Anorexia nervosa and unresolved rapprochement conflicts. A case study.

The psychoanalysis of a 16-year-old young girl with the classical signs and symptoms of anorexia nervosa: the early phase of treatment is described. The intense, disruptive, and affect-laden transference and countertransference engagement is selectively portrayed. Utilizing the developmental perspective of the separation-individuation process as formulated by Margaret Mahler, this segment of clinical material could be best clarified and appreciated. This developmental framework enabled the analyst and patient to make sense out of a relationship which initially seemed chaotic and to be stagnating. The reconstructive, interpretive interventions based on this developmental understanding, with particular focus on the rapprochement subphase of the separation-individuation process, appeared to have major therapeutic impact and allowed for ongoing psychoanalytic work and for personality growth. After a four year analysis, a seven year follow-up is outlined. Discussion and speculation are put forth as to the nature of the therapeutic impact in this case and, more generally, in clinical situations wherein there is evidence of a 'developmental lag'.