September/October 2014 Issue
Mindfulness and Disordered Eating: Food Is Not the Enemy
Food is neither good nor bad; it’s a matter of how a client reacts to her thoughts and emotions about how she eats. The only way clients will mindfully turn towards the difficult is if it is also the therapists’ practice to stay when they want to bolt.
He vowed no more morning donut stops, but it’s Monday and he’s finger-wiping jelly off the steering wheel and blowing powdered sugar from his tie, relieved that the familiar panicky feeling is momentarily tamed.
She swore she wouldn’t let herself go the way her mother did. Then one day as she’s running errands, she catches a glimpse of herself in a store window and recognizes the all-too-familiar shape.
The living legacy of disordered eating waits at home in the welcome-back wink of the refrigerator door as it’s eased open after-hours. It’s there at the fast-food drive-thru window, strapped in and trapped, as an anonymous exchange of cash passes from hand to hand for moments of secretive pleasure. And it always beckons from the hiding places that conceal seductive comforts and the sweet promise of forbidden relief.
The secrets, the shame, the relentless hope and desperation—a tangled web of suffering that consumes the bearer and often the therapist. A client’s urgency that demands and implores from a place of overwhelming pain humbles the best of therapists.
Anywhere But Here
Too much. Not enough. The story of their life.
Yet from a mindfulness perspective an eating disorder isn’t “on top of everything else.” It is everything. How we behave in one area of our life is most likely how we behave in most places of our life. Compulsive eating, bingeing, restricting, and purging are only the manifestations of a much more deeply ingrained fear-based belief system. If we eat large quantities of food quickly, deny ourselves certain foods, or throw it up or away, we most likely have the same behaviors in other areas of our life such as spending, exercising, taking risks, apologizing, loving, and being loved.
One thing is for sure: feeding the stomach will never nourish the heart. Disordered eating can be the doorway that opens into your client’s heart and the rest of her life. To pass through that doorway requires that she be willing to stay with what seems unbearable. Over and over that must become her practice. And the only way the client will engage in the practice of mindfully turning toward the difficult is if that is our own moment-by-moment practice: staying when we want to bolt.
Here Is Where We Begin
From the mindfulness stance, we know that inherent in each client who arrives at our door is the gift of discovery and growth for both of us. We then must cultivate fearlessness: a willingness to turn toward what we most fear, to stay in our body, and to listen deeply. Through leading by example, we may encourage them to step toward freedom from the tyranny of mindless eating and unconscious living.
There is a poem by Rumi that, whenever I read it to clients, causes eyes to roll and inspires hope all at the same time.
The Guest House
— Jelalludin Rumi, from Essential Rumi, translation by Coleman Barks
Meeting all our dark thoughts, emotions, and physical sensations with laughter and welcoming them may be difficult to entertain. But Rumi offers a taste of what might await us if instead of constantly hating and running from ourselves, we came to know our thoughts, emotions, and physical sensations as well as we know an old friend. Then when shame, craving, or loneliness arrived, we wouldn’t need to slam the door, run, or become a doormat in the face of what was once the enemy. This is the gift of transformation that a client with disordered eating brings to a therapist’s life.
How the Unwanted Challenges Us
When we encounter resistance, within ourselves or from our clients, we often become irritated, judgmental, and even disgusted with them or ourselves. It’s important to remember that no matter how destructive the behavior may be, we are always trying to take care of ourselves. As best we know how, we are attempting to cope with unresolved emotions, memories, and habituated thoughts, many of which trail back to childhood. We continue to operate on automatic pilot, a conditioned reactivity, employing old coping skills that don’t get us what we want.
Acceptance Is Not Passivity
Too often acceptance is thought to be passivity. Mindful acceptance is anything but passive. It takes tremendous courage to acknowledge a felt sense of what is here right now in body and mind, rather than to relentlessly wish it to be different or pretend it’s not here. Acceptance and striving take effort, but only acceptance leads to freedom.
Shifting to a different way of being with self, others, and food is a journey, not a destination. I remind my clients: “One breath at a time. One step at a time. One bite at a time.”
Small steps add up. Our clients would like to move from the first stair to the second floor landing without having to tread the steps in between. As therapists, we too must accept small steps as incrementally important and enough. Small steps are possible, doable, and lay down a path that can be retraced.
Being caught up in unhealthy eating patterns pitches us from one extreme to the other. Most of us are terrified by what we imagine lies in the space between our arbitrary assignment of success and failure, right and wrong, empty and stuffed. We have little ability to tolerate the unknown, what is often referred to as the gray, scary, or murky wasteland between right and wrong. There is a desperation that arises from living at the extremes. It’s an energy that carries an urgency to fix, end, have, or get rid of. It is what drives her to try every restrictive diet, every extreme exercise regimen, and every self-punishing, perfecting thought she can conjure up.
Its striving quality peaks and flounders in euphoric moments and inevitable crashes, reinforcing a cycle that exhausts and disappoints. It is what drives her to continuously look for an external authority rather than trust her inner wisdom. And now she’s looking to you to tell her what to do.
As a therapist, it can be difficult to the point of dreading the arrival of a client who lives at these extremes and repeatedly sets herself up for failure by having unrealistic expectations of what she should be able to do.
Disorder as a Pathway
Mindful acceptance is the practice of meeting fear, your client’s and your own, without judgment or striving. It may be unnerving not to set weight- or behavior-related goals with your client. The thought that you are not doing enough may arise over and over. That, of course, exactly mirrors your client’s experience. If in the moment you can recognize, allow, and meet with compassion your own fear about not being enough, you will in turn know how to meet your client’s desperate need to endlessly do more because there is something so disappointing and wrong with her, that she is not enough as she is.
Here is where the therapist’s personal attention to using his or her own bodily sensations to navigate intellectual and emotional reactivity can contribute to the skillful use of self in therapy. If you trace mindfulness back to the Buddha, you will find that his first way of establishing mindfulness is in the body. This access point, through physical sensations in the body, can be a useful practice first for a therapist and then with clients. Learning to titrate between one’s own inner landscape and be present to a client is an acquired skill that takes time to develop. A personal mindfulness meditation practice can help to develop the wise and compassionate observing mind. The ability to be aware of one’s own fear in the form of judgment, irritation, or disappointment, and not speak from that place, allows space for choice to arise as to how to respond rather than react to what the client is sharing.
When a therapist embodies a compassionate mindful presence it is a gift to the client who struggles with eating issues. The therapist’s nonjudging, nonstriving, patient stance slows down the process and creates a compassionate space for all thoughts, emotions, physical sensations, and behaviors, because she knows they are always changing and impermanent. Intellectually we know that everyone and everything will pass away, but day to day we rarely live or respond to others and life as though it is really true. To counsel from a place of experientially knowing that this is indeed how it is creates a spaciousness and ease of being where a gentle light can illuminate even the darkest secrets. Then, in the presence of the therapist’s steadiness that will not be hurried, in an atmosphere of acceptance in which all exploration is welcomed and held in kindly awareness, excitement in the possibility of a new way of being and living begins to grow and flourish. And little by little, food once again becomes nourishment for the body not the heart, eating becomes joyful and pleasurable, and the body is cared for and appreciated.
— Char Wilkins, MSW, LCSW, trains and mentors professionals in the use of mindfulness-based interventions for disordered eating. She serves on the Advisory Council of The Center for Mindful Eating and as a faculty member for the Mindfulness-Based Professional Training Institute at the University of California, San Diego Center for Mindfulness.