A Letter To My Former Therapist

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Dear J,

The three years we worked together were the best and worst of my life. I knew at the beginning– in my bones, I knew— that you were it. You were my ticket out of misery and into living a full, rich life. My first thought about you was, Wow, this woman seems like the reincarnation of Carl Rogers. Your empathy was unprecedented.

I didn’t have a solid enough sense of self at the time, but I could feel that you believed in me. When I doubted myself, when I slipped back into old patterns, whatever happened, you were there. You treated me like I was a worthy, capable, real human being.

Sometimes, I could believe that. Other times, I relied on your strength, and you believed that for both of us.

You cared about my feelings– no — you loved them. You acknowledged whatever I was feeling and took it seriously. I was stunned by how much you cared about me. Maybe even by how much you loved me (in the most platonic of ways).

In your eyes, I was a capable, intelligent therapist, prone to struggles, yes, but worthy of love. You trusted me not only as a human but as a professional.

Words cannot describe how you changed my life for the better. You helped patch my ragamuffin, broken self into a mosaic of messy parts. The mosaic was in the making.

But then again, words cannot describe how you changed my life for the worse.

In a whirlwind, what became a healthy, therapeutic relationship led to your emotional unraveling and at the end, a break up via email, with no closure.

To say that the end of our relationship destroyed me is cliche but true. My life, just like yours, unraveled at the seams, and everything was turned upside down.

You, the person who believed in me, who laughed and cried with me, who I would send my most personal writing, who was my rock, disappeared into thin air. In a moment, you were gone.

Just as I was starting to trust you and the walls were down, you left me without defenses. I was raw, cold, crying, emotional, and numb all at the same time.

I developed a disgust for therapy. I left graduate school. I moved back home to be closer to family. I changed my life completely because I didn’t believe in people anymore, and I didn’t believe in myself.

Almost 3 years later, the scars are still there, and sometimes, they bleed. I cannot trust my new therapist of almost 2 years. She reminds me so much of you, it’s scary. I see you in her sometimes, in her mannerisms and words, and I quiver. I don’t know if I can let anyone into my heart again. Not after you. 

“I wish I could do something to make it safer for you to open up,” my new therapist tells me.

“People always leave, just when you count on them,” I respond.

This has become our therapeutic struggle. I can’t trust, and I think about abandonment constantly. Would I get hurt now if my new therapist leaves? What about now? I can’t hurt again like I did with you. My sense of self can’t sustain another loss of that magnitude.

I think about you less and less over the years. I don’t cry every time I go into Ann Arbor anymore, nor do I listen on replay to Sia’s “Titanium,” a song I remember playing at the time of our relationship’s demise.

I still grapple with this: What happens with all the memories, the loving, painful, bitter, scattered memories?

I have tried locking them all in a box, and it never works. The moments we spent together spill over, sometimes through tear-streaked eyes, and sometimes with a smile.

I’m not back to normal following this experience. I have occasional flashbacks of you, and I remember every moment from when our relationship turned sour. I remember the angry emails we sent back and forth. I remember where I was when you broke up with me.

Then, I remember your face and how you used to laugh at my weird humor. I remember your expressive eyes, and your frown. I remember how you advocated for me. I remember the good things sometimes, and I don’t want to forget those. You were a huge part of my life and my story, and I can’t only hate you and have that be the end.

You weren’t just the “bad object,” you were the “good object” too. 

And yet, what you did and how you ended things caused me so many abandonment issues and trauma, I have needed years of therapy for years of therapy.

The sad thing is, nobody talks about the death of a therapeutic relationship. Nobody talks about a loving, trusting therapeutic alliance gone south.

If I was grieving the loss of a best friend or family member, it would be socially acceptable to feel grief. With a therapist, not so much. Does one ever hear, “Hey, I am a wreck, my therapist broke up with me today”?

Psychotherapy can be wonderful, yes. It can be healing and transformative and beautiful. 

… but it can also hurt. It can cause trauma and pain. It can sting, hurt, and wound on a gut-level. Nobody talks about the latter. 

But you know what, J, I am coming out of the closet. I want to say goodbye to you, but I also want to publicly acknowledge my grief. For years, I was quiet about the matter. No longer.

I am left, almost 3 years later, with no answers, ambiguity, and lots of pain. For a long time I thought it was me. Something I didn’t do. Maybe, despite all odds, you could come back to me if I did x or y.

Now I am learning that it was never about me.

It was about you.

It was your baggage and emotional issues that ended our relationship, and it wasn’t my fault. We will likely never meet again. On a good day, I can be okay with that.

So goodbye, J. You were a great therapist… one of the best. You started me on a path to healing that I hope I’ll one day finish. But I won’t finish that journey with you.

Sincerely,

Charlotte

 

 

 

Confessions of a Girl in Recovery

Many teenagers and young adults measure time with hugs, laughs, and kisses; with tears, heartbreak, and belting out Taylor Swift songs; with midnight donut runs and staying up all night talking.

I measured my life in calories, compulsive exercise, and setting my alarm to 3 AM, because that was a “safe” time in my mind to binge. I spent my moments daydreaming of endless buffets– plate after plate of spaghetti, followed by cookie dough ice cream caves. I would “go to the bathroom” at least 5 times during class for an excuse to walk.

I fantasized about food similar to how teenagers fantasize about a first crush or first kiss. Anorexia was my comfort… my everything. In the little world I made for myself, I felt safe. At least I knew this.

Most of my memories for a good 10 years centered around food. I remember only one thing about my high school graduation: the internal debate about whether I was going to eat lunch that day.

Every birthday party, including my own, I would be “too full” for birthday cake. Sometimes I would swear to anyone who probed, “I just hate sweets.” Lies.

Sometimes people would respond with jealousy, “I wish I could be like that,” or, “I wish I could look like you.” No, no you don’t. 

It is hard to describe what the living hell of an eating disorder is like to someone who has not personally heard the eating disorder siren call. I can’t count the amount of times others have said to me, “Can’t you just eat?” In my mind, that comment was akin to, Can martians become elected officials? Can Michigan be warm during the winter? Can I please teleport? Can there be peace in the Middle East? Anorexia had a neurobiological, psychological, emotional, and spiritual stronghold over my life. It was this gravitational vortex pull mixed with a sensation similar to being held down by the Boogey man.

Being asked to give up my eating disorder felt like asking to give up me.

At some point, I had to realize, No, this is not sustainable. I cannot maintain even a facade of normalcy. Despite the denial, I admitted that what I was doing was killing me. If I was compliant to the incessant demands of anorexia, I would either die or have everything be taken from me. I decided to give the having-a-life thing a shot.

Eating disorder recovery felt like being asked to move to a distant land, a strange, odd place where people would eat cake voluntarily. It was absolutely mind-blowing. Why would someone eat dessert? Willingly no less??? I ate celery voluntarily. I compulsively exercised voluntarily. Voluntary dessert was belching the alphabet at tea with the Queen of England, or  showing up to a job interview with mustard all over my face. It made no sense. I had to trust people who told me, This is normal. This will get easier. This is okay. You are okay.

Stabilizing my weight and food intake did not address the root issues, but it needed to come first.

After time in treatment, I finally admitted that fat free cheese was disgusting. I mean, really disgusting. It should barely count as cheese. Or not count at all. How could I have “preferred it” for years? I could say similar things about sugar free Jello (one word: gross), Molly McButter (I mean, what IS that really? is it edible? should it be?), and Splenda (confession: still trying to fully wean off that one).

Consequently, I found that cake is actually delicious. In fact, now it is one of my favorite foods. Dessert is really underrated when you have an eating disorder. I had this false dilemma in my mind: I could eat a slice or pie OR I could die. It seemed that dire of a situation. But it doesn’t have to be. At treatment for the first time, I started eating cake as often as I could. After years of severe nutritional deprivation, it just tasted so good!

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Me with cake… because it is delicious.

Recovering in terms of weight restoration and achieving medical and nutritional stability were important… but the hardest work came later.

In addition to the important eating component of ED recovery, I also had to learn how to live. Surprisingly, that has been a motherfucker of an obstacle that is ongoing.

So these things are works in progress:

I learned that there is more to life than the prison of anorexia. I learned not only to enjoy food but to enjoy people; to fall in love and fall hard; to open up to others; to experience happiness but also sadness; to feel and to feel it all, the spectrum of human experience, both the good and the bad.

Subsisting indefinitely in an eating disorder netherworld hardened me. The thawing work of recovery and subsequent therapy has hurt like hell, there’s no other way to describe it.

But I am learning how to live.

I didn’t do that for a really long time.

In the process of obsessive exercise videos and “being too tired” to go out for ice cream with friends, I missed so many moments… so much time. I missed the taste of gelato in Italy, and wine and cheese in France. I missed taking deep breaths and soaking up the sunlight. I missed years; in fact, over a decade of my life. I hurt others and myself.

The years…

the memories…

the bodily damage…

the relationships…

the lost opportunities…

I will never get any of that back.

I am still in the process of figuring out the labyrinth that is the sum of my life experiences and feelings. I have to tear off the (emotional) bandaids that I kept on for safety and address the pain that such a process produces. Not to mention the fact that the body does not do well with over a decade of abuse. I take steps forward and steps back. I like to think the overall trajectory is forward, though.

Sometimes I’m growing, and sometimes I’m not. Sometimes I feel motivated, sometimes not. Sometimes I feel like I am exploding with feelings, and I want to gauge my eyes out. Sometimes I laugh until it hurts, and sometimes I am limping in agony. Sometimes my pace of recovery is that of a turtle.

I am learning to believe that is all okay. Sometimes.

Myths About Eating Disorders: Debunked

Knowledge is power, but when it comes to eating disorders, there is a lot of misinformation that is out there. Sadly, this lack of knowledge of accurate information about eating disorders can even extend to health care professionals. With conflicting messages about what is true, it can be hard to sort out what information is accurate.

Because I have lived now over half of my life with an eating disorder, I’ve learned a lot of stuff (mostly out of necessity), and I have become aware of some eating disorder myths and stereotypes that exist. In this post, I am going to go over a few of these myths and debunk them.

 

What are eating disorders?

Myth:

Anorexia means starving yourself and being emaciated. Bulimia is bingeing and purging. And… that’s all.

Reality:

Eating disorders are most commonly described as complicated biopsychosocial mental health conditions that impact all bodily symptoms, the brain, and can have devastating consequences such as death. The most commonly recognized eating disorders are: anorexia, bulimia, binge eating disorder, and EDNOS/ OSFED (eating disorder not otherwise specified/ other specified feeding or eating disorder). Eating disorders involve some type of dysfunctional behavior(s) around food, including restricting food or caloric intake, fasting for long periods of time, using compensatory behaviors after eating such as purging, laxatives, diuretics, or overexercising, and/ or bingeing, or eating a large amount of food (of course there is social construction around what is considered “large”) in a discrete period of time.

Many eating disorder behaviors overlap. People who have suffered from an ED for a considerable length of time frequently experience diagnostic cross-over. Thus, these symptoms are neither clear-cut, nor are they necessarily noticeable. Eating disorder behaviors are often done in secret. Also, people with bulimia or binge eating disorder may not be over- or under- weight. Similarly, those who struggle with anorexia may not be emaciated.

It is important that people educate themselves about the impact of eating disorder behaviors and rely less on stereotypes of how eating disorders are culturally portrayed… namely how someone with an eating disorder “should” look or behave.

 

Who gets eating disorders?

Myth:

Privileged white adolescents.

Reality:

Anyone! While eating disorders are most represented in the media as occurring in Caucasian women of upper or upper middle class SES in a Western country, people of all races, sexual orientations, genders, economic statuses, and ages can develop eating disorders. There is a serious lack of representation of other eating disorder voices, which is why I’m really happy that this Marginalized Voices Project exists. We need to get better media representation of what eating disorders are like and who they affect.

Males, older women (40+), as well as people who are gay and of other racial groups, who have EDs are getting increased attention because—well, they get eating disorders too. Sadly, treatment is not necessarily tailored to them, and it needs to be.

 

What are the causes of eating disorders?

Myth:

Eating disorders are caused by Western media, trauma, families, or other environmental factors.

Reality:

Eating disorders cannot be pinpointed as being caused by one given factor. If you’ve ever taken a statistics class, maybe you’ll remember that correlation does not imply causation. Just because eating disorders exist (or are identified) in predominantly Western-influenced cultures, that doesn’t mean that culture CAUSES eating disorders.

Similarly, any risk and precipitating factors—a traumatic situation, an unhealthy family system—cannot be said to CAUSE an eating disorder. Perhaps these factors may increase the likelihood of an eating disorder developing, or they could be precipitating factors, but they are not the cause or fault of culture, or a family, or trauma.

I would also heed caution in that there has been an increase of media coming from companies such as Dove challenging cultural perceptions of body image. This is all good. I am a fan of challenging the oppressive body-image status quo. However, there is a difference between eating disorders and disordered eating or general body image issues. A girl might have negative feelings about her body from reading fitness magazines, but that is completely different from that girl developing a serious eating disorder.

Also, there is a significant biological basis of eating disorders that is still being explored. One study by Bulik and colleagues in 2006 suggests that anorexia is among one of the more heritable psychiatric disorders (0.56 as reported in her study).

All that to say, in general, there are a lot of unknowns when it comes to a cause or causes of eating disorders. My stats 101 lecture for the day: Be very, very careful about language pertaining to causation. Eating disorder research is being conducted because so little is understood still. There is not enough available knowledge to determine that something is a cause (or even causes) of an eating disorder. Talk about risk factors, talk about precipitating factors, talk about comorbid conditions, that’s fine. But talking about a cause suggests that 1+ factors completely explain the manifestation of someone’s eating disorder, and that is not something that can be said at this time.

 

What are the treatments for eating disorders?

Myths:

Once you have an eating disorder, you never get over it.

or 

You just need to eat.

Reality:

Eating disorders can be treatment resistant. I am living proof of that. However, treatment can also be effective. Recovery is possible. People don’t have to struggle with eating disorders forever and ever until they die. Recovery is not easy, and it may take time… a lot of time. Like years. Maybe more. But it can happen.

While eating disorders can be difficult to treat, certain treatments have been shown to be effective: CBT, DBT, family-based therapy, perhaps even acceptance and commitment therapy. I have more thoughts pertaining to this, but right now I will just say that there are some good options out there. I have been privileged to have seen a lot of great therapists who specialize in eating disorders, and I have been a part of treatment programs that have used all of the above treatment modalities.

People with eating disorders are not lost causes. They are not resistant, difficult, or frustrating. They are hurt and scared. They are in desperate need of empathy and understanding.

Notice that none of the treatment I have mentioned involves locking people up and force-feeding them. I had an acquaintance who once said, “If I got an eating disorder, my parents wouldn’t have put up with it. They would have just locked me in my room until I ate.” Honestly, good luck with that. Because I’m pretty sure that’s not addressing the problem. As in, I’m totally sure. That’s not going to work.

For whatever reason, people can have this mis-perception that the problem is the food, and all we need to do is make these people freaking eat. I both agree and disagree with that– it both is and isn’t about the food. I do not think that people can delve into root causes of their eating disorder while engaging in eating disorder behaviors, but I also don’t think that magically eating will fix everything.

So: there are some treatments that exist for eating disorders that work. Maybe the treatments that exist could be improved, but eating disorders are not untreatable.

 

 

Therapy: A Love Story

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I did not find therapy. Rather, therapy found me.

Or, more accurately, I was coerced, dragged, and bribed with a Harry Potter book to attend what my adolescent self found to be the most pointless 50 minutes of my life. “Waste of time” and “stupid” were other words I used to classify my experience. I wanted to be on my own to… you know… like STUDY (I know, I was lame). Sometimes I would just pull out my AP US History textbook during session. How could she stop me? Our sessions were confidential, right?

My relationship with therapy has been a lot like dating someone you don’t know you like. It has been a very love-hate endeavor. Since I began in therapy as an angsty pre-teen who took selfies with braces before selfies were cool (note taken: selfies with braces = still not cool), a lot has changed. Slowly, I have started to own my need for therapy. And ultimately, I have started to change. It took a long time. But it happened.

When I was a teenager, I was convinced that everyone needed to go fuck themselves and leave me alone. Everyone was concerned with my eating disorder and obsessive-compulsiveness and anxiety and BLAH BLAH BLAH. I put on a facade of wellness enough to appease others and continue doing whatever I wanted which was, in hindsight, destructive. I don’t know if I knew that what I was doing was bad. Honestly, I just didn’t give a shit.

It is really hard to help someone who doesn’t think they have a problem. Therapists tried with various degrees of success but weren’t able to adequately penetrate my ambivalence and denial. The behaviors that I developed were ingrained so deep into my psyche that stopping even one of them felt like I was being suffocated.

There was not a magical revelation or a moment when I owned my need for help. Rather, there was a period of time, over a couple of years, when I admitted– kicking, screaming, crying (okay, fine, bawling)– that I had a problem (okay, fine, many problems), and I needed help.

People often tell you in eating disorder recovery that food is like your medicine. That is true. Without nourishment for your body and brain, nothing else can happen. However, I realized that I needed therapy too. I couldn’t just eat my way to recovery. Therapy was another type of medicine: a different type of sustenance, but sustenance nonetheless. In the past, I had seen therapy as a waste of time, so it was a waste of time. I acted like it was prison, so it was prison. But… what if I saw therapy as healing, and I wanted to heal? Maybe– just maybe– then, I would heal.

As I was also going through a period of identity and paradigm shifts and learning about psychology in school, I was open to self-reflection and growth. For the first time, I was ready to do the work. On my own accord, I returned to therapy and decided to let someone in.

Over the years, I have come to see that therapy is not a series of skills, tasks, and tools in and of themselves. It can include those things, but it can be so much more than that. Therapy is the act of being present with another person. It is a real relationship, albeit special, with a certain purpose. The few therapists who I have let in have given me warmth, love, and empathy that I never thought were possible. In the context of that safety, I began to thaw.

Therapy can be deep and painful. I like the analogy Brene Brown made about the church being a midwife and would like to extend it to therapy. At times, the pain that comes up in therapy has been so overwhelming, it feels like I’m having contractions and it. won’t. end. My therapists have been there in solidarity, holding my hand through pain. As I learned, when you open the Pandora’s box of feelings, pain often coincides.

I had to learn to become vulnerable and unlearn maladaptive patterns from my childhood, such as stuffing, suffocating, and hiding my feelings. Opening myself up, exposing the dark parts of me to someone else, and letting that other person hold those parts were the most terrifying trust-falls of my life. Therapy felt like I was jumping off a cliff and praying that this person who was holding my deepest hurts wouldn’t drop them.

Change took me realizing that I was at the end of my rope, and I didn’t have to pretend like everything was okay anymore.  After years of running in circles and forming tight defenses against anything that might get too close, I found that I could just crumble to the ground. Paradoxically, it was in the posture of utter powerlessness that I could heal.

You would think that I’d be some therapy expert after being in therapy for so goddamned long. Not so. I have not “arrived,” nor do I even understand what “arrived” means. I am not better. I am not healed. And subsequently, I am on the remedial therapy track.

But you know what, there are worse things in the world. I’m just going to come out and say it:

I love therapy. 

After over a decade of therapy, I have more than an abundance of skills and tools from all the BT’s, and I can reference them on cue. More importantly, I have felt unconditionally loved and understood by my therapist. She has learned my dirty webs of defenses and the ever-abounding slime in my deepest parts, but she has not turned away from me. I love seeing her every week to work on my issues. Talking about defense mechanisms has become my crack. I keep a dream journal and text my therapist on command when I dream about her. Her insight has become ointment to my hurting soul.

Therapy is a beautiful, redemptive mess, a microcosm of the craziness of life. 

Now, therapy is not a panacea. For those who are like, “Where can I get a therapist?”, this is not a public service announcement. I do think everyone could benefit from therapy, but the process of therapy takes a lot of work. When I said I was finally ready to do the work, I didn’t know what I was signing myself up for. It’s like ripping off a band aid. No one wants to do it, but unless you want to live the rest of your life with a band aid chilling on your arm, you need to pull it off.

Without therapy, I would be either dead or a brittle body with vacant eyes. I needed to address my issues in order to survive and thrive. It sucks at times. As much as I love my therapist, sometimes she says, “How do you feel about that?”, one too many times in a given session, or she looks at me reflectively with those Carl Rogers eyes, and I want to tell her to go to hell.

Therapy can involve crying and talking about things I’d rather not discuss. It always involves feeling.

FEELING ALL THE FEELINGS.

For a very reflective, existential, intuitive, sensitive person, this has meant feeling a lot of feelings. I don’t like to feel all the feelings. But through therapy, I have come to see that my feelings are an asset, not an annoyance. They are part of makes me, well, me. They are what help me empathize with and love others.

I think my 13-year-old self who would scream in dismay at this, but I have become one of those people who believes in therapy. I have seen the redemption that can come from a corrective, messy, deep experience of connectedness. Therapy has been healing, needed, and so, so worth it.