Psychoanalytic Treatment of the Obese Person* Part III**

Psychoanalytic treatment of fat persons does not differ in its essentials from the psychoanalysis of others. The goal of psychoanalysis, no matter what the presenting complaint, is to help the patient to live more fully and successfully. By stripping away compulsive attitudes and associated behavior through compassionate exploration of unconscious forces, the person emerges with progressive authenticity. As emotional health increases, the person gradually develops the capacity to sustain the process of self-discovery on his own and evolves continuously into a world of deepening subtlety, richness, and meaning. The decision to undertake the psychoanalytic treatment of an obese person is determined by the same factors as the decision to treat those who are not obese: time and inclination of the analyst and the presence in the prospective patient of constructive forces adequate to lead to successful treatment.

This process may be impeded by attitudes in the analyst that are unique to working with obese persons. I am referring to derogatory prejudices about overweight. In this, the analyst may be heir to dominant cultural biases which he may seek to repress in order to avoid insult to idealized professionalism. He may readily externalize his attitudes to the patient. Already burdened with self-hating feelings associated with fatness, the patient suffers from a regret-able collusion with the analyst; both hate the patient's obesity, but the patient carries the burden while the therapist may feel painlessly indifferent or may even show reactive kindliness. Or, again, the therapist may minimize the problem and remain ignorant concerning it.

The fat patient in psychoanalysis is not receiving treatment for obesity. Indeed, to do so might be to conform with his neurotic wish to maintain fatness as a preoccupation, a decoy for himself and for those around him in order to assure avoidance of deeper and more pressing issues. The patient who seeks