Psychosocial health through the life-cycle – adolescents

Providing humane, thoughtful psychosocial care to
young women during the period of enormous transition
and growth that marks adolescence is exciting
and often very challenging for the provider. The
stakes may be high and there is significant content
in screening, assessment, and risk factor identification
that need to be covered. Often adolescents do not
really want to talk, and there are medical aspects of
a visit with which to contend.
The 1990s brought an explosion of work, both
scholarly and popular, about the risks and transitions
for adolescent girls in western culture. Galvanizing
public attention to the issue, the American Association
of University Women Study of 1990 looked at
3,000 young girls and boys age 9 to 15. The results
clearly identified the costs and risks of coming of age
in America within a patriarchal cultural and educational
system. The study found that the passage to
adolescence was particularly treacherous for girls,
marked by decreased confidence, decreasing abilities
in math and science, and an increasingly critical attitude
toward their own body.5
Passage to adolescence was particularly treacherous
for girls, marked by decreased confidence, decreasing
abilities in math and science, and an increasingly
critical attitude toward their own body.
More recent studies of academic success show that
girls achieve substantially higher than boys in reading
literacy (in the developed world) while continuing to
lag in mathematics and science achievement. However,
those differences are narrower than in past
decades.7
Relationally speaking, girls begin to lose their
voice. The pressures and messages about being female
in a western culture sufficiently quieted the strong
and confident younger girls as they learned to be nice,
get along, and accommodate others. “At the crossroads
of adolescence, the girls in the study describe a
relational impasse that is familiar to many women:
a paradoxical or dizzying sense of having to give up
relationship for the sake of ‘relationships’ ” (page 216).5
Thoughtful psychosocial care can be provided by
attending to this fact. By caring about and creating
relationship with adolescent girls, providers come to
know them and identify those risks that arise from
this dissociation from self. The clinician can seek to
identify relationships that may be sources either of
strength and support, or discord and vulnerability.
Table 5.3 presents one series of inquiries that may
be used as screening questions regarding relationship.
A question might lead to a series of others that illuminate
a conflict or highlight a strength. Keeping an ear attuned to a sense of disconnection, whether from
parents, friends, school, or others can provide the tip-off
to other questions to pursue in more depth. Listening
carefully to an adolescent’s version of their relationship
to others helps to avoid the land mines of assumptions,
whether about sexuality, values, or “normalcy.”
Adolescent girls value relationship. They describe
most anxiety about abandonment and they may be
most at risk when they abandon themselves,1 by dissociating
from their own confident younger girl
voices in order to accommodate to the pressures and
expectations of the culture around them.
Studies that have attempted to isolate correlates of
psychosocial health through these turbulent years
have identified active participation in all girl sports
teams as a positive factor.8 Sports involvement helps
not only with body image issues as girls come to view
their bodies as competent and strong, but ongoing
support of other girls in relationship to themselves
can help in weathering the doubt and self-negation so
ubiquitous during this time.
Sports involvement helps with body image issues as
girls come to view their bodies as competent and
strong, and by providing the ongoing support of
other girls.
A study of resilient adolescent teens who became
mothers identified relationships, insight, and initiative
as the positive correlates of coping well with this
major transition.
An additional strategy might be called responsibility/
rebellion. This may be a quality particularly
valuable for adolescents. Some young women who
were determined to prove that they would not fail or
do poorly as all the surrounding systems predicted,
thrived.9
Given the value placed on relationship, the primary
care provider should appreciate the relationship
with an adolescent over time and not despair of the
limited “progress” that seems to be made in any given
individual visit. Many a provider has been suprised
and pleased to learn how strongly the young girl
identifies them as “my doctor.”
Creating the environment of trust necessary for a
productive care relationship with an adolescent if the
provider also cares for the extended family, is challenging.
Issues of confidentiality need to be addressed
directly and adhered to faithfully for the provider to
sustain credibility with the adolescent. Identification
as “my doctor” will be facilitated by seeing the adolescent
alone.
The primary care provider should appreciate the relationship
with an adolescent over time and not despair
of the limited “progress” that seems to be made
in any given individual visit.

Posted in: Health,Psychosocial health of well women through the life-cycle