Teenage Girls

In Teenage Girls, Dr. Karen Zager demonstrates her approach to therapy with adolescent girls. Teenage girls are a complex population difficult to pigeonhole; however, one general fact is that this group usually does not feel that adults listen to them. Dr. Zager therefore recommends listening as the key to working with teenage girls. Therapists must also respect what the client wants to obtain from therapy and avoid imposing therapeutic goals on the teenage girl.

In this session, Dr. Zager works with a 14-year-old girl named Lauren who is having issues with family tensions as well as relationship troubles with boys. Dr. Zager works with Lauren to help her see her problems from a broader perspective.

This is an eclectic approach with interpersonal, family, cognitive–behavioral, and educational strategies. The goals of this therapy approach are to relieve symptoms, to understand the issues and underlying causes, and to develop improved coping and communication skills.

Some key strategies in the approach include a focus on

• education — teens are often misinformed or uninformed, typically getting their information from unreliable sources like peers and the Internet
• active listening, acceptance, and validation of feelings — teens often feel misunderstood or not heard at all
• providing action strategies and suggestions — to assist teens in the development of coping skills
• clarifying communication — to assist teens with development of improved communication skills

Most teens respond well to this type of therapy, with the exception that adolescents with severe acting out, severe pathology, or very high degree of family conflict may need additional interventions, including medication, family therapy, or intensive outpatient or inpatient placement.

It is important to begin with what the adolescent identifies as his or her area of concern, to identify the adolescent's agenda (often different from the parent's or school's agenda), and to form a working alliance. Adolescents must feel understood, heard (although not necessarily agreed with), accepted, and valued.

The therapist should pay attention to forming a therapeutic alliance early in the therapy; otherwise the dropout rate is high, and the rate of success is low. Adolescents need to feel like active participants in the therapy, able to "shape" the course of treatment at least to some degree. Once a solid working alliance is established, the therapist can have greater input and make more suggestions and interpretations as needed.

Adolescents and families (or schools, when appropriate) should feel that progress is being made toward resolution of symptoms and that the problems are identified at the beginning of treatment. Dr. Zager prefers a flexible approach to working with teens, so that once they feel the problems are resolved, treatment ends—at least temporarily, with the door open to resumption of therapy if and when new problems arise.

It is important to make a realistic assessment of progress, so expectations are not set too high or too low. During therapy, Dr. Zager also prefers a flexible approach (which teens respond to very well), in which teens are free to invite their parents, siblings, or even friends to sessions to discuss relevant issues.

Karen Zager, PhD, received her doctorate from Fordham University and is a psychologist in New York. She focuses on clinical work with a specialization in parenting and adolescence.

In 1991, Dr. Zager received the Distinguished Psychologist of the Year Award from the American Psychological Association (APA) Psychologists in Independent Practice division, and in 2000 she received the APA Presidential Citation for contributions to the field of psychology.

She coauthored the book The Inside Story on Teen Girls (with A. Rubenstein; APA, 2002) as well as numerous other articles. Dr. Zager is a regular contributor to TV, radio, and print media on parenting and adolescence, having made appearances on ABC, CNN, FOX, and CBS, including programs such as Good Morning America, The Donohue Show, and Sally Jesse Raphael. She has also provided frequent interviews for YM Magazine, USA Today, Girl Magazine, Twist, Cosmo Girl, Parenting, Parent, Ladies Home Journal, Working Mother, and Newsweek.

• Rubenstein, A., & Zager, K. (1995). Training in adolescent treatment: Where is psychology? Psychotherapy, 32 (1), 2–6.
• Zager, K., & Rubenstein, A. (2002). The inside story on teen girls. Washington, DC: American Psychological Association.

APA Videos

• Adolescent Girls Who Are Suicidal
  David A. Jobes
• Dialectical Behavior Therapy for Adolescents With Multiple Problems
  Alec L. Miller

APA Books

• Bullying Prevention: Creating a Positive School Climate and Developing Social Competence
  Pamela Orpinas and Arthur M. Horne
• The Inside Story on Teen Girls
  Karen Zager and Alice Rubenstein
• Intervening in Children's Lives: An Ecological, Family-Centered Approach to Mental Health Care
  Thomas J. Dishion and Elizabeth A. Stormshak
• Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice, Second Edition
  Edited by Euthymia D. Hibbs and Peter S. Jensen