Compare these to our attitudes reflected in the images prevalent on the internet and other media. The next two pages deal with personal biases against obesity. The following passage opens Irving Yalom's story, "Fat Lady. Read the opening excerpt. You might not like Yalom's attitude toward his patient, but at least he is frank.

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Have you been considering finding a psychotherapist? I am accepting new patients in my office in Belfast, ME or via Skype or telephone. Name Email Subject Message. The essay bothered me then and now it has surfaced in my consciousness again, still bothering me. A Google search tells me that this piece is used in a variety of training programs and it seems usually there is praise that Yalom admitted his bias.

But I have a different thought. In this story, Yalom, a psychiatrist, tells how he treated his obese patient, Betty, and how this process helped her lose nearly pounds. I have always been repelled by fat women.

How dare they impose that body on the rest of us? The origins of these sorry feelings? I have never thought to inquire. So deep do they run that I never considered them prejudice. Obesity, endemic in my family, was a part of what I had to leave behind when I, a driven, ambitious, first-generation American-born, decided to shake forever from my feet the dust of the Russian shtetl.

I can take other guesses. No, not just admired: I have elevated, idealized, ecstacized it to a level and a goal that exceeds all reason. Do I resent the fat woman for her desecration of my desire, for bloating and profaning each lovely feature that I cherish? For stripping away my sweet illusion and revealing its base of flesh, flesh on the rampage? I grew up in racially segregated Washington, D. In the streets, the black attacked me for my whiteness, and in school, the white attacked me for my Jewishness.

But there was always fatness, the fat kids, the big asses, the butts of jokes, those last chosen for athletic teams, those unable to run the circle of the athletic track. I needed someone to hate, too. Maybe that was where I learned it.

Of course, I am not alone in my bias. Cultural reinforcement is everywhere. Who ever has a kind word for the fat lady? But my contempt surpasses all cultural norms. Early in my career, I worked in a maximum security prison where the least heinous offense committed by any of my patients was a simple, single murder.

Yet I had little difficulty accepting those patients, attempting to understand them, and finding ways to be supportive. But when I see a fat lady eat, I move down a couple of rungs on the ladder of human understanding. I want to tear the food away. To push her face into the ice cream.

Poor Betty, thank God, thank God, knew none of this as she innocently continued her course toward my chair, slowly lowered her body, arranged her folds and, with her feet not quite reaching the floor, looked up at me expectantly. There is no question that openly admitting such strong prejudice, such clear countertransference, takes some courage.

But then again, it is acceptable to hate fat and to think ill of fat people so there was little chance of serious criticism except from the fat acceptance folks who could be dismissed as defensive. Nevertheless, I do hand it to Yalom for saying out loud what I am quite certain that many therapists feel and never speak. The essay goes on to talk about the process of therapy, of Betty's depression, and her weight loss, which by the time treatment ends amounts to pounds. And of course the consensus is that because she lost so much weight, this therapy was spectacularly successful.

She had been crying, her eyes downcast, but at my words she stopped sobbing and looked toward me, expectantly. Do you know that for the first six months you hardly ever looked at me? Not even for a handshake! My heart sank. I have never touched her. How naive for Yalom to think that Betty hadn't known all along of his distaste, for having lived in world of people who shared his feelings of disgust, she was an expert at detecting it and doing what she could to minimize herself as a target for their scorn.

And in her rebuke, she points out that in fact he has changed far less than he imagines. I wonder what Betty is like now, 20 years later. Or maybe she has now had bariatric surgery. Or maybe she is in that tiny minority who succeeded in maintaining that weight loss. But no one ever questioned why she would lose weight and what the effect of a therapist filled with contempt and disgust for her body would have on her feelings about herself. If even one's therapist finds one repulsive, what hope is there after all?

Honesty compels me to acknowledge that I am a fat woman. So I know what it is like to sit in Betty's place and I also know, as a therapist, what it is like to be confronted by one's shadow in the person of the patient who has come to see me.

How is a fat person, who, no matter the reasons for being fat, certainly has a whole host of emotional issues about her size and her body -- how is such a person to find the courage to talk about those feelings in the presence of someone who finds her as disgusting as she herself often does? How can she roar her anger at the prejudice she encounters? How is she to arrive at being able to care about her body and for herself lovingly rather than with contempt and hatred?

And supposing she doesn't want to devote herself to losing all that weight? Supposing she wants to get off the diet merry-go-round and concentrate on being healthy and fat and yes, that is possible?

The operative assumption is that in a room with a normal weight therapist and a fat patient, that only the patient has a problem is, it seems to me, a very weak one. And I wonder what other unchecked assumptions that we therapists have need to be taken out into the open and wrestled with? Sidebar [Skip]. Openings Now Have you been considering finding a psychotherapist? Contact Me Please leave this field empty: Please leave this field empty:. Created with Sandvox.

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Genre: Case Study. This is the story of Betty, a pound, 5-footinch woman who comes to the psychiatrist-narrator's office to be treated for her eating disorder. What makes the story more than the sad tale of a depressed, obese woman is the immediate disclosure of the narrator that he is "repelled" and "disgusted" by fat women, that his "contempt surpasses all cultural norms. Nevertheless, he decides to treat Betty, who successfully manages to shed huge amounts of weight and come to terms with many of the problems leading to her obesity. The narrator, too, confronts his own excessive biases so that readers are left with a sense that Betty "helped" him too. Commentary This is an essay that begs for multiple readings. The first time I read it, I focused more on the psychiatrist-narrator than I did on the patient Betty, so in awe was I that he "overcame" his bias because of his engagement with Betty.



By Irvin D. New York: Basic Books. Is there an analysand sitting in the waiting room who isn't curious to know what the patient behind the closed doors is saying? On the occasion when A crossed with B in the entrance hall, A's reddened eyes and mottled cheeks exposed unmistakable signs of emotional turmoil. What was its subject?


Fat Lady (Irvin D. Yalom)

Have you been considering finding a psychotherapist? I am accepting new patients in my office in Belfast, ME or via Skype or telephone. Name Email Subject Message. The essay bothered me then and now it has surfaced in my consciousness again, still bothering me.


Zen masters endlessly aspire to quiescence of the mind, the ballerina to consummate balance; and the priest forever examines his conscience. Every profession has within it a realm of possibility wherein the practitioner may seek perfection. For the psychotherapist that realm, that inexhaustible curriculum of self- improvement from which one never graduates, is referred to in the trade as countertransference. Some- times countertransference is dramatic and makes deep therapy impossi- ble: imagine a Jew treating a Nazi, or a woman who has once been sexually assaulted treating a rapist. But, in milder form, countertransfer- ence insinuates itself into every course of psychotherapy. The day Betty entered my office, the instant I saw her steering her ponderous two-hundred-fifty-pound, five-foot-two-inch frame toward my trim, high-tech office chair, I knew that a great trial of countertrans- ference was in store for me.

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