You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Sarah is a white British adolescent who lives with her mother and father in a small town in the north of England. She was referred by her GP to the local Child and Adolescent Mental Health Service at the age of 17 following the breakdown of a relationship with a boyfriend. After discovering that intimate and humiliating details of their sexual contact had been shared with several of her friends, Sarah had refused to return to college and had started cutting her arms and legs – causing superficial scratches – with a razor blade. Over time, I learned that her mother had responded to Sarah's self-harming by moving her daughter into the parental bed; her father, I was told, slept in the living room during this period. Shortly after the referral, her mother secured Sarah a job as a waitress in the local restaurant where she worked as manager. Sarah has three older brothers, all living away from home. The referral reported that mother had a stress-related illness, which had resulted in several hospitalisations during Sarah's infancy. Sarah, too, suffered from regular bouts of irritable bowel syndrome.
Following an assessment with another clinician, Sarah began once-weekly psychotherapy. My first impressions were of an attractive, provocatively dressed girl – with tattoos and body piercings – who would spend long stretches of her early sessions in silence, tapping her teeth with her tongue stud or carefully picking at her clothing. Her wish seemed to be to make me curious and closely attentive to her body, while maintaining a distance between us. Slowly, however, Sarah began to talk, going on to describe the ways in which her mother would remove knives and other sharp instruments from the house in an attempt to prevent her from harming herself. With considerable satisfaction she would insist that her mother's actions made no difference – she could always, she told me, find other ways of cutting. Her father – who worked as a lorry driver – was rar