Understanding Eating Disorders from the Inside
By Matthew Campling BA (Hons) CounsellingMatthew Campling offers Counselling, Psychotherapy | Securely Book Online | Contact Me
Now I work as a psychotherapist and half my client load is people with eating disorders. Then were the 1970’s in Apartheid South Africa where I was first an overweight child and then an Anorexic teenager. Then there were no resources to help me, no understanding therapist on hand and I recovered by looking deeply inside myself, realising what had happened and what was necessary, and gradually regaining my healthy self. My story of how I cured myself was published in the June 2006 issue of Therapy Today. This article takes up the story, from what has happened since the article was published, and how my clients and I have been learning what is needed to understand eating disorders from the inside.
My first clients with eating disorders came as a direct result of the article; they were the adult children of therapists. I should also say that I have worked as a therapist generally since 1994, so before I began specialising in this way I had worked with many clients on other issues. Working from myself, the process of applying learning, the inner voice that hears and the gut where emotions resonate, I had to trust to instinct what I hadn’t been able to find in books.
Sue, my first client, was a strikingly attractive blonde who always wears her hair neatly arranged, and at her throat a row of pearls. From certain angles it was plain to see that there was something amiss. When she turned her head, where the face should have been softly rounded, there was something missing, flesh, the skull was too much in evidence below the surface. Her physical tension was painful to observe. Each movement was an effort and when she sat on the sofa opposite me she sat unnaturally still as though constantly needing rest, that every change of position required a special effort of will.
Instinctively I knew I had to reduce my usual style to meet with her. She could not take in much, so we talked in fragments, not full sentences, a thought, an idea, with the bare minimum of words. She was caught up in a demanding and punishing regimen of exercise and restricted eating. It felt like each word needed to do a job, to be heard by Sue and not rejected by the eating disorder.
‘I remember the first time Matthew said something like "I believe an eating disorder is a defence mechanism’’ says Sue, ‘it seemed to make so much sense with what was going on inside me. Everyone had been acting as though I was deliberately not eating to make a drama but they didn’t understand how helpless I felt. I remember the impact the first time he said ‘When I had Anorexia – this is what helped’. It cut through my exhaustion and the ongoing buzz of the disorder’s demands. It filled me with hope, something that sounded fresh all the years of progressively hostile demands – why won’t you eat? Why can’t you finish your food like your sister? What’s wrong with the food I make?’
‘In sessions with Matthew I began, as he suggested, to separate from the illness, to realise that ‘I’ was not ‘it’. Rather than fighting it, trying to break it down as doctors had tried in the past, he said something like ‘In the beginning there were good reasons why it started up … you can’t force it to behave … but you can separate from it … once you separate from it, and see it as something inside you … that’s mechanical … you can start to negotiate with it … say to it if you want me to exercise, you have to let me have fuel’.
Understanding that an eating disorder is a mechanism, that it is not the person doing it but a defence mechanism that has woken up and now runs their life, is the single most important insight that my own experience has shown me. When I started working with clients, I didn’t really know if it would be the same for everyone. There’s a lot of talk about it’s different for everyone. I remember another client, Adam, a young man who had had Bulimia for many years, at one session really letting me see the ongoing fear and confusion he was experiencing. The strength of the description seemed to overwhelm me. I remember thinking ‘This is too much for me – he needs to be in hospital’.
But staying in the moment, I reflected that he had been in hospital, he had also been through recovery units, and all his distressing periods in these places hadn’t brought about meaningful understanding and recovery. Instead I stayed with him and repeated what was becoming my mantra ‘It’s a defence mechanism… think of it as two flowers, one open (the disorder) one closed (the healthy self) … what you have to do is take the energy back from the disorder, little by little … closing the flower of the disorder as you open the flower of the healthy self … it’s an exchange of energy’.
I started to believe I had made an important discovery when, after the first five weeks of sessions, Sue began to take an interest in my consulting room. Before she had sat slumped on the sofa, staring exhaustedly at me. Now she would ask me questions about the pictures and ornaments in my study, and her conversation wasn’t only about exercise and restriction. As I myself had experienced many years ago, she was coming back to life.
Adam, who had been Bulimic for many years also responded to the sessions. It felt like the first six months all I did was repeat the same ideas over and over again. I didn’t find this repetitive, only that that was what was needed. He was back living at his parent’s house, living mainly in the chaos of his bedroom. I said it made sense that a disorder – being a disorder, would want to have chaos around it. After a few weeks he made a start on organising his room. Just this external change helped and complimented his internal change.
Adam one day recounted how during the week he had had to make an important decision, to break up with one girlfriend and take up with another. Listening to his careful recounting, I suddenly realised the symbolic meaning of what had happened. ‘You’ve told me you usually end things badly. You make a mess and don’t sort it out, instead you rely on the disorder to shut off the feelings. But what you’ve done here is different. You negotiated – and you managed this difficult situation successfully’.
He stared at me, amazed to be shown his own power to influence. This power, gently and at a pace the disorder could tolerate, he continued to bring into his life. A year after we began working he was able to leave his parents house and move in with his new girlfriend. He has also found a job he can feel passionate about, and this productive use of energy, as we have often discussed, also takes energy away from the disorder mechanism, and promotes a return to a more balanced daily life.
Tofe made initial contact in great distress. He worked in advertising. A big part of his job was having boozy lunches with clients. In order to manage the distress coming from his disorder at having to eat so much food, he was drinking alcohol heavily and being bulimic up to ten times a day.
‘I knew I had to sort myself out but I had such immense fear of failing and of eating. I kept telling myself to behave and it didn’t work’ notes Tofe. ‘Matthew showed me a new way to understand myself. Apparently there’s an Eastern philosophy which says that rather than everything coming from the head, the brain, we actually have different and separate centres – an intellectual centre (brain), emotional centre (emotions) moving centre (all our movements) and an instinctive centre for everything that has to be unconscious, like breathing and blood circulation.
‘The painful emotions I was feeling were in the emotions but I was trying to crush them down with my thoughts. I realised I had to find a different way of contacting my emotions and understanding what they needed. This in itself was a great relief – in the past I remember going to a recovery unit and this really overweight woman going on and on about needing to eat – it felt completely indigestible, almost mad. Once we worked on all the painful emotional stuff from my past, I found my bulimia subsided. I also quit that job and found something less stressful which I would never have had the guts to do before I really understood what my illness was about. It was some sort of mechanism that was trying to help me get through my life, but the only way it could do this was through bulimia.
‘Matthew says that when we grow up, if we don’t get all the right elements to give us a proper set of psychic defences – like if you have low self esteem or self worth or no confidence – then when it gets too much the eating disorder mechanism activates to get us through life. But it does it in its own way that’s even worse than the problem. The answer is what Matthew calls PTI – Positive Therapeutic Impressions – which ‘fill up’ the holes in the psyche.’
In developing my theory of eating disorder recovery, a question that puzzled me was why the body would create such a destructive defence mechanism. The answer lay in coming across analytic theory. According to Wilfred Bion, as the baby develops, it projects indigestible feelings of fear, bewilderment, etc onto the mother. If the mother is unable to contain and process these feelings, they come back to the baby in the form of what Bion called ‘nameless dread’. As the baby develops it should grow a properly knitted-together set of defences. But for some, holes develop in the psyche. My theory is that it’s these holes that are filled by the action of the disorder. For Tofe, working through his painful memories of early life helped to fill up the holes, bringing more energy back into his healthy self and dis-empowering the disorder mechanism.
The father of Jane, another client who found me through the internet, was drawn to my work because he said ‘Matthew writes like Jane talks’. Jane’s illness had been triggered by the tragic death of her mother. ‘I was trying to get help through the NHS but they said there was a 6 month waiting list. I asked my father where we would be if we had waited that long and he said ‘you would be in hospital now’. In sessions with Matthew we worked through all sorts of contributing factors – like the fact that my friends had deserted me as though I had died - and now my boyfriend and my father say I’m becoming my old self. Another idea I like is that if we are active it makes the disorder passive so Matthew says if we start the day with a plan, the plan is in our healthy self and it helps bring energy back from the mechanism’.
A chance question when I was presenting early thoughts to a group of therapists widened my understanding of eating disorders. ‘Could you apply your model to overweight?’ Now I also work with people with binge disorder and where overweight is seen as more than a need to ‘stop eating and start exercising’. During 2007 I researched, wrote and published a book – Eating Disorder Self-Cure –The Matthew Method - and established an ongoing group for professionals who want to learn and work with my approach. The interesting thing about this group is so far they are all people who have had eating disorders themselves. I am also working to widen this since all that’s really needed is therapist empathy and I will be starting an ongoing workshop programme later in the year.
From the beginning I have offered my approach as additional understanding to what professionals already do. I have drawn elements of the theory from highly divergent sources, and always from the direct experience of clients in our sessions. I remember hearing about a TV programme where an ‘expert’ stated that ‘One third of patients here get better. One third don’t respond to treatment. One third don’t make it’. I was horrified, but another high-placed NHS manager said this was a common average. I don’t know why there is such complacency. I do know that if we think of a disorder as a mechanism, and negotiate to take back its energy rather than punishing the person, surely we would save more people from its frightening, but in my experience, treatable progress.
All identifying details have been changed. Matthew welcomes correspondence and enquiries at matthew@rscpp.co.uk
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This article was written by RSCPP Therapist Matthew Campling:
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