"On Healing" March 2007

Posted on Mon, Mar. 19, 2007
Girls are becoming 'sexy' too soon
By Dan Gottlieb

Last summer, I took my niece to a store that specializes in clothes for girls ages 7 to 14. I was troubled by what I saw. Thin little girls were coming out of the dressing rooms in flimsy halter tops and tanks, T-shirts with flirtatious writing on the chest, cotton pants that announced eye-catching slogans on the bottom. Mothers were casually helping their daughters try these things on.

I worried: If this is considered normal for little girls, what will they be wearing when they get to high school? And I wondered: What is this doing to how girls see their bodies, and themselves?

Apparently, I wasn't the only one. The American Psychological Association's concerns led it to form a Task Force on the Sexualization of Girls, which last month issued an extensive and worrisome report. Reviewing existing research, the task force found that the sexualization of girls went far beyond merchandising. Girls were portrayed as sex objects, their sex appeal and behavior valued above all else, in television, music videos and lyrics, magazines and movies. Women were used for decoration rather than as complete people. Perhaps most dangerous, the task force reported, the mass media's definition of physical beauty was very narrow and unrealistic.

But hasn't this always been the case? According to Eileen Zurbriggen, lead author of the task force study, all of this has escalated dramatically over just the last several years. The messages have become much more sexual and available.

And there is little question that the messages are being received. Research shows that girls and boys both evaluate girls by these sexual standards, and popularity is based on how well they are met. Girls either praise or make fun of one another based not just on physical appearance, but sexuality.

The impact? Researchers have found that early sexualization can undermine a girl's sense of her own body. This places girls at much higher risk for the many issues associated with shame, including eating disorders, depression and anxiety disorders. And we know that while some girls flaunt their bodies, others hide them and still others cut them. All of which suggest body discomfort.

Last year, I saw a 12-year-old girl with her parents. They had just learned from her diary that she had been sexually active with several older boys. When the family came in for therapy, I expected the girl to be angry at her parents for their intrusion. She wasn't. She felt sad, ashamed and probably relieved. After her parents left the room, she told me she was not as skinny or pretty as the other girls, so she felt pretty alone. So she thought that if she was sexually active, she would be popular. She didn't like sex, she said, but she hated being unpopular. Sadly, it worked. Boys paid more attention, and that made her feel more popular.

Many of the actions that can be taken by parents and schools are listed in the American Psychological Association report - media and sex education programs, extracurricular involvement and more. The APA especially recommends sports, so girls can begin to experience their body in more ways than just appearance. Girls most at risk are those who have learned that their only value is either how they look or how they perform academically.

This was the case with the 12-year-old I saw. Because she felt inferior, she spent much of her time comparing herself to others. That always makes you feel worse. Like most people growing up in a fast-paced and highly competitive world, this girl developed her identity based on external characteristics; she has not learned much about who she is on the inside. Sure, she needs counseling and sex education. But I also advised her parents to help their daughter find what she loves and brings her a sense of pride and joy - and, once discovered, to help her do it better, and then expand to other things.

Ultimately, our job as parents is not to help our children become all they can or should be. Our job is to help them become who they are inside.

Posted on Mon, Mar. 5, 2007
If you're depressed, this is what you should do
By Dan Gottlieb

Dear Dr. Dan: My adult daughter is in desperate need of psychological counseling. She has been unhappy for a long, long time but rarely talked about her feelings and, for the most part, has been putting on a brave front that has broken down due to a recent personal rejection. She has been home since this happened, crying uncontrollably and missing work.

She finally said she was depressed and accepted my offer to find professional help. How can I help?
Concerned mother

Dear Concerned: Depression can be debilitating but it is also quite treatable with a combination of medication and psychotherapy. In today's mental-health world, that usually means two different people: one for medication and another for psychotherapy.

Medical doctors such as psychiatrists, internists and family physicians have the authority to prescribe antidepressant and other drugs. But most psychotherapy these days is done by various kinds of licensed mental-health professionals (psychologists, social workers and family therapists). Psychotherapists who treat depression generally are used to working in conjunction with a prescribing physician.

Finding a good therapist may take some research, which is especially difficult for someone who is depressed. So I'm happy that your daughter is open to your offer of help. The best way to find a good therapist is through word-of-mouth. Ask friends or relatives if they have ever seen or know of a psychotherapist they have been happy with. A family doctor might know a name but is less likely to have specific knowledge of the person's clinical skills.

If you can't get a personal recommendation, find out from your insurance carrier who in your area it reimburses. Then have your daughter begin to make calls. Most therapists should be willing to spend a couple of minutes on the phone. (If not, call another therapist.)

Some issues to cover:

Make sure the therapist is a licensed mental-health professional with experience treating depression.

Find out how much a session costs and how long the therapy takes, on average.

Perhaps most important, your daughter - or anyone seeking therapy - should get a sense of whether she would be comfortable with that clinician.

If all is good, make an initial appointment. This first session is really a two-way evaluation, as both will be deciding if they can work together. Your daughter probably won't feel completely safe with a new person but she should get a sense of competency and a feeling that she is understood.

Hopefully, she will leave with an idea of how that therapist works and how long treatment typically lasts. I wouldn't be comfortable with a therapist who says it will be X number of sessions because I wouldn't want a "one-size-fits-all" treatment (although health-insurance companies may push in that direction). On the other hand, therapy should not take years.

Finding a physician for medication is easier. Psychotherapists often can recommend a medical doctor they have worked with. I also sometimes encourage new patients to start with their family doctor. Family physicians and internists are pretty knowledgeable about depression and medication, and this is generally the easiest and least expensive way to begin.

If the first drug prescribed is not effective, or if there are too many side effects, don't worry; it's sometimes difficult to find the right medication on the first try. Even if you do, it could take four to six weeks to see results. If one or two tries with the family doctor don't work, I think it is important to see a psychiatrist who can do a more thorough evaluation and who may have more knowledge about which medication, or combinations of medication, would be helpful.

If your daughter doesn't feel at least some improvement after a few months, it might be time to review the direction of therapy, medication or both.

Our Partners and Sponsors