BBD Make-up

Clinical Social Work Journal Vol. 25, No. 1, Spring 1997

THE DESOMATIZING SELFOBJECT TRANSFERENCES ANALYSIS OF

AN EATING DISORDER

Vicki Dellaverson, MSW, Ph.D.

ABSTRACT: This article documents the manner in which psychological treatment, with its attentiveness to the vicissitudes of the unfolding selfobject transference, gradually enabled a patient to contain and articulate painful affect states. The patient's passionate relationship with food, strikingly illustrated in the clinical material, including her dreams, endowed eating with the functions of an idealized selfobject. Over the course of treatment, she seemed to traverse a psychic bridge that took her from an isolated reliance on food through a more focal awareness of her body and her feelings, to an investment in, and capacity for, deepened relationships with other people.

KEY WORDS: self psychology/eating disorder; self psychology/desomatization.

INTRODUCTION

Self psychologists have consistently viewed eating disorders as at- tempts to supply missing selfobject functions (Brenner, 1983; Goodsitt, 1984; Sands, 1991). Eating disorders, they argue, are a response to the chronic failure of caregivers to respond to the child's appropriate narcis- sistic needs. When early needs and the affects associated with them are disavowed, repressed, or split off from the gradually consolidating self structure, the resulting nuclear self is marked by a structural deficit in self-cohesion, temporal stability, and/or self-esteem regulation (Stolorow et al., 1987). In turning to food, the eating-disordered child tries to cir- cumvent the need for human selfobject responsiveness, thereby avoiding further shame and disappointment that may compound the structural deficit to the point of fragmentation and/or depletion. Since food and the

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process of ingesting it function as a selfobject, often the only reliable selfobject, eating-disordered behavior may be defended with as much ar- dor as the selfobject connection to a human being (Sands, 1991).

Buckman (1992) has recently introduced the term a "desomatizing self-object transference." He defines this term as "a multifaceted trans- ference configuration that embodies idealizing and affect-integrating selfobject functions that are fundamentally tied to the process of de- somatization'' (p. 93). Brickman introduced this concept with the success- ful analytic psychotherapy of a middle-aged man with severe, chronic gastrointestinal pain. I hope to demonstrate that the concept can be usefully extended to work with eating-disordered patients.

LITERATURE REVIEW

Within Freud's classical drive-conflict model, food has a range of symbolic possibilities. It may represent the desire for unobtainable love or rage and hatred; sexual gratification or aesthetic denial; the wish to possess a penis or the wish to be pregnant. It may provide a sense of power and self-aggrandizement or defend against the demands of adult- hood. Hamburger (1951) has underscored the variety of different, often contradictory connotations carried by food.

Bruch (1978, 1985), who adopts an ego-psychological perspective, emphasizes an inability to recognize hunger and other bodily sensations and a lack of awareness of "living one's own life" as fundamental to the development of severe eating disorders. She links these deficits to moth- ering that is unresponsive to the child's early needs and impulses, thus preventing the child from acquiring a body identity that includes con- ceptual awareness of one's own functioning. Bruch's emphasis on early mother-child interactions is consistent with the Mahlerian estimation of eating disorders as adaptive responses to disruptions of the separation- individuation process.

Mahler (1975) herself linked such disruptions to the late symbiotic or early differentiation subphase of the separation-individuation pro- cess, whereas other investigators have traced eating disturbances to ar- rests during the rapprochement subphase (Sours, 1981; Johnson, 1991) or, in the case of bulimia, to the earlier transition from the differentia- tion to the practicing subphase (Sugarman & Kurash, 1982). Mushatt (1982, 1983) probably represents the Mahlerian consensus that the ego defects of eating-disordered patients represent varying degrees of failure to negotiate the separation-individuation process, with more severe symptoms indicating relatively greater impairment of self-object differ- entiation.

One problem with Mahlerian investigations of eating disorders has

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been a failure to distinguish adequately between transitional objects and their precursors, sensation objects (Tustin 1980). Sugarman and Kurash (1982), for example, propose that the potentially bulimic pa- tient, arrested at the earliest stage of object development, uses her body as a transitional object to play out in concrete form unresolved conflicts over individuating and separating from a maternal object. Given an ar- rest at a presymbolic stage of development, however, "self and "object" cannot be represented in the body; the very notion of a "transitional object" means that the "object" cannot be a part of either the child's or the mother's body (Winnicott, 1953). Goodsitt (1983), who has criticized Sugarman and Kurash's hypothesis in a similar vein, suggests that the symbolic deficit in eating-disordered patients results in various self-reg- ulatory disturbances, and that their symptomatology is better under- stood as a desperate measure to drown out states of overstimulation and fragmentation. Johnson's (1991) notion of food as a soothing, self-regula- tory tool for bulimics, whose clinging behavior during the rapproche- ment subphase distanced their mothers, is consistent with this perspec- tive.

Consideration of eating disorders as adaptive responses to impend- ing overstimulation or fragmentation, hence as vehicles of self-regula- tion, paves the way for the self-psychological viewpoint. Kohut (1971) saw eating disorders as attempts to supply missing selfobject functions; food is a particularly compelling selfobject substitute, since it functions developmentally as a first bridge between self and the human selfobject, providing soothing and comfort. According to Kohut (1984), eating-disor- dered behavior most often substitutes for the idealized selfobject. Food, that is, comes to provide an early experience of oneness with an ideal- ized source of strength, security, and calm. This experience, which nor- mally follows from the soothing, comforting responses of caregivers, is critical to the child's emerging ability to integrate and tolerate distress- ing affect states, to self-sooth, and to arrive at an overall sense of well- being. For a smaller subset of eating-disordered patients, Kohut held, behaviors like binges and purges are activated by unconscious fantasies of grandiose omnipotence.

The problem with a restitutive selfobject system organized around food is that its satisfactions, while seductively powerful, are only mo- mentary. Kohut (1978) writes of addictive processes in general:

It is the tragedy of all these attempts at self cure that the solutions they provide are impermanent, that in essence they cannot succeed ... They are repeated again and again without producing the cure of the basic psychological malady. No psychic structure is built; the de- fect in the self remains. It is as if a person with a wide open gastric fistula were trying to still his hunger through eating. He may obtain pleasurable taste sensations by his frantic ingestion of food, but since

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the food does not enter the part of the digestive system that absorbs it into the organism, he continues to starve.

Since Kohut's contribution, Ulman and Paul (1990, 1992) have pro- pounded a comprehensive self-psychological theory of addiction in which the substance or behavior to which one is addictively attached triggers archaic narcissistic fantasies (subsequently designated "selfobject fanta- sies" [1992]) that anesthetize the addict against chronic states of anx- ious self-fragmentation and/or depressive self-collapse. They demonstrate how food can provide both antianxiety and antidepressant selfobject functions with the case of a young bulimic woman (1990, pp. 137-144). More specific to the phenomenology of eating disorders, Sands (1990) theorizes that bulimics endure such massive selfobject failure during the earliest years of life that they cannot communicate their deepest needs verbally or symbolically. The resulting bulimic self is thus an ar- chaic "body self expressing these needs at a somatic level.

CASE REPORT

The patient, whom I shall call Karen, was 46 years old when she entered treatment. She was bright and articulate. Her blonde hair had a wild, almost disheveled look, and she wore dramatic, flowing clothes and ethnic jewelry. At that time she complained of difficulty at work. She had been passed over for promotion and felt discriminated against. She complained of chronic depression, including frequent episodes of insomnia, exhaustion, and a sense of hopeless- ness. Her life-long tendency to overeat compulsively, compounded by work-related stresses, made her obese. Karen recounted a distant and difficult relationship with her family; both parents and an older brother were continually critical, referring to her as a misfit. Her chaotic childhood was marked by her fear of her brother's uncontrollable rages and physical abuse. She felt unprotected by her mother, who, she subsequently learned, was also abused by her own brother as a child.

In fact, Karen complained that her mother had not been responsive to any of her needs, insisting that Karen take care of her. She was often expected to listen to her mother's problems, remaining quiet and compliant so as not to make mat- ters worse. The mother,for her part, would not give advice, express affection, comfort Karen or even discuss anything of emotional significance with her daugh- ter. She was prone to remark that Karen was like Topsy, "she just growed." Karen had a mental picture of her mother as a sullen, obese woman who spent all of her time doing housework and seldom had fun. The mother had never developed her talents and had few interests or hobbies. One of Karen's saddest memories was of packing all of her mother's personal belongings into two shoe- boxes at the time of her death. She then realized that her mother had had "no sentiments in her life."

No one in Karen's family displayed open affection and her mother never discussed sex. She was frightened by the onset of menses and had relied on friends for information about reproduction. Her mother hid her own body under tent dresses and refused to respond to Karen's questions about clothes and grooming. Throughout her life Karen was disgusted by, and cut off from, her

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body and her sexuality. At the time of treatment, she felt her body was ugly and would not undress in front of anyone.

Karen described her father as passive and emotionally uninvolved with the family. A salesman, he was away from home five days a week. Karen wondered whether her father worked long hours to avoid the tensions at home. She de- scribed him as a perfectionistic man frustrated by his own limitations. Like her mother, he was incapable of verbalizing any feelings for her. He reprimanded Karen for any assertive behavior within the family or for failure outside. Her positive memories of him centered around his returning home from trips with gifts of food and taking her shopping to the local deli.

Karen's older brother was always in trouble as a child and exhibited uncon- trollable rages. He intimidated the entire family and his aggressive, abusive be- havior toward Karen was completely ignored. Karen became quiet and compliant to avoid making trouble. When she felt angry or scared she kept her feelings to herself.

Karen had been obsessed with her weight since early adolescence and had been through many periods of weight loss and gain. She recently decided to work on her eating disorder and, to that end, had both joined Overeaters Anonymous (OA) and sought therapy and then analysis.

COURSE OF TREATMENT

We began treatment on a twice a week basis. In her first session, while expressing her complaints, Karen told me that she experienced me as under- standing. She felt so needy that simply being able to express herself provided tremendous relief. During the entire first year of treatment, she continued to find it remarkable that someone was listening to her point of view. The thera- peutic relationship alone seemed to alleviate some of the depressive symptoms related to her job. When she was laid off from her job, she rallied and began her own business.

One year after therapy began, a major shift occurred. Karen now com- plained of an underlying feeling of emptiness and lack of satisfaction. My inter- pretations were directed toward her dawning recognition that internal problems were now coming to the fore. She began to relinquish her view that external events were causing her difficulties and became increasingly aware of her inter- nal conflicts. With the working through of this insight, the transference deep- ened.

Karen requested additional sessions; we decided together to increase her sessions to four times a week and began an analysis. The increase in frequency led to the gradual development of a selfobject transference, largely of an idealiz- ing type but also with mirroring components. There were predictable periods of resistance to these transference developments, characterized by Karen's moving away from the analyst and returning to previous soothing mechanisms, such as food and reliance on OA.

IDEALIZATION

Throughout the early phase of the analysis Karen's dreams illuminated her use of food to supply missing selfobject functions. Her dreams about food were

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frequent, had the most vivid detail and expressed the most affect. It was as though dreams about food were in technicolor and dreams about other topics were in black and white.

One of the first dreams Karen reported highlights the use of food by her entire family as a substitute for emotionally responsive caretaking:

I dreamed I was back in Brooklyn eating dinner with my family. We had deli food—wonderful corned beef, kishka, brown gravy, matzo balls, kreplach, fresh rye bread with the stamp on it, crusty bagels and cream cheese. For dessert we had Pennsylvania Dutch chocolate pretzels, bittersweet almond bark, double dipped chocolate mint.

When I asked for her associations, she observed that "Everyone in the family had their favorite deli food and their favorite chocolate pretzels. The food was wonderful." The trips to the deli took her away from the family to a place where everything felt good to the last swallow. She recalled her relief at being alone with her best friend, food, and added that everyone in the family seemed to use food to relieve tension. She realized now that her mother had been obese, al- though no one had seemed to notice her mother's weight when Karen was a child. She also recalled that if she went to her mother in distress, her mother would say, "Eat something. You'll feel better." As we continued to discuss the dream, Karen remarked that belonging to OA was like being with her family: Everyone seemed to share the experience of using food to quiet painful feelings. Karen's dream associations were consistent with my feeling that her disordered eating behavior provided the functions of an idealized selfobject. As an idealized selfobject, food provided soothing comfort and helped regulate painful affect states. I was experienced as understanding, but was not yet the object of an idealizing transference.

Karen fiercely defended against the idealizing transference that she uncon- sciously yearned for. She maintained that her relationship with me was second- ary to her relationships at OA because her fellow overeaters could better under- stand her "disease." A year and a half into the treatment a shift occurred. The crucial turning point seemed to come when Karen realized that I could empa- thize with her eating-disordered self. It promoted the hope that I would also be able to understand the isolation, longing and self-destruction that fueled this symptom. A dream from this stage of the analysis illustrates the shift.

I dreamed that I went to a restaurant after an O.A. meeting. I had Copper River salmon. It was a one-half inch fillet, basted in ver- mouth lemon butter, so it turned out slightly crunchy, sweet and del- icate, served with perfect asparagus tips. The salad was fresh aru- gula, with rainbow radishes, baby cucumbers, gorgeous red tomatoes, dressed with crumbles of gorgonzola cheese and balsamic oil and vin- egar. The crusty rolls were fresh with sweet, warm bread inside.

When I asked for her associations, she said that the dream was beautifully nurturing, especially the Copper River Salmon. She stated that when a local restaurant served this fish during the salmon season she would go there for dinner every night for three weeks. She said, "I can see it and taste it right here. It is a truly spiritual experience." As we continued to discuss her dream, she elaborated that "Eating is an emotional experience like looking at art or listen-

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ing to fine music. Food is one of the best things in life and provides an oppor- tunity to have a spiritual experience three times a day." When I asked her if anything else provided this kind of experience, she replied, "Yes, when you and I discover new insights, or recently when I realized that you truly understand my experience with food—that is Copper River salmon. This experience of being understood," she added, "has stayed with me longer than the food. It really stuck to my ribs."

After that session, it seemed that a tear had appeared in the fabric of Karen's defenses. Following my two week vacation, she admitted for the first time that "it wasn't fair for you not to be here during the holidays when they were so hard." In the next session the question of whether there was any genu- ine caring between us emerged. Karen told me that she resented having to pay for help. She worried that our relationship was only professional and stated that she could not know me, much less care about me. When I commented that she must wonder if I could really care about her, she replied, "This is your job but if you really cared about me you would see me for free." Our working through of this issue highlighted her longing for love and nurturance. The session ended with my suggesting how frightening it must be to hope she could be helped while knowing she might be let down again.

At the beginning of the next session Karen reported the following dream:

I was in the castle of a potentate who adored me. There was a woman assigned to attend to me. We were sitting on pillows which were soft, billowy, and had a wonderful texture and beautiful bright colors. The room was the community bath, which held a huge pool, large, luxu- rious towels, and wonderfully scented oils. The entire environment was sensual, erotic. I had finished my bath and was laying on the pillows talking to the woman. She suggested that we go to the bazaar so she could help me find my own scent.

Karen's associations were, "The woman was there to take care of all my needs. I think the woman was you. You were gorgeous in the dream, with beautiful clothes, makeup and the kind of hair you can do anything with. You wanted to take me to the bazaar to help me find makeup and my own perfume." As we discussed Karen's dream, she observed, "This was a very rich dream. I feel that your helping me find my own scent represents bringing out the richness inside and teaching me how to take care of myself." Her continuing resistance to the selfobject transference gained expression in further associations to the dream: "I see the richness inside as coming out in the kind of glow you seem to have on your face but maybe I won't have a glow, only a red, embarrassed face." As we explored this association, she expressed the fear that, "We may find that I am rotten inside andnlon't deserve all of these good things." Our work during this phase of the analysis was dominated by the elucidation of Karen's longing to feel lovable and deserving, which alternated with fear that we would discover her mother was correct in telling Karen that she was rotten at her core.

This dream and Karen's associations represent the first evidence that Karen was beginning to direct her longstanding needs to a specifically human respon- siveness. The dream had the same richness of description and affect that had previously been present only in dreams about food. The underlying thoughts revolved around the demeaning quality of Karen's relationship with her mother and her unsatisfied longing to be admired and cared for. The corresponding deepening of the mirroring and idealizing transference represents a pivotal shift

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in the analysis, as Karen now began to rely on her relationship with me to calm and soothe herself. With this deepening of the transference she began for the first time to express painful affect states that included fear, shame and rage.

DESOMATIZATION

Karen's affect so far had been somewhat constricted. She tended to describe bodily sensations as a substitute for feelings and internal experiences. In spite of an increasing internal focus, she continued to resist introspection, focusing in- stead on her objectified eating disorder. She exhibited a noncohesive body self and had never been able to distinguish between affects and bodily sensations.

Two years into the analysis I observed that Karen had begun to arrive late. On one occasion I inquired about this new behavior. She replied, 'If I'm a little late it adds some excitement, gets my juices flowing, like living on the edge." She fantasized that I would become angry and impatient and leave, hence being un- available when she arrived. As we explored this, she remembered that as a child she would come home to an empty house and have to look for her mother. When Karen eventually tracked her mother down at the neighbors or the local movie theater, the latter would become irritated with the interruption of her activity. I proceeded to interpret Karen's growing fear that I too would feel impatient and angry by her need for my time and attention. She seemed astonished by my interpretation and responded, "That's what the rush is. It's fear."

Following this session Karen continued to arrive late. I noticed that she would arrive with a vigilant, fearful look on her face, followed by a smile when she realized that I was waiting for her yet did not appear angry. She began to report a shift in her attitude toward me, admitting that she now looked forward to the sessions. On one unavoidable occasion, I was 10 minutes late and arrived to find her waiting. I ended the session on time and when she left she noticed that a man was waiting to see me. At the beginning of the next session Karen reported the following dream:

I was in the Catskills with my friend Isabelle and she gave me her watch. We were walking up a hill on a country road when I noticed that the homes along the road had caught fire from the inside and the people in the houses seemed to be in agony and were screaming for help. The houses started to implode and we began running to get to higher ground. We got into a field at the top of the hill and could see the flames from all the fires seemed to be forming an electrical arc from hill to hill. We started to roll down the hillside and I real- ized we were in a gully in the mud. Isabelle pulled me down and covered me as the fire roared over us.

When Karen had finished reporting the dream, she appeared frightened. When I inquired what she was feeling, she exploded with anger. She said that I had been late the day before and had ended on time. It was clear to her that since a man was waiting to see me, he was more important than she was; she speculated that, in general, men were more important to me than women. As we explored this issue her painful feeling of being a second-class citizen as a child spilled out. The watch in the dream reminded her of her affection for her Uncle

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Cid. When her uncle died she asked her father for her uncle's gold pocket watch and he gave it to her. When her brother complained that the watch should be passed down by the men in the family, her father took the watch back and gave it to her brother. She recalled that the men in the family got everything, "the tenderloin from the steak, the cream off the top of the milk." She began to sob and recalled that all of her stuffed animals had been taken away from her as a child because her brother was allergic to them. From the dream she recognized the overarching sensation of rage that seemed to dominate her childhood and color her longing for soothing and protection.

With my growing ability to function as an attuned, accepting and affect- articulating presence, Karen's eating-disordered behavior began to recede. She was able to recognize and differentiate feelings and began to eat only when hun- gry, not when she was depressed, angry, or tired. She started to lose weight and is currently 75 pounds lighter than she was when she began the treatment. Commensurate with the weight loss, Karen's sense of her body and body exhibi- tionism began to emerge. She announced that it felt wonderful to shower daily in contrast to her previous neglect. She began to buy more stylish clothing and declared with delight that she selected outfits according to her style, not her mother's.

It was after this important phase of the analysis, during which Karen's body self became more integrated into her self structure, that she became able to exhibit other potentialities to me. She raised her hourly consulting fees and her business became more successful. She took great pride in her growing affect tolerance. In the past she had avoided any conflict situation because feelings of anger were so intolerable that she would feel an immediate urge to binge. She recalled that her mother had been unable to tolerate any expression of anger, calling her names and sending her to her room. As we explored her anger Karen began to recognize that her powerful feeling of badness had been connected to unexpressed rage. At the beginning of one session she burst in with excitement and told me that she had worked through a painful conflict with a friend and had realized, "I wasn't rotten at the core like my mother said; I was just angry."

Karen had dreamed of tracks throughout the analysis, and we had never been able to understand their meaning. She had speculated that they might represent the beams on my ceiling or the telephone wires she could see out my window as she lay on the couch. She dreamed:

I was on a scooter that was moving so fast I feared it would go out of control. The scooter was following tracks that led down to the water. I could see the skyline of the city across the way. I realized it was the George Washington Bridge. I crossed the bridge and drove through the food court at Century City on my way home to the Bronx.

Karen's first association was to tracks: "I have been dreaming about tracks but in this dream they form a bridge." The bridge signified connection: "When I was a child I had to cross a bridge to go to my favorite places, to visit my aunt in Manhattan and to go to the Catskills for the summer." She continued: "My fam- ily never understood me, I never felt connected. Now I feel connected to you and I feel connected to myself." Together we understood her driving through the food court at Century City on her way home as a symbol of her lifelong tendency to use food to replace human connections. The analysis itself has functioned as a psychic bridge leading her back to connection with herself and other human beings.

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DISCUSSION

During the initial phase of the analysis with Karen, archaic needs and wishes, and the associated affects of rage and disappointment were activated. We focused on the transition from an external point of refer- ence, in which Karen understood herself in terms of the needs and wishes of others, to an internal point of reference. This process gener- ated intense anxiety, as the achievement of a sense of body self and the accompanying capacity for introspection required moving away from food, the most addictively consoling of her external referents.

The course of analysis charts Karen's arduous journey back to the primary route of psychological growth—the route by which she dared to seek a new type of human responsiveness in order to resume her devel- opment. In short, my understanding of Karen's hopes and fears slowly convinced her that she should give human beings another chance. The mid-phase of the analysis involved the activation of early selfobject needs and the subsequent elaboration of a full-blown selfobject trans- ference, with both mirroring and idealizing components.

Clearly Karen's mother had been pitifully hard to idealize, her in- ability to provide mothering functions being compounded by her self- devaluation, her fear of her own sexuality, and her unpredictable moods. Nor had Karen's distant father been available for idealization. Another possible candidate for idealization, her older brother, was angry and abusive. And owing to the family's social isolation, it is unlikely that Karen was exposed to many other idealizable figures. Having no one to idealize as a child—nor anyone to soothe her and help her integrate painful affects—she was left with a structural deficit to regulate inter- nal tension states. This deficit compromised her ability to find direction and meaning in life's activities.

So it was that Karen's idealizing needs were met by food. Her early need in the analysis to devalue me masked her fear that the therapist would disappoint her as her parents had in the past. The remobilized need for an idealized selfobject whose reliable, calming presence would sustain her was defended against with a facile, brittle independence. In working through this resistance, my interpretations were directed to- ward Karen's fear of what would happen if she allowed me to become important to her. As repeated instances of empathic responsiveness counteracted Karen's fear of disappointment and failure, I could move on to analyzing the genetic origins of her selfobject needs. Through em- pathic immersion and subsequent interpretation, corresponding to what Kohut (1984) terms the "understanding" and "explanation" phases of treatment, Karen acquired new insight into the role of food in her life and became more accepting of the developmental circumstances that

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had rendered her eating behavior adaptive and necessary. Her self- awareness culminated in a more empathic self-acceptance.

Kohut's (1971, 1977) conceptualizations of mirroring and idealized selfobjects can be viewed as very important special instances of an ex- panded concept of selfobject functioning that revolves around the inte- gration of affect. That is, his discovery of the developmental importance of phase-appropriate mirroring of early grandiose-exhibitionistic needs points to the critical role of selfobject responsiveness in the integration of affect states involving pride, expansiveness, efficacy, and pleasurable excitement.

As Kohut as shown, the integration of such affect- states is integral to the consolidation of a cohesive nuclear self with healthy self-esteem and realistic goals and ambitions. The importance of early experiences of oneness with idealized sources of strength, security, and calm, on the other hand, indicates the central role of soothing, comforting responses from selfobjects in the integration of affect states involving anxiety, vul- nerability, and distress. As Kohut implied, and as Socarides and Stolorow (1984) have more explicitly argued, such integration is essential to the development of self-soothing capacities which, in turn, contribute vitally to anxiety tolerance and an overall sense of well-being. Indeed, accord- ing to Stolorow, Brandchaft, and Atwood (1987), the overarching selfob- ject need is for affect attunement, which leads over time to an affect integration that subsumes mirroring and idealizing needs.

Turning now to the experience of affect, Krystal (1988) has sug- gested that a critical dimension of affective development is the evolution of affects from primitive bodily sensations to subjective states that can gradually be verbally articulated. He emphasizes the key role of the caregiver's ability to identify correctly and verbalize the child's early affects in this maturational process. When an individual anticipates that more advanced, symbolically elaborated feelings will be ignored or rejected, thereby replicating the faulty attunement of the childhood sur- round, he or she will revert to more archaic, exclusively somatic modes of affective experience and repression (Socarides and Stolorow, 1984/1985). Karen's addictive reliance on food and her body experiences in general exemplify this somatization of affective experience, and her treatment bears out Krystal's (1988) trajectory of advance along this developmen- tal line. As Karen's analysis proceeded she assumed the capacity to inte- grate her bodily experiences into symbolically encoded meanings, lead- ing to the verbalization of distinct feelings of fear, shame, and rage.

With my ability to function as an attuned, accepting, and affect- articulating presence, Karen's psychosomatic symptoms began to recede. As she was able to express formerly arrested exhibitionistic needs, her body self became more integrated with her total self-structure. She de-

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veloped the capacity for self-soothing and the self-regulation of painful affect states. Most importantly, she was able to desomatize and express her affects through meaningful work and in deepening relationships with people.

The use of the expression "desomatizing selfobject transference" (Brickman, 1992) in the title of this paper denotes the multiple selfob- ject functions encompassed by the bond between Karen and me. In addi- tion to the idealizing aspects, affect differentiation, affect articulation, affect containment, affect tolerance, and self-delineation were all selfob- ject functions that entered into the transference. As with Brickman's (1992) patient, so with Karen: transference furthered the conjunctive processes of affect development and desomatization.

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Vicki Dellaverson, MSW, Ph.D. 2336 Malcolm Avenue Los Angeles, California 90064