Eating Disorders - fieldi

weight and shape, as well as changes in these characteristics, are
invariably noted by eating disordered individuals. Whether the female
therapist is thin, average, or heavy, her patients will react. Discussion
of these reactions and accessible fantasies may be productive in terms
of repetitive themes of body-image distortion, competition, envy, and
disparagement. I have noted that as I entered middle age, patients
became less attentive to my shape. Therapists who harbor their unresolved
issues about beauty and shape may experience envy and competitive
feelings with patients who are more attractive. Male therapists
are also undoubtedly affected by issues of physical attractiveness and
shape to which they must be attentive.
Deficits in self-regulating and self-soothing capacities are characteristic
of most of the eating disordered women I have worked with.
The causes for these deficits are so varied and complex as to defy
generalization. However, they include constitution, health, early
trauma, and derailment or detours in their emotional development.
These deficits are manifested in the person’s inability to deal with
frustration, unpleasant affects, and distressing experiences. Connections
are broken and reactions are short-circuited by automatically
turning to or away from food and becoming obsessed about weight
and shape. Developing the capacity to bear feelings and modulate
affect involves both specific and general strategies. These include
using a journal and exploring ways of stimulating, expressing, satisfying,
and comforting oneself other than eating or purging. Further,
the person needs to be encouraged to turn to people and relationships,
rather than their bodies and food, to meet their needs. A guiding
principle that I articulate is that the eating disorder is a solution, however
misguided, that has meaning and value for the individual. The therapeutic
alliance and work promotes the individual’s development of
her capacity for self-reflection, her sensitivity to personal needs, and
her empathy for the needs and feelings of others. Over the course of
more lengthy and intensive therapy, the work and therapeutic relationship
is taken in and woven into the patient’s personality.
Case Discussion
Individual Psychotherapy 139
To illustrate, I will describe my work over a period of six years with
Laura, a twenty-five-year-old woman who is bulimic. Her issues