Helping Clients Identify and Resolve Underlying Conflicts About Eating and Weight
Although we know that disregulated eating and obesity are influenced by factors such as stress, genetics, abuse, lifestyle, chemical imbalances, and even environmental toxins, intrapsychic conflicts may also play a major role in promoting these conditions. Unconscious dilemmas can prevent clients from losing weight or cause them to yo-yo between healthy and unhealthy eating. In fact, conflicting desires can create a pattern of doing and undoing that precludes clients from ever reaching or sustaining their eating and weight goals.
Clients generally recognize the manifest reasons they wish to eat “normally” or lose weight: disease prevention, improved self-esteem, increased longevity, and greater physical comfort. However, they usually are unaware of their latent fears about improving their eating and downsizing their bodies. When clients understand and resolve these unconscious conflicts, their self-defeating patterns make sense, and they are in a far better position to get healthy and stay healthy.
Disregulated eaters’ most common unconscious conflicts center around the following:
• how change happens;
• how to make effective choices;
• coping and self-comfort;
• what they deserve;
• what enough is;
• getting close to others; and
• their identity.
How Change Happens
Clients’ misguided perceptions of how change happens include magical, wishful, unrealistic, and perfectionist thinking. Moreover, they often cling to a success-or-failure model that inhibits them from moving forward. As we know, lasting change involves having realistic expectations, using effective life skills, and making incremental progress. Clients must learn to set goals that are appropriate and achievable, that progress comes in fits and starts, and that recovery is a slow and arduous process.
Rather than cheerlead when clients eat healthfully or lose weight, our job is to help them understand the nature of the change process and reframe underlying, erroneous beliefs that keep them from achieving and holding on to success.
How to Make Effective Choices
Some of them had food and weight struggles with parents or felt undue pressure to look good. Others had parents who were rigid, overbearing, or controlling and, as children, the only way they could muster a sense of self was to resist or defy parental demands. Today these clients are conflicted about whether to listen to external wisdom—to exercise and eat healthfully—or to rebel against anyone telling them what to do. Many of them sabotage their best efforts by doing the “right” thing and being “good” for a while and then resorting to doing the “wrong” thing and being “bad.”
Clients need support while working through their rebellious feelings. The goal is for them to recognize that what started out as an interpersonal battle with early caretakers is now being carried on intrapsychically and thwarting their ability to grow and change.
Coping and Self-Comfort
What They Deserve
This deep-seated sense of feeling undeserving of success, love (by self or others), and fulfillment is in direct competition with their wish to be whole, happy, and loved. When they lean toward feeling worthy and fixable, they eat well and take care of their bodies, but when uncertainties arise, they slide back into food and body abuse. Our work here is at the deepest level of clients’ feelings and beliefs about themselves. When this core dilemma is resolved in favor of non-defectiveness and lovability, sustaining “normal” eating comes more easily.
What Enough Is
Another facet of this dilemma is clients holding a deprivation vs. an abundance mentality. If they believe there is not enough of something—love, food, approval—to go around, they focus on getting as much as they can yet still end up feeling unfulfilled. For these clients, there is no internal ping of enoughness.
Guiding clients toward a worldview of abundance and helping them sense internal sufficiency moves them toward finding authentic answers to the question of what is enough. Teaching them about boundaries and self-care gives them the tools to experience satisfaction and create better balance in their lives.
Getting Close to Others
When clients talk about their weight as a buffer between themselves and others, they are speaking not only metaphorically but also concretely. Exploring fears of sexuality and intimacy gives clients a chance to understand the emotional push and pull that underlies their unfulfilling relationships. As fears about closeness decrease, clients have less need to act them out through their eating or their size.
While the medical community, dietitians, and fitness trainers do their part to encourage clients to become healthier, therapists should not underestimate their role in shaping clients’ physical well-being. No matter how much up-to-date information our clients have about nutrition, health, and weight or how motivated they appear to eat better and work out, underlying, unconscious conflicts can—and will—sabotage their hard won gains. It is our job to help them understand and resolve their underlying, unconscious dilemmas, so they can attain—and sustain—their eating and weight goals for life.
— Karen R. Koenig, LCSW, MEd, is a psychotherapist, eating coach, and author of Nice Girls Finish Fat and What Every Therapist Needs to Know About Treating Eating and Weight Issues.