Sharing therapists

I’ve been in all different levels of treatment with numerous professionals and various treatment centers, and overall I’d have to say that both group and individual therapy are important (and beneficial) in recovery.  With group, there are several people who you can bounce ideas off of, get advice from, relate to, and rely on for support.  I feel like most of the real therapy work happens in individual, though, where you can focus on your specific issues, goals, etc.  I really do think it helps to have both individual and group components to your treatment plan, though.

This said… something that has always thrown me off is having my individual therapist as my group therapist.  This has happened to me a couple of times, in residential, IOP, outpatient, etc.  It changes the dynamic for me for a couple of reasons:

1. Every time I said something to the group I though, “has she heard this already?  did I tell her this before?”
2. I read (too much) into the things that she said
3. If I were having a bad day, she usually noticed
4. I wondered if there would be repercussions to the things I said (for example, I didn’t want to mention something in passing and have to spend the next two individual sessions processing it).
5. I worried that I’d treat group like an individual session and spend too much of the total time focusing on my own issues

These aren’t all bad things.  It’s good that my therapist would recognize that I was having a crappy day, since I likely wouldn’t have brought it up and the therapists who didn’t know me as well probably didn’t know anything was not right.  She also probably pushed me a little harder, since we did have a relationship and she could do that comfortably.  So, for the most part, it was good for me to have some groups with my individual therapists.

With all of this said, where things start to get a little messier is when other people in the group also share the same individual therapist.  I’ve been in some programs where everyone had the same primary therapist and others where there were a handful of individual therapists that also ran groups.  Both situations add that extra variable to the equation – sharing a therapist with another person in your group.

The therapeutic relationship is so unique that sometimes I think it can be challenging to “share” your therapist with someone else that you know.  I’m not concerned about the confidentiality as much as the dynamics of the relationship.  As the patient, you only have one therapist.  When you have a good relationship, it feels special.  You feel like you have this connection that maybe other patients don’t have.  It makes sense – every week you are confiding in this person, trusting him/her to guide you and to give you some insight.  This relationship and person mean something to you.  He/she is a part of your life.

Being in a group with your therapist and another one of her patients is a reminder that you’re not the only patient.  You know this logically, but the reminder can be kinda tough.  Sometimes it’s rough to see her concerned and focusing on someone else.  It can feel invalidating.  It can feel like a competition between you and the other patient.  It can be hurtful if you feel like you’re being ignored or that your interaction with the therapist is different.  It really adds a dozen additional variables into the therapeutic relationship equation.

There are a lot of things that make eating disorder groups tough.  Girls get competitive over eating, weight, exercise, etc – even if you don’t allow talk about numbers.  You have to be careful who you put in a group together, and even having one or two pretty anti-recovery people can change the whole atmosphere.   Sharing a therapist with several of the girls almost adds another thing to compete over.  Even if you refuse to participate in the competition to get the most attention or require the most concern (really, these competitions exist!), it can be hurtful to to feel neglected or uncared about.  I don’t think this is a topic that is often addressed in groups… but I think that sharing a therapist with other girls, and all being in the same group together led by your primary therapist, can be a little tricky…

It’s not about what you are doing

Since I have a serious Dr. Drew Pinsky addiction (irony intended), I was really sad when his podcast was cancelled.  Thankfully, Celebrity Rehab 2 and Sober House came out shortly after the podcast ended, so I was able to watch those repeatedly for awhile. When VH1 stopped running CR2, I read his books.  Now, having exhausted all of those Dr. Drew resources, I am listening to Loveline.  This kills me a little bit, for several reasons:

1. It’s called Loveline
2. Half of it is sex talk
3. I have to pay $5 a month for it!

Still… It’s Dr. Drew, so I have to do it.  There are calls about addictions and psychological issues, and listening to his responses to those questions is worth my $5.

Dr. Drew had a particularly great quote today:

“It’s not what you’re doing, it’s what you’re missing – and you deserve better.”

The quote was not in relation to alcoholism or eating disorders, but it really hit home with me.  Yes, you need to get better because it’s important to take care of yourself, people care about you, you should care about you, you want to be healthy, it’s pathological, etc.  But also, when you are wrapped up in the ED you are missing life.  Maybe that’s semi-intentional; maybe you’re avoiding life.  You might think you’re just coping with life in an unhealthy manner, but you really are missing it.

You’re missing:

1. Close relationships with friends
2. Many normal social situations (getting pizza, going out for lunch, meeting for a drink, getting ice cream for no reason)
3. Good experiences (as well as bad experiences) that shape you as a person

I can think of a lot of things that I “missed”

1. Close relationships with HS friends
2. Trying anything new (for most of my life)
3. Getting ice cream with friends
4. A lot of summer cookouts
5. Trips I wouldn’t go on because there would be too much food or b/c I was depressed & wanted to stay home
   (okay, this is a depressing list so I’m going to stop here)

I think that eating disorders are as much about avoiding life as they are hurting yourself.  First there is all the time that you spend wrapped up in the disorder.  You’re isolating, avoiding events with food, and spending 90% of your day thinking about food and weight.  You have no idea what is going on around you.  And then there’s treatment, which takes up even MORE time… because along with the continuing disordered behavior (it’s not going to go away overnight), you now also have a dietitian, a therapist, a doctor, a psychiatrist (and this is assuming that you don’t really put your life on pause to go to a residential or partial hospitalization program).  You are spending your free time in treatment.  And I don’t know about you, but when I’m working on tough stuff in therapy, I have a harder time dealing with the rest of life.  When I’m upset about whatever my therapist said two hours ago, the last thing I want to deal with is a presentation that’s due tomorrow.  So yes, even in recovery, you are avoiding / escaping / missing (whatever you want to call it) your life.

It’s kind of ironic when you think about it.  You spend so much time in therapy trying to change behaviors, discussing why you are coping with life via your ED, identifying unhealthy aspects of your career and relationships, etc.  However… how much time do you spend talking about what you’re missing?

And for awhile, this is the point.  Maybe something in your life is not okay.  Maybe there is too much on your plate, maybe you are in a bad relationship, maybe you do need to change your job, maybe you are killing yourself trying to please everyone else in your life–whatever.  One of the best things about residential (I think) is that you don’t have to deal with the real world while you’re in treatment.  I can just focus on myself and what I need to be doing without the constant stress and anxiety of bills, relationships, responsibilities, work, money, and the list goes on.

However, I am not new to treatment, and neither are several of my friends.  And while I do worry about their health and their symptoms, what really makes me sad is what the ED takes away from them.  For one friend, it takes away time and energy that she would rather be spending with her children.  For another, it limits her career because work has to be planned around the ED and ED treatment.  Another friend has to put relationships, summer plans, and a lot of the life that she has created in the past year on the side right now to get more intense help.

All of these friends are making the right choices to work on the eating disorder and to get the help that they need!  Absolutely.  Friend #1 can’t take care of her family if she isn’t taking care of herself, Friend #2 won’t be able to put the energy and concentration into the job that career that she really wants until she is healthier, and Friend #3 won’t be able to maintain that life if she doesn’t do intensive treatment.  My point is, though, that what saddens me the most about these friends is not their concerning ED symptoms, but all the things that they are missing out on in their lives.  They’re such wonderful people and are meant to do so much more in the world than they can with this eating disorder.  They deserve so much more out of life than this eating disorder, and that’s why I hope they can get better.

It's not about what you are doing

Since I have a serious Dr. Drew Pinsky addiction (irony intended), I was really sad when his podcast was cancelled.  Thankfully, Celebrity Rehab 2 and Sober House came out shortly after the podcast ended, so I was able to watch those repeatedly for awhile. When VH1 stopped running CR2, I read his books.  Now, having exhausted all of those Dr. Drew resources, I am listening to Loveline.  This kills me a little bit, for several reasons:

1. It’s called Loveline
2. Half of it is sex talk
3. I have to pay $5 a month for it!

Still… It’s Dr. Drew, so I have to do it.  There are calls about addictions and psychological issues, and listening to his responses to those questions is worth my $5.

Dr. Drew had a particularly great quote today:

“It’s not what you’re doing, it’s what you’re missing – and you deserve better.”

The quote was not in relation to alcoholism or eating disorders, but it really hit home with me.  Yes, you need to get better because it’s important to take care of yourself, people care about you, you should care about you, you want to be healthy, it’s pathological, etc.  But also, when you are wrapped up in the ED you are missing life.  Maybe that’s semi-intentional; maybe you’re avoiding life.  You might think you’re just coping with life in an unhealthy manner, but you really are missing it.

You’re missing:

1. Close relationships with friends
2. Many normal social situations (getting pizza, going out for lunch, meeting for a drink, getting ice cream for no reason)
3. Good experiences (as well as bad experiences) that shape you as a person

I can think of a lot of things that I “missed”

1. Close relationships with HS friends
2. Trying anything new (for most of my life)
3. Getting ice cream with friends
4. A lot of summer cookouts
5. Trips I wouldn’t go on because there would be too much food or b/c I was depressed & wanted to stay home
   (okay, this is a depressing list so I’m going to stop here)

I think that eating disorders are as much about avoiding life as they are hurting yourself.  First there is all the time that you spend wrapped up in the disorder.  You’re isolating, avoiding events with food, and spending 90% of your day thinking about food and weight.  You have no idea what is going on around you.  And then there’s treatment, which takes up even MORE time… because along with the continuing disordered behavior (it’s not going to go away overnight), you now also have a dietitian, a therapist, a doctor, a psychiatrist (and this is assuming that you don’t really put your life on pause to go to a residential or partial hospitalization program).  You are spending your free time in treatment.  And I don’t know about you, but when I’m working on tough stuff in therapy, I have a harder time dealing with the rest of life.  When I’m upset about whatever my therapist said two hours ago, the last thing I want to deal with is a presentation that’s due tomorrow.  So yes, even in recovery, you are avoiding / escaping / missing (whatever you want to call it) your life.

It’s kind of ironic when you think about it.  You spend so much time in therapy trying to change behaviors, discussing why you are coping with life via your ED, identifying unhealthy aspects of your career and relationships, etc.  However… how much time do you spend talking about what you’re missing?

And for awhile, this is the point.  Maybe something in your life is not okay.  Maybe there is too much on your plate, maybe you are in a bad relationship, maybe you do need to change your job, maybe you are killing yourself trying to please everyone else in your life–whatever.  One of the best things about residential (I think) is that you don’t have to deal with the real world while you’re in treatment.  I can just focus on myself and what I need to be doing without the constant stress and anxiety of bills, relationships, responsibilities, work, money, and the list goes on.

However, I am not new to treatment, and neither are several of my friends.  And while I do worry about their health and their symptoms, what really makes me sad is what the ED takes away from them.  For one friend, it takes away time and energy that she would rather be spending with her children.  For another, it limits her career because work has to be planned around the ED and ED treatment.  Another friend has to put relationships, summer plans, and a lot of the life that she has created in the past year on the side right now to get more intense help.

All of these friends are making the right choices to work on the eating disorder and to get the help that they need!  Absolutely.  Friend #1 can’t take care of her family if she isn’t taking care of herself, Friend #2 won’t be able to put the energy and concentration into the job that career that she really wants until she is healthier, and Friend #3 won’t be able to maintain that life if she doesn’t do intensive treatment.  My point is, though, that what saddens me the most about these friends is not their concerning ED symptoms, but all the things that they are missing out on in their lives.  They’re such wonderful people and are meant to do so much more in the world than they can with this eating disorder.  They deserve so much more out of life than this eating disorder, and that’s why I hope they can get better.

Numbers – a Catch 22

I read this post on Dads and Daughters With Eating Disorders: Eating Disorders – Weights & Scales

To summarize:

Because her health is directly related to her weight.  Measured by scales.
Her recovery is directly related to her weight.  Measured by scales.
Her life is directly related to her weight.  Measured by scales.
Weight matters.
And scales matter because they measure weight.

I posted a comment on this post, which hasn’t been approved yet, but I decided that I wanted to discuss the issue on Grey Thinking anyway.

Yes, weight is inexorably tied to health and to recovery.  Weight restoration is vitally important to recovery.  You can’t be recovered and still be below the healthy weight range.  Professionals need to monitor weight.  Some treatment decisions need to be made based on weight.  In short, I am not at all arguing that weight is unimpotant for recovery.

With all of that said… I find a lot of diagnostic criteria and treatment approaches to be contradicting and frustrating.  In therapy, you’re told that you are not a number.  That you are lovable regardless of what the number on the scale says.  That coping with food / weight is not okay.  That eating should be mindful and emotional eating is unhealthy.  You don’t have to be sick to deserve care.

But think — how is your health measured?

• weight, BMI, % of IBW
• calories, exchanges, % of meal plan completed
• heart rate, blood pressure, potassium, electrolytes
• # of binges / purges, # of laxatives, # of diet pills
• hours exercised

… see my point?  Everything is measured in numbers.

I have an issue with your mental health being measured in numbers.  From this point of view, gaining weight = a good week and losing weight = a bad week.  That has just never been a linear relationship for me.  I have bad weeks and gain weight, and vice versa.  Sometimes I follow my meal plan and lose weight, and other times I restrict and gain weight.  The system reinforces the necessity of communicating through your eating disorder.  If you’re feeling crappy but follow your meal plan, then obviously you weren’t really feeling bad — if you were, you would have restricted.  Plus, when you are at a healthy weight — ta da, end of treatment!  You’re all better!  Even if you feel as crappy as ever, you’re not sick anymore, so…..

Thankfully not all professionals practice this way, but measuring your progress in recovery by numbers is not unusual.  I feel strongly that weight is just a piece of the puzzle… and while weight and eating are core components to eating disorders, by basing treatment on just these factors you are really limiting treatment.  There are people who will stay sick because the system inforces that they need to be to get help.  And that’s unfair…

Testing your therapist

Last night I watched all of the “In Treatment” Sophie episodes.  I am just engrossed in this show.  I feel so connected to the patients and to Paul.  I think that they discuss such intimate details that I feel like I am part of some deep relationship.  I can relate to a lot of what the patients say, so Paul’s responses are meaningful to me.  It’s also funny that I don’t feel comfortable ending therapy at the end of each season.  In episode nine of Sophie I was thinking, “No!  You can’t go!  There are so many things we still need to talk about.  I’m not ready to end therapy!  I’m still processing things.”

Anyway, one of the things that struck me about Sophie were all of times that she tested Paul.  “Testing” is a good word to describe the scenarios.  I probably would have looked at it differently had he not used that word.  But yes, “testing” is perfect.

I was trying to think if I’ve ever tested my treatment professionals.  I’ve definitely never overdosed, threatened to kill myself, or asked my therapist to change my clothing (I felt so awkward even watching that moment)… but the more that I think about it, the more aware I am of how many times I have tested professionals.

For example:
Nutritionist – With my most recent nutritionist, I’ve turned in a couple of really bad days worth of foods logs to see if she would say something (that wasn’t really the reason they were bad, but it’s the reason I turned them in instead of just not writing those days down).  If she didn’t say anything, then it meant that my following my meal plan didn’t matter.  She passed.  Another time when I felt like she was tired of dealing with me, I stopped making appointments.  I figured that when she decided that I needed an appointment, she would say something.  No such luck — failed that test.

Therapist – Sometimes my therapist assigns me homework.  I’ll do it, but don’t bring it up or turn it in during our next session unless she says something.  If she doesn’t, that means she doesn’t remember and it doesn’t really matter.  She usually fails this test.  It’s probably the only test that she fails, though.  For months I didn’t tell her much just because I didn’t trust her… I thought she would think I was ridiculous.  So, piece by piece I’d tell her little bits of information and watch how she responded.  She was concerned and validating and understanding — definitely passed.  Another big issue of mine is calling/emailing/anything outside of a session.  I just feel like it is not her responsibility to deal with me outside of that hour a week.  I am so afraid that I will be too needy or too much and that I will ruin the relationship.  She says that it’s impossible to ruin the relationship, but I don’t know.  Anyway, I called her one day when I was really upset, and she was there for me and she wasn’t at all annoyed that I called.  Pass.

I could go on, but that’s more than enough examples.  While I do like the word “testing,” I think that it has a negative connotation.  I think that to some degree, it’s a part of therapy — learning to trust the professional.  I hate feeling vulnerable and it takes me a long time to open up and trust someone.  I have to feel certain that the person isn’t going to hurt me, though.  It’s like testing the waters.  It’s hard to build trust.  I need to reassure myself somehow that this person is going to care and isn’t going to walk away when I actually need her.

What if your child were ill?

Everyone should go and read the discussion about this post — so many interesting things have been said from people with very different beliefs about the cause and treatment of eating disorders.  One question stood out to me, though:

Who would you go to if your child was ill?

I’m going to change the question a little bit:  What would you do if your child were ill?

I’ve thought about this a lot since “discovering” the Maudsley Method (I had never heard of it until a couple of years ago).  Maudsley contradicts many of the beliefs that I was taught in treatment — it’s not about the food, there are lots of issues to work through, family therapy is necessary, etc.  I’ve been to residential treatment centers a couple of times and seen a dozen (or two) professionals outpatient.  Everyone has a different thought on what “caused” (or contributed) to my eating disorder.  My parents have both been blamed at times (each individually — either my mom OR my dad), sure.  My ex-boyfriend has been blamed.  I’ve been told that I’m just perfectionistic and that I feel out of control in my life.  I don’t even remember half the things that I’ve been told.

Honestly, I think that discussing what “caused” my eating disorder is a waste of time:

1. because it is biological
2. because there isn’t one thing
3. because my childhood was 15 years ago and I am tired of rehashing it

In therapy, I’m dealing with what’s going on now.  Just as an example, I’m afraid of wrecking relationships.  Maybe this is because I didn’t feel like my mother cared, or because I feel unlovable, or because I wrecked a relationship with a guy — I don’t know.  I can’t change any of that and I’m not sure that identifying the source would make a difference.  I can, however, explore how this issue is affecting my life now.  I’m afraid to be open with friends because I don’t want to be a burden and screw things up.  I hate emailing my therapist because I don’t want her to think that I’m needy and unreasonable.  I feel like a lot of my work right now is exposure therapy.  It’s taking that step and emailing my therapist when I’m having a bad night, and then talking about it at our next session and realizing that I didn’t wreck anything.  I’m trying to be more “real” with friends and trusting / hoping / praying that they can be there for me and don’t mind listening.  You get the point.

I know that I seem way off-topic, but I have a purpose for all of this.  When I was an adolescent, I would have probably responded well to the Maudsley Method — especially since I so badly wanted my parents to care and to notice and to tell me that my health was important.  That didn’t happen, but I did get that support and education from residential treatment.  My parents wouldn’t have done family-based treatment if they had known about it.  I don’t really care to elaborate on that, but trust me, they would not have.

If I had a daughter, though, I’d use the Maudsley Method.  Well, if I had a daughter, she would never GET to a point where she needed inpatient treatment because I would have her in therapy so fast.  But yes, I would be the adult and I would tell her that this is important and I would make her sit at the table for two hours or however long until she finished her meal.  Of course I would have her in therapy, too…

Not all families are willing to make the investment that FBT requires.  If you are on this blog and are reading this, then that’s probably not you.  One reason that I think Maudsley is effective is because it addresses so many of the underlying issues and concerns — whether you realize it or not.  You’re telling your child that you love them, that you are the adult, that their health is important, that it’s okay (and necessary) to take time out for themselves, that you support them, that you notice and care, that they matter, etc.  That’s not something that my parents would do, so I got those messages in residential treatment.  It’s not the same, for sure.  I still think that I would have needed years of therapy, just because there is / was a lot of stuff to process.  But yes, I would use FBT with my daughter.  It’s not an option for everyone, but if you are educated and knowledgeable about the illness, then you know how important your role is as a loved one.

What does Ed look like?

I know a lot of patients (and professionals) who refer to their eating disorder as “Ed” (E.D.).  I’ve always been a little wary of this… it feels weird to name a disorder that I’m struggling with.  It makes me feel like I have schizophrenia or DID or something.  However, in some ways it helps to thing of the eating disorder as a separate voice.  It helps me to separate what I want from what the eating disorder wants.

My dietitian once told me “don’t bring Ed to dinner – leave him at home.”  I have this vision of my sitting at a restaurant, with Ed at the end of the table with just a glass of water.  Very silly, I know… but for some reason that helps me.  Maybe it’s because I am separating the eating disorder from myself.

People with eating disorders are competitive — that’s (one) reason why you have to be careful who you put in groups together.  I have some friends who I really like, but feel competitive with or triggered by.  It’s easier for me to think of our two Ed’s fighting.  We brought them along with us and now they are arguing.

Okay, now it sounds like I have an invisible friend… and usually I don’t think of the eating disorder as “Ed” — but there are certain situations where it’s helpful for me.  But, my question is — what does your Ed look like?  Do you have a mental image of it?  I’m curious to hear how others envision it.  I’ll draw mine and post it in the next entry…

Letting it go

I started this day in a panic over insurance.  I hate insurance.  I know that is such a blind, ignorant statement, but at this moment (and a lot of other moments) I really do.

Unfortunately it is a holiday (well, that in itself is not unfortunate), which means that neither insurance nor my treatment provider is working.  There’s nothing I can do about it today.  I can’t resubmit my claim or beg for more days.  I don’t know if I will be going to my appointment tomorrow.

I don’t want to spend the next 24+ hours fretting over this, but at the same time, I do want to.  I know that worrying is not productive, but my mind is filled with “what if?”s and worst-case scenarios.  It’s as if turning it over and over in my mind will somehow prepare me for whatever happens tomorrow.

While trying to remind myself that worrying is not productive, I remembered this quote:

Behind all of this lay the “mind like water” concept … when you throw a pebble into a pond, what does the water do?  It responds with total appropriateness to the force and mass of the rock.  It does nothing more and nothing less.  It doesn’t overreact or underreact.  It doesn’t react at all.  It simply interacts with whatever comes to it and then returns to its natural state. – David Allen, Getting Things Done

So that’s my goal for today and tomorrow: “mind like water.”  I have to let it go for today.  I will try and be calm until hit with the insurance rocks.

I’m going to need that in writing.

I am not  an auditory learner.  At all.  I’m definitely a visual learner — in college I took copious notes, but didn’t really grasp the class material until later going over and reading those notes.  There’s just something about reading/writing that I need to get it.

Unfortunately, this doesn’t serve me too well in therapy.  I can have a great session and later that night not even remember half of what we talked about.  And on the same level, when I’m in session I don’t remember half of what I planned to say.

In an effort to make my time in therapy more useful, I’ve started to write things down.  Not quite journal, but write when I’m upset or just a couple of points I want to make sure that I let my therapist know.  If I’m afraid that I won’t bring up the issue in therapy, sometimes I’ll email them to her before my appointment.

That’s just one way that writing things down helps me in treatment.  Another is with my meal plan.  I know my meal plan backwards and forwards at this point, but one day I decided to pin it to pin it to my bulletin board above my desk.  This probably sounds silly, but it has made such a difference.  I am reminded all day that my meal plan and recovery are important.  When I’m in the middle of work I think “oh, I’ll eat that later” or “I am too busy right now,” but just having it written out and sitting in front of me helps me remember that treatment is important even when I’m not in my therapist’s office.

A third way is with affirmations.  Well, affirmations may not be the word that I’m looking for… but clips of little things that mean something to me.  For instance, also on my bulletin board is a fortune from a fortune cookie that says “Remember there are people who care deeply about you.”  I also have this paper on which my therapist wrote, “You can let go of your ED and still be validated” and “Never forget, but forgive and make yourself a better person.”  And then, sometimes I’ll print out pieces of funny or significant emails (from anyone in my life) and pin those up.  Yes, I have a very large bulletin board!

I need a written reminder for several reasons:

1. I’m a visual person
2. I twist things and second-guess myself and think “she didn’t mean it that way” or “I am reading into that too much.”
3. Being continually reminded helps me convince myself that it is true

Different types of therapy are helpful for different people, and I think that there is some trial-and-error involved in figuring out what works for you.  Personally, I highly recommend investing in a bulletin board.

I'm going to need that in writing.

I am not  an auditory learner.  At all.  I’m definitely a visual learner — in college I took copious notes, but didn’t really grasp the class material until later going over and reading those notes.  There’s just something about reading/writing that I need to get it.

Unfortunately, this doesn’t serve me too well in therapy.  I can have a great session and later that night not even remember half of what we talked about.  And on the same level, when I’m in session I don’t remember half of what I planned to say.

In an effort to make my time in therapy more useful, I’ve started to write things down.  Not quite journal, but write when I’m upset or just a couple of points I want to make sure that I let my therapist know.  If I’m afraid that I won’t bring up the issue in therapy, sometimes I’ll email them to her before my appointment.

That’s just one way that writing things down helps me in treatment.  Another is with my meal plan.  I know my meal plan backwards and forwards at this point, but one day I decided to pin it to pin it to my bulletin board above my desk.  This probably sounds silly, but it has made such a difference.  I am reminded all day that my meal plan and recovery are important.  When I’m in the middle of work I think “oh, I’ll eat that later” or “I am too busy right now,” but just having it written out and sitting in front of me helps me remember that treatment is important even when I’m not in my therapist’s office.

A third way is with affirmations.  Well, affirmations may not be the word that I’m looking for… but clips of little things that mean something to me.  For instance, also on my bulletin board is a fortune from a fortune cookie that says “Remember there are people who care deeply about you.”  I also have this paper on which my therapist wrote, “You can let go of your ED and still be validated” and “Never forget, but forgive and make yourself a better person.”  And then, sometimes I’ll print out pieces of funny or significant emails (from anyone in my life) and pin those up.  Yes, I have a very large bulletin board!

I need a written reminder for several reasons:

1. I’m a visual person
2. I twist things and second-guess myself and think “she didn’t mean it that way” or “I am reading into that too much.”
3. Being continually reminded helps me convince myself that it is true

Different types of therapy are helpful for different people, and I think that there is some trial-and-error involved in figuring out what works for you.  Personally, I highly recommend investing in a bulletin board.