In response to Novack’s (this issue) insightful paper, this discussion endeavors to extend her arguments with my own thinking about alexithymia in patients with eating disorders and the fundamental role of the psychoanalyst in promoting the patient’s capacity for the psychic elaboration of emotion as he or she moves through the treatment process and engages with the larger treatment team. While the necessity of the analyst engaging in the concrete work of management – drafting treatment contracts, setting goals, facilitating contact with other providers, etc. – in an effort to promote the patient’s agency is acknowledged, the importance of the analyst as a facilitator of meaning-making is emphasized. The tension between meaning-making and management is thus a fundamental aspect of therapeutic work with this population.