2002 Newsletters
Jan–April 2002
Finding Meaning And Fulfillment
Amy Grabowski, MA, LCPC
This article, that you will read in January of 2002, was written only 6 weeks after the terrorists attack on the World Trade Center. At this time, we are still in the midst of the Anthrax crisis and the bombing in Afghanistan. On the night of September 11th, only four women braved going out to attend the weekly ANAD support group. Feeling fear, anxiety and shock, they wanted to pull together, to get comfort in being with others who understood and cared. But that evening we didn't talk about food, eating, or weight at all. We had very deep conversations about trust and relationships. As one woman so aptly put it, "Worrying about the size of my thighs seems so unimportant now."
In the days that followed, people coped in their own unique ways. Some watched the televised news accounts regularly, wanting to be informed at all times. Others avoided television, needing a break from the vivid visuals. Personally I was drawn to reading the many personal stories of the people who died in the tragedies. It was touching to read what people said about the loved ones who were gone. For the most part the friends and family members remembered the person's kindness, generosity, sense of humor; the good times they had spent together talking and sharing activities; their intelligence and what they gave to their workplace and communities. Rarely was the person's appearance even mentioned. Not once did someone mention the size the loved one wore.
For weeks after the tragedy, many of my clients gave blood, brought treats to show appreciation for their local fire fighters, and donated money to the relief effort. If anything positive can come of these tragedies, for a while it was easy to put food, eating, and weight in perspective. What seemed really important was reaching out and connecting with others as a way of finding true meaning and fulfillment in life. I saw a sign in my children's school, which sums this up nicely: "If you want to be happy for an hour, watch TV. If you want to be happy for a day, go to Great America. If you want to be happy for a life, help another."
This New Year, I encourage you to find that meaning and fulfillment for yourself. It can be small things, for example: giving away clothing for those less fortunate, giving food to a food pantry, working one time in a soup kitchen or homeless shelter, donating blood or money.
If you are looking for a way to build a bond with others, you may consider volunteering on a regular basis. There are hundreds of children in the Chicago area who need tutors. Organizations such as ANAD could always use clerical, phone or other office help. Answering phone calls from teen runaways or playing bingo with seniors can be very rewarding.
For longer commitments, there are 500 mile bike rides for AIDS or 60 mile walks for Breast Cancer Awareness.
In a city the size of Chicago there are thousands of organizations that would like volunteers. A Google search of "volunteer Chicago" resulted in over 313,000 websites. Here are a few to help you get started.
The United Way has a website devoted to matching people with volunteer opportunities in Chicago. You can search any number of categories to find a volunteer placement that suits your needs. www.chicagovolunteer.net
The Bottomless Closet: provides professional clothing, job readiness and employment training and coaching services to women on assistance
www.bottomlesscloset.org - (312) 527-9664
ANAD (National Association for Anorexia Nervosa and Associated Disorders) often needs clerical, phone and office help; support group leaders and cash donations are needed as well.
www.anad.org (847) 831-3438
The National Runaway Switchboard provides non-judgmental confidential crisis intervention and referrals to youth and their families through a 24-hour hotline.
www.nrscrisisline.org - (773) 880-9860
Tanqueray Heartland 500 mile Aids ride from Twin cities to Chicago, July 22-27; Avon Breast Cancer 3 day walk from Kenosha to Chicago, June 14-16:
www.bethepeople.com - (800) 825-1000
Big Brothers Big Sisters of America is the nations oldest youth mentoring organization.
www.bbbsa.org
Ten Thousand Villages, a store in Evanston, sells handicrafts made by unemployed and underemployed artisans around the world, providing them with vital fair income. Volunteers are needed for many daily operations of the store. (847) 869-8262
I want to close with a poem written by Edward Everett Hale
"I am only one,
but still I am one.
I cannot do everything,
but still I can do something,
and because I cannot do
everything,
I will not refuse
to do the something I can do."
I wish you peace in the New Year,
Amy Grabowski
_____________________________
Fear of Food
Kathleen Check, MS, LCPC
The Fear of Food group is new to the Awakening Center. This unique group offers members a safe and supportive environment to eat a meal and discuss and share their feelings, thoughts, and behaviors surrounding food and eating.
This weekly process-oriented group, which meets from 6:30 - 8:00 pm every Friday, is geared towards those struggling with food restriction, bulimia, and irrational fears about food.
Members bring their own food each week and will be provided an opportunity to discuss and explore new behaviors surrounding eating. This group will also provide members with a place to relate and discuss fears and anxieties about food with peers experiencing similar concerns, as well as having a professional leader that understands and is sensitive to issues related to food, eating, and body image.
____________________________
Nourishing Concepts
Elisa D'Urso-Fischer, MS, RD, LD
What is "Nourishing Concepts"?
Nourishing Concepts is a weekly nutrition counseling group. While general nutrition issues are also covered, the main focus of the group is helping you to relearn how to nourish your body, resolve emotional overeating, and achieve internally cued "intuitive eating".
But, what is intuitive eating?
Intuitive eating is eating in tune with your body. It is what a one-year-old baby does…….they know when they are hungry and they eat, and they know when they are full and they stop eating.
What do you actually do in the group?
Often we start with a relaxation or breathing exercise. We "check in" by sharing how the past week went. In a safe and supportive environment, we discuss a specific topic. During "check out" we each decide what to work on during the next week.
What kind of topics do you discuss?
Topics include: The problems with dieting; How different foods work in your body; Why we need carbohydrates, protein, and fats; Identifying emotional and physical hunger cues; What helps when you want to eat and it's not from physical hunger; Learning the different levels of "fullness"; Relaxation techniques; Improving self-acceptance and self-esteem; Replacing negative self-talk with more neutral language; Nutritional suggestions to help ease PMS, menopause and cravings; Eating socially, with your family and through a holiday.
Is this a therapy group?
No, this group is to help you change how and why you eat. We may identify emotional issues connected to your eating, which you may want to work on with an individual therapist.
Who is in the group?
The group is for women who are trying to end emotional overeating and bingeing, and learn how to eat in response to their body's needs.
_________________________________________
Joys And Losses
There have been many changes at The Awakening Center this year.
In November, Kathleen Check graduated with her Master's degree in counseling and became a Certified Alcohol and Drug Abuse Counselor. She has joined The Awakening Center where she will continue to see clients as well as lead the "Fear of Food" group and the Saturday ANAD support group.
At the time this newsletter is going to press, we are anxiously awaiting news from Andrea Harris-Alpert, who's first baby is due any day now.
Unfortunately not all our news is good. Marianne Evans-Ramsay has moved to the East coast. She wanted people to know, "It has been very rewarding for me to work with many of you for the past seven years. I will miss working with such a fine staff as those here at The Awakening Center. I am thankful that Amy Grabowski brought me on board and supported me over the years. I wish you all well in your pursuit of good health through nutrition." We will miss you, Marianne.
_______________________________________
- Finding Meaning and Fulfillment - Amy Grabowski, MA, LCPC
- Fear of Food - Kathleen Check, MS, LCPC
- Nourishing Concepts - Elisa D'Urso-Fischer, MS, RD, LD
- Joys & Losses
Finding Meaning And Fulfillment
Amy Grabowski, MA, LCPC
This article, that you will read in January of 2002, was written only 6 weeks after the terrorists attack on the World Trade Center. At this time, we are still in the midst of the Anthrax crisis and the bombing in Afghanistan. On the night of September 11th, only four women braved going out to attend the weekly ANAD support group. Feeling fear, anxiety and shock, they wanted to pull together, to get comfort in being with others who understood and cared. But that evening we didn't talk about food, eating, or weight at all. We had very deep conversations about trust and relationships. As one woman so aptly put it, "Worrying about the size of my thighs seems so unimportant now."
In the days that followed, people coped in their own unique ways. Some watched the televised news accounts regularly, wanting to be informed at all times. Others avoided television, needing a break from the vivid visuals. Personally I was drawn to reading the many personal stories of the people who died in the tragedies. It was touching to read what people said about the loved ones who were gone. For the most part the friends and family members remembered the person's kindness, generosity, sense of humor; the good times they had spent together talking and sharing activities; their intelligence and what they gave to their workplace and communities. Rarely was the person's appearance even mentioned. Not once did someone mention the size the loved one wore.
For weeks after the tragedy, many of my clients gave blood, brought treats to show appreciation for their local fire fighters, and donated money to the relief effort. If anything positive can come of these tragedies, for a while it was easy to put food, eating, and weight in perspective. What seemed really important was reaching out and connecting with others as a way of finding true meaning and fulfillment in life. I saw a sign in my children's school, which sums this up nicely: "If you want to be happy for an hour, watch TV. If you want to be happy for a day, go to Great America. If you want to be happy for a life, help another."
This New Year, I encourage you to find that meaning and fulfillment for yourself. It can be small things, for example: giving away clothing for those less fortunate, giving food to a food pantry, working one time in a soup kitchen or homeless shelter, donating blood or money.
If you are looking for a way to build a bond with others, you may consider volunteering on a regular basis. There are hundreds of children in the Chicago area who need tutors. Organizations such as ANAD could always use clerical, phone or other office help. Answering phone calls from teen runaways or playing bingo with seniors can be very rewarding.
For longer commitments, there are 500 mile bike rides for AIDS or 60 mile walks for Breast Cancer Awareness.
In a city the size of Chicago there are thousands of organizations that would like volunteers. A Google search of "volunteer Chicago" resulted in over 313,000 websites. Here are a few to help you get started.
The United Way has a website devoted to matching people with volunteer opportunities in Chicago. You can search any number of categories to find a volunteer placement that suits your needs. www.chicagovolunteer.net
The Bottomless Closet: provides professional clothing, job readiness and employment training and coaching services to women on assistance
www.bottomlesscloset.org - (312) 527-9664
ANAD (National Association for Anorexia Nervosa and Associated Disorders) often needs clerical, phone and office help; support group leaders and cash donations are needed as well.
www.anad.org (847) 831-3438
The National Runaway Switchboard provides non-judgmental confidential crisis intervention and referrals to youth and their families through a 24-hour hotline.
www.nrscrisisline.org - (773) 880-9860
Tanqueray Heartland 500 mile Aids ride from Twin cities to Chicago, July 22-27; Avon Breast Cancer 3 day walk from Kenosha to Chicago, June 14-16:
www.bethepeople.com - (800) 825-1000
Big Brothers Big Sisters of America is the nations oldest youth mentoring organization.
www.bbbsa.org
Ten Thousand Villages, a store in Evanston, sells handicrafts made by unemployed and underemployed artisans around the world, providing them with vital fair income. Volunteers are needed for many daily operations of the store. (847) 869-8262
I want to close with a poem written by Edward Everett Hale
"I am only one,
but still I am one.
I cannot do everything,
but still I can do something,
and because I cannot do
everything,
I will not refuse
to do the something I can do."
I wish you peace in the New Year,
Amy Grabowski
_____________________________
Fear of Food
Kathleen Check, MS, LCPC
The Fear of Food group is new to the Awakening Center. This unique group offers members a safe and supportive environment to eat a meal and discuss and share their feelings, thoughts, and behaviors surrounding food and eating.
This weekly process-oriented group, which meets from 6:30 - 8:00 pm every Friday, is geared towards those struggling with food restriction, bulimia, and irrational fears about food.
Members bring their own food each week and will be provided an opportunity to discuss and explore new behaviors surrounding eating. This group will also provide members with a place to relate and discuss fears and anxieties about food with peers experiencing similar concerns, as well as having a professional leader that understands and is sensitive to issues related to food, eating, and body image.
____________________________
Nourishing Concepts
Elisa D'Urso-Fischer, MS, RD, LD
What is "Nourishing Concepts"?
Nourishing Concepts is a weekly nutrition counseling group. While general nutrition issues are also covered, the main focus of the group is helping you to relearn how to nourish your body, resolve emotional overeating, and achieve internally cued "intuitive eating".
But, what is intuitive eating?
Intuitive eating is eating in tune with your body. It is what a one-year-old baby does…….they know when they are hungry and they eat, and they know when they are full and they stop eating.
What do you actually do in the group?
Often we start with a relaxation or breathing exercise. We "check in" by sharing how the past week went. In a safe and supportive environment, we discuss a specific topic. During "check out" we each decide what to work on during the next week.
What kind of topics do you discuss?
Topics include: The problems with dieting; How different foods work in your body; Why we need carbohydrates, protein, and fats; Identifying emotional and physical hunger cues; What helps when you want to eat and it's not from physical hunger; Learning the different levels of "fullness"; Relaxation techniques; Improving self-acceptance and self-esteem; Replacing negative self-talk with more neutral language; Nutritional suggestions to help ease PMS, menopause and cravings; Eating socially, with your family and through a holiday.
Is this a therapy group?
No, this group is to help you change how and why you eat. We may identify emotional issues connected to your eating, which you may want to work on with an individual therapist.
Who is in the group?
The group is for women who are trying to end emotional overeating and bingeing, and learn how to eat in response to their body's needs.
_________________________________________
Joys And Losses
There have been many changes at The Awakening Center this year.
In November, Kathleen Check graduated with her Master's degree in counseling and became a Certified Alcohol and Drug Abuse Counselor. She has joined The Awakening Center where she will continue to see clients as well as lead the "Fear of Food" group and the Saturday ANAD support group.
At the time this newsletter is going to press, we are anxiously awaiting news from Andrea Harris-Alpert, who's first baby is due any day now.
Unfortunately not all our news is good. Marianne Evans-Ramsay has moved to the East coast. She wanted people to know, "It has been very rewarding for me to work with many of you for the past seven years. I will miss working with such a fine staff as those here at The Awakening Center. I am thankful that Amy Grabowski brought me on board and supported me over the years. I wish you all well in your pursuit of good health through nutrition." We will miss you, Marianne.
_______________________________________
May–August 2002
"Recovered? What's That!"
Amy Grabowski
When I introduce myself as leader of the ANAD group, I say that I have recovered from eating disorders. I often get the same reaction from the new members in the group: "Is it possible to recover fully? How do you know when you are recovered? You don't think about food all the time!"
Total recovery to me means that food, eating, and weight eventually become "non-issues". I tell my clients that we have to take the "power" out of food and turn it back into, well, food. Total recovery means being able to eat without feeling guilt, remorse, despair, panic, self-hatred, etc. After I eat I forget about it! It becomes a non-issue! I can get on with the rest of my life.
At this point I usually get quizzical looks: "You mean you can eat ice cream or pizza and not feel bad afterwards? That's fine for you, but I can't stop eating! I can't have those foods." Part of the recovery process involves learning how to eat like a "normal eater". Normal eaters eat foods like ice cream and pizza. Normal eaters eat three meals and a snack or two a day. Normal eaters eat when they are hungry and stop when they are full - most of the time. Normal eaters do not panic at the sight of pizza!
When I was in college there was a woman in my class who would bring a slice of left-over pizza for lunch every Tuesday. This truly amazed me at the time, because the words "left-over" and "pizza" never went together in my vocabulary before! And she brought it EVERY Tuesday! I got up my courage and as nonchalantly as I could I asked her about it - how could she have pizza every Tuesday and feel OK about it? She told me that she and her husband had pizza every Monday night and always had left-overs for the next day. At the time I wondered how she could "control" herself having pizza so often. She explained that since she knew she was going to have pizza on Monday and the next and the next… it was no big deal! She had taken the power out of the pizza and turned it back into, well, food.
This story illustrates that when we give ourselves "true permission" to have a food, we do not have to "control" it. Total recovery involves learning how to give ourselves "true permission": "Yes I can have that and I can have it again too". This is opposed to "sort of permission": "Well, OK, I'll have it this one time, but never again!" (You know the consequence of "sort of permission": "Since I can never have it again, I better eat it all and then some!") The consequence of "true permission" is that we do not feel deprived and can trust that there will always be enough and that we will always be able to get our share.
How do we learn how to give ourselves "true permission"? Everyone is going to come up with their own solution to this. One approach is to buy food in such large quantities that you could not possibly eat it all. This can be expensive and very very scary. Another way is to start by allowing yourself one "treat" a day. I, myself, took the middle road by starting with a scary food: peanut butter. I decided one day that if I wanted peanut butter I was going to have peanut butter! I had peanut butter for breakfast, lunch, and dinner. On the first day, I just relished it like a greedy little child! On the second day, I found that I could relax a bit and get in touch with the taste and texture. The third day, I still liked it but the enjoyment was beginning to wear off. On the fourth day, I ate it but did not really want it. By the fifth day, I rebelled and refused to eat it! I craved a salad! I couldn't believe it! To see peanut butter and think, "No, thanks." Peanut butter had been turned back into, well, food!
This wasn't a freak occurrence. I have repeated this experiment with my clients and most have found that by the fifth day of "true permission" they no longer need to "control" the food. When food is, well, food you can eat it and enjoy it. You can stop eating when you are satisfied and forget about it. It takes a lot less food to satisfy you when you know that you can eat again in a while, when you are hungry. You can get on with the rest of your life.
_________________________________
"Why is Starting Psychotherapy so Hard?"
Susan Bachman, MSW, LCSW
Why is starting psychotherapy so hard? Whether it is one's first attempt, or second or third, for some-perhaps even most-beginning the process of psychotherapy can be a daunting prospect. It is not uncommon that people consider starting therapy long before they actually take the first step. Usually one is experiencing some sort of pain or confusion and it oftentimes needs to become fairly acute before she is willing to take action; therefore, many people find themselves starting the process of therapy when they are in the middle of a crisis. This can contribute to feeling overwhelmed by the changes that come with adding this important relationship to one's life.
The first layer of concern tends to be around the nuts and bolts of arranging therapy. What if I can't afford the fee? What if I can't fit it into my schedule? What if I don't have the emotional energy to do this? These are all valid concerns. Therapy costs money-even if you negotiate a reduced fee or attend a low-fee clinic or you have excellent health insurance benefits. There isn't any way around the fact that you pay for therapy. You might imagine that it would be easier if therapy didn't cost money, but the truth is that money is an important part of the process of therapy-and not just because the therapist needs to make a living, although of course this is the case. The fact that money exchanges hands sets up the relationship as a professional one. Some people find that this helps to establish a boundary, allowing them to feel safe enough to share some of their most intimate thoughts and feelings. Some people find themselves having negative feelings about paying for the service. This is not an uncommon reaction and optimally will lead to an open discussion with the therapist, hopefully revealing a deeper understanding of the specific meaning this has for the client. Money is a part of our lives and having it enter into the treatment relationship is important and necessary.
Scheduling can also seem like an obstacle, especially at first. When is it a good time to go to therapy? If I go at the beginning of the day, will I be worn out? If I go in the middle of the day, will it be disruptive? Will I be tired if I go at the end of the day? Perhaps the client has a demanding work schedule or limited child care. And don't forget travel time to and from therapy, which includes the hassles of parking or waiting on public transportation. There are also the limitations of the therapist's schedule to add to the mix. It might seem like the stresses of arranging therapy could make one feel worse instead of better! Though it may be hard to imagine getting used to a weekly or more than weekly appointment time, in fact there is a rhythm that develops. Therapy becomes a regular part of one's week, ideally contributing to a feeling of cohesiveness.
Everyone has limits to how much energy they can expend. It seems that some imagine therapy will leave them emotionally drained. While I would never suggest that psychotherapy is easy, I would say that it shouldn't be depleting. It is hard work and therefore demands energy but also provides an opportunity for deep satisfaction. No one's therapeutic experience is exactly like another's and so it is impossible to predict how any one individual will feel, but therapy can very often lighten one's load at the same time as it demands energy.
If one is struggling with the practical issues in arranging therapy-money, scheduling, allotment of emotional energy-it may be that one is also struggling with these very same issues in other areas of one's life. In therapy, one has the opportunity to talk about these things and perhaps understand them better. However, further exploration might reveal that the client does not struggle with these issues elsewhere, but was in fact frightened about starting therapy without being fully aware of it and that this created difficulties getting started.
Once the practical arrangements have been settled upon, sometimes there are more complicated worries that come up. What if I don't like my therapist? What if therapy doesn't work? What if it does! What if I get worse? What if I get worse before I get better? The anxiety experienced around the idea of beginning this new, intimate and unusual relationship is understandable. I believe that it is really important to like and trust your therapist; however given all of the potentially confusing feelings around starting therapy, it is possible that one could be unclear about whether she did or didn't like her therapist. Unless you have a particularly negative impression of the therapist that becomes obvious to you in the first meeting, I usually recommend trying a therapist at least three times. There is a lot of information that needs to come out at the beginning and this can make it hard to get a feel for how you and the therapist are "clicking." I advise people to begin by going to a reliable source for a referral-such as a friend or a reputable organization-in order to narrow down the search. Even so, some people end up trying more than one therapist before they find the right fit.
Obviously people come into psychotherapy with expectations. Doubtless these will change as the therapy gets underway and change again and again throughout the duration of the treatment. Anticipating this can cause a fair amount of anxiety and that is why it is important to find a therapist with whom you feel as comfortable as possible. Specific questions about what one can expect are essentially the work of an individual's therapy and cannot be addressed in general terms, except to say that the relationship with the therapist will ideally help the client to tolerate the unknowns in the beginning and to tolerate the "knowns" further down the road.
To be sure, therapy isn't for everyone. It requires a real investment of resources and there are some people who simply can't make this kind of commitment for a variety of reasons. But I find it interesting that many in our current society view going into therapy as indicative of some sort of personal weakness on the part of the client, when it seems to me to be the opposite. Taking the risk in starting a relationship with a therapist, making the effort to understand oneself in deeper ways and facing painful feelings indicates courage and strength and a special kind of optimism.
______________________________
"Should I Take Medication?"
Sandra Sheinin, MD
Medication can be an important adjunct to therapy and other healing interventions. When considering medications, there are many factors to evaluate. It is important to thoroughly assess one's symptoms and how much the symptoms are interfering with functioning and everyday responsibilities. It is important to consider one's current symptoms in the context of one's history and to evaluate to what degree and frequency these symptoms have been present in the past. One's medical status is another critical variable to be evaluated to ensure that a medical condition is not contributing to the picture since medical conditions can masquerade as psychiatric conditions. Drug and alcohol use can also make it difficult to ferret out what symptoms are due to substance effects as opposed to primary psychiatric conditions.
Many people with an eating disorder have other psychiatric diagnoses. Sometimes these diagnoses precede the eating disorder and may contribute to the development of the eating disorder. Other times these diagnoses occur secondarily as an outgrowth of contending with an eating disorder. Coexisting diagnoses commonly include mood disorders, anxiety disorders and substance abuse.
Depression is seen very frequently and medications can help to diminish symptom frequency, intensity and duration. Common medications include the selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft, Luvox, Paxil and Celexa.
SSRIs can also be helpful in managing irritability, anxiety and mood lability that often accompany depression. If one has mood changes that alternate more clearly between states of depression and mania or hypomania, then a diagnosis of bipolar disorder is more likely and a mood stabilizer is the treatment of choice. Other non-SSRI antidepressant medications such as Wellbutrin, Effexor, Serzone and Remeron are also available if the SSRIs are not preferable. Finally, there are antidepressant medications that predate the SSRIs that are available and well suited for particular patient profiles.
Anxiety can take many different forms. In brief, the anxiety disorders that commonly coexist with eating disorders include panic disorder, social phobia, obsessive compulsive disorder, generalized anxiety disorder and post-traumatic stress disorder. Panic disorder involves panic attacks. Panic attacks are abrupt, discrete episodes of intense anxiety and physical symptoms that often appear without an identifiable trigger and diminish within minutes. Social phobia involves impairment in social situations due to preoccupations with being seen critically or harshly by others.
Obsessive compulsive disorder involves repetitive, intrusive, anxiety provoking thoughts that seem to be beyond one's control and/or repetitive rituals to help manage anxiety. Eating disorders have been conceptualized by some as being on the obsessive compulsive spectrum because of the obsessional ideation involving body image and size and compulsive rituals such as purging or exercising that need to be consistently followed.
Generalized anxiety disorder involves consistent and pervasive anxiety and worry accompanied by poor concentration, irritability, fatigue and muscle tension. Post-traumatic stress disorder involves having experienced or witnessed a traumatic event with helplessness that is then reexperienced and accompanied by avoidance of related trauma stimuli and a state of heightened alert.
Many of the aforementioned antidepressant medications are also equally powerful in ameliorating anxiety. Other common antianxiety medications include the benzodiazepine class (such as Valium, Klonopin, Ativan and Xanax) and Buspar, a nonbenzodiazepine. Benzodiazepines must be closely monitored as consistent usage can contribute to dependence and tolerance. There are other medications that have been found serendipitously to have antianxiety properties that are also frequently prescribed.
As mentioned above, eating disorders have been conceptualized on the obsessive compulsive spectrum. Obsessive compulsive symptoms have been found to respond well to SSRIs in particular and may require higher dosages than that prescribed for other forms of depression or anxiety. This treatment strategy has also proven useful for eating disorders and is often utilized as one treatment option. In some studies, SSRIs in higher dosages have helped to diminish the anxiety provoking thoughts and behaviors as well as decrease relapse rates.
As always, every person must be evaluated individually and the chosen treatment should be based on what the person and prescribing physician feel is the best fit.
_________________________________
"Dialectical Behavior Therapy"
Cindy Butler, PhD
From joy and love to hatred and disgust, emotional experiences are part of everyone's life. However, some people are more sensitive to emotion than others. They experience feelings quickly and intensely, and take more time to "recover" from strong emotions. Reasons for this sensitivity may include biological causes, as well as growing up in a family where one's feelings were ignored or dismissed as unreasonable. Emotionally invalidating family experiences deprive us of the opportunity to learn the skills we need to cope with strong, sudden emotion in healthy ways. Instead we may seek temporary solutions to emotional pain through behaviors that are destructive to our bodies, our relationships, and our lives, such as self-injury, disordered eating, or substance use. These solutions come with their own set of problems that eventually add to a sense that one's life is out of control.
Dialectical Behavior Therapy (DBT), developed by Dr. Marsha Linehan, provides an opportunity to gain the skills necessary for identifying, experiencing and regulating emotions, in order to interact more effectively with ourselves and others. There are two components to DBT: skills training group and individual therapy. In skills training group, lectures and discussions focus on managing emotions, learning to be more effective in relationships, and learning techniques for tolerating distress. Individual therapy focuses on staying motivated, understanding how and why problem behaviors occur and identifying alternative, more skillful ways of coping. The overall approach to therapy is called "dialectical" because it seeks balance between opposites -- such as acceptance and change, validation and challenge, rigidity and flexibility. Underlying DBT is the practice of "mindfulness." Drawn from the Zen tradition of meditation, mindfulness is about attending to the moment, without judgment or impulsivity.
DBT recognizes that everyone works hard at finding solutions to the problems in their lives. It is not designed to take away the solutions that you already have, many of which are probably very effective. Instead, DBT can help you find more and possibly better ways of solving problems than what you are doing right now, especially if what you are doing does not seem to be working for you.
_______________________
"The Art Within"
Lisa Cohen, Art Therapy Student Intern
The brush moves across the page and creates vivid imagery. Hands shape the soft clay into shapes and figures. The tools of art-making and other forms of creativity allow constant self-expression. Often, the words that describe our emotions become stuck inside. The process of art therapy encourages our thoughts to emerge in a safe and tangible manner. By building, painting or creating in group or individual sessions, we can establish positive connections with ourselves, others and our surroundings.
Artistic ability is not necessary to fully appreciate the benefits of moving the brush or shaping the clay. We all possess the creative ability within us to participate in art therapy. Internal thoughts and sensations externalize via a safe and supportive environment, producing a somewhat cathartic escape. Kathy Mattea once said that we should all, "dance like no one is watching." When we express ourselves without boundaries, possibilities become limitless. The wildness and wonder surface as our hidden creative pleasures push our otherwise protected selves. The exposure can be freeing.
Through the process, some of us may discover our talent for painting flowers or sculpting the human form. Others may use the art-making as a time to breathe, away from daily stressors. During the session, the therapist facilitates and guides the participants. However, the therapist allows clients to find their own way through the session.
Art holds a power and when used as a tool, expressions flow. I believe in this power, as it has been a strength in my life many times. I now want to share this passion of mine with you, as we create together using various materials. I am currently a student at the Adler School of Professional Psychology and am in the Masters of Counseling: Art Therapy Program. I believe that everyone has the ability to participate in the creative process and the benefits constantly amaze me. Together we can create, inspire and discover art-making.
__________________________________
- Recovered? What's That! - Amy Grabowski, MA, LCPC
- Why is Starting Psychotherapy so Hard? - Susan Bachman, MSW, LCSW
- Should I Take Medication - Sandra Sheinin, MD
- Dialectical Behavior Therapy - Cindy Butler, PhD
- The Art Within - Lisa Cohen, Student Intern
"Recovered? What's That!"
Amy Grabowski
When I introduce myself as leader of the ANAD group, I say that I have recovered from eating disorders. I often get the same reaction from the new members in the group: "Is it possible to recover fully? How do you know when you are recovered? You don't think about food all the time!"
Total recovery to me means that food, eating, and weight eventually become "non-issues". I tell my clients that we have to take the "power" out of food and turn it back into, well, food. Total recovery means being able to eat without feeling guilt, remorse, despair, panic, self-hatred, etc. After I eat I forget about it! It becomes a non-issue! I can get on with the rest of my life.
At this point I usually get quizzical looks: "You mean you can eat ice cream or pizza and not feel bad afterwards? That's fine for you, but I can't stop eating! I can't have those foods." Part of the recovery process involves learning how to eat like a "normal eater". Normal eaters eat foods like ice cream and pizza. Normal eaters eat three meals and a snack or two a day. Normal eaters eat when they are hungry and stop when they are full - most of the time. Normal eaters do not panic at the sight of pizza!
When I was in college there was a woman in my class who would bring a slice of left-over pizza for lunch every Tuesday. This truly amazed me at the time, because the words "left-over" and "pizza" never went together in my vocabulary before! And she brought it EVERY Tuesday! I got up my courage and as nonchalantly as I could I asked her about it - how could she have pizza every Tuesday and feel OK about it? She told me that she and her husband had pizza every Monday night and always had left-overs for the next day. At the time I wondered how she could "control" herself having pizza so often. She explained that since she knew she was going to have pizza on Monday and the next and the next… it was no big deal! She had taken the power out of the pizza and turned it back into, well, food.
This story illustrates that when we give ourselves "true permission" to have a food, we do not have to "control" it. Total recovery involves learning how to give ourselves "true permission": "Yes I can have that and I can have it again too". This is opposed to "sort of permission": "Well, OK, I'll have it this one time, but never again!" (You know the consequence of "sort of permission": "Since I can never have it again, I better eat it all and then some!") The consequence of "true permission" is that we do not feel deprived and can trust that there will always be enough and that we will always be able to get our share.
How do we learn how to give ourselves "true permission"? Everyone is going to come up with their own solution to this. One approach is to buy food in such large quantities that you could not possibly eat it all. This can be expensive and very very scary. Another way is to start by allowing yourself one "treat" a day. I, myself, took the middle road by starting with a scary food: peanut butter. I decided one day that if I wanted peanut butter I was going to have peanut butter! I had peanut butter for breakfast, lunch, and dinner. On the first day, I just relished it like a greedy little child! On the second day, I found that I could relax a bit and get in touch with the taste and texture. The third day, I still liked it but the enjoyment was beginning to wear off. On the fourth day, I ate it but did not really want it. By the fifth day, I rebelled and refused to eat it! I craved a salad! I couldn't believe it! To see peanut butter and think, "No, thanks." Peanut butter had been turned back into, well, food!
This wasn't a freak occurrence. I have repeated this experiment with my clients and most have found that by the fifth day of "true permission" they no longer need to "control" the food. When food is, well, food you can eat it and enjoy it. You can stop eating when you are satisfied and forget about it. It takes a lot less food to satisfy you when you know that you can eat again in a while, when you are hungry. You can get on with the rest of your life.
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"Why is Starting Psychotherapy so Hard?"
Susan Bachman, MSW, LCSW
Why is starting psychotherapy so hard? Whether it is one's first attempt, or second or third, for some-perhaps even most-beginning the process of psychotherapy can be a daunting prospect. It is not uncommon that people consider starting therapy long before they actually take the first step. Usually one is experiencing some sort of pain or confusion and it oftentimes needs to become fairly acute before she is willing to take action; therefore, many people find themselves starting the process of therapy when they are in the middle of a crisis. This can contribute to feeling overwhelmed by the changes that come with adding this important relationship to one's life.
The first layer of concern tends to be around the nuts and bolts of arranging therapy. What if I can't afford the fee? What if I can't fit it into my schedule? What if I don't have the emotional energy to do this? These are all valid concerns. Therapy costs money-even if you negotiate a reduced fee or attend a low-fee clinic or you have excellent health insurance benefits. There isn't any way around the fact that you pay for therapy. You might imagine that it would be easier if therapy didn't cost money, but the truth is that money is an important part of the process of therapy-and not just because the therapist needs to make a living, although of course this is the case. The fact that money exchanges hands sets up the relationship as a professional one. Some people find that this helps to establish a boundary, allowing them to feel safe enough to share some of their most intimate thoughts and feelings. Some people find themselves having negative feelings about paying for the service. This is not an uncommon reaction and optimally will lead to an open discussion with the therapist, hopefully revealing a deeper understanding of the specific meaning this has for the client. Money is a part of our lives and having it enter into the treatment relationship is important and necessary.
Scheduling can also seem like an obstacle, especially at first. When is it a good time to go to therapy? If I go at the beginning of the day, will I be worn out? If I go in the middle of the day, will it be disruptive? Will I be tired if I go at the end of the day? Perhaps the client has a demanding work schedule or limited child care. And don't forget travel time to and from therapy, which includes the hassles of parking or waiting on public transportation. There are also the limitations of the therapist's schedule to add to the mix. It might seem like the stresses of arranging therapy could make one feel worse instead of better! Though it may be hard to imagine getting used to a weekly or more than weekly appointment time, in fact there is a rhythm that develops. Therapy becomes a regular part of one's week, ideally contributing to a feeling of cohesiveness.
Everyone has limits to how much energy they can expend. It seems that some imagine therapy will leave them emotionally drained. While I would never suggest that psychotherapy is easy, I would say that it shouldn't be depleting. It is hard work and therefore demands energy but also provides an opportunity for deep satisfaction. No one's therapeutic experience is exactly like another's and so it is impossible to predict how any one individual will feel, but therapy can very often lighten one's load at the same time as it demands energy.
If one is struggling with the practical issues in arranging therapy-money, scheduling, allotment of emotional energy-it may be that one is also struggling with these very same issues in other areas of one's life. In therapy, one has the opportunity to talk about these things and perhaps understand them better. However, further exploration might reveal that the client does not struggle with these issues elsewhere, but was in fact frightened about starting therapy without being fully aware of it and that this created difficulties getting started.
Once the practical arrangements have been settled upon, sometimes there are more complicated worries that come up. What if I don't like my therapist? What if therapy doesn't work? What if it does! What if I get worse? What if I get worse before I get better? The anxiety experienced around the idea of beginning this new, intimate and unusual relationship is understandable. I believe that it is really important to like and trust your therapist; however given all of the potentially confusing feelings around starting therapy, it is possible that one could be unclear about whether she did or didn't like her therapist. Unless you have a particularly negative impression of the therapist that becomes obvious to you in the first meeting, I usually recommend trying a therapist at least three times. There is a lot of information that needs to come out at the beginning and this can make it hard to get a feel for how you and the therapist are "clicking." I advise people to begin by going to a reliable source for a referral-such as a friend or a reputable organization-in order to narrow down the search. Even so, some people end up trying more than one therapist before they find the right fit.
Obviously people come into psychotherapy with expectations. Doubtless these will change as the therapy gets underway and change again and again throughout the duration of the treatment. Anticipating this can cause a fair amount of anxiety and that is why it is important to find a therapist with whom you feel as comfortable as possible. Specific questions about what one can expect are essentially the work of an individual's therapy and cannot be addressed in general terms, except to say that the relationship with the therapist will ideally help the client to tolerate the unknowns in the beginning and to tolerate the "knowns" further down the road.
To be sure, therapy isn't for everyone. It requires a real investment of resources and there are some people who simply can't make this kind of commitment for a variety of reasons. But I find it interesting that many in our current society view going into therapy as indicative of some sort of personal weakness on the part of the client, when it seems to me to be the opposite. Taking the risk in starting a relationship with a therapist, making the effort to understand oneself in deeper ways and facing painful feelings indicates courage and strength and a special kind of optimism.
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"Should I Take Medication?"
Sandra Sheinin, MD
Medication can be an important adjunct to therapy and other healing interventions. When considering medications, there are many factors to evaluate. It is important to thoroughly assess one's symptoms and how much the symptoms are interfering with functioning and everyday responsibilities. It is important to consider one's current symptoms in the context of one's history and to evaluate to what degree and frequency these symptoms have been present in the past. One's medical status is another critical variable to be evaluated to ensure that a medical condition is not contributing to the picture since medical conditions can masquerade as psychiatric conditions. Drug and alcohol use can also make it difficult to ferret out what symptoms are due to substance effects as opposed to primary psychiatric conditions.
Many people with an eating disorder have other psychiatric diagnoses. Sometimes these diagnoses precede the eating disorder and may contribute to the development of the eating disorder. Other times these diagnoses occur secondarily as an outgrowth of contending with an eating disorder. Coexisting diagnoses commonly include mood disorders, anxiety disorders and substance abuse.
Depression is seen very frequently and medications can help to diminish symptom frequency, intensity and duration. Common medications include the selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft, Luvox, Paxil and Celexa.
SSRIs can also be helpful in managing irritability, anxiety and mood lability that often accompany depression. If one has mood changes that alternate more clearly between states of depression and mania or hypomania, then a diagnosis of bipolar disorder is more likely and a mood stabilizer is the treatment of choice. Other non-SSRI antidepressant medications such as Wellbutrin, Effexor, Serzone and Remeron are also available if the SSRIs are not preferable. Finally, there are antidepressant medications that predate the SSRIs that are available and well suited for particular patient profiles.
Anxiety can take many different forms. In brief, the anxiety disorders that commonly coexist with eating disorders include panic disorder, social phobia, obsessive compulsive disorder, generalized anxiety disorder and post-traumatic stress disorder. Panic disorder involves panic attacks. Panic attacks are abrupt, discrete episodes of intense anxiety and physical symptoms that often appear without an identifiable trigger and diminish within minutes. Social phobia involves impairment in social situations due to preoccupations with being seen critically or harshly by others.
Obsessive compulsive disorder involves repetitive, intrusive, anxiety provoking thoughts that seem to be beyond one's control and/or repetitive rituals to help manage anxiety. Eating disorders have been conceptualized by some as being on the obsessive compulsive spectrum because of the obsessional ideation involving body image and size and compulsive rituals such as purging or exercising that need to be consistently followed.
Generalized anxiety disorder involves consistent and pervasive anxiety and worry accompanied by poor concentration, irritability, fatigue and muscle tension. Post-traumatic stress disorder involves having experienced or witnessed a traumatic event with helplessness that is then reexperienced and accompanied by avoidance of related trauma stimuli and a state of heightened alert.
Many of the aforementioned antidepressant medications are also equally powerful in ameliorating anxiety. Other common antianxiety medications include the benzodiazepine class (such as Valium, Klonopin, Ativan and Xanax) and Buspar, a nonbenzodiazepine. Benzodiazepines must be closely monitored as consistent usage can contribute to dependence and tolerance. There are other medications that have been found serendipitously to have antianxiety properties that are also frequently prescribed.
As mentioned above, eating disorders have been conceptualized on the obsessive compulsive spectrum. Obsessive compulsive symptoms have been found to respond well to SSRIs in particular and may require higher dosages than that prescribed for other forms of depression or anxiety. This treatment strategy has also proven useful for eating disorders and is often utilized as one treatment option. In some studies, SSRIs in higher dosages have helped to diminish the anxiety provoking thoughts and behaviors as well as decrease relapse rates.
As always, every person must be evaluated individually and the chosen treatment should be based on what the person and prescribing physician feel is the best fit.
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"Dialectical Behavior Therapy"
Cindy Butler, PhD
From joy and love to hatred and disgust, emotional experiences are part of everyone's life. However, some people are more sensitive to emotion than others. They experience feelings quickly and intensely, and take more time to "recover" from strong emotions. Reasons for this sensitivity may include biological causes, as well as growing up in a family where one's feelings were ignored or dismissed as unreasonable. Emotionally invalidating family experiences deprive us of the opportunity to learn the skills we need to cope with strong, sudden emotion in healthy ways. Instead we may seek temporary solutions to emotional pain through behaviors that are destructive to our bodies, our relationships, and our lives, such as self-injury, disordered eating, or substance use. These solutions come with their own set of problems that eventually add to a sense that one's life is out of control.
Dialectical Behavior Therapy (DBT), developed by Dr. Marsha Linehan, provides an opportunity to gain the skills necessary for identifying, experiencing and regulating emotions, in order to interact more effectively with ourselves and others. There are two components to DBT: skills training group and individual therapy. In skills training group, lectures and discussions focus on managing emotions, learning to be more effective in relationships, and learning techniques for tolerating distress. Individual therapy focuses on staying motivated, understanding how and why problem behaviors occur and identifying alternative, more skillful ways of coping. The overall approach to therapy is called "dialectical" because it seeks balance between opposites -- such as acceptance and change, validation and challenge, rigidity and flexibility. Underlying DBT is the practice of "mindfulness." Drawn from the Zen tradition of meditation, mindfulness is about attending to the moment, without judgment or impulsivity.
DBT recognizes that everyone works hard at finding solutions to the problems in their lives. It is not designed to take away the solutions that you already have, many of which are probably very effective. Instead, DBT can help you find more and possibly better ways of solving problems than what you are doing right now, especially if what you are doing does not seem to be working for you.
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"The Art Within"
Lisa Cohen, Art Therapy Student Intern
The brush moves across the page and creates vivid imagery. Hands shape the soft clay into shapes and figures. The tools of art-making and other forms of creativity allow constant self-expression. Often, the words that describe our emotions become stuck inside. The process of art therapy encourages our thoughts to emerge in a safe and tangible manner. By building, painting or creating in group or individual sessions, we can establish positive connections with ourselves, others and our surroundings.
Artistic ability is not necessary to fully appreciate the benefits of moving the brush or shaping the clay. We all possess the creative ability within us to participate in art therapy. Internal thoughts and sensations externalize via a safe and supportive environment, producing a somewhat cathartic escape. Kathy Mattea once said that we should all, "dance like no one is watching." When we express ourselves without boundaries, possibilities become limitless. The wildness and wonder surface as our hidden creative pleasures push our otherwise protected selves. The exposure can be freeing.
Through the process, some of us may discover our talent for painting flowers or sculpting the human form. Others may use the art-making as a time to breathe, away from daily stressors. During the session, the therapist facilitates and guides the participants. However, the therapist allows clients to find their own way through the session.
Art holds a power and when used as a tool, expressions flow. I believe in this power, as it has been a strength in my life many times. I now want to share this passion of mine with you, as we create together using various materials. I am currently a student at the Adler School of Professional Psychology and am in the Masters of Counseling: Art Therapy Program. I believe that everyone has the ability to participate in the creative process and the benefits constantly amaze me. Together we can create, inspire and discover art-making.
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September–December 2002
"Both Halves of Recovery"
Amy Grabowski, MA, LCPC
A Note from Amy: "As I've mentioned in the newsletter before, I'm writing a book about recovery from Eating Disorders. In this issue of our newsletter I've decided to print an excerpt from chapter one."
…."How did you do it? How long did it take? How is your approach any different from the hundreds of books already written about recovery?" In a nutshell, I'll tell you that I couldn't recover until I had all the parts of recovery in place. As long as I continued to work on only half of recovery, it all kept tumbling down.
Let me explain by giving you a visual example. Right now stop reading and put your hands together so that your fingertips are touching and your fingers are curved, like you are holding a large softball. How long could you hold your hands like this? Like most people, you'll find it comfortable, fairly easy to do.
Now, move your hands apart but keep them in the same position, with your fingertips curved towards one another. How long you can hold them like this? Your hands may start to shake. Are you feeling tension in your hands? Tingling? You probably couldn't hold them like this for very long. It would be too uncomfortable, a struggle.
When you put your hands back together, what happens? Relief! Phew! The hands instantly relax. It becomes easy again. The hands balance each other. Each hand represents the two halves of recovery. One half alone causes tension and discomfort, a struggle. You need both halves of recovery, and then it is easy.
So, you might be thinking, what are the two halves of recovery? One hand represents food, eating, weight and the body.
This is the half that people want to fix, why they seek out therapy. When I ask a new client for her goals for therapy, inevitably she says, "I want to stop bingeing and purging. I don't want to eat this way." She will also go on to tell me all the ways that she has tried to "fix" her eating.
You know what I'm talking about, don't you? You probably already have vast knowledge about food and nutrition; know all about food groups, portion sizes, and servings. Without a doubt, you could rattle off from memory the fat grams and calorie counts of various foods. Like most women with eating disorders, you are certainly very intelligent, you know this information and have made numerous attempts to use this information to recover.
Have you been drawn to certain food combinations looking for "the answer" to fix your eating disorder? "Maybe if I eat more carbohydrates and less protein..." "Maybe less carbs and more protein is the way to go." "If I eliminate all fat and sugar, then I'll be able to eat normally." "This book says that with my blood type I shouldn't eat fruit in the morning." "I must be addicted to sugar. If I avoid all sweets, then that will make me OK." But even as you search for the answer among the many different foods out there, you know that food is not the real issue. And since food is not the issue, it is not the answer.
So if food is not the answer, then maybe the answer is…. Exercise! Maybe, like "Libby", you need to run or workout everyday, no matter what! During one of our sessions together, Libby admitted to running when the wind-chill was sixty degrees below zero! What!? Is she crazy?! Why would she put herself in a potentially harmful situation like that! Her answer, "I had to! I would have felt fat if I hadn't." Ironically, Libby felt fat even when she did.
Many women look to weight as "the answer". You may think that if you only could reach a certain number on the scale, then all would be well with the world, you would never make mistakes, everyone would like you, in other words you would be perfect. As you know, that number never appears! No matter what the scale reads, you never feel OK inside. That little voice inside your head continues to say, "Maybe if you lose five more pounds…" Even if you appear emaciated to others, you still feel "fat", not good enough, defective and empty, inside and out.
Even the labels Anorexia Nervosa (which means "nervous loss of appetite"), Bulimia ("ox-hunger") and Binge Eating Disorder emphasize the disordered eating half of the eating disorder. Outside people, those "normal eaters" out there, also don't get it. They think, "You have an eating disorder. So fix the eating and you'll be Okay." Voila! The solution is simple. Very well meaning friends and family members say, "All you have to do is eat three meals a day." "Just eat when you're hungry and stop when you're full." And my personal favorite, "Just stop, don't do it anymore!" At this point, as the recipient of this helpful advice, you are supposed to hit your forehead with insight and gratefully exclaim, "Wow! I never thought of that before! Thanks so much for that advice. I'm all better now! Let's go have lunch!"
If only it was that simple!
I, myself, also fell for these common fallacies. During my first attempt at recovery, a lot of my time and energy was spent "controlling my food" and stopping any food related symptom: I ate well-balanced, pre-planned, "normal" meals and I weighed a pre-determined, "normal" weight. Even though I received some praise from others because "I had recovered!" inside I still felt hollow and empty, not good enough. Every day was a struggle, but that's how I assumed all "normal" people felt. Now that I had "recovered", I thought that life was going to be "perfect". The first time Life threw a "zinger" my way, I freaked out! I didn't know what to do and not knowing how to handle it made me feel out of control again! But this made no sense to me! I had fixed my eating disorder, right? I ate "normal" and looked "normal", right? So why was Life throwing zingers at me? What was wrong with me? After a few more weeks of struggling to be "normal", of trying to control life by controlling my "normal" eating and by looking "normal", the eating disorder symptoms came back. And I must admit I welcomed them like old friends!
So if you only fix half of the problem, just the food, eating, weight and the body, you have the constant tension, struggle, and discomfort. Hold up only one hand with curved tense fingers again. Feel it again? It's like the phrase that some groups use, "You're always one bite away from your next binge." That way of thinking says you can never recover, you can only be abstinent. I found this to be very depressing. If I was going to have to fight with myself everyday for the rest of my life, then why bother?! Why not just stay sick!?
So you need both halves, the balance of two halves supporting each other, for total recovery. Go ahead and put your two hands together again. Feel the relief, the ease. By now, you're wondering what the other hand is. The other hand represents your sense of Self. Total recovery is achieving peace with your food, your body, and your Self.
Amy Grabowski "In our next Newsletter I'll print another excerpt from my book. I'd like to hear your comments, questions, feedback or examples on what you've read so far. Please send an email (please no attachments) to or write to me at The Awakening Center. Thank you."
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"Mapping Your Progress"
Kathleen Check, MS, LCPC
Last winter I was with my family in the North Woods. I am a daily runner and enjoy this form of moving my body. I decided to head out into the beautiful woods and go for a run. I had never been there before. Shortly after I began running, I became distracted and began to feel disconnected from the moment and lost. I had a difficult time distinguishing how far I had run, where I was going, or where I had been due to the fact that each tree looked the same. I wanted to stop. I turned back and began walking towards where I had started. I didn't attempt to run again during this trip.
Not long after I returned home, I started to run in the familiar surroundings of my neighborhood. As I was running, I noticed that I keep track of where I am going and the progress I am making. I accomplish this by looking at familiar houses and markers along the way. The red brick house designates half-mile marker; Victorian house, designates mile marker; lamp post and park bench tell me that I am at one and one half miles. When I was in the North Woods running, I had no way of looking at where I had come from, or where I was headed; I was in dense woods, I couldn't capture where I started, how far I had gone, or where I was going. I lost focus of what I was doing in the moment, and how I feel when I run.
This situation reminded me of the process of recovery from an eating disorder. As I felt lost in the woods, many people get lost in eating disorder symptoms…they want desperately to stop engaging in eating disorder behaviors (whether they are bingeing, bingeing and purging, restricting food, over exercising). The focus becomes stopping the behaviors; all else is ignored or not acknowledged.
Just as I had difficulty gauging how far I had run, sometimes people with eating disorders lose sight of how far they have come without markers to identify and define their progress. Just as it was important for me to chart my progress while running and to have markers to guide and motivate me to move forward, it is equally important for individuals recovering from eating disorders to chart their progress and identify markers in their own recovery process. Not to judge or criticize yourself, but to identify strengths and triumphs along the way; to take notice of your surroundings, rather than beating yourself up for not accomplishing full recovery overnight.
Whether you are attending a support group, beginning the process of therapy, attending nutrition counseling for the first time, or learning to move your body in a way you enjoy, it is important to acknowledge the steps you are taking to recover from an eating disorder. Map your process of recovery; give yourself credit for even the smallest steps that you take in the process of recovery from an eating disorder. Acknowledge that you attended a group you were anxious about; that you continue to discuss your feelings, thoughts, and relationships in therapy, or that you identified physical hunger as you relearn to feed your body.
The process of recovery can be difficult at times. It becomes an important part of the process, to accept yourself and acknowledge the steps you are taking, as well as helping you to be gentle with yourself along the way. Mapping your process can help you to see where you have come from, where you hope to get, and most importantly, to give yourself hope and encouragement in the present moment.
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"Transforming Body Image"
Claudia Braun
From time to time, we ask professionals not affiliated with The Awakening Center to write articles and hold workshops at our center. Claudia Braun is a Shiatsu and Yoga practitioner who will be leading a workshop "Transforming Body Image" on Monday, December 2, which combines yoga, breath, postures and inner vision, to experience greater appreciation for your body, and to connect with a place of inner peace. Claudia makes sure that it is a safe place for all sizes and fitness levels. (See Page 3.)
Using body work and yoga I have come to discover how often our mind tells us we aren't as good as ... For women with eating disorders this voice is loudest about the body. When the body becomes who we are, the self-talk is so constant it is easy to forget it isn't the truth. So what are some ways of change?
Two ways are through Shiatsu and Yoga. My discovery of these modalities began in the late 80's. At the time I frequently didn't know what I was feeling. I had an intellectual experience of feelings, and my self dialogue was painful. A friend "Molly" was talking about having received a Shiatsu session and her experience from it. What I heard was how she became aware of feelings she hadn't known about, and how she felt more connected. Having never heard of Shiatsu, having limited massage experience, and not liking them, it surprised me to be so enthralled that I wanted to go and experience it for myself. Her experience resonated with my inner being. I liked hearing there was a way to feel more connected. I felt a pull to have the experience, I had the feeling it was what I was missing.
I can't remember much about the first session, but I do remember wanting more. Suddenly the other things seemed in perspective. I felt calmer, more peaceful and less worried. I new this was a homecoming. As I was receiving on-going Shiatsu sessions I began seeing myself giving Shiatsu to others and offering them what I was experiencing.
Now, after giving Shiatsu sessions for nine years and teaching yoga principles, I have many clients who have received what I have. Shiatsu, meaning "finger pressure" works the energy system acupuncturists use, only without needles. The results are somewhat similar. Shiatsu facilitates balance in the physical, mental and spiritual body. Because of the energetic nature of the Shiatsu, it works at a deep level under muscle and tissue to create change. Shiatsu can work on internal ailments as well as tightness from stress.
Shiatsu has taught me a great deal, about slowing down, listening, and paying attention to what is important for me. In the discovery of Shiatsu I found yoga, another way to achieve inner peace, internal freedom and release from the worries of the mind. Yoga, meaning "union", allows one to find their inner self, through movement, meditation and breathing.
With my clients, Shiatsu and yoga together teaches a deeper level of trusting ourselves, our inner process and accepting who we are. Both of these works help in connecting with our inner being, finding the love and compassion that is there for us, and coming to experience a kinder and gentler way of being.
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"Therapy Group or Support Group?
That is the Question"
Maybe you've been attending a support group for a while and have been feeling that you want something more, but don't know what. Or maybe your therapist has suggested that you join a therapy group and have questions about it. You may have been asking yourself, "What is the difference between a support group and a therapy group?"
There are several differences. While a support group can be therapeutic, it is not a therapy group. In a support group, whoever shows up at any particular meeting, whether it is 3 people or 23 people, that is the membership of the support group for that meeting. New members are allowed to join any week and members can stop attending whenever they want without explanation. While a core group of members who attend regularly does form in the support group, there is no guarantee of continuity of members.
In a therapy group the number of members is fixed, usually 6 to 8, and the members are committed to attend every week. There is a prescreening process to see if someone is appropriate for the group and if the group is appropriate for them. If a group is time limited, for example a 12 week group, once the group starts no new members are allowed. If a group is ongoing, new members are only allowed to join when a member leaves the group, and the group will process their feelings about allowing new members in, as well as feelings about current members leaving. Because the same members attend on a weekly basis, a therapy group can build a level of trust and intimacy that is not found in a support group. This trust and intimacy is necessary to take the risks necessary to produce growth within the group setting.
The leaders' role and how the groups are led are different also. In a support group, the leader acts as a teacher and moderator, not the therapist. Discussions are on general topics and the leader tends to "teach" about eating disorders and their underlying issues. Generally, the members' personal issues are not explored at length. Members are not required to speak; they may just sit and listen for the entire meeting.
In a therapy group, the leader acts as a therapist. While some topics are discussed generally, most of the time is spent exploring the members' personal issues and feelings. If a member does not speak, it is treated as a therapeutic issue and will eventually be explored.
In both kinds of groups, it is important that a feeling of safety for each of the members develops. In the support group the members are instructed to keep all names and identifying information strictly confidential. They are also encouraged to only talk about their experience in the group, and to refrain from talking about other members' experiences.
In a therapy group, because members are taking more risks, it must be done in a supportive and safe manner: "If I reveal my issues to you, I know you will not reject or shame me, because I know that you have the same feelings too. If I need to back up from the group's intimacy, I know that my need will be respected." Members are encouraged to take risks within the structure of the group, i.e. to tell the group when something bothers them about the group, to check out others' reactions rather than assume how others feel towards you.
Because a therapy group spends time exploring members personal issues and feelings the goal of a therapy group is to resolve emotions and change patterns. This is not possible in a support group. The goal of a support group is provide a place where people can be with other people who share the same struggles and successes.
There are many more differences but these are the main points.
At The Awakening Center we offer several kinds of classes, support groups, and therapy groups-please see the current calendar. If you would like more information about any of these groups, please contact the group leader directly and she will be glad to answer any questions you have.
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"Art Therapy and the Creative Self"
Phoebe Whisnant, Student Intern
Art therapy is an expressive form of therapy which provides individuals with a unique opportunity to use art as a means of self expression and self discovery. We all have innate creativity as children, but sometimes lose touch with this part of ourselves as we grow older. The process of art-making provides a means in which to reconnect with this valuable part of ourselves.
Art therapy sessions are conducted in an encouraging and non-judgmental environment where the therapist acts as facilitator and guide for the client's art-making process. This creative process provides a tangible medium in which to explore thoughts and feelings that are often illusive or difficult to put into words. The finished art work acts as a mirror which reflects the "self" in a new way that provides greater insight and
self-understanding. It can help individuals see themselves and how they function more clearly as well as see all of the choices and opportunities that are available to them.
Art therapy taps into the creativity and inner wisdom that we all have and demonstrates that the creative self has much to tell us if we allow it to speak.
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"DBT Skills for Effective Living: Myths about Interpersonal Behavior"
Cindy Butler, PhD
This is the first article in a series of three that will highlight some of the skills that can be learned through Dialectical Behavior Therapy.
True or False: "Saying no to a request is always a selfish thing to do." If you answered True, you may be under the influence of an interpersonal myth. These are beliefs or "rules" that people operate by in relationships -- "rules" which can end up causing relationship problems. Interpersonal myths can prevent you from behaving in ways that promote positive, satisfying relationships. In Dialectical Behavior Therapy, participants learn to move beyond interpersonal myths by identifying and challenging them.
Perhaps the most common type of interpersonal myth has to do with making requests and saying "no" to requests. Most of us can point to a situation where we should have been more firm in making a request or saying no to someone. Myths we hold can get in the way of asking or saying "no" as firmly or as often as necessary in order to manage relationships effectively. Common interpersonal myths regarding making requests include: "Asking for things is a very pushy (or bad, or selfish, or fill-in-the-blank-with-a-negative) thing to do," "I must really be inadequate if I can't fix this without asking for help," "Unless I'm sure I'll get a 'yes' I'd better not ask." Realistically, figuring out whether or not to make a request and how firm to be in asking is usually based on many factors, rather than any single "rule" such as these. And even though there might be a small grain of truth in each of these statements under very specific circumstances, none of them applies across the board. The same holds true for myths about saying no, such as "If I say no someone will get upset and I won't be able to deal with that," or "I don't have the right to say no." Again, potentially true under a very narrow range of circumstances, but too narrow and simple to function as a "rule" that governs all interactions.
Identifying the beliefs or rules by which we interact can be a challenge in itself. Psychotherapy can be helpful in doing that. Once you've identified an interpersonal rule, how do you know if it's actually a myth? One way to tell is if the rule applies to you, but doesn't make as much sense when you think about applying it to other people. Another way is to intentionally break a rule about interacting (in a situation where it won't matter if the worst happens) and see what happens -- do other people really respond the way your rule predicted they would? If not, it was probably a myth. Once you've identified a myth, how can you stop relying on it as a rule that governs your behavior? One way is to think about what you'd say to a friend who stated your myth to you as if it was hers. How would you convince her that it wasn't true? Now, remember what you'd say and say it to yourself when you need to. By identifying and challenging interpersonal myths in these ways, you can increase your capacity to behave effectively in relationships.
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"Nourishing Concepts"
Elisa D'Urso-Fischer, MS, RD, LD
Nourishing Concepts is a weekly nutrition-counseling group, designed to help members move toward "intuitive eating" and away from deprivation, undernourishment, and emotional overeating. This group is open to women who are interested in implementing a non-dieting, natural eating approach. I have been offering this group for several years, and this fall, Candice Luglio, Ph.D. will be joining me in leading the group and I wanted to share a conversation we had recently.
Can you tell us a little about your background? I'm currently completing a yearlong postdoctoral fellowship at The Awakening Center. This spring I graduated with my doctorate in clinical psychology from Georgia State University in Atlanta and I'm working toward licensure in Illinois. I've worked as a psychotherapist in a variety of settings and I have specialized training in the treatment of eating disorders. I also have a master's degree in sport psychology from the University of North Carolina at Chapel Hill.
How is Nourishing Concepts different from groups you've led in the past? Nourishing Concepts is interesting in that it's more like an extended experiential workshop. We begin each session with a brief relaxation or breathing exercise. Following that, we will present a topic to be discussed and members will be asked to share their reactions, thoughts, emotions, and experiences with regard to that topic. Active participation will be encouraged but it is up to the individual group member to decide how much she wishes to talk. At times group members may have realizations that they will want to explore more deeply in individual therapy
What topics will be covered? Among the topics the group will discuss are problems associated with dieting; how various foods (specifically, carbohydrates, protein, and fats) impact the body; how to distinguish between emotional hunger and physical hunger; strategies that might help with emotional overeating; recognizing levels of fullness; improving self-acceptance and self-esteem; learning to be a neutral observer of yourself; eating in a variety of social situations (i.e.; holidays, parties, with family); and nutritional suggestions for easing symptoms of PMS, menopause and food cravings.
As you see it, what are the advantages of this type of group counseling? Clearly, working one-on-one with a nutritionist is recommended when you need personalized attention. On the other hand, there are definite positives to joining a group like Nourishing Concepts. Group members really tend to learn a great deal from each other. Listening to someone describe a situation similar to your own can give you a new perspective and empathy for yourself. Also, many people who struggle with problematic eating patterns may feel alienated from the world around them and it can be helpful to meet people who share similar concerns. Finally, changing eating patterns can be very difficult and it can be empowering to interact with others who also want to change.
- Both Halves of Recovery - Amy Grabowski, MA, LCPC
- Mapping Your Progress - Kathleen Check, MS, LCPC
- Transforming Body Image - Claudia Braun
- Group Therapy or Support Group? That is the Question
- Art Therapy and the Creative Self - Phoebe Whisnant, Student Intern
- DBT Skills for Effective Living: Myths about Interpersonal Behavior - Cindy Butler, PhD
- Nourishing Concepts - Elisa D'Urso-Fischer, MS, RD, LD
"Both Halves of Recovery"
Amy Grabowski, MA, LCPC
A Note from Amy: "As I've mentioned in the newsletter before, I'm writing a book about recovery from Eating Disorders. In this issue of our newsletter I've decided to print an excerpt from chapter one."
…."How did you do it? How long did it take? How is your approach any different from the hundreds of books already written about recovery?" In a nutshell, I'll tell you that I couldn't recover until I had all the parts of recovery in place. As long as I continued to work on only half of recovery, it all kept tumbling down.
Let me explain by giving you a visual example. Right now stop reading and put your hands together so that your fingertips are touching and your fingers are curved, like you are holding a large softball. How long could you hold your hands like this? Like most people, you'll find it comfortable, fairly easy to do.
Now, move your hands apart but keep them in the same position, with your fingertips curved towards one another. How long you can hold them like this? Your hands may start to shake. Are you feeling tension in your hands? Tingling? You probably couldn't hold them like this for very long. It would be too uncomfortable, a struggle.
When you put your hands back together, what happens? Relief! Phew! The hands instantly relax. It becomes easy again. The hands balance each other. Each hand represents the two halves of recovery. One half alone causes tension and discomfort, a struggle. You need both halves of recovery, and then it is easy.
So, you might be thinking, what are the two halves of recovery? One hand represents food, eating, weight and the body.
This is the half that people want to fix, why they seek out therapy. When I ask a new client for her goals for therapy, inevitably she says, "I want to stop bingeing and purging. I don't want to eat this way." She will also go on to tell me all the ways that she has tried to "fix" her eating.
You know what I'm talking about, don't you? You probably already have vast knowledge about food and nutrition; know all about food groups, portion sizes, and servings. Without a doubt, you could rattle off from memory the fat grams and calorie counts of various foods. Like most women with eating disorders, you are certainly very intelligent, you know this information and have made numerous attempts to use this information to recover.
Have you been drawn to certain food combinations looking for "the answer" to fix your eating disorder? "Maybe if I eat more carbohydrates and less protein..." "Maybe less carbs and more protein is the way to go." "If I eliminate all fat and sugar, then I'll be able to eat normally." "This book says that with my blood type I shouldn't eat fruit in the morning." "I must be addicted to sugar. If I avoid all sweets, then that will make me OK." But even as you search for the answer among the many different foods out there, you know that food is not the real issue. And since food is not the issue, it is not the answer.
So if food is not the answer, then maybe the answer is…. Exercise! Maybe, like "Libby", you need to run or workout everyday, no matter what! During one of our sessions together, Libby admitted to running when the wind-chill was sixty degrees below zero! What!? Is she crazy?! Why would she put herself in a potentially harmful situation like that! Her answer, "I had to! I would have felt fat if I hadn't." Ironically, Libby felt fat even when she did.
Many women look to weight as "the answer". You may think that if you only could reach a certain number on the scale, then all would be well with the world, you would never make mistakes, everyone would like you, in other words you would be perfect. As you know, that number never appears! No matter what the scale reads, you never feel OK inside. That little voice inside your head continues to say, "Maybe if you lose five more pounds…" Even if you appear emaciated to others, you still feel "fat", not good enough, defective and empty, inside and out.
Even the labels Anorexia Nervosa (which means "nervous loss of appetite"), Bulimia ("ox-hunger") and Binge Eating Disorder emphasize the disordered eating half of the eating disorder. Outside people, those "normal eaters" out there, also don't get it. They think, "You have an eating disorder. So fix the eating and you'll be Okay." Voila! The solution is simple. Very well meaning friends and family members say, "All you have to do is eat three meals a day." "Just eat when you're hungry and stop when you're full." And my personal favorite, "Just stop, don't do it anymore!" At this point, as the recipient of this helpful advice, you are supposed to hit your forehead with insight and gratefully exclaim, "Wow! I never thought of that before! Thanks so much for that advice. I'm all better now! Let's go have lunch!"
If only it was that simple!
I, myself, also fell for these common fallacies. During my first attempt at recovery, a lot of my time and energy was spent "controlling my food" and stopping any food related symptom: I ate well-balanced, pre-planned, "normal" meals and I weighed a pre-determined, "normal" weight. Even though I received some praise from others because "I had recovered!" inside I still felt hollow and empty, not good enough. Every day was a struggle, but that's how I assumed all "normal" people felt. Now that I had "recovered", I thought that life was going to be "perfect". The first time Life threw a "zinger" my way, I freaked out! I didn't know what to do and not knowing how to handle it made me feel out of control again! But this made no sense to me! I had fixed my eating disorder, right? I ate "normal" and looked "normal", right? So why was Life throwing zingers at me? What was wrong with me? After a few more weeks of struggling to be "normal", of trying to control life by controlling my "normal" eating and by looking "normal", the eating disorder symptoms came back. And I must admit I welcomed them like old friends!
So if you only fix half of the problem, just the food, eating, weight and the body, you have the constant tension, struggle, and discomfort. Hold up only one hand with curved tense fingers again. Feel it again? It's like the phrase that some groups use, "You're always one bite away from your next binge." That way of thinking says you can never recover, you can only be abstinent. I found this to be very depressing. If I was going to have to fight with myself everyday for the rest of my life, then why bother?! Why not just stay sick!?
So you need both halves, the balance of two halves supporting each other, for total recovery. Go ahead and put your two hands together again. Feel the relief, the ease. By now, you're wondering what the other hand is. The other hand represents your sense of Self. Total recovery is achieving peace with your food, your body, and your Self.
Amy Grabowski "In our next Newsletter I'll print another excerpt from my book. I'd like to hear your comments, questions, feedback or examples on what you've read so far. Please send an email (please no attachments) to or write to me at The Awakening Center. Thank you."
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"Mapping Your Progress"
Kathleen Check, MS, LCPC
Last winter I was with my family in the North Woods. I am a daily runner and enjoy this form of moving my body. I decided to head out into the beautiful woods and go for a run. I had never been there before. Shortly after I began running, I became distracted and began to feel disconnected from the moment and lost. I had a difficult time distinguishing how far I had run, where I was going, or where I had been due to the fact that each tree looked the same. I wanted to stop. I turned back and began walking towards where I had started. I didn't attempt to run again during this trip.
Not long after I returned home, I started to run in the familiar surroundings of my neighborhood. As I was running, I noticed that I keep track of where I am going and the progress I am making. I accomplish this by looking at familiar houses and markers along the way. The red brick house designates half-mile marker; Victorian house, designates mile marker; lamp post and park bench tell me that I am at one and one half miles. When I was in the North Woods running, I had no way of looking at where I had come from, or where I was headed; I was in dense woods, I couldn't capture where I started, how far I had gone, or where I was going. I lost focus of what I was doing in the moment, and how I feel when I run.
This situation reminded me of the process of recovery from an eating disorder. As I felt lost in the woods, many people get lost in eating disorder symptoms…they want desperately to stop engaging in eating disorder behaviors (whether they are bingeing, bingeing and purging, restricting food, over exercising). The focus becomes stopping the behaviors; all else is ignored or not acknowledged.
Just as I had difficulty gauging how far I had run, sometimes people with eating disorders lose sight of how far they have come without markers to identify and define their progress. Just as it was important for me to chart my progress while running and to have markers to guide and motivate me to move forward, it is equally important for individuals recovering from eating disorders to chart their progress and identify markers in their own recovery process. Not to judge or criticize yourself, but to identify strengths and triumphs along the way; to take notice of your surroundings, rather than beating yourself up for not accomplishing full recovery overnight.
Whether you are attending a support group, beginning the process of therapy, attending nutrition counseling for the first time, or learning to move your body in a way you enjoy, it is important to acknowledge the steps you are taking to recover from an eating disorder. Map your process of recovery; give yourself credit for even the smallest steps that you take in the process of recovery from an eating disorder. Acknowledge that you attended a group you were anxious about; that you continue to discuss your feelings, thoughts, and relationships in therapy, or that you identified physical hunger as you relearn to feed your body.
The process of recovery can be difficult at times. It becomes an important part of the process, to accept yourself and acknowledge the steps you are taking, as well as helping you to be gentle with yourself along the way. Mapping your process can help you to see where you have come from, where you hope to get, and most importantly, to give yourself hope and encouragement in the present moment.
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"Transforming Body Image"
Claudia Braun
From time to time, we ask professionals not affiliated with The Awakening Center to write articles and hold workshops at our center. Claudia Braun is a Shiatsu and Yoga practitioner who will be leading a workshop "Transforming Body Image" on Monday, December 2, which combines yoga, breath, postures and inner vision, to experience greater appreciation for your body, and to connect with a place of inner peace. Claudia makes sure that it is a safe place for all sizes and fitness levels. (See Page 3.)
Using body work and yoga I have come to discover how often our mind tells us we aren't as good as ... For women with eating disorders this voice is loudest about the body. When the body becomes who we are, the self-talk is so constant it is easy to forget it isn't the truth. So what are some ways of change?
Two ways are through Shiatsu and Yoga. My discovery of these modalities began in the late 80's. At the time I frequently didn't know what I was feeling. I had an intellectual experience of feelings, and my self dialogue was painful. A friend "Molly" was talking about having received a Shiatsu session and her experience from it. What I heard was how she became aware of feelings she hadn't known about, and how she felt more connected. Having never heard of Shiatsu, having limited massage experience, and not liking them, it surprised me to be so enthralled that I wanted to go and experience it for myself. Her experience resonated with my inner being. I liked hearing there was a way to feel more connected. I felt a pull to have the experience, I had the feeling it was what I was missing.
I can't remember much about the first session, but I do remember wanting more. Suddenly the other things seemed in perspective. I felt calmer, more peaceful and less worried. I new this was a homecoming. As I was receiving on-going Shiatsu sessions I began seeing myself giving Shiatsu to others and offering them what I was experiencing.
Now, after giving Shiatsu sessions for nine years and teaching yoga principles, I have many clients who have received what I have. Shiatsu, meaning "finger pressure" works the energy system acupuncturists use, only without needles. The results are somewhat similar. Shiatsu facilitates balance in the physical, mental and spiritual body. Because of the energetic nature of the Shiatsu, it works at a deep level under muscle and tissue to create change. Shiatsu can work on internal ailments as well as tightness from stress.
Shiatsu has taught me a great deal, about slowing down, listening, and paying attention to what is important for me. In the discovery of Shiatsu I found yoga, another way to achieve inner peace, internal freedom and release from the worries of the mind. Yoga, meaning "union", allows one to find their inner self, through movement, meditation and breathing.
With my clients, Shiatsu and yoga together teaches a deeper level of trusting ourselves, our inner process and accepting who we are. Both of these works help in connecting with our inner being, finding the love and compassion that is there for us, and coming to experience a kinder and gentler way of being.
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"Therapy Group or Support Group?
That is the Question"
Maybe you've been attending a support group for a while and have been feeling that you want something more, but don't know what. Or maybe your therapist has suggested that you join a therapy group and have questions about it. You may have been asking yourself, "What is the difference between a support group and a therapy group?"
There are several differences. While a support group can be therapeutic, it is not a therapy group. In a support group, whoever shows up at any particular meeting, whether it is 3 people or 23 people, that is the membership of the support group for that meeting. New members are allowed to join any week and members can stop attending whenever they want without explanation. While a core group of members who attend regularly does form in the support group, there is no guarantee of continuity of members.
In a therapy group the number of members is fixed, usually 6 to 8, and the members are committed to attend every week. There is a prescreening process to see if someone is appropriate for the group and if the group is appropriate for them. If a group is time limited, for example a 12 week group, once the group starts no new members are allowed. If a group is ongoing, new members are only allowed to join when a member leaves the group, and the group will process their feelings about allowing new members in, as well as feelings about current members leaving. Because the same members attend on a weekly basis, a therapy group can build a level of trust and intimacy that is not found in a support group. This trust and intimacy is necessary to take the risks necessary to produce growth within the group setting.
The leaders' role and how the groups are led are different also. In a support group, the leader acts as a teacher and moderator, not the therapist. Discussions are on general topics and the leader tends to "teach" about eating disorders and their underlying issues. Generally, the members' personal issues are not explored at length. Members are not required to speak; they may just sit and listen for the entire meeting.
In a therapy group, the leader acts as a therapist. While some topics are discussed generally, most of the time is spent exploring the members' personal issues and feelings. If a member does not speak, it is treated as a therapeutic issue and will eventually be explored.
In both kinds of groups, it is important that a feeling of safety for each of the members develops. In the support group the members are instructed to keep all names and identifying information strictly confidential. They are also encouraged to only talk about their experience in the group, and to refrain from talking about other members' experiences.
In a therapy group, because members are taking more risks, it must be done in a supportive and safe manner: "If I reveal my issues to you, I know you will not reject or shame me, because I know that you have the same feelings too. If I need to back up from the group's intimacy, I know that my need will be respected." Members are encouraged to take risks within the structure of the group, i.e. to tell the group when something bothers them about the group, to check out others' reactions rather than assume how others feel towards you.
Because a therapy group spends time exploring members personal issues and feelings the goal of a therapy group is to resolve emotions and change patterns. This is not possible in a support group. The goal of a support group is provide a place where people can be with other people who share the same struggles and successes.
There are many more differences but these are the main points.
At The Awakening Center we offer several kinds of classes, support groups, and therapy groups-please see the current calendar. If you would like more information about any of these groups, please contact the group leader directly and she will be glad to answer any questions you have.
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"Art Therapy and the Creative Self"
Phoebe Whisnant, Student Intern
Art therapy is an expressive form of therapy which provides individuals with a unique opportunity to use art as a means of self expression and self discovery. We all have innate creativity as children, but sometimes lose touch with this part of ourselves as we grow older. The process of art-making provides a means in which to reconnect with this valuable part of ourselves.
Art therapy sessions are conducted in an encouraging and non-judgmental environment where the therapist acts as facilitator and guide for the client's art-making process. This creative process provides a tangible medium in which to explore thoughts and feelings that are often illusive or difficult to put into words. The finished art work acts as a mirror which reflects the "self" in a new way that provides greater insight and
self-understanding. It can help individuals see themselves and how they function more clearly as well as see all of the choices and opportunities that are available to them.
Art therapy taps into the creativity and inner wisdom that we all have and demonstrates that the creative self has much to tell us if we allow it to speak.
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"DBT Skills for Effective Living: Myths about Interpersonal Behavior"
Cindy Butler, PhD
This is the first article in a series of three that will highlight some of the skills that can be learned through Dialectical Behavior Therapy.
True or False: "Saying no to a request is always a selfish thing to do." If you answered True, you may be under the influence of an interpersonal myth. These are beliefs or "rules" that people operate by in relationships -- "rules" which can end up causing relationship problems. Interpersonal myths can prevent you from behaving in ways that promote positive, satisfying relationships. In Dialectical Behavior Therapy, participants learn to move beyond interpersonal myths by identifying and challenging them.
Perhaps the most common type of interpersonal myth has to do with making requests and saying "no" to requests. Most of us can point to a situation where we should have been more firm in making a request or saying no to someone. Myths we hold can get in the way of asking or saying "no" as firmly or as often as necessary in order to manage relationships effectively. Common interpersonal myths regarding making requests include: "Asking for things is a very pushy (or bad, or selfish, or fill-in-the-blank-with-a-negative) thing to do," "I must really be inadequate if I can't fix this without asking for help," "Unless I'm sure I'll get a 'yes' I'd better not ask." Realistically, figuring out whether or not to make a request and how firm to be in asking is usually based on many factors, rather than any single "rule" such as these. And even though there might be a small grain of truth in each of these statements under very specific circumstances, none of them applies across the board. The same holds true for myths about saying no, such as "If I say no someone will get upset and I won't be able to deal with that," or "I don't have the right to say no." Again, potentially true under a very narrow range of circumstances, but too narrow and simple to function as a "rule" that governs all interactions.
Identifying the beliefs or rules by which we interact can be a challenge in itself. Psychotherapy can be helpful in doing that. Once you've identified an interpersonal rule, how do you know if it's actually a myth? One way to tell is if the rule applies to you, but doesn't make as much sense when you think about applying it to other people. Another way is to intentionally break a rule about interacting (in a situation where it won't matter if the worst happens) and see what happens -- do other people really respond the way your rule predicted they would? If not, it was probably a myth. Once you've identified a myth, how can you stop relying on it as a rule that governs your behavior? One way is to think about what you'd say to a friend who stated your myth to you as if it was hers. How would you convince her that it wasn't true? Now, remember what you'd say and say it to yourself when you need to. By identifying and challenging interpersonal myths in these ways, you can increase your capacity to behave effectively in relationships.
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"Nourishing Concepts"
Elisa D'Urso-Fischer, MS, RD, LD
Nourishing Concepts is a weekly nutrition-counseling group, designed to help members move toward "intuitive eating" and away from deprivation, undernourishment, and emotional overeating. This group is open to women who are interested in implementing a non-dieting, natural eating approach. I have been offering this group for several years, and this fall, Candice Luglio, Ph.D. will be joining me in leading the group and I wanted to share a conversation we had recently.
Can you tell us a little about your background? I'm currently completing a yearlong postdoctoral fellowship at The Awakening Center. This spring I graduated with my doctorate in clinical psychology from Georgia State University in Atlanta and I'm working toward licensure in Illinois. I've worked as a psychotherapist in a variety of settings and I have specialized training in the treatment of eating disorders. I also have a master's degree in sport psychology from the University of North Carolina at Chapel Hill.
How is Nourishing Concepts different from groups you've led in the past? Nourishing Concepts is interesting in that it's more like an extended experiential workshop. We begin each session with a brief relaxation or breathing exercise. Following that, we will present a topic to be discussed and members will be asked to share their reactions, thoughts, emotions, and experiences with regard to that topic. Active participation will be encouraged but it is up to the individual group member to decide how much she wishes to talk. At times group members may have realizations that they will want to explore more deeply in individual therapy
What topics will be covered? Among the topics the group will discuss are problems associated with dieting; how various foods (specifically, carbohydrates, protein, and fats) impact the body; how to distinguish between emotional hunger and physical hunger; strategies that might help with emotional overeating; recognizing levels of fullness; improving self-acceptance and self-esteem; learning to be a neutral observer of yourself; eating in a variety of social situations (i.e.; holidays, parties, with family); and nutritional suggestions for easing symptoms of PMS, menopause and food cravings.
As you see it, what are the advantages of this type of group counseling? Clearly, working one-on-one with a nutritionist is recommended when you need personalized attention. On the other hand, there are definite positives to joining a group like Nourishing Concepts. Group members really tend to learn a great deal from each other. Listening to someone describe a situation similar to your own can give you a new perspective and empathy for yourself. Also, many people who struggle with problematic eating patterns may feel alienated from the world around them and it can be helpful to meet people who share similar concerns. Finally, changing eating patterns can be very difficult and it can be empowering to interact with others who also want to change.