ABSTRACT
Miriam Miriam had been i l l for five years and had been in and out of hospital on several occasions. She failed to gain weight even in hospital. Her relatives were extremely concerned about her and had brought her to another clinic. Miriam was told that they expected her to work on her problems as an outpatient. She was rather surprised at this as she felt that she needed inpatient treatment. She felt very unmotivated to start to fight her anorexia nervosa. Her weight during the initial four sessions remained extremely low and her therapist remained extremely anxious about her. She had to give up work as she had fainted on several occasions. Her general practitioner had been so concerned about her physical state that she was admitted to a local hospital, but she discharged herself within a day. Eventually, after 8 or 10 sessions, Miriam became more engaged in treatment, she was able to open up about the underljdng problems associated with her illness. Her perfectionism for instance, meant that she spent most of the day cleaning the house. Her illness meant that she had a lot of control over the family. Her mother couldn't use the kitchen as Miriam regarded it as her territory. She would determine what other people could have, make the tea and keep it clean and tidy. One breakthrough in treatment was when she was able to see these underlying patterns of behaviour fi-om an outside perspective. She also realised that it was up to her to start and work on her problems. No magic solution would be foimd by entering hospital, or from therapy alone.
