Hello and welcome to the Eating Disorder Therapist podcast. I'm Harriet Fru, Eating Disorder Therapist, here to support you in overcoming disordered eating and finding peace with food. Now before I launch in, I just want to let you know that I'm launching a course soon, which is going to be available online to learn at your own pace and it's for anyone that's taking the GLP one agonist medication and perhaps wanting to really work on their psychological relationship with food alongside. Now I just really want to say I'm not a huge fan of the drugs, I'm definitely not promoting them. I think if you have an eating disorder, you really want to stay very well clear and I have a strong intuitive feeling that in the next two to five years we're going to have a real backlash for a lot of people who have taken the drug, not really worked on the relationship with food and are going to be perhaps in a not great place when they've had to come off the drug or it's not working in the same way or whatever. So anyway, but that aside, I'm creating this course. If you may be interested, you can also reach out to me on Instagram, send me a DM or email me at
[email protected] and I can kind of get you on the list and let you know when it is released. So what I want to talk about today is a journey through therapy in eating disorder recovery. So I'm an intuitive therapist, I use a range of different tools and skills when I'm working with clients with eating disorders but fundamentally I believe that the relationship is the key for healing. So I think if we have an eating disorder often our attachment is rooted and often perhaps quite an unsafe, insecure place. We often haven't felt safe to be in touch with our emotions, our feelings, our thoughts, our authentic voice, we're often very disconnected from ourselves and we are kind of living our lives through rules around food and body image in a way to try and feel safe. So what is so important in therapy is the relationship is such an important container for healing because actually if you feel safe in a therapy relationship can be one of the first places where you can start to really reconnect with yourself, really start to listen to your voice to get in touch with your body to recognise your feelings because all the wisdom really is within you. I see my job as a therapist really to create that very safe container where you can bring all the parts of yourself in time as trust is built without shame so you can you know really begin to heal. And then of course like tools and strategies and other things on top can be really really helpful but I think sometimes we can have all the tools and strategies in the world but if our relationship with ourselves and our relationship with the people close to us in our life is very disconnected and it's really really hard because you can be doing all the right things but if you're not connected with yourself and your authentic voice and really an alignment with yourself and healing is quite almost impossible really. So yeah so I guess I'm just saying that as a kind of background context that that's the way I work. The relationship is the container for healing and I use different tools and strategies and things on top so I'm going to talk through a journey through eating disorder recovery the different things I will work on. I just want to say as well that my way is not the highway. There are many different ways that you can work with eating disorders and again I would just really say follow your own truth and where you feel led to engage with treatment you know because I think there is not one way to treat an eating disorder. You will speak to many different people and you will find them raving about different types of therapy or raving about yoga or somatic work or different things so it's going to be very very individual for each person. Okay so let's dive in. So how do you treat eating disorders? So eating disorders are complex mental health conditions and sadly there is no wonder cure that can fix you know if there was I would probably be out of a job. So as the proverb says not very nice proverb actually there are many ways to skin a cat it's absolutely true in eating disorder treatment there is no one way to treat these illnesses. So I fully stand by this what works effectively for one person may be very different for another so it's also worth saying that therapy and psychological input are one tool for treatment but people will often need dietetic possibly psychiatric input alongside other people will find different ways of healing to be equally as effective whether it be through arts, musical yoga or something else. And with therapy there are different approaches in ways of working so some therapy will focus more on the past, some therapy will focus more on practical tools for change, some therapies for example mantra which is the modestly treatment for anorexia nervosa. It's a specific therapy you know created for treating anorexia nervosa or maybe CBTE by Christopher Fairburn's team in Oxford which focuses on all the eating disorders but definitely tends to be used more by professionals I would say for bulimia or binge eating disorder. So I'm going to talk about some of the ways I work with my clients and as I said I'm an integrative counselor I'm not wedded to anyone approach rather using different therapies which I found to be particularly helpful for treating eating disorders. I'm also not rigid and what I do and believe in tailoring the therapy to my individual clients. So and I really believe that the relationship is the cornerstone for healing because if you don't have a strong therapeutic relationship with your client it's almost impossible to support them and to build trust. So I believe also in being flexible and tailoring work to suit a client's personal journey and sometimes this may involve a more talking therapy with more insight and self-reflection whilst at other times it may mean utilizing tools and practical strategies or a combination of the two. So having said all this I hope you can see that you know that I'm just giving some insights into the way I'm working so it's not my way is not the only way I believe really believe you're the expert on you and I feel like my job in a way is to help you tap into that wisdom that you have within you because so often we have lost our internal voice and we are outsourcing our decisions to everything else in the world and to external validation and approval etc and that is not the way to happiness. Okay so first of all working with someone in therapy so one of the things I would really do is work on motivation. So when people come into eating disorder treatment they're awfully often even highly ambivalent in two minds about change. So as a therapist I expect this as the eating disorder decoping strategy so it's really helpful to work on this as a starting point. I'm not expecting people to come into therapy really up for it and ready to go I expect the ambivalence. So if you're listening and have an eating disorder you might resonate with this one part of you desperately wants to move on. Let go of a destructive relationship with food. You might be ruled by food of exercising feeling miserable, socially isolated and paralysed by preoccupation with your body however another part of you doesn't want to let it go. You're scared of weight gain, you're terrified of losing control, you don't want to give up binge eating and the escape it brings and this can bring a lot of confusing feelings and you may feel you know in different head spaces about your eating disorder at different times of the day or different hours of the day it's really normal to sometimes feel super motivated about change and other times just feel like I can't do this it's overwhelming it's too much. So my job as a therapist is to really help you embrace this ambivalence okay it's okay to like certain aspects of your eating disorder and actually by bringing those out into the light and actually talking about them it really helps you to actually begin to detach from some of those sort of positives of the eating disorder and to begin to think about other ways of coping and through exploring the ambivalence as well we begin to really recognise what the eating disorder means to you and how it's helping you cope because of maybe it's a way of numbing difficult feelings maybe it's a way of trying to control your weight maybe it's just deeply familiar and offers safety and reassurance so all of those things are fine and maybe there's other reasons too so in therapy you can gain greater understanding about your eating disorder from this psychological perspective you can take a step back and consider you know whether this is a coping strategy that you want to keep or to think about whether there could be other ways of coping and of course you might need to learn new tools to support you with this and you can start to think about the bigger picture of your life and where you want to be going because motivation for change you know when we think about our next meal or tomorrow or short term can be really hard to hold on to motivation however when we start to think about two years or five years from now looking at goals values and what's really important this can help you take a step back and begin to consider change now I know in my own recovery this was so so helpful to really think for me about where I was going and what I wanted in my life and what my future held for me you know I really desperately wanted to train as a therapist and I really wanted to be healed and I really wanted to be authentic so in a way healing just I didn't have another option it just felt like you know of course I have to heal I have to find a way even though I have no idea how I'm going to do this but I'm not saying for you that you need to train as a therapist but you need to have things in your life that are bigger than the eating disorder you know maybe it's um I don't know starting a family or maybe it's traveling somewhere or maybe it's study or education or I don't know maybe it's just enjoying more of the day today there is no right or wrong but it's so helpful to start to think about what really lights you up and where do you want your life to be going okay another area I would really start to work on with my clients number two is to start to understand why you developed an eating disorder in the first place now there is not a simple cause and effect to developing an eating disorder and if there was treating EDs would be so straightforward and I think what's also really important is that you could have two people going through identical circumstances but actually they may cope with those stresses in very different ways due to their genetics due to maybe their birth order due to sources of support in their life at various times you know it's so like nuanced and individual so there's a often a combination of different contributing factors so including your genetics so people with EDs are often highly sensitive possibly more anxious and prone to perfectionism not true for everyone those are generalizations your family life your you know relationships with food that people had in your family body image at home fat phobia weight stigma a lot of pressure to be thin maybe different events life experiences how school was if you experienced a bereavement or more all of these things can contribute it's not one thing so underneath an eating disorder is often low self esteem not feeling good enough maybe being quite disconnected from yourself so the eating disorder becomes a way to feel safe to try and feel better to boost yourself worth you know it's something that you can control something that is yours alone you know it's something you can turn to in a way you can focus on life is really stressful eating disorder gives you this life raft in a way to really hold on to so it's not surprising that it can feel like such a seductive choice because I think in our diet culture world people are praised for weight loss changing their appearance etc and I think most people don't consciously decide they're going to be able to eat in disorder but they might decide that they're going to diet you know they're going to like leave their best life lose some weight get into wellness and it starts off in quite an innocent way but then because of that the underlying trauma and the stresses and the way they're disconnected from the way you're going to be disconnected from yourself it becomes this coping strategy that becomes very very unhelpful and everything unravels so therapy can help you explore the underlying psychology and develop understanding so you start to piece together the parts of the jigsaw puzzle to really start to gain some clarity so you can understand the roots of your eating disorder maybe there was a trigger event which set it off you know I think sometimes people you know had to have a kind of low level dysfunction relationship with food but then they go off to uni or they experience a relationship break up or they experience a stress and that can be a real trigger into the eating disorder and then once you're in eating disorder cycles you know if you're restricting you're eating if you're weighing yourself you're very focused on your body image there are all those perpetuating factors that keep the eating disorder going so you might be doing things like a lot of mirror checking maybe or like continuous weighing or things that make you focus on your body or the time and then reinforce the cycle so of course having awareness about the past it doesn't necessarily guarantee change I think it's important piece of the puzzle to do because of if you haven't got that insight if you haven't really made sense of things and you know you can be a bit stuck you can be a bit in the dark really so doing this work can be a powerful springboard for preparing for change rather than feeling completely lost in the jungle a food and body image preoccupation and not understanding you know why things are happening okay so that's the psychology part understanding is really really important okay so one thing that's also really helpful starting to get clear on your values and diluting the link between self-worth and weight so this is number three now when you have an eating disorder your weight and body shape has become the defining factor in your self-worth okay so if you think about having a pie chart of all the different aspects that make up your self-worth you have an eating disorder probably maintain your weight or controlling your food as maybe 85 90% of how you define yourself now again we have to have real compassion to ourselves if you hear if you recognize this like we live in a culture that reinforces this belief 24/7 you know now as well the skinny jab diets are constantly promoted actively encouraged and it can feel like the whole world is on a mission to be smaller or leaner so you know of course it's so seductive so you've got to be like very compassionate to yourself because of it is a reality in the toxicity of the culture that we live in that if you are in a smaller body you probably will be valued more you'll be considered to be more self-discipline to be somehow superior I mean it's really very toxic isn't it and as we all know really in a way anyone that has ever been on a diet and lost a lot of weight and got a lot of thinner it is not to the magic pill to happiness and fulfillment and robust self-esteem but we have sold this message all the times of course we are seduced so I think most people in society have too much of their body image linked to their self-worth but if you have an eating disorder it's that magnified but I guess for most of us and we're 90 years old looking back on life the number on the scales abs etc how lean we are is not going to count for much in the bigger spectrum of life okay now this doesn't mean you have to throw the baby out with a bath water and not look after yourself and never have aesthetic goals but you don't want these things to be ruling your life when we look back on our lives things that are going to be important are going to be things like relationships having purpose and meaning travel creativity finding our purpose enjoying life experiences these are going to feature so much more important but when you have an eating disorder you've often lost perspective and professor Ferburn the sort of godfather of CBTE he talks about where you're eating disorder sunglasses where you're viewing the world to a distorted lens valuing yourself and others based with an unhealthy emphasis on weight and shape as a defining measure of self-worth now when you do this it's almost impossible to win because of however much weight you lose however defined and lean you get the goal post always move there's always more to look more weight to lose there's always someone else to compare yourself to it feels like a relentless journey and it's so so hard to feel good enough you know we're sold the lie really that this is how you feel good and create positive self-worth it's not true so in therapy you start to take a step back and dilute this connection between controlling your body and worth and you can begin to consider your values think about your hopes and dreams for the future and get back in your own lane of what is meaningful to you rather than being dictated to by all the noise in our culture and so often when you're in recovery you have to really put the blinkers on you know actually close your ears off to all the noise that is coming at you and to really get rooted in your own lane because of diet culture wellness culture it's not going away anywhere soon you know but actually you don't have to buy into that in the same way as everyone else is you can start to really value yourself more in other ways and again like you don't have to throw out the baby with the bath water you can still have some aesthetic goals you might still want to like really value health but you want to do it from a place of where it's like healthy balance not sort of this obsessive preoccupation okay number four developing a healthier relationship with food so if you have an eating disorder you might be restricting heavily dieting missing meals going for long periods without eating binge eating chewing and spitting purging or manner of disordered eating symptoms now when you are living with these disordered eating habits day by day physically you're not going to feel good because when you're physically hungry as well you'll be tired you'll be experiencing blood sugar imbalances you'll feel exhausted find it hard to concentrate because you'll be preoccupied with food all the time and then it's really hard to work on psychology and the emotional side of the problem so developing a healthier relationship with food is really important you know I remember when I did my training that my tutor said to me you know you can if you're working on eating disorder recovery you can talk about your relationship with your mother to your heart's content really but if you never actually work on your relationship with food as well it's not going to bring about healing now you probably do need to work on your relationship with your mother or your father or your parent or whoever else has been significant in your life but you also need to work on your relationship with food so in therapy you can be supported to start to eat more regularly to eat a range of foods from all the food groups to balance your blood sugar and this gives you that stable platform to work from in managing other aspects of the eating disorder now this is the boring and sexy work of regular eating and it's so so so so so important in recovery now of course it sounds simple but it's hard you might feel very scared of introducing more food in today to day life and you might to do this really gradually with support but you know the way I work with people in a way we do this in a very incremental and gradual way so that you feel that you have some safety with this and you might need help as well with managing disorder to eating behaviors so this might be beginning to work on reducing symptoms such as frequency of binge eating or purging it might be starting to reduce over exercise and in therapy they can be supported to manage these changes with tools to deal with the difficult emotions that may arise particularly when and the anxiety that will arise in a way when you are not able to engage in the coping behavior but seriously regular eating makes such a difference does not the one cure for eating disorder but if you can start to implement regular eating having more satisfaction and variety stabilising your blood sugar you will feel in so much of a better place and you will almost have such a stable resource kind of baseline to work on emotion self-esteem and all the other bits and pieces okay number five becoming more food neutral so when you have an eating disorder foods will often be labeled as good or bad clean or unclean healthier unhealthy and your judgment around eating will be extreme now although this feels a way of exerting some control around food in reality often exacerbates binging or overeating behaviors and also makes you terrified of food because food ends up being on the pedestal it becomes this thing that's either like so so so special or so so so like demonised and eating often become this like moral issue laden with judgment and rules which makes having a healthy relationship with food pretty tricky so in therapy you can be gradually supported towards developing a more food neutral approach with less fear and seduction associated with food and this ultimately brings you towards a much more peaceful place now again you don't have to throw out the baby with a bath water you can still honor healthy eating looking after your body balancing blood sugar being self caring with eating but it's coming from a place of balance inner peace good sound mental health not obsession and real anxiety around food because actually sometimes you know so think about sometimes people I work with who have orthorexia her so obsessed about everything being so clean and you know not having any toxins in the body and avoiding gluten and sugar and all these things and actually they experience so much anxiety day by day to try and follow all of those rules actually it's not that healthy so we need to look health as well as in the bigger picture health isn't just about what you eat it's so much about your kind of mental well-being your connections your pleasure how you're engaging with life your nervous system all these things as well okay number six therapy can help you manage difficult emotions so eating disorder behaviors are often a way of unconsciously dealing with difficult emotions through binging restricting chewing or spitting whatever you're doing you might be temporarily distracting yourself and getting relief from difficult feelings so such a vital part of therapy is offering you a safe place to explore these feelings without judgment so it's really getting back into the body and starting to connect with you yourself and how you feel because when you have an eating disorder you're constantly in your head you're constantly in the kind of the rational overthinking brain you're not in your body in touch with your feelings and intuition so and for good when tool well-being is where you don't need to be ruled by your emotions either it's important to learn tools and strategies to deal with your emotions effectively and to learn better coping strategies for when you feel distressed or anxious or sad or angry or whatever it is so you may feel completely out of touch with your emotions and it can take time to begin to feel your feelings in your body to name them to process them in a healthy way and you perhaps been completely cut off from them from a whole part of your life and it's a steep learning curve and I find as well so many people come into therapy with buckets of knowledge about what to do about eating disorder, treatment, recovery, read all the books they kind of know it all but what's really missing is they haven't really integrated it into their body in terms of actually practicing it doing the thing, feeling the feelings you know that's something that's just not familiar with at all and that's where therapy can be so so helpful. Now it can feel safer if you have some underlying trauma or some difficult feelings that you know you just don't want to go there it can feel safer just to like numb some of your emotions and that's where the eating disorder has been a coping strategy and the eating disorder may have really offered you relief, escape, a safe place to escape some of those feelings but the travel is as well when you are cut off from your negative feelings you also miss things like joy, happiness, contentment your inner sort of excitement, surprise, feeling peace you know you've sort of been this kind of numb disconnected state which is not great so getting in touch with your feelings again it's a vital part of healing and this is a messy and imperfect process and takes time but it's absolutely worth it to feel more whole and to embrace all the parts of yourself. Okay number six therapy can help you develop a different relationship with your thoughts so with your mind channeling 60,000 thoughts a day many being repetitive you can understand the power of your thinking when you have an eating disorder your thoughts will be dominated by food, weight and shape concerns and you might also experience anxiety around these issues and your thoughts might feel wildly out of control so in therapy you can be supported to develop a different relationship with your thoughts firstly to develop awareness of them to be more accepting of them as just thoughts to realise that thoughts are not facts and you can also be taught to challenge unhelpful thoughts with more rational alternatives and or just to accept thoughts and thoughts can take more of a back step you know a back sort of a back step in your life rather than ruling the roost and particularly you know you might perhaps you've got a needing disorder voice in your head that's so strong and chastising so you can learn to develop a much more compassionate and kind dialogue with yourself and many people with eating disorders have this very strong inner critic could call it the eating disorder voice people experience it in different ways this voice that chastises them all day long not just about food but everything they do so you know really working to dilute that inner critic to develop a different relationship with thoughts can be infinitely helpful okay number seven you can develop self compassion and a healthier body image now your body image is likely to be negative if you have an eating disorder you might strongly dislike your body feel uncomfortable with it therapy can help you improve your body image you can actively learn to develop a kinder relationship to your body as achieving some self acceptance you can enter appreciate value your body for its strength and mobility rather than judging it so harshly and you can work towards being more body neutral this is often a more realistic goal in trying to be super body positive but many people that come into therapy are spending so much time focusing on their body and actually when you focus on something it expands exponentially in your consciousness so you know if you are constantly looking on social media looking in the mirror comparing yourself with others weighing yourself all the time all of these things are going to absolutely add fuel to the fire of negative body image so when you come start to reduce those behaviors focus your attention elsewhere and also develop self compassion tools you can really shift to a more peaceful place with your body image okay number eight you'll discover new ways to boost self esteem and self worth so as I've said you know when you have an eating disorder your self worth is so based on your body shape your weight when you're doing well with this you feel good when feeling out of control and it's not going so well you'll feel really bad so you can be really supported to value yourself more than for your body size to really start to get to know yourself to understand your unique strengths and qualities and just have to kind of back yourself many people as well with eating disorders are always looking for external validation or that external approval and that's you know that's a trauma response really when we haven't felt safe in the world we look outside to be accepted you know with tribal animals it's very understandable that we would do this but what we do with that is um you know we lose our inner compass when we're always like looking to be validated looking to be the best looking to get the feedback from outside you know it's an endless cycle we never feel good enough we become more more disconnected with ourselves because of we're trying to please the outer world and we've so lost touch with the inner so you can understand as well the roots of your low self worth really start to kind of unpick where you develop some of these beliefs you know often we have beliefs at points in our lives that are formed that are key to us you know that really shaped our whole future about how we feel about our body how we feel about ourselves and actually we can go back and like question some of those beliefs and begin to form alternative much more constructive helpful beliefs and it takes time because your identity may have become retangled with your eating disorder but this can change okay you know we can change our identity at any point okay and we don't just in eating disorder recovery want to focus on changing behaviors we really want to feel like I'm becoming the person that is developing a healthier relationship with food I'm becoming the person you know who is has good mental health who takes care of myself who has high quality connections etc and then the eating disorder gradually at the eating disorder identity becomes diluted okay nine regalapse also an inevitable part of the process is unlikely that you just wake up one day say goodbye to eating disorder and go off into the sunset forever more change takes time often fall down many times along the recovery road it's not linear recovery relapses part of the process and provides a valuable opportunity for learning builds resilience and awareness and you need me help to manage relapse you know in a constructive way we don't see it as a catastrophe but more as a learning point and over time relapse become shorter and duration you recover much more quickly and actually you can pick yourself up so yeah but again relapse lapse blips wherever you want to call them really normal part of recovery not something to be feared okay so I hope it's given you a bit of an insight into therapy for eating disorder treatment again just to confirm no one size fits all there are many ways to recover from eating disorder and this is my own perspective of the work that I do in my own therapy with my clients remember though it is possible to change and to recover from an eating disorder the road will not always be smooth and there'll be many inevitable bumps on the journey however it's worth taking the courageous step to reach out and have therapy it's also worth trying different avenues engaging yourself help taking her holistic approach following the breadcrumbs really where you feel led in your recovery where you feel drawn to engaging so letting go of an eating disorder can be about finding yourself and engaging more fully with life it's worth it it's absolutely possible hold on to hope you can do it thank you so much for listening you're not following me ready on Instagram do see me out the eating disorder therapist underscore the further support with your relationship with food do go to the eating disorder therapist.co.uk if you enjoy this podcast I'll be so grateful if you follow rate and review as it helps it reach so many more listeners thank you so much for listening and I look forward to sharing another podcast episode with you very soon 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