The Fat Lady

In my last session I found out that my T is straight, to my surprise. I had assumed (and hoped) that he was gay because I have huge body image issues. As a fellow member helped me realized, I wanted my T to be gay so that my worth to him would not be compromised by my unattractiveness.

The rational part of my brain knows that they way I look should not matter to my T, regardless of his sexual orientation. The rational part of my brain tells me that my T is there to help me through difficult times and to help me as I embark on a journey of self-discovery, which includes exploring why I use food to medicate painful feelings... in fact, why I eat my feelings.

The emotional part of my brain does not believe any of the above. The emotional part of my brian believes that my T is like most people and therefore he would much rather spend 45 minutes with an attractive woman in his office; he would rather not have to spend time with someone who is overweight and he probably does not like to look at me.

In the midst of this internal struggle, I happened to come across an essay written by a noted,and largely praised, psychiatrist psychoterapist, Irving Yalom. He wrote about his experience with an overweight patient and how he accepted her for treatment so that he could work through the biggest challenge of his career... overcoming his countertransference repulsion for "fat women."

Most of the essay is available online via google books, only a couple of pages are missing. I should warn you that if you have body image issues and if you struggle to believe that you are worthy to your therapist, this essay will likely make you cry, make you sad and feel unworthy.

http://books.google.com/books?id=y_w...0yalom&f=false

If you don't care to read the essay, here are a couple of excerpts to give you an idea:

"I have always been repelled by fat women. I find them disgusting: their absurd sidewise waddle, their absence of body contour – breasts, laps, buttocks, shoulders, jawlines, cheekbones, everything, everything I like to see in a woman, obscured in an avalanche of flesh. And I hate their clothes – the shapeless, baggy dresses or, worse, the stiff elephantine blue jeans with the barrel thighs. How dare they impose that body on the rest of us?"

"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. "Stop stuffing yourself! Haven’t you had enough, for Chrissakes?" I’d like to wire her jaws shut! 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."

Yalom goes on to write that he also found her boring and he pretty much continues to insult her throughout the essay, describing how he had to push away his repulsion to pay attention to what she had to say. This in particular disturbed me:

"Once I accept someone for treatment, I commit myself to stand by that person…most of all, to relate to the patient in an intimate, authentic manner. But could I relate to Betty? To be frank, she revolted me. It was an effort for me to locate her face, so layered and swathed in flesh as she was. Her silly commentary was equally offputting. By the end of our first hour I felt irritated and board. Could I be intimate with her? I could scarcely think of a single person with whom I less wished to be intimate. But this was my problem, not Betty’s. It was time, after twenty-five years of practice, for me to change. Betty represented the ultimate countertransference challenge – and for that very reason, I offered then and there to be her therapist."

Ever since reading Yalom's horrendous essay, the emotional part of my brain has taken over. I wonder if my therapist feels the same repulsion towards me and he is using me as his "ultimate countertransference challenge." It makes me never want to go back into my T's office. I don't want to be the fat lady in his office...

Yalom has written many excellent books, but what he confessed about his feelings for that overweight woman is disgusting!!!!! I don't respect him anymore!! I kind of wish he'd suddenly have a weight problem and he would see how it feels from the other side. I forgot the name of the movie--it's an old one, in which a doctor treats his patients like objects until HE becomes a patient. That sure opened his eyes. Hankster, remember that movie?

I think it's just Yalom's flaw and other Ts do not feel that way. If they do, they shouldn't be Ts. I don't know about Yalom, as he is very successful. Do you think you could bring this up with your T? Get it out in the open? It might be difficult but would be healing and helpful for you.

Hi,

I have read that account by yalom before in one of his books, I can't remember exactly how it turned out, perhaps he ended up seeing past his own prejudices.
Yaolm's feelings are not how all therapist's or people feel, as far as I know his issues came from his own childhood with regards the repulsion he felt.so it really was his issue, not the clients or one that is common with all men.

HOWEVER..... as a larger overweight female I know exactly were you are coming from with this. My T is female and yet I wonder if she is replused by my appearance and it is very hard to talk about food/weight issues with someone who (in my case) is very slim and attractive because I feel like I am being judged and she doesn't understand. I also tell myself she would like me more if I was thin. It's a very sad place to be to feel this way, or to feel like the way you are on the outside is more important than the person you are inside

Personally I would rather spend an hour with someone who is a nice person, irrespective of weight. Weight can be lost and gained but it's the person who is inside that matters

((((( HUGS )))))

I could have written your post. I feel the exact same way. My T's wife is a beautiful, petite woman. All the women in my group therapy are also thin and very pretty....and I am obese and unattractive.

Although I haven't addressed my physical appearance in group T, I have been reassured by several members (women and men) that I am very much valued and cared for. Yet, it's still hard to trust that - because I can't imagine how they could feel warmly towards me with the way I look. And I'm absolutely convinced that the feelings towards the more attractive ones are more favorable....I mean, who wouldn't want eye-candy walking into the room. BONUS!

My T has told me that I fall in the normal range of looks, so if I am seeing myself differently, then it needs to be explored. Umm, normal? BULL. Especially, when I'm surrounded by people in therapy who are much more attractive and within normal weight ranges.

Sorry to ramble on. Just wanted to let you know that you are not alone in these feelings....and when these feelings surface, I, too, want to hide and never show myself in therapy again.

(( HUGS ))

I have lost all respect for Yalom. What a sicko. And he proudly reports that he took on this patient, not because he wanted to help her but because he wanted to help himself. Further, he has no shame about his reaction! Would he publish a chapter about how he was repulsed by a war veteran who had lost a leg? Would he go into detail about what he didn't like about working with a Black man? Fat people are a group that it is still okay to hate.

I feel for your situation. I have never had a male T, but I often worry that my very fit and petite marathon runner female T judges my appearance. If she tells me about the wonders of exercise one more time, I may freak out.

That said, I like to believe that most T's are not a-holes like Yalom and do see beyond the superficial. I think my feelings about my t judging me has a lot more to do with my issues than with reality. Perhaps I'm an optimist, but I think that eventually I will be able to work through it.

Best,
EJ

I think this is they key paragraph.
Yalom accepts the challenge to confront and overcome his prejudices.

Having said that, it is a pretty disgusting prejudice and I'm not surprised that you are upset.

Also, I can hardly respect a T who takes 25 years to recognise this as a problem. Aren't they supposed to complete their own personal growth before they start on others?

I don't know if it is fair to think your therapist feels the way yalom does. You're just kinda assuming he does and feeling badly about what you think. Yaloms feeling were soooo out there (borderline pathological) that it would be hard to find someone with such an elaborated belief.

In fact- i bet your therapist cares very little about your weight. Perhaps it would be good to talk to your therapist about the yalom chapter.

sorry but thats just flat out disgusting-seriously. that "counselor",not you♥

Yes, but as Eliza Jane says, he does it to help HIMSELF not to help HIS PATIENT. In fact, he admits he is not attuned to her at all! He does NOT feel invested in her or in her life. His only investment is in USING her to try and overcome HIS prejudice. He's so focused on hiimself, how could he possibly be helpful to her? Nowhere does he describe how he helps her at all. Instead, he describes trying to force himself to listen to her (listening is the goal he is striving for! not helping, just staying present!) because she was so terribly "boring" to him. He even describes her recounting of her trauma, emotions, thoughts, etc. by saying that "her silly commentary was equally offputting." Really? Her "silly commentary?" If my T called my life experiences, my trauma, and my therapeutic work "silly commentary" I would hit the roof! Yalom cannot possibly think that he was the best T FOR HER. I would love to know if this patient feels as though Yalom actually helped her. I would also love to know if Yalom was really as successful as he thinks he was at hiding his disgust. I think most people are attuned enough to pick up on the signals when other people feel that way about them. I would also love to know if, after Yalom's book was published and received such publicity, if this client was able to figure out that SHE was the one he was talking about!!! Can imagine how much trauma that could cause her? To find out that her T was actually repulsed by her during the entire course of her treatment? That the one person who is supposed to be "on her side" was actually using her as a personal experiment to try and overcome his fat-phobia? I hope for her sake she never figured it out! While I don't think a T can work out ALL of their issues prior to becoming a T, I do think it is ethically irresponsible to take on a patient (who repulses them) solely for the purpose of learning to overcome their own repulsion. That is just so selfish. It places the needs of the T above the needs of the patient. How can the T concentrate on the patient's story and needs, when the T is so distracted by his own repulsion? Is focus is on her "folds" and not on her story-- as he readily admits. Imagine how many crucial details and painful memories he didn't really *hear* because he wasn't really listening to her. It would be like a T taking me on as a client solely because I'm a lesbian and the T wants to overcome homophobia. I would NOT be okay with that! I would want to be referred to a T who was not homophobic because I would NOT feel safe with homophobic T and I would not want to be used as his experiment. If he wants to learn to overcome homophobia, he should take an anti-homophobia and anti-heterosexism seminar. He should volunteer at an LGBT non-profit. He should read some books and educate himself. He should do those things instead of selfishly using a client for HIS purposes.

I've never liked or respect Yalom or his work. I will continue to not like or respect Yalom or his work.

MSWINTER, I agree with Rainbow that you should try to bring this issue up to your T so you can talk about with him. I bet that he does NOT have the prejudices that Yalom has. I bet he has no clue that you worry about this & that it's an issue for you. I think hearing him tell you that he values you (and that weight= personal worth for him) would make you feel much better. It would allow you to stop worrying about this so you can focus on using him as an ally in the therapeutic process.

I can relate to the fear in bringing this issue up to T, though. While I am not overweight, I do have low self-esteem when it comes to body image. I was always compared to my sister growing up, and I was always told I was the "less pretty" one and the "bigger" one. I was called a "fat pag" even though I was/am a size 4 or 6. So I've struggled with "feeling" fat and "thinking" I'm fat even though I'm not actually overweight. I was afraid of talking to my T about this because I was afraid she would be like my family and judge me, too. I was afraid that because she's smaller than me (she's REALLY thin) she would tell me that my family was right, I am fat, I need to stop being in denial about it, and I need to exercise/diet. I was afraid she was secretly thinking I was fat/gross. But, when I finally had the courage to talk to her about it, she explained to me that she thinks I have a "distorted" body image, that she thinks my family was completely WRONG, and that even if they were right and I was overweight, that that would not make me any less valuable as a person. It was so helpful to be able to talk to her about this! And she was very clear that she does not judge clients based on weight or appearance. She even brought some humor in to lighten the mood. She was like "luckily, you're quite physically attractive, so I can be honest with you! Otherwise, I wouldn't know what to say in response! No, just kidding! What I try to get my clients to understand is that they should not put their self-worth in their appearance. I value my clients for who they are as people, and I want them to do the same."

I can certainly understand your point of view.
This is an ugly incident and does him no credit.

Yalom aside, I (of course) think you should talk about this with your therapist. I don't know if you already talked about the straight revelation with him (I know you were going to), but it can't hurt to talk about it again because I think this is important! I know what you mean about the emotional part of your brain thinking for you (been there, done that)--make the saavy social worker part of you tell your therapist everything you said above...about this Yalom essay and what you're worried about him thinking when you sit there with him and about using food and everything else.

If he's not an asshole and he's good at his job, my instinct is that he's going to reassure you. And if you think he's lying...tell him that, too! I think this could be really good for you!

To be completely honest with you, I always felt Yalom was a little on the anti social (psychopathic antisocial) side. Most famous people are. They step on anyone to get their ideas heard.

I had an attractive, young, straight, male T and I am overweight and he never once judged me for it. We became very close, and I even discussed my body image issues with him successfully.

Don't assume what Yalom did is even close to what your T is doing.

I hated the yalom guy's books. I tried a couple and thought he was a total ***.

mswinter, I admire your courage for posting this thread. I think many here may have similar thoughts or feelings although few are able to articulate them in the way you did.

I have read Yalom's book "The Love Executioner" and really despised him in this part of the book. I remember, I kept thinking...."What an ***!". I read his comments as being VERY prejudiced and also questioned, like others, if he was doing her more harm by staying on as her T. ( He was much more specific in the book than the excerpts here)

If I remember correctly, he had grown up in an overweight family and Betty reminded him of his own Mom. In the end, Betty (client) tells him she KNEW of his countertransference toward her. He was surprised to find out she had known since very early on in her therapy.

In the end, she gave him some unmerited grace.

Is it possible to take what you posted in your thread and read it to your T? This might just lead to some great work between the two of you!

I read that extract of Yalom's before starting with my therapist; and hadn't realised what an impact it had on me until I realised that I really believed my T was totally disgusted by me and was viewing me in the same way yalom viewed his client ... I found I'd been holding back things, jumping to conclusions and basically merging Yalom's views with my T's .. even though T didn't think those things. Still very hard for me now; and I do the same thing with everyone, on and offline ... assume they will hate me because of my size and never accept me; so I totally understand your feelings and thoughts with this

i meant to say; i read this last year also

http://www.jung-at-heart.com/jung_at...fat_betty.html

you might find it interesting

This is what really pisses me off.
It's in the movies, books, TV and even politics. Children are taught that it's ok to make fun of ppl who are overweight, that they deserve it and it's even implied that by making fun of them you're actually helping them to loose that weight...I used to be fat when I was a teenager and believe me when I tell you it makes it much worse. Now my weigh is somewhat ok- in a normal range but I still sometimes long for the days when I was severely underweight. Cause it is programmed in my brain that if I got thinner ppl would love me more. We're working on this issues in my therapy- I have a male T.
I've read Yalom's story and it's been discussed here before but man I hated it. However, TBH I thought Yalom wasn't a good T even before this one. The way he sexualize ALL the women clients, that really pissed me off. Chauvinist pig. Makes me appreciate my T even more.

Amen to that! My T is a sweet and very fit lady who constantly tells me how much she cares for me, despite my weight (I'm around 40lbs overweight). Of course I don't believe her, but that's my issue, not hers. I do not believe she is secretly repulsed by me. Like you, this makes me appreciate her all the more.

I've also lost all respect for him. Poor lady - it makes me want to cry.

jesus. that yalom dude was a ****ing asshole. he took on a patient to help himself! he is repulsed by fat people! do not take one assholes personal issues as representative of all t's. there is a lot of fat hatred out there but it's sick and twisted and i'm sure your T is not like that.

I feel exactly the same way. I even told my T how I felt she could never really understand. She was obviously hurt, but glad I was being honest. I tried so hard to apologize, but she wouldn't have it. All she cared about was my honestly.

Despite all this, I still hear the little voice in the back of my head telling me she'd like me so much better if I was thin. It's impossible to believe otherwise.

EDIT: I found Irvin Yalom's Facebook fan page and sent it a scathing message. Psh, that'll sure do a lot (rolls eyes). It's probably not even him.

I have been following the posts on this thread with much interest. I only interpreted yalom's text from your comments because I do not want to read something that will spark my hurt and anger.
I am treated for bipolar, csa, and substance abuse; however, the issue that is biggest to me in my life, and the one I am not treated for, is self-image. I am a middle-aged, overweight woman, and I am extremely intimidated by those who I judge as superior in the looks and weight department. I realize my self-image problems are my own, and those who are treating me could probably help me if I let them; however, my providers are much more fit and in most cases younger than me.
Stereotypes and disgust such as yalom's are so hard to deal with. I can hate him, but that doesn't help me. I can sit here in tears, as I am now, but that doesn't help me either. The question is, how do I take this and help myself instead of hurting? Do I get rid of all of my providers who, other than being "cursed" with youth, good looks and good health, are the most competent I have found in their respective fields?
I don't have any answers, and I am probably just rambling random thoughts, but I do know that I have to find a way to let others' prejudices not hurt me. I also need to find a way to not be so paranoid about what others "see" when they look at me. I guess if I could bottle these solutions, I would be rich!
Bluemountains

T's actively LISTEN, that is what they DO, that is what enables them to help. So I don't think we can criticize Yalom for saying he was going to listen. And I like when my T learns something from me. My family denies ever learning anything from me, so to bring richness and enlightenment to someone else's life just by being myself is very rewarding.

ick. triggered. bawling. Feeling huge and ugly. What if my t is grossed out by me? ugh. I hate this Yalom guy.

i'm sorry you're sad. your T loves and accepts you just the way you are. UPR, remember, unconditional positive regard, always. my T's scrunchy hugs are for ALL of us. when I go in unshowered and he says he doesn't smell anything, but then says, "but I do sleep with a boy dog on my head and he doesn't smell too great...", that's for ALL of us too. These feelings are transference, just like anything else in therapy - my family TOTALLY hates me, but they project it on my weight. It's an easy target. look beyond the obvious, my children.

I have not read this whole thread but after read 3 or 4 posts on the first page I feel the urge to say this.

To all you big, beautiful women out there, please hear me. Im not going to get into any pyscho-babble with you now. All I want to say is that its soooo true that beauty is in the eye of the beholder. As a gay woman, I love bigger women. And there are many men and women out there who do. Please dont think that soley because of your weight you are unlovable or not worthy of compassion. I realize that the world isnt always kind in this area but please know that some of us love and respect your bodies just the way they are. Its merely the vessel holding the most important piece of you - your soul.