Tracking food:
I still track food exchanges (well, sometimes), and originally I could only find one app that was appropriate for this in the app store: EatRight.  After that I discovered Foobi, and most recently have converted to FoodTrackerPro.  Note: none of these apps use calories — just servings/exchanges — and I’ve been pretty pleased with all of them, but FoodTrackerPro is definitely the coolest.  PLUS, it works on the iPad, so bonus points for that.  You can customize your meal plan and make charts and set goals and all of that… but it also has a great food servings cheat-sheet — for all those times that you’re trying to remember how much hummus equals a protein exchange (for example).  iPhone/iPad, $1.99.

Tracking mood:
I started doing this on paper awhile ago and found that it was actually a good exercise for me (not only to see the patterns in mood but also just to check in with myself).  I’ve seen several apps for this, but currently my favorite is MyMoodTracker (same company as FoodTrackerPro, actually).  It’s only for iPhone (no iPad yet, bummer), but it tracks mood using a 1-10 scale and little emoticons.  You can track sleep on here, too, and see how that influences mood.  iPhone, $1.99.

Meds:
You know those times when you’re at the drug store trying to purchase something to help with your nasty cold, and you can’t remember if it’s okay to take Sudafed with the Wellbutrin you’re on?  That’s when you need Epocrates.  Or… when you have a headache and have already taken Tylenol twice and are not sure if it’s okay to take another dose yet?  Okay, maybe it’s just me, but I run into situations like this all the time and would be lost without this app! Plus, when you’re on more than one med at a time (which is pretty common these days), things get complicated (drug interactions, dosing, side effects, etc), and it’s just good to have it for reference.  iPhone, free.

Countdown:
By now you’re probably thinking, “okay, you track way too many things”–and it’s probably true.  BUT, do you know what’s even better than personally tracking something?  An app that does it for you!  That’s Countdown.  I have countdowns for everything — how long I’ve been married, how long it’s been since I last acted on symptoms, how many days until my next therapy appointment, how long until my birthday (hey, why not….), etc.  Random countdowns aside, there’s something really motivating for me about knowing that I haven’t skipped a meal in three months, or drank coffee since…. err, yesterday (okay, really bad example), or that I have therapy in 1 hour, 42 minutes and 18 seconds (and really need to do my therapy homework).  I just love seeing that.

Coping Skills:
Remember my series on coping skills?   Well, for each of those items, there is of course an app for that:

1. card stores – it’s not a card store, but someecards can entertain me for an embarrassingly long period of time (both the app and the website).
2. bulletin boards – Corkulous would probably by my favorite app-equivalent of a regular cork bulletin board.  However, the real purpose of bulletin boards for me are to serve as reminders, so that the “out of sight, out of mind” thing doesn’t kick in.  For that, I’d probably actually use a todo app or custom background/wallpaper (not going to link these because there are a million and I don’t have a favorite!)
3. kudos chart – again, this is something you could probably find in a todo app, but if you’re looking for something a little more…. sticker-chartish… try GoalTracker (ipad).
4. crafting — there are a million apps for: coloring, collaging, drawing, photo-editing… really, a million. You might start looking in Apps for Kids.
5. dvds — you can download just about anything from tv/dvd onto your iPhone/iPad from the app store.  Additionally, ABC has an awesome media player that lets you stream shows for free.

Okay, that’s the end of my list for today.  If anyone has any other app suggestions, I would love to hear them!

First WHAT!? moment:

Participants were asked how the decision had been reached to avail of their various treatment options. Most participants had no involvement in any decisions pertaining to treatment.

WHAT? No way, I don’t believe that. I think there’s a BIG difference between treatment not being your idea and having “no involvement in any decisions pertaining to treatment.” I highly doubt that every person in this study was court ordered or dragged kicking and screaming into the treatment facility. Most of the people in the study were diagnosed in adolescence, so okay, maybe they HAD to go then… but the participants also all had “a lifetime history of AN.” As an adult, they CHOSE to get treatment. Even in Intervention (the TV series), you are given a choice — either get help or live a really difficult life where no one in your family will support you anymore. It probably doesn’t really feel like a choice, but it still IS one.

I know I’m fussing over semantics, but not taking ANY personal responsibility for your health / illness / treatment is a pet peeve of mine. I’ve had my fair share of anti-treatment periods, and can definitely separate the times I wanted help versus the times I didn’t, but the reality is that I DID show up for that doctor appointment. Maybe she “made” me go, but I could have immediately signed out. Staying in treatment is a decision.

Second WHAT!? moment:
(when talking about deciding factors for dropping out of treatment)

while for three participants (15%) the fear of weight gain was a major contributing factor to dropout.

Only 15% of patients would say that the fear of weight gain contributed to their decision to drop out / sign out of treatment? That’s just not honest. If everyone created a pros/cons list when considering quitting treatment, I bet that weight gain would be on 75% of their lists. Maybe it’s not in the top 3 reasons for leaving, but probably most patient’s top 10. Personally, I might not admit to my professionals that it’s a contributing factor, because I’d want to sound reasonable, rational, and believable (and definitely not want it to sound like a decision motivated by my eating disorder). Also, maybe I should clarify this is a list for dropping out of treatment — ending treatment because you’re ready or your team is ready to discharge you is different.

Anyway, I encourage everyone (who can get it) to read the article, and have a lot of other thoughts on it, but these few statements really stood out for me tonight.

I can definitely relate to this. When you first start a higher level of care (like IOP, PHP, IP – anything involving a meal), the amount of food you have to eat (and keep down) is a little overwhelming. At the same time, there’s a little bit of relief that comes with eating at program. You don’t have to make the decision of what to eat yourself. You really don’t even have to take any responsiblity for eating. The meal is structured, dietitian-approved, and you could spend the next couple of hours processing the horror of the meal if necessary (although hopefully not).

While thinking about this, I decided that there are four stages of eating in treatment (in this sense):

1. Eating at program is really hard. It’s more food than you would eat on your own (or not purge). You’re struggling with acting on symptoms at home, and meals at program are much more “normal” and overwhelming than you’re used to.
2. Eating at program is still hard — but for a different reason. You are actually starting to eat more normally at home, and it really feels like too much when combined with all the food at program. You feel guilty for not compensating (or not purging).
3. Eating at program is easier. This is because
             a) you’re used to the meals by now
             b) you’re taking food risks at home (eating fear foods, going out to eat with friends, challenging food rituals, etc.)
   The food at program feels reliable and safe in comparison.
4. Eating at program is boring — and even annoying. You’ve eaten a veggie burger every week for two months and feel that you could go the rest of the year without eating yet another yogurt. You would rather be eating at home — not because you want to restrict, binge, or purge, but because you want to eat something better (that you actually like) or be eating with other people.

I could probably come up with more stages, but these four are the most obvious to me. I’d love to hear your thoughts…

1. Feeling your feelings – good, bad, and everything in between
2. Your body adjusts to where it needs / wants to be (based on your own genetics)

Johanna supports these two ideas with a lot of great thoughts, so I definitely recommend that you read the post.  However, what really caught my eye was one of the comments:

My therapist told me yesterday that “people try to get out of their eating disorder by going into their eating disorder.” I slipped a little in the past two days. My therapist said, “You’re in the hole, but you’re trying to get out of the hole by going farther in the hole. You don’t climb out of a hole by going down. It’s like people are hoping so hard that if they just go farther into the hole, they’ll find a secret back door that will let them out more easily. The truth is, there is no back door. It’s a cul-de-sac. It’s painful to be in the hole, and it’s painful to come out of the hole. But there is only one way out. Up.”

Laura so eloquently articulated something that’s going to take me five paragraphs to describe.  Everyone has heard the phrase about things having to get worse before getting better.  However, it doesn’t say MAKE things worse so that they can get better.  It doesn’t exactly work like that.  I see a couple of different situations where people “try to get out of the eating disorder by going [further] into their eating disorder”:

1. Trying to replace one symptom with another
2. Not feeling “sick enough” to recover
3. Waiting to hit rock bottom
4. Trying to do recovery perfectly

To explain a little further…

Trying to replace one symptom with another
Replacing bingeing or purging with restricting is not recovery.  Replacing restricting with compulsive exercise is not recovery.  It’s tempting to say, “okay, I’m going to stop bingeing and eat only healthy food and lose weight.”  I think this just exacerbates the binge > purge > restrict cycle.  It seems unintuitive… but I think part of the recovery process is learning to forgive yourself when you do screw up.  It’s being a little more lenient with yourself… not stricter.

Not feeling “sick enough” to recover
I’ve blogged about this several times.  There’s the whole “if I were really sick, then I would recover” idea.  Or “if I just lose 5 lb., then I’ll feel ’sick enough’ and will feel justified in trying to eat more and get better.”  There is no “sick enough,” though.  Digging a deeper hole is not the answer to getting out!

Waiting to hit rock bottom
This is the “I’m still functioning, it’s not THAT bad” rationalization.  Or the “I’ve been worse before” idea.  There doesn’t have to be a rock bottom.  While true that some people have that moment when something really awful happens and makes them realize they are ruining their lives and have to change, I’d say those individuals are more the exception than the rule.  I’ve had “rock bottoms” (note the plurality), and sure, they motivated me to change.  However, the times that I really committed myself to recovery were not near those bottoms!  I’m very guilty of the “I’m a functioning person so I’m fine” excuse.  I have to stop and remind myself, “Why would I want to wait until I lose my job, ruin relationships, have a heart attack, etc.?  Can’t I just avoid that horrible bottom and work on getting better now?”

Trying to do recovery perfectly
I know so many people who want to keep “restarting recovery” so that they can “do it right this time.”  Restating seems to imply getting worse… so that you’re back at the starting line to try again.  I’ve done this over and over with eating and my fear of having a slow metabolism forever.  If I’m not following my meal plan, yet maintaining my weight, I am convinced that I screwed up in the recovery process somewhere and am condemned to a life of having to watch my weight because I’ll obviously gain eating a normal amount of calories.  And then, what’s the solution?  To lose weight, of course… so that I can try that again and follow my meal plan and trust the science of it all.  When you’re deep in the eating disorder, it seems to make a lot of sense.  But, looking at it from the outside… why would I think that doing worse would be the solution to getting better?

Laura summed this up so well: You don’t climb out of a hole by going down.

I could not, would not, on a boat.
I will not, will not, with a goat.
I will not eat them in the rain.
I will not eat them on a train.
Not in the dark! Not in a tree!
Not in a car! You let me be!
I do not like them in a box.
I do not like them with a fox.
I will not eat them in a house.
I do not like them with a mouse.
I do not like them here or there.
I do not like them ANYWHERE!

I do not like green eggs
and ham!
I do not like them,
Sam-I-am.

–Dr. Seuss

There are more than a dozen interpretations of “Green Eggs and Ham” out there (just google it, you’ll see), but I’m pretty sure that mine isn’t one of them. When I hear the rhyme, I think of all the rules that individuals with EDs have surrounding food. Sometimes we’ll get a new patient who is not going to eat the meal if any of the following are true:

• One food is touching another food.
• Something requires a spoon.
• The food can’t be picked apart or cut into tiny pieces.
• There are caloric drinks (milk, juice, etc).
• Something is “not warm enough.”
• A piece of fruit has a spot on it (even a microscopic spot).
• The food can’t be eaten in a particular order.
• The room is too hot or cold.
• She’s sitting at the end of the table.

…and I could go on. I will definitely confess to doing some of these things. I hate juice and/or milk. My point is, though, that said new patient is against eating the food here, there, or anywhere. She’s wrapped up in the eating disorder and not even considering any of the above.

While I totally sympathize, part of me can’t help thinking “Well…. actually, you will eat your green eggs and ham – and you’ll (learn to) like it.” That’s kind of how treatment is. You come in screaming, “No no no! I will not I will not I will not! Not in a box or a house or even in the dark!” And you learn (or slowly realize) that not only are you going to eat them in the dark, but with a goat in a tree while it rains as well.

“…Hans Christian Andersen’s The Emperor’s New Clothes, a tale about con men who promise an emperor a new suit of clothes invisible to those unfit for their positions. When the emperor parades naked before his subjects, a child cries out, “The king has nothing on!”

Judith identifies with the emperor who allows himself to be duped because of his own self-delusions. Therapy, she says, deceived her into thinking she was in more in control of what was happening to her than she was and that “through reason, determination and an outlay of cash” she would be able to overcome a lifelong depression.”

I never thought of relating therapy to The Emperor’s New Clothes, but it’s a a really clever allusion.  I think it sums up one of my fears in trusting a therapist.  Maybe I’ll call it the Emperor’s New Clothes Phenomenon.  Hmm.  Anyway, I think this can be a big misconception.. that through the magic of talking about your childhood, therapy can cure all of your ills.  You show up, talk a lot, get some sage advise from your therapist, and bam!  Mental illness cured.

She is understandably angry, more with herself than with her Freudian clinicians: all those years wasted in misery, the attention she didn’t give the people she loved. Her self-preoccupation and childhood focus had put a great deal of tension on her relationship with her parents and distanced her from her husband and son.

I’ve never done true psychoanalysis, but have had therapists who leaned in the direction of psychodynamics.  I won’t lie and say I don’t think there’s any use in talking about past stuff – because in a lot of scenarios there is.  However, there have been times when I explored my childhood and all the possible problems that went along with it, and still didn’t really feel better (nor was my eating disorder better).  My therapist would tell me how much progress I was making and how I was having these great breakthroughs, and I decided I’d just have to trust her, because I really wasn’t sure what she was talking about.  At some point I just got angry, because I felt that there was so much going on in my life NOW that was significant.  Plus, I was spending so much time reading old journals and thinking about things that happened fifteen years ago.  I was not very present in my own life.

Judith articulates this beautifully in one line:

“With my mind free of the minutiae of self-analysis I can tune into what’s around me in new ways”

Anyway, I think that some individuals believe that there are two types of people in this world: Those who’ve had therapy and those who have not.  The people who have processed their unconscious thoughts and all of the significant events in their life have some kind of self-enlightenment.  Those who haven’t are walking around in the dark.

The next time my therapist asks me “How do you know when you are done with treatment?,” I am definitely going to answer “When I can see the invisible clothes.” (Though, that comment might actually land me in several more months of therapy…)

Picture Credit: Annie White at Studio Whites

There are lots of situations where I’m tempted to say “use your words!” (don’t worry, I usually resist the urge).  Often this is with the ED, becuase often people use their eating disorders to communicate.  I’m a huge offender.

For me, restricting could mean…

• I’m not okay
• I need more help
• I am overwhelmed and can’t handle life
• I need a reason to be cared about
• I feel undeserving
• I want someone to think I matter
• I’m having a bad day
• I’m anxious
• I’m depressed
• I’m lonely
• I’m frustrated
• I’m hurt

There are so many things that I won’t say (and things that I won’t even let myself THINK).  Somehow, though, saying them through the eating disorder makes them valid.  Maybe it’s because there is physical proof that something is not right.  Regardless of how I feel (because really, who cares about feelings?), I’m hurting myself and that you can’t ignore.  That matters.

The problem is, this is a really ineffective means of communication!  Restricting could mean a hundred things.  Throw bingeing, purging, SI, exercise, laxatives, etc. into the mix and you have enough symptoms to illustrate your whole emotional vocabulary.

However, it might as well be your own secret language, because no one else really knows what you are trying to communicate.  You’d probably be better off investing in some flares and arranging them to say “HELP” in your backyard.  Or learning morse code.  Or writing down “I’m not okay” and sending it to someone that you care via carrier pidgeon.  Why?  Because you could be overwhelmed and acting on symptoms at every available opportunity to deal with the stress.  Eventually something will happen – someone will notice, you’ll end up in the ER, you won’t be able to take it and will quit, etc.  Something WILL happen.  However, it’s likely not a happy ending.  Do you know how much more effective it is to just SAY something?  Say “I’m feeling overwhelmed.”  If it’s at your job, then you can figure something out to make your work load more manageable.  If it’s with life in general, you can figure out how to get more support, prioritize things, delegate more, weed out less important responsibilities, etc.  You just need to SAY something.

Granted, it’s really hard to do this (for myself as well).  I think some of the reluctance to talk is related to fear – fear of others knowing you’re not okay, fear of ruining relationships, fear of asking for too much, fear or others caring… lots of fears.

This said… something that has always thrown me off is having my individual therapist as my group therapist.  This has happened to me a couple of times, in residential, IOP, outpatient, etc.  It changes the dynamic for me for a couple of reasons:

1. Every time I said something to the group I though, “has she heard this already?  did I tell her this before?”
2. I read (too much) into the things that she said
3. If I were having a bad day, she usually noticed
4. I wondered if there would be repercussions to the things I said (for example, I didn’t want to mention something in passing and have to spend the next two individual sessions processing it).
5. I worried that I’d treat group like an individual session and spend too much of the total time focusing on my own issues

These aren’t all bad things.  It’s good that my therapist would recognize that I was having a crappy day, since I likely wouldn’t have brought it up and the therapists who didn’t know me as well probably didn’t know anything was not right.  She also probably pushed me a little harder, since we did have a relationship and she could do that comfortably.  So, for the most part, it was good for me to have some groups with my individual therapists.

With all of this said, where things start to get a little messier is when other people in the group also share the same individual therapist.  I’ve been in some programs where everyone had the same primary therapist and others where there were a handful of individual therapists that also ran groups.  Both situations add that extra variable to the equation – sharing a therapist with another person in your group.

The therapeutic relationship is so unique that sometimes I think it can be challenging to “share” your therapist with someone else that you know.  I’m not concerned about the confidentiality as much as the dynamics of the relationship.  As the patient, you only have one therapist.  When you have a good relationship, it feels special.  You feel like you have this connection that maybe other patients don’t have.  It makes sense – every week you are confiding in this person, trusting him/her to guide you and to give you some insight.  This relationship and person mean something to you.  He/she is a part of your life.

Being in a group with your therapist and another one of her patients is a reminder that you’re not the only patient.  You know this logically, but the reminder can be kinda tough.  Sometimes it’s rough to see her concerned and focusing on someone else.  It can feel invalidating.  It can feel like a competition between you and the other patient.  It can be hurtful if you feel like you’re being ignored or that your interaction with the therapist is different.  It really adds a dozen additional variables into the therapeutic relationship equation.

There are a lot of things that make eating disorder groups tough.  Girls get competitive over eating, weight, exercise, etc – even if you don’t allow talk about numbers.  You have to be careful who you put in a group together, and even having one or two pretty anti-recovery people can change the whole atmosphere.   Sharing a therapist with several of the girls almost adds another thing to compete over.  Even if you refuse to participate in the competition to get the most attention or require the most concern (really, these competitions exist!), it can be hurtful to to feel neglected or uncared about.  I don’t think this is a topic that is often addressed in groups… but I think that sharing a therapist with other girls, and all being in the same group together led by your primary therapist, can be a little tricky…

Dr. Meredith Grey: In the hospital, we see addiction every day. It’s shocking, how many kinds of addiction exist. It would be too easy if it was just drugs and booze and cigarettes. I think the hardest part of kicking a habit is wanting to kick it. I mean, we get addicted for a reason, right? Often, too often, things that start out as just a normal part of your life at some point cross the line to obsessive, compulsive, out of control. It’s the high we’re chasing, the high that makes everything else fade away.

Dr. Meredith Grey: The thing about addiction is, it never ends well. Because eventually, whatever it is that was getting us high, stops feeling good, and starts to hurt. Still, they say you don’t kick the habit until you hit rock bottom. But how do you know when you are there? Because no matter how badly a thing is hurting us, sometimes, letting it go hurts even worse.

I’ve talked about this before, but I think that wanting to want to recover is a big roadblock in eating disorder treatment. Meredith explains it very well — we get addicted for a reason. The ED plays a role in our lives. You don’t go seeking an eating disorder… but for whatever reason (I’m sure largely biological), coping via food / exercise works for you. Restricting did give me some kind of a high, but more importantly it did make “everything else fade away.” Of course it didn’t SOLVE any issues… but it did somehow mask them and make them less important to me.

The eating disorder doesn’t “work” for me like it used to. It doesn’t give me that relief that I’m looking for. It doesn’t make stressors go away. 10 years ago, I felt some kind of sick accomplishment from restricting. Like somehow not eating made everything better. These days, maybe it deadens things a little bit, but largely it throws off my blood sugar and makes me feel like crap.

I’ll admit that for whatever reason, in many situations it’s still my first instinct to use the ED to cope. All the coping mechanisms I mentioned are attempts to replace the disorderedness with something healthier. But really, it takes three “healthy” coping mechanisms to offset one unhealthy one. The kudos chart is an everyday thing and a bad day might require coloring AND card shops.

I think a lot of people struggle with feeling like they still need their ED. Even if it is kinda ruining their lives and not working like it did in the past, they still feel like they won’t be able to deal without it. If you’re trying to replace that disorderedness with bubble baths and crafts — well, that’s a tough sell.

I’m not saying it’s not worth it or that EDs are just unhealthy coping skills… I’m just saying that recovery takes a lot of coping skills.  You burn some of them out (for instance, reading does not help me like it used to) and have to be creative and come up with new ones.  And sometimes they feel ridiculous.  Heck, I’m in my mid-20s and googling “print complicated coloring pages.”  My kudos chart is remarkably similar to the sticker chore chart that I had when I was seven.  I’m not sure any of this is “normal,” but hey, it helps.  Ridiculous or not — just go with it.

I don’t know why more people don’t hang out in card stores.  Just think about it… when you have a friend that’s upset, it’s not uncommon to send them some kind of “cheer up / feel better” card.  So, if you’re upset… doesn’t it just make sense to spend an hour in a card shop and read 100 of those?

I know that there is more to getting cards than the card itself (say… the thought behind it), but funny cards make people feel better.  I scan the aisles at Barnes & Noble nearly weekly for new stickmen cards and can’t help but laugh at Hoops & Yoyo.  Card stores are just a win-win for everyone.