Psychotherapy is a healing conversation. It provides an opportunity to repair the inner emotional wounds that may have led you to conclude that trusting food is safer than trusting people. And therapy also helps you improve your behaviors around bingeing, purging, or starving.
The nurturing relationship with the therapist provides healing because it repairs the core of a person’s wounded relationships. The therapist works with the patient to understand his or her early history and also helps the patient understand how that history relates to the present eating difficulties. By integrating both the past and the present, the therapist and the patient create an individualized treatment approach. Emotional eaters improve their capacity to regulate their emotions, not act on impulsive feelings. They learn to tolerate discomfort, reflect on the meaning of their emotions, turn to others for security, and learn to love. These are the tasks of creating a healthy and integrated self.
However, many people dislike the idea of developing a strong relationship with a therapist or becoming dependent on a therapist. They say, “I just want to get fixed from my eating disorder,” or “I don’t want a relationship with you,” or “Just let me get on with my life.” They often pose pointed questions to the therapist that reveal their personal fears about the treatment process, as well as relationships in general:
- What if you become a crutch to me, just like the food?
- What if I need you more than you need me, which I assume must be the case?
- How can you really care for me if this is just a business to you and I pay you?
- My last therapist died during my therapy. How do I know the same thing won’t happen here with you?
- How do you remember what I say? Do you write down notes about me?
- What if I say something that hurts your feelings and you don’t like me anymore? Will you pretend to help me but instead lead me on the wrong path out of spite?
- What if I have sexual feelings to you?
- Do you ever have sexual feelings for your patients?
- Do you ever pretend to care when you really don’t?
- Will you think about me when you’re on vacation or do you forget all about your patients when you’re out of the office? Will you miss me?
- Did you know that the word “therapist” is actually “the-rapist?”
- Did you ever lie to a client? Would you ever lie to me?
- If I get better, will you take all the credit?
- Do you love me?
Obviously, these questions are laden with meaning that a mere yes or no can’t answer. The therapist’s stock answer, which has been turned into a joke that pokes fun at “shrinks,” is “What do you mean by that?” This question often leaves people feeling rebuffed and patronized. However, the therapist’s intention in asking, “What do you mean by that?” is valid—to discover and explore the unique thoughts and ideas of each person.
If, for example, a woman asks me, “Do you ever have sexual feelings for your patients?” and she is someone who has been the victim of sexual abuse, then I surmise she is trying to determine if I can be trusted not to act out sexually or impulsively. But the question could mean she is struggling with her own homosexual feelings to me; or it could mean she wants to be mothered intimately like a little girl. A sensitive therapist will help patients identify their specific concerns.
If a young teenage boy poses the same question, he may wonder what kinds of sexual feelings are acceptable and normal. I may kid him and say, “Is the idea of my having sexual feelings to you something you fear or you wish?” or “What would it feel like if I did?” or “Is there something specific you would like to do with me?”
Caring therapists believe every client question has meaning that needs to be understood and every question has value. Therapists need to respect their patients’ inquiries, as uncomfortable as they may be. When clients ask difficult and intrusive questions, it may also be their way of turning the tables on the therapist and putting the therapist in the hot seat.
Emotional eaters have subsumed their inner lives behind struggles with food and weight. The emotional eater’s world has narrowed into the world of numbers: How can I lose 20 pounds quickly? How can I get back to wearing a size 6? I’ll just have an apple for lunch— it’s only 100 calories.
They are fluent in the language of eating disorders, but not so much in the language of feelings and self-expression. Questions to the therapist can deepen the treatment into richer, more alive concerns. The curiosity of the therapist and the therapist’s own genuine personal involvement foster the growing self-reflection of the patient. Rather than taking an action (like overeating, purging, or starving), patients are encouraged to wonder about their feelings, their reactions, their behavior. This work will finally help people claim their true and vital appetite for life!