By Karen R. Koenig, LICSW, M.Ed.
As conscientious clinical social workers we use the intimate knowledge of each issue we have in common with clients—a narcissistic mother, the loss of a child, anxiety or depression, childhood sexual trauma, fear of flying, divorce—to build an empathic bridge to them. We expect to struggle mightily with counter-transferential feelings when their problems are our problems. And, except in extraordinary circumstances, we strive to keep the fact and nature of our shared experiences and difficulties concealed. Those portals to identity we cannot hide—our age, skin color, gender, accent, even a limp or a lisp—we generally anticipate, and hopefully welcome, as Freudian fodder.
But sandwiched between our public and private worlds is a common problem encountered by both therapist and client, one which sometimes evades adequate therapeutic attention: What happens when we share an emotional or compulsive eating problem and are both heavy, fat, overweight? Although we can conceal from the client our suffering, we cannot hide its often shaming results. It is there—we are there—for full public viewing and scrutiny whether we want it or not.
Our overweight may be due to a medical condition or medication, programmed by heredity, ultimately beyond our control. But, often, the problem is of our own doing, the accumulation of years of overeating and secret binging, diets initiated and ignored, a lifetime of food as dear friend and mortal enemy. Occasionally, we may even be slender, belying the shame of alternately stuffing and starving our bodies. After all, food is so basic to our existence and so fraught with emotional overtones that only the lucky few—therapists and clients alike—escape childhood having a normal relationship with it.
Because they rarely impede normal functioning, as do drug and alcohol addictions, destructive eating habits and patterns can so easily slip from our awareness; we’re willing to let them slide. But, if we, as therapists, are not ready or willing to face our eating problems, how can we help our overweight/overeating clients? We may ignore the obvious—that the client is grossly overweight or has dangerous eating binges—because it triggers our emotional discomfort and brings into focus our own unacceptable habits.
We may wonder, How can I possibly help my client if I can’t help myself? Or whether the client, after one look, will instantly write off our ability to provide help with eating and weight—or any—problems. We may project our feelings onto them: I don’t care what the doctor says, it’s only 20 extra pounds. Or, conversely, I’m so gross and ugly, how can anyone bear to look at me? We may unconsciously redirect discussion when the client raises weight or eating issues. Or we may focus on them exclusively, hoping that by curing the client we, too, will be cured.
When we hide this—or any—ongoing, intimate problem from ourselves, there are so many ways the therapy can derail. We may overtly or covertly send out signals that the subject of eating and weight is taboo and/or not worth pursuing. If the client is typically ambivalent about dealing with such issues and senses that we are uncomfortable, he or she may heave an unconscious sigh of relief and never breathe a word about them. Alternatively, the client may wish to pursue the topic, but may be holding our shame about the issue and/or trying to protect us from the discomfort of facing it, and therefore shy away.
There are, however, steps we can take to get back on track and stay there. First, of course, we must face the reality that we have an eating or weight problem similar to that of the client. Second, we must privately acknowledge and experience our painful feelings about our plight—disgust, fear, helplessness, hopelessness, frustration, contempt, self-hate, repulsion, or shame. Lastly, we must maintain exceptional vigilance over any therapy in which we share an eating and weight problem with a client. Individual therapy, group support, or supervision may be helpful. Additionally, there are many wonderful self-help books on the subject.
How we deal with the issue in session depends upon our relationship with the overweight/overeating client and on our therapeutic style. Perhaps all that is needed when the client touches on eating issues is a simple, "This is a painful subject to talk about," or, "It takes courage to face difficult problems." A little encouragement might work: "I’d like to hear about this eating problem of yours if you’d like to talk about it." If the client does not raise the subject when obesity is clearly in evidence, a gentle but direct question about the omission might be called for: "Weight appears to be an issue for you, yet you haven’t mentioned it. I wonder why." If we are brave, we might even venture a comment such as, "We both know that being overweight has its hardships."
In the case of eating and weight problems, the wish to hide and turn away from what we see in the mirror is both metaphoric and literal. But acting on this wish can only lead us away from the process of truth and healing, alone with our heavy burden. Fortunately, for therapist and client alike, the therapeutic mirror is wide, wide enough to encompass us both.
FOCUS Newsletter - March 2000
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