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So, he’s just a little bit busy. 

In this episode, we talk about what psychoanalysis and deep work therapy are. We break it down in easy-to-understand terms, discuss why it’s actually helpful, and most importantly, how it can be helpful to YOU.  

We’ll take the most complex ideas about psychoanalysis and break it down in ways that help you start to think creatively about your own life, your relationship with food, and your recovery.

The Premise of Psychoanalysis

You probably have heard of psychoanalysis before, and much to my disappointment,  it might have not been in the most positive light.

Psychoanalysis has been used in the treatment of eating disorders since the 1940s and 50s. At that point, it was the only game in town and they got some things right and some things wrong. Something they got wrong (or how people perceive psychoanalysis to be wrong) was finding a reductive and simplistic explanation for all eating disorders (i.e., if someone has an eating disorder, it’s often because there were issues in their relationship with their mother during their childhood). Now, we know that there are many causes of eating disorders. 

But what psychoanalysis does very well is provide a way of thinking beneath the surface about a problem, and using someone’s development as clues to figure it out. 

There isn’t one reason why someone would develop an eating disorder (or any mental illness, for that matter); it’s a developmental process. It develops from various experiences and relationships in a person’s life, and it’s incredibly complex. 

So if we try to say the reason someone has an eating disorder is only because of their mom… then we really miss the point. But psychoanalysis shows that our relationships with our families DO matter in trying to decode disordered eating behaviors. 

Why Do I Have an Eating Disorder?

The point of psychoanalysis is not necessarily to discover the cause of the eating disorder… but rather, to think about how someone can move beyond their disorder. 

Sometimes, though, someone in treatment might feel they need to understand why they have an eating disorder before they can recover. 

However, just understanding why you have an eating disorder doesn’t necessarily get you anywhere; you have to be able to live out your life in a new way. 

Putting Feelings into Words

We all have feelings – all the time. We can’t avoid it. And the research is clear: a lot of people with eating disorders have trouble putting feelings into words. 

Feelings start in the body. You can see it at the most basic level in infants and babies. They feel hungry, tired, or wet, and so they cry. They might move their bodies and kick or reach for their parents in order to express their feelings. 

And then, as they get older, they learn the words for their feelings and needs. But if we can’t use our words for whatever reason, then the feelings have to go somewhere else… and they get channeled through our body and our actions.

Sometimes, people have feelings that they’re not consciously aware of. They can’t be put into words. But one way they can be regulated is through a binge, a purge, or restriction. 

So one job of psychotherapists is to help people develop the ability to put their feelings into words to help them begin recovery.

How to Start Putting Feelings into Words

Let’s go back to the babies and infants example. 

When a baby cries after waking up from a nap, the parent might go in to check on their baby. They might pause and reflect on why the baby is crying: are they hungry? Or wet? And the parent might talk to the baby and tell them, “You’re hungry right now.”

The parent is conveying to the baby that it’s okay to have feelings; feelings make sense; and these are the words you would use to capture those feelings. 

This is the same process psychoanalysts use in therapy; it’s called containment.  

For instance, someone in therapy might go into a session and talk about a binge they had last night. The therapist might ask questions like:

• What were you feeling when you binged? 

• What were you thinking about?

• What happened in the afternoon before that? How did it go at school/work?

• As you were driving home, what did you see? What did you think about or feel?

The therapist might try to help this person uncover what they were feeling – and what feeling got expressed through the binge. 

This process takes time. It’s a process of learning how to frame your experiences, thoughts, and feelings into words. 

How much time? The honest answer is that it’s different for everyone. 

Psychoanalysis Doesn’t Mean You Don’t Make Practical Changes 

Now, this isn’t to say that you shouldn’t do other things to help reduce the symptoms (i.e., bingeing and restricting) that you’re experiencing. Getting support from a nutritionist, creating new routines, and so on that help with the symptoms of an eating disorder is a VERY important piece of recovery. 

But if you JUST do that, and you don’t address the feelings underneath the surface… then they will always pop up again in other ways, like a game of whack-a-mole.  

Why Eating Disorders

So if you’re following along and you understand that as people grow and develop, they can begin to have trouble expressing their emotions, you might come to a curious question:

WHY an eating disorder? Why would a person begin exhibiting these behaviors and not others when they have trouble with emotional regulation? 

What is it about food and body image? Why not some other disorder? 

Food is primal. We develop a relationship with food at the very beginning of our lives. Our relationship with food is shaped by so many factors in our lives – our caretakers’ relationships with food, our own biology, and cultural messages about food and body, for example – so there are many different threads that get woven into our relationship with food. 

Let’s take a binge eating disorder as an example. This is a disorder where people consume large amounts of food without control. They’re left feeling full of guilt, shame, and regret afterwards. 

This is a struggle that can be caused by many different factors in any given person. But commonly, you might see someone who struggles with their own relationship with having needs.

The research shows that often for people who struggle with binge eating disorder, there is a history of trauma – emotional trauma and/or physical trauma. They might feel like no one is going to meet their needs or take care of them – and that there’s even something shameful about having needs.  

That might leave this person dissociating – AKA, numbing out – and it may leave them feeling very angry about what they went through and the way they were treated. 

Will a history of trauma alone cause a binge eating disorder? Certainly not. There have to be other factors that made food the place where the symptom got expressed… because for other people, there ARE other ways these feelings are expressed. 

But for the person with a binge eating disorder, food and eating becomes the focus of the emotional distress. 

A Balancing Act 

As stated earlier, a focus on symptom reduction is important – but so is a focus on understanding the feelings underneath. 

You have to have both, and it can be a tricky balancing act.

This is what makes treatment of eating disorders somewhat unique. Because the symptoms of eating disorders are often dangerous, they do require immediate attention with concrete steps to reduce those symptoms. 

Personality Types 

Psychoanalysis also looks at personality structure. We know there are patterns of personality, and understanding someone’s personality structure makes a HUGE difference in how a therapist relates to their patient in treatment. 

For example, there have been studies that looked at the personality structure of patients with anorexia and bulimia. What they found was there were three main categories of patients:

• High-functioning perfectionistic people 

• Constricted and overly-controlled people

• Very emotionally dysregulated and under-controlled people 

Which type of personality someone has makes a huge difference in what kind of treatment is most effective.

This also applies to personality disorders, specifically, people who struggle with Borderline Personality Disorder and Narcissism. It might be really hard doing deep work therapy if some of the questions asked or conversation topics feel more threatening. 

Because difficult interpersonal interactions or firm boundaries feel more than uncomfortable, the structure of therapy sessions may be intolerable. This would affect how their therapist – and their treatment team, if they had one – would approach treatment. 

If You’re Still Skeptical…

If you’ve read this far and you’re thinking, “Okay, I’m really stressed and can’t stop bingeing/restricting, I’m not really sure how talking is going to help that,” then it’s worth noting that you’re already communicating something. 

You’re saying that you feel skeptical about whether or not you can be helped. You are not sure if words can reach your suffering, and you feel that nothing can be said between you and your therapist that could help. 

You feel like you’re battling this alone, and there could never be another person in it with you. 

Your therapist is there to help you identify what you’re feeling. As painful and difficult as it may be, they are there to sit in it with you and help you begin to find your words, one day at a time.

Tweetable Quotes

“If we don’t have access to words and images and narratives, then the feelings have to go somewhere else. Where else can they go? They go into the body and behaviors.” – Tom Wooldridge

“One way to think about eating disorders is that people have feelings they don’t have conscious awareness of… but those feelings still have to be regulated, and one way they can be regulated is through a binge, through a purge, through restriction.” – Tom Wooldridge

“If somebody is in a place of starving themselves, even to the point of potential death, what is their underlying emotional reality? It’s very painful, and it’s hard to meet it with our own open-heartedness. If we [therapists] can do that (which is not an easy thing to do), we can really start to understand that person from the inside.” – Tom Wooldridge

Resources:

Tom Wooldridge’s Website

Tom Wooldridge’s Books:

Eating Disorders: A Contemporary Introduction

Understanding Anorexia Nervosa in Males: An Integrative Approach

Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak

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