Monte Nido Vice President of Clinical Programming Keesha Amezcua, MA, LMFT, CEDS shares about one of the most important concepts taught to clients during treatment. Based on the 8 Keys book by Gwen Grabb, LMFT and Monte Nido Founder Carolyn Costin, Keesha explains how the client’s understanding of the “Eating Disorder Self” and “Healthy Self” plays a crucial role in their recovery journey.
One evening an old Cherokee told his grandson about a battle that goes on inside people. He said, “My son, the battle is between 2 “wolves” inside us all. One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego. The other is Good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith.” The grandson thought about it for a minute and then asked his grandfather: “Which wolf wins?” The old Cherokee simply replied, “The one you feed.” – Cherokee Proverb
Key 2 describes one of the basic and most important concepts we teach our clients at Monte Nido – the idea of the eating disorder self and the healthy self. Carolyn Costin, our founder, has always said that if a client leaves our program with only one thing, she wants it to be a full appreciation of this concept. This core of this idea is that the eating disorder self and healthy self are two parts of one integrated whole. It is not a good part and a bad part, a useful part and a un-useful part. It is not about an externalized eating disorder. It is crucial to know and believe this. We have to believe that every client is born with a core healthy self. This is the authentic, unashamed, loving part of oneself that over time can be lost, covered up and silenced by a variety of factors. In its place, an eating disorder self or critical self flourishes, fueled by the disconnection from the healthy self. This eating disorder voice is a part of the person. Its power comes from within.
Treatment doesn’t focus on the eradication of the eating disorder voice but rather on enhancing the ability contact it in order to acknowledge, explore and learn from it. Then once we have a thorough understanding of the functions it has served and the role it has played, we work to transform it, to reintegrate it back in to the healthy self. This transformation is done through good ol’ CBT techniques. In fact, a large part of our treatment philosophy is built on concepts and interventions found in CBT. This is because one of the main diagnostic criteria of eating disorders – the overvaluation of weight and shape – is cognitive in nature. The cognitive behavioral model suggests that most eating disorder behaviors stem directly from this irrational thought process. One key piece of this approach is the importance of helping client’s make early and significant changes in their eating behaviors. Helping reduce symptoms and behaviors helps clients to recognize the internal conflict between their healthy and eating disorders selves.
The eating disorder self relies on cognitive distortions. It gets its power from illogical thoughts. People with eating disorders become professional irrational thinkers. Their ability to alter a thought, an image, an experience can be quite impressive. They can be the blackest and whitest thinkers, “shoulding” all over themselves in catastrophic style. Usually, when we as clinicians find them on our doorstep, there is an over-developed eating disorder self and the faintest hint of a healthy self. They’ve jumped to the conclusion that if they eat a donut they’ll become a donut, wearing permanent labels like “Fat” or “Sick” and believing things like “thinner is better” or “emptiness feels good.”
It is our job to help reintroduce our clients to their healthy selves and to then strengthen that part of them. Ultimately, to have the healthy self heal the eating disorder self, we have to help our clients to reorganize their beliefs, rip off the ED self labels, and work towards a new set of healthy core schemas.
We find that the most effective way to do this is through the eating disorder self/healthy self dialogue. At Monte Nido, this is a daily practice with clients. We ask them to write down the eating disorder thoughts and counter each point with a healthy one. The critical part of this dialogue is ending with a healthy-self thought. This exercise is similar to a Challenging Cognitive Distortions worksheet in CBT. The goals are the same – poke holes in the irrational/eating disorder thought and strengthen the rational/healthy thought. We ask clients to share this dialogue in sessions and groups. We have them role play each voice with each other. The repetition builds momentum. Key 2 is essential, and we use it throughout the course of treatment. Helping clients practice, rehearse and internalize this concept and these techniques builds the foundation for self awareness, maintaining the capacity for seeing different perspectives, and, fundamentally, it helps them establish a sense of safety and ownership of their eating disorder. You could say that unlocking the healthy self unlocks the door to recovery.