In order to be good, I have to feel bad…

 Anyone who looks at me can see that I am fat, yet even calling myself fat and not being embarrassed or ashamed of that simple fact is less ordinary than we might think. Stigma is attached to being fat. Everywhere every day we encounter messages about weight and dieting and by implication the undesirability of fat. So, fat activists some years ago began to talk about and write about “coming out” —

“Unlike the gay body, the fat body is always already out. The fat body is of course hypervisible in terms of its mass in relation to the thinner bodies that surround it. As Moon suggests, the fat body displays ‘‘a stigma that could never be hidden because it simply is the stigma of visibility’’, and asks the question ‘‘What kind of secret can the body of the fat woman keep?’” — Samantha Murray

To come out as fat means to own it without apology or defense. It means owning my body as my own. It means surrendering the idea that the “real” me is thin and one day I will find the right diet or pill or potion that will release me and make me that “real” me. It means confronting inside myself the internalized fatism and stop hating my body. It means resting quietly within myself. 

Coming out as fat is not the same as coming out in the LGBT world. Because fat is visible and it is no secret to anyone who sees me that I am fat. In the case of fat, it is not a statement to the world, to my world, so much as a statement to myself, reflecting acceptance in myself of my body. 

But as a fat woman, in order to be good, I have to feel bad. In order to feel good, I have to be bad.

If I want to be perceived as good, I, and fat people in general, must present myself as the Good Fatty, the fat person who accepts the socially dominant viewpoint that my number one goal in life is losing weight. All I have to do is talk about trying to lose weight, about my desire to be thin. I can say I have lost 10 or 15 or 30 pounds and I will be praised for my efforts, even if it is a lie. The Good Fatty is apologetic for being fat and is in a perpetual state of trying to become thin. The Good Fatty doesn’t’t threaten thin people because she tells them she is engaged in the same struggle to subdue her body that they are. The Good Fatty is apologetic for her fat, as if she must ask forgiveness for committing an aesthetic crime with her too-muchness or must do penance for taking up too much space. She doesn’t complain that very few stores carry clothing in her size. She accepts as just that she pays more for her clothing, health care, and seats on airplanes. Because she knows she deserves it. She accepts without protest the “helpful” advice and criticism she receives from others because she is trying to become better, to become thin. She swallows her anger because she knows it is all her fault, that she has failed, and is getting what she deserves. She manages her fat identity by covering, by accepting that she should not be fat. She tries to cover her failure by always being in the process of trying to change, a perpetual state of atonement for the sin of being too big and too much.  She can be good so long as she feels bad.

But suppose I want to feel good, not bad. What then? Suppose I call myself fat. Not curvy. Not Rubenesque. Not zaftig or plump. Fat. I call myself fat. Just by calling myself fat, using that word unselfconsciously and without shame or apology, is to move away from being the Good Fatty. Just by calling myself fat, I break a taboo.

But what else? Embracing myself as I am. Coming out as myself, a fat woman who is simply who she is, what she is.

I made the decision over 40 years ago to stop dieting, I never talked about it with friends. I wasn’t dieting but I wasn’t willing to be public with having stepped out of being good, of forever being on the way to being thin. Being the Good Fatty is acting as if I embrace body hatred, dieting, guilt and shame so that I can at least be on the fringes of membership in the “normal” world. I can be good only by feeling bad. By feeling bad I can in a way be normal, be like other women. So stopping dieting is not coming out. It is an act of rebellion, to be sure, but the rebel is always defined by that against which she rebels. 

Coming out means being willing to be bad. It means letting go of the fantasy that there is a thin person inside waiting to get out and that she, not this fat me, is the real one. Coming out is to stop pretending to be trying to lose weight when I am not. Coming out means stopping defending how I eat or my health. Coming out is letting go of shame and embracing the body I have. Coming out is accepting myself, all of myself, fat and all. I can’t be good, be the way I am expected to be and do all of these things.

Perhaps the hardest thing, the most difficult part of coming out as fat, of leaving being good behind, is to really inhabit my fat body. Unconditionally. To love myself, my body exactly as it is, and not withhold that until I lose the 50 or 100 or however many pounds stand between me and being “normal”. No more apologies. No more mute acceptance of dieting advice. No more feeling bad because I take up space. That is the path to feeling good. It leads through a mountain of unexpressed rage and anger at having tried so hard for so long to be good, at having felt guilty and ashamed and bad for being too much. 

Therapy with a therapist who does not equate health with weight can be invaluable in the journey away from self-hatred to self-acceptance and love. 

Please Tell Me What To Do

Often people say they left therapy because “the therapist wasn’t helping” with an expectation that the therapist should DO something — assign homework, give an exercise, something that feels like “doing”.

Now if I go to the dentist because I have pain in my mouth and the dentist doesn’t help, leaving to seek help elsewhere seems reasonable. But I look to the dentist to *do* something to make me feel better. The dentist does not usually, at least in acute situations, require of me that I do more than be cooperative and hold my mouth open. But psychotherapy is a different thing altogether. Therapists do not perform procedures upon patients in order to relieve their suffering. We might sometimes wish we could and certainly patients wish we would, but it just isn’t that way.

In any depth psychotherapy, the therapist does not tell the patient how to solve problems. The focus of treatment is exploration of the patient’s psyche and habitual thought patterns. The goal of treatment is increased understanding of the sources of inner conflicts and emotional problems. This understanding is what we call insight. Now insight without action is pretty useless. But the therapist doesn’t say to do this or that but instead might ask how this new understanding might be put into action in the patient’s life.

In order to accomplish this work of therapy, the patient and therapist must have a good working relationship, or therapeutic alliance. The patient needs to feel that the therapist is on her side, so to speak, allied with her in her desire to have a better, happier life. And in turn, the therapist needs from the patient a willingness to do the work of therapy, to put feelings into words, to talk about what she is thinking and feeling. And that includes being willing to talk about feelings of anger, disappointment or frustration about the therapy or therapist.

Most often when I hear people saying that therapy isn’t helping, I am also hearing an expectation that the therapist will tell the person what to do in order to feel better. And  to a very limited degree, we can do some of that — like take a walk or write in a journal or try painting or some other creative outlet when having difficulty between sessions. But on the big things — like whether or not to stay in a marriage or change careers or leave home or any of many many other important life decisions, we cannot tell a patient what to do. We, as human beings ourselves, have enough trouble finding our way through the complexities of our own lives and not only cannot, but really should not presume to be in a position to make decisions for others in their lives. No matter how much the patient may want it. But talking about wanting that, being angry that therapist won’t do it — that is the stuff of therapy. Because it is the relationship with the therapist that facilitates change.

Ultimately we behave with the therapist the way we do with most important people in our lives, with the same kinds of assumptions about the therapist and about ourselves. And we do so unquestioningly. 

It is also true that it is difficult for the therapist to respond to feelings and issues that the patient does not talk about. All rumors to the contrary, we are not mind readers! This underlies the basic therapeutic dictum that the patient should say whatever comes to mind.

Now of course, this is difficult for most of us, conditioned as we are by social norms, by rules we have learned from our parents. Remember Thumper in Bambi:”If you can’t say something nice, don’t say anything at all”? Most of us operate on some version of that in our relationships and avoid saying things to another person that we think might make them uncomfortable or angry with us. But therapy is a place where Thumper’s Rule needs to be suspended. So, if you don’t tell the therapist you don’t feel cared about, there isn’t much the therapist can do to help you with that. Similarly if you are angry with the therapist, have sexual feelings toward him or her, or any of the myriad of other feelings and thoughts about the therapist you might have. It all belongs in therapy. Putting those feelings into words is a key  part of what therapy is about, after all, because that opens the doorway to understanding where they come from and how to deal with them in ways that are helpful rather than destructive in life.

For psychotherapy to be effective a close rapport is needed, so close that the doctor cannot shut his eyes to the heights and depths of human suffering. The rapport consists, after all, in a constant comparison and mutual comprehension, in the dialectical confrontation of two opposing psychic realities. If for some reason these mutual impressions do not impinge on each other, the psychotherapeutic process remains ineffective, and no change is produced. Unless both doctor and patient become a problem to each other, no solution is found. C.G.Jung 

Now is a good time…

As more of us are becoming vaccinated and we begin to believe that the end of this very difficult time is in sight, oddly many of us are experiencing mildly-moderately distressing effects from having our lives constrained for the past year. Yesterday I read this very thoughtful article in the Atlantic:

Late-Stage Pandemic Is Messing With Your Brain

We have been doing this so long, we’re forgetting how to be normal.

One provocative thought:

“We’re trapped in our dollhouses,” said Kowert, the psychologist from Ottawa, who studies video games. “It’s just about surviving, not thriving. No one is working at their highest capacity.”

I haven’t driven more than a few miles this whole confined year. And though, as an introvert I haven’t found being just with myself and my husband unbearable, even I am chafing at the pace of return to whatever will be normal.

If you are finding this time difficult, that the forgetting that seems to come with living through this pandemic and its attendant confinement, now is a good time to consider therapy. To have a place  and time to talk about what has happened with your life this past year, about your fears, about the discoveries you have made about yourself.

I have openings. Contact me using the contact form on the Home page. I’d be delighted to hear from you.

Fat Patient, Thin Therapist

It is usually assumed that in a room with a slender therapist and a fat patient, it is the patient who has a weight problem. That therapist, benefitting from thin privilege may well assume that the way she eats, what she eats and how she exercises are what make her different from her patient, what make her thin and her patient fat. She may believe that because she carefully monitors what she eats and faithfully exercises, that she has control over her body, control that the fat woman could have if only she tried harder and did as she does. There is nothing in the media or even the professional literature to contradict her assumptions.

There are powerful transference/countertransference forces operating in therapy when fat enters the picture. As a fat patient I came to work with slender analysts with a full set of baggage and expectations based solely on my fears and projections about how my fat body would be experienced and regarded. Nothing in my experience with others contradicted these fears. And more often than not, my fears were borne out as valid. The language used to describe obesity – words like “grotesque”, “gargantuan”, “repulsive” – betray much about feelings toward fat people. It is important for the slender therapist to look within about her own attitudes and responses to fat.

A fat patient who wants to talk about weight exclusively, as if it were all that matters in life, is as much avoidant as is the fat patient who ignores weight entirely. And in either case, the therapist needs to be aware of how her own biases and/or discomfort play a role in this. There are very fine lines here. Weight and appearance and being outside the established norms are touchy things. It is difficult to become accepting of one’s own deviant(in the sense of differing from whatever is considered ‘normal’) body, to be at home with being different. The ambivalence is massive. The longing to fit in is right there next to defiance and anger about not being accepted. The therapist needs to walk that line without falling to either side, either by urging and cajoling weight loss or by denying the difficulties of being different from the expected norm. These are tricky waters for a therapist with thin privilege to try to navigate.

Just as we now know white analysts need to learn about African American culture, our fictional slender analyst needs to learn about the life her fat patient leads, about fat experience, about the experience of being reviled, judged, shunned, pathologized on a daily basis. And consider what her own unresolved body issues might be, because as Barbara Miller writes:

the experience of the analyst may…have to do with his or her own neurotic blind spots. And the analyst needs to consider such a possibility. Concerning neurosis Jung writes, ‘Behind a neurosis there is often concealed all the natural and necessary suffering the patient has been unwilling to bear’… And we can say that the analyst’s own not suffered pain can all too easily be disowned and then ‘found’ as the pain of the analysand: the neurotic countertransference. 

A female therapist, regardless of her weight, has had to deal with the expectations that women should be slender and attractive. Most likely she has dieted or thought about  dieting, fretted about any fluctuation in her weight, and experienced some anxiety about whether or not she is pretty enough, slender enough to attract a partner. In this sense she and her fat patient have shared experience, but her patient’s anxiety and fretting have not resulted in the slender body that the therapist has. And this can well become a source for a blind spot in the therapist – if she has been able through diet and exercise to be thin, then why wouldn’t that also be the answer for her fat patient?

That slender therapist needs to consider where her ideas about fat and fat people come from, what supports those ideas. The one article in Quadrant, a Jungian journal, in which obesity is even addressed carries bias right in the keywords given for the article: obesity, gorging, overeating, gluttony, hunger. 

Outside of the realm of fat studies, the Health At Every Size movement, and fat acceptance circles, the fat person is not seen as trustworthy or reliable about her own lived experience because it is assumed she is always defensive and denying the reality of her condition. If she says she eats moderately, often it will be asserted that she is in denial about how much she actually eats or some comment will be made about the unreliability of self-report. The fat woman is simply not trustworthy. 

Wilfred Bion’s dictum is to approach each session without memory or desire. If the therapist has in mind that her fat patient needs to lose weight in order to heal, whatever that means, then she is in fact imposing her agenda without determining if that is what the patient wants or needs. When the therapist holds this desire for her patient to change in particular ways, when she asserts her own agenda for the patient, Barbara Stevens Sullivan suggests that desire “reflects a yearning to be helped. “If I can put all the woundedness I sense in the room into the patient, and if I can fix it in him, I will be fixed, too”

The assumption, for both therapist and patient, most often is that if the patient loses weight and becomes slender, she will become more the person she is meant to be, that she will be healthier and happier. For any fat woman, her fat identity will remain no matter her weight — her memories of being fat, of her longings and pain alongside secret delight in her big body — are part of the fabric of her being and need to be heard, witnessed, and accepted. For the thin therapist this may mean receiving anger toward her as a representative of thin privilege, as one of the oppressors her fat patient has lived with. I think of my own rage when my first analyst blithely suggested I could lose a few pounds no matter my goals. A paradox for the therapist of a fat patient is that as Sullivan says,  “the analyst must let go of desire, even the desire to help, at the same time as she remains involved and concerned, desiring the best for her patient” and, I would add, accept that the best for her patient may not be what she herself would want or choose.

Really? Whatever Comes To Mind?

I have posted before about secrets in therapy and every time I have, questions arise. Often people conflate privacy with secrets. So today let’s revisit this somewhat difficult issue.

Privacy vs Secrecy

Privacy is the state of being unobserved; changing clothes for example — that which I keep private, I am merely withholding from public view. Private matters are those traits, truths, beliefs, and ideas about ourselves that we keep to ourselves. They might include our fantasies and daydreams, feelings about the way the world works, and spiritual beliefs. Private matters, when revealed either accidentally or purposefully, give another person some insight into the revealer.

Secrecy is the act of keeping things hidden — that which is secret goes beyond merely private into hidden. While secrecy spills  into privacy, not all privacy is secrecy. Secrecy stems from deliberately keeping something from others out of a fear. Secrets consist of information that has potentially negative impact on someone else-emotionally, physically, or financially. The keeper of secrets believes that if they are revealed either accidentally or purposefully,  the revelation may cause  harm to the secret-keeper and those around him or her.

So that which is secret often contains an element of shame that private does not. We may keep something private for all kinds of reasons, but most of the time, we keep something secret out of fear and shame of what others would think if they knew. We keep something secret because we believe the cost of telling is so high that it’s virtually not a choice at all. Privacy is voluntary; secrecy is not.

Private: I got terrible grades in high school.

Secret: I forged my degree.

Keeping something private is an act of choosing boundaries and staying comfortably within them.

Keeping something secret is an act of hiding from the pain of disclosing something shameful.

This difference centering around the feelings about the information which is withheld is the principle factor in the difference between what is held private and that which is secret. It is this element of shame or fear attached to the secret that makes it different from something private.

Secrets, like an affair or a gambling problem or some misdeed or money problems — the kind of thing we lie awake and worry about, worry about others discovering — are often a big part of what brings people into therapy and what patients find most difficult to talk about. Shame and fear of judgment fill the room. The carefully cultivated image of respectability or responsibility or moral superiority will surely shatter into a thousand pieces the moment anyone, even the trusted therapist, finds out what is concealed beneath the facade. Each patient with such a secret imagines herself to be alone in the world, unlike and apart from all the rest of humanity, unable to imagine that the therapist has heard similar tales many times before. 

When we carry secrets like this, they become barriers between us and everyone in our lives, cutting us off from real intimacy. Anything which threatens to reveal what we seek so to hide becomes a source of anxiety and must be avoided. Maintaining the facade, the persona which covers the shame of the secret becomes paramount. In Japan I am told there is a saying that first the man takes a drink, then the drink takes a drink then the drink takes the man. The same is true of secrets as the secret comes to own the life of the person carrying it.

Secrets in therapy

Psychotherapy, like the confessional, offers a unique opportunity to break the secret and its hold on the life of the carrier. First comes the mustering of courage to say it, to tell the therapist what has been held in shame, to brave the condemnation and the rejection, the fear of which maintains the grip of the secret. And once spoken, then the work of discerning the meaning of the secret and opening to the shadow. 

I hear from people about things they are afraid to discuss with their therapists, secrets they carry and feel shame about. I know how hard it is to open up the dark corners of our lives and let another see in. It feels like a huge risk. But what is the point of being in therapy if, at some point, the secret is not told? If it remains untold and unexplored, the therapy in a very real sense is a lie because it never gets to the truth of the patients life and feelings. So we say to patients that they should say whatever comes to mind and mean to include the secrets as well.

Here are some of Jung’s thoughts, all taken from Vol. 16, pp.55-60:

Anything concealed is a secret. The possession of secrets acts like a psychic poison that alienates their possessor from the community.

All personal secrets … have the effect of sin or guilt, whether or not they are, from the standpoint of popular morality, wrongful secrets.

…if this rediscovery of my wholeness remains private, it will only restore the earlier conditions from which the neurosis, i.e. the split off complex,  sprang.

All of us are somehow divided by our secrets but instead of  seeking to cross the gulf on the firm bridge of confession, we choose the treacherous makeshift of opinion and illusion.

Jung here underlines the corrosive effect secrets have because there is no way, so long as the secret is held, for its bearer to know that she is not worse than everyone else, that the secret does not make him unlovable. The revelation of the secret within the container of a secure psychotherapy relationship begins the  cleansing effect of exposing it.

Those things which a person decides to hold private, even in therapy, may in fact be secrets rather than merely private matters. Because if there is no shame attached, then why the need for keeping such a thing outside of the secure container of therapy? 

It is by no means easy to let go of our secrets, whether we feel,  that do so would be rude or because we fear being judged or rejected or abandoned. It is hard work and takes time. But it is important to keep at it.

Saying whatever comes to mind is a goal and one it takes work to reach. An important part of that work is exploring the difficulty we have in getting there.

Let’s Talk about Dreams

This painting by Edward Robert Hughes makes me think of the oddness of dream images. And so today I want to start to talk about dreams.

A few years ago I found  Yorem Kaufman’s The Way of the Image. It is a lovely little book of essays about dreams, images and therapy. The first 2 essays, “The Way of the Image Part 1” and part 2 are about his way of looking at dreams and about how he works with dreams in therapy, an actual technique essay, something a bit uncommon in Jungian writing.Then in the 3rd essay he writes about the analyst as he or she appears in dreams. These three essays are rich and deeply rewarding for anyone seriously interested in dreams and working with them. 

A few juicy bits from Kaufman:

“Everything that has ever been created was preceded by an image— streets, a blender, theory of relativity. Thus, we have the power of images for immense good or horrible destruction. All the history of mankind is, in essence, the unfolding of a series of images.”*

“…every individual has within themselves a unique set of images peculiarly their own. They speak ultimately to them. Although such images may be shared with others, and those others may be affected, they will not be affected equally, and they will not share in the transformative energy to the same degree. It is both the science and art of analysis to find this unique imaginal language for every analysand.”*

“I am saying that the images that an analysand brings to the analysis, in whatever form, be it dreams, his behavior, body language, etc., contain, in addition to whatever psychic messages that they bring, also a set of instructions to the analyst as to what is the best, and sometimes the only, way to conduct the analysis. Contrary to what may have emerged at the dawn of the psychoanalytic movement, there is no single technique that would be suitable for every analysand. It has been a source of continuous astonishment and awe for me that in more than 30 years of practice, I have found that I work with every analysand in different ways.”*

Over the next little while I’ll write the essays and add my thoughts. If you have a Kindle Unlimited account, this lovely book is available free. I hope some of you will read along with me and that we can talk about the book together. 

If you don’t record your dreams, consider starting. Keep paper and a pencil or pen by your bedside and as soon as you awaken, write whatever dream or bits of dream you can capture. 

 

*Kaufmann, Yoram  (2009-07-16). The Way of the Image  Zahav Books Inc.. Kindle Edition.

Mistakes

“People do not grow in sterile containers with perfect analysts; they grow in messy human relationships with analysts who try their best to do right by their patients  but whose best must frequently consist of reparative efforts vis-á-vis the difficulties they have created.”

Therapists make mistakes. I make mistakes. How do we recover from the mistakes that we make? We recover by recognizing that of course we make mistakes because we are human and it is how we learn. I have been in this work for more than 40  years and I still make mistakes — different ones, but mistakes nonetheless. 

We must start with accepting the patient’s feelings of hurt or anger or other feelings affected by our error. Which means at least initially not trying to get the patient to understand or accept an explanation of our good intentions— we have to avoid yielding to the very human effort to defend and explain. When we do that — try to explain — it is  really for the therapist, an attempt to soothe ourselves and to see ourself again in a positive light. 

 Initially I need to be able to simply accept that I made a mistake, be willing to own that mistake. Optimally the relationship is solid enough that my mistake does not end it and we have the opportunity to work through it, to look at what happened and why and how it came to be experienced painfully. 

Sometimes the therapist’s mistake breaks the relationship. What do we do then? Well, we have to sit with it, reflect on what happened to see what we can learn from it. Maybe got some supervision to see if looking at the situation with another pair of eyes illuminates it for us. We learn what we can from it and let the patient go. Pursuing trying to get her to hear the explanation starts to be its own problem.  

A wise supervisor once told me that we fail our patients in exactly the way they need to be failed and the trick is to be able to work through that. And he was right. Years ago I had a new patient come to me after having fired two previous therapists — one who fell asleep in a session with him and another he found unsympathetic. So I knew I started on thin ice, that he was looking for me to fail him also. One day he called and left me a message that he had to reschedule. I called back and left a message saying only my name and a time he could reach me. He got furious and said I had violated confidentiality by leaving the message so his roommate could hear. Now I knew I had left no indicator of who I was or why I was calling, but it didn’t matter because *for him* I failed. No amount of reasoning mattered. So we failed to work it through. I did learn to check with new patients about whether or not it was all right to leave a message if I had to get in touch by phone. And these days with the ubiquity of mobile phones, the chances that a message I might leave will be heard by someone other than the intended recipient is pretty small.

Sometimes with the best intentions, like Humpty Dumpty, all the king’s horses and all the king’s men cannot put the therapy back again.

It is hard to let go but what I want for a patient may not be what is best for her in her eyes — and those are the eyes that count. If she came back, I would be able to feel good, vindicated in some way — and sometimes patients do come back– but at the time, I have to live with the blow to my pride and my sense of my professional self. It is in these humbling experiences where we learn most. 

What would I do?

Like many of you the tensions surrounding the election and the renewed intensity of the pandemic sapped my creative energies for a while. So for the past couple of weeks I have been reading, knitting and watching Netflix to take care of myself. I hope that you have also been tending to your needs.

Today I woke up and I feel ready to write again. So here goes as I consider what to do when a patient presents a really thorny issue that might reach into  the territory of a moral dilemma.

A while back, someone asked me how a psychotherapist deals with the situation in which something the patient has come to understand she would really like to do to improve or change her life is likely to cause suffering to someone in that patient’s life? Situations like this are not uncommon, as for example someone wants to divorce her husband, an action which will doubtless cause upheaval and pain for all involved.  

But this questions contains, I believe, a misperception about what therapy is about and what the role of the therapist is.  

A new patient comes to me. I gather a bit of basic data and then ask her to tell me why she is here, to tell the story in whatever way makes sense for her. I listen. Very rarely is what I hear framed as a moral dilemma. I ask and ask many times during the time we work together “What is the life you want?”, because this is a pivotal issue. And as she frame possible actions, I ask if that action will take her closer to the life she wants. And we do that process again and again. I don’t tell anyone what to do. I am not really a problem solver.  

I deal with what is the life the person wants, what keeps them from having that life, and how/if it can be achieved and what the cost of achieving it might be. In my years of practice, to the best of my knowledge, I have never seen a pedophile or rapist or person who engages in behavior that I think is beyond the pale — those people don’t come in for therapy, at least not to me. Once I saw a person who might have been a murderer. I checked with colleagues and the appropriate state agency to see what my responsibility was to him and to the community. I saw him 3 times and discharged him to a more appropriate facility. That was a professional decision not a moral one.  

So how do psychotherapists navigate these waters?  

I don’t give answers when asked what people should do. I can help them look at why they want to do it and what the consequences are and whether it will get them what they want. But I do not make the decision.  

In two sets of conditions, I am bound to act on what I hear. If I am told by someone that they abuse someone or are abused, in most states, I am mandated to report the abuse. If someone threatens the life of another, case law says I must inform the authorities, but statute does not — so I consult and then report or not. Otherwise, my task is to listen.  

I am not Dr. Phil. I am not a priest. It is VERY hard sometimes not to try to tell people what to do. Because the work I do is not short term and because I usually work with people over the course of months, and  years, we have time to sort through issues, to examine them from as many sides as possible. And ultimately what they do is up to them. 

“The principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help (the client) acquire steadfastness and patience in the face of suffering. “
-C.G. Jung

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.”