The dynamics of clinical management in the treatment of anorexia nervosa and bulimia: an organizing theory
1986
Stern, S.
Extract: This paper examines the psychodynamic parameters of symptom and hospital management in the treatment of severe anorexia nervosa and bulimia. Building on current object relations and self-psychological formulations, it is proposed that in the early stages of treatment when the eating symptoms are out of control, these patients require a therapeutic holding environment that takes over the self-structuring and self-regulating functions that the symptoms have been serving. However, clinical experience suggests that the patients are likely to subject the treatment system to unconscious tests in an attempt to determine whether the therapeutic environment is more benign in critical respects from the early familial environment that necessitated the development of symptoms in the first place. These "transference tests" occur most frequently in relation to four developmental issues that would be predicted from our current psychodynamic understanding of the etiology of these disorders: (1) the provision of external control and regulation, (2) support for autonomy and initiative, (3) tolerance of aggression, and (4) fostering of the "true self."(author)
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