counseling and eating disorders

7/29/2019 Counseling and Eating Disorders

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Counseling and EatingDisorders

Prof. Dr. habil. Christoph Klotter

Hochschule Fulda


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Counseling and Eating Disorders

contents

a case study

some data about eating disorders basics of counseling

basics of counseling eating disorders

societal causes of eating disorders


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case study

a bulimic single woman, 30 years old,

employee at a bank comes to a counselor because 1) her

boyfriend has left her and she cannotexplain why, he did not tell her why,2) she fears to commit suicide(driving with her car against a tree)


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case study

she fears not to be able to control her

behavior (driving against a tree) first impression: she seems to be

happy, extrovert, telling a lot, but herface is like a mask, I would notrecognize her on the street, wears alot of different clothe styles


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case study

she is very friendly und supports herfriends, they can call her at night

but nobody supports her

biography: both parents are priests,when she was nine, her mother left

her father to start to study, for hermother and for her father was aridiculous man


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case study

her much older brother and sister livedtogether with her father, her mother and

she found a new flat since she was born she felt that she was

responsible for her mother, she supportedmother like a mother

her mother could not bear if she hadproblems: Come back if you feel better


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case study

mother was also bulimic but she triedto hide this

since she was thirteen she becamebulimic too

since she was thirteen she had sex

with a lot of men, hundreds of men,she cannot remember the names ofthem, especially older men (40 years)


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case study

having sex is like a compulsion, if she

is going out she MUST find a man forthe night

since her mother left her fathermother had never a relationship to a

man


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case study

in a way mother shares her sexualexperience: mother has a key for her

flat which is very close to the flat ofmother; in the morning mother opensthe door to her flat, brings breakfast,especially Nutella, and sees thestranger in her bed, she never saysanything


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case study

mother knows that she cannot stop

eating Nutella until the glass is empty mother supports her eating disorder


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questions to the case study

why she is depressive?

why she has developed bulimicsymptoms?

why she has become promiscuous?

what does she need from a counselor

to change her eating and sexualbehavior?

how, do you think, she lives today?


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some data about eating disorders

Anorexia nervosa, Bulimia nervosa,

Binge Eating Disorders not obesity

definition: Anorexia nervosa: loosingweight, 15% under the norm weight(like Body Mass Index), selfperception to be fat


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An: 0,1% until 0,5% of all women inWestern Civilization, more often in

higher social classes, nearly onlywomen

Bn: often eat attacks with intake of

huge amount of food, occupation withthe topic eating, weight regulationthrough vomiting, feeling too fat


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Bn: 1% - 3% of young women (17-35), 90% women, 10% men

20% of young women tend to eatingdisorder in Germany (KiGGS)

comparing An and Bn, the prognosis

for Bn is better 10% of An is dying, a third gets other

severe disease


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counseling

difference to health information

dialogue trial and error concerning finding

individual solution

fits to every day life

client is searching for his or hersolution


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counseling

client has the responsibility for his or

her behavior participation

shared decision making

Rogers approach is dominatingcounseling psychology worldwide


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basics of counseling 1)

characteristics of a good counselor

according to Rogers unconditional positive regard

empathy

authenticity


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write down or discuss in a smallgroup why these characteristics arevery important and indispensable forcounseling!


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knowledge of and experience in

diagnostics why do you need this? Why Rogers

might be wrong concerning rejectionof diagnostics?


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knowledge of etiology

why do you need this?

to know how human beings work

what they need from a counselor?

case study: not being fostered, not

accompanied, not strong enough Ego,no impulse control, she needs a goodfather


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knowledge of and experience in

intervention methods why do you need this?

optimal: knowledge of differentapproaches ( for instanceBehaviorism, Psychoanalysis, Rogers)


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containing (Bion) or holding function

(Winnicott) a counselor must be able to hold a

client, giving security and reliance,tolerating all moods from her or him,

making emotional growing of theclient possible


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transference and countertransference (Freud)

unconscious process: transfer ofexperiences and images of the past tothe counselor

the counselor might appear to theclient as a strict father although he isnot strict


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through transference experience fromthe past come to consciousness now

counter transference: how the

counselor answers the transference? accepting and enjoying to be the

strict father? rejecting? registering?


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if you realize transference you candistinct between yourself andtransference and you can understandthe earlier experience of the client

you can talk about transference youcan work with it without talking


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some attitudes of the counselor toher- or himself

he or she is not perfect, must not beperfect

If she or he wants to be perfect she

or he is beyond the clients reach perhaps she or he is a little bit more

healthy than the client, but not more


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because more or less we are prone toa (mental) illness we shouldexperience and express humility

with humility we are more graciousconcerning our own suffer and thesuffer of the client


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with more favour we do not condemnthe disorder of the client, we are notscared because of his or her disorder,but we can figure out that his or herdisorder might be the best solutionfor him or her - until now


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abstinence: the counselor does notsatisfy his or her needs whilecounseling

he or she must not be admired

no thanks, no presents


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abstinence: except satisfyingcuriosity, scientific interest, interesthow human beings function

all clients are unique

thus, each consultation is unique


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abstinence:

thus, each consultation is a newexperience

thus, we enjoy consultation

the client will feel this


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sense of tact: You can saysomething with the sense of tact. Butthis means that you ignore somethings, that you don t talk aboutthis. You have no sense of tact if youtell something you have to ignore.>>


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sense of tact: >> Ignoring somethingdoes not mean to look away but tosee it with your eyes that you don t

touch it when you pass by.(Gadamer)


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An: anorectic girls and women do notlike the counselor

because he or she tries to reachsomething the An-client does notwant to reach: a higher Body Mass

Index (BMI) An-clients often do not feel ill


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a disorder of body awareness

An-clients often are arrogant,aggressive, cold

as a counselor you must havepatience

on an unconscious level often theyare still a unit with the mother, theyare not separated from her


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thus, they have not the feeling to diewhen they die because mother is stillalive and so they too

thus, you must clarify that they aredead when they are dead

psychological separation from motheris a difficult process


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An-clients often have the impressionthat they must be loyal to motherthat they cannot leave mother

a counseling success is when they areless ambitioned, less perfect

when they have more favorconcerning themselves


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Bn-clients on one hand are full ofshame because of their eating

behavior, they think they aredisgusting

on the other hand they are relieved ifthey can confess their bulimic attacks

as a counselor you should not feeldisgust


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the bulimic behavior follows the logicof Christian sin:

try to avoid sin (not to eat), not to beable to resist, eat a lot with pleasureand a bad conscience, vomit to

undone the sin, afterwards happy asif nothing had happen


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pay attention that you don t act thecounter transference of a priest whichhears the confession of the client withvoyeuristic lust and sentencing

you cannot give absolution

with this counter transference youbecome a part of the bulimic behavior


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An is an disorder of being notseparated from mother

Bn is an disorder on the way ofseparation

thus, the counselor must feed thebulimic client with attention andsympathy


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in the transference the counselor isthe good mother who gives the childthe good food (attention andsympathy) and who supports theprocess of separation

the good mother enjoys the growingup of the child


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the bulimic behavior is an attempt offeeding oneself and not to wait any

longer for the mother who should fedwith good things what she never hasreally done

thus, reducing bulimic behavior isconnected with accepting that motherwas not good enough >>


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>> connected with more or lessdepressive feelings

the counselor must be able to bearthese feelings

he or she should not be frightenedthat depressive feelings are like avirus which attacks him or her


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if you are a counselor you must knowhow the psyche of human beingswork (and how your psyche works!)

but, you must also know the societalbackground of eating disorders

for instance: the ideal of slimness


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a history of the ideal of slimness


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history ofWestern civilisation:predominant ideal of slimness

Ancient Greek World: slimness as theembodiment of moderation

self-control of internal nature (drives,instinct) = sensible citizen

overweight = sign of lacking internalharmony


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Western civilisation: a culture ofbeing naked

versus for instance: China

for instance Jesus at the crucifix

being naked the entity of humanbeing can be revealed

obese people refuse to study theirentity


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The possibility of nakedness first isbased on what we called with theGreeks the >form


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Christianity took over the ancientideal of slimness

slimness as an expression of anexistence without a lot of sins

not to give in to the desire of flesh


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Renaissance, mannerism andBaroque: loss of the classicalproportions

overweight as an expression of socialpower

especially concerning men

classicism and civil epoch:return to slimness


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Civil epoch

= the Protestant ethics becamedominant

synonyms: health, morality,ability to work and living like godlikes it

the slim body represents thesesynonyms


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since 1900: transformation slimnessas this synonym in a scientific norm

= covered Protestant ethics

scientific norm officially without anysense except connection to health

but connection to health is disputed

BMI of 25 is no more the limit


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consequence of the Protestant ethicsand the ideal of slimness: hate anddisgust at obesity.

what scientists say:

an eight year old girl, who waspresented in the Palais royal in Paris.

Her eyes were hidden by fat, thenostrils were blocked, thus she had tobreathe through her mouth; >>


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by viewing you could not separate

upper arm from forearm, the breastwas huge. She was fed with a lot ofbread and milk. Once in the morningyou found her dead. (Jaeger 1821,

S. 6)


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The weight of the fat stretched overthe eyelid which stood open. Whatthe sight made horrible were three

round chins which in the length of afoot hanged above his thorax. Thusyou could compare his face with a

mutilated column. (Brillat-Savarin1865, S. 255)


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There are two opposing types ofobesity: the plethoric type, who isable to work and enjoy life, and the

pale and spongy type, who is tired,has no power, is always looking forthe next chair and then reels off a list

of his complaints. (Lichtwitz 1926, S.911)


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The buttocks were monstrous. It wasone of these cases in which a popularand cynical saying is: you are tired, if

you once have circled this person.(Grafe 1958, S. 412)

consequence of the contempt of

obesity: wanting to be very slim andto stop eating


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Our children may be too fat, but they

swim very well as a result


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empirical data on the prevailingdelusion of slimness


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today:nearly a worldwide trend:Everybodyintends to become slimmer,regardless of how slim theyalready are(especially women)

One of three girlshas experience with

dieting by the age of 10(Bruns-Philipps, Deesman 2004, S. 10)


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Schur et al. (2000) 50% of youngchildren want to reduce their weightand 16% have already done so

77% of these children report ofmembers of their families who havechanged their habits of eating


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from the occidental ideal of slimnessto the dictatorship of this ideal


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The ideal of slimness and thedictatorship of this ideal are notidentical

If you want to approach an ideal, theideal is a possible aim

Dictatorship means: you must be slim

if not, you will experience massivediscrimination


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Within the dictatorship of this ideal,many historical processes arebundled

These converge into the ideal andmake it so powerful

There is no one single cause of the

ideal of slimness, but many of them


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possible causes of the dictatorship ofthe ideal of slimness


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1. In the affluent society (since 100years ago), we need a counter-measure to the evolutionary

programmingof eat as much as youcan especially fat and sweet food

Without this evolutionary

programming, our ancestors wouldnot have survived


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2. liberalisation of sex and restrainedeating

Freud: Culture is based on repressionof drives (hunger, sex, aggression)

in earlier times (19th century)repression of sex, nowadays eating

A girl s summer shirt? You can seethe stomach exposed? Sexy? Totalfood control?


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ad 2. liberalisation of sex andrestrained eating

new freedom - new compulsion

an example: from 1920 to 1930American women experienced newkinds of freedom (to study and have

sex) and paradox: new restrictions oneating (Brumberg 1994)


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3. separation of sex and reproduction

In evolutionary terms, an overweightwoman offers her children betterchances of surviving

currently: autonomy of sex: A plumpwoman is irrelevant to reproduction


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4. social distinction

in the past: overweight = wealthyand high social prestige

today in the affluent society: slimness= high social prestige, representsattractiveness, discipline, flexibility

and happiness (Bourdieu)


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5. control of emotions

process ofcivilisation (N. Elias)

from the middle ages until today, amassive increase in the control ofemotions and self-control

connected with this: massive increase

in control of eating


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6. the disciplined body

In the modern age a highlydisciplined body is needed for theindustry, the army and for road traffic

slimness = expression of thedisciplined body (M. Foucault)


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7. delusion of slimness = Opiate for thepeople

instead being engaged in politics,

excessive commitment toown body which remainsimperfect

pre-occupation:the mirror as the rest ofthe world


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8. loss of general societal rules -concentration on body

many different lifestylesloss of obligatory rules for all (religion)

connecting the promise of happiness

with the body (from transcendental to aworldly promise )

not much of common societal meaning


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9. the ideal of slimness as a modernvariation of classical moderation and the

Christian concept ofsina society needs a canon of values

Through the concept of slimness,traditional values are suppressed, whichappear today as old fashioned

Moral of today is enbodied


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10. the ideal of slimness as a remnantofbenevolent despotism

Using the ideal of slimness, our societycontrols the individual body, governs thebody authoritatively and defines how itshould be

= little belief in democracy andindividual autonomy


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11. slimness as a variable norm

Norms are variable in principle

for instance, definition of hypertensionalways difficult: a correlation between anorm and health

very questionable: Can a BMI higherthan 25 damage your health or higherthan 35?


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Ad 11. slimness as a variable norm

The ideal of slimness became more

radical in 20th century : ideal weight(Twiggy)

In principle, a variable norm is purelyarbitrary

consequence? Anorexia nervosa startingwith a BMI of 18,5 or 17,5?


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Ad 11. Slimness as a variable norm

Anette Kellerman (swimmer and actress, 1,60

m, 62 kg, 1920): Thick is a short and uglyword. But plumpness, corpulence andoverweight are only euphemistic expressions.All these words mean thick and sound, with 10

letters, just like plump, unhealthy, ugly anddumpy as with four letters. (Brumberg 1994,S. 214)


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12. the ideal of slimness as a waragainst women

Man is afraid of voluptuous and sensualwoman

Both sexes are afraid of the greatmother which gives life and can possiblydestroy life too - in childrens fantasy (E. Neumann)

consequence: Twiggy + Kate Moss


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13. the return of the Gnosis

weakening Christian beliefs

therefore increasing strength of Gnosis(Adorno, C. G. Jung, R. Steiner)

Gnosis: rejection of matter and the

bodyone consequence: radical asceticismand renunciation of the world


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Thank you for your attention!

counseling and eating disorders

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