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My initial impression of this sixth session of psychotherapy is of the breathtaking contrast between 17-year-old Lily’s profound fragility and her silent steely power. This is a young woman who has suffered from life-threatening anorexia nervosa and continues to be at the mercy of anorexic states of mind. The transference/counter-transference dynamics have the familiar hallmarks of this punishing illness. The clear background summary provides a useful external perspective for considering Lily’s internal world. She has recently been discharged from hospital, has a history of poor engagement in individual work and so, at the beginning stages of Lily’s psychotherapy, there are understandable concerns about the viability of this work.
There has been a psychotherapy assessment where one imagines that Lily was able to tolerate emotional contact; that there was evidence of a part of her that might hope for change and a view formed by her therapist that there was potential to mobilise this in response to the more stuck and anti-life/anti-developmental parts of Lily. It is significant that Lily comes to these initial sessions and that in the early stages a relational experience, however rudimentary, has begun. The transference experience is rich and alive, possibly symbolised for us by the therapist in her description of Lily’s long red braided hair, a weaving together of vibrant colour amidst the drab, sad isolation of the session. In addition there is the larger than life art book of Frida Kahlo’s work which has been provided as a result of Lily letting her therapist know about her interest in this artist and her therapist’s active response of then introducing the book into the psychotherapy to create a third space.
The close attention and minutely captured observations of Lily is reminiscent of closely observed psychoanalytic infant observation. This contrasts starkly with Lily’s gaze that seems barely to connect with her therapist. Lily’s physicality and somatic responses