Individual Therapy: Putting The Eating Disorder Out Of A Job

continued

Carolyn: You say, "I didn't want to, but I did it." And to me it's like, remember I was telling you about putting it up on the shelf and taking it down when you need it because you can't give it up for me or for anybody else?

Patient: Well, I have tried that shelf thing and it's almost like there is a bungie cord hooked onto it because it keeps slapping me right back in the head. I mean it's like there is something attached to it and it won't stay up on the shelf, it hurls itself at me.

Carolyn: Okay, so it's not ready to be up there, so where is it then? Because you are not doing it like you used to.

Patient: It's just hovering around.

Carolyn: All right, so let's go back to this because it makes sense to me now that there is no way you are going to put it on the shelf and delay gratification and tell yourself that it is anywhere that you don't have immediate access to it.

Patient: Because that would be back to what it was when I was growing up.

Carolyn: Yeah, yeah. In the box and on the shelf is like when it was in your parent's control. You haven't quite got it yet that it is in your control. And all of a sudden thinking about all of those foods and wanting to go eat them is like your right to do it. And not only that, it is your right to do it and what else? There is something else besides that?

Patient: My desire.

Carolyn: Yes, it is your desire. There is a preference for sweet foods, it's natural in human beings and besides that it's natural to want it more if you are restricted from it. It made those things even more desirable. And when you were little you must have built up a great desire for all those things. So I don't think it is just about your right to do it, it's desire as well.

Patient: Yes.

Carolyn: I read about this experiment once where a psychologist put a bunch of toys in a room and had a one-way window where he could view kids in the room playing with the toys but they only could see a reflection on their side, so for them it was a mirror, not a window. One thing he did was to put kids in there one at a time and tell them they could play with anything but the green truck. Then he would leave and go watch in the one-way mirror. So, what do you think they did?

Patient: Well, I think they'd go for the green truck.

Carolyn: Do you get the analogy?

Patient: Yes, the more I think I'm not supposed to have those foods, the more I want them, or I think I want them.

Carolyn: Then after the hospital you were really strict with yourself, with a very strict food plan. How were you doing that?

Patient: I was just parenting myself all the time, saying, "You can't have it." Oh no, I really see. I mean I never had dessert, maybe one or two bites of my boyfriend's. I guess it was the same old thing.

Carolyn: So could you . . .

Patient: It's hard to go back to that because it is that all- or-nothing thing again.

Carolyn: I don't want you to go back to that.

Patient: But that is how it is in my mind. If I stop bingeing and purging it means I can't have anything else, you know? I can't have those foods.

Carolyn: So you have to be bad and sick to have them?

Patient: Yes, it's an all-or-nothing thing.

Carolyn: So what is an alternative, to the all or nothing?

Patient: Well, I will try to let myself have it sometimes but I don't want to say whenever I want because I will have it every single day all day long.

Carolyn: Not necessarily, that is the point. But what's it?

Patient: Junk food.

Carolyn: Well, but why don't you pick an "it," like "every day after work I'll go get something." Not a bunch of things, not, "okay, I'm going to let myself eat those things today and go crazy, all out," but rather, "Every day after work I'm going to go and get a treat."

Patient: I don't know if I can.

Carolyn: I'd just like you to try an experiment. Every day after work you have something, like, give me some ideas, what are some things that you would have? What would you go have?

Patient: Like a frozen yogurt or something.

Carolyn: That is a junk food? You mean you don't even allow yourself that?

Patient: No. But if I was going to keep it, it would still have to be something nonfat.

Carolyn: (Holds up a chocolate chip cookie she has on her desk, left over from lunch)

Patient: There's no way I could eat a chocolate chip cookie and keep it.

Carolyn: Because?

Patient: Because chocolate's full of fat.

Carolyn: Well, okay, and what's it going to do to you?

Patient: Eventually, it will make me fat.

Carolyn: A chocolate chip cookie is going to make you fat? That's like insane.

Patient: Well, it's like once in a great while, okay, that's fine. But if I have one every single day, you see the problem is stopping after one.

Carolyn: But the reason you have a problem stopping after one is the same reason that you rushed to the cake the next morning when you and your brother woke up.

Patient: Because, I'm not going to get it again.

Carolyn: So that's why I'm suggesting you start out by going and getting a cookie. I want you to acknowledge it. I don't want you to have to turn into this crazed rush-to-the-cake-in-the-morning kid. I want you to be able to say, "It's after work, I really feel like having something." Boy, am I so glad you said, "Well, I'd have frozen yogurt," it tells me a lot. I didn't know you couldn't even allow that. It's like that's not a big deal. I'm talking about . . . like for me my first thought would be to have a big treat, frozen yogurt is more of a standard thing.

Patient: But I don't even let myself have frozen yogurt.

Carolyn: Well, for you, maybe we can start there. I'm okay to start there if you don't even let yourself have that, but good God.

Patient: Well, it's a dessert, to me.

Carolyn: A dessert, it's amazing. Why should you go through your life without dessert?

Patient: Because that's how my life started out.

Carolyn: (Sighs) Well, it doesn't have to be that way.

Patient: Yeah. Well, I'll try the one-thing-a-day idea.

Carolyn: So, at least one thing, and if you want to be safe, just drive someplace and get one thing.

Patient: Okay.

Carolyn: So on the way home you get whatever it is that is going to be your dessert. Then eat dinner and then have your dessert like normal.

Patient: Like a normal person? All right, I'll try.

Carolyn: So the requirement is that you have dinner. There is no requirement about anything else, just that you have dinner. And if you want to eat the cookie on the way home, fine, but the requirement is that you have dinner. The preference is that you have dinner and then see how you feel. Sometimes I have a bowl of cereal before I go to bed just because it is sweet and I like it. It's funny to say that now, as it used to be not okay and now it is. And you are going to be okay.

Patient: Uh, okay.

Carolyn: You don't believe it? Tell me your thoughts, what are they?

Patient: Well, mainly I'm afraid I won't control myself with just one. There was a time when you told me that if I binged just to try and keep it and that would kind of simmer things down. And I did that like half a binge and I did keep it but the next day I was even more crazed for sugar, so it concerns me that it will happen again really bad.

Carolyn: Well, there is a possibility that it will be like, "My parents are gone and we can have all the dessert we want." There is a possibility. And I think that is why we have to have that talk with the two parts of you. I think we have to talk with that little girl. Now I know why you told me in that session before that when you think you will get to eat something you feel like you have a little girl inside you skipping around. I didn't quite get why before, but now it seems obvious. And when you sit down to write now, think of it this way, whichever part of you feels the most present, write to the other part. Let me give you an example: If you are going to eat a cookie, let's say, you need to reassure the little girl part that "Hey, you get to have it tomorrow, too, you don't have to eat it all tonight, we can have it tomorrow, too." I think you need to reassure that part of you. That is the only reason you would have to go way off, craving and eating more. You have to tell her. It's not physical, it's not that you are addicted to certain foods and will never be able to control it. There is no proof that these foods are addictive. Well, you need to know that not everyone agrees with me. I think you already know that. Some people do think they are addictive. It's not that I don't think sugar ever does things to the body. Sugar is empty calories, and raises your blood sugar really high when eaten alone. That's why my preference is that you have dinner. Because when you eat high-sugar foods, what happens to your blood sugar, is that it goes really high and then there is the insulin release and then the crash, causing more craving for more sugar afterward. But this is mitigated by eating dinner first, you know with protein, because then insulin is released more slowly. It's really when you are eating those things instead of dinner that there is a problem. It's not just calories, you know, it's the way your body responds to and utilizes food.

Patient: You know, I really do know this.

Carolyn: Yes, but part of you doesn't know and she needs to be talked to.

Patient: I know, I'm seeing that.

Carolyn: Do you think you could write some reassuring thing to your little girl part? If you go and buy a box of animal cookies, or a chocolate chip cookie, or a muffin, or whatever it is and you go home and have your dinner and then you have it, then you start thinking "I want more, I want more." Do you think you could write, "It's okay, we get to have it tomorrow, too." Do you think you could write something like that?

Patient: Sometimes I can.

Carolyn: And the times you can't?

Patient: I'm mad.

Carolyn: At?

Patient: Probably just that I am being controlled.

Carolyn: By?

Patient: By me (laughs).

Carolyn: So have a fight with yourself, knock yourself out.

Patient: No, I mean it's like I end up having a temper tantrum, I want to have what I want and I'm not going to write on the stinking paper because that's what the parent in me wants and it's not going to happen.

Carolyn: It's the integration of those two that has to happen. It's the meeting of those two. So it can't be your kid and your parents fighting it in the past. You have to know that it's not like that anymore. You really have to be concentrating on "What is it that I want? Me, Kindra, what do I want?"

Patient: You're right. I need help figuring out what I really want. I need help at the moment I'm going through it.

Carolyn: Well, writing will help you get in touch with what you want, with what all of the parts of you want. I think that the kid's playful, spontaneous part is pressed down and that is the one way that she can act out, because if you act out in other ways there are always other people to affect.

Patient: Yeah.

Carolyn: If you do it with your boyfriend, if you do it with your friends, if you do it with your boss or at work, there are other people at stake. But if you do it with the food, if she does it with the food, then it's only you.

Patient: Actually, I've noticed that since my boyfriend and I had that big confrontation and he let me know how hard it has been on him since I've been so down and hard on myself and stuff, well, ever since we had that talk I have been totally up and appearing self-confident but my bingeing has been worse. So it's going there and I can hide it from him all I want but, in fact, he's been gone all this week but he comes back tomorrow so tomorrow I'm probably going to be a total bitch because he comes back and we will be together and I can't binge.

Carolyn: No, no, no, what do you mean you can't binge? Stop talking like that.

Patient: Well, it won't be like it was.

Carolyn: Well, don't say I can't. Reframe it.

Patient: I'll try.

Carolyn: Say . . .

Patient: I can have my one cookie.

Carolyn: Well, yeah, and say, "I'm gonna be a bitch because I'm going to try to change my patterns, and that is going to be unfamiliar," but it's not that you can't binge. You can. I'm going to tell you again. You don't have to give it up for me or for anybody else. You can binge tomorrow. But what you are going to start doing tomorrow, I mean tonight, right after you leave here, is to get in touch with what you really want. You can do anything, you can jump off a bridge, you can stand on the freeway, but what do you want? You don't want to binge. You want your right to eat those things that everybody else seems to be able to eat. You want the right to be able to eat chocolate or cookies or whatever and not be fat and not feel like you can't have it. And if you do have it, you want for it not to turn into some sinister weird kind of obsessive race. So, you might have trouble tomorrow because you are changing and growing and accepting yourself and allowing yourself and that is new and it is uncomfortable. But you are not going to be a bitch because you can't binge, because you can.

Patient : Okay, I get it, but it's hard.

Carolyn: I know, so do you think I'm a nut case?

Patient: I think it could work.

Carolyn: It will work but I'm not saying it will work tomorrow. It will work and you are going to get better.

Patient: Actually, I've thought of trying to do something like that where eating the foods is more commonplace for me because most of my friends have grown up with having junk foods in their house and they are fine with it, they can have it or not.

Carolyn: Yeah, what do you mean by commonplace?

Patient: Well, you know there is always a bag of cookies around or something and it's not a big deal.

Carolyn: Uh huh.

Patient: That's what I want because when I have kids I don't want them to go through this. I don't want them to only have dessert once a year.

Carolyn: Good point.

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Patient: There is another thing that has come to mind since we are talking about this and trying to get myself to come up with what "it is." Well, my most vulnerable time is right after I binge and get rid of the food. I'm like open for maybe two minutes, where I can really see into what's going on, and this week I was in the shower and I kept asking myself, "What is it? What is it?" So I went through ideas: fear, anxiety, blah, blah, blah, and I just started crying. And I said, "What the hell is this?" And then all I could picture was myself rocking back and forth in a fetal position and that was it. It was like a little kid, though, it wasn't me grown-up, it was when I was little. And then the next thing that flashed into my mind was my mom and dad hugging me and then I was like a stone again and shut off to everything. And that was it, so I don't know if that means anything at all.

Carolyn: It means something.

Patient: It's comfort. I don't like being alone, feeling alone, and most of the time I am. Not so much physically but emotionally, I think. I am really isolated. A lot of times, like when I am at my mom and dad's, if I am there for a period of days and it is time for me to leave, I get very anxious because I don't want to go and I always think, "I wish I could stay here. I wish there was some way." And that scares me because I wonder with the different injuries I have had if they were some sort of, oh, I don't know. I forgot the word I was going to say.

Carolyn: You mean an excuse or justification?

Patient: Yeah, an excuse to go home.

Carolyn: I don't know but that is an interesting image.

Patient: It's not like everything is okay when I'm home because I binge there, too.

Carolyn: Well, I think there is something with your wanting to be home now when you can be with your parents and you can have the food, too, you know, because when you were a kid you couldn't.

Patient: Yeah, we sure are getting deeper in these sessions, it makes sense.

Carolyn: Yeah, and we have a long way to go.

End of tape

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