Night eating syndrome, morning anorexia: how do we qualify an eating disorder and where do we draw the line?

Last week, I wrote about the rising new “rexias” in the eating disorder epidemic and based on the interest and comments on this topic, I have decided to dedicate today’s blog to an encore of the subject of eating disorder classification.  While this is the area of expertise in my counseling practice, it also is noted in a blog I was reading that the public has a “fascination” with eating disorders and the terrifying rate at which they are growing and mutating.  This blog brought up some interesting points as to which types of eating disorders should be classified in the DSM-V, the Diagnostic and Statistical Manual of Mental Disorders, the most recent edition of which is expected to be coming out in May 2013.  I say: why focus on the details?  If someone is exhibiting self harm in the form of eating disorders or other ways, this is a not-so-silent cry for help!

As I noted in my previous post, I wonder if the “rexias” such as pregorexia and drunkorexia are terms that are borne out of situational descriptions: a woman or man who is already dealing with an eating disorder or who is vulnerable to one finds himself using alcohol as an inhibitor to an eating disorder, or a woman becomes pregnant who has had disordered eating or body image problems for years.  To me, these are new mutations of anorexia or bulimia (or a combination of both), which are the two “classic” types of eating disorders in the DSM.  Binge Eating Disorder (BED) is a definite shoo-in for the DSM V, but counselors and practitioners in the field are wondering what other types of eating issues could make the cut…and I wonder how one decides what qualifies a “diagnostic” eating disorder — one clinical enough to make it in the mental health professional’s bible?

Blogs are talking about Night Eating Disorder (NES), which is qualified as a “disordered eating pattern in which an individual eats large quantities of food only at night.”  A study performed by Striegel-Moore and colleagues (2006) defined NES as “evening hyperphagia” (an abnormally increased appetite in the evening and consumption of food, after the evening meal, in which the majority of the day’s calories are consumed).  This may cause insomnia and “morning anorexia”.  This seems to me to be similar in criteria for Binge Eating Disorder, though NES appears only at night.  Binge Eating Disorder is defined as when someone frequently eats large quantities of food and feels a loss of control and an emotional response to their eating habits.  This does not involve the purging qualifier that bulimia nervosa does.  As mental health professionals, doctors, and psychologists meet to try to determine what types of behaviors make a disorder and what type of mental issues fall in line with which disorder, many questions come to surface — not only on the eating disorder front but across the mental health and physical health spectrum.  How do we decide what should be included in the newest version of the DSM so that proper diagnoses can be made and clients can be helped in the most efficient and adept way possible?  Is it better to have more probable diagnoses to look at when treating a client, or is less more?

As a counselor who treats individuals, couples, and families affected by eating disorders and as a woman who has dealt with emotional eating issues myself, I wonder if there is a trickle-down effect in handling the broadening scope of eating disorders.  As technology gets more advanced and as society grows larger and more complicated, the types of things that we can struggle with increase (alcohol, drugs, family pressures, wedding pressures, grief and loss, war casualties, and many more) as we cope with the overload of information we are given each day.  But underneath the surface, the river all runs to the same place or few places: the want to be accepted, loved, healed.  Maybe we eat uncontrollably at night because we cannot control our parents’ imminent divorce and the pain that causes.  Maybe we try to starve ourselves so that we fade away to nothing because the feeling of hunger is welcomed compared with the feeling of rejection from a group of peers.

I support incorporating as many words or classifications as possible in the DSM because the more attention we can bring to the dangerous epidemic of eating disorders, the more we can align into one solid voice advocating prevention and elimination.

Self care – it’s no joke!

I have been under the weather since Sunday afternoon.  It started as “allergies”, and has now progressed to a full blown chest cold.  I am not accustomed to having to slow down my daily pace due to unforeseen sickness, and it has really made me look at the way that I make choices and take care of myself (the short answer is: often, not very well!!).

When we are forced to “stop and smell the roses” (bad metaphor…I can’t smell anything!), we must take a look at our lifestyle choices in ways that we might feel we don’t have time for in our daily busy schedule.  For instance, sleep has been an important factor in trying to battle this body-invading cold.  I realize that I often glaze over the healing powers of sleep, because somewhere along the way I got the idea that taking naps was a “waste of time”.  By listening to my body’s strong urges to get some rest this week, I have benefitted from the rejuvenating and invigorating healing powers that something as natural as sleep has gifted me.  I was also forced to call in sick to an important job this week, and I went through the usual feelings of guilt that typically accompany my saying “no”.  However, when the reason that I needed to say no was to take the time to relax and give myself a break, why must I feel guilty about that?

This leads me to wonder why self care has gotten so far down on my list of time-worthy tasks.  As a counselor, I have learned through coursework and through the guidance of teachers and supervisors that self care is a MUST in this profession.  Burn out, soaring levels of stress and anxiety, and decreasing levels of mental health are only a few of the consequences that may occur when therapists do not offer themselves the same care and affirmation that they gives their clients.  It seems simple: in order to be able to help clients find their way to happiness and change through acceptance and support, a therapist should be able to model those very qualities him or herself.  But all too often, we overlook our own needs in the face of demanding jobs, competitive markets, and devaluing our own desire for peace.  This week I have found that in order to get past this and to move forward with my career and my life, I must take the time to care for myself.  It is ironic in a way, that my body should physically break down before I notice this, and that when I push myself too far it definitely lets me know that I need to slow down.

Why can’t we slow down and listen to what we need?  Not only therapists, but doctors, lawyers, health care workers, teachers, parents, and anyone who meets high demands each and every day — we all struggle to put our self care high on the list.  I think that a big piece of this puzzle is being able to listen to your body.  As I have written before, the mind and the body are deeply connected and they will tell us when we need to turn our attention inward.  Last week a friend was celebrating her birthday and when I called her to wish her a happy birthday, she told me that she was having a good day but that her shoulders were very tight and tense.  I suggested that she get a massage, and it took me several minutes of convincing her that she deserved to do this (her body was yelling at her to get one!)….not just because it was her birthday but because her muscles were carrying all of the stress that she was feeling.  We don’t have to wait for the “excuse” of a special day to allow ourselves a kind break.

I think that sometimes self care can take on the pretense of feeling indulgent or selfish.  I argue the exact opposite.  When we are in the helping profession, it may be unethical to meet our clients in a state of anxiety, stress and tension.  What would we be modeling to them?  Not only is it healthy to take baths, take vacations, go out for a celebratory dinner, or whatever else you like to do for self care, our jobs require that we do these things because of the challenging subject matter that we work with every day.  We are in our profession because we live to help people, to listen to their stories and to support them in finding peace and love in their own lives.  However, we cannot help them to the best of our ability if the problems we hear each day weigh us down.

So, as I have learned this week (it took a debilitating cold to teach me!), it is a necessity that we engage in self care activities.  We must put ourselves as a priority and be comfortable with saying no when need be.  Schedule at least thirty minutes of self care each day.  Read a book that you love, take a walk with your partner, go to the park and admire the changing leaves, take a hike in the mountains, go out to dinner with your sister.  Our families, clients, partners, and most importantly – YOU – depend on it!!

…I’m going to go spend some time with my dog now 🙂

Drunkorexia, pregorexia — the rise of new “rexias” in the eating disorder epidemic

Today is the start of “Fat Talk Free Week”, which is a national campaign that visits college campuses, does presentations, and encourages women and men to eliminate conversations that reinforce the thin ideal and that contribute to dissatisfaction in one’s body.  October 18-25, 2010 is a week set aside for motivating positive body image and educating the country about the dangers of disordered eating and negative body image.  I am doing my part to spread the word about the beauty and vitality of our healthy bodies, and encourage you to do so too!

Newspapers, magazines, and internet blogs are bringing focus to this topic in some of their writings this week.  As I was reading an article in the Denver Post this morning about a shocking new eating disorder called “drunkorexia”, it struck me how many different kinds of eating disorders are in development and how there are many diverging opinions about the “trendiness” of these “rexias”.  I wanted to learn more, so I looked online for what people are saying about the “rexia” trend.  The two most talked-about types are “drunkorexia”, which is a sensational term for when (most commonly) college aged women limit their food intake and “drink” their calories instead.  This often involves binge drinking on an empty stomach, which causes ulcers, black-outs, and the lack of nutrients can lead to serious medical concerns.  On the other extreme, the Denver Post article talks about students binge-drinking and then consuming massive amounts of “drunk food” such as hamburgers, pizza, and ice cream and then throwing them up later after feeling guilty.

I had heard of drunkorexia before, but pregorexia is a relatively new term which refers to behaviors that seriously concern me as a mental health professional, as a woman, and as a potential future mother.  Pregorexia refers to women who limit or carefully count their food intake, sometimes significantly, during pregnancy so as to not gain very much weight.  Blogs call this “the pregnant woman’s eating disorder”, and a “buzz word” for this type of eating disorder that some believe is inspired by looking at celebrities who remain slim during pregnancy and then lose the baby weight within a matter of weeks after birth.  When I think about this, it is just another version of the same issue that plagues all women and men with eating disorders: comparing themselves to others and feeling inferior.  It scares me to think of the effect this might have on the child growing inside of the mother and it saddens me that women feel that they cannot embrace one of the most natural and beautiful parts of human life: growing a child and giving birth.

Negative messages are sent to pregnant women through the media every day.  A psychology blog explores how women are told that having a c-section can lead to faster weight loss after birth because their metabolism is increased as their body tries to repair itself from the surgery (and the liquid diet the doctor puts women on after a c-section can “help you lose pounds very quickly”).  These messages are unhealthy, as they insinuate that a pregnant woman’s body is not beautiful (unless it’s thin!), that weight loss is the most important thing to focus on after giving birth, and that every woman must be perfect when navigating life transitions.

It makes me wonder in a sort of which came first – the chicken or the egg type way:  do women who are susceptible to eating disorders get triggered by substance use or changes in their body, such as pregnancy?  Are these new “rexias” part of an already-developed eating disorder that presents itself and gets tangled with life transitions?  What is the link between entering a new phase of life (starting college or starting a family) and coping mechanisms like eating disorders and substance abuse?  Much research has been done about ways of coping as life throws us new curves and paths as it tends to do.  I think that the different facets that eating disorders have found all point to the same underlying issues: needing a sense of control, feeling “not good enough”, and desiring a release of anxiety and tension.

The last blog that I found about this topic is one written by those who have (or currently are) suffered from an eating disorder so it can be very real, sometimes triggering, but incredibly insightful.  An author who wrote about “the rise of the rexics” feels that the many new variations on anorexia (including “brideorexia”) makes fun of or minimizes the seriousness of anorexia.  The author argues that the cutesy terms are meaningless and that we need to get down to the real problem: that a bride has anorexia, or a pregnant woman has anorexia.  In order to validate those who suffer, no matter what their circumstances, it must be heard that the psychological, cognitive, and physical devastation is the same for all and that every form of disordered eating needs to be treated with the same amount of care and seriousness.  The consequences of eating disorders affect not only the person exhibiting behaviors, but also affect their family members, their friends, their community, and their children.

So, in honor of Fat Talk Free Week and in honor of our beautiful, natural selves, please be aware of the messages that we send through our actions and words and notice when you are conforming to the thin ideal.  We all deserve to feel happy and accepted just the way that we are!

Connecting with your inner child: comforting and listening to your authentic self

There is a part of us that never forgets.  We are all child-like in some way, and just as a body remembers past events and feelings through emotional muscle memory, our inner child lives on inside of us for our entire lives.  It may come out in ways we react to certain situations, such as how we respond to a new person who reminds us of someone we knew as a child, or it might come out as we go through life cycle transitions.  We grow up, find partners, live on our own or with a partner, have children, get married, develop new patterns and coping mechanisms.  Living independently of our parents physically, financially, and socially can reignite patterns of ways we have managed transitions before, and our inner child might react against a choice we make.  For example, a colleague recently told me about a client she has who exhibits fiercely protective feelings towards her brother.  The client cannot understand why she becomes enraged when she sees him being taken advantage of by his partner.  The woman had been physically assaulted when she was a child and she states that she has always felt like she wanted to protect those she loves because she has been made to feel unsafe in the past.  The client and her therapist are working on expressing the needs, fears, and feelings — perhaps never safely expressed before — of her inner child and understanding how this interacts with her present day life.

Psychotherapists refer to the inner child as the emotional memory and experiences that we have stored in our brains and bodies from our very first memory.  An inner child can come out in playful ways, as grandparents bond with their grandchildren and play in ways they have not engaged in for decades.  I feel that animals have inner children that never lose their light; I have reveled at many dogs who have played with and loved their humans in puppy-like ways until the day they died.  The inner child can be a joyful expression of hidden and forgotten youth; it can also be an expression of trauma and hurt from childhood that has not been healed yet.  Therapists have long studied the inner child and how it affects our personality, functioning, and relationship styles.  In the 1970s, the concept of the inner child developed alongside the concept of codependency, connecting the needs of the inner child to the patterns of relationship formation and behaviors later in life.

Carl Jung called the inner child the “Divine Child” and Charles Whitfield called it “The Child Within”.  I am fascinated, like many psychotherapists before me, with this concept.  I believe that within each of us is our authentic and true self, and that our inner child is the purest form of who we are.  Throughout our lifetimes (and perhaps even beyond) our inner child stays innocent and true, though it is affected by experiences that we have throughout the years.  I can imagine it as an enormous old tree, the kind that has been around for a hundred years and has grown twisting, gnarling branches and bark all over its form.  It has housed nests, dens, and perches.  It is chipped away at by storms, by humans, by squirrels and birds, and it suffers from disease at times.  But inside, beneath all of that “living”, is the sapling from which it grew.  Trees are resilient things and can withstand many torrents without altering their worth and purpose.

I believe that same thing about humans: we can endure many storms, but inside of us lives an innocent child who, though he or she may have some chips, dents, or knicks, lives on as the inner light and inner child that expresses who we truly are.  Through counseling, support, and love, our inner children can be freed and healed.  How do you connect with your inner child?

Recognizing the importance of National Coming Out Day

Today is National Coming Out day.  I did a little bit of research about this civil holiday and found that it is borne out of the event of the first march on Washington by Lesbian, Gay, Bisexual, Transgender people (LGBT).  The march was on October 11, 1987 and signifies the LGBT community’s struggle for acceptance in society.  Every October 11 since then has recognized this message.  The purpose of National Coming Out Day is to promote honesty and openness about being lesbian, gay, or bisexual (read more:  I think this is a courageous, outstanding, and respectable event for all of us to bring to our awareness, especially after the recent tragic deaths of four teenage boys who committed suicide after being bullied for their sexual orientation.

I have written before about the dangers of social media and how this ‘instant connection’ we have through Facebook, LinkedIn, Twitter, and other sites can interrupt honest communication and can promote misunderstanding and bias.  I do have to say that today I am encouraged to see many people post to their Facebook accounts messages about being advocates for the LGBT community: (______) is a straight ally and today is National Coming Out Day. Donate your status and join me in coming out for lesbian, gay, bisexual and transgender equality by clicking here:  I have seen a few people come out today on Facebook, garnering love, support, and empathy from their friends and family.  No matter when or how one decides to come out, it can be risky as you cannot predict the reactions from those you open yourself up to — especially on a social media network.  Brave and confident souls, I commend you and support you!

The New York Times online blog writes today about the challenges of coming out to parents and loved ones…and how it has never been easy, even without social media.  Coming out can be intimidating for the gay/lesbian family member, as they may fear if they will still be accepted and loved after this revelation.  The recipient of the news may also go through emotions, feelings, resentments, regrets, and all sorts of other reactions to the news – especially if their son/daughter/parent had waited many years to open up.  In the NYT blog, an adult daughter talks about her trepidation about coming out to her mother, and how she felt the only way she could do it, at age 28, was to write her mother a letter and mail it across the country.

The uncertainty of being accepted or judged by family members can escalate into anxiety, depression, anger, and sometimes tragedy.  After Tyler Clementi’s suicide last month after his roommates unjustly exposed him to the internet, his parents have come forward and said that they did not know he was gay.  I can only imagine the complexity and anguish that must have been going on in Tyler’s mind and my heart goes out to him and his family.  Perhaps, with the right circumstances, Tyler could have opened up to his family and his path would have shifted from secrecy about who he is to openness and self acceptance.  But we will never know what “could have been”, and it’s tormenting to imagine that now.  We DO have the choice to change the way we judge, treat, and criticize people who are different from “the mainstream” and we CAN make this world a more understanding place for every type of person who lives in this diverse society.

Today, I embrace each one of my friends and family members who are of the LGBT community, whether they are open about their sexual orientation or not.  I am an ally to each one of you as a friend or as a counselor.  Today, on National Coming Out Day we must all lend our voices in support of the LGBT community, because there are plenty of people who still judge and attack them.  On some message boards today, there are plenty of comments — those supporting National Coming Out Day, and those who believe it should not matter.  There still is bigotry in this society, and it is unfortunate to see.  However, there is also a lot of progress in accepting multiculturalism and diversity.

This day is a chance for those who have never felt safe to embrace who they are, and for those who have confidence to give their hand to those less sure about being out.

Expressing ourselves (or not) in therapy

I have been on both sides of “the couch”.  I have been a client for many years and currently also inhabit the role of therapist with my own clients.  I know how it feels to sit and talk to someone who you do not know on a personal level but still feel this uncanny and close connection to.  I also am familiar with the sensation of sitting down with a client, sensing that certain natural anxiety that accompanies every session (even if I’ve been meeting with that person for a long time).  Both therapists and clients have feelings and reactions.  That is in part why people become therapists: because they can empathize, feel, and connect so deeply with their clients.  Clients come to therapy because they would like to sort through some of the feelings and reactions they have to life circumstances…or to try to understand why they DON’T have feelings or reactions to those circumstances.

Feelings and emotions are natural and normal, and everyone has them.  In therapy, where the room is safe and secure and there is a degree of comfort between client and therapist, emotions can play and explore the open air between the participants.  A psychotherapy blog that I read talks about reactions that clients might have towards their therapists or towards a situation that are really not about that certain thing at all.  Psychodynamic therapists call this projection.  In this blog, the writer talks about feeling angry at her therapist and feeling that “the connection was lost” between them.  As she works through this with her therapist, she realizes that she was upset with him because he was going on vacation for three weeks and she feared being lonely and losing her identity without him.  Through this confrontation, she was able to work with her therapist towards developing more autonomy and she explored defense mechanisms that, according to psychodynamic theory, have been in place since the age of three.

In the above example, we can see how a reaction to a situation brought out some deep-seated feelings that the client was unaware of herself, and processing these with her therapist allowed her more freedom and release.  This is an instance where the timing was right (the client was able and ready to go to the level of processing she needed to) and the relationship was built from enough trust that the two could sort through some uncomfortable feelings.  But those circumstances are not always in place.  Sometimes, the client is not able to yet make the steps towards understanding the deeper levels of his/her reactions and feelings, or the therapist is not prepared to hold the anxiety of such a situation and may allow her own feelings to enter the picture.

I have had clients expose a wide variety of emotions in session, and I am grateful that those clients felt safe enough with me to allow me to see them.  There have been clients who have let me into their deepest thoughts, thoughts that they sometimes do not feel are “okay” to have.  When working through challenging situations, such as when clients are trying to recover from an eating disorder, thoughts and feelings that have not been allowed to come out for fear of rejection can enter the therapy room.  This is a healthy dynamic of the therapeutic process, as clients feel accepted despite their struggles.  It is crucial that both therapist and client are prepared to work with these sensitive emotions when they are expressed, as they could be stuffed back down at any sign of judgment.

Fear of judgment or being unaccepted can be presented in forms of anxiety, withdrawal, dismissal, and aggression.  I had a client that I had been working with for a long time whose eating disorder was spinning out of control.  I could tell that she was terrified of this disorder because she felt torn between two very powerful forces: the temptation and addiction of the eating disordered behaviors, and the desire to be healthy and free.  We worked for months exploring this tug of war and attempting to empower the voice of recovery that was buried inside of her.  When we finally got to the point of challenging the eating disorder, she responded with anger and retreated back inside.  The anger was a natural reaction that, if given the chance to work through it, could have been a tool for her to turn against the disorder.  However, we did not get to explore that possibility and she never returned.

Timing and readiness for change are essential components to progress in therapy.  The therapist must have the tools and experience needed to help support clients as they take steps towards expressing themselves freely and finding those answers that they came into treatment to uncover.  One of the most difficult things for therapists to accept is if their clients are not yet ready for change.  This is something only the client can decide, as it is ultimately their work.  Through my learnings and wanderings as a therapist, I have come to accept that clients will make that commitment when they are ready and that is it my role to support them (and not push them) as they grow.

The deadly power of bullying: when do we stop hurting each other over differences?

Is anyone safe?  I am moved to write today and lend my voice to the growing and dangerous epidemic of bullying.  The recent tragic suicides of four young boys Seth Walsh, Tyler Clementi, Billy Lucas, and Asher Brown have brought this topic to national attention.  This, paired with the new movie about Facebook entitled The Social Network and my recent blog post about the risks of opening up to social media makes it very evident that social media has significant influence in the feelings, emotions, self esteems, and lives of millions of people.

When I was younger, bullying mostly took the form of mean handwritten notes that were tossed across the school bus aisle, whispers in the hallway, and an occasional prank call on the home phone line.  That was scary enough.  These days in addition to the aforementioned bullying threats, there are text messages, cell phones, and every type of social media network you can think of to get your voice heard.  There can be some good that comes out of this instantaneous form of communication, such as alerting each other in the event of a natural disaster or a threat, or viewing wedding photos of a family member that lives on another continent.  But I’m afraid of the power of social media and how it makes bullying so much easier…and so much more deadly.

With much of the personal contact in communication stripped away, it is more challenging to connect with your son or daughter and see how social life is influencing them.  And with so many ways to communicate in private or masked ways online, friends and family members of victims of bullying can be in the dark about what is really going on until it is too late.  In devastating circumstances such as the recent tragedy of the Rutgers student Tyler Clementi, who jumped off a bridge because he was exploited online, my heart goes out to him and his family because I know the pain that can come from bullying and I also know that this could have been prevented.

Bullying is going to get easier and more convenient, and in order to prevent more tragedy we all need to do our part to stop this vicious epidemic.  What causes bullying?  We could talk about that all day.  I see bullying as a form of a defense mechanism; in order to protect something inside that is vulnerable or unsure, bullies create a character of intimidation and meanness so that no one tries to hurt them as well.  Along with protection, bullying can be born out of misunderstanding and lack of awareness.  Many victims of bullying are picked on because they are different in some way (sexual orientation, appearance, interests, background, you name it) and to focus on this person’s uniqueness can bring the bully more social attention and “popularity”.  We need to raise awareness about bullying so that the very things that make us different and make us intimidated by one another can be exposed and brought into light…so that bullies can not use our differences to separate us any more.

Parents may wonder how they can tell if their child is being bullied or if they are bullying another person.  Some signs to look for:  if the child gets more aggressive with siblings or his/her parents, school work plummeting, change in eating patterns (especially lack of eating), withdrawing and mood changes.  The best thing to do if you fear your child is being bullied or is bullying another person is to get resources for your child.  Talk to your school counselor, or set up an appointment with a  therapist who specializes in bullying.  Reach out and ask for help, and gain awareness because your child’s and thousands of other children’s and adults’ lives depend on it.

Honesty in recovery

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.

Functional dysfunctions: families in life, transitions, and therapy

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.

Social media: when to open up and when to shut up

Social media is the thing of the present and the future.  Only someone who lives in a very rural area or someone who tries incessantly to avoid Facebook, Twitter, LinkedIn, blogs, etc can sidestep its influence — and even then, media still finds a way to reach you.  There is much chatter and debate about the pros and cons of the social media universe, but my concern in this post is: in fields such as medicine, counseling, and therapy, where confidentiality is so important, when do you communicate and when do you keep your mouth (and typing fingers) closed?  Most professionals agree that it is always best to err on the side of caution and not talk at ALL about what is going on in your career in order to protect your clients.  I agree with this.  It brings me back to the lessons I learned when I was just beginning graduate school about the necessity to omit details, identifying information, and specifics when talking about what psychotherapists do.  In the realm of protecting client rights and privacy, the less said the better.  I felt then, and I still feel today, a sort of isolation based on this rule.  And it’s difficult when the very nature of your work is to process and help clients get through challenging situations that may require the psychotherapist’s own emotions to become involved (no matter how hard they try to protect their boundaries).  When you are carrying around the secrets and concerns of so many clients over the years, how do you release them so that they don’t bind you down?

Social media is NOT the answer, but it can be tempting to open up to a forum that might provide you with comfort and feedback.  Psychotherapists would say that it is most helpful to find a group or community of people in the same field with whom to confidentially process the needs of our clients, so in to help us help our clients best.  Supervision (individual or groups) is cathartic and essential, both legally and emotionally.  But it costs money, as do many of the groups that psychotherapists can join to talk about the ins and outs of the field.  It can leave a therapist feeling alone, and that they have many decisions to make solely — whether they are about client treatment or about the therapist’s own inner feelings.

An interesting twist on this topic is that therapists are encouraged or as this blog states, pretty much required to be on social media sites: writing blogs, marketing themselves, making a solid presence.  In the modern day of technological advancement, newly established counselors would be left in the dust if they did not jump on the social media bandwagon.  So again my question states: what is too much information, and what kind of communication is needed in social media for counselors to grow and thrive in this day and age?