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Professional Boundaries with Eating Disorder Patients: considering right brain studies and work of Dr. Allan Schore

(elaborating on my comment in Eating Disorders for Professionals Blog)

Humanity Appreciation
Today, happily, we have evidence based scientific research to back up the use of our humanity in our clinical work with patients. Appropriate boundaries between patient and psychotherapist are essential in any psychotherapy and particularly in the field of eating disorders. However, the topic is often discussed in terms of content: e.g. a patient asks my age, if I'm married or divorced, if I have children, my religion, if I've ever had an eating disorder.

Young anorexic woman is murdered in family tragedy

skullReflections on Tragic Death In Ireland

A young anorexic woman died in Ireland. Her mother was a psychiatrist. She drowned her daughter in the bath.

It's a tragic story of Gothic proportions going back who knows how many generations. The mother couldn't bear the daughter's anorexia. The daughter refused treatment. The mother had an eating disorder. The grandmother committed suicide.

Perspectives on Eating Disorder Recovery and Relapse

waveSpain Canarias AjuyMeaning of "Fully Recovered"

A thirty-three year old man wrote to me saying he had been a binge eater most of his life and now was fully recovered because food has been a non issue for two years. Of course, I am glad he is happy with the strides he has made in his life. But his post got me to thinking about what recovery means.
*

I have been working since 1980 with people who have and who have had eating disorders. I don't know what people mean by "fully recovered." While it is possible that people can have two years or more of being in a state where food is a "non-issue" that doesn't necessarily mean you are "fully recovered." By the same token, if you have not binged or purged for some time and then begin again you may be responding to a signal to grow and develop more rather than entering relapse (although, of course relapse is possible too.)

Effective Ongoing Recovery Work

As I see it, you develop an eating disorder to cope with what you cannot bear. When you are committed to getting well you:

work in psychotherapy;
participate in 12 step programs and/or support groups;
explore and develop your spirituality;
nurture your creativity;
gain education and skills to function as you choose in this world.

As part of this life long process you:

feel your emotions;
recognize and bond with trustworthy people;
develop a sense of self worth.

As you develop you learn and discover how to address your inner and outer life situations without the eating disorder.

Symptom Return Can Signal Your Need to Grow

As you age, develop, mature, take on new challenges, are confronted with life's strong pleasant and unpleasant surprises, aspects of the eating disorder may return. If it's not a relapse, (meaning collapse and surrender) it can be a signal that a new strength needs to be developed. It can also mean you are overstretching your capabilities and need to pace yourself.

Eating disorder symptoms, developed to defend you from what you could not bear, return to some people not as an enemy but as a guide. Your symptoms can show you that you are feeling too much or not enough. This teaching occurs in a language you understand, perhaps better than any other. This is the language of the eating disorder which may have been your life long companion.


"Recovered Person"

In my opinion the "recovered" person, is consciously aware of his or her liaison with the eating disorder. It's as if the eating disorder were some kind of sleeping general or police force who, when you take on more than you can bear, rises up to alert, protect and defend you using the old eating disorder methods. This gets your attention.

The "recovered" person recognizes the return of the eating disorder urges or actual behavior as a signal to pay attention to something that is out of conscious awareness. Past recovery work allows you to reevaluate what's going on in your life knowing now that something is being denied. You can then do more inner work to be present for your experience without needing the numbing protection of the eating disorder.

 When Symptoms Return


There can be gaps of five, ten even twenty years of no acting out. Then your old faithful protector emerges to wake up you up if you are involved in more than you can bear. The symptoms let you know you need to pay attention and make some healthy adjustments in you way of living or dealing with a situation.

Symptoms can last one or a few days and be of tremendous value.

I would not like people who have occasional psychological informative incidents of their eating disorder symptoms to believe that they have lost their recovery. Nor would I like people who have no symptoms for two years to believe that their disorder is over.



Need for Continued Growth and Learning

No one knows what challenges life will present in the future. I doubt that any of us are fully equipped right now to deal with what the future will reveal. We all need to keep learning and growing to survive and thrive in this life. We all have signals that let us know we need to learn and grow beyond our current limitations.

A return of eating disorder urges is one kind of signal that lets you know more growth and learning is required.The more recovery work you've done the more capable you are of continuing the recovery work when those inevitable life challenges emerge. Those urges can help you open a blind eye or a dulled psyche to a new challenging reality and help you continue to live a full life.o you

1.   Have you been surprised by a return of symptoms?
2.   What was going on in your life at the time?
3.   Could you see then or can you see now how your symptom return signaled an alarm?



*Spain, coast of Fuerteventura near Ajuy. photo by Hansueli Krap


Recent Flurry of Blog Posts Regarding Family Dinner Research

Love is left out of the eating disorder prevention equation yet again. Eating disorder prevention does not mean following a check list of correct behaviors at the dinner table. It means behaving reasonably and practically with a powerful undertone of love, respect, a glad willingness to listen, honesty confidence to passionately disagree and deep certainty that right or wrong everyone in the family loves and will stand by everyone else. When that is brought to daily life in a family, including family dinners, eating disorders don't have a chance to develop.

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JoannaPoppink Africa’s cities face the harshest outcomes of climate change and its young people know it https://t.co/HvD1hSlhPJ by @Lattif
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JoannaPoppink Yes, Greta! You break my heart with your/our truth. https://t.co/LGXWurAN1F
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JoannaPoppink Document reveals how Bureau of Land Management will spread offices across country in reorganization https://t.co/b7ZZXwJKNk
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JoannaPoppink Latest Sustainable World online now. https://t.co/iR4EwD2Rrf #wildlife #extinction
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