Comprehensive Treatment of Eating Disorders

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Comprehensive Treatment of Eating
DisordersPreferred Provider ConferenceSunday,
January 31stTheresa Chesnut, LCSWCastlewood
Treatment Center for Eating Disorders800 Holland
Road636-386-6611www.castlewoodtc.comtheresa.che
snut_at_castlewoodtc.com
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• Comprehensive Treatment of Eating Disorders

In less than 2 hours
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• The secret of life that we are all looking for
  is just this
• To develop through sitting and daily life
  practice the power and courage to return to that
  which we have spent a lifetime hiding from, to
  rest in the bodily experience of the present
  moment even if it is a feeling of being
  humiliated, of failing, of abandonment, of
  unfairness.
• -Charlotte Joko Beck

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• Back to Basics

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Compassion

• In other traditions, demons are expelled
  externally. But in my tradition demons are
  accepted with compassion.
• -Machik Labdron, The Places That Scare You

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Eating Disorder Takes Away

• Ability to be human (stay out of your body!)
• Voice
• Ability to be in your body
• Breathe
• Pleasure
• Joy
• Spontaneity
• Allowance to have needs, wants, desires
• Passion and vibrancy
• Balance
• Intimacy with self and others
• Resulting in the loss of self,
• Loss of soul and spirit

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How is Recovery Measured?

• Recovery is not just the absence of symptomsit
  is the presence of a full life as evidenced by
  the ability to be human. A truly recovered life
  will reflect spontaneity, freedom, the ability to
  breathe, to have wants, needs and desires,
  knowing that the quest for perfection is an
  unattainable illusion. Having the ability to
  embrace the feminine, having close intimate
  relationships, and it is being aware of the tears
  in your eyes (whether out of intense or subtle
  sadness or out of joy or from a flicker of
  utter gratefulness) and then to allow your tears
  to flow freely. It is a life in which decisions
  and choices are made more from self and less from
  a shame and fear based prison. It is a life
  where you fully experience pleasure, joy, and
  passion and believe and know it is good to desire
  and enjoy sex

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vulnerability
eating disorder
vulnerability
recovering
childhood
safety
safety

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Recovery and Treatment Process

• Eventually, the eating disorder takes up
  residency in the headso work to separate it by
  working with cognitive distortions
• Offer your client education
• Be aware of intense fear and body distortions
• All the while taking care of nourishing the body
• The goal realigning the head, body, heart and
  soul

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• The client hired you
• to fight their
• Eating disorder. To be
• warrior for their
• recovery

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In Reference to Eating Disorders

• These disorders which are so pervasive in our
  current world, illustrate that beneath the veneer
  of self reliance lies the core of powerlessness,
  alienation, detachment, self-hate and shame.
• (K.B. Walant, 1995)

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• Each are goodbut not sufficient to treat
  eating disorders
• Dr. Mark Schwartz

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Create Safety, Then

• Get them out of their heads! Working with
  cognitive distortions.
• Give anticipated guidancethere is no quick fix.
• Recovery work has to take place outside of the 50
  minute hour.
• Realities about the illness, relapse and
  mortality

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• Contain Symptoms

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• Imperative to know and understand the eating
  disorder
• Inside, outside, the good, the bad, the ugly

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Writing/Journaling

• Your worst eating disorder day
• Using a journal entry or intense situation,
  follow the thoughts and map out the feelings and
  triggering event

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Writing Assignments

• Dialogue with fat
• Have family members write why they believe client
  has an eating disorder
• Letters to ED, to the body, from the body
• How does the way you relate to food resemble how
  you relate to people

• Have the eating disorder write and introduce
  itself
• likes, dislikes, values, fears, hopes, and goals
• What will your life look like in 5 years
• What did you learn in your family about food,
  body size, femininity, feelings

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Free Associationalways be listening for
cognitive distortions/errors and be curious

• In this body
• If I recover
• Eating means
• Thin, normal, healthy, fateach mean
• My eating disorder is active by
• Without my eating disorder, Im
• From ED
• I need
• I want
• I hope

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Relapse Prevention

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• Faith is taking the first step even when you
  dont see the whole staircase
• Martin Luther King,
  Jr.

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• Are you willing to be
• uncomfortable?

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It Is About the Food!

• Deconstructing the meaning of food
• Write in detail a description of your addictive
  behaviors
• Have a meal with your client
• Explore fears of allowing self to taste, enjoy,
  desire food.

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Expressive Therapies

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Interventions

• The art as a container allows the person to view
  and own the authentic experience thereby
  enhancing the observing functions, boundaries and
  self-esteem.
• Art work allows a visual representation of
  dichotomous beliefs, relationships, etc -
  thereby allowing the individual to a space to
  reconsider and revise what has been.

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Goals of Expressive Therapies in the Treatment of
Eating Disorders

1. Embodiment.
2. Development and enhance affect regulation.
3. Enhance other self functions such as boundaries
   and self esteem.
4. Re-associate what has been disassociated exiled
   parts or ego states.
5. Access emotion/sensory motor experience
   (traumatic/implicit memory).
6. Dissolve dichotomous boundaries and ways of
   perceiving.
7. Vivify internal resources.

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• Hilde Bruch (1985) considered anorexia to be
  characterized by an underlying disturbance in the
  development of self, identity, and autonomyArt
  therapy with the anorexic individual can provide
  a means of addressing underlying deficits in the
  organization of the self.

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• The fucking
• MUFFIN

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• Control of Symptom
• vs
• Recovery

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• We have to ask our clients to be willing to
  stay. You must be willing to stay with your
  client.

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• Relapselapserelapselapse

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The Balancing Act

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Restrictive Part

• Exercise
• Rules yoga, pilates, work hard, push through
  it, dont listen to your body, isolate, minimize,
  deny, dont let anyone know, lie, rigidity, feel
  the pain, feel the burn, suck it up, be the best
  at what your doing, be better than everyone else,
  always compete, you dont have a choice (belief),
  you have to even if you dont want to, you always
  have to be in shape, control weight, weigh
  yourself, weight training, elliptical for 1
  hours, 2 miles in 12 minutes, count calories
  burned on machines at gym, you must always time
  yourself when exercising, miss hanging out with
  friend or family obligations to exercise, 3,000
  sit-ups and 100 pushups everyday, stretching
  everyday, out of shape, Ill be fat, Ill gain
  weight, I have to work harder than everyone else
  just to level out, theres nothing wrong to
  exercise and take care of body if Im going to
  be/am a competitive, collegiate athlete, exercise
  will make me happy, taking care of your body is
  what youve done your whole life you cant stop
  now, Im slow, Im weak, Im proud of myself in
  showing off my talents to make me feel better
  about myself, I define (my) self-worth (is only
  defined) through my athletic performance and
  exercise accomplishments, a serious athlete can
  never work too hard or too long at their sport,
  if I dont work hard enough my performance will
  suffer, even the smallest breaks from training
  will cause me to gain weight and be unable to
  compete at the same level, I have to force myself
  to exercise even if I dont feel well, Exercising
  gives me a sense of power and control over my
  life.
• Goals start exercising, sculpt body, lean,
  muscular, fit, in shape, be a yoga instructor, a
  personal trainer, train to play soccer
  competitively again, have a regime, yoga
  retreats, live at Kripalu, join a gym, do yoga
  4-5 times a week, do sit-ups, exercises, yoga in
  the morning before breakfast.
• Eating
• Rules pure, healthy, organic, clean, perfect,
  nurturing, holistic, alternative, nothing toxic,
  nothing processed, raw and living, simplistic,
  controlled, pretty, natural, fruits and
  vegetables, sprouting, juicing, dehydrating,
  food, no carbohydrates, wheat grass, highest
  nutrient value, health food stores, Farmers
  Markets, whole foods, Kambucha, Yerba Mate, no
  breakfast, a salad for lunch, edemame, rice
  cakes, kefir, legumes, steamed vegetables, big
  salads, veggie juice, no soda, no coffee, lots of
  water, antioxidants, café Gratitude, salad bars,
  raw, vegan, vegetarian restaurants, fasting,
  cleansing.
• Beliefs in control motivated, allow self to do
  things that critical part would tell you youre
  not capable of doing, hardworker, do whatever you
  can to succeed, finds misleading happiness,
  confidence, self-assurance, determination, eating
  this way and carrying out this lifestyle will
  lead me to connect to types of people that will
  lead me to eating healthfully will make me happy
  and will bring me joy in life, I have to eat this
  way and weigh a certain amount in order to stay
  motivated, determinated, worthy, confident,
  capable, accepting, to be loved, and succeed
  (make all the things that I envision in my life
  to be) as true in my life, anything is possible,
  I can be loved and love myself when I take care
  of my body in this way, this is the way I grew
  up, this is how I am, the way I view food is
  different and I must keep true to myself, Im
  different I care what I put in my body, Im
  helping improve mother earths state by eating
  this way, I contribute to the locals not
  corporations, it says to eat this way in the
  magazines, in books, etc. to keep healthy,
  theres nothing wrong with the way I view food,
  other people dont understand, they didnt grow
  up in Berkeley, CA, they didnt grow up learning
  about how and why to eat healthfully and
  organically is good for our agriculture.

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Binge Eating Part

• Food
• Rules dont tell anyone, dont let anyone know,
  be secretive, be alone, eat past fullness, lie,
  sneak around, eat foods that are most enjoyable
  to the palate, do it again after the pain is
  gone, if no other alternative use soda or coffee,
  dont be in touch with hunger and fullness, buy
  everything from health food stores, whole foods,
  dont purge, feel the pain and uncomfort, detach
  from body, keep people away, do it alone, dont
  go out into public afterwards, isolate, sleep the
  whole day, dont live life, feel hopeless,
  helpless for oneself, gain weight, feel like
  shit, carry out on fantasies with food, gorge
  with food you like, eat when your sad, lonely,
  bored, unloved, plan the perfect binge,
  disociate, go to the store and buy food so no one
  will notice any food gone at the house, cheese
  with honey, almonds/peanut butter/almond butter,
  cereal with soymilk, indian food, panninis,
  carbs, organic Amys frozen food,
  chocolate/yogurt covered anything, baked goods,
  scones, muffins, breads, cookies, ice cream,
  chocolate, buy things that are the best quality,
  when desperate just eat whatever you can find to
  fill the void with.
• Beliefs it will fill my void, I cant cope with
  daily stresses and problems in life so I might as
  well binge, lack of control, if I can never stop
  eating or control what or how much I eat, whats
  the point of living? Nemesis, greatest enemy,
  greatest fear, steals serenity, hate yourself, it
  makes me feel comfortable for the time being,
  food will love you, will lead to obesity, will
  lead to self-soothing, it alleviates loneliness,
  it comforts me, initially its so satisfying,
  its my only friend, a planned binge gets me
  something to look forward to, in the beginning it
  brings happiness and excitement, I deserve to
  enjoy food and not starve myself, doesnt care,
  this will make me feel better in the moment, I
  deserve to self-soothe through food, nothing else
  will make me feel better other than the food Im
  craving, if I started why stop? Why deprive
  myself? Ive let myself fall a little - might as
  well fall the whole way, I cant just have 1
  cookie, I deserve to splurge, theres no such
  thing of having a normal sized portion of what
  Im craving, countering urges is impossible, if
  urges become present theyll never go away until
  I act out, binge all you want because you know
  your not going to live for long, bingingdeath.
• Feelings anxiety, overwhelming, distressed,
  loathing, hatred, rage, depression, numbness,
  suicidality, unsatisfied, shame, guilt, no
  self-esteem, embarrased.

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Recovery Part

• Capable
• Creative
• Compassionate
• Self love!
• Connected
• Clear
• Courage
• Curiosity
• Tolerant
• Acceptance
• Strength
• Confidence
• Trust

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Critical Part

• Comparing myself to unrealistic/impossible
  standards.
• I criticize for criticizing myself
• You cant recover!
• Im dead
• Failure
• Youre worthless
• Youll always be rejected
• Be thin again
• My dreams will never come true
• Disgusting
• Stupid
• No success
• Disappointment
• Be perfect
• Therapy is not working
• Youll never be happy
• Youre a failure
• I hate myself!
• Insecure

• Errors
• Youll never go to college
• Why?
• Too judgmental
• Intoxicated
• You will never recover!
• You should of
• Will I
• Too hard for you to handle!
• Toxic
• Im hopeless
• Youre not capable
• Why did you trust?
• Youre a piece of shit
• Mistakes
• Dont let anybody in
• Never accept yourself
• Be miserable.
• INSANE

• Uncontrollable
• Kill yourself!
• Inadequate
• Nothings working
• End your life
• Youre going to become obese
• SHAME
• Criticism
• Dont upset people
• Humiliation
• Vulnerable
• I have no capacity of succeeding in the
  future!
• I can never change
• Pollution!
• Too difficult
• Fake and unreal
• Ostracized
• No risks
• Poison!

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• She called upon the different Parts of herself
  for Help. If she was going to make it, she
  needed to Accept them all, Unite them all. And
  Believe in them all. It was time for a huddle of
  tremendous proportions. It was the making of her
  Giant.
• anonymous

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• What are you willing to do to recover?
• Risk not feeling safe?
• Risk being vulnerable?

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• Still willing
• to be uncomfortable?

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Its okay, no it is essential to ask for, and
allow others to help.
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How is Recovery Measured

• Recovery is not just the absence of symptomsit
  is the presence of a full life as evidenced by
  the ability to be human. A truly recovered life
  will reflect spontaneity, freedom, the ability to
  breathe, to have wants, needs and desires,
  knowing that the quest for perfection is an
  unattainable illusion. Having the ability to
  embrace the feminine, having close intimate
  relationships, and it is being aware of the tears
  in your eyes (whether out of intense or subtle
  sadness or out of the joy or from a flicker
  of utter gratefulness) and then to allow your
  tears to flow freely. It is a life in which
  decisions and choices are made more from self and
  less from a shame and fear based prison. It is a
  life where you fully experience pleasure, joy and
  passion and believe and know it is good to desire
  and enjoy sex.

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Music

• That I Would Be Good
• That I would be good even if I did nothing
• That I would be good even if I got the thumbs
  down
• That I would be good if I got and stayed sick
• That I would be good even if I gained ten pounds
• That I would be fine even if I went bankrupt
• That I would be good if I lost my hair and my
  youth
• That I would be great if I was no longer queen
• That I would be grand if I was not all knowing
• That I would be loved even when I numb myself
• That I would be good even when I am overwhelmed
• That I would be loved even when I was fuming
• That I would be good even if I was clingy
• That I would be good even if I lost sanity
• That I would be good
• Whether with or without you
• Alanis Morissette

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Music

• Precious Illusions by Alanis Morrisette
• Youll rescue me right?
• In the exact same way they never did
• Ill be happy right?
• When your healing powers kick in
• Youll complete me right?
• Then my life can finally begin
• Ill be worthy right?
• Only when you realize the gem I am?
• But this wont work now the way it once did
• And I wont keep it up even though I would love
  to
• Once I know who Im not then Ill know who I am
• But I know I wont keep on playing the victim
• These precious illusions in my head did not let
  me down
• When I was defenseless
• And parting with them is like parting with
  invisible friends

• But this wont work as well as the way it once
  did
• Cuz I want to decide between survival and bliss
• And though I know who Im not I still dont know
  who I am
• But I know I wont keep on playing the victim
• These precious illusions in my head did not let
  me down when I was a kid
• And parting with them is like parting with a
  childhood best friend
• Ive spent so long firmly looking outside me
• Ive spent so much time living in survival mode
• This wont work now the way it once did
• Cuz I want to decide between survival and bliss
• Now I know who Im not
• I dont I still dont know who I am
• But I know I wont keep on playing the victim
• These precious illusions in my head did not let
  me down
• When I was defenseless

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Music

• Perfect by Alanis Morrisette
• Sometimes is never quite enough
• If youre flawless, then youll win my love
• Dont forget to win first place
• Dont forget to keep that smile on your face
• Be a good boy
• Try a little harder
• Youve got to measure up
• And make me prouder
• How long before you screw it up
• How many times do I have to tell you to hurry up
• With everything I do for you
• The least you can do is keep quiet

• Be a good girl
• Youve got to try a little harder
• That simply wasnt good enough
• To make us proud
• Ill live through you
• Ill make you what I never was
• If youre the best, then maybe so am I
• Compared to him compared to her
• Im doing this for your own damn good
• Youll make up for what I blew
• Whats the problemwhy are you crying
• Be a good boy
• Push a little farther now
• That wasnt fast enough
• To make us happy
• Well love you just the way you are
• If youre perfect

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Music

• Calling All Angels
• I need a sign to let me know youre here
• All of these lines are being crossed over the
  atmosphere
• I need to know that things are going to look up
  
• Cause I feel us drowning in a sea spilled from a
  coffee cup
• When there is no place safe and no safe place to
  put my head
• When you feel the world shake from the words that
  I said
• And Im calling all angels
• And Im calling all you angels
• And I wont give up if you dont give up
• I wont give up if you dont give up
• I need a sign to let me know youre here
• Cause my t.v. set just keeps it all from being
  closer
• I want a reason for the way things have to be
• I need a hand to help build up some kind of hope
  inside of me
• And Im calling all angels
• And Im calling all you angels
• Train

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Music

• I dont know the first time I felt unbeautiful
• The day I chose not to eat
• What I do know is how I changed my life forever
• I know I should know better
• There are days when Im okay
• And for a moment
• For a moment I find hope
• But there are days when Im not okay
• And I need your help
• So Im letting go
• I need you to know
• Im not through the night
• Some days Im still fighting to walk towards the
  light
• I need you to know
• That well be okay
• Together we can make it through the another day
• You should know youre not on your own

• Super Chick
• I told another lie today
• And I got through this day
• No one saw through my games
• I know the right words to say
• Like I dont feel well
• I ate before I came
• Then someone tells me how good I look
• And for a moment
• For a moment I am happy
• But when Im alone
• No one hears me cry
• I need you to know
• Im not though the night
• Some days Im still fighting to walk towards the
  light
• I need you to know
• That well be okay

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• Protect your recovery at all costs!!!

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• When there is understanding and appreciation the
  protective nature
• of symptoms, then
• lasting shifts in recovery can
• take place

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Staying in recovery means learning how to trust
that the waves of emotions will not pull you
under the process is like an ocean tide