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Combating “Fine”

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Jen GaudiniExpert Advisor to Monte Nido Jennifer L. Gaudiani, MD, CEDS is nationally known for her work on the medical complications of eating disorders. She recently opened the Gaudiani Clinic, a unique outpatient medical clinic specifically dedicated to adults with eating disorders. Dr. Gaudiani shares her expertise in this week’s blog post where she discusses her work with patients struggling to ignore their eating disorder voice telling them “I’m fine”.

One of the greatest and deadliest ironies of eating disorders is that the eating disorder voice often tells you, “You’re fine.” No matter that trusted and loved people in your life say how worried they are and point to evidence both physical and psychological that you’re not You anymore, the eating disorder voice whispers so convincingly, so cruelly, “Actually, you’re fine. There’s no need to let up on your rules. In fact, tomorrow let’s take it further.” Your mother might have been crying earlier that day about how worried she is, your therapist might be threatening to terminate the relationship unless things turn around, you honestly aren’t feeling that great, but just one call from one poorly informed doctor’s clinic that briefly tells you, “Your labwork came back, and it’s fine,” and BOOM, the eating disorder says, “See? I told you. Push onwards.”

The disorder will use any available evidence to prove to you that you’re fine: you’re still getting good grades, you’re still a star employee at work, your blood tests look normal, you get admiring comments from (terribly misguided) people on the street about how thin you look, you’ve seen sicker looking people than you online…or the greatest argument of all: you yourself have been sicker than this before (however you measure that), and see? You’re fine right now.

Without a doubt, this denial of illness is one of the hallmarks of eating disorders, one of the greatest barriers to seeking help, changing behaviors, and confronting coping mechanisms. Feeling like “I’m fine” is one of the devastating cruelties of these diseases, both to sufferers and to their loved ones, and treatment teams. It’s a torment to be restricting, bingeing, purging, compulsively exercising, using substances, or some combination of these…and still have that deep belief that you’re not enough, not “there” yet (at whatever goal the disorder set that day), not sick enough to stop. And it’s a torment to those who love you, hearing you say (argue! insist!) that you’re fine, when it’s so very clear that you’re not.

So how can you try to combat “fine”? Because I assure you, having been an internal medicine physician who specializes in eating disorders for the last eight years, that if you have an eating disorder, you’re not fine. Medical complications from eating disorders occur at all shapes and sizes. One of my greatest passions is using my medical knowledge of objective body suffering—whether measurable or not—to break through denial and help motivate recovery. There are two stories I like to tell my patients, to help combat “fine.” I share them with you so that you can use these too, maybe ease the eating disorder’s hold on you today, maybe strengthen a recovery you’ve been working so hard towards.

The first story tries to answer the cry of “But I’m not as sick as I have been!” Please don’t compare yourself today to your sickest day ever (thinnest, lowest potassium, weakest, most critical) and decide you are fine by comparison. Imagine instead that you are comparing yourself today with either a truly well past version of yourself, or an imagined potential well self. Everyone’s vision of this is different, but let’s imagine that someone who is truly fine can do some or all of the following: eat joyfully, enjoy a wide variety of foods in a wide variety of settings, have room for spontaneity and connection, not worry about your body’s shape or size, not use a critical inner voice, keep emotional challenges separate from body image, and do physical activity for joy and strength, rather than as an atonement. Ok, now compare yourself with this vision of fine. Depending on how far off you are, that’s how not fine you are.

The other story is what I like to call the “house on fire story.” It uses a metaphor to help you understand and challenge your “I’m fine” philosophy, when you find yourself arguing that you can’t be that badly off because you can still (fill in the blank…). Imagine someone standing outside their burning house. The fire department roars up and says, “We’re here to put out your fire!” The person says, “Oh, I don’t have a fire.” The fire fighter says concernedly, “I see the smoke, I feel the heat, I see the flames. What do you mean?” The person says, “Well, if I had a fire, it would be so hot that the sidewalk would be bubbling, and because my sidewalk isn’t bubbling, clearly I don’t have a fire.” At this point, the fire fighter understands the person to be mentally ill and proceeds to put out the fire! I like this story because it sheds light on how absurd (even if, in the moment, compelling) many of the “I’m fine” arguments actually are.

Ultimately, look at yourself as a whole person. Not one single number. If you have an eating disorder, no matter what shape or size you are, no matter what your blood work says, you are not fine. The more you fight the eating disorder’s attempts to convince you you’re fine, the sooner you can move back towards the things in life you truly care about, and return to being a whole you.

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on Facebook, LinkedIn, Twitter, and Instagram.

 

The “WTF” of Recovery

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JenniferJennifer Kreatsoulas, PhD, the founder of Chime Yoga Therapy, is a yoga therapist specializing in eating disorders. In recovery herself, Jennifer is exceedingly passionate about helping others connect with their natural gift of resilience through yoga. In addition to her private practice, Jennifer is also a yoga therapist at Monte Nido Eating Disorder Center of Philadelphia. She works with individuals one on one and leads yoga therapy groups and seminars. Jennifer shares about the importance of checking in with yourself and being aware of your feelings in her writing.

Like you, over the course of my healing journey I’ve been told countless times that my eating disorder thoughts and behaviors serve to distract me from painful feelings. Years in, I’ve come to understand my illness is a silent temper tantrum, a quiet way to express unhappiness, sadness, anger, hurt, pain, and disappointment. Recovery, then, is the process of learning how to use our voices instead of our bodies to express feelings and emotions.

I know, you’ve heard it 1,000 times: It’s about the feelings, feelings, feelings!

I went through a phase of questioning how much of my thoughts and behaviors served to numb feelings or were simply habit. Let’s face it, if you do something repetitiously over and over again, it becomes a habitual way of life. Research has shown that the brain physically changes as a result of an eating disorder. In the simplest of terms, prolonged symptom use paves new neural pathways in the brain, essentially hardwiring in those thoughts and behaviors, which is why they feel natural and habitual. Luckily, “pro recovery pathways” can form, and as a result of a strong commitment to new behaviors, the “eating disorder pathways” eventually become less and less traveled.

After a few slips and backslides, I came to the hard truth that it was dangerous to call my eating disorder a habit. Doing so let me off the hook. It allowed me to disconnect from my feelings and became an easy excuse for restricting or obsessive bodychecking. It also allowed me to settle for a life as a functioning anorexic. But that was not the life I really wanted. Not at all.

The only way to rise above this new habit of mine, was to get back to the feelings. Ugh…the feelings, feelings, feelings! But I needed a new way to decode my eating disorder thoughts and behaviors–one that allowed me to look at my feelings but that didn’t smack of the trillions of times I was asked about my feelings in treatment or therapy.

This is what I came up with: WTF. Or, “What’s the Feeling?” WTF is a catchy acronym (for obvious reasons), so why not put it to work in a very productive and helpful way?

I use WTF to check in with myself and keep on top of the feelings bubbling under the surface. I say WTF to myself when I am arguing with myself about what to eat for lunch or what I see in the mirror. I also say it to myself when I am avoiding a hard conversation or feel drawn to isolate.

I know it’s hard, painful, tiring work, this healing journey. Just because it’s hard doesn’t mean we can’t smile or even chuckle to ourselves once in awhile. So ask yourself, WTF. Say it over and over until you feel what you have to feel. Let “WTF” become a positive and lasting habit for your recovery.

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on Facebook, LinkedIn, Twitter, and Instagram.

8 Keys Series: Motivation, Patience & Hope

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Keesha - Circle

Monte Nido Vice President of Clinical Programming Keesha Amezcua, MA, LMFT, CEDS shares about The 8 Keys to Recovery from an Eating Disorder,by Gwen Grabb, LMFT and Monte Nido Founder Carolyn Costin, the philosophy that guides Monte Nido’s practice in supporting clients to becoming fully recovered in this weeks blog post. In her writing, she explains the first key, Motivation, Patience & Hope, for part one of this eight part series. 

When talking about the 8 Keys to Recovery from an Eating Disorder, the first thing to note is that there are obviously more than just 8 steps in the process. The publisher’s directive to Monte Nido Founder Carolyn Costin was to create 8, and only 8, keys. So in her trademark creative way she packed as much in to each key as possible. The entire book is full of insight, wisdom and evidence-based treatment strategies. I call it Monte Nido in a book because each page speaks to what we do each day with our clients in treatment.

The first key – Motivation, Patience & Hope – is the starting point, even before a client steps foot in one of our facilities. We applaud clients and their loved ones for pursuing treatment in the first place. Just the idea of it can be daunting. It takes motivation to pick up the phone and make the call. Of course, it’s often not the client’s idea. They have been softly, or not so softly, nudged in to that idea. There is often an external motivating factor – school, a relationship, a job – that makes the idea seem like a good one.

Although, for recovery to truly take root the client has to find his or her own internal motivation for it. But if we waited to treat clients until they are truly motivated, we would sometimes be waiting forever. Treating eating disorders is often very similar to raising a toddler. With a 2.5 year old and a 1 year old at home, I find so many similarities and parallels between my personal and professional life. Take for example, tooth brushing. My daughter loves her toothbrush, and my daughter LOVES her toothpaste. At this point her fine motor skills are not quite developed enough to allow her to adequately clean her teeth, which results in a steady diet of toothpaste with very little actual brushing happening. So I am tasked with tenderly helping her, guiding her, teaching her. She does not necessarily love this part of the experience. Is she motivated for teeth brushing? Yes. Is she always willing to do what is necessary for it? No. It’s the same with clients at the beginning of treatment. They might be motivated for parts of it. They might be able to see the benefits and enjoy the relief that recovery provides in some areas. But they don’t always want to do all the parts of it. As clinicians, we have to be willing to step in to this discomfort with them. To model the healthy behaviors, to support them in doing what is needed even when it’s hard. To tolerate the kicking and screaming or silent refusals. To embrace the ambivalence and work with it. We have to gently elicit the behavior change. The research on motivational interviewing is pretty clear. Trying to directly persuade a client to change won’t necessarily resolve ambivalence. I can persuade my daughter to let me brush her teeth, but this will be a temporary fix, not a solution.

Motivation builds on itself. It’s like a freight train that starts slowly, building steam. Once it gets going, it’s a force to be reckoned with. But there has to be patience to allow the motivation momentum to grow. One of the core interventions we use is the eating disorder/healthy self dialogue. This intervention is the heart of motivational interviewing – synonymous with change talk. As clinicians, we are constantly looking for signs that of our client’s healthy self is present. Any time a client says something that is indicative of his/her core, authentic self we recognize this as a motivation for change, no matter how small. We hold on to these examples and help to foster more because motivation is also built on change.

Our weekly contracts help clients identify objective and measurable goals that are small and achievable. When a client meets these goals, there is a feeling of success and mastery, which then ignites more motivation. It takes creativity, great empathy and compassion for how difficult even the smallest of steps can be for a client. It also requires a balance of firmness and fearless on the part of the therapist

Confronting a client about change often seems like the right step. If we know that deep down they want to get better, then forcing their hand will just help them get there faster, right? Well, actually that’s wrong. And if a clinician falls in to that trap, we can quickly find ourselves in the midst of a powerful power struggle just as a client’s loved one often does. When we push clients to make changes before they are ready, we are missing the motivation part. At Monte Nido, we gently and steadfastly meet clients where they are at. And we start there.

But we always have hope. For me, that’s the easy part. As someone who has recovered from my own eating disorder, I know being recovered is possible. I don’t question this. It’s not an elusive idea. And I don’t just have my own positive outcome guiding this. I have seen and met many, many people on the other side. There is an army of us who know recovery to be true. This is how I am able to do this work. As motivational interviewing suggests, at Monte Nido we have respect for a client’s ability to choose. We reflect the privileges that recovery offers and the consequences of the eating disorder. On the hardest days, with the most resistant or ambivalent clients, I maintain hope that recovery is possible and that every client will choose it. Ideally today is the day. If not, I am confident that there will be tomorrow, which means there is always another chance for that choice.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on Facebook, LinkedIn, Twitter, and Instagram.