The Basics of Eating Disorder Psychotherapy:
How It Works

by Joanna Poppink, M.F.C.C

This is a straightforward summary, from the psychotherapist's point of view, of what can happen when a person with any eating disorder starts therapy.

I'm a psychotherapist in private practice. My job is to help make the unconscious conscious & support people as they learn to live with greater awareness of themselves & the world.

When people with eating disorders come for their first appointments they have a lot to say. Some know it & start talking right away.

Some are so nervous they don't know what to do or say or expect. But it doesn't take long before they start to tell their story. It's often a relief to start talking.

So first, I listen. Sometimes I listen for a long time. People with eating disorders have little or no experience or knowledge in really trusting anyone. Some know they don't trust & some think they do.

The people who think they trust others often open too fast, pour their hearts out in the first few minutes, make impossible demands (like "tell me what to do to make everything fine right now").

personal note: this is what happens here at night eating, people who correspond with me often think there is a quick fix to stopping the night eating, but it's just not that easy!

When they hear that recovery takes time & effort they panic or get angry or both. Then they disappear.

The ones who know they don't trust may actually be in a more advantageous position. They know they don't trust me or anyone. But perhaps they want to & are willing to try.

The delicate part of this first issue is that people with eating disorders often put their trust in untrustworthy people long ago. Perhaps they had no choice. Sometimes the untrustworthy people were their caregivers.

So it's difficult for them to come to another caregiver, the psychotherapist & develop a genuine relationship. They trust too fast, or they don't trust at all.

So, an early & important step that continues throughout therapy, is working with, talking about, living thru, feeling & appreciating the complexity of trust.

When they say they don't trust me, I say, "Why should you? You just met me. It'll take time for me to earn your trust."

You see, they feel isolated in what they experience as a distant, cold & dangerous world. So it often doesn't occur to them that someone, without pressure or manipulation, would accept their distrust & make an effort to be a reliable presence in their lives.

When they say, "Oh, I trust you." I say, "Why should you? You just met me. It'll take time for me to earn your trust."

Some try to ignore their feelings of isolation & danger. After all, people with eating disorders try to ignore many of their feelings. That's what their eating disorder is for. So, to prove that the world is safe, that there are no dangerous people in it & they have no need of fear or anxiety, they trust almost anyone very quickly.

When they know they don't have to trust me blindly or pretend to trust me, the pressure is off. They can relax a little. They may start to share more of what's going on inside of them.

Eventually, if all goes well, they will share with me not only things they've never told anyone else, but also things they didn't know themselves.

That's when awareness & appreciation of themselves & their life situation begins.

People don't have eating disorders because of food. They binge, starve, compulsively eat & purge as a way of self medicating themselves. There are feelings they can't bear to experience. Often they don't even know this. But when they eat to the point of emotional numbness, starve to an ethereal high, fill themselves up & get rid of it thru vomiting or laxatives or excessive exercise, they're fighting off a terrible despair.

We don't try to find out what that terrible despair is right away. I doubt that we could succeed in a fast way if we did. But even trying in a focussed concentrated way can be too threatening. The person might not be able to bear so much pain.

When a person feels more pain than they can bear they may choose self destructive behavior even more harsh than their eating disorder. Suicide can look like the only option to a person in total despair. The eating disorder helps the people not feel that despair.

So the work proceeds gently.

As people become stronger & more aware, they develop an earned confidence in themselves. They're capable of accepting more realistic knowledge of the world & the kinds of people in it. They then can develop & use more tools for functioning well in the world. When they can do that the eating disorder isn't such a crucial defense.

Because of this the person can begin to let go of their disorder without feeling that they're in unbearable danger. They're participating more in life & they're beginning to develop trust in their ability to care for themselves.

At this point, even though they feel vulnerable & new, they start to rely on their new competence. They have proven themselves trustworthy to themselves.

In the therapy process they learned how to live with their misgivings about the therapist & over time learned valid reasons for giving that therapist their trust. They learned what it takes to earn trust.

That learning extends over to their own internal experience. For the first time in their lives, they appreciate what it takes to earn their own trust. When they do earn it they discover a strength & security they never dreamed possible before.

Overeating, bingeing, purging, spacing out on sugar or massive quantities of anything can't compare to the freedom & security in relying on your own strength, judgment & competence.

People learn to let themselves feel, now that they trust themselves to be their own trustworthy caretaker. They learn to listen to their thoughts & feelings, now that they know what listening is. They make decisions that are in their best interest for health & a good life, now that they have tools & know how to use them.

An eating disorder is a pretty paltry, flimsy, time consuming & useless protector when you compare it to your own trustworthy, caring & responsible self. You integrate some of the relationship you had with your therapist into your own style of being in the world. You become your own caretaker. And before you take any action you remember that first step in therapy. You can listen to yourself now.

• Do you use food as medication?

• Do you eat to compensate for feeling depressed?

• Do you eat because you feel sluggish & you think food will somehow give you energy?

• Do you eat when you feel sorry for yourself?

• Do you overeat in social situations because you feel insecure?

• Do you eat when you feel overwhelmed?

• Do you eat when you've received bad news?

• Do you eat when you're anxious?

• Do you eat when you're disappointed?

• Do you eat when you're angry?

• Do you eat when you're lonely?

Friends, some of us eat & overeat as a way of self medicating or numbing the emotions & pain we maybe experiencing. Some of us eat & overeat to distract us from dealing with what's really going on inside or outside for us.

If we focus our energies on eating & overeating, we don't have to deal so quickly (if ever) with the loneliness or anger we feel toward those situations or circumstances.

I'm tempted to overeat even though I'm not hungry when I'm angry. Generally, I'm angry when I think I have no control in a situation. For instance, one of our young adult children (w/ one semester left of college) decided not to return to college but to follow a "boy" across country. Aaahhh, stuff, stuff, stuff.

Friends, if you overeat as a way of medicating your emotional pain you need to identify those triggers & make a plan. My plans are prayer, journals, email, research & music, lots of music.

Don't let your emotions set you back. Emotions can be tricky & dangerous & we need to be very aware of them in order to enjoy successful & permanent weight loss.

I find one of the best things I can do to stay on top of my emotions is to be well rested. Being well rested gives me the emotional stamina & energy to cope with what's going on for me & not let my emotions lead to overeating. Evaluate your situation & don't medicate, plan. You can do it!

excerpted from the website: Sam Turton's Primal Works - To understand Primal Integration click here!

Meditation

This week I want to introduce another classic, self-directed means of augmenting the process of growth and healing.

Meditation can be a confusing subject because it is a word that indicates different things in different cultures and traditions. At one extreme, it means to think deeply on a subject, and at the other, it means to not think at all! To me, the word meditation means "attention."

The root of the word "attention" is "attend" - to be present, to be here. Its Latin roots are "tendere" (to stretch) and "at" (to) - that is, "to stretch to" or "to attach to," like a tendon connecting a bone to muscle. To be alive is to attend to the sensations of life. If the sensations in our mouth are attended to, we fully taste the pie. If the pain in our foot is attended to, our leg muscles lift it off the sharp rock.

Depending on circumstances, attention can be simple and whole, or complex and chaotic. If, for instance, attention is bouncing between daydreams, thoughts, TV images, computer programs, recorded music, magazine photos, printed words, and social conversation, it may not be with our body and feelings. Due to regular neglect and abuse in childhood, we often develop distracted attention as a way of coping with the pain of our lives and feelings.

Life is attention. Many of us have become "out of touch" with our lives and suffer because of it. Meditation, as a practice of attention, can help. Some of the benefits of meditation are to allow our attention to:

• simplify and settle
• focus and become aware of our condition
• notice our pain, so that we can remove the cause or feel and release it
• focus away from pain in order to experience relief
• recognize our internally created thinking, both positive and negative, for just the thoughts they are
• feel the sensations of life directly, rather than through the distorted "lens" of internal traumatic imprints

Meditation can allow us to open up and focus our attention on painful feelings to release them, as well as focus our attention away from painful feelings to ground and shield ourselves. It can also assist us by focusing on the real, positive, nurturing elements in present-day life.

I also find meditation far safer and more effective than the "cognitive behavioural" approaches which are very "in" right now. Psychotherapists using these approaches direct you to adjust your thinking and behaviour patterns from negative to positive, according to the therapist's idea of what is "good for you." Meditation, on the other hand, is simply your own awareness, from which recognition and healing naturally flow. There's no external manipulation - it's like the body's immune system healing itself. And if you're looking for credentials and reliability, meditation can't be beat. Cognitive behavioural psychotherapy has only been around for a few decades. Meditation has a successful track record that is as old as humanity itself.

Another great thing about meditation is that it's something you can do every day, for free, and without the direct supervision of a therapist. Even though it is a gentle approach, do keep in mind that focused meditation may allow unresolved pain to rise into consciousness. Caution and moderation are always recommended.

If you feel that you need instruction from a "meditation expert," be aware that the simple, stripped down version I recommend may not be what other instructors suggest. Many insist on the use of mantras ("holy" phrases), imagery, and submission to a certain belief system. As far as I'm concerned, attention and healing are natural to the organism and do not require diversions and complexity. Simple is best.

The introductory method I recommend is outlined at

http://www.primalworks.com/primalzen6.html

Read the general section "Still Attention." Under the heading "Various Forms - Focused to Unfocused," follow the instructions for "Counting the Breath." Eventually you can move on to other forms if you wish.

As an adjunct to primal integration work with a therapist, I suggest sitting in meditation no less than 15 minutes at a time, and if possible, at least once a day. And be sure to write the experiences in your journal!

Reading

Reading primal-related material can help you know your process. Knowing your process can help in many different ways:

• you are less likely to be manipulated into methods that do not suit your nature
• you are more likely to direct your process, and allow faster, more significant change
• you are more likely to integrate depth emotional experiences (primals) into your whole bodymind system
• you are more likely to understand and respect yourself - your issues and your shields
• you are more likely to develop an awareness of the embedded belief systems, or myths, that affect your healing process
• you are more likely to develop a realistic mythic system, or "map," that will stand as a guide through times of confusion and overwhelming emotional change

Those Wily Belief Systems

Most of us are driven to growth and healing by problems and pain, not because we question our belief systems. When we walk into session, however, we bring our entire belief system with us - a system that is often both a reflection, and a cause, of the problem.

Belief systems are not just ideas we pick and choose like cards. In fact our ideas, and the actions we take based on those ideas, come out of neurophysiologic (bodymind) patterning molded by the pressures of our development. For example, extremely conservative thinkers don't just choose their ideas - their stringent stance (physically and ideologically) emanates from a stringent bodymind, molded by an overly stringent/neglectful childhood.

"Myth" is a word used eloquently by Joseph Campbell to describe these all-encompassing belief systems, or worldviews. Myths are more than ideas - they are the way we perceive the world. Myths attempt to indicate the way things are, and the way things work - including ourselves. Religious and spiritual beliefs, scientific views of the universe and medicine, political platforms and governmental systems - these are all myths. Unfortunately, most of them describe life in divisive terms - good/evil, matter/energy, brain/body, feeling/thinking, liberal/conservative, should and shouldn't, right and wrong. These myths present views that split up the wholeness of reality - the essential unity and interconnectedness of things. They come from, and lead to, a sense of being divided and separate. This is the emotional illness of our times.

It is important to know that we have been infected with divisive mythologies and we bring them into our growth work. They are extremely resistant to change. Just doing deep feeling work and letting emotions flow won't always dislodge all these bodymind patterns. And, as a part of our defense structure, they will often interrupt our process just as we are about to make a significant breakthrough. When big feelings start to come to the surface, often people run away to the "protection" of their familiar worldview - and a band-aid solution to the problem.

Reading relevant material can be a big help with this. Instead of blindly going along with the "expertise" and "superior methods" of the priest, teacher, therapist, doctor, or politician, you can seek the truth and direction for yourself, both in your feeling work and in print.

Primal purists believe that primaling alone will heal, and that reading is an intellectual distraction. Although reading can become a distraction from feeling, one of the things that "Primal Integration" means to me is an integration of the feelings and the intellect, the body and the brain. To go from exclusive thinking to exclusive feeling is just another divisive swing of the pendulum.

Picking through the Minefield

Unfortunately, there are a million books that shout "my way is right!" What do you believe?

Start with the essential reality. You are you. Your life is your life, not somebody else's. Nobody knows what it's like to be you better than you. You may be thinking, "But I don't know, I'm confused." That's right. That's what you are right now - confused. And nobody knows what that's like better than you. So right away you can exercise caution toward authors and books that insist they absolutely know what's best for you, or that you should follow their way. As an author, I may suggest things that have worked for me, but I firmly stand by your right to discover what is true and right for yourself.

Another caution: beware of systems that do not accept you as you are, that judge, criticize, or present an ideal image of what you should be like - even if they do so in an apparently caring, expert, or "holy" way. Living things grow and change from the inside outward at their own pace if they are not manipulated, abused, or denied. You are a living thing.

Psychotherapy and self-help books are an especially challenging minefield of advice on how to "get well quick." Authors with letters after their names often try to convince us to accept their methods and theories as facts "we now know." The assumption is that they, because of their expertise and pages of "findings" and scientific studies, know something you don't. They are saying, "You don't need to question this. You can't trust your own experience. I have a Ph.D. and you don't. Believe me because I say so." But scientists and doctors and professors are just people like you and me - with the same addictions, health issues, and personal problems as everyone else. Ask yourself - if the scientific method is so reliable, how can all these authors with opposing methods manage to find hard research to back each of their conclusions? The infallibility of science and credentials is just another lie we were brought up to believe. Don't fall for it. Sift through the information. Find out for yourself.