Click here to contact Deborah and/or see her GoodTherapy.org Profile

People who struggle with eating and food issues often also struggle with poor self-esteem. I say “poor” rather than “low” because I believe the concept of high and low self-esteem to be problematic. If low self- esteem means perceiving one’s self to be inferior to others, it follows that high self-esteem means perceiving one’s self to be superior to others. Healthy self-esteem is neither high nor low. It is defined by the lack of concern about one’s worth, coupled with a sense of competence and a belief in one’s innate value. When one is comfortable in one’s own skin and doesn’t worry about whether they are good enough, being neither better than nor worse than anyone else, that’s good, solid, healthy self-esteem.

Years ago, I worked for a foster care agency, where I taught classes to prospective foster parents. Out agency used an excellent curriculum called Model Approaches to Partnerships in Parenting (MAPP). MAPP was designed to help prospective foster parents understand the experience of children coming to live in their homes. One of the MAPP modules was on self-esteem. It explained that, in order for a child to develop a sense of healthy self-esteem, they have to be taught, by virtue of the way they are treated by parents and caregivers, that they are four things: loveable, capable, responsible and worthwhile. It’s not just about what children are told, it’s also about how they are treated, and what kinds of responsibilities they are given and when.

Getting three out of these four isn’t enough. It’s like a dining room table: all four legs are needed for it to work as designed. When parents aren’t able, whether because of their own experiences earlier in life that failed to enable them to develop healthy self-esteem, or by circumstances that interfere with their ability to parent well, to convey to their kids that they are these four things, children look outside themselves for indicators that they are good enough. They compare themselves to others using the criteria available: the grades they make, athletic abilities, physical appearance, popularity.

When eating problems develop, comparing one’s self to others intensifies. The act of comparing functions as an attempt to decrease feelings of insecurity and anxiety. The person who struggles with eating and food usually compares his/her body size and shape to others. A smaller body means relief and reassurance; and bigger body means anxiety and shame. The disordered eater judges him/herself harshly, to keep him or herself in line with food and exercise. This judgment erodes self-esteem even further, and perpetuates an unhealthy relationship with food and body.

The antidote is self-acceptance. This is bedrock. It means zero self-judgment, no self-criticism, no comparing to others, no using external criteria as indicators of worth or value. It means affirming that, “No matter what I do, think, feel, say, or look like, I deeply and completely accept myself.” It’s not about whether one is acceptable in the eyes of others. The active practice of accepting one’s self is healing.

Acceptance doesn’t mean liking or approving of something. It means not fighting reality. Not fighting the body one is living in today, or flagellating one’s self for eating or exercise behaviors, but simply acknowledging, without any judgment, what is. For it is axiomatic that nothing can change unless and until it is first accepted.

The idea of self-acceptance often raises concerns: “If I accept myself as I am, it’s condoning unhealthy behaviors.” “If I accept myself, I’ll never be motivated to change.” “I can’t accept my [body/behavior] because I find it repulsive. I have to improve it before I can accept it.” I’ve often said that I’ve never seen anyone whip or beat themselves into making positive changes. Practicing non-judgment of one’s self creates safe space, an arena in which there is no pressure to better one’s self, but instead an opportunity to heal.

©Copyright 2010 by Deborah Klinger, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Deborah and/or see her GoodTherapy.org Profile

Click here to contact Joy and/or see her GoodTherapy.org Profile

Natalie has been in recovery from Bulimia Nervosa for more than three years. She still, however, unfairly compares her body to other women in the room, tries on several outfits each morning, and sits on my sofa with a pillow across her stomach as we talk.

Long after eating patterns and weight have stabilized, many eating-disordered women continue to struggle with issues of body image. In fact, body dissatisfaction has become so prevalent many authors propose it has sadly become simply part of the female experience. Body dissatisfaction is believed to be one of the highest predictors in adolescent girls of going on to develop an eating disorder.

This topic deserves focused attention in our sessions.

NEDA defines negative body image as:

• A distorted perception of your shape—you perceive parts of your body unlike they really are
• You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure
• You feel ashamed, self-conscious, and anxious about your body
• You feel uncomfortable or awkward in your body

I am a psychotherapist who specializes in the treatment of adolescents and women with eating disorders. For several years I have been leading Body Image Therapy groups in my outpatient practice. What follows are some of the group topics we cover as well as resources and activities I have found useful in body image work with clients.

Generally, the group series runs for 8 – 10 sessions outlined as below:

1. My Body Relationship. How do I feel about my body? To introduce this topic, group members participate in an art activity exploring how they feel about different parts of their bodies–from head to toenails. When asked to voice to the group the body part they like most, frequently the women will speak about a part that allows them to pleasantly experience some aspect of life, for example: “My hands–because I love to play the piano.” This activity allows members to recognize that some parts of their body are just fine in their eyes. It’s not all body “hatred.” Great! We can build on this.

Leslea Newman’s book SomeBody to Love has journaling exercises and activities to help clients creatively work toward repairing a broken relationship with the body. She recommends writing love letters, having dialogues with body parts, speaking compliments into the mirror, and more.

2. Create a vision. How do I want to feel INSIDE this body? If I felt this way, how would I move differently, how would I interact with others differently, what would this free me to do & experience? Using guided visualization to step into and experience this vision allows each client to plant and hold in their awareness a goal to guide them in the work ahead.

3. Contributing factors. How did I come to define beauty? What experiences and messages contributed to my personal body opinions? Using a time-line, each member looks at significant life events and paralleling patterns of weight and feelings about the body. The women in group often speak of having felt “different” from their peers, of family relationships with one another and with food, and ambivalence about their developing bodies. We also take a critical look at the media and the conflicting messages received from advertising. NEDA offers a number of handouts useful in facilitating this discussion.

4. Body Talk. What’s being said inside my head? How we talk to ourselves and what is said has a powerful effect on how we feel. Thomas Cash, PhD in The Body Image Workbook tells us this talk is often self-defeating, derogatory, and distorted rather than realistic. His book (and audiotape program) provides clients with specific steps and tools to help them become aware of their negative body talk and begin to transform these messages.

5. Body as Camouflage. What do I hide with my body? To explore this dynamic, each group member creates a collage with magazine clippings portraying the “inside me/outside me.” Clients have used this activity to explore their beliefs about what others assume and expect of them, the image they try to portray and then what they really feel like on the inside. We explore how they have used their bodies to protect or distract them from certain feelings and what it has been like to live with such a dichotomy.

6. Body as a Vehicle. What can I do and experience, thanks to my body? Sondra Kronberg, RD writes, “True body power is the power of the body to accomplish tasks and be the vehicle through which to experience life.” As a group we meet for a nature walk (adapted from “Sensual Walk” in Working with Groups to Explore Food & Body Connections.) In silence, we mindfully pay attention to the titillation of all of the senses. “Notice the smell of air, the feel of the elements, the textures beneath your feet, the views along your route, the taste on your lips, the ever-changing sounds in the background or foreground” (Christian, p.112). In processing the experience, we talk about beginning a new relationship with our bodies by celebrating all the amazing things our bodies do for us and allow us to experience. Using Thomas Cash’s “Adult Pleasant Activities List,” members are asked to mindfully and joyfully experience something from the list each day for the next week.

7. Body as Container. What is this spirit, this essence-of-me that lives inside my body? Kronberg goes on to write about the importance of helping our clients find their “real beauty,” that is the beauty “stored inside of them.” During this session, group members create a word and picture collage of favorite things, causes they passionately believe in, relationships that matter most, compliments received, qualities of character they admire in themselves. This activity is often a favorite and reminds participants that they are so much more than the size of their clothes.

8. Body as a Rich Source of Wisdom. What can I learn if I slow down and listen to my body? This session opens with a deep breathing exercise to practice being still, quiet, and focused. We then explore “gut” instinct–where and how we experience it in our bodies and how we have used this information to reliably guide us. Members are also invited to explore feeling states in the same way. Using a body outline on paper, members draw where in their bodies they feel anger, sadness, loneliness, etc., noting the size, color, and shape of each, and what distinguishes one from the other.

9. Body Respect. I can honor and take care of my body. This is a brainstorming session of all the things we can do to take care of and nurture our physical selves. Belleruth Naparestek’s affirmations are used from A Meditation for Relaxation and Wellness. Examples from her beautiful work include:

• “I thank my body for all it has done for me in the past and all it will do for me in the future.
• I am learning to trust my body and to make good use of the information it offers me
• More and more I sill save my energy for what truly matters to me
• I am aware that with each breath in I am sending precious oxygen and rich nutrients to the places in my body that need them
• I welcome my ability to listen to the wisdom of my body and sense what it needs—telling me to rest, pace my energy, and take gentle good care of myself
• More and more I can understand that my body is my ally, my oldest friend, and steadiest companion.”

Body image work is a critical step in full recovery from an eating disorder. I am seeking your story for future articles: What helped you most in repairing the relationship with your body?

Recommended Reading:

• The Body Image Workbook by Thomas Cash, PhD
• The Body Myth by Margo Maine, PhD & Joe Kelly
• Eating in the Light of the Moon by Anita Johnston, PhD
• A Meditation for Relaxation & Wellness (CD) by Belleruth Naparstek
• SomeBody to Love by Leslea Newman
• Transforming Body Image: Learning to Love the Body You Have by Marcia G. Hutchinson, EdD.
• Working with Groups to Explore Food & Body Connections by S. Christian, Editor

Additional References:

1. Kronberg, MS, RD, CDN, Sondra. “Nourishing a Healthy Body Image: A Nutritionist’s Perspective,” The Renfrew Perspective. Fall 2002.

2. Levine, PhD, Paula. “The Meaning of the 3D’s,” Eating Disorders & Awareness Prevention. 1993.

3. Ressler, MA, LMSW, Adrienne. “A Body to Die For: Advanced Training in the Treatment of Eating Disorders & Body Image Disturbance in Women,” Renfrew Center Foundation, May 2006.

4. Hawkins, PhD, Nicole. “Battling Our Bodies: Understanding and Overcoming Negative Body Images,” Center for Change.

©Copyright 2010 by Joy A. Davis, LCSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Joy and/or see her GoodTherapy.org Profile

Click here to contact Gail and/or see her GoodTherapy.org Profile

National Eating Disorders Awareness Week occurs this month, and it is a necessary reminder of the role body image plays in women’s self-esteem. While women with clinical eating disorders, such as anorexia nervosa or bulimia, typically have a distorted body image, even those without eating disorders often struggle with body image concerns ranging from mild dissatisfaction to outright self-hatred. Any woman can feel tormented, terrorized, and completely obsessed with the image reflected back in the mirror.

What perpetuates this assault on body-esteem? Well, one of the biggest offenders is the media. Air-brushed, photo-shopped images of models and celebrities create unattainable expectations of perfection. Ninety-eight percent of American women are heavier than most models (Smolak, 1996), yet they frequently aspire to these impossible standards. Billions of dollars are spent each year on anti-aging skincare, plastic surgery, and diet products. According to the Social Issues Research Centre (1997), 80% of adult women are unhappy with their appearance. Many women internalize the media’s standards of an ideal body, and this can be a risk factor for poor body esteem, dieting, negative mood, and binge eating (Vandereycken, 2006). And this dissatisfaction starts early. Collins (1991) found that 42% of girls in first, second and third grade want to be thinner, and by age 17, approximately seven out of ten girls have been on a diet (SIRC, 1997). Wardle and Marsland (1990) found that almost 40% of 11-12 year-old girls viewed themselves as overweight. Family dynamics, peer pressure, and emotional problems, such as depression, low self-esteem or even a history of trauma, can all contribute to a poor body image. However, societal expectations are the most insidious.

Body image distortion and dissatisfaction are characteristic of eating disorders such as anorexia nervosa or bulimia nervosa. Eating disorder symptoms usually consist of restrictive eating, binge eating, and/or attempts to eliminate what was consumed. A poor body image can also compel women to mistreat their bodies in other ways. Some women exercise to the point of injury, unable to accept a body that is not perfectly toned. Others compulsively tan, despite the risk of skin damage. Still others seek out plastic surgery to correct any perceived flaw or forestall the effects of aging. The most extreme form of body self-hatred is body dysmorphic disorder (BDD), defined as a preoccupation with an imagined defect in appearance, or an excessive concern over a slight physical irregularity. Women with BDD may become obsessed with a particular body part, such as a nose or stomach, and will go to extremes to hide or camouflage it. They might avoid social situations, become depressed, and may even seek plastic surgery in hopes of repairing the problem.

While women with eating disorders or BDD often benefit from psychotherapy, others with less severe body image concerns still need to challenge the negative effects of society’s message, that to be attractive you must be young, white, wealthy and impossibly thin. What are some basic things you can do?

1) Challenge unrealistic assumptions and expectations. Appreciate your body for its capabilities and power, for what it can do and how it moves, not just for how it looks. You are a whole person, not the sum of body parts that need to be perfected. Be realistic about your size, build and genetics and learn to enjoy your own unique beauty.

2) Treat your body well. Feed it, exercise it, give it plenty of rest and pleasure. Learn to enjoy all of the good things it has to offer, and the things you take for granted, like walking down the street or drawing a breath. Remember, the body truly is the “temple of the soul.”

3) Refuse to accept the dictates of the media and fashion industry. Question the motives of ad campaigns that stress unattainable standards and vote with your wallet. Wear clothes that make you feel comfortable. Challenge attitudes that equate self-worth with physical attractiveness. Think of the values you would want your daughter, your niece, your friends to internalize. Then apply those values to yourself.

References:

Collins, M. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10, 199-208.

Smolak, L. (1996) National Eating Disorders Association/Next Door Neighbors Puppet Guide Book.

Social Issues Research Centre (1997). Mirror, mirror: A summary of research findings on body image. Retrieved from http://www.sirc.org/publik/mirror.html.

Vandereycken, W. (2006). Media influences and body dissatisfaction in young women, Eating Disorders Review, 17, 5.

Wardle, J. & Marsland, L. (1990). Adolescent concerns about weight and eating: A social-developmental perspective. Journal of psychosomatic Research, 34, 377-391.

©Copyright 2010 by Gail Post, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Gail and/or see her GoodTherapy.org Profile

Pressure to stay thin while growing up has been significant for many years, as the fashion and beauty industries project images of notably thin women and other media portrayals of beauty suggest that a wraith-like appearance is most desirable. But as waistlines across the country have been steadily increasing, the pressure to keep weight away is doubtless becoming even more great as girls are warned by parents and doctors about the health issues associated with obesity. Taking a mental health-based approach may be a more positive way to teach girls about healthy eating habits, suggests a study recently produced by the National Institutes of Health.

Though the study worked with a small group of under forty participants, girls were split among those who received interpersonal therapy sessions and those who were given basic health educational courses. While all of the participants showed positive results in terms of weight loss, those who had been involved in the interpersonal therapy groups exhibited a higher success rate. During these therapy sessions, which were held over the course of a year while eating habits were recorded, the girls were encouraged to examine their relationships and how various social and other influences had an effect on their desire to eat.

As mental health concerns and fluctuations in weight are sometimes closely linked, this type of therapy may hold substantial promise for young people struggling to understand health and self-image in a media-driven environment. Through establishing a positive exploration and understanding of the self as well as providing support for potential binge eating and other undesirable behaviors, interpersonal therapy for obesity prevention may improve the lives of adolescent girls both inside and out.

Whether one writes with the left or the right hand has been suggested to have an impact on various personality traits and other aspects of the life of the mind, but a study recently performed at the University of Virginia with collaborators from other colleges has found that this seemingly simple characteristic can have a great influence over body image. Participants in the study were asked to estimate the lengths of their arms, and to guess how far they could reach with either limb. Left-handed participants tended to rate both arms as being of equal length and reaching ability, but those who were right-handed scored their right arms as being significantly longer and more able than their left arms. The research may inspire further inquiry into how body usage affects perception, in turn helping mental health professionals to gain insight about their clients.

Weight loss is something that scores of people attempt to achieve each year, and some approach the topic with a more positive outlook than others. Though there are options available for rational weight loss, many programs focus on treating non-idealized bodies as wrong or unacceptable, and suggest the restriction of certain foods –sometimes entire food groups– in order to cause a drop in pounds. The “Healthy at Any Size,” or HAES program, has recently been tested on women attempting to lose weight, and has taken a health, rather than a weight, centered approach. Concentrating on healing emotional issues surrounding eating, the program was found to be successful compared to a control group, but still needs further research to distinguish it from basic social support offerings.

Those who experience visible skin lesions and irritations due to the skin condition psoriasis are often faced with negative reactions from others, as the appearance of the dermatological issue can be surprising and unusual. Though people with psoriasis often exhibit symptoms of insecurity or concern over their appearance, a study recently performed at the University of Manchester suggests that those with the skin condition may adapt to negative social reactions by registering them in a much more shallow way than those without psoriasis. The researchers, who used MRI brain imaging to examine how the brain handled images of disgusted faces in test and control groups, may help explain how the mind overcomes some psychological difficulties.

Society at large has been praising the merits of thinness for many years, with super models and silver screen stars proudly strutting svelte figures. But recently, as awareness grows about worldwide “obesity epidemics,” media is becoming ever more harsh on the matter, and a recently released report on eating disorders among children suggests that this surge may be responsible for significant increases in dangerous diets and poor body image. Some mental health professionals have suggested that children abstain from watching television shows such as “The Biggest Loser,” but others note that the concentration on being thin and losing weight extends far beyond the TV. Instilling positive self-image ideas in kids may hold the key to warding off harmful eating habits.

Check into a given health-related news portal these days and you’re likely to find a wealth of material about obesity. Calling the increasing number of people who grow up overweight an “epidemic,” some medical professionals and reporters have represented the increase with a fair amount of shame and guilt directed towards those people who struggle with their weight. But what such news pieces often fail to highlight is the emotional and mental damage dealt to people who are frequently barraged with talk about the negativity and unhealthiness of fat. Thanks in part to the rare occurrence of such unbiased discussion of the growing weight issues in developed countries, a recently published article in a major UK periodical has gained plenty of attention among medical and mental health professionals alike.

The article focuses on the presence of additives and other unnecessary substances in modern convenience foods, as well as the convenience culture itself, and its role in the creation of a substantial number of overweight people. Touching upon psychological impulses that lead people to eat mindlessly or compulsively, the article provides insight into the mental health perspective on nutrition that is rarely delivered in pieces geared towards the public. This attention to the awareness of practical problems in weight management rather than unorganized blame and negativity directed towards overweight people has great potential to help heal and restore the confidence of those who suffer from difficult body image issues.

As therapists and other mental health professionals work to deliver more quality care to people in need of self-esteem development as well as assistance in nurturing themselves properly with food, a culture obsessed with making a scandal of overweight persons may experience a worthy change.

It’s fairly common knowledge, and particularly plain to see with a bit of insight and experience, that the women typically depicted in fashion and beauty magazines have had their pictures significantly altered by digital artists. Steps to improve skin tone, remove any fatty appearances, and cover up blemishes have been a mainstay of such photography for decades. But a group in the UK has decided that this mainstay is a hazard to the mental health of teenage girls. Citing the annual rates of hospitalization for anorexia and bulemia, the group hopes to ban airbrushing from magazines in an effort to present growing girls with more reality about body image, and less unrealistic ideals.

Teenagers who are overweight, or believe they are, appear to be at higher risk of suicide, according to a new study published online in the Journal of Adolescent Health. This was found to be the same for girls and boys.

While the research results certainly can’t be said to be reliably predictive of any one teenager’s suicide risk, the study does help to support the view that teenagers with real or perceived weight problems should be particularly assessed for depression and suicidal thoughts – and that all teens should ideally be screened. Teenagers with depression and/or suicidal thoughts should then be referred for psychotherapy geared to these issues, and medically evaluated for possibly discernible physiological causes and treatments. The study included 14,000 US high school students, their body mass indexes (BMI) and beliefs concerning whether of not they are overweight, along with the rate of suicide attempts within the group. The analyses controlled for demographics and possible confounding variables.

Monica Swahn, an associate dean for research at the College of Health and Human Sciences and an associate professor in the Institute of Public Health at Georgia State University was the lead researcher. “We cannot only focus prevention strategies on those who are overweight and who are concerned about their weight, but we also need to include youth who feel that they are overweight even though they may not be,” Swahn said in a news release.

Swahn points out that the rate of teen obesity in the US is growing and reminds us of the importance of self-image in the adolescent years. Development of the adolescent is more reliant on positive acceptance by peers than at any other time of life. That development is also more reliant on peers than on family, teachers or others. News of the link between overweight, perceived overweight and suicide may be particularly important information in modernized cultures where the mass media actively promotes being thin as hip, fashionable or, otherwise, as healthy and physically fit – sometimes even as an indication of personal virtuosity. Attention to how we communicate concerns about teenagers’ body weight and body image, and promote fitness and positive body image, is merited.

This is a challenging prospect since we don’t want simultaneously and inadvertently to promote overweight among teens. It’s probably a task best achieved by a well-considered, multi-pronged public education initiative that involves teens, parents, schools, health providers, government and media. In the meantime, personal mindfulness of our messages to teens about weight and the factors that support fitness, health and beauty are in order. Most certainly called for is provision of opportunity and encouragement for teen participation in any of the numerous ways of achieving self-esteem not based on image, such as social functions, arts, sports, and so on.

Sources:

Preidt, Robert. Worries about weight are tied to teen suicide tries, Center for the Advancement of Health. News release to HealthDay, May 18, 2009, id=626771, published online in HONnews

Swahn, Monica H., Reynolds, Melissa Tice, C. Miranda-Pierangeli, Maria, Jones, Courtney R. and Jones, India R. Perceived overweight, BMI, and risk for suicide attempts: Findings from the 2007 youth risk behavior survey. Journal of Adolescent Health. Society for Adolescent Medicine Published by Elsevier Inc. May 18, 2009

©Copyright 2009 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jolyn and/or see her GoodTherapy.org Profile.

Click here to contact Tom and/or see his GoodTherapy.org Profile

As a therapist who offers counseling for teens and their families, I’ve become aware of some of the biggest issues facing young people today. While depression and anxiety remain two of the major reasons why parents seek my help, often these are not the first issues that drive them to consult a therapist about their child. Usually, it’s one of the “Big 3” teen issues of our day – Sex, Drugs and Body Image issues (which includes eating disorders and steroid use).

Understanding the Adolescent Brain
Adolescence seems to be a time when these 3 issues surface more commonly than at other ages. That is not by accident. From what we now know about the developing brain – and what we are continuing to discover – dramatic changes occur during adolescence. These changes include forming a sense of identity, acquiring the ability to think critically, testing judgments about risk and reward, conceptualizing the world in abstract ways and forming lasting social relationships, among others.

These are all critical skills that will prepare young people to become independent and autonomous adult individuals. However, these changes – and the rapid, sometimes “herky, jerky” pace at which they happen – also leave many teens vulnerable to the lure of unhealthy sexual activity, dangerous abuse of alcohol and other drugs, frightening problems with food and eating, as well as the use of steroids and other “body enhancers.”

Often, teens are expected (by both adults and their peers) to be able to handle life’s unpredictable events as an adult would, even though they have yet to fully master the skills necessary to do so. Therefore, when stressful, traumatic or depressing events occur – sometimes exacerbated by high performance expectations in school or athletics, physical or sexual abuse, loss of a loved one, problems with romantic relationships, etc. – teens often find the attraction of sex, drugs, steroids and other behaviors too good to ignore.

Drugs and alcohol can provide short-term feelings of comfort, confidence and euphoria. Sexual activity is often connected with an adolescent’s desperate search to connect on an intimate level with another person. And problems associated with body image, such as eating disorders, often are attempts to control at least one aspect of a teen’s life, especially when other dimensions feel out of control.

Constructing a Coping Plan
Whether an adolescent has only recently begun to dabble in one of these Big 3 issues, or whether he or she finds themselves in the throes of addiction, bulimia, steroid use and other alarming behaviors, one of the critical steps in either resisting or recovering from these problems involves constructing a solution-focused plan.

In my experience as a teen therapist in Pasadena, helping my clients to cope with Sex, Drugs and Body Image issues is not a “one-size-fits-all” process. Each adolescent, and their families, school situations and living conditions that surround them, is unique and different. So the best plan to coping with these problems usually involves consulting with an experienced therapist and constructing a plan that fits with the teen’s specific situation. That being said, I do tend to follow a general structure when I help teens and their families construct their own Coping Plan:

1) Naming It.
In order to break through the assumptions or silence that often accompanies drug use, sexually acting out and other issues, I invite teens and their families to specifically name what the problem is. Sometimes, they use a generally accepted name, like “Bulimia” or “Drug Use.” But other times, they come up with their own titles, like “Pretending that She Eats” or “The Pot Smoking Problem.” This naming process can be very helpful in getting everyone on the same page and focused on what the goal of counseling is going to be.

2) Describing It.
During this stage in the process, my clients and I usually go through a variety of different questions and scenarios. The goal is to paint as specific and detailed a picture of the problem – when it happens, how it shows up, what it interferes with, etc. Describing the problem and understanding its facets and dimensions really help my clients to clearly express what they are really dealing with.

3) Formulating a Goal.
This stage involves understanding how teens and their families would prefer to live in relation to the problem. Why do they want things to be different than they are right now? How would they prefer to deal with their problems? This can also be a time to discuss how they will define success. For example, “If you finally have control over drinking, what will you be doing differently?” Or, “How will you know when you’re doing better?” This is very helpful in measuring success.

4) Finding Exceptions & Strengths.
During this part of the process, it can be helpful to start identifying and describing ways in which the Problem doesn’t influence you. When does it not seem to be as big? When you are able to say “no” to drugs? How are you able to do that? What things or people seem to help? I often invite teens and their families to identify strengths and resources that can help, including activities that don’t involve their specific problems. I believe that every teen has strengths that can be useful in building their coping skills.

5) Writing a Contract.
Often, I find that teens and parents can more easily experience success when they put down on paper how they will work to overcome the problem. This contract can look several different ways, but it seems to be best when all members of the family are involved on the same team against the problem. For example, when everyone has a role to play in battling an Eating Disorder, it tends to become overwhelmed, rather than your teen.

6) Doing the Plan.
During this phase, my teen client and their team members will start acting against the problem. Success tends to increase even more when they can find other sources of support – from groups like AA or OA, social or church groups or other types of gatherings that don’t tolerate the problem or are vigilant against it.

7) Monitoring and Adjusting.
Once a teen and his or her family start seeing some initial success in their plan against a specific problem, it’s vitally important that this progress is noted and monitored. Often we think that it is the job of the parents to monitor how the teen is doing, but I’ve found that the Coping Plan is even more successful when every member of the team has a role in monitoring the other members. Once again, it keeps everyone on the same page and working towards the same goal. This is also the time to keep track of things that are not working and discard them, while identifying and starting to do more of the things that do seem to help.

This 7-step plan is meant to be general, so it may be difficult to implement after merely reading this article. But it should give you ideas of possible ways to help a teen and their family to cope with problems involving Sex, Drugs and Body Image issues. A good therapist can help implement such a plan and open more possibilities.

©Copyright 2009 by Tom Badzey, M.A., MFTI. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Tom and/or see his GoodTherapy.org Profile

Click here to contact Ondina and/or see her GoodTherapy.org Profile

If you tend to struggle with food, weight and body image, holidays like Thanksgiving and Christmas can be particularly challenging, because they revolve so much around food and mealtimes. For someone who is addicted to food, it can feel like there is no escape. Unlike other addictions food is not something you can simply go cold turkey (pun intended) especially this time of year.

Following are some tips for dealing with the food, family and holidays dilemma:

1) Identify your trigger foods and situations:

A ‘trigger food’ is food that when eaten makes someone feel out of control or compulsive with food. Figuring out which foods put you in that “I can’t stop” mode is really important. For some, it’s the first taste of sugar that gets them craving for more. For others, it’s the carbs (bread,cake etc.) that jump starts the “bottomless pit feeling.” Surprisingly, trigger foods are often linked to allergies. It’s worth getting a nutritional evaluation just to be sure. For now just try and avoid your trigger foods altogether. There is a catch, however. Ironically we often crave our trigger foods or those foods to which we are most allergic! Here’s a quick tip if you find yourself dealing with an irresistible craving for that trigger cookie: eat some protein (especially important for sugar/ carb addicts) or a fresh piece of fruit or vegetable and drink lots of water.

Trigger situations and people can be trickier to identify. This is a skill that develops over time and with practice. Food addicts often use food as a way to suppress or divert from difficult feelings. So when you find yourself obsessing about that last slice of pie or can’t stop munching on the chips, see if you can back-track to what happened just before you started to obsess or feel out of control. This investigation can provide you with important clues about what feelings you might be using food to avoid.

For example: I had a client who binged every time anger came up for her. At first it was a week or more before she could link a binge to its’ trigger. Eventually she could recognize within a few hours what event and/or person had triggered her feelings of anger and consequent binge. When she was finally able to identify her anger more quickly and find constructive ways to give it voice in the moment, she found that the urge to binge disappeared.

2) Find ways to self-soothe:

For food addicts, food can be the primary way to self-soothe. Often this imprint was created long ago when, for instance mummy gave you a lollipop to stop you crying over your hurt knee. But there are a million other ways to self-soothe: Taking a bath, going for a walk, calling a friend, listening to music, going for a drive and so on….

Try creating your own ‘Top 10 soothers list’.

One crucial point: Create your list before going to your holiday events and take it with you. If you’ve thought about it beforehand and your list is as readily available to you as that box of chocolates, then maybe instead of eating half the box you’ll just eat one chocolate before going out for a breath of fresh air with your I Pod and some of your favorite tunes. It takes a bit of consciousness to initially change old habits.

Help yourself by taking your‘Top10 soothers’ list with you whenever you go out. It really works and is much more fun than yet another holiday when you end up feeling down on yourself.

3) Keep your blood sugar stable:

Eat at least every 4 hours. In order to avoid a blood sugar crash or the fast/ feast cycle, space mealtimes and snacks throughout your day. Think of your meals as rocks helping you cross a river (i.e getting through your day). If you space the rocks too far apart you can slip and fall. However if the rocks are evenly spaced you can cross the river without getting wet.

Try eating 3-5 snacks/ meals a day with at least one of them containing protein. Keeping your blood sugar stable will help enormously to keep food compulsions at bay.

4) Avoid overly rigid rules around food:

Rigid rules around food will only make you more preoccupied with food. Expect to slip up. Don’t expect perfection. See if you can allow yourself the pleasure of food while staying connected with yourself and reconnecting with loved ones this holiday season. After all isn’t this the best present of all to yourself and others?

Follow these 4 simple steps and see if it doesn’t make a difference…. Here’s to a happy holiday!

©Copyright 2009 by Ondina Nandine Hatvany, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Ondina and/or see his GoodTherapy.org Profile

Click here to contact Jeanette and/or see her GoodTherapy.org Profile

Flora was proud of herself. Her stomach felt flatter. Her new diet and exercise regimen was paying off. She ate things she liked and found exercises that fitted in with her energy levels- not the self flagellation she inflicted on herself in the gym the last time she tried to lose weight. She was amazed at how easy it was to follow her program and how much she was enjoying it.

A couple of weeks into the project Flora was part of a decision making team at work. There were disagreements and heated opinions flying around making her feel uneasy. She wanted to let them know what she thought but couldn’t fight her way into the conversation. She didn’t want to be the center of attention by yelling her way into the debate. Nor did she want to be ignored. Suddenly Flora sensed something was missing. She grabbed a pillow and put in on her abdomen. What a relief! At that very stressful moment Flora missed the ‘padding’ that her fat had provided. The cushion smothered her conflict, removing the need for making a choice. Driving home she felt annoyed that no one had invited her to comment or made room for her opinion. Demeaned and diminished Flora’s anger frothed up. She stopped at a store and bought a quart of vanilla ice- cream and a large bag of corn chips.

The War of Emotional Control
Flora may have lost the diet battle but she won the war of emotional control. Her rage was a delayed protest at being choked off in the meeting. It felt like a ball of sharp nails stuck in her mouth that couldn’t be digested. Chewing and tasting it would tear up her insides and make her bleed. It had to be anaesthetized with ice-cream and chips. So what if she gained back the 10 pounds she worked so hard to shed? At least she didn’t have to deal with the storm of fury that threatened to obliterate her sense of self.

Payoff
But there was an even better payoff. Sealing off her feelings in an industrial strength freezer bag means that there were no disgusting leaks. Flora wasn’t weak or needy – the twin towers of terror. No one would want to be with her if her feelings oozed out, least of all herself. Logic and rationality were the only winning strategies. Binging on the earned self-respect and admiration was the best meal ever!

Converting Emotional Trash Into Fat
Each time Flora traded uncomfortable feelings for a shot of strength she gave a powerful message to the people in her life. She said ‘I am made of steel. I can take all your whining, selfishness, love with strings attached, and melt downs.” Better to make her feelings into bad guys and murder them, than stand her ground. She couldn’t afford to upset the people in her life and risk being an outcast.

Flora made herself into a tough bottomless pit for everyone else’s debris. She was bloated with her own undigested emotions and other people’s sewage. Keeping it all in was a badge of honor. Emotional constipation was her sign of strength and resilience. Her body took on the job of dealing with the massive amounts of gunk – by converting the trash into fat. Her weight went up and stayed up despite her valiant efforts with personal trainers, fitness gurus, nutritionists and weight loss support groups.

Flora the Fat Girl is Better than Flora the Bad Girl
During the first few months of psychotherapy Flora described her experience of eating in the context of family relationships. Eating and pleasure were strangers. Meal times were either a chore, a lonely experience or a punishment. Young Flora often had to make her own lunch, and take care of her evening meal while her mother was away. At grade school she was considered the model child from a divorced family. She survived by turning up the volume on being the best ‘grown up’ child and muting her feelings of helplessness, neediness and fear of being alone. There was no reliable person to lean on. An inner steel container was built fast to lock up those big scary powerful feelings.

Flora’s mother fell to pieces over every little thing. So Flora protected her mother by keeping her worries and fears to herself. Flora added several more layers onto her tough and limitless container to hold her mother’s emotional gunk. Two lots of muck rotted and festered accumulating poisonous properties with no opportunity for detoxification.

As a preteen she lived with her father and stepmother who disapproved of her having her own opinions. Flora learned to stuff her feelings in order to survive. Flora the fat child was born. The fat became her armor. Family members ridiculed Flora the fat child, not Flora the ‘bad’ child. The fat took the piercing blows, protecting Flora’s fragile personality.

Often she would be left alone at the table to finish her food, making her feel punished for saying something wrong. She had to murder her own individuality to receive acceptance and care from her family. The sadness, frustration, outrage and loneliness was squashed. Flora began to hide food in her bedroom and binge when she was alone and safe. At those times food was a comforter. Secret gorging kept the feelings from exploding and comforted the scared girl..

As an adult Flora repeated those abuses on herself by murdering her feelings in order to maintain relationships that were important to her.

Flora’s struggle may appear to be with her physical weight. Her real struggle is with weight that represents the unbearable aspects of life and the weight that comforts and shields.

Unbearable things turned into fatty weight
•the tragic weight of growing up before she was ready
•the stifling weight of her suppressed individuality
•the unfair weight of other people’s emotional trash
•the paralyzing weight of fear around losing significant others if she asserts her individuality
•the terrifying weight of not being able to trust that loved ones will treat her well
•the angry weight of not being acknowledged and loved for who she was
•the disgusting weight she needs to beat herself up with, just like her parents did.
•the fat can take the hit, safe-guarding the authentic Flora.

The protective armor of weight
•the comforting weight shielding her vulnerable self from abuse and annihilation
•the numbing weight that bypassed all those horribly explosive feelings
•the reliable weight that no one else can take away and that is totally in her control
•the friendly weight when there is no one else around

Flora’s dilemma: feeling physically attractive or emotionally strong
Flora’s euphoria at dropping the pounds quickly faded when she felt vulnerable to awful feelings of weakness or explosiveness. When the armor of fat was needed, the diet had to be aborted. Flora was left with an intolerable choice. Did she focus on feeling physically attractive by losing fat, or feeling emotionally strong by keeping the fat? Either way, she had to abandon one part of herself – a no win situation.

With continued psychotherapy Flora found a safe place where she began to loosen her emotional stools and get rid of her constipating experiences. She experimented with expressing herself without fear of losing her therapist. Her messy feelings were accepted, understood, detoxified and digested. She used the nutrients from the therapy to build her emotional muscles. She learned how to set up effective boundaries that allowed her to receive and give support without having to seal up and freeze her feelings, or explode and feel ashamed. Along the journey Flora tuned into her hunger pangs. She learned that a craving for ice-cream and chips meant she had some yucky feeling to digest. Mutual exchange in the therapeutic dialogue in conjuction with artistic expressions honored her need to feel capable and strong. Unsatisfying meetings with family and friends that once led to gorging changed to excreting her disappointments and fears after tasting and chewing them. That made room for Flora to prepare for re-configuring relationships without the risk of loss. It also helped her make new relationships where she was not a doormat, and didn’t have to hide her individuality.

Flora worked hard in her therapy. She found a way of accepting and expressing all parts of herself equally. Her eating patterns followed suit. In therapy she digested the emotional weight she had been carrying. As she found room for all parts of herself to be appreciated, she no longer needed the fat to be her armor. She lost weight and did not put it back on. As her emotional life stabilized, so did her body weight. Flora had a new relationship to food, because she found emotional sustenance with her therapist, and then allowed herself to find similar sources of nutrition with other significant relationships. All parts of herself were allowed to get attention. Flora was in balance and her body responded.

©Copyright 2008 by Jeanette Raymond, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jeanette and/or see her GoodTherapy.org Profile

Click here to contact Andrew and/or see her GoodTherapy.org Profile

When you look at your body in the mirror, two things occur. First, you see the body’s physical structure; its size, shape, texture, curves, and nuances – great and small. Then comes the part that’s hard to control – the thoughts and comments that swirl about our brains concerning the body in that mirror. Oh man, can those cause trouble!

It’s usually at this point when most of us look at our bodies and berate ourselves for not having that flat stomach, or shapely thighs and buttocks, or taut breasts and biceps that many of us crave. But these thoughts are not just passing emotional blows to the psyche. For nearly 60 percent of women and over 40 percent of men in the United States, they are constant barrages of hatred and self-loathing. They are statements that bend and distort the reality of our perceptions about the body and its abilities, and thus the core beliefs we have about our worth as human beings.

Here’s where the danger evolves into more than just compulsive thoughts. Depression and anxiety invade our daily existence, limiting and even atrophying, social, professional, personal, physical and sexual development. More frightening is that as many as 10 million women, and possibly as many as a million men, develop eating disorders, leading to approximately 50,000 deaths per year from this disastrous disease.

Children as young as six years old express unhappiness with their looks, while other studies show that most girls by fourth grade are diet veterans. By high school, one in five young women take diet pills, or use laxatives, diuretics, fasting and vomiting to attain the “ideal” image. More telling, an increasing number of women and girls fear being fat than they do dying. Some 50 percent of women and 30 percent of men who smoke say they do so to help keep them trim.

So where does this phenomenon come from? The media is a force to be reckoned with, of course. Most models in magazines and on fashion runways today are 23 to 25 percent leaner than the average American woman, and any imperfections are digitally airbrushed before publication to create the more perfect bosom, thighs, hips and buttocks.

And there are comments from parents, family members and peers that reinforce the idea that being fat is sinful based on their own negative self-image. It’s a cultural cycle that only amplifies the media message that looks determine success, and thin equals beautiful. Then there are other traumas of childhood, from the sad yet inevitable teasing that goes with any school-age experience, to the truly horrific cases of physical and sexual abuse where hatred and disassociation from the body results.

What next? Well, for many, it’s all about fixing the problem from the outside in. More than $50 billion are spent each year in health club memberships, and on home exercise equipment, diet pills, Botox injections and cosmetic surgery. And then there are the diet programs of every shape, size and design from Atkins to the Zone. Do they work? For about two to five percent of people, yes, they do. For the vast majority, the weight is regained, and for 33 to 55 percent of people, even more is gained than what was initially lost. Dieting, it seems, is not the answer.

Cosmetic surgery, for most, is too costly and poses the same health risks any surgery has, which includes severe infection and even death. And it doesn’t prevent the weight from being regained, and some even become addicted to it, never feeling completely “perfect.”

So does that mean there is no hope for happiness for those suffering from body image disorders? Of course not! But the fight to regain a sense of control and satisfaction with the body requires a multi-pronged attack to fight back. It means looking at the emotional roots of the issues; challenging the thinking that helps reinforce the anxiety, depression and compulsive behaviors that result; and finding behaviors that reinforce positive body image such as healthy diet and exercise programs. It also means regaining a sense of what the body feels like rather than looks like, which can include increasing a sense of sensuality through massage, movement through dance and yoga, and even increasing sexuality when ready.

This is a life-long battle for many, and it requires finding those professionals who can help you achieve your goals of increasing body image satisfaction, and ultimately personal satisfaction in life. That person in the mirror will thank you.

©Copyright 2008 Andrew Walen, LGSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Andrew and/or see her GoodTherapy.org Profile

Click here to contact Jeanette and/or see her GoodTherapy.org Profile

A few months ago Gillian felt lifeless, dead inside and uninterested in anything. Everything was an effort. She just wanted to sleep. She suffered bouts of constipation. She didn’t want to meet anyone, prepare food for herself or take care of her dog. She couldn’t go to work. Her words came out slow and with long pauses in between. The words were flat, without expression – just like she felt. She couldn’t even cry. Nothing touched her and she moved like a robot from her bed to the shower to a chair and back to bed again. She didn’t care about anything or anyone. This was not the Gillian she knew or wanted to be. She had always been driven to work hard, please those around her and then earn her rest. She had been very sociable and knew how to have a good time.

Now Gillian is very angry and tearful. She cries easily when memories of past hurtful relationships invade her as if from nowhere. She complains of being exhausted and resents having to go to work. She is impatient with herself and others when problems don’t get sorted out quickly. Anything in her immediate environment that has a glitch feels like another burden on her shoulders. Nothing feels right and that makes her furious. She has enough of her own stuff to deal with. When the world outside also has ‘problems’ it makes Gillian want to give up bothering to face the day at all…

Working and being busy no longer protected her from her past wounding experiences. Her back and neck pain interrupted her sleep. Skin eruptions came and went. It was as if she had lost control and is the unwilling victim of her history. She was reliving that history and it was unbearable. She wanted to get back to being in total control and able to glide through life as before. Having to interact with a car that breaks down, a dog that barks to be taken for a walk, and an insurance companies that refuse to reimburse her for necessary expenses made her crazy. She was irritable, short tempered, unable to wait her turn in lines at the bank or supermarkets. Her interface with the world became brittle, drained of any juice and fractured.

As time went on Gillian’s anger seemed to subside. It had robbed her of space to feel any joy, excitement, softness or empathy. As she pushed it down again for the millionth time, she became more able to function in her job and did the bare minimum to take care of herself and her dog. While she slept for longer periods it wasn’t refreshing and didn’t give her the oblivion she wanted.

She felt disenchanted with her colleagues and friends. Even when friends gave her what she wanted it didn’t register. It was as if she was still starving. The only thing that appeared to satisfy her if only temporarily was food. She would eat and eat when she was alone at home. It calmed her from the moment she began to get the food to the last bite. It was the one sure way she could give herself some peace from her disappointment with others, their unreliability, their ingratitude and inability to satisfy her. She began to put on weight and whipped herself with criticism and loathing. When the self-flagellation became too much to endure she would gorge on food and then drink lots of water, stick her fingers down her throat and throw up. If she got most of it out, she could approve of herself and get a break from the harsh judgments. If she couldn’t vomit it up then she would be consumed with guilt. She continued this cycle of emptiness, bingeing, crucifying herself, attempting to vomit, taking pride in herself if it was successful and drowning in guilt if not. Gillian tolerated this life since it was preferable to the risks she had to take if she allowed herself to be open to relationships. At least this cycle was in her control and familiar. She was the slave master and the slave. Better than being someone else’s victim with repercussions that last forever.

Gillian’s depression had at least four heads. It came in waves. From a sense of lifelessness she would shift to being full of uncomfortable emotions like anger. Hair like triggers would set off bouts of crying that would sap her and make her numb again. When the emptiness came she would fill herself with food that put on weight and that set up a binge, guilt and purge rotation. Each head of the depression acted separately with little communication among them. Each head ruled for a time and then relinquished its power to the next head. Gillian finally came to grips with what she wanted from life when all four heads were vying for supremacy at the same time. Each squeaked a little but didn’t get top billing. They were all dying off, and Gillian was challenged to find out what the costs and consequences were for her of accepting empathy, generosity and care without obligation. It wasn’t till all parts of her got ‘sick’ that she was forced to face the inevitable.

Terry thrived on work. He got a buzz from the autonomy his managerial position gave him. He could work when he wanted and felt important taking on extra responsibility. He was always ready to stand in for other colleagues when they were sick or on vacation. He would think nothing of doing his job and that of a sick employee simultaneously. He was well paid and could afford the nice things in life. He had a girlfriend and took satisfaction in being able to buy her expensive gifts. However there were times when he wondered what all this was for. He never had time to enjoy his money in a leisurely way. He never took time off, never got sick and had no long term plans for settling down.

After years of living mostly for the ‘high’ that work gave him, Terry began to feel more tired than usual. He forced himself to continue performing at the same level as before, but his body protested. His concentration span became shorter and he found himself having to ask people to repeat themselves. He read things two or three times before he absorbed the information. He realized he was less alert when driving when he hit a car as he parked near his apartment.

Terry thought this was just a phase and he tried to make sure that he got plenty of sleep. But it made no difference. He was dragging himself up in the morning and falling asleep before he could eat his dinner at night. He would go long periods without eating when he was absorbed in the fast pace of work. He was worried about the difference he noticed in himself and tried working even harder to compensate. He never took breaks and delegated fewer tasks. He had no feeling for the issues his work force brought to him which was unusual for him. He went to a medical doctor to find out why his energy was flagging. All test results were normal, and he was told to ensure a good balanced diet with regular meals.

Terry became alarmed when other people commented on the changes within him. He had no idea that it could be so obvious. He couldn’t bear that his ‘weaknesses’ were visible. His whole image of himself was under threat. The harder he tried to return to his former self, the worse his performance and functioning became. When the first set of wake up calls didn’t lead him to take a good look at what he was doing to himself, the spiral downward came faster and with greater force. He was no longer eager to answer calls from work to bail them out, do shifts for others or sort out difficulties other managers left behind. He didn’t want to have to find time to go out with his girl friend. He didn’t want to deal with paying for the car he hit when he was sleepy at the wheel. When his body demanded extended amounts of sleep, he had to give in and take a few days off work. He had to be ‘sick’ before he felt he could legitimately separate himself from work.

He got angry with his body for failing him. He was disgusted with himself for having to call in sick and for having to rely on others to do his job. He worried that he would have to do it all again since no one could do it like him. He hated depending on his girlfriend for shopping and housecleaning when he was too weak to do it himself. He didn’t answer calls offering comfort or understanding. He hated the time he got to ‘feel’ himself.

Unfortunately for Terry, as soon as he felt a little more energy he went back to his old ways with a stronger sense of fervor. He was determined to compensate for the time off and wanted to prove to himself and everyone else that he was the same reliable superman. He was terrified that if he showed himself to be as human as anyone else, he would be denied promotion and became ordinary, with a non-descript life. That wouldn’t serve the voice inside him that said he had to achieve at the highest levels at all costs or else he was a failure and hence unlovable. The time periods between his normal functioning and depressions became shorter. The depressions themselves became longer, forcing him to examine his life style and what he expected of himself. What he found was that he was terrified that he was really trash, and that he had used the status of work, the money it provided and the time it used up as a costume to hide the garbage.

Terry’s depression had three heads. He catapulted from lack of concentration and sluggishness to self-disgust and anger, followed by being shut down. As in Gillian’s case the heads led independent lives and controlled him. He thought he was in control but it was exactly the opposite.

Having many heads to your depression provides extra places to go when one head is tired and used up. As it replenishes itself with your self-hatred and critical voice you can sap the energy of another head. Eventually none of the heads will have the chance to recover. They will all shrivel up and crumble. You have to feel all the trash, and smell the stink. It is truly awful, but the best news ever. Without feeling, smelling and tasting the parts of yourself you have ignored, you are going to stay depressed – each head waxing and waning through your life.

Depression at its worst is a gift that your are given so that you can be your own master. No more do you have to live according to those voices inside you that won’t allow you to be human, and deprive you of the simple pleasures of life. You get to plan and build in your time, take pleasure and pride in your work and be comfortable in your own skin. For those who need to go through the fires of depression with its many heads, there is a treasure at the end that is not found in any other way. It is the authentic you, that you can accept and be proud of.

Imagine having the chance to build your own self your way. How exciting and thrilling! You can be the architect, give the planning permission, act as your own contractor and inspector, buy your own materials and construct the best you that you want to be. This does not mean that you cannot get relief from medications. If used in conjunction with the work you do to feel all parts of yourself no matter how distasteful, you can construct a stronger and more resilient person. One that you will like and others too.

©Copyright 2007 Jeanette Raymond, Ph.D.
All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jeanette and/or see her GoodTherapy.org Profile