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Ashley Solomon, Psy.D is a psychologist who specializes in the treatment of eating disorders, body image, trauma, and serious mental illness.

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05 Oct

Programming Note, Part II

Ideas to Consider 1 Comment by Ashley @ Nourishing the Soul

I truly had hoped that the post I wrote back in April explaining my missing person status would be the last of that type of post I would ever have to type.

Ha!

Call it relatively-new-and-somewhat-still-naive-mom-syndrome, I suppose. That April post gave me a little kick-start and I was able to keep up with posting periodically through the start of the summer, sharing things like my feelings on chocolate milk and my curiosity on the lack of size diversity in our field. But then came a firestorm of transitions.

To name a few: I relocated with my family back to my hometown, and in the process purchased a 130+ year old home. The house is absolutely amazing and perfect for our little family, but doing some important projects and creating a home for ourselves has been a labor of love. We’ve poured most of the moments that we weren’t working (you know, for, like, money) and caring for our son into trying to make our space beautiful and ours. I’m happy to report that it is just about complete — at least, based on what we want to accomplish at this stage.

Just in time for — baby! As I mentioned back in April, I’m expecting a new little one in October. So now it’s October and we’re counting down the days to meet our precious gift. My due date is in one week, meaning baby could come at any time over the next couple weeks, putting me just a teensy bit on edge and in nesting mode. I’ve been working to prepare the baby’s room, making meals to freeze, and doing what I can to get our son prepared for this big transition.

And finally, I’m working on birthing another wonderful being — a new treatment center here in my hometown. I promise to share more details of that soon, but suffice it to say that it has been another labor (no pun intended) of love and an amazing process.

So with a few things going on, it’s been challenging to get myself into a chair to write for the past few months. I’d like to say that maternity leave will afford me some more time to focus, but I’m not that delusional, okay? I’m going to do my best to get back to this space more frequently because it truly inspires me and the work that I do. I love sharing my thoughts and questions with all of you and getting such a thought-provoking feedback. So don’t delete NTS from your Feedly just yet! Also feel free to drop me a line over on the Facebook page or via Twitter anytime.

 

 

10 Jul

Where are the fat eating disorder therapists?

Ideas to Consider 7 Comments by Ashley @ Nourishing the Soul

A few weeks ago, a wanted-to-be scientist name Rachel Fox, bravely shared the fat-shaming she’s endured during her years as an undergraduate science major at a prestigious university. The overt and covert discrimination by the scientific community has led her to make the decision to say goodbye to the field altogether.

Her story should make us angry. Not only on her behalf for another human to have to endure insensitivity and harassment based on size, but also for ourselves. We’ve just lost a potential brilliant scientist because our society is so bigoted that we can’t see talent beyond a jean size. She could have been the next scientist to cure a terminal illness or discover a new planet. What if Jonas Salk or Stephen Hawking were told to avoid milkshakes and made to feel less than?

Fox’s op-ed piece left me reflecting on where else larger people are missing. I started to look around at my own field and wondered… how many aspiring therapists have changed course because they didn’t feel welcomed by the community?

In the field of eating disorders, I’d anecdotally suggest that there is a disproportionate number of clinicians with smaller bodies, as compared to the general population. I can take educated guesses as to why this might be. One reason might be that of fields in psychology, those with histories of their own eating disorders are perhaps drawn to working with this population. And while the vast majority of clinicians with their own histories of eating disorders are fully recovered, they may continue to be more aware of their own body size and possibly engage in some weight-control practices. More optimistically, it could be argued that these clinicians may be disproportionately smaller because they tend to be more mindful about their eating, practicing what they preach and not using food in unhealthy ways.

But the cynic in me wonders if there is not something more disheartening going on. Are we losing therapists of larger body sizes because they are not feeling welcomed into this field?

There is some research to suggest that this may have some validity. For starters, patients with eating disorders are often considered to be much more highly attuned to others’ weight and shape, including those of their therapists. While some with eating disorders claim that they “judge” only their own bodies, many others acknowledge feeling hyperaware of others’ bodies and even making assumptions about their therapists based on body size. A recent study (Rance, Clarke, & Moller, 2014) examined patients’ perceptions of therapists bodies and found that some patients assessed a fat therapist as less trust-worthy and more likely to lose control. This study asked patients to report on their experiences, but often the beliefs, assumptions, and feelings are less overt and conscious. It’s not difficult to imagine how a patients’ weight bias, particularly in the midst of an eating disorder in which weight and shape’s importance often gets elevated, can create a seemingly hostile environment for a therapist.

I wonder, though, if more of that hostility and distrust doesn’t actually come from within our own ranks, however. A study by Puhl, Latner, King, and Luedicke (2013) reveled weight bias among eating disorder professionals. In fact, 56% of us reported having observed our colleagues express negative comments about obese individuals. If more than half (and I’d suggest it’s actually much more than half) of us observe these behaviors occurring — and are we addressing them? — it’s easy to imagine how uncomfortable a fat therapist might feel in that setting.

Just as in the STEM field, the eating disorder realm is full of assumptions about what professionals should be doing with food. Insiders and outsides, explicitly and implicitly, seem to assume that someone who treats eating disorders should be of a middle-of-the-road weight, or even thin. If someone deviates from this, the assumption becomes that they must not really know how to manage a relationship with food. Thus, how in the world could they teach or inspire someone else to do the same?

Obviously — or, apparently, maybe not so obviously, these assumptions are unfounded. But they permeate our experience in this field and it’s easy to see why we don’t observe as much diversity in body shape and size among therapists.

Perhaps the best thing that we can do to avoid losing talent and diversity is to become ever more aware of own stereotypes and biases. Once we can acknowledge these, we can take more conscious steps to not allow them to guide our decision making and treatment of others in our field.

Do you think people of larger sizes are underrepresented in the eating disorder field? Why or why not?

 

**Please note that I don’t believe that there are not fat eating disorder therapists. I personally know many. I do believe that there aren’t as many as one might expect and that there are reasons for this…

16 Jun

An apple a day won’t keep your waistline at bay, but…

Ideas to Consider 2 Comments by Ashley @ Nourishing the Soul

A recent study in A Cancer Journal for Clinicians indicated that, despite popular wisdom, consuming more fruits and vegetables won’t reduce rates of obesity.

The dictum that eating more of the nutrient dense foods would slim our society has taken hold in recent years, and has become the basis for a number of public health initiatives encouraging fruit and vegetable consumption. But according to researchers, these programs are based on false assumptions.

Namely, the belief is that if people eat more fruits and vegetables, they’ll fill up and take in less calorically dense foods. Some of us have heard the tip to eat an apple before a meal because you’ll consume less of the higher calorie items, or to always start with a salad.

But what actually happens is that we tend to eat the apple or the salad, and consume just as much. In fact, it could be the case that our eating the “healthy” item psychologically primes us to feel we then deserve something “unhealthy.” Researchers found that people eat on average 30 more pounds of vegetables and 25 more pounds of fruit than 50 years ago, and yet they believe that we are heavier as a nation.

So what can we take away from this research?

If we are eating fruits and vegetables to reduce our waistlines, we might be sorely disappointed. But we still might have less disease, think and feel emotionally better, have prettier skin, and have more energy. And I think those are all much better reasons to consume than to have a lower number on a scale.

Oh, and they are delicious and better for the environment than animal-based products and highly processed foods. So there’s that.

We also have to recognize the difference between what is true for a society and what is true for an individual. While increasing fruit and vegetable consumption overall didn’t reduce population-wide weight, eating them could have an impact on an individual. That may not even be weight (or it could be…), but could be even more important health indicators.

So the message you’ll read here is this: don’t give up on your fruits and veggies. And don’t worry so much about what will make you thinner. Listen to your taste buds and tune in to the foods that make you feel happy and healthy.

10 Jun

Could Naming Your Eating Disorder Help or Hurt?

Ideas to Consider 241 Comments by Ashley @ Nourishing the Soul

On the heels of a wonderful #aedchat, I’ve been spending a lot of time thinking about the concept of externalizing eating disorders. (If you missed the tweetchat, you can read the entire transcript here.) To grossly over-simplify, externalizing an eating disorder refers to the technique of considering the eating disorder as a separate entity from one’s self.

Jenni Schaefer, author of Life Without Ed, is often credited as being the first to really popularize this idea. In her book, now ten! years old, she talks about assigning her eating disorder the name Ed and coming to think of Ed as an abusive boyfriend, one that she loathed but was also afraid to leave. Jenni shares over the course of the book how creating this distance between herself and the eating disorder allowed her to garner the strength to begin fighting back, eventually making real change and forging a path to recovery. Creating “Ed” was a starting point for her in changing the way she saw herself and the disorder.

Many other therapeutic traditions have adopted a similar approach. Narrative therapy teaches individuals to reconceptualize their disorders garner a new sense of strength and the power to rewrite their stories. to In Family Based Treatment, for instance, practitioners introduce the eating disorder as a separate entity, a grave disease, to patients and families. The rationale is that the family needs to be united against this “intruder.” Indeed, many families come to this on their own. They observe how this awful “being” has seemed to come to posses their child, leaving at times a shadow of their loved one’s former self in its wake.

In my own work, I’ve heard from countless individuals how externalizing their eating disorder helped them begin to distinguish between their own thoughts and those of the eating disorder. Over time they began to recognize their true (“healthier”) self as distinct from this disorder who’s goal was to trick and deceive them. Once they were able to recognize this distinction, they could begin to attend more to the true self, letting the Ed or Ana or Mia fade further into the background (or kicking him or her to the curb).

While I observe how powerful an intervention this can be, I do find myself concerned that it has become almost an expected part of the treatment process. When one group member in an eating disorder group I run expressed that this didn’t resonate for her, other members told her that she would “get there” and seemed to indicate this as a sign of her not being further along in recovery.

Eating disorders can be so insidious and I think externalizing and visualizing them can be helpful in undermining their strength. But this doesn’t work for everyone. And not only that, I think there are some potential costs that come for some with treating the eating disorder as a separate entity. Hearing Dr. Kelly Vitousek talk at a conference a couple of years ago, I was struck by a number of these costs.

For one, I worry that it oversimplifies a very complex and nuanced issue. One of the issues that we continually challenge in eating disorder treatment is the practice of dichotomous (“black and white“) thinking, and creating two selves – healthy/sick or good/bad — seems to perpetuate that approach. It could be more powerful, in some cases, to consider the complexity of the disorder and acknowledge that the traits we may associate with each “self” — e.g. perfectionism with the anorexia — are not solely good or bad. Those traits are part of the person himself or herself and can be used in pursuit of more or less workable goals.

Further, while they are painful and destructive, eating disorders often emerge initially as a means of self-protection and safety. For some, a the world has become too dangerous or chaotic or unpredictable and the eating disorder serves an important function. To separate it from one’s self and villainize it could prevent one from fully acknowledging the role the eating disorder has played.

Some individuals end up feeling invalidated by this approach, that what they think or feel is treated by others as “just Ed talking” versus him or her. When I once remarked to a patient of mine that it felt like “Ed” was the loudest person in the room and I wished I could hear her instead, she became very upset and reminded me that she was the person behind all of the words, and it was important that I hear them all, not dismissing any because they were “Ed’s.” It was an important learning moment for me, and I’m cautious, even when a patient externalizes her own disorder, to not treat what is shared in that way.

And finally, could seeing the eating disorder as distinct from one’s self impair accountability? I’ve observed this go various ways with individuals with whom I’ve worked. I do think there can be a risk is over-externalizing, to the point where an individual feels that they are actually powerless over this much stronger being. The person feels that he no longer has any control, so why bother? It requires energy to fight a monster, and if someone is physically malnourished and weakened by the symptoms, they could feel unable to take on Ed, finding it easier to submit.

The bottom line is that this is an intervention that should be used judiciously. It’s not a one-size-fits-all approach, and one has to consider the individual or one’s self before determining if creating an “Ed” is the right way to go.

Have you used this technique in your work or recovery? If so, what was your experience?

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