So much of the holidays can be taken up with the busy stuff of gift buying, travel plans, and food and festivity preparations that we’re often left exhausted and depleted. It’s easy to forget what the holidays are fundamentally about: to connect and be with family, friends and loved ones. This holiday, offer the gift of your presence to both yourself and your loved ones.

What do I mean by “the gift of your presence”?

Simply put, being present is about being a human being as opposed to a human doing. It’s about being with yourself or your partner instead of busily doing something with your mind elsewhere. You can also practice being really present while doing something fun with your partner. For instance, you could be on a bike ride with your love, enjoying and participating in the experience, giving both your partner and yourself the gift of your full presence. On the other hand, you could be on that bike ride with your mind a million miles away, thinking about that turkey you have to buy or something else on your to-do list. In this case you are just “doing” the bike ride. And your lack of presence may unintentionally give your partner a really negative message about your value and appreciation for them.

Most of us fall somewhere in the middle of the spectrum between “being” and “doing.”

Some of us are more toward the “being” end and some more toward the “doing” end of the Being/Doing Spectrum. If, like me, you find yourself more at the “doing” end, some kind of mindfulness practice can really help, even if it is just for 5-10 minutes a day. Consider this a chance to work out your “being muscle.” At first, you may have a hard time simply locating this muscle! Then, once you locate it and start working on it, you may feel awkward and clumsy. Afterwards, you may be super sore! But over time it gets easier and easier to work that muscle, and eventually it even becomes enjoyable. This is what mindfulness practice is like. At first it can feel difficult and awkward. Your mind is racing a mile a minute. You have no idea if you are even doing it right. Eventually, it gets easier and you start to enjoy the practice. It becomes a way to connect with yourself that is different from your habitual “doing” mode. It’s really about being with yourself, with no agenda, nowhere to go, nothing to do. It can become a deeply nourishing space that you find you really miss if you skip a day!

The Neurobiology of “We”

Your ability to be present for yourself in this mindful way not only radically shifts your relationship with yourself, it can also deeply affect your relationships. You may find that you are able to be present in a much fuller way with loved ones and that this deepens your relationships. Studies show that mindfulness increases empathy, which increases trust in relationship. As Daniel Siegel, a well-known neurobiologist, says:

If you can be open to what’s going on inside of you as it’s happening, then there’s a gateway to being open and present to other people as well… The more you are aware of your own bodily sensations, the more you could be aware of other people’s internal emotional states. It’s called the neurobiology of “we.”

Too Busy to be Present?

Does all this feel like something else to add on your to-do list? Some of the couples I see are so busy that they barely get a chance to connect with themselves, let alone each other! I saw a couple the other day who told me their session with me was the first chance they had all week to sit down and talk! In cases such as theirs, I suggest “connection rituals” that I encourage them to schedule into their busy lives. Prioritizing time together is as important for couples as going to a class or a business meeting. These connection rituals can become the lifeboat for a relationship that is drowning in to-do’s.

What is a connection ritual?

These rituals vary depending on the couple. There are 101 different ways to be together. The operative word here is be. A connection ritual is not a time to talk about the kids or scheduling. It’s a time to relax, play and enjoy each other. The couples I see have come up with a variety of connection rituals: going for a hike, playing music, taking a bath together, reading out loud to each other, having breakfast in bed, going out for a meal, having a coffee date, and so on. Be creative and see what you and your partner can come up with! And most of all, have fun!

I will leave you with this quote (and if anyone knows the source of it, please let me know!): “A beautiful marriage is built on a long series of little things you do for your mate for no reason on earth except the best reason of all, and that is that you love them.”

The Pleasure Principle is simply this: Our bodies are wired to move towards pleasure and avoid pain. We naturally gravitate towards things that taste, smell and feel yummy and delicious. We naturally avoid the opposite.

What if following and listening to our pleasure was really the secret to it all? What if by listening to our bodies instead of fighting them we started to come into a better balance around our weight and body image?

Impossible you say? Let me invite you to temporarily suspend your disbelief until you read the rest of this article…

Pleasure is the key to the practice of intuitive eating.

If you are practicing intuitive eating (which, in a nutshell, is to eat when you’re hungry and stop when you’re satisfied, and to eat what your body wants), then when you are hungry you ask yourself: “What is the most nutritious and delicious thing I can eat right now?” You need to have your pleasure muscle well toned and flexed in order to be able to answer this question. In fact the more tuned in you are to what will bring you pleasure, the better you will be able to intuit what your body wants and needs.

Left to their own devices, our bodies are naturally going to want to eat what will increase our chances of survival. Our default mode is for strength and health. Of course, if you have been dieting most of your life, some of these natural predispositions of the body might have become skewed, so it’s important to be patient with yourself.

So many of my clients who have spent a lifetime going from one diet to another are terrified at the thought of practicing intuitive eating. “I won’t be able to stop eating chocolate!” wailed one of my clients. Chocolate was her number one forbidden food, so of course once she considered legalizing it, that is where her mind went. There is nothing like scarcity to increase our desire for something.

Although this is a valid fear and one that might even get played out, in my experience, this phase of overdosing on forbidden foods is relatively short-lived. Once your body gets that it can eat what it wants, when it wants, and even as much as it wants, a forbidden food like chocolate starts to lose its grip on you.

In their book When Women Stop Hating their Bodies Hirschmann and Munter tell us:
Always having large quantities of the food you love at hand is critical to the process of legalizing. As a rule, everyone starts this process by doing just that—stocking up. There is no question that the biggest surprise for people in the early stages of legalizing food is that, contrary to popular belief, the more food you have at hand, the less you eat. Scarcity produces anxiety; surplus makes people feel more secure.

Pleasure can also be used as a barometer for when we’re starting to feel satisfied and have had enough. When we first start to eat, we are truly hungry; the food tastes that much better because we have an appetite for it. However, once we start to fill up, our pleasure begins to diminish. This is our sign that we have probably had enough food. If we know that there will be more food and plenty of it when we are hungry again and can really enjoy it, it won’t be so hard for us to stop eating.

If you’ve been trying diets and they haven’t been working, try using the pleasure principle. Our bodies don’t do well with deprivation and punishment; they are so much more responsive to pleasure. Like it or not, our bodies are wired for pleasure. Try working with your body instead of against it for a change.

What I am writing about here is completely counter-cultural to what most women have been spoon-fed since birth (pun intended). It’s certainly not what the dieting industry wants us to believe. They have spent billions of dollars convincing us that our bodies are battlegrounds to be controlled and conquered. Has this approach been working for you?

If you are going to try some of the suggestions I have outlined here, please enlist some support, whether it is individual or group therapy or both, because it is hard to change these deeply encoded messages on our own. The more support you can get, especially in the beginning, the better your chance of success.

Here’s to your pleasure!

1) Yvonne & Angela: How homophobia ruined our romantic vacation

After I asked a lesbian couple why they hadn’t taken a vacation together in five years, this is what they told me:

Yvonne:
I took her on what was advertised as a “gay-friendly destination” but as it turned out, we were the only queer couple in sight! Consequently she was really paranoid in public and wouldn’t hold my hand on the beach or became really uncomfortable if I suggested a restaurant that looked slightly romantic. She’s a butch woman, so people were staring at her anyway because they couldn’t quite place her on the gender spectrum. It pretty much killed the romance factor out in public, and unfortunately it translated into the bedroom as well. She just couldn’t make that transition when we were alone. It was as if she didn’t take a breath until we got home. Needless to say, we haven’t been on an overseas vacation since!

Angela:
I think on some level I just didn’t feel safe. I didn’t speak the language or know the people. They stared at me all the time. I think they couldn’t figure out if I was a guy or a girl. It might sound ridiculous, but I was expecting to be attacked at any moment. Consequently, my guard was up at all times.

This couple had to deal with a whole set of stressors that a heterosexual couple would probably never need to consider when planning their holiday (like having to find a “heterosexually-friendly destination”). So much of the travel industry is geared towards the romantic getaway, but those getaways are mostly aimed at heterosexual couples. This omission of queer couples is part of what is termed “heteronormative assumptions.”

[Heteronormative assumptions] refer to automatic unconscious beliefs and expectations that reinforce heterosexuality and heterosexual relationship as the ideal norm. Thus, heteronormative assumptions create a society where only heterosexual relationships are visible (McGeorge and Carlson, 2011).*

Although the travel industry has become savvy to a whole previously untapped market and there are now ads for gay-friendly destinations on every queer travel site, the truth is that this can also be a marketing ploy. As Yvonne and her girlfriend found when they got to their “gay-friendly” destination, the locals hadn’t been informed!

2) Gloria & Maria: A pregnant lesbian couple’s first birthing class together

Gloria:
I was so uncomfortable that we were the only queer couple in the room! On top of that the trainer had us do an experiential where she asked the fathers to go on one side and the mothers on the other. She at least corrected herself when she saw me standing there awkward and alone. I felt so humiliated!

The rest of this session was spent processing Maria’s feelings about the class and her ambivalence toward attending more classes. Although Gloria was sympathetic to Maria’s dilemma, she was also clear that she wanted Maria’s support at the birth and needed to know that Maria had the knowledge to provide it. In the end, despite the stress the first class had caused, they did go back for another class and found to their delight that there was a new trainer who was much more GLBTQ savvy and aware. What a relief!

Again, these are not stressors a heterosexual couple would ever have to deal with. Being part of mainstream culture, it is easy for heterosexuals to take for granted the safety net that is automatically available. This is part of what is coined as “heterosexual privilege.” Furthermore the lack of affirmative mirroring that queer couples receive has both subtle and gross implications. “One of the less visible, but potentially most influential privileges that heterosexual individuals receive is an increased self worth that comes with being part of the dominant socially sanctioned group” (Hoffman, 2004; Worthington, Savoy, Dillon & Vernaglia 2002). When who you are and how you love is not reflected in your world, whether on TV, in films, books or other forms of mainstream media, the effect on self-esteem is persistent and corrosive, once again creating more stressors for queer couples

3) Disturbing comments from well-meaning family members

Even family members who are normally respectful toward a gay couple can fall prey to heteronormative assumptions. The following occurred during a session with a gay couple, one of whom was unemployed and looking for work. He had been offered a position overseas but had decided to turn it down because it meant being too far away from his partner.

Mike:
Can you believe my Dad encouraged me to take that job in Singapore with no regard for how it would affect my partner who has a full practice here? It was as if he saw me as a single man, living with “a good friend,” but certainly no one to consider if I was being offered employment overseas. He would never say that to my heterosexual brother and his wife!

Bill:
Your dad is always friendly to me when he sees me but hearing that makes me feel invisible.

Mike’s father was unintentionally hurtful by omission. The undermining quality that this lack of mirroring creates has a corrosive effect on self-esteem. Mike is left with the message that his relationship is less visible, less valid, and less valuable than his heterosexual brother’s.

In summary…

When I hold space for a queer couple in session, I am also considering factors outside the couple dyad, such as the effects of heteronormative assumptions and privilege that can exacerbate existing stressors in the couple. For instance, Gloria and her wife have all the stressors of being pregnant but not the knowledge that they are seen and held in a supportive community. Yvonne and her girlfriend finally find the time and money to take a vacation together only to discover they have to keep their guard up and don’t feel safe enough to express their affection and love for one another. Then, there is Mike having to deal with the crushing effects of unemployment on his self-esteem, only to have his father exacerbate this problem by unintentionally disregarding his long-standing partnership.

Queer couples simply don’t have the safety net that heterosexual couples can take for granted. The society at large does not provide the validation and affirmation that a queer couple could rely on for support during difficult times. The need for this validation and affirmation first has to be acknowledged by the individual or couple and then self-generated. While many queer couples have been very resourceful in generating their own safety nets by building their own communities and support systems, the freefall, in terms of the stigma of being an outsider and the resulting isolation, is ever present for those who do not.

*McGeorge, C. and Carlson, T. S. (2011) Deconstructing Heterosexism: Becoming an LGB Affirmative Heterosexual Couple and Family Therapist. Journal of Marital and Family Therapy, 37(1), 14-26.

“Spring is the ideal time to cleanse and rebuild from the sluggishness and inactivity of winter. According to Chinese Medicine, spring corresponds to the liver and gallbladder organs in our bodies. During the winter we tend to consume diets heavier in protein, fats and dairy, which can all overburden these organs. When congested, the liver and gallbladder can also cause more feelings of depression, irritability and anger. Spring is the time to detoxify, give the liver a good cleansing and boost our digestion, resulting in better moods and increased energy levels.”

But what if you are someone who already struggles with simply trying to establish stable and consistent eating habits? Doing a cleanse could be the thing that pushes you back into your binge/purge cycle or your under-/overeating patterns with food. If you are someone who struggles with food, weight and body image issues you’ll want to ask yourself very honestly: What is my intention in doing a cleanse?

If your intention is for anything other than your health and well-being, don’t do it! However, if the focus of your cleanse is for better health and perhaps to establish more mindfulness around your eating habits, then a spring cleanse could be just the thing that gives you a jumpstart in the right direction or helps you fine-tune an already healthy regime.

In either case, do not begin a cleanse without first consulting a nutritionist or other professional. There are many different cleanses as well as a lot of misleading information out there, and it’s important to choose the cleanse that’s appropriate for your unique needs. If you have a predisposition towards food, weight and body image issues, you may want to find someone you trust who can keep you on track.

Cleanses are used worldwide not only for their physical health benefits but also as a form of spiritual practice. Freeing yourself from the constant preoccupation with what to buy, cook and eat can allow your mind to focus on other nurturing sources, such as your spiritual and energetic health and wellness. Breaking your food routines can also help you establish more mindfulness around your food habits because you’re taking yourself out of your automatic, habitual mode. For example, if you change what you eat for breakfast, you might pay a bit more attention to how you start your day with food.

Chalita’s 5 Tips for Simple Cleansing are easy steps that anyone can implement into their daily routine:

• Upon waking, drink 1 TBS of fresh lemon juice in 8 oz. of water to stimulate digestion.
• Drink your greens. Add 1–2 cups of green vegetables (chard, spinach, kale, cucumber and/or celery) to your favorite smoothie recipe for a boost of energy.
• Drink 1–2 cups of dandelion or milk thistle tea a day to cleanse the liver and gallbladder.
• Limit or avoid caffeine, alcohol and white sugar to support detoxification.
• Get regular acupuncture treatments to help your body’s cleansing and rebuilding process.

Here’s to your health and wellness this spring!

With the eating-disordered population, however, the connection between food and relationship can become a troublesome link. When there is a lack of safe, connected, nurturing relationships in an individual’s life, food and food rituals can easily become a substitute.

As Susan H. Sands, PhD says:

“It is now generally accepted that eating disorders serve essential self-regulatory functions. The disordered relationship to food has been viewed, essentially, as filling in for a missing bond with a self-regulating Other.”

(Sands, S. H. The subjugation of the body in eating disorders. Psychoanalytic Psychology, 20(1), 103-116. 2003)

What exactly does Sands mean? Let’s take the first phrase:

“It is now generally accepted that eating disorders serve essential self-regulatory functions.”

What does it mean to self-regulate? Most of us have learned how to emotionally self-regulate; for instance, if we are upset we find ways to calm down. The ability to calm or self-soothe is usually learned in relation to a calming and soothing Other. For example, when a child falls down and hurts her knee and is crying, Mommy picks her up and comforts her. But what if Mommy doesn’t do this? What if she yells at the child and blames her for being so clumsy? Then the child has to turn elsewhere for soothing. Here is where turning to food in order to self-regulate or self-soothe can begin.

I have yet to meet someone suffering from an eating disorder who does not also suffer from a relational trauma, by which I mean that the person grew up without the experience of a caregiver being attuned to them and their needs and acting as a source of comfort when they were stressed or hurt. The caregiver was either absent or blaming and generally not attuned to the child. As Susan Sands so eloquently puts it: “The disordered relationship to food has been viewed, essentially, as filling in for a missing bond with a self-regulating Other.”

Let me illustrate the above ideas with some client stories:

Emma was a 21-year-old client who had grown up being her mother’s main support in a dysfunctional marriage. Dad was absent and not very involved in her life. Her mother was lonely and turned to Emma for a shoulder to lean on and someone to talk to, but the conversation was always about her mother and her mother’s needs. Emma had little experience of her mother being there for her. So, Emma learned how to have few needs or none at all. She identified with being a caretaker and had little awareness of her own needs. This dynamic also played out with food. Emma would cook meals for her mother but she rarely ate a full plate herself. By the time she was 16 years old she’d been hospitalized for anorexia.

Betty was addicted to compulsive binge eating.

Her nightly ritual was to binge on chips or ice cream while zoning out in front of the TV. She had experienced mostly neglect growing up with an overwhelmed mother and an alcoholic father. There was never any room for Betty and her needs. She learned how to take the need out of her relationships with Mom and Dad in order to preserve those relationships. Later, when she became an adult, food replaced her need for friends and relationship. She started to gain a lot of weight and then was too embarrassed to go out. She became stuck in a self-reinforcing loop.

The good news is that both Betty and Emma healed and overcame their eating disorders and in doing so, they also found that their relationships improved. As they began to acknowledge their needs and find healthy ways to take care of themselves, they also began to develop more nurturing relationships. As my client so succinctly put it: “It’s about relationships, not food!”

The antidote to exhaustion is not rest but heart-felt activity.
—Source unknown

I love this quote (even if I can’t remember its source) because it works! The best way to combat stress and exhaustion is not necessarily sleep. In fact, if you’re really exhausted, sometimes you can find you’re too tired to sleep—or if you do sleep, you sleep fitfully. The real cure for feeling strung out and stressed is to find something that touches your heart and nurtures you—something that is enlivening, silly and even a waste of time. Something that is about play, not work or your to-do list. Children know this one really well. Why do you think they have so much energy?

A fast track to knowing what would be a heartfelt or nurturing activity is tuning into the child in you. Ask yourself: “What does the child in me want?” or “What is purely about fun and play for me?”

Then see if you can make some time and space for “your inner child.” You will be amazed what a difference this can make! There is something powerful that happens when you turn your attention and focus toward what is pleasant and enlivening. It’s as if what your radar is focused on is what you end up seeing more of, simply because you are tuning in. See if giving “your inner child” some time and space this year doesn’t change the whole flavor and tone of the holidays for you.

My favorite questions to clients at this time of year are: What is heartfelt activity for you? What would be nurturing?

I have found that women in particular can have a hard time giving themselves permission to focus on their own fun and pleasure. We are so often encouraged to focus on everyone else but ourselves, so it’s no surprise that at the end of all the festivities we can find ourselves feeling resentful and depleted! Yet if we focus on ourselves we think we are being selfish. So I encourage my female clients to reframe “selfish” and instead be “self-full.” If you are giving when your glass is full, it’s a very different experience than when your glass is nearly empty.

For the eating-disordered population, needs and self-care are especially crucial during the holidays. Ignoring one’s needs is a set-up for a relapse. I focus almost exclusively on needs and self-care with my eating-disordered clients at this time of year. Otherwise, it is too easy for food or rituals around food to become the only attempt at self-nurturing. (Look at my article “Food, Family and the Holidays” for more about ways that those of us who struggle with food, weight and body image issues can take better care of ourselves during the holidays.)

Here are some of my favorite ideas for self-nurturing during the holiday season:

* A hot bath with your favorite tunes and scents
* Curling up with a good book
* Calling a loved one to chat
* Playing with your pet
* A cup of hot cocoa by the fire
* Playing a game
* Drawing, painting, beading or doing something creative

* Spending time in nature

What are your own favorite ways to nurture yourself? Remember don’t forget to ask “your inner child”!

The story of Anna and how anorexia provided the perfect “asexual solution”

Anna was hospitalized for anorexia at age 16. She had been struggling with her eating disorder since the age of 12, and she realized she was queer when she was 19. She talked about the stormy period between ages 12-16 as her attempt to be as “asexual as possible” because, as she said, “I didn’t want boys to be attracted to me.” She was thrilled when her anorexia stopped her breasts from developing and eventually stopped her periods, because with that came less unwanted attention from boys.

It wasn’t until Anna realized she was queer that her anorexia started to make more sense to her:

What better way to stop the problem of boys and all that pressure to be a heterosexual than to stop eating? Once I got control of my eating I suddenly had control of everything! My period stopped, my breasts stopped growing and best of all, no more unwanted attention from boys. I didn’t realize why at the time, but I do remember feeling such a huge relief!

Part of Anna’s healing process from anorexia was to embrace her queer sexuality, suppressed by growing up in a heterosexual and homophobic environment. Once she realized what she was saying no to, her body didn’t have to do it for her.

The story of Margaret and how she used her weight to keep away sexual attention

Margaret came to me because she suffered from compulsive binge eating. She had a history of yo-yo dieting—gaining and losing weight over and over again. Her self esteem was at an all time low. She couldn’t understand why despite having the will power to lose the weight, she always put it back on.

After only a short time of working with me, Margaret went on a six-week trip to India and came back 25 pounds lighter. Part of the reason for this rapid weight loss was that she had caught a stomach bug, but mostly it was due to her friend Debbie’s eating patterns: Debbie ate when she was hungry, stopped when she was full and didn’t eat again until she was hungry. Margaret, who had lost her ability to read her hunger signals from repeated yo-yo dieting, followed Debbie’s rhythms and found that her own eating stabilized. With time Margaret discovered her own cues for hunger and satisfaction; this further helped to improve her relationship with food and her body.

Everything was fine until Margaret returned to the States and started to put the weight back on. We explored what had shifted for Margaret now that she was back in America. She confessed that she was binge eating again. When I explored with her what was triggering these binge episodes, it seemed that the main trigger for Margaret was feeling more attractive and getting more sexual attention. It unnerved her.

Margaret began to tell me about a rape she had survived 10 years ago. She started to piece together that she was putting weight back on because she was uncomfortable with the sexual attention and still suffered trauma from her rape.

The rest of Margaret’s treatment was focused on healing from her rape trauma and learning how to voice her need for boundaries so that her body didn’t have to do it for her. Once Margaret was more conscious about the need to establish sexual boundaries, her weight came off and stayed off!

Sue’s bulimic cycle and how it mimicked her childhood abuse cycle

Sue had suffered from bulimia for 15 years. She was scared about the effect it was having on her teeth, hair and skin. She wanted to get healthy again. Sue had also been repeatedly incested by her father from ages 5-9 years old. At the time it was the only attention she got from an adult. Her mother was an alcoholic and neglected her. When Dad gave her attention, it was confusing; some of it felt good and some of it felt really toxic.

The turning point in Sue’s recovery happened when she realized that the relationship she had with food mimicked the relationship she had with her Dad as a girl. Sue barely ate all day and when she did she usually binged, then purged. In a similar way, she got little attention growing up, and when she did, it was usually in the form of sexualized attention from her Dad that was overwhelming and confusing.

On the one hand I was getting the attention I so desperately needed, but at the same time it felt really toxic. I do this with food; I overwhelm my body with too much food and then throw it up because it feels toxic.

Once Sue identified the cycle of abuse she was inflicting on her body and how it mimicked the abuse she suffered growing up, she was able to start healing her bulimia.

Each of these clients had different stories and suffered from different trauma, yet all of them suffered from a battle with food, weight and negative body image that had its roots in sexual trauma. Once the roots were discovered, their healing began. This is why when working with clients I always have enormous respect for “the problem.” Problems don’t persist unless they serve a function. Once we discover the function the problem serves, we can develop more choices for healthier ways to replace that function.

For Anna it was learning how to say no to the pressure to be heterosexual so that her body didn’t have to do it for her.

For Margaret it was learning how to create sexual boundaries so that she didn’t need the weight to make the boundary for her.

For Sue it was making the connection between the abuse she suffered as a girl and the abuse she was inflicting upon herself as an adult.

More research is needed to fully understand the correlation between eating disorders and sexual trauma. For now, I will continue exploring the link client by client.

Some inconclusive research on the correlation between eating disorders and sexual trauma:

1) Adverse sexual experience in childhood and clinical eating disorders: A preliminary description.
R. Oppenheimer, K. Howells, R. L. Palmer and D. A. Chaloner (1985). Journal of Psychiatric Research 19(2-3), 357-361.

Abstract
Seventy-eight eating disordered patients were asked systematically about any history of adverse sexual experience. About two thirds gave such a history. The events reported were often distressing and significant to the subject. It is unclear what role such events play in the causation of later eating disorder.

2) Reported sexual abuse and eating psychopathology: A review of the evidence for a causal link.
Joanne Everill B.Sc., Glenn Waller D.Phil. (1995). International Journal of Eating Disorders 18(1), 1–11.

Abstract
It has been claimed that there is no specific link between a reported history of sexual abuse and the eating disorders. In particular, studies and reviews investigating the relationship between reported sexual abuse and the eating disorders have concluded that the prevalence rate of abuse among eating-disordered women is similar to the rates found in other psychiatric groups and in the general population. However, it is argued in this review that such a conclusion is based on an inappropriate level of analysis of the phenomena of sexual abuse and diagnosable eating disorders. When these two relatively blunt constructs are considered in finer detail, there appears to be a complex link between the nature of sexual abuse and specific bulimic symptomatology. This relationship is discussed with particular reference to important mediating factors (including dissociation, self-denigration, borderline personality disorder, and disclosure experiences), the functions of the bulimic behaviors, and the particular cognitive schemata that the victims of abuse may develop. The clinical implications of this relationship are considered, and suggestions are made for further research. © 1995 by John Wiley & Sons, Inc.

3) A meta-analytic examination of the relationship between child sexual abuse and eating disorders.
Linda Smolak, Sarah K. Murnen (2002). International Journal of Eating Disorders 31(2), 136–150.

Abstract

Objective
This study had two goals. The first was to assess the magnitude and consistency of the relationship between child sexual abuse (CSA) and eating disorders (ED). The second was to examine methodological factors contributing to the heterogeneity of this relationship.

Method
Meta-analysis was used to examine both questions. Fifty-three studies were included in the analysis.

Results
A small, significant positive relationship between CSA and ED emerged. The relationship was marked by heterogeneity. Effect sizes were largest when CSA was the grouping variable, the Eating Disorders Inventory (EDI) or the Eating Attitudes Test (EAT) was used as the measure of eating disorders, and nonclinical groups were compared with clinical samples.

Discussion
Models of CSA and ED need to more clearly specify what aspects of ED (e.g., body image or binge eating) are most influenced by which types of CSA. These specific relationships then need to be examined empirically. © 2002 by Wiley Periodicals, Inc. Int

4) Childhood sexual experiences with adults reported by women with eating disorders: an extended series.
R.L. Palmer, R. Oppenheimer, A. Dignon, D.A. Chaloner and K. Howells (1990).
The British Journal of Psychiatry 156, 699-703.

Abstract
A total of 158 women presenting with clinical eating disorders have been investigated using a self-report questionnaire and subsequent interview concerning their recollections of sexual experiences with adults before the age of 16 and later adverse sexual experiences. About a third reported events in childhood and over half described some adverse experiences. It may be that these experiences are relevant to the subsequent illness in some cases, but greater certainty must await further research. In the meantime, inquiring about such matters would seem to be advisable in the assessment and therapy of eating-disordered patients.

Following are some client examples of the above. Names/stories have been altered to protect identity:

“Ice cream is my best friend”

One of my clients Laura calls ice cream her “best friend” and claims that as long as she has a good movie and her ice cream she doesn’t need anything else to entertain herself in the evenings and during the long weekends. This habit started after a painful break up. She since has put on so much weight that she doesn’t feel confident enough to go out. Instead she stays home and eats. Laura is caught in a self-perpetuating cycle of social isolation and comfort eating.

“Bulimia has taken over our marriage!”

I also work with a client couple who struggle in their unhappy marriage. The husband Bob complains about the lack of touch or affection in their relationship; “She doesn’t need me. She doesn’t want me! I think she’s happier when I’m not around.”

The truth is that his wife Sue turns to food, not to him for comfort. Research shows that the binge purge cycle releases serotonin “a feel-good hormone” that is produced naturally during hugging and cuddling. Sue has learned to turn to food for all her needs related to comfort and soothing and thus has taken these needs out of her marriage. It is slowly dying as a result.

Let’s not put all of the blame on Sue. There are other complicating reasons that food became a “safer option” than her husband for meeting her emotional needs. Furthermore, this is complicated by a pattern that Sue is repeating from her childhood where she learnt not to depend on unreliable, alcoholic caregivers for comfort.

So how do Laura, Bob + Sue break out of these destructive cycles?

Step 1: Breaking Free from Shame and Secrecy

Laura took this first important step when she broke out of her denial that ice cream could replace her need for relationships and sought guidance. Bob and Sue took this first step when they realized that their marital issues weren’t going away by themselves and decided to seek professional help. Coming out of denial and actively seeking assistance is an enormous step because it sets in motion the wheels of change.

For Sue, there was also the added step of letting her husband in on her “secret.” Although he already knows about her binging and purging, I encouraged her to be more open with him about her triggers to “act out.” For instance she could let him know when she feels the urge to binge or share it with him after the fact.

This is important because it starts to break the shame and secrecy that keeps the eating disorder in control behind the scenes. Laura and Sue are breaking the power their eating disorder has over them by bringing it out into the open. This is often the most difficult step.

Step 2: Got support?

Support is crucial to keep the ball of recovery rolling and there are a myriad of ways to get this reinforcement. Initially Laura, Bob and Sue all chose therapy. Laura also found an eating disorders support group to supplement her individual therapy. She was really motivated and wanted to speed up her recovery. Other ways that Laura got support was by developing a network of people she could call when she felt she was in a dangerous place. She arranged to have a friend she could walk with after work and before it got dark. This had previously been her time to buy ice cream and choose her movie.

Laura started to feel that she had more options. She found more walking buddies. Sometimes she would go out for dinner with a walking buddy or invite them over for a movie. She began to break the isolation her eating disorder demanded of her.

She started to feel better about herself and go out more. Without dieting, Laura’s body started to correct back to her ideal weight. Laura began to feel more confident about herself and as a result became more social. She was on the road to recovering her life and relationships.

For this step Sue learned to enlist the support of her husband by sharing with him when she felt the urge to binge. He could then remind her of other ways to soothe besides turning to food. Sometimes a hug or cuddle with him was enough or they would go for a walk together until the urge was gone.

It was extremely vulnerable for Sue to let her husband support her in this way. She had always feared his judgment around her eating issues and was surprised to find that he actually welcomed this opportunity to support her!

Bob appreciated feeling less shut out by Sue. Inadvertently, by Sue trusting Bob enough to let him in on her “deepest, darkest secret”, more intimacy started to develop between them. It was enough to give them a taste of something different and now they wanted more!

In Closing…

I hope that in sharing these stories you are encouraged to explore the link between your relationship with food and how it might have parallels to other relationships in your life… In closing let me leave you with these two questions to consider:

1) Do you have a nurturing relationship with food?
2) Do you let your relationships nurture you?

Please share your thoughts and ideas on this important topic…

EMDR stands for Eye Movement Desensitization Reprocessing. A big name for a relatively simple but highly effective method for dealing with trauma or what I like to call “emotionally stuck places.” It involves what is called bilateral stimulation of both hemispheres of the brain with a variety of methods. These methods can include eye movements to the left and right, an auditory tone in each ear or alternating vibrations in each hand. When I first started working with EMDR I was very skeptical that such a simple procedure would make any difference for my clients struggling with long standing issues around food, weight and body image. The results varied from incremental but profound shifts to complete turn-a-rounds. Here is the story of a client who experienced immediate results using EMDR.

Case Example: Using EMDR to address Pat’s Bulimia

. (Name and story altered to protect identity)

Pat came to me because she wanted to stop what she described as “wrecking my body.” She was binging and purging everyday sometimes a few times a day. Pat was 35 years old. She had a job she enjoyed but as a newcomer to San Francisco she missed having a friendship circle. Because her evenings were consumed with binge/ purge episodes she had little time for developing a social life. In any case she usually felt too awful after an episode to even think about going out.

The first step with EMDR is to develop a ‘target.’ I asked Pat what part of her destructive cycle around food felt the most emotionally charged and stuck? Pat did not hesitate: “After work when I open the door to my home, I just know that I am going to be going out within the hour to buy food for my binge. I know it’s messed up but I can’t stop myself!” This moment of homecoming became Pat’s target for her EMDR session because it was at this point that Pat started to feel the most out-of-control with her bulimia. It was a highly charged feeling that occurred daily. I have found that EMDR seems to work best when the target carries a lot of emotional charge and feels stuck.

After the preliminary set up for her target was complete Pat was ready to begin the bilateral stimulation. She had a headset that was emitting a tone in each ear, at regular intervals and she was holding vibrating pods in each hand. I prepped her to start with her target and then let her creative unconscious free associate. She immediately started to have memories from her childhood of coming home from school to an empty house after her parents divorce. I encouraged her to imagine she was on a train and to just let these memories go by like scenery. Memories came flooding back as she re-experienced the intense anxiety and loneliness around her parent’s divorce, having to move, losing her best friend and more memories associated with this time. Pat went through a whole array of feelings including anger and tears. It was as if a tightly wound ball of feelings and memories had started to unravel.

Periodically I checked in with Pat to measure the level of upset she felt around her original target on a scale of 0-10. When this level was down to 1 (i.e very little to no disturbance upon coming home after work) we were done. I instructed Pat to take it easy that evening and that she might feel more vulnerable or “raw” than usual.

Disclaimer: Although I have found EMDR helpful with most of my clients it is not for everyone. Some people feel little to no effect or change. More research is needed to evaluate why EMDR can be so effective for some and others not at all.

Follow-Up

A week later I saw Pat again. Her binge/ purge episodes had stopped happening every night. She had even started setting up some social events in the evenings. Pat told me: “It’s like someone turned the volume down on my bulimia voice. It just isn’t quite as loud as it used to be and it definitely does not have as much power over me!”

We explored the night that she did have a binge/ purge episode. This was after a particularly difficult day at work and had a different set of triggers associated with it that was more related to stress and perfectionism. We talked about using EMDR to address this different set of triggers for a future session.

Pat was beginning to peel away the different layers of emotions and triggers that fueled her bulimia. She was starting to free up her evenings for socializing and felt less alone as a result. As her “bulimia voice” became less prominent Pat started to feel that she could make healthier choices and had more options to dealing with challenging feelings. She was on the road to recovery.

Is EMDR for you?

Call or write Ondina Hatvany, MFT with any questions or concerns.
(415) 381-1065 Confidential Office line
Or e-mail: ondinah@gmail.com

Learn to negotiate so you can effectively handle conflict. All healthy relationships need conflict to grow however many people are afraid of conflict because they don’t know how to negotiate. Learn how to create “win-win” situations with effective negotiating skills. Good negotiation will also vastly improve your communication skills.

What Can Be Negotiated?

The only things that can really be negotiated are behaviors and decisions: In other words what someone will do and when they will do it. You cannot negotiate things like your core values, your spirituality, emotions, attitudes and trust.

3 Most Common Negotiating Mistakes:

1) Caving in too quickly to avoid tension or keep the peace
2) Stubbornly pushing too hard for your own solution
3) Failure to prepare before negotiating with your partner

Negotiation is an ongoing process not a one-time event. The more complex the situation is the more trial and error solutions will be needed. There is no such thing as a perfect solution. Good negotiation leads to acceptable solutions that work for both parties and strengthen the relationship.

Good Negotiation Starts With You

Ask yourself how you aspire to be during the negotiation. Some helpful attitudes to consider are:

• Openness about yourself
• Listening
• Curiosity about aspects of your partner’s struggles
• Managing your emotional reactivity when talking about sensitive topics

A Grossly Simplified Overview of Successful Negotiating Steps

A) Prepare!

Before you start negotiations ask yourself:

• What do I want?
• How important is this to me?
• Why is it important
• How could I make it easier for my partner to say “Yes”?

B) Start by stating the area of disagreement without finger pointing or blaming your partner. Otherwise you will cause your partner to become defensive, which would begin negotiations on a very slippery and unproductive slope.

A good starting line is, “We seem to disagree about…” Rather than; “The problem is you…”

C) Take turns expressing your concerns and desires about the disagreement.
Person ‘A’ talks while person ‘B’ listens without interrupting. After person ‘A’ has finished person ‘B’ offers a summary of what they heard without reframing or interpreting. They are simply recapping so that person ‘A’ feels heard.

I would like to emphasize here that recapping what your partner said does not mean you are agreeing with them! This is also a good time to ask questions for clarity.

D) Switch roles.
E) After each person has expressed all their concerns and desires and each person feels understood it is time for brainstorming solutions.

It is important to realize that there might be some parts of solutions you agree with and other parts that you don’t. Remember that negotiating is an experiment and that no one is locked into a permanent solution.

F) Continue making suggestions until an agreement is reached.

G) Make a time specific agreement. Decide for how long you will try this solution. Decide when you will review these negotiations.

Et Voila! Obviously negotiating takes practice and sometimes a skilled third person is needed to help a couple navigate the many pitfalls that can arise. However with persistence and willingness, negotiating is a skill that can be developed. It is also an invaluable ‘tool’ for your communications toolbox that will serve you in all your relationships.

[sources: original article by Ellyn Bader, PhD and Peter Pearson, PhD edited by Robert Solley, PhD]