Dear Therapist:

Thank you for allowing us to gain so much from your collective wisdom each week. I'm in my fifties and watch my weight pretty carefully. I have a normal BMI. I avoid all the bad food at my workplace and stick to my healthy diet instead. Shabbos is my day off. My eating habits recently came up in therapy. My therapist felt that I have an unhealthy relationship with food.  She said I should not be limiting my eating this way. She called it disordered eating. I felt defensive and disagreed. This system works well for me. Let's face it: anyone slim in my age group is restricting their eating in some way. After my session I was thinking how nice it would be not to worry about my weight so much. I don't enjoy the disgust and self-loathing I feel when I cheat and eat 'bad' food or gain a few pounds. I wish I wasn't a slave to my scale. But the fear of getting fat is strong. I would appreciate your insight into disordered eating and how a person can learn to have a healthier relationship with food, while still staying in a healthy weight range. 

Thank you so much.

Response:

I cannot speak to your relationship with your therapist. I don’t know what the issues are that you have discussed, and I don’t know your goals for the therapy process. I don’t know the context in which the conversation about your weight was brought up. I don’t know who initiated the conversation, or whether issues ancillary to weight were—or have been—discussed.

Generally, however, a therapist is there to help you with the issues that you bring to the table. It is not generally the therapist’s job, role, or responsibility to identify issues that have not been initiated by the client (except in certain situations, like when there is an imminent danger).

There are a number of reasons that therapists should not broach new subjects. One reason for this is that the therapist may be bringing up the subject due to their own issues, needs, and insecurities, or for other emotional reasons. It can often be difficult for a therapist to discern their own agenda from that of the client. Even the best-meaning therapists can do things that—unconsciously—serve their own interests in some way. This can relate to ego, as well as to other unconscious motivations.

Although therapists are trained to identify their own needs within the therapy session (as in countertransference) and appropriately deal with them, this can never be completely addressed and resolved. Therefore, there are certain safeguards that should be upheld. This is only one reason that therapists should be careful about remaining within their therapeutic mandate.

You mentioned that your therapist felt that you have an unhealthy relationship with food. I don’t know whether you used the word “felt” intentionally. If so—and your sense is that she was speaking from her gut—this may be an indication that her suggestion was at least partly due to her own emotional needs.

Another issue relates to labelling. Your therapist used the words “unhealthy,” “limiting,” and “disordered.” Words like these tend to pathologize otherwise normal aspects of life. Labelling often causes more problems than it solves. As with most everything, there are better and worse ways of approaching our “relationships” with food. However, this doesn’t necessarily mean that all but the ideal approach is problematic and needs to be addressed. 

If the discussion about your eating habits was obviously overreaching on the part of your therapist, normalizing—rather than pathologizing—your behavior will likely serve you better. There is also a possibility, however, that the discussion about your eating habits was an unconscious attempt to point out something that has been bothering you. You were clearly discussing your eating habits. I don’t know who broached the subject, or if it was mentioned in casual conversation. I don’t know whether your therapist’s suggestion that your eating is “disordered” was a followed logically from the flow of your conversation, or if she jumped from a casual conversation to an assumption.

Ultimately, it is your body, your eating habits, and your choice. If you have never had an issue with the way that you choose to eat—and the only reason that you are now questioning this is that it was pathologized by your therapist—renormalization can help you to view your eating habits from a more neutral perspective. Regardless, a frank discussion with your therapist about your thoughts and feelings (assuming that your therapist is professional enough to do so without feeling attacked) can help you to resolve what now appears to be an internal conflict.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro University

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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