Missy is a 26-year-old relentlessly upbeat dental hygienist. She loves making patients laugh and smile (not during their cleanings, of course) and the whole office cherishes and enjoys being around her. Her mother takes care of her seven-year-old twin boys while Missy works and while Missy's husband, Ed, works long hours as a master carpenter whose jobs sometimes take him out of state for days at a time. Missy describes herself as a clone of her mother who always sees the bright side of every situation and, says Missy, has absolutely no frown lines on her face at age 56.
I meet Missy through one of my "normal" eating workshops and shortly after it ends, she calls for an appointment. With some teeth pulling, she confesses that she's a secret binge-eater but has never told anyone because she's afraid of what people will think of her. I reassure her that this behavior is common in my practice and that together we'll figure out what's going on. At that, Missy's face collapses and she cries for nearly 10 minutes. When she stops, she looks at me in utter surprise at herself, then spends the next 10 minutes apologizing for her tears.
What I learn about Missy puts her secret binge-eating right into perspective. Her father died seven years ago and her mother was just starting to get over the loss when Missy had the twins and needed her help if she was going to continue to work. Financially, there's no question of being a stay-at-home Mom, so Missy's mother, Evelyn, who lives nearby, comes every weekday to take care of the boys. Missy feels terrible that she's "stealing" her Mom's life from her, particularly because her mother doted on Missy's alcoholic father, catering to his every whim as she struggled to keep him sober and from sinking into deep depression. Missy also feels abandoned by her husband's long periods away from her and their sons. She believes she shouldn't complain or share any of these negative feelings with her mother who is doing her such a gigantic favor, saying it would seem unappreciative.
Down the road, Missy talks about her fear of telling her friends and co-workers how unhappy she is. Although she's close with both of her sisters, she dismisses telling them as well, fearing they'll think she's a whiny complainer, a behavior which was frowned upon by both of her parents. With me, however, she laments missing the twins when she's at work, feeling guilty about all her mother does and shamefully resentful toward her husband. The only thing that makes her feel better is sneaking into the kitchen at night when the boys are asleep and eating her heart out. She knows it's "wrong" and has tried to stop but can't. She's unable to put together the image she has of herself as such a nice girl and the greedy, needy demon that takes over during her binges.
Our work in therapy focuses on normalizing Missy's feelings and helping her tolerate and express "negative" emotions. After a while, Missy realizes that what she really needs is more time to herself, especially after work when she fixes dinner for herself, Mom, and the twins, tucks in the boys, says goodbye to her mother, chats on the phone with Ed, then falls asleep exhausted. With encouragement, she shares her feelings with her mother who offers to have dinner ready for the family so that Missy can see more of the boys when she gets home. Ed comes in for a therapy session and between gulps of tears and half a box of tissues, Missy lays out everything that's been on her mind. He appears understanding and they discuss how he might change his schedule to spend more time at home.
Although during our work together, Missy is unable to tell her mother or husband about her food binges, as she becomes more honest about her feelings in general and does some problem-solving about how to improve her life, they began to subside. The most important message Missy takes away from therapy is that her binges do not make her a terrible person, but that they are her way of trying to take care of herself. She is beginning to understand that putting others' needs before her own is a pattern she will have to keep tabs on and that a resumption of out of control eating will be a signal that she needs to focus more on herself.
A month shy of her 40th birthday, Stephanie is a single, self-described career woman who runs her own company which produces a local "shoppers guide." She is the poster child for success walking into my office that first session looking as if she hasn't spent the day working her butt off but luxuriating at a spa: every hair in place, lipstick freshly applied, nails beautifully manicured, wearing a smart, stylish suit. After complimenting me on my office décor, she sticks out her hand confidently for a shake, and rolls her eyes as says she needs me to teach her how to unwind without food.
Handing me a type-written chronicle of her eating and weight history, she says she's gained and lost anywhere from 50-70 pounds more times than she can remember and is "so done with that." She hates dieting, but her job is so stressful that she finds scant comfort in anything but food. She explains that she's at a low weight now, but is terrified that she won't stay there unless she learns how to chill. In the middle of the session, her cell phone chirps and she insists on taking the call. The next time this happens, I ask her to shut off her phone and she nervously, reluctantly complies, making a joke that rather than see a psychotherapist, she should have gone to a doctor to have herself cloned.
Her upbringing doesn't surprise me, with her dad an award-winning director of an advertising agency and her mother a former top magazine model. She has two brothers, one of whom is a tennis pro and the other a lawyer. In her family, being top-seed at everything is of utmost importance. As I press her on details about her shining family, however, dark smudges appear: Dad has had a string of mistresses, Mom is addicted to plastic surgery, and her brothers marriages are both falling apart. She agrees that being a super-achiever has its price and connects her constant striving to fear of failure. "If things aren't perfect, they'll be a mess," she insists.
When I tell her that perfection is a nice girl trait, Stephanie laughs. At work, she's not only the driving force behind her thriving business, but the shoulder everyone cries on and the cheerleader who's constantly pressing her team toward victory. She admits that when she eats less and weighs less - like now - she's more irritable and less approachable, and wonders if that's one of the reasons she regains the weight, wanting to be the perfect boss in her own - and everyone else's - eyes. But the next moment, she can't imagine doing less for her employees or for her business. Her all-or-nothing thinking leaves no middle ground for simply being good enough.
Going more deeply into her family background, Stephanie has difficulty talking about the shame she sensed under her parents' patina of success. Until now, she hasn't connected that shame to herself, but snaps to attention when she realizes that it's shame she feels when she overeats for months on end and the numbers keep bumping up on the scale. It's shame she feels whenever the current business quarter doesn't measure up to the previous one, whenever she thinks about the fact that she'd like to get married and have a family but isn't so sure she's quality marriage material and that she can "do it all."
I work incrementally with Stephanie, starting by asking her to pick a number of hours she'll work a week and not go beyond, by focusing on a weight range that's comfortable for her physically and one she can stay within through "normal" eating (no dieting!), by calling her on it every time she falls into black-and-white thinking, by gently exploring her fears of shame, by even more gently probing early and current family dynamics.
Within a few months, Stephanie comes into session very excited: she's found a business partner who shares her vision, values, business style, and complements her strengths. They're talking about doing a probationary period together to see how things fly (I, of course, praise her for not jumping in with both feet but finding a middle ground) and proceeding from there. She's also begun playing meditation tapes in her car, during her treadmill workouts, and before she falls asleep, crediting them with helping to reduce body tension and excessive worrying. She's now comfortable allowing herself to gain and lose five pounds, but no more, and is trying her hardest (of course she is!) to loosen up, let her employees take care of each other, and not make being a successful businesswoman the be all and end all of her life.
Ardra is a 62-year-old classically trained pianist who enjoys some minor celebrity for her exceptional musical abilities. She is shy by nature, but has forced herself to get over her discomfort in order to be in the limelight. At a crossroads in her life, she has come to therapy because she's tired of touring the country with different orchestras, yet can't imagine what she would do with her time if she were to retire. She laments that the one thing she values about being on the road is that it keeps her too busy to eat and that when she's home by herself, that's all she does. Inevitably, when she's on tour, she loses weight, which pleases her, but when she returns home for a spell, she puts it all back on - and then some.
Ardra's niceness is not immediately evident, as she doesn't exude excessive cheeriness, gush compliments, smile or laugh a lot, or seem your typical caretaker. In fact, her niceness is more about goodness and her belief that her self-worth is based on her musical talents. In childhood, she performed for her parents' approval, then that of her teachers and contest judges. She was highly competitive, more because she wanted praise than from any innate drive to be a consummate pianist. She acknowledges that she plays piano almost solely in anticipation of audience applause.
Married briefly in her 30s to a man she deems "an inappropriate mate," Ardra has few friends or interests outside of music. She comes by her gifts naturally: her father was a cellist and her mother a high school music teacher. At first, she talks about enjoying an only-child youth and adolescence filled with concerts and musical events, but after a while she starts to sound resentful. She stares at me blankly when I ask what she would have done if she weren't a professional pianist. "It could not have happened," she informs me. "It was out of the question. The thought was never spoken." But in subsequent sessions, Ardra begins to talk about how grueling piano practice was, how rigid and often cruel her teachers were, how she envied school mates who could spend their time as they wanted, and how disappointed her parents would have been had she ever expressed interest in doing anything else.
Soon we're talking about how these buried feelings come flooding over her when she's alone at home and that the only thing that keeps them at bay is food. When she's eating, she's not feeling and after she's overeaten - which is most of the time - her attention is on how stuffed and ashamed she feels. Yes, she agrees, these emotions are easier to experience than her vague longings to live a different life, even one which might include a second chance at love. Her biggest fear is not knowing whom to please if she gives up her career. The thought of pleasing herself has never occurred to her - or, more accurately, whenever it has tried to surface, she's eaten it away.
It's an uphill battle getting Ardra to even consider that she could live a life seeking self- over other approval: What happens if she never figures out what she wants to do, if she disappoints herself, if the only thing she's good at is tickling the ivories? While we explore and try to answer these questions together, we also focus on her eating. I suggest she try to eat healthier foods when she's at home, even if she's still grazing all day. She experiments with eating only 3-6 small meals a day. Some days she's successful and some days she isn't.
In spite of all our discussions about what she wants, Ardra remains stuck on the issue of getting approval, disappointing others (Like who? I ask, as her parents are both dead), identifying her wants and needs, and charting a new course for herself. Yet, she moves forward in baby steps: dating a new man (who, unlike her former husband, is "appropriate"), contemplating retiring when she reaches 65, and challenging herself by learning to play the flute. As therapy progresses, she is more comfortable being at home with her thoughts and feelings and less driven to eat, a change of which she approves. For her, pleasing herself around food is a major step in learning to seek and enjoy self-approval.