Creating Structure: Top Requirement for Effective Recovery Work

800px-Banyan tree ClevelandA young woman with very little money ranted about wasting her last therapy appointment complaining about how her support group was ending. She spoke in broken sentences. She tried to overwhelm her fear and grief with rage. *

Her group, sponsored by a government program, was time limited. Her therapy was ending because insurance wouldn't cover more sessions. She was adrift and in a panic without finances or structure.

If you have an eating disorder and are low on funds you need a recovery template that will carry you through your recovery work when the insurance or government programs limit your treatment .This means you need to act on recovery needs that you don't understand yet. Not an easy task, but then, we all know eating disorder recovery is not an easy task.

Here's what you need to know. This knowledge will help motivate you to follow the suggestions at the end of this post. Follow them and you will be equipped to deal with powerful disruptions and remain stable on your recovery path.

When  anyone, has an eating disorder, separation is a major trigger. This means separation in terms of:
  • ending a relationship
  • ending a date
  • ending a class or group
  • ending an appointment (even if another is scheduled)

Separation includes:
  • leaving a party
  • guest leaving your home
  • moving to another town
  • starting school
  • ending school
  • starting and ending a vacation
  • starting a job
  • ending a job
  • starting a relationship
  • ending a relationship

Separation  can even include day turning into night and vice versa.

Effective treatment includes sustained relationships where you have a recovery place and person there for you throughout your recovery work. Going in-patient gives you that, but you are in a bubble. When you are in a fragile state both physically and mentally, in-patient can hold you and bring you up to a more sturdy condition. However, in-patient removes you from the reality of every day living.

Intensive out-patient treatment, where you spend many hours a day every day or every evening or three to five evenings a week, gives you ongoing support and treatment. You have more of an opportunity to be in whatever the real world is to you as you do your recovery work.

Both may give you opportunities to work individually with a clinician. This is important. You need to be really seen, known, understood and accepted with respect by another person for you to develop beyond your pain and shame into the healthy person you can be.

Interruptions in the continuity of that experience are more than triggering. If you are in your recovery process and venturing into new ways of trusting and healing, disruptions can plunge you back into unbearable feelings that drive you into your eating disorder behaviors for protection.

Individual psychotherapy that is ongoing with no time limit and allows thorough access to your therapist provides continuity and stability. You work in an environment of trust, acceptance and respect knowing you and your therapist will be together for as long as it takes and through all the events that occur in your life during your recovery work. This is costly.

You say:
  •   "My insurance only covers 20 appointments."  
  •   "My therapist is only allowed to see patients once a month."
  •   "I've reached my limit of appointments. Even after several extensions I'm still feeling awful. Now I'll never see my   therapist again."  
  •   "I can't afford private practice with an unlimited time frame."  
I hear stories of bewildered anguish from women struggling to keep their treatment going while they feel rage and despair at the limitations of treatment available to them.

Thinking has got to get blurred when you know separation is looming from the first appointment because you have a specific number of sessions available to you. Thoughts and feelings can go haywire when the inevitable separation occurs.

You need to know this. You need to know that separation and disruption in your life triggers your eating disorder and will trigger your eating disorder until you are really in recovery. When you know this you can create structure for yourself so when separations occur, especially if your treatment is disrupted, you don't lose the entire foundation of your stability.

Solution: Put healthy, supportive and healing activities in your life and honor them in a regular schedule now.


Have a "friend event" one a week. Could be lunch or a walk in the park, etc. Your choice. Block it out in your calendar, and make it happen no matter what. (little or no financial cost) 

Find a spiritual program that suits you and make it a regular part of your life. Go to meetings. Meet people. Contribute. (little or no financial cost)

Find a creativity outlet like a writing class or writing group or art class. Attend once a week or alternate weeks or once a month, but make it regular. And give yourself the space and time to do the creative action on your own on a regular basis several times a week. (little or no financial cost: yes, costly through some schools and private offerings. Look to the park system, museums, local community organizations. Don't overlook the internet for possibilities, e.g.

Recovery work: You can vary this. Give yourself recovery projects on a regular basis and follow them. For example, you might go to 12-step meetings or be part of an ANAD support group. You might go on a week-end retreat or do a workshop about healing something amiss in your life. Experiment and keep yourself open to new opportunities. (little or no financial cost: again, many programs and events are costly but many are not. 12-step and ANAD are free. )

Find a meditation or mindfulness class, group or program and attend on a regular basis. Again, one a week or alternate weeks or once a month.  Just make it a regular event in your life. Meet the people. Contribute. (Some are costly, but some are free. Look carefully for what is right for you.

Healing Your Hungry Heart: recovering from your eating disorder will give you many more suggestions about what activities to bring into your life that contributes greatly to your healing. Each chapter ends with recommendations.  The Appendix is rich with many options and possibilities.

The forum and comment sections of this site often serve as mini support groups for readers. 

With all this in place, you still go to your mental health professional to do your individual recovery work. Now you have a structure that holds you and your therapy. You can do deep work with your therapist in a climate of love and support.

You can feel and be more secure knowing that if and when insurance and government programs fall away, taking your treatment with them, you are not alone. You do not go into free fall. You do not retreat with pain and shame into your eating disorder behaviors.

You have a supportive healing structure around you so you can stumble but not collapse.    (see how the Banyon tree in the photo gives itself many structual supports.  Yes, it's a picture of one tree.)

  1.   What is in your life now that is regular, consistent and supports you with care, respect and health?  
  2.   What more like this could you add to your life?  
  3.   What is in your life now that is supports you but on a casual and unorganized basis?  
  4.   How can you make this stable and consistent in your life?
  *A Banyan tree claimed to be the oldest in Queensland, located in Cleveland beside the Grand View Hotel. photo by NJM2010


Laura R
0 # SeparationLaura R 2012-09-23 21:24
I struggle so much with separation. I can remember struggling with it in high school when my good friends who were seniors left. I remember after college when my best friend and I had to separate. All very traumatic. I've always had this feeling of terror with separation. I wonder if I always will.

My eating disorder came into it's glory during a time when my relationship with my long time T was not working and I was sure she was going to fire me. When I left her and went to my new T, I started having a terrible time w/the 10 minutes before the end of every session. That was a year and a half ago. I still struggle with those last ten minutes. I even kind of do anticipatory grieving of the goodbye even before the hello. I rarely restrict or skip these days but when it does happen it's almost always after seeing T. There is something about the parting that gets to me even though I know I can call, email, probably even make an appointment the next day if I wanted to. It would be nice not to feel that terror or feeling that something really bad is happening.

The structure in my life right now is mostly around work and appts with my team. With work, I feel like I have to please -- so it's not really a safe place where I can be myself and I won't be "left". Last week two of my colleagues' positions were eliminated and they were forced to leave w/out saying goodbye. It really shook me. I am lucky to have good insurance right now so I can see all my providers. I do feel like it's conditional though.

I can see how building in other kinds of regular support and activities that are not so conditional or treatment related would give me more of a feeling of stability.
0 # moving on...shh 2012-09-24 02:24

When I was younger, I struggled terribly with separation

My parents could not go out and leave me with a babysitter, I could never sleep over at anyones home, I couldn't hack overnight trips with school or camping with scouts, I struggled with going on holiday, yet once I was there I cried because I didn't want to leave people/places/things behind to come home etc

What I learned though, to cope with most things, was that if I told myself that it was okay, I could get it back if I really needed it - as in call my parents to come home if I really needed them, go home early from overnight trips if necessary, revisit holiday destinations in the future if the need felt so great, keep in touch with people I'd met etc.

Which helped a little

But then that didn't address the "finality" of some situations - mainly death

But I learned that - I never did desperately need to revisit all my old holday haunts, I lost touch with people over time etc,  but what I didn't lose were the memories, and the memories I could revisit and recollect at any time I felt I needed them.

And with death this was the same - the physical being is gone, but the person lives on in my memories, and is not completely lost.

And that is how I feel about therapy... my sessions will end, but my therapist will live on in my head.

Of course there is a fear, that nobody is "as good" as my therapist in my real world, she is in many ways akin to a primary caregiver, but her voice will still be there in my head, pointing me in the right direction.

I have lost a lot of relationships in the last year - my father died, I have cut my mother out of my life, I split from my husband, my children changed schools, my best friend was forced to move away at short notice, I left my main social group because I had changed so much I didn't fit there anymore....

...but life moves on...I have reconnected with old friends - in fact some of the ones who used to be more like acquaintances have become true friends, I have made new friends through my girls new school, I am en route to a new career and have made a couple of friends from that, I have plans to set up a small business, I have started swimming again, I am starting to reacquaint myself with nature and have joined an ecopsychology group....

...I know I will be fine, I will miss my therapist, I will never forget her, she has kickstarted my journey, but this is just the beginning, it is by no means the end :-)

0 # wowmylifex2 2012-09-24 10:50 are kicking butt here!  So proud of all of your accomplishments this year. You sound like you are really in such a good place for your recovery work to flourish.

I have always been fairly independent.  Perhaps an anomoly amongst my peers here.  I did have some separation issues as a young child...the normal stuff, I think.  As an adult, I actually enjoy being single with my girls.  I don't feel I have to have a partner, however it would be nice to not be afraid to have a partner. 

As far as my therapist is concerned, I have been very, very lucky.  I have been seeing her since 1996.  Back in the day she took insurance, now she is mostly self pay.  She works with me at a greatly reduced fee.  I can see her as often as I like.  I am usually able to afford two to three times a month. 

I do think about what will happen when she retires.  She is at retirement age now, although I don't see her as the type to retire at a traditional age.  She doesn't need the money, I don't think...she really loves what she does.  I do dread the thought of this happening.  I have shared so much with her.  I hope to finish my therapy before she retires, as to not have to start over with someone new. 

This week I will see her on Wednesday.  As I stated in a previous post, I plan to email her my thoughts and fears on the whole abuse issue.  I want to really get this out, and start doing the work.  I want to get moving with my life.  Part of this push is because I do want to work on this with her, and no one else (in terms of face to face). 
0 # How did it go?shh 2012-09-27 02:11

Thanks Tracy - I do feel like I have turned some kind of corner in the last month or two.

I am also fairly independent - I think I learned to be from a young age, in order to protect myself, and I also enjoy my own company a lot! I can do relationships and be with men, but I still have intimacy issues, that I need to work on more.

How did your session go yesterday? I hope it was productive and not too tough on you xx

0 # Individual therapyPTC 2012-09-28 15:02
Individual therapy...until your therapist refuses to see you because you don't weigh what she wants you to weigh, even if you're not medically unstable.
0 # separation and transitional objectspinkjoanna 2012-09-28 15:46
Laura, Shh and Tracy,

Beautiful support and stories of recovery efforts!


Courageous and determined exploration of your process, even when it's frustrating.

Creating structure gives you stability and helps you cope with disruptive separations.

In addition, you can eplore the many benefits of transitional objects - without, of course, going over the top with them.

We all know about "bankies" and teddy bears foryoung  children as they cope with going to sleep at night and deaing with the separation from light to dark and separation from caregivers to being alone in bed.

But adults have transitional objects to help them cope with separation.  In fact, a case can be made that every item in your life is a transitional object because it connects you to something else.

Gifts from people or photos of them are transitional objects.  So are songs they liked or a favorite food of their that you notice on the shelves in the grocery store. 

We create a kind of lattice network that connects us emotionally or spiritually or intellectually to what has meaning for us.

I remember man years ago, clearing out my garage that was packed like an old attic with furniture I didn't use anymore.  I came to the realization that these large objects were all transitional objects and that was why I stored them instead of passing them on. 

That was a great realization. Now I make an effort to keep my transitional objects small.  :-)
A piece of jewelry or photgraph or book or crystal works just as well as a chair, as long as I can feel the connection that comes through the object.

How about you? 
0 # Transitional objects and terminationshh 2012-09-28 16:19

I asked my therapist last session if she would do one thing for me before I terminate, but only if she could do it because she genuinely meant it, not because she thought it might be good for me..

and that was for her to write on a piece of paper "I believe in you" and sign it

she smiled and said of course she would, that she could do that with pleasure and genuinely mean it, and that she thought it was important for me to have that.

And that will be my transitional object :-)

0 # love, courage and transitional objectpinkjoanna 2012-09-28 17:37
Fabulous, shh.

You are moving through this major event in your life with grace, courage and love. 

Inspirational and so very heartwarming.
Laura R
0 # Transitional ObjectsLaura R 2012-09-28 17:49

shh - I think it's so cool that you asked for what you wanted and your T did it! When I  ended with my former T I asked for a note with a couple of the sayings she always said to me and she said no because she thought I had them in my head. I was disappointed.

Joanna - I'm a total believer in transitional objects. Current T gave me a little fist sized stuffed guy early in our time together when he realized how much I struggle w/separation. I bring it with me to therapy every time and T touches his nose and "loads him up" with positive energy. Then I clutch that little guy when I want to remember the connection. Kind of silly for a 40 something year old but the little kid inside me LOVES it. It's gone with me on travels and all kinds of places.

My hubby just did a race in another country and he was very nervous about going alone and how he would do. I found a stuffed animal that he could put in his carry on bag and told him that it had courage from me inside it. He took it with him and when we did our video calls the stuffed animal always got on the camera and said hi.

I think some of my clothes might be transitional objects. There are certain things I like to wear that I associate confidence or comfort with.  

0 # Transitional objectspinkjoanna 2012-09-28 19:37

I don't believe any of us outgrow our need for transitional objects.  :-)

Heirlooms are transitional objects connecting us formally and emotionally with our family, sometimes through many generations.

The moon can be a transitional object that connect us, even when we are on different sides of the earth.  Sun and stars too.

I visited dear and aging friends in Sweden.  I walked through a forest by a lake without them because it was beyond their capacity. Sad because we walked together for many years. Bittersweet because I knew I was learning to walk without them.

On the ground I found a black Swedish stone that, to my eyes, was shaped like the continental United States.  I brought it home and keep it in my garden. My friends are both gone now.

The stone connects me to them, to Sweden, to that forest by the lake and to the love I have for them as I physically walk without them but always carry them in my heart.

Oh yes, and don't we keep at least a few things from our children's childhood???? :-) Something to bridge the years and remind us of past treasured times?
Laura R
0 # The moon :)Laura R 2012-09-28 20:38
When I look at the moon now, I remember hearing my mom sing to us when we were little..."I see the moon, the moon sees me"...and then I smile and I miss her in a good way.
0 # The moonpinkjoanna 2012-09-28 22:15
Yes, Laura!

This is one of the oh so very human ways we cope with separation.  It's not just coping, i.e. getting through it.

We can experience a richness of emotion, memory, appreciation, pangs of loss mixed with sweetness and even wisdom.

How lovely to discover the moon is a tender transitional object that connects you and your mother in this way.
0 # I don't knowPTC 2012-09-29 06:18
I have absolutely no idea.  I'm sure I have a million things, but I don't really know.  oct. 12 is D-day, the day I find out if my T will stop seeing me or not based on my weight.  Hopefully she won't fire me.
0 # D-Day - time to go deeperpinkjoanna 2012-09-29 10:45
Dear PTC,

Maybe this is the time for you to tell her how and why she and the work you do together is so important to you.   Maybe it's time to make some committment changes or realignment changes or some kind of change that moves your work together in a different and more meaningful way.

If you are at an impasse - if anyone is at a impasse with a person or an activity - the answer is not to go back a few steps and repeat what you've been doing so you wind up at the impase again.

The answer, or the hope of an answer, is in looking clearly at what you cannot do, i.e. the impasse and how, perhaps, you've been here for a long time or amny times.  Then you explore different alternatives. 

This involves real honesty with yourself and the other person or people involved.  This involves strength and courage bec

PTC, please look inside yourself for your personal goals and set your intetion to get there.  Share that with your therapist and offer her an opening so you can discuss new possibilities. It's possible to get through an impasse, but not if we keep using the same method that doesn't work.

If she fires you, your therapy with her is over.  If you both can work out a new approach, your old therapy style is over and something new begins.

I do hope with all my heart that you will be open with her.  The fact that you don't want therapy to end says a lot about how much she and the work you do together means to you.  I wonder if you've told her - or even admitted this to yourself?

I believe you have what it takes to make progress from here, PTC.  :-)
0 # why can't i think of one?mylifex2 2012-09-29 18:25

I can't think of anything that I veiw as a transitional object...when I try, my mind just blanks out.

0 # can't think of onepinkjoanna 2012-09-29 22:42

The backtracking exercises in Healing Your Hungry Heart are about how transitional objects are everywhere in our lives.  They connect us to other people and other places.

Maybe this is a time in your life when it's difficult to acknowledge that you do have connections.

Pick any object in your home and trace it back to where it came from.  It serves as a transitional object for every step along the way as you follow it to its source.  If memories are attached to your backtracking then the object serves as a transitional object to who and what are connected to those memories.

Let us know what happens when you try.
0 # motherspinkjoanna 2012-09-29 22:45
I found this quote while clearing through papers.  I think it relates to some of the discussion on
this thread.

"When I stopped seeing my mother with the eyes of a child, I saw a woman who helped me give birth to myself."   ----- Nancy Friday

I agree that a lot of powerful insight, growth and change happens when you can see your mother as a woman.
0 # repeatPTC 2012-09-30 05:31
Thanks Joanna,

I have told her that I don't want to stop working with her and that she has helped me so much already and I don't get why she would stop working with me because of this one thing, when we can still work on other things (she wants to know what other things).  She has really helped me, and she can continue to help me, even if I don't gain those stupid 4 lbs she says I have to gain.

We have gone through this weighing cycle over and over again for the past few years and it never gets us anywhere.  It gets me annoyed, mad and frustrated and I'm sure it gets her frustrated, but I have no desire to change my weight, nor do I think it's necessary, nor do I really believe that I need to change the way I eat.  (More variety, yes, but that's it).  It's like the tape player is on repeat. 

I know I had more to say but I can't think of it.
0 # transitional object?mylifex2 2012-09-30 17:54
When I was growing up my dad worked 3 jobs at times to keep me and my siblings in private school.  My parents felt strongly that my mom should stay home and keep things going on that end, as there were many children in our family. I didn't see a lot of my dad because of this, but I always have appreciated how hard he has worked his entire life to make things better for our family.  Now that he has retired and has a limited income, he still does what he can to assist us when we get in a tight spot or two. 
I remember a time when I was about 10, my parents were having a particularly difficult time financially. My birthday was coming up and even at that young age I was able to realize that my birthday was coming at a pretty bad time for them.  Despite this, I did receive a couple of small items bought from the store, a barbie, I think, and some other little trinkets.  But what I remember the most is a Bible that my dad gave me.  Not too long before my birthday, my dad had been a pawlbearer for his best friends funeral.  At the funeral the family gave all of the pawlbearers bibles with their names engraved in the leather on the front.  My dad gave me this bible. I know it meant a lot to him to give this to me.  I saw how he had tried to scratch the gold lettering off the front to remove his first name, leaving only the last name.  Despite this attempt, most of his name still showed. It was an obvious "scar" on this precious item.  I know it bothered him that he couldn't fix it for me. 
I have this Bible to this day. I used it for years until I finally got a new women's study bible a few years ago for another birthday.  In fact, I can see the bible on a bookshelf from where I am sitting.  I have moved atleast 10 times since I was 10.  I could have easily lost this bible, or allowed it to go into storage, or be boxed up in a closet. 
I guess I could consider this a transitional object as it holds good memories for me, and will be a memory of the type of person my dad is, for long after he is gone.  My relationship with my mom has often been tumultuous, but my dad has always been so level headed. He is a man of few words, but I know that he would do anything for me.  My childhood was not easy.  I had years of sexual trauma that my parents still do not know about, as I did not disclose my maternal grandfathers abuse to my family - ever.  But I feel my dad just "gets me".  One New Years Eve a long time ago, our family played a game where we had to go around the room and describe the person next to us in one word.  My dad was sitting next to me and his word for me was "determined".  I knew he meant it in a positive sense. I carry that memory with me as well, as I feel he has always seen my strength.  I have needed this memory often in my life.
0 # Bible as transitional objectpinkjoanna 2012-09-30 22:00
What a beautiful healing story, Tracy.  I feel as if I've met your father in person.  Yes, that Bible is a rich transitional object that connects you to much love and support that you did have and perhaps helped youto be and keep becoming the determined woman you are. 

0 # a very late commentshh 2015-02-14 20:34

I searched for this thread because I'm sat here on the verge of tears over a dining table.

My life is now so very separate from my ex's, there are a couple of things that will take time to settle - namely our youngest daughter who is struggling with the transition, and my career plans/finances, but I am otherwise pretty happy.

I have secured the family home and the means of affording to keep it now, so I'm feeling more settled and I'm in the process of decorating downstairs, freshening the place up, and replacing some of the old furniture. My budget is pretty limited, but it's amazing how much can be achieved if you put your mind to it. I have, however, reached a sticking point with one particular piece of furniture - my big,old dining table.

Even if I kept it, I would need to sand it and fix the wax finish and buy new chairs - and even then it would still just look like a big old table. The cost of the chairs I've seen is more than the cost of a new table and chairs that I really like that match the new décor - it should be a no brainer, but it isn't -  the prospect of parting with it reduces me to tears, whilst the prospect of keeping makes me feel like I'm wasting money on a look that I'm not even that keen on, it all feels quite ridiculous, so I'm trying to fathom out why I'm so attached to it, what it means.

This table is big and chunky, it is solid and sturdy, made of scandinavian oak - any replacement, however aesthetically pleasing, will not match the quality of this table, although I'm sure will be sturdy enough for our needs. This table has always been at the heart of the family - it has seen homework, arts and crafts projects, birthday parties, Christmases, meals with family and friends etc. It was also the place where we ate together, the 4 of us, every day, no phones, tv, toys, gadgets, just the 4 of us, our meal, and conversation about our day. It was our quality time together each day as a family.

I guess it's reliable and virtually indestructible, just like I believed our family unit was. I worry - what if I get rid of it and then want it back, what if a new table just isn't the same, doesn't have the same feeling?

If a new table is a representation of our new family unit - what if it turns out to be flimsy and poor quality - does that mean as just the 3 of us we are not that strong family unity anymore? Does it mean our relationships are superficial and lack stability and durability? Is that what I'm scared of? Am I scared that I'm not enough on my own and that I can't hold our new family unit together?

I need to have a think about this.





0 # Never late to comment and share processpinkjoanna 2015-02-14 22:51
Dear Shh,

You've accomplished so much! Congratulations. Your sorrow over the table means that you have cleared away so many old obstacles and causes of anxiety that you are now free to explore what you perhaps have denied or neglected or considered minor compared to the big work you had in front of you.

Your table is a transitional object. You've laden it with memories, feelings, associations and given it power.  I remember a woman saying, after she looked at her garage filled with old emotionally laden furniture, "Why can't my transitional objects be jewelry or hats or special spoons? Why do they have to be huge pieces of furniture?"

Once she asked the question she began the process of keeping her memories but separating them from the objects. The process was another level of creating freedom for herself and establishing greater strength within.  Gradually she didn't need the giant couch and ottomon from earlier days to carry her emotions. She could carry them herself and then, benefit from the freedom of new space and new possibilities.

So a major transitional object for you is the dining table. How can you free yourself yet keep the meaning? Can you take a photograph of it or draw or paint it or all of these things and make an art collage?  Or perhaps you can breakdown the actual table and make some of it a piece of art to hang on the wall. Or you can give it, donate it, sell it so it goes to a new and worthy home as you create your own home anew.

You might create a gratitude ceremony and write your memories and appreciations.  Keep the writing in a lovely way as you say good-bye to the past.

There's an old Buddhist saying. Use the raft to get to the shore.  Once you get to the shore, prepare to walk through the forest. Leave the raft.

Even if that raft saved your life, you say thank you and leave it as you face the new challenges presented by the forest.

You are doing great, Shh.  I'm glad you wrote. 

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