Self Harm

Essay Title: “What are the challenges that face a psychotherapist working with Self-harm or eating disorders?”

The focus of this essay will be to examine the challenges a psychotherapist faces when working with eating disorders. Whilst acknowledging eating disorders can include overeating I will base the essay around anorexia nervosa and bulimia nervosa. I will look at the various theories around the subject as well as provide examples of my own experience working within this field.

“I am dying to be thin”. And quite literally death is a strong possibility for people who have an eating disorder. Whether it is anorexia or bulimia the person affected will normally have a distorted body image. Even where there isn’t a morsel of fat on their bodies, they look in the mirror and see a fat person looking back (see Figure 1).


Figure 1: Distorted Body Image

Having worked on an eating disorder unit in Essex for over a year I have personally experienced the frustration of working with this condition. For me, it was very hard to understand what went on within the mind of the client, who would be manipulative, secretive and cunning in order to avoid eating, or be sick after eating to enable them to lose even more weight. Often a target weight of say 6 stones would be their goal, which inevitably would be lowered again once this was achieved.

I remember the trauma that clients would go through when it came to being weighed. Sometimes, they would become hysterical if they found out that they had put on so much as an ounce. They would also try to resort to tricks such as water loading (drinking fluids in the bathroom) to avoid their true weight being revealed. Dinner times proved to be another ordeal as they were normally on set calorific diets of say 1000 calories per meal, and had to eat what was on the plate. Staff had to eat along with them and in fact staff often compensated by never leaving their plates clean, thus putting on weight themselves, whilst...