HealthyPlace.com Mental Health Conference Transcripts (Table of Contents)

Transcripts from chat conferences on mental health issues - depression, anxiety, eating disorders, psychiatric medications, schizophrenia and much more.

Click on the topic of interest below to see the list of conference transcripts related to that topic.


ABUSE, DISSOCIATIVE IDENTITY DISORDER, SELF-INJURY

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ADDICTIONS

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ADHD

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ALTERNATIVE MENTAL HEALTH

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ANXIETY, OBSESSIVE COMPULSIVE DISORDER (OCD)

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BIPOLAR DISORDER

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DEPRESSION, SUICIDE

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EATING DISORDERS

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GENDER, GLBT

GENERAL MENTAL HEALTH

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PARENTING SPECIAL KIDS

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PERSONALITY DISORDERS

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PSYCHIATRIC MEDICATIONS

RELATIONSHIPS

SELF-HELP

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SEX

SCHIZOPHRENIA, THOUGHT DISORDERS

APA Reference
Staff, H. (2009, January 21). HealthyPlace.com Mental Health Conference Transcripts (Table of Contents), HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/other-info/transcripts/mental-health-conference-transcripts-toc

Last Updated: July 9, 2019

HealthyPlace Mediminder and Mood Journal Tools

HealthyPlace.com Mediminder (Mental Health Medication Reminder) Tool

The HealthyPlace.com Mediminder is a medication reminder tool for people with mental health concerns that's simple to implement and easy to use. And it's free. If you haven't already, all you need to do is register on our site, complete a short form and you're done. Depending on your personal settings, you can receive alerts via email or text message reminding you it's time to take your antidepressant, antipsychotic, antianxiety, ADHD or other psychiatric medication.   There's also an alert to remind you to refill your mental health medication.

HealthyPlace.com Mood Journal

The HealthyPlace Mood Journal is a unique, easy to use, daily tracking system that enables you to keep track of your moods and the feelings and actions behind them. In addition, the HealthyPlace.com Mood Journal, using a scientifically validated algorithm, measures when your mood is dangerously depressed or elevated (manic) and will send an alert to your doctor or therapist via email or fax and include a copy of your recent mood journal entries (with your authorization, of course). Our journal system can also send a text message alert to a family member or caregiver's cellphone advising them to look in on you. Many mental health professionals urge their bipolar disorder and depression patients to use a mood journal as part of their treatment plan. You must be a registered user to take advantage of the HealthyPlace.com Mood Journal.

(NOTE: After you register and log in, you can access your Mediminder and Mood Journal through links on the left side of your profile page.)

APA Reference
Gluck, S. (2009, January 19). HealthyPlace Mediminder and Mood Journal Tools, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/about-healthyplace/about-us/healthyplace-mediminder-and-mood-journal-tools

Last Updated: January 14, 2014

Watch The HealthyPlace TV Show

Real People. Real Stories. Real Hope.

We bring personal stories of what life is like living with a mental illness. Our goal is to let others facing similar challenges know they are not alone in their feelings and experiences.

Each week, we'll be discussing different aspects of mental health. Our host, Ruth Mendoza, will be talking with people about their experiences, how they're coping and what is and isn't working for them. Our co-host and HealthyPlace.com Medical Director, Dr. Harry Croft, will be providing insight and his expertise on the subject matter.

In the second half of the show, we open it up to you, our viewers. During this segment, you can ask Dr. Croft your personal questions about anything you wish concerning mental health. Dr. Croft will give you an easy-to-understand straight answer.

How to Watch The HealthyPlace TV Show

The show airs live on Tuesday evenings at 8:30p ET, 7:30 CT, 5:30p PT. You can watch the show from the player on the TV Show homepage. If you happen to miss the live show, simply click on the word "on-demand" at the bottom of the player and select the recorded version of the show. If you have a blog or website and would like to embed the player on your page, click the word "embed" and you can obtain the embed code for the player.

Want to Participate or Be A Guest?

At the first of each month, our producer, Josh Nowitz, will be posting a list of the topics that will be discussed on the show. If you are interested in being a guest on the show, drop Josh an email (producer AT healthyplace.com) and put "I want to be a guest" in the subject line. Tell us which show topic you're interested in plus a bit about yourself and why you think your story would be a compelling one. We interview all our guests remotely, so of course, you must have a webcam.

We also have other ways of participating in the show.

  1. Question for our guest: During the interview, Ruth will mention that we are now taking questions for our guest. All you have to do is type your question on the chat screen. We will be taking 2-3 questions. If we don't select your question, please do not feel that we are ignoring you or that your question isn't worthy of being asked. The fact of the matter is that we only have a few minutes for questions and we can't possibly take them all.
  2. Question for Dr. Croft: You can email your question to our producer by Monday at 5 p.m. before the Tuesday show. Please include your real first name. We will also be taking a few questions through the chat screen.
  3. Make a Video: We want to personally encourage you to participate in the show. So many people will benefit by what you have to say. Each week, after Ruth finishes interviewing our guest, we will run a 2-3 minute video of viewers talking about their personal experiences with the subject matter we are discussing on the show that week. You can share your message on any aspect of the topic, whether it's one of struggle or success, by recording a :15-:45 second video and uploading it to your youtube site. (a couple of technical tips -- please make sure you are well lit and the sound is clear) Again, please drop Josh an email at - producer AT healthyplace.com - and let him know that you have uploaded a video ( include the link to the video) and the show topic you are addressing. We need the video by the Sunday before the Tuesday show so we have enough time to edit the clips together.

The HealthyPlace TV Show tagline is: "Real People, Real Stories, Real Hope." Each week, our goal is to deliver a show which lives up to that. Whether you participate or you decide to be a viewer only, we hope you'll join us and benefit from the show. Feel free to email Josh anytime with your suggestions, concerns, well wishes or comments.

We'll see you on Tuesday evenings.

next: about our hosts and producer ~ tv show homepage ~ tv show blog

APA Reference
Gluck, S. (2009, January 19). Watch The HealthyPlace TV Show, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/about-hptv/info/watch-the-healthyplace-tv-show

Last Updated: January 14, 2014

About The HealthyPlace TV Show Team

A lot of work goes into putting on a good television show each week. The key people associated with The HealthyPlace TV Show are:

Dr. Harry Croft - Host

Dr. Harry Croft - Co-host of The HealthyPlace TV ShowHarry Croft, MD, is Medical Director of HealthyPlace.com and co-host of The HealthyPlace TV Show. Dr. Croft is a well-known and highly-respected psychiatrist and researcher. He is triple board certified in: Adult Psychiatry, Addiction Medicine, and Sex Therapy. His background includes training in both OB-GYN and psychiatry at the University of Texas Medical Branch in Galveston, Texas. In addition, Dr. Croft trained with the famed sex therapy team of Masters and Johnson.

Dr. Croft came to San Antonio to serve in the U.S. Army Medical Corps from 1973-1976, when he received the U.S. Army Meritorious Service Medal. He has been in private practice since 1976.

In addition to his private practice, Dr. Croft serves as the Medical Director of the San Antonio Psychiatric Research Center and has been the principal investigator in over four dozen clinical trials since 1986. He has published dozens of papers in leading medical journals and lectured to over 1000 groups of physicians and mental health professionals across the United States, Canada, Mexico, France, England, St. Thomas and San Juan.

Dr. Croft has been educating the public about mental health on television and radio for many years. He appeared on evening TV newscasts for over 17 years with his national award-winning mental health feature: "The Mind is Powerful Medicine." He is the author of the popular audio book for depressed patients: "Treating Your Depression: Finding Light at the End of the Tunnel."

About Christina Torres - Producer

ctorres-aboutChristina is the producer for The HealthyPlace TV Show. She is a true Texan and proud to say she is born and raised in San Antonio.

While working for a large, San Antonio-based financial services company for many years, she knew it was time to call it quits and pursue her childhood dream of working in the television broadcast industry.

After a lot of struggling and late nights, she was able to obtain her degree in Television Broadcasting from Our Lady of the Lake University. At the University, she was instrumental in reviving the television station, KOLL-TV, where she served as anchor and reporter. During college, she interned at KSAT-12, an ABC affiliate and the Guadalupe Radio Network, a non-profit organization.

"My goal with The HealthyPlace TV Show is to bring mental health and its related issues to the forefront of peoples' minds. In addition to educating viewers about the different facets of living with a mental illness, I want to let them know they are not alone with their feelings and experiences. And in some small way, if the show helps reduce the stigma surrounding mental health, I think that would be a great thing."

During her spare time, Christina enjoys spending time with her husband and their two children who are very active in sports. She also enjoys reading, exercising (when she has the time) and online shopping.

next: about the show ~ tv show homepage ~ tv show blog

APA Reference
Gluck, S. (2009, January 19). About The HealthyPlace TV Show Team, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/about-hptv/info/about-the-healthyplace-tv-show-team

Last Updated: January 14, 2014

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APA Reference
spignataro (2009, January 19). nbasdsf, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/tvshow/tvshow/nbasdsf

Last Updated: January 14, 2014

Family Members of the Eating Disordered Patient

For Family Members And Those Who Treat Them

Family patterns of socializing, preparing food, going out to restaurants, and just plain talking to each other are all disrupted by an eating disorder.Individuals with eating disorders directly or indirectly affect those with whom they live or who love and care about them. Family patterns of socializing, preparing food, going out to restaurants, and just plain talking to each other are all disrupted by an eating disorder. Everything from finances to vacations seems jeopardized, and the person with the eating disorder is often resented for an illness she cannot control.

A family member with an eating disorder is most likely not the only member of the family with problems. It is common to find problems with mood or behavior control in other family members, and the level of functioning and boundary setting among parents and siblings should be evaluated. In many families there is a history of excessive reliance on external achievement as an indicator of self-worth, which ultimately or repeatedly fails. Fluctuations between overinvolvement and abandonment may have been occurring for some time, leaving family members feeling lost, isolated, insecure, or rebellious, and without a sense of self.

Parents, who have their own issues both from the past and in the present, are often frustrated, fighting between themselves, and unhappy. Overinvolvement with the eating disordered child is often a first reaction in trying to gain control of an out-of-control situation. Futile attempts at control are exerted at a time when understanding and supportive direction would be more helpful.

In a marriage where one partner has an eating disorder, the spouse's concerns are often overshadowed by anger and feelings of helplessness. Spouses often report a decrease of intimacy in their relationships, sometimes describing their loved ones as preferring or choosing the eating disorder over them.

Individuals with eating disorders need help in communicating to their family members and loved ones. Family members and loved ones need help as they experience a variety of emotions, from denial and anger to panic or despair. In the book, Eating Disorders: Nutrition Therapy in the Recovery Process, by Dan and Kim Reiff, six stages that parents, spouses, and siblings go through are delineated.


STAGES OF GROWTH EXPERIENCED BY FAMILY MEMBERS AFTER BECOMING AWARE THAT A PERSON THEY LOVE HAS AN EATING DISORDER

Stage 1: Denial

Stage 2: Fear, ignorance, and panic

  • Why can't she stop?
  • What kind of treatment should he have?
  • The measure of recovery is behavior change, isn't it?
  • How do I respond to her behaviors?

Stage 3: Increasing realization of the psychological basis for the eating disorder

  • Family members question their roles in the development of the eating disorder.
  • There is increased understanding that the process of recovery takes time and that there is no quick fix.
  • Parents/spouses are increasingly involved in therapy.
  • Appropriate responses to the food- and weight-related behavior are learned.

Stage 4: Impatience/despair

  • Progress seems too slow.
  • The focus shifts from trying to change or control the person with the eating disorder to working on oneself.
  • Parents/spouses need support.
  • Anger/detachment is felt.
  • Parents/spouses let go.

Stage 5: Hope

  • Signs of progress are noticed in the person with the eating disorder and oneself.
  • It becomes possible to develop a healthier relationship with the person with the eating disorder.

Stage 6: Acceptance/peace

Family patterns of socializing, preparing food, going out to restaurants, and just plain talking to each other are all disrupted by an eating disorder.To help family and friends understand, accept, and work through all the problems a loved one with an eating disorder presents, successful treatment of eating disorders often mandates therapeutic involvement with the patient's significant others and/or family, even when the patient is no longer living at home or a dependent.

Family therapy (this term will be used to include therapy with significant others) involves the creation of a powerful therapeutic system consisting of the family members plus the therapist. Family therapy emphasizes responsibility, relationships, conflict resolution, individuation (each person's developing an individual identity), and behavior change among all family members. The therapist assumes an active and highly responsive role within this system, altering the family rules and patterns in a significant way. If the therapist appreciates the vulnerability, pain, and sense of caring within the family, he can provide initial support for all family members. Supportive, guided therapy can relieve some of the tension created by tenuous and previously disappointing family relationships.

One goal in family therapy involves helping the family learn to do what the therapist has been trained to do for the patient (i.e., empathize, understand, guide without controlling, step in when necessary, foster self-esteem, and facilitate independence). If the therapist can help the family and significant others to provide for the patient what a healing therapeutic relationship provides, the length of therapy may be reduced.

In doing family work, the patient's age and developmental status are important in outlining the course of treatment as well as highlighting the responsibility of family members. The younger the patient is, both chronologically and developmentally, the more responsibility and control the parents will have. On the other hand, patients who are developmentally more advanced require parental involvement that is more collaborative and supportive and less controlling.


SUMMARY OF IMPORTANT TASKS FOR SUCCESSFUL FAMILY THERAPY

The multidimensional task of the therapist in family therapy is extensive. The therapist must work on correcting any dysfunction occurring in the various relationships, for this may be where the underlying causal issues have partly developed or at least are sustained. Family members, spouses, and significant others need to be educated about eating disorders and, particularly, the patient's unique manifestation of symptoms. All loved ones need help in learning how to respond appropriately to various situations they will encounter. Any serious conflicts between family members, which contribute highly to the development or perpetuation of eating disorder behaviors, must be addressed.

For example, one parent may be stricter than the other and have different values, which may develop into serious confrontations over the raising of the children. Parents may need to learn how to solve conflicts between themselves and nurture each other, which will then enable them to better nurture their child. Faulty organizational structure in the family, such as too much intrusiveness on the part of the parents, too much rigidity, or fused boundary issues, must be pointed out and corrected. Expectations of family members and how they communicate and get their needs met may be underhanded and/or destructive. Individual members of the family may have problems that need to be resolved separately, such as depression or alcoholism, and the family therapist should facilitate this happening. The task of family therapy is so complex and at times overwhelming that therapists often shy away from it, preferring to work solely with individual patients. This can be a grave mistake. Whenever possible, family members and/or significant others should be a part of overall treatment.

The following is an excerpt from a session where an extremely upset father was complaining about the fact that the family had to be in therapy. He felt that there were no family problems except that his daughter, Carla, was sick. Allowing this kind of thinking is detrimental. In fact, for teens and younger patients, statistics show that family therapy is necessary for recovery.

Father: Why should I listen to this? She is the one with this disgusting sickness. She's the one screwed up in the head. She's the one who is wrong here.

Therapist: It is not a matter of right or wrong, or of blame. It is not just something wrong with Carla's personality. Carla is suffering from an illness that affects you and the rest of the family. Furthermore, there may be certain things in her development that got in the way of her being able to express her feelings or cope with stressful situations. Parents can't be blamed for creating eating disordered children, but how a family deals with feelings or anger or disappointment can have an effect on how someone turns to an eating disorder.

Yelling and punishing Carla have not worked to help resolve her problem, and in fact things have been getting worse. I need you all here if Carla is to get better, and if all of you are to get along better. When you try to force Carla to eat, she just finds a way to throw up afterward - so what you're doing isn't working. Also, everyone is angry and frustrated. For example, you disagree on things like curfew, dating, clothing, and even going to church. If you want Carla to get better and not just follow your rules, I need to help you find compromises.

The therapist creates an experience of continuity for the treatment and remains its guiding force until the family as a whole trusts both the therapist and the changes that are asked for and slowly taking place in treatment. It is important for the therapist to show patience, continuity, support, and a sense of humor within the context of optimism about the possibilities of all family members for the future. It is best if the family experiences therapy as a welcomed and desired situation that can help foster change and growth. Even though the therapist takes responsibility for the course and pacing of treatment, she can share this responsibility with family members by expecting them to identify issues for resolution and to demonstrate greater flexibility and more mutual concern.

ESTABLISHING RAPPORT AND GETTING STARTED

Families with eating disordered individuals often seem guarded, anxious, and highly vulnerable. Therapists must work at establishing rapport to make the family feel comfortable with the therapist and the therapy process. It is important to lessen the anxiety, hostility, and frustration that often permeate the first few sessions. When beginning treatment, the therapist needs to create a strong relationship with each family member and imposes himself as a boundary between individuals as well as between generations. It's important for everyone to express their feelings and viewpoint as thoroughly as possible.

It may be necessary to see each family member alone to establish a good therapeutic relationship with each one. Family members must be recognized in all their roles (i.e., the father as husband, man, father, and son; the mother as wife, woman, mother, and daughter). In order to do this, the therapist obtains background information about each family member early in treatment. Then, the therapist provides recognition of each individual's strength, caring, and passion while also identifying and elaborating on individual difficulties, weaknesses, and resentments.

If the individual family members trust the therapist, the family can come together more at ease, less defensive, and much more willing to "work" at therapy. Treatment becomes a collaborative effort where the family and therapist begin to define problems to be solved and to create shared approaches to these problems. The therapist's responsibility is to provide the proper balance between stirring up controversy and crises in order to bring about change, while at the same time making the therapeutic process safe for family members. Family therapists are like directors and need trust and cooperation in order to direct the characters. Family therapy for eating disorders, like individual therapy, is highly directive and involves a lot of "teaching style" therapy.


EDUCATING THE FAMILY

It is important to have information for family members to take home to read or at least suggestions of reading material they can buy. Much confusion and misinformation exists about eating disorders. Confusion ranges from the definitions and differences between the disorders to how serious they are, how long therapy takes, what the medical complications are, and so on. These issues will be discussed, but it is useful to give family members something to read that the therapist knows will be correct and helpful. With reading material to review, family members can be collecting information and forming questions when they are not in the session. This is important, as therapy is expensive and family therapy will most likely take place no more than once a week.

Additional sessions are usually not feasible for most families, especially since individual therapy with the patient is also ongoing. Information provided in the form of inexpensive reading material will save valuable therapy time that would otherwise be spent explaining the same information. The therapy time is better spent on other important issues, such as how the family interacts, as well as questions on and clarification of the material read. It's also comforting for family members to read that other people have been through similar experiences. Through reading about others, family members can see that there is hope for recovery and can begin to look at what issues in the reading material relate to their own situation.

Literature on eating disorders helps to validate and reinforce information the therapist will be presenting, such as the length of time therapy is going to take. The new studies indicate that recovery is possible in about 75 percent of cases but that the length of time necessary to achieve recovery is four and a half to six and a half years (Strober et al. 1997; Fichter 1997). Families may be inclined to be suspicious and wonder if the therapist is simply trying to get several years of income.

After reading various material on eating disorders, family members are more likely to understand and accept the possibility of lengthy therapy. It is important to note that the therapist should not doom a patient or her family into thinking it will absolutely take several years to recover. There are patients who have recovered in much less time, such as six or eight months, but it should be made clear that the longer time period is more likely. Being realistic about the usual lengthy time necessary for treatment is important so that family members don't have unrealistic expectations for recovery.

EXPLORING THE IMPACT OF THE ILLNESS ON THE FAMILY

It is necessary for the family therapist to assess how much the eating disorder has interfered with the feelings and functioning of the family. Is the father or mother missing work? Has everything else been put secondary to the eating disorder? Are the other children's needs and problems being neglected? Are the parents depressed or overly anxious or hostile due to the eating disorder, or were they like this before the problem started? This information helps the therapist and family begin to identify whether certain things are the cause or result of the eating disorder. Families need help learning what is appropriate behavior and how to respond (e.g., guidelines for how to minimize the influence of the eating disorder over family life).

The therapist will need to find out if other children in the family are affected. Sometimes other children are suffering silently for fear of being "another bad child" or "disappointing my parents more," or just simply because their concerns were ignored and they were never asked how they were feeling. In exploring this issue, the therapist is making therapeutic interventions from the very beginning by (1) allowing all family members to express their feelings, (2) helping the family examine and change dysfunctional patterns, (3) dealing with individual problems, and (4) simply providing an opportunity for the family to come together, talk together, and work together on solving the problem.

Reassuring family members that the eating disorder is not their fault is crucial. Family members may feel abused and perhaps even victimized by the patient and need someone to understand their feelings and see their sides. However, even though the focus stays off blame, it is important that everyone recognizes and takes responsibility for their own actions that contribute to family problems.

The therapist also addresses the quality of the patient's relationship with each of her parents and assists in developing an effective, but different, relationship with both of them. These relationships should be based on mutual respect, with opportunities for individual assertiveness and clear communication on the part of everyone involved. This depends on a more respectful and mutually supportive relationship between the parents. As treatment progresses there should be a greater ability on the part of all family members to respect each other's differences and separateness and enhanced mutual respect within the family.

Sessions should be planned to include appropriate family members according to the issues being worked on at that time. Occasionally, individual sessions for family members, sessions for one family member with the patient, or sessions for both parents may be necessary.

In situations where chronic illness and treatment failure have led to marked helplessness on the part of all family members, it is often helpful for the therapist to begin with a somewhat detached, inquisitive approach, letting the family know that this treatment will only be effective if it includes all members in an active way. The therapist can define everyone's participation in ways that are different from previous treatments and thus avoid earlier pitfalls. It is common for families who have been faced with chronic symptoms to be impatient and impulsive in their approach to the therapeutic process.

In these situations, therapists need to gently probe family relationships and the role of the eating disorder within the family, pointing out any positive adaptive functions that the eating disorder behaviors serve. This often highlights difficulties in family relationships and offers avenues for intervention in highly resistant families. In order to gain the family's participation in the desired fashion, the therapist must resist the family's attempt to get her to take full responsibility for the patient's recovery.


DISCOVERING PARENTAL EXPECTATIONS/ASPIRATIONS

What messages do the parents give the children? What pressures are on the children to be or to do certain things? Are the parents asking too much or too little, based on the age and ability of each child or simply on what is appropriate in a healthy family?

Sarah, a sixteen-year-old with anorexia nervosa, came from a nice family who had the appearance of having things very much "together." The father and mother both had good jobs, the two daughters were attractive, good in school, active, and healthy. However, there was significant conflict and constant tension between the parents regarding the disciplining of and expectations for the children.

As the eldest child got into the teenage years, where there is a normal struggle for independence and autonomy, the conflict between the parents became a war. First of all, the mother and father had different expectations regarding the daughter's behavior and found it impossible to compromise. The father saw nothing wrong with letting the girl wear the color black to school while the mother insisted that the girl was too young to wear black and would not allow it. The mother had certain standards for having a clean house and imposed them on the family even though the father felt that the standards were excessive and complained in front of the children about it. These parents didn't agree on rules regarding curfews or dating, either. Obviously this caused a great deal of friction between the parents, and their daughter, sensing a weak link, would push every issue.

Two of the problems regarding expectations addressed in this family were (a) the parent's conflicting values and aspirations, which necessitated couple therapy, and (b) the mother's excessive expectations for everyone, especially the oldest daughter, to be like herself. The mother would constantly make statements such as "If I did that when I was in school . . . ," or "I would have never said that to my mother." The mother would also overgeneralize, "all my friends . . . ," "all men . . . ," and "other kids," for validation of rightness.

What she was doing was using her past or other people she knew to justify the expectations she had for her own children instead of recognizing her children's own personalities and needs in the present. This mother was wonderful at fulfilling her motherly obligations like buying clothes, furnishing rooms, transporting her daughters to the places they needed to go, but only as long as the clothes, the room furnishings, and the places were those that she would have chosen for herself. Her heart was good, but her expectations for her children to be and think and feel like her or her "friends or sister's kids" were unrealistic and oppressive, and one way her daughter rebelled against them was through her eating disorder behavior: "Mom cannot control this."

Unrealistic expectations for achievement or independence also cause problems. Consciously or unconsciously children may get rewarded, particularly by their fathers, only for what they "do" as opposed to who they are. These children may learn to depend only on external rather than internal validation.

Children who get rewards for being self-sufficient or independent may feel afraid to ask for help or attention because they have always been praised for not needing it. These children often set their own high expectations. In our society, with the cultural standard of thinness, weight loss often becomes another perfectionistic pursuit, one more thing at which to be successful or "the best." Steven Levenkron's book, The Best Little Girl in the World, earned its title for this reason. Unfortunately, once successful at the dieting, it may be very hard to give it up. In our society, all individuals are praised by their peers and reinforced for an ability to diet. Once individuals feel so "in control," they may find they are unable to break the rules they set for themselves. The attention for being thin, even for being too thin, feels good, and too often people just do not want to give it up, at least not until they can replace it with something better.

Individuals with bulimia nervosa are usually trying to be overcontrolled with their food half the time, like anorexics, and the other half of the time they lose control and binge. Some individuals may place so many expectations on themselves to be successful and perfect at everything that their bulimic behaviors become the one area where they "go wild," "lose control," "rebel," "get away with something." The loss of control usually leads to shame and more self-imposed rules (i.e., purging or starving or other anorexic behaviors, thus starting the cycle over again).

There are several other ways in which I have seen faulty expectations contribute to the development of an eating disorder. The therapist needs to uncover these and work with the patient and the family to set realistic alternatives.

GOAL SETTING

Parents don't know what to expect from treatment or what they should be asking of their sons or daughters who are being treated. Therapists help families set realistic goals. For example, with underweight anorexics, the therapist helps the parents to expect that weight gain will take time, and when it begins, no more than a steady, slow weight gain of as little as one pound per week should be expected. In order to meet the weekly weight goal, parents (depending on the patient's age) are usually advised to provide various foods but avoid power struggles by leaving the issue of determining what and how much to eat up to the patient and therapist or dietitian. Setting goals in a family session helps guide parents in assisting their sons or daughters to meet weight goals while limiting the parents' intrusiveness and ineffective attempts to control food intake. An agreement will also need to be made regarding an appropriate, realistic response should lack of weight gain occur.

An example of goal setting for bulimia would be symptom reduction, as there may be an expectation on the part of the family that, since the patient is in treatment, she should be able to stop bingeing or purging right away. Another example would be setting goals for using alternative means of responding to stress and emotional upset (without resorting to bingeing and purging). Together the therapist and family help the patient discuss goals of eating when physically hungry and managing her diet appropriately to reduce episodes of weight gain and periods of anxiety leading to purging behavior.

For bulimics and binge eaters, a first goal may be to eliminate the goal of weight loss. Weight loss considerations should be set aside while trying to reduce binge eating behavior and purgings. It is difficult to focus on both tasks at once. I point this out to patients by asking them what they will do if they overeat; since when weight loss and overcoming bulimia are simultaneous goals. If stopping bulimia is a priority, you will deal with having eaten the food. If weight loss is a priority, chances are you will purge it.

The usual focus on the need to lose weight may be a big factor in sustaining the binge eating, since bingeing often precedes restrictive dieting. For a further discussion of this, refer to chapter 13, "Nutrition Education and Therapy."


ROLE OF THE PATIENT IN THE FAMILY

A family therapist learns to look for a reason or adaptive function that a certain "destructive" or "inappropriate" behavior serves in the family system. This "functional" behavior may be acted out on an unconscious level. Research on families of alcoholics or drug abusers have identified various roles that the children take on in order to cope. I will list these various roles below, as they can be applied to working with individuals with eating disorders.

Scapegoat. In the case of parental disharmony, the eating disorder may serve as a mechanism to focus the parents' attention onto the child with the eating disorder and away from their own problems. In this way the parents can actually work together on something, their son or daughter's eating disorder. This child is the scapegoat for the family pain and may often end up feeling hostile and aggressive, having learned to get attention negatively.

Often, as an eating disordered patient begins to get better, the relationship between her parents gets worse. When not sick herself, she ceases to provide her parents with a distraction from their own unhappy lives. This certainly must be pointed out, however carefully, and dealt with in therapy.

The Caretaker or Family Hero. This is the child who takes on too much responsibility and becomes the perfectionist and overachiever. As mentioned under the issue of parental expectations, this child puts the needs of others first. An anorexic is often the child who "never gave us any problems." "She was always so good, we never had to worry or concern ourselves about her."

There is a careful and gentle technique to uncovering and confronting these issues in a family. Yes, the parents need to see if their child has become the caretaker, but they need to know what to do about it and they need to not feel guilty about the past. In this case, they can learn to take more responsibility themselves. They also can learn to communicate better with and focus more attention on the child with the eating disorder, who has been virtually ignored because she was doing so well.

A caretaker often comes from a household that has a chaotic or weak parental system - the child becomes independent and assumes too much control and self-reliance before being mature enough to handle it. She is given, or takes out of necessity, too much responsibility. The eating disorder occurs as an extension of the child's self-imposed control system. Anorexia nervosa is the ultimate form of control; bulimia nervosa is a combination of overcontrol combined with a sort of loss of control, rebellion, or at least escape from it. A bulimic controls weight by purging; forcing oneself to purge is exerting control over the binge and the body.

The Lost Child. Sometimes there is no way to overcome a combative parent or abusive family situation. Sometimes there are too many children, and the competition for attention and recognition is too tough. Whatever the reason, some kids get lost in a family. The lost child is the child who learns to cope with family pain or problems by avoidance. This child spends a lot of time alone and avoids interaction because she has learned that it is painful. She also wants to be good and not a problem. She cannot discuss her feelings and keeps everything in. Consequently, this individual's self-esteem is low. If she discovers that dieting wins approval from her peers (which it almost always does) and gives her something to be good at and talked to about, then she continues because it is reinforcing. "What else do I have?" she might say, or at least think and feel. Also, I have seen the lost child who takes comfort in night binges as a way to ease loneliness and the inability to reach out and make meaningful relationships.

The lost child who develops an eating disorder may also discover a sense of power in having some effect on the family. This power is hard to give up. Even though she really may not want to cause family problems, her new special identity is too hard to surrender. It may be the first real one she has had. Some patients, who are conflicted about desperately wanting their disorder but desperately not wanting to cause the family pain, often tell me or write in their journals that they think it would be better if they were dead.

ANALYZING AND ADJUSTING THE ORGANIZATIONAL STRUCTURE OF THE FAMILY

Looking at the family structure can help tie all the other components together. This is the family's system for working. Each family has rules its members live or function by that are unspoken. These rules concern such things as "what can and cannot be talked about in this family," "who sides with whom in this family," "conflicts are solved in this way," and so on. Family structure and organization is explored to answer the question, "What makes it necessary for the patient to go to the extreme of having an eating disorder?"

What are the boundaries that exist in the family? For example, when does the mother stop and the child begin? Much of the early focus in family treatment for eating disorders was on the mother and her overintrusiveness and inability to separate herself from her child. In this scenario the mother dotes on the child but also wants to be in on every decision, feeling, or thought the child has. The mother feels that she has been nurturing and giving and expects it all back from the child, wanting the child to be a certain way because of it. There is also the overpleasing mother who is emotionally weak and is afraid of the child's rejection, so she tends to let the child be in charge. The child is in charge too soon to be able to handle it, and inside actually resents that the mother did not help her enough.

Marta, a twenty-three-year-old bulimic, came to therapy after her mother, with whom she was still living, called for an appointment. Although the mother wanted to come to the first session, Marta insisted on coming alone. In the first visit, she told me that she had been bingeing and purging for five years and that her mother had not said anything to her until a few days before the phone call to me. Marta described how her mother "came into the bathroom when I was throwing up and asked me if I was making myself sick. I thought, 'Thank God, I will now get some help.' " Marta went on to describe her reluctance to share things with her mother: "Whenever I have a problem she cries, breaks down, and falls apart and then I have to take care of her!" One obvious issue in this family was for the mother to become stronger, allowing the daughter to express her needs and not have to be the parentified child.


One sixteen-year-old bulimic, Donna, and her mother Adrienne alternated between being best friends and sleeping in the same bed together, staying up late to talk about boys, to having fist- and hair-pulling fights when Donna did not do her homework or her chores. The mother in this family gave a lot but demanded too much in return. Adrienne wanted Donna to wear the kind of clothes she wanted, date the boys she approved of, and even go on a diet her way. In wanting to be best friends and expecting her daughter to be a best friend yet still obey her as a parent, Adrienne was sending mixed messages to her daughter.

Mothers who get overly invested in getting their needs met from their daughters get uncontrollably upset when their daughters don't react in the "right" way. This same issue may very well exist in the marriage relationship. With Adrienne, this was one factor in breaking up the marriage. The father was not living at home when Donna came into treatment. The end of the marriage had made the mother even more dependent on Donna for her emotional satisfaction, and the fighting was a result of her daughter not giving it to her. Donna felt abandoned by her father. He had left her there to take care of her mother and to fight with her, and he had not stayed to help her out in this situation.

Donna's bulimia was, in part, her struggle to get back at her mother by having something about which her mother could do nothing. It was a call for help, a plea for someone to pay attention to how unhappy she was. It was a struggle to escape a reality where she could not seem to please herself and her mother at the same time. If she pleased her mother, she wasn't happy, and vice versa. Her bulimic behaviors were a way of trying to get control over herself and make herself fit into what she considered the standards for beauty so that she would be accepted and loved, something she did not feel from either of her parents.

One aspect of Donna's treatment was to show her how her bulimia was not serving any of the purposes she consciously or unconsciously wanted it to serve. We discussed all the above aspects of her relationship to her family and how she needed to make it different, but that her bulimic behavior was just making it all worse. Not only was bulimia not helping solve her underlying issues, it wasn't even helping her to be thin, which is true for almost all bulimics as the bingeing gets further and further out of control.

Other ways of dealing with dieting and the family have to be explored. In Donna's case this involved family participation with both the mother and the father. Progress was made when the mother and father discussed their own problems. Solving them helped lead to the solution of the mother-daughter issues (for example, the mother's expectations and demands). Donna benefited greatly from the knowledge of her parents' role in her feelings and thus her behavior. She began to see herself with more self-worth and to see the futility of her bulimia.

Even though early researchers focused on mothers and mothering, over the last few years there has been more emphasis on the role of fathers in the development of eating disorders. One issue where the effect of the father's role has been discussed is when a father applies his sense of values, achievement, and control to areas where they are misinterpreted or misused. For example, achievement and control should not be values to strive for in the area of weight, body image, and food.

Although children are more biologically dependent on their mothers from birth, fathers can provide the traditional role of being "outside representative" while also offering a non-threatening transition from the natural dependency on the mother. The father can help his daughter confirm her own separateness, enhancing her sense of self. As stated by Kathryn Zerbe in The Body Betrayed, "When a father is unable to help his daughter move out of the maternal orbit, either because he is physically unavailable or not invested emotionally in her, the daughter may turn to food as a substitute. Anorexia and bulimia nervosa have in common inadequate paternal responses for helping the daughter develop a less symbiotic relationship with her mother. When she must separate on her own, she may take on the pathological coping strategies embedded in eating disorders."

Literature on fathers and eating disorders is scarce. Father Hunger by Margo Maine and "Daddy's Girl" a chapter in my book Your Dieting Daughter, both address this too little discussed but important topic. See Appendix B for more information. Other issues in the family structure involve how rigid or flexible the family is and the effectiveness of members' overall communication skills. The therapist needs to explore all the various kinds of communication that exist. Effective teaching on how to communicate is very beneficial to all families. Communication skills affect how families resolve their conflicts and who sides with whom on what issues.

ADDRESSING ABUSE ISSUES

Numerous studies have documented a correlation between eating disorders and a history of physical and/or sexual abuse. Although one study by the Rader Institute on sexual abuse and eating disorder inpatients reported a correlation of 80 percent, most research seems to indicate a much lower rate. It is important to understand that the association is not a simple cause-and-effect relationship. Abuse does not cause an eating disorder but can be one of many contributing factors. Both physical and sexual abuse are boundary violations of the body, thus it makes sense that abused individuals manifest both psychological and physical symptoms including problems with eating, weight, and body image.

Both therapist and family therapist should explore family histories by asking very specific questions regarding any abuse. Individuals who are abused are reluctant to reveal it or perhaps have no recollection of the abuse. Perpetrators of the abuse are, of course, reluctant to admit it. Therefore, therapists must be well trained and experienced in these matters, paying heed to signs and symptoms of possible abuse that need further exploration.


CHALLENGING CURRENT PATTERNS

Whatever is going on, family members will usually at least agree that what they are presently doing is not working. Coming for help means they haven't been able to solve the problem on their own. If they have not already tried several solutions, they at least agree that something in the family is not working correctly and they can't or don't know how to fix it.

Usually the family is trying to do all the things they are sure will help because they have helped before in other circumstances. Many of the standard approaches used with other problems or with other children are inappropriate and simply don't work with the eating disordered child. Grounding, threatening, taking away privileges, rewarding, and so on will not resolve an eating disorder. Taking the eating disordered patient to the family doctor and having all the medical consequences explained to her doesn't work either, nor will planning a diet or guarding the bathroom.

Parents usually have a hard time stopping their own monitoring, punishing, rewarding, and other controlling behaviors in which they are engaging to try to stop the eating disorder even though those methods don't seem to be doing any good. Often many of the methods used to prevent behaviors actually serve to sustain them. Examples of this are: Father yells and screams about the daughter's eating disorder ruining the family, and the daughter's reaction is to go and throw up. The more control a mother exerts over her daughter's life, the more control the daughter exerts with her eating disorder. The more demands for weight gain are made, the thinner the individual gets. If yelling, grounding, threatening, or other punishments worked to control an eating disorder, that would be different - but they don't work, and so there is no use in continuing them.

One night early in my career as an eating disorder therapist, I was in a family session when this useful analogy came to me. The father of Candy, a sixteen-year-old anorexic, was attacking her about being anorexic, harassing her, and demanding that she "stop it." The attacks had been going on for weeks prior to their seeking therapy. It was clear that the more attacking the father did, the worse Candy got. The attacking provided distraction for her; thus, she didn't have to face or deal with the real underlying psychological issues that were at the root of her eating disorder. Most of our sessions dealt with the combat that was going on with her father and her mother's ineffectiveness. We were spending most of our time repairing damage that resulted from her parents' attacks concerning what their daughter was or wasn't eating, how much she weighed, why she was doing so and so, and how she was harming the family. Some of these arguments at home ended up in hair-pulling or slapping sessions.

The family was falling apart, and, in fact, the more Candy argued with her parents, the more entrenched she became in her disorder. It was clear from watching Candy that the more she had to defend her position, the more she believed in it herself. It was clear that while being attacked by others, she was distracted from the real issues and had no time to really go inside herself and "clean house" or, in other words, really look inside and deal with her problems. In the middle of more complaints by Candy's father, I thought of the analogy and I said, "While you are guarding the fort, you don't have time to clean house," and then I explained what I meant.

It is important to leave the individual with an eating disorder free from any outside attacks. If the person is too busy guarding themselves against outside intrusion, they will have too much distraction and spend no time going inside themselves and really looking at and working on their own issues. Who has time to work on themselves if they are busy fighting off others? This analogy helped Candy's father see how his behavior was actually making things worse and helped Candy be able to look at her own problem. Candy's father learned a valuable lesson and went on to share this with other parents in a multifamily group.

MULTIFAMILY GROUP

A variation on family therapy involves several families/significant others who have a loved one with an eating disorder meeting together in one large group called a multifamily group. It is a valuable experience for loved ones to see how other people deal with various situations and feelings. It is good for parents, and often less threatening, to listen to and communicate with a daughter or son from another family. It is sometimes easier to listen, be sympathetic, and truly understand when hearing someone else's daughter or son describe problems with eating, fear of weight gain, or what helps versus what sabotages recovery. Patients also can often listen better to what other parents or significant others have to say because they feel too angry or threatened and many times shut out those close to them. Furthermore, siblings can talk to siblings, fathers to other fathers, spouses to other spouses, improving communication and understanding as well as getting support for themselves. Multifamily group needs a skilled therapist and perhaps even two therapists. It's rare to find this challenging but very rewarding type of group in settings other than formal treatment programs. It might prove very useful if more therapists would add this component to their outpatient services.

Family therapists must be careful that no one feels overly blamed. Parents at times feel threatened and annoyed that they are having to change when it is their daughter or son who is "sick and has the problem." Even if family members refuse, are unable, or it is contraindicated for them to attend sessions, family therapy can still occur without them present. Therapists can explore all the various family issues, discover the family roles in the illness, and change family dynamics when working solely with the eating disordered patient. However, when the patient still lives at home, it is essential to have the family come to sessions unless the family is so nonsupportive, hostile, or emotionally troubled as to be counterproductive. In this case, individual therapy and possibly group therapy may very well be enough. In some cases, other arrangements can be made for the family members to get therapy elsewhere. It may be better if the patient has her own individual therapist and some other therapist does the family work.

Treatment for eating disorders, including family therapy, is not a short-term process. There are no magic cures or strategies. Termination of treatment can occur at different times for different family subsystems. When the patient and the entire family are functioning effectively, follow-up sessions are often helpful in assisting family members to experience their own resources in dealing with stresses and transitions. Ultimately, the goal is to create an environment in which the eating disorder behavior is no longer necessary.

It should be noted that although family involvement in the treatment of those with eating disorders, particularly young people, is considered vital, it is not sufficient by itself to produce lasting changes in family members or a lasting cure. Neither will the absence of family involvement doom the eating disordered individual to a lifelong illness. In some instances, family members and loved ones may not be interested in participating in family therapy or their involvement may cause more unnecessary or unresolvable problems than if they were not involved. It is not uncommon to find family members or loved ones who feel that the problem belongs solely to the person with the eating disorder and that, as soon as she is "fixed" and back to normal, things will be fine. In some cases the removal of the eating disordered person from her family or loved ones is the indicated treatment, rather than including the significant others in the therapy process. Each therapist will have to assess the patient and the family and determine the best, most effective way to proceed.

By Carolyn Costin, MA, M.Ed., MFCC - Medical Reference from "The Eating Disorders Sourcebook"

next: Helping a Friend with an Eating Disorder
~ eating disorders library
~ all articles on eating disorders

APA Reference
Staff, H. (2009, January 18). Family Members of the Eating Disordered Patient, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/eating-disorders/articles/family-members-of-the-eating-disordered-patient

Last Updated: January 14, 2014

A Place to Start Healing

Having a healthy sense of detachment is the working foundation for an intimate relationship.

We heal in relationship with ourselves and with others.

Being aware of my mother's moods was significant to my survival. Read my Addictions Recovery Guide. For children of addict parents.Detachment is the first skill to learn to heal. Being aware of my mother's moods and actions was significant to my survival. I no longer need this skill. However, the skill I learned had a trade off. I traded the awareness of myself (my identity) in exchange for the awareness of my mother's moods and actions. I had no awareness or identity of myself so I learned how to attach myself to the things and people in my life in order to assume an identity. I used the things and people in my environment to decide about how I am to think about myself and who I am (external referencing for self awareness and identity). The definition of who I am had become dependent on external factors rather than internal factors. It's time to trade back.

The Rewards of Detachment

  • Learning how to live without the need to create chaos.
  • Learning how to become self aware and self defined.
  • Learning how to care for myself in nurturing ways.
  • Learning how to cope with addicts without being an object of addiction.
  • Learning self acceptance and the acceptance of other people or events.

Below are some lessons to practice in order to learn the skill of detachment. Any lesson may be practiced by itself or in combination with other lessons. Go slow. Go easy.

The Lessons

  1. Stop analyzing.
  2. Stop interpreting.
  3. Stop explaining.
  4. Stop looking for answers.
  5. Allow other people to have a "belief system" separate from my own.
  6. Stop "rescuing" other people from their shortcomings or problems.
  7. Control as competition.
  8. Listen in a way that allows me to take "a vacation" from what is being said.
  9. Hang up the phone.
  10. Walk away.
  11. Keep in mind that the perceptions I have are going to differ from the perceptions that other people have.
  12. What I say is good enough the first time it comes out of my mouth.
  13. Ask for clarification.
  14. Build an "inner authority."
  15. Keep in mind that people do the best they can at the moment.
  16. When the object is an object (not a person).
  17. Behave in a way that says to the outside world, and to myself, that I have value.
  18. Non-Fishing for approval.
  19. Recognize what "other-oriented" feels like.
  20. Recognize the "addictive pull."
  21. Living in the present.
  22. Spending time alone.
  23. Acceptance as a way to extradite chaos.
  24. Allowing myself to feel bad.
  25. When I talk to expel stress, I talk for myself and not for the audience.

Stop Analyzing

Stop analyzing means to relax. By trying to figure it out, whatever it is, I compulsively keep myself busy with activity in my head. I no longer claim serenity when I'm analyzing. Analyzing is a way for me to create chaos and maintain terror in my head. Chaos is a way for me to continue to terrorize myself.


Stop interpreting

Stop interpreting means to give up "stories." This is another activity that is designed to keep me busy in my head. By creating stories about something that has happened, or is happening, I create chaos in my head. The chaos is designed to maintain a level of terror for myself. Terror has become so normal, that to me, the lack of it feels terrorizing.

If I choose to interpret something that has happened, or is happening, I try to start with the phrase, "The story in my head is . . . . . ." Sometimes I have fun with this lesson by making up an outrageous story. Creating humor for myself is healthier than creating terror for myself.

Another way to stop interpreting is to check it out. When I need to stop creating chaos around a situation that I think is bothering me, I check it out. When I'm interpreting something that has happened and I need to know without guessing, as a way to acknowledge and affirm what I feel, I check it out. As an example, when I have an impression that someone is angry with me, I say, "Are you angry with me?" Without controlling or being controlled by the other person, I ask in a way to affirm and nurture what I feel or believe. Whatever the situation, I ask as a way to affirm, comfort, and nurture myself, "I feel like you are . . . . . . . ." "Are you . . . . . . . .?," to check it out.

Stop explaining

Stop explaining means:

- Stop over-explaining.

- Explaining when no explanation was asked for.

- Explaining as a response to hostile questions.

Over-explaining is saying the same thing over and over in different words as a way to create chaos and terror for myself. Over-explaining may be offering an entire dictionary when only a single definition was asked for. Over-explaining is a type of approval seeking; "Is what I say acceptable to you? I need your acceptance to feel safe so I'll continue to explain until I feel accepted and safe enough (acceptable to you)." When I start to feel anxious about what I'm saying as I'm explaining myself, chances are that I'm over explaining without realizing it. This is the time to catch myself and nurture the anxiety.

Explaining when no explanation was asked for, is when I react to something someone has observed. I feel like I'm "on the spot" in response to someone else's observation. As example, someone might say to me, "It sounds like you have a cold." In reaction to this observation I might find myself explaining the entire history of colds and how I got mine. If I were to look back at what was said, I see that the observation was not a question. It was an observation. My reaction to this observation was as if the person had stated a question like, "How did you get your cold and tell me how to avoid one and while your at it, could you explain the history of colds to me." I practice responding to observations by nodding my head or saying, "Hum-m" and wait for an observation to become a question before answering.

Explaining as a response to a hostile question, means to answer a question that was asked as a way to shame and not to gather information. Examples of questions that are hostile (attacks) and are not being asked to gather information are:

(said from an angry victimstance)

  • "Why did you do that!"
  • "How come you always do that!"
  • "How come you did that!"
  • "How come you're always late!"
  • "How come you didn't do this!"
  • "You're just doing this to piss me off aren't you!"

What sounds like a question is not a question. The question is actually a hostile remark designed to attack and shame. One way to respond to an attack like this is for me to say, "I don't know." And I continue to say it until it is accepted, or I walk away (hang up, etc).

Stop looking for answers

Stop looking for answers means to accept that:

- Not knowing something is ok.

- Not knowing something does not mean I'm defective.

- I don't need to know everything as a way to compulsively meet someone else's needs or gain their approval.

Saying to myself, "I don't know anything and I don't need to know" is a free-ing experience. This takes the pressure off myself by reducing the chaos and terror of having to know everything. Having to have all the answers is a weighty responsibility. It's designed to create chaos and maintain a level of terror. By looking for answers I don't have, I terrorize myself for not knowing the answer.


Allowing other people to have a belief system separate from my own

Allowing other people to have a belief system separate from my own may also keep me out of chaos and terror. When my young son looks up in the sky, points at a group of clouds and says, "Look daddy . . . . its a dog!," I don't need to create chaos for myself by discounting his belief system. By saying to him, "No son . . . . . . its just clouds," I create chaos for myself and discount him at the same time. He believes the clouds to look like dogs. He has a right to experience clouds (his life) in his own way.

When my spouse says to me, "I think you are golfing too much," I don't need to create chaos for myself by discounting or minimizing her belief system. By saying something like, "Your crazy or No way," I create the opportunity for chaos and terror to occur for myself and discount or minimize her at the same time. She believes I'm golfing too much. The point is not whether I am, or am not golfing too much. The point is that she believes that I am. I may respect her beliefs without agreeing with them. I don't need to create chaos by trying to gain her approval, i.e. convincing her that my golfing is not too much and that it ought to be ok with her. I may respect her belief system without agreeing with it or creating chaos in a compulsive way for myself. I do this by saying, "I didn't know you felt like that," or "I'm sad you feel that way," and stop there. Acknowledging her belief system is all that I need do. I need not change it, change her, or change myself.

Stop "rescuing" other people from their shortcomings or problems

Stop "rescuing" other people from their shortcomings or problems means to allow people the dignity to find their own way. Some examples of rescuing would be:

  • Filling in the blanks for someone who is stuck looking for a word (in a conversation I'm having with them).
  • Anticipating a need I perceive them to have and acting on it. Each person is responsible for asking for their needs to be met. The only exceptions would be those who are incapable of asking, such as an infant, someone who is unconscious, or someone impaired with a disability and unable to verbalize their needs.
  • Analyzing a problem someone has told me about in order to solve it for them without being asked if I would.
  • Reading minds or interpreting cues, body language, and other non-verbal communication; then using that information as the basis for a response to that person, instead of allowing that person to ask directly for what they need.
  • Helping as approval seeking.

These activities as well as all destructive control activities are designed to create chaos and maintain terror; and addicts are said to be addicted to excitement (chaos and terror). The excitement is two-fold:

Creating Chaos in order to Maintain a level of Terror which feels secure (a childhood norm) and, Creating Chaos to Avoid Feeling

The key to detaching from the need to rescue is to wait until I've been asked for help. However, I need to keep in mind that people ask in awkward and unclear ways for help. People do the best that they can at the moment and people do what they think they need to do to take care of themselves. Unfortunately, their behavior may also result in miscommunication (or the lack of it).

I can choose to ask for clarification if I think someone is trying to solicit my help, but hasn't actually said:

  • "I need your help."
  • "Will you help me?"
  • "May I have your help for a minute?"

The word "help" is the common link in each phrase. I need to listen for the word help before I react, even though it may be painfully clear to me what needs to be done or said. In this way I allow people the dignity and love to find their own way. I can also detach when I feel the need to rescue by stating,

  • "I feel helpless when this happens."
  • "I don't know what to say."
  • "I wish I could help."
  • Or any other statement that doesn't state things like, "Here's how to do that." or "Let me tell you how to fix that".

Control as competition

I don't need to compulsively compete in a conversation in way that creates chaos for myself. I don't need to compulsively compete driving my car in a way that creates chaos for myself. I don't need to compulsively compete to create chaos as a way to maintain terror in myself.

One of the ways I continue to create chaos for myself is in competition. This is different than healthy competition. The competition I'm referring to is the need to win or the compulsion to win. As an example:

In conversation, when someone relates a story to me, as a way to create chaos for myself I compulsively compete with them by adding to their story, relating a bigger or better story, or in some way discount their story. I'm sabotaging the other person's story in a way to compete, create chaos, and maintain terror.


Another way people compete in conversation is by playing the "Ain't it Awful" game. It is a conversation style that competes for gloominess. The object of the game is to expel as many stories about gloom as possible. And the winner controls the attention of the other players. The game creates a sense of depressing weight or chaos in the room.

Gossip is a form of playing the "Ain't awful game" where the speaker relates a story that does not pertain to themselves, i.e. "Did you hear about so-and-so . . . . ?" or "Isn't awful about what happened to . . . . .?"

When I'm driving I create chaos for myself by compulsively competing for position; either with another car, or for a relative position at the stop light. I do the same thing in a line at the store or at the movie. In some cases I compete as a reaction to feeling impatient or insufficient. When I feel helpless (feel trapped) I feel myself becoming impatient (angry and scared). At these times my compulsion is most noticeable, i.e. long lines, credit checks, cashing a check, taking a test, going to an unfamiliar place, heavy traffic, being in a crowded room of unfamiliar people. The feeling to compulsively compete is not competing in a way that's healthy for myself. What I need to consider is that creating chaos, within the context of competition, may have become so impulsive that it feels comfortable to do. Achieving an old sense of chaotic normalcy may be a reason why I create chaos in order to terrorize myself.

Listen in a way that allows me to take "a vacation" from what is being said

When I listen I notice that sometimes I listen as if I am receiving instructions on how to:

Keep the World from Ending Tomorrow

It keeps me in my terror to listen that intensely. When I find myself listening that intently, I try to go on vacation intermittently throughout the conversation. If someone is talking as a way to "expel" something that is bothering them, I need only be present physically. "Expel" is a way to release stress covered in section II. If the conversation is by phone I need only to be quiet. Allowing myself to become so involved in what is being said that I lose a sense of myself in the conversation is not healthy for me.

It is not necessary for me to react to what is being said. I may listen, nod, make sounds that acknowledge I'm listening, without becoming reactive to every word. Occasionally I might ask a question, knowing ahead of time that I needn't solve anything. It's not my job to look for another person's solutions when they are speaking aloud to clear their thought processes. Not only that, but it insults the speaker's own intuitive abilities to solve their problems from within themselves.

Some of the things I do on vacation is:

  • Silently play or hum a melody in my head.
  • Think of something separate from the conversation.
  • Sketch or doodle on paper.
  • Focus on something on the wall.
  • Focus on their eyebrows.
  • Say something to myself like, "It's neat that they chose me to talk to."

What ever I do it would serve to separate myself from the conversation if I feel myself being intense about listening. It's an old childhood defense mechanism to listen intensely.

Another way to vacation from what is being said is by not analyzing, not interpreting, not solving, or not taking an inventory. When words feel loaded or weighted down with hidden agenda's, I may refuse to accept the information except at face value (or face word value). That means to accept the words they say as what they mean without reading between the lines. Reading between the lines invites chaos. I am not responsible for doing the extra work of interpreting for someone else. If they need a professional interpreter, let them hire someone else. I don't need the chaos.

The following (4) listening situations are places for me to practice going on vacation even more than in other situations. When I am in these situations I'll notice the weight in the room (there will be a heaviness in the air). I'll feel weighted down. I'll feel compelled to try distance myself, fight, or run away. I'll notice myself thinking of trying to use destructive control behaviors or becoming compulsive.

Situation 1

The Victim

The conversation will feel like the speaker has been victimized by another person's behavior or a situation. They will be venting anger, frustrations, and hidden resentments. They will be soliciting any help they can get, usually in a very chaotic or hidden way, as a way to gather support for their victimization. They won't be sharing feelings directly about "how helpless they feel" in regards to not being able to change something or someone. They will share indirectly as a way to distance themselves from the listener and project their victimization onto someone else (including the listener). They will talk and complain about things like:

  • How come the other person (the one the speaker is complaining about), is doing what they are doing.
  • How come the other person (the one the speaker is complaining about), isn't doing what the speaker thinks they should be doing.
  • How come the other person won't change.
  • How come the other person is so inadequate.
  • How come they (the speaker in this case), are the only one in the world that feels like this and why can't anybody see that.
  • How come the job is, the boss is, the wife, the husband, the friend, the service, etc. is so inadequate.

 


What ever wording the speaker uses, it will always sound like: "I've been victimized by another person's behavior or some situation which is unfair. If only they would change, or it would change, I could lead a happier life. I can't do anything about my life because they (the objects of their addiction) are preventing me from doing so. Can't you see I'm helpless?"

In my own case, when I speak as a victim, it's usually because I don't feel good about myself when I'm in close contact with the one I'm complaining about.

Situation 2

Approval Seeker

The conversation will feel like the speaker is either gathering support for an opinion, thought, or feeling they are having, or the conversation will feel like the speaker is sharing information in order to gain approval without asking for it. The goal of getting my approval will be hidden in the language use; however the pull and the weightiness will be present. They may talk about things like:

How knowledgeable they are.

  • Aren't you impressed? *
  • Here's how to fix that.
  • Let me explain, explain, explain, explain, and explain (out of terror or shame; let me get your approval). *
  • I'm sure you're thinking . . . . . . . *
  • You're probably thinking . . . . . Right? Right? *
  • You probably think this is dumb, stupid, silly, queer, weird, bad, but . . . . . . . . .*

* Hidden: Affirm me, affirm what I say, I need to use you to affirm myself.

Or these examples: The information will feel like a question without being asked in the form of a question. The influx in their voice will make a statement sound like a question.

  • "Red is good?" (instead of, "I need to know if you think red is good")
  • "People just do things to get attention?" (instead of, "I need to know if you think people do things just to get attention")
  • "My dress is ok?" (instead of, "I need to know if you like my dress")
  • "I'm sure you're thinking . . . " (instead of, "I need to know if you think . . .")
  • "You probably think this is dumb, stupid, silly, queer, weird, bad, but . . . . . . "

However the statement is presented, it will feel like a question. There will be a pull for me to try and respond to a statement that is not a question.

In my own case, when I speak as an approval seeker, It's usually in the form of issuing statements to the listeners for review, without telling them that I'm asking for a review, then waiting to see if anyone affirms the statements I've made. It's a type of "fishing" for approval.

Situation 3

Ain't it Awful

The conversation will feel like the speaker is trying to converse with me in a way that says, "Let's talk about things that are awful." It's a conversation game that requires the participants to engage in relating to each other by sharing stories of calamity and chaos. They will be soliciting my help and support in order to continue the game. The stories of calamity and chaos usually start with phrases like:

  • "Did you hear . . . . . . . . . . ?"
  • "It said on the news that . . . . . . ."
  • "Don't you just hate . . . . . . . . ?"
  • "Last week I heard that . . . . . . . ."
  • "You know Mr., Ms. _________ is having . . . . . . . ."
  • "You did what?. . . oh you'd better think about that.* I heard so- and- so had the same problem and they did . . .

Whichever phrases are used, they will have one thing in common: " The relating of calamity or chaos."

* Hidden:"You'd better not do what you're thinking of doing because I know what's best for you and you're about to screw up."

Situation 4

Chaos for the sake of chaos

The conversation will feel like no matter what I respond with or how I listen, the speaker compulsively engages in soliciting another response from me. It will be like the speaker is engaged in fighting for the sake of fighting with no resolution. It's a set up. The speaker will bait me into responding. And when I respond, they will bait me again into responding. There is no resolution.

They will ask for my opinion only as a way to react to it. The game is to keep the conversation going on in conflict. I'm able to tell when I'm in this type of listening situation because I feel like punching the speaker in the face or run away screaming. I can choose not to create chaos, by choosing not to participate. A conversation designed to create chaos, and discount my feelings, opinions, and thoughts at the same time, is not the kind of conversation I choose to participate in.

In my own case, when I speak to create chaos it is usually in the form of baiting someone into an opinion, then attacking the opinion. It's a way of attacking their belief system after I've suggested to them that I'd like to know what it is they believe.


Chaos for chaos includes "Hide and Seek." Hide and Seek is a conversation style where the speaker hides and the listener seeks. It's another set up. The speaker will engage in the conversation in a limited fashion in order to bait the listener into coming back for clarity. The speaker will offer information, but not enough for the listener to participate in the conversation. In this way the speaker hooks and baits the listener into coming back for more. Then when the listener comes back (by asking questions in order to participate) the speaker withdraws, leaving the listener frustrated or as if they have done something improper or not asked the right questions. Clarity will be void in this kind of conversation. Metaphors or similes may or may not be used extensively by the speaker in order to maintain a level of obscureness (which baits the listener into asking for clarity). When I'm feeling hooked, helpless, and unable to participate in the conversation, I'm most likely engaged in a game of Hide and Seek. "It's a distorted type of come-rescue-me game or a self-fulfilling-prophecy game, i.e. I believe myself to be inadequate so I'll converse in an inadequate (vacant of info) way so that the listener will react and respond (probe to fill in the missing info) to affirm the perception I have of myself."

In almost all listening situations I can choose to be in or out of chaos . I can choose to vacation from a conversation as I need to, in order to stay out of creating chaos. I may choose to participate in the chaos and know that I am there. I can choose.

I may also choose to create chaos for fun. Sometimes I see that the situation I'm in is the "Ain't it Awful" game; and I choose to play. I can choose to make up some totally outrageous "Ain't it Awfuls" and play (this is another way I vacation as I listen).

Conversations that are intimate will not feel like a hidden agenda, or pull, is occurring. Intimate conversations feel like: action on my part is not required. I will not feel attacked or like I need to detach. The information feels direct and clean. I will feel like moving toward the person who is sharing. That is to say I will not feel like running away from them, discounting them, or punching them out.

Hang up the phone

When ever a conversation becomes abusive or painful to listen to, I hang up the phone. If the information I'm choosing to listen to, makes me ill as I listen, I excuse myself and hang up. I lie if I need to, but I need to get off the phone. People who care about me will respect my right to take care of myself.

Walk away

When ever a conversation becomes abusive or painful to listen to, I walk away. If the information I'm choosing to listen to, makes me ill as I listen, I excuse myself and walk away. I lie if I need to, but I need to walk away. People who care about me will respect my right to take care of myself.

Keep in mind that the perceptions I have are going to differ from the perceptions that other people have

My perceptions are uniquely my own. How I experience my life from inside my body is uniquely my own experience. The perceptions I have of myself are different than the perceptions that other people have of me. The perception I have of someone else is different than the perception they have of themselves.

Occasionally someone will choose to "take my inventory." If I allow them to have their own perception, I may choose those parts of the information which I consider to be kind and nurturing. The rest I discard or walk away from.

Words, which are descriptive judgements, are "concepts" open for interpretation or debate. Concepts are open for debate because they are given definition by the user or users perception(s) of the word describing the concept. Words are a way to summarize a concept. When I hear judgmental words of description which summarize a concept, I quitely say in head, "What's that mean? I have no idea what that means," immediately after I hear the word. It's a way for me to detach from and remove power from words which are summary-concepts that judge; especially if the words are used in a non-nurturing way or were used in a non-nurturing way when I was a child. Groups of people give meanings to words.

Which group did I first hear the use of the word and was it in a nurturing way? Each person has a list of judgmental words which is unique to them. Some of the words on my list of non-nurturing and judgmental word concepts are: selfish, grow-up, inappropriate, smart, talented, good-looking, femme, irresponsible, late, wrong, still-dirty, that's terrible, that's a terrible thing to do, stuck-up, half-assed, smart ass, conceited, queer, stupid, behave, weird, that's a strange thing to do, messy. When I find myself responding uncomfortably to a word, I use the "What's that mean?" technique to detach. I need not listen closely, hypervigilantly, on guard, or in a way to analyze each word in order to make a decision about whether or not to detach. I need only detach from words that trigger me or produce a response in me that makes me uncomfortable to listen to. Is the word being used to be unkind? I trust myself to decide which words, in the group I am presently in, are being used to be unkind. This is another part of "Present Moment Living" discussed later in this section.

What I say is good enough the first time it comes out of my mouth

On occasion, someone will respond to me in a way that leads me to feel like they don't believe what I've said or that what I've said was not good enough. As an example: Say I share something about myself like, "It scares me to drive fast." And the response by the listener is something like, "How come?," or "What do you mean?," or "Don't you think if you just _____________, you wouldn't be scared?"

By remembering that what I said was good enough the first time I said it, I respond by restating the same thing again. "It scares me to drive fast." I continue to repeat the same thing as long as they continue to imply that I need to elaborate or improve on my original statement.


Ask for clarification

Mixed messages are common in the use of language. The same words may be verbalized in many different ways to alter the meaning. When someone says something that makes me wonder: "What are you trying to say?," a mixed message has occurred. Examples would be:

  • Someone smiling at me while they are saying "You really piss me off."
  • Someone laughing while they are talking about something sad.
  • Someone frowning as they are saying "I really like this."
  • Someone using sarcasm or odd facial expressions to discredit what they've just said.

Another mixed message, which is harder to understand, is the message which is open for debate. What does the word "trust" mean? The word trust means something different to me than it does for someone else. What does the word "commitment" mean? What does the word "cold" mean? What does the phrase "too salty" mean? When someone says, "This is a good book," what criteria are they using for the word "good." How about when someone says, "He or She is a jerk or an ass-hole." What constitutes being a jerk or an ass-hole?

Words are symbols that people use to communicate. Each word has a symbolic meaning. The meaning of each symbol is defined by the person using the symbol. Imagine asking a house painter to paint your house green without showing him the color of green you want. Green is a word symbol. Without looking at the same color green, do you think the green you're thinking of is the same green he's thinking of ? (It's not).

The point to all these situations is to ask for clarification. The only way for me to understand what someone else's word concepts mean, is to ask them. When the information I'm listening to requires my understanding of the other person's point of view, I ask for clarification. I don't need to get caught up in creating chaos for myself by not asking for clarification.

I also need to remember that the person I seek the clarification from may not always be able to clarify their statement (especially children). I don't need to be responsible for their clarification. Taking on the responsibility for their clarification creates chaos for myself and discounts them at the same time. I say to myself, "I choose not to be caught up in someone else's chaos. This isn't my chaos." I may choose to ask for clarity or not to ask for clarity.

One of the things I do as a way of attaching myself to someone else's chaos is to agree with someone else's information without understanding what it was they've said. One day a friend turned to me and said, "You know ticks on fleas make dogs run sideways." I turned to him and said, "Yep! I know exactly what you mean."

Build an "inner authority"

Build an "inner authority" means to develop a new loving parent inside of myself. This loving authority will be my source for love and approval. Before I make any decisions about myself, or my behavior, I stop here inside myself and visit with my inner authority before I proceed. I try to remember to ask myself what I think, before I decide if I need to inquire elsewhere.

My inner authority is where I go to be honest with myself. Choosing to share that .i.honesty; is another matter. My inner authority allows me to feel safe. My inner authority is not willing to allow myself to become injured as a result of being honest with someone outside of myself. Over-explaining and giving up information that may injure me is not something I need to do. Honesty is earned. Testing the waters (taking a risk to share an honest feeling, a thought, or an opinion) is an option; not a requirement.

Accepting and developing healthy (authentic) sets of limits for myself is also part of building an inner authority. Being able to recognize my limits and checking them out with my inner authority before I proceed (saying "Yes") is being compassionate to myself. No expectation, mine or someone else's, is worth meeting if it jeopardizes my health. Saying, "No" is easier with an inner authority for support, love, and compassion. I also learn to laugh at mistakes with my inner authority. Changing my decisions is easier and more nurturing to myself with an inner authority that accepts my right to change my mind. Decisions are not forever. My inner authority has two rules to help me live by:

Have I, or am I about to, hurt myself. My loving inner authority says, "No" to activities that hurt me. Have I, or am I about to, intentionally hurt someone else. My loving inner authority says, "No" to activities that intentionally hurt someone else.

As long as I'm not hurting myself or someone else, my inner authority is happy with me. When I do hurt myself, or someone else, my inner authority reminds me that I'm ok to be human. I apologize* to myself and to the other person, in order to feel better. And when I apologize, I apologize without requiring forgiveness in return. I don't need to require forgiveness (seek approval) from the person I'm apologizing to. This adds control and compulsion to the apology and causes a hidden approval seeking agenda to occur.

*Also referred to as "making an amends."

Note: This is always a confusing issue when someone is doing the "victim thing" as a destructive control behavior. Understanding the "victimstance" concept and the use of "victim" as a destructive control behavior will help me avoid unnecessary amends and feeling unworthy about myself. I used to find myself apologizing profusely (I'm sorry, I'm sorry, I'm sorry) when ever I was in the presence of someone doing the "victim thing" until I understood the concept of "victim" as a destructive control behavior and started wondering "What the hell I am saying sorry again for?" I need only to know that being in the presence of someone doing the "victim thing" will compel me internally to:

  • Say I'm sorry.
  • Wonder how I can cheer up their day.
  • Get really pissed off because they're acting like this.
  • Get crazy about wondering what I did wrong or why they are angry or ignoring me (How come they don't like me, etc).

The answer to "victims" is: None of the Above.

It's a destructive control behavior. It's not necessary to respond to anyone doing the "victim thing." It's an abusive attack on their part and need not be responded to. I can save my anxiety and complaints about someone doing the "victim" for someone who will nurture the feelings I have. "Victims do not nurture feelings if they are destructively controlling so I can save my breath; it's a waste of time and spirit. Their's and mine.

My inner authority also reminds me that when I find myself complaining repeatedly about the same thing, or the same person, it's time for me to ask myself, "Am I trying to tell myself something important to listen to?" When I complain, I'm telling myself important information that needs to be heard by "me." And as long as I continue to ignore my self, I'll continue to try and complain to my self until I acknowledge my self. Maybe I'm telling myself I don't like to be around this thing or that person. And if that's the case, I've got information to use in deciding how I want to live my life.

My inner authority allows me to choose between something or someone I like, and something or someone I don't like. When I don't feel good about myself around some person or some thing, I can choose to not to be in the company of that thing or that person. Being in the company of some person or some thing I don't like creates chaos for myself. I can choose to be in or out of chaos.

Keep in mind that people do the best they can at the moment

Hounding someone, to be something that they are not, is abusive. When someone is being something other than I want them to be, I try to remember that they are doing the best that they can at the moment.

I really hate to wait in line. When I wait in line, should I demand that the line move faster than it does? I really hate to be close to people who have a cold, should I demand that that person refuse to have a cold? Spending my energy trying to make things different than they are is another way I keep myself in chaos.

"God grant me the serenity,

to accept the things I'm not supposed to change,

the courage to change the things I can,

and the wisdom to know the difference."

I try to remember this version of the serenity prayer when something is not going the way I would like it to. I also try to remember that I am doing the best that I can at any moment.

A friend at work asked me, "How goes the battle?"

I said, "I don't know. . .they keep moving the fricken front line on me."

"Where is the war?" I think the battle is over. I don't need to war on anything that isn't going the way I think it should go. I'm not a warrior for hire or a mercenary. My life is not the battle of the ages. The only battles I fight are usually with myself. The rest are created out of addiction and compulsion.

"Keeping myself in chaos keeps me cluttered and worn out."

When the object is an object (not a person)

There are objects in my life that I use to keep me in chaos. By endowing these objects with human attributes, I find that I create an additional amount of chaos by deciding that: the object is "Out to get me."

My car is one object that I might choose to endow with human attributes. When I decide to endow my car with human attributes, I can then go to war with my car or I compete with my car to see who is going to win.

My computer is another object that I endow with human attributes. When I do this, and then the computer isn't operating like I want it to, I say, "It doesn't like me. It hates my guts. I must have done something to piss it off."

The fact is, cars are machines that people use to get from place to place. Machines break down. Machines wear out. Machines come with poor instructions. Machines can't reason or communicate a complex idea. Machines are not a group of assassins or aliens set on the planet in order to create chaos and public riot. A machine is a convenience that we were told to expect it to be convenient. The man on television, and in the newspaper, and in the store, told me to expect the machine to be convenient. He said, "You'll like this little beauty."

I don't need to expect a machine to be convenient. I don't need to endow a machine with human attributes (such as the innate ability to change). I don't need to fight the machine and win. It's a battle with something that is unable to understand whether it's winning or losing. I don't need to create chaos over a thing, an object, a non-convenient convenience.

Behave in a way that says to the outside world and to myself that I have value

Explaining myself excessively, playing the victim, being perfect, refusing to ask for help, controlling, being exactly on time or substantially early, lying to say: "I like something when I don't," fishing for approval, kicking myself for mistakes (mine or someone else's), terrorizing myself with the past (or the future), scaring myself to avoid mistakes, scaring myself to scare myself, avoiding boundary setting (when people hurt me), avoiding conflict, having sex when I don't want to, going somewhere where I don't want to be, liking someone I don't like, agreeing to something I don't agree with, all say to the same thing. It says to myself and to the world, "That I'm damaged goods, and not valued." Today I can choose to conduct my life in a way that says to myself, "I have value."


I can choose to express my needs. I express my needs in a way other than from the role of victim. I don't need to be the raging- victimized parent as a way to get my needs met. I don't need to be the helpless- victimized child as a way to get my needs met. I can choose to be the loving adult as a way to get my needs met. Asking for my needs to met is healthy. Asking for my needs in a compulsive or victim-like way is not.

Sometimes people will have the ability to meet my needs. Sometimes people will not. When my needs aren't being met I empower myself as a loving parent and say, "The things I need here aren't available and that's not easy, it hurts; but I'll be here for you as a loving parent when it hurts." I enable myself to choose to go elsewhere when the needs I have are not being fulfilled. This is the type of loving parenting and action that says to the world, and to myself that, "I have value." I can choose to conduct my life in a way that says to myself, to my children, to my spouse, to my friends, to my parents, and to my other acquaintances, that "I have value."

Defining my needs is the first step in asking for them to be met. I can be patient with myself when my needs aren't clear. I shake around in the dark and abstain from getting my needs met outside of myself until I know what it is that I want. I say, "I don't know what I want," without feeling defective. Not knowing what I need or want is healthy. Scary . . . but healthy.

Non-Fishing for approval

Non-fishing for approval is a direct and clean approach to asking someone for their approval of me. It's cluttered opposite is fishing for approval. Fishing is baiting people into affirming me. I feel my .i.anxiety; level way up when I'm fishing for approval. Fishing is a non-direct way to hide the intended need of asking for someone else's approval. When I stop fishing for approval, I can ask directly. Below are some examples of fishing verses asking directly.

____________________

Situation: Something that I've done myself and want approval for.

Fishing: "I don't think this is very good."
Fishing: "Do you think this is good?"

Direct: "I need to know if you think what I've done is good."

____________________

Situation: Needing support for how I look.

Fishing: "I don't think I look good in this outfit."
Fishing: "Do you like this outfit?"

Direct: "I need to know if you think this outfit looks good on me."

____________________

I don't need to fish for approval. When I need approval, I can choose to decide what approval I want and then ask for it. I can be clear, so the person knows exactly what I'm looking for. When I'm not clear it frustrates me and the person I'm talking to. When I'm not clear, I don't get what I thought I was asking for and the other person doesn't know what it was that I was asking for. Fishing for what I want keeps me in chaos and unfulfilled.

Recognize what "other-oriented" feels like

Other-oriented refers to seeking self definition outside of myself ("other" meaning other than myself or not being self-oriented). My anxiety level is way up when I feel other-oriented. My behavior becomes a guess based on what I "think" others think I should be. I become anxiously focused on what I think others want me to be, instead of being relaxed or comfortable about being who I'd like to be.

Recognize the "addictive pull"

When someone is relating to me in an addictive way, the use of destructive control behaviors discussed earlier will be present. When I am relating to someone else in an addictive way, the use of destructive control behaviors will also be present. It's a tug-of-war game that wears me out and frustrates me. Anger, craziness, playing the victim, and compulsion are almost always a part of these types of interaction.

Addicts use people to affirm themselves. The process of using people in a dependency way for affirmation is also referred to as "being needy." When I feel this "neediness" from an addict, I'll get angry and/ or feel controlled, shamed, or terrorized. The anger, controlled-ness, shame, or terror I feel are cues I can use to help determine when this type of interaction is occurring.

In addition to control, shame, or terror, "destructive control behaviors" are designed to create chaos. A sense of chaos will be present in most types of addictive interactions. By removing myself physically, mentally, or emotionally from an exchange of this type, I trade chaos for serenity . When I find myself in the midst of one of these addictive interactions, I practice one of the lessons I've learned in detachment.

Living in the present

This refers to the concept of present moment living. I cannot re-live the moment I just lived nor live past the moment I am living now. I am who I am at this moment. I'll always be changing. I am as I am at any moment in time. I cannot undo or redo what's been done.


Decisions aren't forever. I can choose to change as life changes. If I try to live one minute ago or one minute into the future, I will miss out on living now. I am not able to relive yesterday nor is anyone else. And I cannot live tomorrow until it arrives. The world is all that it is at the time that it is. Choosing to be a part of it, at the time that it is, is a choice. I can choose to live now, yesterday, or a perception of tomorrow. If I choose to live now, I'm able to detach from yesterday or tomorrow; or moments from now or moments ago.

Spending time alone

Having feelings is scary. Chaos blocks feelings. The absence of chaos is terrorizing to me. The absence of chaos feels like I've been abandoned or something creatively terrible is about to happen.

Spending time alone allows me to begin feeling. Feeling allows me to discover myself. Through feeling I discover who I am. Spending time alone helps me to say to myself, "I don't need to have chaos. I don't need to scare myself."

Spending time alone is not the same as being lonely. I don't need to be lonely. I can choose to have friends and I can choose to spend time alone. When I'm alone I reach out if I need to be in the company of others. Using the phone, talking to a friend, going to a recovery meetings, going to counseling, calling my sponsor, are all options available to me. And those options (choices) don't have to be all or none (all alone or never alone).

Acceptance as a way to extradite chaos

I am all my feelings, likes, dislikes, opinions, thoughts, and behaviors. When I accept myself as "all that I am at the time that I am," I give up chaos. When I accept other people as "all that they are at the time that they are," I give up chaos. Staying in serenity is available to me through this option. Saying the serenity prayer is one of the ways of helping me affirm a choice to accept myself and other people as they are and give up chaos. The serenity prayer is a way to help me detach:

(modified version)

"God grant me the serenity to accept the things I'm not supposed to change,

(meaning other people; all that they are at the time that they are) The courage to change the things I can, (the parts of myself I can choose to change) And the wisdom to know the difference." (what's their stuff and what's my stuff)

Acceptance also includes not giving away or changing something that I don't own. When I don't own something, it's not mine to do with as I might want to. Acceptance is about .i.owning something;. I'm unable to own something when I don't like or if I am not comfortable with it. If I refuse becoming comfortable with it, I'll never own it or want to own it. Examples might be:

  • Likes
  • Dislikes
  • Thoughts
  • Opinions
  • Choices
  • Aches and pains
  • My children
  • My parents of the past verses the present
  • A job I don't like or enjoy
  • A husband or wife that I don't enjoy
  • An acquaintance or friend I don't enjoy
  • A disability
  • A resentment (old or new)
  • A lie or falsehood
  • An illusion of myself or of someone else
  • A behavior disorder
  • A perception verses a fact
  • A feeling of scared-ness
  • A feeling of terror or shame
  • A feeling of anger or frustration
  • A feeling of laughter or humor

When I acknowledge something about myself, I'm taking the first step to owning it. When I choose to be comfortable with it, I become the owner. As the owner I may choose to change, trade, or keep it. This is how I change.

When I talk to expel stress, I talk for myself and not the audience

The need to talk is different than the need to talk to share information. When I talk as a "need" to talk, I'm talking for myself as a way to expel stress and not to control. When I'm taking as a need to expel stress, I'm not talking to entertain, nurse, repair, fix, offer advice to, order, control, coerce, influence, maneuver, influence, or manipulate the audience. And when I talk to make an amends*, I'm talking to expel my feelings of guilt, sadness, or remorse and not to solicit forgiveness (controlling to receive forgiveness).

* Examples of Amends:

  • "I'm sorry I've taken your inventory."
  • "I'm sorry I've accused you of something."
  • "I'm sorry I labeled you."
  • "I'm sorry I made an assumption about your behavior."
  • "I'm sorry I insisted you weren't doing the best you could."
  • "I'm sorry I left you uninformed."
  • "I'm sorry I wasn't able to hear your feelings."
  • "I'm sorry I ignored you."
  • "I'm sorry I abused our confidence."
  • "I'm sorry I terrorized you."
  • "I'm sorry for acting like I'd been victimized by you."

The need to talk is an important way for me to remain clutter free (Free from "stress response" buildup discussed in section II). It's time to move on to section II to find out why the need to talk is important and healthy.

End Section I.

next: A Closer Look
~ all Art of Healing articles
~ addictions library articles
~ all addictions articles

APA Reference
Staff, H. (2009, January 16). A Place to Start Healing, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/addictions/articles/a-place-to-start-healing

Last Updated: April 26, 2019

Eating Disorder Victim's Right-to-Die Closer

The US Supreme Court has refused to step in and keep a severely brain-damaged woman hooked to a feeding tube.

Terri Schiavo with her mother, Mary Schindler, in 2001

Terri Schiavo was 26 when she suffered brain damage in 1990 after her heart temporarily stopped beating because of an eating disorder.

The court's decision all but ends a long-running right-to-die battle pitting her husband against her parents.

It was the second time the Supreme Court dodged the politically charged case from Florida, where Republican Governor Jeb Bush successfully lobbied the Legislature to pass a law to keep 41-year-old Terri Schiavo on life support.

The decision was criticised as "judicial homicide" by Mrs Schiavo's father, Robert Schindler, but applauded by her husband, Michael Schiavo, who contends his wife never wanted to be kept alive artificially.

The court's action is very narrow, affecting only Schiavo.

More broadly, sometime after returning from their Christmas break, the justices will consider the Bush administration's request to block the nation's only law allowing doctors to help terminally ill patients die more quickly.

Oregon voters passed that law in 1998, and more states could follow if justices find that the federal government cannot punish doctors who prescribed lethal doses of federally controlled drugs.

Most of the legal wrangling in the case has involved whether she is in a persistent vegetative state with no chance of recovery and whether her husband has a conflict of interest because he lives with another woman and has two children with her.

The legal battle between Schiavo's husband and parents began in 1993 and appeared to reach its climax in 2003 when Michael Schiavo won a court decision ordering that the feeding tube be removed. But it was reinserted six days later, after the Legislature passed "Terri's Law."

The Florida Supreme Court ruled that the law was an unconstitutional effort to override court rulings. The nation's high court refused without comment to disturb that decision.

"It's judicial homicide. They want to murder her," Schindler said. "I have no idea what the next step will be. We're going to fight for her as much as we can fight for her. She deserves a chance."

George Felos, the attorney for Michael Schiavo, said his client would have his wife's feeding tube removed as soon as pending appeals were over and a stay was lifted.

"You've got to look at it from his perspective - he's a citizen living in Clearwater (Florida) and up against the weight of the governor and Legislature of the state of Florida - a governor whose brother is president of the United States. That was a very, very difficult and imposing fight. He was very relieved that the rule of law prevailed," Felos said.

next: Exploring the Role Relationships Play in the Development of an Eating Disorder
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APA Reference
Gluck, S. (2009, January 15). Eating Disorder Victim's Right-to-Die Closer, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/eating-disorders/articles/eating-disorder-victims-right-to-die-closer

Last Updated: January 14, 2014

Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD) is a mental disorder defined as a preoccupation with a perceived defect in one's appearance. Typical complaints concern the face, hair, lack of symmetry, body parts, body size such as too thin, too fat, or perceived ugliness.Body Dysmorphic Disorder (BDD) is a mental disorder defined as a preoccupation with a perceived defect in one's appearance. If a slight defect is present, which others hardly notice, then the concern is regarded as markedly excessive. In order to receive the diagnosis, the preoccupation must cause significant distress or impairment in one's occupational or social functioning.

An Italian doctor, Morselli, first coined the term dysmorphophobia in 1886 from "dysmorph" a Greek word meaning misshapen. It was subsequently renamed Body Dysmorphic Disorder by the American psychiatric classification. Freud described a patient whom he called the "Wolf man" who had classical symptoms of BDD. The patient believed that his nose was so ugly that he avoided all public life and work. The media sometimes refer to BDD as "Imagined Ugliness Syndrome". This probably isn't particularly helpful, as the ugliness is very real to the individual concerned.

The degree of handicap varies so that some people will acknowledge that they may be blowing things out of all proportion. Others are so firmly convinced about their defect that they are regarded as having a delusion. Whatever the degree of insight into their condition, sufferers often realize that others think their appearance to be "normal" and have been told so many times. They usually distort these comments to fit in with their views (for example, "They only say I'm normal to be nice to me" or "They say it to stop me being upset"). Alternatively they may firmly remember one critical comment about their appearance and dismiss 100 other comments that are neutral or complimentary.

What are the most common complaints in BDD?

Most sufferers are preoccupied with some aspect of their face and often focus on several body parts. The most common complaints concern the face, namely the nose, the hair, the skin, the eyes, the chin, or the lips. Typical concerns are perceived or slight flaws on the face or head, such as hair thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the complexion or excessive hair. Sufferers may be concerned about a lack of symmetry, or feel that something is too big or swollen or too small, or that it is out of proportion to the rest of the body. Any part of the body may however be involved in BDD including the breasts, genitals, buttocks, tummy, hands, feet, legs, hips, overall body size, body build or muscle bulk. Although the complaint is sometimes specific "My nose is too red and crooked"; it may also be very vague or just refer to ugliness. 

When does a concern with one's appearance become BDD?

Many people are concerned to a greater or lesser degree with some aspect of their appearance but to obtain a diagnosis of BDD, the preoccupation must cause significant distress or handicap in one's social, school or occupational life. Most sufferers are extremely distressed by their condition. The preoccupation is difficult to control and they spend several hours a day thinking about it. They often avoid a range of social and public situations in order to prevent themselves feeling uncomfortable. Alternatively they may enter such situations but remain very anxious and self-conscious. They may monitor and camouflage themselves excessively to hide their perceived defect by using heavy make-up, brushing their hair in a particular way, growing a beard, changing their posture, or wearing particular clothes or for example a hat. Sufferers feel compelled to repeat certain time consuming rituals such as:

  • Checking their appearance either directly or in a reflective surface (for example mirrors, CDs, shop windows)
  • Excessive grooming, by removing or cutting hair or combing
  • Picking their skin to make it smooth
  • Comparing themselves against models in magazines or television
  • Dieting and excessive exercise or weight lifting

Such behaviors usually make the preoccupation worse and exacerbate depression and self-disgust. This can often lead to periods of avoidance such as covering mirrors or removing them altogether.

How common is BDD?

BDD is a hidden disorder and its incidence is unknown. The studies that have been done so far have been either too small or unreliable. The best estimate might be 1% of the population. It may be more common in women than in men in the community although clinic samples tend to have an equal proportion of men and women.

When does BDD begin?

BDD usually begins in adolescence - a time when people are generally most sensitive about their appearance. However many sufferers leave it for years before seeking help. When they do seek help through mental health professionals, they often present with other symptoms such as depression or social phobia and do not reveal their real concerns.

How disabling is BDD?

It varies from a bit to a lot. Many sufferers are single or divorced, which suggests that they find it difficult to form relationships. Some are housebound or unable to go to school. It can make regular employment or family life impossible. Those who are in regular employment or who have family responsibilities would almost certainly find life more productive and satisfying if they did not have the symptoms. The partners or families of sufferers of BDD may also become involved and suffer.


What causes BDD?

There has been very little research into BDD. In general terms, there are two different levels of explanation - one biological and the other psychological, both of which may be correct. A biological explanation would emphasize that an individual has a genetic predisposition to a mental disorder, which may make him or her more likely to develop BDD. Certain stresses or life events especially during adolescence may precipitate the onset. Sometimes use of drugs such as ecstasy may be associated with the onset. Once the disorder has developed, there may be a chemical imbalance of serotonin or other chemicals in the brain.

A psychological explanation would emphasize a person's low self-esteem and the way they judge themselves almost exclusively by their appearance. They may demand perfection and an impossible ideal. By paying excessive attention to their appearance, they develop a heightened perception of it and become increasingly accurate about every imperfection or slight abnormality. In the end there is a big disparity between what they believe they should ideally look like and how they see themselves. What a sufferer therefore "sees" in a mirror is what they construct in their head and this depends upon a number of factors such as mood and their expectations. The way a sufferer avoids certain situations or uses certain safety behaviors perpetuates the fear of others rating them and maintains their excessive attention on themselves.

What are the other symptoms of BDD?

Sufferers are usually demoralized and many are clinically depressed. There are many similarities and overlaps between BDD and Obsessive Compulsive Disorder (OCD) such as intrusive thoughts, frequent checking and reassurance seeking. The main difference is that BDD patients have less insight into the senselessness of their thoughts than OCD sufferers do. Many BDD patients have also suffered from OCD at some time in their life. Sometimes the diagnosis of BDD is confused with anorexia nervosa. However in anorexia, individuals are more preoccupied by self-control of weight and shape. Occasionally, an individual may have an additional diagnosis of BDD when she is also preoccupied by the appearance of her face.

Other conditions that frequently exist in combination with BDD or are confused with BDD include:

- Apotemnophilia. This is desire to have a disabled identity in which sufferers with healthy limbs request one or two limb amputations. Some individuals are driven to DIY amputation such as putting their limb on a railway line. Very little is known about this bizarre and rare condition. However there are significant differences between apotemnophilia and BDD as cosmetic surgery is rarely successful in BDD.

- Social phobia. This is a fear of being rated negatively by others leading to avoidance of social situations or marked anxiety. This usually stems from the sufferer's belief that he or she is revealing themselves to be inadequate or inept. If the concern is only about appearance then the BDD is the main diagnosis and the social phobia is secondary.

- Skin-picking and trichotillomania This consists of an urge to pluck one's hair or eyebrows repeatedly). If the skin-picking or hair-plucking is out of concern with one's appearance then BDD is the main diagnosis.

- Obsessive Compulsive Disorder (OCD). Obsessions are recurrent intrusive thoughts or urges, which the sufferer usually recognises to be senseless. Compulsions are acts, which have to be repeated until a sufferer feels comfortable or "sure". A separate diagnosis of OCD should only be made if the obsessions and compulsions are not restricted to concerns about appearance.

- Hypochondriasis. This is a doubt or conviction of suffering from a serious illness which leads a person to avoid certain situations and to check their body repeatedly. The International Classification of Diseases (ICD-10) classifies BDD as part of hypochondriasis whereas the American classification regards it as a separate disorder.

Are people with BDD vain or narcissistic?

No. BDD sufferers may be spending hours in front of a mirror but believes themselves to be hideous or ugly. They are often aware of the senselessness of their behavior, but none the less have difficulty controlling it. They tend to be very secretive and reluctant to seek help because they are afraid that others will think them vain.

How is the illness likely to progress?

Many sufferers have repeatedly sought treatment with dermatologists or cosmetic surgeons with little satisfaction before finally accepting psychiatric or psychological treatment. Treatment can improve the outcome of the illness for most sufferers. Others may function reasonably well for a time and then relapse. Others may remain chronically ill. BDD is dangerous and there is a high rate of suicide.

What treatments are available?

As yet, there have been no controlled trials to compare different types of treatment to determine which is the best. There have been a number of case reports or small trials that have shown benefit with two types of treatment, namely cognitive behavior therapy and anti-obsessional medication. There is no evidence that psychodynamic or psychoanalytical therapy is of any benefit in BDD, in which a lot of time is spent looking for unconscious conflicts that stem from childhood.

Cognitive Behavior therapy

Cognitive Behavior Therapy (CBT) is based on a structured program of self-help so that a person learns to change the way he thinks and acts. A person's attitude to his appearance is crucial as we can all think of people who have a defect in their appearance such as a port wine stain on their face and yet are well adjusted because they believe that their appearance is just one aspect of themselves. It is therefore crucial to learn during therapy alternative ways of thinking about one's appearance. BDD sufferers need to learn to confront their fears without camouflage (a process called "exposure") and to stop all "safety behaviors" such as excessive camouflage or avoiding showing one's profile. This means repeatedly learning to tolerate the resulting discomfort. Facing up to the fear becomes easier and easier and the anxiety gradually subsides. Sufferers begin by confronting simple situations and then gradually work up to more difficult ones.

Cognitive Behavior Therapy has not yet been compared to other forms of psychotherapy or medication so we don't yet know which is the most effective treatment. However there is definitely no harm combining CBT with medication and this may be the best option.

Cognitive behavior therapists come from a variety of professional backgrounds but are usually psychologists, nurses or psychiatrists.

next: Body Image Problems Stop Hating Your Body
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APA Reference
Gluck, S. (2009, January 15). Body Dysmorphic Disorder, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/eating-disorders/articles/body-dysmorphic-disorder

Last Updated: July 3, 2016

The Twelve Steps of Co-Dependents Anonymous: Step Seven

Humbly asked God to remove our shortcomings.


This step may be the most powerful of the twelve.

Step Seven is where I admitted my powerlessness and consciously asked God to be my Higher Power. Yes, I'd wrecked my life. Yes, I'd hurt many people, including myself. Yes, I was powerless to change on my own. Yes, God was powerful enough to transform me and salvage my life.

Humbleness is an attitude of the heart, a posture of the heart. Humbleness recognizes a higher power and defers (lets go) to that higher power, rather than demanding equality. Humbleness is the opposite of pride.

Up to this point, I'd proudly and erroneously assumed equality with God concerning my own life. Now, I was ready to let God be God. I was ready to be the follower rather than the leader. I was ready for God to remove my shortcomings, rather than attempting to remove them myself or by my own willpower. I was ready to stop fighting God and start yielding to God. I was ready to stop defying God and start trusting God.

By changing my heart's posture and my attitude, I placed my life once and for all in God's hands. If I was going to be changed, it would be through God's power and in God's time.

This step occurs daily for me. Every day I must set aside pride and remind myself that I am not my own higher power, that I am no one else's higher power. Each day, I renew my humbleness before God.

As the priest in the movie Rudy said: "There is a God and I am not Him."

Step Seven is consciously contacting God and asking for help. That is the humbleness Step Seven requires of me.


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next: The Twelve Steps of Co-Dependents Anonymous Step Eight

APA Reference
Staff, H. (2009, January 15). The Twelve Steps of Co-Dependents Anonymous: Step Seven, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/relationships/serendipity/twelve-steps-of-co-dependents-anonymous-step-seven

Last Updated: August 7, 2014