of never being able to please his "domineering" father. His mother, a Holocaust survivor, is an inveterate worrier. She was fearful that Mike, her only child, would not survive because he was extremely thin when he was very young. Mike described his mother as feeding him great quantities of food--"eat . . . eat"--and then lecturing him about his weight problem. He complained about a lack of love and acceptance in his family of origin and spoke of his parents' hostility to one another.
Mike returned repeatedly to his continuing desire to be attractive. He characterized himself as having been a good athlete as if that should have guaranteed him success with girls when he was in high school. He described his sexual relationship with his wife as satisfying, but confessed to wondering what sleeping with other women would be like.
The client is habitually 40 to 50 pounds over his "ideal" weight, a condition of obesity that disturbs the client greatly. Consequently, the behavior selected for control is overeating. The behavior selected for increase therefore consists of positive eating habits. The client will be instructed in ways to modify his behavior in order to lose weight quickly and gain control over his eating. His progress through this program will be closely monitored, but with the understanding that his obesity is, in some respects, only the "tip of the iceberg." To address the underlying problems that manifest in overeating, the client needs more than a diet and a program of behavior management. The behavior modification component will be accompanied by other interventions intended to assist him in gaining at least partial mastery of the forces that impel him to overeat.
Behavior modification weight-loss programs generally involve forms of contingency management and stimulus control, as well as the more or less direct manipulation of actual eating habits (Craighead, Brownell & Horan, 1981). The program desc...