Do I have to stop engaging in my eating disorder behaviours when I start treatment?
No. I believe that regardless of age or experience, everyone who has an eating disorder has it for a very good reason and will continue to use these behaviours until he or she has made other changes and has alternative ways of coping with life’s stresses and issues. Preparing to replace these behaviours with new ways of coping is part of the process of recovery.
Is it possible to recover from an eating disorder?
The short answer is yes and that many people recover from eating disorders. What it means to overcome an eating disorder is difficult to define as clinicians and researchers have never come to any agreement as to what constitutes recovery.That said, many people do overcome their eating disorders, while others maintain varying degrees of their symptoms and learn to live more fully and healthily, and still others fluctuate between remission and relapse. There is a myriad of factors that will determine an individual’s readiness for change and/or ability to let go of their disordered eating. Furthermore, the secrecy and shame surrounding disordered eating and relapse make it particularly difficult for researchers to determine exact percentages.
How long can I expect to be in therapy?
The bottom line is that there is no simple answer. Everyone is unique but generally speaking, full recovery usually takes several years (not necessarily with one therapist or programme). Studies suggest that the length of time a person has had an eating disorder will be a determining factor in the time required for recovery, which makes sense when we think about our habitual natures. It is not at all uncommon for individuals to have struggled with an eating disorder for decades before seeking help, many having spent years telling themselves that this will be the last day that they will engage in their eating disorder behaviours. Most people find recovery very difficult without professional guidance.
What experience do you have dealing with eating disorders?
I did my graduate work in Counselling Psychology with a focus on eating disorders in my clinical training, as well as in my research for my thesis. I have worked in a variety of capacities in the eating disorder field for over 20 years (see About Cynthia Johnston).
What type of psychotherapy do you offer?
My therapeutic approach is eclectic and individualized, depending on the needs of the client. My approach typically draws upon the transtheoretical model of change, psychoeducation, harm reduction theory, interpersonal therapy, acceptance and commitment therapy, motivational interviewing, cognitive behavioural therapy, dialectical behavioural therapy and/or brief solution-focused therapy, among other therapeutic approaches, theories and techniques.
My approach to treatment has always been to work in concert with my clients to facilitate change when, and if, they are ready to do so. I firmly believe that people have their eating disorders for very good reasons (albeit perhaps not the most functional or healthy way of coping) and that with education and supportive therapy, they can let go of their unhealthy behaviours and learn new ones as they are ready.
Most often, new clients are curious about the root of their problem and believe that if they can just figure out the why, then they will overcome their eating disorder. I think that the process of exploring underlying issues can be important for self-compassion and sometimes helps with recovery, but the current reasons for the eating disorder may not be the same as the original ones.
While I use a variety of techniques and tools (eg, to address body image, meal planning, regulating emotions, family patterns, trauma), exploring one’s attitudes and beliefs about weight and shape and how one processes negative thought patterns are important on-going aspects of treatment, as is examining replacing less-functional behaviours with healthier ones, one small step at a time.
I am on a varsity team and I want to know if I can continue to train while I am in treatment?
Individuals also ask me about running or going to the gym. The short answer is yes, but it depends on the person’s health status and ability to know where to draw the line. Over-exercising, or any exercise at all for those who are very underweight or have particular risk factors (such as a very low heart rate or multiple fractures), can be extremely dangerous for some athletes. That said, I believe that exercise – in relative moderation and with monitoring – can be very helpful to the recovery process with regard to body image, moderating mood, maintaining bone density and helping to better understand that food is fuel. I sometimes work in concert with team coaches or personal trainers.
Is it only teen-age girls who are at risk to develop eating disorders?
No, but the number of children and teens of both genders has not decreased in the years I have worked in this field. The females and males that I currently see in my practice range in age from 16 to mid-50s.
I have worked with many women who are over the age of 40, many of whom have denied or minimized their disordered eating over the years. While individuals of all ages are more at risk of developing disordered eating if they are experiencing some sort of life transition (eg, parents separating, changing schools, leaving home, death of a family member, break up or divorce), this is often the case with my clients who are in their 40s and 50s.
Aside from quality of life issues and health concerns, another potentially important reason to seek treatment is that the children and teenagers of women and men with disordered eating are at a much greater risk of developing eating problems.
My daughter is considering a career in modelling but I am concerned that this may put her at greater risk of developing an eating disorder.
This is a legitimate concern for you to have given the preponderance of disordered eating and waif-like bodies in the industry. However, there are so many contributing factors as to why anyone develops an eating disorder that it is impossible to attribute the blame entirely on modelling.
That said, if your daughter does choose to become a model, it would be particularly helpful for her to have some experience with assertiveness and setting her own boundaries, as well as learning about the importance and real facts around healthy eating and exercise. The family is a most significant role model in all of these areas.
Should I be concerned if my teenager stops eating meat?
It is not uncommon for children and teens to decide to become vegetarian or vegan. Most often, this seems to be a reflection of their learning about – and concern for – the planet and the animals that inhabit it with them. It is important to explore your child’s/teenager’s own reasons for choosing not to eat meat. You will be more likely to open the lines of communication (which may in turn help you to ascertain if there might be more of a problem, such as body image issues or disordered eating) if you can avoid sounding judgemental when exploring his or her reasons. A few will maintain vegetarianism but for many, it will be a passing phase.
If your child’s rigidity around eating increases over time, you might want to suggest, or even make it a condition, that your son or daughter meet with a dietitian to make sure that his or her nutrition needs are being met. The willingness to do so and to make any necessary changes will help you and the dietitian determine whether or not your child might be at risk of developing an eating disorder.
I have read that CBT is the treatment approach of choice for eating disorders.
Cognitive behavioural treatment has been recognized as an effective approach to treating eating disorders but there are various newer approaches that also incorporate what is referred to as “mindfulness” – or how we think about our thoughts and react to them – such as Dialectical Behavioural Therapy or Acceptance and Commitment Therapy. Many therapists, including myself, will incorporate a variety of approaches, often depending on the particular needs of the client.
Do you offer family or couples therapy?
Yes, when and if a client finds that it would be helpful to do so. I think it is particularly important to involve
family members if a child, teenager or young adult is still living in their parents’ home or in frequent contact.
I also offer counselling to family members and partners to help them better understand eating disorders and how they can be of support to their loved ones.
Do you see people with disordered eating who also have problems with drugs or alcohol?
It is certainly not uncommon for someone to struggle with these problems concurrently, particularly with bulimia nervosa and binge eating disorder. Depending on the substance and the level of dependence on drugs or alcohol, I may address both the substance and eating disorder issues in treatment, or I may refer the individual to work with a drug and alcohol counsellor and to see me with regard to the eating disorder.
Are you ready to take the next step and to book a free 15 minute phone consultation? If so, contact me at 416-922-3311 or send me an email at CynthiaJohnston@bell.net