not constitute anorexia. Because the disorders are in vogue now, some people are seeing an anorexic or bulimic "behind every bush." I think treatment professionals must be careful not to overdiagnose and inadvertently make women even more uptight about their appetites and lifestyles. That would defeat the whole purpose. "Normal" healthy eating varies a great deal with lifestyle, mood, age, and time in menstrual cycle, and l'urge women to allow for the changes.

But when food and weight become an obsession, when they interfere with activities, work and relationships, when they sap a woman's valuable energy from life's real challenges, that is the essence of an eating disorder. Usually these women-bright, articulate and competent-find that "will power" no longer works when they try to change and they feel even more like failures. This is when psychotherapy and self-help groups are in order.

Illusions of Intimacy

By Fern Levy

Diane Keaton: "Sex without love is an empty experience."

Woody Allen: "Yes, but as empty experiences go, it's one of the best.”

Therein lies the dilemma surrounding intimacy, sex and love. How are they connected and how can we integrate them in order to establish and maintain fulfilling relationships? How do we avoid having “a case of the Windows" as described by a Harvard student in Esquire: "You look at the stranger sleeping next to you the next morning, you look out the window, and you want to jump." And can we have intimate relationships without sex?

Choosing a therapist must be done very carefully, as it is important that s/he be quite familiar with eating disorders, both theoretically and in practice. I have heard too many sad stories of women who have seen therapist after therapist, some of them extremely skilled and competent, who have told them ridiculous things such as, "Well, just eat," or "Just stop when you're full." These women inevitably drop out of therapy, unchanged except for being a little more frustrated and depressed since they'verated from the fear of unwanted pregnancy and ennow even failed at therapy These are difficult behaviors to change and the therapist must be trol over our reproductive lives, we have been em-

familiar with the territory. So I would ask the therapist about her approach and experience with clients.

The actual discipline of the therapist (psychiatry, psychology, social work) doesn't matter, although a competent physician should be consulted to deal with medical problems such as amenorrhea, electrolyte imbalances, etc, Mode of therapy and theoretical orientation (behavioral, Gestalt, etc.) can vary. Through the years all sorts of treatments have been tried, ranging from psychoanalysis to anti-psychotic drugs, to insulin shock (one of psychiatry's grislier offerings). Most haven't worked, but lately professionals seem to be agreeing that considerable success can be achieved through combinations of individual, family and group therapy. Hospitalization and medical intervention of course are necessary when the disorders become life-threatening.

I personally have found that for women who are living on their own, away from family, a combination of individual and group therapy is the best. The troublesome symptoms and actual behaviors need to be eliminated and this can be done with behavioral contracts worked and reviewed in individual therapy. Also, intense individual work can be done with the therapist. Then, in a supportive group, common issues of body image, sexuality, societal pressure, etc., can be worked out. My approach in both individual and group therapy is rather Gestalt-ish, present-oriented and attentive to both surface behaviors and complex underlying problems. For younger women and adolescents still living at home; family therapy is necessary in combination with individual therapy for the girl.

Different therapists will certainly vary in their styles and theoretical orientation, but there are some problem areas which must always be addressed in any eating disorder therapy for it to be successful. As suggested already in this article, they are:

1) Body image-Educating the woman about pressures of socialization and how to combat them. Helping her to love and accept her body, and put it in perspective as part of her, not all of her. Expanding her concept of health and beauty beyond “being thin".

....

2) Self-concept-Helping the client to expand and (continued on page 14)

During the last fifteen years, since the advent of the women more or less safe and effective contraceptive methods and the women's movement, women have been liber-

couraged to explore their sexuality. With greater con-

powered to acknowledge, appreciate and act out our sexuality.

Paradoxically, however, these same "freedoms" have created a new set of cultural constraints and have encouraged us to engage in some of the same behaviors we have always found despicable in men. We have been told to have clitoral, vaginal, simultaneous, multiple, sequential, and extended orgasms as we compete for G-Spots on the Orgasm Olympics team. And we have sought out casual sex, instant intimacy, one-night stands, and notches on the bedpost, believing that somehow, as we learned to behave more like men, we would become better

women.

Part of the confusion stems from the invaluable pioneering research of Kinsey, published in 1953, and Masters and Johnson, published thirteen years later in 1966. While we must be forever grateful for their

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"Oh, excuse me I thought you were someone I knew.”

Y-

Psychology Today

painstaking research, we must also be forever aware. that an unintended by-product of their work was to reduce our budding sexuality to orgasmic functioning.

The Kinsey study was primarily an investigation of orgasmic behavior just as the Masters and Johnson study was an investigation of the physiology of orgasm. In fact, Kinsey and his research associates added up all orgasms reported by an individual over an average week to determine, in, a rather simple-

•

minded and mechanistic way, the six major "outlets" their subjects used to attain orgasm. And Masters and Johnson creatively invented a plastic phallic-shaped camera to study the physiology of women's orgasm. We must wonder who clicked the camera...and how....

So while the researchers set out to provide us with much-needed information about a wider range of sexual behavior than we were familiar with, we ended up with more pressure to perform. It thus became imperative, to have orgasms whenever possible with whomever was available. And so the establishment of intimate relationships became secondary to fulfilling our over-researched ability to experience the "right kind" of orgasm. The non-goal-oriented process of love-making was lost in all the hype.

Is it any wonder then that both sexuality and intimacy are equated with having sex, which is equated with having "good" orgasms? As a result, our need --for emotional intimacy is clouded by our need for physical intimacy. Our need for security and attachment is clouded by our need for excitement. And our ~~need to be known and understood is clouded by our need for freedom of sexual expression.

By now, I think we know what intimacy isn't. But what is it? First of all, intimacy can exist in all types of friendships and relationships, including those that do not even potentially include a sexual dimension.. The following are ten concepts that are components of intimacy:

1) free choice

2) mutuality

3) reciprocity

4) trust

5) attachment

6) caring

7) profound identification 8) empathy

9) delight

10) unconditional love

Free choice exists when both individuals are involved with each other without internal (intrapersonal) or external (interpersonal) coercion. Our free choice ceases to exist when we impose someone else's values and standards on ourselves, for example, the beliefs that "I am nothing without a partner," or "S/he loves me so I should love in return:”

Mutuality, and reciprocity are also very important facets of intimacy. Mutual feelings and the reciprocal expression of these feelings are necessary to a good relationship.

Mutual trust, attachment, and caring also play a

role in establishing and maintaining intimate relationships. A high self-disclosure level indicates that trust exists: "I feel that I can confide in —— about virtually everything.” Attachment means, "If I were lonely, my first thought would be to seek —— out.” And caring: "I would do almost anything for --

Profound identification and empathy also need to be present within the context of intimacy. Being empathic means attempting to experience another's life from her/his perspective, without judgment, as if you were actually the other person. Profound identification is closely related to empathy, identifying with the experiences of another in such a deep way so as to imagine that what happened actually happened to you, too.

And what is friendship and loving without the experience of delight and joy in sharing one's total self with another? Usually, smiling, laughing, and an

(continued on page 15)

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