Dear Cary,
A year or so ago, I moved to a new city and took a great new job. Everything was going well, my job was great, and I have a nice house and made some good friends. Before I moved, I was seeing a therapist and a psychiatrist for depression issues. My psychiatrist suggested I try medication, which I did and it helped a lot. Now that I am in a new city, I found a wonderful psychiatrist and an MSW. I continue to take the same medication prescribed by my original physician; but as many know who suffer from depression, it's an ongoing battle. So, talk therapy has helped, especially during my adjustment to living in a new and bigger city and all the changes that come with that.
I have a great relationship with my MSW therapist and see him roughly once per week. I have been seeing my psychiatrist regularly also. My psychiatrist has recently finished psychoanalytic training and is now a licensed psychoanalyst. After seeing him for my medications for a few months, he asked if I would be interested in starting psychoanalysis with him at a reduced rate. He said I would be a good candidate for psychoanalysis since I am educated and verbose.
Now for my problem: My psychiatrist is highly educated and we connect on many levels. When I first met him, I was taken aback by his size -- the man weighs at least 600 pounds. He has some health issues and he is in his early 60s, so I doubt that any drastic change to his weight through surgery is a viable option. At first his weight didn't bother me too much, since he sat behind his large desk during our early sessions. Now that I have agreed to go into analysis with him, he now sits in a chair just behind me and I lie down on a sofa. This arrangement bothers me because each time I enter his office, he is sitting there, as huge as can be, and his size is troublesome and startling to me. I am a thin man, who goes to the gym regularly; but I am not obsessed with my weight or my body image. I don't think I have issues with obesity, but his weight is upsetting for three reasons:
One, his shear size is disturbing to me. I didn't pay much attention to his weight when he sat behind his desk, but now, he sits across the room and he is the first thing I see when I enter his office. Each time I walk in, I almost have to avert my eyes, he is just that huge.
Secondly, I worry about his health. He has had some weight-related surgeries, i.e., two knee replacements and he has been hospitalized for high blood pressure and diabetes. But overall, I think he is one of the “healthy obese.” He exercises and is on a strict diet, which makes me think his weight may be the result of a chemical imbalance, not overeating. However, I don't think losing a few hundred pounds at this point is a priority or a viable option for him because of his age.
Thirdly, I am in analysis with him and the relationship between patient and analyst is critical to the process. I sometimes feel that I don't reveal as much in our sessions because I don't want to get too close to my analyst because I'm afraid he's going to keel over and die, leaving me with unresolved issues, grief and feelings of abandonment.
We have never spoken of my doctor's weight, and I am mortified even thinking of bringing up the subject. After all, I am working with him on uncovering the root of my depression -– mind to mind, so to speak. Why am I hung up on the physical aspects of my analyst?
The whole thing makes me feel shallow and superficial. Any advice would be great, Cary.
Thin, Shallow and Depressed
Dear Thin, Shallow and Depressed,
You are hung up on the physical aspects of your analyst because it is an obvious fact that you have difficulty saying anything about. It's not his weight, but your difficulty talking about his weight. For that reason, this phenomenon can be useful in therapy. A discussion of your analyst's weight could lead to a discussion about other areas of your life where you want to say something but don't feel you are allowed to. This in turn may lead to a discussion of the behaviors you have adopted instead of communication -- your methods of avoidance and how that avoidance makes you feel.
Perhaps you feel that you are supposed to pretend that everything is fine when it is not. That can make life harder than it needs to be.
So I suggest that you tell your psychiatrist what you have told me.
If discussing it leads to a better relationship, then feel free to continue if you want to. If it improves things a little but you don't want to continue, feel free to find a new analyst. It's really up to you.
Here is an informative paragraph from the WebMD section on psychodynamic therapy -- which is similar to psychoanalysis:
"There is also an emphasis in psychodynamic therapy on relationships, especially the relationship between the therapist and the patient. Seeing how the patient reacts inside that relationship gives the therapist an indication of how the patient reacts, feels, and interacts in other relationships. Often, psychological difficulties stem from problems in the way someone relates to others that interfere with the ability to have emotional needs met. An aim in psychodynamic therapy is to recognize those difficulties and to find ways to resolve them or cope with them better."
In this case, your reluctance to reveal what you are thinking about your psychiatrist's weight may be part of a pattern of how you relate to people, and how that style of relating fails to get your needs met. So it sounds like it would be useful to bring it up. If you do not want to lie down with him sitting behind you, but would prefer to sit up and look at him, it would be useful thing to say. Perhaps you and he could explore the things that run through your mind when he is sitting there. There may be irrational fears that you are reluctant to express, but it would be good to express them, to get them out in the open where you and your analyst can regard them together, with intelligence and compassion.
His job is to create an atmosphere in which you feel safe bringing such things up. Your job is to bring them up. So trust the process. Explain what is going on and have a dialogue. It's possible that he has fears of his own that he is bringing into the session. If so, in order to build trust, he may need to say something about that.
I'm not a psychoanalyst. I don't know what his protocol is. But I suggest you present him with these challenging feelings and take it from there.
There is an elephant in the room. You and he must face the elephant together.
Shares