Girls, Grime, and Relationships

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					Girls, Grime, and
 Relationships




    TAPG best practice conference 2007
 Eilean Mackenzie LCPC
  Clinical Director New Horizons for Young
  Women. Nhywcd@earthlink.net
 Deb Hibbard

  Program Director New Horizons for Young
  Women. Nhywpd@earthlink.net



               TAPG best practice conference 2007
                  NHYW History
   : Started 6/ 2001, Jackie RMA graduate vision to have a
    program that meets the needs of girls.

   “Connection Philosophy is my concept that everything we do
    in life, positive or negative, connects or disconnects us with
    something else. An example of this is technology. The more
    connected we become through technology the more
    disconnected we become with our family. As a society we have
    replaced family dinners with electronic jewelry!”

Jacqueline Danforth – Founder and Executive Director
 New Horizons For Young Women
                       TAPG best practice conference 2007
   Girls, Grime, & Relationship
            Workshop
Our goal is to provide a review of literature
that is specific to girl’s developmental issues
and discuss how that plays out at NHYW. To
provide participants with an opportunity to
share experiences and talk about what they
have found that works. Lastly, to present what
we believe makes for best practice in working
with teenage girls.

              TAPG best practice conference 2007
                 Program Description
   Program Department
        Young Women Ages 13-18
        6-9 Week Year-Round Program located in Maine
        Clinical Therapy integrated with Emotional Growth work
        Nature/Outdoor 5 day Expeditions, 3 day Base Camp Model

   Clinical Therapy Department
           Bio-Psycho-Social Model: using cognitive behavioral, relational and family systems
           interventions
           Therapy is driven by an individualized treatment plan
           o Individual Clinical Therapy (2) times per week/Group Clinical Therapy
           Weekly Clinical Family Support
           Psychological/Psychiatric Assessments Offered
           o Comprehensive discharge summary with progress on goals, accomplishments and
           recommendations

   Field / Logistics Department
            Physically challenging, experienced focused, year-round expeditions
            Seasonal Physical Activity Averages:
            Summer Canoeing/Backpacking & Winter Camping/Snowshoeing: 8 miles/day

                                TAPG best practice conference 2007
                  Program Description
   Medical / Nutrition Department
          On Site, Fully Equipped Infirmary staffed by state licensed medical personnel
          Weekly Wellness Check-Ups
          Medical and Medication Education
          Monitored Nutrition consisting of whole grains, protein, fruits and vegetables

   Admissions Department
         Enrollment Application Accessible on Website
         Educational Loans Offered, Maine scholarship fund

   Supportive Services
          Therapists involved in family aftercare planning
          Parent Representative available for support

   Human Resources Department
       Therapists Mental Health licensed in the State of Maine (Min. Masters)
       Annual training and/or certification in various disciplines: Medical, Risk Management,
       De-escalation/Intervention Techniques, Client Rights, Confidentiality, Cultural
       Diversity, Workplace Conduct, and Seasonally Specific Outdoor Activities


                                TAPG best practice conference 2007
                NHYW Mission
   INDIVIDUAL: To support young women in better
    understanding themselves and what motivates their
    choices, relationships and behaviors.
   FAMILY: To establish healthy connections between
    young women and their families.
   SOCIO-CULTURAL: To empower young women
    in navigating society and culture.
   APPROACH: To challenge young women with
    empathy, respect, truth and support on their journey
    of personal growth.
                    TAPG best practice conference 2007
           NHYW Values
New Horizons For Young Women provides
the opportunity to reflect on past decisions and
future choices. If participants choose to fully
engage in the program they will learn the value
of personal challenges, relationships and
empowerment. We will encourage girls to
embrace opportunities designed to enhance
their personal strengths. New Horizons
empowers young women to confidently meet
the complex challenges in today’s society.
              TAPG best practice conference 2007
                     Licensing
   State of Maine DMH licensed as an outpatient
    mental health clinic for children and 18 year
    olds.
   State of Maine DHS licensed as an outdoor
    youth camp.
   CARF Commission on Accreditation of
    Rehabilitation Facilities, 3 year accreditation.
   MOFGA (Maine Organic Farmers and
    Gardeners Association) Certified Gardens.
                   TAPG best practice conference 2007
                                     YOQ Data 2006
                                     Table 1- NHYW Total Scores YOQ-SR 2.0 for 2006

                                70
                                             65

                                60


                                50
                                                                               41
                  Me an Score




                                40


                                30


                                20


                                10


                                 0
                                          Admission                         Discharge

   Table 1:
   This table details the admission and discharge totals for students completing the program in 2006. A drop
    of 18 points is considered clinically significant, and our students had a drop of 24 points. Total number of
    students seen in 2006 =46, completed forms =42.
                                           TAPG best practice conference 2007
                                        Table 2 - Comparison of YOQ Baseline Admission Scores

                                 80

                                 70                          67
                                            61                               65             65
                                 60
                   Mean Scores




                                 50

                                 40                                                                     34
                                 30

                                 20

                                 10

                                 0
                                      Residential      Outpatient   Partial Hospital   NHYW 2006   Community

                                                                    Sample Groups




Table 2:
This table details baseline admissions YOQ-SR 2.0 scores compared to baseline scores of students in
residential, outpatient, partial hospital, and community settings.

                                                    TAPG best practice conference 2007
                                      Table 3- Comparison of NHYW Total Score vs. Keith Russell
                                                           Research 2002

                                 80
                                                                     71
                                          68
                                 70                     65
          Total Average Scores



                                 60
                                                                                                              48
                                 50
                                                                                   40            41
                                 40
                                 30
                                 20
                                 10
                                  0
                                        NHYW          NHYW         Russells       NHYW          NHYW        Russells
                                      Admission     Admission     Admission     Discharge     Discharge     Discharge
                                      Total Score   Total Score   Score 2002   Total Score   Total Score   Score 2002
                                         2005          2006                        2005          2006


   Table 3:
   This table is a comparison of 2005 and 2006 NHYW admission and discharge scores with
    Keith Russell's admission and discharge totals from research conducted in 2002.

                                                      TAPG best practice conference 2007
    Teenage Developmental Issues
   Important to look at teenage developmental issues for both boys and girls. The study ‘Raising
    teens: A synthesis of Research and a Foundation for Action’ published by Harvard School of
    Public Health and edited by Rae Simpson 2001 outlines the 10 Tasks of Adolescence. This
    study pulled together much of the current research on adolescent development and put it into a
    format that is helpful for both parents and professionals alike.

        Adjust to Sexually Maturing Bodies and Feelings
        Develop and Apply Abstract Thinking Skills
        Develop and Apply a More Complex Level Of Perspective Taking
        Develop and Apply new Coping Skills in Areas such as Decision Making, Problem Solving, and
         Conflict Resolution
        Identify Meaningful Moral Standards, Values and Belief Systems
        Understand and Express more complex Emotional Experiences
        Form Friendships that are Mutually Close and Supportive
        Establish Key Aspects of Identity
        Meet the Demands of Increasingly Mature Roles and Responsibilities
        Renegotiate Relationships with Adults in Parenting Roles

    Young women attending our program readily address these developmental tasks and the
    combination of both outdoor, wilderness experiences and therapeutic interventions provides a
    framework to explore these issues.

                                  TAPG best practice conference 2007
    Young Women are different than
            Young men

   While research continues to confirm that there are similarities between
    genders, there are also issues unique to the process of development in
    teenage girls. I want to present a brief overview of literature that has
    spoken to these differences and why they are important.

   Jean Baker Miller: ‘Toward A New Psychology of Women’ (1976)

    In this groundbreaking book Dr Miller maintained that women’s desire to
    connect with others and their emotional accessibility were strengths, not
    weaknesses as they were traditionally regarded. She created a framework
    for looking at girls and women’s development within the context of
    relationships.



                           TAPG best practice conference 2007
   Carol Gilligan: ‘In a Different Voice: Psychological Theory of
    Women’s Development’ (1982)

    Gilligan asserted that women have differing moral and
    psychological tendencies than men. According to Gilligan,
    men think in terms of rules and justice and women are more
    inclined to think in terms of caring and relationships. She asks
    that Western society begin to value both equally. She outlines
    three stages of moral development progressing from selfish, to
    social or conventional morality, and finally to post
    conventional or principled morality. The developmental
    challenge for women is to learn to attend to both their own
    interests and to the interests of others.
                       TAPG best practice conference 2007
   Lyn Mikel Brown & Carol Gilligan, ‘Meeting at the Crossroads: Women’s Psychology and
    Girl’s Development’ (1992)

    Based on a 5 year study of girls going through middle to high school Brown & Gilligan listen
    to the stories of girls as they negotiate their way through adolescence.

    “ We witness the struggle girls undergo as they enter adolescence only to find that what they
    think and feel can no longer be said directly. We see them at a cultural impasse, and listen as
    they make the painful, necessary adjustments, outspokenness giving way to circumspection,
    self-knowledge to uncertainty, authority to compliance. These changes mark the edge of
    adolescence as a watershed in women’s psychological development, a time of wrenching
    disjunctions between body and psyche, voice and desire, self and relationship.”

    For a brief period in early adolescence, usually about age 12 , girls appear to understand the
    centrality of relationships in their lives; at the same time they are able to verbalize the
    frustrations they feel when faced with the conflict between maintaining themselves and their
    relationships with others.

    Their research “suggests that adolescence is a time of disconnection, sometimes dissociation
    or repression of women’s lives, so that women often do not remember – tend to forget or to
    cover over- what as girls they have experienced and known”.



                                 TAPG best practice conference 2007
   Mary Pipher, ‘Reviving Ophelia: Saving the Selves of Adolescent Girls’ (1994)

    Pipher argues that we live in a look obsessed, media-saturated, ‘girl poisoning’
    culture. A culture that encourages girls to stifle their creative and natural impulses.
    Prior to age 12 girls are often assertive, energetic and resilient, then with the
    transition to adolescence they become more deferential, self-critical and depressed.

    She names her book after the story of Ophelia in Shakespeare’s Hamlet. As a girl
    Ophelia is happy and free, but with adolescence loses herself. When she falls in
    love with Hamlet she lives only for his approval. Ophelia is torn by her efforts to
    please both Hamlet and her father. When Hamlet spurns her for being an obedient
    daughter, she goes mad with grief and drowns herself in a stream of flowers.

    “Most girls chose to be socially accepted and split into two selves, one that is
    authentic and one that is culturally scripted. In public they become who they are
    supposed to be.”



                               TAPG best practice conference 2007
   Sarah Shandler, ‘Ophelia Speaks: Adolescent Girls Write about Their
    Search for Self’ (1999)

    Inspired by reading ‘Reviving Ophelia’ Sarah Shandler provides a forum
    for adolescent girls to tell the honest stories of their lives. Ophelia Speaks is
    a compilation of short essays and poetry on themes of body image,
    sexuality, friendship, self-identity, family relationships. Shandler notes in
    her editorial that many of the girls who wrote about dark problems were on
    the surface ‘perfect girls’; smart, pretty and popular. She maintains that
    adolescent girls are caught in the crossfire between ‘ where we have been
    told we should be and where we really are’.

    This is the first book we have students read at NHYW. Their assignment is
    to read the book, write about several stories they identify with and then run
    a group talking about why they chose the specific stories and how they
    relate to your life.

                            TAPG best practice conference 2007
   Rachel Simmons, ‘Odd Girl Out: The Hidden Culture of Aggression in
    Girls’ (2002)

    Building on the work of Gilligan and Brown Rachel Simmons used their
    ‘Listening Guide’ to interview adolescent girls (10 –14 years old) and
    explore the topic of bullying between girls. She notes that ‘the importance
    of relationships and connection in girls’ lives, along with the fear of
    solitude, leads many of them to hold on to destructive friendships even at
    the expense of their emotional safety’.

    She explores the dual role of both bully and being bullied and how girls are
    often both. She sees that particularly for white middle class girls the
    expression of anger and aggression is frowned upon. In attempts to be a
    ‘good girl’ girls avoid openly expressing anger and instead it goes
    underground and is expressed through indirect acts of ‘relational
    aggression’.

                           TAPG best practice conference 2007
   Lyn Mikel Brown, Ed.D ‘Girlfighting: Betrayal and Rejection Among Girls’ (
    2003)

    Brown looks at girl fighting and “relational aggression” within the today’s social
    context as a reaction to girls feeling powerless. Girls are discouraged from
    expressing strong feelings and are pressured to fulfill unrealistic expectations, to be
    popular, and struggle to find their way in a society that still reinforces gender
    stereotypes and places greater value on boys. Under such pressure, in their
    frustration and anger, girls (often unconsciously) find it less risky to take out their
    fears and anxieties on other girls instead of challenging the ways boys treat them,
    the way the media represents them, or the way the culture at large supports sexist
    practices.

    ‘The answer to reducing girl fighting and girl bullying is less about tightening
    control over girls than about appreciating girls’ need to have control in their own
    lives, to feel important, to be visible, to be taken seriously, to have an effect.’

    We need to work to replace old stories of girls and women as deceitful,
    backstabbing, nasty and mean with alternative realities of strong girls and women,
    girls as allies, and collation-building.


                               TAPG best practice conference 2007
   Lisa Machoian, ‘The Disappearing Girl: Learning the Language of Teen
    Depression’ (2005)

    Machoian argues that teenage girls begin to ‘disappear’ when they feel
    disconnected from friends or family, and when the pressures of society to fit in or
    be a certain way become overwhelming.

    “At age 12 years girls are no more likely than boys to be depressed; by 18 years
    they are twice as likely to suffer from depression.”

    “Genes make some kids vulnerable to the stresses of adolescence. It is particularly
    difficult when girls are intelligent; high intelligence increases girl’s risks for
    depression, but not for boys because brainy girls are rejected more.”

    “The more girls are concerned about relationships and pleasing people, the more
    prone she is to over think- to ruminate and worry. These over thinkers are most
    likely to become depressed.”


                              TAPG best practice conference 2007
            Issues we see at NHYW

   On entry “I hate girls”
   Importance of peers and being in peer group
   Acceptance by peers more important than self & own needs
   Who am I, different personality with each subgroup
   Emotional reactivity/ regulation - do they like me etc
   Difficulty identify feelings
   Depression, lack of acceptance & feeling different
   Anxiety fueled by peer group issues & acceptance
   Self harming behaviors cutting, often triggered by conflict, feeling out of control
   Anger management: stuffing or exploding
   Binge purging, feeling out of control in group, life
   Body image issues, comparisons & jealousy
   Sexual behavior, the power of sexuality
   Substance use often for peer acceptance, managing social situations or managing feelings.
   Family conflict; lack of relationship with dad, conflict with mom
   Academic difficulties, as struggle academically look for peer acceptance with lower functioning peers




                               TAPG best practice conference 2007
   Have participants break into small groups
    (approx 6 people per group).

   Ask each group to do a group drawing or
    creative presentation that represents the issues
    they see teenage girls struggling with in their
    work.


                   TAPG best practice conference 2007
          Research specific to Wilderness
           Programming and Girls
   Whittington Anja, ‘Challenging Girls Construction of Femininity in the Outdoors’
    Journal of Experiential Education (2006)

    Qualitative study of teenage girls who participated in a 23 day wilderness canoe
    expedition. Found that girls challenged conventional notions of femininity in
    diverse ways:

        Perseverance, strength & determination
        Challenging assumptions about girls abilities
        Feelings of accomplishment and pride
        Questioning ideal images of beauty
        Increased ability to speak out and leadership skills
        Building significant relationships with other girls

    “They were able to place themselves in two domains – being in the wilderness and
    being a girl”. The experience allowed them to challenge the assumption that the
    wilderness is a masculine sphere.


                                  TAPG best practice conference 2007
   Caulkins, White & Russell, ‘The Role of Physical Exercise in Wilderness
    Therapy for troubled Adolescent Women’ Journal of Experiential
    Education (2006)

    Study explored the impact of backpacking in the therapeutic process for
    teenage girls & revealed 8 central impacts:

        Reflection; removed from every day experiences & have time to reflect on
         themselves
        Perceived Competence; increased physical strength
        Accomplishment; feeling good about what they have done
        Self-Efficacy; increased faith in their ability to influence their personal
         thoughts & behaviors
        Awareness of surroundings, self & others. With this an ability to take more
         responsibility for one’s behavior
        Timelessness; distraction free

                              TAPG best practice conference 2007
     Recommendations for Successful
    Programming with Young Women:
    Regardless of gender the importance of good programming:
    -State licensing standards, CARF/ JACO, AEE, NATSAP, NATWC
    - Standardized staff training, supervision, and continuing education.
    - Networking with other programs, sharing information.

   Wilderness & outdoors has traditionally been viewed as a male environment.
    We know that empowerment & self –efficacy is important so how do we allow girls to be
    girls & feel comfortable in the woods: just because you carry a pink back-pack does it make it
    any easier?

        Using gender specific gear,
        Being aware of our language how it can be exclusive
        Brains vs. brawn
        Do we need to get to the top or is it about the journey?
        Balancing soft and hard skills
        What is a soft program?

   Being a girl, getting dirty, being playful, feeling strong challenges stereotypes of women &
    girls as passive & helpless.


                                          TAPG best practice conference 2007
   Staff as role models

   All female staff vs. co-ed staff groups.

    1. How girls respond & react to all female staff teams: anxiety, excitement,
    different conversations.

    2. In co-ed staff teams it is important that all team members are aware of
    their roles, how they share power, decision making and resolve conflict.

   Sharing of hard and soft skills

   Male staff to be aware of sexual issues, boundaries, appropriate touch



                            TAPG best practice conference 2007
   Not just about the individual journey but about the group – supporting one
    another, acknowledging when we need help. When one girl hurting it
    impacts them all. Honoring the role of caring and nurturing while balancing
    needs for self.

        Learning about co-operation and collaboration
        Being aware of in and out groups, sub cultures and covert communication
        Teaching respectful & direct communication/ assertiveness training/ role plays
        Focus on friends & what are healthy friendships
        Leadership skills, decision making & organizational skills
        Honoring different roles and skills within the group
        Importance of relationships with staff, collaboration
        Learning about differences; girls often surprised about the friends they make
         which are girls they wouldn’t usually talk to
        Finding their voice


                              TAPG best practice conference 2007
   Feelings, feelings, feelings…..drama is the base line

   Regardless of different diagnosis (borderline personality disorder, bipolar,
    mood disorders) much of what we do is helping girls understand their
    feelings, label them and manage them. Emotional discharge for the sake of
    emotional expression is not enough and at times harmful. First girls need
    emotional regulation skills and then how to contain feelings.

        Teaching skills, learning about and identifying feelings
        Mindfulness awareness of and letting go of feelings vs. them controlling you
        Meditation skills; guided meditations, walking meditation, relaxation skills,
         yoga
        Learning assertive communication
        Conflict resolution



                              TAPG best practice conference 2007
   Food issues:

        Food as a source of strength, learning to eat 3 meals a day & healthy food.

        Wilderness cooking provides opportunities for building competency, pride, skills.

        Food as an issue of control, mindfulness

        Binging: eating for comfort, developing mindfulness and awareness of being full

        Purging – awareness of talking about emotionally charged issues during meals, 20
         minute bathroom rule, feelings check ins, journaling

        Parent reunion, cooking a meal allows them to demonstrate skills & give back.
         Welcoming parents into their hearth




                                 TAPG best practice conference 2007
   Hygiene & body image:

       Learning self care skills
       Discussions about female bodies (hair, smells)
        what is normal
       Challenging conventional notions of beauty
       Pride in strength, stamina
       Using your body as a way to feel grounded

                     TAPG best practice conference 2007
   Trauma:

       Being aware of when a student is triggered/ dissociating and how her
        story is effecting others in the group

       Staff using grounding and containment vs. pushing

       Staff helping students with emotional regulation; meditation, yoga,
        breathing exercises

       Boundaries and appropriate disclosures, not always appropriate to tell
        everything to everyone

       Physical boundaries, touch

                           TAPG best practice conference 2007
   Incorporating the cultural context:

       Media images of girls, music, fashion, all appropriate
        conversations

       Societal double standards: “good girls”, “bad girls”

       Class & race differences

       Religious differences

       Looking at family culture
                        TAPG best practice conference 2007
    Use of ceremonies and female rights of passage:


    Solos balance personal development and awareness with the group sharing in the experience

    Ceremonies help establish group norms, mark progress, provide a context and support for
     change. Traditional female rights of passage frequently center around puberty and the power
     of a woman’s sexuality and ability to give life. They often involve a girl entering into the
     world of women sharing stories, learning about healing, relationships and support. Girls today
     discover the power of their sexuality but may not have the support of other women to figure
     out how they can use it and respect their own bodies.

    Solo experiences are brought back and shared within the context of the group

    Group members giving words of advice and support before a student leaves for solo

    Challenge with encouragement, and modification of solos for younger girls



                                  TAPG best practice conference 2007

				
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