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About a year ago, I was looking for a therapist who specializes in eating disorders for a friend. I researched several professionals online and decided to call each office to speak with them over the phone. I called one office, and like I had with the others, asked the receptionist to speak with the psychologist. I explained that I had a few questions about her treatment practices and would take up several minutes of her time.

The receptionist’s answer? No. I was a bit taken back, so I repeated myself. But, according to the receptionist, the psychologist never speaks over the phone. That’s her policy, and that was that.

I was so turned off by this person and her policy that I’m still irritated. (Within seconds, I crossed her off the list.) Interestingly, the other therapists I contacted were happy to answer my questions and speak with me about their treatment methods.

Maybe you’ve had a similar experience. Or maybe you’re looking for a therapist and have no clue where to start. Or what a good therapist even looks like.

Finding a good therapist can be overwhelming. That’s why, today, I’d like to share with you several tips from Sarah Ravin, Ph.D., a clinical psychologist who specializes in eating disorders. I’ve interviewed Ravin before, and she’s incredibly knowledgable and skilled.

On her blog, she’s written an excellent post on how to find a good therapist.  According to Ravin, “Having a good therapist is a powerful predictor of your chances for recovery, so it is important to take the therapist selection process seriously.”

For starters, if a therapist flat-out refuses to speak to you over the phone or answer your questions, that’s a red flag. (If they’re busy at the moment, the receptionist should take down your contact info and the therapist should return your call.) It shows they’re not open or accessible. And open and accessible is what you want in a clinician.

Your treatment should not be a secret. Fortunately, most therapists will do a free consultation over the phone for about 10 to 15 minutes.

Choosing a therapist based on location, insurance coverage or experience is not helpful. According to Ravin,

Choosing a therapist based on proximity alone is not a good idea. The therapist closest to you may not be a good fit for you. Choosing a therapist based on insurance alone is also not a good idea because many therapists don’t take insurance. Further, if you do use your insurance to pay for treatment, the insurance company will likely request a great deal of personal information about your mental health conditions, may discriminate against you based on diagnosis (or lack thereof), and will probably limit the number of sessions you can receive. Getting personal recommendations for therapists is tricky because it involves disclosing at least some personal information to a friend or colleague, and many people are not comfortable doing that. It is not always wise to choose a therapist based on how much experience she has in the field, because many therapists who have been practicing for decades remain entrenched in antiquated theories of mental disorders and practice less effective treatments Also, if you are a young person, it may feel more comfortable to talk to someone closer to your age who can relate to you more easily and who has a better understanding of your generational issues.

As far as what is helpful, Ravin recommends readers do extensive research on eating disorders and effective treatment and find a therapist who specializes in eating disorders and uses well-researched, successful treatments.

You’ll probably find this information on the therapist’s website. For example, Ravin plainly lays out her education and training on this page and her treatment methods on this page.

Don’t hesitate to call prospective therapists and talk to them over the phone. Ask questions about their knowledge of eating disorders and how they treat EDs. Ravin has written another thorough blog post about which responses serve as red flags.

For instance, some red flags that Ravin mentions are: not knowing the etiology of eating disorders; blaming the parents or patient for the ED; not discussing their treatment methods and explaining the reasoning behind them; or believing that people don’t recover from EDs.

Also, ask how many of their patients have actually recovered. For instance, Ravin suggests asking the number of patients the therapist has treated in a three-year period and how many of those have recovered. “If she hems and haws, or describes therapy as a lifelong journey, or claims that one never recovers from your particular disorder, move on to someone else,” she writes.

Finally, Ravin suggests choosing therapists with a Ph.D or Psy.D and checking out university clinics or academic medical centers. She writes:

University-based mental health clinics and academic medical centers are excellent places to seek psychological treatment. Many of them offer low-cost services or provide treatment for free as part of research studies. The therapists are typically doctoral-level graduate students, pre-doctoral psychology interns, and/or post-doctoral residents, all of whom are closely supervised by licensed clinical psychologists. Advanced graduate students, interns, and post-docs tend to make excellent therapists because they are young, idealistic, energetic, fully informed about recent advances in the research and practice of therapy, well-trained, and constantly evaluated on their performance.

Please be sure to check out both of Ravin’s valuable posts on picking a therapist and red flags.

Making art “is a remarkable tool for recovering our right to be heard, letting go of perfectionism, and restoring self-acceptance,” according to art therapists Mindy Jacobson-Levy and Maureen Foy-Tornay in their book Finding Your Voice through Creativity: The Art and Journaling Workbook for Disordered Eating.

“And it can foster self-discovery by opening new, symbolic doors into our hearts and minds. Creativity connects us to our ‘inner voice’; healing occurs when we listen!”

Their book features a variety of interesting and valuable activities. Today, I’m sharing four artful activities to help you heal your relationship with food and with yourself.

After each activity, a journal entry follows so you can dig deeper. Because it’s better to do the activity before reading the journal entries, I’ve included those at the bottom. So if you’re interested in doing any of the activities, avoid peeking at the entries!

1. “This is Me” Collage

How often do you put yourself first? My guess would be not very often. Many of us think that doing so is selfish. It isn’t. It’s just good self-care. Taking the time to focus on yourself is healing.

According to the authors:

“Eating patterns that are chaotic and unhealthy may indicate you feel unheard or misunderstood in another area of your life that has nothing to do with food. Giving yourself the opportunity to listen within may help you figure out what might be driving your disordered eating. It may also help you feel more alive, engaged in your life, and happier.”

• To create your collage, find words and images that say something about you and that you can relate to. Glue them onto a piece of paper.

2. Your Disordered-Eating Dictator

It’s safe to say that your battered relationship with food and with yourself stems, in part, from hidden or unexpressed feelings and beliefs. The authors write:

“Somehow in order to protect or take care of yourself on your life journey, you found it necessary to hide your true beliefs (mind) and feelings (heart). Any difficult thoughts or emotions you experienced became secrets lodged within your body, only to be replaced by dissatisfaction with your hips, breasts, stomach, butt or other body parts…

Here entered the disordered-eating Dictator, a simultaneous solutions for so many things! But who is this inner Dictator that promotes feelings of self-loathing, and what would happen if you confronted the Dictator in an old-fashioned tug-of-war?”

• Look through magazines or newspapers to find three small images, which represent your heart, mind and the Dictator. Glue them onto a piece of paper. Then “write what each part would say to the other.”

3. You Are a Treasure

When we have an unhealthy relationship with food (and ourselves), the last thing that comes to mind is our wonderful qualities. Rather, we immediately think about our weaknesses and unworthiness. We feel worse and feel even more stuck in our harmful habits.

Having a better relationship with ourselves includes acknowledging that we’re good people and that we have many positive characteristics. We just might’ve forgotten.

This activity helps you see these qualities. The authors say to think of yourself as a treasure chest with precious gems just waiting to be discovered.

• Draw a treasure chest that represents you, and make it as lavish as you like. For instance, you might put stickers on it, paint it or glue glitter. “Now cut five 1″ x 4′ strips of paper and jot one positive self-statement that doesn’t have to do with your appearance on each one,” and tape them to your paper.

4. My “Precious” Disaster

Even though we know that behaviors like restricting our food, bingeing, over-exercising or bashing our bodies and ourselves are harmful, we still might be afraid to let them go. They might be our only ways  to cope with life.

The authors ask a powerful question: “Is perhaps your obsessions with your body size and what you eat precious to you, even though it leads you on a self-destructive course?”

• Draw a line down the middle of the page to create two columns. On one side, draw what you think your life would be like if you continued to engage in those current “precious” behaviors. On the other side, draw what you think your life would be like “if you devoted yourself to positive, life-affirming alternatives.”

–

By the way, be sure to check out “The Choose Love Project,”created by Lori Race and Rachel Cole. “The Choose Love Project aims to help women, both young and old, to understand that loving our bodies and healing our relationship with food and exercise are choices, that these are indeed about choosing love.”

It’s amazing and features many of my fave bloggers and good friends: Anna, Mara, Joy, Julie and Sally.

–

Journal Entries (Read ONLY after you’ve done the activity)

1. Look at your “This is Me” collage, and write whatever comes to mind. “How did you feel making it? Did you have fun? Are you aware that you have that creative energy inside you, waiting to emerge?”

2.What do you notice about your conversation with the mind, heart and Dictator? What is the role of the Dictator in your life? Is it a healthy one? Do you think that disordered eating and a poor body image are your “allies”?

3. “What do you think about the riches you uncovered? Are other people aware of the treasure within the box-all the wonderful qualities you possess?”

4. What do you observe in the two drawings? What’s different about them? What’s the same? How do you think you’d feel if you relinquished these “precious” unhealthy beliefs and behaviors?

{image by Sui; check out more here!}

Today, I’m thrilled to publish a beautiful guest post by Sui from cynosure. On her blog, Sui writes about love, growth, presence, eating and body image. As she says, “I share my journey to help you on yours.”

What I love about her piece is that it has a very powerful and positive message. Very sadly, in our society, hunger is a dirty word or something to be feared. Hunger, we’re taught, is what sabotages dieting. It’s what keeps us from losing weight. It’s a slippery slope to excess pounds and deep dissatisfaction.

How many of us have wished that we didn’t get hungry, that we didn’t have (healthy) appetites?

Below, Sui explores hunger and eloquently explains why it’s actually a necessary, healthy and wonderful thing.

I spent so many years of my life running away from my hunger when I had an eating disorder.

Or perhaps, instead of running away from it, I plunged into it. I plunged into the experience of hunger by denying it.

When I ignored my hunger, I ignored my needs. And not just my bodily needs– for nourishment, for sleep, for tender loving care, for gentleness and ease– but the needs of my heart. For love. For presence. For joy. And my need for space — space to let myself feel the sadness, the uncertainty, and even, sometimes, the misery.

When I ignored my hunger, I didn’t just ignore my stomach rumbling, my body needing food. When I ignored my hunger, I was ignoring my hunger for life.

My hunger to be truly alive, to truly inhabit this life with this body, to truly taste every delicious morsel and moment of this human experience.

When I denied my physical hunger, I was denying my spiritual and emotional hungers.

I was denying my heart hungers.

As I recovered from my eating disorder, I began to love hunger. I know what you might be thinking– that sounds like a dangerous thought, especially for someone whose downfall came in the form of starving, binging, and purging– dysfunctional relationships with hunger and feeling too much hunger.

But my love for hunger is different from wanting to be hungry. (In fact, I think that the very reason I inflicted starvation on myself was because I wanted to ignore just how much hunger for life I had and how powerless I felt because I wasn’t truly living, wasn’t nourishing myself at all.)

My appreciation of hunger is only possible now because I allow myself to feel it; I respect it; and, I do my best to mindfully nourish it.

I’m grateful for my hunger, because it reminds me that life is a cycle, and we never stop, we never stand still– we’re always going, changing, falling, getting back up– and that we always need nourishment along the way.

I’m grateful for my hunger, because it serves as a reminder that after all these years and after all that abuse, my body hasn’t failed me; in fact, it’s definitely more reliable to me than the other way around.

I’m grateful for my hunger, because it tells me over and over again: You are human. You have needs that you have to nourish. Take care of yourself.

And I like hunger, because it’s a signal, a clear-cut message: it means now, I can dig in!

—

I’m grateful to Sui for sharing her stunning post here on Weightless! Here’s how you can connect with Sui and her writing:

Get my work via RSS or email, and get on the list for a free guide to mindful, loving eating and exclusive updates. Say hello on Google+ and Twitter.

P.S., Stay tuned this week for a little giveaway to celebrate my two-year anniversary writing Weightless!

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Yesterday, we discussed recovering from eating disorders. I shared my interview with Carolyn Costin and excerpts from her book,  8 Keys to Recovery from an Eating Disorder: Effective Strategies from Therapeutic Practice and Personal Experience, with co-author Gwen Schubert Grabb.

One of the topics we talked about was feelings. Learning to tolerate your emotions in a healthy way is important for recovery – and for living life. But many of us, whether we have an eating disorder or not, have a tough time identifying and processing our emotions.

Interestingly, our perspective can make or break negative emotions. As Costin said: “Your emotions are your body’s response to your thoughts.” Or, “What you tell yourself affects your emotional state.”

We run into trouble when our thoughts are inaccurate and self-critical but we see them as pure fact. These are called cognitive distortions. Psychologist and eating disorder specialist Sari Fine Shepphird, Ph.D, defines cognitive distortions as “a biased way of thinking about oneself or one’s environment, including one’s body image, weight or appearance” in her excellent book 100 Questions & Answers About Anorexia Nervosa.

Cognitive distortions exacerbate disordered eating and undermine a positive body image. And it becomes one bad cycle: You have a negative thought, which makes you feel like crap. Which sinks your mood and triggers more negative thoughts and criticism. Negative thoughts also can fuel anxiety and depression.

Shepphird provides a list of cognitive distortions in her book. I wanted to share these with you, because, again, these thoughts can do some serious damage, without us even realizing what’s going on. Being aware of these cognitive distortions can help you better understand the inner workings of your disordered eating or negative body image. Once you can identify these insidious thoughts, and how they impact you (lead you to binge or purge; ignite anxiety symptoms), you can work through them, and start to move forward.

Here are some of the problematic distortions from Shepphird’s book.

• All-or-nothing thinking. Many of you are probably familiar with this one. It’s the idea that things are either black or white, right or wrong. There are no shades of gray. Shepphird’s example is “I am a failure because I ate too much today.” In other words, you’re either good because you restrict, or  bad because you had a second helping. Or you either diet or binge. (Some “health” magazines perpetuate this type of thinking by telling us that if we don’t diet and abide by strict food rules, we’ll become ravenous beasts and inevitably eat everything in sight.)
• Catastrophizing. Here, you assume the worst in a situation. For instance, Shepphird writes, “If I binge again, I have no hope of getting better.” Another example would be “I feel so bad about my body today; I’m never going to have a positive body image.” Basically, you create a mountain out of a molehill.
• Mind reading. You assume you know what people are thinking. If you remember, I talked about this in my post on not fitting in at the gym. I pretended to be a psychic who could read every gym-goer’s mind. I knew they thought I was some impostor and didn’t belong. (Of course, I didn’t know that but I convinced myself that I did.) People with body dysmorphic disorder often mind-read. They believe they know that others are thinking negatively about their appearance (e.g., “I just know that person is disgusted by my big nose.”)
• Personalizing. This involves reading into others’ behaviors. You assume that someone’s actions are in response to you. Shepphird gave this example: “He went out with his friends because he thinks I’m dull.” Or “My boyfriend didn’t hug me because he thinks I look horrible today.”
• Shoulds, musts and have-tos. Like all-or-nothing thinking, this cognitive distortion is all about rigidity. Shepphird shares several quintessential examples: “I should not eat the other cookie,” or “I have to be the one who gets straight A’s.”
• Comparisons. So many of us compare ourselves to others, whether it’s their supposedly magical life, personality or appearance. How often have you assumed that someone didn’t finish their meal because of their powerful willpower? I have! Shepphird gives that scenario as an example. She writes, “She didn’t finish her plate; she must have more willpower than I do.” Other examples: “She’s in much better shape than I am.” Or “She was able to recover from her eating disorder must faster.”

Which of these cognitive distortions do you relate to most? How have you been able to overcome these thoughts? What helped you?

Carolyn Costin and Gwen Schubert Grabb have written a fantastic book called 8 Keys to Recovery from an Eating Disorder: Effective Strategies from Therapeutic Practice and Personal Experience. Not only are both women psychotherapists, but they’ve also been there. Costin began struggling with an eating disorder in her teens. Grabb was Costin’s client, who recovered and then became a therapist herself.

In their book, they write: “This book is about getting over an eating disorder, how we did it, how we helped thousands of others do it, and how we hope to help you do it, too.” Below are several excerpts from the book and my interview with Costin, who discussed everything from obstacles to recovery to strengthening your “healthy self.”

The 8 Keys

The eight keys are based on scientific research, both authors’ personal recovery and their work with people with eating disorders. The book includes stories from Costin’s work with Grabb and other clients of both authors. The eight keys are:

• KEY 1: Motivation, Patience, and Hope
• KEY 2: Your Healthy Self Will Heal Your Eating Disorder Self
• KEY 3: It’s Not About the Food
• KEY 4: Feel Your Feelings, Challenge Your Thoughts
• KEY 5: It Is About the Food
• KEY 6: Changing Your Behaviors
• KEY 7: Reach Out to People Rather Than Your Eating Disorder
• KEY 8: Finding Meaning and Purpose

Obstacles to Recovery

Costin and Grabb believe that many people sabotage their recovery because they think they’ll never become fully recovered. (I actually talked about this here.) “They think they’ll always have an eating disorder, which they view as an ‘addiction’,” Costin told me in a phone interview. “It’s really astonishing to me how many people don’t realize the effect this has.” The effect? It becomes a “self-fulfilling prophecy.” You don’t think it’s possible for you to fully recover, so you don’t.

In our interview Costin went on to say that some people “throw in the towel too soon,” whether it’s been a few months or years. But she’s treated many women who’ve suffered from EDs for 20 years and have found full recovery. “There is no reason to give up,” she said.

Because depression and anxiety often accompany EDs, taking medication can help. But some people are resistant to taking medication, which may undermine recovery, too. As Costin said, “A lot of times medication helps give you a full deck of cards.”

Social support is also key to recovery. Costin and Grabb are both big fans of support groups to complement traditional treatment and familial support. And if you don’t have support from family or friends, “find it somewhere else,” Costin said. Again, this might be an ED support group or even a book club.

She regularly hears people say that having the support of someone who’s recovered from an eating disorder “was a huge part of their success.” Costin underscored the importance of talking to people who’ve recovered from an ED, because “if you never see it, you might not think it exists.”

Personality Traits

Some traits may make individuals more susceptible to eating disorders. For instance, people who tend to be perfectionists apply that trait to how they eat and exercise. And before you know it, they’ve become obsessed and start to restrict more and more and work out more and more. Costin and Grabb teach their clients and share in this book how to channel these traits elsewhere. For instance, Costin admitted to me that she’s a perfectionist but said she no longer applies this to food or weight. As she emphasized, as a therapist “I’m not going to change who you are, rather I help you channel your energy into healthy pursuits.”

Feeling Your Feelings

In the book, Costin and Grabb write, “Many of the most meaningful parts of life are dependent on learning the skill of tolerating your feelings.” But for many people with eating disorders, tolerating their feelings is incredibly difficult.

In our interview, Costin said that “your emotions are your body’s response to your thoughts.” In other words, “What you tell yourself affects your emotional state.” She helps clients identify their thoughts and work through them. (In the book, they talk about cognitive distortions.)

How your family responded to your feelings also determines how you process emotions. As Costin said, you might have to do some unlearning, “especially if [your feelings] weren’t responded to or validated appropriately.” “Over time, [an eating disorder] becomes a method of distraction or coping.” The key is to sit with your feelings and learn to calm your anxiety with strategies like breathing exercises and mindfulness, she said.

Eating Disorder Self vs. the Healthy Self

In her own struggles with an ED, Costin realized that she had two parts: the eating disorder self and the healthy self. Costin and Grabb define these two sides in the book. They write:

Chances are, you are aware of an internal battle going on in your head. If you want to eat dinner but hear yourself saying, “You can’t eat or you will get fat,” or if you are eating dinner and hear a voice saying, “You need to get rid of all this food right away,” these directives are from a part of you we call your “eating disorder self.” For various reasons that will be revealed throughout this book, some people more than others are susceptible to developing an eating disorder. If you have an eating disorder it means that over time, as you binged or dieted, made these comments to yourself and engaged in extreme weight loss behaviors, your thoughts and actions began to take on a life of their own. Soon there was a part of you that did things automatically. This part of yourself acts stronger and stronger and becomes a separate, adaptive, disordered self, the “eating disorder self,” which is different from the core “healthy” part of you. The eating disorder self has different feelings, thoughts, and behaviors than your “healthy self.” Your “eating disorder self” may tell you to get rid of your dinner, but your “healthy self” understands that vomiting your dinner is not an appropriate or healthy thing to do. Just ask yourself what you would say to someone else in your same situation. What would you say to a little girl who claims she must throw up her dinner to avoid becoming fat? We are pretty sure you would reassure her that she does not need to do so, and you would perhaps even try to explain the dangers of such behavior. Your healthy self comes forward to help others, but is quickly overpowered by your eating disorder self when it comes to you. It is your eating disorder self that will “talk you into” behaviors like vomiting, not eating all day, taking laxatives, cutting your food into tiny bits, or eating a whole box of cookies because you ate one.

Costin doesn’t help clients get rid of their ED selves. She helps clients “learn from it, discover what it is doing for them, and then strengthen their healthy self to take over its job,” as she and Grabb write in their book. For instance, Costin suggests clients talk back to their eating disorder self and challenge what it says. Here are three examples from her clients:

Eating Disorder (ED) Self: The only way I can feel OK with myself and deal with my emotions is to restrict and exercise.

Healthy Self: Even when you exercise and restrict you still don’t feel OK with yourself. Yes, it numbs you from your emotions temporarily, but those feelings don’t go away, they always come back. Exercising and restricting is only a quick fix.

ED Self: Even if I resist bingeing this one time, I am still fat, and what will one night of healthy eating matter any- way. Seems like a waste of time to try.

Healthy Self: Every time you are able to eat in a balanced and healthy way instead of bingeing, you are strengthening your skills for the next time. It’s never a waste to try.

ED Self: If I don’t lose weight, I can’t ever be happy.

Healthy self: Your mind is in control of your happiness, not your body. There are plenty of people who weigh as much or more than you who are happy. If you work on making your life happier in a variety of ways, you might focus less on food, and both your mind and body will improve.

What resonated with you from the book or Costin’s words? What would you like to know about eating disorder recovery?

Whether you have body image issues, disordered eating or are in recovery from an eating disorder, it’s important to recognize your problems and work to resolve them prior to pregnancy or motherhood.

As authors Claire Mysko and Magali Amadei write in their excellent book, Does This Pregnancy Make Me Look Fat? The Essential Guide to Loving Your Body Before and After Baby*:

If you know you have food and weight issues and you want to go into motherhood prepared to deal with them, that doesn’t mean you’re selfish. It means you’re smart, savvy and self-aware – and we think your kids will thank you for it.

In their book, Mysko and Amadei, who both struggled with and recovered from eating disorders, include a valuable checklist with healthy tips for before and during pregnancy and after your baby’s birth.

Here are their suggestions:

Before & During Pregnancy

• Talk with your doctor or therapist about wanting to start a family. (Remember, though, that many family physicians and gynecologists and obstetricians just aren’t well-versed in eating disorders or body image issues. If they seem insensitive or not knowledgable, find someone else.) Taking medication? Mysko and Amadei suggest “develop[ing] a plan that will best address your own psychological well-being and your baby’s health through pregnancy and beyond.”
• Accept that your body will go through changes and you’ll gain weight. As the authors also underscore, avoid assuming that your food or weight issues will go away without getting treatment. Seek help.
• Pick an OB or midwife you’re comfortable with and who has a good understanding of eating disorders. And tell them about your history. This way, they can better meet your needs.
• Have a support system. This might include a therapist who specializes in eating disorders and body image issues, who, according to the authors, “can help you navigate the emotional ups and downs of pregnancy and new motherhood.”
• “Set boundaries with your friends, relatives and coworkers to minimize the talk about weight gain and other topics that could be triggers for you.” You can simply say “I’m not comfortable talking about that,” as Mysko and Amadei suggest.
• Don’t keep to yourself. As the authors write: “Remember that there is nothing shameful about asking for help. It’s the most courageous thing you can do for yourself and your baby.”

After Birth

• Don’t ignore your own mental and physical health needs. According to Mysko and Amadei, women with a history of eating disorders are more vulnerable to postpartum depression. So if you find yourself feeling depressed or anxious, seek help. (By the way, this website is an incredible resource for postpartum depression and related info.)
• Work toward becoming at peace with gaining weight and possibly not losing it. Instead of trying furiously to count calories, shed pounds and engage in painful exercise, see a therapist “who can help you get to a healthier place with your body issues.”
• “Look at your recovery as an ongoing process that will help you reach your full potential as an individual and as a mother.” Your disordered eating struggles or body image issues might’ve taken a respite during pregnancy but they can return. If that’s the case, again don’t hesitate to seek help.

I love what Mysko and Amadei say at the end of this chapter, which I think will resonate with you, too:

For all the minutes, hours, days women spend talking about food and weight, it is our silences that really hold us back. The size 2 jeans are not the key to our happiness. And deep down, we know it. So instead of discussing diet resolutions we’ve broken and ruminating over workout routines that aren’t giving us the results we want, let’s finally start getting real about what’s holding us back. Let’s get help if we need it and let’s trade in the shame for a reality check. For our sake and the sake of our children, it’s time to roll up our sleeves and support each other in finding true health and confidence.

“I have a feeling that if many women are really honest about how they see themselves, there is much room for improvement,” says Sari, a forty-two-year-old mother of three daughters. The improvement she speaks of does not come in the form of pounds shed and calories cut – it is what happens when we open up and start those deeper conversations with ourselves and with each other.

If you’ve struggled with disordered eating and had kids, what helped you get better? What advice do you have for others? Or what would you like to know about pregnancy, body image or eating disorders?

* I received a free copy.

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When you’re trying to recover from an eating disorder, setbacks can happen. In fact, relapses are quite common. But the key is to use them as learning opportunities, adjust your treatment and try to move on. Sometimes, you may be able to prevent a relapse.

For more information on relapse and what individuals can do, I spoke with Pam Cleland, MS, LPC, an aftercare coordinator at the Eating Recovery Center. Below, she provides valuable insight into how people can prevent and minimize relapses.

Q: How do you define an eating disorder relapse?

A: An eating disorder relapse can be defined as occurring when a patient in recovery begins resorting to his or her old methods of coping (i.e., eating disorders symptoms begin to reappear). Specific harmful behaviors such as binge/purge cycles, restricting, over-exercising, using laxatives/diuretics can enhance and accelerate the relapse.

Q: What are several ways that individuals recovering from an eating disorder can prevent relapse?

A: First and foremost, consistent, regular visits with your outpatient treatment team (therapist, dietitian, psychiatrist) are crucial.

It’s also important to follow your meal plan or dietary routine as designed by your nutritionist and creating a relapse plan, which can be revised as needed, to build and provide empowerment.

Surrounding yourself with a support network of friends and family who understand and will not judge you can help with preventing relapse.

Continue working on internal values, which will help improve the “selfs,” self-esteem, self-worth, self-confidence and self-awareness.

Q: If a person does experience a relapse, what are the best ways to deal with it?

A: Seek support from a therapist, friend, family member, etc. Many relapses, if identified early, can be arrested so that the relapse becomes a “slip” and doesn’t become a full-blown relapse lasting weeks or months.

Explore your feelings before the slip or relapse occurred. Remind yourself that just because a relapse is looming or in process, it does not mean that you have failed.

Q: How do you help patients who’ve experienced a relapse at your center?
A: Prior to discharge at Eating Recovery Center, patients complete a Wellness Plan, a tool for the patient’s dedication to wellness, as well as acknowledging and accepting help from others.

Reminding our patients of their values and how those values do not align with eating disorders behaviors or the long-term goals of the patient is vital to the prevention of relapse.

Additionally, negative self-talk statements are exposed and turned into positive self-talk affirmations.

Q: I’ve read that setbacks in recovery are common but the key is to learn from them. What are your thoughts on using relapse as a learning opportunity for recovery?

A: It is not always possible to avoid slips and relapses, as this is a very difficult disease to treat and manage. The eating disorders population tends to be very hard on themselves if relapse occurs.

Therefore, it’s important to remember that no one can recover “perfectly”; a learning opportunity in and of itself that defines the notion that perfection does not exist.

Acceptance of that can be powerful during or after the relapse.
Q: I’ve also read that patients with histories of excessive exercise should not return to exercise because it significantly raises the risk of relapse. But movement is also critical to one’s emotional and physical health. So what can these individuals do?

A: It is unrealistic to expect a patient to completely let go of any and all exercise. After all, exercise is healthy for you! The difference is that eating disorders patients exercise because of their eating disorder.

The goal for the patient is to incorporate a healthy “movement plan” into his or her relapse prevention or Wellness Plan. The patient’s dietitian can – and should – be very helpful in working with the patient to create a managed, calorically balanced meal plan with appropriate exercise. Exploring the implications of excessive exercise with the patient is vital.

Q: Anything else you’d like readers to know about relapse and getting through it?

A: Remember to…

• Be kind to yourself and give yourself time to recover.
• Refer often to your values and strive to live by them.
• Work on self-approval, which is not dependent on weight.
• Accept your personal limitations.
• Create an environment of respect, optimism, trust and honesty with yourself and others.
• Know that “failure” neither dooms nor defines you. You are just a person who is willing to take on challenges.
• Practice, practice, practice!

—

Over a year ago, I interviewed eating disorder expert and psychologist Sarah K. Ravin, Ph.D, who also revealed important information about relapse. In our interview, she said:

This is a very important question because relapses are quite common in eating disorders. In order to prevent relapse, it is essential that the client and their family understands the brain disease model of eating disorders. While full recovery is possible, the underlying biological and temperamental predisposition will always be there.

People who have recovered from eating disorders must be very conscientious with their self-care, always ensuring good nutrition, maintenance of a healthy body weight, plenty of sleep, and regular exercise. They must be careful to manage any other mental disorders or physical illnesses they may have, as these can trigger relapse. They should be mindful of living a low-stress life and surrounding themselves with supportive people who are aware of their eating disorder history and prepared to intervene if necessary. Ongoing psychotherapy can be very helpful as a means of self-care and stress management, and can help the client spot early signs of relapse and fix them right away.

Many recovered persons believe that they will not relapse because they don’t want to relapse, or because they no longer have a drive for thinness. This belief is understandable because many people first fall into an eating disorder through dieting during adolescence. Nevertheless, it is possible to relapse unintentionally, without ever going on a diet.

Granted, dieting is a terrible idea for anyone, especially those with eating disorder histories. However, some people relapse into eating disorders as a result of emotional stress or unintentional malnourishment (e.g. due to illness, surgery, depression). Any amount of malnourishment, even one skipped meal, is dangerous for someone with an eating disorder history.

I recommend that clients and their families have a specific, written plan in place to deal with any future relapses. Fortunately, clients who have been through successful treatment are less likely to relapse and are more likely to get help immediately at the first sign of struggle. For these clients, relapses are usually shorter and less severe than the initial episode.

If you’d like to check out the rest of the interview, here’s part one and part two.

If you’ve struggled with a relapse, what helped you overcome the setback? What have you found to be helpful in preventing a relapse? What things were key in your recovery?

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Welcome to the worst opening lines for an eating disorder article ever:

Eating disorders often begin with the best of intentions — a desire to lose weight and control eating. But in some people, those good intentions go badly wrong, resulting in anorexia nervosa, bulimia, binge eating, or other disorders.

Sadly, very, very sadly, this article didn’t appear on some shoddy website viewed by several people.

No, this article comes to us courtesy of WebMD.com, where it was written by a seasoned writer and then reviewed by a doctor for “medical accuracy.”

Hmm.

These simple sentences are so grossly misinformed that I’m shocked the medical editor didn’t see anything wrong with them. But I do, and I bet you do, too.

For starters, we get the usual undertones of weight loss and food restriction as virtuous pursuits.

Curiously, there’s no mention of the words healthful eating. (Of course this wouldn’t solve the issue of gross misinformation but it’s interesting to note the odd choice of words.)

Instead, we get “control eating.” As though you need to overpower your eating with a sledge hammer, whip it into shape and watch it like a hawk.

Sure, I may be being nit-picky here. But the problem with this word choice – and the scary thing about it all – is that readers get the same old damaging message about the importance and goodness of wanting to lose weight and controlling what you eat.

Except that, you know, it’s worse.

Because it comes in an eating disorder article!!! (In my mind, I’m screaming these last two phrases.)

Then, of course, there’s the egregious error of what eating disorders actually are. The article focuses on the connection between eating disorders and depression, and oddly, there’s no mention of genetics or biology. (There is a phrase about physiological changes from malnourishment but that’s it.)

Also, these words make it seem as though eating disorders aren’t illnesses. It’s simply that “some people” just happen to take these good behaviors of dieting and weight loss too far.

(Again, the implicit message is to engage in these behaviors, but just don’t go overboard or you’ll catch an eating disorder, as if by accident. Oops.)

To be fair, the rest of the article cites experts and research. But that still doesn’t excuse these two sentences. Not only do Web readers have short attention spans and tend to skim (it’s simply the way of the Internet), but the opening sets a tone for the entire article.

While, logistically you can’t pack in lots of information into a two-sentence introduction, the blatantly casual tone and weird word choice are troubling.

Not to mention that it perpetuates the same myths about eating disorders: that they’re simply about wanting to be thin and wanting to eat “well.”

It’s as if they’re on a conveyor-belt continuum, the virtuous behaviors of wanting thinness and dieting like a good girl (or boy) on one end, and still yearning for thinness but restricting your food too much on the other.

It misses the point of how severe eating disorders are. That their symptoms and causes are incredibly complex, and not due to good intentions or behaviors gone wrong.

They’re debilitating conditions and reducing an entire group of eating disorders to weight loss and food intake is insulting, confusing, damaging and downright foolish.

Articles like these on reputable websites infuriate me because they disseminate inaccurate information. (Though perhaps I shouldn’t be surprised because WebMD is plastered with weight-loss and diet pieces.)

And then there’s the not-so-small issue of glorifying weight loss and controlled eating. Even when we’re discussing eating disorders, we can’t escape the cultural obsession with these two things.

I’d like to leave you with posts that debunk common eating disorder myths and offer the facts, both from Weightless and other places:

• NEDA Week: Dispelling common eating disorder myths
• Fighting the wrong battles by Dr. Sarah Ravin
• Expert Amy Pershing talks about binge eating myths
• Eating disorder myths from experts and women who’ve recovered from EDs
• Myths from SomethingFishy.org
• Posts on the biology of EDs from Carrie at ED Bites (a great blog on eating disorders; it provides accurate information on EDs and regularly cites research studies)
• Author Harriet Brown talks about several other ED myths

What articles have made you mad because of their blatant (or subtle) inaccuracies? What do you think about the opening lines of the WebMD article? Am I being too nit-picky or is it grossly misinformed?

Yesterday, Katie wrote a fantastic post (as always!) about being yourself. Basically, she blurted out a curse word in front of strangers at a networking event. The big deal? Well, Katie never curses. She did so in this case to be cool, to be liked.

Wow.

Wow because I have been there. So. Many. Times.

So many times I’ve blurted out things I didn’t really mean to fit in, or tried to make myself like something because others did (whether it was music or certain hobbies). So many times I thought I wasn’t cool enough, which translated to I wasn’t good enough.

Building relationships is hard. They’re especially hard if your inner critic, well, keeps criticizing you. Keeps telling you that you aren’t worthy as you are. That you must change in order to be liked, because why would anyone like the real you in the first place, right?

When my boyfriend and I started dating, I was in awe that he fell for me. How could he? Why would he?

He, the blonde-haired, blue-eyed baseball star. Me, the pale, brown-haired musical theater buff.

Still to this day, there are many times when I feel like the awkward, shy, insecure girl from many, many years ago. (In fact, here’s a recent experience.)

For people with eating disorders, the inner critic is especially vicious and manipulative.

In the must-read book Restoring Our Bodies, Reclaiming Our Lives: Guidance and Reflections on Recovery From Eating Disorders, Mary Tantillo, Ph.D., Director of the Western New York Comprehensive Care Center for Eating Disorders, writes about how EDs can sabotage relationships:

“But ED may have sabotaged your relationships by pretending to be your best friend and discouraging you from trusting or perhaps even approaching others who might support you. In fact, ED acts as an agent of disconnection and isolation, playing off your insecurities about appearance, popularity, identity, and uncertainty, as well as deeper anxieties. This not only deters you from developing healthy friendships, but may also nudge you toward negative relationships that end up promoting illness.”

Even if you’ve never struggled with an eating disorder, I bet many of you can relate. The harsh critic within can easily lead us to unhealthy relationships because that’s what we think we deserve. Or it can hinder healthy ones, because we choose to isolate ourselves or become suspicious, distant or overly dependent.

So what can you do?

Tantillo has two valuable suggestions (which are helpful whether you have an ED or not):

1. Identify how ED controls your current relationships.

Tantillo lists off several examples, including: “Telling you the other person will never like you? Warning that you’re not thin enough or attractive enough to be seen with your friend? Whispering that others can’t be trusted to truly understand your experiences, and that they’ll inevitably hurt you?”

She suggests sharing your list of negative messages with your therapist or a mentor who’ll be encouraging about making new friends. If you have neither, sharing it with a family member or friend you trust can help, too.
2. “Learn what a healthy relationship looks and feels like.”

She writes:

“A true mutual relationship gives both people an increased sense of self-worth, empowerment, zest or energy, clarity about themselves and each other, and desire for more connection with others. In genuine friendships, it’s OK to show each other your emotional vulnerabilities because that helps you open up and feel empathy for each other…And when genuine friends disagree, they’re willing to work to repair any damage, listening to one another and taking responsibility for their own part in the problem.”

But what do good friends look like? When choosing your friends, Tantillo suggests people who:

• Accept the whole of who you are – including both your strengths and limitations
• Enjoy the ways you’re both similar, but also respect and appreciate your differences
• Are able and willing to help when you’re in trouble
• Support your recovery by encouraging you to stay aware of your own thoughts, needs and feelings while also considering those of others
• Gently help you look at problems from all sides
• Encourage you to discuss your concerns with others and have other friendships

It’s hard to dismiss the inner critic when they’re screaming so loud and clear. But remember that the inner critic exaggerates, twists and outright lies.

Being comfortable in your own skin takes time. So may sharing that with the world.

Sometimes, we have setbacks. And that’s OK. We move on, do the best we can and keep doing the work of finding and maintaining fulfilling friendships with others – and ourselves.

How has ED affected your relationships? When were you insecure about being yourself in front of others? What’s helped you build healthy relationships and be your true self?

P.S., Please check out Dana’s round-up of this month’s Self-Discovery, Word by Word posts. If you remember, the word was brave – and the posts are awesome!

P.P.S, I had the great opportunity of guest posting on Melanee’s blog about what to do when you experience a body image rut. Please check it out! It’s in honor of her blogaversary. Happy Blogaversary, Melanee!

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Today, I’m thrilled to present a beautifully written guest post by Joy Choquette, who writes the awesome blog 156 Things, where she takes on about three things each week that take her out of her comfort zone. I love Joy’s writing, and I’m honored to share the below post with you.

Joy is a Vermont-based professional writer. As she says,  among her many interests are psychology geekery, people-watching and interpreting and everything relationship oriented: from marriages to childhood patterns to habits involving food, money and faith. She’s also very much interested in intuitive eating (please read this amazing post about it on her blog).

Without further ado, here’s Joy’s post about food in today’s world.

I am sitting in a café, warm coffee-scented air hanging heavy. I type away on my laptop. Today, this café is a retreat from my real life, a place to focus entirely on my writing and block out the distractions that plague me at home.

At least, I try to block out the distractions. More than once I’m pulled into a conversation at a nearby table, ears perking as I stare into space waiting for the right order of words to come.

“Do you know how many calories that Danish has?” an older woman, hair too-blond and mouth pinched asks her graying husband. She stabs a finger toward the offending pastry as though it were sharp and spiny.

“400.”

He mumbles something in reply, takes another bite.

I continue typing, sipping my quickly cooling Earl Gray. I’m about to make the perfect point in my next paragraph when I’m distracted yet again, this time by two young women who have been chatting animatedly for the past half-hour.

“Let’s get out of here before I add 10 more pounds to my thighs,” the first one groans. The second giggles and pats her nearly flat abdomen.

“Oh, I know,” she replies. “Just breathing the air in here makes me fatter.”

Five minutes later, I hear the group of people next to me dissecting their food verbally, asking each other what the health benefits or lack thereof each of their breakfast selections has.

I can’t help but wonder, as I push away the too-cold mug of tea, what happened to enjoying our food? Is it any wonder that in today’s society we aren’t all plagued with food-related issues? Since birth?

I recognize, fully and completely, that I have issues with food. These are deeply ingrained, tangled in my past, snarled up with my emotions.

But how much of what I am trying to unlearn as an adult, is exacerbated by the neurotic view of food and diet in our society as a whole?

I think of Julia Child. The woman ate pounds of butter, white flour and sugar with seemingly unheeded abandon but lived to the ripe age of 91. Her husband, known to passionately enjoy her cooking, lived to 92.

Europeans, on the whole, aren’t as obsessed with counting calories and dieting as we are here in the U.S., yet they remain thinner and many studies say, healthier.

Sometimes I daydream about my perfect food world. Yes, chocolate would be consumed with abandon and sans guilt.

But more luscious is my daydream of walking into a café or restaurant and hearing nothing but the murmuring of contended, happy eaters. I’d listen to the satisfied slurping and munching, barely controlled moans of enjoyment, not contempt.

I’d sit, comfortable and secure in the knowledge that food was a gift, not an evil force, a sin, or a pleasure to be enjoyed now and mentally flogged for later.

Just food and nothing more.

—

A huge thank-you to Joy for her wise and eloquent post! So tell us, what does your perfect food world look like?

Also, please check out my guest post on Joy’s blog: When Everyone You Know (and Don’t) is on a Diet.

P.S., Don’t forget that Julie is giving away one copy of Be Yourself Be Beautiful, an e-book filled with original inspirational quotes and beautiful illustrations. I’ll announce the winner next Wednesday! All you have to do is answer this question on that post: What’s one quote you live by or what inspires you?