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In this compelling and lucid contribution, members and associates of the Eating Disorders Workshop in the Adolescent Department of the Tavistock Clinic describe their understanding and clinical approach to the intensive psychoanalytic treatment of adolescent eating disorders. Each author presents in rich clinical detail the treatment of adolescent and late adolescent female patients with severe eating disorders in either intensive psychoanalytic psychotherapy or psychoanalysis. Most of the work is outpatient, with the exception of a chapter focusing on a psychoanalytic treatment conducted entirely in an inpatient setting. The use of theory in this volume to organize observations into understandings and to guide clinical technique is both sophisticated and eloquent.
Melanie Klein's object relations theory (Klein, /1975b, /1975a, /1975c, /1975d) is the principal theoretical orientation used throughout as the authors focus on the etiology of eating pathology in the disturbed early psyche-soma developmental relationship, and on the projective and introjective processes central to understanding both these disorders and the analytic process. This contribution extends previous work in the Tavistock group to relate eating disorders to specific failures in the container/contained relationship (Bion, 1962), which these patients defend against by constricting their own receptivity and developing a “no entry system of defenses” (Williams, 1997).
A complexity is introduced in the paradoxical subtitle, The Generosity of Acceptance (also used in this volume's companion, Exploring Feeding Difficulties in Children ). The subtitle refers to the overwhelming anxieties in eating disorders around dependency, and to the treatment aim of