Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak

304 Pages·2018·3.342 MB·English

by  Tom Wooldridge

“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 emo-
tion 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, Develop-
mental 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, DMH, 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, PhD, 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 conceptual-
ization 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 neces-
sity for a treatment team and hospitalization.”
– Mary Brady, PhD, 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 bridg-
ing that gap. Through vivid clinical examples, new theoretical advances are illu-
minated 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 stu-
dents and seasoned clinicians.”
– Peter Carnochan, PhD, 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 treat-
ment can offer an eating-disordered patient: it reintroduces meaning, metaphor,
and substance into an otherwise concrete, impoverished, and symptom-dominated
existence. As editor, Wooldridge has brought together an impressive anthology
of papers that integrates multiple psychoanalytic perspectives. Without minimiz-
ing the need for symptom management with eating-disordered patients, Wool-
dridge'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.
PSYCHOANALYTIC TREATMENT
OF EATING DISORDERS
Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies
Speak offers a compilation of some of the most innovative thinking on psycho-
analytic approaches to the treatment of eating disorders available today. In its
recognition of the multiple meanings of food, weight, and body shape, psycho-
analytic thinking is uniquely positioned to illuminate the complexities of these
often life-threatening conditions. And while clinicians regularly draw on psycho-
analytic 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 disor-
ders 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 mod-
els of treatment, whereas others delve into the complex convergence of culture
and psychology in this patient population.
Psychoanalytic Treatment of Eating Disorders will be of interest to all psy-
choanalysts and psychotherapists working with this complex and multi-faceted
phenomenon.
Tom Wooldridge, PsyD, CEDS, is Chair in the Department of Psychology at
Golden Gate University, San Francisco, CA, and an Executive Director at the
National Association for Males with Eating Disorders. He has published numer-
ous journal articles and book chapters on topics such as eating disorders, mascu-
linity, technology, and psychoanalytic treatment. His first book, Understanding
Anorexia Nervosa in Males: An Integrative Approach, was published by Rout-
ledge in 2016. He is an advanced candidate at the Psychoanalytic Institute of
Northern California and has a private practice in Berkeley, CA.
Relational perspectives book series
LEWIS ARON & ADRIENNE HARRIS
Series Co-Editors
STEVEN KUCHUCK & EYAL ROZMARIN
Associate Editors
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 Mitchell1 to bridge the traditions of inter-
personal relations, as developed within interpersonal psychoanalysis and object relations,
as developed within contemporary British theory. But, under the seminal work of the late
Stephen A. Mitchell, the term relational psychoanalysis grew and began to accrue to itself
many other influences and developments. Various tributaries – interpersonal psychoanaly-
sis, 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 fantasized, 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 spec-
trum 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. Committed to dialogue among psychoanalysts, 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
promoted new voices across the generations.
Included in the Relational Perspectives Book Series are authors and works that come
from within the relational tradition, and extend and develop that 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. A full list of titles in this series is available at www.
routledge.com/mentalhealth/series/LEARPBS.
Note
1 Greenberg, J., & Mitchell, S. (1983). Object relations in psychoanalytic theory. Cam-
bridge, MA: Harvard University Press.
PSYCHOANALYTIC
TREATMENT OF
EATING DISORDERS
When Words Fail and Bodies Speak
Edited by Tom Wooldridge
First published 2018
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa
business
© 2018 selection and editorial matter, Tom Wooldridge; individual
chapters, the contributors
The right of the editor to be identified as the author of the editorial
material, and of the authors for their individual chapters, has been asserted
in accordance with sections 77 and 78 of the Copyright, Designs and
Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilized in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Names: Wooldridge, Tom, editor.
Title: Psychoanalytic treatment of eating disorders : when words
fail and bodies speak / edited by Tom Wooldridge.
Description: Milton Park, Abingdon, Oxon ; New York, NY :
Routledge, 2018.
Identifiers: LCCN 2017033101| ISBN 9781138702011 (hardback) |
ISBN 9781138702042 (paperback) | ISBN 9781315203706 (master) |
ISBN 9781351788816 (epub) | ISBN 9781351788809 (mobipocket)
Subjects: LCSH: Eating disorders—Treatment. | Psychoanalysis. |
Psychotherapy.
Classification: LCC RC552.E18 P793 2018 | DDC 616.85/260651—dc23
LC record available at https://lccn.loc.gov/2017033101
ISBN: 978-1-138-70201-1 (hbk)
ISBN: 978-1-138-70204-2 (pbk)
ISBN: 978-1-315-20370-6 (ebk)
Typeset in Times New Roman
by Apex CoVantage, LLC
CONTENTS
Acknowledgments x
Contributors xi
Introduction: contextualizing psychoanalytic
approaches to eating disorders 1
Tom Wooldridge
PART I
Conceptualization of eating disorders 15
1 Psychodynamic improvement in eating disorders:
welcoming ignored, unspoken, and neglected concerns in
the patient to foster development and resiliency 17
Kathryn J. Zerbe and Dana A. Satir
2 Invisibility and insubstantiality in an anorexic adolescent:
phenomenology and dynamics 43
Mary Brady
3 Primary interactions and eating disorders: a
psychoanalytic perspective 58
Antonella Granieri
4 An island entire of itself: narcissism in anorexia nervosa 70
Anthony P. Winston
viii Contents
5 The dead third in the treatment of an adolescent with
anorexia nervosa 83
Lorraine Caputo
PART II
Treatment of eating disorders 97
6 From knowing to discovering: some suggestions for work
with an anorexic patient 99
Yael Kadish
7 Heathen talk: psychoanalytic considerations of eating
disorders and the dissociated self 113
Judith Brisman
8 To know another inside and out: linking psychic and
somatic experience in eating disorders 125
Danielle Novack
9 On targeting emotion regulation deficits in eating
disorders through defense analysis 140
Timothy Rice
10 Eating disorders, impaired mentalization, and attachment:
implications for child and adolescent family treatment 165
Starr Kelton-Locke
PART III
Contemporary issues related to eating disorders 197
11 The low spark of high-heeled ‘girls’: hyperdeadness and
hyperawareness with eating-disordered patients 199
Jean Petrucelli
12 Psychodynamic importance of “cyber” and “in the flesh”
friends in psychotherapy with college-aged adolescents
with eating disorders 206
F. Diane Barth
13 The enigma of ana: a psychoanalytic exploration of
pro-anorexia Internet forums 223
Tom Wooldridge
Contents ix
14 Towards social justice: the continuum of eating and body
image problems: how social and psychological realities
converge into an embodied epidemic 241
Susan Gutwill
15 Enduring perfectionism: seeing through eating disorder
recovery and America’s cultural complex 268
Kim L. Grynick
Index 285