Eating Disorders - fieldi

138 Individual Psychotherapy
the person’s experience and feelings underlying the anorexic or
bulimic behavior. We move into detailed discussion of how she sees
the therapist and what images and illusions she brings to the therapeutic
relationship. In contrast to traditional psychoanalysis, interpretation
of the transference in terms of parental figures is selective
with bulimics and may be contraindicated as too intrusive with
anorexics. Johnson (1991) generalizes that restricting anorexics have
experienced maternal overinvolvement, whereas bulimics have
experienced maternal under-involvement. He goes on to recommend
that therapists provide a corrective experience in their interaction
with the patient.
I have found that, in contrast to my work with noneating disordered
patients, my countertransference is more intense with eating
disordered patients and can be overwhelming. Therapists differ in
their definition of countertransference. For me, countertransference
is the sum total of all my reactions to the patient and our work,
including unconscious associations and fantasies as well as reactions
and feelings of which I am aware. The unconscious components
come into awareness when I note and then analyze an action or comment
on my part, which is unusual. I believe that the ongoing interplay
between the transference and countertransference as described
above is the most vital aspect of the therapeutic work.
Many patients with eating disorders have great difficulty tolerating
and modulating their intense neediness and bad feelings, particularly
as they give up their symptoms. This is enacted in the therapeutic
relationship by either demanding relief or dismissing the
therapist as useless. It is at this juncture that I may find myself feeling
exhausted, frustrated, thwarted, impotent, useless, and sometimes
confused. Although undoubtedly some of my own personal
issues contribute to these feelings, a good portion are in response to
patients’ projections of their intolerable feelings. Epstein (1987)
refers to this phenomenon as the “bad-analyst-feeling.” It certainly
gives me a sense of what the patient is experiencing when I analyze
and process the countertransference.
Sharing my reactions with other female therapists has been particularly
helpful to me. Among the countertransference issues we hold in
common are our own sensitivity to cultural pressures to diet and to be
thin, as well as our feelings about our own bodies. The therapist’s