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.

Dear Kettle — Love, the Pot

“The pot calling the kettle black.”

My nutritionist in college introduced me to that phrase. It was new to me at the time, and I thought that it was ridiculous (although we weren’t on very good terms, so there was definitely a negative bias there), but I’ve heard it 100 times since and it perfectly fits the situation I want to talk about:

Subject: People with eating disorders advising others with eating disorders.

I will be the first to admit that I am guilty of it — I’m not 100% recovered. I’ll also admit that there’s definitely a place and distinct value to empathy, support, wisdom, first-hand understanding, etc. This is what makes group therapy a useful tool. But…. group therapy also has a non-eating disordered therapist! Someone relatively healthy and objective, who (hopefully) does what she says!

This morning, a friend of mine blogged about all the arguments surrounding food that she had with her husband in the last 24 hours. In the time it took for me to read her post, she had commented on one of mine (personal blog) — saying that it sounds like weight plays too large a part in my relationship with my boyfriend, that she used to have that problem, and that it took her awhile but she worked through all of that with her husband and now things are so much better. … WHAT. clearly, neither of us should be giving each other advice.

People with eating disorders are helpers, caretakers, do-gooders (I know that’s not a word, but it sounded okay). Often we’ve gone through a lot, made a lot of personal progress, had years of treatment, and probably do know a lot… but I still think that if you have an eating disorder, you can’t be objective. You can be supportive, but you really need to take a step back and look at your own situation before giving advice to others.

Like I said earlier, this something that I definitely need to work on… however, my goal with Grey Thinking isn’t to give advice, but to really be more of a commentary. With journal articles, magazines, news, blogs, podcasts, you name it… there’s so much out there. And I don’t think a lot of people with psych backgrounds and eating disorder histories are giving their two cents about it all.

Some treatment could sink the Titanic

“I’m not going to rearrange the furniture on the deck of the Titanic.” — Rogers Morton

I think that during recovery, a lot of people get stuck rearranging deck chairs. While you’re spending all this time working on some trivial issue, your overall recovery progress is stagnant (at best).

Examples from my own history:
* Dozens of Dermatologist appointments during the height of my eating disorder (I’m sure my acne was caused mostly by nutrition issues). When asking my Dermatologist about the depression side-effect of Accutane (since I was already on antidepressants), she replied “oh no, it will actually help grey’s depression! she’ll have clearer skin so she’ll have higher self-esteem and therefore be less depressed.” … Really? And who cares about acne when my EKG is off?

* Spending months talking about how I was controlling food because my parents were too controlling of me. (not only do I think this is complete BS, but really… what were we waiting for? My accepting this as true and therefore then being able to move on and give myself permission to eat?

* Three months fighting with my nutritionist about eating a sandwich. She felt the sandwich was very symbolic of my motivation to recovery…. I felt (and still feel) like it was just a sandwich. I wasn’t eating more than 1000 calories at the time (obviously not a stellar recovery period)… who cares about the sandwich?

* Art therapy. Okay, lots of people participate in meaningful art therapy… but really, I was happy to just draw pictures and make stuff up about their significance. “My mother and I are wearing the same color because we compete with each other.” “My flower has no roots because I don’t feel like I know myself.”

My point: Great Feng Shui won’t keep your boat from sinking.

Therapists are like Starbucks Drinks

Choosing a therapist these days can be like ordering a drink from Starbucks:

I’ll have a grande CBT lite DBT Gestalt-free psychotherapy with two shots of psychoanalysis and breve IPT.

This image came to mind have after dinner with a friend last night. She’s been in therapy for several years, and has decided to switch to someone with “a little more of a CBT focus… who still integrates interpersonal therapy but spends less time talking about family.” Hmm… good luck with that search, Rach.

The reality of it is, there are so many types of therapy out there. Just to give you an idea of how many:

• Art therapy
• Cognitive-behavior therapy (CBT)
• Dialectical-behavior therapy (DBT)
• Exposure therapy
• Family therapy
• Gestalt therapy
• Group therapy
• Integrative psychotherapy
• Interpersonal therapy
• Hypno-therapy
• Marriage counseling
• Music therapy
• Narrative therapy
• Play therapy
• Psycho drama
• Psychoanalysis
• Psychodynamic psychotherapy
• Psychoeducation

… and on and on and on. Granted, some of these are much more common than others, and you could probably lump a lot of them together, but you see my point — what therapy is right for you?

No one therapy has been proven to be the best choice with eating disorders (especially anorexia), so your perception of recovery and ED etiology will be largely influenced by your first therapist. I think very few people have much information on all of the available types of treatment (not to mention the different kinds of therapists, psychiatrists, social workers, doctors, nutritionists, counselors, etc.). And even if they did… how do you know which therapy to try? And what exactly is the focus of therapy supposed to be? What is the interaction between you and your therapist supposed to be like? How are you supposed to feel when walking out of therapy?

There are so many beliefs in the psych field right now, that maybe you do need to customize your treatment like you would your Starbucks drink. And beyond that, maybe you’ll need to just around between types of treatment… not necessarily because you chose wrong in the first place (although that’s common), but because you have different needs at different times in your life and stages of your disorder.

Where this gets tricky, though, is with the concept of “bad therapy” — and if you’ve read my other posts, you’ll know that I believe that there is bad therapy. Maybe the kind of therapy that you gravitate towards is appealing is because it allows you to perpetuate your disorder or to ignore some issue. You can draw pictures forever in art therapy and never change any eating behaviors. Or, you can talk about your meal plan every single week with a nutritionist and never bring up a bad relationship that you’re in. So, I guess what I’m asking… is to what extent is therapy supposed to be comfortable? Is it no pain, no gain?

Any input would be appreciated…

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