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Table of Contents:
Catching the "Uh Oh's" When "Lisa" came into my office I could tell she was very upset. "I don't know what happened. All of a sudden I started eating and I couldn't stop! I just can't control my eating. There must be something wrong with me. My body just can't handle food like normal people do. I need to watch everything I eat. I'm so scared to lose control like that." Lisa's torment may sound familiar to you. I know that when I was in my eating disorder, I too described binges very similarly. I remember telling my therapist that it was like a wave that just came over me, out of the blue. I was sure that my body was somehow to blame. Lisa's reaction is typical too. Since she can't figure out what brought on the binge to begin with, she can only try to fix what she is aware of: the food. But becoming more controlling with food and more restrictive in her eating doesn't work; it only makes the problem worse. So if trying to control the food isn't the answer, if restricting her eating only makes it worse, then what is Lisa to do? Sometimes we have to admit that doing more of the same is not the answer, especially when it always results in the same outcome. In the words of Monty Python, "And now for something completely different.!" Focusing our attention on what foods Lisa binges on is not helpful. Becoming aware of what happened before the binge is much more constructive. When a client comes to me and says she binged, I help her to understand that the binge is just an opportunity to learn about her self and to become aware of what is going on inside. Most women who have eating disorders are not very mindful of what is happening within themselves in the moment. Most of the time, they are ruminating about the past or worrying about the future. But the present moment is a blank, they are unaware of what they are experiencing in the moment. To become aware of what led up to a binge I often will help a client "dissect" the binge. I ask them to talk about the 24 to 36 hours before the binge began. We try to recreate what happened in detail: who she interacted with, what she ate, what she was thinking, what she was feeling. I often ask clients, "When did you know you were going to binge? What was the first sign that you were headed for trouble?" Not surprisingly, the majority of the time, clients had an inkling of a sign in advance of the binge. I used to call these signs the "Uh Ohs". Does this sound familiar? A tiny voice in the back of my head would be saying "uh oh something's wrong" hours before the binge even began. If I didn't pay attention, I would miss it. The voice would then just get louder, "Uh Oh! Something is definitely not OK." If I continued to ignore it or not pay attention it would turn into "UH OH! Do something quick!" But if my unawareness continued, it would soon be, " UH OH! Oh forget it! Too late! Let's eat!" If my clients become more aware, more mindful they are more able to catch the "uh ohs" as soon as possible, when they are still very quiet voices. When the uh ohs are small, they can be handled more easily than if they are loud and extreme. When I described this to Lisa, she came up with a wonderful analogy that helped her to "see" what she needed to do. (And you know how I love analogies.) She said bingeing was like going over a waterfall in a small boat. If she was far back upstream on the river and she paid attention to quiet signs (the sound of the waterfall, the mist of the waterfall in the distance, the acceleration of the current of the stream) she would become aware that "uh oh", there was a waterfall ahead. She would be able to paddle to shore to not go over the waterfall. If she was not paying attention or ignored the quiet signs, she would be closer to the waterfall and it may be hard for her to get to shore by herself. When she became aware that "Uh Oh!" there's a waterfall ahead, she would have to ask for help from someone who could help her bring her boat to the shore. But if she still did not pay attention or continued to ignore the signs (which by the way are becoming ever louder and more apparent - UH OH!) she would be so close to the falls that it would be inevitable that she would go over - " UH OH , too late! Let's Eat!!!" By dissecting a binge we learn what our "uh oh's" are for us: what emotions, relationships, feelings, body sensations, thoughts and events are likely to cause us distress and if not taken care of can trigger a binge. Let's go back and look at what Lisa was dealing with on the day before her binge. At first Lisa focused on the food aspect of the binge. "I had such a craving for sweets and on my way home I kept fighting off the urge to pull into every convenience store. Finally I broke down and bought a huge bag of cookies and since I knew I was going to get rid of it, I bought some cake and ice cream too." I asked her to think of any associations to the sweets, what they meant to her at that particular day. "Well, it could be that at a meeting at work today someone brought in a tray of sweets. I wouldn't let myself have one even though I really wanted one." I commented, "I think we just found an "uh oh". But I'm sure there's more to this." Lisa reflected, "I was really hungry when I binged, because I hadn't eaten much that day. I usually only have coffee for breakfast and a salad for lunch." (Did you just hear another "uh oh"?) "Tell me about how you were feeling during the day?" I asked. Lisa related, "For some reason, I was a bit on edge ("uh oh") and I'm not sure why. Nothing really happened at work." She had been at a meeting led by her supervisor with seven of her coworkers. She just happened to be the only female at the meeting. At one point in the meeting her supervisor asked Lisa to make some copies even though she was not sitting by the door. "As I maneuvered my way around everyone else's chair to get to the door, I was annoyed that he asked me, a female, to make the copies. The guys who were closer to the door know how to make copies. Why didn't he ask one of them? But I know I shouldn't let it bother me, it's such a little thing." ("UH OH!") "But it did bother you," I prompted. Lisa's face lit up as she realized, "Yeah! I was mad and felt belittled by him! I tried to make myself feel superior by turning down the sweets in the meeting. But I kept yelling at myself for letting it bother me at all (UH OH!) !" "Is this the first time something like this has happened at work?" I asked. "Oh no. He does things like this all the time at work. I tried to talk to him about it, but he dismissed my concerns," she replied. Her face became downcast as she realized, "I think I'm going to have to find a new job and I'm scared." "Lisa, I think we found the biggest UH OH of them all." As you can see by this example, if Lisa just focused on the cookies she would be missing what really was wrong. She learned how to pick up subtle signals that she was experiencing an emotion that she needed to deal with. Eventually with practice she became more mindful of her internal reactions to what was going on around her. She started making connections between these reactions and feelings and her cravings for binges. Working hard over time, she was able to learn how to handle these events without resorting to food. Amy Grabowski, MA, LCPC *"Lisa" is a composite of many clients and is not the real name of her client. Note: You may be wondering how to become more mindful, more aware of your own internal reactions. You may consider joining the DBT group that meets here at The Awakening Center , led by Dr. Cindy Butler (ext 18). Mindfulness is the "Core Skill" of DBT, one of the four topics covered in the DBT group. Please see page 2 for more info about this group. Eating Disorder Recovery..It's Not Like Brain Surgery! Or is it? Have you ever heard someone say: "It's not like it is brain surgery or something?" Sometimes people say this when they are referring to a task that appears to be understandable or simple. This is one way that eating disorder recovery is sometimes viewed. Many times, eating disorder recovery is viewed from the perspective that all one needs to do is eat in a normal way. From time to time, I have heard clients (as well as families of people with eating disorders) say, "I should be able to get over this quickly" or "why is this so hard? I know intellectually how to eat, and bingeing/purging/ starving/over exercising is not good for me. So, why can't I just stop?". And very recently, I heard someone say that eating disorders aren't brain surgery, and they should just be able to stop. This last statement touched me in a different way than the previous statements. Over a year ago, I had brain surgery for a hearing problem. Since that time, I have thought a lot about the similarities of major surgery recovery and the process of recovery from an eating disorder. Eating disorder recovery may not seem to resemble brain surgery - but in fact it is my experience that they do have some things in common. There is a process involved with both. This process can have emotional, physical, and social aspects. This is a process that is sometimes frustrating and intolerable, and at other times, connected and empowering. The key component here is that both take time, persistence, and incorporate the individuality of the person going through the process. Physical recovery from eating disorders and physical recovery from brain surgery are important pieces. People going through eating disorder recovery often feel disconnected from their bodies. Similar to how someone recovering from major surgery may be feeling. Certainly, there are physical differences, but relearning to eat and feed your body when recovering from eating disorders can be a daunting task. The same way that interacting with your body after surgery may also be overwhelming and scary at times. Likewise, identifying and listening to physical cues, in either the process of recovery from eating disorders or from major surgery, can be difficult and confusing. Many clients have said that learning to feel hunger is scary and exciting at the same time, much the same way it can be to experience one's body cues after surgery. Separate (but connected) to the physical nature of recovery, is the emotional experiences of recovering. People recovering from surgery and people recovering from eating disorders may struggle when dealing with varying emotions. It can be part of the recovery process for individuals with eating disorders to learn to tolerate different emotions, much the same way people recovering from surgery may have many differing and conflicting emotions. For both sets of recovering people it can be important to understand the emotions, and also learn what they need to do in order to tolerate them. Last is the social impact of recovering. People recovering from eating disorders often feel alone; sometimes feeling they are the only ones going through the struggle to recover from eating disorders. Feelings of isolation and disconnection are common experiences in both recovery processes. It is also likely that through the process of recovery there may be times when it is difficult to relate to others. It may be hard to connect with others. Especially if one is feeling different, relating and sharing (or making one self vulnerable) can seem overwhelming. It is not uncommon for both processes of recovery to be wrought with feelings of disconnection, isolation and feeling misunderstood by others. From both emotional and social aspects of the recovery, there may be anger or resentment for having to go through the process in the first place. There may be other times when one feels misunderstood by those around them, and one may feel confused by what is happening to them. Recovery from surgery, as well as from eating disorders, is a complicated process. There may be days when things flow smoothly, and the once very present struggle seems miles away. Then there may be days when that struggle is the lens that you see your world through. These days can sometimes feel endless. But, as I have experienced, both professionally and personally, these days will not last forever and as time goes by and you move along your own individual path of recovery, these days will become fewer, and farther in between. Eating disorders, as is brain surgery, are complicated. Both processes of recovery take time and the ability to be gentle with one self to discover, uncover, and heal. Kathleen Check, MS, LCPC (Kathleen has fully recovered from the surgery and is doing fine.) Dialectical Behavior Therapy (DBT) DBT skills can be a valuable addition to individual therapy because they offer practical strategies for managing strong emotions. The group (Saturdays 11am-12:30 pm) is open to new members approximately every 4 weeks. Each 4-week unit focuses on one of the four DBT Skill Areas. While group members are encouraged to experience the whole 16-week cycle of training, they may commit to one 4-week unit at a time. The skill areas are: * Interpersonal Effectiveness (Jan. 8-29): ways to get your needs met without damaging relationships or feeling overwhelmed. * Emotion Regulation (Feb. 5-26): understanding what emotions are and ways to eliminate, de-escalate, or change them. * Distress Tolerance (March 5-26): ways to tolerate distressing emotions when you can't eliminate or change them. * Mindfulness (April 2-23): The "core" DBT skill, cultivating awareness of thoughts, emotions, and present-moment experiences. Because mindfulness is so central to DBT, we not only spend 4 weeks on it, but we also do a mindfulness practice together to start every group. Group members who join prior to this unit are required to meet with a group leader individually for a brief tutorial on Mindfulness. The fee is often covered by insurance. (A reduced-fee is also available.) Group members are required to be in individual therapy, which does not have to be with Dr. Gulin Guneri-Minton, as long as the individual therapist is willing to support the use of DBT and attend a 6-hour seminar on DBT. The first step in joining the group is to meet with Dr. Gulin Guneri-Minton individually. If you're interested in joining or for more call Dr. Cindy Butler (ext. 18). More information is available on our website: www.awakeningcenter.net. Using Art Therapy to Understand Your Self Art therapy can be very healing and beneficial. Using art to explore issues can lead you to options you may never have considered consciously. Art therapy enhances self-knowledge and understanding. We all have an unconscious instinct to be creative, but in art therapy artistic ability is unimportant because often work is done symbolically. In art therapy the process of creating the work is more important than the finished product. Clients often will discuss their art therapy pieces with their individual therapist, leading to increased self-awareness. Nicole Bailey sees clients for individual art therapy and also runs the art therapy group on Friday evenings. If you are interested in using art therapy to enhance your individual therapy, please call Nicole (ext 22).
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