SUSIE Orbach’s cat has got into her tights drawer, and she has to halt, momentarily, the interview in order to get it out. It seems right that this little glimpse into her day-to-day existence revolves around something so seemingly intimate and feminine. Orbach, after all, is most famous for several things: her seminal book, Fat Is A Feminist Issue, and the fact that she was psychotherapist to Princess Diana throughout her eating disorder. In recent years a third element has been added to that list: her marriage to the literary author, Jeanette Winterson, after decades in a heterosexual relationship.

She is preparing, she says, to go to the United States for an event celebrating the 40th anniversary of Fat Is A Feminist Issue, or “Fifi” as she almost affectionately calls it. It’s 40 years, in other words, since her work at The Women’s Therapy Centre which she founded, prompted her to write what was both a self-help guide and feminist thesis. The book revolved around her belief that, since compulsive eating was primarily a woman’s problem, it must have something to do with women’s place within society. Forty years on, she declares things haven’t got any better.

In fact, what concerns her, is that, when it comes to how we feel about our bodies, they have got worse. What she observes is that there’s more anxiety around bodies now than there was when she wrote the book, and that, worse still, it has been exported to other parts of the world, and impacted increasingly on men as well as women. “It's much worse,” she says, “and it enrages me. When you think of not just the girl and women hours, but everybody’s hours spent on this. It’s just absolutely completely the wrong focus for what we should be doing with our lives.”

It concerns her, she says, that we no longer think of our bodies as what we do and make things with. “Our body has now become the thing we make. We have to repair it and make it and spend this amount of money on it and do all this sort of beauty labour.”

What particularly outrages her, she says, is “how much particular industries have grown since, fast fashion, the cosmetics industry, the food industry, the diet industry, the clean food industry. These are huge bloody industries. They are targeting us, and that’s not even dealing with the whole issue of social media. What chance does a human being have?”

Such pressures over body image are particularly potent for those in the public eye, among them people like Princess Diana, and now Meghan Markle and Kate, the Duchess of Cambridge. Does Orbach think it’s got any better for princesses? “It must be very hard,” is her only comment.

She is a grandmother now – what does she worry about for that generation? “The horrible thing,” she says, “is that little boys are now worrying about their bodies like little girls. It’s really disturbing.” Forty years on, in other words, and fat is not just a feminist issue, but an issue for everyone.

But isn't fat also a health problem, the famed obesity epidemic burdening our NHS, that actually needs to be tackled? Orbach says we need to be careful of how we frame this. "Obesity could be thought of as an eating problem that shows, unlike most troubled eating which doesn’t. We have a society obsessed with size, with image, with transformation, with BMI and with food. And particularly non food foods."

Orbach is 71 years old, slim and attractive in a way that looks effortless. Yet, she went through her own issues in her younger years. Fat Is A Feminist Issue is quite open about them, describing how she suffered her own “10 years of dieting, bingeing and self-hatred". Since Fifi, she has written a number of books on bodies and eating. Among them is On Eating, which recommended an intuitive approach to food, an attempt to eat when you are hungry and to appetite, while avoiding junk food. “I eat what I want,” she says of her current diet, “and I’m pretty okay with it all.”

How does she feel about her body now? Does the way she is ageing bother her? “I’m lucky because it’s been a long time since I’ve been troubled at the level people are troubled at. That doesn’t mean that when I see an ad for a mascara that turns itself, I don’t have a moment where I think that’s great. Then I think, ‘Hello. You can turn the mascara yourself girl.’ And it doesn’t mean I don’t have issues around the fact that ageing bodies are not really accepted and they’re degraded. It’s not that I’m immune from the cultural attack – because obviously I’m not.”

Orbach believes it’s going to take some aggressive action to change the culture around our bodies. “We have to make the cosmetic surgery show the real pictures of before and after. We have to support a #Nolikesneeded campaign around social media [of the sort created by Dove]. We probably have to prosecute the diet companies. We probably have to challenge fast fashion, where a huge percentage of clothes get thrown away within the first year and then they have to be recycled somehow. They either go to landfill or they’re exported abroad to third world countries who aren’t happy about having them because they want to develop their own textile industry. I think everything needs to be thought about.”

But this interview isn’t just about Fifi. Rather, it’s chief focus is In Therapy, and the fact that she is soon to appear at Aye Write in Glasgow. In Therapy is one of those books that puts the reader through the wringer: simple, short, based around the transcripts of a series of therapy sessions, which are not in fact real, since that would breach confidentiality, but improvised by actors. It’s so challenging, it’s hard to read the book and not crave a series of sessions in therapy yourself.

I ask if, since publication, she’s had a lot of people approach her interested in therapy. “I get overwhelmed,” says Orbach, who is so busy she has no space for new clients herself, “with people wanting to come to therapy. And then I spend a lot of time trying to find the right therapist for them.”

But therapy, she says, is not in fact for everyone. “Some people don’t really want to reflect on things. They find it troubling to reflect. Or some people really have had enough resources inside them to cope with the ride they have in life.”

The first time Orbach went to therapy was as a teenager. “I remember going there and describing a situation and the therapist saying something that was just really helpful and that made me realise I wasn’t nuts. I must have sobbed my heart out and said the kind of pressure I was under.” She says that she can’t remember what she talked about in detail. “Perhaps I don’t want to remember it at this moment.”

Orbach, who grew up in London, the daughter of a Labour MP, certainly had some difficult teenage years, for, at 15 years old, she got pregnant, had an abortion and was expelled from school. Her parents, she has said, “facilitated a solution” for her. She went on to study history in London, dropped out of her degree, then jumped the Atlantic to New York, where she would carve out an academic career in Women’s Studies. She wouldn’t return to therapy till her early twenties.

Does she think she would be a therapist were she growing up now? “It’s very different because I grew up at a time which was less about money. We weren’t interested in money or housing. There was cheap housing. There was the squatting movement. It was so different that it’s really hard for me to make comparisons.”

She was prompted to create the Radio 4 series upon which this book was based, by a comment by her wife Jeanette Winterson. “She just said to me, ‘I want to be in the room’. But it wasn’t simply that I was inspired by her. I’ve always been trying to get into the experience of being in the room, trying to convey it. I tried to in my previous book, The Impossibility Of Sex. So when I found this mechanism of doing it through radio, it seemed to work. I think people just find it spellbinding. I’m amazed that they do, because it’s my day job.”

The dialogues presented in the book are acted and improvised sessions around particular themes, which Orbach says get very close to the real experience. The most recent of such performances, she says, not included in the book, had a #MeToo theme to it. The story of the session revolved around a client who was an actress and who had been involved in a #MeToo situation, which her producer was pushing her to make public.

“It’s such a big topic,” she says, when I ask her for her views on #MeToo. “I should say, first of all I’m not opposed to flirting or erotic play or anything like that. So I want to put that on the table. But on the other hand, I am very upset about sexual aggression whether it’s towards women, or from men to men. I don’t think that’s about sex. It’s about something else. And I think it’s very easy for young women to play into it because that’s what they’re brought up to do. I think the whole thing is a bloody mess.”

But what does she think about the tensions currently arising within the feminist movement? While #MeToo has triggered a great deal of support and solidarity, we have also seen women fiercely attack each other. Orbach, who came of age, during feminism’s second wave, isn’t surprised by this. “I wrote a book years ago, called Between Women. And it’s all about love, envy and competition between women. It was about how to manage all those complicated themes.” She suggests that now might be a good time for it to be reissued. “It’s another moment for feminism.”

Why does she think this happens? Orbach’s explanation of why these tensions exist is useful in these times. “The thesis that I would put forward is that the first person we fall in love with is our mother. And the first person who, in a way, teaches us to be second class, or has done, is our mum. As well as teaching us to be powerful. So it’s a very complicated relationship and it’s the model for all our relationships, and it’s the model that we take into our relationship with girls and with women. We want to sort of have that support but we also feel like we’re going to be punished or restricted.”

Orbach, herself, is of course in a marital relationship with a woman. Isn’t that interesting to her, I ask, from the point of view of these dynamics? “Well it is very interesting, but I think that’s all I’ll say about it,” she replies.

Orbach married Winterson in 2015. Back in 2013, the literary author tweeted her proposal to the therapist, saying, “Valentine’s Day. Sun shining. Susie Orbach will you marry me? x”. Prior to that Orbach had spent almost 40 years in a heterosexual relationship with Joseph Schwartz, with whom she had two grown-up children.

In a 2013 interview with the Telegraph, Orbach described herself as “perplexed by how heterosexuality happens”. Given that our first love is our mother, she said, “you could say there is a primary for girls to be homosexual, just as there is a primary for boys to be heterosexual, given their own mother love.”

But she is sparing in the personal detail she is willing to divulge. Do she and Winterson, as two writers, share thoughts about their work and craft? “We don’t talk about writing at all," she says. "She doesn’t talk about it. And I talk about it a little with my other writer friends.”

What’s striking is that, for the most part, on the issues in which she has worked and written, she feels things have got worse, not better. When it comes to gender stereotyping, she’s concerned that, in this era of so-called gender fluidity, the roles for each gender have tightened not loosened. “In all sorts of ways we’ve become more uptight. The constraints on girls and boys have got more and more polarised.” For her, one of the big questions is, “How do we raise kids so that when a boy says that he’s really interested in sewing, he knows that fashion designers or weavers can be men. And that’s normalised?”

She’s also sceptical of how far we have come in terms of improving mental health. Isn’t it good, I say, that young people are now so mental health aware? And they now have a rich vocabulary with which to talk about it. “Yes,” she says, “but are we eloquent on our own emotions? People can look like they can speak about mental health but I’m not sure they are speaking about their emotions in textured or nuanced or complicated ways. It can be difficult to find the words. Often we just feel difficult and disturbed. It’s not like we feel suicidal or the worst thing ever, but that we have things that trouble us. We don’t really have such a good vocabulary for that.”

She worries about the factions that are currently being created by identity politics, and the energy going into those debates. “I think we’re fiddling while Rome burns. We’ve got a major crisis going on in the world. We’ve got a rotten, corrupt capitalist system that is just marauding the earth and bringing more and more people into its lair, and we’ve got massive poverty. That’s not okay. It’s not okay to have this level of privilege sit alongside this level of unprivileged.”

Above all, though, the message that I get from Orbach is that we need to listen. As befits a book about therapy, one of the most compelling sections of In Therapy is one in which she describes the basic therapeutic technique of just listening. “The fact of being heard and of hearing one’s words in a space,” she writes, “in which they are not necessarily interrupted or soothed but just hang, means they can reverberate.”

She worries that listening is a skill that as a culture we appear to be losing. “Listening,” she says, “is the most powerful tool. Being listened to. Listening to someone allows you to think about them and it allows them to think about them.” It sounds like a prescription for our time. Simply to listen more.

Susie Orbach will be talking about In Therapy at Aye Write on March 16 at 6.30pm