Monthly Archives: December 2011

Friday Q&A- I can’t stop calorie counting

Question:
I was wondering if you could give me any advice with my problem. I lost 6 stone 4 years ago calorie counting by writing it down every day.When i got to my target I tried to stop the counting,  but found instead of writing it down it stayed in my head. Every day I worry about my weight and what I’m eating, I log calories of meals in my head but don’t know how many I actually have each day.I think I’m trying to keep track but in a haphazard way and it’s stressing me out.I try so hard not to count but cant seem to manage it. If I eat anything extra or different I try somehow to make it add into another meal I might have that day, so i don’t feel i have overeaten.
I have NOT BINGED OR PURGED or been ANOREXIC.Only had an issue counting
 calories.
I have seen a therapist but they put me on 3 meals and 4 snacks a day regime which hasn’t helped. ( Is this more suited for binge eaters rather than obsessive calorie counting)
I have tried to stop weighing, is that a good idea? I have gone a month without weighing, is the goal to never weigh?
Any advice would be so helpful as I’m rock bottom with this problem.My life has come to a stop and I have a struggle to get out and do normal things. Its as if i become paralyzed when thoughts about counting come into my head, I muddled with what amounts  I should be having. I don’t want to go back to writing them down again as it was not working doing that at the end.
Debra
Answer:
Hi Debra,
Thanks so much for your question. This is a very good example of an eating issue that’s not a straight up  eating disorder, but nonetheless as you stated, it’s incredibly distressing and beginning to take over your life.
Your instincts are right. I agree with you that choosing to quit weighing is a great idea. In fact, trying to stop counting your calories and refrain from weighing and measuring your food is probably best. As you said, you’ve become obsessed with weighing, measuring and counting and if you don’t “do it right” you feel stressed out and distressed.  A way that you can continue to keep some level of control without counting calories or pounds is to begin quantifying your hunger and satiety using a scale.
Before you begin to eat, rate your hunger on a scale from from 0-10.  0 is so hungry you’re practically passing out, 10 is so full you’re vomiting. Eat S L O W L Y— and stop half-way through and check in with yourself. How are you feeling? What do you need? Instead of having a goal for a certainly calorie count, see if you can change your goal to giving your body what it needs. Your body does not want to be uncomfortably full, nor does it want to be empty, it wants to be satisfied. So, rather than looking outside your body to numbers, you might want to look inside your body for cues for what you need. When you eat to your hunger and stop when you’re satisfied (not still hungry but not very full), your body will come a place that is comfortable to you.
If you use a notebook before each meal to record your hunger before the meal, in the middle of the meal and at the end of the meal, you might find that you still feel that sense of control that you had when you were counting calories. Then, as you find that you’re able to stop actually recording the numbers, you will naturally be eating when you are hungry and stopping when you’re satisfied. The numbers won’t be stuck in your head because you’ll be focused on yourself rather than on something outside yourself.
I hope that this is helpful.
Do you have a question about binge eating, bulimia, anorexia, or anything associated with eating disorders? Send an email to bingeeatingtherapy  at gmail dot com. All questions will be kept confidential. Include your first name or the name you want to be referred to as and your location.

Reduced Posting Due to Maternity Leave

As you might have noted, I’ve not been posting as often as usual lately. I welcomed a new member of the family last month, one who is very demanding of my time. I will continue to post, just not as often. Happy Holidays to all!

Eating Disorder Therapy

What exactly happens when you go to therapy to heal from an eating disorder? What is therapy anyway?

This is the first of a series about different levels of treatment.

Unfortunately, most people who suffer from eating disorders don’t get treatment, either because they don’t have the money, the time or they feel that they should be able to heal from eating disorders all on their own, or that their particular issue isn’t severe enough to warrant treatment. What is important to remember is that it’s always okay to get help. Your eating disorder thrives in isolation and reaching out and getting help is what will heal it. Trying to work through it alone often perpetuates the issue. It doesn’t have to get to the point of totally unmanageable before you ask for support. You don’t have to hit bottom. You don’t have to be vomiting all day long, or starving yourself down to nothing or eating constantly all day to get help. It’s really common for someone to come in and feel embarrassed that they’re asking for help because they feel that they’re “not sick enough” or even “not skinny enough” to qualify for an eating disorder. If food feels hard for you, if you find that you’re simply overthinking eating, if you’re uncomfortable in your body, or you just want someone to talk to in order to suss out your situation  and figure out if you even need help and what kind of help you need, it’s okay to call someone. Going to therapy or to treatment doesn’t mean you’re crazy or that you “need help.” Therapy is a place for you to take care of yourself. It gives you time and space to think about your needs and to act on them. It’s a way to take care of yourself.

 

You can choose to see a Psychologist (Psydoc), a Licensed Social Worker, (LCSW), a Licensed Marriage & Family Therapist, (MFT) or a Licensed Mental Health Professional (LPC) or a Psychiatrist (MD).  Psychiatrists are the only ones who can prescribe medication, but many psychiatrists don’t do counseling. If you need meds, your therapist will usually consult with your psychiatrist, so that you are getting med management one place and therapy elsewhere.

Before a therapist becomes licensed, she or he must see patients a certain amount of hours (usually 3000) and then take some exams in order to be licensed in their state. This process can take anywhere from 3-6 years after finishing from graduate schools. Before getting licensed, these interns are supervised by licensed professionals while seeing clients. If you would like to see an intern, they usually charge much less than those who are licensed.

When you go in for eating disorder treatment with a therapist, they will often want to treat you along with a nutritionist and sometimes a psychiatrist.

So what happens in therapy? That’s difficult to say. First off, a therapist will not fix you. Therapy isn’t a magic cure, but it’s an open space that gives you the opportunity to think about your situation and strategize ways to improve it. There are a million different ways that therapists work to heal eating disorders. My own personal brand of therapy is eclectic integrative, which means I draw from many different modalities of psychotherapy to create  my own brand. I most often utilize a mixture of psychodynamic therapy  - which is more of the classic Freudian approach- where we discuss your family dynamics and past events in your life and how they have contributed to your current ways of existing in the world. This is incredibly helpful because it makes the unconscious conscious. It allows you to understand why you are behaving in ways that you’re behaving rather than purely reacting as you always have. It gives you some perspective and the ability to step outside of yourself so that you can make better choices about your behaviors. This goes well with cognitive behavioral therapy- which then takes your unconscious that you have now made conscious and enables you to make a choice by giving you options of different ways to think about your situation and react toward your situation. I also utilize somatic therapy and mindfulness which both make you more aware of the feelings that you are holding in your body so that you can work with the actual feelings that you are having rather than hiding from them by acting out with food. I also utilize hypnotherapy which is another way of increasing mindfulness and making you aware of your behaviors and the choices you have.

When you start with a therapist you will begin by education your therapist about your specific eating issues, how long you’ve been suffering, what your behaviors are and the severity of them. They might take your weight and find out how many times a day, week, or month you’re bingeing or bingeing and purging. Understanding the severity of your eating disorder is key to understanding what kind of treatment you will need. You might need weekly therapy sessions as well as sessions with a nutritionist and/or group therapy and a psychiatrist, or weekly sessions might be enough. It’s also possible that  you might need a higher level of care, such as an IOP, a PHP, residential treatment or hospitalization. But your therapist can help you to assess that. Sometimes, if you don’t seem to be on track with your healing, you might need a higher level of care as therapy goes on.  With eating disorder treatment, the first course of action is working to reduce the behaviors, as those decrease, you then begin to work on the feelings or the issues that trigger the behaviors. Often, as the symptoms decrease, challenging feelings increase.  I personally believe that it’s very helpful to stay in therapy after the symptoms (eating disorder behaviors) end in order to work deeply on the underlaying issues. This helps to prevent relapse and also helps you to continue moving forward in your life and achieve the things that you couldn’t before because your eating disorder was taking over.

To find a therapist who treats eating disorders, you can look on ED referral, Something Fishy, or  NEDA.

You can also search on Good Therapy or Psychology Today. Look for someone who specializes in treating eating disorders.

It is possible to find low-fee therapy. You might want to call a University near you that probably has students and interns in counseling centers. You might call a local hospital or mental health agency. If that fails, call a local therapist who probably knows where to refer you go.

Next up: IOP (intensive outpatient treatment)