Eating Disorders Counselor Certificate Training Part 5

Dr. Dawn-Elise Snipes PhD, LPC, NCC, CRCClinical Director, AllCEUs.com

Unlimited CEUs $99 per year. Copyright AllCEUs.com

“We must welcome the future, remembering that soon it will be passed; and we must respect the past, remembering that once it was all that was humanly possible."


Most of us have experienced certain distress It's easier to recognize misdirected emotions in somebody

else From infancy we rid ourselves of painful feelings by projecting

them out into the world or another person. Young children do not yet have the internal ability to handle

their feelings alone The expectation is that our parents will be able to reflect the

feelings back to us in more manageable doses. Sometimes parents cannot handle the child's needs

◦ Because they are going through stressful period◦ They are just unable to intuitively match the child urgent

demands.


When parents are overwhelmed by their children◦ the child begins to experience the world as unable to

meet its basic requirements◦ the world seems abandoning, attacking, persecutory, and

cruel. ◦ children develop the view that their needs are

inappropriate or wrong

One outcome is the individual gives up on having her needs met. ◦ How are the ED symptoms a solution to not getting needs

met?


Early lack of ability to get basic needs met may also lead to the defense of splitting. ◦ Many children are unable to perceive the parent as "doing

the best they can." ◦ The child's egocentric mind believes the parent can only

handle as much anger and emotions as he or she can. ◦ Since emotions or overwhelming to him or her, she believes

the emotions would therefore be overwhelming to the parents.

◦ Expressing these emotions to the parent risks abandonment, and ultimately the child's death.

◦ Instead of risking abandonment and death, the child splits the parent seeing the parent as all good and his or her needs as all-bad.


As the eating disorder patient begins to recognize that not all riches, goodness or abilities lie within the world of others, she will naturally be less envious.

Envy is anger directed towards someone because they have something you want

The Anger protects the person from anxiety◦ What things might the ED patient be envious of?◦ How might she display this anger?


The patient might also have strong transference reactions to the therapist—male or female

These reactions might lead to◦ Envy◦ Rage◦ Power Struggles◦ Sadness

◦ Discuss why each of these might occur and how you could constructively deal with it in treatment


Is important for family members therapist and friends to be aware the generosity may be particularly aversive to the individual with an eating disorder. ◦ Why?

It causes even more envy because she feels so unable to give anything herself.

She must then attempt show others up to deflate the value of those who seem to have more than she has.


By becoming the thinnest or the greatest suffer anorexic patient creates within herself an illusion of power.

Her target weight becomes a measurable, achievable goal.

She then has the right to feel special because she is finally achieved something grand.


Looking into the history of the eating-disordered patients, it is not uncommon to find ◦ a child who either had to act as the parent and was thus

deprived of her childhood, or ◦ a child who served as a vessel for the parent to live

vicariously through her and was thus deprived of her own unique childhood.

Their illness permits them to turn the tables on those who symbolically or realistically deprive them of their childhoods.

For once they hold the power to cause concern or worry.


Because people with eating disorders believe they've sacrificed their own lives for others they also believe that they deserve to be treated better.

They seem to feel entitled to special treatment and understanding.

Feelings of entitlement may breed contempt and inappropriate displays of frustration and anger


Psychodynamic treatment helps us to examine the important memories and how we will inadvertently play out the past.

We also come to see how our present is shaped by our parents and other loved ones.

These people for whom we have a memory are referred to as identifications and incorporations.


Children raised in an environment in which the parents are never satisfied and reprimands them repeatedly may develop eating disorders.

On a conscious level patients, love their parents and want to emulate and please them

The child who has identified with the parental drive to control and punish may end up relentlessly punishing herself

She may take on some of their negative qualities (the solution) to avoid being helplessly subjected to her parents anger,


The individual who has internalized a parent who finds her unlovable or despicable will:◦ be unable to nurture her own good qualities◦ Fail to take advantage of opportunities ◦ Engage in relentless self punishment◦ Be terrified of success of the good

◦ How is this manifested in ED symptoms◦ What are the solutions to an “unsatisfied” parent?


What can be done when aggression is bottled up inside? ◦ It can be directed against the external world. ◦ Just as her parents treated her poorly, she will treat her friends and

others poorly. ◦ Relationships will be spoiled because only another masochist can

tolerate the overt criticisms of one with so much self-hatred.

The patient must develop friendships that show her that interdependence does not destroy independence.

By identifying with the aggressor, patients cope with life, wreaking havoc on others as it was done to them.

They are compelled to repeat the past over because it is the only past that they have or know.


All persons in the eating-disordered population have one facet in common: given the opportunity, they can use their intellect either constructively or destructively.

One way to understand eating disorders is to view them as highly innovative (albeit destructive) defense mechanisms.

Sometimes they are found with other symptoms that also alleviate anxiety pain and sadness such as substance abuse, compulsive exercise


ED patient’s parents◦ Have difficulty understanding and attuning themselves to them◦ Communicate to the child that her needs were inordinate and

unmanageable

Symptoms/manifestations:◦ The patient now strives to control those needs, keeping them

inside or become painfully aware that she is not totally self-sufficient. How?

◦ Relying on other people creates an unsettling anxiety that must be allayed. How?

◦ The therapist must be made to feel flawed and inefficient and therefore unenviable and not needed. (Strike first to prevent abandonment)

◦ It is better to defeat treatment than to acknowledge one's dependence and risk rejection. What is this a solution to?


Psychotherapy can be used to ◦ Identify defense mechanisms◦ Develop alternate solutions to cope with defended

emotions◦ Allow the patient is to see how a therapist deals with life

and his or her own imperfections.

It is crucial for patients to remember the therapist cannot provide a perfect understanding or immediate cure.

The individual with an eating disorder must feel that her own point of view and strengths are appreciated.


Eating-disordered symptoms persists because they provide at least one and probably more ways of coping

Ultimately the individual clings to the eating disorder to avoid something worse.

Successful therapy helps the patient◦ Identify the “something worse” she is running from◦ Find a new and more adaptive way of coping “solution”◦ Address or debunk the “something worse”◦ Make the choice to find new solutions◦ Identify some of the ways the disorder has been useful◦ Feel empowered and hopeful


Health & Medicine

Eating Disorders Counselor Certificate Training Part 5