Body Talk: Looking and Being Looked at in Psychotherapy

An increasing number of patients in psychotherapy, male and female alike, express anxieties and obsessive concerns about their bodies—thinness, facial features, being toned, or other aspects of their appearance. Less concerned with issues of gender and sexuality than with the narcissistic cathexis of the body and ways of shoring up the body ego, these patients require a specific responsiveness from clinicians.

Dr. Janice Lieberman recommends that the traditional emphasis placed on patients speaking and therapists listening be balanced with an increased awareness and understanding of the many visual cues and communications exchanged in therapy. Stressing the important role of vision in the development of identity formation and self-esteem, she discusses such issues as mirroring, the gaze, the gleam in the eye, feeling invisible or falsely mirrored, and the learning early on to attach positive and negative values to one's appearance as they become manifest in the therapeutic relationship. These patients use the therapist as a spectator whose focus on their bodies helps supplement insufficient cathexis and repair feelings of deficit. Amply illustrated with clinical vignettes, Dr. Lieberman's treatment of patients who come to therapy with heightened narcissistic body awareness is both informative and instructive.