“Where to begin eating disorder treatment? Start here…”

Meanwhile, wishing you all a refreshing break as we honor the nation’s labor force, wind down the summer and head into fall.

If you have an eating disorder, you probably don’t have as much resilience as you need. It doesn’t take much to throw you off and it’s hard to rebound. In fact, your eating disorder symptoms represent how you’re trying to fill in for missing resilience. Recovery is fundamentally a process of building in the skills and capacities that help create this missing resilience. This makes recovery a great opportunity: If you continue working on recovery after your symptoms have diminished, you’re likely to emerge from your eating disorder stronger than when you started! You will also have greater protection from other psychological woes  such as depression, anxiety or addictions.

In Eating Disorders for Dummies, I identify vulnerability factors that put a person more at risk for developing an eating disorder (pp. 61–68). In recovery, we can identify “resilience factors,” that is, strengths and capacities that make you less at risk for an eating disorder, less likely to relapse. As you will see, resilience involves developing a good balance of external and internal resources. Resilience factors include:

• The capacity to connect with others Loving, caring relationships are valuable buffers to the slings and arrows of outrageous fortune. It’s important to know how to create and nurture such relationships and to call on them for support in times of distress. For many people with eating disorders, learning how to establish trust and feel safe in such relationships is a very healing part of recovery.
• Emotion management skills Learning to manage uncomfortable feelings is a key recovery competency. Emotion management includes the skills of self–soothing, the ability to center or ground yourself, and the capacity to tolerate uncomfortable emotions or experiences even when you can’t do anything to make them better.
• Efficacy, competence Being effective and competent is already in overdrive for many of you with eating disorders. For others, a sense of floundering in life is one more experience of being you that keeps the eating disorder going. For example, turning to dieting for missing structure and rules is usually a set–up for the next round of eating disorder symptoms. Becoming more effective and competent in managing your life includes being able to self–reflect, to delay gratification, to contain impulses, to develop and follow through on personal goals and to be a self–starter.  These capacities add up to feelings of independence and confidence that you can rely on yourself when necessary.
• Flexibility Flexibility includes being able to role with the punches, change course as life events demand, and accept when pursuit of perfection is undermining your quality of life. To be flexible doesn’t mean caving in or being weak; it means being able to adapt. It includes expecting change as part of living. Flexibility also involves the willingness to let go of habitual ways of thinking or responding and to experiment with new approaches.
• Perspective Having perspective means being aware of the relative value of things, for example, knowing that how you feel is more important than how you look or that your health is more important than being thin. Perspective also means being able to hold onto the bigger picture; for instance, knowing that even the worst feelings are temporary, or that your mistakes are just a part of a larger life experience that includes many things you’ve done well.
• Self–esteem, feelings of worth When you have a positive view of yourself, setbacks feel like an expectable part of life rather than a revelation of your inadequacies or lack of worth. Self–worth means knowing you’re valuable just because you are, not because of how you look, what you produce or who likes you. Self–esteem includes being able to recognize and value your personal assets and accept your flaws, even while working toward self–improvement.

Just how you develop these resilience factors in yourself will have your own personal stamp on it. Individual or group therapy can be great places to work on resilience factors. Relationships with trusted friends or family can support your efforts to become more resilient. Some people find spiritual practices make a significant contribution to their resilience. Others focus on the cultivation of attitudes that fuel resilience: faith, optimism, gratitude, a half–full rather than a half–empty glass, seeking to learn from mistakes, and so forth. Self–care—healthy eating, exercise, sleep, recreation—can make a big difference in resilience.

Here is a challenge for you in service of resilience–building: Pick one of the resilience factors above to focus on. Then think of a small, accessible stretch from where you are now in relation to that factor to work on this week. For example, if you pick connecting to others, you might decide to make a list of groups or organizations that would interest you. Next, you might list any external or internal obstacles that interfere with joining. External obstacles might be that you live far from where the group meets or that you worry that it will take too much of your time. Internal obstacles might include shyness or fear of being judged. Finally, you could think about what you’d need to support your reaching out toward such a group, such as working on the obstacles in therapy or talking about them with a friend, or journaling or praying about them. (Notice this step only involves preliminary thinking about this way of connecting. A next stretch might be some small action toward actually working on the obstacles you identified.)

The great thing about working on resilience is that any growth begins to make your life better. And any growth reverberates in every part of your life, not just eating disorder recovery. Good luck!

People who rely on logic alone are usually encouraged to become more familiar with their gut sense of things and put more faith in it. Many a therapy hour has been devoted to these goals. Those of us who practice body–based therapies place a special premium on being able to access the way experiences feel in the body. We rely on these feelings as a gateway to self–knowledge and change.

So it’s simple, right? Just go with your gut. Not so fast! What about when your gut tells you to eat an entire cake? Or to reject food as the enemy? What if it tells you to trust no one, or that you can only be loved if you’re perfect?

Confused now? Time for an important distinction: Gut feelings don’t guarantee a direct line to objective truth. What they give you is an absolutely accurate reading on what feels true to you in the moment. If the accumulated experiences that give rise to your gut sense have been basically grounded in a larger–consensus reality, what your gut tells you is likely to be a good guide for reading the world around you and your relationship to it. For instance, you  instinctively lower your guard when entering a brightly lit street where people are going about their business, while just as instinctively you become wary on a street that’s dark and sparsely trafficked. You have a sense something is off when a person’s body language doesn’t match their words.  Or you just “click” with somebody, subliminally reading a host of cues that tell you: “This is my kind of person.”

Bur we all have characteristic blind spots when it comes to the trustworthiness of what our guts are telling us. These blind spots usually come from early experiences, especially in our families, which gave us a distorted picture of ourselves or how things are in the wider world. For instance, if you were repeatedly let down, your instincts may tell you never to trust what other people promise. Or, if criticism was used as a weapon in your family, your instinct may be that even constructive criticism is really an attempt to hurt or undermine you. These are examples of a kind of distortion known as overgeneralizing from your personal experience: You unconsciously use what happened in your family as a guide to the entire universe.

In another kind of distortion, you can develop a faulty filter for incoming information. For example, if everyone pretended nothing was going on when Dad arrived home rip roaring drunk, you probably learned not to be aware of alcoholic signals  (a misperception known as denial). Or, if abusive language was tolerated without comment in your family, you may not register such talk as inappropriate in others. You could be drawn into relationships in which you are demeaned or disrespected with no alarms going off to warn you: “Get out of here!”

Either kind of distortion, overgeneralizing or faulty filters, causes your predictions and judgments to be off base in certain areas. Your gut sense feels completely true but leads you in the wrong direction. This can sound like pretty discouraging information. You’re supposed to be able to trust your instincts, but it turns out your instincts are unreliable? What are you supposed to do? First of all, what not to do: Do not fall into all–or–nothing thinking! Your experiences may have distorted your gut sense about some things, but certainly not about all things.

All of us need to learn what our characteristic blind spots or distortions are. You can learn about yours in any safe situation that provides you with reliable feedback about your instincts. This might be therapy, a support group, friends, a partner, work colleagues or others from whom you can get a reality check. Reality checks don’t necessarily make long–held distortions disappear. But they can help us learn when to take our gut reactions with a large grain of salt—and conversely, when to relax into trusting them as we were meant to do!

Last time I talked about shame and feeling unsafe as obstacles to intimacy. This time I pick up the thread about feeling unsafe and go over ways to establish a greater sense of security in intimate relating.

By “feeling unsafe” I mean fearing abandonment. (In my post on boundaries, June 18, 2010, I discuss the opposite fear, that of being taken over, invaded or controlled in intimate relationships.) Abandonment fears may result from early experiences in which caregivers are unreliable, untrustworthy or not sufficiently present. Such fears may also be the legacy of catastrophic loss. Without realizing it, you internalize these experiences as a guide for what to expect in the present. To be more secure in present day relationships, you’ll need to work on putting past experiences into the past, not just in your mind, but in the way you feel. Easier said than done!

In my last post I identified three important ways to work on distinguishing past from present:

• Unlearning old patterns
• Learning to choose safe people
• Discovering you can live through breaches of trust

In the rest of this post, I give you pointers on how to work on each.

Unlearning Old Patterns

Last time, I said: “The pattern you learned is that if you trust or rely on someone, you get abandoned. Your grown–up brain probably knows it’s not cause and effect. But deep down it feels like it is.”

It can make a very big difference just to realize that those scary expectations actually come from the past. Knowing specific experiences (one–time events or chronic conditions) that contributed can help with the job of assigning fears back to the past.

It’s one thing for your brain to know and quite another for your nervous system to catch up! You tell yourself “that was the past” but your body  responds with a clench in your stomach, shortness of breath or a racing heart. This is one of those places where body–based therapies can really be helpful. (See “Recovery from the Top Down and the Bottom Up,” November 20, 2009) For instance, you might review reassuring experiences about people who have been trustworthy—experiences you’ve scarcely noticed for being so afraid. Given time and space, you can weave these comforting examples into your felt experience of what’s true and possible until your body can respond calmly.

For a number of you, putting the past into the past will involve resolving early relationship trauma. (Remember, anything that overwhelms your ability to cope at the time it occurs can be traumatizing.) Be sure to work on traumatic history with someone who is experienced in trauma treatment.

Learning to Choose Safe People

If you had untrustworthy or unavailable caregivers, you might pick people who fit these patterns and thus match your worst expectations— a kind of self–fulfilling prophecy. Similarly, if you experienced the catastrophic loss of a caregiver, you may find yourself repeatedly drawn to people who can’t be there for you.

The new idea is that you can recognize who is reliable and present and who is not. This is an example of how awareness—choosing with your eyes open— can be your best friend. If you choose people with your eyes closed, you’re overwhelmingly likely to repeat the old choices. P.S. It also helps to learn that you aren’t going to change the unreliable ones. They aren’t unreliable because you are unworthy. It’s who they are.

While you work on increasing your awareness, make sure to pay at least as much attention to what others do as to what they say. Start by investing small amounts of trust in people who seem promising. Then stop and take time to evaluate how reliably they behave before investing more. Do they show up or call back when they say they will? Do they listen to what you tell them about yourself? How do they treat their commitments to others?  For some of you, this will be a break from a familiar all–or–nothing approach: trusting no one on the one hand or jumping in blindly on the other.

A focus outward on evaluating the other person’s behavior may also be new to you. If you have an eating disorder, you’ve probably spent most of your time focusing a harsh critical eye on yourself. Your concern has been how to make yourself acceptable to others. (I post about the “Internal Critic” on 4/23/10 and 5/7/10.) In recovery you learn that the people you let into your life need to be worthy of you!

As you work on sharpening your eye for reliability in others, watch out for the following paradoxical reaction: I can’t risk picking reliable people because then I’d try to rely on them and that’s not safe! If you realize you’re stuck in this bind, make sure you talk about it in your recovery treatment.

Discovering You Can Live Through Breaches of Trust

In the last post I said: “For a dependent child, an unreliable caregiver or the loss of a caregiver can be devastating. For an independent adult, untrustworthiness in others or loss can be terribly disappointing, but it doesn’t have to rob you of all solid ground.” This is the core truth on which your current security is based.

This idea will be hard for some of you to get your mind around. Perhaps without even realizing it, you’ve been searching for that external anchor—a partner, a relative, a friend, a therapist—who will permanently provide the security you don’t feel inside. This approach is, of course, doomed to failure for at least three reasons:.

1) The arrangement is bound to make you feel more vulnerable, not less. If you think another person is essential to your stability, you’ll focus  on what ‘s needed to keep them around at the expense of your own desires and needs. Not only does this put you at the other’s mercy, but it keeps reinforcing a self–image of helplessness and dependency.

2)  People are just human. The most rock solid among us will fail others, let down those we love or be unavailable sometimes. But if you’ve elected another person to be your security source, this will feel intolerable to you.

3)  People who sign up to be the strong one in a relationship need you to be vulnerable to feel better about themselves. They won’t be able to support your strength or confidence as you grow in recovery.

The only reliable road to feeling secure is to develop a sense of security within yourself. This is not to deny our basic human need for connecting to and being comforted by others. And a secure relationship seems just about essential as a place to work on building up internal security. It just means that support from others can’t permanently substitute for security that comes from inside.

How do you begin to build up inner security? Like so many other recovery projects, it’s something you accomplish with small steps and regular practice. Here are some examples of small practice steps you can take:

• Regularly notice and credit yourself with your competencies.
• Resist listening to harsh internal criticism that undermines your self–confidence.
• Practice turning to internal resources just for a few minutes, even if you go on to seek the support of others.
• Think of what a supportive person (real or imagined) might say or do that would reassure or comfort you when you need it. Notice even small ways these thoughts affect how you feel.
• Make sure your recovery work includes practicing—again in small steps—skills you need for greater self–reliance. These might include the ability to manage difficult emotions, skills of self–assertiveness, tolerating being alone, distinguishing adult aloneness from childhood abandonment, constructive expression of anger and more.
• Practice ways of feeling grounded in your own body, such as locating your center, feeling your feet planted on the ground, tracking your breath as you inhale and exhale, and so on.
• Let others support your efforts in ways that encourage growth and independence rather than dependency. This could be cheerleading your successes, offering suggestions, debriefing missteps, encouraging you to keep going, just to name some examples.

When you are confident that you can stand on your own two feet, even in the face of disappointment or loss, it becomes possible to risk connecting intimately to others. You can let yourself be known because rejection, however unpleasant, won’t leave you helpless or rob you of belief in your own worth. You can lean on another person because you know if they fail you, you still have yourself. Whatever the other person does, you are secure in the knowledge that you will still end up okay.

• Letting someone see you as you really are
• Sharing personal information and feelings
• Relying on another person; asking for and receiving help
• Letting another in on your efforts to stretch and grow
• Revealing secret dreams and hopes
• Sharing in mutually–satisfying sex with a partner

If just thinking about these ways of being vulnerable with another person makes you shiver, chances are your childhood experiences of being vulnerable were hurtful. Remember: your family—the people who knew you best at a time when you were at your most vulnerable—provided your first and most enduring model for what vulnerability in intimate relationships is like. If you were treated respectfully and made to feel worthwhile, you’ll expect that being vulnerable with someone you trust in the present will be a positive experience. If, on the other hand, your experiences with family involved being ridiculed, criticized, humiliated, devalued or ignored, this is what part of you, perhaps unconsciously, is likely to expect out of being close and vulnerable with someone now.

Negative childhood experiences of relationship vulnerability lead to shame and feelings of unsafety with others. Each of these feelings makes intimacy in present relationships feel too risky.

Shame

Shame is the feeling of having been exposed as utterly and completely unworthy. It includes the expectation of being humiliated and abandoned by others because of unworthiness. Shame always has to do with our relationships with others, others who can see, judge ridicule or exclude us. Eating disorder symptoms often represent an effort to manage shame. For example, shamed people might believe that being thin will protect them from being judged as unworthy by others. They hope thinness will substitute for missing self–worth, and keep others focused on what’s outside, not inside. People with such beliefs will go to extremes to achieve thinness. (Of course, the sad irony is that eating disorder symptoms, such as bingeing and purging, almost always result in making shame worse.)

Shame is one of the most toxic of human experiences. What can you do if shame makes being deeply known by an intimate other feel intolerable? First what you can’t do: You simply cannot fix shame with external achievements, whether that’s thinness, beauty, wealth, academic or professional accomplishment or a trophy partner. If you live with lots of shame, you’ll always fear that if people get to see what’s inside, you’ll be rejected or ridiculed.

Shame requires an inside cure. It involves acceptance of the most flawed parts of yourself and recognition that being flawed is part of the human condition. This shift in perspective actually results in feeling more connected to others, not less, as feared. It makes being intimately known seem not so risky after all. Easier said than done.

No one instantly stops hiding what’s inside to let it all hang out. Two ingredients seem essential for shame reduction:

• At least one other trustworthy human being—someone who can be relied on for acceptance and understanding. This could be a therapist or therapy group, spiritual leader, family member, friend or partner.
• A tiny step–by–tiny step approach which involves determining manageable stretches of your comfort zone, small–bite risks in letting yourself be known. Testing the waters in this way can allow you gradually to transform childhood learnings about how others will see and respond to you into a more accurate adult perspective.

What you’ll eventually discover is that mutual sharing of vulnerabilities promotes the deepest and most satisfying of intimate relationships. When you share vulnerability you are giving and receiving a priceless gift: acceptance and embrace of who you each really are.

To read more about coping with shame, check out “The Power of Shame” (posted September 17th, 2009).

Feeling Unsafe

When it comes to being vulnerable with others, feeling unsafe results from the expectation that if you rely on someone, you’ll be abandoned. The opposite of this fear is trust. Trusting can seem irrational if your early experiences have involved abandonment, rejection, neglect or abuse by those you relied on most.

The goal is to achieve confidence that you can be safe while being close and vulnerable with another person. This requires making some important distinctions between your childhood and the present, including:

• Unlearning old patterns You learned is that if you trust or rely on someone, you get let down or abandoned. Your grown–up brain probably knows it’s not actually cause and effect. But deep down it feels like it is.
• Discovering you know how to choose safe people or can learn to know The new idea is that you can recognize who is reliable and who is not. With this in–between approach, you take your time to get to know someone to learn if they are trustworthy. You aren’t stuck in the trust–no–one position on the one hand, nor do you jump in blindly, hoping for the best on the other.
• Discovering you can live through breaches of trust by people you are close to For a dependent child, an unreliable caregiver can be devastating. For an independent adult, untrustworthiness in others can be terribly disappointing, but it doesn’t have to rob you of all solid ground.

In my next post, “Developing the Skills of Intimate Relating in Eating Disorder Recovery, Part IV: Security“ (July 16, 2010), you can read about ways people work on achieving a greater sense of safety and security in their intimate relationships.

Boundary–making is drawing the line between yourself and another, a line that defines you as a separate person with your own distinct thoughts, opinions, feelings, needs and desires. Boundary–making includes claiming your body and personal space as your own. Implicit in boundary–making is your understanding that you have a right to have your separateness respected.

Why do I start with separateness as a quality necessary for closeness?  When you don’t know yourself as a separate person or respect your right to separateness, you become a sitting duck for boundary invasions. You are vulnerable to being bullied, intimidated, controlled, chronically disrespected, discounted, taken for granted, intruded upon, or physically violated. None of these experiences is good for self–esteem. The presence of any of them make relationships a place where you could lose yourself, feel undervalued or be exploited—all understandable reasons for fearing or avoiding closeness.

Examples of boundary invasions include when another person:

• Assumes they know your mind or your wishes without asking
• Speaks for you, interrupts, finishes your sentences
• Betrays your confidences
• Confides in you inappropriately (for instance, a parent confiding in a child about the relationship with the other parent)
• Acts as if your opinions or wishes don’t matter
• Reads your diary, mail, journals or other private matter without permission
• Enters your private space without asking
• Touches you without permission
• Comments on your body weight, size or shape

You may repeat patterns of boundary invasion learned in childhood by picking other people who don’t respect boundaries. This path leaves you robbed of intimacy because it’s impossible to have real intimacy when the person you’re with doesn’t respect you. In such a situation, the problem is boundaries that are too porous for healthy intimacy.

On the other hand, even if the other person is respectful of boundaries, your fear of boundary violation might be so great that it feels too risky to take a chance. You maintain your territorial integrity by keeping others out; in other words, at the expense of intimacy. In this case, the problem is boundaries that are too rigid for healthy intimacy.

Porous Boundaries

When you have learned to expect boundary invasions, it can feel very scary to start asking for boundary respect. You may feel you aren’t entitled. You might fear that the other person will be hurt, become angry or ignore you, even abandon you. Maybe you simply don’t know where to start.

When a new behavior pattern like boundary–setting feels too unfamiliar or scary, it’s usually a good idea to:

• Look for models: Notice people who already behave in ways you’d like to learn when it comes to respecting their own boundaries and asking others to do the same. Notice who and what seems effective and what would be consistent with your own personal style.
• Start small: Try something that feels like a manageable stretch. Having it out with your dad about weight remarks may seem too daunting right now. But maybe it feels okay to tell your friend who loves to call you at all hours that you’re working on getting more sleep, so you’ll be turning off the ringer on your phone at 11:00PM. 
• Pick a person you trust to practice with: Try first with somebody you’re pretty sure will respond well. Maybe that’s your best friend, your sister, someone in a therapy group or community in which you participate.
• Rehearse: Don’t try to think of what you want to say or do on the spot. This could be too difficult if you’re nervous. Go over what you’d like to accomplish and how you’d like to put it. Think of possible responses you could get and how you’d like to handle them. If you have someone to role play with, all the better!

Rigid Boundaries

The opposite pole of boundary problems is having boundaries that are too rigid. Opening up too–rigid boundaries can feel even more frightening than setting limits where boundaries are too porous. If you’ve clamped down to the point that no one can get in, it’s for a reason. You’ve been hurt, betrayed or disrespected by people you relied on. If your boundaries are too rigid to allow closeness to others, the most important healing tasks for you will be:

• Gaining confidence that you can figure out who is safe to let in and who is not
• Taking risks with letting others in more

Flexing up boundaries that are too rigid leads us right into the second capacity needed for intimacy: being known and being vulnerable. Be sure to check back in two weeks for my posting, “Managing Vulnerability,” where I’ll describe ways to build this capacity.

Many people with eating disorders long for close, intimate connections but don’t know how to achieve them. Or they end up feeling trapped, suffocated or resentful in the relationships they have. If these descriptions fit you, you may have a history that taught you closeness to others is not basically safe.

A person’s childhood experiences with caregivers and others create expectations—largely subconscious—of what future intimate relationships will be like. If your experiences growing up were positive and secure, you’ll expect adult relationships to be the same. If your caregiving was not so positive and secure, or if peer relationships were traumatizing, your expectations won’t  be so rosy. For example, you may have learned that in intimate connection you’ll be: swallowed up, intruded upon, robbed of an independent self, ignored, humiliated, abused, exposed as unworthy or ultimately abandoned.

Your eating disorder may be acting as a protection to keep you isolated and “safe” from relationships. It probably serves as comfort when relationships or isolation hurt. If you’re in a relationship, your symptoms may help you keep a safe distance from your partner, give you a sense of control or provide a way to ask for caretaking. Increasing your comfort with intimate contact, whether with family, friends or an intimate partner, is not only part of a robust recovery, it’s your birthright!

If you’re having trouble reaching out or establishing secure, satisfying relationships, your history may have left you underprepared in one or more of the following capacities essential for relationship intimacy:

• The ability to establish and maintain healthy boundaries
• Confidence about being known and being vulnerable
• A sense of security that comes from inside

In my next three posts, I’ll go over why each of these overlapping capacities is so important to intimacy. I’ll discuss how you can build skills relevant to each, even if it feels frightening right now. Healthy intimacy is not a matter of “the luck of the draw” in the people you meet. It has everything to do with how you feel about yourself and other people and what you feel entitled to expect from those you include in your life. Often, as eating disorder symptoms subside in recovery, the way you relate to others comes more into focus. That means recovery can be a great time to work on any trouble spots!

Check back in 2 weeks, on June 18th, to read about creating healthy boundaries.

Add an alternative treatment Sometimes it can be really helpful to approach things from a new angle. As an adjunct to your primary therapy, an alternative treatment, such as acupuncture, dance, art or music therapy, biofeedback, EMDR (which can also be a stand–alone treatment) or hypnosis might offer just the fresh perspective or new entry point you need to jump–start your overall recovery. (See “Boosting Recovery with Experiential and Alternative Therapies,” 2/19/2010.)

Join an eating disorder therapy group Working with others can add a distinct dimension to your recovery. Guided by a professional, you get to experience the support, shared wisdom and personal feedback that others on the same path can offer. Groups can be a great place to develop skills of social connection and to discover how to do so safely.

Check out an online support group If a face–to–face group isn’t available, or you’re not ready for that experience, many people find online support groups to be a viable alternative. If you’re interested, you can check out reputable eating disorder web sites, such as something–fishy.org, bulimia.com or edreferral.com, for resources. Given how important it is to keep the conversation non–triggering and growth–oriented, I recommend you stick to groups that are moderated by eating disorder professionals.

Blog These days it’s common for people to journal about their personal experiences in the public forum of the blogosphere. As long as you stick to non–triggering content, your thoughts and experiences about recovery could be valuable to others. And you might get useful commentary back.

Participate in a body image workshop Improving the way you view and relate to your body is a crucial part of recovery. Spending a day or a weekend learning, sharing with others and participating in experiential exercises can be an eye–opening and inspiring add–on to your treatment.

No workshops in your area? Approach an eating disorder professional and ask him/her to offer one! (Note: If you come equipped with the names of a few other people who would like to attend, this will help your cause.)

Contact your body in some new way that’s joyful, soothing or enlivening Dance, dive, get a massage, learn to chant, consult with a body worker (for example, Alexander Technique, Feldenkrais Method, Somatic Experiencing, or Sensorimotor Psychotherapy), try yoga, t’ai chi, Qigong, or martial arts training, practice mindfulness meditation, experience intuitive eating, and so on.

Pursue an interest that has nothing to do with your eating disorder Develop a new skill: artistic, athletic, technical, craftsy… Learn more about a topic that interests you: a person, an era, a region, an activity, an art form… Visit a place you’ve never been: a new neighborhood, a nearby town, a site in nature…

Breaking out of your habitual mode can be energizing. Developing new knowledge or skills promotes self–esteem. All the while, you’re reinforcing that there’s more to you than your eating disorder. And you get an important reminder of your ever–present potential for growth.

Volunteer Engaging with needs or problems outside your own can boost your mood, provide perspective and enhance your self–image. Of course, the list of possible ways to volunteer is endless, so you can offer your time and energies to whatever cause touches you most: people or animals in need, the environment in need, policies or causes you care about, and more.

Try a goal–setting exercise In goal–setting exercises, you envision your future as you’d like it to be and then establish bite–size steps to help get you there. Here’s one commonly–used outline:

Set aside 30–45 minutes when you won’t be distracted. Start by writing a paragraph about how you’d like your life to look in five years. Include dimensions such as school/career, relationships, self–care, living situation, spiritual development, extra–career activities, and so on. Next, make a short list of what you will need to have accomplished in a year to be on the road to your five–year vision. When you have that list, list what you will have to accomplish in six months to move you toward your one–year goals. Now list what you will have to accomplish this month in service of those six–month goals. Finally, list what you will need to do this week in order to accomplish your one–month goals. Try to limit each list to no more than four or five goals. One–week and one–month goals should feel clearly doable. If not, break your goals down to smaller steps.

Working with concrete goals can help you clarify your personal values and priorities and invigorate them with some forward momentum. The success of the exercise depends on your ability to be realistic about short–term goals (not what your perfectionistic self tells you you should be able to do!) and your willingness to adjust, based on what you learn as you go along.

Alert! For some people, goal–setting exercises just feel overwhelming or discouraging, not invigorating. Pay attention to how you’re responding and honor any signals that tell you this won’t be helpful to you.

Connect with your “Future Self” Psychotherapist Nancy J. Napier describes the “future self” as the part of you that has already gone ahead on the path of healing, problem resolution or growth in a way that’s optimal for you. The future self draws on unconscious reserves of learning and life wisdom projected forward in time to an image or sense of yourself already experiencing the best possible outcome. Contacting a future you that’s recovered completely from your eating disorder or specific symptoms or issues can encourage forward momentum, act as a guide or a prompt for steps along the way, or help you arrive having already become familiar and comfortable with the changes involved.  If you’d like to explore more about how to work with your future self, see Napier’s Recreating Your Self: Help for Adult Children of Dysfunctional Families (Norton, 1990).

To get the best results from adjunctive recovery activities or practices, review what you’re thinking of with your primary therapist. This will help you make sure any additions fit well with other work you’re doing and are well–timed for where you are in recovery. Your therapist’s participation will also ensure you of any support you might need for your efforts.

Your Inner Critic has held tyrannical power over you. The revelation that it is actually just a very young part of you opens up new pathways for dealing with its tyranny. Remember that its intentions are protective. It wants you to behave in ways that will make others accept and love you. It doesn’t want you to experience the shame of being judged inadequate. It’s the keeper of the rule book for how to accomplish these goals. But now that we know your Critic is still stuck in your childhood, we can say that its rules were relevant for you then but not now.

You may wish to take a moment to imagine how your Critic would appear if you “pulled away the curtain.” How old would it look? What stage in your life might it come from? If it feels comfortable, you might wish to start thinking about the experiences in your early life that could have given rise to the rules your Inner Critic enforces. (Here and elsewhere, stop if the exercise makes you uncomfortable.) The following is an example of how this process might look:

Karen (a fictitious but representative example) hears her Critic’s voice anytime someone she knows needs something from her, no matter how inappropriate the request or how it affects her. It says, “You must always take care of other people’s needs; you must always put them before your own.” Or: “This person won’t like you if you don’t do what she wants.” Karen thinks of her mother who was selfless to a fault and always expected the same of Karen. What’s more, her mother always appeared profoundly disappointed if Karen failed to live up to this standard. The shame and anxiety Karen felt under her mother’s disappointed gaze became powerful motivators. Her Critic came into being to help Karen remember and avoid feeling like a disappointment to others in the future.

Locating your Critic’s demands and character attacks back where they originated can be a starting point for developing some distance and objectivity. That is, you can start to question them. Here’s how this looks for Karen:

Karen had no way of knowing as a little girl that such excessive, unbalanced selflessness was evidence of her mother’s own Inner Critic and her particular life experiences. Back then Mother was taken to be an accurate representative of the larger world. Karen concluded, largely unconsciously, that she better learn the lesson if she didn’t want to be shamed or rejected by others. Of course, as Karen moved out into the larger world she encountered people who reinforced her mother’s teachings. But she also met people with more balanced views. The problem was that her mother’s teachings had so much fear attached to them that it always felt too risky to think any other way. Now, as Karen begins to assign the lessons on selflessness back to her mother and not the world, she can dare to consider more balance between her own needs and those of others.

In my experience, when people do this contextualizing work, in time their Inner Critics  tend to shrink, soften and lower the volume. As with Karen, who begins to value her own needs alongside those of others, people become freer to develop previously undervalued and underused aspects of themselves. They experience more flexibility and more options for living.

Okay. So now you’ve uncovered your Inner Critic’s childhood origins and realize that the rigid rules it wants you to live by don’t actually apply in your current life. You’ve begun to work on updating the rules to take into account what your older self knows and to establish more balance and humanity in the way you live. Does this mean it’s time to chuck the Inner Critic? Some take that view. I always try to remember that the Inner Critic is actually on your side, however misguided its methods. It seems to me that you can never have too many resources on your side! If you’re of the same mind, you may wish to consider giving your Critic a more adult role in your personal guidance system.

A modernized Critic’s judgments would be ruled by wisdom and compassion, not fear. A part that can think wisely about what’s best for you without terror of humiliation or abandonment can be a mighty valuable ally. As an ally, the Inner Critic might act more like a consultant, for example, helping you stay on track toward your goals, reminding you of your standards or encouraging you to put out your best effort—but only for objectives that are right for who you are. This updated Critic’s tone would always be encouraging and advisory, never threatening or demeaning.

So you’re working on maturing and modernizing your Critic, what do you do when the old, familiar voice pops up? Here are some responses that may help:

• Imagine what the voice would be saying if it were speaking from its adult viewpoint: For example, you failed the exam for a driver’s license, even though you worked so hard to prepare. The old Critic stops by to tell you: “You’re so stupid! Only an idiot would have made that left turn. You should just forget it.” A consultant Critic, by comparison, would help you review what you got right and go over the areas where you need more practice. It might encourage you to think of whether you need other assistance, like a professional driving instructor. It would remind you of how much having that license is going to mean to you, that the effort will really be worth it. Most of all, it reminds you that failing from time–to–time is human, that failing proves you’re taking risks and trying.
• Bring in your “pride resources” (See “Countering Shame with Pride Resources,” 10/2/09) This could be a great time to remember what you do well: using your high school Spanish to get around in Mexico, building those shelves, wowing everyone with your salsa… Or think of setbacks you’ve overcome: you had to rip out a whole sweater you made and start over, you failed that audition but came back the next year and got chosen, they didn’t make you committee chairperson but you made a big contribution anyway…
• Use this as a chance to practice tolerating imperfection In my post “Doing Nothing Usefully in Eating disorder Recovery” (10/16/09) I discuss how increasing your capacity to tolerate difficult feelings gives you more flexibility and options. Tolerating difficult feelings about yourself gets extra credit, especially when you’ve been used to a harsh Inner Critic. Your old Critic will tell you your imperfections are the final, fatal word on your worth. From a more grown–up perspective, you can learn that your imperfections are only a part of a bigger you and just make you human.
• Limit the air time the old Inner Critic gets If all else fails or you just need a breather, you don’t have to sit around and listen until the old Critic has spent itself. Change channels! Think about something else. Get involved in something else. The old Critic’s voice may be familiar, but it doesn’t have anything useful to tell you. You won’t be rude if you interrupt!

You know how sometimes you mean to do something but somehow it never happens? Or  you have a goal, but seem to keep doing the opposite? In February I suggested thinking of an “objecting part” of you that feels differently about your conscious goal, worrying that doing that thing, reaching that goal might make things worse for you in ways your conscious mind isn’t considering. The “objecting part” speaks through sabotage rather than words. (Check out “Getting Unstuck in Eating Disorder Recovery by Befriending Objecting Parts” to learn more.)

Objecting parts are examples of parts of your mind that have a purpose, that is, they are trying to do something important for you. The objecting part’s purpose is to put on the brakes when it has doubts or fears, sometimes unconscious ones, about the direction you’re heading. Your eating disorder probably includes a number of parts with a purpose. For instance, you’ve probably got a part that has cued you to go straight into eating disorder behavior when difficult emotions pop up. Or maybe you’ve got a part that signals you to restrict when you feel out of control. Today I spotlight yet another “part” of mind that virtually everyone with an eating disorder shares: the Inner Critic.

The Inner Critic

The “Inner Critic” is the part of your brain that lands on you like a ton of bricks whenever you make a mistake, disappoint or offend someone, fail to live up to your highest standards, or think you’re being weak or inept. Your Inner Critic also predicts your future: you will fail, be humiliated or rejected, maybe end up alone and outcast. You know exactly what I’m talking about, right?

You can recognize the Inner Critic by the way it talks and thinks. For instance, the Inner Critic’s favorite words are never, always and should. As in: You never do anything right. You always say the wrong thing. No one will ever love you. You should never get angry at anyone. Your Inner Critic thinks in all–or–nothing, black–and–white terms, never in gray.  For example, when it comes to your eating disorder, your Inner Critic is the part that tells you’ve blown it if you eat one bite outside your meal plan or that a pound above ideal weight means you’re gross. And that’s another thing: it’s not above calling you the worst kind of names.

How can I say that a part that treats you so cruelly serves a purpose, other than to torture you? To figure this out, you need to distinguish between the Inner Critic’s methods and its intentions. Its methods involve kicking you around, judging you and predicting you’ll have a miserable future. But its intentions are quite the opposite: the Inner Critic exists to protect you! I realize this is hard to believe, but bear with me.

How the Inner Critic Means to Help You

Your Inner Critic believes its cruelty is necessary to make sure you’ll succeed and that other people will accept, admire and love you. It’s beliefs come from lessons you learned growing up. That’s because your Inner Critic came into being way back when to help you be a kid your parents would love and approve. If their love and approval weren’t so easy to come by, your Critic tried to help you adapt to the parents you had, as seen from a kid’s eye view.

Part of being a kid, and especially being the kid of parents who seem hard to please, is to blame yourself for what’s wrong. Though very hard on self–esteem, this belief has the advantage of making all–powerful parents seem benign and reasonable, if only you could be good enough to be worthy of their love. Believing it’s all your fault also provides a sense of control to a small, powerless child: you can always try to change and improve yourself. The Critic is in charge of this all–important mission. Its harshness reflects not only how kids experience hard–to–please adults, but the dire necessity of its aims—after all, you were completely dependent on your caretakers.

What if your parents didn’t seem so hard to please and you still ended up with a tyrant of an Inner Critic? Sometimes a harsh Critic reflects your childhood intuition and internalization of one or both of your parents’ own harsh Internal Critics. Your budding Critic may also have absorbed judgments from other important adults, like coaches or teachers, or from peers or the wider culture (for instance, the message that says you have to be thin to be worthwhile).

Of course, what made these “lessons” tricky is that they often weren’t taught in any open way. You probably stored some or all of what you learned unconsciously. All that pops into consciousness is your Critic, attacking you when you fail, or fear you will. Here are some examples of things you may have learned you needed to be in order to gain love and approval:

• a high achiever at school or work
• a standout athlete
• compliant, agreeable
• neat and organized
• a selfless caretaker of others
• someone who sticks to a strict moral code
• kindly and generous
• attractive, thin

A big part of the problem is that you didn’t internalize these lesson as just temporary ways to help you get through a difficult childhood. You installed them as laws of life that apply everywhere, always. They come up in the present in any situation where you could be accepted or rejected, approved or disapproved, succeed or fail. This could be in school, on a job, in your social life or romance. They rule even when the only one who knows is you. Fail to live up to expectations even a little and your Inner Critic will let you have it.

In my next post, I’ll go over some specific ways you can work on changing your relationship with your Inner Critic. For now, I want to leave you with the first and most important step: awareness. When you understand that your Inner Critic is trying to protect you in its own misguided way, you have space to stand back and consider taking its criticism with a grain of salt. Here are some awareness–promoting exercises for you:

• Listen for always, never or should. Is there anything else you notice about your Critic’s habitual language or tone–of­–voice?

• Write down the situations in which your Inner Critic gets activated. What pattern(s) do you notice?

• Make a guess about what your Critic is afraid will happen if you don’t heed its warnings.

These exercises will be good preparation for my next post: Dethroning Your Inner Critic in Eating Disorder Recovery: Part II (5/7/10). Stay tuned!