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 am a psychotherapist in private practice. My job is to help make the
unconscious conscious and support people as they learn to live with greater
awareness of themselves and the world.
When people with eating disorders come for their first appointments they
have a lot to say. Some know it and start talking openly 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, and some think they do.
Some people who think they trust others often open too fast and pour their
hearts out in the first few minutes. They may feel unbearably vulnerable
after such an emotional release and begin making impossible demands (like
“tell me what to do to make everything fine right now”). When they hear
that recovery takes time, effort and resources they panic or get angry or
both. Then they disappear.
Some people are looking for someone to trust. They pour their hearts out
hoping they are in a safe place. They are being brave and taking a risk. They
feel a powerful sense of relief when the therapist is trustworthy and
understands eating disorders. They stay to explore because they’ve already
discovered that they can take an emotional risk in the service of their
recovery and be okay.
The people who know they don’t trust may be the most courageous of all.
They come to therapy, sometimes in terror. They know they don’t trust me
anyone, but they know they need help. They expect the worst of their
imaginations and hope for the best which is beyond their imaginations. They
hope. They want to run away as fast as they can, but they use their strength
and great desire to be well to stay 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,
and develop a genuine relationship. They trust too fast, or they don’t trust at
all.
An early and important step that continues throughout therapy, is working
with, talking about, living through, feeling and appreciating the complexity
of trust.
When they say they don’t trust me, I say, “Why should you? You just met
me. It will take time for me to earn your trust.”
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You see, they feel isolated in what they experience as a distant, cold and
dangerous world. So it often doesn’t occur to them that someone, without
pressure or manipulation, would accept their distrust and 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 will take time for me to earn your trust.”
Some try to ignore their feelings of isolation and danger. After all, people
with eating disorders try, often successfully, to ignore many of their feelings.
That’s the main function of their eating disorder. So, to prove that the
world is safe, that there are no dangerous people in it and 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 is 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. This is
when awareness and appreciation of themselves and their life situation
begins.
People don’t have eating disorders because of food. They binge, starve,
compulsively eat and purge as a way of self medicating themselves. There
are feelings they cannot bear to experience. Often they don’t know this
themselves. But when they eat to the point of emotional numbness, starve to
an ethereal high, fill themselves up and get rid of it through vomiting or
laxatives or excessive exercise, they are 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 focused
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 to not feel their despair.
So the work proceeds gently. As people become stronger and more aware,
they develop an earned confidence in themselves. They are capable of
accepting more realistic knowledge of the world and the kinds of people in it.
They then can develop and use more tools for functioning well in the world.
When they can do that the eating disorder is not such a crucial defense.
Because of this the person can begin to let go of their disorder without
feeling that they are in unbearable danger. They are participating more in
life, and they are beginning to develop trust in their ability to care for
themselves.
At this point, even though they feel vulnerable and new, they
start to rely on their new competence. They have proven themselves
trustworthy to themselves.
In the therapy process they learn how to live with their
misgivings about the therapist and over time learned valid reasons for giving
that therapist their
trust. They learn what it takes to earn trust.
This 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
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they develop and discover their own trustworthiness they discover a strength
and security they never dreamed possible before.
Overeating, bingeing, purging, starving, spacing out on sugar or massive
quantities of anything can’t compare to the freedom and security in relying
on your own strength, judgment and 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 and
feelings, now
that they know what listening is. They make decisions that are
in their best interest for health and a good life, now that they have tools and
know howto use them.
An eating disorder is a pretty paltry, flimsy, time consuming and useless
protector when you compare it to your own trustworthy, caring and
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 have confidence that you can feel, know what you are feeling
and listen to yourself now. You recognize your frailties. You know how to
draw on your own inner reliable and trustworthy sources of life affirming
wisdom. That’s where you find your freedom.++—
Joanna Poppink, MFT, licensed psychotherapist, specializing in eating
disorders
