Problems We Address • 207Eating Disorders
Art and other expressive therapies are very effective in the treatment of anorexia, bulimia,
and compulsive overeating. People who are obsessed with their weight, who frantically pur-
sue “magical control of the body” (Levens, 1995), are usually not in touch with the powerful
feelings and fantasies they are working so desperately to master. Because what is repressed
can be expressed in imagery more easily than in words, art therapy is a way to get in touch
with the ideas behind their symptoms. And using art materials can also satisfy the intense
need of these patients to be in control (Dokter, 1994; Hinz, 2006; Hornyak & Baker, 1989;
Makin, 2000).
Since those with eating disorders tend to deal with their problems through action, the
energy involved in creating makes art congenial (Hornyak & Baker, 1989). For these patients,
who are indeed “starving” for affection, art therapy offers a way to be “fed,” by “gobbling
up” luscious supplies—and a way to “feed” the self and others, by “cooking up” delicious
creations. It is thus not surprising that the first hospital to specialize in treating eating disor-
ders—the Renfrew Center—has made extensive use of art and other creative therapies (A).
For Lila, in the vignette below, art therapy was her self-selected treatment of choice.
Art Therapy for an Adolescent with Anorexia: LILA (17)
I had met Lila during her junior year of high school when she was hospitalized for a life-
threatening weight loss. She was referred because of her artistic talent, as well as her ten-
dency to hide feelings in defenses like intellectualization and rationalization. She attended
an art therapy group I led on the adolescent unit, but she preferred her individual sessions.
After Lila was discharged and I had left the hospital for private practice, she asked to con-
tinue in art therapy. We met twice a week for about a year.
Like many patients with eating disorders, Lila had found that her old symptoms began to
return as soon as she left the controlled environment of the hospital. Unlike some, however,
she was eager to overcome them. She expressed her feeling of emptiness and her longing for
nurturance in a series of agonized and eloquent drawings (B) and paintings (C). Despite
Lila’s excellent intellect, she could articulate her pain in pictures far better than in words
(Fig u re 9.11). Using her own images (D) as springboards for associations, she began to
name her vague feelings (E). An intense family art evaluation also enabled both of us to bet-
ter grasp the source of her problems, as they related to her painfully enmeshed (Figure 9.12)
family (F).
Meanwhile, determined to increase her appetite and to maintain a normal weight, Lila
got an after-school job in a homemade ice cream parlor. During her senior year, she also
concentrated on building her portfolio, and was able to win a full scholarship to a presti-
gious art school in New York. She was then able to manage college without a recurrence of
her disabling symptoms, a significant achievement.
Shortly after she had graduated, Lila called from New York to tell me that she liked her
design job, and that she was enjoying a deeply satisfying love relationship. Ten years later, I
heard indirectly that she was still finding constructive ways to nourish herself and had been
able to maintain a healthy distance from her family while sustaining warm connections
with friends and relatives.
Substance Abuse
Some patients with eating disorders also suffer from the similarly oral and addic-
tive problem of substance abuse. Since Elinor Ulman’s pioneering work at the Alcohol