You may be living with or in recovery from an eating disorder or maybe you just know what its like to experience body shame with the diet culture we live in. Spring and Summer can be a trigger to restrictive urges, body comparisons and self-judgement. Learn 3 tools to strengthen your body image this Summer.
At times, all of us have eaten a bit, or a lot more than is comfortable in our bodies. Holidays, celebrations or sometimes mindless eating in front of the TV can leave us feeling overly full. For some, this way of eating is more common and happens more frequently than we’d like. The new DSM-V, the Psychiatric Association’s manual on diagnosis, has created a diagnosis under the eating disorder umbrella called Binge Eating Disorder or BED. Whether you meet the criteria for this disorder, for bulimia, anorexia, or you just find yourself overly stuffed at times, these tools can be helpful:
1. Notice what types of foods you’re binging on and write them down.
It helps to look at your behavioral patterns. Some people find themselves eating excessive sweets, some are more geared towards fats or starches. Some people with emotional eating tendencies excessively eat any kind of meal including vegetables. See if you can find a pattern in your binge choices.
2. Notice what you DON’T binge on.
Are there any types of foods that you’d never consider in a binge or never feel the need to over-eat? In a recent session, a client was relaying the guilt and shame he felt after a binge. He reported that he doesn’t usually allow pastries in the house, but was feeling strong recently and thought it’d be okay. He found himself finishing off the pastries he had in one sitting. Upon further investigation into what foods he was allowing himself to eat regularly, the client determined that he felt very satisfied when he ate waffles and allowed himself to eat waffles multiple times per week. I asked him if he ever binges on waffles. He was shocked when he thought about it and said that – no – he never binges on waffles. Ok, great, so there’s no waffle binging going on, but how does that help? Follow me here.
3. Take a look at what you ‘allow’ yourself to eat regularly.
What foods do you consider safe? In an attempt to be healthy, lose weight, or just get control over your food choices, you may be very rigid or restrictive about what you allow yourself to eat on a regular basis. Perhaps your choices look benign enough like chicken and veggies multiple times per week. Write down what you’ve eaten over the past 3 days to 1 week or track your food for a week. What do you notice?
4. What is missing from your regular eating habits?
Take those same meal journals and notice what you don’t have there. If we consider all the food groups: protein, fat, starch, veggies, fruits and dairy – are there any food groups missing? Are there lots of repeated meals without much variety?
Now I know this might seem completely insane and a bit scary, but HERE’S THE KEY to quit binging. Ready?
5. Allow yourself to eat the foods you binge on.
Try adding a portion or 2 of the foods you don’t allow yourself to eat and some of the most common foods you binge on to your regular meal schedule. I know this might seem counter-intuitive. Our society tells us to resist, have discipline, diet harder, avoid sugars and carbs and fats and this may be the only voice you’ve ever heard that encourages these things, but just give it a try for a month or even a week and see what happens. If you are on the anti-carb kick, but then you find yourself binging on carbs, try adding a normal amount of carbs to each meal and see what your body craves after a while.
Here’s the rub – We are creatures of desire.
Food is part of life! It’s nourishing and delicious and sensual. When we restrict ourselves from eating foods we love, we may lose weight in the short run, but this does not happen without consequence. Our animalistic nature, our Id, it craves pleasure and passion and vigor. If we force ourselves to live inside a rigid box of rules around food and body, we will always desire to break free and stepping outside of that box causes immense shame and fear. I am not telling you to overeat or teaching you how to binge differently, but what I am suggesting is that you try to take the power out of the foods that haunt you.
If you regularly binge on entire cartons of ice cream, see what happens when you have a cup every night for a week. What emotions come up when you eat it? Can you journal about them and bring them into your therapist? What do you find yourself craving after that week of glorious freedom with ice cream?
If you live near The Main Line of Philadelphia or West Chester and want to learn more about binging and how to quit, or you’re not sure where to find support for your feelings around food, you’re not alone. Please feel free to contact me at 610.314.8402 – I’d be happy to help you find support.
Exposure therapy can be very effective when done in a way that gives a sense of empowerment and helps people defeat their fears. If you have a client who has avoided eating normal meals or meals out at restaurants, challenge meals can be a great intervention for them.
Challenge meals are something that I usually suggest to a client after we’ve been working together for a while. We’ve sat in the therapy room a number of times and I’ve built a therapeutic alliance with them. I assess for their fear foods. I find out what their “red” foods are – their biggest fear foods, their “yellow” foods are foods that are moderately anxiety provoking and their “green” foods – ones they eat regularly and don’t usually feel guilty about. They’ve relayed their goals, their history and are comfortable in the room with me. Once this stage has been set, we begin working towards their goals. Often times, their goals include a desire to normalize their eating habits or to be able to eat in social situations without sinking into extreme guilt afterward. When I see that the client is motivated and willing to take some risk in order to accomplish their goals, I present the idea of a challenge meal to them. I let them know that sometimes I go out to eat with my clients in order to help them find normalcy around food and restaurants. I ask if this is something they might be interested in trying. If fear, other types of resistance or hesitancy comes up, we process that. I may use Motivational Interviewing techniques in order to help them find benefit in pushing themselves towards their goal.
Once the client has agreed to a challenge meal, I start with the easiest scenario first. We start with green level foods and see if we can make a “normal” meal out of them. So for example, if they’re regularly eating tuna fish, but eat it with vinegar instead of mayonnaise, and with vegetables instead of bread, we see if we can create something a bit more normal and a bit more challenging. So I might suggest tuna with mayo on bread or if bread is too scary, perhaps we’d start with a cracker or tortilla. During the preparation phase, I negotiate with the client and their eating disorder on what would be challenging yet doable.
The goal is for the client to feel successful so that they desire to try again. It’s like learning to lift weights at the gym, we start with lighter, easier weights until our body gets used to it and builds up to the heftier weights. The first few challenge meals may be done in the office and the client may bring the food or the therapist may bring the food.
When the client is ready to eat at a restaurant, we prepare by negotiating where they want to eat. We also decide what we will say if we bump into anyone we know in order to keep their confidentiality. Sometimes we agree to say we know each other from school or a friend or sometimes a parent’s friend. I am very careful to speak quietly and refrain from any intervention when others’ could overhear. I usually ask them if there’s a restaurant they’ve been wanting to try or if there’s a type of food they’d like to get support around. Once we pick the restaurant, then we look at the menu. When eating a challenge meal in a restaurant, depending on that particular client, we may decide what they will be ordering before we go to the restaurant or we might negotiate once we get there. Depending on what would most ease the clients’ anxiety, we may do this right before going to the restaurant or the week before. I wouldn’t want them to fret all week about what they’ll be eating, but sometimes it helps ease anxiety to get used to the idea and sit on it for a week. Timing of this is at your and your clients’ discretion.
Beginning the meal
If the challenge meal is in the office, begin the meal as soon as possible in order to leave the most time afterward to digest and process and reduce the risk and desire for a purge. The client can use the bathroom before the meal begins so that they won’t need to use it for at least an hour after the meal.
Ordering from a menu
If the food needs to be ordered in a restaurant, help the client decide what to order, ask if they’d like an appetizer or a side dish and assure them they will only need to eat an appropriate amount. So if they get an appetizer and a main course, they might only eat half of each, depending on their satiety cues. Eating a variety of foods is good practice to combat ED. If they’re getting overwhelmed by the menu, help them to narrow it down by quietly reminding them of the original goal they had in mind. For example, “well, when you chose this restaurant, you wanted pizza, so let’s stick with that – and you can get a vegetable to go with it and that will provide all the food groups: starch, fat, protein and veg. So which type of pizza looks or sounds the most appetizing to you right now?” This way they still have choice, but the overwhelming choices are paired down for them. Pay attention to what they’re ordering to make sure it’s an appropriate meal. If they’re ordering an appetizer only, be sure it includes all the food groups and possibly suggest they order 2 appetizers or have a roll with their appetizer to supplement their meal or they may just need an entre. Salads are usually not an appropriate challenge meal, but a salad with a challenging appetizer may make sense. Diet foods are not appropriate for challenge meals, so eliminate any diet drinks or egg whites, protein bars, etc. Make sure the food YOU order is also not triggering to your client. They are watching you. If you order the same meal as them, it may make things easier on them. When they have progressed further along, this may become part of the challenge – to tolerate your food item while they eat theirs.
Set the stage for the meal by activating the body signals that have been shut off for so long. Ask the client on a scale of 0-10 with 0 being supremely starving and 10 being so stuffed they feel sick and unable to move – the most full they’ve ever felt in their life – what number are they at right now? You can use a hunger cue card like the one shown here.
Identify their hunger signal and yours and if you’re in a group, have each member identify how hungry they are both emotionally and physically.
The actual process of a challenge meal should not be emotionally heavy or food focused. Try to steer the conversation away from inspecting or commenting on the food or body or fullness. Instead, talk about lighter appropriate topics like the weather, the atmosphere in the room, how their day was, sports – a movie or TV show. In a group, playing a game can be very helpful. Some favorites are “contact” or thinking up famous peoples’ names in alphabetical order.
Eating the meal should not take more than 30 minutes. Sometimes clients will try to cut food into tiny pieces or take very small bites or eat very slowly. This will require an intervening prompt from you. Something like “please take normal bites” or “that’s cut small enough, let’s start the meal now” or “we’ve got 15 minutes left, please keep up the pace so we can finish the meal on time” are some prompts you might use. It is our job to help them contain and combat their ED voice. We state the prompt clearly, yet quietly so others’ don’t over-hear and we say it neutrally and without judgment. If they’re still playing with their food and interventions aren’t working, I usually just let it be rather than getting into a struggle with them in public and process what happened later.
If they’re getting an especially challenging meal and they’re anxious about it, I will suggest they can cut their meal in half and just start with the first half. After the first half, we can check into hunger cues and see how they are with continuing. I often tell clients that I believe it is more important that they feel successful in eating a challenge meal, but perhaps less of it, than eating too much and feeling overly full and triggered to purge. This is true in an outpatient therapy setting. Residential or partial hospitalization has more containment and ability to monitor clients after the meal, so that’s a different story. But for my purposes, I don’t believe feeling overly full is in the client’s best interest.
After the meal
Once the meal is complete, be sure to sit at the table for a while and discourage any bathroom use. You can ask them how their meal was and how they feel emotionally. Ask what the experience was like and if they’d get the same meal next time or if there’s something else they might like to try next time. Focus on their success and offer any authentic praise for challenging themselves and their ED. If they have some regret or guilt, help give them the words to combat the guilt internally. Something like: “This is one meal, it was enjoyable and my body knows how to process it.” Or “I’m defeating ED one meal at a time. I need food to nourish my body. I am proud of myself for standing up to ED.” Another favorite “this is what normal looks like. People go out to eat and enjoy food and they’re okay so I can be okay too.”
The more exposure, the more the client will get used to eating food and eating it in challenging settings. This helps lay the foundation for less social isolation and more ability to tolerate food and restaurants. Really and truly, one meal at a time really does make a difference. Supporting a client through a challenge meal shows them that they are capable and gives them a successful experience to remember when they’re ready to try it on their own.
What have been your experiences with challenge meals? Comment below.
If you want to learn more about challenge meals, I’d be happy to help. Contact me at 610.314.8402 or TiffanySpilove@yahoo.com
Please comment below and tell us your story!
West Chester, Pennsylvania is just south of The Main Line – an area rich with resources, beautiful settings, history and academic prestige. With all this knowledge about … well, everything - in our town, why is it so difficult to fully grasp what eating disorder therapy actually is? What does it do? How does it work?
And the most important question of all – WILL – IT – MAKE – ME – FAT?
You may have found counselors in West Chester that were kind enough and surely helpful. Understandably, you’ve got lots of questions.
It is so normal to be scared.
It is completely understandable if you’re wanting help – wanting support, but you can’t quite get yourself to take the plunge – and for MANY reasons (including the fear of getting fat). There are other reasons you’re probably scared:
you know there’s a bunch of things in your past, or perhaps your family, that may have contributed to your anorexia, but you don’t want to blame them.
You know you’ve got some difficult memories stored away, but that’s just the point – they’re STORED neatly away and the thought of walking into a counseling office and TALKING about them seems like the worst idea ever! Also, the commitment!
The binging and purging takes up ALL OF YOUR TIME –
every last ounce of energy you have to get to the grocery store, buy your binge foods, bring them home, make sure no one’s around and then the binge. Eating and purging and eating and counting and cleaning and being COMPLETELY EXHAUSTED! Who has time for therapy, let alone has the ability to commit to a specific time every week to show up?
But you’re so tired!
Tired of this dance you are doing with a gorilla – he won’t let go and you just keep spinning and you’re out of control and you want help, but it all just seems too overwhelming.
I hear you – it’s a dark way to live
You don’t have to feel like this anymore
Here are some debunked myths about eating disorder therapy:
1. Will my therapist try to make me fat?
No. We are not here to make you fat, contrary to popular belief. Geneen Roth says that recovery is about finding balance in food, weight and life; it's not about gaining weight. Recovery from anorexia, bulimia and binge eating disorder is NOT about making you fat. My focus, when I work with clients struggling with ED, is to help them break free from the obsession with food and body. To help them learn to love their bodies and live inside of them. To find peace around food and this is NOT done through binging! This is done by UNdoing the diet mentality. Diets make people with eating disorders either fat or nutty or both.
The goal for someone trying to find recovery from anorexia, bulimia or binge eating disorder is to eat when you are hungry, to eat enough food, that you enjoy, to SATISFY you and to stop eating when you are SATISFIED.
If you practice this way of normal or intuitive eating, your body will follow suit. If you are not restricting all day, every day and then binging and purging up your food, your body will do what it was born to do naturally – it will process the food and use the calories to give you energy and help your hair shine and your skin retain moisture. It will also alleviate the depression and anxiety you are experiencing from malnutrition.
2. If I go to therapy, will I spend all my time digging up the past and talking about my mother?
No. As a therapist, I believe your history is one important component of what makes you - YOU. I usually spend some time exploring things that happened in the past, but only as I find it helpful for the present – or if my client wants to explore or use EMDR to process an upsetting memory, then, of course we go there. But this is not the focus. As a therapist, my job is to help you identify YOUR GOALS and I am the guide that helps you reach them.
Another thing to consider is coaching. One of the differences between a therapy and a coaching is that coaching is usually much more directive and there’s virtually no history that comes into play. Coaching can be very useful especially for help with navigating things like grocery stores, restaurants or meal times. I incorporate coaching techniques when my clients are in need of this sort of direction. Whatever it takes to reach your goals and so you don’t need to be in therapy for the rest of your life.
3. Won’t I just be put on another diet?
No. Not when working with this type of eating disorder recovery, anyway. Some clinicians believe the way to heal an eating disorder is through rigid meal plans and restriction of certain food groups. Perhaps this works for some people, but don’t you want freedom? REAL freedom? As Jenni Schaeffer said, “How free do you want to be?” YOU CAN FULLY HEAL FROM YOUR EATING DISORDER. You CAN find freedom from all sorts of restriction. The beginning stages of recovery may involve a meal plan from a registered dietitian who specializes in eating disorders. We usually work on the exchange system. Rather than counting calories or measuring amounts of foods, we use exchanges to help you get away from the diet mentality.
And we meet you where you are at.
If you are not ready to eat 3 meals a day, that is okay. It is our job to help you mediate your anxiety around food; not to overwhelm you. Middle and late stages of recovery often move away from meal plans and move more towards intuitive and normal eating. (whatever that is right?) But honestly, the goal is to help you find freedom to enjoy meals with friends and family – to put food in its place in your life instead of allowing it to dominate and terrorize you. Dieting is not part of eating disorder recovery.
I hope this helps debunk some of the myths about eating disorder therapy, and hopefully, it will help you in your search for the right eating disorder therapist in West Chester Pennsylvania. If you are still feeling stuck, please don’t hesitate to call me at 610.314.8402 for a free 15-minute phone consultation. I’m happy to hear about what is happening and help direct you to the right person. If you are looking for help with eating disorders, you can read more about how I can help here.