Clinical commentary by Em Farrell, an adult psychotherapist in private practice

My eccentric aristocratic great aunt who loved unicorns always used to start her thank you letters with, ‘What a delight!’ She came to mind after I read this transcript. It is such a pleasure to have the opportunity to read a session where so much sense is made of things and the patient is so clearly contained and helped by the work in which she is taking part.

Being asked to do a clinical commentary was fundamentally disorientating, as I suddenly became deprived of so much that I would usually use to try and understand the therapeutic work. I am currently undertaking an advanced training in intensive short-term dynamic psychotherapy where we video our sessions in order to help monitor physiological changes that take place in the patient in response to the material they talk about and in response to their therapist's interventions. It also requires the patient to face the therapist as affect is more likely to emerge quickly in an eye to eye experience. Although some patients I see do still use the couch, with eating disorders in particular, the symptoms speak so much through the body and the attendant shame connected to it that I tend to ask them to sit up so that we can look at each other.

Eating disorders are symptoms that find expression through the body and a core focus of my own work with patients is the interplay between bodies: mine and theirs. So the first major difficulty I faced was that there were no bodies to look at. Almost all the information I wanted in order to make sense of things was missing. I wanted to know the context of Anna being seen, her background, in terms of colour, class, wealth and location. I wanted to know what she looked like.

We are told by her psychotherapist that she was tall, thin, has black wavy hair, and is attractive and likeable. That is all very useful information, which whetted my appetite for more. How did she hold her body? Did she look at the therapist when she came in? Did she glance furtively from the couch? How was it f