HOW I WORK WITH EATING DISORDERS

“To actually accept that you have an eating disorder or a mental health issue is actually a sign of great, great strength. It is not a sign of weakness at all.”
Nigel Owens
“A cultural fixation on female thinness is not an obsession about female beauty but an obsession about female obedience.”
Naomi Wolf

EATING YOUR EMOTIONS

How many of us use food to regulate our emotions either by overeating (refined carbohydrates and refined sugars) or by restricting our eating? How many of us use food or semi /starvation or starvation in order to numb our emotions in a desperate attempt to silence the nagging voices resulting from our own internal pain? Finally, how many of us have an unhealthy and obsessive relationship with food often to the detriment of our own personal relationships?

As a counsellor specialising in Eating Disorders and Obesity I am often moved whilst observing the constant battle my clients have endured in order to have the courage to say goodbye or indeed change often the most intensive relationship they have ever had! Time and time again whilst working with this client group it is in my experience that at one stage, food or the controlling refusal of food, became, a friend before it then became a relentless and punishing enemy.

Helena Wilkinson, a therapist, who wrote ‘Insight into Eating Disorders’, asserts that “an Eating Disorder is like an iceberg and it is what is going on below the tip of the iceberg is what is maintaining a dysfunctional relationship with food”.

 

 

 

 

 

 

 

 

I also read somewhere that people often use food and their body to tell a story for which they have no language and  I have found that to be so true.

So, how can I  as a therapist support these clients fighting this battle, with food, weight & shape?

Working with this client group is however very different from how I work as a general practitioner as it is directive and at first I found this transition challenging.

The differences are;

Work begins even before the first assessment, as ideally I have a returned a detailed life style questionnaire and food diary and in the case of children the parent or significant other will have also completed and returned a detailed history. Once I have received all of this information I will then have an overview and an idea of how I can most therapeutically support the individual’s presenting issues. I will also then be able to prepare appropriate assignments and information that can be if deemed suitable be taken away at the end of the first session.

During my training at the National Centre of Eating Disorders we were taught that there are sixteen factors that maintain an eating disorder and therefore it is my job to understand, work with and address all of those maintaining factors,  which are applicable to these cleints, which are;

  • low self esteem
  • poor assertion
  • low blood sugar
  • thrush
  • other biochemical reasons
  • stress
  • lifestyle
  • feelings (show/hide)
  • attitude traps
  • faulty food script
  • malnutrition
  • habit
  • poor body image
  • allergies
  • addiction process
  • Fat/thin conflict

After the assessment which lasts at least two hours or more, we will have completed a comprehensive life/weight line and pie chart is then compiled which will highlight the main areas which keep the iceberg intact and the bullying voice of the eating disorder in power. Following on from the latter, if is therapeutically viable then the clients and my my remit is to work together in order to challenge and begin to disarm the maintaining factors.

Furthermore support is given in all of the following areas;

  • Nutritional, educational and practical advice are routinely given.
  • Clients are given information and guidelines on motivational changes, menu planning and education on super foods and portion control.
  • Direction is given regarding life style changes.
  • An important part of my work is working with clients to support them into developing a healthy relationship with food.
  • Educating and supporting clients  in how to balance their blood sugars which are essential for both physical and mental well-being. Balanced blood sugars stop food cravings that often lead to binging and an addiction to sweet foods.
  • I work as a coach, a mentor as well as a sponsor for change throughout this work.
  • Food diaries are worked with as a therapeutic tool at, as it allows us to begin to understand patterns of behaviour and highlight feelings/or indeed lack of feelings which trigger dysfunctional eating.
  • A comprehensive life line is compiled focusing on age and weight which is an extremely effective intervention.
  • Assignments are routinely given (according to personal requirements), addressing all the maintaining factors and other contributing obstacles (if applicable) such as obsessive compulsive disorder, anxiety, depression, body dysmorphic disorder (BDD) Personality Disorders  and substance abuse. The latter factor often treads a weary path alongside the eating disorder and need to be dealt with as a part of recovery.
  • A nutritionist who works with me is often a necessity and occasionally a non-negotiable part of the therapeutic package.
  • I will use, (if appropriate and if a client desires) the Emotional Freedom Technique which can disempower the addiction to certain foods (chocolate for example).
  • Work is directed in supporting clients in developing stimulus control.
  • Relapses are routinely accepted and indeed considered useful in order to support long term changes.
  • I am more likely to be in contact with GP’s or medical professionals (if necessary).
  • Use and misuse of exercise is addressed and activity guidelines supplied.
  • We need to motivate ‘self efficacy’, so that a belief in long term change thus becomes part of the clients belief system.
  • Work on self esteem and assertiveness training is vital as from my experience we cannot begin to say no to food, until we are unable to say no to other people.
  • Family therapy, especially for clients under the age of consent is often a therapeutic requirement.
  • Educating and therapeutically supporting the family and caregivers as to how to deal with a loved one with an eating disorder is often an important part of my work.
  • Counselling clients who are considering or about to embark on Bariatric surgery is a significant part of my work, as is post operational therapy.

Finally, my experience and training has taught me amongst many other things, that it takes only two things to support a successful therapeutic journey, a willing counsellor and a willing client, therefore if together and committed we can only succeed!