Anorexia nervosa: an object relations approach to primary treatment

Concurrent behaviour therapy and psychotherapy in the treatment of anorexia nervosa creates significant problems in the development of a therapeutic alliance and in the multiple roles staff are required to assume. Our protocol was developed to keep treatment personnel in their usual roles so that their various treatment skills could be fully utilised. A physician treated the anorexia with naso-gastric feeding, freeing the psychotherapist to act in the usual manner. This avoided role confusion, and the split of 'bad' and 'good' treatment personnel was appropriate and therapeutic, rather than pathological. Four successful cases are described.