I found this amazing blog the other day called Voice in Recovery. It is a comprehensive narrative on the struggles, challenges, victories, feelings, and wonderings that occur along the path of eating disorder recovery. It is an accessible resource to all — those who are struggling with an ED, those who have recovered/are in recovery, and families and friends of those affected by EDs. The topic brought out recently in this blog that I was inspired to write about is honesty in recovery. The blog author talked about being honest with all of the feelings, cravings, desires, and motives that you might have in your recovery. I was struck by the HIDDEN theme in the post.
Eating disorders are complex and intricate mental illnesses that affect every part of a person’s life: their mind, body, emotions, feelings, soul, and their family and friends. The ED can completely alter the way that you perceive the world as your are seduced by the powers of the ED voice. The most essential ingredient in recovery, in my opinion, is the way that you fight back against the power of the ED, reclaiming who you are and revitalizing your strengths. To find yourself and reclaim that fighting voice, you must be honest — with yourself, your family, your friends, your therapist, and anyone else who is in your life and who you would like to support you in your recovery. While we are surrounded by people who love us and want us to be healthy, we cannot stand only on the feet of others…we must learn to stand on our own and we must turn inward and take a stark look at the factors that are contributing to the ED behaviors. This can be intimidating! It can bring feelings of guilt, shame, and loneliness – the very feelings that EDs thrive upon – to open ourselves up and try to heal the wounded parts. I VERY strongly suggest that you do this with the help of a therapist, someone who is trained to hold those feelings for you as you sort through them and find ways to not let them be so central to your perspective. Those uncomfortable and sometimes painful feelings that can surface when honestly looking at recovery may tempt you to close up and HIDE again…but they will not go away until they are exposed and you are freed of them.
Honesty is crucial in every part of life: in intimate relationships, in financial transactions, in college applications, and in legal documents. Being honest can bring with it a feeling of freedom and release. For someone who has suffered from an eating disorder, you may yearn for that feeling of freedom and release, but find yourself confronted with a dark and tangled forest of secrets, low self-esteem, and negative feelings that leave you exhausted before you even take a step. Being honest is the key to getting to the light on the other side, and with that honesty must come a promise to embrace yourself with acceptance as you wade through the tangled roots. I think the most liberating thing about honesty, whether it is in recovery from an ED or if it is involved in a relational issue, is the fact that you are letting a weight off of your shoulders that you may have carried around for some time. And as you feel emotionally lighter, there is less and less obstruction towards the freedom and healing that you have been working towards. Ultimately on a journey towards honesty, you will end up in a place where you can say “I am okay”. Those three words can be very powerful. When you are able to say “I am okay” and “there is nothing wrong with me”, and ED begins to lose its power and you begin to regain the strength you crave to design your own free life.
As a family therapist, I thrive on the family communications that most would not even notice: the body language, the eye contact, who sits by whom, who speaks to/for whom, and so on. The actual words take second place to the intense signals sent between family members…and even more so if certain family members are unable to be in attendance. With so many people in the room and their stories, connections, backgrounds, and hidden agendas filling up every inch of space, how is a therapist to see it all clearly? I admit: when I first started seeing families, I felt a high level of anxiety as I tried to keep track of all of the dialogue (verbal and nonverbal) in the room and tried to get a picture of the family’s story while honoring their culture and presenting problem. I still feel that today, but the anxiety is lessened and the energy is more focused on getting each member’s viewpoint, reading the multiple forms of communication, and adopting a curious and open stance. I have learned that often the person that is “identified” in the session as “needin’ fixin'” is often the unknowing recipient of a mixture of all family members’ struggles, concerns, and personal issues. Whew – how exhausting! As I was reading an interesting family therapy blog, I started reflecting on the author’s point that the family member who is “identified” as the problem might suffer low self esteem, guilt, and depression based on the unconscious projection of the family’s issues on one or two members. Thus, the family gets more dragged down by the new issues created by placing this weight on that family member.
I decided to write about this topic today based on a recent episode I watched of the TV show “Brothers and Sisters”. This show, centered around the cycles of the Walker family, is the poster child for family struggles, transitions, love, and heartache. I admit that almost every time I watch it, I cannot hold back the tears and I think it is because of how connected and committed this family is. Granted, it’s a TV show and it exaggerates normal family processes, but I believe that everyone could find some part of the Walker family that he or she can identify with. I love the diversity of this family and how it is defined not only by blood connections but by creating new definitions for what “family” means to each member. The most recent episode made me think about how families react to tragedy and how each family strains to get back to that “balance” or homeostasis that they had (however functional or dysfunctional it might have been) before tragedy struck. As the Walker family tries to cope with enormous loss, each member isolates and creates barriers between other members and it is up to one family member to confront his family about the distance created between them as they struggle to cope. He tells his mother that he misses her meddling, overbearing, over-involved, controlling self, and that she “was the best mother ever” when she was embracing her natural tendencies. Since a lot of the show is focused on the mother’s boundary-breaking in her childrens’ lives, I found it interesting that in the wake of crisis, what this family really needed to heal was for them to re-balance, and to find their old ways again.
So, in family therapy, I wonder how it is decided what is healthiest for the family? Are their normal, regular, comfortable, dys/functional cycles and patterns helping them or hurting them? Would going back to those patterns help a family in crisis or did the patterns themselves help to initiate the crisis? And can crisis ever be a good thing? I think it depends on how one defines crisis, family, normal, and healthy. It is different for everyone, and a family therapist’s primary job is to get those definitions from each member and to see how those definitions function within the family system. It is also crucial to observe how each family member reacts to change in the system and how each member strives to regain that balance. Family therapy is challenging — for the clients and the therapist — but it is essential in a society that is growing and embracing all types of family structures.
Taking that step and beginning the process of selecting a therapist that is a good fit can be a daunting challenge. When considering the decision to open up to someone about the inner-most feelings, emotions, thoughts, and secrets that you might not even know are there, you want to be talking with someone you trust. It can seem unnatural to open up and process feelings with someone you don’t know – someone whose inner secrets you will never know yourself. But, in a way, that is the point of therapy – talking to someone about those things that you may not want to or cannot unravel with your best friends and family members. So how do you decide which therapist is going to be the truest fit for your needs, offering you trust, empathy, and safely?
We all are different and have different qualities that we look for in friends, mates, and even therapists. There cannot be a “top ten list” that fits everyone, based on these unique characteristics and backgrounds. But perhaps you can consider these items and fit them to your specific situation, and perhaps they can help you in some way to narrow down the necessities you desire in that confidential communicator you meet with every week.
Top ten things to consider when selecting a therapist:
1.) Specializations. Do you have a specific issue that you need/want to work on more than others? Is there a need to focus on one or two things so that you can lessen your anxiety or depression? Do you want to see a therapist with your partner? If this is the case, search for a therapist based in his or her specialization. Some examples might be: substance abuse, trauma, grief and loss, eating disorders, couples therapy, bipolar disorder, divorce issues.
2.) How is the therapist spoken of by others? If you know someone who sees this therapist, or if you were referred to him/her by a colleague or friend, or if you found him or her on the internet, what reputation does the therapist have? Are they known to be comfortable to talk to, have they given speeches or seminars in the area and had feedback given, do they try innovative practices or are they comfortable with traditional techniques (also may be a quality that you are looking for in a good fit), what sort of credentials do they have? Their impression on others can tell you a lot about how they do their work and impact those they interact with.
3.) Location. Is the therapist close by? It can seem inconvenient to drive an hour every week to meet with a therapist, and you could arrive worn out and stressed. Or, you may prefer the traveling and you may seek out therapists in another area.
4.) What is their office like? This is something that you can only truly know once you have met with the therapist. Is the office warm, accepting, inviting? Or is it stark, dark, and drab? You might consider what type of environment you would feel most comfortable in as you process your thoughts with your therapist. Location can also factor into this.
5.) Is she or he professional? Meaning, do they approach you with professionalism and do you feel respected? Another reason we go to therapy is so that we can have a nonjudging third party to bounce our thoughts off of. We don’t want our therapist to act like our friend — we have friends for that, who don’t charge so much! We want a friendly, organized therapist who will be honest and direct with us when we are working on our goals. A recent blog talks about 21 tips for clients in psychotherapy…and it mentions the same thing in reverse: clients should also be professional and responsible. It reduces awkwardness and increases trust.
6.) Is your therapist listening to you? Again, this is something you will know after the first session, but it’s important. As you are searching for a therapist, take note of the therapists that truly listen to your story in a non-judgmental, open, curious way. You are going to therapy to work through things that you are having difficulty with, and the last thing you want to do is have to repeat yourself or for your therapist to get a blank glaze over their eyes as they stare off into space. You are the client: you are in charge, this is your therapy, and your therapist is there to listen to, support, challenge, understand, empathize with, and encourage you.
7.) Do your needs fit? Some therapists do not see certain types of clients, like children, or men, or couples, or those who are perpetrators in abusive or violent situations. Some therapists offer 24 hour care; some have strict limits on the amounts and types of services they offer. Be sure to check with the therapist to see if he or she is qualified to work with you, if he or she meets your needs, and if you are a client that fits with his or her treatment approach.
8.) Does your therapist accept insurance, or does he or she have a sliding scale that fits your ability to pay? Some of us are able to pay the full amount that a therapist might ask for, and some of us are unable. This is an important thing to talk to your therapist about, so that you can develop a strong relationship with him or her by being able to attend weekly sessions. Financial restrictions are very real, but it is unfortunate if these are the reasons that you cannot find the treatment you need and want.
9.) Does your therapist make you do the work? Yes, that is what therapy is about: you processing your struggles with the help of a trained professional. Therapists do not give you advice, do not tell you what to do, do not tell you what not to do. They are a reflecting board, a mirror, a discussion. They will help you answer your questions and work on your goals, but they will not do it for you. If you have a therapist that does the work for you, he or she is not listening to you and is instead doing you a disservice. Make sure your therapist is supportive, sometimes directive, but not directing you in what you “should” think, feel, or do. The “shoulds” are never healthy.
10.) Do you LIKE your therapist? Is he or she someone you can laugh with, cry with, be honest with, be upset with, be trusting of? The therapeutic relationship is the most important part of the healing process in therapy, and work cannot be achieved without the basis of a solid and human therapeutic relationship. This may take a few sessions, so don’t rush it, but if after several weeks you do not feel connected in the way you want to be, bring it up with your therapist.
We have all heard the common statistic that body language communicates about 80% of what we are saying and feeling, and our actual words only contribute 20% to getting our point across. Much has been said about how “body language sends messages to your date or partner that you may not even realize”, and how you can have a whole conversation with another person across the room without uttering a syllable. There is truth in the power of body language, and I feel that it is most prominent when two people are interacting and other factors are prohibiting them from honestly communicating. For example, when a partner or friend is tired, stressed out, or if it is a person that you are just getting to know, the most authentic and direct way of communicating how you are feeling is through the way you approach them — are you open and welcoming to connection? Are you scared or frustrated about revealing your feelings to the other person? Or do you not even realize the types of messages you are sending to the recipient?
A popular body language blog gives some examples about what might truly be going on in certain body language interactions. Avoiding eye contact, in this culture, can mean a sign of insecurity or disinterest. In other cultures, such as Asian cultures, avoiding eye contact can be a sign of respect. I would note that in any type of body language-reading situation, the cultural context of the individuals and society involved must be considered, as body language messages differ greatly across cultures. In my therapeutic practice, I take special interest in getting to know the way that my client defines his or her culture and I take an open stance to understanding the cultural undertones of their actions and words. This is another reason I wanted to write about body language in this post: it can often be misinterpreted due to lack of cultural awareness, or due to preconceived notions or feelings of the individuals communicating.
A client once expressed to me how she and her partner often get in conflict because they seem to be “in different emotional states” at the end of the day and cannot connect authentically. I asked her to describe the words, actions, and feelings that she perceives in these situations. She admitted that they don’t often talk about it but that she feels her partner is angry or upset with her because he physically turns away and slumps his shoulders as if he is closing down. I encouraged her to talk to her partner about the feelings she was expressing to me, and she came back to report that things are much better because her partner was not aware of the signals he was sending. Body language and the messages it sends have now become a regular conversation topic for the couple, and they have been able to deepen their relationship through understanding each other’s intentions and feelings.
Not only can body language be a third party in a relationship, it can be a bird on your shoulder as you move throughout your day, processing your own internal feelings. Notice what your face is doing right now. If you cannot tell, look in the mirror. Are your eyebrows tense? Is your chin locked? What are your shoulders and arms doing? Counselors and psychologists note the power that your own body language can have over the way you perceive yourself and how your day is going. I believe that if you make a conscious effort to inhabit an open, accepting stance with your body language, you can influence the course of your emotions throughout your day. Try it — be active, engaging, relaxed, and natural with your body today and see how you feel at the end of the day.
Dreams and dream therapy get a bad wrap. My intent in this post is to “unwrap” the reputation that dream analysis has. We all know those books that are full of symbols and colors that, if you match them to your dream parts, are supposed to tell you what exactly your dream is saying to you! I agree with the majority of people that this type of interpretation is full of fluff and not based in true meaning. But I DO think that dreams can hold something important for us, can tell us to notice or pay attention to parts of ourselves and our lives, and that talking about them in therapy can resolve anxieties.
In my last post I mentioned Post-Traumatic Stress Disorder (PTSD), which affects millions of people for different reasons and in different ways. I believe that our dreams can be linked to PTSD, as a way for our minds to try to process some of the trauma or memories we have experienced, or as a signal that we still have things we need to work on. A recent article suggests that dream therapy can offer relief to PTSD sufferers. It talks about scripting, which is a technique that uses imagery and guidance by the therapist. In this intervention, the client is awake and together they alter the course of the client’s dreams by talking about the content and feelings associated in the dream and uncovering parts of the client’s life that may be coming through, hiding behind a mask, in the dream.
There are opponents to dream mastery (or scripting) in the psychology field. Jungians feel that altering or changing part of a dream takes away the opportunity to read what the subconscious is trying to say. I believe that sometimes the things that come into your dreams are parts of your day that you had not yet processed, that you had stored away because you did not have the time to infiltrate them into your brain. Now, when you are sleeping, you do. These types of dream parts can hold meaning, but they also can be just a filtering system for important and unimportant memories day-to-day.
I believe that there are parts of our dreams that do play a significant role in how we are feeling mentally, and that nightmares in particular can be a signal that there are some memories or feelings that need to be worked on. For me, I have a lot of anxiety dreams that revolve around food. This has been going on a long time, and I always wake up with relief that I am only dreaming. These dreams occur during times when I have a lot going on in my life and I have learned that the food is a tool to show how anxious I am about a certain thing (such as starting a private practice!). The food is a doorway into my inner mind and when I have a food anxiety dream, I know that there is something in my life that I need to focus on in therapy.
Whatever your take on dream therapy, you cannot argue that aspects of present life do not affect your sleep in some way — restless sleep, waking up multiple times in the night, insomnia, nightmares. Whether you have experienced trauma, are in recovery from a disorder or addiction, or are anxious about something going on in your life, dreams can be a bell that rings in your ear and tells you to listen.
I have recently been intrigued by the concept of body memory, finding it to be a very real concept that can be a focus of therapeutic healing. I was reading a post that talked about how a body can remember a trauma or memory that may have happened many years ago, but that is somehow still trapped in the tendons, muscles, and morsels of a person’s body. What does this mean for a person’s mental well-being, and how does this experience shadow the mind-body connection that is so often used in therapy?
As I write a lot about body image, bodily harm, mental anguish that is projected onto the body, and other body-centered topics, I was curious about how eating disorders, emotional eating, and other types of body-involved mental disorders are connected to body memory. I have heard accounts of survivors of sexual abuse where the survivor talks about their muscles being tensed up and they “know” that there is emotional pain lingering in that part of their body. Getting a massage can be traumatic for someone who has had emotional pain felt in their body; I have learned about a new form of massage called Trauma Touch Therapy, which is a method used to release body memories in a safe way.
Bodies that are affected by and/or recovered from eating disorders may hold some of these same memories — of pain, shame, guilt, grief, loss. As a person heals emotionally, cognitively, and physically from a trauma — whether it is abuse by another, abuse by an eating disorder, or emotional anguish that results in such things as cutting — the body will hold some of those memories of times past in its tendons, whether it is as a protective mechanism against further trauma or, I wonder, because the body has coped with this memory for so long that it does not know how to let it go.
As we work through processing our issues, past and present, in therapy, does emotional release follow or precede with body memory release? Is body memory a therapeutic tool to help us cope and remember what we have survived, or is it a remembrance of traumas of times past that we just cannot let go?
This makes me think of war veterans or other victims who must get a limb amputated due to injury or illness. Research shows that the person’s body remembers that limb as if it is still attached for years to come. The body never really forgets. The effects of post-traumatic stress on the mind and body are intensifying as more people go to war, as the eating disorder epidemic increases, and as traumatic experiences that we may not even remember show up in body memory sensations.
As a therapist, this reiterates the importance of taking care of our minds and our bodies and remembering that they are connected in such deep ways. Yoga, exercise, breath-work, meditation, and mindfulness are all ways of highlighting the mind-body awareness to promote healing.
We all know what it’s like to start another school year. Sometimes you’re going back to the same school, one grade older. Sometimes you’re starting a new middle or high school, or even going away to college. There’s the excitement of the unexpected — who you will meet, what you will learn, how you will change. There’s also the underlying anxiety and nervousness of “will people like me?”, and “will I be accepted?”. I remember this all too keenly.
It is fall, and students are going back to school with visions of basketball games, cheerleading practice, football heroes, and chemistry tests floating through their minds. As a recent blog post http://www.goodtherapy.org/blog/school-stress-adolescent-eating-disorder-psychology-counseling/ noted, Back to School Stress can show up in many forms, and sometimes the overwhelming feeling of expectations and rules leads to the development of eating disorders.
How do you deal with it all without losing your self?? Whether it is being a part of the popular crowd, or earning A’s to get into a good college, we all have to cope with the stress of new and intimidating opportunities. Eating disorders can show up in the form of restricting amount and type of food, it can mean triggering a feeling that you can never exercise enough and that “goal” weight just keeps getting smaller. In other instances, eating disorders can involve bingeing on food until you cannot feel anymore, and then purging or using laxatives.
All of these behaviors, in some combination or another, really underline the emotional pain that is underneath. It is a pain that pangs as you wonder if being yourself, as you truly are, is “good enough”. It is a vicious cycle of being ashamed or embarrassed by these behaviors that you do not understand, and in turn hiding or lying about these behaviors because they have, at some point, “helped” to cope with overwhelming feelings. These behaviors in fact make the pain worse, and feelings of isolation and despair continue to intensify.
What can you do? Whether you are a parent, friend, or person affected by an eating disorder, first know that you are NOT ALONE. With over 10 million women and 1 million men (reported by the National Eating Disorders Association) showing symptoms of an eating disorder, the epidemic is growing and impacting us all. Secondly, know that you are not at fault for this — I repeat — NOT at fault for the issues, and there are many qualified professionals who are eager to help you. Families, loved ones, individuals, I challenge us all to come together in the mission to erase eating disorders and to educate the public about the causes, dangers, and treatment options.