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…

A Treatment Refresher

While I do have several new posts on the way, I want to highlight a couple of older Grey Thinking posts (some are several years old!  I bet you were not reading GT two years ago) that talk specifically about treatment, your attitude toward treatment, recovery expectations, etc.  While there are a couple of people that I have in mind when it comes to the subject of these posts, I think that everyone can use the refresher.

You as your own case manager
Originally Posted: 01/01/2009

I wish that all these guys were going to stay clean, I really do. I’ve just seen it so many times that I can tell when someone’s really willing to do whatever it takes and when someone’s willing to do what they think it should take. And it’s just not going to work like that, unfortunately.

–Shelly, Celebrity Rehab with Dr. Drew 2

Wanting to want to recover
Originally Posted: 06/12/2008

Motivation to change implies an intention–weak or strong–to change one’s behavior. However, AN patients may at the same time both wish to recover and be highly resistant to change their behavior. Therefore, we suggest that assessment of motivation in these patients should include not only their motivation to change, but also their different wishes to recover which do not necessarily imply a behavioral intention.

Dr. Drew should treat eating disorders
Originally Posted: 07/01/2008

There are a lot of components of addiction treatment that I believe in and think are important, and should be applied to eating disorders:

1. Recovery is a lifelong, daily process
2. Denial, and not necessarily that you have a problem, but that you need help
3. The importance of personal accountability
4. There’s no magic cure
5. The disorder should be taken as seriously as any potential fatal disease

Do not pass Go, Do not collect $200
Originally Posted: 12/09/2008

“I don’t want to play the rehab game anymore”

– Jeff Conaway, Celebrity Rehab 2

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore.

“I don’t want to play the rehab game anymore”

– Jeff Conaway, Celebrity Rehab 2

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore.

Positive self-help or self-hurt?

I’ve written several posts on the negative aspects of therapy as well as my disdain and frustration with positive self-talk, so I was pretty excited to see this headline: Study Shows The Negative Side To Positive Self-Statements In Self-Help Books

“…individuals with low self-esteem actually felt worse about themselves after repeating positive self-statements.”

“…paradoxically, low self-esteem participants’ moods fared better when they were allowed to have negative thoughts than when they were asked to focus exclusively on affirmative thoughts.”

Now, I don’t think I’ve ever claimed positive self-talk caused anyone to feel worse… but personally, I’ve never found it helpful as a coping mechanism. The results of the study do make some sense to me, though. Saying completely untrue statements like “I accept myself completely” make me feel further from that as a goal. I start to think, “Will I ever really accept myself completely? What’s wrong with me that I can’t right now? Does it matter if I do? Will I really feel better if I do?”

Also, the article makes a good point with being “allowed to have negative thoughts.” I think that often only positive affirmations are used in treatment in recovery. Things like “Everyone can get better,” “I know that you will beat this, you are such a strong person,” “You have too much potential to struggle with this forever,” “You’re making amazing progress,” etc. are all meant as motivational compliments. Maybe for some people they are… but again, I am backwards and actually feel a little invalidated when I hear how awesome I am doing in recovery. I don’t mind my therapist telling me I’ve made a lot of progress, but I do mind being told that I am doing great when I am feeling crappy. Additionally, sometimes I do worry that I will never get over this or that I will be considered “recovered” once I am 100% ideal body weight, regardless of whether or not I feel mentally/emotionally okay. I’d rather be told that she (therapist) knows that I am struggling and that she is there to support me, and that those fears are understandable becuase people do die from this illness or suffer from it their entire lives, but that I’m in treatment and working for something better than that.

I would love to see if there is a difference between others giving you affirmations vs. you creating them yourselves. I have a letter from an old therapist that says “you are more than enough” as well as a card from a different professional that says, “there are people who care deeply about you.” Both of these are comments that I could tell myself (I am lovable, my family and friends love me, etc.) but they are only significant because I care about and really look up to the people who gave them to me. I guess that’s what makes it so different from positive SELF-talk.

That's not actually a deep question

“I’m not deflecting because I’m avoiding something deep. I’m deflecting because I’m avoiding something shallow.” – House, MD

One of my biggest treatment pet peeves is when professionals ask non-deep “deep” questions. For example:

1. What does it mean to feel?
2. How did it feel to be in that space?
3. How does it feel to be in this space now?
4. What does it mean for you to not be in that space anymore?
5. How do you experience that process?
6. What would it mean for there to be grey in your world?
7. How does it feel to have acknowledged that out loud?

Okay, depending on the situation, some of these questions could potentially be useful. However, I’ve had therapists who use them over and over and over again. “What does it mean to feel?” is probably my least favorite question of all. Maybe it SOUNDS deep and therapeutic, but there are really only two answers to this question:

1. It means that I have feelings
2. It means that I am allowed to have emotions and that it’s okay for me to recognize them and not judge them as being either “good” or “bad”but to just accept them as they are… and that emotions may be scary but I can work through them and get support to handle them… and that they are normal and a necessary part of human life and essential to enabling us to connect to other humans and form relationships….

My point is, your answer is either “this is a stupid question” or “I just had this revelation about the significance of feelings and everything else in my life.” And if your answer is the first, then it’s “But what else? What does it really mean?” This is where the House quote comes in. I’m not deflecting the question because I don’t want to address some deep underlying issue, but because it’s really not a deep question! And if you won’t accept “Um, it means that I have feelings” as an answer, then you are going to get whatever fictitious BS I can come up with off the top of my head. Plus, I’ll be frustrated and won’t want to intelligently answer your additional questions.

You can ask me what I’m feeling, what I felt at that time, how I feel about feeling that way, etc…. but I hate when it is reworded to sound like a deep question. “How does it feel to be in this space now?” is just “How do you feel?” with six extraneous words.

Wow, I swear I am not as bitter (or as difficult of a patient) as I sound in this post! I just don’t like shallow questions that are pretending to be deep.

That’s not actually a deep question

“I’m not deflecting because I’m avoiding something deep. I’m deflecting because I’m avoiding something shallow.” – House, MD

One of my biggest treatment pet peeves is when professionals ask non-deep “deep” questions. For example:

1. What does it mean to feel?
2. How did it feel to be in that space?
3. How does it feel to be in this space now?
4. What does it mean for you to not be in that space anymore?
5. How do you experience that process?
6. What would it mean for there to be grey in your world?
7. How does it feel to have acknowledged that out loud?

Okay, depending on the situation, some of these questions could potentially be useful. However, I’ve had therapists who use them over and over and over again. “What does it mean to feel?” is probably my least favorite question of all. Maybe it SOUNDS deep and therapeutic, but there are really only two answers to this question:

1. It means that I have feelings
2. It means that I am allowed to have emotions and that it’s okay for me to recognize them and not judge them as being either “good” or “bad”but to just accept them as they are… and that emotions may be scary but I can work through them and get support to handle them… and that they are normal and a necessary part of human life and essential to enabling us to connect to other humans and form relationships….

My point is, your answer is either “this is a stupid question” or “I just had this revelation about the significance of feelings and everything else in my life.” And if your answer is the first, then it’s “But what else? What does it really mean?” This is where the House quote comes in. I’m not deflecting the question because I don’t want to address some deep underlying issue, but because it’s really not a deep question! And if you won’t accept “Um, it means that I have feelings” as an answer, then you are going to get whatever fictitious BS I can come up with off the top of my head. Plus, I’ll be frustrated and won’t want to intelligently answer your additional questions.

You can ask me what I’m feeling, what I felt at that time, how I feel about feeling that way, etc…. but I hate when it is reworded to sound like a deep question. “How does it feel to be in this space now?” is just “How do you feel?” with six extraneous words.

Wow, I swear I am not as bitter (or as difficult of a patient) as I sound in this post! I just don’t like shallow questions that are pretending to be deep.

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.

Now you can facebook-stalk your therapist

There have been many blog posts written on facebook and pro-anorexia, however, lately I’ve been thinking a lot about facebook and recovery in general.

Facebook is really unique in that EVERYONE (okay, almost everyone) is on it.  If you’re an eating disorder patient, this means your professionals, the other girls/guys you’re in treatment with, past patients, your school / work friends who may not know about your eating disorder, your family members, etc.  In what other realm do all of these people connect?

For most people, “Facebook stalking” means checking out what that guy you liked in high school is doing now (or some variation of that idea).  However, for anyone in eating disorder treatment, Facebook stalking can mean following up on the girls you were in treatment with or tracking down all of the professionals you’ve worked with.

Luckily, there are privacy settings.  Some professionals even know how to use them.

I was pretty convinced that facebook could be nothing but hurtful to recovery until a girl I used to be in treatment with told me how she and another woman used it to keep in touch.  There’s probably a 20-year age difference between the two girls (for the sake of this example, let’s call the older one Kristy and the younger one Jackie), but neither of them had a lot of support outside of their families.  In the evenings they would talk on facebook (something I haven’t gotten into yet — facebook messenger).  Kristy would see the unhealthy things about dieting that girls would post on Jackie’s wall, with prom coming up, and they’d talk about it.  Jackie saw all the cute pictures of Kristy’s kids.  Basically, it served as an outlet for both of them — something that was missing in their outside world.

Now, you could argue that this isn’t different than email or IM, but I don’t think that IM bridged the age-barrier in the same way that facebook is now.  IM also doesn’t have the public information that facebook has — you can’t see how others interact with someone.

So what do you think about facebook — helpful or harmful to recovery?  Staying in touch with people you were residential with could definitely be triggering (especially if they are not doing well and you have access to their photos), but having the support of people who have been great friends is also valuable.  And I’d love to know — do professionals ever search for their clients on facebook?  Just out of curiosity?  For the record, I have never tried to friend a professional myself — although I won’t lie, I have looked at a couple of profiles.

In tune with each other

I’ve been reading Dr. Drew’s book, “Cracked: Life on the Edge in a Rehab Clinic.” There are a million things that I could talk about concerning this book, so don’t be surprised if it’s referenced several times in future posts. Tonight, the following quote really caught my attention:

“Most believe [addicts] connect around a common experience of pain and powerlessness without the fear of exploitation. Their pain is so raw and tender that getting them to start the process requires them to be convinced that their pain will be understood. They’re all people with extreme trust issues, and the only people they’ve ever trusted are other addicts. They understand each other. (Interestingly, doctors have discovered that survivors of torture have similar reactions to treatment. They don’t open up unless they’re around others who’ve been through similar horrors, as though the pain of being misunderstood would be too great of a risk.)”

If you’ve ever been in ED treatment (or addiction / trauma treatment, I assume), you know that there’s something very different about the relationships that you form with other ED patients. You know all about their relationship issues and what they are / aren’t eating — but don’t know their last name. They might be thirty years older (or younger) than yourself or living a totally different lifestyle. Maybe they are completely opposite of the type of people that you usually hang out with, and if you met them in any other context you probably wouldn’t hit if off. But… despite all these differences, just their having an eating disorder makes it easier to talk with them than non-ED friends that you’ve had for years.

I have good friends, but the closest friends that I have are all people that I met in treatment. I just can’t open-up to other people in the same way that I can with them. Some of it is their ability to understand me — that definitely is a large part. My non-ED friends cannot relate to my frustration over food rituals. But I think it’s more than just their ability to empathize. Because they have an eating disorder (and were in treatment), it means they are the kind of person who you CAN talk to about this stuff. They have issues, too. I don’t know how some of my “regular” friends will respond to the stuff that I tell them… however, I do know that these ED friends are not going to invalidate my struggles. They aren’t going to think that I am ridiculous, and I don’t have to feel so ashamed. Dr. Drew explains it so well — “the pain of being misunderstood would be too great a risk.”

Anti-ED Coach

I’d never heard of a “Sober Coach” until watching VH1’s “Sober House.” In the last episode (I think), Will, who is Seth’s Sober Coach, accompanies him to his first concert and make sure that nothing happens to jeopardize his sobriety. While watching this I thought, “Well that’s convenient — I could use someone protecting me from anything eating disordered.”

Upon thinking about it a little more, though, I wasn’t sure what this Anti-ED Coach would protect me from. Would he make sure no one served me diet coke? Or that we only went to public places with healthy-weight people? Or would he stand outside the bathroom (any bathroom) and make me count? Okay, so maybe the idea was silly.

However, then I went and Googled “Sober Coach,” and found a website that explains what a sober coach does. Wow, they do a lot… they really seem like “life coaches” to me. If I had to adapt the list from this website for eating disorders, it would look something like this:

1. 24 Hour Crisis Support
   1. Phone support available 24 hours a day, 5 days a week.
   2. Education on how to ask for help.
2. Daily, Weekly, & Weekend Planning
   1. Creating an hour by hour schedule when necessary.
   2. Learning to deal with free time and/or unstructured time.
   3. Establishing weekly goals.
3. Physical Well-Being
   1. Nutritional consulting.
   2. Support with eating disorder issues.
   3. Support for anxiety and depression.
   4. Creating a personalized self-care plan (acupuncture, yoga, body coach, personal trainers, etc.)
4. Career / Academic Guidance
   1. Finding a job / volunteer work / internship.
   2. Support with changing careers.
5. Fun / Passion / Purpose
   1. Learning how to have fun & explore different hobbies.
   2. How to build fun into weekly schedule.
   3. Finding one’s own aspirations and dreams.
6. Recovery Support
   1. Help in finding appropriate treatment.
   2. Daily relapse prevention plan.
   3. Support in establishing healthy friendships and relationships.
7. Team Approach
   1. Works with psychiatrists, therapists, dietitians, and outpatient programs to provide a team approach.
   2. Referrals to various professionals as needed.

If you look at the original website, you’ll see that I didn’t have to add much. If Sober Coaches really do all of the above, that’s pretty amazing. I need someone to educate me on “how to ask for help” and “how to deal with free time and/or unstructured time” ! I also like the idea of someone coordinating things with a treatment team. I think that often professionals don’t work well as a team or they don’t necessarily consider the input of the patient (when appropriate). It’s a nice thought to think you could have someone advocating on your behalf in those meetings…

I realize that this is probably realistic, but it’s an interesting thought. An Anti-ED Coach could play a role that I don’t think really exists right now in treatment. Many of these responsibilities don’t fall under the job description of your doctor, therapist, or dietitian. It’s tricky relying on your spouse / family members to serve all of these functions, too, because they all don’t necessarily mess with the nature of the relationship. For instance, if I’m having a bad night and freaking out about something food-related, I don’t really want to make my fiance listen to my possibly irrational rant about calories. At the same time, though, it wouldn’t be appropriate for me to call or email my dietitian about this, either.

I am fortunate enough to have ED friends in recovery who can support me and give me advice during tough times, but that’s still a different relationship that with a Sober or Anti-ED Coach. You always have to consider if you are hurting or triggering the friend with your ED thoughts and behaviors.