The Basics of Eating Disorder Psychotherapy : How it Works, Part 2

by Joanna Poppink, L.M.F.T.

(Page 2 of 2)

When patients know they don't have to trust me blindly or pretend to trust me, the pressure is off. They can relax a little. They may start to share more of what is going on inside of them and with courage and curiosity observe me and allow me to be present with them.

Eventually, if all goes well, they will share with me not only things they've never told anyone else, but also things they didn't know themselves. This is when awareness and appreciation of themselves and their life situation begins.

A new patient may believe her eating disorder is caused by food. She may not yet understand that she binges or starves or compulsively eats and purges as a way of self-medicating herself. She can't bear to experience much of her own emotional experience in life. She eats to the point of emotional numbness, starves to an ethereal high, fills herself up to the point of physical pain and then gets rid of the binge through vomiting or laxatives or excessive exercise and doesn't know she is fighting off a terrible despair.

She and I don't attempt to find out what the terrible despair is right away. I doubt that we could succeed if we tried. But even trying in a focused concentrated way can be too threatening. She is limited in what she can bear emotionally. An important part of therapy is to help the her develop a capacity to tolerate a greater range and depth of emotions so the eating disorder is less necessary.

When a patient feels more pain than she can bear she may choose self-destructive behavior even harsher than her eating disorder. Sometimes suicide looks like a reasonable option to a person in total despair. So we proceed with the work gently.

As a patient becomes emotionally stronger and more aware of her internal life, she develops an earned confidence in herself. She can feel and think at the same time. Her fears may be strong, but they are not overwhelming. She can bear her experience, make decisions about what is best for her and communicate those decisions to others. As her healing progresses she is more capable of accepting realistic knowledge about the world and the kinds of people in it. Then she can develop and use more personal skills in functioning well in the world. And best of all, she discovers she has choices and opportunities she never dreamed possible. At this point the eating disorder behavior is not as crucial a defense as it was.

When the eating disorder behavior diminishes the recovery work continues. She is experiencing a challenging psychological event. She no longer has the familiar numbing methods available. Now she is simultaneously feeling emotions and having perceptions that are new and seem strange or frightening to her. She is a fledgling who needs to learn how to make herself safe while she stretches her wings to fly. .

Being wise and responsible while taking the necessary and reasonable risks of living in this world challenges all of us. To the eating disorder person in early recovery the challenge is particularly intense. She did not learn about reasonable boundaries and reasonable risks in gentle stages as she moved through childhood and into young adulthood. In early recovery she is facing the reality of a world that requires us to recognize the need for boundaries, create them and respect the boundaries of others. She is facing the reality of a world that presents us with consequences to our actions. She has little experience or awareness of boundary setting or consequences is shocked and frightened when confronted with these realities. .

This confrontation, if too severe, can tempt her to go back to the numb oblivion of her eating disorder. But gentle and consistent support and understanding during this critical period when the eating disorder is not an option helps her learn to take steps in this new and challenging world. Each step creates more emotional strength, clear thinking and self confidence. . .

Without the familiar methods of numbing she can let go of her disorder without feeling unbearable danger. She is participating more in life and developing trust in her ability to care for herself. Even though she feels vulnerable and new, she can use her courage to rely on her competence. She continually proves to herself that she is able to trust herself because she is trustworthy.

Understanding trust remains an important aspect of her healing and her life decisions. Through the therapy process she learned first, how to live with her misgivings about the therapist and herself. Over time she learned to recognize how and when her therapist earned reasonable trust.

This learning extends to her internal experience. For the first time in her life she learns what it takes to earn her own trust. When she develops and discovers her own trustworthiness she discovers a strength and security she never dreamed could exist.

Overeating, bingeing, purging, starving, emotional numbing on sugar or massive quantities of any substance or experience doesn't compare to the freedom and security created by strength, clear awareness and competence.

She learns to feel and be aware of her experience in the world when she knows she can rely on herself to be her own trustworthy caretaker. She learns to listen to her thoughts and feelings now that she knows what listening is. She makes decisions that are in her best interest for health and a good life when she have personal living skills and knows how and when to use them.

A patient in recovery integrates aspects of the relationship she had with her therapist into her particular way being in the world. She becomes her own caretaker. She has confidence that she can feel, know what she is feeling and listen to herself. She recognizes her frailties. She knows how to draw on her own inner reliable and trustworthy sources of life affirming wisdom. That's where she finds her freedom.

An eating disorder is a paltry, flimsy, time consuming and useless protector when compared to a trustworthy, caring and responsible self.

About the Author

Joanna Poppink, L.M.F.T is a Los Angeles psychotherapist in private practice who specializes in working with people recovering from eating disorders and their loved ones. She has been in practice since 1980 and is the author of “Triumphant Journey Workbook: a guide to stop overeating and recover from eating disorders.” She gives presentations on treatment, prevention and family dynamics as they relate to eating disorders to health professionals and community gatherings. www.poppink.com