Therapy for an eating disorder requires patience and persistence.
Posted Jul 03, 2012
Coming out of my office late in the day I was greeted by a homeless man. “Do you have any change?” he asked. “I haven’t had anything to eat for two days.” After a full day of seeing clients I was tired, eager to get home. Yet I stopped. Not wanting to just hand him some money, I offered to buy him some food. “There’s a deli right here. I’ll buy you a sandwich and something to drink.” He ordered a roast beef hero with the “works.” “Can I buy some chips to go along with it,” he asked. “Sure, and why don’t you buy some fruit,” I added, thinking that an apple or banana would balance out his meal. Clearly the total cost of his meal came out to more than spare change. “Thank you,” the man said, and I watched him wheel his cart stuffed with all his belongings to the park across the street.
As I walked to the bus stop I noticed that I suddenly felt less tired. I felt a spurt of energy and something else which I could not yet identify. I have given money and purchased food for homeless people before, but this time I felt different. Reflecting on this experience and the change in my emotions later that night, I realized that my burst of energy came from a feeling of instant gratification. In a matter of minutes and by simply doing a good deed I had made this homeless man happy. For a short time I too felt gratified. This feeling reminded me of the instant gratification and sense of accomplishment I used to get when I suffered from anorexia. I would push my food to the side of my plate, leaving the table when I still felt hungry. One difference between these two actions is that one is life-giving and the other can result in death.
There is no instant gratification in the work I do with my clients, many of whom suffer from eating disorders. Therapy with sufferers of anorexia and bulimia is a slow process which involves learning to cope with feelings and life stresses without starving, binging, purging, or overexercising. It requires patience, tenacity, and persistence. Along with movement forward, there is often movement backwards. As I know personally and professionally, almost no recovery occurs without periods of regression. As much as the sufferer wants to be free of her obsessions about eating and starving, she does not know how to navigate life without her illness. In order to protect and to hold on to her eating disorder, she builds elaborate brick-like defense mechanisms around it. Her emotions go underground, and in their place are obsessions about the number on the scale and how many hours she can exercise. My client’s mind is filled with rigid rules about diet and exercise so as to avoid thinking about what she truly fears. It can be issues such as separating from parents and going to college, dating, choosing a life partner, or having a child.
My last client that day illustrates the slow therapeutic process. Samantha came in and said that for the past few days she had been preoccupied with the size of her stomach. She frequently checked herself in mirrors and in the reflection of windows and pinched herself around her abdomen to see if she could grab hold of any flesh. “If you weren’t focusing on your body, what might you be thinking about or feeling?” I asked her. Having worked with Samantha for more than a year, I knew she had the capacity to dig deeper and be self-reflective. Yet today she was very resistant. Squirming in her seat and avoiding eye-contact, she replied,”I don’t know. I just feel so out of shape.” I asked her if anything had happened in the past few days that would cause her to be obsessed about the size of her stomach. “No,” she replied. “I don’t want to talk about it because that will only make me more anxious.”
Trying another angle I asked her to tell me more about her anxiety. What did it feel like? Where in her body did she feel it? Was it a lump in her throat? A pounding behind her eyes? Butterflies in her stomach? When during the day did it begin? Did she wake up with it? Were there times in the day the anxiety felt worse? When Samantha focused on her stomach, or as with many of my clients, obsessed about her food, she was trying to distract herself from the anxiety and what may have been causing her distress. By asking her questions about the anxiety, my goal was to be with her in a safe place and to help her to see and experientially know that she could tolerate the anxiety and that it would not overwhelm her. Together, we could also look for ways that she could soothe herself and decrease its intensity. Ultimately she would not need to use her illness to flee the anxiety and we could fully explore its underlying causes. All of this transpired over many sessions.
Giving up anorexia or bulimia, learning to tolerate difficult feelings, and finding new ways of coping with life stresses is a slow process. Many of my clients do not remember a time when they lived without their illness. Yet the work we do together is life-changing. It feels meaningful to me and I hope to my clients. I am deeply touched as Samantha and all of my clients let down their defenses and learn to express their true doubts and fears through their voices and not their illnesses. It is fulfilling to watch my clients internalize and integrate our work and begin to develop richer more textured lives. Feeding the homeless man added to my life as well, and once in a while instant gratification feels good too.