Therapist Perspective | Michael
Comparison is a Trap
It seems like everywhere we go we are compelled to compare. ‘She has a better car than me’, ‘I’m so glad I’m not in their shoes’ or ‘I wish I had his job’. Our society tells us to measure ourselves by how we stack up to others; however, comparison is a trap! No matter what your status is in any category, you will always find someone to be ‘better off’ than you and someone more ‘worse off’ than you. Focusing on the former leaves us feeling inferior, inadequate, and unsuccessful, while focusing on the latter makes us feel lucky at best and arrogant at worst. It is very difficult for someone who is suffering from a severe eating disorder to look at another person through non-judgmental eyes. As eating disorder clients, we often even look at our therapists through these eyes. After all, therapists are people too and they go through the natural cycle of physical change as well. Therapists gain and lose weight too. They may become pregnant, they can get sick, they can decide to get into better shape, and they can even relapse into their own disordered eating patterns or back into a diagnosable eating disorder. How does the therapist’s body affect the client and the therapeutic relationship?
Change can be difficult
It has been long believed that eating disorder patients are not good at handling change. In my experience both as an eating disorder client and an eating disorder therapist, I can personally vouch for this assertion. Clients usually know what they can and cannot handle in the way a therapist looks, if not consciously then through some “sixth sense”. If a good therapeutic relationship is able to be formed, the size and shape of the therapist usually takes a back seat to other issues. Talking about how they relate to one another is usually the best remedy for any difficulties that may arise between therapist and client regarding size and shape. But what happens when the therapist goes through changes? Fear of weight gain is common among clients with anorexia. Shame and guilt are common among clients with bulimia and binge eating disorder. Therefore, when a therapist gains or loses a significant amount of weight, his/her clients are at risk for intense reactions based upon the struggles they face.
Let’s talk about the elephant in the room
I have recently had a severe relapse in my eating disorder. Over the past year and a half, anorexia has come roaring back and the shape and size of my body has changed dramatically. I have had several clients comment on this. Some have expressed concern, worrying that I had become physically ill, while others have said how “good” and “healthy” I look. Since my relationship with each client is different, my response to each of these questions and concerns has been different as well. My relationship with Tina prevented me from hiding or being dishonest. Although we have not discussed it specifically, I believe that Tina knew for a long time that there was something askew. The situation came to a boil when, during a therapy session several months ago, Tina came out and said, “You are a frickin’ rail!” It was at that point that I began talking about the changes in my body with her. I explained that I had been heading towards a relapse for several months, and that I had decided to take stronger, more directed action to address my eating disorder. This seemed to have the effect of allowing Tina to open up and not only ask the questions she had been holding on to for some time, but also for her to express her concern and her care for me. The many months of not naming the elephant in the room were over, and we were able to address the issues that mattered. Tina explained how the changes in my body were difficult for her because my new thinness was something that she had been taught by her family and society as ‘the goal’ and the only thing to strive for. She shared how frustrated she was that I was unable or unwilling to address this issue sooner. I was able to explain to her how unheard of it is in the treatment community for a therapist to open up in this way to a client. I shared with her my worry that knowledge of my struggles would negatively affect her healing process. She assured me that it was more difficult for her to be shut out and in the dark than knowing the real truth.
There are a few morals to this story. The first is that the size and shape of the therapist’s body is significant and does affect the therapeutic relationship, either positively or negatively. The second is that people with eating disorders are highly intelligent, creative, and intuitive. We often know what is going on without being told and can identify situations energetically even before our conscious minds have access to the information. The third is that given this highly intuitive nature of eating disordered clients, it is often unwise and unsupportive for the therapist to hide or to be less than forthcoming regarding his/her own personal struggles. There is certainly a case for keeping this kind of information closer to the vest. In these instances, however, it is much better to disclose that there is a problem and be unspecific about what exactly the problem is. Lastly and perhaps most importantly, it is possible that a client can be helped by knowing something about the struggles of her therapist. This knowledge can help the client realize that eating disorders do not discriminate and that taking care of one’s self is of primary importance. In short, the client can learn from the therapist’s example.
Client Perspective | Tina
“Comparison is the thief of joy.”
This is a quote that I’ve often recited to myself in order to challenge and interrupt the self-judgment that can comfortably move in and unpack its messy contents within my eating disordered mind. Let it be said and then set in stone that eating disorders thrive off of anything that can propel them to belittle and dehumanize the sufferer of this insidious disease. As someone who is living in recovery, I have yet again hit a roadblock on this bumpy road. These roadblocks are what Michael and I refer to as the realities in healing from an eating disorder. As a result, I’ve come to know that this kind of setback isn’t something I can avoid by pretending it isn’t there or that it doesn’t exist. It requires me to stop and assess the situation, acknowledge that I’m going to have to take an unplanned detour, and try to figure out how I’m going to handle myself under the circumstances. What I usually see in front of me is a treacherous mountain of comparison and judgment starring me in the face. The voices let me know that they will not only be visiting but staying with me for a while until I confront their presence and silence them.
Feeling weighed down
Prior to this latest detour I had been struggling for months with my own body image and appearance; as well as simultaneously feeling weighed down by the fact that I still have no idea what I want to be when I grow up. So last week when I picked up the phone to hear a friend proudly unfold her vast list of career achievements, I felt my heart begin to sink. Then in the very same day I received yet another phone call from someone I’ve recently met who is passionate about becoming a writer. She too read her list of achievements and dreams for the future. Both seem to have found their path and true purpose in life and are pursuing it with a happy-go-lucky attitude. If I’m honest, my first reaction was the desire to punch each of them squarely in the face. However, once I hung up the phone and I sat sadly on my front porch I felt shame wash over me with vivid reminders of all the opportunities that have been lost on me and all the unclaimed talent I’ve let waste away. Tears welled up in my eyes and streamed down my face. There I sat comparing my life to the life of each of my friends and in my mind I came up short. I felt as though I had failed in every way possible, including the superficial and useless quest to be thin.
I felt like the elephant in the room
During this same time period I had started to observe a sad and troubled look in Michael’s eyes that I had never seen or witnessed before. I knew something was going on with him but I didn’t know how to ask what it was. Out of the respect I have for him I wondered if I had the right to ask him what was happening; fearful of putting him in the awkward position of having to answer me. This nagged at me for weeks but I set it aside until I could figure out what it was I was feeling about the situation. I then noticed how aware and focused I had become on the appearance and size of Michael’s body. This alarmed and frightened me as this was something that had never entered my thought process before. It was nothing I had ever paid attention to in all the years we have worked together as client/therapist or in any of our other interactions. I’d also like to point out that I am not a person who generally gets triggered by those around me and I suddenly felt the urge to go engage in destructive eating disorder behaviors as a result of this trigger. However, I slowly noticed how hypersensitive and uncomfortable I felt in my own skin when I entered the room to meet with Michael. I felt anxious and overwhelmed with boatloads of shame and couldn’t wait to sit down to be rescued by the pillows he has in his office to hide safely behind. As Michael mentioned earlier, his drastic weight loss and relapse was definitely the elephant in the room. Ironically, I was the one who felt like the elephant in the room as I started comparing my size to his size. I started having thoughts from the past rush in. I was taught that a female should be smaller and weigh less than her male counterpart, otherwise her femininity is at stake. I was taught that a woman’s personhood was automatically cancelled out in favor of her physical appearance and in that instant, it was my femininity and womanhood that was in danger of being erased.
Being honest is healing
The one thing that I’ve always requested from Michael is that he be honest with me. I can handle honesty because it’s clear, I know what I’m dealing with and there’s no second-guessing or unpredictability. Unpredictability instantly leaves me feeling unsafe, anxious, and ‘crazy-making’ in my thoughts. My desire for honesty stems from continuously being deprived and starved of knowing anything human about the struggles my parents faced growing up. Ultimately this type of behavior taught me that I had to play a game of cat and mouse to figure out the unpredictability and/or lack of their emotions. This left me unable to understand or trust what others were feeling; as well as what I was experiencing and feeling, so I simply turned off my emotion switch. Therefore, when Michael shared with me that he was struggling and in full relapse from his eating disorder, I felt an immediate sense of relief and it made everything fall into place for me. The fact that he trusts me enough to share what he is experiencing and feeling makes it even safer for me to talk about anything and everything with him; something I was never allowed to do or experience with another human being. That I can say to him, “Hey what’s going on with you?” and that he knows I care about him allows for a more honest conversation to ensue that is personally healing for me.
Next, check out these other articles: A Therapist and Patient Perspectives On: Having an Authentic Therapeutic Relationship TOGETHER WE HEAL: Mealtimes & Eating Disorders The Invisible Eating Disorder