How Far is near Enough? A Waiting Game

In this paper I describe once then twice a week therapy with Becky whom I met when she was fifteen. She presented with anorexia; after referral, bulimia, suicidal behaviour and a history of sexual abuse emerged. In looking for the meaning of her symptoms, I have had to look at her earliest experience as a feeding baby, when psychological and physiological aspects are virtually inseparable.

The development of early object relations and the nature of internalised objects were, I believe, critical for Becky, as was the way in which this process was influenced and modulated through a particular feeding experience. That this occurred for Becky in the context of a family with an inter-generational history of violence, neglect and lack of appropriate or protective boundaries added to the problems of developing an integrated sense of a self and healthy body ego. In this Becky differed from those adolescents presenting with anorexia, who appear to be seeking strategies of dealing with separation (cf. Dare 1993). She appears to be more typical of Lacey's (1993) core group of multi-impulsive bulimics whose self damaging and addictive behaviour has huge treatment implications. The trauma for Becky and the focus of her therapy was unsatisfactory attachment. This presented complications as the adolescent's main developmental task should be separation and individuation. Our heady therapeutic cocktail was shaken and stirred by a high capacity for acting out and dramatic swings between self destruction and a sense of hope. Counter-transference feelings were often my principal therapeutic tool: the idea of the mutative counter-transference was critical to our survival and progress.

Also of great importance has been the impact of the work with Becky and her family on the clinic team. We have found ourselves at times in dispute, at times in very atypical non-communication, always under seemingly great pressure to split and go in different ways. The impact of this was stressfu