How often does it happen that a perfectly valid therapeutic approach fails, although there may be nothing wrong with that approach whatsoever? Maybe, for example, an outside force exerts a negative influence on the relationship between a therapist and the person being counseled. Among adults, an insecure partner, especially one who lives with the patient, can sabotage weight-loss efforts with ease.
In a far different setting, on the conceptual level, there may be difficulties, like those that can occur in the implementation of Internal Family Systems (IFS) theory. This modality is said to be designed for patients 18 and older, and may seem to have only a slight connection with childhood obesity — at the moment.
But if our current offspring emerge from their teens still carrying extra weight, the popularity of IFS guarantees that they will run into it sooner or later. It claims to be very successful in dealing with weight-control issues centering around either substance addiction (to food itself), or behavioral addiction (to the process of eating). IFS raises questions that may seem to stray far afield, but which provide glimpses into areas of human psychology that are quite different from jogging for miles, juggling calories, or judging portion sizes.
Human frailty never ends
In the Sixties, group therapy became popular and helped scads of people with various problems. There was a lot less obesity in those days, but for some folks, it was their main difficulty. For them, and many other types of help-seekers, there were side effects.
What if, during every group therapy session, a patient was fantasizing… “I’ll lose so much weight, and at our anniversary parties, I’ll tell the story of how we met because I couldn’t fit into my jeans, but my doctor fell in love with me. And he/she will playfully pinch my bottom, and all our friends will laugh and laugh…”
This is a tempting road to explore, because in the hearts and minds of most psychological counseling participants, to win the approbation of the therapist is golden. It is a powerful drive, and the possibility exists for a patient of any age or sexual orientation to develop very strong, situationally inappropriate feelings toward their therapist.
Another question
How heavy an effect does this need for approval, validation, and love exert in already-established obesity prevention programs? Everyone who enters therapy might not visualize an engagement ring, but plenty of us like to believe that we are the favorite patient, the one whose astonishing improvement makes it all worthwhile, not like those ordinary schlubs our therapist merely tolerates.
How does it tend to work out, for instance, in IFS, where the therapist has a chance to become acquainted with not just one aspect of the help-seeker, but with an entire cast of interior characters, each one of them whispering into the patient’s ear whenever they feel like it?
The future is now
All of this brings up a much bigger and potentially more dreadful problem that gains ground daily. Never mind being the favorite patient. Do we really, really need our psychological maladies to be addressed by a human intelligence or consciousness, at all? Or, for therapy to succeed, can a mere simulacrum do the trick? If we truly require a certain amount of human attachment in this context, how can the most useful amount of it, along with the correct amount of intellectual and emotional content, be achieved and maintained?
A human connection, whether through office visits or online counseling sessions, can affect a patient at any age, though with varying manifestations. In the case of weight-related problems, the relationship involves ideas and emotions about the body, and this additional dimension can be tricky.
What happens when human practitioners are replaced by chat robots and artificial intelligence? How has that method succeeded so far? In light of recent news reports about teenagers persuaded to commit suicide by human-imitating AI programs, the very existence of such an abomination is terrifying. (On the other hand, the issue becomes more complicated when, for instance, we learn that AI counseling may be of great help in preventing suicide among military veterans.)
Two views
Getting back to Internal Family Systems, here are two pertinent quotations from an article by Rachel Corbett, who conveys some of Richard Schwartz’s ideas about how the method that he originated (and developed at Castlewood Treatment Center) “is really the opposite of fragmenting people.” Corbett writes,
Clients come into treatment with their parts already intact — like a bulb of garlic, rather than the layers of an onion, he has said — “It’s not like I’m creating them.” Instead, IFS therapists work on “rounding up all those outlying parts and bringing them back home.”
Corbett views it all from another angle (and more about that is coming up next time). She cautions:
Most of Castlewood’s methods, starting with its use of IFS and the focus on trauma, contradict the prevailing playbook for treating eating disorders. Dredging up harrowing memories can overwhelm already fragile psyches and may lead to self-harm, substance abuse, or other unhealthy coping behaviors.
Your responses and feedback are welcome!
Source: “The Therapy That Can Break You,” The Cut, 10/30/25
Image by ThomasWolter/Pixabay
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