Clinical Psychology and Adolescent Girls in a Postfeminist Era

Rosalyn H. Shute

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351591027
• Edition: 1
• Topic: Psychologie
• Subtopic: Geschichte & Theorie in der Psychologie

Adolescent girls' wellbeing is under threat. They face pressure to achieve academically while simultaneously negotiating a life dominated by social media, an unrelenting focus on appearance, cyberbullying, sexual harassment and ready access to pornography characterised by male violence to women.

The sociocultural environment presents significant risks for girls' mental health, yet clinical psychology remains largely focused on the individual. Cultural factors are also overshadowed by postfeminist forces and a renewed emphasis on biological determinants of psychological sex differences. Clinical Psychology and Adolescent Girls in a Postfeminist Era goes back to first principles and revisits the question of the place of nature and nurture in children's development, in the light of what we now know about neural plasticity, dynamic systems and gender socialisation. Feminism and its sometimes uncomfortable relationship with psychology is discussed, as are the meaning and implications of 'postfeminism', and whether girls have 'special strengths'. Practice principles and specific ideas for practice with today's girls are all included. Finally, there is a complementary chapter on working with adolescent boys.

Feminist writings about psychotherapy (with women) had their heyday some time ago, and some see boys as the ones who now need special attention. This book contends that the changing pressures of today's western world call for a renewed interest in specialised practice with girls, taking account of up-to-date theories about child development, and exploring the idea of expanding clinical practice beyond the individual.

1
‘There is Something Deeply Worrying about Girls' Wellbeing’

As all clinical psychologists know, there is a classical difference between how male and female clients tend to present. Boys are the ones most often seen with externalising problems such as hyperactivity and oppositional behaviour, and men with alcoholism and antisocial presentations. By contrast, females are more likely to turn their distress inwards, in forms such as anxiety, somatic problems and eating disorders. For example, from 6 years of age, the prevalence of anxiety begins to rise at a greater rate in girls than boys (Merikangas et al., 1999), and by adolescence, girls are twice as likely to experience anxiety and depression, a difference that persists through the adult years (Crick & Zahn- Waxler, 2003). Women are also more likely to present with multiple mental health problems, accounting for the greatest burden of mental health disability worldwide, and are at the highest risk of any single group to suffer from Post-Traumatic Stress Disorder (PTSD), as a result of high rates of exposure to sexual violence (World Health Organization [WHO], 2016a).

Such gender differences are usually treated as a ‘given’ in clinical psychology practice, and our approach to clients is generally governed more by the nature of the disorder than by the gender of the client. This is easily verified by picking up almost any textbook in the field and seeing how the chapters are organised. As far as causality is concerned, the main focus is on proximal factors such as how a child is being parented or what thinking style a client uses, and it is on such issues that interventions usually focus. While these proximal factors are very important, I argue in this book that it is also essential for clinical psychology practice to take more account of distal factors; in particular, the sociocultural environments in which boys and girls grow up. Of course, we need to avoid gender stereotyping of mental health problems, as girls can certainly display antisocial behaviours, and boys can suffer depression. However, it is equally negligent, I believe, to ignore the fact that boys and girls are subject to different sociocultural pressures, with serious implications for their development, mental health and psychological wellbeing. For girls, the resultant mental health difficulties become especially acute in adolescence.

The term ‘mental health’ is often associated with mental ill health or being subject to psychiatric diagnosis. Many clinical psychologists take this approach, and indeed it is often argued that clinical psychologists need to be good diagnosticians. When mental health services are under pressure, it is also understandable that the focus is on the most needy. However, I believe that clinical psychology can, and should, be about more than working towards relieving a client of a diagnosable condition. It can also be about attenuating distress that falls short of a formal diagnosis, and promoting ‘wellbeing’ in a more broad- ranging and positive sense, and not just for individuals, but for the wider community. Judith Worell called for this ‘accountability beyond symptom reduction’ back in 2001, yet clinical psychology is still overwhelmingly narrowly focused (Harper, 2016).

While some clinical psychologists do take a broader approach, others may say, ‘That’s fine for community psychologists, but is it really our role?’ A WHO (2012a) report, in association with the United Nations Children’s Fund (UNICEF), stated that: ‘Adolescent mental health is everybody’s business and nobody’s responsibility’ (p. 20). Key informants from a range of organisations concerned with adolescent mental health from around the world identified the need to ‘[a]dopt gender-based and human rights- based approaches to adolescent mental health programming’ (p. 23, emboldened in original). My hope is that this book may inspire some in the profession to consider whether their clinical psychology practice with young people can accommodate such ideas to a much greater extent than it currently does.

Adolescent girls' mental health and wellbeing

My starting point is evidence that the mental health and wellbeing of girls in adolescence is declining — both in terms of developing individuals and as cohorts over recent decades, particularly in the West. Of course, there are many reasons to be concerned about girls worldwide, and I will occasionally refer to this, but the discussion here is particularly rooted in the context of western psychology research and practice. It is important to address mental health in childhood and adolescence, as most adult mental health problems originate in the early years (e.g., Kessler et al., 2005), and study after study tells us that there is good reason to be concerned about adolescent girls’ psychological wellbeing.

A United Kingdom (UK) study with nearly 7000 young people (from which this chapter’s title is taken) found that girls aged 11 have lower emotional wellbeing than boys, and that this further declines steeply over the next few years (Finch et al., 2014). Wellbeing is a multi-dimensional concept, and whether we consider resilience, self- esteem, overall life satisfaction or satisfaction with the community, girls’ scores in that UK sample declined across the adolescent years, with boys’ scores declining to some degree or remaining stable. Even in the one area where girls had a head start — satisfaction with friends — girls’ scores were slightly below those of boys by the age of 16.

An Australian survey of middle-school young people studying for the International Baccalaureate produced similar findings (Skrzypiec et al., 2014). Just over 5 per cent of boys, but 12 per cent of girls, exhibited poor mental health when narrowly defined. The study also adopted the positive psychology approach of measuring whether students were ‘languishing’ or ‘flourishing’; that is, being productive, having positive relationships and coping with change and adversity. While 60 per cent of the boys were flourishing, only about half of the girls were. Fewer than 5 per cent of the boys were languishing, compared with over 8 per cent of the girls. As the authors pointed out, while languishing does not necessarily indicate poor mental health, it does imply unfulfilled potential. Girls were also far less likely than boys to always feel emotionally positive and to have a positive outlook on life.

While both these studies had limited samples, wider- ranging surveys indicate that they are not anomalous. A Europe-wide WHO survey (2016b) showed that although European girls tend to enjoy school more than boys, they feel more pressured by it as they grow older, and increasingly report poorer health, multiple health complaints, and lower life satisfaction than boys. Although boys are more likely to be obese or overweight, girls are much more likely than boys to perceive themselves as too fat, and this gender gap increases from age 11 to 15. The strongest predictor of body image dissatisfaction and weight- reducing behaviours in the study was not Body Mass Index (BMI), but being female. By the age of 15, in every European country surveyed, girls are more likely than boys to be engaging in weight reduction behaviour. The report comments that, ‘Adolescents often try to lose weight through inappropriate methods that may result in negative health consequences, including nutritional deficiency, growth retardation, delayed sexual maturation, menstrual irregularities and osteoporosis in girls, poor self- esteem and body image, anxiety and disordered eating’ (p. 101). Clearly, poor mental health can have significant implications for physical health as well. At the extreme, anorexia nervosa can damage most bodily systems, including the heart and kidneys, is the most lethal of all psychological disorders, and is notoriously difficult to treat.

The European finding that girls feel under more academic pressure than boys is echoed by an Australian survey of students in their final year at high school. Pressure for students overall (boys and girls) had increased compared with previous studies, with clinically concerning levels of anxiety in 42 per cent, twice the general population rate (North, Gross, & Smith, 2015). Stress, anxiety and pressure were all higher in girls, and even higher in girls identified as academically gifted. Sources of pressure were named by students as, first, themselves, followed by family and then school.

Changes over time

Are these gender differences in adolescent mental health a new phenomenon? Making comparisons over time is fraught with difficulties, but there is solid longitudinal evidence from a community in Scotland of increases in girls’ psychological distress from 1987 to 1999. Furthermore, this sequence of studies showed that from 1999 to 2006, while there was an increase in distress for boys as well as girls, it was more marked for girls (Sweeting, Young, & West, 2009). A similar drop in adult women’s happiness (in the United States of America [USA] and much of the industrialised world) compared with that of men has been observed since the 1990s, despite many gains in women’s position in society — the so-called ‘paradox of declining female happiness’ (Stevenson & Wolfers, 2009). The reasons are probably complex, with one likely factor being women’s changing expectations for their lives. While the women’s movement has driven many positive changes over the past century, including women’s voting rights and greater career opportunities, another likely reason for women’s declining happiness is their dual burden of workplace and domestic responsibilities. There seems to be, therefore, unfinished business for feminism, yet we are often considered to be living in a postfeminist era. This conundrum will be explored in Chapter 4.

Challenges for girls and women

The WHO has identified a range of gender-specific risk factors for mental health problems that disproportionately affect women across the world. These include ‘gender based violence, socioeconomic disadvantage, low income and income inequality, low or subordinate social status and rank and unremitting responsibility for the care of others’ (WHO, 2016a, n.p.).

Gender-based violence

Females are at greater risk

Women can be violent to their intimate partners (sometimes in self-defence or to protect children), and violence can also occur in same- sex relationships. However, the vast majority of such violence is perpetrated by men against women, and women are at far greater risk of physical harm from it, as well as PTSD (Betts et al., 2013). Violence may also take the form of sexual or emotional abuse or controlling behaviours (WHO, 2012b). For example, in the USA, high-school girls are between 1.5 and 4.5 times more likely than same-race boys to be subject to sexual dating violence, while one in ten girls has experienced forced sexual intercourse at some stage of her life (Institute for Women’s Policy Research, 2016). Between 15 and 27 per cent of men in several South African communities admit to raping girls or women (Wilkinson, 2016). Mass rape is also used as a weapon of war, a recent example being by Sudanese government forces against civilian women in Darfur (Human Rights Watch, 2016).

Women who experience such abuse are not only at heightened risk of PTSD, but of anxiety, depression, self-harm and suicide. Of females who are murdered, 40–75 per cent (in various studies around the world) die at the hands of a husband, boyfriend or ex-partner. In cases of homicide of both a partner and their children, 82 per cent of perpetrators are men, the primary motivations being control and revenge against the woman (generally for leaving or starting a new relationship) (Domestic Violence Resource Centre Victoria, 2013).

Gender- based violence can be so normalised that it goes unrecognised. For example, most school shootings in the USA are by boys who target girls who have rejected them, yet most media reports ignore gender as possibly causal, instead identifying factors such as violence in entertainment media (Klein, 2006).

Sexual harassment

Murder and rape have been identified as being at the extreme end of a continuum of violence against women and girls, which includes sexual harassment — a topic that has come to international attention in the wake of revelations about Hollywood’s Harvey Weinstein (Paquette, 2017). Sexual harassment is often seen as a separate issue from aggression, but the two are closely linked (Shute, Owens, & Slee, 2016), and one definition is that sexual ha...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Preface
• 1 'There is something deeply worrying about girls' wellbeing'
• 2 Nature and nurture in child and adolescent development
• 3 Becoming a girl: Gender socialisation
• 4 Getting political: Feminism, postfeminism and clinical psychology
• 5 Is there an upside for girls?
• 6 Dynamic systems and feminism: Practice principles
• 7 Principles into practice
• 8 What about the boys?
• Postscript
• Index