title: Coming alive: the psychotherapeutic treatment of patients with eating disorders.
abstract: OBJECTIVE
  To describe a dynamic psychotherapeutic approach specifically developed for women with eating disorders.
  
  
  METHODS
  The developmental origins and psychological disturbances associated with eating disorders are outlined based on a review of the literature and the authors' observations. Principles from contemporary psychodynamic theories that focus on subjectivity and intersubjectivity are applied to the treatment of women with eating disorders and are illustrated with clinical vignettes. Theoretical models employed include intersubjective and relational theory, self psychology, and feminist psychodynamic theory.
  
  
  RESULTS
  Relative unresponsiveness to a child's subjective experience and to child-initiated cues are thought to contribute to psychological disturbances among women with eating disorders. These disturbances include impairment in the sense of effectiveness, in the capacity to appreciate and tolerate emotions, and in the continuity and cohesiveness of self-experience. Self-imposed starvation, binge-purge episodes, and excessive exercise may act as psychic organizers in women with these vulnerabilities. An active psychotherapeutic approach with sustained interest in the patient's authentic subjective experience promotes the identification, organization, and integration of emotional experience and the consolidation of a more differentiated sense of self.
  
  
  CONCLUSIONS
  In the psychotherapeutic treatment of women with eating disorders, a therapeutic posture of sustained empathic enquiry contributes to the patient's curiosity about her own subjective world. Feeling understood in a therapeutic relationship and feeling assisted in organizing and understanding one's subjective experience contributes to the gradual unfolding of the psychological sense of self.
authors.affiliation: Toronto Hospital, University of Toronto, Ontario.
authors.forename: J
authors.initials: J
authors.lastname: de Groot
authors.forename: G
authors.initials: G
authors.lastname: Rodin
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy; D001364:Awareness; D002032:Bulimia / Q000523:psychology / Q000628:therapy; D003379:Countertransference; D001068:Feeding and Eating Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D011575:Psychoanalytic Therapy; D014167:Transference, Psychology