ABSTRACT
The therapeutic encounter with a patient with anorexia nervosa (AN) or bulimia nervosa (BN) is tough and complicated for the patient and therapist alike, at least in its early stages. More often than not, the patient does not enter therapy at her own will but is pressured by parents, teachers or a judicial decision. In therapy, the patient has difficulties to relate to the therapist as a human selfobject, since she is used to turning to consumption or avoidance of food - an inanimate selfobject. The therapeutic stance of willingness to serve as a selfobject for the patient, advocated by self psychology, facilitates turning to human objects. However, it takes crucial time in the beginning of therapy to establish such transition. Further down the road, other modes of selfobject transference emerge, evoking respective powerful countertransference reactions in the therapist. Discussing transference and countertransference reactions, such as devaluation, despair or grandiosity, this chapter also explains the importance of a multi-professional team and/or supervision group for the therapist. The chapter also touches upon the issue of under- or over-management of the treatment by the psychotherapist, paying too little or too much attention to the physical or nutritional condition, respectively.
