Psychology of Women Quarterly, 30 (2006), 231238. Blackwell Publishing, Inc. Printed in the USA.

Copyright C 2006 Division 35, American Psychological Association. 0361-6843/06

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TO FLOURISH AS A THERAPIST How to Survive and Thrive as a Therapist: Information, Ideas, and Resources for Psychologists in Practice. KENNETH S. POPE & MELBA J.T. VASQUEZ. Washington, DC: American Psychological Association, 2005. 496 pp., $49.95 (paperback), ISBN: 1-59147231-8.
The title of Pope and Vasquezs new book communicates their goals in a self-evident manner. They have written a book to help practitioners develop and maintain a private practice. The key word in the books title is thrive. This book is not only an informative, concise, and spirited compilation of the necessary ingredients for a successful private practice, it also provides and emphasizes information that will help ensure that our business endeavors as psychologists are as satisfying as they are profitable. The authors language is straightforward and down to earth. They attend in a refreshing manner to many topics that I have not yet seen in other private practice manuals, such as the use of an attorney, developing a professional will, and using computers to support a psychology practice. Even when they address matters that have been covered elsewhere, they do so with much more user-friendliness than other sources. For instance, Pope and Vasquez do not assume that clinicians have business knowledge and succinctly provide details for formulating a clear business plan, including suggestions about descriptive categories for organizing projected income and expenses. In addition, they provide several possibilities for how one might analyze this financial data and make more pragmatic and cost-effective decisions. Despite consulting many resources prior to establishing my private office, the business plan always remained elusive for me. I have finally found clear and helpful advice for formulating this important ingredient of my practice. Pope and Vasquez also include advice on how to select and use an attorney before a critical legal situation arises. They suggest a variety of issues to consider with an attorney in order to prepare oneself to respond to potentially complicated procedures such as subpoenas, establishing a group practice, ethics complaints, or the reporting of child abuse. Their advice in this regard can only help a clinician feel more prepared to face these dilemmas and sustain their confidence in handling them. The chapter on using computer technology to support professional practice is innovative and informative about the advantages and inherent obstacles. Particular attention is paid to strategies for minimizing the risks, such as protecting the confidentiality of the data stored on your computer. In this chapter, as with the other chapters, the authors provide references for more information. For example, they offer listings of several programs that can assist

with billing and managing a practice and explain how one might acquire them. After reading about developing a professional will, I was encouraged to consider how I might organize for client care, client files, and financial records in the event of my death. As a young clinician, it has been tempting not to contemplate this due to the inevitable discomfort associated with the topic. Pope and Vasquez, however, gently prod us to take this matter seriously and to ensure our personal and professional arrangements do not contradict each other. Several of the chapters list common questions related to private practice and include answers that outline likely ramifications. For example, the authors explain the facets of liability coverage and the process of locating ones office. Other chapters use bulleted lists regarding policies and procedures or how to avoid problematic ethical rationalizations. Both of these formats allow the reader to easily consider aspects that might potentially be overlooked and lend themselves nicely to developing personal checklists. Pope and Vasquez light-heartedly tackle areas of potential embarrassment to a clinician without de-emphasizing the seriousness of specific problems. Several of their chapters are devoted to common ethical concerns for clinicians in private practice. They inform us of our responsibilities while compelling us to maintain these responsibilities even when we may feel inclined to rationalize our behavior and fall prey to common logical fallacies. The chapter on self-care is excellent, a topic often neglected by our profession. Pope and Vasquez provide strong arguments for the necessity of nurturing ourselves as practitioners and suggest many solid ideas for how clinicians may expand their repertoire of self-care strategies. Self-care has been a strong value within feminist psychology and its emphasis here is refreshing. Finally, Pope and Vasquez collected and included 15 practical appendices of information and guidelines that have not previously been easily within reach. These appendices include guidelines for working with ethnic, linguistic, and culturally diverse populations; and the guidelines for psychotherapy with lesbian, gay, and bisexual clients. This book is worth every penny of the selling price. It is undoubtedly the best source of information and advice on how to set up a private practice that I have come across. The book is written for a general audience of psychologists, however, it may be particularly useful to those feminist psychologists who have ambivalence about the business aspects of private practice.
Shawna Atkins, Ph.D. is a Psychologist at Concordia University in Montreal and in private practice. Her research and clinical interests are in the areas of multicultural awareness development, deliberate self-harm, and trauma.

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232 GROWTHFUL CONNECTIONS: RELATIONAL-CULTURAL THEORY IN THERAPEUTIC ACTION How Connections Heal: Stories From Relational-Cultural Therapy. MAUREEN WALKER & WENDY B. ROSEN (Eds.). New York: Guilford, 2004. 258 pp., $23.00 (paperback), ISBN: 1-59385-032-8.
Many feminist therapists know that relational-cultural theory (RCT) is built on an understanding of people that emphasizes a primary movement toward, and yearning for, connection with others throughout the lifespan, and that RCT emphasizes that people grow through action in relationship with others (p. 4). However, some therapists may question how to use this theory to guide therapeutic sessions. Maureen Walker and Wendy Rosens insightful collection of case narratives addresses this concern and answers practical questions such as: How do relational-cultural therapists use boundary issues as a place of meeting and exchange rather than a line of rigid demarcation? (p. 15) How can therapists increase their sensitivity to various socially constructed cultural images to enhance growth-fostering relationships? How can the RCT model guide clinical work? The first section of the book focuses on the subtle but complex relational nuances that transpire between therapists and clients in individual therapy. The middle section describes in thorough detail the multidimensional dynamics that occur among therapists and families, partnerships, therapy groups, and organizations. With considerable emphasis on variables that produce organizational disconnect, the last section closes with cases that illustrate how RCT has been used to create models of change in institutional settings. In the most salient chapters, various contributors thoughtfully show how sociocultural and economic factors impede or enhance patterns of connection, disconnection, and reconnection in the therapeutic relationship with a wide range of clients: heterosexual and lesbian couples, young and middle-aged women, students, family members, group therapy participants, women prisoners, and adolescent females. For example, when applying RCT in cross-cultural therapeutic relationships, Roseanne Adams offers invaluable and practical insight about how paying attention to her personalized and internalized dominance and oppression (p. 155) helps her conceptualize familial issues, respond to clients initial calls, provide appointment times during parents nonworking hours, schedule longer and less frequent sessions to accommodate working family members, create a comfortable therapeutic milieu, and respond to personal questions about herself. Relational images, defined as notions we form, beginning in childhood, about how the world operates . . . often based on limited or distorted information (p. 70), which trigger repetitive reenactments and inhibit psychological growth (p. 18), play a recurring role in most of the case narratives. Particularly when illuminating ways in which naming, owning, understanding, and working through these relational images transform therapeutic connections, several writers skillfully demonstrate the usefulness of the relational-cultural model. A striking example is when Alice Lawler reveals how her relational image that the anger and rage of others toward her could be devastating and overwhelming (p. 69) caused her to withhold upsetting information from her

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client whose personal relational image included the belief that she could expect betrayal if she trusted another person. As predicted, her client felt retraumatized as well as betrayed, enraged, and disconnected (p. 70) when this information was eventually revealed to her. Throughout this chapter, Lawler effectively details the therapeutic process through which the relationship was strengthened. The willingness on the part of therapists to share therapeutic mistakes is an additional strength of this book. For example, Cynthia Walls engaged the reader by disclosing how she failed initially to consider how the similar relational images that she shared with her client might influence the therapeutic relationship and then demonstrated how to handle such clinical errors. Chapters that reveal how therapists work through mistakes with clients are exceptionally beneficial for new therapists and graduate trainees who often fear that unintentional blunders will cause irreparable damage to their clients or the therapeutic relationship. Regrettably, many case narrative collections omit client perspectives. This book, by contrast, presents a commendable supply of client perspectives, even when the therapeutic encounter is placed in a negative light. For example, an extremely challenging client revealed a list of reactions in response to the therapist/client dialogue from the previous session including: Yes, Im a little slow at expressing emotions, but whose time clock do I need to be on? You set me up by minimizing and devaluing gifts you give me; you disconnected from me during our session, and it says on page 32 or something of that book you gave me [The Healing Connection, Miller & Stiver, 1997] that thats not a good thing. (p. 63) In each chapter, the various authors carefully contextualize the case narratives within RCT. Although there is value in theoretical positioning, particularly for readers unfamiliar with the theory as well as teachers who wish to select particular chapters for student reading assignments, the theoretical clarifications were extremely repetitive when reading the book from cover to cover. Though thematically similar to previous RCT books, this very readable compilation of previously unpublished narratives is highly recommended for advanced undergraduate and graduate students, inexperienced and advanced feminist therapists, college student human services personnel, organizational administrators and leaders, as well as supervisors and supervisees who wish to deepen their understanding of the RCT model. Regardless of the various limitations of this edited collection, the individual authors skillfully illuminate the space between: not one person or the other, but the dynamic interchange between them that is the heart of therapy (p. x) to show how to put RCT into practice as a theoretical template and guide.

REFERENCE
Miller, J. B., & Stiver, I. P. (1997). The healing connection. Boston: Beacon Press.
Karyn J. Boatwright is Associate Professor of Psychology and chair of the Womens Studies Department at Kalamazoo College in Kalamazoo, Michigan. Her major research interests include college womens leadership aspirations and feminist pedagogy. Bridget B. Nolan is enrolled in the Counseling Psychology masters program at Western Michigan University in Kalamazoo, Michigan. Her major research interests include multicultural issues and womens developmental transitions.

Reviews THE INSTITUTION OF HETEROSEXUALITY Thinking Straight: The Power, the Promise and the Paradox of Heterosexuality. CHRYS INGRAHAM (Ed.). New York: Routledge, 2004. 256 pp., $24.95 (paperback), ISBN: 0-415-93273-4.
The goal of the book Thinking Straight: The Power, the Promise and the Paradox of Heterosexuality is to offer a discussion of heterosexuality as both natural and socially constructed. That is, the authors juxtapose the societal view of heterosexuality as naturally occurring against the ways in which heterosexuality is socially constructed. As the editor indicates, the metaphor of thinking straight means to embrace the institution of heterosexuality as naturally occurring, normal, and universal. All other forms or derivatives of sexuality are then socially constructed. With this definition at the forefront, the basic premise of the book is to identify the institutionalized history, materiality, practices, systems, contradictions, and power embedded in heterosexuality. The book is divided into three sections. Each of the sections contains a series of essays that address different aspects of the theme put forth by the section title. The first section, entitled Power, includes four articles that offer historical, theoretical, and cultural discussions of heterosexuality, gender, sexuality, and homosexuality. Of the three sections, this is the strongest and offers a balance between different perspectives on sexuality and gender. The second section, The Paradox, attempts to address the contradictions embedded in the duality of sexuality. Each of the essays offers a unique perspective on gender and sexual expression and the contradictions therein. Two of the essays are specifically focused on heterosexual men, with only one addressing female heterosexual imagery. Finally, The Promise offers four essays that analyze idealized heterosexuality. Three of the essays in this section analyze movies, books, and literature as media for conveying heterosexual expression, with one essay offering a sociological discussion about poor womens rejection of marriage. Although each of the essays in the second and third sections provides interesting insights, there seems to be a lack of balance in the subject matter, with a tendency to overemphasize one area while ignoring or minimizing others. The strength of this book is that it offers a series of essays that require the reader to think and rethink what is straight and the ways in which straight is fundamentally embedded and institutionalized in society. Although many of the ideas included in the book are not new, the way the editor has organized the discussion into three sections helps the reader to continually assess and analyze the natural versus constructed aspects of sexuality. Although the book offers much food for thought, the writers struggle with the dualism between heterosexuality and homosexuality. That is, whereas the goal of the book is to offer a discussion of heterosexuality, the authors tend to juxtapose this construct against the definition of homosexuality. When this duality emerges, the focus is somehow moved away from natural versus institutional heterosexuality to an implicit comparison between gay and straight. This divergence takes away from the strength of the analysis of heterosexuality as natural or normal, moving the reader to assessing homosexuality as deviant from the heterosexual norm. When this occurs, as it does throughout the book, it serves to dilute the dis-

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cussion and, at times, is antithetical to the fundamental goal of the book. A second limitation of this book is that, with the exception of one essay about women in poverty, there is no discussion of diversity. The book does not address racial, ethnic, or other forms of diversity that affect the nature of gender and institutionalized heterosexuality or other forms of sexuality. The examples from the movies and literature are predominantly of White people and, for the most part, the discussion is based on White societal systems and structures. With the exception of one essay that the author indicates is about [W]hite heterosexuality, the authors do not discuss explicitly the assumption of Whiteness embedded in their arguments. This omission renders White as the norm and makes the diversity within heterosexuality, sexuality, and gender invisible. Even the picture on the cover depicts a White heterosexual couple. Therefore, the book appears to offer a description of sexuality that assumes Whiteness. That being said, the book is well written, and each section leads naturally to the next. Not only is each chapter strong enough to stand on its own, but the book also offers a series of essays that can be read as a comprehensive whole. Overall, within the bounds of its limitations, this book provides a historical, theoretical, and cultural analysis of sexuality that requires the reader to continually assess and reassess his or her own social location with regard to gender and sexuality. This feature, in and of itself, is a major strength of the book and makes it a worthwhile read.
Ada Sinacore is an Associate Professor in the Department of Educational and Counseling Psychology at McGill University. Her major scholarly interests include the intersections of multicultural and feminist theories, social justice pedagogies, negotiating multiple oppressions, and sexuality and gender.

NATURE AND NURTURE: COMPLEXITIES OF GENDER RE-EXAMINED Gender, Nature, and Nurture (2nd ed.). RICHARD A. LIPPA. Mahwah, NJ: Erlbaum, 2005. 336 pp., $34.50 (paperback), ISBN: 0-8058-5345-6; $79.95 (hardcover), ISBN: 0-8058-3605-5.
Richard Lippa presents a detailed look at an old debate, nature versus nurture, using the current lens of gender. Although it seems in many ways we have already moved beyond arguments regarding nature and nurture (despite Lippas concern that he has placed himself in the crossfire of a rancorous debate), the text provides an interesting updated view of this debate with particular emphasis on sexuality and sexual orientation. The text is organized according to the naturenurture debate with chapters on the study of sex differences, masculinity and femininity, and theories of gender. The book concludes with separate chapters dedicated to nature and nurture, an amusing and interesting chapter on the discussion between Nature and Nurture (over tea), and a synthesis chapter that identifies reallife gender issues that may be impacted by nature or nurture-type policies. The book, though dense, is interesting and makes several good points. For example, Lippa emphasizes that the sexes are not

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opposite and that the existence of sex differences does not tell us anything about why the differences exist. However, Lippa seems to gloss over the difference between sex and gender. Although he attempts to clarify this difference in the first chapter, the clarity is lost in later chapters in which his definition of gender loses some of its coherence. One of the unique and promising aspects of the text is that Lippa presents, in Chapter 1, a comprehensive review of the meta-analyses that have been conducted on a wide range of gender topics (e.g., aggression, group behavior, and nonverbal behavior). He also includes his own cartoons and several interesting examples, such as likening the fuzzy concepts of masculinity and femininity to the category of fruits and the concept of prototypes. Yet many of the criticisms included in the review of the first edition of this book (see Portwood, 2002) might still apply to the second edition. For example, the author discusses feminist theorists several times in ways that seem vaguely insulting of feminist positions. Feminism is usually treated as a monolithic entity rather than as a dynamic, pluralistic force, and women often seem to be an afterthought. For example, there is a lengthy section on testosterone with a side note to estrogen. In addition, Lippa rarely presents the criticisms or limitations of the works he cites, and he uses several terms without questioning the assumptions behind the terminology itself. The term mothering instinct is used, for example, without questioning whether such a construct really exists. In addition, Lippa does not mention the file drawer phenomenon (Rosenthal, 1979), which has resulted in much of our gender literature focusing on gender differences. Findings that focus on gender similarities tend to be much less exciting and therefore less publishable. In addition, Lippa also leans heavily on biological examples throughout the text. Though he notes that the existence of differences does not necessarily give clues to the origin of the difference, his examples are usually based on biological rather than sociocultural factors. For example, the reasons he suggests for the finding that clinical depression is found twice as often in women than in men include genetic and hormonal factors but not cultural factors such as the impact of sexism (Landrine, Klonoff, Gibbs, Manning, & Lund, 1995) and clinician bias (Caplan, 1995). Despite some of the potential drawbacks of the text, the final chapter presents a noticeable change of pace. The last chapter is detailed, interesting, well-balanced, and frankly fun to read. Lippa presents intriguing questions about the complexity of the issues, such as the idea that we may overlook subgroup differences by overly focusing on men in general and women in general. For example, he notes that the wage gap is largest between men and women with children and smallest between single men and women with no children. He also asks thoughtful questions about policy dilemmas (e.g., gender-segregated classrooms, child custody, men and women in the military), asking both where we could intervene and where we should intervene. The citations in the final chapter seem well-balanced and emphasize the importance of cross-cultural research. Lippa ends with a reasoned assessment that answers to the questions posed are complex and unlikely to be either or (nature vs. nurture). In summary, Lippa has presented a vast amount of information on a complex topic of great interest to many people, whether academics, students, or the general public. His chapter on the discussion between Nature and Nurture would make a wonderful debate assignment for classes on gender, and his chapter on causal cascades and policy challenges provides a comprehensive discussion of issues that move us forward into the future.

REVIEWS REFERENCES
Caplan, P. J. (1995). They say youre crazy: How the most powerful psychiatrists decide whos normal. Reading, MA: AddisonWesley. Landrine, H., Klonoff, E. A., Gibbs, J., Manning, V., & Lund, M. (1995). Physical and psychiatric correlates of gender discrimination: An application of the schedule of sexist events. Psychology of Women Quarterly, 19, 473492. Portwood, S. (2002). A new spin on an old debate: Nature versus nurture [Review of the book Gender, nature, and nurture]. Psychology of Women Quarterly, 26, 383. Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86, 638641.
Elizabeth Nutt Williams, Associate Professor of Psychology at St. Marys College of Maryland, is also the Coordinator of the cross-disciplinary program in Women, Gender, and Sexuality Studies. Her research, based in counseling psychology, has focused on the intersection of feminism and multiculturalism, qualitative methodologies, and the process of psychotherapy.

MIXED MESSAGES MAY IMPEDE THE SEARCH FOR THE DISAPPEARING GIRL The Disappearing Girl: Learning the Language of Teenage Depression. LISA MACHOIAN. New York: Penguin, 2005. 244 pp., $24.95 (hardcover), ISBN: 052594866X.
The Disappearing Girl is intended to provide guidance for depressed girls, their caregivers, and their health care providers. Using everyday language, this book outlines the symptoms, causes, and treatment for teenage depression. The personal stories collected by the author serve as easy-to-understand case examples of the many faces of the disorder. The author, Dr. Lisa Machoian, provides rich clinical examples detailing her 20-plus years of experience with depressed teenage girls. Written from a developmental perspective, The Disappearing Girl is a culmination of the authors dissertation work, postdoctoral research, teaching, and clinical experience. The difficult issues adolescent girls face are thoroughly discussed and recounted with compassion and empathy. The book also provides relevant information about the disorders that may co-occur with mood disorders, such as disordered eating. In The Disappearing Girl, the clinical warning signs of depression are presented and then reworked to demonstrate how these symptoms may manifest themselves in an adolescent girl. The book is punctuated by many relevant case snippets and quotations from the girls being interviewed. After outlining depressive symptoms, the remaining chapters are devoted to more comprehensive clinical examples that flesh out the girls phenomenological experience of depression. The examples are written in the context of a clinical interview, in which the author asks questions related to depressive symptoms, social circumstances, and family dynamics. For example, one case details the symptoms of a 14-year-old girl whose depression is precipitated by loneliness and loss, but is marked by the suppression of emotions, acting out behaviors, and anorexia. In another example, a 20-year-old woman reflects

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upon her own teenage depression that was brought on by social stressors (e.g., wanting to fit in with others), though the symptoms of her depression were ignored and missed by her parents and physicians. In both cases, valuable information is provided about the hidden or atypical symptoms of depression, including somatic difficulties such as stomachaches, headaches, and selfmutilation. The author also emphasizes the importance of listening to and validating girls who reach out for help and speaks to the stigma of mental disorders that my interfere with or delay treatment. By employing an easy writing style and utilizing first-person perspective, the author attempts to align with the reader. The author decodes the language of depressed girls by posing questions to the girls interviewed for this book and presents their answers verbatim, offering clinical clarification along the way. The psychosocial factors inherent in an adolescent girls life are thoroughly examined, as are the problematic behaviors that may mask underlying depression. The authors dedication to and compassion for adolescent girls is readily apparent in the manner in which research and clinical cases are presented. The Disappearing Girl attempts to bring hope and understanding to girls and the adults in their lives. Despite a number of strengths, there are also a number of limitations found in the book. First, although The Disappearing Girl explicitly addresses the negative effects of look-based media campaigns and the sexist-laden values inherent in American culture, the book also contains language that implicitly runs counter to an otherwise positive message. The Disappearing Girl offers compelling reasons why caregivers and mentors should make the effort to praise girls on strengths and talents (rather than simply on their appearance); however, the author describes several of the adolescent interviewees with gender-stereotyped and appearance-based language. The author describes many girls as, among other things, having doe-like eyes, pretty, petite, being smart, beautiful, and talented, slim and adorable, and an anorexic girl as, in part, being beautiful. This is surprising, considering not only the overt content of the book, but also that the author earned a doctorate under the direction of Carol Gilligan and has also directed Harvard Universitys Gender Studies program. At key moments within the text, The Disappearing Girl reinforces the notion that society values stereotypically feminine girls that are physically diminutive and strikingly attractive. A further limitation of the book is that diversity issues, such as ethnicity, are not meaningfully addressed. In addition, although the author makes a strong case for the psychosocial factors involved in teenage depression, the biologically predisposing factors relevant to mood disorders and the utility of medical treatment for depression are not satisfactorily addressed. A final limitation of the book involves the references chosen by the author. Although it is a reflection of many years of research, including dissertation work, two-thirds of the authors references are primarily derived from sources that are over 10 years old. Overall, this book would be more useful to a lay reader than to a professional mental health care provider. Because this book is written in language that is readily accessible to most readers, it can be offered as a solid recommendation to parents and other caregivers who are seeking a better understanding of depression and how to help adolescent girls with this disorder. All the same, caveats regarding the implicit messages in The Disappearing Girl that reinforce cultural biases and traditional gender roles for adolescent girls are in order.

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Julie A. Kellaway, M.S. is completing her doctoral internship at the Colorado State University Counseling Center. Research interests include minority and womens issues, secondary education, media analysis, and mood disorders.

NAVIGATING WOMENS MENTAL HEALTH: A PSYCHIATRIC PERSPECTIVE Clinical Manual of Womens Mental Health. VIVIEN K. BURT & VICTORIA C. HENDRICK. Washington, DC: American Psychiatric Publishing, Inc., 2005. 209 pp., $35.95 (paperbook), ISBN: 1-58562-186-2. Mood and Anxiety Disorders During Pregnancy and Postpartum. LEE S. COHEN & RUTA M. NONACS. Washington, DC: American Psychiatric Publishing, Inc., 2005. 148 pp., $34.95 (paperback), ISBN: 1-58562-2257.
Our society is fraught with misconceptions about the nature of womens physical and mental health. These misconceptions go back to the ancient Greeks, who thought PMS was the result of agitated blood trying to escape from the womb (Dalton, 1983). Yet this misinformation did not end in ancient Greece; just as recently as this year, a popular actress was publicly berated for taking antidepressants to treat postpartum depression and accused of irresponsible behavior. Fortunately, some physicians and mental health providers are attempting to replace such misconceptions with accurate, scientific knowledge about womens mental health, which is evident in the two recently published works being reviewed: the Clinical Manual of Womens Mental Health and Mood and Anxiety Disorders During Pregnancy and Postpartum. In these two medical resources, numerous psychiatrists critically examine the mental and physical health issues that are unique to women and provide a wealth of information on both the risks and benefits of pharmacological treatment. The authors accomplish this riskbenefit analysis primarily through an examination of the empirical literature in medical research, which provides helpful, if ultimately inconclusive, evidence on the medical risks involved in treating mental disorders with medication during critical times in a womans life, such as pregnancy or postpartum. The intended audience for these books is clearly medical professionals, which unfortunately results in an omission of the various psychosocial and sociocultural factors that often contribute to the development of mental disorders in women. Although the authors from both books frequently mention the usefulness of nonpharmacological treatment strategies, there is little variability in the types of psychotherapy listed. Together, these works may serve as an excellent supplementary resource for psychologists treating women with mental disorders, as they provide helpful information for understanding the biological mechanisms through which women are affected by pharmacological treatment. However, for psychologists, and physicians as well, these works should not stand alone as the only means of understanding the complexity of womens mental health. The Clinical Manual of Womens Health addresses some of the most stressful and traumatic medical issues faced by women. The authors cover experiences including rape, miscarriage, eating disorders, and depression, and focus on the options for treatment.

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Not surprisingly, the authors primarily use the medical model, as well as numerous biological explanations, in their description of etiology, presentation, and treatment. The section on eating disorders, for example, discusses the medical complications that may arise for women with anorexia or bulimia, but offers a limited range of nonpharmacological treatments (only cognitive-behavioral therapy). This section also fails to provide any information on the psychological reasons women may develop eating disorders, such as societal expectations for thinness and beauty. Despite the books medical and clinical focus, a feminist worldview can be detected throughout. In their introduction, the authors acknowledge that psychosocial factors, as well as womens disadvantaged status in society, may play a role in mental health issues. Additionally, the authors consistently emphasize the need for empathic counseling with these female patients, which is emphasized in the books sections on abortion, miscarriage, sexual assault, and domestic violence. In these sections in particular, the authors succeed in clearly relaying the need for a combination of treatments that include psychotherapy and counseling with a mental health provider. In Mood and Anxiety Disorders During Pregnancy and Postpartum, the authors delineate an admirable mission. Through their analysis of the treatment of mental disorders, the authors aim to clarify the risks for women who may need psychopharmacological medication during the periods of pregnancy and postpartum. Women receive mixed messages from doctors, the media, and most likely friends and relatives about why they should, or more likely should not use various medications (such as antidepressants) during this unique and potentially stressful time. The authors address this quandary both for women entering pregnancy with a preexisting mental disorder and for women who may develop depression and/or anxiety throughout the course of pregnancy or postpartum. Similar to the Clinical Manual of Womens Mental Health, this resource is clearly intended for a medical audience, and thus, its focus is on the medical implications for treating mood and anxiety disorders pharmacologically. The contributing authors anticipate and understand the need for physicians and psychiatrists to effectively communicate the risks for their patients, many of whom may need to either initiate pharmacological treatment during this period or remain on such treatments due to preexisting conditions. In addition, the authors succeed in addressing the societal expectations that new mothers should be nothing short of ecstatic and delighted with motherhood, and contributors sensitively provide evidence that this may actually be a vulnerable time for many women. However, the authors could have dedicated more attention to the stigma associated with women battling postpartum depression and how women may feel chastised for their condition. Both of these medical resources are important contributions to the psychiatric literature because they thoroughly and scientifically examine the available data concerning womens mental health and the risks and benefits involved in various treatment strategies. Neither resource, however, should be the sole source of information for physicians treating women with mental health disorders. Mental health providers should also be aware of and knowledgeable about the numerous psychosocial factors that women face on a daily basis that have the power to influence mental health and functioning. Psychologists may certainly benefit from these resources to enhance their medical perspective and to learn what

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information may be disseminated to clients by physicians. Ultimately, however, a more integrated understanding of the intersection between psychological and medical knowledge is needed to provide women with the most holistic and gender-sensitive health care possible.

REFERENCE
Dalton, K. (1983). Once a month. Claremont, CA: Hunter House Inc.
Anne B. Scott is a doctoral candidate in Counseling Psychology at the University of MissouriColumbia, where she also earned her bachelors and masters degrees. Her areas of emphasis include career development, gender issues, and social class identity.

WHERE AM I GOING, AND HOW DO I GET THERE? Geographies of Girlhood: Identities In-Between. PAMELA BETTIS & NATALIE G. ADAMS (Eds.). Mahwah, NJ: Erlbaum, 2005. 304 pp., $89.95 (hardcover), ISBN: 0805846735; $32.50 (paperback), ISBN: 0805846743.
Geographies of Girlhood: Identities In-Between provides a detailed map of the experiences of diverse groups of adolescent girls as they embark on the journey to understand themselves as girls and women in this society. The girls, whose lives are presented in the 15 chapters, are traveling through many different locations, and are following various routes to develop a sense of their own identities. Each chapter includes a rich, qualitative investigation of the thoughts, feelings, and experiences of young women as they interact with others and explores how these experiences shape their understanding of what it means to be a girl. The chapters give us a glimpse of girls lives in such varied locations as the back seats of a school bus and classrooms in a Christian high school. The chapter also expands our understanding of normative girlhood by including girls who engage in physical fighting as a way of declaring their individuality, as well as those who overcome stigmatized, sexualized labels to gain positive self-identities. The book is set within the context of twenty-first century notions of girlhood, in which girls are expected to embody both traditional feminine and masculine traits and behaviors. The notion of ideal girlhood requires that adolescent girls be independent, assertive, and achievement-oriented, while also being demure, softspoken, underweight, and deferential to boys and men. The book strives to convey the many ways in which girls attempt to deal with this confusing dichotomy. Each chapter presents a rich discussion of girls identity development process that is drawn from qualitative research. There is thematic consistency throughout the chapters, which gives the edited volume a holistic integrity that is unusual for a volume with so many singly and jointly authored chapters. In addition, the book addresses the experiences of girls who are often underrepresented or invisible in the mainstream discourse on girlhood. As the chapter authors so distinctly illustrate, some girls negotiate ideal girlhood and travel this journey in ways that are consistent with socially constructed normative behavior, while others resist the prevailing societal notions and define girlhood on their own terms.

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The introduction to the volume articulates the editors perspective that adolescence is a liminal space, which is a term borrowed from anthropology to describe the in-between place that adolescent girls inhabit as they undergo the rites of passage between childhood and adulthood. The editors use this term to make sense of the complexities inherent in the lives of adolescent girls. In so doing, they allow us to gain an emic view of girls everyday experiences as they travel from home to school, during school hours, and into their lives after they have completed their education. The chapters that constitute Part I of the book (Before School) provide insight into the challenges faced by adolescent girls as they reconcile childhood behaviors (e.g., playing with toys) with more normative adolescent behaviors. These girls are portrayed as active agents in their own identity development processes, and readers are able to gain an appreciation for the varied ways that girls choose to travel through this period. The powerful and provocative chapters in Part II (At School) explore girls identity development within the school context. The authors take us into the lived experiences of groups of girls who approach the identity journey from roads that are diametrically opposed to each other, and give voice to girls who are typically absent from feminist discourse. Although these nonconformist girls are often situated outside of normal girlhood, their experiences make an important contribution to the cultural script and force us to broaden the definition of ideal girlhood beyond traditional boundaries. As a feminist scholar who has read the literature on adolescent girls development for a number of years, I was pleasantly surprised to see Fingersons chapter on girls public and private menstrual identities. Menstruation is such a routine part of life for adolescent girls that it often remains invisible, and few studies examine its intersection with identity development. The chapters in Part II reconsider the ways that girls developmental needs are often at odds with the institutional status quo by introducing us to girls who are attending a Christian high school and struggling to make sense of the theological expectations surrounding submission to males, as well as girls who must learn to resist the negative stereotypes about parenting and teen mothers. Their experiences reveal the myriad ways in which institutional structures are nonsupportive of girls development and the types of structural reforms that would be needed to assist girls in their identity development journey. Part III (After School) comprises of studies based on adult womens reflections about experiences in high school and/or college that placed them at odds with their environment. The chapters draw us into the thoughts and feelings of young women as they struggled to find ways of developing and maintaining a positive self-identity in the face of slander, homophobia, disability, and the cultural divide that separates ethnic-minority from majority group members. The book left me with an essential question: What can be done to reduce the anguish and confusion that many girls experience as they journey through the identity development process? The key recommendation of authors is that the cultural script for ideal girlhood needs to be rewritten to include the voices of girls that are typically absent from the dialogue. Fewer of the authors call for revisions in the school system, and only one author recommends facilitating resistance strategies among girls who find themselves being oppressed by stereotypes and the narrow definitions of ideal girlhood that abound within our society. The editors

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go a bit further and recommend revisions in our theoretical understanding of girlhood; however, they make little or no mention of ways that institutional structures can be reformed. In the Afterword, they write, . . . So what have we learned from all of these explorations? First, we have learned that place must be taken seriously in schooling, and obviously we are not talking about the classrooms of schools; second, that teachers and scholars need to understand the socialization of girls or the production of girlhood differently; and third that by taking place seriously and understanding the production of girlhood differently, we can construct a pedagogy that is place and gender based. (p. 272) Although these are valid recommendations, I believe that more needs to be said about the institutional, systemic changes necessary to better support girls identity development. I was also somewhat disappointed that only one chapter acknowledged the importance of helping girls learn better strategies to resist the oppressive forces embedded within the traditional feminine ideal. In contrast, other feminist scholars such as Robinson and Ward (1991) have articulated numerous ways that adolescent girls can be helped to develop effective resistance strategies as they struggle against adverse social conditions in their quest to find self-identity. The chapter authors and editors of Geographies of Girlhood have given us much food for thought, and it is important to take this knowledge and move to the next step of articulating ways that adolescent girls can be helped to resist the negative forces they encounter on their journey toward womanhood. It is also necessary for feminist scholars, educators, and researchers to work toward removing the institutional and social barriers that impede girls progress in this quest. In 1991, Jean Baker Miller, a noted feminist scholar, wrote: . . . [a girls] sense of self as an active agentin the context of acting within a relationship and for the relationship has been altered to some degree all along by a sense of a self who must defer to others needs or desires. However, at adolescence she experiences a much more intense pressure to do so. Her sense of self as developed so far now faces a more serious conflict with the external forces she confronts. The question is how she will deal with this conflict. (Miller, Jordan, Kaplan, Stiver, & Surrey, 1991, pp. 2021) The chapters in Geographies of Girlhood provide an answer to Millers question, and help us better understand the challenges and triumphs that girls experience as they interact with external forces at home, school, and beyond. I recommend the book to anyone interested in understanding the lives and identity development of adolescent girls. It will be an excellent addition to reading lists for both undergraduate and graduate courses in womens studies, counseling psychology, and applied developmental psychology. It also provides a solid overview of adolescent girls issues, which can be used by researchers to support empirical research. Bettis and Adams are to be commended for editing a volume that provides such a rich and insightful picture of the lives of diverse groups of adolescent girls and for helping us understand the various roads that girls take on their journey toward identity.

238 REFERENCES
Miller, J. B., Jordan, J. V., Kaplan, A. G., Stiver, I. P., & Surrey, J. (1991). Some misconceptions and reconceptions of a relational approach. Work in Progress, No. 49. Wellesley, MA: Stone Center Working Paper Series. Robinson, T., & Ward, J. V. (1991). A belief far greater than anyones unbelief: Cultivating resistance among African American female adolescents. In C. Gilligan, A. G.

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Rogers, & D. L. Tolman (Eds.), Women, girls and psychotherapy: Reframing resistance (pp. 87103). New York: Haworth.
Elizabeth Sparks is an Associate Professor of Counseling Psychology at Boston College and a faculty member of the Jean Baker Miller Training Institute. Her research and writing focuses on the lived experiences and mental health needs of delinquent adolescent girls, and issues related to multicultural competence training.