I have never worked directly with an anorexic client, something that is generally considered quite difficult. Possibly it is difficult because the standard treatment model is still somewhat medieval: maximum security institutionalization and force-feeding, and little or no therapy–at $30,000 per month!
However, I would like to offer a couple of clues that I learned recently from a woman who had once been anorexic (and as usual, I’d like to hear from any of you who try them out).
It is always said that an anorexic looks in the mirror and “sees themselves fat,” rather than the skin and bones image that the mirror faithfully provides; this is something that has never quite made sense to me. When I asked this woman about this puzzling contradiction she said something very interesting that does make sense to me.
She said that if she was walking in a crowd at a mall, and glanced over and saw herself reflected in the glass windows without recognizing that it was her, she saw the person in the mirror accurately. But as soon as she realized it was HER reflection, she “saw” herself fat. When I explored this with her, she discovered an internal image of herself at 13, when she was pudgy and her father would pinch her waist and make fun of her weight; this is the image that she “saw” when she looked in the mirror. Resolving the unpleasantness associated with this old image, and replacing it with an image that shows how she looks in the present ought to reinstate the accurate external visual feedback, and eliminate the anorexia. However, I was primarily working with her critical voices, and after she was no longer anorexic.
This 32-year-old woman had also been a binge drinker since going to college, and had been in recovery for five years. She had a host of internal critical messages that had plagued her since she was eight, saying things like (verbatim) “You’re ugly. You’re fat. Don’t eat that, You’re not good enough; not pretty enough. Weigh this; be this size so people will like you. You’re lazy; get your fat ass to the gym. You’ve eaten too much”–really devastatingly cruel.
When I asked her to ask the voice what its positive intent was, she initially had great difficulty, saying, “What it said sucked. I could not for the life of me figure that out, because these voices were devastatingly cruel.” When she actually asked the voices–instead of trying to figure it out consciously–she was amazed to discover that its positive intent was to ” ‘make me feel good about myself, the person that I am.’ I’ve spent five years and thousands of dollars in therapy, weekly or biweekly, but I’d never thought about it in this way.”
As is so often the case, finding the positive intent made a huge difference in her response, and it was then a simple matter to educate her internal voice to say more useful things to carry out its positive intent.
When I asked her “What do you think would have happened if you had known this years ago,” she said, “I don’t think I would have had to go through all that,” meaning the anorexia and binge drinking. Of course I don’t know if she was correct, but if the tormenting voices caused her anorexia and binge drinking, it certainly seems likely.
So there are two very interesting possibilities to explore in a client with anorexia:
1. Find the internal image that the client uses to determine that they are fat, and transform and update that image,
and/or
2. Work with critical voices, determine their positive intent, and then use that to reeducate the voice in what it can say to better carry out that intent.
(My audio CD “Transforming Troublesome Voices” includes a lot of ways to work with voices, and also includes a report from the client described above, who was in the workshop.)
