The emotional side of Eating Disorders - Part II

by Stella Stathi

To read the first part of this article, please click here.

How can therapy help Eating Disorders' clients learn to healthily and effectively deal with their emotions?

a) Setting the foundation – Developing Awareness

Eliminating negative beliefs about self and feelings

First and foremost, the individual who has developed such rigid and negative attitudes towards emotions and their expression needs to be given explicit permission to feel; to be encouraged to allow their inner experience to be revealed and openly shared in an environment free of judgment and filled with respect. In order for this to happen, it is important for the client to be assisted in recognizing, challenging and eventually eliminating the unhelpful beliefs about themselves, and their needs and emotions that cause them to neglect their feelings in the first place.

Such beliefs act as barriers, often taking the form of what is known in psychotherapy as the inner critic, or the victimizer, and prevent the individual from making any progress, by freezing their natural, spontaneous expression and connection with themselves. However, because they have usually been part of the person’s mindset/inner dialogue for too long, they tend to go unnoticed and be taken for granted, until somebody else brings them to one’s attention and facilitates an alternative way of thinking.

Becoming aware of emotions, as they exist in the body

After the foundation is established, one of the most important tasks of therapy is to guide the eating disorders’ sufferer to notice and acknowledge their emotions. As was discussed in part I of this article, people who struggle with food-related issues have become experts in dissociating from, ignoring and suppressing the signals from their bodies, mind and heart; therefore, the process of re-education and restoration of this connection constitutes a critical part of treatment.

One of the most effective ways to become aware of one’s emotions, funnily enough, is through the body. Every emotion manifests through a combination of specific physical sensations -for example, anxiety is associated with an increased heart rate, cold sweat, an upset stomach, etc. As a result, body awareness is an invaluable skill that enables the individual to get back in touch with their internal experience.

This is one of the main benefits of body-inclusive approaches to psychotherapy; incorporating the body and using it as an anchor and a guide, so as to take the individual on a deeper level than that of the mind. People with eating disorders are typically really bright and strong intellectually; however, talking and rationalizing, when not balanced with an equally developed connection with the rest of one’s body -below the head- can also be used as a defence against feeling.

Naming emotions

Finding the words to name an emotion naturally follows its observation. Many individuals with eating disorders also suffer from alexithymia; a condition characterized by the inability to recognize and describe emotions. Naming emotions and being able to distinguish among the wide range of them is crucial, in order to be able to share one’s emotional experience and make meaning out of it. Practicing naming and identifying the numerous different shades of emotions, with the help and support of a therapist, slowly but steadily builds an enriched emotional repertoire, which in turn facilitates deeper understanding of oneself and one’s ensuing behaviour.

b) Dealing with emotions through compassionate acceptance and self-loving action

In my practice, I have had clients who had reached in advance that state of being able to both track their emotions and recognize them for what they were. Their burning question then, when they came to see me, was one: What do I do with them? The answer to this question is the subsequent vital part of therapy and of this article.

Up until this point, food and other related means and actions were the only ways people had to deal with what they experienced –whether conscious or unconscious of what that experience was about, at any given time. Coping strategies like those, no matter how unhelpful, cannot and should not be taken away prematurely, or the person will run the risk of becoming emotionally overwhelmed. What actually needs to happen is for alternative, functional and healthy skills to be acquired, which will then gradually replace the old ones, until they are simply not needed anymore.

With regard to emotional regulation, there are two distinct yet complementary fundamental approaches in contemporary psychotherapy practice and in eating disorders treatment, in particular. These can be divided into the energetic/’doing’ and the passive/’being’ approach, or, in other words, the ‘masculine’/proactive and the ‘feminine’/accepting one.

Mindfulness; staying with our experience

Beginning with the ‘being’/accepting one, this approach originates from the ancient tradition of mindfulness. Mindfulness is otherwise translated as awareness and describes a state where one is conscious or ‘mindful’ of their experience in the here and now. As a practice, it consists of many different practices and stages, such as: mindfulness of the breath, mindfulness of the body or physical sensations, of emotions, of thoughts, etc.

As can be assumed, focused awareness is part of each and every one of the steps and processes that have been described so far; we need awareness to notice our physical sensations and our thought patterns, and to distinguish one emotional tone from another. Nevertheless, mindfulness has even more to offer when it comes to constructively dealing with our emotions. By utilizing the breath as an anchor and the body as the container, it progressively teaches us how to ‘stay with’ our experience, to ‘hold’ it and embrace it, without trying to change it in any way. Over time, through practice, the individual develops a state of mind known as the inner witness, who observes their inner environment non-judgmentally and with compassion, and is hence able to respond in an informed and wise, rather than an impulsive, unconscious and defensive way.

Therapy, in and of its nature, facilitates mindfulness, by exclusively focusing on the client and exploring their beliefs, feelings and behavioural patterns. However, the more actively and consistently the therapist brings the client back in touch with their embodied experience, the easier will the client become familiar with the practice and able to incorporate it in their daily life. Being in the presence of a professional who can mirror their emotions, while modelling and encouraging unconditional acceptance and non-judgmental curiosity towards them, the client becomes capable of internalizing this response and making it ‘their own’, gradually building up their emotional resilience.

Attending to our needs in a self-loving way

Last but not least, there is the ‘doing’ part in the process of learning how to positively regulate our emotions. This more active approach naturally and organically rises from the previous one; mindfulness. All negative emotions occur because a very important need goes unmet. Therefore, they are the most reliable sources of information about what we truly need, in order to return to our natural state of joy and ease. When we open our inner eyes and ears, through mindfulness and curiosity, we become receptive to the important messages our emotions hold about what kind of support and care they/we need. What is then left is to actually provide that care in an efficient, loving way.

A skilled therapist will work together with the client and assist them in acquiring and strengthening non-food-related, self-comforting skills that can successfully replace their old, self-neglecting ones. This can include very small yet significant actions of self-love and care, such as touching one’s heart when it aches, going on a long walk in nature when stressed, or calling a friend when feeling lonely. All that might sound common sense to some people, but self-care firstly requires awareness of one’s feelings and needs, and also the confidence that one deserves to have their needs met; both of which, more often than not, are initially missing in eating disorders’ clients.

There is also a large gap between knowing what is best for us and actually getting to do that for ourselves. The presence of a therapist acts as a grounding, reinforcing energy, providing consistency and support, when one’s own motivation is not strong enough.

c) The therapeutic relationship

The above-mentioned steps and processes, though displayed as distinct and successive, are always present and worked through concurrently in therapy. The progress one makes in any one of them instantly facilitates further progress on all the rest. Ultimately though, beyond all theories and practices, it is the solid, genuine, empathic relationship between therapist and client that is invariably the most important element in any type of therapy, eating disorders treatment included. The experience of being respectfully listened to, sincerely understood and unconditionally accepted for who you are, create the unique conditions that encourage and support emotional openness, compassion for oneself and healing on all levels.