Supervising the therapy of patients with eating disorders

Supervising residents, fellows, and interns conducting psychoanalytic psychotherapy with eating-disorder patients presents special problems and opportunities. The authors explore specific countertransference issues in the long-term therapy of patients with anorexia and bulimia, and describe how these issues in the therapy are often mirrored in the supervisory process. Countertransference phenomena include being secretive, intrusive, shaming, overcontrolling, overindulgent, or overidentified. Experiences associated with countertransference impasses include power struggles, despair, helplessness, and boredom. The wide range of transference and countertransference manifestations represents the difficult domain of long-term therapy with anorexic and bulimic patients, whose relationship with their eating symptom is so complex and ambivalent. Therapists in training benefit from a supervisory attitude of respect and empathy, with specific attention to countertransference difficulties as they arise. While unaddressed countertransference poses the risk of disrupting the supervision and/or the therapy, appropriate recognition and exploration of its meaning in the supervision is an especially valuable training tool in the teaching of psychodynamic psychotherapy, and a source of learning for the therapist in training, the supervisor, and ultimately the patient.