chores and her father’s strict curfews on school nights. She said her biggest problem was that her parents treated her like a little kid and she was sick of it.

I suggested that it might help to talk about the assault. She said, “Maybe some girls, but I’m not the type who spills my guts to just anyone.”

I didn’t expect Brandi would return for therapy, but, to my surprise, she asked for another appointment. The next time she came alone with her stuffed panda. She curled up on my couch and told me the real story.

Shana sat on the couch between her two psychologist parents. She was dressed in jeans and a Jurassic Park T‑shirt and looked much younger than her 13 years. Her father, a big bearlike man in a tweed jacket, explained that Shana wouldn’t go to school. At first, she played sick, but later she just wouldn’t go. They couldn’t understand why—her grades were good, she had friends, and, as far as they knew, nothing traumatic had happened.

Shana’s mother, a tall, confident woman who researched addictions, wondered about depression: her father had killed himself and one of her brothers had been diagnosed bipolar. She noticed that Shana stayed up nights, slept all day, and had no appetite.

I asked Shana why she wasn’t going to school. She thought for a moment and said, “I feel like I’ll suffocate or stop breathing if I go in that building.”

What is happening in that environment? I wondered.

When I first met clients, I searched for things about them that I could respect and ways in which I could empathize with their situations. Unless I could find these things, it was impossible to help. I didn’t believe that analysis of the past was always necessary, but I was interested in the life circumstances of my clients. What were their daily routines? Where did they spend most of their time? How comfortable were they at home and away from home?

I preferred ordinary language rather than academic or pop-psychology language. In general, I didn’t like victim talk, self-pity, or blaming. I believed psychotherapy should empower people, help them be more in control of their lives and enhance their relationships with others.

I tried to be what psychologist Don Meichenbaum calls “a purveyor of hope.” I didn’t encourage negative labels, diagnoses, or the medical model. I was drawn to therapists who viewed families in more positive ways. I respected Michael White and David Epston, who taught that clients come to therapists with “problem-saturated stories.” It was the therapist’s job to help clients tell more powerful and optimistic stories about themselves. White and Epston stressed that the client wasn’t the problem, the problem was the problem, and they preferred “solution talk” to “problem talk.”

White and Epston believed that many families were in trouble because they told problem-saturated stories about themselves. They warned that often mental health professionals contributed to these stories by asking questions about failure and conflict and ignoring areas in which the person or family was strong and healthy. White and Epston empowered families by helping them tell new stories about their own resilience. They took pathology and shame out of therapy and instead generated optimism, trust, and collaboration.

My general goals for all clients were to increase their authenticity, openness to experience, competence, flexible thinking, and realistic appraisals of their environment. I wanted to help them see things in new ways and develop richer, more rewarding relationships. Psychotherapy is one of many processes by which people could examine their lives intelligently. It helped people steer, not drift, through life. Examined lives were indeed more worth living. The ideal life was calm, fun, and responsible.

Working with adolescent girls and their parents pushed me to reexamine my training about families. Much of the writing in our field at the time viewed families as a primary source of pathology and pain. The language of psychology reflected this bias—words about distance were positive (independence, individuation, and autonomy), whereas words about closeness were negative (dependency and enmeshment). Indeed, psychologists were so prone to pathologize families then that one humorous definition of a normal family was “a family that has not yet been evaluated by a psychologist.”

Years ago, Miranda and her parents came to my office. Three months earlier she’d been diagnosed as bulimic and referred to a treatment center eight hours away from her hometown. While Miranda was in this program, her parents secured a second mortgage on their home to pay for her treatment. They called her daily and drove to the faraway center every weekend for family therapy. After three months and $120,000, Miranda still had her eating disorder and her parents had been diagnosed as codependent.

My first question to Miranda was, “What did you learn in your stay at the hospital?”

She answered proudly, “That I come from a dysfunctional family.”

I thought of her parents; Dad was a physical therapist and Mom a librarian in a small community. They weren’t alcoholics or abusive. They took family vacations every summer and put money into a college fund. They played board games, read Miranda bedtime stories, and attended her school programs. And now, with Miranda in trouble, they had incurred enormous debts to pay for her treatment. For all their efforts and money, they had been labeled pathological.

Miranda was quick to agree with this label. It’s easy to convince teenagers that their parents don’t understand them and that their families are dysfunctional. Almost all the girls I saw in therapy felt that their parents were uniquely unreasonable. When a professional corroborates their opinions, they feel vindicated, at least for the moment. But in the long term, it hurts most teens to undercut their parents.

My goal with Miranda was to restore some balance to her concept of her family. When I suggested that her parents deserved some credit for the efforts they’d made to help her, Miranda seemed confused at first, then visibly relieved.

Psychology’s negative view of families began with Freud. He believed that character was fully formed within the family in early childhood. Because of the pathology of the parents, he felt that the character structure of most children was flawed. The goal of analysis was to save the client from the damage done by the family. It was still a common view in the 1990s.

My work with adolescent girls helped me see families in a different light. Most of the parents I saw clearly loved their daughters and wanted what was best for them. They were their daughters’ shelter from the storm and their most valuable resource in times of need. I respected their willingness to seek help when they were in over their heads. I was honored that they allowed me, temporarily, to be part of their lives.

Good therapists work to shore up family bonds and to give hope to flagging families. We strive to promote harmony and good humor and to increase tolerance and understanding between family members. Rather than searching for pathological labels, we encourage the development of those qualities that John DeFrain found in all healthy families: appreciation and affection, commitment, positive communication, time together, spiritual well-being, and the ability to cope with stress and crises.

We can help girls discover positive ways to be independent. We need to politicize, not pathologize, families. Of course, each family has its own history, unique problems, and blind spots as well as its own unique strengths and coping mechanisms. A worthy goal is to strengthen families and to give the daughters power and permission to be who they truly are.

Daughters can learn to recognize the forces that shape them and make conscious choices about what they will and won’t endure. They need consciousness-raising therapy to help them become whole adults in a culture that encourages them to forever be the object of another’s gaze. It means teaching them a new form of self-defense.

Even with these general ideas about therapy, I found adolescent girls to be difficult in the 1990s. It was harder to establish relationships with them, and they were more likely to quit therapy without notice. Mistakes with them seemed more serious. They were much less forgiving than adult clients. Their surface behaviors were often designed to hide their deep-structure needs so that it was hard to discern their real issues.

Here’s how the work actually went. On the first visit, girls radiated confusion and a lack of confidence. They moved uneasily in their bodies. They flashed me a kaleidoscope of emotions—fear, indifference, sadness, smugness, resignation, and hope. They signaled despair about their sexuality and loathing of their appearance. They were braced for rejection and ridicule. Questions formed and re‑formed in their eyes: Did they dare discuss bad grades, bingeing, alcohol, sex, cutting themselves, or suicidal thoughts? Would I be judgmental? Unable to understand? Or, worst of all, would I smugly offer advice?

New clients often smiled at me in a way that signaled, I want you to like me, but don’t expect me to admit it. With girls this age, relationships are everything. No work can be done in the absence of mutual affection and regard. The first step is helping the girl develop trust—for the therapist, for the therapeutic relationship, and for herself.

Girls have dozens of ways to test the therapist. The best way to pass these tests is to listen. Sincere, total, nonjudgmental listening happens all too rarely in any of our lifetimes. It’s best to ask open-ended questions. How do you feel about that? What do you think? What did you learn from this experience?

I learned to resist the urge to offer advice or sympathy. It was more useful to help with sorting—what could my client control? What opinions were hers, what opinions were others’? What was most important in her story of the week? What could be a small move in the right direction?

The most important question for every client was, “Who are you?” I was not as interested in an answer as I was in teaching a process that the girl could use for the rest of her life. The process involved looking within to find a true core of self, acknowledging unique gifts, and accepting all feelings, not just the socially acceptable ones. It included knowing the difference between thinking and feeling, between immediate gratification and long-term goals, and between her own voice and the voices of others. The process included discovering the personal impact of our cultural rules for women and discussing the possibility of breaking those rules and formulating new, healthy guidelines for the self. The process teaches girls to chart a course based on the dictates of their true selves. The process is nonlinear, arduous, and discouraging. It is also joyful, creative, and full of surprises.

I often used the North Star as a metaphor. I told clients, “Imagine that you are in a boat that is being tossed around by the winds of the world. The voices of your parents, your teachers, your friends, and the media can blow you east, then west, then back again. To stay on course, you must follow your own North Star, your sense of who you truly are. Only by orienting north can you chart a course and maintain it, only by orienting north can you keep from being blown all over the sea.

“True freedom has more to do with following the North Star than with going whichever way the wind blows. Sometimes it seems like freedom is blowing with the winds of the day, but that kind of freedom is really an illusion. It turns your boat in circles. Freedom is sailing toward your dreams.”

Even in the Midwest, where we had no large lakes, many girls had sailed. And particularly in the Midwest, girls loved images of the sea. They liked the images of stars, sky, roaring waters, and themselves in a small, beautiful boat. But most girls also felt uncertain how to apply this metaphor to their own lives. They asked plaintively, “How do I know who I really am or what I truly want?”

I encouraged girls to find a quiet place and ask themselves the following questions: How do I feel right now? What do I think? What are my values? How would I describe myself to myself? How do I see myself in the future? What kind of work do I like? What kind of leisure do I like? When do I feel most myself? How have I changed since I entered puberty? What kinds of people do I respect? How am I similar to and different from my mother? How am I similar to and different from my father? What goals do I have for myself as a person? What are my strengths and weaknesses? What will I be proud of on my deathbed?

I suggested girls keep diaries and write poetry and autobiographies. Girls this age love to write. Their journals are places where they can be honest and whole. In their writing, they can clarify, conceptualize, and evaluate their experiences. Writing their thoughts and feelings strengthens their sense of self. In their journals, their point of view on the universe matters.

We talked about the disappointments of early adolescence—the betrayals by friends, the discovery that one is not beautiful by cultural standards, the discovery that smartness can be a liability, the pressure to be popular instead of honest and feminine instead of whole. I encouraged girls to search within themselves for their deepest values and beliefs. Once they discovered their own true selves, I encouraged them to trust that self as the source of meaning and direction in their lives. I encouraged them to stay focused and goal-oriented, to steer from their self-defined sense of who they were.

Maturity involves being honest and true to oneself, making decisions based on a conscious internal process, assuming responsibility for one’s decisions, having healthy relationships with others, and developing one’s own true gifts. It involves thinking about one’s environment and deciding what one will and won’t accept.

I encouraged girls to observe our culture with the eyes of an anthropologist in a strange new society. What were the customs and rituals? What kinds of women and men were respected in this culture? How were gender roles assigned? What were sanctions for breaking rules? It was only after girls understand the rules that they can intelligently resist them.

I taught girls certain skills. The first and most basic was centering. I recommended that they find a quiet place where they could sit alone daily for 10 to 15 minutes. I encouraged them to sit in this place, relax their muscles, and breathe deeply. Then they were to focus on their own thoughts and feelings about the day. They were not to judge these thoughts or feelings or even direct them, only to observe them and respect them. They had much to learn from their own internal reactions to their lives.

Another basic skill I explored with my clients was the ability to separate thinking from feeling, something that all healthy adults must be able to do. It’s particularly difficult for teenagers because their feelings are so intense. They are given to emotional reasoning, which is the belief that if something felt so, it must be so. In our sessions, as we processed events, I asked, “How do you feel about this? What do you think about this?” Over time, girls learned that these were two different processes and that both should be respected when making a decision.

Making conscious choices is also part of defining a self. I encouraged girls to take responsibility for their own lives. Decisions needed to be made slowly and carefully. Parents, boyfriends, and peers might influence their decisions, but the final decisions were their own. At first the choices seemed small. Who shall I go out with this weekend? Shall I forgive a friend who hurt my feelings? Later the choices included decisions about family, schools, careers, sexuality, and intimate relationships.

Girls can learn to make and enforce boundaries. At the most basic level, this means they decide who touches their bodies. It also means they set limits about their time, their activities, and their companions. They can say, “No, I will not do that.” They can make position statements that are firm statements of what they will and will not do.

Closely related to boundary-making is the skill of defining relationships. Many girls are “empathy sick.” That is, they know more about others’ feelings than their own. Girls need to think about what kinds of relationships are in their best interest and to structure their relationships in accord with their ideas.

This is difficult for girls because they are socialized to let others do the defining. Girls are uncomfortable identifying and stating their needs, especially with boys and adults. They worry about not being nice or appearing selfish. However, success in this area is exhilarating. With this skill, they become the object of their own lives again. Once they have experienced the satisfaction of defining relationships, they are eager to continue to develop this skill.

Another vital skill is managing pain. All the craziness in the world comes from people trying to escape suffering. All mixed‑up behavior comes from unprocessed pain. People drink, hit their mates and children, gamble, cut themselves with razors, and even kill themselves in an attempt to escape pain. I taught girls to sit with their pain, to listen to it for messages about their lives, to acknowledge and describe it rather than to run from it. They learned to talk about pain and, to express it through writing, art, or music. Life in the 1990s was so stressful that all girls benefited from predictable ways to calm themselves. If they didn’t have positive ways, such as exercise, reading, hobbies, or meditation, they found negative ways, such as eating, drinking, drugs, or self-harm.

Most girls needed help modulating their emotional reactions. I encouraged them to rate their stress on a one‑to‑ten scale. I challenged extreme statements. A girl who came in saying “This is the worst day of my life” likely needed help reframing her day’s experiences and putting events in perspective.

Girls in the 1990s were socialized to look to the world for praise and rewards, and this kept them other-oriented and reactive. They were also vulnerable to depression if they happened to be in an environment where they were not validated. I taught them to look within themselves for validation. I asked them to record victories and bring them in to share with me. Victories were actions in keeping with their long-term goals. Once a girl learned to validate herself, she was less vulnerable to the world’s opinion. She could orient toward true north.

Time travel was another survival skill. All of us have bad days, lost days. Sometimes on those days it helps to go into the past and remember happy times or times when problems were much worse. Sometimes traveling to the future helps. It reminds a girl that she is on course toward her long-term goals and that certain experiences will not last forever. Traveling in time is just like traveling in space. Going somewhere different gives girls perspective on the experiences of the day.

Finally, I taught the joys of altruism. Many adolescent girls are self-absorbed. This is not a character flaw, it’s a developmental stage. Nonetheless, it makes them unhappy and limits their understanding of the world. I encouraged girls to find some ways to help people on a regular basis. Volunteer work, good deeds for neighbors, and political action helps girls move into the larger world. They feel good about their contributions and they rapidly become less self-absorbed.

As a therapist and teacher, I have found adolescent girls quirky, fragile, and changeable. I also have found them to be strong, good-hearted, and insightful. As I write this I remember certain clients: the girl with lemon-colored hair in the rock band Veal who was flunking out of school; the girl in forest-green Doc Martens who wore nose and lip rings; the 88-pound twirler who felt too fat; and the hearing-impaired girl who insisted on being sexually active to demonstrate her normalcy.

All these girls tried to figure out ways to be independent from their parents and stay emotionally connected to them. They explored ways to achieve and still be loved. They reflected upon moral and meaningful ways to express their sexuality in a culture that bombarded them with plastic, pathetic models of sexuality. They learned to respect themselves in a culture in which attractiveness was women’s most defining characteristic. They tried to become adults in a culture in which the feminine was defined as docile, weak, and other-oriented. Depression set in when girls failed to realize their true possibilities. Its cure was growth encouragement and resistance training.

Working with adolescent girls changed me. I became humbler, more patient and respectful of families, and more aware of the difficulties that they encounter when girls are in adolescence. I became angrier and more determined to help girls fight back and to work for cultural change.

Today, social media has made it even more essential that girls follow their North Stars. It’s vital to teach centering, setting and holding boundaries, and how to distinguish thinking from feeling. Girls still benefit from looking at their culture from an anthropological vantage point, and they have even more to gain from spending time with people very different from themselves.

If I were in practice today, I would body. I would encourage girls to explore tai chi or yoga and to get massages as often as they see therapists. I would help girls find and localize emotional pain in their bodies. And I would begin and end each session with a moment of silence.

If I were a therapist now, I would conduct more therapy outdoors, walking with clients or sitting in park to talk. I would assign my clients the homework of hiking on quiet trails or looking at the stars. Some teens in urban and suburban areas can’t see the stars and don’t feel comfortable outdoors. Many teens have never hiked or identified plants and birds. Yet wherever girls live, they can find ways to connect with nature. Learning to be at home in the natural world is a great skill. It soothes, informs, and opens girls’ hearts to bliss and grandeur.

I would actively work to connect girls to each other in face‑to‑face situations. I would encourage them to have sleep­overs and form clubs. I would suggest they spend time with older people and children. And I’d advise them and their parents to connect to a community of families that see each other once a week.

Therapists today report that girls still come in because they are fighting with parents or suffering through a divorce. One positive change they note is that being smart is no liability. Girls are more stressed today than in 1994 about getting good grades, but they are proud of them. Many girls struggle with eating disorders or the trauma of assaults. However, the most common presenting problems are self-harm, suicidal thoughts, anxiety attacks, and depression. Often these complaints can be directly linked to social media.

Social media disrupts the most basic of functions, including sleep. Several psychologists have said that the girls they see are all sleep deprived. This chronic sleep deprivation affects biorhythms and contributes to anxiety and depression. It also increases the risk of obesity.

Therapist Gillian Jenkins believes that the most important advice she can give parents regarding their children’s social media use is, “Don’t let them sleep with their phones.” This approach allows girls to get their much-needed seven hours of sleep and unplug from peers and alerts.

“FOMO is a big deal,” Jenkins said. “Although I think it is less FOMO than some sort of fear of not measuring up.” In her experience, constant comparison is girls’ biggest problem; the sheer volume and accessibility of photos and information is staggering, and a lot of unhealthy thinking is supported by smartphones.

All the therapists we interviewed for this update commented on their clients’ isolation. Many girls almost never went out with friends. They liked staying home on weekends watching Netflix and texting their friends. Therapists said that girls often chose to deal with their stress with digital distractions, rather than by talking to parents or going out with friends.

“Girls’ use of social media is motivated by legitimate goals, such as desire for community and curiosity, but somehow these goals are not really met,” one therapist said. “There is a real loneliness in girls today, much deeper than when we were teenagers.”

Therapists have observed that social media makes girls dependent on superficial feedback for self-worth. They encourage girls to come up with their own views of themselves, regardless of social media. They help girls learn to say, “Facebook is not about the real me.”

One therapist told me that with social media, girls have no sense of no context, no room for nuance, and no idea about subtleties, sarcasm, or humor. She said, “Girls get their feelings hurt all the time.” She urges girls to wait for half an hour before responding to hurtful messages. She hopes they would consider taking the high road, assume positive intent, and remember that whatever they sent out could become a screenshot and passed around.

Clearly, therapists now spend a great deal of time discussing social media. They help girls decide how much time each day to spend on devices and offer suggestions for meeting their goals. One girl had the idea of asking all her friends to agree to not text after 10:00 at night. Then no one would feel left out. Another girl decided to turn off her phone when she was with her friends. Still another approached things differently. She simply set daily activity goals, such as playing basketball or calling her grandmother. Then, at least sometimes, she wouldn’t be on her phone.

Many therapists look at sites during sessions. Their clients show them great stories, fan fiction, or poetry. They encourage parents to do the same. By ignoring the world of websites and social media, some parents are missing out on the opportunity for great conversations with their daughters.

At the same time that therapists help girls manage their devices, they empathize with how hard it is to control use and they encourage self-compassion. They know how much adults struggle with many of the same issues. One common recommendation is that everyone in the family put their phones in a lock box at a certain time of night and keep them there until after breakfast.

Therapists believe in the essential beauty and promise of all adolescent girls. As one compassionate psychologist told me, “I have faith in both the immensity and resilience of the human heart.”

From Reviving Ophelia: 25th Anniversary Edition by Mary Pipher, PhD, and Sara Pipher Gilliam published by Riverhead, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2019 by Mary Pipher, PhD, and Sara Pipher Gilliam.

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