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Cathy had been a volatile child, often exploding in anger, sometimes refusing to eat, having regular nightmares, and frequently sleeping in the hallway outside her parents' bedroom when they refused to let her in their room at night. Her parents responded to her distress by ignoring and then punishing her. In time, like many children, she shut down and turned her rage inward as self-blame and self-hatred. "My parents ignore me and punish me because there's something wrong with me," she'd said to herself as a child. "If I were prettier, smarter, different, then they'd love me." In an attempt to win over their affection and attention, she said, "I outwardly perfected the ability to smile, even though I felt utter despair inside."

I began to see that for clients like Cathy, family-of-origin trauma, neglect, and abuse often played a pivotal role in their narrative of suffering, frequently providing the internal "logic" behind their eating disorder. Even when eating-disordered clients haven't been abused, they may reveal old bereavements, traumas, or developmental disruptions that left them with unresolved feelings of shame, betrayal, deep insecurity, or worthlessness. Whether the result of overt abuse and neglect or not, such feelings often contribute to a distorted sense of self-blame, self-hatred, and the need to punish the body.

By inflicting physical pain on her through sexual abuse, Cathy's grandfather taught her to disrespect and dislike her body. Her sense of disconnection from her body was amplified when her parents forced her to finish food, even though she felt physically full. Cathy carried into her teen years and adulthood a sense of contempt for and alienation from her body.

"Throughout my adolescence, I dated boys who emotionally mistreated me and pressured me to do things sexually that I didn't want to do," she told me. "But I remember feeling numb and going along with it, never saying 'no' or 'stop.' This happened over and over. At the time, I didn't understand why, but in my head, I thought, 'It doesn't matter what happens to your body. You're just a lowlife and you deserve being treated like garbage.'"

The combination of self-blame, the need for self-punishment, and the dislike of one's body powerfully frame an eating disorder. These clients discover that they can chastise themselves by punishing their bodies through self-starvation, excessive overeating, or purging.

Abusive, neglectful, or emotionally unavailable parents don't comfort or soothe their children. As a result, their children never learn to soothe or comfort themselves, and they have no idea how to manage or regulate their emotions. "I felt bad all the time," Cathy told me. "I was angry, terrified, and alone. I wanted the emotional pain to stop. Sometimes I drank to feel better; to be numb. I experimented with cutting to make the bad feelings disappear. Then I discovered a kind of euphoria and a feeling of control, when I starved myself, and a release of the rage, when I purged. These were my only options for comfort."

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Jodie   |Registered |2011-04-22 10:58:04
avatar I really loved your article - it was moving and filled with love and acceptance
- exactly what the client with an eating disorder needs!
nkohlenberger  - Excellent article   |Registered |2011-02-11 07:16:48
I found this article filled with valuable information and a very supportive
example of working with an eating disordered client.

I had a client like this
leave my practice recently as the material we were covering was "too
uncomfortable for her," and she, after only a few months, was distressed
that she was still binging and purging. It is valuable to know that this can be
a very long process, and I am sad that my client was not able to hang in there.
However, your article was very validating in regard to how I worked with her.
It will also support me with other eating disordered clients in the
future.
Thank you.
debbragg  - "It's Not About the Food"   |Registered |2011-01-17 05:54:18
avatar I thought this was a wonderful article. As a new therapist, too -- I have been
told to steer clear of folks with eating disorders.

Lisa's approach showed
much empathy and "coming along side" the client to facilitate
healing.

Loved it and looking forward to her new book being published.

New
Marriage and Family Therapist

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