My boundary then should be established in such a way as to discourage any attempts to manipulate me into validating Josephine's false perceptions of her own body as "overweight" or even "fat" as opposed to her conception of the ideal body type. My personal boundary needs to enable me to help Josephine towards a healthy body perception which should precede any attempts at changes in her diet.
Time is a naturally imposed boundary by the therapy situation. This enables me to help the client within a certain time frame. Since many of her perceptions will have to be changed, this is a good way to help her gradually towards a new frame of mind, without overwhelming her for prolonged periods of time.
The only boundary violation I would consider would be in terms of place and situation. Because of Josephine's specific therapeutic needs, I might invite her for dinner in a public setting such as a restaurant. Here I would be able to make her aware of the "normal" concept of a healthy diet by pointing to certain items on the menu that she can eat without guilt while also maintaining a healthy diet. I could also point towards certain restaurant patrons with healthy body types to make her aware of what this constitutes. This will only be during the later sessions, however, when I have ascertained that Josephine has at least entered the contemplation stage of change. First, my focus will be on making her aware of the flawed nature of her body perception and the nature of her eating disorder as a disorder in itself. If ever a restaurant setting is to be used for future therapy sessions, this would be on the strict premise of the therapeutic purpose. Furthermore, at least one family member -- perhaps ideally Josephine's mother -- would be approached for permission to use this kind of boundary violation for the purpose of continued therapeutic success.
Another personal...
At least during the first few months of therapy, I will address Josephine by her last name, providing a platform of some distance even while attempting to appear caring and understanding of her situation. This will facilitate my attempt to dissociate myself from the role as mother, particularly as Josephine appears to have concerns and issues with her mother that must be resolved before therapeutic success can be achieved. Too much linguistic informality early in the therapeutic relationship could adversely affect my attempts to help Josephine work towards a healthier body image. She needs to reach a point where she can feel satisfied that her body is healthy and fit without excessive concern about weight or the types and amounts of food that she consumes on a daily basis.
In terms of culture, one important thing to keep in mind is the apparent fact that culture and food play an important and integral role in the client's life. During the therapy sessions, I will therefore endeavor to determine how the ideal female body type is perceived in the client's native culture.
Furthermore, I will determine how this relates to the client's relationship with food and the food paradigms she perceives as necessary to achieve her ideal body type. It is possible that root cultural concerns will have to be addressed before an effective therapeutic approach could be taken towards the client's eating disorder.
The questions that I would ask will revolve around determining the nature of the eating disorders from which the client suffers. I would, for example, ask her whether she ever overeats or binge eats. I will also ask what the concept of overeating means to the client. I will ask if she would be willing to simply eat less of her mother's food rather than replace it entirely with what she considers to be healthy food.
