eJournal

As I mentioned in my last eJournal, I plan to write at least a few entries about the recent Eating Disorders Summit I attended.

While there, I had the pleasure of attending another presentation by Carolyn Costin, MA, MEd, MFT of the Monte Nido and Rain Rock treatment centers on the west coast. Carolyn is one of my favorite professionals in the eating disorder field. Carolyn's presentation was "Healing from the Inside Out." In her presentation, Carolyn was speaking about working with the ... pick your term ... soul, spirit, inner wise mind, etc., of a person with an eating disorder.

Carolyn described a key element of her own stance in treatment as looking past the eating disorder to the person. Her presentation made me think of a deep ambivalence I've seen in many of my clients with eating disorders. Part desperately wanting to get better. Part not yet willing to let go of their eating disorder. I think in most cases, successful treatment requires recognition that eating disorders do not develop in a vacuum. They develop to meet a need the person could not find another way - at the time - to meet. In every case I have seen so far, the needs that led to the development of an eating disorder, were perfectly legitimate and positive! To many people with eating disorders, the danger is that if one gives up the eating disorder, the fear is that they also have to give up on the need they were trying to meet with it. Fortunately, there is never only one way to meet a need; and eating disorders are not very good ways to meet any personal or interpersonal needs.

Recognizing and working with this ambivalence is vital to successful long term treatment of eating disorders. Both parts of the person - the deep, inner self - or soul, and the eating-disordered self have to recognized, understood, and worked with during the course of therapy. It has become a bit of a truism that eating disorders are "about control." For the most part, this is a huge over-simplification at best. But treatment generally proceeds better when a client's self control is enhanced and supported, rather than reduced. Clients comment that recovery happens when they are "nudged, not rushed."

As I've written about before, my treatment style is collaborative. It's very natural for me to work with a person to try to find a uniquely personal pathway to recovery and health. Working with ambivalence and dueling desires is a very natural part of that process.

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