Eating Disorders - fieldi

144 Individual Psychotherapy
future was confirmed. Her relentless pursuit of thinness gave her the
illusion of control by projecting onto her body her sense of defectiveness
and the attempt to establish control. It took her a long time
to accept a positive framing of her difficulties and to try the recommended
strategies to compensate for her specific learning disabilities.
From the beginning I was concerned about Laura’s drinking. While
she complained bitterly about her mother’s drinking and its destructive
impact on the family, she denied her own drinking problem and
resisted all attempts on my part to engage her in addressing it. After
several months she had a blackout experience, which frightened her
and broke her denial. She stopped drinking and began attending
Alcoholics Anonymous meetings daily. While her sobriety represented
growth, Laura had great difficulty dealing with some of the
consequences. These included the loss involved in relinquishing
friendships that had been based on alcohol, the consequent isolation
and loneliness, and the experience of being overwhelmed by
painful feelings. Over some months, her bulimia and depression
worsened to the point where she felt out of control and suicidal. She
agreed to admit herself to a hospital, where she remained for six
months. During this time she and her family became involved in family
therapy at the hospital, and she became involved in group therapy.
Although I had met with Laura and her family periodically, both
she and her family had refused ongoing work. She worked with
another therapist while she was hospitalized and resumed therapy
with me upon her discharge. She also participated with her family in
family therapy with another therapist and joined a therapy group.
My work with Laura combined a psychodynamic relational
approach with active cognitive-behavioral interventions later in the
treatment when she was more capable of tolerating stress and anticipating
and delaying her own reactions. I used the first year to introduce
Laura to the process of therapy and our mutual participation,
my interest in her candid response to me, and anticipation of her
discomfort during the course of therapy. Her alcoholism and learning
disabilities were explored and attended to in addition to her eating
disorder, dysphoria, and anxiety. Dynamically and developmentally,
Laura had a fragmented, unevolved sense of herself. She
lacked the inner resources to modulate her anxiety and to soothe