9th July 2014
In my opinion the success of CBT is greatly dependent on your rapport with your therapist. I have worked with countless therapists over the years and I can count on one hand those who have actually found a way to get through to me. This is mainly because I am incredibly strong minded and stubborn. When you are convinced that you know it all, why on earth would you consider new or different perspectives offered by someone else? I have now had to come to terms with the fact that, yes I have a plethora of knowledge about anorexia and bulimia, my obsessive reading about the disorders and my own experiences provide me with this. What I don't possess is the precious pearl of wisdom that can make these illnesses go away. This is the job of the brow beaten therapist, they have to open the oyster's shell so that you can first of all see the pearl and then make you want to reach out to it. When you put a giant protective shield around your shell, which many of us do, it makes their job all the more difficult.
I would need an abacus to rack up all the therapists who have tried and failed to make me see sense. I am a tough nut to crack. I have had the quiet ones, who just sit there with their arms folded and wait for you to talk. They never had to wait long with me as I just can't keep quiet to save my life, but when I had to open the session I would end up running it and dismissing whatever he/she had to say, as if they had had anything valid to say, surely they would have brought it to the table earlier? I have had the shy young girls half my age, who are so desperate not to offend you, they are ultra nice and their pleading tone would just signal a green light to me 'you are gonna run rings round this one' I have also had the all knowing matronly therapists who deem it to be appropriate to jump to conclusions about your family. By grasping at straws and trying to draw links from your past that simply don't exist, I would become defiant and belligerent. My most memorable experience was with my nemesis, an utter control freak. She thought that despite her inconsistent advice and the shocking mistakes that she made, she could bully and intimidate me into submission. Those sessions ended as abruptly as they had begun. My worst experience in therapy was when someone contacted my employer and conveyed confidential information about me to him. The things that she relayed had been taken completely out of context, but a meeting with the boss ensued and I was devastated. I made a formal complaint, but I have found it hard to trust anyone ever since. I am still guarded around those who have a say in my future, except for my GP, who is amazing and has been a wonderful support to me over the years. Find a good GP, it will be the best move you ever make.
On a positive note (yes, there is one!) I worked for a number of years with a consultant who I believe is the best in this field. His insight and razor sharp wit could not help but keep me captivated. He had just the right mixture of humour and straight talking when it was required. I would never have dreamt of arguing with him, I had far too much respect for him. This is the approach I need, somebody that I can relate to, laugh with, but who is direct and stands for no nonsense. My current therapist is all of these things and unbelievably he is making me think. It is he who has given me the confidence to write this booklet and for that I will be eternally grateful. He likes a challenge (good job because he has his work cut out for him with me!) and I like the way that he gives me tasks to do but compromises with me so that I don't feel like he is trying to make me relinquish all control. Granted it is early days in my current stage of CBT, but I would urge anyone who is jaded by unsuccessful attempts at counseling not to give up. Know what you need from a therapist, everyone is different and don't be afraid to say if you just aren't getting anywhere. This is far too serious an illness to sit back and go through the motions for the sake of it. Don't stop searching until you find someone, who when you leave their room, you will think about what they have said and feel the urge to act on it. I mean if I can find somebody that can do that, anyone can!
My experience of group therapy is limited as I point blank refused to engage with it for so long. I did not want to tell a group of strangers about my idiosyncratical behaviour and I was afraid. I was worried that the group would consist only of teenage girls and that everyone one of them would be thinner than me and that I would feel like a big fat lump who had no business being there. Having voiced these fears to others, this seems to be perfectly normal amongst people with eating disorders, as although you can see perfectly well that fellow ED sufferers look emaciated you just can't see it in yourself. This body dysmorphia was once described to me as like being 'blue/green colour blind' and this is as good an analogy as any. Truthfully I was pretty much forced into group therapy as it was part of the daycare package that was the only alternative to inpatient treatment. I stand firm on my resistance to inpatient care, whether or not I am making the right decision remains to be seen. I have read about people who have conquered anorexia/bulimia without going into hospital and I have met a girl with an awe inspiring success story in my daycare group. I had been offered group therapy before out of the daycare setting but I never thought that it would help me, so I declined.
The concept of 'daycare' is scarier than merely attending a group counseling session, as it is a full day and contains 2 very frightening elements to the eating disordered mind; being weighed and eating with others. The weigh in is still the worst bit for me, as I know that whatever BMI flashes up on those scales will determine whether or not I face another lengthy meeting to try to persuade me to go into hospital. On my first day, which is by far the worst I did not have to eat with the group, I was permitted to eat on my own so that I could ease my way in gradually. The group I am in currently is nothing like what I expected it to be. There is a mix of genders and the age range is between 18 and 60. Everybody is supportive of one another and we actually have a laugh. It is surprisingly refreshing to hear about other people's struggles, it makes you feel less abnormal to know that other people are finding things just as tough as you. You also hear stories that are a warning to modify your behaviour before you do yourself some serious medical damage, luckily I have escaped this thus far. Being with other people who understand what you are going through helps you to open up. This takes longer for some than others depending on your personality type. Don't feel that you have to spill out your life story straight away if you are not comfortable in doing so. Wait until you feel at ease in your group, talk when you are ready. Once you start to unload in group you get the added advantage of saving your nearest and dearest the odd rant or two where they try to abate you but they just don't really understand what they are dealing with. It teaches you to be a better listener and to be less judgmental, sure I have heard things that have taken me out of my comfort zone, but you learn to empathize and show compassion. We all have our bad and good days, so if someone is in a low mood we can try and lift them up, I know that even when I am anxious about going that I always leave eager to get myself back on track. I have made friends in my current group who I know will be friends for life. Being part of something again has given me something I severely lacked and that is acceptance simply for being me.