The Clinician's Guide to Collaborative Caring in Eating Disorders by Treasure Janet;Schmidt Ulrike;Macdonald Pam;

Author:Treasure, Janet;Schmidt, Ulrike;Macdonald, Pam;
Language: eng
Format: epub
Tags: Behavioral Sciences
Publisher: Taylor & Francis Group
Published: 2009-08-26T00:00:00+00:00

Case study: Sally

Sally had a severe bulimic form of anorexia nervosa complicated by depression. Over time it emerged that Sally’s mother had strong views about treatment and was eager to be involved.

Sally worked as a nurse. Her eating disorder began after two consecutive relationships ended unpleasantly. She had her first boyfriend at the age of 16. She accidentally fell pregnant and came to the difficult decision that she should have an abortion. Her relationship deteriorated after this and she broke it off. However, her ex-boyfriend continued to harass and follow her for several months. Her next boyfriend suddenly exploded one day and raped and trapped her for a period of time. She fell pregnant during this incident and had a further termination. Her eating disorder developed soon afterwards. After the assessment Sally and her therapist decided to try an antidepressant to supplement her psychotherapy as she had many features of depression and was highly aroused and not sleeping. Sally lived at home and so once the initial formulation was made, the therapist suggested that her mother be invited to the third session. It quickly emerged that Sally’s mother did not approve of the anti-depressant that had been suggested in the prior session. She explained that she tried to avoid medication as much as possible. Part of the reasoning underpinning this was that Sally’s mother had diabetes mellitus and was dependent on medication. She did not want Sally to be dependent on medication too. Sally’s mother had a model of illness, which was that control and micro-management of the problem would be helpful and so she was very involved in Sally’s eating.

This led to a discussion about how Sally related to her mother’s diabetes. Sally as the oldest child had learned how to look after her mother when she became hypoglycaemic. She had learnt from an early age how to feed her mother sweet drinks, inject her with glucagon and call her father. This information helped the therapist understand the repeating patterns of interactions throughout Sally’s life. Sally had a degree of role reversal in childhood during which she had to care for her mother, who was vulnerable. She therefore

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