Counseling and Eating Disorders

Counseling and Eating Disorders
Prof. Dr. habil. Christoph Klotter Hochschule Fulda

contents a case study some data about eating disorders basics of counseling basics of counseling eating disorders societal causes of eating disorders

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 cannot explain why, he did not tell her why, 2) she fears to commit suicide (driving with her car against a tree)

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 her face is like a mask, I would not recognize her on the street, wears a lot of different clothe styles

case study she is very friendly und supports her friends, 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 her mother and for her father was a ridiculous man

case study her much older brother and sister lived together 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 supported mother like a mother her mother could not bear if she had problems: Come back if you feel better

case study mother was also bulimic but she tried to hide this since she was thirteen she became bulimic too since she was thirteen she had sex with a lot of men, hundreds of men, she cannot remember the names of them, especially older men (40 years)

case study having sex is like a compulsion, if she is going out she MUST find a man for the night since her mother left her father mother had never a relationship to a man

case study in a way mother shares her sexual experience: mother has a key for her flat which is very close to the flat of mother; in the morning mother opens the door to her flat, brings breakfast, especially Nutella, and sees the stranger in her bed, she never says anything

case study mother knows that she cannot stop eating Nutella until the glass is empty mother supports her eating disorder

questions to the case study why she is depressive? why she has developed bulimic symptoms? why she has become promiscuous? what does she need from a counselor to change her eating and sexual behavior? how, do you think, she lives today?

some data about eating disorders Anorexia nervosa, Bulimia nervosa, Binge Eating Disorders not obesity definition: Anorexia nervosa: loosing weight, 15% under the norm weight (like Body Mass Index), self perception to be fat

some data about eating disorders An: 0,1% until 0,5% of all women in Western Civilization, more often in higher social classes, nearly only women Bn: often eat attacks with intake of huge amount of food, occupation with the topic eating, weight regulation through vomiting, feeling too fat

some data about eating disorders Bn: 1% - 3% of young women (1735), 90% women, 10% men 20% of young women tend to eating disorder in Germany (KiGGS) comparing An and Bn, the prognosis for Bn is better 10% of An is dying, a third gets other severe disease

counseling difference to health information dialogue trial and error concerning finding individual solution fits to every day life client is searching for his or her solution

counseling client has the responsibility for his or her behavior participation shared decision making Rogers approach is dominating counseling psychology worldwide

basics of counseling 1) characteristics of a good counselor according to Rogers unconditional positive regard empathy authenticity

basics of counseling 1)
write down or discuss in a small group why these characteristics are very important and indispensable for counseling!

basics of counseling 2) knowledge of and experience in diagnostics why do you need this? Why Rogers might be wrong concerning rejection of diagnostics?

basics of counseling 2) 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 good father

basics of counseling 2) knowledge of and experience in intervention methods why do you need this? optimal: knowledge of different approaches ( for instance Behaviorism, Psychoanalysis, Rogers)

basics of counseling 3) 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 the client possible

basics of counseling 4) transference and counter transference (Freud) unconscious process: transfer of experiences and images of the past to the counselor the counselor might appear to the client as a strict father although he is not strict

basics of counseling 4) transference and counter transference (Freud) through transference experience from the past come to consciousness now counter transference: how the counselor answers the transference? accepting and enjoying to be the strict father? rejecting? registering?

basics of counseling 4) transference and counter transference (Freud) if you realize transference you can distinct between yourself and transference and you can understand the earlier experience of the client you can talk about transference you can work with it without talking

basics of counseling 5) some attitudes of the counselor to her- or himself he or she is not perfect, must not be perfect 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

basics of counseling 5) some attitudes of the counselor to her- or himself because more or less we are prone to a (mental) illness we should experience and express humility with humility we are more gracious concerning our own suffer and the suffer of the client

basics of counseling 5) some attitudes of the counselor to her- or himself with more favour we do not condemn the disorder of the client, we are not scared because of his or her disorder, but we can figure out that his or her disorder might be the best solution for him or her - until now

basics of counseling 5) some attitudes of the counselor to her- or himself abstinence: the counselor does not satisfy his or her needs while counseling he or she must not be admired no thanks, no presents

basics of counseling 5) some attitudes of the counselor to her- or himself abstinence: except satisfying curiosity, scientific interest, interest how human beings function all clients are unique thus, each consultation is unique

basics of counseling 5) some attitudes of the counselor to her- or himself abstinence: thus, each consultation is a new experience thus, we enjoy consultation the client will feel this

basics of counseling 6) some attitudes of the counselor to her- or himself sense of tact: You can say something with the sense of tact. But this means that you ignore some things, that you don t talk about this. You have no sense of tact if you tell something you have to ignore.>>

basics of counseling 6) some attitudes of the counselor to her- or himself sense of tact: >> Ignoring something does not mean to look away but to see it with your eyes that you don t touch it when you pass by. (Gadamer)

basics of counseling eating disorders An: anorectic girls and women do not like the counselor because he or she tries to reach something the An-client does not want to reach: a higher Body Mass Index (BMI) An-clients often do not feel ill

basics of counseling eating disorders a disorder of body awareness An-clients often are arrogant, aggressive, cold as a counselor you must have patience on an unconscious level often they are still a unit with the mother, they are not separated from her

basics of counseling eating disorders thus, they have not the feeling to die when they die because mother is still alive and so they too thus, you must clarify that they are dead when they are dead psychological separation from mother is a difficult process

basics of counseling eating disorders An-clients often have the impression that they must be loyal to mother that they cannot leave mother a counseling success is when they are less ambitioned, less perfect when they have more favor concerning themselves

basics of counseling eating disorders Bn-clients on one hand are full of shame because of their eating behavior, they think they are disgusting on the other hand they are relieved if they can confess their bulimic attacks as a counselor you should not feel disgust

basics of counseling eating disorders the bulimic behavior follows the logic of Christian sin: try to avoid sin (not to eat), not to be able to resist, eat a lot with pleasure and a bad conscience, vomit to undone the sin, afterwards happy as if nothing had happen

basics of counseling eating disorders pay attention that you don t act the counter transference of a priest which hears the confession of the client with voyeuristic lust and sentencing you cannot give absolution with this counter transference you become a part of the bulimic behavior

basics of counseling eating disorders An is an disorder of being not separated from mother Bn is an disorder on the way of separation thus, the counselor must feed the bulimic client with attention and sympathy

basics of counseling eating disorders in the transference the counselor is the good mother who gives the child the good food (attention and sympathy) and who supports the process of separation the good mother enjoys the growing up of the child

basics of counseling eating disorders the bulimic behavior is an attempt of feeding oneself and not to wait any longer for the mother who should fed with good things what she never has really done thus, reducing bulimic behavior is connected with accepting that mother was not good enough >>

basics of counseling eating disorders >> connected with more or less depressive feelings the counselor must be able to bear these feelings he or she should not be frightened that depressive feelings are like a virus which attacks him or her

if you are a counselor you must know how the psyche of human beings work (and how your psyche works!)
but, you must also know the societal background of eating disorders for instance: the ideal of slimness

a history of the ideal of slimness

history of Western civilisation: predominant ideal of slimness Ancient Greek World: slimness as the embodiment of moderation self-control of internal nature (drives, instinct) = sensible citizen overweight = sign of lacking internal harmony

Western civilisation: a culture of being naked versus for instance: China for instance Jesus at the crucifix being naked the entity of human being can be revealed obese people refuse to study their entity

The possibility of nakedness first is based on what we called with the Greeks the >form<: a form with ideal function which often is described mathematically (geometrically) and posses the value of an ideal. (Jullien, 2003, S. 51) obesity offends against this form

Christianity took over the ancient ideal of slimness slimness as an expression of an existence without a lot of sins not to give in to the desire of flesh

Renaissance, mannerism and Baroque: loss of the classical proportions overweight as an expression of social power especially concerning men classicism and civil epoch: return to slimness

Civil epoch = the Protestant ethics became dominant synonyms: health, morality, ability to work and living like god likes it the slim body represents these synonyms

since 1900: transformation slimness as this synonym in a scientific norm = covered Protestant ethics scientific norm officially without any sense except connection to health but connection to health is disputed BMI of 25 is no more the limit

consequence of the Protestant ethics and the ideal of slimness: hate and disgust at obesity. what scientists say: an eight year old girl, who was presented in the Palais royal in Paris. Her eyes were hidden by fat, the nostrils were blocked, thus she had to breathe through her mouth; >>

by viewing you could not separate upper arm from forearm, the breast was huge. She was fed with a lot of bread and milk. Once in the morning you found her dead. (Jaeger 1821, S. 6)

The weight of the fat stretched over the eyelid which stood open. What the sight made horrible were three round chins which in the length of a foot hanged above his thorax. Thus you could compare his face with a mutilated column. (Brillat-Savarin 1865, S. 255)

There are two opposing types of obesity: the plethoric type, who is able to work and enjoy life, and the pale and spongy type, who is tired, has no power, is always looking for the next chair and then reels off a list of his complaints. (Lichtwitz 1926, S. 911)

The buttocks were monstrous. It was one of these cases in which a popular and 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 and to stop eating

Our children may be too fat, but they swim very well as a result

empirical data on the prevailing delusion of slimness

today: nearly a worldwide trend: Everybody intends to become slimmer, regardless of how slim they already are (especially women) One of three girls has experience with dieting by the age of 10
(Bruns-Philipps, Deesman 2004, S. 10)

Schur et al. (2000) 50% of young children want to reduce their weight and 16% have already done so 77% of these children report of members of their families who have changed their habits of eating

from the occidental ideal of slimness to the dictatorship of this ideal

The ideal of slimness and the dictatorship of this ideal are not identical If you want to approach an ideal, the ideal is a possible aim Dictatorship means: you must be slim if not, you will experience massive discrimination

Within the dictatorship of this ideal, many historical processes are bundled These converge into the ideal and make it so powerful There is no one single cause of the ideal of slimness, but many of them
possible causes of the dictatorship of the ideal of slimness

1. In the affluent society (since 100 years ago), we need a countermeasure to the evolutionary programming of eat as much as you can especially fat and sweet food Without this evolutionary programming, our ancestors would not have survived

2. liberalisation of sex and restrained eating Freud: Culture is based on repression of drives (hunger, sex, aggression) in earlier times (19th century) repression of sex, nowadays eating A girl s summer shirt? You can see the stomach exposed? Sexy? Total food control?

ad 2. liberalisation of sex and restrained eating new freedom - new compulsion an example: from 1920 to 1930 American women experienced new kinds of freedom (to study and have sex) and paradox: new restrictions on eating (Brumberg 1994)

3. separation of sex and reproduction In evolutionary terms, an overweight woman offers her children better chances of surviving currently: autonomy of sex: A plump woman is irrelevant to reproduction

4. social distinction in the past: overweight = wealthy and high social prestige today in the affluent society: slimness = high social prestige, represents attractiveness, discipline, flexibility and happiness (Bourdieu)

5. control of emotions process of civilisation (N. Elias) from the middle ages until today, a massive increase in the control of emotions and self-control connected with this: massive increase in control of eating

6. the disciplined body In the modern age a highly disciplined body is needed for the industry, the army and for road traffic slimness = expression of the disciplined body (M. Foucault)

7. delusion of slimness = Opiate for the people instead being engaged in politics, excessive commitment to own body which remains imperfect pre-occupation: the mirror as the rest of the world

8. loss of general societal rules concentration on body many different lifestyles loss of obligatory rules for all (religion) connecting the promise of happiness with the body (from transcendental to a worldly promise ) not much of common societal meaning

9. the ideal of slimness as a modern variation of classical moderation and the Christian concept of sin a society needs a canon of values Through the concept of slimness, traditional values are suppressed, which appear today as old fashioned Moral of today is enbodied

10. the ideal of slimness as a remnant of benevolent despotism Using the ideal of slimness, our society controls the individual body, governs the body authoritatively and defines how it should be = little belief in democracy and individual autonomy

11. slimness as a variable norm Norms are variable in principle for instance, definition of hypertension always difficult: a correlation between a norm and health very questionable: Can a BMI higher than 25 damage your health or higher than 35?

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 purely arbitrary consequence? Anorexia nervosa starting with a BMI of 18,5 or 17,5?

Ad 11. Slimness as a variable norm Anette Kellerman (swimmer and actress, 1,60 m, 62 kg, 1920): Thick is a short and ugly word. But plumpness, corpulence and overweight are only euphemistic expressions. All these words mean thick and sound, with 10 letters, just like plump, unhealthy, ugly and dumpy as with four letters. (Brumberg 1994, S. 214)

12. the ideal of slimness as a war against women Man is afraid of voluptuous and sensual woman Both sexes are afraid of the great mother which gives life and can possibly destroy life too - in childrens fantasy ( E. Neumann) consequence: Twiggy + Kate Moss

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 body one consequence: radical asceticism and renunciation of the world
Thank you for your attention!

Counseling and Eating Disorders

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Counseling and Eating Disorders

Prof. Dr. habil. Christoph Klotter Hochschule Fulda