From Radiance Fall 1987 issue

Alissa is eight years old.

She is painfully shy. She does not converse easily. She will not make eye contact and she does not like to be touched. She walks with her head down, afraid to look around her, suspecting all eyes that are on her. She wears oversized sweaters and baggy pants, and her bangs cover half her face. She smiles infrequently. Her brother teases her incessantly about how large she is, and how much she eats. He tells her that she smells bad, and he calls her Petunia Pig.

At school Alissa skips lunch because she’s afraid other children will see her eating. She is mortified to go to P.E. class. She never raises her hand in her classes because she does not want to be called on. Alissa does all right in school, earning Bs, but her parents disapprove of her grades because they cannot tolerate someone who doesn’t work to potential.

Alissa does not have a favorite teacher, and no one at school seems to pay attention to her. She has one best friend, another outcast, who is tall and gangly. They are referred to as Mutt and Jeff. They are always seen together, huddled, sneaking looks at the outside world. Mostly, Alissa is an invisible child, although she is convinced that her presence takes up a great deal of space.

Family life is far from ideal. Alissa gets home and withstands her brother’s verbal taunting for two hours. Her parents arrive home together. Alissa’s mother is fit and wears tailored clothes. Her father is successful and a workaholic. Alissa has already eaten the food she has stored in a secret place in her closet. Sometimes, her brother uncovers her latest stash, and she’s constantly afraid this will become a topic for conversation at dinner.

Alissa’s mother cooks dinner, and dinner takes place without enthusiasm from anyone. During the meal, most of the remarks directed at Alissa are negative. Her brother, for example, reports the jokes that were played on Sis at school. Everyone’s behavior at the dinner table indicates that two sets of rules exist for each child, the "good" child and the "bad" child. What makes Alissa bad is that she is fat. What makes her brother good is that he looks physically good.

Alissa is scrutinized by her mother every day. They discuss what she will wear. "Are you wearing the same old clothes again? My God . . . don’t you have any self-respect at all? I’m telling you now, unless you wear some of the clothes I’ve been buying you, I’m just gonna stop buying you clothes altogether . . . It’s clear you don’t care how you look anyway . . . Your father wanted to invite his friends to dinner but he was ashamed to let anyone see the tub of lard we call our daughter . . . I’m going to take you to a shrink to see if they can figure out how to get you to stop eating us out of house and home . . . I just can’t believe you’re my flesh and blood."

"But Mom," Alissa thinks to herself, "I’m sorry. I don’t know what’s wrong with me. People don’t like me. Nothing I wear looks good. I’m ashamed too. But mostly I’m sorry for you and Dad, because I know how gross I look. I wish I were dead. I wish you had adopted me and could give me back. I wish I could get a really bad disease and get skinny from it. I wish you could trade me in. I wish I could trade me in. I hate to go to school. I hate people looking at me. I can see them laughing. I know how I look. I look awful. There’s nothing good about me. Why couldn’t I look like my brother? I can’t even exercise. I can’t bend down. When it’s time to swim, my body and face get hot inside, and I could just die when I have to go into the pool. When I went in with my towel wrapped around me, I could have died. And I hate to try on clothes. I know nothing fits. And I can see the disgust in your face when I try things on that don’t fit. I can’t stand to have you look at me. I can’t stand to look at myself. I wish I were invisible. I hate myself."

The mother described her child as inadequate, dowdy, and obese. When I asked if there were any positive qualities she saw in her child, she stated that Alissa was able to entertain herself alone in her room, and that she did "keep out of the way." She said that the child was causing marital problems, since her husband felt that she should be able to get the child to lose weight.

When I asked for a history, it was clear to me that Alissa had been born as a result of an unplanned pregnancy. The parents were Christian, did not believe in abortion, but felt that the child was a mistake they would have to "live with." The pregnancy was difficult, and resulted in a weight gain that the mother found intolerable. She angrily told me that it had taken her four years to achieve her normal weight. She claimed that the infant was "no picnic." Feedings were perceived as contradictory because even though the child cried for food, she spit up half of what she was given. The mother’s explanation for this was that the child couldn’t wait to stuff herself and made herself sick as a result.

The mother says the child embarrasses her, and she wants some assistance to help Alissa lose weight. When I offered to assess Alissa’s situation, her mother firmly stated, "Her only problem is she can’t control her appetite, and she looks like hell . . . of course, no one wants to be around her." When I asked how she had helped her daughter in the past, she replied that she had tried a thousand different diets and punishments for the past year, and then simply "gave up." When I asked how Alissa and her brother got along, she said "He does the best he can, given that they go to the same school. He has to bear the burden of his relation to her."

When I finally met Alissa, I found a severely depressed child with an extremely negative self-image. She felt unacceptable, unloved and unworthy. She was helpless and hopeless. She desperately wanted her family’s approval, but none was forthcoming. Her drawings, her play, her comments all suggested a child whose spirit was broken, and who assumed a tremendous responsibility for the problems in her family.

Her parents were unwilling to meet with me unless I was ready to suggest a weight-reduction program. I insisted that the issues were deeper, and that I was concerned about the child’s depression and self-deprecation. They acquiesced to twice-weekly visits for a specified period so that I could determine the best "weight-reduction program" for her.

The work was compelling. I allowed the child to be herself, free from judgments. She looked forward to our sessions, since I was the only nurturing resource in her life. Slowly, we explored her sense of being defective. Slowly, we looked at her strengths. She developed trust, and began to see herself through my eyes. She began to develop confidence in certain abilities—she was one of the most artistic children I had ever seen. I encouraged her, and was by her side when she began to validate her accomplishments.

She was afraid to take her work home. One day she was able to, and her father responded positively. Her father’s validation, slight as it was, meant the world to her, and gave her hope. Her mother still ignored her talent, asking, as she always did, if I were discussing her weight.

I helped Alissa love herself. My premise was that she should love herself as she was, and learn to appreciate her cognitive, emotional, creative and spiritual aspects, so that she could accept her physical being later. I tried to achieve the same goal with her family.

The child was a scapegoat in this family. She was held responsible for her father’s slow succession up the career ladder; for her brother’s disruptive behavior; and for her mother’s unhappiness with her own career. The mother held her responsible for damaging her body, and for restricting her education (she had quit school when Alissa was born). Her father was unfortunately passive and disconnected. His energies were focused on his job, which resulted in his wife’s feelings of rejection and neglect, feelings that she inflicted upon her daughter.

Alissa was lucky. Through therapy she had a "corrective experience," in the sense that I allowed her to be herself. I repeated key phrases to her; "you are special just the way you are," "you are a pretty girl," "you are smart and I like being with you because you’re fun, too." I remember her silence and look of disbelief when I first made these remarks. But I was able to convey the sincerity of my words, and slowly she allowed the thoughts to enter her mind.

I took Alissa on outings to the park. I encouraged this reluctant child to experience the pleasure of physical activity. She was so constricted by her negative self-image that she had learned to hold still, in an effort to remain unnoticed and free of ridicule.

I traced her body on a large piece of paper once, and together we colored in a wonderful outfit. I would comment that this body was strong and healthy. She took great pride in picking out the colors to dress her doll. When it was finished she was proud of her art-work, and the task had been fun and not layered with the shame and anxiety I had come to expect.

My work with Alissa was positive for her. Her parents, however, treated the therapy with the same disregard as they did almost anything Alissa liked. They constantly asked me when they would see results. I kept telling them that the results were happening under their very eyes. They did say that Alissa was taking better care of herself (combing her hair, "matching" her clothes, etc.) but the enormity of such events escaped them. Alissa was developing a positive identity.

I met with her parents for a number of sessions. They listened attentively as I talked about their daughter. Their quizzical looks usually meant that they thought I was describing another child. I told them I believed that if they ignored the weight issue, and restrained themselves from making comments that pressured Alissa, her weight might begin to decrease. My goal was not to have Alissa lose weight, but to get her parents to stop badgering their child. They were willing to try anything, and acquiesced to my request.

Alissa noticed the change right away, and responded initially by eating more food, and then by eating as she always did. She no longer needed to horde food. She began to believe her parents might actually like her.

Alissa developed an interest in volleyball, and played the sport well. I instructed her parents to make family outings, and after postponing six times, the outing occurred. Alissa’s parents were surprised at her agility, and refrained from making anything but positive statements.

While her parents changed minimally, Alissa thrived. I see her or hear from her at least once every six months. She is now fourteen, and feels more optimistic about herself, her talents, and the future. ©