Let’s face it. Relapse episodes are the pits. They always feel seriously discouraging. It’s the same if you’re just starting your recovery, or if you’ve been thinking you’re out of the eating disorder woods. Everybody who’s ever tried to change anything in their lives can commiserate. Though we all sort of know better, we fall into believing that improvement is a straight–line process to our destination. Of course, this just isn’t reality.

My opinion is that if you’re going to have to deal with the misery of relapse, you deserve to come out of it with something to show for your trouble.  Unfortunately, the benefits you get from relapse don’t fall off trees or otherwise just come with the territory. You have to get in there and dig! But there are some guaranteed nuggets to be mined if you go looking for them. I’m going to discuss three relapse nuggets. Hopefully this will set you searching for your own.

Nugget 1: Learning from the relapse

If you’ve been working on recovery, I’m going to assume you’re already at least a little familiar with the necessary process of learning from your relapses. What led to the episode? How does this knowledge help you improve your recovery plan? What light does it shed on symptom triggers you may not have been aware of till now? Doing the post–relapse review is often one of the richest sources of information about your own personal eating disorder profile.

Nugget 2: Developing compassion for yourself

I’m an insight kind of therapist. By insight I mean gaining awareness about why we do the things we do. Not that I believe insight “cures,” but it’s awfully good for some things. One of the things insight seems good for is the way “getting it” about relapse episodes not only helps you plan better for recovery (see Nugget #1), it helps you forgive yourself.

Most of the time it seems to me my eating disorder clients start out with some pretty harsh explanations for their relapses and slips (for instance I’m stupid; I’m weak; I can’t succeed at anything.) Most of the time if they’re willing to dig for a deeper explanation, they discover the episodes actually happen for very human, very understandable reasons. More often than not, this involves seeing how their symptoms represent efforts to cope with overwhelming experiences. This awareness allows them to appreciate the positive intention of their symptoms while directing them to look for more constructive methods. Such a compassionate understanding can help neutralize the shame

Nugget 3: Building resilience

Think of all the unwanted personal experiences that confront you when you relapse: mistake–making, frustration, personal imperfection, disappointment and more.

All of these experiences are an inevitable part of recovery, just as they are a part of any change or self–improvement project, or, for that matter, of life itself.

So if we can’t avoid these experiences, what can we do? We can build our tolerance and flexibility in dealing with them when they occur. Tolerance means we come to know we can stand it even if we don’t like it. Flexibility means we can reset, learn from what happened, make appropriate adjustments, and move forward. When we work to increase our tolerance and flexibility in the face of recovery setbacks, we become more resilient, that is, we have more bounce–back. Bringing this increased resilience to life beyond an eating disorder is one of the great gifts of recovery.

Nontraditional treatments often address aspects of eating disorder experience that conventional therapies may miss. In this post I review some experiential and alternative therapies many people with eating disorders have found helpful.

If an experiential or alternative therapy appeals to you, talk with your primary therapist about it. The two of you can figure out how it might contribute to your recovery process. If you’ve been in inpatient or residential care, some of these treatments may be familiar to you.

Experiential Therapies

Experiential therapies increase your awareness of being in the present moment. Practices that help you focus on your moment–by–moment thoughts, feelings and sensations ¬not only anchor you in the present, they increase your connection to yourself. If you have an eating disorder, connecting to yourself probably hasn’t felt all that rewarding. Experiential therapies may help you tune in more comfortably and effectively.

Dance/movement therapy

If you’re picturing the dancercise class at your gym, this isn’t it. Dance/movement therapy (DMT) uses body sensation and body movement as a source of healing for people with eating disorders. DMT therapists believe this makes perfect sense because the body is the battleground where the eating disorder occurs. Typical goals for DMT include:

• Improved body image
• Increased ability to know and express feelings
• A more solid sense of body boundaries and personal space
• Increased capacity for pleasure in movement

Dance/movement therapists must have a master’s degree and meet other requirements set by their professional organization, the American Dance Therapy Association.

Art therapy

Art therapy allows you to use the stuff of artistic expression—drawing or painting materials, clay, dioramas, mosaic, what-have-you—to explore your feelings and discover more about who you are. Creating an object to represent difficult feelings or hidden aspects of yourself can present some distinct advantages. For example:

• You get a little distance, as if the feeling is outside you, so exploration feels safer.
• You can experiment with ways to control or manage the feeling.
• You can explore visually how one part of you fits in with other parts and with the whole picture of you.

All of this, of course, works best when you have the support and guidance of someone who understands why it all matters. You want to work with a registered art therapist (ATR). And you want him or her to have some additional training in working with eating disordered clients.

Music therapy

Like art therapy, music therapy promotes healing through an expressive form that doesn’t involve talk. Music can often be the added ingredient that allows people to take risks and move their treatment forward. Music therapists assure you this requires no musical abilities. It can involve making music, writing it, hearing it, or listening to it.

If you have an eating disorder, music therapy may help you

• Express yourself: You may find that the music of others brings out emotions you can’t put into words. Or you may discover that making your own music—writing songs, singing, or playing an instrument— helps you express yourself.
• Relax: Music goes right to the part of the brain that’s in charge of relaxation.
• Improve your mood: You can pair the relaxation you get from music with experiences that make you anxious, like eating or gaining weight. You can weave the sense of well-being that certain music or music-making gives you with times when your mood is low.

Find ways to participate safely with others: In a group music therapy setting, you can practice “chiming in,” taking the lead, trying something creative, getting and giving feedback, and making mistakes—all in a supportive environment.

The American Music Therapy Association (AMTA) sets the education and clinical training standards for music therapists. These standards include completion of a college level music therapy program. Professionals with the designations RMT, CMT, or ACMT have met AMTA standards and are qualified to practice music therapy.

Alternative Therapies and Practices

Alternative therapies are only “alternative” from the perspective of Western medical tradition. Most of the treatments and practices I review below are actually centuries old and considered mainstream in the cultures that produced them. In the current era, people are thinking more about mind-body integration and, as a result, alternative practices are getting more attention (and respect!) There seems to be a natural place for them in increasing the effectiveness of eating disorder treatment.

Meditation

Meditation is a practice of focusing the mind. It comes in a variety of “brands,” any of which can be useful for becoming calmer and more centered.

One particular brand of meditation, known as mindfulness meditation, has shown some promise for people with eating disorders. In other meditation practices, the aim is to clear your mind. Mindfulness, instead, has the goal of helping you create a different relationship to what is in your mind in the present moment. For example, mindfulness meditation teaches you to observe but not avoid or judge current thoughts, feelings, or emotions.

For people with eating disorders, mindfulness can introduce a new way to deal with eating urges. A study at Indiana State University has already shown good results for people with binge eating disorder. Others use mindfulness meditation to help alleviate the emotional distress that goes with eating disorders.

Acupuncture

Acupuncture is an ancient Chinese medical practice. Acupuncturists believe our bodies have energy meridians or channels and that ill-health— physical and psychological—results from blockages or imbalances in these channels. Inserting tiny needles at strategic meridian points is intended to free up blockages so energy can flow freely again and the body can regain balance. Acupuncture has been used successfully to treat many ailments in Western culture.

Acupuncture may help with the physical discomforts of your eating disorder. It can be used to ease symptoms of the digestive system, like bloating, diarrhea, and constipation. It also can begin to set your digestive system right in a more long-term way. It may be effective at getting your hormonal system back on track as well.

Acupuncture has also been used successfully to treat some of the psychological companion disorders that go with eating disorders. Known for its calming effect, it has a good track record for relieving symptoms of depression and anxiety. Acupuncture has also helped people who are detoxifying from alcohol and drug addictions.

If you just can’t stand the thought of needles, acupressure is an alternative form of acupuncture that uses pressure to unblock meridians.

Massage

Massage has long been used to produce emotional release, improve mood, and increase relaxation. Studies show that people with body image disturbances often have been deprived of nurturing touch. Researchers found that women with anorexia and bulimia responded positively when massage was added to their treatment programs. Women who received massage were less anxious and less driven to be thin than women who did not receive it. They felt better about their bodies, their mood improved, and their need for perfection decreased.

Yoga

Yoga is a set of practices from ancient India that use body postures, breathing, and meditation to create physical health and peace of mind. The postures call on you to develop greater balance, flexibility, strength, and stamina. Yoga practice requires that you read feedback from your body in order to know how far to push in a particular posture and when to stop.

If you have an eating disorder, you’ve been in a state of war with your body. Recovery requires that you and your body make peace. Yoga appears to be a good peacemaker. Developing awareness of body cues helps put you and your body back on the same page. According to a study published in Psychology of Women Quarterly, women who regularly practiced yoga were less preoccupied with physical appearance, more satisfied with the way they looked, and showed fewer disordered eating attitudes and better regulated eating than women who didn’t practice yoga.

Final Notes about Experiential
and Alternative Therapies

Note I: If you have a trauma history, one or more of these experiential or alternative treatments may be especially helpful for you. This is particularly because of the way they encourage mind-body integration. Just be sure you select a practitioner who understands the special needs of trauma clients.

Note II: Many insurance companies are discovering that market demand for greater patient choice makes providing coverage for experiential and alternative therapies a plus. However, coverage is still likely to be determined on a case-by-case basis, using a standard of medical necessity. Coverage for alternative therapies may be a wellness perk for some plans.

The following made–up examples represent experiences  I regularly encounter in my practice in which people have gotten stuck in their eating disorder recovery:

Sally is forever intending to get started with healthy exercise, but           somehow she never gets there. Even when she has the opportunity, the temperature seems too hot (or too cold), she’s afraid she’s coming down with something, or she needs all her time to prepare for an upcoming presentation. In the end, Sally decides she’s just lazy.

Tracy’s therapist keeps encouraging her to focus on what’s happening before she binges, hoping to help Tracy identify binge triggers. Tracy consistently responds: “It’s just that I don’t have any willpower.”

Madeleine has been working on recovery from her bulimia for over a year. Every time she’s had a month or so of healthy eating with no bingeing or purging, she relapses. She’s so discouraged, she feels it will be this way forever.

Maybe you’ve had an experience similar to Sally, Tracy or Madeleine. There’s a next step you’ve been trying to take, a goal you’ve been trying to reach, a new approach you’ve been meaning to practice, but somehow it never happens. You know you should, that it would make things better if you did, but knowing that doesn’t make any difference. Which only makes you feel worse. You’re already in despair about changing. Now add to it the toxic conclusions you draw about yourself as a result of being stuck: I’m lazy, I’m stupid, I’m just self–destructive and so on.

Before you decide that you are suffering from a defect of character, consider another way of understanding what’s happening. In each instance, if you’re willing to tap below the surface, you’ll find what we might call an “objecting part.”

We’re all familiar with having more than one feeling about something; for instance, part of me loves the change of seasons here in New York, while another part thinks I could really get used to year–round warm weather. Part of me believes every word you say, while another part suspects you’re not telling everything you know. Each “part” represents a different state of mind about the same subject.

Let’s take this familiar experience to a situation where our thoughts say one thing—I should do X—but our behavior “says” the opposite, that is, we fail to do X.  Imagine that the failure to act represents a part with the point of view that I absolutely shouldn’t do X, not a good idea. Let’s make the desired action a recovery­–related behavior, like adding healthy exercise or working to identify binge triggers. Now imagine that instead of calling yourself disparaging names  (like lazy or stupid), you get curious about why a part of you might object to moving in an obviously useful direction. An “objecting part” believes or fears that the “obviously useful” direction will not make things better for you but will actually make things worse.

That sounds really weird, doesn’t it? But stay with me. Let’s see what comes up when we apply this line of thinking to each of our example people:

Sally, who just can’t get around to healthy exercise, is asked to think about why she might have a part that objects to it. What could be better, not worse, if she went ahead? Sally realizes she is afraid of her own perfectionistic standards. If she gets started, nothing short of Olympian efforts will do. She’s burnt out before she’s even started! Recognizing this allows Sally to work with the objecting part’s concerns, which she has to admit are legitimate. Her exercise routine becomes another opportunity for Sally to practice moderation instead of extremes. Her objecting part is satisfied and gets out of her way.

Tracy is the one who believes her binges are all about lack of willpower. Her therapist asks her what the worst thing might be that could happen if she thinks of her binges as a reaction to something, not just evidence of no willpower. Tracy becomes aware that she’s terrified of falling into an abyss of overwhelming emotions if she starts connecting to what’s triggering her binges. Better to think of herself as weak–willed! Armed with this insight, Tracy and her therapist work together to help her develop skills for managing her emotions so they no longer feel too threatening to explore.

Madeleine, who is stuck in a pattern of getting better and relapsing, is in an eating disorder group. The group has always assured her that her slips are a normal part of recovery. However when they try to help her discover triggers for the latest episode, Madeleine usually comes up empty. Finally the group leader asks Madeleine to imagine what might be bad about continuing with her healthy eating patterns with fewer and fewer slips. Madeleine surprises even herself by blurting out that if people no longer see her as “sick,” they will expect more and more of her and she’s afraid she won’t be able to live up to it. The group begins to focus on supporting Madeleine in prizing her own needs and recovery over other people’s expectations. The cycle of regular relapsing begins to fade.

In each situation, getting curious about the concerns of an “objecting part” opens up an important aspect of experience that hasn’t been taken into account: Sally’s expectation of being tyrannized by her own perfectionistic standards, Tracy’s fear of being overwhelmed by her emotions, Madeleine’s dread that she’ll be crushed by other’s expectations. Once these concernsare aired, it’s possible to make a plan to address them, one that allows you to resume working toward your goal with the obstacle out of your way.

Can you find examples in your own recovery where it might be useful to listen to an “objecting part”? “Listening” includes paying respectful attention to any negative thoughts, emotions or body sensations that come up when you think of a particular recovery goal, an area of exploration in your treatment, or just about getting better in general. Here are some common concerns or fears of objecting parts:

• Being overwhelmed by emotion
• Disappointing others
• Having more expected of you than you feel you can do or wish to do
• Losing support or help
• Losing important relationships that seem to depend on your being “sick”
• Having to grow up without feeling ready
• Making others angry
• Being exposed as inadequate
• Having shameful feelings exposed
• Feeling too alone if you get better