My clinical experience

Following graduation from secondary school, I studied for a Bachelors of Arts

Degree and following that an Honours and a Master’s degree in Psychology. In 1984 I registered with the Professional Board as a counselling psychologist and started a private primary care practice, specialising in working with people who had weight problems. During this time I discovered that weight was a primary issue in governing the way a person felt about him- or herself. Overweight and obesity had a negative effect on my patients’ self-esteem. In affecting the way they felt about themselves, it affected the way they projected themselves, and in affecting self-projection, it

affected every relationship that they were engaged in. So overweight was not simply accompanying dysthymia and depression, but overweight in fact was a major

causative factor in my patients’ development of depression. I also discovered with many patients the causes for being overweight were actually not always

psychodynamic but instead cognitive and behavioural. In many instances the causes for overeating were easy to identify, unravel and understand. This was a significant insight for me and influenced my thinking in writing the ITAND Programme. My approach to therapy was integrative. In addition to my psychodynamic orientation, I employed a transactional analysis and cognitive-behavioural therapeutic orientation

which led me to reach an insight which I believed could contribute to a “paradigm shift” for the treatment of overweight and obesity.

Through a counselling process with many overweight and obese patients, I

discovered that their destructive relationship with food, their weight and their bodies was attributable to four major factors – all of which were underpinned by the “diet mentality”, that is, a mind-set generated by prescriptive, restrictive eating plans and schedules.

• The first factor was that diets, and the associated behaviours, alienated my patients from their own physiological functioning. More specifically, it alienated them from their physiological cues regarding hunger and satiety. The loss of ability to identify hunger was critical in causing, maintaining and escalating my patients’ struggle with food, weight and their bodies. While I uncovered that many patients had lost touch with their physiological cues of hunger and satiation through family eating scripts and/or more complex emotions associated with life events, diets served to overlook this alienation, thereby exacerbating the very issue which required focus in order to regain personal comfort with food, weight and their bodies. My patients required physiological awareness coaching which focused on learning hunger satiation awareness in order to lose weight and develop a comfortable relationship with food and their bodies.

• The second contributing factor to the destructive relationship patients had with food, their weight and their bodies, was that diets and the associated

behaviours had resulted in my patients externalising their locus of control in the belief that an external authority, such as a dietician or weight physician, would provide the answer to their struggle with food, weight and their bodies. My patients needed to be coached in internalising their locus of control regarding food and eating in order to restore the physiological and emotional integration essential to permanent weight loss. My patients needed to learn that they were able to determine for themselves when to eat as well as to decide what to eat and how much to eat through remaining in touch with their relearned awareness.

• The third factor was that diets physiologically disempowered my patients and resulted in their believing that they had insufficient adult capacity to make their own food decisions and choices. This further alienated them from their core physiology, and reintroducing all food back into my patients’ lives through coaching became essential. They needed to be assisted in recognising that they could behave normally around all food.

• The fourth, and possibly most significant destructive feature of diets, derives from my insight that the psychological foundation on which diets are based is incompatible with personality integration. The psychological foundation stone of diets is the concept of “willpower”. “Willpower” I realised through inductive reasoning and my application of TA, is in fact the “power of the will” of the “Critical Parent” (CP) ego state over the “Child Ego State” and the will of the rebellious “child”. While the Parent ego state was “in control” my patients would lose weight on their diet, but invariably the imposition of “willpower” resulted in the escalation of resentment and defiance in the Child ego state, causing the “Child” ego state to become rebellious and defiant. This dynamic resulted in the “Child” ego state overthrowing and defeating the “Parent” ego state at some stage in every diet. With the rebellious “child” in control the diet is overthrown and defiant compensatory eating for the imposed deprivation follows. This invariably results in regaining the weight which was lost in the initial stage of the diet in which the “Parent” ego state dominated. I discovered for myself and my patients that only by giving up dieting, empowering the “Adult” ego state, and re-contracting between the “Parent” ego state and the “Child” ego state, would he or she never again have autocratic restraint imposed and never be forced again to endure feelings of continued

deprivation, and would desired weight loss be attained as well as maintained. I also uncovered that nutrition education, exercise education and the learning of psychological strategies, including problem-solving skills which enhanced the Adult ego state, were essential in attaining weight loss goals which were sustainable.

My unique application of psychologically integrative counselling, as well as

transactional analysis, in assisting my patients to achieve sustained weight loss, and simultaneously regain personality integration, improved mood as well as

psychosocial functioning, provided the theoretical framework for the ITAND approach on which this study is based.