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Excerpts Excerpts from a chapter from "Person-Centred Practice: Case Studies in Positive Psychology" (Ross-on-Wye: PCCS books, 2007) A Person-Centred response to Eating Disorders by Matthew Campling I have a particular, personal, reason for believing in the effectiveness of the client-centred approach. I developed anorexia in my late teens. Living in Durban, South Africa, in the mid 1970’s there was no network as exists everywhere now of trained, supportive professionals. If I had not found a way to work through my illness myself and to recover from it I would possibly have died. Or been forced into the nightmare world of the psychiatric ward. But as it was, with a minimal degree of outside support I discovered my own inner resources. A key aspect of my recovery was in rediscovering the joy of living: as the desire to survive and be healthy grew stronger, the anorexic self naturally became weaker and less able to dictate unreasonable behaviour. Even though there is much greater awareness of the existence of eating disorders now, there still seems to be a great deal of misinformation and worse about the illness. Therefore I am writing to offer a different, a new approach to regarding the nature of eating disorders and also to offer an alternative way to work with the client so they can actively cure themselves. … Many people with eating disorders develop bizarre – sometimes seen as humorous – manifestations around food. I began to haunt the sweet counters of the big department stores, buying a pound or more of chocolates in their shiny, seductive wrappers and eating them in the privacy of my bedroom. Then I would drink pints of orange juice which I was convinced neutralised the sugar. Then I would refuse dinner saying I was full and spend the evening exercising before finally passing out. … One morning I stood on a pair of scales and saw I weighed under 95 pounds – about 92. At that moment I had a profound realisation of being seriously ill. But I didn’t know what to do about it. I had had a couple of incidents in the previous six months when, persuaded by my mother’s pleas to ‘eat something nourishing’ I had tucked into a cheese fondue – and been horrified at the following morning’s weigh in to find I appeared to have gained five pounds overnight. The horror that I could once again become overweight, that I would lose the control I now exercised over food, over myself and my life, manifested in a still stricter eating regime – with of course the infrequent binges such as devouring two packets of chocolate biscuits on a rare occasion when hunger overwhelmed the controlling anorexic self. … So this was my position. Unable to put on weight sensibly, able only – under the direction of the powerful anorexic self- of approaching each day with more control, more denial, more diseased discipline. I knew the anorexic self was powerful. I knew it was merciless. I knew I was seriously ill. And I knew I wanted to live. Not for any specific reason other than I also didn’t know how to die so I had no choice but to try to learn how to live. The weak, healthy part of my psyche talked to the stronger, frightened, anorexic part – it negotiated. The deal was not that I would need to eat more in order to recover my health. But that I needed to eat in order to exercise. That was the only way the anorexic self could hear the suggestion. … For me, without a map, it wasn’t by following a set order – in fact any attempt to make me follow an ‘order’ would have resulted in rebellion from the still strong anorexic self. My tentative steps back to a normal eating pattern and a more regular life were delicate, offering rather than pushing the anorexic self. In fact it seems to be that we cannot confront our emotions directly because they aren’t under our control, they have a mind of their own. Therefore I keenly, gently, learned to listen to my senses and rather than impose, I offered. … A vital element in my recovery was finding new ways to live. On my wardrobe mirror I began to write notes to myself. ‘Eat’. ‘Sleep’. ‘Rest’. ‘Breathe’. ‘Enjoy’. On each I carefully included the date. This was because if I had the same thought a week or a month later, but I could see I had had the same thought before, it gave me a new sense of continuity, that I could let go of my erratic over-controlling and trust that something healthy, something that new better, was emerging from inside and instinctively knew what was good. … Having battered my body and psyche – not just during the anorexic period but also when I was overweight – I became aware of needing to instil new beliefs. Since becoming a therapist I have sometimes spoken to new clients of my belief in a need to find somewhere inside us where good feelings, good experiences, can ‘stick’. This place can then grow inside us, influencing and pervading the old, sick beliefs and fostering a joy and strength inside. … Having this sort of healthy independence is the opposite of what is central to anorexia – an unhealthy independence. The anorexic independence is unhealthy because we do have some dependencies – what may be more helpfully thought of as an inter-dependence with life, with food, with others. But the anorexic independence – which begins so proudly with a demonstration of discipline over food and the pleas of others to eat something becomes confused and lost in an psychic quagmire. … Another eastern theory is that these different ‘centres’ we have – intellectual, emotional, instinctive and the physical body – fight for each others energy. Thus when we need to make an intellectual decision our emotions do it – what we might label a ‘hotheaded response’. Or we have a difficult meeting ahead – and spend the minutes pacing anxiously (using the physical body) rather than coolly working out our strategy. … One thing I have emphasised to clients with an eating disorder is that they should not see the self-concept as something hateful or evil. For me in my recovery, part of loving myself was integrating the anorexic self concept into the whole. What I used to say to myself, and what I say to clients is that the self concept was doing its best. The fact that it was woefully inadequate is not actually its fault. It is trying to accomplish the task. Which is to survive and get the whole person through life. … To simplify what has happened contains information as to how to approach a recovery. Therefore: We are not one, whole ‘I’ – we have different parts, different motivations, belonging to different physiological parts of us – the intellect, the emotions, the instinctive system and the moving or physical centre. Each of these tries to do the work of others and steals energy from other centres. Rather than being in our organismic self we are in some kind of self-concept. The self-concept is rigid, black/white thinker, wildly fluctuating, unable to see beyond a narrow line. Because at the beginning it seems a positive thing, energy grows in an artificial eating disorder. This eating disorder self has the same characteristics as the self-concept. Additionally it is desperately frightened and often paranoid and sees no way out other than ritualised behaviour, denial of normal bodily needs and strict discipline. We cannot fight the eating disorder/self concept head on – it is rooted in the emotional centre and is not available to our intellectual arguments. It has to be negotiated with, it has to be understood for what it is – trying to do a job but with the wrong set of tools. This is why the correct person to be in charge of the recovery process is the person with the disorder. Only they can make the delicate internal changes, only they can know when they are pushing too hard and can step back to allow the disordered self room to breathe, to calm down. One precious asset in the recovery process is sleep. When I was in my own recovery I often felt overcome with great waves of tiredness during the day. Because I wasn’t working I was able to take to my bed. When I woke up I felt invigorated, full of new energy and I was aware that something had happened during sleep. … What had worked was negotiation. Just that. Internal negotiation between my healthy and anorexic self. Quietly, methodically, patiently. And this is what I shared with my client. And this made sense to him. Another fear which clients express is ‘once I am no longer ill – who will I be?’ Or ‘when I’m no longer talking about my illness, what will I talk about? – There seems to be this great black void’. When a client expressed this, we looked at another aspect of the results of an eating disorder: isolation. In the process of the disorder attention moves from the external world to the internal. Constant monitoring of bodily functions eats into available energy and becomes all-consuming. Therefore it can appear to the individual that recovery necessitates the appearance of the black void. What the client needs to hear at this point is that firstly it is the self-concept talking – so it needs to be loved, appreciated, thanked – and gently disengaged and allowed to let go. Assure your client that as their focus begins to move away from the illness and back into the world, the world will move back – perhaps rush in – to fill up the void. Again it’s obviously desirable that recovery takes place at the client’s pace. I suggested to one client that he go for walks – as long as he felt comfortable with – in order to give him something other than food to focus on in the morning. In this way, carefully and at their own speed, the client begins to separate the action of the disorder with other, healthier, uses of their waking hours. A simple daily routine of a walk in the morning, reading of an informative book, writing in a diary, talking to a friend, will begin to instil balance. Remember that the centres rob each others – and take advantage of that fact. If a certain amount of energy is being used in non-disorder pastimes, the disorder itself is proportionately weaker and the healthy self can grow. It is this re-alignment that was the ultimate secret to my own recovery. There was no dramatic cut-off, blocking or denial of the anorexic self, only that my life took off in other ways and since my energy was going in other directions, the anorexic self became weaker and was gradually integrated into the whole of me. From my congruence I told the client who was concerned about the black void that my experience had been that when I really began to embrace the outside world I needed all my energy – I just didn’t have enough energy to maintain the disorder. … Therefore it’s a vital part of the recovery process that what lies beyond the disorder is explored and embraced. Overall I can report that I can eat food or not, take exercise in moderation, and basically its only when I’m working with a client that I look into their eyes and see back into my own history.
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