Dr. Darlene Atkins and her bichon frise, Murph play together in her office at the Children's National Medical Center. (John Kelly/The Washington Post)

The teenagers wonder why they should trust Darlene Atkins. She is the enemy, after all, part of a team that tries to persuade these adolescents to do the thing they hate the most: eat.

“Often, by the time we see them, they’re awfully shut down,” said Atkins, a child psychologist and director of the Delaney Eating Disorders Clinic at Children’s National Medical Center. “They may be withdrawn from their families and pulling away from their friends.”

These young people see themselves not as anorexic or bulimic — not as so dangerously thin that their bodies are starting to fail — but as on the road to perfection.

“In psychotherapy, the core of treatment is the relationship,” Atkins said. “That’s really the best tool that I bring: forming a relationship.”

And that’s where Murphy comes in. The 21 / 2-year-old bichon frise joined Atkins in her Spring Valley office two years ago.

“My thought was, there’s literature showing that even petting a dog lowers people’s blood pressure,” she said. “Maybe some of these kids could be reached by just the warmth and the tactile experience of relating to an animal.”

Atkins and Murphy don’t work alone. A team of specialists engages the entire family at the clinic. A physician and nutritionist drive home that the child must eat, and they outline how much.

“My piece is really the terror that’s going to evoke,” Atkins said. “If you’re a kid who’s been losing weight, you can imagine that, at first, everyone at school is, ‘My God, how did you do it?’ In this culture you initially get praise, admiration, envy.

“It goes beyond that, and each new weight goal becomes their gold standard. The goal post keeps being moved.”

Move it too far and children stop growing, menstrual cycles stop. Most of the patients are girls, but some are boys who have become unhealthily fixated on muscularity.

“It isn’t just that they want to be thin or that the media has affected them,” Atkins said. “Certainly, we need to give kids a lot of guidance around media, but all these kids are reading the same magazines and Web sites. They don’t all develop eating disorders.”

Atkins said many of the clinic’s patients are genetically predisposed to developing an eating disorder. Often there is also an underlying anxiety disorder or depression that has not been fully diagnosed.

“When other things in their life are out of control, they latch on to this,” Atkins said. In the midst of their bodies changing or their families going through difficulties, they think food is an area where they can have supreme control and get measurable results.

Atkins said she enlists her patients in the search for how they ended up needing help. “You want them to come and trust you and start to explore this,” she said. “Let’s think about how this got away from you. We’re putting together a jigsaw puzzle. I try to make them curious.”

Atkins has been with Children’s since 1983. When she was growing up, her family had collies, but that breed just sheds too much for use in a doctor’s office, so she decided on the relatively hypoallergenic bichon frise. Murphy comes from famous stock. His grandfather was Ch. Special Times Just Right, the only bichon to win Best in Show at the Westminster Kennel Club competition.

Although Murphy is very much at home under his owner’s desk, Atkins’s office is the last place most of the patients want to be. Teenagers are famously skilled at letting their displeasure be known. Atkins remembers one girl whose parents said, “We don’t even know if we can get her there beyond the first visit.”

But then the girl saw Murphy and dropped to her knees, pulling his face to her own. At the end of her session, she turned to Atkins and said, “I guess I could probably wait a week to see Murphy again.”

And when a kid breaks down sobbing at the enormity of it all, there is Murphy, passing no judgments, just a warm, small ball of fur, eager to be stroked and cuddled.

Helping children

Children’s National Medical Center helps all sorts of kids in our area. This is the time of year when I hope you’ll help the hospital. I’m raising money for the hospital’s uncompensated care fund, which pays the medical bills of underinsured children.

You can make a tax-deductible donation by going to www.childrensnational.org/washingtonpost or sending a check (payable to Children’s Hospital) to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390.

To read previous columns, go to washpost.com/johnkelly.