ABSTRACT
Drawing upon case examples from their clinical, supervisory, and teaching experience, the authors suggest eating disorder treatment that primarily addresses behavioral change and is relatively short term leaves many patients behind in the search for a fuller sense of self and resilience. They have found that improvement rests upon ferreting out developmental deficits and other factors in early life that have been ignored, unspoken, and neglected; and without reflecting on, working through, and integrating these early experiences patients feel a part of themselves is still missing after symptom reduction. The authors assert that longer-term psychodynamic treatment facilitates therapeutic improvement by addressing six major domains: 1) mitigation of shame; 2) integration of split-off affects and defenses; 3) achievement of greater intimacy and/or capacity to play; 4) confrontation of the tendency to spoil forward movement and self-sabotage; 5) identification with benign introjects and amelioration of a primitive, highly punitive superego; and 6) recognition and confrontation of denial of death. By describing the benefits of longer-term work with eating-disordered patients, the authors hope to encourage others to expand the knowledge base of what constitutes therapeutic improvement and resilience, leading to lives that are fuller, more creative, and productive.
