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In this section:

• Stigma
• Recognizing Depression
• Relationships
• Family Communication and Dynamics
• Cultural Expectations
• Racism
• Homophobia
• Ableism
• Friendship, Intimacy, Fitting In and Peer/Social Pressure
• Sizism, Body Image and the Media

Hear Me

We're all, like, based on relationships, and if all the relationships you build up for yourself aren't what you want them to [be]. . . then it has an effect on you, because it affects who you are. Because if you can't get those connections to other people, then you're automatically lost in a hole.

When I think about relationships, I think they are some of the times I've been the saddest.

I think, like, something drastic that changes in your life would cause depression, like maybe your parents getting a divorce, a death, stress and school.

An only child and the only physically disabled member in my family, I lacked a safe, nurturing, affectionate adult who could validate my feelings and experiences.

Would I have been treated by my parents differently if I were a boy . . . ?

If you have a big fight with a best friend . . . you start to re-evaluate your own self-worth, wondering why they didn't want to be your friend anymore. It starts to eat away [at you].

Queer teenagers are often teased, bullied, battered and even kicked out of homes simply because they cannot change.

Many girls have an idea that once they are part of the in-crowd, their lives will suddenly become wonderful. They'll be invited to all the right parties, be in a hot relationship and all of their problems will cease to exist. Because of this, some girls will try anything to be part of the in-crowd, such as smoking, taking drugs, underage drinking or becoming sexually active.

Understand Me

In their teens, many young women have an increasing desire to choose new relationships and have more control over existing ones. As young women struggle to shape their identity around families, peer groups and intimate partners, relationships become a focal point in their lives. As they explore a myriad of relationships, young women may find themselves managing new emotions, expectations and tensions, both within these relationships (e.g., between a young woman and her friends) and between these various people in their lives (e.g., between a young woman's parents and her intimate partner, or between her intimate partner and her friends).

Through relationships young women come to know themselves better and evolve. Positive, supportive interactions validate their experience; teach them about their needs, cares and worries; and offer a structure in which to learn how to relate to others. Yet for young women just developing a sense of themselves, relationships can be very scary.

Relationships are complicated, and take practice to "get right" - and young women are only at life's starting gate. Relationships are also risky; a person's self-esteem can be very vulnerable, depending on the level of intimacy in a relationship and its importance to that person. In a young woman's life, a variety of relationships - family relationships, the proverbial "best friends," lovers and other sorts of interactions (e.g., with teachers, health care professionals, counsellors, coaches or other mentors) - play different roles and call for different levels of trust. As with the broader social issues of sizism, body image and media portrayal, others' expectations are cause for concern and affect how young women feel in relationships with those people. Negative impressions from trusted family members, a lover or a friend can strongly influence a young woman's thinking and definition of self, which can undermine her self-esteem. The young women of VALIDITY confirmed that relationships are challenging, and can cause them to question who they are and their place in the world.

Particularly challenging are situations over which a young woman has no control, in which she is expected to fulfill many different roles for others' benefit, at the same time. Family dynamics, sex-role stereotypes, cultural expectations and customs add layers of complexity with which a young woman may have to deal. Racism, ableism, homophobia and sizism further complicate matters.

For example, a young woman, the only English-speaking person in her immigrant family, may carry the burden of communicating in English on her parents' behalf; she may also be teaching them the language. In addition, in a foreign country where North American customs are unfamiliar to the parents, the pressure to fit in with her peers may contradict her traditional family's expectations. As a caregiver, yet also needing care herself, this young woman may numb herself to the discord, knowing it's unacceptable in her culture to express negative emotions. This can become too much for her to bear and lead to unconscious expression through the only available "safe" route: depression.

Being outside "the norm" in her relationships, where trusted others question or judge her choices, can also cause a young woman great stress. A young lesbian may face extreme pressure to marry a man. Imagine her inner turmoil, frustration and anger at being unable to be true to herself, at being expected to swallow her feelings and fulfill her roles in a family that depends greatly upon her.

A young woman's relationships and how she feels in them deeply affect her self-esteem; how much she feels she has control in her life is a crucial variable in her emotional well-being. Emotional support for being true to herself is essential, even when that means ending an (albeit unworkable) relationship; the only place she may find support for such a step may be in a professional's office.

Young women are viewed as sexual beings as they mature physically. Young women who mature earlier are thus viewed in sexual terms earlier, and may begin dating well ahead of their peers. They may be self-conscious about their new curves, and may not yet be emotionally ready to handle sexual and affective dating pressures. And these pressures to date may interfere with their friendships with other girls.

Furthermore, being different from peers (e.g., being overweight, of a different culture, of a different class) often means being excluded from social groups. Lack of social support can contribute greatly to depression, while the instinct to push people away and become more isolated when you are depressed can exacerbate depression. People who are depressed may be more likely to interpret rejection from their peers, even when there is none. This too can deepen the depression.

The nuances of these relationships will be explored in greater deal in the following discussions of these challenges: family communication and dynamics; cultural expectations; racism; homophobia; ableism; friendship, intimacy, fitting in and peer/social pressure; and sizism, body image and the media.

Support Me

Young Women's Health
www.youngwomenshealth.org/PDFs/curric_healthy_relat.pdf

As you develop your own relationship with a young woman, it is important to let her know from the beginning that there are limits to confidentiality (e.g., there is a legal obligation to report if someone states that she is going to harm herself or others, or if a child is at risk).

As with most issues of a personal nature, the young woman will likely be more open if she feels that a health care professional is genuinely interested in and cares about what she has to say about her life. While an adult may not relate to a young woman's experience of her relationships, validating hers, in the end, is in and of itself a powerful way to help her listen to her authentic inner voice, to prevent her from minimizing her experience as less than important, and ultimately to prevent her from succumbing to depression. Building a trusting, non-judgmental relationship can lead to conversations that will provide insight into the nature of the relationships that are important in the young woman's life.

Be careful not to make assumptions about a young woman's family relationships. She may be living with birth parents, with adoptive parents, with same-sex parents, with extended family (e.g., grandmother, aunt, uncle), with friends, in a single-parent family, in a foster home or in a group home. As you get to know the young woman, you will learn about the nature of her relationship with her family.

Young women are often taught to feel that intimate relationships are the most important thing in life. Acknowledge the role and impact of intimate relationships (or the lack thereof) on young women, as they can be extremely overwhelming and/or isolating. Also ask about the people in the young woman's social network and what role they play in her life. The lack of social support is considered a risk factor for depression.

Provide opportunities for young women to come together and talk with each other. (See Let's Talk . . . Girls Talk Girl-Centred Health - Reframing Prevention) A facilitated non-treatment group will give the young women the opportunity to hear how others view relationships. This could involve discussions about stress, relationships and self-esteem. Young women need to be able to figure out what a good, healthy relationship means to them.