the future of eating disorders

Today was long.

First day seeing clients at a new job. Without revealing too much information, the population is vastly different from the one I’m used to at my other agency. It’s also time-limited, brief therapy, which isn’t exactly my favorite. But it’s kids and adolescents, which I enjoy, especially the junior high kiddos.

I wonder what my life would have been like if I went to therapy when I was younger. My parents don’t really believe in it. They’re more along the lines of “getting over it” and just “thinking about the positive,” which, as a mental health professional, terrifies me. No parent should ever be ashamed of their child needing psychotherapy. It’s like being ashamed of needing to go to the dentist or doctor.

The stigma may be lessening over time, but it’s still there, and it’s still devastating.

Recovery stuff has been good, however I’ve been having trouble sleeping the past few days, which throws me off track. This is the ebb and flow though, and it’s okay.

I’ve been seriously researching this eating disorder recovery work, and I truly think I can make a difference in the systemic approach we have. I have several ideas and am writing extensive literature reviews on the research that already exists.

Most of it frustrates the hell out of me.

For one, I’m tired of overpriced services. For two, I’m tired of high relapse rates. For three, I’m tired of the overall unwillingness to work with a population that DESPERATELY needs help.

I have a vision, and I am set on following it. Maybe it won’t manifest today or this month or this year, but it WILL happen because I know I have the drive, motivation, and creativity to achieve it. I also know how important it is in this society.

It’s something I wish I had when I was deep in the disorder. I want to revolutionize the private practice vs. treatment center recovery plan (which are both extremely expensive), and I want to be able to help re-define a realistic recovery for people who are suffering. I want to be able to reach to those who may NOT be upper-class or even insured. I want to be able to reach to those who cannot afford to do inpatient or residential work. I want to RAISE AWARENESS to this epidemic that is happening in our schools, to our children, in the bathroom stalls, on the plates of people everywhere.

Some would say it’s dangerous because I’m in recovery myself. And I would agree. But you know, it’s worth the risk. Because life isn’t just about helping myself. It’s about using WHAT I’ve learned to help myself to help the greater good. So maybe it’s dangerous, but nothing worthwhile ever happened while staying in a comfort zone. I want to bridge this gap between clinical jargon and actual application. I want to reach out to the bleak and hopeless, the ones who feel they have failed over and over again. I want to change the way we perceive these diagnoses.

And that’s exactly what I intend to do.

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The “SYSTEM.”

I have issues with most of the standard “theories” relative to eating disorder treatment.

CBT is a decorative bandaid, DBT is hard to find and difficult to buy into, psychoanalysis is too expensive, and group therapy leaves little room for in-depth personal exploration. Family therapy has high efficacy, but typically, it’s geared towards adolescents, and typically, it’s for wealthier and more motivated families.

Oh, that and most non-profit agencies and college campuses REFUSE to treat eating disorders. Which leaves everyone with: private practice.

Which is no small fee.

What’s happening with me is that I’m developing my own.

I’ve been researching. I’ve been writing. I’ve been thinking and talking outside the box. Using my own experience and my own therapy modality to guide me.

Maybe it’ll go somewhere someday. Actually, no. IT WILL GO SOMEWHERE SOMEDAY.

I’m tired of eating disorders being that “lifelong” illness. I’m tired of high relapse rates. I’m tired of the stigmatization, the broken medical model, the in-and-out recovery, the refusal to work eating disordered patients because they are too “high risk,” the utter lack of funding we have for individuals in lower to middle-class income brackets, and, of course, the fallacy that a disorder as complex as these can be solved with a thought record or a positive coping strategy. I’m tired of anorexia being the most fatal illness and the third highest leading cause of death for adolescents. I’m tired of people neglecting bulimia and binge eating as “crisis issues” because it may not be as physically apparent.

We need more. We need so much more.

There is research. Lots and lots of articles and brilliant professors in laboratories researching neurobiology and possible eating disorder treatments. Great. There are clinicians. Lots and lots of clinicians in residential facilities and private practices.

But there is a gap. There is not enough. The theories are weak. The treatment is difficult. The prognoses are poor.

Inspiration struck last week. My diploma arrived yesterday.

Who knows what will happen from here?

But if someone needs to do it, why not me?

Today is a 7.

Dear Bee, 

Finally, a week has passed without any eating disorder behaviors. This used to be an insignificant milestone for me. MONTHS was how I tracked it. Lately, however, it has been more of a battle, and, so I’ll take the small victory. Because I’m being kind to myself 🙂

Six months of being a training therapist. Nearly 250 therapy sessions and groups. Kids as young as 4 and adults as old as 70. Couples on the brink of divorce. Recovering addicts. Personality disorders. Abuse of every kind. Physical disabilities. People all over the sexuality spectrum. Anxiety, depression, fetishes. Existential concerns. Suicidal thoughts and plans. Religion. Teenage drama and breakups. Cutting and drinking and drugs and sex and eating and withdrawing from the world. Shame, hope, frustration, tears, letters, therapeutic rapport, interpretations, expression, and, finally, some healing.

Every dialogue, every client teaches me something new. I love it all.

Life just moves differently now. More meaning. More purpose. More intuition. 

Someone told me that the other day, One of your greatest assets is your intuition. He was referring to my clinical intuition with clients (using my “gut instinct” to respond and interact with clients in a natural way), but that cannot be possibly limited to a therapy room. My intuition is beautiful. It guides me. It loves me. It keeps me safe. All I need to do is listen to it! 

I spend a lot of time thinking about the power of intuition over the power of compulsion. So much of what we do is engrained into us. It is our habitual thinking. We roam on autopilot. But to use intuition, to channel the inner voice, that’s where the healing begins. That’s where the individuality and uniqueness of human creation flows. That’s the stuff that defines WHO YOU ARE, rather than just WHAT YOU DO. It’s not easy: our intuition may move us directions opposite from the ways we are used to moving, but ultimately, it is so rewarding. Our bodies and souls are so smart…if and when we choose to channel them.

Once upon a time, I wanted to change the world. Interesting how that component never actually included myself. I didn’t want to look inwards. I wanted to focus on everyone else, on anything other than my own internal chaos. 

Today, my needs come first. I am my best friend. I expect NOBODY to put ME first, whereas before, I was disheartened when I was anything BUT first. My shift in thinking has allowed me to lessen on the perfectionism, embrace my unique flaws, and reach a happier place of self-acceptance. Sometimes, I’ll use scaling questions to ask my clients where their confidence/happiness/fear/etc. (concern of the day) lies on a scale from 1-10. And then I’ll ask them, where do you want to be? What do you have to do to get there? What does being (this number) look like? 

Today, my self-love is at a 7. It’s not a 10, but that’s okay. A 7 means I am happy with myself; a 7 means that I appreciate my body; a 7 means that I feel grateful and loved. A 7, indeed, is a lovely number to be. 

What’s your number today? 

 

being THAT person

Dear Bee,

I am now that person.

The one who people frantically call, on a rainy Saturday morning, while I’m still in sweats and typing a literature review, in their perceptions of a crisis.

The one who people cry to and confide in. 

The one who people look to for answers, for fixing, for the solving of problems.

It is hard, being on this pedestal. It is even harder, because I want to be there. I’m that person for a reason. I’m that person because I am good at what I do, because I’m compassionate, because I believe everyone deserves a safe space and a chance to heal. Pain, to some degree, is nonnegotiable and part of the contract of life. We cannot avoid it, although some of us will get more of it than others. I work with people who have faced all levels of pain, whether it has been internal or external. I do not discriminate. It does not matter who is the sickest nor does it matter who has the worst sob story. Pain hurts us all. It is not a competition. 

Most importantly, everyone’s pain is valid. There is no such thing as “fake” pain, because even the pain that we perceive as fake or attention-seeking indicates a PAINFUL problem in it of itself. 

Anyways, being a therapist is a challenging job. Yes, it is entirely rewarding. And no, I can’t picture myself being as fulfilled doing anything else. But, it’s definitely difficult. And it definitely makes me question humanity and how we approach life. It makes me question why we do the things we do and why we make the choices we make. It makes me question fairness and equality, especially when some of the sweetest people seem to face the worst circumstances. It makes me feel grateful, that is, without a doubt, that I can function in this world relatively well and give to others what they cannot give to themselves. In a single session, I can feel so many emotions, ranging from happy to sad to angry to afraid to bored to curious to impressed to worried to insecure. I can be just as emotional as my clients. The difference is, I have to contain it differently. Because, otherwise, I wouldn’t be doing anyone any favors. And therapy isn’t about me. It’s about them. My job is only to facilitate that.

In conclusion, I really care about my clients. Every last one of them. I want them all to prosper. 

snapshot of a therapist’s thoughts

Dear clients,

Today, you challenged me. Some of you made me laugh. Others completely wrecked me. At times, I felt overly confident. Other times, I felt completely clueless. Just as you are growing as my clients, I am growing as a new therapist. And I’m going through a journey just as you all are. 

Today, I saw five of you back-to-back.

The first one, you were easy. You’re my favorite client, but on paper, you look like such a difficult case. Really, you’re just in so much pain, and I sense all of that. Fortunately, you are so responsive to help, and it feels so good to be that person who can shell it out for you! I can feel our connection; I know you like therapy, I know you like coming to talk to me, and I know you feel safe with me. I am so grateful that you are willing to explore your darkest secrets with me, as most of society would absolutely condemn them. I know you are dealing with such a shameful issue, but I think nothing less of you for it. I find you brave for being able to be so honest and in touch with your emotions. I always look forward to seeing you.

The second one, you are also one of my favorites. You remind me so much of someone I know. We call it countertransference in our field. I don’t find it problematic, but I do find it intriguing. You are so smart that you almost don’t know how to handle your intellect. On one hand, you can explain the entire world from your scientific explanations, and, on the other hand, you struggle to understand the ordinary day-to-day human interactions that come with dating, forming friendships, and feeling connected with others. Sometimes, I think you think I’m dumb. Like you’re smarter than me and all this. I have no problem challenging you. In fact, I enjoy it. I think you do, too. I’m not sure why you’re coming to therapy, but you seem to like coming, so we’ll see where it goes from there.

The third one, you came in with your child. A heartbreaking story, really. I admire your desire to be a good mother, and I was reminded just how cruel the world can be to young children. I’m not sure what to do with you yet. I have some ideas for what we can do with your child (he is absolutely adorable, by the way), but you seem to be very guarded and emotionally vacant, despite having endured incredible trauma and a recent catastrophe that has affected your whole family. I want to see your entire family, but admittedly, I don’t feel competent at all doing family therapy yet. I barely feel competent doing individual work. There is a major issue that needs to be addressed among all members, but the timing is essential, and I am not sure when that will be. 

The fourth one, I apologize for instantly assuming you had an eating disorder or drug addiction. You just looked extremely thin and emaciated, and when you started talking about your sky-high anxiety, it was a sound judgment. Clearly, you don’t have one, but you do have a multitude of issues. You seemed leery of me, and I sensed that. You’ve been around a cocktail of therapists, psychiatrists, and doctors. You understand the system; you speak the therapeutic jargon. Clients, like you, who have had a lot of therapy exposure intimidate me. I wonder how they are comparing me to their past clinicians. It’s just like dating, I realize. Except, in this analogy, I’m like that fresh-faced thirteen-year-old pubescent boy with sweaty palms who can barely muster up the courage to ask his crush out to the movies. And, of course, I feel like I’m competing with the varsity quarterbacks. 

To the fifth one, your session affected me the most. You were the client that essentially stayed with me on my car ride home tonight. You made me think. A lot. I see your pain and I identify with it. You are in such deep distress, and yet, I keep thinking I would be in that exact same distress if I were you in your situation. Is it hypocritical for me to expect you to feel better when I’m not sure I would have faith that I could feel better in that same position? I feel like it must be somewhat hypocritical. I feel like my expressions are not genuine if I tell him to have faith in something I don’t even have faith in. I don’t know how I feel about you as my client just yet. You are extremely bright, and I know you’re expecting huge strides out of therapy, but I’m not sure what it is you need that will help you. You seem resistant to being able to accept “what is,” and I think that may take some really deep, heavy processing to get there.

why shame keeps you stuck

Dear Bee, 

Earlier this morning, I told a very distressed client that shame counteracts healing. Thus, to foster the process of healing, one must express the shame. One must become familiar, attack, and confront it. Shame keeps us sick. Toxic, stuck, hurting. Shame penetrates into every fear and robs us of our ability to be genuine with ourselves and others.

The antithesis of shame is acceptance. And that’s why recovery, recovery from anything, is hard. Because we don’t want to accept ourselves. We don’t want to accept our self-perceived flaws, and we don’t want to accept the elements that are simply and painfully out of our control. 

Shame is deeply entrenched in any mental illness, but I only recognized my own roots of it this year. I think of mental illness as a tree. The leaves embody the outward manifestations we call symptoms. The branches represent triggers that exacerbate the symptoms. The trunk is the history that develops the branches. The roots signify perceptions we hold about ourselves and the world, which, in turn, make the trunk grow. 

I couldn’t talk about my eating disorder. Whatsoever. I still struggle with open disclosure of my distorted thoughts and difficult feelings, simply because I often think I’m crazy, irrational, stupid, incompetent, etc. etc. etc. The list of negative adjectives could go on forever. Before this year, I couldn’t even identify my feelings. Imagine that. If someone had asked me how I was really feeling, I couldn’t tell them. Because I didn’t know. 

I would minimize, lie, exaggerate…I was essentially wrapped in a choke-hold of shame. I wouldn’t tell people when I began slipping back into old behaviors. I wouldn’t tell people if I was bingeing. Weighing myself. Getting obsessive with food counts. Checking calories. Overdoing my exercise. And so forth. I would smile and say, everything was fine. Because that’s what I thought people wanted to hear, and that’s what I wanted to believe. And the more you lie, the more bitter the taste…but that taste becomes familiar, and eventually you are all but desensitized to it. I’ve been working with the same therapist for a year, and I still find myself occasionally being deceitful in session! This just shows how painstakingly uncomfortable it can be to express utmost honesty. I have a hard time letting people believe I am anything less than perfect. I still sometimes feel weak asking for help. In turn, I do not like being vulnerable. Because it triggers the shame, and sitting in shame is like sitting on a bed of nails. 

Face the vulnerability. Relish in it. Accept it. If shame is Trainstop A, vulnerability is the train that takes us to Health, Trainstop B.

Bee is a voice that thrives in the name of shame. Even through recovery, you do all you can to keep yourself hidden, concealed, and protected from the world. You want me all to yourself. You absolutely recognize that healing comes from expressing, which is why you do all that you can to prevent yourself from being talked about. You’re a smart and powerful voice. It’s taken several years, books, individual and group therapy sessions, and support teams to start using MY voice, rather than yours.

You kept me in deep pain and turmoil, and I now recognize that same deep resentment in my clients. Their struggles may be starkly contrast from my own, but each person I work with desperately wants to remedy his or her distress. They want that sense of normalcy and health we all crave. Shame, however, often prevents them from believing they are truly worthy and deserving of those gifts.

Shame may manifest in different ways through different illnesses, but the feeling is universal: sheer humiliation, self-loathing, disgust with oneself, the disbelief that others can possibly accept or tolerate the particular circumstance. Shame is dangerous; shame keeps us isolated and afraid. 

The process of healing shame takes time. It involves forgiveness and a willingness to examine inner turmoil. Ultimately, it also boils down to finding a place of acceptance: acceptance of past, present, and future. This is not an easy task. Not by any means. We are constantly bombarded with reasons not to accept ourselves or our realities. We are constantly receiving messages that tell us we are not worthy of health, respect, or dignity. When we feel broken in some way, we often think we are doomed.

I know I did.

I didn’t think I deserved help for my eating disorder until I finally felt so frustrated that I walked into my college counseling center and asked to talk to a professional. I didn’t think I deserved to be honest until I met a supportive treatment team who promised that I could not let them down, no matter how many times I believed I failed. 

Tackle the shame. Even though it may put up a tough and scary front, you will overcome it if you are willing to put forth the fight.

Guess who had her first client today!?! :)

So anyone who reads this (and really, anyone who’s anyone should be reading my alternating sagas of eating disorder recovery, anxiety, graduate school, therapy, nudity, and contemplations on the meaning of life) knows that I’m studying to be a therapist. The past year was foundation work. All classes, consultations, demonstrations, and role-play interventions. A thousand textbook readings and papers. Almost fifty personal psychotherapy sessions. 

WELL…drumroll please…

I had my first client EVER today. Real session. Fifty minutes. One-on-one.

It went so well. OMG. We totally connected, and it was magical and beautiful, and I already have a million ideas spinning in my head for how I want to address her issues, work through them, and develop some strategies for healing. Ah yes. I’m flying. My supervisor and peers were extremely impressed with my compassion and ability to sit with her feelings and provide empathy. Even the obligatory constructive criticism was scarce.

STOKED. Fresh-faced novelty at its finest. 

This is what I’m meant to do GUYYYYYS. I have been on this euphoric high all evening.

It feels so great to be following my passion and, in turn, help others with my knowledge, intuition, and support. I have thousands of clinical hours to complete, another year of graduate school to finish, endless hours of supervision, research, treatment plans, and presentations to create…but MOMENTS like this, SESSIONS like those, and INTERACTION like that make it all worth it. This is my DREAM. This is where I SHINE!

I have a couple more clients that I am meeting for the first time this week, and, as you can probably tell, I’m overjoyed. 

AHHHHHHH ❤

I love me some mother fucking therapy.