Putting things in balance

    The Case of Laura Menu

    • The case of LAURA Vignette 1 by Johanna Tabin, Faculty, 7/12/98

    Putting things in balance
    by Jessica Broitman, Faculty, 7/22/98

    Thank you Johanna for offering us a chance to think together about this interesting patient and the role of eating disorders for all our patients. Over the last ten years, I have seen a significant rise in the prevalence of eating disorders and find them complex and often hard to shake. Laura is certainly attached to her treatment and offering you the information you need in order to help her.

    In my own way of formulating a case I am helped by knowing more of the details of her family history. She may not have given you more yet or more details may be following but some of my questions are : I would like to know more about her mother's coldness? did Laura experience it as always like that? Did her mother become more aloof when Laura reached puberty, or tried to separate? What was her relationship like with her father? Was he warm and caring? Why at 30 does she still live at home? Are there siblings ? Has she tired unsuccessfully to leave home before? How serious are her eating disorders? Has it effected her healthand or ability to work? The questions I have are all in the service of understanding Laura's plan and goals for the therapy and herself. I am interested in understanding what are her conflicts? What would she like to change?

    You have told us that Laura was not comfortable with the "perfect man" who agreed to accept a non sexual relationship. I would surmise that if she liked it when her boyfriend did not give up on her sexually but allowed her the space to get over her concerns, she would like to be less fragile, and a more comfortably sexual woman. She appears to want to have a healthy relationship. Her abuse experiences are likely to be an inhibiting factor here. I like the metaphor that you use of "wanting to put things in balance". Things indeed do not seem in balance. You are helping Laura to take appropriate step in changing this by developing healthy relationships such as with her employer. In Control Mastery terms this was an opportunity to pass a protection test. An action that her mother failed to do in Laura's retelling of her mother's reaction to the rape. This appears to have paved the way for your work with Laura to deepen.

    Laura seems to be in a deep loyalty conflict about her relationships. I am interested to learn more about how the symptom of bingeing fits into her system. I was struck at the sequence when Laura threw up after she had resolved her argument with her boyfriend. She was still mad even though Tom was now acting reasonable. She tells you about the fight as though it is a very serious problem that she is still very upset about. That makes me wonder about the role of anger in her life. She is holding on to an angry stance because it offers her something she feels she needs. She might have been uncomfortable feeling close to Tom. This as you say, might promote "a deeper conflict". This seems confirmed by her response being to now able to think of her dying mother. You have told us that she has been previously uncomfortable allowing herself to grieve for her ill mother. It is important to understand what about your comment freed her to begin to feel her sad feelings. It is related to understanding the bingeing? I wonder what had prevented her from having the sad thoughts before? Does she feel overwhelmed at the thought of losing her mother, and, or is there conflict about her feelings toward her mother? I do not have enough data yet to understand it.

    I think you have the idea that she feels unable to feel close to her mother and another man at the same time. That seems intuitively right to me. She may not feel free to enjoy her life as people separate from her dying mother. When she throws up is she is out of control, a person with a serious problem , a difficult defiant child? getting rid of unacceptable feelings? There are so many ways these symptom might be operating for Laura. I look forward to hearing more.

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