A THERAPIST’S PERSPECTIVE | Dr. Michael Maley
Facing The Negativity
When I first started working with people who struggled with disordered eating, I received a great deal of skepticism, cynicism, and pessimism. The skepticism came from people who doubted a client’s motivation to recover from his or her eating disorders. The cynicism dripped from the mouths of “seasoned” therapists who had worked with these clients for a long time. And, the pessimism was from most folks in the treatment centre community who believed that these chronic and acute patients would likely never recover. Having experienced my own journey from sickness to living in recovery, these evaluations of individuals with disordered eating attitudes and behaviours sent a chill down my spine. But as a clinician, the words only made me angry.
Discovering What Clients Need
In the spring of 2005, Dr. Anita Johnston invited me to her presentation in Denver. I considered myself lucky. Dr. Johnston is a gifted speaker with a passion for changing the lives of her clients and changing the way the treatment community sees these clients and their issues. One of the important concepts from this presentation has stayed with me for the last 10 years and has coalesced into a strategy and mantra for my work: clients with eating disorders often need more. “More what?” you might ask. They may need more time, more connection, more empathy, more understanding and more validating. They need more of the things that make therapy successful. This can come in many different forms, often requiring the therapist to move beyond more traditional boundaries. I would like to share one of the ways Tina and I navigated this difficult concept.
Working With Tina Klaus
Tina and I worked together for many years and in several different levels of care. We have done a lot in traditional ways including two individual sessions per week, extended time sessions, and emailing between sessions. Tina is a very insightful person and quite brilliant at recognizing what she needs. She is also very adept at using her voice and is good at speaking up for herself. Her direct manner is quite rare in individuals and almost unheard of for people with disordered eating issues. After a successful time at a higher level of care, Tina and I resumed our therapy relationship. Tina soon realized that she needed more support around meals and that the most beneficial part about partial hospitalization was just that – support around meals. She shared that she benefitted from not having to worry about what to eat, when to eat it, and how to work through her accompanying emotions. She suggested that we try texting each other after completing each meal.
Healing As A Two-Way Street
Tina was aware of my history with anorexia and frequently asked me how I was doing in my recovery. Through these “check-ins” as we called them, I had disclosed that I was concerned about my own eating habits. I shared with Tina that a text check-in regarding meals would also help me stay in recovery and that, by doing this, we each could have additional accountability. Our agreement resulted in an extended period of time for Tina to complete meals successfully; a reduction in disordered eating behaviors and urges for behaviors; a higher level of connection between us; a feeling of camaraderie and a great many ideas on how to reform treatment in this mealtime arena.
What I Learned
Several of these ideas and decisions may seem unconventional to providers and, perhaps, clients alike. I learned several very important lessons from this exercise. First, I learned that clients with eating disorders benefit greatly from providers who are courageous enough to step outside traditional boundaries and give more support. Second, meeting Tina where she was, gave me an invaluable glimpse into the psyche of her disordered eating.
It was in this space where we were able to get to some crucial discoveries. The first is what food and meals truly mean for Tina. The second is how impactful my physical presentation and attitudes about food and eating are to my clients. The third is that connecting with Tina outside the rigid boundaries of the scripted, fifty-minute therapy created a higher level of trust, empathy and care in and for each of us. Finally, we discovered that extra support was provided without the need for the client to return to a higher level of care.
There are countless ways that providers can give more to their clients. The benefits for both parties are big. The therapeutic relationship is crucial and the extra connections that develop when more is offered facilitates the strength and motivation that clients need to stay in recovery and reinstitute the optimism that being in recovery can provide.
A PATIENT’S PERSPECTIVE | Tina Klaus
The Roller Coaster
The one component that I have always found to be the most arduous in my recovery from bulimia and binge eating disorder, is holding myself accountable in eating all of my meals. Intellectually, I know my meal plan works and that I can trust in it, and yet I convince myself that it’s ok to take a detour off the meal path by making excuses, exceptions, and compensations. I successfully detour well for a period of time but eventually the control dwindles away and time and time again catches me and pulls me back into the sticky disordered eating roller coaster.
“I’ve lost all control over my life.”
For whatever reason I’ve not been able to handle mealtimes and the food piece on my own effectively. As a result it has been one of the major factors that caused me to end up back in residential treatment. Once my eating gets out of whack and inconsistent I start to feel that I’ve lost all control over my life. Then, the eating disorder thoughts start infiltrating and screaming at me until I can’t think about anything else.
At this point, I am unable to access the other skills and tools I’ve learned to help get me through those times such as: ACT, creative journaling, Zentangle drawing, or simply asking for support. I feel paralyzed, hopeless, and trapped in a deep dark hole that I know I can’t climb out of alone.
One of the most helpful and powerful parts of treatment for me has always been having the responsibility of what to eat and when to eat lifted off my shoulders. The enormous sense of relief and freedom this gives me is immediate. Being relieved from this responsibility feels like my daily gigantic burden with food has been removed not only from my shoulders, but also enables the cluttered thoughts in my headspace to clear. It allows me to take a much-needed breath so I can think about other things besides food. This, of course, was not something that I anticipated happening. The act of someone taking care of me by giving me a menu to choose my meals from each week and then having them prepared was an emotional and healing experience.
Once again after my third treatment stay, I did well for a while, but then I slowly broke down and my meal plan dwindled away. I started to panic, feel defeated and worried that I would have to go back to treatment AGAIN! However, this time I knew something had to change. As a result, during a therapy session with Michael, I expressed my frustration, anger, and desperation of the continued struggles I have around mealtimes. I wished for a viable alternative to having supported eating around mealtimes, without the rigid confines of returning to treatment to get it. I asked him if he would be open to the idea of texting each other after each of us completed breakfast, lunch and dinner. He was willing to give it a try and agreed to the idea.
We’ve been doing this unconventional exercise for about 2 months and it has made all the difference. It has been a game changer for me. There have been relapses, but they’ve become further apart. For example: In the last five days I have had four relapse-free days and one day with some slip-ups. As a result I gained confidence that I can do this with support, without having to return to intensive care. This worked between us because we have established trust; I know he would not lie to me and I would not lie to him.
Some may say:
“Doesn’t a nutritionist seem the most obvious path to take to get that kind of help and support?”
I will tell you no, it is not for me and here’s why. In the past when I have seen a nutritionist it has not helped me. I feel crazed by having to write down every little thing that goes into my body. It feels like I’m on a diet and it triggers my obsessive food thoughts. None of which are good for me. Everything that a nutritionist tells me is nothing I haven’t heard before, and the added stress that insurance does not cover nutritional therapy has only added to my anxiety. A nutritionist’s sole focus is on the food itself and not about what the food represents to me.
A Shared Experience
Michael and I texting each other about completing meals signifies so much more to me than just the act of being accountable for eating and nourishing my body. It allows me to pull apart and separate my emotions from the act of eating. By processing those emotions I am able to see why meal times are difficult for me: it is because I feel the most vulnerable and alone when I am eating. Something I’ve never been able to tell anyone. Getting those text messages at meal times represents to me that someone actually cares about my well being, cares about my recovery and cares about me as a person. In turn, it deepens our connection, understanding of each other, and signifies that we have each other’s backs.
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