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Working with adolescent girls in a residential treatment centre

Jane Matheson

"There was a little girl, who had a little curl
Right in the middle of her forehead
And when she was good, she was very very good
And when she was bad, she was horrid."

This nursery rhyme is only one of the many that present "acting out" girls in a poor light. When rhymes like these were written, girls were expected to behave in a particular manner and when they did not they were deemed "incorrigible." As the years have moved along, so has what is deemed good behaviour. Yet girls are seen as bad if they stray from this norm, whatever the norm may be.

The next two verses of this same nursery rhyme are less well known and yet are more revealing:

"She stood on her head, on her little truckle bed,
With nobody by for to hinder;
She screamed and she squalled, she yelled and she bawled,
And drummed her little heels against the winder.
Her mother heard the noise and thought it was the boys,
A-kicking up a rumpus in the attic;
But when she climbed the stair, and saw Jemima there,
She took her and did whip her most emphatic."

The questions then become: is Jemima bad and therefore does she deserve a whipping? And what decides bad? Or is Jemina bad for good reason considering the behaviour of her mother and society’s expectations of appropriate girlish behaviour? The answers unquestionably depend on your point of view.

Last week, a supervisor from one of the residential programs came to me to talk about the number of young women who had recently moved into the program. Every once in a while this happens; usually the proportion of young men in residential programs far exceeds the number of young women. When a group of young women is in a residential program, the whole milieu changes and the expected response from the caregivers is "Girls are a lot harder to deal with." This time was no exception and as we watched the four young women walking together, talking loudly, giggling, and generally being very noticeable, it occurred to me that this was true only because we are less experienced in the ways of the development of young women. "Dealing with them" really means trying to understand the root of their issues and knowing how to meet their needs. The difficulty, therefore, lies more with us than with them.

Self-in-relation model

The development of girls into young womanhood and then into adulthood has been understood in the past to follow the same path that the development of young men has taken. Only lately has this come into question. The ideas that have spawned this questioning have come from professionals and caregivers who have watched young women launch themselves into the adult world in ways that are quite distinct from those of young men. As a result, many questions have arisen regarding the education of young women, and the ways in which women are different from men. This article is a description of some of the experiences I have had while working with young women in a residential treatment centre. A brief and simplified feminist theory base is used as the foundation of understanding the behaviour of the young women.

The development of the adolescent female has been seen until recently as not being any different than the development of the adolescent male. The advent of feminist thinking and the beginning attempts at defining the social, physical, and emotional development of young women as different from young men has begun to change this knowledge base. Physical development has always been clearly different; however, other areas have not been well understood. In 1976, Jean Baker Miller put forth a new theory about women’s development. It is called self-in-relation and has as its premise the concept that all infants start life as a being-in-relationship who is connected to the primary caregiver and sensitive to this person’s emotional state (Miller, 1991). Thus, the infant begins life with a sense of self that reflects what that person is actually doing to and with the child and a sense of self that understands what is happening between people, not just what they are doing (Miller in Jordan et al., Chap. 1, 1991). Miller’s premise is that all infants start life this way, but only women continue as self-in-relation due mostly to cultural emphasis and caretaker bias. Women are taught to be other-oriented while men are taught the importance of self-development. Women develop, using this self-in-relation, into individuals who have the ability to respond to the process of the relationship and as such develop an internal sense of self. According to Miller "the concepts of self are therefore inseparable from dynamic interaction" (p. 14).

Self-in-relation model in residential treatment

How does this apply to adolescent girls and especially those who reside in treatment programs? Young women who live away from their parents, especially their mothers, are seen by society as being different than the norm. Young women who live in residential treatment centres are seen as delinquent or as "bad girls." They are generally "unmanageable" and by the time they arrive at the residential setting they have been unmanageable for quite some time. The definitions of this word are endless.

Statistically, young women are less in need of residential treatment than young men. Patricia Miller (1979) suggests that there is a ratio of four males for every female. Miller continues that girls specialize in authority offenses such as truancy, sexual misconduct, running away, ungovernability and incorrigibility. They are rarely involved in violent crime. My own observations are quite similar. In the residential programs in the agency where I work about one in four of the young people are female. Even in our day-treatment programs, the ratio is approximately the same. The only case where this is not the norm is in the family support programs. In these programs, where the intent is to reinstate young people into their families and assist the families to work better together, more than half of the admissions are female.

In my agency, there are five residential programs that provide a continuum of care and attempt to meet the diverse needs of the many young people referred to our services. The programs vary in length and intensity of service. The agency is a co-educational facility. Some programs are parented while others are staffed. All the programs offer extensive clinical and school services and provide follow-up at discharge. The length of stay can vary from three months to several years depending on the need and the program.

Young women have resided in all of the residential programs; however, some of the programs have had a greater number of referrals of young women. This seems to have a direct correlation to the kinds of problems identified during admission. These descriptions are, of course, given by those who expect the behaviour should be different. Regardless of the particular program into which they are admitted, the young women co-exist with young men of a similar age as well as a gender-balanced staff group.

The problems most often identified at admission for young women in our programs are promiscuity, running away, disobedience, suicide ideation or self-mutilation, past sexual abuse issues, substance abuse, poor peer relations and school problems. Many of these problems have reached the chronic stage and the frustration of the previous caregivers is as much an issue of referral as the presenting problems. Occasionally, a young woman is referred due to concern about a possible psychiatric problem due to the severity of her behaviour, indicators of psychosis or a suspected developmental problem such as Fetal Alcohol Syndrome. Rarely is violence towards others one of the presenting problems. Aggression, when present, is usually of a verbal nature. Past delinquencies are drug-related, truancy-related or stealing. These are often done in groups. Sexual assaults are also extremely rare. Although there is overlap in the descriptions of female and male presenting problems, the way in which these problems are manifested are usually distinctly different.

Adolescent developmental theory is characterized by several themes which provide the basis for understanding the tasks that are necessary to reach adulthood. The first theme is the need for the development of a separate identity and subsequent greater autonomy which is achieved by an increasing disassociation with parents or primary caregivers. Erickson (1968) is probably most well known for his explanation of adolescent development within a stage framework. Blos (1962) stated that the first tasks of this stage are those of emotional disengagement and the loosening of affectionate ties. A second theme is what he called the firmly bounded self whereby firm lines are drawn between the self and others. Blos also put forth a third theme which suggests that conflict is necessary for the tasks of separation and personality development.

The development of boys into men was the prototype for the development of these themes and task. Questions are now being asked with regards to the viability of these themes for female adolescent development and the past interpretations of young women’s behaviour. It has become more and more evident that young women negotiate the transition from childhood to adulthood differently than young men. Although the same themes may be in evidence, the way in which these themes are interpreted are of the most interest.

The relation-in-self model proposes that "a relational sense of self begins with the earliest mother-daughter relationship and progresses to increasingly complex relationships characterized by mutual identifications, attention to the interplay between each others’ emotions and caring about the process and activity of relationship" (Kaplan, Gleeson, & Klein, 1991, p.123). Although young women do need to develop their own life outside of the home, there is a definite need for the maintaining of strong and positive mother-daughter ties. The self-in-relation theory also sees conflict as a means of engagement, creating relationship and even testing the strength of relationship by conflict, using it for learning about oneself and others (Miller, 1991).

Prior to adolescence, the latency-age girl is busy – not latent in any way. She is busy creating relationships, particularly with other girls. Relationships with boys may or may not be a possibility. This seems to be related more to boys’ disinterest than to her lack of interest (Miller, 1991). Eleven-and 12-year-old girls speak with the clarity of knowing and seeing, a confidence in what they believe to be right and a clarity of judgement (Gilligan, Lyons, & Hammer, 1990). Upon entrance to adolescence, this clarity of comprehension ends. New rules seem to apply. The beginning adolescent has to struggle to understand the new rules, learn how to disobey the new rules, and still maintain the relationships which are important to her.

And what about the young woman who enters adolescence without the firm foundation of loving and understanding caregivers or an abundance of opportunities for growth and challenge? Is her development the same, different, or a combination of all the same unstructured patterns and just interpreted in a different way? It is hard to know how adolescents think. We are often more impressed, overwhelmed or exasperated by their behaviour. As such, young women who negotiate their way through troubled waters present behaviours that more often than not detour us from the understanding of how they think and feel. Instead they usually have us concentrating on managing or controlling them.

It is my observation that troubled young women are even more obvious and determined in their search for self-in-relation than young women from more stable backgrounds. Often they have no idea what relationship they have to anyone or anything due to abandonment, lack of trust, or fear which has happened as a result of abuse or violence. They are searching for a safe place to test things out and for a connection that makes sense for them. Many look for security and connectiveness on the streets despite the ever-present dangers. Many will deliberately or accidentally-on-purpose become pregnant in order to find a connection with someone. Many find relationships that perpetuate the violence and mistrust of their past simply because it is a known commodity and is therefore something understandable.

The logic that adults present to these young women of "this is not good for you" or "you are worth more than this" is inconsequential and falls on deaf eyes. It is the action by caregivers that, over time, makes an impact. In my agency we have followed young women downtown, taken them out for coffee, given them warm clothes and a quarter to "phone home," making it clear that they must make their own decisions. We have concentrated on our relationship with the police, the outreach workers, the hospitals, and paramedics and used them and their resources to protect the young women and make our expectations of them, however seemingly impossible, clear.

Adolescence is a time of trial and error. The importance of being consulted, asking their opinion, and being allowed to make some of their own decisions is extremely important. It gains importance as the years progress. Compromise is not easily learned by adolescents. Conflict is an important part of the growth towards adulthood. Adolescence is a time of testing boundaries and trying new behaviours.

Young women in a treatment centre have the same need to try things out, make mistakes, suffer the consequences, and learn from their experiences. Unfortunately, their behaviour is often so worrisome to their caregivers that decisions are made for them, often without consultation. At a time when more freedom and responsibility should be the norm, these young women are cared for by adults who attempt to enforce more rules. Many of these rules serve to hamper the movement towards adulthood. I do not advocate for the troubled young women to be left to their own devices. However, we should concentrate on the chances given, channelling behaviour elsewhere and recognizing the need for being able to take charge or make mistakes.

Case #1
A young woman, Sharon, who is 15 and Native, was referred to a residential program by her adoptive parents. Sharon had been in another program prior to her transfer and had endangered her life many times through drug-taking, involvement with a very rough crowd, and running away. She also was threatening to leave school at 16. Her parents were very concerned about her safety, future, and inability to make good decisions. They wanted her "under control." They were understandably frustrated and scared. Sharon had made friends after about six months in the program, and although she continued some acting-out behaviour, the degree of dangerous behaviour had decreased significantly. At this time she came to ask about her future. She clearly stated that she wanted to know the plans—her mother would not tell her—and that she wanted a say in the decision. "I am almost 16," she said, "and no-one has consulted me. It’s my life."

Sharon was right. Her issue was one of self-in-relation. She was trying to maintain her relationship with her mother while at the same time asserting herself and her opinions. Her conflict was in not knowing how to do this. I asked Sharon to imagine a bridge over a deep canyon. Her mother was on one side of the canyon and the future was on the other side. She was on the bridge and couldn’t go back even though her mother was calling. She had to get to the other side first. I repeated this story at least three times. It did not seem to have any effect. A week later Sharon’s mother called and told me the story – somewhat confused in the relating of it. But it was hard to know who was more confused, Sharon or her mother. Subsequent to these conversations, and the mother’s transferred anger at me, Sharon was able to make some decisions that were akin to her mother’s wishes yet still feel she had asserted herself. She had been given information, she had been asked for her opinion, she had been presented with the good and not-so-good parts and she had decided for herself.

Oftentimes we become overwhelmed with the delinquent or endangering behaviour of troubled young women. It is more often the latter than the former that causes us to lose our objectivity. We then stop giving them information, or explanations of how we feel or why we are doing what we are doing. We have trouble presenting ourselves as being vulnerable and scared for the person and as such forget that we can be role models to young women looking for themselves in relation to others. Trusting young women with information, either about ourselves or the situation, or interpreting another’s behaviour that is confusing, hurtful or frightening in a way that helps them understand how that person might be feeling, reinforces an understanding of their self-in-relation.

Case #2
A young woman came to see me to ask if she could keep a snake in her room. She answered all of my questions about the snake. She knew the rules about pets and felt the snake fell within the rules. She also told me the staff would not let her keep it and felt this was unfair. She wanted me to tell the staff she could keep it. Although she seemed to know this was not a good idea, she was convinced I should do it. We talked about fear of snakes and how some people have this fear and are afraid to admit it. We also talked about how people have a need to feel safe about the snake not showing up in their bed. She said she had talked with all the kids but not the staff. The fact that they might be afraid did not seem to have occurred to her. We talked about getting the staff on her side by identifying their fears and being reassured, and not by demanding or issuing an ultimatum. She practised in my office about what to say and how to say it. She was successful in convincing the staff and kids to give it a try. The snake stayed in her room without incident until one of the boys kidnapped it. She made sure she came and told, although she was not too upset. The point of the snake was really about learning how to negotiate and how to use her understanding of other people’s feelings to her best advantage.

We all love to be asked for our opinion or trusted to give advice or relied upon when there is a problem. Young women with troublesome problems of their own, are no exception. They will willingly put aside their own troubles to help or listen to others. More often than not, this is seen as colluding with another’s hard time—jumping on their hard-time bandwagon. This could be a misinterpretation. Like adults who have "been though it," troubled young women feel that because of their experiences they are the only ones who can really help. Their sense of right or wrong is clear, their morality very rigid and rule-oriented. They are willing to suffer the consequences to help a friend. Their spontaneity is no different than that of my 16-year-old daughter who goes out at 11 p.m., against my wishes and with the knowledge of a future consequence, to help a friend. My daughter arranges a ride for herself; the young people I work with wander the streets and endanger themselves otherwise. Still their commitment to friendship should not be criticized.

There are many ways of handling acting-out behaviour specific to adolescent females. Most of these behaviours, such as running away, promiscuity, and self-mutilation, are related to other more deep-seated emotional issues. Nevertheless, knowledge and conversation about knowledge is of great assistance regardless of the underlying issues. Girls emerging into womanhood are beset with managing their developing sexuality, a new body, and the politics of being a woman as defined by society. Knowledge given, explained over and over, and treated matter-of-factly and non-judgmentally is of prime importance.

For example, many adolescent girls – old before their time – talk as if sexuality were old hat to them. With careful investigation, one often discovers that their knowledge is a collection of unconnected experiences and conversations. Their embarrassment and uncomfortableness is enormous. Knowledge prepares them and gives them confidence. Discussions about "women’s issues" encourages them to think, have and state their own opinions and prepares them for a future within society – a self-in-relation to the world. The adult world is full of differing opinions regarding benefits and consequences related specifically to women that are difficult to explain, let alone live with. Preparation for the many possibilities is of prime importance for good choices in the future.

Case #3
A 16-year-old woman says, in a conversation about abortion, that she knows her mother is "for abortion" but she is not sure if she is or not. When asked to elaborate, she said she does not like the thought of killing a baby and she knows there are many people who need babies to adopt. She also stated that in school they heard about girls who get abortions all the time and shouldn’t something be done about this, as it was not good. For these reasons, she felt she was more pro-life than "for abortion" but she wasn’t sure. When she was asked what pro-choice means as related to being "for abortion" she said that they are the same and refused to listen to a discussion about the importance of choice. She said that this is not the issue. Only when an adult present said that she hoped that the young woman would never have to be confronted with choice, did she see the distinction. Her confusion remained but her understanding of an extremely complex and highly emotional issue was broadened.


We need to find ways to balance our own anxieties and expectations of young women with their needs to stay connected or find connections in the adult world. Troubled young women have fewer resources and opportunities but no less capacity for the development of a self-in-relation to others. They have a voice we should listen to. They are more outspoken in their confusion and more vehement in their disdain for those adults who break the rules of trust and guidance. They have high expectations, often higher because their dreams are unfulfilled. They have no less desire for a future of peace and contentment. Their relationships are just as important to them as they are to you and me, even though we may feel they are "hanging around with the wrong crowd." We can learn much from the voices of these young women. We must listen to them.


Blos, P. (1962). On adolescence. New York: The Free Press of Glencoe.
Erikson, E. (1968). Identity, youth, and crisis. New York: W.W. Norton and Company.
Gilligan, C., Lyons, N.P., & Hammer, T. (1990). Making connections: The relational worlds of adolescent girls at Emma Willard School. Cambridge: Harvard University Press.
Kaplan, A., Gleason, N., & Klein, R. (1991). Women’s self-development in late adolescence. In J. Jordan, A. Kaplan, J.B. Miller, I.P. Stiver, & J.L. Surrey (Eds.), Women’s growth in connection (pp. 124—142). New York: The Guilford Press.
Miller, J.B. (1991). The development of women’s sense of self. In J. Jordan, A. Kaplan, J.B. Miller, I.P. Stiver, & J.L. Surrey (Eds.), Women’s growth in connection (pp. 11—26). New York: The Guilford Press.
Miller, P. (1979). Female delinquency: Fact and fiction. In M. Sugar (Ed.), Female adolescent development (pp. 115—140). New York: Brunner-Mazel.
Opie, I. & Opie, P. (1963). The puffin book of nursery rhymes. Middlesex, England: Puffin Books.

This article reprinted from the Journal of Child and Youth Care, Vol.7 No.2 1992, pages 31-39 


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