Karin Lawson is a licensed psychologist, certified eating disorder therapist and writer in private practice. She’s located in Miami, FL. Dr. Lawson is currently the Vice President of the International Association of Eating Disorder Professionals – Miami Chapter, as well as the President-Elect of the Miami-Dade-Monroe Psychological Association. Dr. Lawson discusses the idea of S.M.A.R.T. goals in this week’s blog post.
Dr. Kristen Neff acknowledges in her writings and her academic research, self-esteem is created by comparison and evaluation. It’s the work, school and sometimes even the play environments that most often builds or tears down our self-esteem. If you know me at all, you’ll know that I’m not a fan of the comparison route. We do enough of it already and are schooled in it literally. However, I also believe that rare is the thing that is “all bad” or “all good.” So, how can we utilize this idea of self-esteem stemming from evaluation into a well-thought-out self-esteem boost?
We can set some very intentional, realistic goals. But these goals can’t be just any ol’ goals. To really set ourselves up for success, we need to set S.M.A.R.T. goals. Smart stands for Specific, Measurable, Achievable, Realistic, and Time-bound.
What does this look like in real life?
Is there something you’ve been wanting to do but haven’t gotten around to? Perhaps you started a project a while ago but have yet to complete it. Deep down this lack of completion has caused your self-esteem to take a hit.
Let’s say you’ve been wanting (and very much needing) to clean out the garage. You’ve probably said to yourself, “I’ve really got to go through the garage and throw a bunch of stuff out.”
That’s an okay start, but as goals go, it’s pretty vague. Let’s use S.M.A.R.T. goals to get the job done.
Here’s a Specific goal: “I am going to clean out and reorganize the garage.”
That’s good. Now how do we make that Measurable? Let’s add some words that will help us know when and if we complete our goal. “I am going to clean out and reorganize the garage so both cars and all of our bikes fit.”
You’ll also want to be able to measure your progress toward your goal to be certain you are staying on track. So, you could decide to spend two hours each Saturday and Sunday for the next 4 weeks. If you do that, you will know you’re on the right path to achieving your goal. If you don’t meet these milestones, you’ll know you’ve gotten off-track.
Now let’s talk about whether or not your goal is Achievable. Well, other human beings have cleaned out and organized their garage, so you know it’s possible. You have the desire and you’ve carved out an appropriate amount of time to complete the job. Yep, this seems like a very achievable goal!
Instead of cleaning out the garage you already have, your goal could have been to build a new garage by yourself all in one weekend, but no, that would not have been an achievable goal.
You know your goal is achievable, but is the schedule you’ve set for yourself Realistic? Do you actually have 4 hours on the weekend to devote to this project, or with your work and family time, is half an hour more realistic? While it’s understandable you want to get the job done as fast as possible, you also don’t want to set yourself up for failure. So be sure your schedule is realistic.
And lastly, you’ll need to set a Time-bound deadline for the attainment of your goal. Will this task be completed in 4 weeks? Will it take two months? Choose a deadline that’s reasonable and motivating at the same time. It’s a balance between being practical and pushing yourself slightly. A date too far in the future could kill your motivation.
Let’s recap. We started with the vague goal of “I’ve really got to go through the garage and throw a bunch of stuff out” and ended up with “I am going to spend four hours every weekend for the next four weeks cleaning out and reorganizing the garage so that both cars and all of our bikes fit.” Now you have a specific, measurable, attainable, realistic and time-bound (SMART) goal with built-in milestones to get you there. But more importantly, you’ve made a promise to yourself, and keeping this promise is what will enhance your self-esteem.
Of course, sometimes it takes a little more work than reaching a goal to lift our self-esteem, although they sure can feel good and help us with feel self-efficacy. There are also without a doubt experiences in our lives that can truly devastate our sense of self-worth, and often we need the guidance of a therapist to help us recover our sense of identity and other concepts that give us value beyond the idea of self-esteem.
Jennifer Kreatsoulas, PhD, RYT 500 is the founder of Chime Yoga Therapy and specializes in eating disorders and body image. In addition to her private yoga therapy practice, Jennifer leads yoga therapy groups at the Monte Nido Eating Disorder Center of Philadelphia, is cofounder of the Body Kindness Project, and a partner with both the Yoga and Body Image Coalition and the Transformation Yoga Project. She is the creator of the home video series Yoga to Strengthen Body Image and Support Eating Disorder Recovery. Her writing on the topics of yoga, body image, motherhood, and eating disorder recovery can be found on her blog as well as several influential online publications. In this week’s post, Jennifer shares 6 ways to build trust and heal the trauma of hating your body.
Mending the severed relationship with our bodies is a vital yet difficult aspect of eating disorder recovery. There is great truth in the common saying that “body image is the last to go.” As our symptoms pick up momentum and take on a life of their own, our bodies become the battleground upon which the self-doubt and loathing play out. Intensely dislike yourself for a month, 1 year, 5 years, a decade, or half your life, and it’s no wonder that body image is the last to go in recovery. “Body disgust” becomes deeply ingrained in the brain, thoughts, and emotions. It becomes the narrative we live by, and often the one that defines us and locks us into unhappiness.
Based on my own healing path and what I’ve observed as an eating disorder professional, I believe that negative body image is a trauma. Every time we stand in judgement of our bodies—criticizing, hating, pinching, despairing, wishing to be different—we widen the divide between feeling safe and unsafe in our bodies. We doubt them. Mistrust them. Worry they will turn on us. That they will disappoint us. Abandon us. That no matter how disciplined, we can never be certain that our body won’t betray us.
So often, in the frustration of not feeling at peace with our bodies, we bash ourselves by blaming our body image struggles on vanity. Or we compare our own strife with others’ stories of heartache and hardship, as if self-loathing isn’t a valid enough pain for one to carry. I assure you it is. That pain is traumatic. That divide within yourself is traumatic. And it takes time to heal.
Rebuilding trust with our bodies is essential to strengthening body image. It’s only through establishing trust that we can begin to feel safe in our bodies again and experience a sense of peace and wholeness. In the same way we don’t wake up one morning and automatically love our bodies, we also don’t magically begin trusting them without practice and commitment.
I’d like to share with you 6 ways to work on building trust with your body. These may seem small and insignificant at first glance, but if you proactively integrate them into your life little by little, they will make a difference.
No. 1. Talk kindly to yourself. Watch the way you speak to yourself. What words do you use to express how you feel about your body? I challenge you to call yourself out when you are being mean and talk back with kindness. Tell yourself you are working on feeling better in your skin, that you are working on building trust with your body. If it feels right, you can even apologize to yourself. You don’t need to say things you don’t mean, but it is important to verbalize your efforts in making a shift in your relationship with your body. Doing so will be a tangible reminder to yourself.
No. 2. Remove what reinforces distrust. Old pictures, scales, mirrors, social media pages and websites—get rid of anything in your physical and mental space that reinforces bad feelings about your body. It will be impossible to rebuild trust with your body if the first thing you do in the morning is read Thinspiration memes or look at old pictures of a different and probably very unhealthy time in your life. Those items are cluttering your recovery and personal space and reinforcing the “unsafe” feeling. Free yourself of the limitations those things symbolize.
No. 3. Limit mirror and closet time. It’s so easy to lose track of time inspecting our bodies in front of the mirror or changing our outfits over and over in the fury of trying to find one that looks “ok.” Time is precious. Your time matters. Filling up time with self-doubting thoughts and expending energy on frustration, disgust, and other strongly negative feelings sabotages your trust with your body. Put limits on how long you will allow yourself to get dressed for the day. Start with small reductions in time and slowly increase them as you feel more trusting of your right to be in your body and in the world versus trapped in distress front of the mirror.
No. 4. Be with people who raise you up. Choose to spend time with others who are not obsessing over their bodies or food. Trust me on this: be with those who raise you up rather than keep you down. Those people are not wrong for their own struggles, however, as you are building trust with your body it is imperative that you surround yourself with people and energy that uplifts your hard work.
No. 5. Let others in on your body image goals. If it feels right, share with supports that you are working on building trust with your body. Consider how they may be of help to you throughout the process. We don’t have to go this road alone, and you deserve support.
No. 6. Remind yourself why often. I strongly encourage you to journal, list, draw, or vision board all the gifts that will result from having a trusting relationship with your body. I also encourage you to remind yourself of these gifts daily. On hard days, you can use your what you wrote or drew to reinforce why you are choosing to persevere and why all your efforts are worth it and truly necessary.
Remember, healing the trauma of negative body image takes time, patience, and determination. Work at your own pace, but don’t give up. With every effort to rebuild trust with ourselves, we mend a severed connection. We become less fractured and more whole. I believe such peace of body and mind is possible with trust.
Dr. Stacey Rosenfeld is a clinical psychologist specializing in eating disorders and body image concerns. She also works with substance misuse, anxiety and mood disorders, infertility, and relationship difficulties. A certified group psychotherapist and certified eating disorder specialist, Dr. Rosenfeld has worked at various treatment centers and universities and now directs the Gatewell Therapy Center in Miami, Florida. Dr. Stacey Rosenfeld is the author of “Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight”, based on her award-winning blog of the same name. She is committing to helping people develop healthier relationships with food and their bodies. Check out Dr. Rosenfeld’s podcast on Life Unrestricted where she discusses disordered cultural messages, compulsive exercise and co-occurring issues.
Karin Lawson, Psy.D., CEDS, RYT is a licensed clinical psychologist and certified eating disorder specialist in Miami, Florida. After serving as a clinical director at Oliver-Pyatt Centers for 5 years, Dr. Lawson continues her passion in private practice. She is certified in Curvy Yoga, which promotes making yoga accessible and body positive regardless of age, ability or size. In this week’s blog post, Dr. Lawson discusses the idea of self-compassion and the importance of being kind to yourself.
There is a common misconception in this world that harsh criticism creates results. You see it with some athletic coaches, some teachers, some parents and I bet if you listen to yourself, you’ll definitely hear it happening with your own internal self-talk. Unfortunately, many people struggle with a fear that kindness creates laziness and it potentially creates too much permission for one’s self . . . and that as a result the fear is that we then become out of control. This idea can be found in relation to food, to fun, to sleep, to friendship, to pleasure, to relaxation . . . the list goes on.
The good news is that we actually don’t have to do that to ourselves to help ourselves. We don’t have to harshly put ourselves in our place. In fact, it’s actually NOT effective. The research in the last few years on self-compassion is showing some amazing connections to those qualities that we’re actually striving for with the harsh criticism (FYI, if you don’t like the term self-compassion make up your own . . . maybe internal kindness, inner compassion . . . get creative). What the research is finding is that self-compassion is associated with healthier relationships, successful goal pursuit and less procrastination, as well as resilience when goals are not met (Hope, Koestner & Milyavskaya, 2014; Williams, Stark, Foster, 2008)
Self-criticism on the other hand is related to eating disorder severity (Kelly & Carter, 2013), predictive of depressive relapse (Teasdale & Cox, 2001) as well as numerous other struggles, including anxiety. There’s so much more research to share with you, but my hope is that this is enough to convince you to give self-compassion some space in your life and that it actually might take you to a more fulfilling life. How do you do that? I’m so glad you asked.
The most basic way is to listen to some guided exercises and make it a practice. Please note the word PRACTICE. It’s not an achievement. Our critical voices will still pop up, but this is how we counter it and work to create a new voice of comfort, support and encouragement. Here are a couple of great resources from leading researchers, authors and clinicians on self-compassion to get you started right away:
Dr. Kristen Neff http://self-compassion.org/category/exercises/#guided-meditations
Dr. Christopher Germer http://www.mindfulselfcompassion.org/meditations_downloads.php
Some people will wonder why this has to be in the form of meditation. Settling (or learning to settle) allows our parasympathetic nervous system to activate, which means our relaxation response is getting some time on the field. When we allow ourselves to activate our parasympathetic nervous system, we become more receptive and open (and therefore less defensive and dismissive). So, when trying new things it’s particularly great to allow ourselves to get into the most open and receptive state we possibly can. If you’re saying to yourself “I’m not good at meditation.” My answer is: There is no good meditation. It is what it is. Your self-compassion can actually start right there with that critical eye toward your meditation ability.
The other starting point with self-compassion is to catch yourself when you’re putting yourself down or being particularly harsh and demeaning to yourself. Would you talk to your dearest friend, loved one, therapist or pet that way? When you catch yourself, you create more awareness of how much you’re doing it and you’re creating a pause. One way to extend that pause is to ask yourself what your dearest friend, loved one, therapist or pet would say to you? Most likely (and hopefully) they would not be the type of being to put you down, but rather to comfort, encourage and raise you up. Allowing yourself the headspace to take that in a little bit is part of the work. It’s not easy though. It sounds all rainbows and butterflies, but when we are tapping into self-compassion we are also tapping into pain, so it is a bitter sweet experience. I don’t know about you, but I’d rather have bittersweet, than emotional pain (ie. Self-criticism) on top of emotional pain.
Hope N, Koestner R, Milyavskaya M. The role of self-compassion in goal pursuit and well-being among university freshmen. Self Identity. 2014;13(5):579-593
Kelly AC, Carter JC. Why self-critical patients present with more severe eating disorder pathology: The mediating role of shame. Br J Clin Psychol. 2013;52(2):148-161
Teasdale JD, Cox SG. Dysphoria: self-devaluative and affective components in recovered depressed patients and never depressed controls. Psychol Med. 2001;31(7):1311-1316.
Williams JG, Stark SK, Foster EE. Start today or the very last day? The relationships among self-compassion, motivation, and procrastination. Am J Psychol Res. 2008;4(1):37-44
Oliver-Pyatt Centers Founder Wendy Oliver-Pyatt, MD, FAED, CEDS matches both her comprehensive training and personal victory over food and body issues with an unwavering belief in compassionate and scientifically sound treatment. She shares some of her expertise in this week’s blog post by discussing the stigma surrounding weight and body size in our culture.
Weight stigma, also known as weightism, weight bias, and weight-based discrimination, is discrimination or stereotyping based on one’s weight, especially larger or thinner people. Weight stigma reflects internalized attitudes towards body size that affects how those who are the targets of bias are treated.
A person who is stigmatized possesses a weight that leads to a devalued social identity, and is often ascribed stereotypes or other labels denoting a perceived deviance which can lead to prejudice and discrimination. Some common “weight-based” stereotypes are that obese persons are lazy, lack self-discipline, and have poor willpower, but also possess defects of intelligence and character. Pervasive social portrayals of people of larger body size create and reinforce biased attitudes.
Research has documented that physicians are the #2 source of weight stigma. Weight stigma has also been demonstrated in nurses and medical students, psychologists, dietitians, and fitness professionals.
Rebecca Puhl of the Yale Rudd Center for Food Policy and Obesity illustrates in the Cycle of Bias and Obesity the pursuit of help followed by the avoidance of help, likely caused by the stinging, invasive weight bias experienced by the patient. The patient may not know they were subject to weightism, and may even believe that the shaming, unhelpful remarks are warranted, deserved and appropriate, and that they are even less valuable a person and therefore avoid the doctor and pursuit of health care altogether.
The person experiencing weight stigma is in a bind. They may seek assistance from healthcare or other providers, but the “help” can in fact reinforce and intensify shameful feelings the person experiences on a day to day, moment to moment basis. This leads to avoidance of health care, and even turning to food and bingeing to dissociate from this painful experiences.
When well-intentioned providers “prescribe” simplistic, behavioral weight loss plans (the typical eat less, exercise more mantra,) the individual with Binge Eating Disorder feels even more powerless. Not only is their shame exacerbated, their illness is being mismanaged, and they enter into a hopeless-helpless paradigm.
The truth is Binge Eating Disorder is a mental illness, and requires treatment that addresses the bio-psycho-social issues that contribute to the development of an eating disorder.
A patient told me that a physician once told her “You’re fat everyday so you should exercise everyday.” This statement is grounded in ignorance. It was not helpful. Worse yet, it was harmful and might have contributed to further avoidance of healthcare, shame, and ultimately, bingeing. Thankfully, this patient knew better. She found another healthcare provider rather than blame herself or avoiding the help she desperately needed.
Weight Stigma is perhaps the most recent, socially acceptable form of discrimination. I am thrilled that Binge Eating Disorder Association (BEDA) and National Eating Disorders Association (NEDA) are spreading the word on the insidious, destructive reality of weight stigmatization, a current reality of modern society and modern medicine. I hope we will be able to look back one day and realize how far off medicine once was, and recognize instead that attitudes and approaches founded on compassion, love and science are how we heal our patients.
© Wendy Oliver-Pyatt, MD, FAED, CEDS
Oliver-Pyatt Centers Clinical Director of Intensive Outpatient and Transitional Living Programs Giulia Suro, PhD will present at OPC’s First Wednesdays Breakfast Series for Clinical Profressionals on October 5th. Dr. Suro will share her expertise on “Applying Acceptance and Commitment Therapy in the Context of Eating Disorders”.
Acceptance and Commitment Therapy (ACT) challenges conventional wisdom and overturns the ground rules of most of Western psychology. Within the framework of ACT, quality of life is dependent on mindful values-guided action, regardless of how many symptoms you have. Applying an ACT approach in the context of eating disorders provides an opportunity to address the numerous and complex factors that maintain the disorder. ACT encourages clients to examine the function of their eating disorder from an objective and compassionate stance. Additionally, ACT techniques teach individuals how to live a meaningful and valued life in the presence of the most painful and unrelenting thoughts and feelings. Dr. Suro will provide an overview of the theoretical underpinnings of ACT as well as specific clinical techniques that may be applied successfully to eating disorder clients.
Through this presentation, participants will be able to identify and define the six core components of the ACT hexaflex. They will also learn techniques to illustrate the skills of delusion and experiential acceptance in the context of thoughts and feelings associated with the eating disorder. Lastly, they will be able to define the difference between a value and a goal in the framework of working with clients toward behavioral changes.
Breakfast begins at 9:00am and the presentation will be from 9:30-10:30am. One CE hour will be offered for PhD, PsyD, LMFT, LMHC, LCSW, LPCC and RD. If you would like to join Oliver-Pyatt Center’s First Wednesdays on October 5th, please RSVP to Florida Outreach Manager Callie Chavoustie at email@example.com or RSVP here by October 3rd.
Oliver-Pyatt Centers Clinical Director Stephanie Diamond, PhD, CEDS specializes in eating disorders and personality disorder co-morbidities. In her writing, Dr. Diamond shares a glimpse into the inner world of someone struggling with an eating disorder and about the importance of self-compassion in eating disorder recovery.
Think about your own inner dialogue. Is it kind, gentle, friendly? Is it aggressive, rejecting, demeaning? Both? Neither? For the less fortunate among us, self-critical thoughts come automatically, while thinking kindly about oneself might feel inauthentic or indulgent. Why is it some of us struggle to treat ourselves in the manner that we might treat a friend?
The inner world of someone with binge eating disorder (BED; or any other eating disorder) can often be an unfriendly place. The stream of consciousness thoughts within the mind of the person who is struggling tend to be skewed toward self-critical, self-deprecating, and self-blaming statements. The person is fairly constantly under siege by these negative, judgmental and disapproving and shaming thoughts about self. Ah, shame… what a dark and haunting emotion. Shame is a destructive emotion that makes us feel less-than and fosters isolation. The eating disorder enters as a way to manage the shame, and often exacerbates these feelings. It is a nasty positive feedback loop. And it is no coincidence that shame is often a main target in psychotherapy during the treatment of BED.
How do we target shame, you ask? Well, there are many ways we can work to take that terrible monster down! Have you heard about self-compassion? It is about self-kindness, it is about recognizing our humanness, and it is about mindfulness of reactions to our painful thoughts and feelings (Neff, 2003). And, amazingly, self-compassion may just be the best antidote to shame.
Don’t worry if you find yourself self-compassion-deficient. You are not destined to remain that way, as there are methods for you to develop more! Self-compassion is not an all-or-nothing thing. It is not about “having” or “not having” self-compassion. Self-compassion exists on a continuum, and like anything worth having, it takes work and practice. How might your life be different if you were a little kinder to yourself? What might change? Can you dare to imagine…? Might you have more patience with yourself; might you befriend your body; might you forgive a mistake you made?
Let’s not forget that when it comes to eating disorder recovery, the very act of honoring your body’s hunger and fullness cues is an act of self-compassion. The practice of self-compassion can make all the difference in helping a person bridge from self-destruction to self-actualization. We need to nurture a self-compassionate voice to counter the self-critical one, otherwise, recovery will likely remain out of reach.
So, what can you do today to nurture some gentleness and loving-kindness towards little old you? You deserve it!
Oliver-Pyatt Centers Primary Therapist Lisa Jimenez, MS works closely with clients suffering from eating disorders, specifically Binge Eating Disorder. She discusses our society buy in to the ideal “thinner is better”, and offers some strategies to embrace your body, no matter the size.
Everyone knows that feeling. You wake up, look in the mirror, and don’t like what you see. Bad body image, its the worst. For our women in larger bodies there seems to be an added layer. Not feeling our best, we turn to someone we love for some validation and get the dreaded response, “don’t worry, the weight will come off”. Hmm… that didn’t really help. What about my body now, right as it is in this very moment? Will people not like it? Will they think I’m too much?
We live in a society that idealizes the thin body. Those closest to us, the ones we care about most deeply, often buy into this misconception as well: thinner is better. We search for validation and acceptance in a body that’s beautiful and curvaceous, however one that others may not idealize and may not strive for.
As a larger bodied woman working with clients seeking treatment for Binge Eating Disorder (often larger bodied, however, not always the case) I’ve gathered tools both in my personal and professional life to help combat bad body image. In a society that idealizes thinness, some of these steps may be hard to believe, however, I can say confidently that they work. So why not? Be your own advocate. Give them a shot!
Get inspired. There are many amazing, body positive women all over social media speaking up. Add them to your Instagram, Pinterest, and Twitter! Flood your feed with women of different body shapes, colors and sizes. Who wants to see the same image over and over? There’s beauty in diversity.
Remember your unique worth. You’re a lot more than your body. Think about your values, your interests, all those people in your life that love you greatly. There’s so much to be excited about!
Practice body gratitude. This one can be hard, but it is key to body acceptance. Do you remember that cool move you did in Zumba the other day? Yeah, that was your body doing its thing. How about those Latin genes seeping out of your curves? Personally, I like to reflect on how my body connects me with my ancestry. Wherever you’re from, your body is part of your history. How cool is that?
Rock your style. I know it may be hard to find a wide variety of sizes in retail store, but there are some fun, stylish brands online. Order yourself something cute. Spend the money. Feel good in what you’re wearing! You deserve it. For now, rummage through your closet and thrown on an outfit you feel good in,
Nourish yourself. On a day where body image is not at its best, make it a priority to properly nourish yourself, both physically and emotionally. Don’t skimp on the food. It’s the ultimate set up for mindless eating. And please, do something nice for yourself. Mani, anyone?
Practice body neutrality. Okay fine, you may not love your body today, but you can still show it respect. Try a more neutral approach like “I may not love what I see but I can accept it. I am more than a body.”
Gather the evidence. Will people really like me more if I lose weight? Will all my problems miraculously vanish? Is my weight truly the cause of my unhappiness? I think you get it. And if you struggle with this one (as many people do), you might need to move on to number 8.
Stop the spiral. There’s a great cognitive behavioral therapy tool where you imagine a stop sign to help you stop ruminating thoughts. If you notice that your head is taking you down the rabbit hole, this is about the time where you whip out this tool. If this doesn’t work, go distract: read a book, watch a funny video, keep that brain of yours occuppied.
Call a body positive friend. Hopefully you have at least one person in your life on board with body positivity. Take note of these women and call them up when you need a little extra TLC. If you don’t have a friend like this in your life, it’s time to go out and find one!
Ask yourself this: when did hating my body ever result in anything positive? Never!
For more information about Oliver-Pyatt Centers, Clementine adolescent treatment programs and Monte Nido, please call 866.511.HEAL (4325), visit our website, subscribe to our blog, and connect with us on Facebook, LinkedIn, Twitter, and Instagram.
Join us in reading inspirational and informative articles we have cultivated from across the web. If you have found an article you feel is inspirational, explores current research, or is a knowledgeable piece of literature and would like to share with us please send an e-mail here.
Anxiety, Fears, and Things That Go Bump in the Night Psychology Today
How Weight Information Can Increase Overeating/Binge Eating Dr. Stacey Rosenfeld
Yoga May Be Good for the Brain The NY Times
If We Treated Ourselves The Way We Treat Our Children Kantor & Kantor Law
How Anorexia Causes a ‘Starved Brain’ Dr. Jen Gaudiani
Understanding Anorexia Nervosa in Males Psychology Today
Karin Lawson, PhD is a licensed psychologist who is passionate about helping people create change in their lives through self-reflection, self-compassion, new perspective and new ideas. In her writing, Dr. Lawson offers some thought about the power of storytelling both in and outside of therapy.
Feeling incredibly honored to be a contributor for the OPC Blog, I am jumping in this week with a reoccurring theme for me these past few months . . . storytelling. While this has actually been a theme in much of my life, more recently it has been popping up consistently. As a psychologist, I have the privilege of hearing people’s stories. In that work, it’s important to note the stories that they were told, the stories they tell themselves and the new stories that we create together. While I have never been formally trained in narrative therapy, I have used it without realizing it. Being someone who naturally has gravitated toward journaling and creative writing in my early life, that thread continues on in my blogging and the talk therapy that occurs in my office. My recent run-ins with reflections on storytelling have clarified some incredibly important aspects to why storytelling in our life matters. I’d love to share them with you.
In his University of Pennsylvania commencement speech on May 16, 2016, Lin-Manuel Miranda, the creator of the wildly successful Broadway musical Hamilton, says this:
Every story you choose to tell, by necessity, omits others from the larger narrative. One could write five totally different musicals from Hamilton’s eventful, singular American life, without ever overlapping incidents. For every detail I chose to dramatize, there are ten I left out…This act of choosing—the stories we tell versus the stories we leave out—will reverberate across the rest of your life.
To me, this speaks to a couple of things that we can look at more closely and gain insight. Take any story of your life, maybe the one you have told yourself or your therapist most recently and take note of what details you were pulled to emphasize versus which ones didn’t seem as interesting to you. Why are those details so important to us? This question isn’t meant to be a judgment that someone has chosen the wrong details to signify, but rather an opportunity for gentle curiosity to explore and understand better how we work and what’s important to us. Then we get to play around with perspective and think of the story we’ve recently told and tell it from another perspective. Was there someone else in the story? Can we tell the story from the imagined perspective of that person? Or can we tell it as if someone had been looking in from a far, but wasn’t a part of the story, as much as an observer? What is it like to think about this life experience as a “story”, not a made-up story or a fiction story, but a story, none the less?
My second recent run-in with the concept of storytelling was in the May-June 2016 issue of Psychotherapy Networker, in which the editor Richard Simon writes about The Moth. The Moth is a international phenomenon started by a poet in New York City, in which average people (i.e. people who don’t necessarily professionally write or perform) gather in groups, in cafes and theaters and tell true stories, as remembered by the storyteller, 5-minutes in length. There’s always a theme for the story night such as fathers, food, grudges, life in the fast lane, etc. The piece of Richard’s discussion of The Moth that struck me the most was the sense of connection that people feel in the shared experience of hearing stories. There is often tears, laughter and a knowing that even though the audience’s experience doesn’t mirror the storyteller’s experience, there is a relatable emotion at the heart. That’s the hard-part though for most of us, allowing ourselves to be revealing rather than omitting, self-editing and trying to keeping the rawness at bay.
In the spirit of knowing that our true stories are healing and connecting, I encourage you in the journey of recovery to share your truth, to know that others want the truth and to give yourself that gift of not being alone with it. That may mean that you reveal yourself to your family, your group therapy, your individual health care providers, your friends . . . whoever is safe and deserving of hearing your stories.
You can watch Lin-Manuel Miranda’s speech on YouTube here https://www.youtube.com/watch?v=ewHcsFlolz4
Primary Therapist Giulia Suro, PhD shares three specific strategies that can be integrated into the therapy process. In her post, she explains how Acceptance and Commitment Therapy (ACT) can be a useful approach to help clients with eating disorders.
Acceptance and Commitment Therapy (ACT) is a creative, mindfulness-based therapy that hinges on acceptance and values-driven action. You do not need to be well-versed in the theory of ACT to integrate ACT techniques in to every day sessions. Below are three core concepts to ACT that can be brought in to therapy when you might feel like changing things up.
Functional Contexualism, or, “How did this serve you?” Imagine a chair that has a leg that gives out every time you sit on it. What words would you use to describe this chair? Broken? Faulty? Garbage? What if this chair was being used as an educational tool in a furniture-making class? Or as prop in a circus act? In these contexts, the chair would be serving its purpose, or function, perfectly well. Eating disorders also serve a function in the specific context each individuals’ life. This may be to provide a sense of control, safety or distraction. Yet, our clients are very quick to label their own behavior as dysfunctional or wrong. Focusing on the function of behaviors given their context can shift clients to examine their eating disorder from a more compassionate stance and help them move away from guilt and self-blame.
Experiential Avoidance, or, “Feelings won’t kill you.” Eating disorders, like most mental disorders, are characterized by avoidance. This may be avoidance of specific foods, settings, people and often life in general. From an ACT perspective, it’s truly not the external stimuli that are being avoided. Instead, it is how these things make us feel internally. Family therapy would not be difficult if it did not bring up feelings of anger or guilt. Fear foods would not be threatening if they did not incite terror or disgust. In this way, acts of avoidance are really an attempt to escape some internal experience. From this framework, discussions about exposure can center on the emotions that are truly at the heart of avoidance.
Defusion, or, “You are not your thoughts.”A common frustration in the recovery process is that eating disorder thoughts continue to persist despite progress being made. This can be scary and discouraging. When this comes up, ACT offers the skill of defusion. When we defuse from our thoughts, we see them from an objective stance and are better able to hold them lightly. A quick exercise in defusion entails identifying a powerful thought such as “I’m worthless,” and noticing how it feels to buy in to it. Adding the phrase “I’m having the thought that..” to the beginning of the sentence (“I’m having the thought that I am worthless”) immediately provides some space and allows us to and observe the thought from a distance. While the thought itself doesn’t change, we decrease its power and increase our clarity.
For more information about Oliver-Pyatt Centers and Clementine adolescent treatment programs, please call 866.511.HEAL (4325), visit our website, subscribe to our blog, and connect with us on Facebook, LinkedIn, Twitter, and Instagram.
Primary Therapist Tali Yuz Berliner, PsyD has run a body image group at Oliver-Pyatt Centers for almost three years. In her group, she works with clients on accepting their bodies and letting go of the “thin ideal”. In her writing, she shares about her use of cognitive fusion in aiding clients through this process.
After almost three years of running body image group at the comprehensive level of care, I have learned a lot from the many incredible clients I have had the pleasure to sit with. One significant theme that is revisited time and time again in my group is the need for the women to “grieve the thin ideal.” It has been important for these women who suffer with eating disorders to not only accept that they cannot strive for thinness any longer but also to accept that the body that they have been chasing will not bring them the fantasy life they envision. I often use the ACT(Acceptance and Commitment Therapy) term cognitive fusion, to explain this concept to the group. Cognitive fusion proposes that certain attachments are made through verbal interactions that people spend endless amounts of energy trying to prove or disprove. People will do so despite the thought not being accurate in the present moment or having evidence to the contrary.
The way we (I say “we” since the process is always collaborative with the clients) tackle this theme in my group is two-fold. First, it is imperative to challenge the distorted thought that a specific body type will lead them to happiness. This is done through a variety of exercises from several modalities, such as:
Looking for evidence that challenges the thought
Exploring body image development
Identifying and connecting other values
Challenging the media
In addition to the exercises, it is important to openly process and review the topic of body image acceptance and how it occurs on a continuum. We explore how it begins with tolerating the body, then accepting the body, then liking it, and eventually one day learning to love it. Exploring where the woman is on the continuum and moving them through it allows the loss of the thin ideal to be less painful.
Second, it’s important that we validate the loss of this ideal. The work can often mirror general grief and loss work whereas the women can experience similar emotions to the loss of a loved one. It is necessary that they process how this void has and will impact them in the future. We continuously reinforce the significant need to strengthen and connect to other roles and values outside of the body/appearance and the eating disorder. The women explore the integration of values to replace what is lost and to reinforce the message that the idealized body will not bring them to a happy life but instead being connected to others and immersed in their values will lead them to life satisfaction. The above is a snapshot into a very complex process that is inherent in both group and individual sessions. My hope is for these women to start to trust their values and their healthy voice to come to the understanding that there is more to life than the thin ideal.
For more information about Oliver-Pyatt Centers and Clementine adolescent treatment programs, please call 866.511.HEAL (4325), visit our website, subscribe to our blog, and connect with us on Facebook, LinkedIn, Twitter, and Instagram.
Primary Therapist Thaimi Fina, LMHC is the facilitator of the Body Image Group for women at the Oliver-Pyatt Centers. Through her work, she has learned various strategies to help battle negative body image thoughts. In her post, she shares five effective ways to establish a more positive relationship with your body.
Whether they struggle with an eating disorder or not, most women (and men!) experience negative body image thoughts throughout their day-to-day life. Unfortunately, this has become our norm. Despite the automatic nature of these thoughts, it doesn’t mean that we have to be bound by them and allow them to impair our daily functioning. As a Primary Therapist in Casa Verde at Oliver-Pyatt Centers, one of my most valued tasks is facilitating the Body Image Group for our adult women. Throughout my time facilitating this group, I have had the privilege of learning a lot from our women about which strategies have proven most effective in battling their negative body image thoughts. In this post, I will be sharing 5 of these tips with you in hopes that they will assist you in managing these thoughts and making peace with your body.
Tap into your values and determine the most values-oriented actions you could take. During one of my groups, I provide clients an expansive list of potential values and ask them to prioritize their top five values. These values may include honesty, family relationships, spirituality, independence, health, etc. Clients are then asked to identify a situation that would likely trigger negative body image thoughts and brainstorm as many different actions they could take in that moment to manage these thoughts. Then, they are asked to reference their list of top values and identify the most values-oriented actions they could take. For instance, say you experience negative body image thoughts while getting dressed to go to work. You could decide that these thoughts are too strong, they are impacting your mood, and you should just stay home and avoid being seen today. However, you choose to reference your list of top values which include family relationships and independence, and identify values-oriented actions you could take instead. You decide to call a loved one to share your frustrations or maybe just distract with small talk. You also remind yourself of the importance of showing up to work in order to continue striving for financial independence, and commit to going to work. These thoughts may still be present, but you are not allowing them to control your life.
Write a letter of gratitude to your body and read it when negative body image thoughts arise. During another body image group, our women begin by participating in a gratitude meditation. There are many wonderful gratitude meditations available on youtube if you’re interested! Then, they are asked to write a letter of gratitude to their bodies, choosing to suspend criticism for just a moment, and taking the time to honor their bodies. As they write this letter, clients are encouraged to reflect on all the ways that their body serves them and enables them to live a life worth living. This letter could serve as a powerful reminder of your body’s amazing resilience and value, when you find yourself criticizing its appearance.
Commit to doing one to two random acts of kindness for your body each day. These acts of kindness could vary significantly from person to person but should include any action that makes your body feel good and honors your body’s needs. These acts of kindness could include (but are certainly not limited to): resting when your body is tired, taking a mindful walk, taking a warm bath, putting on a favorite scented lotion, getting a massage, wearing a cozy sweater, honoring your body’s hunger and fullness cues, stretching, meditating, etc. Create your own list of acts of kindness that resonate the most with you and commit to trying 1-2 of these acts each day. Building a better relationship with your body doesn’t just involve battling the negative, but also actively creating positive interactions with your body.
Practice self-compassion. You can’t control that these negative body image thoughts pop up in your head, but you do control whether or not to beat yourself up for having them. Instead, it is important to gain awareness of how these thoughts became so embedded in our heads. We live in a society where women are constantly given the message that their worth is determined by their appearance and body size and that they must never be satisfied with either. It’s no wonder that we feel compelled to criticize our bodies and compare them with unrealistic ideals of perfection. As you work towards building a better relationship with your body, practice self-compassion and be patient with yourself. Choosing to honor and accept your body exactly as it is, is truly revolutionary in our society. Rather than beating yourself up when these negative thoughts arise, speak to yourself with the same loving kindness that you would to a loved one.
Actively seek and create body-positive messages. Be creative and find ways to surround yourself with body-positive influences. This tip could include following body-positive blogs or Instagram accounts. Create your own pro-recovery and/or body-positive Pinterest board. Join organizations and participate in events that promote body acceptance and health at every size. Create and display a collage of images and quotes that inspire you to be kind to your body and honor it. Spend more time with friends and loved ones who do not engage in negative body talk. Serve as a role model for others and avoid criticizing your body in conversations with others. The options for carrying out this tip are endless. Our society, mass, and social media are full of images and messages that promote body shaming and/or unrealistic body ideals. Actively work towards surrounding yourself with very different messages and avoid following accounts that reinforce your negative body image thoughts.
These are just a few of the strategies that the women in our program have found most helpful in battling negative body image thoughts. As you begin trying some of these tips, I encourage you to remember that the goal is progress and not perfection. These thoughts are common and likely to pop up from time to time but you can become more effective in how you manage them and choose to respond. Remember that a thought is just a thought. It does not determine fact or how you must respond. I hope that you find these tips to be helpful and encourage you to brainstorm your own strategies for building a better relationship with your body. To end, I will leave you with one of my favorite poems from Nayyira Waheed. “And I said to my body. Softly. ‘I want to be your friend.’ It took a long breath. And replied ‘I have been waiting my whole life for this.’”
For more information about Oliver-Pyatt Centers and Clementine adolescent treatment programs, please call 866.511.HEAL (4325), visit our website, subscribe to our blog, and connect with us on Facebook, LinkedIn, Twitter, and Instagram.
Associate Director of Clinical Recruitment and Resources, Jessica Genet, PhD shares how practicing gratitude can be an effective treatment tool in body image work. She explains how the use of gratitude in the recovery process can help heal the clients relationship with the body, and offers seven different ways to begin doing so.
Imagine the following: “You are driving your car to the store. Up ahead, the road is closed and road workers redirect you towards an alternate route. Once you arrive, you walk into the store and are greeted by a store employee with a friendly smile.”
Take a moment to reflect on how you would respond to this scenario. Would you focus on the hassle of the road closure? Or would you notice the small act of kindness shown by the store employee?
It is easy to take for granted the small “gifts” that occur in our daily lives as well as the more substantial blessings and silver-linings. It is also unfortunately easy to fall into a pattern of focusing on hassles, irritations and life stressors. However, research has shown that taking the time to actively practice gratitude – acknowledging goodness in ones’ life and recognizing the contribution others (people, animals, higher power) have made for the sake of our well-being– can be incredibly beneficial to our emotional and physical health. Research has shown that gratitude increases happiness and feelings of optimism, joy and pleasure. Gratitude also encourages us to “pay it forward” and be more helpful, altruistic and compassionate. A grateful focus helps us feel more connected to others and less lonely, and improves our health, strengthens the immune system and encourages us to take better care of our bodies.
At the Oliver-Pyatt Centers, we regularly incorporate practices of gratitude into our treatment. For individuals with an all-consuming eating disorder, moments of gratitude are often overshadowed by obsessive thoughts, anxiety and sadness, isolation, and other hallmarks of the disorder. We also know that the journey to recovery is often challenging. By teaching our clients to practice gratitude, we can help build their resilience to the challenges of recovery and move towards a life that feels more joyful, meaningful, and connected to others.
One area of treatment that especially benefits from the practice of gratitude is body image work. Many of our clients enter treatment extremely critical of their bodies and preoccupied with body shape and size. By encouraging our clients to take a moment to reflect on the gifts and miraculous functions of the body – such as appreciating arms because they allow us to hug a friend and our eyes which allow us to see a summer sunset – we can slowly begin to heal the relationship with the body.
Below are some suggestions for how you can start a practice of gratitude (from the book “Thanks!: How Practicing Gratitude Can Make You Happier” by Robert Emmons, Ph.D.)
Keep a Gratitude Journal – Establish a daily practice of reminding yourself of the gifts, benefits and good things you enjoy. By writing each day, you magnify and expand upon these sources of goodness.
Buddhist Meditation Technique of Naikan – This practice involves self-reflection on three questions that can help address issues or relationships. It involves recognizing the gifts we receive and what we give to others, and acknowledging how we may cause pain in the lives of others.
What have I received from__________?
What have I given to ____________?
What troubles and difficulties have I caused _______?
Pay Attention to Your Five Senses – By paying attention to the ability to touch, see, smell, taste and hear we connect to what it means to be human.
Use Visual Reminders – Visual reminders (e.g., post-it notes on our bathroom mirror, reminders in our phone) serve as cues to trigger thoughts of gratitude.
“Breath of Thanks” (by Dr. Frederic Luskin) – Two or three times a day, slow down and bring attention to your breathing. Notice the flow of your breath. For each of the next five to eight exhalations, say that words “thank you” silently to remind yourself of the gift of being alive. Practice at least three times a week.
Learn Prayers of Gratitude – Spiritual traditions are universally filled with prayers of gratitude. If you identify with spiritual tradition, incorporating these prayers into your daily life can heighten gratitude.
Go Through the Motions – If we go through grateful motions (e.g., saying thank you, writing letters of gratitude) we can trigger the emotion of gratitude. Psychological evidence has shown that attitude change often follows behavior change.
Primary Therapist Josephine Wiseheart, MS recently contributed to an article published on PsychCentral, “What It Means To Teach People How To Treat You.” The full, original article can be accessed here. The article explores the importance of and your own role in teaching others how to treat you. Please enjoy an excerpt of the article below.
Start with yourself.
“[T]o teach people how to treat you, you do not begin with them, you begin with yourself,” said Wiseheart. Morgan agreed: “The way you believe about and treat yourself sets the standard for others on how you demand to be treated. People learn how to treat you based on what you accept from them.”
Wiseheart regularly tells her clients to “Be the pebble.” In other words, “to create even a seemingly small amount of change will ripple out and create more change.”
Teaching others how to treat us starts with self-awareness, Wiseheart said. She suggested asking yourself these questions: “How do I treat myself? What do I value? What do I want? What do I think I deserve?”
Remember that you can’t change anyone else. But we can “create a different reaction in others if we change ourselves,” she said.
Talk about your “rules of engagement.”
One of the biggest misconceptions Wiseheart’s clients have about relationships is that others should know how they want to be treated. However, “in order for people in a relationship to be on the same page, they need to have access to the same instruction manual,” she said.
She calls this manual the “Rules of Engagement.” She suggests having “business meetings” to discuss the “rules” of your relationship. Have these meetings when people are at their best: They aren’t in an emotionally heightened or vulnerable situation, she said.
Rules might include no name calling or yelling during a conversation, and taking a break when tempers flare.
Communicate your needs clearly and compassionately.
For instance, many couples criticize, yell, or give each other the silent treatment to communicate their needs, said Morgan, who practices at Wasatch Family Therapy. This not only is ineffective, but it also hurts your relationship.
“Rather than scream ‘you never listen to me,’ it is more helpful to express ‘I feel alone right now and I would be very grateful if I could have your undivided attention for 10 minutes,’” he said. Another example is: “I am feeling overwhelmed right now and would love it if I could get a few ideas from you.”
In other words, we teach people how to treat us when we can identify a need and then express it in a clear and comprehensible way, Morgan said.
“If we use pouting, desperation, or even abuse, people do not learn how we want to be treated. All they hear is pouting, desperation and screaming. The message does not get across.”
Model how you’d like to be treated.
Wiseheart also often tells clients to “Be the person you want other people to be.” That is, treat others the way you want them to treat you, which is reminiscent of the Golden Rule, she said.
“If you want your children to be kind to you, be kind to them; if you want your sweetheart to be romantic and affectionate with you, be that way with them.” If you want others to listen to you, listen to them. Focus your full attention on the person, maintain eye contact, ask questions, validate their feelings and be empathetic, Wiseheart said.
Reinforce behaviors you like.
Reinforcement simply means expressing appreciation when the other person makes the effort to change their behavior, Wiseheart said. For instance, you might say: “I appreciate that you listened to me so intently yesterday.”
“Reinforce [behaviors you like] at the time, 5 minutes later, 10 minutes later, an hour later, a day later, 10 days later. You cannot reinforce a positive behavior enough.”
Pick a role model to emulate.
“Find a role model of someone who demands respect and appears to have a strong sense of worth,” Morgan said. This person might be a parent, peer, friend, teacher, coach, therapist, mentor or even a well-known celebrity, he said. “The important component of a role model is that they are emulating the desired beliefs and behaviors that you would like to adopt or integrate.”
Have realistic expectations.
According to Wiseheart, “You don’t teach people how to treat you in a day, or a week, or a month; it probably takes many months at a minimum to really get someone to treat you the way that you want to be treated.” This process takes lots of practice and patience. And sometimes, people are too caught up in being rigid and defending their own reality to try to act differently, she said.
When you start clarifying what you will and won’t tolerate there’s also a risk that some people won’t stick around, Wiseheart said. “At that point, you need to ask yourself what’s in your best interest — a relationship at the cost of you, or making room for the future relationships that you deserve?”
For the full article, written by Margarita Tartavosky, MS who writes her own blog, Weightless, please visit here. Marriage and Family Therapist Michael Morgan, of Wasatch Family Therapy, also contributed to the article.