2008 Newsletters
| November - December 2008 |
January –June, 2008
Table of Contents:
- Capturing Recovery Moments – Amy Grabowski, MA, LCPC
- Confused About The Awakening Center?
- Who Am I? Self, ‘Pseudo-Self’ & Identity Issues – Jerry Lind, PhD
- You Can Make a Difference….
- Perfectionism – Friend or Foe? – Linda Winter, MA, LPC
- Messages From The Media – Beth Hennessey, MA, LCPC
- Integrative Approaches To Recovery – Dr Mari Richko, MA, ND, LCPC
- To Be or Not To Be… Deciding To Go Organic – Jennifer Reiner MS, RD, LD
- Dialectical Behavior Therapy & Eating Disorders – Gulin Guneri, PsyD
- Save The Date! “Healthy Living In a Challenging World”
- Three Stages of Healing From Trauma – Erin Diedling, MEd, LPC
- Food For Thought – Susan Witz, LD
- Finding The Beauty & Passion Within – Jennifer Schurman, MA, LPC
- Reducing Job Search Stress – Liz Cotter
Capturing Recovery Moments
Amy Grabowski, MA, LCPC
Editor’s Note: Amy is in the process of writing a book about recovering from eating disorders, which she expects to be published this year.
This is the time of the year when most clients reflect upon the past year and make plans for where they want to be in the coming year. Unfortunately, most clients find themselves feeling discouraged because they aren’t where they think they “should” be in their recovery. Their critical ‘Part’ tells them they aren’t far enough along or that their progress is too slow. The Critic, stuck in its all-or-nothing thinking, often sets them up for failure by demanding huge “Momma may I Giant Leaps” of progress: “Starting today we will never make any mistakes and always say the right thing.” “We will never overeat and will always stick to our diet.” “We will never leave the house unless we are impeccably groomed and dressed.”
Clients then complain in therapy, “I don’t think this is working. I’ve been coming here for two months and I’m still overeating. In fact talking about all the other stuff seems to be making the eating worse.” Their Critic says “If you are not completely binge and purge free without effort then you are not recovering.” The Critic discounts all the small steps of progress towards recovery.
I encourage my clients at this time to “Capture Recovery Moments” every day. Greeted with a quizzical look, I explain that every day we are given opportunities to learn about ourselves and about our body and to make small changes that add up to steps of recovery progress. If we look for and capture these moments our recovery moves forward at a faster pace. But at the same time I remind my clients, “You can only go as fast as your slowest Part. Your recovery will take as long as it needs to take.”
I also have to remind them that there are two halves of recovery – the food/eating/ weight half and the thoughts/feelings/moods half. Both of these halves are important and you cannot make progress in only one without making progress in the other. This would be like walking using only one foot – you don’t get very far unless the other foot takes steps too.
Capturing recovery moments can be as structured or unstructured as you want it to be. You can set aside specific time, say an hour before bedtime, to writing in a journal as you reflect upon your day. Or you could use little “snatches” of time already in your schedule, for example simply practicing relaxation and deep breathing while riding the bus.
One of the goals of capturing recovery moments is to become more mindful and to increase awareness of your body sensations, thoughts and emotions – something I like to call “Noticing the Noticing.” A simple example: While riding the L home from work, Ellen noticed her shoulders were tense. While she was noticing her tense shoulders she then noticed that a critical voice yelled at her, “What do you have to be tense about?! Don’t be such a wimp!” Usually she would begin to feel worthless at this point but instead she felt surprised at how quickly the yelling began, “I never noticed before that I yell at myself for such inconsequential incidents.” She wrote this down in her calendar as a reminder to discuss this in her next therapy session. Even though on the surface it did not appear to be a “Giant Leap” she somehow knew this was a major “A-ha!” moment in her recovery.
Another goal of capturing recovery moments is to use every difficult situation and every “slip” as an opportunity to learn. If something happens and you just yell at yourself, learning becomes blocked. If you can suspend all judgments and criticisms, and allow yourself to step back from the situation or slip, and observe yourself objectively you can learn vast amounts about your Self, body, emotions and relationships. Once you step back you can ponder, “What was I feeling or thinking before the slip up? What was I looking for in the moment? What could I have done differently? What suggestions would I give to a friend from the ANAD support group?” You can then apply that learning to the next time a similar situation arises. If you have trouble or slip up, you simply step back and observe and learn once again.
Ellen often became anxious in the grocery store and impulsively bought extra food that she didn’t need. Usually she would get very stern with herself, “You are NOT going to buy any sweets or junk food! What is wrong with you?!” Rather than curbing the overbuying, she then bought even more.
I encouraged Ellen to learn from this difficult situation and look at it not as a failure, but rather an opportunity to learn about herself and grow. Imagining herself in the grocery store, she described the point at which she noticed the anxiety start. We were able to connect the anxiety to a young Part of herself who was afraid she was not going to be fed. This reminded Ellen of times in her childhood when her parents left the children home alone to fend for themselves. Ellen resorted to eating raw foods because she was too young to cook. When Ellen yelled at herself for buying sweets, her young Part panicked even more, fearing that her foods were going to be taken from her thus causing the overbuying.
By looking at the situation without judgment or criticism, Ellen gained compassion for the young Part of herself. She realized she needed to remind herself that she was no longer a child dependent upon others who were not there for her. She promised the young Part there would be food for her to eat and she did not need to overbuy. If in the future she slipped by yelling and overbuying, she knew it to be a reminder to take time before shopping to reassure the young Part again.
There are other practical ways to capture recovery moments. If you use more areas of your brain your recovery will be more effective. Write in your journal and read it aloud to yourself. Draw images and make collages which you hang around your apartment to remind yourself to capture recovery moments. Meditating, stretching, and yoga are wonderful to help you with the Noticing. Ask your therapist for “assignments” to think about or work on between sessions.
You may also decide to add more elements to your individual therapy. Attending support groups on a regular basis can bring up issues to bring back to your individual therapy. Joining a therapy group, yoga class, or the art therapy group can move your recovery along as well.
As you think about how to grab small snatches of time to capture recovery moments for yourself, I’d like to share a saying that was given to me by a client a while back: “I Choose to Not Should All Over Myself Today.” (Hint: Read it aloud quickly.)
Peacefully, Amy
Amy Grabowski, MA, LCPC leads the Eating Disorder Therapy Group on Thursday evenings at The Awakening Center. If you would like to add this group to your recovery process, please contact her at (773) 929-6262 x11.
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Confused About The Awakening Center?
Recently at a professional networking event I was disconcerted by similar reactions from three different professionals: “The Awakening Center? I heard that you went out of business!” or “I was told you changed your name.”
Nothing could be further from the truth. The Awakening Center is alive and thriving in our new home in Lakeview! In fact we are now offering services in Evanston and DesPlaines as well.
I founded The Awakening Center in 1994, and will always practice under this name. In our “lucky 13th” year we reorganized bringing The Awakening Center back to my original vision of providing a unique “user-friendly” wholistic treatment approach that helps clients recover their true sense of Self, and learn to honor the person they were meant to be.
While we are best known for our Comprehensive Eating Disorder Treatment Program, we also have special expertise in the treatment of Trauma, Sexual Abuse, Anxiety and OCD, Relationships and Cancer Survivors. We have expanded our services to include Nutrition, Yoga, Shiatsu, Acupressure, Meditation—and we started a workshop series “Awaken Your Mind” so clients and professionals can ‘try out’ alternate treatment ideas.
As we celebrate our 14th anniversary this year we welcome you to attend “Healthy Living in A Challenging World” - an Eating Disorder Conference. On April 17, 2008 there will be an evening workshop for those working on recovery and their families, while a day long conference for professionals will be held on April 18.
I hope to see you there!
Namaste,
Amy
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Who Am I? Self, ‘Pseudo-Self’ & Identity Issues
Jerry Lind, PhD
We would like to introduce the newest Member of The Awakening Center team, Dr Jerry Lind. Jerry is a clinical Psychologist with over 20 years experience. He has advanced training in IFS therapy, individuals & couples.
From an early age we develop a variety of self-images that reflect our perceptions and conclusions of how we were treated by our parents or other significant people: “Mom likes my new dress: I must be pretty. But she said my hair’s a mess: I guess I’m not pretty enough.” “Dad yelled at me for not following directions: I can’t do anything right. But my new teacher gave me an A: I’m smart.” On and on, the kaleidoscope of conflicting images turns. Over time we develop an idealized self-image, trying to please others, and to gain parental approval. If our experiences were mostly negative our prevailing self-image may be negative as well.
From a Western perspective, the development of self-identity is a positive psychological process: from symbiosis to separation-individuation to positive introjects to ego structure and identity. But from an Eastern perspective, this idealized self-image thwarts the development of our true nature – the essence that is born into this world brimming with vitality, curiosity, enthusiasm for life, and the energy of the core ‘Self.’ As our true essence fades, we protect ourselves by constructing ‘Parts’ or aspects of our personality around our sense of deficiencies. A.H. Almaas refers to this as the theory of holes. As our essence is wounded, it is forced underground. Other ‘Parts’ try to protect us by filling the holes to ease the pain and provide a sense of wholeness and security. We become preoccupied with covering the holes, distracting ourselves from them, or finding ways of filling them to compensate for feelings of deficiency and unworthiness. We eat too much or not enough. We try to look sexy or act cool. We try to accomplish things, be successful, be ok.
Our core ‘Self’ is eclipsed by ‘Parts’ that carry our pains and negative beliefs, and ‘Parts’ that try to protect and compensate for those beliefs and feelings. In the absence of ‘Self’, a ‘Part’ or coalition of ‘Parts’ steps up and takes on the task of managing our whole personality system and organizing our experiences. With little real ‘Self’ around, this ‘Pseudo-Self’ often comes to believe it is the real ‘Self’ and can make a convincing case to other ‘Parts’ and other people.
One of the vital functions of the ‘Pseudo-Self’ is to establish, validate and protect our sense of who we are, our idealized identity to compensate for feelings of pain, inadequacy and unworthiness. ‘Pseudo-Self’ tells us who we are and how we should act and judges us on the basis of how well our performance confirms our idealized identity. All experiences are sorted and judged on the basis of whether it confirms or threatens our identity. We then develop positive feelings and attachments to people and experiences that confirm our idealized identity and become hostile and rejecting of people and experiences that threaten our idealized identity.
The cost of maintaining our idealized identity is enormous. Distorted interpretations of experience and presumed assaults on our identity lock us into suffering. Sorting and judging experiences to protect our idealized identity limits us and keeps us from learning and growing. Perceived threats to our idealized identity reactivate the pain and belief of the exiled ‘Parts’. Our critical ‘Part’ may arouse the exiled ‘Parts’ further, and their pain causes the ‘Pseudo-Self’ to redouble its efforts. The whole personality system is stressed and vulnerable and can overwhelm and incapacitate the ‘Pseudo-Self.’ Our idealized image can shatter and we lose our identity, no longer sure of who we are.
An identity crisis is an opportunity to develop a more diverse, flexible and accurate sense of ‘Self.’ We need to let go of the self-image we’ve been protecting. Internal Family Systems (IFS) is a model of therapy that incorporates elements of both Western and Eastern perspectives. From the IFS perspective, threats to our identity can be viewed as trailheads for exploration that hold potential for healing and growth. IFS therapy can help us to understand concerns and fears of the ‘Pseudo-Self.’ We can assist the exiled ‘Parts’ in a loving way to unburden the pain, fears and distorted beliefs they carry. They can take back the ‘Self’-like qualities that were crowded out by their burdens and become harmoniously connected to ‘Self’ and other ‘Parts’. The ‘Pseudo-Self’ is now free to unburden skewed identities and take on more effective roles following the leadership of the ‘Self.’ In this process, difficult feelings can heal the holes of deficiency created when ‘Self’ was pushed out. This healing process facilitates the return of ‘Self,’ allowing our essence to flow through and we regain the wonderful distinctive flavor of being that expresses who we really are. It tastes and feels good.
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You Can Make a Difference…
Did you know The Peace School, a non-profit educational organization located here in Lakeview since 1972, is a United Nations Peace Messenger organization? In addition to offering classes to help individuals of all ages create peace within the mind, body and spirit, The Peace School is the original sponsor of Peace Day. This year’s celebration in Daley Center Plaza on September 21 included the Call to Peace and World Peace Flag Ceremony, honoring every country of the world equally with sincere wishes, thoughts or prayers for peace.
Next year will be the 30th anniversary of Peace Day in Chicago! Planning for 2008 has already begun, and many hands are needed as well as financial support for the event.
If you would like to make a tax-deductible contribution, or for information on how you can help The Peace School in its mission to build world peace, one person at a time, please call Jennifer Kim or Greg Garrett at 773.248.7959. For more info visit www.peaceschool.org.
Thank you, and peace!
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Perfectionism – Friend or Foe?
Linda Winter, MA, LPC
Psychologists have learned a lot about perfectionism over the last 20 years. Perfectionism is now understood to have both helpful, adaptive, and not-so-helpful, maladaptive, aspects. So what kind do you have, and can you change it if you want?
Perfectionism is made up of several factors.
Personal standards of performance: How high are your personal standards of performance? Are they realistic? Are they attainable?
Concern over mistakes: How harshly do you judge your performance? How severe is your self criticism? Does the evaluation of performance become an evaluation about yourself and your self-worth?
Doubts about one’s actions: Do you have trouble making decisions because you are afraid of making a mistake? Does it take you a long time to makes decisions because you need to gather ALL the facts? Do you second guess yourself often?
Perceptions of others’ criticism: Does it seem that those around you judge you? Are you afraid they will judge you with harshness and criticism?
Perceptions of others’ expectations: Have those around you set high standards for you?
High levels of these factors indicate maladaptive perfectionism associated with psychological distress, stress, depression, anxiety. In fact, levels of perfectionism in clients with eating disorders are higher than clients with depression or anxiety alone.
The setting of unrealistically high standards is often a way to compensate for low self-esteem – “The only way people would love me is if I perform perfectly.” It is also a way to manage anxiety – “I’ll stay busy. If I accomplish this goal, then I’ll feel better.”
Concern over mistakes and doubts about one’s actions can make people feel paralyzed and unable to stop the cycle of their thoughts. Procrastination in perfectionists can be a way to avoid the potential of failure. When a project has to be beyond-perfect and you are terrified of making a mistake, it is hard to get started. One researcher has postulated that excessive concern over mistakes and doubts about actions are so closely related to low self-esteem that they might be the same thing.
So can perfectionism ever be adaptive? The answer is YES, it can. Adaptive perfectionism is associated with achievement, striving, persistence and positive reinforcement. The setting of personal standards of performance that are high but realistic is very adaptive. The evaluation of performance that is balanced and geared toward problem solving is also adaptive. Problem solving includes the ability to be flexible, in the way one perceives the situation and in the choices of action available to resolve it. These adaptive perfectionists have the ability to strive and persist in reaching a goal and feel accomplishment when the goal is achieved – they feel good about their actions. Setting realistic goals, adjusting and problem-solving, and reaching our goals is a way to create self-efficacy and self-esteem.
A quick note about the last two aspects of perfectionism -- perceptions of others’ expectations and criticisms. What is significant is not the reality of others’ expectations and criticisms but one’s perceptions of it. Again, excessively high expectations and severe criticism – sources of maladaptive perfectionism – create fear of failure. In this case the failure is the failure of others to love us. Which we perceive to be the failure to be lovable. When perfectionism is adaptive, others have high, but realistic, expectations for us, along with balanced and encouraging evaluations of our performance.
In sum, setting high standards for ourselves or others can be a good thing when standards are realistic and achievable. The really important factor is how the performance is evaluated. Overly harsh criticism that evaluates the person more than their behavior is destructive. A reality based, balanced evaluation directed toward problem solving is productive. Perfectionism can be adaptive.
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Messages From The Media
Beth Hennessey, MA, LPC
Mass media has increasingly become a part of our American lifestyle. It is one of the most powerful cultural factors, communicating to large amounts of people and influencing societal standards. We are bombarded with so many images with messages about outward appearance, that it can be difficult to take a step back and think about how they impact our thoughts and emotional responses. The fashion and diet industries promote a certain message to the public and equate it with one’s self-worth, “You will fit in if you have this season’s latest trends” or “You are a strong person only if you are able to stick to this diet plan and ignore temptations.” It is not possible for these industries to consider each unique individual in their marketing campaign, but most people internalize these projected norms and feel pressure to conform to social choices.
Looking specifically at the portrayal of women over time, more voluptuous figures such as Botticelli’s Venus were greatly romanticized and considered unattainable in the past. Currently, women are exposed to ideals of beauty much thinner than previous standards through print and electric images “…and often the sub-textual, if not the overt, message is that one need only comply with provided guidelines to achieve the ideal.”* Rather than communicating positive messages, the media’s primary concern is to maximize profit; thus the female body is used to further capitalistic gains by exploiting people’s self-esteem and sense of self. A study of non-eating disordered college females, in which the women were exposed for three minutes to photographs of thin models from popular magazines, led to an increase in “depression, stress, guilt, shame, insecurity, and body image dissatisfaction.”* The control group, which was exposed to average sized models, did not have these negative responses. It is important to note that this strong personal reaction occurred after only three minutes! Consider the impact of consistent daily exposure.
We know that models in ads are digitally altered to correct any imperfections. Yet it is so easy to forget this when you are confronted by these images of “ideal” beauty. How can we guard ourselves against manufactured images that are presented as reality? We need to become active consumers who can critically deconstruct the media’s messages. Such standards as, “beauty is a woman’s primary objective”, “thinness is crucial for success and happiness”, and “it is normal and acceptable for a woman to be ashamed and anxious about her body and appearance”, need to be more closely examined. The following questions are empowering to consider when exposed to media messages:
What does this advertisement tell me to change about myself?
Is this advertisement portraying a realistic image of women or men?
Is this advertisement’s goal to make money by making me feel bad about myself?
Will I look like the model in this advertisement if I buy this product?
Does this advertisement represent my own personal views of happiness and success?
Looking honestly and openly at our answers to these questions may help us to more deeply explore our relationship to the media. As technology continues to evolve, mass media is only increasing influence on cultural norms. We must take a closer look at the relationship between these messages and our individual experiences.
Thompson, J., & Heinberg, L. (1999). The media’s influence on body image disturbance and eating disorders: We’ve reviled them, now can we rehabilitate them? Journal of Social Issues, 55 (2), 339-353.
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Integrative Approaches To Recovery
Dr. Mari Richko, MA, ND, LCPC
The amount of stress and life pressures we experience in the world today is beyond what any of our ancestors could have imagined. It is no wonder we carry many burdens and unhealthy strategies in order to get through life. And at their extreme, they leave us lifeless and exhausted. Thousands of years ago, when the classic texts of Chinese medicine existed, most people lived simple lives. Anxiety and depression were not as common. Some of the ancient tools were essential keys to personal growth and healing. These long forgotten methods can be most eloquently expressed in the creative use of body-centered psychotherapy and the utilization of the acu-points in bodymind acupressure.
I practiced traditional psychotherapy for many years before my exposure to Body-centered Psychotherapy and Chinese Medicine. What exactly are these approaches and how can they be helpful to our healing processes?
First, these approaches are integrative because they use various approaches (psychotherapy, meditation, bodywork, breathwork, body focusing techniques, eastern concepts and theories) in a unifying manner. It is somatic because it focuses on body experiences that are important in shaping the individual’s experience. It is psychotherapy because it uses verbal interventions between the body and the psyche. And finally, it also integrates touch therapy and expressive movement.
Much has been learned recently about the body and its relationship to the mind. New studies show the transformational effects of these therapies on a body, mind, and spiritual level to be mind provoking. The acu-points have been said to be “doorways” to blocked experiences, memories, and feelings. In the hands of a trained practitioner, the gentle touch to the points and slow noninvasive movement can be used to uncover submerged feelings and emotions which have been locked away in the bodysystem. Clients may talk with their practitioner, and share memories, images, and feelings that surface during the session. The aim of this work is to move the client out of their head and into their body while gradually releasing the armoring in different parts of their body. In this process, whether through bodywork or psychotherapy, the client becomes increasingly aware of the bodymind connection. Pain and tension begin to be seen as messages from the inner self, while the client gradually recovers emotional responsiveness.
Recently, I had a very powerful experience working with a client who had an eating disorder. She had lost a tremendous amount of weight, had weakness in her limbs, lost her ability to feel hunger and was emotionally locked into persistent “patterns and strategies” that didn’t serve her.
My responsibility as a practitioner of integrative approaches was to recognize her own personal disharmony and set up a treatment strategy. From a Chinese perspective, her stomach was asleep and the nourishing aspects of the fluids in her body were depleted. I chose acu-points from what we call the “earth” points on the body and held them in a gentle and noninvasive way. During the treatment, she relaxed in a deep enough way to create awareness around the armoring in her solar plexus and experienced an “unwinding” sensation in her abdomen as the session progressed. I encouraged her to allow this feeling and anything else that may come to the surface. Through our sessions we processed her experience and came to know many of her unhealthy ‘Parts’ via the body experience. As she progressed in our sessions, she reported a new sensation in her abdomen. It is no longer “gripping” but more expansive and open. She claims it has been closed since she was a child. She also has a new profound sense of awareness in the bodymind connection and finds this helpful in communicating with her healthy and unhealthy ‘Parts.’
In my work, I see how we interfere with our healthy selves by investing a lot of energy into these defenses both physically and mentally via the body as well as the mind. The same inner power that we have to grow and become healthy is used instead by our survival mechanisms and our life “strategies,” creating bodymind blockages. By becoming mindful of our interference with our growth, it becomes possible to free up this armored energy and begin a transformation. Using these bodymind approaches increases the power of our interventions and the opportunity for change.
A typical session would involve the client relaxing while the practitioner guides them through a bodycentered exploration either through psychotherapy or acupoint bodywork. In my clinical experience, clients report feelings of deep relaxation, restoration, and a deeper sense of connection to themselves. This is very beneficial in itself because it allows the body chemistry to reset and neurological impulses to reorganize. It also reduces muscle tension, creating an opening for the breath, and the weakening of defenses gives the client a deeper connection to “Self” creating a calling back of parts that have been lost or disassociated. The effects on a psychological level are also seen in the restoration of balance and harmony to the emotions. This restoration completes a transformative relationship between body, mind, and the vital functions of the body.
Mari Richko, MA, ND, LCPC has twenty years experience in Asian bodywork and uses shiatsu and bodymind acupressure in conjunction with a holistic approach to psychotherapy. She has a masters degree in psychology, is a licensed psychotherapist and naturopathic doctor. Her training in bodycentered work includes Hakomi Psychotherapy, IFS (Internal Family Systems), and studies of indigenous cultures including eastern philosophy and Taoism. She is active in expanding the dynamic learning process by integrating these different forms of medicine into her work in the community as well as her private practice.
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To Be or Not To Be… Deciding To Go Organic
Jennifer Reiner, MS, RD, LD
Take a quick stroll through the aisles of your local grocery and you will find the brown, green and white USDA organic logo on virtually every aisle. This logo which used to be limited to mostly fruits and vegetables now adorns everything from chocolate bars to your favorite potato chips!
The USDA organic logo assures consumers that their purchases were grown free of pesticides, hormones or antibiotics and they were produced in a humane manner. Interestingly, market research suggests that the number one reason consumers purchase organic products is not for themselves but rather for their children. This explains the explosion of new products targeting children such as cereal, ice cream, crackers and other snack foods adorning the ever popular 100% Organic logo.
In my practice I am often asked whether or not these products are any healthier than their conventional counterparts. My answer to this question is Yes and No. Without a doubt the quality of the ingredients found in Organic products are far superior to conventional ingredients. The USDA logo represents strict standards to ensure that 100% Organic products prohibit the use of 38 synthetic ingredients, including high fructose corn syrup, partially hydrogenated oils and artificial sweeteners. For this reason we can say that 100% Organic products are healthier than their conventional counterparts. However, eat with caution because Organic “junk food” does exist and should not take the place of wholesome organic foods such as fruits, vegetables, dairy products and protein sources.
As a society we have a tendency to go to extremes. Think back to when Nabisco’s Snack Well® product line hit the market – it was like a green light to an endless supply of cookies. And now we find ourselves in the world of 100 calorie packaging because we have to rely on a multi-billion dollar industry to tell us how much is enough – and they charge us more to do it! So, be careful not to fall into the Snack Well trap – organic or not. Enjoy organic products and snacks because they are better for our bodies, but remember that they are no replacement for whole foods.
So, the next time you have a craving for a delicious ice cream sundae feel free to pick up a container (or two) of your favorite organic ice cream but be sure that you top it off with an organic cherry!
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Dialectical Behavior Therapy & Eating Disorders
Gulin Guneri, PsyD
Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment originally developed by Marsha Linehan, Ph.D. DBT was originally designed as an effective treatment module for chronically suicidal individuals and for those who met criteria for borderline personality disorder. Currently, DBT has been adapted to treat clients who have difficulty regulating their emotions and who resort to impulsive behavior to deal with their distressing feelings. Since clients with eating disorders use restrictive eating, binge eating, self-induced vomiting and other unhealthy behaviors to cope with their negative emotions, they are perfect candidates for DBT treatment.
DBT treatment focuses on enhancing clients’ skills to use healthy behaviors to cope with their overwhelming emotions rather than resorting to maladaptive eating disorder symptoms. To achieve this goal, DBT focuses on four modules of skills.
During the first module, “Mindful-ness”, clients learn skills that enable them to be more present in the here-and-now and enjoy the present moment rather than dwelling on the past or worrying about the future. Clients, in this module, gain knowledge about the significance of their “reasonable mind” (the rational, logical mind) and their “emotion mind” (where thinking and behavior is controlled by current emotional state). They learn skills to integrate these two minds to create “wise mind,” that is, the optimum balance of emotional experiencing and logical analysis. In this way, clients with eating disorders are encouraged to find the balance between the extremes of overcontrolled/rigid eating and out-of-control binge eating within the framework of “effective/balanced eating.” Lastly, during the Mindfulness module, clients with eating disorders learn skills to take a nonjudgmental stance about their body image and their food intake.
During the second module, “Distress Tolerance”, clients learn to tolerate and survive crisis situations without making the situation worse by resorting to impulsive, unhealthy behaviors. The skills taught in this module are intended for getting through overwhelming emotions by utilizing adaptive coping skills. Clients with eating disorders learn specific coping skills to distract themselves to overcome their urge to binge and/or purge. They are introduced to self-soothing activities where they learn to be gentle and kind to themselves and most importantly, learn healthy ways of nurturing themselves when they are in distress. Lastly, clients learn strategies to improve the moment when they are in the middle of a crisis which cannot be changed right away.
During the “Emotion Regulation” module, clients learn about the function of emotions and acknowledge humans’ tendency to react to negative emotions with secondary emotions of guilt, shame, or anger. Since clients with eating disorders often possess feelings of guilt and shame about their actions/lifestyle, it is imperative for them to learn skills that would help them identify their primary emotions, which are overshadowed by their secondary emotions. Lastly, clients also learn skills to decrease emotional vulnerability by means of increasing positive emotions.
During the last module, “Inter-personal Effectiveness”, clients learn effective strategies for establishing healthy boundaries with others. Clients with eating disorders resort to unhealthy eating behaviors when they become overwhelmed by interpersonal conflict. They learn skills to stand up for their personal rights, including learning how to ask for things and make requests when they feel emotionally vulnerable as well as learning how to say no to people and resist pressure when they feel that their personal space is intruded upon.
Overall, Dialectical Behavior Therapy is a very effective treatment module for clients with eating disorders. DBT teaches skills that enable clients to building mastery and self-respect. As a result of DBT skills training, clients with eating disorders feel empowered as they become equipped with coping tools that are effective and applicable for lifetime.
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The Three Stages of Healing From Trauma
Erin Diedling, MEd, LPC
You may be familiar with the 5 stages of grief. You may not know that trauma too has a specific series of stages. Individuals recovering from trauma can experience three progressive stages, and may cycle and re-cycle through any of the stages at any time.
The first stage is The Victim. This may seem self-explanatory. It’s raw. It is a time of incredible vulnerability. Just moving from moment to moment may be excruciating. Even if the trauma happened long ago, when it is addressed, the individual may not be aware that spent much of her life in the victim stage, feeling ineffective, unable to take control of events and surroundings, and only being able to distract or escape these feelings for short periods of time.
Children can by-pass the victim stage if her caregivers give her love, validation and treatment as soon as she reports the victimization. She may feel little to no repercussions from the trauma. If the child reports the trauma, and is met with invalidation she may linger in the victim stage and feel despair and despondency. The child can be re-traumatized if she is met with punishment or denial from her caregivers.
In the victim stage, Life feels overwhelming. The individual feels that things happens to her rather than being able to create effective outcomes in her own life. She often questions, “Why me?” She may feel she cannot win in specific arenas of life. She may feel resignation. Depression is often a symptom of the victim stage.
In the victim stage, the individual’s intuitive “fire alarms” may be turned off. She may not always be aware when she is in immediate danger. Marsha Linehan, the creator of Dialectical Behavioral Therapy (DBT) calls this “active passivism” in which the victim may place herself in harm’s way without knowing it (e.g., trust untrustworthy individuals, tell unsafe people about having been a victim, not lock doors, not wear a seatbelt, etc).
As the individual begins to transition out of the victim stage, she may seek answers, wanting to know why she feels ineffective in her life. She may begin to question why she cannot seem to get any progress on particular patterns. She may come upon answers inadvertently by means of flashbacks or by overhearing family accounts of past events.
In the seeking may come the answers. Knowledge can be liberating. Often this liberation brings about a fight or flight response as she moves into the stage of Survivor. In the survivor stage, she channels her anger.
This stage is marked by knowledge, education, awareness and liberation. The individual will feel like an athlete with strength, anger, fight and action. She will acknowledge the abuse, shock, life threat that happened and take stock. “I survived (cancer, accident, sexual abuse)” She likely will believe she is stronger for having survived.
The individual may gather as much knowledge as she can in order to “better know the monster.” She may feel empowered by adopting a cause and increasing public awareness and aid in prevention. There are countless organizations, movement, events that were founded in the Survivor stage: Amber Alert, The Susan G. Komen Foundation, Live Strong, for example.
By questioning the quality of her life she finds meaning in the experience of the original threat/trauma. She replaces old coping and survival skills of the fight/flight with presence of mind. As hope enters the picture, she finds joy, moving from the “action” Survivor stage to the “being” Thriver stage.
In the Thriver stage there is a shift in perspective. Circumstances can not change, but one’s experience of the circumstances changes. The shift in perspective allows an individual to notice the chaos, pain, suffering, without having to engage in them. Curiosity and wonder are genuine by-products of the Thriving stage. She becomes more mindful and present, what DBT calls the Wise Mind. When a traumatizing trigger comes up, the individual stays in the Wise Mind and protects herself from the throes of chaos.
Eastern philosophies views the Thriver stage as a commitment to happiness. Yoga traditions call this equanimity: getting to the edge while maintaining a balance. While the individual may not consistently experience happiness, she is committed TO the outcome of happiness; committed to getting through conflict with the knowledge that an effective outcome and more peaceful mindset is possible.
The journey from Victim to Survivor to Thriver is a difficult phenomenon, marked by contraction and expansion. In my work as a trauma counselor, I’m honored that I am allowed to walk this path with my clients and watch them tackle the various stages with courage, curiosity, and tenacity. Often I am amazed at the resilience of the human mind, body and Self.
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Food For Thought
Susan Witz, LD
Research from the field of "mental medicine" strongly associates our physical health with our state of mind. Our thoughts, attitudes and behaviors can either help or hinder our ability to manage stress and resist illness. The following practices can have a positive effect on our total well being.
*Slow down. How often do you say, "I'm so busy I don't have time to breathe?" Break the hurry/ worry syndrome, which contributes to high blood pressure and heart disease. Try moving, driving, eating, talking and breathing more slowly. Ten to twenty deep, slow breaths can quiet a racing mind and heart.
*Don't just do something, sit there! Spend 15 minutes in meditation, prayer, or visualization. Uplift a sagging spirit, strengthen a weak mind, brighten a gloomy outlook and shape up a bad attitude. Reconnect with yourself and your Higher power.
*Cultivate optimism. Put on the rose-colored glasses. View yourself and your life in the best possible light. Choose to pay more attention to what's right with the world. Optimists have fewer visits to the doctor, better immune function and live longer than pessimists. Even when faced with a dire prognosis, optimism and prayer can work wonders to change the outcome.
*Spend more time in nature. Hug a tree, feed the ducks, gaze at the stars, and enjoy a glistening snowfall. Hospital patients whose rooms overlook trees, recover sooner and go home earlier than those who see only a brick wall. Bring nature's beauty inside with lots of green plants, and let in the light! During the winter when daylight hours dim and shorten, instead of hibernating and feeling "SAD" (Seasonal Affective Disorder), try using a "light box" which simulates the healing light of summer. This could be your happiest winter yet.
*Get moving! Exercise and physical activity are forever. Walk, dance, swim, bike, ski, surf, skate, stretch and strengthen with yoga postures. Exercise for fun, fitness, flexibility, sociability and mood elevation.
* Nourish yourself with healthy, tasty foods and beverages. Choose brightly colored fruits and vegetables, chewy whole grains, leaner proteins, lower-fat dairy or soy foods, healthy oils, some green tea, a little dark chocolate or red wine and lots of water. Plan and shop ahead. The more you plan, the luckier you get!
* Cultivate a variety of healthy pleasures. Feeling good pays off twice in immediate enjoyment and better health. Calm your mind with aroma therapy, or a scented eye pillow. Relax your overworked body with a massage. Touch is healing, and hugging raises your hemoglobin! Steam off tensions in a hot tub or sauna. Controlled heat offers muscle relaxation, improved immunity and promotes sleep. Turn on the music to increase your endorphins, slow you down and lift you up to heavenly realms.
* Nurture your relationships. Those who isolate themselves experience more health problems and a shorter lifespan. So work out with a buddy, travel with a friend, take a child to the zoo or "bond" with your sister during a spa visit. If you're lonely, buy a cuddly kitten or friendly puppy. Consider doing something for the needy. Helping others also helps our health and makes us happier.
* Live and enjoy today while you can. Yesterday is history. The future is a mystery. Today is a gift. That is why it is called the present. Time, not money, is your most important resource. You can run out of time long before you run out of money. Do you remember how much the millionaire left when she died? She left it all!
Therefore choose life. Remember to treat yourself as the valuable being that you are. Unfortunately, many of us take better care of our cars and our pets than we do of ourselves. Feed yourself at least as well as you feed your cat. Ultimately it is your ability to love and to nourish yourself in body, mind and spirit that will keep you healthy, happy and helpful to others. Then your life becomes a blessing wherever you are and whatever you do.
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Finding The Beauty & Passion Within
Jennifer Schurman, MA, LPC
Perhaps one of the greatest tragedies in living with an eating disorder is the tendency for this label to overshadow all that truly defines an individual. As eating disorders develop and take control of life the many aspects of our true uniqueness seem to get clouded. The behavior, patterns and cycles of destruction lead individuals to feel disconnected with their true selves. Rather than focusing on all that makes each individual unique and gifted, the mind focuses in on the aspects of ourselves that we want to change. While surely much of the healing process involves being honest with behaviors and choices we hope to change, why does the focus end there? Often there is much time and energy examining the dynamics of ourselves that are unhealthy, destructive or simply obstructing our goals. How might focusing on our strengths, gifts, talents, and passions impact the journey of recovery? It seems that highlighting these aspects of ourselves may offer the perspective and hope needed to remind individuals what the journey of recovery truly is aimed at, finding ourselves again.
Exploring the many dynamics of an eating disorder often highlight the ways we have left essential parts of us behind. We can take care of others but not ourselves. We are bound and stuck by perfectionism. We can understand a mistake or struggle of another but can’t accept it in ourselves. We can empathize with another’s feelings however cannot approach the feelings in ourselves. We are paralyzed by expectations and fears that deny us the many joys and passions we desire. Perhaps the first step in recovery is beginning to uncover all the beauty that lies beneath the destruction of eating disorders. And perhaps even before that is cultivating the belief and trust that surely there is a source of strength, uniqueness, and beauty there to find.
The healing process is often focused on change rather than all the individual already possesses that is truly beautiful. Beautiful as it is today, completely untouched and unchanged. In these moments of discovery we can find the strength and peace that connects us with the determination to face the fears and challenges. Finding the beauty and passions within ourselves is a reminder of that part of us that is connected, has a sense of knowing or wisdom, and surely leads to a life defined by authenticity and joy. In finding our beauty and brilliance we can approach recovery with a renewed sense of hope. Holding this hope and belief not only gives purpose to recovery but also opens the door to experiencing all that you were meant to experience. Life surely has many gifts, treasures and blessings along the way that we so often miss as we let fears and anxieties get in the way. The many aspects of living with an eating disorder can obscure the view of all our beauty and the beauty around us. However, the most sacred and precious moments in recovery and healing are when one chooses to uncover their eyes, take steps on new paths, and discover all that life was meant to offer. My hope is that each of us will challenge ourselves in this new year to find the courage to begin realizing our gifts, passions, and uniqueness while beginning to invite the gifts and blessings of life that surely await us.
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Reducing Job Search Stress
Liz Cotter
Job searching can evoke a range of emotions from fear to depression to anger. Although the average person goes through numerous job changes throughout their lifetime, job hunting remains a stressful process for most of us that can become increasingly discouraging as time passes. However, the more you learn to manage your stress level, the easier it will be to remain focused and have a successful search.
The first step in a successful job search is to assess your skills and interests. The job search process will be more stressful if you are unclear about the type of job you would like. If you’re confused about what career is the best match for you, the internet has a number of free tests that measure career interests and transferable skills. Just remember that these tests aren’t completely accurate and are meant to offer suggestions rather than a definite decision. Www.jobhuntersbible.com has numerous assessments that may be helpful.
The next step in reducing stress is to learn which job search activities have the highest rates of success in leading to being hired, and spending the bulk of your time engaging in them. Networking is consistently rated as the number one way to get a job, and is an “in” to the many jobs that aren’t advertised. In fact, 60% of people in a survey by BH Careers International report getting their last job through networking (versus 10% who found their job through an online job site). Networking isn’t as daunting as you may think- the first step is tapping your existing contacts, such as friends, family, and ex-colleagues. Tell each person that you are looking for a new job, and ask if they know of anyone who could be helpful. Remember to have a 30-second speech prepared that briefly describes who you are, what you do, and what you are looking for. For more tips, the Wall Street Journal’s www.CareerJournal.com has many helpful articles about networking and other productive job search activities.
Finally, reducing job stress means gaining back control of your emotions. It’s completely normal to feel a rollercoaster of feelings while job searching. But instead of ignoring these feelings it is important to identify them and give them a label. By naming your emotions, you shift them from being a fuzzy generalized state, to one that is specific and can be influenced. One way to influence your emotions is by monitoring your “self-talk”, or the internal conversations we all have in our heads. By changing your self-talk from negative messages (e.g. “Only incompetent people can’t find jobs” or “I’m going to lose my house and family”) to positive ones (e.g. “I can deal with whatever comes along”) you can shift your emotions in a constructive direction and make your job search more productive.
While job hunting may never be a pleasant experience, there are ways to reduce the stress and anxiety associated with it. Assessing your skills and interests, engaging in job search activities that have the highest success rates, and monitoring your emotions and self-talk are all ways to make job hunting more relaxing and fruitful. By utilizing the tips in this article, as well as the many excellent resources available on the web, your next job search is likely to become a learning experience rather than a stress-filled situation.
Liz Cotter is a Doctoral Psychology student at The University of Wisconsin Milwaukee.
