I am a member of an online site called Mumsclick (www.mumsclick.co.uk). As the name suggests it is mainly for mums, so that they may have ‘me’ time. A number of weeks ago, an article was posted by another Mumsclick member, Felicity, about her experiences with regard to her daughters anorexia. It got me thinking, and lead to me writing the following article, which was posted over two weeks, and is reproduced here in full.
I read the very moving story that Felicity was kind enough to share with us recently on this site (mumsclick), about the experiences of her and her family around her daughter’s anorexia. I know that it stirred a lot of thoughts amongst the members, and it certainly got me thinking about the relationships that we have with something so simple as the food we eat.
In my Cognitive Hypnotherapy practice (http://www.anitamitchell.co.uk), I see many people who would like help with weight control. Quite simply, they are overweight and would like to be slimmer. Usually they have tried more diets than they care to remember, and they may come to me with mixed ideas of what is achievable. I’m sure that many of us can relate to this sort of thing – I know that in the past I have had my own, not very healthy relationship, with food that was along these lines. So my client and myself will begin to work together. One of the first things I will tell them is that with my approach, they are not ‘on a diet’. If this is going to work long term, we need to tackle the relationship that they have with food. So, weight control in these circumstances can be a fairly easy thing to help people with, and over a number of weeks, together, we look into the relationship that the client has with food, and work to change it. If they are really committed to the process, we get to the stage were my clients are able to have a normal eating pattern, so that food doesn’t have the emotional attachment that it might once have had. People begin to eat consciously, body weight can naturally begin to stabilise to a sustainable level over time. Depending on how much they need to lose, it can take from a few weeks or months, to a few years. Occasionally, I will have a (usually) young person come to see me whose relationship with food has gone beyond this to the stage that it may even be life threatening if something isn’t done soon. Quite often they have already been through mainstream approaches which have not had the desired affect. Sometimes, it’s their parents who bring them to see me, at their wits end because they don’t know where to go from here. Occasionally the clients may themselves recognise that they need more help than they are presently receiving. However they end up in my office, unlike the person who might want to lose weight, those diagnosed with anorexia or bulimia nervosa, are unlikely to be with me for only a short number of sessions. But this is still brief therapy! I say that because we presently have a system were a patient may often see a psychiatrist for a long period, some will need to enter residential treatment, others will be seen as day patients. With this traditional way of treatment, it can often continue for many years. Mainstream approaches tends to centre on group therapy, action planning with a key worker, and health and weight monitoring. Therapeutic interventions are mainly behavioural. So, they may focus on changing eating habits and routines, food choices, portion size, or the feelings surrounding food, rather than their feelings about themselves, which in my opinion is key. It may also be that by focusing on altering conscious behaviour towards food rather than the unconscious intention behind their behaviour towards food, that the motivation behind the behaviour is being overlooked. Could that be why recovery levels in such places appears to be quite low and subsequent relapse upon discharge so high?
When I was in training to be a Cognitive Hypnotherapist, my trainer, Trevor Silvester of The Quest Institute (www.questinstitute.co.uk), talked about his thoughts on these places of residential treatment. As an ex-policeman, he recognised a parallel between young offender’s institutes and residential treatment homes. In his opinion, young criminals are often sent to young offender’s institutes as inexperienced juveniles, only to re-emerge at the end of their time there having learned the tricks of their criminal trade. In the same way, residential treatment homes could be seen as places where those suffering from anorexia or bulimia go to learn how to do it properly! If we bear in mind the competitive nature that those with eating disorders quite often have, then it is easy to understand why. If each person wants to be ‘the best’ at being anorexic/bulimic, what better place to learn! The result may be that sufferers could get worse and not better in this environment. Don’t get me wrong, I am not suggesting that this mainstream approach hasn’t had its successes, or that it is not the right way for some people. All I am saying is that it is not necessarily the best course of action for everyone, and that alternatives need to be available so that there is choice. We need to ask ourselves if this is always the most effective way of dealing with the problem?
Another common factor of people who have eating disorders is the avoidance of adulthood. By not eating, the body re-enters a pre-pubescent stage. What better place to stay a child than somewhere that has adults controlling almost all areas of someone’s life?
One of the main things with people who have eating disorders is that they often use food and the control of food in an attempt to compensate for feelings and emotions that may otherwise seem overwhelming. Sometimes they feel that it is the only area in their lives that they can control, after all, no one can make them eat if they don’t want to, or indeed stop them from vomiting afterwards. This is how it often starts; dieting, bingeing, and purging may begin as a way to cope with painful emotions and to feel in control of one’s life. Ultimately, these behaviours damage a person’s physical and emotional health; their confidence and self-esteem diminished. The irony is that the sufferer ends up being controlled by the behaviour, instead of the other way around.
From the point of view of a Cognitive Hypnotherapy approach, the first step in treatment is to change “I am an anorexic,” into “I am doing anorexia,” so that it is no longer the person’s identity, but merely a series of behaviours – it is no longer who I am, but something that I am doing. Quite often clients with this illness have grown up with a poor sense of identity and low self-esteem. They may fell like being labelled anorexic or bulimic somehow makes them feel like they are somebody. Better a label than invisibility. Often this desire for a label is a defence to hide the belief they hold at an unconscious level about their relationship with themselves and the world. This might typically be expressed as “I am not loved” or “I am not loveable.” They will usually rate their liking of themselves very low, so there is much work to do to improve self-esteem and confidence. Initially food and eating habits are not focused on at all. It is important to pace the client, so that we only move forward at a rate they are comfortable with. So it may be some time before food is even mentioned during therapy sessions. Instead work is done in two main areas, to improve their relationship with themselves, and also to de-identifying themselves with their illness. It is about getting to the root of a problem and dealing with it, rather than putting a sticking plaster over it – doing the ‘head stuff’ as one of my clients once put it.
Cognitive Hypnotherapy is not THE answer to eating disorders, and of course, may not be right for everyone, but it certainly has the potential to be the difference that makes the difference for many.