By: Angie Heim, LMHP
I went back and forth on the title for this. First blush was to call it “The Things I Wish I Could Tell You,” but the fact of the matter is, sometimes those things are actually told to our clients. And sometimes the information is not ready to be received.
Working in eating disorders can be a tough road for providers, and is definitely a tough road to recovery for our clients. When you first start working with someone, it is important to gauge where they are at in their journey. Is this their first time working on recovery with a professional? Or are they coming to you after their second time working in an intensive outpatient program? Did they come willingly? Or is this an ultimatum from a significant other or a requirement from a parent? Are they dealing with trauma? Depression? Anxiety? All of the above? What is their level of motivation? Are they abusing substances? These questions, and more, help us to discover where our clients are at. It also helps us to understand what level of information they are willing and ready to hear. Sometimes, even when they are not ready, we try anyway.
I wish that my clients who vacillate between binging and restricting, and are allured by the next “greatest” diet, could hear me when I say that diets don’t work. They may see a temporary change in their weight, but the fact of the matter is that dieting promotes weight gain in the long-term (see Pietilaineet, 2011). Unfortunately, the positive reinforcement individuals get when they lose weight while dieting entices the dieter to try and try again each time after the quit (or, as they see it, fail) the diet. The dieting industry is strong, promising a better life, alleged research based methods, and doctor supervised programs. As eating disorder providers, we try to teach our clients mindfulness, self-acceptance, body love, and emotional awareness, among other things. But sometimes the perceived attractiveness of celebrities, the pull of social media, the desire for a change in body (which we cannot promise in our field, but the diet industry DOES give this hollow promise), and society’s judgement leads them to another diet. I wish they could hear me when I say diets don’t work.
I wish that when a client arrives underweight, struggling to eat more than once a day, and is also suffering from anxiety and depression, that they could hear me. I wish that they could hear me when I inform them that, due to lack of nourishment to the brain, they are not able to concentrate well. If they nourished their bodies and brains, their ability to cope with some of the emotional turmoil would improve. Their sleep would improve. They wouldn’t cramp as frequently. They wouldn’t have to be concerned about passing out when they stood up. They would understand that their brain is tricking them into believing that restriction is a good thing, but it is simultaneously killing them. I wish they believed this information.
I also wish that I could tell them that, once the food behaviors decrease, then the real work will start. This is when we now have the opportunity to look at the pain, disappointment, trauma, loss, fear, etc. that led them to their eating disorder. This is tricky. While the work is worth doing, oftentimes people with eating disorders are sensitive, feeling emotions in a more intense manner than the general population might experience them. The possibility of relapse is heightened at this time. I wish I could warn them about this work without scaring them away from it.
The bottom line is that approaching treatment comes down to balance. It comes to meeting your client where they are, while gently pushing them in the direction of recovery. It is a dance, where you let your clients steer, but you’re there to help keep them on the path. Give support and empathy, while guiding and empowering.
Also, you can use research, statistics, and science to help you, but keep in mind that rarely are people guided by facts when making sensitive changes in their lives. One of my favorite quotes, which is from Clifton Mitchell, spells this out well, “Do not waste time trying to create change through logic. If people changed because of logic, nobody would smoke or drink and everyone would have an exercise program and get eight hours of sleep. When people make major changes in their life, they don’t do it because of logic. They do it because they have an emotional compelling reason.” So, meet your clients where they are at, and help them to find their emotionally compelling reason for walking the path of recovery.
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