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Fortunato, G. Meltzer, D. (1977). Psychotherapy of an Adolescent Case of Anorexia Nervosa. J. Child Psychother., 4(3):111-120.
  

(1977). Journal of Child Psychotherapy, 4(3):111-120

Psychotherapy of an Adolescent Case of Anorexia Nervosa

Giuliana Fortunato and with an introduction and ducussion by Donald Meltzer

Introduction

The treatment of Luigi covered the four years from the age of fourteen, during which time he was never seen more than once a week. I had the opportunity of hearing about it on five occasions during the latter half of the therapy, and found the progress so impressive and the material so interesting that I asked Mrs. Fortunato to write it up with a view to publication. Despite the relative infrequency of the sessions a dynamic and deep-going transference developed and underwent extensive evolution. Although her technique relied mainly on observation and thought and relatively little on continuous interpretive activity, its power to assist the evolution of the transference is impressive. The fascinating way in which this evolution is paralleled by the metamorphosis of Luigi's social life, especially in his club, the Tabina, raises important questions about the limits of the concept of acting out. Finally the termination process shows with unusual clarity the interplay of dependence, relinquishment and the need for freedom in an adolescent patient.

Case Presentation

When Luigi first came to the Department of Child Psychiatry he was fourteen-and-a-half. Some months earlier his father had rather peremptorily demanded treatment for his son who had been suffering from the age of thirteen from a digestive disturbance, finally diagnosed as anorexia nervosa, after exhaustive examinations and drug therapies. For periods the boy had refused to eat for fear of “indigestion” and at other times ate in such a haphazard way that his weight had fallen as low as 29 kilos. Other symptoms included headaches, constipation and nausea.

Because of the emaciation a two months period in a nursing home was necessary before psychotherapy could be started on an out-patient basis, one session per week only being feasible. The nursing home, where some psycho-therapeutic effort had been made, along with feeding and transfusions, continued to follow Luigi's medical state.

The family situation was described in a history written by the father. In it he revealed himself as rigid, intrusive and dictatorial, posing as the ideal parent, but was clearly obsessive, conventional and lacking in emotion.

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