Starving and purging, besides offering temporary comfort, paradoxically felt "right" because by hurting her body, Cathy was both comforting and punishing herself. Immediately afterward, as she said, she felt a sense of relief, even of self-control. But the calm was short-lived, followed closely by all the old, bad feelings, redoubled—self-loathing, embarrassment, shame, guilt, worthlessness—all of which primed her for more self-harm, continuing the cycle.
Eventually, if therapy is working, clients begin to see the paradox and futility of using self-harm as a way to cope, soothe, and gain control. "Almost every day, I do something I'm ashamed of," Cathy said, once she began to understand her own behavior. "I feel compelled to do it—and then I feel worse. And since I have no other way to calm myself down, I do the same thing all over again to cope, to numb out, and feel better. I just keep going round and round in this endless, no-win circle."
Of course, it's one thing for a therapist to grasp something of the inner dynamic of eating disorders, but another thing entirely to help clients themselves recognize the vicious cycle they're in and find a way to interrupt it. Before clients can begin to look objectively at the larger pattern of their behavior, they need to feel safe and secure, gain some sense of inner composure, and experience more self-acceptance. And these things, in turn, go hand in hand with a strong, nurturing relationship with the therapist. The worst way to begin therapy with these clients, I learned, is to focus on behavior—food journals, calorie counting, weigh-ins. Their problems aren't primarily about food, but about pervasive, longstanding emotional pain. Furthermore, since they're already fighting themselves—and often members of their families—about their eating behavior, insisting that they begin following a series of rules just makes them feel they have to fight the therapist too.