How Clients
Express Themselves
Through Food
Although we wish to have neutral feelings and objective opinions about size and weight, especially regarding clients, it is virtually impossible as therapists to grow up in this culture and not have a strong predisposition toward thinness and against fatness. What I learned in social work school about color and racism sadly applies to weight as well: Due to institutional cultural bias that permeates almost every aspect of our lives, we all suffer, to a greater or lesser degree, from prejudice against fat people. The best we can do is to acknowledge our preconceptions, try to correct them, and avoid contaminating the therapy hour with them.
In spite of the fact that stereotypes about fatness and thinness are not true across the board, we persist in prejudicial perception because that is the way the mind works—we automatically group folks together in order to anticipate what they will be like. We all have a natural inclination to stereotype, to prejudge others by associating how a person appears with expected behavior. However, because we have that tendency does not mean that it is healthy or productive—especially when it distorts reality.
Another reason we hold stereotypes about fatness and thinness is because we live in a society that unequivocally exalts being thin and despises being fat. Who can pick up a newspaper without reading an article cautioning about the obesity epidemic, thumb through a magazine without noticing promotions for diet programs and weight-loss drugs, or get caught up in TV news segments offering the skinny on bariatric surgery or liposuction? Even at a doctor’s visit, the first thing we are asked to do is hop on the scale as our weight is carefully charted in our record.
Moreover, we live in an era in this country and in the “developed” world in which fitness rules. In earlier times, the goals were a roof over our heads, enough to eat, and the well-being of family. Later came the possibility of a little land and perhaps satisfaction and pleasure from work. Life was largely a struggle, and joy and success related to meeting basic needs. Although fitness started out—and even now might be viewed as—a health issue, American culture has made staying in shape and living a healthy lifestyle an end in itself. Our bodies must be pretty and fat free—and preferably youthful. It follows that, in most eyes, folks who by virtue of slimness may appear fit trump those who do not. No matter that a heavy person might actually possess more endurance, flexibility, strength, and balance than a thinner counterpart.
Overeaters and undereaters are also pigeon-holed, though often unintentionally. We often assume that overeaters lack self-restraint, live a life of excess, are out of control, and have no idea what is good for them. We presume that undereaters couldn’t care less about food or are highly picky and selective, that they are in perfect control, and place a high value on good health. Again, these stereotypes do not hold water. There are overeaters who try to eat nutritiously but eat beyond satiety, and undereaters who eat junk food but little of it. There are undereaters who exert tight control over their eating because, underneath, they feel wildly out of control and are terrified of overeating, and overeaters who are restrained in every area but food. Moreover, there are folks who do not eat much but who chain-smoke (which decreases their sense of taste), and those who have no vices other than food.
It is vital for us to understand the extent to which people are stereotyped for how much they weigh and eat. To start, we must be as objective as possible and not prejudge clients. By recognizing our own biases (painful as that may be), we can attempt to neutralize them and minimize their affect. Because most clients grow up and live in the same culture we do, they often have similar judgments about food and their bodies. On the other hand, if they come from another culture, their views about food, fatness, and thinness might be very different from ours.
Reflections for Therapist
PART 1: To understand how societal messages impact our perception of being thin or fat, think of descriptive words or phrases about fat and thin people. Without judgment, jot down images that come to mind. Most people come up with the following for fat people: lazy, stupid, earth mother, unhealthy, slovenly, excessive, jolly, mothering, genial, generous, caring, and inactive. Conversely, cold, selfish, perfect, sexual, hard-driving, fit, rigid, and in control are words commonly applied to thin people. Notice that some terms are positive, others are negative, and a third group could be viewed both ways or as value-neutral.
PART 2: Now consider the people you know who are fat and thin (including yourself). Do any of these descriptions of fat people seem true of thin people, or vice versa? Are there words that could apply to either or both weight groups? Do any of the stereotypes apply to you or other people, that is, are they true? My point is to illustrate that we have unconscious and conscious ideas about weight that are nothing more than prejudices. There are plenty of overweight people who appear jolly but are actually depressed and others who are grumpy inside and out and would probably be that way if they were as thin as a beanstalk. There are control freaks who are large and fat and earth-mother types who are petite and slim. There are folks in both camps who are lazy, generous, stupid, cold, sexual, caring, and hard-driving.
To understand how culture affects a client’s
perception of being overweight/underweight and
being an overeater/undereater, ask:
1. How does the country/culture you grew up in view being overweight/underweight and overeating/undereating?
2. How does your current culture affect your beliefs and behavior?
3. Does this create a conflict?
4. How might you resolve it?
It is useful to recognize how society views weight-challenged people, because some clients play out common stereotypes unconsciously. Of course, not every client acts out against others or herself through food or body size. Sometimes a cigar really is just a cigar, that is, as discussed in Chapter 3, “The Biology of Eating and Weight,” many weight and eating problems are primarily due to biological causes and there is little more to them than that. However, it is our job to entertain possibilities and to know the lay of the land, which in this case is both the internal and external pressures that clients yearn to live up to regarding societal body ideals.
In later chapters, we will take a closer clinical look at how to handle behaviors that may get expressed through weight and eating problems. First, though, we must understand how societal perceptions and prejudices often dovetail with client issues. In addition to stereotypes that get projected onto people with food or weight problems, there are also internal issues with which disordered eaters struggle. Some of these emotional disturbances are conscious, but most are not. They are so interwoven into the fabric of clients’ existence and so outside of their awareness that even when we point them out, the client may look at us as if we have two heads and fail to understand what we are talking about.
Feelings about Life Being Unfair
A common conflict that drives disordered eating has to do with underlying anger. Clients may be angry at their metabolism, which they inherited from a long line of overweight overeaters, or at the fact that they are the only family members who are slow calorie burners. Although they may understand cognitively that they did nothing to cause their body to have a particular set point or react to food by putting on pounds, they may become stuck on the unfairness of the situation. Instead of focusing on a window of opportunity to eat more normally and become fit, they resent that they have to work so hard to have a tolerable relationship with food and the scale.
Much of what they feel derives from beliefs about fairness. There is a certain point in the lives of mature adults when they realize that life is truly unfair and, therefore, stop railing against what they cannot change. They accept their dyslexia, diabetes, nearsightedness, arthritis, poor coordination, large nose, or dearth of talent that keeps them from their dream career. This “aha” moment is generally a turning point because they can then stop putting energy into negative thinking, move on, and start creating and enjoying a more satisfying life. However, most of us have had clients who cannot seem to get over this hurdle or who manage to climb over it only to slide backward into resentment and anger when times get tough.
In the eating arena, many clients remain stuck in feelings of injustice because they have a weight or eating problem. They are angry that their sister can eat ice cream every night and not gain an ounce, that their friends can have butter on a baked potato and real cream in coffee, that (what they falsely perceive as) the rest of the world can eat whatever it wants without clothes straining at the seams. Although there is truth in various assumptions (some people most certainly can eat more than others because that is how they were genetically engineered), this sense of grievance often precludes recognizing that many, many people struggle with weight and eating and that most of us have to work hard to become and remain fit and be ever vigilant to hold on to a comfortable, healthy weight.
This kind of anger may surface around food allergies. Clients complain about the restrictive choices that being allergic to gluten and dairy imposes on them, their hypersensitivity to sugar and how it seems as if all they need to do is look at a chunk of cheesecake for the scale to creep up a notch. To be sure, it is extremely trying to eat when one has bona fide food allergies—from food shopping to eating out—but the fact is that people who do not have eating problems manage to respond to this inconvenience fairly well. They accept that they are allergic and eat accordingly, albeit with occasional envy, annoyance at limited choices, or yearning for forbidden foods.
The sense of grievance that surges for those who have eating problems and food allergies is more about deprivation, helplessness, feeling on the outside looking in, and issues about having choices and getting emotional needs met. This rage gets played out by a client dividing herself in two: One part acknowledges she should avoid a particular food because of health repercussions, while the other part rebels against the unfairness of restriction. Sadly, the client often ends up eating (more likely, overeating) the prohibited food and, consequently, suffering both emotionally and physically.
Feelings about Food and Parenting
Another kind of fury that is often embedded in the unconscious of clients with (over- and under-) eating problems is against parents or primary childhood caretakers (often an aunt or grandmother). Some anger is about food and weight and some is not. For example, clients may become angry because, as children, their food intake was severely restricted. This may have happened because there was insufficient money for groceries or because parents, older siblings, or one special child received more food while other family members received less. The end result is that clients feel deprived and resentful even when they are adults and have plenty of food around.
It is important to remember that poverty is not the only reason that children do not receive adequate food. Sometimes parents are selfish and neglect their children’s nutrition while feeding themselves quite well. Often, especially for younger children or girls, older children or “growing boys” get the best of what is on the dinner table, while everyone else is stuck with what remains. Clients who grew up in this kind of household may feel competitive when eating with others, fearing they will not get their fair share. Once again, their conflict is whether to listen to their body and stop eating when full or satisfied, or to overeat and feel as if they are making up for the inequities of the past.
Yet one more type of anger and bitterness arises when parents are hypercontrolling and regularly impose food choices onto children. Clients often feel as if they lacked opportunities to decide if they were hungry, rarely got to choose what they craved, or hardly ever got a chance to eat until they were satisfied. Frequently, these children were fed on a rigid schedule and in such a way that their food needs were barely, if ever, considered. Sometimes they were told that if they did not eat what was put in front of them, they would go without, or that if they did not sit down at the table when dinner was ready that they would go to bed hungry. Additionally, well-intentioned parents may fear that chubby children will grow up to be fat, so they severely restrict portion size, seconds, and treats.
A child who grows up with these kinds of rigid external limitations feels helpless and hopeless that her hunger, pleasure, or fullness needs will ever be met. As an adult, she might take out her anger on herself by consuming foods she really does not want or by stuffing herself just to prove (to herself? her parents? the world?) that she is in control of her nourishment needs. Unfortunately, her conflicting feelings are generally outside her awareness: The conscious, healthy side of her knows she cannot make up for the past, while the unconscious, unhealthy side continues to try to do so.
Not only overeaters, but undereaters (and those who are underweight) may suffer from underlying rage that fuels their eating problems. Children who were forced to eat or finish all their food often rebel in adulthood by eating as little as possible, even though there is no longer a parent standing over them. These rebellions often drive anorexic behavior, as the client’s inner “child” continues to wage war with the “adult” by repeatedly saying no to food now in spite of causing physical self-harm.
Feelings about Nonfood Deprivation
Another kind of deprivation and resentment is not about food, but may get displaced onto it. This happens when children are fed adequately and appropriately, but in other ways are neglected or have their needs marginalized, especially emotionally. A parentified child who received little nurturing but had to take care of a brood of siblings while Mom and Dad worked may feel she did not get enough love, guidance, or support, and may angrily act out a sense of greed with food. Conversely, the middle or youngest child may have sorely lacked attention and may try to make up for it by “getting enough” food as an adult, particularly if this food is prepared by someone else (a spouse or a restaurant).
To assess the client’s underlying anger regarding food, ask:
1. Do you feel angry when you think about eating?
2. What might make you angry about food or weight?
3. Is there unacknowledged anger, greed, or resentment driving you when you say, “I deserve” a food, and then eat it when you’re not hungry?
Feelings about Self-care
Far too many clients suffer from low self-esteem and care for themselves inadequately, especially regarding appearance. It makes sense that clients who were neglected might, in turn, neglect themselves, but this narrow perspective oversimplifies a complex issue. To be sure, there are clients who were mistreated physically or lacked positive attention as children who as adults manifest maltreatment by not caring about how they look. They may be disconnected from their body (through abuse and/or trauma), or may not recognize that proper self-care includes being clean and dressing presentably and appropriately. In fact, they may pay little attention to how they look because they never learned that it mattered.
However, clients who were brushed aside and received little care as children also may overfocus on how they look as adults—clothes, makeup, and hairdo may need to be just so, as if to say, “See, nothing’s wrong here.” The underlying issue is how poorly these clients feel about themselves when they fail to put extra effort into looking good and when they do not feel they look “perfect.” Because they feel unattractive and unlovable enough “as is,” they may end up spending enormous amounts of time, money, and energy striving for physical perfection. Their underlying fear is that if they stop being thin or looking attractive, they will lose popularity, status, attention, and, of course, love.
At the other end of the spectrum is the client who was treated poorly in every aspect of life but physical appearance. She may have received scant attention and guidance except in the area of looks, leading her to think that appearance is more important than any other attribute or that it is her only one. Maybe her parents lavished clothes on her and bought her things to make up for not spending quality time with her. Perhaps she had a parent (generally same gender) who believed looks were all she had to offer and projected this belief onto her child. Or maybe an opposite-gender parent ignored this child except to fuss over her appearance (perhaps even seductively). Although as clinicians, we may see a well-groomed client sitting before us and think she has excellent self-care skills, she may be covering up a deep and long-standing sense of unworthiness and defectiveness.
By far the most common reaction to poor self-care as it relates to physical appearance surfaces in clients who are trying to make a statement about how little they care about their looks. This declaration may be conscious or unconscious, but its intent is to create an air of “Who cares?” Too often parents impose impossibly high standards of appearance on their children who must at all times be slaves to neatness, good grooming, and cleanliness, and must remain hypervigilant about how they look. Healthy parents want their children to look presentable, but understand that they need to feel free to make a mess and forget about their appearance in the service of letting loose and having fun.
The child who, against her will and inclination, was forced to be Mom or Dad’s little beauty queen or king may take a stand at self-preservation (that is, the autonomous self) by shrugging off how she looks. She may not realize that she is thumbing her nose at a parent’s lofty standards or might intentionally dress provocatively (wearing dirty jeans out to dinner, leaving a shirt tucked out at a time when it should be tucked in, wearing ill-fitting clothes or the same clothes day in and day out) in order to upset a parent. Though it may seem as if the client truly does not give a hoot about appearance, her goal is more likely to make a statement about autonomy and send a message about self-rule.
Another common internal conflict gets played out when an adult becomes or remains overweight in order to be unlike a parent. If the parent was constantly on a diet and made the child feel unentitled to eat what and when she wanted, the client may get fat and establish independence through rebellion. This is especially true if a parent withheld food from a child while insisting that it was for her own good (even though it may have been!). This dynamic can also occur when the parent struggles with food herself and tries to make sure her child will be slim by controlling food intake. As resentment builds, often the child packs on the pounds.
Unfortunately, rebellion in the service of separation can often develop into a pattern of poor self-care. Issues of feeding are very delicate, as youngsters are highly sensitive to nuance. It is not necessarily the lack of food or choice that makes the child rebel, but the way in which the parent dominates the child and unilaterally takes away her control. I often ask clients to bring in photos of their families, especially their parents, and am not surprised when an overweight client has a pencil-thin, perfectly coiffed mom or a dad who looks as if he could step off the pages of GQ. In discussing the contrast in appearance between client and parent, what generally surfaces is resentment about being made to look a certain way and lacking the freedom to be or eat differently from Mom or Dad.
One of the most obvious ways that effective self-care gets generated is through a client feeling she is worthy and deserving of looking and feeling good. However, many clients feel woefully undeserving and cannot imagine treating themselves well. They fail to take care of their health or possessions, allow themselves to be taken advantage of, abused, or victimized, are underachievers, and sabotage their best (and others’) intentions because of low self-esteem. They operate on the assumption that they should be grateful for the good things that come their way and, even when they try to improve their lot, often undermine or sabotage their endeavors—to eat healthier or establish a comfortable weight—because deep down they do not believe they deserve success.
To understand how self-care issues may relate to the client’s eating and weight problems, ask:
1. How do you think you do taking care of yourself?
2. Do you understand how eating too much or little might be a way of not taking care of yourself very well?
3. Is how you look any kind of rebellion against your parents or society?
4. Do you express how you feel about yourself through your weight?
Feelings about Growing Up
Although some clients look as if they are rebelling through their eating or their weight, they really may be expressing ambivalent feelings about becoming autonomous, making their own decisions, and trusting themselves. Clients who are still dependent on their parents well past the age when it is appropriate (because their parents have enabled this behavior) really do have difficulty trusting themselves in the food arena. They are so used to being undermined or, alternately, being overly controlled regarding food decisions, only to be left alone the next moment, that they are truly confused. They have been taught that they cannot count on themselves to meet their needs, food and otherwise.
As such, eating unhealthily by over- or underdoing it is a way to keep parents (or others such as a spouse, partner, friend, or therapist) engaged so that clients can avoid being responsible and accountable for their own feeding. Their conflict is that they both want and do not want the involvement of others. That is, they desperately desire instruction so they can avoid the consequences of making their own mistakes and can blame others when feeding goes wrong (and they gain or lose weight), but also resent a firm hand because it diminishes their sense of independence, competence, and self-trust. They end up acting out their dilemma by gaining or losing weight or having an ongoing eating disorder that keeps others involved in guiding their life.
Feelings about Suffering
Some clients who have suffered trauma either are unable to recover from it sufficiently to let it go or have made it such a central part of their identity that it defines who they are. In cases where a client has survived exceptional neglect, sexual, emotional, or physical abuse (especially at the hands of parents), or numerous significant losses, she may feel that she needs a way to tell people that she has not had an easy life. She may wish more than anything to be “normal” and to have gone through life without trauma, while her history or experience may feel like the only thing that makes her unique and truly special.
One way she may signify to others that she feels different or marked is by continually having problems. If she is grossly overweight or underweight, people may feel sorry for her or fear that she is emotionally vulnerable or fragile and go easy on her. If she has an eating problem, she can keep people involved with her on a controllable level (giving her advice about eating or finding a healthy weight) and still feel connected to the world without engaging in true intimacy. She may see her current food problems as a symbol of all she has suffered and of the bitter life that has made her who she is. Without having to say a word, by her size alone, she may be telling people her most heavily guarded secret or sharing the most sacred part of herself.
Feelings about Sexuality and Intimacy
It is hard to grow up in this culture and feel comfortable in one’s own skin and with being sexual. Mixed messages about sexuality abound: Be as attractive as you can be. Don’t look too good or it’s your fault if you get hit on. You’ll only snag a man/woman if you look good. Being fat precludes being/feeling sexual. Being thin means you have to be sexual. You must look muscular and trim to be a turn-on. Revealing your body means you must want to have sex. The way these messages collide and cancel each other out makes a person’s head spin. Worse, they make it very confusing to know exactly how to feel about and what to do with the sexual self.
Although there is a high correlation between sexual abuse and eating disorders, most women who have problems with eating or weight were not raped or molested and are not incest survivors. They may not have had specific, negative, traumatic sexual experiences, but by virtue of growing up in this society, they cannot help but internalize the conflicting and confusing messages that are embedded in our culture and institutions: the need for strict school dress codes versus the provocative or scant attire of stars and celebrities; government intervention to restrict contraception and abortion while allowing pornographic images to permeate TV and the Internet; being pushed toward popularity while holding virginity sacrosanct; keeping up sexually with a peer group while practicing safe sex.
Because sexuality generates intense and frightening emotions, it can be easier for a client to use body size as a way to feel safe and secure than to go out in the world as a sexual being or try to contain lustful feelings. In this culture, being extremely under- or overweight desexualizes people to the extent that it often takes them completely out of the social running (in their own or others’ eyes). Their unconscious hope may be that if people consider them unattractive, they will be left alone. This does not mean that clients who use weight or size to buffer romantic intimacy do not want to be sexual, only that they have conflicting feelings about it, especially regarding saying no. That is, they may be as frightened of their own sexual desires as those of others toward them.
Similar mixed feelings hold true regarding intimacy, and size can be used as a way to say, “Keep away. Can’t you see I’m not available?” The desire to withdraw from relationships may be related to childhood interactions being too intense or too distant or a perplexing yo-yo of the two. A client who had an overbearing, controlling parent may feel engulfed by a push for closeness from another human being; a client with a parent who had no idea how to express closeness or completely avoided being intimate might believe that intimacy in a relationship is unwarranted, unnecessary, or unusual. Using weight to withdraw from interpersonal relationships is generally based on fear of not being able to regulate emotional closeness and distance. Rather than take a chance at having appropriate interpersonal connections and failing, it is easier to opt out completely by having a weight outside the cultural norm.
Being over- and underweight can also be a way the client ensures that she will never get hurt. If she refuses to allow anyone to get close enough to matter, she cannot be rejected or abandoned by them. Maybe she has been through a rough divorce or had a partner who left her for someone younger, or perhaps she has suffered through a series of abusive partners or romantic losses and equates romance with heartache. Either way, weight may be used as an impenetrable shield around her heart.
To assess how the client might be acting out through body size or eating problems, ask:
1. How independent and autonomous do you feel or believe you are?
2. Is it better to be independent or dependent and why?
3. Do you connect past trauma to your eating or weight problems?
4. Does your body size play a part in how you relate to people socially or romantically?
Acting Out and Acting In
Although clients may think of us as mind readers, we know that we are not. We pick up cues and apply principles of psychology to pull the rabbit out of the hat as often as we use intuition to reveal what is inside a client’s mind. The only way to verify what is going on with a client, however, is by hearing about and/or observing behavior. Client actions prove our hunches true or false; their patterns of behavior indicate whether a singular act is an anomaly or a manifestation of personality. Whether we start from the premise that a client has distorted thinking or difficulty regulating emotions, or we focus on dysfunctional, destructive behavior, the goal is always to help the client connect her actions with what is going on inside her.
One of the most obvious indications of internal conflict about food and weight is when a client reports that a spouse or partner is helping her stay away from forbidden foods by hiding treats or acting as the gatekeeper to them. I call this behavior, “Save me from myself.” In this scenario, to feel more comfortable and secure around food, a client who is unable to say no puts the responsibility on an intimate. What develops is a dependence on the gatekeeper to control the client’s food intake and a concurrent resentment that she is unable to do this for herself. A client may also avoid struggling with her food desires by asking a co-worker to hold her treats, again setting up unhealthy dynamics that feel comfortable (and comforting) in the moment but do not serve the client (or the other person) or foster relational health in the long term.
Another dysfunctional way that clients use other people in food struggles is allowing family members or co-workers to sabotage or undermine their efforts to become “normal” eaters and establish a healthy weight. A client will often “blame” someone for tempting her to eat, therefore avoiding taking responsibility for her food choices. She may unconsciously feel relieved that there is someone out there “making” her eat so that she does not have to do battle with her impulses and can give in without acknowledging that she wants to.
Internal conflict about food and weight also gets played out when clients allow family members, friends, or colleagues to make ongoing comments about their weight, even those disguised as pep talks. Comments do not have to be negative to be inappropriate. Each client has a body and that body belongs to her alone. An occasional nudge in the right direction regarding food may be welcome (if invited), but ongoing commentary makes the issue of weight an interpersonal rather than an intrapsychic one. That is, each client has to be her own cheerleader as well as her own gatekeeper. Allowing others to take either role only undermines opportunities to practice saying yes and no to food appropriately, and to feel consequent pride, disappointment, or shame from one’s choices.
Another set of unresolved feelings that gets played out in the weight or eating arena relates to being taken care of. When a client puts an intimate in the position of monitoring what is good and bad for her to eat (or weigh), she may actually enjoy the feeling that someone values her enough to take an interest in her health and well-being. She may interpret being scolded for or restrained from eating treats as caring behavior, and to an extent it is. However, true caretaking fosters, but does not take the place of, self-nurturing and self-regulation. Often, a client may not allow people to take care of her in other ways and be dependent on nurturance in the food and weight arena.
A rebellion against weight and eating norms may also surface in relationships when an oversized person feels unlovable at her weight yet expects others to love her as is. In this situation, a client may be saying, “If you really loved me, my weight wouldn’t matter to you,” or “Prove your feelings by loving me at any size.” What a client really desires is unconditional love, which is unrealistic for adults to request (although perfectly natural for them to yearn for!). Although people are lovable (or not) in spite of their weight, using weight to test out someone’s love is usually done unconsciously. This kind of acting out fails to address the underlying quandary about lovability in the first place or whatever is going on in the relationship that may be causing the client to feel insecure.
Another form of acting out with weight arises when one person in a relationship ends up either actually or symbolically expressing anger or rebellion for the unit. This may happen when one person in a diad is a strict conformist who uses the other person, the client, to act out unconscious feelings of individualism or a desire to buck the norm. The client who has unresolved issues about conforming (most often to what her parents wanted her to be or look like) ends up using her weight to act out this sentiment, and her overweight status, therefore, becomes a symbol of defiance for them both.
To assess how a client expresses unconscious needs in relation to others, ask:
1. Do you take responsibility for your food and weight issues, or do you sometimes blame others or hold them responsible?
2. Do you have a desire to be loved unconditionally, no matter what your weight is?
3. Are there other unconscious internal conflicts, needs, or fears that you might be acting out through your body size or eating problems?
There is a great deal to consider in deciding whether a client’s emotional needs are getting expressed through eating or weight, and the job may feel overwhelming. However, many of these dilemmas are connected to other internal conflicts we already recognize regarding neglect, rebellion, lack of self-love, or autonomy. Unconscious, underlying conflicts that get played out in the eating or weight arena generally add to what we already understand about a client. Rarely is this new information. When it is—when a therapist first notices a dynamic in the food/weight arena—it is highly likely that it will crop up in other areas of the client’s life as well.