I recently received the following feedback from another eating disorder treatment professional regarding my approach as she perceived it from reading this blog:
“It appears [we have] a differing philosophy in treating eating disorders. We don’t help clients to lose weight or make that part of our treatment plan. We help them regulate eating and discovering the underlying issues driving the ED behavior. Sometimes that results in weight loss. In addition, we have found that keeping the focus on weight and a restrictive diet maintains the ED. We do not recommend elimination diets such as the Whole30 as this is another way the ED stays active.”
I had rather a lot of feelings upon reading her response.
The first of these was the hot flush of shame, and thoughts that I’d been caught doing something wrong by an authority. Incidentally, shame and a fundamental belief in my own “badness” is one of the “underlying issues driving the ED behavior” that I unearthed in my own early treatment experiences. This was followed by a roller coaster of anger and defensiveness. So, first I dealt with the feelings: 73 deep breaths, a draught of lavender essential oil, a big glass of cold water and a long walk with my partner to talk it out. Thus soothed, I returned to my critic’s words for some reflection.
Going back over the feedback line by line, from a less emotionally reactive place, I made an interesting discovery: what she wrote has absolutely nothing to do with me or my treatment philosophy. In the words of Byron Katie, her response is not my business. The feedback I received was the author’s reaction to my blog, which reflects her thoughts, her beliefs and her agenda, none of which are my business.
What is my business are my reactions in thought and feeling to the feedback I received and what I choose do with those. I could rant and rant here about how my post about the Whole30 virtually insisted eating disordered clients not do a Whole30. I could be all righteous and s@#t, but the only person ingesting that vitriol and raising her cortisol levels would be me.
Historically, I would have reacted to these kinds of difficult thoughts and feelings with a cascade of eating disordered behavior, but I’ve learned that the core of recovery is to employ mindfulness in order to be on guard for my triggers and access alternative coping strategies accordingly. In terms of treatment philosophy, this is also what I teach my clients, and what I have intended for this blog to reflect.
Here’s an another potential twist on things: my initial response to the feedback was an angry and defensive “That’s not true! I know what I’m ‘supposed’ to do in this field and I do it!” But what if, for the sake of argument, everything she wrote is accurate? Would that be bad? While the author of the comment reflects the conventional wisdom of our field, I am not entirely conventional in my approach.
While I certainly don’t make weight loss a part of every treatment plan, depending on the context and goals of my client, it’s sometimes included. For example, if I’m working with an obese binge eater who is trying to avoid knee surgery by losing weight, and that goal is the only thing that’s motivating her to work for recovery, then I’m going to honor that goal. We’re still going to need to explore the underlying issues supporting the eating disorder, and regulate eating, but in my experience not every person who wants to lose weight wants that from a disordered or distorted place. To my way of thinking, this is not dissimilar from noting that weight restoration is a goal for an anorexic client.
This is me. This is my blog. These are my words. These are my beliefs. Some people won’t like them, and that’s ok. Some people will like them, and that’s ok, too. Ultimately, neither of those things are my business; my business is to make sure that I am ok with what I put out onto the interwebs, and for today, I am.