The contributions of self psychology to the treatment of anorexia and bulimia

Abstract

This article reviews the contribution of self psychology to the treatment and understanding of anorexia and bulimia. It tries to show that the unique conceptualization of self, selfobject relations, and this theory's conceptualization of resistance and defenses constitutes a therapeutic stance which especially fits the therapeutic needs of eating-disordered patients. Clinical vignettes illuminate three main issues exemplifying the opportunities and dilemmas that this new development in psychoanalytic theory brings to the fore in the treatment of eating disorders: (1) empathy with deeds and attitudes of the patient that the therapist finds difficult to empathize with; (2) empathic understanding "from within" from an experience-near stance vs. experience-distant interpretation "from without"; (3) self, selfobject relations with food and as a result of progress in therapy, with human beings.