Psychotherapy with Adolescent Girls and Young Women

Fostering Autonomy through Attachment

Elizabeth Perl

February 11, 2008
ISBN 9781593856519
Price: $33.00
198 Pages
Size: 6" x 9"

Adolescent girls and young women in therapy—even those who genuinely desire change—often are highly ambivalent and difficult to engage. This book provides fresh insights and powerful clinical tools for understanding a young woman's conflict between her attachment and dependence on her parents and her efforts to be autonomous, and how this may play out in seemingly treatment-rejecting behavior. Rich case material illustrates innovative ways to embrace resistance, rather than fight it, to build a strong therapeutic relationship that can get to the root of self-defeating patterns. The book is unique in addressing clinical work both with teens and with women in their twenties and beyond, who frequently struggle with unresolved adolescent issues.

“Dr. Perl's contributions to our understanding of 'the adaptive edge of resistance' (p. 2) as well as the therapeutic challenges posed by attachment and resistance are worthy of consideration by all mental health practitioners. This text will serve as a valuable resource for practitioners working with older adolescents and young adult women in outpatient and residential settings. It should be required reading for clinicians in college-based counseling settings. All readers will benefit from Dr. Perl's candor regarding her practice experience and her respect for the relational, dynamic, and developmental processes that inform therapeutic engagement and practice.”

Clinical Social Work Journal

“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.”

Metapsychology Online Reviews

“The development of a person's sense of self requires a delicate balance of loving attachment to primary caregivers and ample opportunity for expressions of autonomy. In this illuminating book, Perl, through her rich and varied clinical experiences, presents a therapeutic approach that includes profound respect for her patients' ways of participating in the process. Sometimes a patient has to resist what seems good for her from the therapist's point of view in order to protect her highly vulnerable sense of separateness and individuality. Perl shows how deeply respectful engagement with such opposition can be critical to therapeutic action. A very wise, practical, even indispensable guide for therapists working with adolescent girls and young women as they negotiate the often turbulent transition from childhood to adult life, this book also has extensive implications for therapy with patients of either gender and of any age.”

—Irwin Z. Hoffman, PhD, Lecturer in Psychiatry, University of Illinois College of Medicine; private practice, Chicago

“Perl expertly guides the reader into a complex understanding of psychotherapy with adolescent girls and young women, using frank kindness, sophisticated knowledge, and remarkable openness—an approach that closely parallels her work with her young patients. She carefully outlines the principles of relational dynamic psychotherapy with this population, focusing on attachment, resistance, and autonomy, and vividly illustrates her approach with unforgettable vignettes. Perl's book is a key addition to the field of adolescent psychotherapy as well as psychotherapy more generally, and will be extremely useful to students and trainees in varied disciplines.”

—Lynn Ponton, MD, Department of Psychiatry, University of California, San Francisco

“This book illuminates the interwoven processes of attachment, maturation, and individuation in adolescence and young adulthood through compelling, masterfully formulated clinical illustration. Seamlessly integrating theory with practice, Perl draws on her vast experience to create an unusually practical text that avoids formulaic techniques and instead articulates an orientation in which the therapeutic relationship is used to awaken developmental possibilities. Her understanding of the potentially adaptive elements in behaviors that in less skilled hands might be treated wholly as pathological usefully informs the treatment of a wide range of patients, adolescent and adult alike. A pleasure to read, this book does more than tell us what troubles our youthful patients—it leaves us with a rich appreciation of what to do about it.”

—Richard J. Eichler, PhD, Director, Counseling and Psychological Services, Columbia University

Table of Contents

1. The Mother-Daughter Bond and Its Implications for Understanding the Therapeutic Relationship

2. Embracing Resistance and Building Attachment

3. When Parents Collude with Their Daughter’s Resistance

4. Challenging ResistanceandSustaining Attachment

5. The Going Gets Tough When the Patient Gets Angry

6. When Attachment to a Therapist Is Not Therapeutic: Recognizing Malignant Regression

7. Beyond Idealization: Fostering Genuine Intimacy and Mutuality

8. Repetition as a Path to New Experience

9. Allowing for Attachment after Therapy Ends

About the Author

Elizabeth Perl, PhD, is a board-certified clinical psychologist and an Assistant Professor at Northwestern University's Feinberg School of Medicine. For the past 25 years, Dr. Perl has conducted individual and group psychotherapy in private practice, partial hospital, inpatient, university, and hospital clinic settings. This diverse population has included many adolescent and young adult women with a wide variety of emotional, familial, and relationship problems. Dr. Perl has spoken nationally, published articles, and appeared on television and radio addressing concerns of therapists, graduate students, parents, and young women. She maintains a private practice in Chicago.



Mental health professionals who work with girls and young women, including clinical psychologists, psychiatrists, social workers, family therapists, and school psychologists and counselors.

Course Use

May serve as a supplemental text in graduate-level courses.