What’s Fat Got to Do with It? On Different Kinds of Losses and Gains in the Analytic Relationship

This article uses the blunt term fat to shake up readers’ attitudes and to challenge them to think about how their own prejudices about fatness affect their treatment of fat patients. The clinical work presented is a reconsideration of Bion’s work, with a relational emphasis on projective identification and container/contained. It follows what happens in a treatment where both analyst and patient are unable to examine dysregulating feelings related to the size of their bodies and what their bodies conveyed regarding feeding, overeating, and being fat. This article traces the analyst’s own growth and learning, starting from a position of sharing the patient’s fat hatred, through her own integration of previously dissociated fat hatred, the consequent emergence of an impasse and what she learned in its working through. It highlights how the impact of the patient helped her to change, reciprocally enabling the patient’s growth.