“Sitting Through Silence: Countertransference, Apathy, and the Frozen Time of Eating Disorders”

In the analytic work with patients suffering from eating disorders, we often encounter a peculiar emotional atmosphere. Sessions may be filled with silence, precision, and control—and yet something vital feels absent. As analysts, we may find ourselves experiencing an unsettling sense of flatness in the countertransference: a quiet internal withdrawal, as though we, too, have become emotionally frozen.

This phenomenon often expresses itself in two distinct but interrelated experiences: apathy and the sense of merely “serving time” in the session. We feel as though we are simply enduring the hour—waiting for it to pass—without vitality, movement, or mutual resonance.

But this numbing sensation is not meaningless. It is a deeply informative signal from the analytic field. And if we fail to recognize and explore it, we risk colluding with precisely the defenses that maintain the patient’s suffering.

The Eating Disorder as Psychic Retreat
Anorexia, bulimia, and other eating disorders are not simply about food, control, or appearance. At their core, they are complex psychic configurations—forms of retreat from intolerable internal states, often rooted in early relational trauma or deeply conflicted object relations.

As Joyce McDougall (1989) described in Theatres of the Body, these are conditions in which emotional conflict is enacted through the body rather than symbolized in the mind. The psyche goes mute, and the body becomes the stage for expression. In such cases, the analytic relationship can feel strangely empty. Patients may speak, even eloquently, but the affective charge is missing. Emotional presence is withdrawn. Words become hollow.

The Analyst’s Apathy: Frozen Countertransference
In response, we as analysts may find ourselves feeling curiously numbed. The patient is present, and yet we feel detached—tired, passive, even bored. Time seems to stretch endlessly. There is little urgency, little inner response. This is not a failure of technique or attention, but a transmission of the patient’s internal world.

R.D. Hinshelwood (1999) notes that such countertransference states often reflect the patient’s unconscious dynamics. The apathy we experience may be the very apathy the patient feels—but cannot yet name. This can be particularly prominent in eating disorders, where internal deadness or dissociation has become a way of surviving unmanageable affect.

The Danger of Collusion
The greatest risk here is unconscious collusion with the patient’s defensive structure. We may unwittingly mirror their withdrawal, fall into procedural routine, and “wait out” sessions without emotional investment. In doing so, we reinforce the psychic retreat rather than challenge it. The analytic setting becomes an echo chamber of emptiness.

This is a serious risk. The patient may perceive our disengagement—however subtle—and experience it as confirmation of their internal aloneness or unworthiness. The analytic potential of the treatment suffers. In some cases, the result is chronic stagnation; in others, abrupt termination.

Reclaiming Meaning from the Void
But the very experience of apathy can become meaningful—if we are able to reflect on it. When we catch ourselves “serving time,” the question is not What is wrong with me? but What is being enacted here?

When the analyst’s mind falls silent, it may be resonating with a part of the patient that is similarly silenced. When nothing moves in the session, it may be because movement has become too dangerous for the patient. A stance of reverent curiosity, rather than frustration, is needed.

John Steiner (1993) wrote about psychic retreats—pathological organizations that protect the self from unbearable pain by shutting down mental life. Our task is to gently illuminate this shutdown, not shatter it. We can begin to interpret the silence, not simply fill it. We can begin to feel into the void—thus becoming the first presence to do so.

In this way, countertransference apathy becomes not a failure, but a compass. It directs us toward the most defended places in the patient’s world—the places where time itself has stopped. If we can endure those places together, without retreating ourselves, we may offer something truly transformative: the beginnings of meaning, where once there was only mute survival.

References:

McDougall, J. (1989). Theatres of the Body: A Psychoanalytic Approach to Psychosomatic Illness. New York: Norton.
Hinshelwood, R. D. (1999). Countertransference and the Patient’s Contribution to Difficult Therapeutic Relationships. British Journal of Psychotherapy, 16(1), 56–66.
Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic, Neurotic and Borderline Patients. London: Routledge.