Monte Nido & Affiliates Vice President of Clinical Programming Keesha Amezcua, MA, LMFT, CEDS continues her series this week on the 8 Keys to Recovery from an Eating Disorder: Effective Strategies from Therapeutic Practice and Personal Experience by Gwen Grabb, LMFT and Monte Nido Founder Carolyn Costin with the 4th key. In her writing, Keesha discusses the importance of “feeling your feelings” in eating disorder recovery.
Key 4 can be one of the most difficult for clients to work through. They are on board for challenging their unhealthy thoughts, but the “Feel Your Feelings” part can be harder to get buy in for. Often a client’s eating disorder has functioned to numb, prevent or distract from uncomfortable feelings. As the book states, “at some point, the behaviors that started out as a way to ‘fix’ or cope with anxiety, guilt or shame about eating transfers to other areas.” In this key, the therapist’s job is to help clients actually practice abstinence from behaviors in order to let the emotions rise to the top and into awareness. As long as the behaviors are active, there is little opportunity for the thoughts and feelings beneath those behaviors to reveal themselves. It can be easier for a client to hide behind the “I don’t know why” response, or the “It’s just a habit” reaction to the therapist’s questions about what purpose the eating disorder serves. I’m sure we’ve all heard answers like these from clients. It’s similar to what I get from my toddler:
“Why don’t you want to use the potty?”
“Because I don’t want to.”
These are super satisfying conversations with a high level of insight (* read with intentional sarcastic tone) but most therapists will recognize this sort of interaction as a reflection of the ways in which the eating disorder stunts emotional awareness and curiosity. Without this curiosity about what lies beneath, clients stay stuck on the surface. Of course, encouraging a client to let the feelings come takes quite the persuasion. And insight is only part of the equation. There’s almost always a compelling reason they have kept these feelings at bay.
No matter what the compelling reason is, it is the avoidance of these emotions through eating disorder behaviors that perpetuates the disorder. So our clinical work has to involve a deliberate, gradual, supportive and persistent focus on helping clients experience and tolerate feelings while developing alternative coping skills. An important part of the work during this stage of treatment is teaching a client how to get his/her body back to “neutral.” Decreasing heightened sensations and moving away from numbness. Yoga, breath work, meditation and mindfulness training can be extremely beneficial in this stage. Bringing it back to the toddler example, I’ve learned a lot of parenting lessons by watching Daniel Tiger’s Neighborhood. He (being a 4 year old cartoon tiger) has lots of great lessons for kids that are accompanied by catchy little jingles. If only life actually came with a soundtrack for every moment. One of Daniel’s most helpful songs is about what to do with anger. “When you feel so mad that you want to roar, Take a deep breath, and count to 4.” I use this with my kids more than I want to admit. But honestly, stopping, taking a deep breath and learning to get the energy out of your body so that you can come back to neutral is a critical skill for anyone at any age. The lesson is not “don’t get mad.” It’s “learn how to cope with anger in a productive way.” When our clients are taught that certain feelings are bad or too uncomfortable to feel, they shut them out, shut down, shut up. And this is when we see eating disorder behaviors become their way for emotional expression or management. Treatment can be a safe place for them to really roll around in Key 4. And as clinicians we have to make sure we maintain a neutral stance about emotions. They are not good or bad. They just are. And they just are meant to be felt. With curiosity, not judgment. With compassion, not criticism. Whether it takes 4 deep breaths or many, many more, we teach clients that feelings are not forever.