Case study: anorexia

"It's Sally. We can't let it all go to waste. Surely there's something we can do. . . " Wombwell's Year 11 tutor was feeling powerless to help Sally, an anorectic 16-year-old, writes Linda Birkby.

Her weight had fallen - along with her attendance - throughout Year 10. Her year tutor had spoken to Sally and her parents about her frequent absences and the effect on her progress. Her attendance improved, but then fell again. The pastoral deputy and the year tutor met Sally and her parents again. Her mother started to think there was something wrong as Sally had become moody and was off her food. Sally agreed to see her GP, who referred her to hospital. She went during the summer but later refused to go as she denied being anorectic so "it was a waste of everybody's time".

By October of Year 11, she was constantly truanting, seeing no point in school. But she eventually agreed to meet me. During our first session she seemed neither reluctant nor resistant to the idea of counselling, possibly seeing the activity as a pacifier for others. But she talked about herself and her role in the family. She thought teachers saw her as bright - they said she was a "good pupil" or a "nice girl", although they expected too much from her in exams.

She described herself as "being full of everybody else". Everyone expected her to be perfect (she was the best little girl in the world at everything - daughter, friend, girlfriend and pupil), but her self-esteem was low. She was also her family's principal carer, supporting her father in his job and both parents through difficult times. These stresses made her feel she was in the middle of her own power struggle, and satisfying others' expectations led to a relentless dissatisfaction with herself. The one thing she could control was what she put into her body.

Time and space helped her recognise her needs - and how to meet them. The school played a major support role. Her year tutor, for instance , started an intensive advice and guidance programme that included daily problem-solving and realistic target-setting. Gradually the length of time between target setting and reviewing increased, with Sally and her tutor acknowledging each small success. All teachers were given advice about communicating positive messages - and practical support allowed her to catch up her work. I worked with Sally and her parents together - as well as on her own. A peer support group helped increase her sense of belonging in school.

Sally began to attend school more often. By Easter last year, her weight was stable, she had completed work experience and she passed five GCSEs.

Sally's eating disorder was a response to a situation she found psychologically intolerable, and everyone at Wombwell played a significant role in her return to some age-appropriate normality.

Linda Birkby is a teacher-counsellor and manager of the Unicorn Centre for Learning Support at Wombwell high school, Barnsley

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