For my previous post, I had the pleasure of interviewing Richard Achiro, Ph.D., an L.A.-based psychotherapist who both researches and treats men grappling with issues of self-esteem, masculinity conflicts, and body dysmorphia—all of which may manifest in an obsessive drive towards muscularity accompanied by excessive consumption of (legal) workout supplements.
In this post, I quoted Achiro on one of the primary goals of the type of therapeutic alliance he aims to create with his clients—namely, how it can help “open men up to what’s going on with them, emotionally, and understand how their external world is just a concretized symbol of what they’re feeling.”
In the comments section, one reader asked for further clarity on this point. How, exactly, are men supposed to engage in such opening up—and what happens in therapy to enable this?
Great question! And a perfect segue into what therapy entails—especially the kind that helps individuals overcome unhealthy relationships with exercise and food.
Societal messages and repression
Before comprehending the value and function of the therapeutic alliance, it’s critical to note what clients are bringing to the table when they seek help for body image and self-esteem issues—as well as any concomitant anxiety and depression laced into these problems. As Achiro explains, many of us absorb a message from our consumer-based society (and the caregivers who were, like us, steeped in its values) that we will never be or feel good enough if we can’t demonstrate—via appearance, our bank account, or our accumulation of possessions—our status in some tangible, external manner.
That most of us are repeatedly rewarded (via praise, money, or more attention) for appearing and doing our best to appear desirable can foster a belief that all those parts of us which don’t conform to what gets us the most validation (i.e., the weaker, needier, more emotional aspects of our full selves—in addition to our aggressive impulses) are, in some way, wrong, bad, and must, at all costs, be hidden or disavowed.
This repressive, self-denying response is compounded when we are repeatedly and consistently shamed (by caregivers, teachers, and peers) for expressing such less-than-perfect emotions.
Development of symptoms
Such emotional cauterization, Achiro notes, can and frequently does give rise to a variety of symptoms, including the symptoms of anxiety, depression, and behavioral problems—from eating disorders and exercise addiction to other self-destructive endeavors (think: pathological gambling, alcoholism, and substance misuse). If only we could have the perfect body, we tell ourselves, toiling day in and day out to burn more, lift more, and train harder at the gym. (Or restrict our food intake to an ascetic level that results in weight loss but ends up wreaking havoc on our bodily health and mental wellbeing.). Alternatively, we might busy our minds with anxious thoughts, or consume substances that dull our self-awareness, so as not to have a moment to face that which lies at our core—those unacknowledged, shameful, and scary feelings and thoughts we’ve been trained to negate.
“Instead of acknowledging or even being able to recognize what we actually feel (e.g., deadness, dread, emptiness, loneliness),” says Achiro, “we continue to try to fill ourselves with goods, food, fashion, drugs, etc.—short term fixes that leave us feeling more empty in the long run.”
Now here’s where therapy comes in—provided, of course, someone opts to seek help. (When it comes to overzealous exercisers, it’s more often the anxiety or unhappiness resulting from an injury that prevents them from carrying out their normal routines that triggers a first visit, rather than the overzealous and rigid adherence to multi-hour or multi-session workouts.)
How therapy can help
Step one of this therapy process? Cultivating trust.
Unfortunately for those seeking a quick fix, the type of trust that enables a therapy-seeker to feel comfortable relaxing his or her hold on external measures of validation (i.e., excessive workouts, the pursuit of some arbitrary and possibly unsustainable scale number or body fat percentage) and loosen his or her adherence to rituals and strict modes of operating that grant only transient sensations of comfort in one’s skin, can’t be accomplished in one or two sessions alone.
But the hope, says Achiro, is that in a reasonable amount of time—which some evidence suggests is between 7 and 10 psychotherapy sessions—the therapist’s nonjudgmental stance and openness to the whole range of a patient’s emotional experience, can set into motion a process in which the patient begins to grapple with the notion that they can be and are worthy of being “loved and accepted even if they perceive themselves as ‘different;’ hateful; or full of envy, shame, regret, or a sense of inadequacy—feelings that are highly unpopular in a society that leads us to believe that fulfillment means being happy all the time.”
It may not be easy to radically alter one’s perspective in a way that allows him or her to see how their external behavior (i.e., overuse of supplements, self-deprivation, denial of needs, etc.) is a means of both avoiding that which is going on inside of them as well as seeking the human validation, connection, and approval that is so crucial to psychological survival.
“The trust that the therapist gains,” Achiro goes onto explain, “is the product of many factors including (but by no means limited to): attunement to the feelings a patient is trying to disown ("bad," loving, or “needy” alike); genuine curiosity (rather than judgment) regarding the patient's experiences, behaviors, and reactions; openness to the patient's negative feelings or criticisms toward the therapist and the treatment; as well as the ability to enforce boundaries which keep the therapeutic space safe.” No small feat. But certainly within the realm of possibility—given enough time, patience, effort—or, for many of us, alas, adequate insurance coverage.
Only when we reclaim those previously devalued parts of ourselves through acceptance and trust—modeled, at first, by the therapist—can we feel “real and human again—and imbue our lives with meaning,” adds Achiro.
That is to say: Only once we face those aspects of our humanity we seek to repress in the service of gaining external approval can we stop feeling empty and compelled to overcompensate for that void by obsessively pursuing external validation—which can, in the case of eating disorders and exercise addiction, take the form of bodily harm.