Therapeutic Case Notes

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Lily has attended three therapy sessions so far.  She is very engaged in therapy and tells me she looks forward to her sessions.  

 

In her second and third sessions, Lily talked a lot about her weight issues.  She said she did not feel comfortable discussing this at our first session.  I note this and wonder if there is some shame that Lily attaches to her discussion regarding her weight.  I am curious about where this shame is coming from.  She has followed my instructions in building mindfulness in listening to her self talk and so I know that she is very negative in her thinking, very self demanding, and sees every glass as half empty instead of half full.

 

Once again, I ask Lily to review her genogram history, this time through the lens of weight.  I find out that Lily’s mother has struggled with her weight since Lily was a young girl.  From the time she was little, there was a pattern of overeating that often coincided with chatter about dieting.  Lily has been overweight since childhood and remembers her first diet in elementary school.  She says she is a veteran of every diet, though she also says that every diet ultimately failed, and so whatever weight she lost, she ultimately  regained.  Her father did not have a weight problem although he loved to snack on fattening and unhealthy foods constantly.  He insisted that the house had to be stocked with sweets, and then he would berate Lily by telling her that she had no willpower when he spotted her snacking.  At her yearly checkups as a child, she overheard the doctor telling her mother that she needed to lose weight.  When the doctor asked her mother what the problem was, her mother always responded that Lily had no willpower.  Lily today believes that her success or failure on a diet is always a result of her willpower.  To succeed at a diet means she will lose weight and that means she has strong willpower.  If she gains weight, it means her willpower is weak or nonexistent.

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I learn other interesting and relevant historical facts as I deepen our conversation about Lily's family genogram.  Lily tells me that all four of her great-grandparents were immigrants to the United States.  Lily's maternal grandfather grew up during the Depression and had vivid memories of his father being out of work and the family being poor.  Poignantly, Lily remembers that he frequently talked about feeling hungry and finding no food in the refrigerator.  As an adult, Lily's grandfather married, and he achieved financial success.  He insisted on doing all the food shopping for his family and loaded the refrigerator and pantry with excess and abundant food.  Lily's mother grew up in an environment in which food represented financial security and chubbiness was viewed as demonstrating stability and safety.  Lily's mother carried these beliefs into the next generation.  Lily and her siblings also lived in an overstocked food environment.  But Lily also lived in a "thin-is-in" culture.  There was a social price to be paid in being overweight.  Fat kids were teased, clothing styles favored thin people, and dieting was viewed in a strong and positive light.  Lily found herself caught in a world of mixed messages about food and dieting that came down to "EAT"; "DON'T EAT".