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Somerset
and Wessex Eating Disorders Association
"Serving those affected by eating disorders" Strode House, 10 Leigh Road, Street, Somerset, England, UK |
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 Our Thoughts for Medics "serving those affected by eating disorders" When do we take action? Does the council wait for a child to die Professionals and shame Shame, this is a thing we all feel and can affect how we work and approach things. As a client, a therapist, a professional, a family member- whoever we are it is important that we keep our ability to think and do not become suffocated and intoxicated by shame and unspoken rage. This leaflet attempts to look at the dynamic of shame and the affects of this on working with clients who have eating difficulties. The paralysis of Shame and asking for help Is it that our clients don’t want to get better and don’t do what we need them to? Let us consider all of these elements of eating disorders. A person burdened with shame paralysed in a tent of isolation comes to a place where they can no longer bear their own world. Their world is not any longer working for them, they have approached the outside world for help, asked a GP, counsellor, nurse or helpline for support and are told:-
How would you feel? Can you now imagine the humiliation, the fury that develops and probably in most cases is swallowed in silence and the person retreats to the world they knew? They become more entrenched in their ways to reach the goal of ill enough, they lose weight, vomit more, gorge more cut more and will not ask for help because the one time they came out of their world they were let down just like when they looked at their mother for love as a baby and found there was none there for them in a digestible form. Let down again, the world is not a safe place to go. They go back out to the world, the eating disordered world, where the effects of media, image and pressure are rampant. Returning home The anorectic, bulimic, compulsive eater in them greets them back with open arms” told you so” it says inside they may feel shame for daring to expose their vulnerable self and ask for help, who did they think they were the guilt kicks in. They are alone in the world once more, finding safety and control in their own way of being. Whose journey? Perhaps another person is accepted on a programme. They fit the criteria for starting and the aim of starting a race is to finish it. They enter the race for a “cure,” which you and I know is mission impossible and sets services, professionals and clients up to fail and feel shame, a duty of care. Does it have to aim straight at the finishing blocks at recovery for what is recovery and for whom? What is the goal and who sets it? And when you get there what will you have? You get the badge, the tee shirt, even the video you made it and then is there anything for your? In the time you were given did you find an inner self to love you hopefully a healthy one that will not return to your old patterns 2 weeks, 2 months or 2 years after the support finishes at recovery? For recovery is an ongoing journey, we enter it with help and by choice, of our own making our own destiny not your destiny, we must each find our own. This can be a lonely road to walk, a very lonely road which needs as much if not more support than other roads. Risk and Vulnerability Does brief support leave them with Pandora’s Box lid open and feeling like they are going to break down with all this vulnerable material exposed? Does it leave them to walk the roads their life may take without their protection they once had and with not enough time to have worn the new protection? Do your client feel they have lost their love object their eating pattern and yearn for it to return to put the world back into balance? Does your client feel blown apart by it all and have no where to shelter. Their hiding place has been witnessed is there nowhere to go anymore? Is the self they wear so visible that everyone can see and maybe they develop a new love object, another faulty coping strategy, to manage the out of control feeling be it bingeing and vomiting, losing the power to vomit, cutting, or other harmful uses of their bodies? Perhaps your client are exhausted of managing all the inner thoughts, feelings and wobbles and take a holiday from this and seek shelter but can you get back in the road you want to walk on? Has it left them feeling guilty, they have had help they have left the people where they belonged and now they belong nowhere and the treatment you offered is finished , they are alone in the world or so it feels. They have taken in from outside and cannot use it how can they put it back out there? It can be as a professional that we hold sadness and sit there powerless knowing we have done what we can and we can do no more. A therapists experiences “I found this so hard it hurt inside I found myself in a continual inner turmoil and this made me realise even though I loved my work as therapist I could not work manage to work with stopping before I had begun the real work. The boundaries constrained what I would like to offer it began to affect me. I hurt. I felt raw feelings and rage and for myself so resigned from my post in the NHS. After leaving I experienced a huge amount of grief and bereavement the career I had chosen was going for now. I hurt because I knew how it worked and reached People. I felt shame in facing other professionals having lost my professional umbrella. I had kept enough self to leave to take care of me to put me back on to my own two stable feet.” Reflecting time How often do we as professionals and people talk of our shame our guilt and our humiliated fury? Where does it all go? Do we talk about it or bury our feelings, the feelings that cripple our clients and our own souls? And your honest response to this shame is it :-
Your hope and drive , like your clients hope for change may become deflated and you maybe just accept what there is, people may say you are not motivated , just like they do your clients but actually you are hurting and you bend over in every way to help anyone but cannot allow you to help yourself. Will you allow a system to destroy you? Keys to successful intervention
I believe that the key to success in supporting someone is about taking time to build a good enough therapeutic relationship where the person can learn to depend on you and feel these feelings and then can come to a place of wanting to leave. The managing of the thoughts and risks of separation even if it has Sunday Lunch visits (not literally but less frequent sessions as a check in) to leaving home to build their own free independent life and recovery with support. To Care or to Cure The let us think of the shame we as professionals may feel shame when we do not get people on the road to recovery or cure people who said it was about cure? Guilt when we cannot complete or travel far enough with a client and pass them on and they feel like a parcel passed from one to another like a baton in a relay race. Sometimes they may be referred into the emptiness of no service. We send them away because we have no time or resources to help shame guilt embarrassment and anger, anger they don’t get better anger we can’t offer enough anger at the system and service and where does that get us. Maybe the way we help ourselves with these feelings is to name them address them and be honest and allow the client to express their anger their tears. The plight of professional shame The professionals what of their shame, guilt and fury? Measuring wellness Scales cannot measure wellness, they may measure degree of risk and unwell ness, but wellness and recovery come form inside out. I have not known anyone recover by standing on the scales, I have known people panic and play the game but not find a place that feels well inside. Can judge a book by its cover? Can you see someone at a BM! That is normal and say they are well without checking out how they feel and how they manage their weight? By vomiting, excessive exercise or starving and gorging? Can you look at someone with a gorgeous figure and think they have a great life then find they can only do this by being so hungry as one famous lady told Parkinson” I don't look like this by eating! I look like this and I am starving! The signs of an eating disorder that a GP may look for may include.
The GP may co-ordinate their care with other specialists. It will be important to know
Be honest and kind, it takes a lot for someone to ask for help and while you are referring them on they will need support and reassurance. If a referral will take a long-time offer them supportive safety net sessions in the mean time to reduce anxiety and backing out. The first steps will often be a joint assessment and thinking about possible treatment by a person with special experiences of caring for people with eating disorders. The nice guidelines can be useful to see what a client is entitled to. They may be offered to work that specialise in
It is important to understand that eating disorders are not just about food. Eating disorders are a coping mechanism, Using food and the control of food to resolve emotional and painful issues that they cannot deal with in any other way. The most important thing is developing a good boundaried therapeutic relationship with the person. This alongside clear communication will help the client decide what they want to do with their life. SOMERSET & WESSEX EATING
DISORDERS ASSOCIATION 
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© 2004 ~Somerset and Wessex Eating Disorders Association Date:   
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