Working with Eating Disorders: Myths, Metaphors & Storytelling

Speakers:

Mr Clinton Power Founder and Website Concept Developer-Australia Counselling & Consulting Pty Ltd

Relationship Counsellor for Individuals and CouplesClinical Counsellor and Gestalt Therapistwww.ClintonPower.Com.Au

Ms Sue PatonDirector, Psychotherapist, Educator, ConsultantEATFED Pty Ltd, NSWCertified Transactional Analyst, UKwww.EATFED.Com.Au

Working with Eating Disorders: Myths, Metaphors & Storytelling

www.AustraliaCounselling.Com.Au

[START OF AUDIO]

Clinton Power: Hello! This is Clinton Power from AustraliaCounselling.Com.Au. I’m

here today with my colleague, Sue Paton, who is a Psychotherapist, Counsellor, Consultant,

Supervisor and Educator from Sydney.

She has over 15 years of experience as a psychotherapist working with individuals,

couples, and groups. She’s been an educator at the Australian College of Applied Psychology

since 2007, where she teaches undergraduate and post graduates students in the master’s

program. But I’m very excited to be speaking with Sue today in particular about her new

enterprise and company called “EATFED” which is an intensive outpatient treating program for

eating disorders in Sydney.

So, welcome, Sue. It’s great to have you on the call.

Sue Paton: Thank you, Clinton. I’m actually very excited to be talking to you about this

project.

Clinton: I’m very excited as well, because it sounds so unique what you’re doing. But

let’s back up a bit. Tell me about how did you come about to be interested in working with

eating disorders?

Sue: Well, I suppose over the years I had come across a few clients who had eating

disorders and worked with them for some time, but never really felt like I did the work that I

wanted to do with them. How this came about just recently probably 10 years ago now, is my

partner, Evonne, suffered with bulimia for many years before I met her. So she suffered for

about 13 or 14 years.

Working With Eating Disorders: Page 2 of 17Myths, Metaphors, & Storytelling 2012 Australia Counselling & Consulting Pty Ltd

And as I got to know her, I came to really sort of personally understand the impact of

what an eating disorder can do and can have on someone and their family. So we started to

talk about eating disorders are currently treated, and we thought we’d really like to do

something that was different. And it was around this time that Evonne actually got an

opportunity to work at one of Sydney’s eating disorder clinics.

At that particular time, I also read Dr Anita Johnson’s book, “Eating in the Light of the

Moon.” It was one of those books that fall off the bookshelf when you’re in the book shop. I

was taken by the title “Eating in The Light of The Moon.” So I read this book and was really

impacted by it. I found that it was somebody talking about eating disorders where they really

got inside the psyche of someone suffering with an eating disorder.

I thought, “Wow! This is a really good book.” So I emailed Dr Anita Johnson and said,

“I’m really interested in bringing your treatment to Australia. How can we go about this?” And

that’s where it started. We started talking about how we could do that, and so this is now the

combination of nearly two years of work to get it up and launched in Sydney.

Clinton: So this is your organization EATFED that you’re referring to.

Sue: Yes. EATFED is an acronym for Education And Therapy For Eating Disorders. That

kind of another discussion that I had with Evonne around what actually helped her recover

from bulimia after having it in so many years.

Clinton: I’m guessing from the acronym there that education is an important part of

your philosophy around working with eating disorders.


Sue: Yeah, I think the psycho education with anybody that you’re working within

therapy is really useful. I suppose that comes from being an educator and also seeing the

impact of education on my students.

It’s another layer to their own personal development work when they start to really

understand what it’s all about. So yeah, that came out one afternoon, we’re out and I just

finished one of my essays from my Masters of Education that I was doing. We sat down and I

sort of did a mini-interview with Evonne and said, “Okay, so what was it that helped you

overcome this eating disorder?” And she said, “Well, first and foremost, it was the education.”

She had been studying counselling and she realized that in all her time of visiting clinics

psychiatrists and psychologists that there were things that as a patient were never explained to

her. So the psycho-education component was really important in helping her to understand

what she had been through.

I made a mental note of the word “education” and then she went on to say, “Well, the

next thing is of course therapy.” And that therapy really stopped that binge-purge cycle that

she had been in. So I thought, “Oh, okay, education and therapy. That spells eat.” So we

started like honing that and then the rest was—for eating results EATFED.

Then we thought, “Oh, that’s actually quite a unique name for us.” And people actually

warmed to it. When we’ve said **** [05:21] they got, “Oh, actually, that’s quite a good name.”

So that’s how it came about. And now Anita will be here at the end of the month to train us

and our staff program, and we’ll go from there.


Clinton: Fantastic! I’m hearing that there is a real personal relevance in your story in

becoming interested in eating disorders. But also hearing it there was a passion. It sounded

like you started to investigate this area you realized you had a passion for the area.

But I’m curious, maybe you just give us an overview of what is considered an eating

disorder? Because I think there are many different definitions.

Sue: Yeah, I think that is true, because we hear the common ones which are of course

anorexia or bulimia. But it does cover quite a few different types of eating disorders. I suppose

what you first have to understand is that they are asymptomatically complex. There’s this sort

of area that’s called “eating disorders” not otherwise specified in terms **** [06:26]. But

mainly of course they’re characterized by maladaptive behaviours and thoughts around food—

that’s the main thing, also around eating weight and body image, and typically, they include

mood disturbances.

So typically, people will also suffer from depression or anxiety. They also have difficulty

with impulse regulation and their interpersonal functioning. The relational functioning is also

impacted.

In a nutshell, anyone who’s obsessed with their body, continually dieting, and or

excessive exercise can be classified as having an eating disorder. So an example of that would

be a compulsive eater. They find themselves seeking about food that they’re not supposed to

eat and then they scold themselves for what they did eat and then how fat they look.

This of course makes friends and family think that the issue is food. Actually the issue is

not food, which I know it sounds a bit strange. But with eating disorders it’s actually not

anything about food. It’s really about their behaviour around food.


Clinton: That sounds like a really important point. So I’m wondering hearing that, can

you actually have a normal healthy eating pattern? But if you’re showing a maladaptive

thinking, obsessive thinking, and cognitive processes around food, can you still be considered

having an eating disorder?

Sue: Yes, because it depends of course on the level of impact that that has on your diet

daily life. So if it’s stopping you from doing the normal things that you would do, yes, it could

be class as an eating disorder. If you’re working at the gym four hours a day rather than

spending time with your time with your partner or family and friends and then obsessing about

how much you’re eating and how you look, then they’re sort of extremes of what could be

considered as having a disorder.

Clinton: Right, okay.

Sue: There’s an eating disorder that can be actually classified through the **** [08:47]

and then they disordered eating. So not everybody that fits into having disordered eating can

be classified as having an eating disorder, but it still has an impact on their life.

Clinton: Yes. Many therapists I think aren’t sure on how to approach working with

eating issues when they come up with sessions. What would you recommend for a therapist

who is unfamiliar with working with these issues?

Sue: Yeah, I think the first thing that would help would be to help the client understand

how the issue is impacting their life. The client may not be aware, they may be talking to about

their thoughts and their feelings and their behaviours around food but they may not be aware

that they actually have—that this is something that could be considered a disorder.


First of all, they need to understand that it’s impacting their life. Then you probably ask

things, like, what is it about their eating that’s causing them concerns or if they start to be

concerned about some of those thoughts and behaviours. I think the next suggestion would be

to remember that the real issue is not about food.

Anita Johnson talks about the same in her book around eating disorders that when food

is actually like the proverbial red herring. So it’s something that diverts attention away from

something else. This is where family and friends get distracted and also well-meaning

professionals around the fact that they need to do something about the food issue. In fact

what they need to do is focused on the behaviour around food.

Then we get into talking about eating addictions. People would talk about eating

addictions. But eating addictions is not the same as addiction to substance like alcohol or

drugs. An eating addiction is a process addiction. That’s why we talk about the addiction is

actually around behaviour with food, not food itself.

So it’s quite a different way of thinking and this is why you can’t just abstain from

certain food or develop food plans, because they just don’t work. To focus on food is actually

the red herring, as Anita talks about.

Clinton: I guess it makes sense and it would be an easy trap to fall into to think if

someone has disordered eating to have a food plan or some kind of structures around eating in

a better way. But I think what you’re saying is looking at the processes is around which include

cognitive processes as well as behaviour processes around food.


Sue: One of the things that I find particularly interesting in not working with focusing on

the food is to focus not on client’s relationship with food. And often their client’s relationship

with food is symbolic of their relationship with others in their life.

So if you think about someone who is binging not necessarily purging, but they binge,

you’ll notice that in their way of relating and being with others is that they actually will binge on

people or even binge on therapy. They want to come more than once a week, or they want to

come two or three times a week.

It’s quite interesting to watch how that manifest. When you can work with that, that’s

when you can really deal with what the issue is.

Clinton: That’s fascinating. So the eating issue can be a metaphor for how they live

their life or how they relate to others.

Sue: This is what’s wonderful and what I loved about Anita’s book is that it’s based on

working with eating disorders based on myths, metaphor, and storytelling. So really it’s looking

at the symbolic level of what the eating disorder is about.

Clinton: Great! My sense is that women get the majority of press around eating

disorders. But what do you seen with the male population around this issue?

Sue: The reason why women get the majority of the press obviously is they are the

most affected. It’s hard to know what the real statistics are. But we do know in Australia that

15% of all women will at some time in their life be diagnosed with an eating disorder. That’s a

huge amount of women.

What we know about men is that there will be—for every 10 women diagnosed, there

will be one man diagnosed. And they do tend to not show the symptoms that women show.


So for example, they will be less weight concern and they’ll less likely to do the purging,

induced vomiting with bulimia. So there’s a little difference in terms of how they manifest the

eating disorders.

But still in Australia the statistics are out at the moment, but it’s about 1 in every 100 of

men. Our program will start with working with women, and then the next major preference

will be to work with adolescents, because there is also a very high prevalence and it’s increasing

with the youth particularly between 15 and 24. And then if there’s a demand for it we’ll

certainly move into working with males as well, but it is not the prevalence that we see in

women. That’s for sure.

Clinton: Are you seeing an increase, though, in men that are presenting with eating

issues?

Sue: I personally am not, because most of the people that are coming to me are

women. So I can’t talk about that personally. I can only just go on the statistics that I do know

which is recently it’s 1%, so 1 in a 100.

Clinton: Give us a brief overview of your approach to working with an eating disorder. I

know that may seem like enormous question, but can you kind of capture a flavour of how you

work with someone presents with an eating disorder?

Sue: Well, at the moment, I’m working individually with people. My particular

approach is a very relational approach. My training is in transactional analysis, but I’m also

influenced a lot by relational psychoanalysis.

Again, it goes back to that symbolic level of what their eating disorder actually means

and working in a relationship with the client. For some clients that might mean at least twice a


week therapy, and it also may mean contact you in a week in order to sort of get some

attachment or some relational need work week in the therapy.

But in terms of our intensive outpatient program, that really is very different to what is

being offered in other programs. Certainly, in Sydney, as far as I know around Australia because

that is very much focused on—their inpatient treatment or daily programs. They’re very much

focused on the cognitive behavioural aspects of the eating disorder and also the food.

So you’re looking at food plans and those types of issues around food. Whereas, we’re

looking at something that’s more holistic, I suppose you’d say, a very therapeutic model of care.

It looks at not only cognitive behavioural change but also insight support development and

more effective social skills nutrition self-care, but also looking at the underlying emotional

issues.

In my experience, the clients that I’m seeing, sadly to say the clients I’m seeing come to

see me as a last resort. They’ve done the rounds of inpatient outpatient day programs and

they’ve done them four or five times.

When they come to me, they’re really wanting to get to what is the cause of this eating

disorder, why do they keep relapsing. And so it’s really important that we do deal with the

underlying emotional issues. I find often they haven’t been addressed and so that creates a

feeling of despair that they never got into recover. I think one of the things is about instilling

some hope in them that there is a possibility of recovering.

We do that in the intensive outpatient program, and of course we also work with their

GP or psychiatrist or both, dieticians, and of course their referring therapist as well. Just like

anybody else we’re wanting to stabilise and normalise their weight and also their eating


behaviour and stop the cycle of the binging or purging or the food restriction or whatever it is

that’s going on.

Clinton: I’m curious about the fact you’re doing an outpatient treatment program.

Because I’m wondering maybe there is an advantage there and that people are still leading

their life, they’re still working, they’re still in their homes and getting your holistic treatment as

opposed to maybe an inpatient program which maybe is not as connected to the real world.

Sue: Yeah, I think you’re right, because my experience with some of these clients that

I’ve seen that have come out of these programs, is that they’d have to take either leave without

pay or they’d have to leave their jobs. And sometimes coming in to Sydney from other states,

and so they have to find somewhere else to live once they leave the inpatient and go into the

day program.

Yeah, it will be something very different. But that’s not to say that we don’t need those

sorts of inpatient treatment facilities as well, because often they are necessary particularly, if

you got someone with anorexia who really actually needs to go in and be fed and be bought to

a weight that is sustainable for them to be able to do therapy.

So we see it as not only as an alternative to the inpatient and daily program but also as

an adjunct to them. I believe we need lots of different types of treatment because we have lots

of different types of people. So I believe that one treatment will come in and be the “be all and

end all” of all treatments. It is something that’s going to go with the treatment that’s already

there.

But I know myself and actually I was just looking on Twitter this morning, someone was

saying about how in New South Wales at the moment there are two hospital beds for anorexia


for eating disorder patients—two. I mean, that is for New South Wales. That is unbelievable.

But it used to have four, cut them down to two.

I know the day program here—Royal Prince Alfred Hospital, the waiting is just so long to

get in there. We do need more treatment and we also need different treatments.

Clinton: Just a staggering statistic. But I’m also mindful that one of the scary aspects

when it comes to working with eating disorders there’s always the potential for death I guess is

much higher than it is for maybe other populations we work with.

Sue: Absolutely, there is a huge lot of research to show that anorexia actually has a

very, very high death rate. This morning, what I was hearing, because there’s actually petition

going around to get more beds open, but this morning though they were saying that the cost of

eating disorders is actually far more than what schizophrenia is. Yet, schizophrenia gets a lot

more funding and a lot more interest.

So I don’t know what it is particular about eating disorders that they don’t get that sort

of focus. But certainly in the media we really need to do something about raising its profile in

terms of the impact that it has on women in particular.

Clinton: I hope your organisation EATFED can certainly contribute to that getting a

greater visibility in the Australian public.

Sue: Well, that is the hope.

Clinton: What resources can you recommend for therapists who want to learn more

about working with eating issues?

Sue: I think the first thing that I say to people read Anita’s book. It’s been around for a

little while now. But when I’ve given it to women who suffered with eating disorders, often


their response is I wish I had read this earlier. I wish I had with this when I first got an eating

disorder. As I said before, she really was able to get inside the psyche of someone with an

eating disorder, and she has a whole different perspective on who these women are who

manifest eating disorders.

Certainly, it correlates with my experience of them being very high functioning, very

intelligent, very intuitive women—amazing women. And this is what she talks about. She said

that they are the one with the eyes with the family so they’ve seen what’s going on. But often

through whatever’s happening on or happening in the family they get solace in some way.

So that would be the first thing that I would talk about. Of course, we’re having Anita

coming at end of the month. That would be great for people to come along and listen to her

talk. I’m giving a workshop that **** [24:13] Psychotherapist Association Conference the

beginning of June. I’ll be talking about Anita’s work there.

There are excellent papers on working with eating disorders. One is by relational

psychoanalyst, her name is Mary Tantillo. She’s certainly a great help on looking at the

relational aspects of eating disorders. Just here in Sydney, we have a wonderful psychologist

who’s done some really excellent studies on eating disorders looking at their life histories.

Her name is Joanna Patching. She interviewed about 40 women on their experience of

eating disorders over their life span. She came up with three things that women have and that

is that they have issues around conflict, control, and—I can’t remember the next one. I forgot

just for the moment. But there are three Cs. I’ll come back to it in a moment.

The other woman I think who writes really well is a woman who’s also a psychoanalyst

here in Sydney is Sue Austin, and she wrote a fantastic book on women’s aggressive fantasies.


She’s a specialist in eating disorders. And this is what I find too, a lot of women with eating

disorders have a lot of anger that never gets processed.

Clinton: What was the name of Dr Johnson’s book again?

Sue: It’s called “Eating in The Light of The Moon.” How women can transform their

relationship with food through myths, metaphor, and storytelling.

Clinton: Great. I think we’ll put a link to that book in the replay centre as well of

Australia Counselling. Is there a specific thing that Dr Johnston is speaking about when she

comes next month?

Sue: She’s going to be talking about working with eating disorders, but particularly

looking at aspects of hope, healing, and change. What she’s going to do is she’s going to

present the history development of her model. She developed this out of her intensive

outpatient program in Hawaii. She heads up the **** [26:39] Intensive Outpatient Eating

Disorder Program, and she co-founded the Anorexia and Bulimia Centre there in Honolulu back

in 1982.

She’s worked for 30 years with eating disorders and this outpatient treatment program

has come out of her work there. She’d be talking about that and talking also about the

integration and use of metaphor in therapy, particularly, in working in an intensive outpatient

program. She uses a mixture of storytelling and metaphor to describe the underlying issues

that in the treatment of eating disorders.

She actually hasn’t been here since 2006, so she also get either off and on, but our

relationship will allow her to come over a little more often than she does because she travels all


over the world talking. She’s actually just been in Virginia this last week in the U.S. talking out a

eating disorder conference there.

So that’s basically what’s her. Actually that presentation will be open to not only

practitioners but also the public sufferers of eating disorders, their families, carers, whoever is

interested in eating disorder. It’s not directed at clinicians specifically, but open to everybody.

Clinton: Where could therapists go to get more information or register for that

professional development event?

Sue: They could go to our website www.EATFED.Com.Au. There’s spot there that you

can go and get the details, you can call us up or email us and we’ll just do that.

Clinton: And also that’s where the best place for people to contact you as well if they’re

going to find out more?

Sue: Absolutely! Just go to the website and email us and we’re happy to talk to

anybody and anybody who’s actually wanting to know more about the Intensive Outpatient

Program. We give a 30-minute free consultation today to let them know what it’s all about.

We’re also going to be doing some information evenings for that. So that will also be on

the website so practitioners can come along and learn about what the treatment is about also.

And then we have our art exhibition that we’re having to launch at Sydney University. So that’s

exciting also.

Clinton: So tell us about the art exhibition.

Sue: That came about through my life-long friendship with a lecturer in political

economy at Sydney Uni. She’s also a wonderful artist. So this is her first foray into curator of


http://www.EATFED.Com.Au/

an art exhibition. She came up with this idea to launch and said, “Yeah, great! That sounds

fantastic.”

What we’re basically looking for is anybody who wants to submit an artwork, we’ll have

there, and if you want to sell them we’ll sell them, and the percentage of the price of whatever

you put your artwork in for will go to the Butterfly Foundation, the Eating Disorder Association

here in Sydney. All the information is on the website again.

But it’s pretty much looking at people who’ve had a personal experience with an eating

disorder. So it can be your personal experience with therapy, it can be providing therapy for

people with eating disorders, relational aspects of eating disorders, the social dimensions,

political aspects, gender body image—I mean there’s a whole range; you’re looking at culture.

So any sort of thing that has an eating disorder theme we’re looking for, and so this will

go away to sort of again promote some sort of focus on eating disorders and the importance of

working with this disorder and finding ways of treating it.

Clinton: When are you planning to hold the artwork?

Sue: That’s May 1st and May 2nd. The launch will actually be on the May 1st and that’s

set the Verge Gallery in Sydney University.

Clinton: Wonderful! Sounds like the best place to get more information about any of

this material we’ve talked about is your website which again is EATFED.Com.Au and they can

contact Sue directly.

Sue, I just want to say thank you so much for your time today. I really appreciate all the

work you’re doing to raise awareness around eating issues, and it sounds like we certainly have

a long way to go in Australia to really bring it to the forefront where it needs to be to get the


kind of attention and funding that’s required to make a significant difference. But it sounds like

your organisation is certainly getting the ball rolling.

Sue: Well, thank you, Clinton. I really appreciate your time too and your interest in our

project. And yes, I hope it does help to raise the profile somewhat in terms of how we treat

eating disorder. And as you say, the funding, we really do need that because I have found a lot

of women who are really struggling financially, and so to find a treatment that works is really

difficult.

So part of our project will also be setting up a scholarship where people can come who

are financially disadvantaged so that’s another thing as well.

Clinton: Wonderful! Well, thank you again for your time. And I hope we can speak

again soon.

Sue: Okay, thanks, Clinton. Okay.

Clinton: Bye for now.

[END OF AUDIO]

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Working with Eating Disorders: Myths, Metaphors & Storytelling