Elizabeth Perl: Psychotherapy With Adolescent Girls and Young Women: Fostering Autonomy Through Attachment

Psychotherapy with Adolescent Girls and Young Women: Fostering Autonomy through Attachment by clinical psychologist Elizabeth Perl is based on her considerable and diverse experiences working with female adolescents and young adults. In the introduction to her text, Dr. Perl identifies ‘‘the [female adolescent’s] struggle around attachment and self-direction’’ as a central feature in her patients’ therapeutic interactions (p. 9). Her introductory synopsis also describes psychotherapy as the process of ‘‘providing patients with an experience of connection and separation that differs from that which they had with their mothers’’ (p. 9). These introductory statements forecast both the noteworthy strengths and limitations of the text: The book offers a solid conceptual perspective of female adolescent development that is grounded in relational frameworks, yet the aptness, richness, and number of case illustrations devoted to young adult women exceeds those devoted to adolescents. In Chap. 1, ‘‘The Mother-Daughter Bond and Its Implications for Understanding the Therapeutic Relationship,’’ Dr. Perl defines her use of the concepts of attachment and autonomy by drawing upon the contributions of attachment theorists such as Ainsworth, Blos, and Bowlby as well as those of Chodorow, Benjamin, and Gilligan specific to the relational development of girls and women. Dr. Perl also draws on the somewhat less known yet pertinent work of Allen and Land, Doctors, Marohn, and Ryan and Lynch, all of whom have furthered our understanding of attachment, individuation, and autonomy in adolescent development and functioning. Given Dr. Perl’s relational perspective, it is somewhat surprising that she does not reference the contributions of Judith Jordan and Irene Stiver who have added to our knowledge of female development in the context of familial and therapeutic relationships. Dr. Perl’s articulation of opportunity and risk in the therapeutic dynamics of attachment and autonomy rings true for work with younger adolescents girls as well as young adult women. Dr. Perl identifies how an adolescent’s ‘‘acting out within therapy may serve both to rebel against therapeutic influence and to pull for protective intervention’’ (p. 15). She acknowledges the potential for strong emotional reactions on the clinician’s part when an intervention is critically warranted yet rejected by the patient. The following dynamic dimensions are noted in this first chapter and more fully developed in the remaining chapters: the ‘‘hostile-dependent bond’’ (p. 26) that may exist between mother and daughter (as well as therapist and patient), how ‘‘parental dependence can undermine a daughter’s autonomy’’ (p. 35), and the extent to which ‘‘therapists cannot escape the pitfalls associated with attachment’’ (p. 38). Several chapters of the text address resistance and the permutations of resistance as they emerge in therapy with female adolescents and young adult women. Dr. Perl demonstrates acute respect for resistance as an adaptive function as well as a defensive one. She carefully delineates several adaptive functions in her chapter on ‘‘Embracing Resistance and Building Attachment.’’ Embracing resistance represents an invaluable enjoiner to beginning practitioners who often fear rather than embrace resistance and need to be reminded of the understandable developmental and treatment-specific aspects of resistance. Embracing resistance is often central to creating the protected holding space that Dr. Perl describes in her chapter on ‘‘Challenging Resistance and Sustaining C. Springer (&) Salem State College School of Social Work, Salem, MA, USA e-mail: cspringer@salemstate.edu