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When I first met Marilyn I was confronted by a thin, wan and rather politely frozen girl of fifteen-and-a-half. She had mousy, short straight hair and large eyes. She spoke softly and I had to change rooms in order to hear her voice above the traffic noise. Her appearance was alarming. Her heels did not meet the back of her shoes and the gap between her neck and her collar and tie was many inches. She was pale, bluish and cold. She was of average height, just above the 25th percentile, but her weight was below even the 3rd percentile for a girl of her age and height. She was referred for psychotherapy following two periods of hospitalisation, one of a week, the other of a month. The latter had been terminated by her twice running away and then refusing to go back to hospital. The treatment aim in hospital, where she had been on a special anorexic programme, had been to return her to her original weight of 7½ stone (she weighed only 5 stone 11½ lbs. when she was admitted) and to help her overcome her fear of eating. Marilyn agreed to twice weekly psychotherapy on an outpatient basis in a clinic separate from the hospital, while expressing resentment that such help would only mean getting her to eat which she said was the last thing she wanted to do. It was explained that psychotherapy would have a broader aim, which was to try and help her understand herself and her anxieties as well as what her non-eating meant for her.
From her social history it was clear that Marilyn shared all the typical features of anorexic patients as reported in the literature (Bruch (1974), Cohen (1977), Crisp (1977), Kalucy (1973), Tustin (1958)). She came from an intellectual family, both parents being teachers of a “precise science”. She was intelligent and consistently achieving 80% and 90% in all her subjects at school. Her parents married as students, having been the head girl and boy of their respective schools. Mother had never had another boyfriend. She was a