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The excerpt opens with some key details of the patient’s history giving a helpful context to generate some first ideas about this young woman’s difficulties and also the details of the presented session. We learn that Lily comes from a professional family with expectations of high academic achievement. As her mother is a general practitioner, it is likely that the family culture includes a familiarity with and interest in the manifest changes, the signs and symptoms of the body. The corporeal self is in focus and perhaps, with this, ideas about ‘health’ are more defined in this family.
Lily is attending her sixth session, perhaps her ninth meeting with her therapist. I would regard this as still early in their relationship, though not too soon for powerful emotional exchanges to take place. We learn that Lily has been referred for psychotherapy after being discharged from hospital where her treatment has involved very invasive, uncompromising contact with her body, in response to the severity of her symptoms of anorexia. It sounds as if the patient, like other young people afflicted with an eating disorder, has found some kind of refuge, or displacement, for intolerable emotional states in somatic expression. Not only is the body suffering from illness, but the illness demands physical treatments. Both elements of this physical experience are probably employed unconsciously to ward off the experience of psychic pain.
In this session, there is a strained atmosphere and the therapist communicates his or her bewildered sense of being coshed, rendered mindless and weak, alongside feelings of deep concern about the young patient. Much of the therapist’s experience will be recognised by those who work with troubled adolescents, especially patients with obsessional symptoms or eating disorders. Lily’s apparent passivity and fragility evoke a terrified state in the countertransference and the therapist finds herself almost embarrassed by the apparent crudeness of her own vita