Saturday, April 30, 2016

Art Therapy for Eating Disorders



Experiential Art as Therapy for Women Suffering with Eating Disorders
Author: Kathleen Slade Hofer, MS TRS

Art can be used as a powerful therapy to help a woman recover from an eating disorder. In the process of creating her own art, she must participate in her own therapy, and thereby her own recovery. The initial commitment to paper is also a commitment to the recovery process. Art works are not found, they are created, and they require a person to initiate action. While in an intensive therapy relationship, concentrating on a painting removes the focus from the patient and provides a safer, non-threatening arena for disclosure. Pictures can facilitate personal exploration and provide a safe vent for strong emotions such as anger, depression, fear, anxiety, or hate. They can help the patient to “express the mess.” Women with eating disorders hate their emotional “mess” which is often symbolically flushed down the toilet in secret. “Purging” on paper can become an important transitional tool for the therapist and the patient as she unlocks her hidden inner world.

The actual process of painting helps to break down defense mechanisms as projected images often escape internal censorship. Art images have a boundary that can contain whatever feelings of chaos may be expressed within them. Artwork by a woman with an eating disorder can become a container for unconscious material that begins to bridge the gap between inner and outer worlds. It can be an intermediary between the racing thoughts in the head and the numbed emotions of the heart. The patient can begin to express her needs and feelings through images and words rather than through her body and behavior. Art used in therapy may provide the first experiences of safety, and the first expressions of pain.
Through the art process and the relationship with the therapist, the perceived empty and unlovable self can be safely experienced. The patient can begin to give up her hateful, defective self-image as she discovers her creative potential. The process of creating art is a means of experiencing the true authentic self — the self as a whole. Growth and progress are recognized and supported. Self-acceptance and self-soothing are taught and encouraged. The patient is validated as the authority concerning the meaning and interpretation of all her own artwork. Mastery over the art materials often correlates with mastery over fears. Experiencing the self in art increases self-cohesion over the course of time and strengthens the sense of boundaries.

The activity of creating art often brings back early memories of playing, and the inner child has a space in which to come alive, to vent frustration, and to express sadness. Like play, art is a symbolic, pictorial communication. If the patient does not feel she had enough nurturing and has not learned how to listen to her own needs, she will be both hungry for more and at a loss to know how to feed herself, literally and metaphorically. Images, the basic form of memory, hold important information that relates to perceptions of self, the world, and one’s self in that world. Art facilitates the emotional repair of the psyche and the empowerment of spiritual reconnection.

“Utilizing imagery, creativity and the arts in the healing process is an age-old practice that transcends time and culture...it is a means to gain self-awareness, reconnect to the strength of soul/spirit and to influence desired change. Creative experience breathes life back into what has often become an empty routine of existence.”
~Sue Kimball M.A., Art Therapist

A woman obsessed with the size of her body may be expressing the fact that she feels uncomfortable being female in this culture. Art provides a means for a young women to give “voice” to the pain of becoming an adult woman, crossing thresholds unknown to their mothers. Societal assaults on female bodies and minds fill young women today with shame and fear of their own rage. Many of the young women I work with have a terrifying fear of becoming mature and independent as they associate being independent with being alone and alienated. They need adult females who model assertiveness, self-acceptance, self-nurturing, spirituality, and joy. I have found, as an experiential therapist, that I must often become an auxiliary ego for the patient who is developing ego strength. I can provide empathy and soothing, and I can mirror the patient through verbal reflection and repetition of themes in their art. The mirroring of the patient through art confirms the individual’s uniqueness.

A trained eating-disorder professional with a respect for experiential therapy, the art process, and a personal involvement in creativity can use art as therapy. Emphasis must always be on the patient’s own interpretations and self-understanding. In moving to symbolic, kinesthetic expression we are agreeing to speak the patient’s own language. Women with eating disorders adopt complex, metaphoric means of expressing their emotional pain which suggests they have difficulty articulating it. I have found that I can provide an experience which helps the patient “show” what she cannot “tell.” Often, the only time a patient is truly honest and non-defensive is in her artwork. Art can also provide visual evidence of a patient’s strengths and progress, providing hope to the treatment team.

Art can, at times, be used as a defense by anorexic patients. Empty, stereotypical art is often used as an anorexic patient seeks to please others or to intellectualize reactions. When the patient is threatened by emotions that seem out of control, defensive art can provide a sense of safety. The therapist can accept, but not encourage stereotypic artwork. As trust increases, the patient can be invited to experiment with experiences of losing control with the art materials. Patients can be gently encouraged to “color outside the lines” and let go of pencils, rulers, and rigid art making. The creative act especially provides for adolescents who need a means of safely handling anxiety, tolerating conflicts, and exploring alternative solutions. Art gives form to chaos and a way to work through the struggle of separation. Creativity operates in the service of maturation in development. Creativity is a human birthright and accessing this power of life force energizes the creator. Control over art materials provides an outlet for wishes of control.

Art materials such as soft pastels, oil pastels, and acrylic paint promote the expression of affect, encouraging self-expression. Finger paints may encourage regression because of smearing and its similarity to body fluids. Clay can also invite regression, yet can also support reintegration. Regression presents the possibility of reworking early unmet needs. Making collages with magazine pictures is usually perceived as safe and is encouraged if the patient becomes too apprehensive. Body tracings can be made and the patient then asked to create an “emotion self-portrait” in order to explore their inner world. Face masks can be created and painted to reflect the identity of appearance, as well as what is internal underneath the mask. Feelings concerning the physical body are related to feelings and experiences of the psychological self. The patient often fears that if another person “gets inside her” she will lose any sense of self that is still there. Art making can provide a safe place to let others see inside the eating-disorder sufferer’s world.

Suicide Prevention



National Suicide Prevention Month
It's National Suicide Prevention Month and I can't even fathom the importance of helping someone in need. It may be your mother, your friend, your cousin, or even a stranger, but one person can change the difference of what the outcome may be.
I lost a friend to suicide and there are all the what could I have done? Why didn't I see the signs? Why didn't they call me or reach out?  None of that matters...if a person is in that amount of pain to end their own life they will find a way end the pain. Typically, those who are suicidal will not reach out for help, but rather find a way to do it and that why it's so important to be aware of the warning signs. I don't believe that suicide is selfish. I believe it's a mental illness and when someone is in that much pain you're thinking isn't straight. I have heard people say "Doesn't that person care of the people they are hurting?" It isn't about hurting anyone!
In 2011 my mind kept spinning in circles to make sense of my friend's death.  There are no easy answers. No one knew how much pain my friend was in until...that was the end.  I'm not going to go into details for the sake of my friends that knew her, but my point is this...if you know someone is struggling, they are blogging about suicidal tendencies, DON'T just sit there and think it's a phase because it's NOT  It's not something to joke about or think they will be okay tomorrow.  

The following signs may mean someone is at risk for suicide. The risk of suicide is greater if a behavior is new or has increased and if it seems related to a painful event, loss, or change. If you or someone you know exhibits any of these signs, seek help as soon as possible by calling the Lifeline at 1-800-273-TALK (8255).
  • Talking about wanting to die or to kill themselves.
  • Looking for a way to kill themselves, such as searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live.
  • Talking about feeling trapped or in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious or agitated; behaving recklessly.
  • Sleeping too little or too much.
  • Withdrawing or isolating themselves.
  • Showing rage or talking about seeking revenge.
  • Displaying extreme mood swings. 
Suicide Facts
  • Suicide takes the lives of nearly 30,000 Americans every year.
  • Many who attempt suicide never seek professional care.
  • Between 1952 and 1995, suicide in young adults nearly tripled.
  • Over half of all suicides occur in adult men, ages 25-65.
  • Suicide rates in the United States are highest in the spring.
  • For young people 15-24 years old, suicide is the third leading cause of death.
  • Suicide rates among the elderly are highest for those who are divorced or widowed.
  • 15% of those who are clinically depressed die by suicide.
  • The strongest risk factor for suicide is depression.
  • In 2004, 32,439 people died by suicide. (CDC)
  • It is estimated that there are at least 4.5 million survivors in this country. (AAS)
  • An average of one person dies by suicide every 16.2 minutes. (CDC, AAS) Research has shown medications and therapy to be effective suicide prevention.
  • Suicide can be prevented through education and public awareness.
  • Last year SAVE educated 10,618 youth & parents on depression and suicide prevention.
RESOURCES
Suicide Prevention Lifeline
1-800-273-TALK
Suicide Hotline
1-800-784-8433
National Hopeline Network
1-800-SUICIDE
National Alliance on Mental Illness
800.950.NAMI (800.950.6264)
Depression Hotline
1-630-482-9696
Grief Support
1-650-321-5272
Trevor Project
1-866-488-7386
SUICIDE PREVENTION


More,More, More: The Dangers of Over Exercise



More, More, More: The Dangers of Over Exercise
Media messages encouraging us to exercise away our “flaws” are rampant, particularly in these summer months when many people are self-conscious about wearing bathing suits and dressing for warmer weather.   We’re nearly halfway through summer but the seasonal cultural pressures to attain the “perfect” beach body are still in full swing. The relentless marketing often focuses on incorporating the most strenuous new workouts, squeezing in more time at the gym, pushing just a little bit harder and faster every step of the way.  When it comes to exercise, the message almost always seems to be more, more, more.
It’s true that staying active and engaging in exercise is a positive activity that can have long-lasting benefits for physical and mental health.  However, it becomes increasingly important in our “faster, longer, harder, more” exercise culture to ask ourselves, can you have too much of a good thing? The Answer:  Absolutely.
More is not always better.
Exercise can quickly become unhealthy when taken to extremes or when the body is not equipped with proper nourishment.  Individuals who struggle with perfectionism, rigidity, obsessive/compulsive behavior, addiction or eating disorders are particularly at-risk for engaging in over-exercise (also referred to as exercise abuse or obsessive exercise.)  These individuals often start out with moderate exercise goals in an attempt to change their weight/body shape but can easily slip into patterns that become compulsive.
Often, the same messages that promote extreme exercise also encourage people to ignore their body’s cues – to push past pain and exhaustion in order to reach goals.  But when you override your body’s need for rest, healing, or even medical attention, it can have long-term negative consequences on health, not to mention on overall fitness and athletic performance. Furthermore, exercise and weight loss goals may gradually become more and more extreme, and thus more and more dangerous. It’s important to note that even individuals who do not appear underweight, may be exercising obsessively or working out beyond what is healthy for their body.  Even high caliber athletes are at risk.
“It is no secret among athletes that in order to improve performance you’ve got to work hard. However, hard training breaks you down and makes you weaker. It is rest that makes you stronger. Physiologic improvement in sports only occurs during the rest period following hard training.” [Overtraining Syndrome]
Signs & Symptoms of Excessive Exercise
Because exercise is such a socially acceptable and culturally applauded behavior, it can be difficult to identify when someone is engaging in healthy activity and when they may have crossed the line to over-exercise.  It’s particularly important for coaches, trainers, fitness instructors and other professionals in the exercise industry to be aware of the warning signs and red flags that someone may be struggling with obsessive exercise.  These are just some of the signs that an individual may have an unhealthy relationship with exercise:
  • Exercises above and beyond what would be considered a normal amount of time (For athletes, prolonged training above and beyond that required for the sport)
  • Refusal to build in days of rest or recovery; Exercises despite injury or illness
  • Athletic performance plateaus or declines (Overtraining Syndrome)
  • Rigidity, inflexibility regarding exercise schedule
  • Excessive concern with body aesthetic
  • Withdrawal effects (sleep/appetite disturbance, mood shifts, intense anxiety) and feelings of depression or guilt when exercise is withheld
  • Exercise is prioritized over family, work, school or relationships (sometimes to the point of neglecting important responsibilities or obligations)
  • Exercise is the person’s only way of coping with stress
  • Deprives self of food if unable to exercise (feels he/she has not “earned” or “does not deserve” the calories)
  • Defines overall self-worth in terms of exercise performance
  • After workouts, is plagued by thoughts like “I didn’t do enough” or “I should have done more”
  • Rarely takes part in exercise for fun. Activities like hiking, paddle boarding, etc, don’t seem like “good enough” exercise.
If you or someone you know identify with this list, it may be time to step back and take an honest assessment of the exercise relationship.
Excessive exercise not only interferes with an individual’s daily life and interpersonal relationships, but it is also dangerous. Excessive exercise can easily result in overuse injuries and stress fractures which could be temporary or permanent.  Women may have menstrual irregularity and men may experience a decrease in testosterone.  Among the many other potential consequences, exercising too much can lead to decreased immunity and frequent colds or illnesses.  Over-exercise is often a sign of an underlying eating disorder.  Furthermore, recent research found that the frequency of over-exercise predicted suicidal gestures/attempts and concluded that excessive exercise should be noted as a potential warning sign of suicidality among individuals with bulimia. [source:Eating Disorders Review,  May/June 2013]
If your body is telling you that it needs a rest…
You should never exercise when you are sick or injured. When you have a fever, fatigue or muscle injuries, take the day off to help your body heal.  Even a very healthy body needs adequate rest in between workouts.  It’s recommended that you take at least two days off a week to allow your body time for healing and recovery.  Also, make sure that you are properly providing your body with enough carbohydrates, dietary fats, proteins and water to fuel your workouts. Proper hydration is critical when working out.  Dehydration can lead to overheating, muscle fatigue, headache, nausea and it impairs your body’s ability to transport oxygen.
Maintain a Healthy Relationship with Exercise
There are many ways to have a healthy relationship with exercise. First, it is extremely important that you have spoken to your doctors and they have all cleared you for exercise. Just like many things in life, moderation is the key to success.  Focus on establishing a balance between working out and other experiences, relationships and responsibilities in your life.  Consider combining a variety of activities that you enjoy and are convenient to your lifestyle instead of becoming overly attached to one type of exercise for a specific amount of time each day.  Hiking, golfing, dancing, biking, tennis, kayaking and taking your dog for that much needed walk are great ways to be active in different ways. Remember that the goal of healthy exercise is not to change your body but to care for your body so that it will allow you to enjoy your life.
If you think you may be struggling with excessive exercise, we encourage you to talk with someone close to you and seek help to establish a healthier relationship with exercise. Y
Blog contributions by Amy Gooding, Psy.D., CED Therapist