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.

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.