Therapy Issues-Mental Health

[Norma 10]

Being obese in America is hard-even traumatic. We are discriminated against for being "fat, lazy slobs" and expected to be "jolly" all the time. We are treated rudely by store clerks, doctors, flight attendants, etc and considered to have no will power and to eat all the wrong foods and know nothing about nutrition. We learn to have guilt and feel shame about ourselves, our appearance, our eating habits, our sexual needs, etc. We even start discriminating against ourselves with the same mores of our culture.

My experience as an obese person for 45 years and a Licensed Professional Counselor for over 20 years has led me to some conclusions about our therapy needs while undergoing a lifestyle change as is possible with the sleeve. I do not think we need the services of a bariactric specialist who specializes in bulumia or anorexia. Most of us have considerable knowledge of nutrition and don't need another diet plan or to be told what foods we should eat.

Therapy needs to be centered around the traumas( yes, I mean TRAUMAS) that we have suffered through being discriminated against, ridiculed and ignored and the guilt and shame we feel about our eating, our size, our value to society, the way we have learned to hide what we eat, and the way we connect food with love and nuturance. We need to learn to accept ourselves for who we are and how we got here. Work can be done on reframing the importance that food has on our happiness and in our lives. We need to be able to "eat to live" rather than "live to eat". Food does not need to consume every waking moment in our lives; we should have other interests and activities than always planning our next meal or snack or eating.

For these reasons, I suggest that people find a counselor who specializes in DBT or EMDR. We need to reprogram our thinking and emotions as they relate to food and as they relate to shame, guilt, embarrassment, intimacy and love. That therapy will allow us to strive with the tool of the sleeve. Hope these words have helped. Feel free to PM me if you have futher questions that you do not feel comfortable posting here.:thumbup1:

Edited November 15, 2009 by Norma

[3636millie 3]

Fantastic post. Agree 100000++%.

[LAN2k 18]

I want to print this out. Can you please tell me what DBT or EMDR stand for. Thank you for this very important information.

[Norma 10]

I want to print this out. Can you please tell me what DBT or EMDR stand for. Thank you for this very important information.

I will break down the two types of therapy. Hope this is not too technical. Will do EMDR in a separate post.

DBT stands for Dialectical Behavior Therapy--this technique was developed by Marsha Lineham to work with people with Borderline Personality Disorder. (I am NOT saying that obese people have this disorder, but many obese people CAN benefit from this type of therapy). It is based on the following ideas:

Mindfulness is the capacity to pay attention, nonjudgmentally, to the present moment. Mindfulness is all about living in the moment, experiencing one's emotions and senses fully, yet with perspective. It is considered a foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations. The concept of mindfulness and the meditative exercises used to teach it are derived from traditional Buddhist practice, though the version taught in DBT does not involve any religious or metaphysical concepts. Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.

Individuals frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing his or her own situation.

The interpersonal effectiveness module focuses on situations where the objective is to change something (e.g., requesting that someone do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person?s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person?s self-respect. Emotion regulation:

• Identifying and labeling emotions
  
• Identifying obstacles to changing emotions
  
• Reducing vulnerability to emotion mind
  
• Increasing positive emotional events
  
• Increasing mindfulness to current emotions
  
• Taking opposite action
  
• Applying distress tolerance techniques
  

Distress tolerance

Many current approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by psychodynamic, psychoanalytic, gestalt, or narrative therapies, along with religious and spiritual communities and leaders. Dialectical behavior therapy emphasizes learning to bear pain skillfully. Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although this is a nonjudgmental stance, this does not mean that it is one of approval or resignation. The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them. This allows individuals to make wise decisions about whether and how to take action, rather than falling into the intense, desperate, and often destructive emotional reactions that are part of borderline personality disorder.

Skills for acceptance include radical acceptance, turning the mind toward acceptance, and distinguishing between "willingness" (acting skillfully, from a realistic understanding of the present situation) and "willfulness" (trying to impose one's will regardless of reality). Participants also learn four crisis survival skills, to help deal with immediate emotional responses that may seem overwhelming: distracting oneself, self-soothing, improving the moment, and thinking of pros and cons.

[Norma 10]

I want to print this out. Can you please tell me what DBT or EMDR stand for. Thank you for this very important information.

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories. Basically, it was used with war veterans and rape victims to process the traumatic events and the emotional responses of the events to separate the emotional overlay the memory of the event caused in the client. During a trauma, what we think, hear, see, experience gets connected in the brain and then anytime we experience something similar, we tend to share that original emotion with the new event. For example, in junior high home economics class, we made a peasant blouse and skirt. Mine was a bright yellow solid blouse with a black and yellow striped skirt. On the first day I wore it, while I was enjoying an ice cream sandwich in the cafeteria and at the exact moment that ice cream fell on my breast, some teenage boys laughed at me and called me a "fat bumblebee". I was humiliated and connected the color yellow with being unattractive and ashamed. For years, I unconsciously avoided the color yellow in clothing and hated sewing and wearing skirts/blouses and did not want people to see me eat.

This is a very minor example but, I hope that you can see how isolated incidents can be imprinted with emotions and affect how we live. I feel that the highly charged emotions of shame and guilt relate to a lot of food issues and the importance that we have placed on food. EMDR is a method of separating out the emotions from the events.

[thinoneday 445]

Thank you Norma for all your kind words and inspiration to us. . . of course here comes an However, and I hope as a therapist, you do not take offense to this. . . but I am a morbidly obese woman at 6'0 tall and anywhere from 340 - 360 lbs give or take a pound or two. . . I have never had those issue you discuss above in your post. . .I walk proud, talk proud and am proud of who I am. . . I have never hung my head in shame because of obesity. . .I guess you can say I've "adjusted to it" I've been obese all of my teen and adult life. . .yes there have been insults hurled my way, but my attitude toward that is "just consider where it's coming from and it makes me feel so much better" Why then am I getting the sleeve right? Well it's basically because of health issues now. . . as I've gotten older, my knees and back hurt a lot, I've gotten into sleep apnea, cardiac arrythmias. . . sooooo it was time I think. . . my daughter, 20, is obese 5'7 and 200 lbs but she too carries it well and has such a great outlook on life, she dresses herself stylishly and loves to shop at Torrid (for overweight young people sorta like Lane Bryant - my store) she has learned, from me, that those who can't accept how she is, have a fear or insecurity of their own and need to project that fear and insecurity towards others, be it the obese, handicap, or elderly. . .she too holds her head high and loves life. . . we do talk about healthy eating in moderation and exercise and she does go to the gym and such. . . now I'll get off my soap box and shut up cause I could go on and on about this (smile). . . thank you for listening!

Edited November 19, 2009 by thinoneday

[Norma 10]

Thinoneday,

I am not offended by what you said. I would hope that many people could say the same things--that they like themselves, that they rise above the difficulties of insults and criticism about being obese, that despite their weight they have a well balance life with relationships, dating, intimacy, independent thinking and live life to the fullest. However, my experience as a therapist is that you and your daughter are not the norm and that many people are truly bothered by the taunts, the discrimination, the feelings that they "should be able to control their eating and weight and that there is something wrong with them because they are fat". My postings are only to give people who want it an idea of what type of therapist might be able to help them with these issues. If it doesn't apply to you, don't pay it any attention.

[Ky.hen 5]

Norma, thank you so much for posting about this. It really makes sence to me. I can see myself in some of the things that you have talked about. I am going to print this out so that I can study it a little more.

Thanks again for your help.

[LAN2k 18]

Thank you Norma, I find this information very helpful as I am undergoing psychological treatment currently and have, out of necessity, been taking Klonopine and Trazadone to relieve the immobilizing anxiety I have encountered since the surgery. My primary care physician has been prescribing the meds and monitoring me closely. She and my psychologist have consulted with eachother and agree that I consult with a psychiatrist. I never dreamed I would sink so low but of course as you know there were other major changes that occurred in my life only a week before my surgery. Your knowledge is much appreciated. I hope you are faring well. Thanks again. -Lis

[thinoneday 445]

Thinoneday,

I am not offended by what you said. I would hope that many people could say the same things--that they like themselves, that they rise above the difficulties of insults and criticism about being obese, that despite their weight they have a well balance life with relationships, dating, intimacy, independent thinking and live life to the fullest. However, my experience as a therapist is that you and your daughter are not the norm and that many people are truly bothered by the taunts, the discrimination, the feelings that they "should be able to control their eating and weight and that there is something wrong with them because they are fat". My postings are only to give people who want it an idea of what type of therapist might be able to help them with these issues. If it doesn't apply to you, don't pay it any attention.

I had my visit today with the doctor, psych, and nutritionist, I requested that once I get the surgery done that a psychotherapist be assigned to me because I may not be able to "handle" the new me. . . she told me that amazing enough quite a few people need counseling for this exact thing. . . she was very nice and reminded me of you. . .

[ouroborous 519]

I think that the most positive thing America (assuming we're Americans here... Canucks and limeys, feel free to correct me ) can do for obesity would be to STOP MAKING IT A MORAL issue. Overweight and obesity are NOT character flaws. The truly compulsive, mentally ill eater is the rare exception to the rule; far more common are simply people who don't know how to eat properly, or are trapped in busy-but-sedentary lifestyles. As a computer programmer, I know very well how you can be busy 10-12 hours of the day, and still get almost zero physical activity. And still, the TV would have me believe that I'm just fat because I guzzle ice cream and sit on the couch all day. I wish it were that easy!

[LAN2k 18]

I think it is true that not everyone who is obese is that way because they over eat. The convenience of addictive/junk/fast food at every corner and sedentary workplaces absolutely contribute to the problem. In my case however, I have been an excessive or over eater since I can remember. I ate more than the average person or more than I needed. My stomach always felt stretched and as time went on (by about age 14 my body caught up and I got fat. Being heavy caused me to slow down. After coming home from school, left to my own devises-- both parents at work, I would pull out a loaf of soft fake white bread and slather on the Peanut Butter and jelly and eat one sandwich after another until I tired of the taste. After that I'd be so lethargic I'd take a nap. Then dinner with family then whatever I felt like eating....this for me was not normal and I knew it but hadn't the self control. As I got older I became educated hence I made healthier food choices but I still ate too much. I am definitely a compulsive over-eater so having this surgery is only part of my cure. Since sleeved 6 months ago, my appetite has grown and though I am not able to eat as I used to, I'm seeing my obsession with food as an issue or disorder that needs to be addressed. Now I'm sorting things out, and open to the 12 step program for "Over Eaters" (OA) and psychological counseling. I guess I'm an exception.

[wannalise 15]

I don't think you are the exception. I appreciate just how honest you've been in all of your postings about the anxiety you've felt and the difficulty you've had. I KNOW that I will need more than just the tool of the sleeve. I will have to be a part of a support group and may need additional therapy beyond that. This is not for me just an issue of liking food too much, it is a full blown addiction that has affected me spiritually and I am excited to have this extra bit of help with the sleeve, but ultimately it all comes down to us. And lady we can rock this!

[LAN2k 18]

I don't think you are the exception. I appreciate just how honest you've been in all of your postings about the anxiety you've felt and the difficulty you've had. I KNOW that I will need more than just the tool of the sleeve. I will have to be a part of a support group and may need additional therapy beyond that. This is not for me just an issue of liking food too much, it is a full blown addiction that has affected me spiritually and I am excited to have this extra bit of help with the sleeve, but ultimately it all comes down to us. And lady we can rock this!

You put a smile on my face and the timing couldn't have been better. I have spent the last 3 hours reading and writing and thinking about my weakened spirituality and need to strengthen my relationship, trust and reliance on God. You have reminded me of something I knew when I was eating out of control because I felt myself being cut off from Life...in hindsight it is no wonder that I am need of healing and nourishment spiritually. Thank you for your honesty wannalise...and encouragement...rock on!

[WildIris 4]

I've been getting treatment for Type II bipolar disorder for almost 12 years, and the various mood stabilizers I've taken are the major contributor for my obesity. Fortunately, I've been absolutely rock-solid stable now for just over five years. I haven't gone to a therapist in more than three years. I'm wondering if the psychological adjustments post-surgery are so great that I should resume seeing my therapist. I've learned to be VERY careful about monitoring my moods--I have too much to lose if I tumble too far into depression.

Norma, you're the expert on this--advice? Please?