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Feminist Psychodynamic Psychotherapy: A Perspective from Practice, Part 1.

by Kathryn J. Zerbe, MD

Reprinted from Eating Disorders Review
November/December Volume 27, Number 6
©2016 IAEDP

Recently Gloria Steinem, iconic spokesperson and author who helped transform what is now commonly known as ‘Second-Wave Feminism,’ said, “People in hard times need a witness.”1 In this interview Ms. Steinem was not overtly lauding psychotherapy as one road that an individual may take in order to find a witness ready to assist in bearing hard times and cultivating new paths to traverse them. Nonetheless, I find myself sharing this quotation often in my practice. Patients and students, no less than each of us who has toiled in the field for quite a few years, have a need to remind ourselves of the reasons and context in which we recommend an undertaking that is a time-, financial-, and labor-intensive commitment.

What Offers Hope

For those of us to whom much is disclosed that is often heart-wrenching and perplexing, the question about what offers hope often pops up as we do the work. Sometimes thinking through a well-tread, fundamental theoretical idea or applying a new perspective or even hearing an example in the press of a celebrated person who has benefited from efforts like our own can be helpful. For example, Ms. Steinem has been courageous in various publications about the benefit she derived from psychotherapy.2, 3 After doing quite a bit of reading about her and her life as I planned a speaking engagement, I was truly inspired by the breadth of her vision and knowledge. I now routinely reference her autobiographical books for those in my practice undergoing similar midlife and later-life transitions. These books have a lot to teach us about staying active and involved in life, for all of our life, and especially after undergoing significant loss and personal travail.

This opportunity also led me to step back and ask myself some tough questions. Was I, a psychoanalyst who considered herself to be practicing and writing from a contemporary, feminist persuasion, up to date or in need of an update? Could I push the ‘refresh button’ and hear some new voices and rethink some older ones that would revitalize my passion for doing feminist psychodynamic psychotherapy? Writing this essay for EDR provides another chance to pull some of these fragments of learning together, and is an example of why I recommend to students in our field the importance of putting pen to paper or presenting one’s ideas to peers at a conference. Sometimes we only know what we really think when we write it down, and we most certainly discover a lot that we don’t know! Writing helps inform - and transform - our practices.

Inquiring about Culture and Sexuality

The list of feminist contributors to psychodynamic treatment is long, and they each have complementary, and sometimes contradictory, things to say about facets of therapy. One fact that remains central in working from within a feminist psychodynamic perspective is the important role that gender and sex play in life, even if these issues are not the core concerns of the patient when he/she enters treatment for an eating problem. The therapist using a feminist psychodynamic approach will take time to question how the patient perceives gender roles in her family system and how this has influenced her individual point of view. Time will also be spent looking into perceptions about culture and how the patient believes cultural norms may have influenced the development of her particular struggles with eating and self-image.

The philosophy of this ‘spirit of inquiry’4 is not to suggest any bedrock issue that the individual must embrace but rather to create an atmosphere wherein assumptions and conflicts can be talked about and perhaps ultimately challenged. For example, feminist psychoanalyst Gohar Homayounpour5 notes that in her practice in Tehran sexual issues and conflicts are frequently brought up by her patients and become a focus of the therapy early on. She contrasts this to Western countries like the United States and Great Britain, where problems with basic attachment, mood dysregulation, charged interpersonal relationships, and development of a sense of self have received a great deal of attention in the psychodynamic literature for decades. Dr. Homayounpour thus explicitly makes the point about how essential it is for the clinician to recognize and to “own” cultural differences in treatment and how these variations impact the psychological depth of the human being and what the clinician is likely to hear in psychotherapy.

Coming to Terms with Trauma

Recognition and treatment of a wide array of traumas, including but not limited to physical and sexual abuse, have reshaped the mental health field in the past 4 decades. Research has shown that a significant number of our eating disordered patients come to us with these histories, and although there are many new and encouraging therapies for the residual symptoms of these developmental derailments, feminist psychodynamic psychotherapy also contributes an important point of view to assist patients. In addition to acknowledging that the abuse occurred and assisting the patient in giving voice to the dissociated or split-off self states that have had few if any safe places to explore the multiple meanings of the abuse to the individual, clinicians working within a feminist psychodynamic framework will be attuned to the impact of the abuse on relationships. In addition the therapist will be aware of the tendency to attempt to master what has ‘been done’ by unwittingly and unconsciously becoming ‘a doer.’6

(Part 2 continues in the January-February 2017 issue; the references will follow Part 2.)

The Author

Kathryn J. Zerbe, MD, a long-time member of EDR’s Editorial Board, has a private practice in Portland, OR. She is Professor of Psychiatry at Oregon Health and Science University, and Training and Supervising Analyst, Oregon Psychoanalytic Center, and the Institute of Contemporary Psychoanalysis, Los Angeles. Dr. Zerbe is the author of numerous articles and books, including The Body Betrayed and Integrated Treatment of Eating Disorders: Beyond the Body Betrayed.

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