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.

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.

Parents, personality, and eating disorder symptoms

There have been many studies on family dynamics and the development of eating disorders, but I think that this is the first that I’ve seen that takes the next step and makes connections with specific symptomology: The dynamic relationship of parental personality traits with the personality and psychopathology traits of anorectic and bulimic daughters

Before I go further, I want to make two disclaimers.  First, from the article:

…we cannot infer a casual relationship between the parents’ personality traits and the daughter’s personality or psychopathology.  Moreover, correlational analysis does not define a direction for these relationships.  Nevertheless, some of the parental personality traits were specific to eating-disordered daughters, suggesting that they may be relevant.

Second, I in no way believe that parents cause eating disorders (just want to make that clear before I get any attacking comments).  I do think that parental personalities are significant, though.  Not only do they affect your core beliefs but they also influence the relationships that you have with your parents… which affect all of your other relationships in life.

So, with that said, on to my commentary of the article!

The study used several scales (the Clinical Global Impression Scale, Beck Depression Inventory, Temperament and Character Inventory, and the Eating Disorders Inventory-2) to assess personality and ED symptomology in daughters and their parents.  Among these variables were BMI, overall functioning, disease duration, eating attitudes and severity of ED behaviors, depression, and temperament.  The Temperament and Character Inventory (TCI) was a large part of the study, and previous to this article I was largely unfamiliar with it, so I’ll briefly explain it at the end of the post.

In short, the personality of parents, personality of daughters, and ED symptoms were all analyzed.  Among the results, some of the more interesting were:

1. In AN-R, father’s persistence predicted the daughter’s age of ED onset.
2. Also in AN-R, novelty-seeking, body dissatisfaction, and interpersonal distrust were all affected by the father’s reward dependence.
3. Mother’s self-directedness affected novelty-seeking in AN-P and BN.  The same was not true for AN-R.
4. AN-P exhibited the most severe eating psychopathology.  These girls had the greatest body dissatisfaction, drive to thinness, and level of depression.
5. Women with AN-R were less concerned about body shape than both AN-P and BN.
6. The father plays a larger role in personality-based family dynamics of ED women (especially with AN-R).

There are a MANY more conclusions than just those in the study, but I could probably write a whole series on the findings.  I’m trying not to do that.  There are a couple more things that I want to mention, though.  First, the paper discusses the personality types of the ED-daughters.  If you are a family member and are feeling attacked by this point, you might want to read this section since it’s not very complimentary to those with EDs, either.  No one escapes the article feeling good:

Restricting Anorexics – stubborn, obsessive, self-determined
Purging Anorexics – impulsive, immature, disordered personalities
Bulimics – explorative, disorderly, conflicting
All EDs – frightened by potentially harmful stimuli, immature character, low self-acceptance, low resourcefulness, low self-esteem

Now, what’s the take-home message from all of this?  Well, I think that the article does a good job of explaining the role of family therapy in the treatment of eating disorders.  Specifically:

Counseling or family therapy may help modify specific aspects of the parent-daughter relationship to produce specific changes in eating symptoms.

I like the point about helping the parents in family therapy.  To change your relationship and your home environment, you have to help your parents.  The things that you learn from them are reflections of both their own core values and their personality traits.  When they are struggling with their own anxiety, negative body image, etc,., that translates.  I think that when you (the person with the eating disorder) is in therapy and are being told things like it’s important to take care of yourself, you have to cut yourself some slack, what you think and how you feel matters, you don’t have to listen to the messages of society, etc., that it’s hard to believe these things and take them as truth when the people around you don’t.  Will my dad ever work on his anger issues?  Probably not.  Do I think it would help both him and I?  Sure.  Is my mom ever going to let go of her own disordered eating tendencies?  Unlikely.  Would her being healthy being a good influence on me?  Yes.

There is clearly a link between parental personality, the daughter’s personality, and ED symptoms.  I think that family therapy that helps the parents with their own issues then allows them to form healthier relationships with their daughters, which helps with her ED recovery.

——————————–

The Temperament and Character Inventory (TCI)
Purpose: Instrument used for the dimensional assessment of personality, with four dimensions assessing temperament and three assessing character.

Temperament:

1. Novelty seeking – level of exploratory activity
2. Harm avoidance – efficacy of behavioral inhibition system
3. Reward dependence – maintenance of rewarded behavior
4. Persistence – ability to resist frustration

Character:

1. Self-directedness – view self as autonomous and integrated
2. Cooperativeness – view self as part of society
3. Self-transcendence – how self is integral part of the universe

The worst parts of eating disorders

The National Council for Community Behavioral Healthcare and AstraZeneca conducted a really interesting survey on the impact of bipolar depression on people’s lives.  There were a couple of points in the study that really caught my attention:

• The greatest concerns among people living with bipolar disorder are that their symptoms will have an impact on daily life, such as family, relationships, or job (73%), and that they will have long periods of depressive episodes (63%).
• Ninety percent of people living with bipolar disorder said that they have difficulty managing or completing day-to-day tasks due to their bipolar depression symptoms.
• When asked how they felt most of the time, only 27 percent of people living with bipolar disorder said they felt well-balanced and just 23 percent felt their depression was well-controlled.
• The majority of people living with bipolar disorder agreed that bipolar depression causes difficulty in their ability to manage housework (73%), run errands (59%), groom themselves (53%), and pay bills (49%).
• Sixty-one percent of people with bipolar disorder said their depressive episodes last longer than their manic episodes
• Fifty-three percent of people living with bipolar disorder agreed that they would rather feel “less than perfect” than go through another medication switch.

These findings got me thinking — what are/were the most disturbing effects of the eating disorder on my life?  I would have to say….

• Constant preoccupation with food that took away from my ability to concentrate on school / work.
• Low blood sugar and tiredness that further inhibited my school / work efforts.
• Heightened depression, anxiety, and panic attacks.
• Tension among family members due to their frustration/concern and my irritability.
• Avoidance of most social situations in fear of the event involving food.
• Isolation from friends.
• Lack of interest in all hobbies and many relationships, and. the inability to motivate myself to care about the things I once cared about.

I could probably make a list three-pages long, but these are probably some of the most upsetting elements of the eating disorder.  It would be interesting to see a similar survey to the Bipolar Depression Treatment Dynamic conducted for EDs.

It's Your Reality

“You get to define which experiences are traumatic for you, whether or not it would impact others in the same manner.  It’s not the objective facts that determine whether an event is traumatic,  but your own emotional experience of the event.”

— Dr. Kathleen Young

This is just a quick post, but I read this on a trauma blog tonight and thought it was so well-put.  This is something that i struggle with a lot — whether or not something “counts” as significant.  Maybe I am making it up.  Maybe it was no big deal and I should have been fine.  Maybe I am fine and am just crying wolf.

I’m not even limiting this to trauma — of course I can extend it to eating disorders, too (because I have to somehow relate everything to eating disorders, or so it seems).  There’s always that fear that maybe I’m not sick enough to actually need help.  It’s not that I want to be sicker; I’m just afraid of asking for help that isn’t justified.  What if someone else in my position wouldn’t need help?  What if I’m actually okay-enough?

It is such a good reminder for me that my “own emotional experience” is my reality — and in the end, that’s what is important.  Regardless of whether or not it should “count” as significant, it affects me, my sense of self, my relationships, and my future.

It’s Your Reality

“You get to define which experiences are traumatic for you, whether or not it would impact others in the same manner.  It’s not the objective facts that determine whether an event is traumatic,  but your own emotional experience of the event.”

— Dr. Kathleen Young

This is just a quick post, but I read this on a trauma blog tonight and thought it was so well-put.  This is something that i struggle with a lot — whether or not something “counts” as significant.  Maybe I am making it up.  Maybe it was no big deal and I should have been fine.  Maybe I am fine and am just crying wolf.

I’m not even limiting this to trauma — of course I can extend it to eating disorders, too (because I have to somehow relate everything to eating disorders, or so it seems).  There’s always that fear that maybe I’m not sick enough to actually need help.  It’s not that I want to be sicker; I’m just afraid of asking for help that isn’t justified.  What if someone else in my position wouldn’t need help?  What if I’m actually okay-enough?

It is such a good reminder for me that my “own emotional experience” is my reality — and in the end, that’s what is important.  Regardless of whether or not it should “count” as significant, it affects me, my sense of self, my relationships, and my future.

Due next week: Therapy homework

Once in awhile, my therapist assigns me homework — usually for one of several reasons:

1. We only had time to touch on a subject in therapy and she wants me to keep thinking about it to flesh it out.
2. She wants to keep better track of my symptoms and I’m not very good at bringing up bad days (not because I’m manipulative and want to hide it from her, but because I never feel it’s “bad enough” to bring to her attention).
3. There’s something that I’m not able to say in person, and can much better articulate in writing.

I’m not anti-therapy homework, because it really is easier for me to write than to talk.  We started to talk about this in the comments of my last post, but I feel less uncomfortable and/or vulnerable when writing about issues than when talking about them.  Also, it’s helpful for me to be able to write and re-write my thoughts — I can spend 3 hours on that homework assignment if I want.  I can go back to old journals and do “research” (only I would come up with research for therapy homework!).  And…. I don’t have to necessarily be there when my therapist reads it, which means I don’t have to deal with the heavy emotions.

At the same time, though, I think a major problem with therapy homework is that it IS done at home.  Sometimes, if it’s a tough assignment, I end up really upsetting myself.  It’ll be 11:00pm and I’ll be sitting in my bedroom with old journals and reading things that I really should just burn.  My therapist isn’t there.  It could be a week until I see my therapist again.  Sometimes I’m still upset the next day, and it does affect my eating or mood.

Maybe I should put off any assignments until a couple of hours before therapy….

Adults & Adolescents – In Treatment Together

I have mixed feelings about putting adolescents and adults together in treatment. I have been on both sides of the equation (treatment as an adolescent and treatment as an adult), and definitely have a stronger opinion about it now that I’m older.

Pros:

1. Adolescents can learn a lot from adults who often have been in treatment before and have some more insight into the disorder.
2. Adults are (hopefully) more mature and less competitive. Eating disorders in general are competitive… and I’ve just found that when you have a large group of ED high school females in a room, who are not necessarily in the best place, you could be in for a disaster. Sometimes just having a couple of older people in the room is enough to keep everyone from competing as much.
3. Adults can learn a lot from adolescents. They have a different perspective, and sometimes you need that.

Cons:

1. Being an adolescent and seeing adults in the group can cause some hopelessness that you’re never going to get better. It can give you the sense that people never really do get better and that you’re going to struggle with this the rest of your life.
2. As an adult, I often feel like a bad role model — especially if I’m having a hard time and an adolescent is doing well. I feel like as the older, “more mature” one, I should be responsible for setting the example.
3. Adolescents still live with their parents and (hopefully) their families are very involved in their treatment. I’m always a little jealous since my parents were pretty anti-treatment and didn’t (and still don’t) think that eating disorders are really problems. Sometimes interacting with others’ parents brings up stuff that you haven’t thought about recently (maybe that’s good, but it feels bad).
4. Adults and adolescents have different bodies, ideal weights, nutritional needs, etc. I know adults who have a really hard time being on the same meal plan as a 15-year old, with all the info they’ve heard about slowing metabolisms, muscle loss with age, etc.
5. Tiny, underweight adolescents are triggering. It’s hard to not compare yourself to someone who is 15.
6. Adolescents and adults are (obviously) at different stages in life. Sometimes it’s hard to relate to one another and certain sessions may not seem helpful for one group or the other.

This is just the start of a list — I’m sure there are 100 reasons. Personally, as an adolescent, I was really happy to be in treatment with older women. I really looked up to them and thought that they were so wise — they knew so much and had so much insight. There were a couple of people who I wanted to be like. There were also people who I did not want to be like, and it was motivating to me. I definitely told myself that I would NOT be one of those adults with an eating disorder. It wasn’t until I WAS an adult that I started feeling guilty about still struggling and/or being a bad example.