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How Therapy Can Help Exercise Addicts (Part II)

Learning to feel worthy without others' constant approval

In a previous post Richard Achiro, Ph.D., gave us some insights into the origins of self-denial that undergird eating disorders and compulsive exercise habits, derived from his own private practice treating men and women with body-image issues. He’s back this week to shed some further wisdom on the therapeutic alliance and its role in helping individuals who struggle with these problems heal.

A huge step in helping people emerge from their disorders, Achiro explains, is the cultivation of trust between a client and therapist. The goal is that, with enough trust, the client feels increasingly safe in loosening his or her rigid grip on behaviors (i.e., over-exercise or misuse of supplements) that lead to external validation (i.e., praise, admiration, attention, and perhaps even others’ envy for his appearance) and learn how to feel worthy enough without others’ constant approval.

None of this is to say that the goals of therapy should be forswearing the pleasures derived from being told one is beautiful. Rather, the intent is to not need that superficial reinforcement in order to feel okay.

Gaining the trust that enables clients to build internal worth is by no means easy. And it relies, says Achiro, upon the therapist “relentlessly offering space for all of the patient’s emotions with an attitude of curiosity and acceptance.” In so doing, the therapist carefully tries to avoid showering the client with too much verbal praise for his progress, as doing so can unintentionally serve to reinforce that overreliance on externalities that’s led the client to so much turmoil in the first place.

“Of course, not being overtly praised or guided by the therapist can be excruciating for patients who have the most difficulty validating themselves and who are constantly searching for recognition that they are worthy,” Achiro acknowledges. “But by not accommodating patients in this way, they are able to become aware of the fact that the external relief and reassurance they’ve been chasing puts them out of contact with themselves.”

When we rely upon others to tell us how worthy we are, we actively forfeit strengthening a connection with our own sense of value—alienating ourselves from the deeper core of our beings which houses our most truthful wants, needs, and fears. Often, reaching for everyone else’s praise, admiration, or even others’ advice can be a means of actively avoiding any awareness of what we truly think and feel. “We don’t want to know what we actually think or feel because such vital core aspects of ourselves can be overwhelming without the containment of another,” Achiro says. “Moreover, those very aspects of self are often thought to be what drive others away. This is a critically debilitating cycle which thwarts our abilities to feel connected with ourselves and to connect in a meaningful, enriching way interpersonally.”

“When patients ask for concrete advice or regularly seek evaluative comments from me, I often ask them whether they're trying to leave themselves. It's not a coincidence that they most often ask for my direct input at moments in the session when they've just come upon a particularly difficult emotional experience—something that seems indigestible and that they want to get rid of. My asking why they want to leave themselves in such moments offers an opportunity for them to connect with and express any number of emotional experiences which had formerly been projected out only to leave them feeling more empty, anxious and/or depressed in the long run.”

Anger and other aggressive feelings are common examples of those emotions that tend to overwhelm people and which, by extension, escape recognition and expression. Achiro points out that patients who have difficulty constructively expressing aggression can benefit from using the therapeutic relationship as an interpersonal forum in which to test their abilities at allowing for difference and conflict to manifest and be worked through.

Achiro offers the example of one such patient:

“After expressing anger toward me for the first time, he returned to his next session apologetic. Through a collaborative exploration with me, he was able to discern that he was afraid he had pushed me away with his anger; a situation that recalled experiences with his parents who he believed to only want him when he was happy. In time, he began to relish his ability to connect with his anger and now has the capacity to view it as constructive—finding in it a feeling of aliveness as well as an opportunity to be heard and assert himself in ways he never before believed possible.”

At the same time that this client began to accept rather than repress and displace his anger, his binge eating behaviors began to decrease. Over the course of several sessions, Achiro recalls, “the client came to understand that binging was formerly a self-destructive attempt to ‘teach a lesson’ to people (often psychological stand-ins for his parents) who he didn't believe could tolerate his rage.”

Fears that a “destructive” emotion may endanger our ability to hold onto those we love and need, Achiro points out, are quite common. Many of us hold the barely conscious, false belief that simply having negative feelings or thinking negative thoughts about others is bad. Especially if we’ve been raised to believe that expressing such negative emotions results in punishment, shame, or the withdrawal of someone we love’s affection. Unfortunately, this leads many of us to repress those emotions we learn to be afraid of. But just because we can swallow a feeling doesn’t mean it disappears. The more we push our emotions down, the more they manifest in inadvertent ways—i.e., a compulsive drive to perfect one’s body or control one’s food intake or appearance. Or, in the case of Achiro’s client, in the self-abusing abnegation of control via binge eating.

Because Achiro’s client came to increasingly trust that his therapist would not abandon or reject him for feeling or expressing anger, he learned that it was safe to acknowledge its surge. In this way, the client was able to establish trust—not only with his therapist but also with himself, his own emotions, and his ability to thrive even in the absence of excessive external praise. The most fundamental element in this process, says Achiro, was to hold a space in which the client’s difficult feelings could surface, necessitating awareness of his own interiority and forcing him, with his therapist’s help, to process and more optimally channel previously repressed feelings.

Ultimately, this increased capacity not only mitigated the client’s binge behaviors, says Achiro, but it also fueled his ambition. The patient is now pursuing training in work that is meaningful to him rather than remaining complacent in a work situation which had long made him feel like a victim, Achiro reports.

Being able to face the emotions we’ve learned not to express is an arduous and often painful process. Hence why it can feel so much easier to cling to a grueling and relentless exercise routine, a rigid and restrictive diet, or dive into excessive consumptions of food, shopping, alcohol, drugs, or sex. But by continually chasing confirmations of our worth through externalities—or by seeking escape from repressed emotions via self-destruction—we further alienate ourselves from understanding what would truly make us feel alive, empowered, and satisfied.

To venture beyond these behaviors, we must trust in ourselves. But often we have lost this trust or forfeited it altogether for fear that, by being honest with ourselves or allowing our true emotions adequate expression, we will in some way be harmed. Likely because we were shamed for that honesty, rejected, or in some other way lost the approval of someone we loved. But with the guidance of a well-trained therapist who carefully toes the line between encouragement and eliciting those emotions we’ve stuffed so far down without judging or punishing us for their expression, we can learn that it’s okay to feel things we’ve spent so long avoiding.

In this way, we come to appreciate the much greater reward of being able to feel, validate, and regulate our emotions more effectively, rather than destroying ourselves in the process of avoiding their intensity and obsessively seeking confirmation from others that we are “okay.”

*Details and identifying information have been altered to protect client confidentiality.

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