Nutrition and psychotherapy: collaborative treatment of patients with eating disorders.

The nutritionist has a variety of roles in the treatment of patients with eating disorders. The authors describe the psychotherapeutic issues raised in the course of this work. They also discuss how to integrate the nutritionist most effectively into a multidisciplinary team, and in particular how to build a collaborative relationship with the psychotherapist in creating and implementing a cohesive treatment plan.

Characterization of the degradation products of luteinizing hormone releasing hormone.

The degradation products of luteinizing hormone releasing hormone [LH/RH; 1; gonadorelin releasing hormone (GnRH); less than Glu-His-Trp-Ser-Tyr-Gly-Leu-Arg-Pro-Gly-NH2] were determined in aqueous solution (pH 6.5) at 25, 37, 50, and 80 degrees C. The predominant route of degradation involved the cleavage of the less than Glu-His and Trp-Ser peptide bonds to give peptides 5-9 and hydrolysis of the terminal Gly-NH2 to the free acid form in peptides 4 and 10. Racemization of the serine and histidine residues to give peptides 2 and 3 was a second route of degradation.

Interpretation and empathy: reading Lacan with Kohut.

This paper reads Lacan's exploration of the unconscious through the prism of Kohut's emphasis upon empathy as the basis for psychoanalytic interpretation. Lacan described the disconnexion characterizing human relationships; our experience of each other and of ourselves is radically alienated by the unconscious. Lacan's unconscious is structured like a language, revealing its complexity through symbolic forms. Language and desire always belong to the Other, a dislocation underlying all transferences. In psychoanalysis, transferences provide interpretive access to the language of the unconscious. For Kohut, interpretation depends on the prior establishment of a stable, sustaining transference; human connexion is a lifelong necessity and full understanding an achievable aim. Lacan's more structural approach to the inner world provides an important counterweight to Kohut's narrow preoccupation with the two-person field, while Kohut's concept of maternal mirroring lends a humane dimension to the icy realms of Lacan's intellectual structures. Despite enormous differences, each of these contemporary rediscoverers of Freud's legacy serves to supplement the perspective of the other.

Supervising the therapy of patients with eating disorders.

Supervising residents, fellows, and interns conducting psychoanalytic psychotherapy with eating-disorder patients presents special problems and opportunities. The authors explore specific countertransference issues in the long-term therapy of patients with anorexia and bulimia, and describe how these issues in the therapy are often mirrored in the supervisory process. Countertransference phenomena include being secretive, intrusive, shaming, overcontrolling, overindulgent, or overidentified. Experiences associated with countertransference impasses include power struggles, despair, helplessness, and boredom. The wide range of transference and countertransference manifestations represents the difficult domain of long-term therapy with anorexic and bulimic patients, whose relationship with their eating symptom is so complex and ambivalent. Therapists in training benefit from a supervisory attitude of respect and empathy, with specific attention to countertransference difficulties as they arise. While unaddressed countertransference poses the risk of disrupting the supervision and/or the therapy, appropriate recognition and exploration of its meaning in the supervision is an especially valuable training tool in the teaching of psychodynamic psychotherapy, and a source of learning for the therapist in training, the supervisor, and ultimately the patient.

Psychotherapeutic change and the experience of dwelling.

The theme of dwelling is a rich metaphor for issues of containment, safety, entrapment, building, and hiding. Over the course of four years of individual psychotherapy, a young woman described the changes in her experience of dwelling in the family home where she grew up. These changes mirrored the transformation of her sense of identity to provide a record of psychological growth.

Long-term course in 14 bulimic patients treated with psychotherapy.

Fourteen patients with bulimia were treated with group psychotherapy and with strategic use of antidepressants and individual psychotherapy as needed. The 12 who achieved sustained remission required an average of 21 months of treatment. Patients with both an axis I and an axis II diagnosis did less well and required longer treatment than those who met criteria for bulimia only. Bulimic symptoms varied substantially with time, so that a definition of remission requiring that a patient be symptom-free for 6 months was more accurate than acute outcome data. Patients with comorbid affective disorders, personality disorders, and bulimia had the poorest prognosis.

House and psyche.

The theme of house and dwelling arises in psychotherapy as patients speak about their homes. Houses imply issues of containment, safety, entrapment, building, and hiding that also pertain to the experience of psychotherapy. This paper looks at the theme of dwelling with reference to clinical and literary sources in the hope of opening a fertile ground for therapeutic listening.

Substance use, eating behaviors, and social impairment of medical students.

Self-report instruments assessing substance use, eating behaviors, social adjustment, and depression were distributed to all 329 first- and second-year medical students at a private northeastern university. Two-hundred students (61 percent) completed the questionnaires. Thirty-five students (17.5 percent) were found to be at risk for substance (alcohol and psychoactive drugs) abuse, of whom 13 were found to be at high risk. Thirty-three students (16.5 percent) were found to be at risk for an eating disorder, of whom only one was at high risk. Risk for eating disorders was greater for the female students, but risk for substance abuse was not related to gender. Psychosocial impairment and depression were associated with risk for either eating disorders or substance abuse.