Be Still My Heart

What was rumored a few weeks ago is becoming a reality — In Treatment Season 4! Uzo Aduba (Emmy® winner for “Mrs. America” and “Orange is the New Black”) will play the lead role of the therapist at the center of the season, Dr. Brooke Lawrence.

Back in 2008 when the series first ran and this site was new, I became a big fan and wrote about each episode as it ran. You can find these posts still by selecting In Treatment above and choosing the season you wish to read about. If you haven’t seen this series, I urge you to do so — it is available on DVD and if you subscribe to HBO Max, is available there. And of course, do read my posts and ask questions and comment — more discussion is welcome.

In my mind, this is the best dramatic presentation of therapy I have seen. Of course the therapy is compacted and made more dramatic for purposes of the drama. But still, it is faithful to the basics.

In sadder news, Daniel Menaker, who wrote my favorite novel about psychoanalysis (this is a genre, you ask??), died this week. His book,The Treatment, which was also made into a movie, is based on his own analysis. The book is funny and moving and well worth the read.

Therapists and Fat

 As a therapist I am very interested in how therapists respond to fat patients and how fatness is viewed psychotherapeutically. I have had some interesting experiences myself with therapists who made assumptions about me and the issues I wanted to work on based on my size rather than what I said. It is  interesting to me that the literature is relatively silent on this subject. I have searched long and hard to find pieces written by therapists about their reactions to fat patients and written by fat therapists about patients’ reactions to them — the picking are pretty slim.

One of the books I stumbled upon is Eating Problems: A Feminist Psychoanalytic Treatment Model. I am impressed that the articles in this book do not take what I would consider a fat negative posture at all, but offer the author’s thoughts and experiences with patients — anorexic, bulimic, fat and everything in between — in light of feminist theory and with a deep understanding of cultural forces we must all contend with. The net result is an approach that offered me some fresh insights into my own history and some very useful material I can use with my patients.

Here is a statement that it seems to me describes what underlies so much of the negative feelings every fat woman and many who only fear being fat that I know has struggled with at least some of her life:

“A fat body is cruelly stigmatizing in this culture. It is treated, seen, and felt as an object of disgust and fear. Many disabilities are so treated and seen; but fatness is also seen as reason to blame the fat person who ate her way into “freakishness”.  ” p. 154

I found myself nodding in agreement frequently as I read this book, underlining many paragraphs and sitting and reflecting on the ideas therein. If you are a therapist, I recommend this one. And consider this:

“The therapist can feel concern about weight, but to be invested in weight loss as a goal is to be aligned with the cultural and internal saboteur.” P. 70

 When therapy works, when patient and therapist are able to influence each other, both do change. In the case of dealing with fat, usually it would be that the fat patient becomes free enough of the cultural fat complex, a fish able to see the water, and who then can dare to confront her therapist’s attitudes and beliefs. She can begin to tell her story in her own voice. Jane Burka asks:

If my body is present and significant for me and for my patients, but remains outside the discourse of the therapy, what kind of taboo have my patients and I created? 

A great deal of change is needed for it to become the norm rather than the exception for a fat therapy patient to be perceived as a person who should be asked what she wants to work on, for her not to be subject to the suggestion that she could/should lose at least a little weight, for it to enter the mind of the therapist that this patient may not see her weight per se as the problem in her life, even though she experiences the negative effects of stigma and bias. Or that it may be that she needs most to deal with the pain, the trauma of having a stigmatized body. In a little book published in the late 80s, Fat Oppression and Psychotherapy, Laura Brown puts her finger on a problem: “…while it was acceptable for clients to be fat women, therapists as so-called models of good functioning, we’re required to stay thin.”  

Home

Every twice in a while when I am a little bored, I sometimes watch an episode or two of the HGTV show “House Hunters”. It can be almost addictive, watching couples and families with their list of must haves in a new house — the house must have a kitchen with granite counters and stainless steel appliances. There must be a large “master suite” with an equally large master bathroom. And even the bathroom must have updated fixtures. Even more surprising was the amount of space these people felt they needed. Even couples without children and not planning to have any often wanted four or five bedrooms and 3000+ sq. ft. 

I am hoping to offer a workshop on What is Home? next spring, which has taken me back to a favorite book of mine House As a Mirror of Self: Exploring the Deeper Meaning of Home,  by Claire Cooper Marcus. Growing up as I did as an Army kid, the houses I lived in were provided by the Army and we had little to no freedom of choice in the appearance or style of the houses. Due to my history of home, I like to think about houses and what they say about us.

So what does it mean that people want huge kitchens, designed not so much for cooking convenience, as many of these huge kitchens require many steps in order to prepare food simply because they are so large, but as exemplars of luxury and being up-to-date? I am not speaking here of really high end houses — most of what I saw were for middle to upper middle class people who would not have others preparing food or cleaning for them. And what is it that makes relatively new but white appliances not acceptable? What makes stainless steel so important? What does it mean? What are these people wanting their kitchens to show about them? Is it only about prosperity and success? And today as we see into the homes of many news people and pundits who often speak from their kitchens, I am impressed by the elegant and very large kitchens.

Now the whole concept of the huge master suite rather amuses me. I use my bedroom for sleep and related activities. It needs only to be large enough to comfortably accommodate the bed, a couple of bureaus and allow us room to move around a bit. My bedroom is 13′ x 14.5′ and it is plenty for us. But these master suites were often larger than some apartments I have lived in in the past. In a family with children, what does it mean to have so much space set apart for adults only? And why must it be so much larger than an ordinary bedroom?

I live with my husband in a 1000 sq. ft. house. It is plenty big enough for both of us; in fact we could easily and comfortably live in a smaller place. So I try to imagine what it would be like for us to be in 3000 or more sq. ft., just us and the three cats. What would that be about? 

In my town there is a shortage of affordable houses, or what is sometimes called “workforce housing”. Were the discussions not often acrimonious it might be amusing that for many people this term, “workforce housing” connotes subsidized housing for low income people. And in the discussions a deep suspicion and antipathy for renters leaks in, renters being almost lesser beings than home owners. What does this mean about our notions of “home”?

On the other end of the scale are “tiny houses”. The typical small or tiny house by definition is a home with square footage between 100 and 400 square feet. The house may be mounted on wheels and thus also be movable. Many look to this movement as a desire to downsize. And predictably there are shows on tiny houses too.

I have some ideas forming about these extremes in housing and what they mean about what home is today.. But I am interested in what you think. What does it mean that expectations are for so much or so little.