The Psychology of Eating: From Healthy to Disordered Behavior

256 Treating Eating Disorders

of object relations generates a fear of becoming close to others. Sufferers
of eating disorders are also described as having a longing for an ideal
relationship. This results in a conflict between wanting and not wanting
closeness. The role of the therapist is to facilitate the patient’s understanding
of her relationships. The therapist aims to provide a forum for the patient
to express her conscious thoughts and feelings and also to identify her unex-
pressed attitudes, feelings, fears, and wishes.

The function of symptoms

The second component of the “focal hypothesis” is the function of symp-
toms, and it is argued that the therapy should focus on “the use the patient
makes of the symptoms in current personal relations” (Dare and Crowther,
1995a, p. 298). This addresses the second core theme of the symbolic nature
of symptoms. It is argued that the symptoms of food avoidance and weight
loss function to control and modulate the patient’s relationships with other
people. For example, the symptoms can transform the patient into a
dependent needy person, one who cannot be expected to fulfill the normal
expectations and demands made on a healthy person. The patient there-
fore fears weight gain, as it brings with it an expectation of coping and the
assumption that emotional problems have been dealt with. The body is
therefore used by the patient as her only form of communication to
express her feelings. The role of the therapist is to be aware of these com-
munications, to understand the function of the symptoms and their symbolic
value, and to help the patient to find a way of putting these feelings into
words. The patient is therefore encouraged to face her own feelings and
describe them in words rather than to express her feelings through a
degradation of her body (Dare and Crowther, 1995a).

The therapeutic alliance

Psychoanalytic psychotherapy therefore examines the role of childhood in
terms of the early relationships with significant others, and focuses on “object
relations.” It also explores the function of symptoms in terms of their
symbolic meaning and their impact on current relationships. Both of these
factors are addressed with the context of the third component of the focal
hypothesis, which is the relationship between the patient and therapist.
This therapeutic alliance is central to any psychoanalytic approach, as it is
assumed that “the patient’s use of the therapy relationship will resemble