The Psychology of Eating: From Healthy to Disordered Behavior

Treating Eating Disorders 255

Psychoanalytic Psychotherapy

The two core themes of a psychoanalytic model of eating disorders were
described in chapter 10 as the role of childhood and the symbolic nature
of symptoms. Dare and Crowther (1995a) have developed a form of “focal
psychoanalytic psychotherapy” specifically for eating disorders, which is time
limited, is standardized, and addresses these two core themes. This approach
involves giving no advice about the individual’s eating problems but focuses
on the development of “the focal hypothesis,” which hypothesizes an associa-
tion between three factors: object relations, the function of symptoms, and
the therapeutic alliance (Dare and Crowther, 1995a; see figure 11.1).

Object relations

The term object relationsis used within psychoanalytic psychotherapy to
describe the “patient’s internalised representations of the significant people
in her past, and her relationships with them, these being, for the most part,
family members” (Dare and Crowther, 1995a, p. 298). This therefore
addresses the role of childhood. It is argued that patients with eating
disorders often have a pivotal time point when their relationships with
others changed (this may be real or perceived), and that their inner world

Therapeutic alliance

“to provide information about

the patient’s relationships

with others”

The function of symptoms

“to understand the function

of the patient’s symptoms in

her relationships”

The focal

hypothesis

Object relations

“to promote the patient’s

understanding of her fears of

and need for relationships”

Figure 11.1 Focal psychoanalytic psychotherapy.