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Obesity and the Pregnant Therapist

In our book A Womb of Her Own (Routledge 2017) author Meredith Darcy describes the challenges of the pregnant therapist in working with obesity in the client. She writes as follows:

Abby had difficulties relating to others and would use food to self-soothe and regulate affect.  As with many people with eating disorders, Abby would concretize her emotional experience; she was not able to think symbolically.  She experienced her feelings as literally being in her body.  Therefore if her problem was experienced in body, she would do something to the body to relieve this discomfort (e.g. compulsive overeating).  She felt “badly” and therefore she was bad—ashamed of her self and needs.  Concretizing neediness in the body makes it more possible to actually manage and control such needs (Sands 2003), because the body can be used in a way that purely affective experience cannot: eating disorders provide a concrete, doable solution to the experience of intolerable, overwhelming affect and need.

Hatred of the Bjody

Abby would often state matter-of-factly that she was obese, a “fact” I would question. She had a big presence, and at times I would find her intimidating—to me she seemed strong, athletic, somewhat overweight, yes—but the term “obese” had never crossed my mind to describe her build or frame. At times, I would point out this discrepancy between our points of view.  For her, I was not seeing her body in a “positive” way, but was actually NOT seeing her, and she would therefore become indignant, questioning my judgment and authenticity.  This was a common struggle Abby and I would have over the next 5 years; her need to see herself as bad, ugly, and fat and my need to see her in a kinder, more accepting light.  Abby’s body hate, her concrete experience of self-hatred felt in her body and about her body, was palpably felt in the room.  Moments like these were vivid testimony to the oft-stated observation that “the body is where the self lives.” (quote?)

Parents’ Preoccupation

Abby described her parents as being preoccupied with  about their appearance, especially about their weight and size.  She claims to have inherited her father’s body; he was always dissatisfied with his weight, trying to lose that extra 20 pounds, and was very critical of himself and others.  He viewed “fat” as a weakness: ugly and self-indulgent.   Abby describes her mother as being tiny and eating like a bird—well practiced at being self-denying.  I still remember a story Abby told me: One evening after dinner, while talking to her mother about something, Abby spontaneously and uncharacteristically started to cry. After several minutes of talking about what was upsetting her—Abby looked around to find that her mother had left the room. Abby defended her mother’s actions, “We don’t talk about real things—she was uncomfortable, so she left.”   This present time story reminded me of other childhood interactions Abby had described—her mother being either uninterested or unable to listen, take her in, or soothe her.   Abby’s stories illustrated a remoteness that seemed abundantly clear to me, yet Abby would protect her mother. Her idealized notion of her mother was fiercely protected. Unable to assign her blame, Abby took full responsibility for her un-lovability, acquiring decade’s worth of self-hate and self-blame for the ugliness of her “neediness”—an experienced ugliness, manifestly residing in the subjugation of her hated body. Sands (2003) writes that “the subjugation of the body” is an attempt to dominate one’s needy self experience rather than the maternal object.  Abby’s attempts to destroy her early experience of dependence on, and need for, the chronically misattuned and unresponsive other, has brought with it unbearable feelings of rage, helplessness and shame.

Body Image and Representation of the Self

The foundations of the self and the distinction between self and object are shaped by an integration of bodily experience with mental representation (Pines, 1982). If the child was satisfied by her mother’s body, she rightly felt that her own body satisfied her mother (Balint, 1973, p. 200).  If the child has not felt satisfied by her mother at the pre-oedipal stage; not felt that she herself has satisfied her; she can never make up for this basic loss of a primary stable sense of well-being in her body and with her body image unless she sacrifices her normal drive towards a positive oedipal outcome (Pines, 1980). Narcissistic injury, giving rise to narcissistic rage, envy of the mother and lack of self-esteem, will add to the difficulties of separation from her. (Pines, 1982, p. 312).

Balint, Enid (1973).Technical Problems Found in the Analysis of Women by a Woman Analyst: A Contribution to the Question ‘What Does a Woman Want?’   International Journal of Psycho-Analysis, 54:195-201

Pines, D. (1982). The Relevance of Early Psychic Development to Pregnancy and Abortion.

International Journal of Psycho-Analysis, 63:311-319.

Sands, Susan, 2003. The Subjugation of the Body in Eating Disorders:  A Particularly Female Solution.  Psychoanalytic Psychology, 20: 103-116




Obesity and the Pregnant Therapist

Ellen Toronto, Ph.D.

Dr. Ellen Toronto is a licensed clinical psychologist/psychoanalyst in the state of Michigan.

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APA Reference
Toronto, E. (2019). Obesity and the Pregnant Therapist. Psych Central. Retrieved on August 19, 2019, from


Last updated: 20 Jul 2019
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