Eating Disorder Recovery and Issues of Abandonment


please_dont_leave_meTouching story of felt abandonment on Babbling Cats2.

"I feel like I'm being abandoned by [my therapist].  This is what I don't get.  She obviously thinks I'm not doing well at all and need more help, or something.  So why, when someone is "not well"  (her words, not mine) would you, a T, stop working with the person?  If you're in the field to help people, why would you abandon them when they apparently need you the most?  This is what I don't get.  It's like, "You're doing badly so I can't work with you anymore."  She didn't say that, but that's what it's like.  Does that make sense?  Also, if she knows that things we'll just get worse without her, why would she fire me?  These people are supposed to be helping people, not letting them go when things go a little south."

As a psychotherapist working with people with eating disorders, here is how I answer her question.

First, I'm sorry she is going through a hard time.  I hope she gets through it and continues her therapy.

In my work sometimes a patient forgets that I'm her therapist. She thinks of me as a friend or parent or even her private and personal cheerleader.  She loses sight of the fact that I am actually providing treatment through different projections she may have of me.

My love is real, but love alone doesn't cure a person of an eating disorder.

I have a private practice.  That means I can only work with people who can be treated in a private practice setting.  If their situation becomes too severe for containment in a private practice I need to refer them to a different treatment structure, like intensive outpatient or residential treatment centers or hospitals.

Sometimes a patient is so full of a sense of personal abandonment she lives it out when she is the one withdrawing. She pulls away and accuses me of abandoning her.  She may not even know that she is pulling away.  If she goes beyond the limits of what a private practice can bear then she is pulling away.

If she becomes violent or suicidal she needs a more firm and ever present structure than I can provide. I need to refer her. Because she needs more containment than I can provide she may feel I am abandoning her.

If she insists on attempting to have me play the role of a supporting parent who pays her way through life she may become angry when she is expected to pay her bills on time (or at all). She may leave therapy, outraged that she is required to pay for her sessions and believe that I am abandoning her. 

If she is becoming entrenched in life endangering behaviors such as starving or breaking bones on the treadmill, or associating with violent and dangerous people, she may become furious when I bring up possible consequences of her behavior.  She may feel betrayed that I do not minimize and justify her behavior as she does and leave feeling abandoned by me.

I feel helpless when what I offer a patient is refused, and she insists on following a course dictated by her eating disorder. If that situation is sustained, then I must refer her on. If she is wracked with feelings of abandonment she will believe that I am abandoning her when she is abandoning her treatment and her relationship with me.

It's difficult for her, and many people -- maybe you too--, to recognize that I support her and not her eating disorder.  When the pull of her eating disorder is strong she may believe I am not supporting her because I am not supporting what the eating disorder voice wants. I honor and respect her eating disorder and its power.  But my role is always to support her health and recovery.

I'm grateful to the author of Babbling Cats for being so open with her thoughts and feelings.  She is articulating what many people, struggling to stay on their eating disorder recovery path, cannot say.  Her questions and my opportunity to respond could help her and others gain more insight into the power of eating disorders and what it takes to heal.

One last note: I always leave the door open for a patient to return.  I tell a woman who is leaving that she is welcome to come back. I do my best to leave her with some parting words that she may remember when her passions subside.  I hold no grudges against her when I know it's the eating disorder controlled mind that is speaking. I still support her authentic personhood and will welcome her back.

Recognizing and honoring boundaries are formidble challenges to a person with an eating disorder.  I know she has difficulty when I honor the boundaries of private practice treatment. But when I do, she learns that boundaries are real and have a healing function as well as serve to make a life manageable.  If she does recognize this, her return can be a new beginning for deeper and more long lasting recovery work. 

Have you felt abandoned in your therapy? Did you leave or work through it? What would you advise others based on what you have learned?


More on this topic



0 # Hey Joanna, Thank you for your kind worPTC 2011-02-20 17:16
Hey Joanna,
Thank you for your kind words, advice and comments. My sesh should be interesting tomorrow. I've already warned her that I'll be laying face down on the couch with my jacket over my head. I hate talking and suck at expressing my feelings, so I feel like just laying there is somewhat expressing how I feel, which is pretty crappy. I don't want to lose my T. Not only does she know what she's doing, but I really like working with her. I just wish this was easier. I can't gain the weight she wants me to gain. I don't want her to think I'm choosing the ED over her, but I just can't do what she is asking of me. It's too much. I know she's doing what she feels she has to do, but it still sucks. I still don't understand why she can't continue to work with me regardless of my weight. I'm not unhealthy or unstable.
0 # I've never had any reason to feel rejectKymL 2011-02-20 17:36
I've never had any reason to feel rejected by my therapist, but when I first started seeing her, I was so afraid I'd start to feel comfortable, gain some weight then my HMO would say I was no longer sick so they wouldn't pay for anymore. My fear was that emotionally I would still be feeling like crap, only all my wounds would be left opened. It took me a long time to finally admit that my early resistance to therapy was because of that fear. Once I told her this, she assured me that the intent of the treatment wasn't just to get me eating again, but to fully address the issues behind the disorder. We still have to re-address this when my trust level goes down, but over all I'm glad shared that fear and began to trust.
0 # Dear PTC, Sounds like your getting mopinkjoanna 2011-02-20 19:05
Dear PTC,

Sounds like your getting more clarity every minute! I hope you bring her a written list of your questions and concerns since saying them outloud to her is difficult for you. Some people draw their feelings too. You have many ways to communicate.

One point I'd like to comment on. You wrote, "I don't want her to think I'm choosing the ED over her,..."

Please know that as much as you and your therapist care about each other (and that's vital in recovery) this issue at hand seems to be: choosing the ED over your healing or recovery work.

It sounds like the two of you have created a wonderful therapeutic relationship. It's tough when issues come up that seem to turn the relationship into a pwer struggle.

When that happens it's a sign that eating disorder governed perceptions are coming up. You know that control issues are a big part of eating disorders.

If this seems relevant to your situation you might consider putting control issues on your list of issues to explore with her.

Good luck tomorrow!
0 # Thanks. I haven't written down anythingPTC 2011-02-21 04:10
Thanks. I haven't written down anything yet so hopefully I won't freeze up when I get in there and have nothing to say.

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