Essays · Clinical Case Study
Sensation of Excess Weight as a Somaticized Symptom: A 10-Session Gestalt Therapy Case Analysis
Maryia Neoberdina
Practicing Psychologist · Gestalt Therapist
Community Social Services Center
Psychological & Pedagogical Mastery Program
Minsk, Belarus · 2024
Case Supervisors: Elena Artemenkova, Olga Sharai
Published October 1, 2026
Editorial Introduction
In gestalt therapy, the body is not a container for symptoms but a site of interrupted contact. When unexpressed feeling cannot move outward into relationship, it settles inward into tissue, posture, and sensation-held there until the therapeutic encounter creates conditions in which it can be met and metabolised. The case presented here illustrates this process with particular clarity. A woman's felt sense of "excess weight" proves to be neither a problem of nutrition nor of willpower, but an embodied metaphor: a somatic holding pattern that gave form to grief, self-suppression, and relational isolation. Working within the gestalt framework, the therapist tracks not numbers on a scale but the lived experience of heaviness, restriction, and the slow reclamation of bodily agency. The work demonstrates how somatisation, understood as a contact interruption rather than a symptom to be eliminated, opens a field-sensitive path toward integration-one in which the body's symbolism is honoured rather than bypassed.
1. General Client Background
The client is a 42-year-old woman with higher education. She is married with three children aged 20, 14, and 9. Her eldest son has been diagnosed with Autism Spectrum Disorder (ASD). The family lives in a private suburban house with a household and a dog. The client is currently not formally employed, though she occasionally assists her husband with photo retouching. She presents as well-groomed, pleasant, smiling, neat, and of average build. She had no prior experience with psychological therapy.
Her son attends the Social Rehabilitation Department at a local social service center. Initially, the client expressed a desire to speak with a psychologist specifically about her son. However, when invited to explore other personal topics-"If you could talk about another subject, what would it be? What is equally relevant for you?"-she identified a persistent, distressing sensation of "excess weight." She noted having tried various techniques and practices without achieving lasting relief.
2. Client's Request and the Tri-Fold Manifestation of Symptoms
The client's felt sense of "excess weight" manifests across three primary dimensions:
Physical Dimension
Observing extra kilograms on the scale, perceiving increased body volume in the mirror (primarily thighs and lower face), experiencing heaviness in the legs, rapid fatigue, and a loss of physical ease in movement.
Emotional Dimension
Negative impacts on mood and overall well-being, reduced self-esteem due to body dissatisfaction, elevated anxiety, low self-confidence, and difficulty managing emotional stress.
Psychological Dimension
Feelings of shame and anxiety regarding appearance, guilt over an inability to maintain eating habits, and self-aggression following episodes of overeating. In moments of dietary relapse, food ceases to bring pleasure and turns into remorse.
Therapeutic Goal: The client seeks to transform her habituated action patterns, discover alternative avenues for emotional fulfilment and pleasure without resorting to overeating, and cultivate self-acceptance and self-understanding.
3. Initial Presentation and Therapist Countertransference
The client described her situation in elaborate detail, gesturing actively and pointing to specific body zones-her thighs and lower face. She noted that food serves to "fill" her, helping her feel whole. Binge episodes occur impulsively during times when routines are disrupted, leading to emotional and physical overload, fatigue, and inner emptiness. Overeating episodes are followed by intense guilt, self-blame, and remorse. She metaphorically described her sensation of excess weight as a "diving suit"-something that cuts off breath and body connection.
"I don't want it to be impulsive. I try to stick to clean eating, but during a lapse I crave sweets. Afterward, I torment myself for failing and lacking willpower. I want an ordinary lifestyle without these breakdowns."
- Client, Session 1
Therapist Resonance: During the initial minutes, the client flooded the session with rapid speech, abundant gestures, and conflicting demands-wanting relaxation, boundaries, support, no guilt, no sweets, total control. I felt overwhelmed, confused, and experienced a tinge of shame over my initial difficulty absorbing this volume of information. To establish grounding, I intervened by slowing the pace and summarizing her input.
4. Overview of the 10-Session Therapeutic Process
The following table summarises the focus and key interventions across each session.
| Session | Focus & Key Work |
|---|---|
| Session 1 Unpacking the Symptom & Grounding |
Established therapeutic contact. Defined "sensation of excess weight" as the working symptom rather than numerical weight on a scale, focusing on bodily experience and over-control dynamics. |
| Session 2 Life Sphere Imbalance & Art Therapy |
Explored imbalance across life domains (overburdened family sphere vs. empty professional identity). Art therapy experiment revealed the onset of the symptom at age 18 (leaving home for a dormitory). Introduced the "Soldier" self-image. |
| Session 3 Symbolism of the Diving Suit |
Explored the grief of halted professional fulfilment following the birth of her son with ASD. Visualised the symptom as a diving suit blocking respiration and vitality-symbolising the transition into restricted motherhood. |
| Session 4 Narcissistic Vulnerability & Isolation |
Processed feelings of isolation, shame, and unworthiness. Explored how overeating conceals emotional expression in a family context where feelings are suppressed. |
| Session 5 Somatic & Relational Shifts |
Investigated therapist-client bodily resonance (shallow breathing, constriction in throat, numbness in legs). Client reduced daily weigh-ins and began tuning into internal fatigue signals. |
| Session 6 Relational Function of the Symptom |
Explored communication dynamics with her husband. The symptom acted as a buffer-"heavy cotton wool"-against interpersonal negativity, giving physical form to unexpressed distress. |
| Session 7 Resource Integration & Seasonality |
Shifted focus to internal strengths using the metaphor of a rose bush in winter-reframing slowing down as a necessary period of replenishment rather than laziness. |
| Session 8 Relinquishing Unrealistic Control |
Refocused from trying to "eliminate the symptom" to relinquishing control over uncontrollable external realities. Explored underlying self-critical inner voices. |
| Session 9 Unlocking Permission & Core Needs |
Examined childhood conditioning ("never sit idle"). Client began granting herself permission to rest, express feelings, set boundaries, and decline external requests. |
| Session 10 Assimilation & Termination |
Re-evaluated the "diving suit" metaphor via clay modelling. The symbol transformed into a transparent, dissolving form. The client reported lightness, flexible eating habits, and enhanced self-acceptance. |
5. Key Outcomes and Clinical Interventions
Focus on Here-and-Now & Somatic Grounding
Therapeutic work moved from cognitive over-analysis to present-moment somatic awareness, tracking breath, vocal tightness, and bodily posture.
Deconstruction of Introjects
Unpacked deep-seated beliefs such as "Rest is forbidden," "I must always stay busy," and "I must maintain a cheerful facade for others."
Boundary Setting & Emotional Expression
The client gained the capacity to express feelings directly-sadness, fatigue, irritation-rather than somatising them through food urges.
Reframing Agency and Choice
Transformed "prohibited food" mindsets into conscious choice: "I am allowed to eat anything, but do I genuinely want it now?"
