This paper looks at some of the opportunities and challenges inherent in therapeutic work with a multi-impulsive bulimic patient. Using material from a single case, the psychological aftermath of an unsafe, unprotected infancy and childhood is outlined, noting the role of the bulimic symptoms in blocking intolerable pain. Where unbearable feelings from infancy remain unthinkable, the need for a safe environment in which to explore and make emotional sense of traumatic experiences is emphasized.

The role of the therapist in the reparative, ‘re-parenting’ function and in fostering the development of an emotional vocabulary is considered. The extent to which it is possible to heal longstanding and profound psychological injury is explored, questioning whether at least partial re-integration of a fragmented personality can occur and allow a stronger sense of self to emerge.