From Knowing to Discovering: Some Suggestions for Work with Anorexic Patients

ABSTRACT

In this article I offer some technical suggestions for psychoanalytic work with anorexic patients. Although focused on an outpatient setting, certain parts of the article will also have utility for inpatient work. As an outpatient therapist working with an anorexic patient, especially in the acute stages of the illness, there are case management demands that need immediate attention. The setting up the particular frame is required to augment the therapeutic work. The most urgent pressure felt by the clinician is the precariousness of the patient’s physical health. This can be experienced as if there is a gun to the head of the therapist. This deathly force must be carefully and constantly grappled with, and particularly so in the most symptomatic stages of the illness. The clinician must work with a patient who might die at any time, yet an anorexic patient cannot be managed the way a suicidal patient would be. The question of technique in this situation is a complex one. Above all, the patient must be met where s/he is. Notwithstanding the uniqueness of each patient there are some specific themes that often arise in the acute stage of the illness. Certain technical suggestions are offered.

Acknowledgment

My gratitude goes to Prof. Susan van Zyl for her valuable counsel.

Notes

1. I am referring to patients suffering from either subtype of anorexia, that is, purging or nonpurging types.

2. In this article I use the feminine pronoun because anorexia is still far more prevalent in women than men (Hoek & Van Hoeken, 2003).

3. Unfortunately the current socio-cultural impellent that promotes thinness, almost as the loftiest life aspiration there is, means that anorexia is less socially denounced than it has been at other times in history. Several writers have contributed very meaningfully to our understanding of the nature and influence of contemporary social phenomena on women generally, and on the prevalence of eating disorders (Chernin, 1983; Lawrence, 2008; Malson, 1998; Orbach, 1978).