Alexithymia, Meaning-Making, and Management: Response to Novack

ABSTRACT

In response to Novack’s (this issue) insightful paper, this discussion endeavors to extend her arguments with my own thinking about alexithymia in patients with eating disorders and the fundamental role of the psychoanalyst in promoting the patient’s capacity for the psychic elaboration of emotion as he or she moves through the treatment process and engages with the larger treatment team. While the necessity of the analyst engaging in the concrete work of management – drafting treatment contracts, setting goals, facilitating contact with other providers, etc. – in an effort to promote the patient’s agency is acknowledged, the importance of the analyst as a facilitator of meaning-making is emphasized. The tension between meaning-making and management is thus a fundamental aspect of therapeutic work with this population.

This article refers to:

“It Takes a Village”: Concurrent Eating Disorder Treatment and the Multiperson Field

View responses to this article:

Multiple Perspectives on Multitherapy Situations: Reply to Wooldridge and Petrucelli

Notes

¹ As descriptive diagnoses, eating disorders – anorexia nervosa, bulimia nervosa, muscle dysmorphia, binge eating disorder, and others – do not refer to single structural entities. This discussion describes the psychodynamics commonly, but not exclusively, encountered in patients with these symptom presentations.

² While a full review of psychoanalytic thinking on trauma is beyond the scope of this paper (see Brown, 2019), here I wish to emphasize trauma as both exceeding the individual’s capacity for emotional self-regulation and for representing and symbolizing emotional experience so that it can be reflected upon.

³ Empirical research offers strong support for conceptualizing alexithymia as a dimensional construct instead of an all-or-nothing phenomena (Mattila et al., 2010; Parker et al., 2008; Waller & Meehl, 1998).

⁴ Numerous analysts have applied nonlinear dynamic systems theory to psychoanalysis. See Seligman (2005) for citations of their important work.

Additional information

Notes on contributors

Tom Wooldridge

Tom Wooldridge, Psy.D., A.B.P.P., C.E.D.S., is an Associate Professor of Psychology at Golden Gate University and Faculty, Psychoanalytic Institute of Northern California. His books include Understanding Anorexia Nervosa in Males: An Integrative Approach and Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak (Relational Perspectives Book Series).