Thanksgiving may be the ultimate family festivity, but many Americans find it more distressing than pleasurable. In recent sessions clients have worried about guest lists and obligations to attend dinners with people they really don't want to spend time with. I've listened to concerns about dishes and flower arrangements, cleaning the apartment well enough to appease Mom's critical eye, and even discussed the best way to roast a turkey (and yes, these are all perfectly legitimate topics for a therapy session!).

Running through it all is often anxiety about how to manage the great quantities of food on offer. For anyone who struggles with an eating disorder, the holiday can be a nightmare. But even if you don't have a problem with food (and who can honestly say that they don't?) it can be extremely hard to manage the day without feeling like a badly stuffed turkey yourself.

At the bottom of this post, I have a list of practical suggestions for dealing with the food; but before you skip to the end, it might be useful to look at the psychological component of all of this food. As we all know by now, the real problem is not what we eat (or don't eat) on Thanksgiving. It's what we feel - or try not to feel.

In my articles "Speaking of Feelings," and "Food for Thought," I write about the ways food, exercise, and diet help us manage unbearable or distressing emotions. On Thanksgiving, even folks with no food issues can find themselves using the huge meal to cope with situations that can't be put into words. One client, who I'll call Annie, loves her family but dreads the gathering on Thanksgiving Day. "We all try to protect my Mom," she said to me. "It's her favorite holiday, and we want her to have a good time. But no matter what we do, her sister (Annie's aunt) always ends up saying something mean to Mom. It may be that the turkey isn't big enough, or the tablecloth has a stain or one of the dishes is chipped. Or she tells Mom that she's gained weight! Then Mom gets upset, and cries in the kitchen, and the rest of the day is miserable." Annie has begged her mother not to invite this sister anymore, but without success. "She's the only member of her family who doesn't have somewhere else to go. None of her children invite her to their homes - for good reason! But Mom doesn't want her to be alone on the holiday. No matter that it ruins it for all the rest of us."

Thanksgiving is the beginning of the holiday season, when all sorts of family tensions come to the surface, despite - or maybe because of - the myth that it's a time of happy family togetherness. To live up to this fantasy, young children and teens are forced to divide their time between divorced or separated parents; and married adults with little ones of their own struggle to meet the needs of two, three and sometimes four sets of in-laws (whose house are we supposed to be at for which meal?).

Used as I am to all of the stories of the less-than-joyful gatherings at this time of year, I was interested when one client, who I will call Rachel, told me that it was her favorite holiday. I asked what made it special for her, and she explained that her family never made turkey and never watched the Thanksgiving Day parade. Since she had been very young, her parents, brothers and some mixture of friends and family members had gotten together mid-morning to visit men and women in nursing homes. "It's just a really nice, quiet, friendly day," Rachel said. "The old folks are so grateful to us for being there. We don't do anything special, just sit and visit for a while. Sometimes they ask us about ourselves; and sometimes we get them to talk to us. Sometimes they don't even want to talk, but like it that we're talking to each other while they're sitting there with us."

Afterwards they gather at someone's house to watch football and enjoy a potluck dinner of casseroles and salads brought by whoever felt like joining.

Rachel's family's celebration offers two of the solutions to the sometimes painful emotions that can destroy this holiday for many of us.

1) Make the day "other-centered," but don't lose sight of your own needs and feelings.

Not every family can or wants to get involved in volunteer work on the holidays (although in some cities, the number of volunteers is greater than the number of positions available on this day!). But Rachel described another kind of "other-centered-ness" that any of us can engage in.

She and her husband had been trying to get pregnant for more than two years when she told me about her Thanksgiving celebration. She was one of several clients who were dreading spending the holiday with a houseful of nieces and nephews and, in her case, a pregnant sister-in-law. She was close to all of the children in her family and usually enjoyed spending time with them; but this year she was feeling sad and tearful and like she did not want to be there. "Going to the old folks will be great," she said. "It will take me out of myself - away from my own problems." But being back at the house afterwards was going to be painful.

As we talked about how she could handle the situation, Rachel commented that her sister-in-law had not seemed happy the last time she'd seen her. I wondered if Rachel had any idea about what was going on. "Well, it seems weird to me, given how badly I want to be pregnant, but I'm wondering if she's not happy about this baby. I mean, she's let it drop that she might have wanted a little more time to get her body and her life back before she got pregnant again." We discussed the issue of timing and the idea that being pregnant wasn't a guarantee of happiness.

In our first session after Thanksgiving, Rachel told me that she had had a much better time than she had expected. "I thought about what we had talked about last week," she said, "and I realized that it might be helpful to both my sister-in-law and me if we talked about what we were feeling. I told her I was feeling envious that she was having another kid. And she told me that she was jealous of me for being able to have a career and not be tied down! It didn't make all of the sadness go away; but it made us both feel better somehow!"

Instead of being tied up in their own internal worlds, Rachel and her sister-in-law had spoken of their feelings - and had, as a result, been able to turn their attention away from themselves.

2) Relax the food ritual.

While traditional foods can make us feel festive and make a day special, they can also bring with them all sorts of unspoken expectations. Does your turkey look and taste as good as the ones from your childhood? Will your pumpkin pie live up to your mother-in-law's? Do you have to taste everything today because there won't be another opportunity to eat corn bread stuffing for a full year?

Rachel's family had one way of dealing with this - no traditional foods allowed! Another is to add something different but special every year - chocolate pudding for dessert, butternut squash instead of sweet potatoes as a veggie. And yet another is to have these goodies at other times! Who made it a rule that roast turkey could only be served on holidays?

And finally, since Thanksgiving will still, in all likelihood, involve an abundance of food, here are some simple suggestions to deal with it:

• Get some sort of light exercise before the celebration starts - take a walk, go for a run, do a few sun salutations at home.

• Eat something before the celebration. The worst plan in the world is to starve yourself throughout the day in preparation for gorging at the meal.

• Once the day begins (whether you are host/hostess or guest) start with a glass of ice water or seltzer and a slice of lime or lemon. The ice and citrus add a festive touch, and the drink gives you time to socialize and nibble any goodies available prior to the meal; and it helps take the edge off your appetite. Refill throughout the day and evening.

• Taste everything, even things you don't particularly like. Keep small quantities of something on your plate at all times.

• Keep drinking lots of water; limit your alcohol intake, since alcohol will decrease your ability to make good choices and increase your tendency to get emotional!

• Focus on conversation rather than food. Find out what your Aunt Tillie has been doing, ask your cousins where they got their shoes, see if anyone knows a really good shiatsu massage therapist...

• Suggest that the group go for a walk between the meal and dessert.

These are just a few suggestions. I'd love to know what has worked for you!

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