Dr. Burnside asks her assistant to call the social worker to book an appointment for Kelsey and her mother in one month. She writes a referral note for the family therapist.
PO Box 1839
Humphrey’s Harbour, ON
Could you please see this 15 year old patient of mine who may be developing anorexia. I think some counselling might be helpful.
The social worker sends Dr. Burnside a consult letter which she receives three weeks after the appointment.
Dr. W. Burnside,
Main Street, Humphrey’s Harbour
Dear Dr. Burnside,
Thank you for your referral of the Cournoyer family. I met with Mrs. Cournoyer and your patient, Kelsey, on November 22. Unfortunately, the husband was unable to attend and Mrs. Cournoyer did not bring the two younger children as they would have missed school. Therefore, my assessment of the family dynamics and possibilities for therapy are somewhat incomplete.
Mrs. Cournoyer is a pleasant, well-groomed woman who seems quite concerned about her daughter’s eating disorder. She seems to be having trouble coping. She referred several times to the difficulty she is having in planning meals that will please all of the family. It may be of interest that Mrs. Cournoyer herself watches her weight carefully and in the past has gone to Weight Watchers. Kelsey seems a typical teenager. She didn’t say much, but seems to feel that she is fine and everyone is overreacting. This may be a form of denial, since her teachers have noted her grades are falling and she was told she could no longer be on the school cross-country team due to failure to maintain weight.
I am concerned about some underlying family issues, although Mrs. Cournoyer was reluctant to speak about her relationship with her husband in front of Kelsey. Mr. Cournoyer is a computer programmer who travels quite a lot and therefore leaves much of the parenting responsibilities to his wife. My sense is that he is a hard-driving person who may be rather distant and cold, except with his sons. He interacts with them primarily through sports. He plays hockey and golf and is evidently very competitive. I would sense that he is probably quite proud of his physical abilities. I asked Kelsey about her relationship with her father, to which she replied: “Well, he doesn’t beat me, if that’s what you mean.” Mrs. Cournoyer explained that Kelsey and her father have not had a good relationship since he made her remove a nose ring. He is impatient with Kelsey’s behaviour, and sees no reason why she can’t eat like everyone else. It would appear that family members are less frequently together at mealtime, as this has become a source of family distress and conflict.
I am not an expert on adolescent eating disorders, but it would not surprise me if at least part of Kelsey’s problem is related to the family dynamics. Mrs. Cournoyer has a history of eating concerns herself and the father appears to be a perfectionist, “Type A.” The mother is caring, but struggling somewhat ineffectually to deal with Kelsey and the rest of the family’s response to her problem. I think the husband may not be supportive and that this current issue has further strained a shaky marriage. I also sense that there may be financial problems. Mrs. Cournoyer indicated that her husband’s business is not going well right now.
I could address the family issues I have noted above, but only if the entire family is willing to participate in therapy. Mrs. Cournoyer seems quite uncertain that her husband would be willing or indeed could fit this into his business schedule. I have left it to her to contact me if this becomes possible. The travel issues and cost may prove insurmountable, since this service is not covered by provincial health insurance.
With regard to Kelsey, I am surprised that the entire teenaged population doesn’t have problems. Consider the barrage of media coverage of film stars, with the ideal of thinness on TV — never mind peer pressure. Body image is so important in our postmodern society. If indeed this is more than teenaged angst and a diagnosis of anorexia nervosa has been made, I can only suggest that she be referred to an academic centre for more expert treatment.
I hope that this will be helpful to you in managing this interesting and challenging family situation.
George Palentino, BA, MSW