Knowing ahead of time what to expect in therapy can be helpful. Let’s look at the stages of psychotherapy as they unfold and see how they apply in the recovery of Ellen.*
The Stages of Psychotherapy
The stages of psychotherapy for emotional eaters often follow a certain course. It’s similar, whether the person is anorexic, bulimic, or a binge eater. I have identified four stages which most patients travel in recovery: Awareness, Exploration, Grief, and Integration.
Many people work hard to deny that food is making their lives painful and unmanageable. Perhaps this is your story too. Hopefully, at some point, you will come across a helpful book on eating disorders or see a friend change and grow through therapy. This offers you hope that change is possible. You get curious about what makes you “tick” with food. And, you begin to reflect on how your food problems have colored so many aspects of your life. Intimacy, self-care, friendships, health, your family, and work. You admit you are unhappy with bingeing, purging, starving, or dieting and an inner yearning to get better begins.
In this stage, you start to realize how inner un-named feelings have caused you to reach for food as a way to soothe and comfort yourself. You take a risk and disclose your story to safe, supportive people. They will acknowledge your pain and help you learn to trust again. As you become able to share yourself, your feelings will unfreeze. You will realize you are not alone, and the feeling of being “on the outside looking in” begins to diminish.
This grief stage is often the turning point in the recovery process because it hurts. The temptation to return to emotional eating looms large. In the grief stage, you are mourning for your inner child who felt hurt and betrayed and who learned to rely on the consolation of food more than relationships. Grieving is also a way to legitimize your pain by declaring, “I am justified to feel wounded and hurt.”
Jenny’s father had died from a drug overdose when she was five, and she described her fat as “frozen grief.” “When I was ten” she said, “I had an experience that was unbearable to me. My mother had just come out of a drug rehabilitation program. We found a baby robin on the sidewalk with a broken wing and we brought it inside to nurse it back to health. My mother put the bird on the stove and turned the heat on low to warm him up. But when I came home from school, the bird was lying dead on the stove. She had forgotten to turn the heat off. I felt destroyed, and no one could understand the depth of my reaction. People said ‘But, Jenny, it was just a bird.’
When I came to therapy many years later and related my struggles with overeating, memories of that bird came back. It realized that I myself felt like that little bird—despite all my mother’s good intentions, she was unable to really care for anyone, herself included. These memories of the bird made me experience for the first time the shock and fear I had about my father’s death. The little robin had seemed so vulnerable and helpless. That bird was like my tender self that had to go underground with food because I could not trust anyone to take good care of me.”
In this final stage, you learn to trust your own inner voice and intuition. You can identify and express your needs without shame and find ways to fulfill yourself without retreating to your hurtful eating patterns of the past. You no longer feel driven to be perfect, but rather have compassion for yourself. This capacity for self-forgiveness helps you empathize and trust other people, as well. You learn to look at your foibles with humor, rather than with harsh judgment, and in your relationships, you find a comfortable balance between dependence and independence.
The Case of Ellen
Ellen, a divorced woman, had been bingeing and purging for 12 years. She came for therapy for her eating problems when she was 36 years old. Her boyfriend Joe refused to make a permanent commitment to her because of her depression.
When we traced her episodes of bingeing and purging, Ellen became aware that they were often triggered by feelings of intense rage and jealousy towards Joe. If he went to lunch with a female co-worker or they were at a party and he danced with another woman, Ellen became furious. Unable to tolerate her hateful feelings, Ellen tore into food with a vengeance and then purged herself with violent spasms of vomiting. She felt tremendous guilt at her anger toward Joe; after all, how could she be so furious at someone she supposedly loved?
In therapy, we discovered that rage and jealousy were issues for Ellen long before Joe came on the scene. She was the younger of two girls and was born with a deformed arm which required many operations and hospitalizations. When she expressed feeling upset to her parents about her handicap, they would reprimand her, “You should be grateful for all we’re doing for you. We’re spending money we don’t even have to make you better.” Their comments left Ellen feeling ashamed, and she remembered beginning to secretly overeat at this time.
There was another feeling in her heart, though, which she could never reveal to anyone. It was a wish that proved what a terrible little girl she really was and that she deserved to be punished. She secretly wished, “If only my sister Laura could have this ugly arm. Why did it have to be me? If only she were the one going through this.”
Speaking of this her sessions opened up a stage of intense grief for Ellen. She revealed how she never felt pretty as a little girl. She felt like an outcast, and she hated the other girls for their popularity.
Now it began to make sense why Ellen would fly into a rage when Joe paid attention to another woman. She feared that practically any woman was more attractive than she was and that it was just a matter of time before Joe would choose someone else over her.
In one session, Ellen brought with her the tiny brace she had worn on her arm when she was two years old. It had been wrapped in a handkerchief and kept in her drawer all these years. Looking at that cast together helped us appreciate just how little and tender and vulnerable Ellen had been when she went through this suffering. We began to understand why she had turned to food to comfort herself. Throwing up was her way of trying to rid herself of her inner, jealous feelings toward her sister and the other girls. It was also her way of trying to make herself feel clean and innocent and less guilty inside.
Through our relationship, Ellen started adopting my accepting attitude. She began to see herself with similar compassion that I felt towards her. As she gradually became more accepting of her inner world, her need to hurt herself with food and vomiting subsided.
It was not until the following incident, however, that I saw how much Ellen had really used her therapy to grow emotionally. It marked one of the first times she was able to tolerate her own angry and jealous feelings without resorting to the self-punishment of bulimia.
A year into treatment, Ellen reported that her ex-husband, whom she had divorced five years before, was about to enter an alcoholism treatment program. This was something she had never been able to get him to do during their marriage. In one way, she hoped he would finally get sober. Their children would benefit from having a more responsible, healthier Dad. But in another way, Ellen wanted him to fail. Why should his new wife reap the benefits when Ellen had suffered so much with him? Why should he get healthy now when he had never taken her advice in the past to get help? Voicing this in therapy helped her accept her vengeful feelings with a mixture of humor and rue. She no longer felt like a monster worthy of her old punishment—bulimia—for harboring destructive feelings.
With an increasing sense of self-esteem, Ellen also discussed her hurt directly with Joe about his flirting with other women. Unable to appreciate her complaint, Joe criticized her for being overly sensitive. Ellen, now feeling stronger and more deserving of a kinder relationship, decided to break it off. It was one of the few times in her life she respected her intuition. She finally honored her feelings about what she needed to do to feel good about herself.
Ellen’s case illustrates the stages of psychotherapy for emotional eaters: awareness in which she learned to identify the emotions that had been responsible for her eating problems, exploration in which she came to understand the roots of these emotions and their connection with her past history, grief in which she experienced and mourned the original pain that she had stifled with her eating disorder, and integration in which she came to use these insights towards handling new experiences without resorting to the same hurtful eating behaviors of the past. Ellen learned to sink her teeth into life, not into excess food. You can too!
*All names and details have been changed for confidentiality.
(Last Updated: May 3, 2022)