Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speakoffers a compilation of some of the most innovative thinking on psychoanalytic approaches to the treatment of eating disorders available today. In its recognition of the multiple meanings of food, weight, and body shape, psychoanalytic thinking is uniquely positioned to illuminate the complexities of these often life-threatening conditions. And while clinicians regularly draw on psychoanalytic ideas in the treatment of eating disorders, many of the unique insights psychoanalysis provides have been neglected in the contemporary literature.
This volume brings together some of the most respected clinicians in the field and speaks to the psychoanalytic conceptualization and treatment of eating disorders as well as contemporary issues, including social media, pro-anorexia forums, and larger cultural issues such as advertising, fashion, and even agribusiness. Drawing on new theoretical developments, several chapters propose novel models of treatment, whereas others delve into the complex convergence of culture and psychology in this patient population.
Psychoanalytic Treatment of Eating Disorderswill be of interest to allpsychoanalysts and psychotherapists working with this complex and multi-faceted phenomenon.
"A report from the front; the unconscionable front, which has brought an assault on our bodies, with its devastating price on individuals and families. Here is the work of clinicians who engage with the troubled bodies and eating of our times as they theorise their understandings and learning. There is much to learn here."
-- Susie Orbach is a psychoanalyst and psychotherapist, co-founder of The Women's Therapy Centre. Her books include Fat is a Feminist Issue, Hunger Strike, and the award winning Bodies. Her most recent is In Therapy, annotated sessions from her BBC Radio series of the same name.
"Tom Wooldridge has assembled an impressive array of contributors to offer a rich and valuable survey of the contemporary psychodynamic approach to eating disorders. New therapeutic conceptualizations, including mentalization- and emotion regulation-based strategies, are applied to the special circumstances involved in eating disorders. At the same time, the deep traditional analytic insights are included and updated: Freudian, Kleinian, newer Object Relational, Developmental Psychoanalytic, and Self Psychology. All of this is coordinated with an interest in the effects of contemporary culture on how eating disorders develop and present, including attention to the "pro-anorexia" groupings emerging on the Internet and the occurrence of eating disorders in boys and men. This book will be invaluable to any practitioner working with such patients, and of significant interest to all."
- Stephen Seligman, D.M.H.
Clinical Professor of Psychiatry, University of California, San Francisco; author of Relationships in Development: Infancy, Intersubjectivity, and Attachment; Joint Editor-in-Chief, Psychoanalytic Dialogues; Training and Supervising Analyst, Psychoanalytic Institute of Northern California & San Francisco Center for Psychoanalysis
"Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak is an indispensable volume of psychoanalytically informed contributions to the literature on eating disorders. This irresistible recipe combines one part theory with two parts clinical wisdom. I was especially drawn to the treatment of the roles of specific emotions, like shame and anxiety. Equally useful for the seasoned clinician and those at earlier stages of their careers, this is a worthy addition to any clinician's library. These 15 authors represent the best in the field."
- Sandra Buechler, Ph.D. Author of Understanding and Treating Patients in Clinical Psychoanalysis: Lessons from Literature. Training and Supervising Analyst, the William A. White Institute, New York.
"Wooldridge provides us with a valuable collection of papers on the conceptualization and treatment of eating disorders. He also presents us with several chapters on contemporary cultural issues, including social media, which impact patients with eating disorders. Wooldridge and the contributing authors are keenly aware that eating disordered patients are among the most difficult to treat. These patients present clinicians with potentially life threatening crises and the possible need for substantial ancillary care. These assembled authors do not shy away from the thorny problem of combining psychoanalytic containment and understanding with the variations in frame needed to ensure safety, such as the potential necessity for a treatment team and hospitalization."
- Mary Brady, Ph.D., Author of The Body in Adolescence: Psychic Isolation and Physical Symptoms
"For too long there has been a divide between psychoanalytic thinking and the treatment of eating disorders. This vital collection of essays is a key step in bridging that gap. Through vivid clinical examples, new theoretical advances are illuminated in ways that promise to deepen our understanding of eating disorders. With impressive clarity, this collection is a vital addition to the field that will extend what we understand as psychoanalytic. It will be of real value to both students and seasoned clinicians."
- Peter Carnochan, Ph.D., Author of Looking for Ground: Countertransference and the Problem of Value in Psychoanalysis (Relational Perspectives Book Series) ?
"This anthology of papers offers its readers what a skillful psychoanalytic treatment can offer an eating disordered patient: it reintroduces meaning, metaphor, and substance into an otherwise concrete, impoverished, and symptom dominated existence. As editor, Wooldridge had brought together an impressive anthology of papers that integrates multiple psychoanalytic perspectives. Without minimizing the need for symptom management with eating disordered patients, Wooldridge's emphasis is on integrating classical psychoanalytic conceptualizations of eating disorders with contemporary psychoanalytic thinking, on development, phenomenology, affect regulation, dissociation, attachment, mentalization, and socio-cultural context. The individual chapters are theoretically and clinically rich, varied, thought provoking, and useful. They will nourish and hold both beginning and seasoned clinicians in their struggle to find words that can touch and transform those patients for whom words have perilously failed."
- Sarah Schoen, PhD, Supervising Analyst and Faculty at the William Alanson White Institute; Faculty at NYU Postdoctoral Program in Psychotherapy and Psychoanalysis, and Co-Editor of Unknowable, Unspeakable, and Unsprung: Psychoanalytic Perspectives on Scandal, Truth, Secrets and Lies.
Table of Contents
Tom Wooldridge, PsyD, CEDS
PART I. Conceptualization of eating disorders
1. Psychodynamic improvement in eating disorders: welcoming ignored, unspoken, and neglected concerns in the patient to foster development and resiliency
Kathryn J. Zerbe, MD, FAED and Dana A. Satir, PhD, CEDS
2. Invisibility and insubstantiality in an anorexic adolescent: phenomenology and dynamics
Mary Brady, PhD
3. Primary interactions and eating disorders: a psychoanalytic perspective
Antonella Granieri, PhD
4. An island entire of itself: narcissism in anorexia nervosa
Anthony P. Winston, PhD
5. The dead third in the treatment of an adolescent with anorexia nervosa
Lorraine Caputo, LCSW
PART II: Treatment of eating disorders
6. From knowing to discovering: some suggestions for work with an anorexic patient
Yael Kadish, PhD
7. Heathen talk: psychoanalytic considerations of eating disorders and the dissociated self
Judith Brisman, PhD
8. To know another inside and out: linking psychic and somatic experience in eating disorders
Danielle Novack, Ph.D.
9. On targeting emotion regulation deficits in eating disorders through defense analysis
Timothy Rice, M.D.
10. Eating disorders, impaired mentalization, and attachment: implications for child and adolescent family treatment
Starr Kelton-Locke, PhD
PART III: Contemporary issues related to eating disorders
11. The low spark of high-heeled 'girls': hyperdeadness and Hyperawareness with eating-disordered patients
Jean Petrucelli, PhD
12. Psychodynamic importance of "cyber" and "in the flesh" friends in psychotherapy with college-aged adolescents with eating disorders
F. Diane Barth, LCSW
13. The enigma of ana: a psychoanalytic exploration of pro-anorexia Internet forums
Tom Wooldridge, PsyD, CEDS
14. Towards social justice: the continuum of eating and body image problems: how social and psychological realities converge into an embodied epidemic
Susan Gutwill, MSW, LCSW
15. Enduring perfectionism: seeing through eating disorder recovery and America’s cultural complex
Kim L. Grynick, LPC
The Relational Perspectives Book Series (RPBS) publishes books that grow out of or contribute to the relational tradition in contemporary psychoanalysis. The term relational psychoanalysis was first used by Greenberg and Mitchell (1983) to bridge the traditions of interpersonal relations, as developed within interpersonal psychoanalysis and object relations, as developed within contemporary British theory. But, under the seminal work of the late Stephen Mitchell, the term relational psychoanalysis grew and began to accrue to itself many other influences and developments. Various tributaries—interpersonal psychoanalysis, object relations theory, self psychology, empirical infancy research, and elements of contemporary Freudian and Kleinian thought—flow into this tradition, which understands relational configurations between self and others, both real and fantasied, as the primary subject of psychoanalytic investigation.
We refer to the relational tradition, rather than to a relational school, to highlight that we are identifying a trend, a tendency within contemporary psychoanalysis, not a more formally organized or coherent school or system of beliefs. Our use of the term relational signifies a dimension of theory and practice that has become salient across the wide spectrum of contemporary psychoanalysis. Now under the editorial supervision of Lewis Aron and Adrienne Harris with the assistance of Associate Editors Steven Kuchuck and Eyal Rozmarin, the Relational Perspectives Book Series originated in 1990 under the editorial eye of the late Stephen A. Mitchell. Mitchell was the most prolific and influential of the originators of the relational tradition. He was committed to dialogue among psychoanalysts and he abhorred the authoritarianism that dictated adherence to a rigid set of beliefs or technical restrictions. He championed open discussion, comparative and integrative approaches, and he promoted new voices across the generations.
Included in the Relational Perspectives Book Series are authors and works that come from within the relational tradition, extend and develop the tradition, as well as works that critique relational approaches or compare and contrast it with alternative points of view. The series includes our most distinguished senior psychoanalysts along with younger contributors who bring fresh vision.