I have been following with great interest the dialogue concerning Johanna Tabin's valuable presentation. In studying carefully the case material, I see differently from others the incident about Laura, her mother, the dog, and the boyfriend. I've been reluctant to comment because although I have worked with a number of patients with eating disorders, I am by no means an expert. But since all of you faculty continue to encourage differences of opinions, I decided to speak. So, here goes.
I am not so certain that the boyfriend, Tom, was such a good guy in this situation or that he many any genuine effort at all to resolve the conflict between him and Laura. What I am specifically disagreeing with is that Laura "threw up just after Tom demonstrated that . . .he ought to prevent such a thing from happening in the future." Here's what I see in the incident: Tom promises to take care of Laura's dog so that Laura can work later. Laura gets home earlier than expected only to find that Tom never walked the dog or did anything to care for the dog. Fortunately, the dog got walked anyway by the boarder. Laura has something to eat because Laura "was hungry after a day at work."
When Tom appears, he behaves in a way that "abusers" (I'm using this word very loosely and generally here) normally act: first they neglect, abuse, injure, or ignore; then they deny that their "abuse" was significant and use crazy-making maneuvers to make the victim feel uncertain of and unentitled to their own feelings and perceptions; if this denial fails to get the victim to submit to THEIR view of reality, often they try to win over the victim with apologies and empty promises. I have no idea what the details are around Laura's substantial and chronic sexual abuse from the horrendously early age of 3 until puberty, but I am quite certain that that experience was pretty important in forming who she is today. Buy back to the case material: So Tom tells Laura that "it was no big deal" that he treated her dog negligently since someone else took care of the dog anyway. Laura continues to express her exasperation with Tom's "insisting that it was no big deal." Laura continues to have very strong feelings about Tom's original negligence AND now also about his denial that his negligence has any significance at all. As Laura stays angry at Tom, Tom promises that in the future he will remember that this incident was important to her (even though he cannot understand at all why it is important to her). Tom promises that in the future he will "try to let her know so that something workable could be arranged." The major problem with this so-called solution is that in reality TOM FORGOT to take care of the dog. Tom "was not working late. He was preoccupied with a report that he needed to make, only that was not immediate." So, if in the future Tom is preoccupied or forgets a promise of care, how can he try to let Laura know so something workable can be arranged?
It is at this exact moment that Laura excuses herself to go throw up. Sure she returns to Tom still feeling angry. She SHOULD have concerns about Tom. Tom is not listening to her feelings at all. Tom is not respecting her feelings at all. Tom is trying to placate her with empty promises that make no sense and Laura knows it. Tom is behaving like an abuser. Perhaps Laura's childhood abuser made promises or told Laura stories to placate her. In any case, her history of sexual abuse serves as quite a foundation for her feeling unentitled to her own feelings and her own reality. In the current situation, Tom was trying to force Laura to "swallow" HIS view of reality. I see Laura's throwing up at this moment in time as a refusal to "swallow" and submit to HIS view of reality.
Johanna, I see how Laura "set the scene" in the session, but I interpret it differently. I see Laura as talking first about her mother's taking care of her by picking her up from work and then later about her boyfriend's FAILURE to take care of her by behaving negligently. I see the entire eating behavior described in this session as an attempt to "take in" her own sense of reality and later "throw up" the reality Tom tried to force on her. I think the reason Laura had such a positive response to your interpretation was because she felt your support of her connection to her mother. I see Laura's goal as: To be BOTH autonomous AND connected in relationships. You helped her tremendously in the employer incident by showing her she could be her real, autonomous self and still keep her relationship to her employer. In the current incident, first you support her "justifiable anger" at Tom, and then you mention her "comfort with mother" allowing her to eat. When you made the statement about her "ridding herself of food/mother," I think Laura responded to the idea of losing her mother rather than to your idea of the food representing her mother. Your support of her wanting a connection with her mother allowed her to feel safely her love for mother. And mother IS dying apparently. Mother is dying and Laura has not until now been in touch with her saddness? In a single sentence, I see your support of Laura's interests both at work and in her relationship with her mother as helping Laura to feel safe now to do some profoundly important work on her relationship with her mother before her mother dies.