Eating Disorders - fieldi

Individual Psychotherapy 145
and regulate herself. Her self-image was of someone who was difficult,
troublesome, and incompetent. She had also internalized the
family’s sexual repression and could not countenance sexual exploration
either alone or with a partner. As noted by Zerbe (1995),
shame, inhibition of joy and liveliness, spiritual malaise, and trauma
were significant factors in shutting down her sexuality. The only
exceptions to her sexual abstinence had taken place under the influence
of alcohol. While she had developed superficial social skills,
she had been thwarted in her attempts to reach out to others for
understanding, care, and intimacy. A combination of her experience
in therapy and increased ability to communicate and engage in relationships
gradually enabled her frozen sexuality to thaw.
In the early therapeutic relationship, Laura expected me to
ignore, misunderstand, criticize, and reject her. A premature attempt
to help her with symptom management failed dismally; it only
heightened her sense of failure and chaos. She needed an empathic
holding environment in which she could express her neediness, her
bad feelings, her shame, as well as her creativity, humor, and idiosyncrasies.
As our relationship deepened following her hospitalization,
Laura moved into an idealizing transference in which she
expected me to be perfectly attuned and understanding of her. Not
being a perfect therapist, and subject to countertransference reactions,
there were times when I talked too much or too little, was
insensitive, and misunderstood her. In turn, she experienced familiar
reactions of withdrawing and turning on herself. There were times
when the depth of her hopeless and helpless despair numbed me.
In response to prolonged confusion and blanking out on Laura’s
part, I would become distracted and lose the connection with her. I
would then jolt myself into pressing her to respond. I used my countertransferential
responses to guess at what she might be experiencing.
She was gradually able to tell me when certain inquiries or
subjects made her so anxious she couldn’t think or when I talked
too much or too little or didn’t understand her. Multiple repetitions
of this process contributed to her sense of effectiveness and were
empowering. For more than three years of our work together, Laura
was on antidepressant medication. While it alleviated her depression
somewhat, it had little effect on her anxiety. I was struck by a
curious dissociation from her depression while on medication, in