In this week’s blog post, Oliver-Pyatt Centers Founder Wendy Oliver-Pyatt, MD, FAED, CEDS shares her personal perspective on being in recovery versus being recovered. Read on to learn more from OPC’s Founder and eating disorder expert…
Recovery is a process. Recovered is more like an outcome. Both are possible. They are connected, but they are different. On one hand, the recovery process begins to unfold when you have started to really develop the conviction that the eating disorder is no longer an option, and you are willing to do whatever it takes to recover. This is when the process of recovery really begins. However, you can also be in the process of your recovery, even before you have truly decided you have “had enough,” or when the conviction to recover has not fully set in; examples of when this may come up are when you are in treatment and are beginning to engage with another human being in a truly meaningful way, but are uncertain of your conviction to actually become recovered. Or perhaps you don’t really have the vision, the hope and the confidence that you can really become recovered; but you are willing to give it a shot, you are willing to step outside of your isolation and allow a new way, or new people into your world. During this phase you may have a lack of intention, or a lacking of strength to behave in a fully recovered way, but you are willing to engage in the process. In this case, you are in a healing phase, and you are recovering (even if you are very ambivalent about it!)
Alternatively, a person may have full conviction, intention, and determination to recover, and they may even be certain they will recover. This does not guarantee immediate results. So often, patients and families are confused. We live in a society that says, “Just do it!” When we try this, we do expect results! Nothing can be more difficult than to have the expectation if we just try hard enough, and want something enough, we are going to be able to “do it.” Time and time again, patients, families, and even providers are attached to this concept. This can lead to very difficult and even dangerous experiences for a person with an eating disorder. A frequent time we hear this mindset is when a patient or family says, “I am going to college in the fall, the structure will really help me” only to find that the stress, the demands, and the nature of a potentially triggering environment make things worse not better. Another situation this comes up is when a patient is willing to do everything expected of them in treatment, but not all the components of recovery are not integrated. Perhaps they will do as they are told, they will try and try and try. But this does not mean the person is fully engaging in treatment, or that they are aware of, sharing, and/or confronting the struggles in their life. Intention to recover does not equate with a guarantee that you are in a healing phase, or that all of the pieces are intact to lead to being fully recovered (the person may in fact underestimate their needs in general – a hallmark of all forms of eating disorders, and may underestimate what they need in order to recover.)
In some of my presentations I create a slide that reads: “Intention to Recover vs Healing Process.” What I am trying to point out is that one can have an intention to recover, yet not be engaging in a vulnerable and open relationship with others, or be developmentally able to process the emotions that leave them locked in the eating disorder and one can be in a healing process, even when they have very little, if any intention to recover.
Becoming recovered is when you have both healing process and intent operating simultaneously, to some extent. For me, personally, I became recovered when I was truly sick and tired of my eating disorder ways, and was willing to do whatever it took to recover. It was still trial and error, but I refused to be controlled by a mandated weight or size, and furthermore, I fully rejected the idea that restriction of my calories would ever bring me happiness, peace or fulfillment. I abandoned the pursuit of weight loss, and instead pursued the practice of mindful eating, and ultimately mindful living. I continued on the trajectory of healing, despite set backs and struggles.
To me, this is a little bit like learning to play the piano. When you first begin, you have to practice measure-by-measure, line-by-line, sometimes right hand alone, sometimes left hand alone. You mistake the F sharp for an F over and over, and have to re-do certain parts of the piece over and over. It seems like it will never work! This is the recovery process. The amount of time and energy this takes is individual to each specific person and their circumstance. What shockingly happens when you are committed to the process is the most amazing. Through this intention, and this process, eventually you play this music “by heart”…meaning no written music is necessary. Isn’t that kind of funny? When you master a piece, and play it without any music, we call it playing “by heart.” That is a little bit what it feels like to become recovered. Over and over you practice and fail at mindful eating. Just like over and over you fail to play that piece of music without errors. But you keep coming back to it. And eventually the song comes out of you, versus being forced. The piece is played without the written music, and when you are playing it, you are not fighting your way through it. It flows.
I think this is why it is so important to remember the distinction between the terms “recovery” and “recovered.” Here is what my friend, Carolyn Costin says about being recovered: “Being recovered, to me, is when the person can accept his or her natural body size and shape and no longer has a self destructive or unnatural relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life and what you weigh is not more important than whom you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size or reach a certain number on a scale.”
A person may not yet have the strength, conviction, confidence or trust needed to leave the eating disorder paradigm. This process cannot always be “willed.” It is an uncertain and mysterious process for a person to develop a sense of trust with self and/or a connection to self that really allows you to be exposed and vulnerable, or be open to a new way of experiencing food (and life.)
Recovery is when you are able to combine the process of recovering, with a willful intention to recover, and you are willing to do whatever it takes for as long as it takes to train or retrain yourself to live a life guided by mindfulness.
Being recovered means that I am not living my life based on weight, shape, or being focused on food. Being recovered is not “white knuckling” it. It is like playing the piano from heart. I am living life based on my heart, by intellect, and my “inner compass.” This also means I am not attached to outside approval, and am not wed to avoiding all conflict. I am thankful I stumbled across Mindful Eating/Intuitive Eating when I did in my life. Had I not, I don’t know if I would have ever recovered. What is most important to me now is that my attention and energy are actually available to me to live according to my values and according to what really excites me. Being recovered is not something I think about a lot – but deep down it is always something I have gratitude for.
Oliver-Pyatt Centers IOP/TLP Clinical Director Giulia Suro, PhD gives an inside look into her work at OPC. In her post, Giulia shares her personal journey to OPC and how she and her team support women on their journeys to full recovery. Read on to learn more about Giulia and the IOP/TLP team…
What is your name and what are your credentials?
My name is Giulia Suro and I am licensed clinical psychologist.
Please give us a brief description of your background.
I completed my undergraduate degree, receiving a BA in Psychology at University of Southern California and went on to pursue my Master’s Degree in Mental Health Counseling at Colombia University in New York City. It was during this program that I exposed myself to a wide range of clinical experiences including non-profit community mental health, inpatient psychiatric settings and even spent two years working in Rikers Island Jail. I realized I most enjoyed working with individuals experiencing severe symptoms of psychological distress and pursued my Doctorate of Clinical Psychology at University of Miami. I spent my third year as a doctoral student working in OPC’s Intensive Outpatient Program as a “prac” a few days a week. I really fell in love with OPC as a setting, its treatment philosophy as well as the meaningful work we’re able to do with the women who come here for care. I returned as a Postdoctoral Resident and spent two years as a primary therapist in the Comprehensive programs before transitioning to Clinical Director of IOP/TLP.
What does a typical day look like for you at OPC?
One of the things I love most about my job is that there is no real typical day. Time is divided between running groups, individual client sessions, supervision, family calls, seminars and administrative meetings. I recently established a weekly Acceptance and Commitment Therapy (ACT) consultation group with the other clinicians conducting ACT groups, and that has quickly become my favorite hour of the week.
In your own words, please describe the philosophy of OPC.
I think there are several threads that come together to create the OPC philosophy. The first is a commitment to individualized care and treating the unique needs of each woman who comes here for help. Along these lines, I believe we are very open to thinking outside the box in our effort to fully eradicate the eating disorder. This may include specialized therapeutic approaches, passes and exposures. Additionally, I believe all of our providers convey the message that the women are deserving of a meaningful life free of shame and suffering. This is conveyed in therapy, groups, meals and all interactions with staff.
How does your team work together? How do your roles overlap and differ?
I am constantly blown away by the IOP team. We are small but mighty! Each of the therapists, dieticians and recovery coaches are so very passionate for and committed to their job. We are consistently discussing how we can creatively continue to support our clients in their recoveries and I love that every member of the team sets a bar of full recovery for each woman we treat. We often come together as a well-oiled machine in multidisciplinary treatment teams to tackle the ED from all angles and push our clients toward recovery as a united front.
What is your favorite thing about OPC?
What first inspired me about OPC was the staff who work here and the culture they created. It is a daily gift to be able to work alongside brilliant, bold, women who are dedicated to helping those with eating disorders. We support one another in achieving our professional goals as well as in having a healthy work-life balance.
What are three facts about you that people do not know?
I usually wake up before the sun comes up to do yoga and meditate.
I love tomatoes so much I designed a garden where I could grow my own.
I have dog named Jack and he is truly magical!
The Nutrition Blog Series will take an in-depth look at the nutrition programs of our three eating disorder programs, Oliver-Pyatt Centers, Monte Nido and Clementine adolescent treatment program. This week, we hope to give a brief introduction to the programs and in the coming weeks, will offer a deeper understanding of what nutrition philosophy looks like at each individual program.
Oliver-Pyatt Centers, Monte Nido and Clementine are three eating disorder treatment programs that operate with the same intention: To support individuals healing from eating disorders and to help them realize their potential of full recovery. That being said, we understand treatment is not a one-size-fits-all formula. Our three directors of nutrition come from the same underlying dietary philosophy that combines medically based research in the treatment of eating disorders with practices that help individuals learn to confidently nourish themselves independently. By understanding the slight differentiators that are practiced in all three facilities, it becomes easy to see that though the day-to-day may differ for clients from facility to facility, the fundamental reasoning for these different practices come from the same place.
Oliver-Pyatt Centers in Miami offers comprehensive, day treatment, transitional living and intensive out-patient programs for women seeking eating disorder recovery. Our program uses thoughtfully planned, supported food exposures to challenge food rituals, beliefs and judgments while building skills and laying the foundational understanding of the role hunger, fullness and satiety play in self-nourishment. We work with a variety of mindful eating techniques, paying particular attention to hunger and fullness cues, while implementing a medically indicated and individually structured meal plans. Our hope is that this combination lays the groundwork for a future of intuitive eating as our clients move toward full recovery after discharge.
Monte Nido treatment centers offers residential, day and intensive outpatient programming and transitional living for clients seeking eating disorder recovery. At Monte Nido treatment centers, we work with our clients to support their nutritional, physical, and emotional health and wellbeing. With treatment of the whole person as our guide, our initial goal is to build rapport with our clients, to gain an understanding of an individual’s challenges and to formulate an individualized treatment plan that promotes movement away from eating disorder ideals and towards whole health. Using thoughtfully planned, supported exposures to a variety of food and eating environments, active challenging of eating disorder behaviors, and individualized, structured meal plans, we work with our clients to support the development of the skills required for a life of conscious eating.
Lastly, Clementine is strategically structured for the treatment of adolescents with philosophies that pull from both of its parent programs. Our dietary practices are no exception; nutritional practices are based on research that is aligned with adolescent growth and development. We practice mindful eating techniques before and during meals and reflect after mealtime. There is an emphasis placed on healing the whole family through education, family food exposures and individual work with the family.
While on paper all three programs appear somewhat different, our objectives remain the same. In the next few weeks we’ll dive into the specifics of each program to reveal some more key similarities and differences between the three programs. Our first in-depth look at nutrition will be focused on Monte Nido programs and can be found here.