Clinical commentary by Ann Horne, retired Consultant Child Psychotherapist

Clinical commentary by Ann Horne, retired Consultant Child Psychotherapist

I approach this commentary less in a supervisory way and more with the aim of freely associating to the material, letting the mind reflect as the material unfolds and perhaps querying some of the ways in which one might think about it.

Before we encounter Lily, we learn that her eating disorder is severe, long-lasting and has required lengthy hospital admissions where compulsory naso-gastric feeding was administered over several months. Psychotherapy has been offered a number of

times in the past to this now 17-year-old but it has not been a sustainable treatment; her present therapist must have had several heart-sink moments when Lily’s referral letter arrived. Nevertheless, Lily has attended for three assessment sessions and six treatment sessions: somewhere there is hope of some kind. Her therapist has managed to engage her in this tentative start. One wonders what has shifted for Lily that this has become possible. One also keeps in mind that there may – given the sustained nature of Lily’s anorexic position – be an investment in controlling her therapist, that the hope in part may be about replaying in the transference an early imperative to influence the object.

I note that her therapist calls her ‘a 17-year-old young woman’, holding in mind not simply her age but the developmental track which she ought to be on. That is an important statement – it feels at times, reading the session, that Lily functions like a very young adolescent or child who has to protect herself from potential intrusion, change and shame by distancing or denigrating the other and avoiding direct expression of need. That she can be seen as a woman, therefore, matters – and perhaps it is this, in the therapist’s mind, that allows Lily a different kind of hope.