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Lily is a 17-year-old young woman who has suffered from severe anorexia nervosa since her early teenage years. Lily’s health has been so compromised by her extreme food restricting that she has needed extended inpatient stays including two periods of several months being fed via a bridled naso-gastric tube. Consequently, Lily has missed a whole year of education, so that she is now just beginning her A-levels. Lily lives with her parents, who are both GPs; her mother is of Irish descent, the first and only of many siblings to go to university. Lily has twin older brothers whom she adored as a little girl; both have been highly successful academically. Lily is particularly close to one of her brothers, who suffers from mild spasticity; at one point he was the only person she would tolerate watching her eat. Several attempts have been made over the years to engage Lily in individual therapy but none has ‘taken’. The present referral was made to the local CAMHS team on Lily’s discharge from hospital four months previously. This session is the sixth of once-weekly work following a three-session assessment.
Lily is waiting with her head bowed when I go to get her from the waiting room. She looks like a refugee or a Victorian pauper in layers of drab clothing that hang off an immensely fragile frame. As I gently say her name, she looks up at me with a far away, almost bewildered expression, as though I have just called her back from a dream state. She gives a tiny yet aggressive shake of her head. I wonder to myself what thought(s) she might be trying to ‘shake off’, what world she might be having to pull herself away from? Lily rises slowly, unfolding herself. Every movement seems to take the greatest of efforts. Her head appears disproportionately large, too heavy to support and she takes small hesitant steps with the greatest of difficulty. The impression is that even the smallest of physical demands, such as the transport of h