Psychotherapy for Anorexia Nervosa: The Daughter Who Said No

The Daughter Who Said No
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June 8, 2022
Understanding the patterns in the family history of patient cases is essential for any clinician. It allows him to consider various internal and external causes of the patient's illness and formulate an appropriate treatment for him. In line with this, this article will focus on the case of a 23-year-old anorectic patient who is born into an anorectic family. The following sections will summarize the case and the persons involved, the cause of the distress, and the use of role-playing in helping the patient address her symptoms. Overall, the author believes that appreciation of the techniques used in psychotherapy, such as role-play, is essential for everyone.
Case Summary
About the Case
As stated earlier, this case involves a 23-year-old patient, Rachel, who has presented with symptoms of anorexia nervosa. Rachel came from a family who also presented the same symptoms (an anorectic family), which is why they agreed to participate in the therapy.
Nonetheless, the case is primarily about Rachel, who is suffering from both physical and psychological problems of anorexia. Her case initially presented that Rachel's problems were because of her 'role' in the household, wherein her parent's conflicts are always diverted through her. She bore this responsibility, whereas her other siblings were isolated from these familial conflicts, thereby affecting how she viewed herself and her burden of becoming the one who would care for and mend every problem in their own family.  
Who was Involved?
The ones who were involved in this case are Rachel's family. Mainly, those who agreed to participate are her sisters Clare and Sandy, who are 31 and 26 years old, respectively. Although her mother agreed to participate, her father did not since his previous experiences with therapy made him believe that these were not effective in dealing with their problems. 
What Happened in the Case and Caused the Distress?
           The case happened with the participation of the four participants in the same family, although their appearance in sessions differs because of their different circumstances in life. Although the sisters in the family are at risk of being anorectic, they manifest these characteristics differently. For instance, the case states that Rachel is overly perfectionist and Clare is "challenging to be with." Their mother is mainly worried about these possible psychological effects of what they are doing compared to their illness's physical effects.
           During the therapy session, it was revealed that the family (especially the sisters) had many quarrels among themselves. Rachel and Clare felt like a power struggle was constantly happening within the family, with them and their father being the 'underdogs.' Accordingly, Sandy, the middle child, was viewed by her sisters as the 'model woman.' They see her as the one who never displeases anyone and is good at everything, whether in terms of family relationships or her personal life. In line with this, the sessions also showed how Clare and Rachel rebelled and engaged in various things such as sexua...