Question: Why Don't You Use The 12 Step Approach?
Carolyn: Sometime in the 80's, early in my career, a client of mine who had bulimia told me she was going to OA where she was told not to eat sugar and white flour because they were addicting and causing her binges. In OA she learned that her eating disorder was a disease she would have for life but she could learn to deal with it one day at a time. She was surprised I called myself "recovered" because she was told that she would always have bulimia. When she was abstinent from her symptoms she would be a "recovering bulimic."
I was stunned. I knew that AA helped many people but I did not know much about OA. The messages this client was getting did not match my personal experience with an eating disorder or my experience treating others. It seemed that many things she was hearing were the wrong messages to give people with an eating disorder. In my role as a therapist I work hard to get my clients to learn how to eat all foods in moderation and not fear any certain foods. I do the opposite of OA, I tell clients they are Powerful over food, not Powerless.
I knew I was "recovered" and the eating disorder was gone. How could OA speak for me or anyone else ? I found the OA view problematic but tried to work with the client while she followed the 12 steps. What became clear was that my client was not getting better following the OA approach. She became obsessed with sugar and white flour being "Bad Foods" and was more compelled to purge if she ate them. Furthermore, even when not eating sugar and white flour she would still binge and purge foods like potatoes or roast beef.
After that first client came another and another trying the 12 Step approach to treat their eating disorder, whether anorexia, bulimia or binge eating. I kept seeing these clients set themselves up, struggle and fail. I kept seeing them take on a self fulfilling prophecy; that they were powerless over food and would have the illness for life.
I began to study the 12-step approach and learned about its value and depth. It is important not to dismiss what 12-step programs have to offer and how many have been helped. The aspects of spirituality, community and sponsorship are invaluable. Concepts, such as making amends and personal inventories are useful for clients to work through. I support the 12 step approach in many instances and encourage my eating disorder clients with co addictions to attend 12-step meetings. However, with an eating disorder the terms recovering and recovery describe useful stages in the path toward wellness, but not the goal. Being fully recovered is the goal.
Some people will say that these semantic arguments are silly, but language has meaning, and in this case, I feel the distinction is critical. The terms "recovery" and "recovering" are ambiguous. A person can say he or she is recovering or in recovery, meaning he or she is abstinent from all eating disorder behaviors. But another person who says she is recovering or in recovery can be referring to the fact she is in treatment yet underweight, restricting calories, or still binging and purging. Clients can use these terms to mean they are in the process of getting better or that they are well and have been for over 20 years. And what does it mean to be recovering? Someone once told me she was recovering from bulimia but she still could not eat sugar or white flour because she was afraid it would trigger her to binge. My goal for this client and all my clients is that they will full heal to the point where they are able to eat all foods without engaging in eating disorder symptoms.
My message, "You are more powerful than food."
The field struggles to define "recovered," but I knew it was important to do so for my clients. So, I came up with my own definition and use it to point out to all my clients
where they are headed.
Being recovered to me is when the person can accept his or her natural body size
and shape and no longer has a self destructive or unnatural relationship
with food or exercise.
When you are recovered, food and weight take a proper perspective in your life and what you weigh is not more important than who you are, in fact,
actual numbers are of little or no importance at all.
When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size or reach a certain number on a scale."
Becoming recovered does not happen from doing any specific thing. It does not happen on a certain day. It will not happen because someone has finished a treatment program. Being recovered is a gradual process and gets stronger and stronger over time. There is no one who can proclaim this for anyone else. When you are recovered, you are the one who truly knows it.
Question: Do you worry that you will slip or relapse?
Carolyn: No, no way, not possible.
Question: How can you know for sure? What if you are under enormous stress?
Carolyn: I have had more than my share of major stressors. Both of my parents died, I suffered a major illness, my husband had two heart attacks and almost died. None of this has caused the slightest set back. It has been over 40 years now, I think it is fair to say I am recovered.... for good.
Question: Aren't you ever worried that if you skip a meal or lose weight and feel thinner, you might get caught up again?
Carolyn: When you are truly recovered those things have no pull, there is no desire, no attraction.
Question: But really, how can you ever really know that something won't set you back?
Carolyn: Well, as I have told others, maybe I have to wait until I die and then hopefully someone will put on my tombstone....
‘She really was recovered."
Question: Why is this term, Recovered, so important to you?
Carolyn: This is not just semantics here. How clinicians and clients view the disorder and the treatment affects not only the nature of the treatment, but the actual outcome. If clients and clinicians believe that those suffering from eating disorders can be fully recovered, they have a better chance of achieving it. They will not settle for less. I have treated so many clients who were exhausted, defeated, and hopeless after years of struggling with the illness and thinking it would always be a part of them. When clients actually see people like me, who are living proof that you don't have to "manage " the illness but can truly leave it behind, they are given much needed hope.
Question: What do others think of this stance?
Carolyn: A number of people in the field now believe that being recovered is possible. A growing body of research including Monte Nido's 1 to 10 year outcome study (Brewerton & Costin, 2011) has backed up this position. Although it takes time, people with eating disorders do not have to deal with their disorder for the rest of their lives. They do not need to keep relapse at bay one day at a time, but rather, with appropriate treatment can become fully recovered where both the behaviors and the thoughts are things of the past.
Brewerton, T. D., & Costin, C. (2011).
Treatment results of anorexia nervosa and bulimia nervosa in a residential treatment program. Eating Disorders: The Journal of Treatment & Prevention, 19(2), 117-131.
Brewerton, T. D., & Costin, C. (2011).
Long-term outcome of residential treatment for anorexia nervosa and bulimia nervosa. Eating Disorders: The Journal of Treatment & Prevention, 19(2), 132-144.
Recovered vs. Recovering
''I recovered and so can you."
"Individuals who suffer from eating disorders can become fully "recovered." I recovered from an eating disorder 40 years ago and soon after became a therapist specializing in the treatment of people with eating disorders.
During my career, I have treated countless individuals who are now fully recovered. Several have become therapists themselves.
I have always spoken openly about my eating disorder and the fact that being fully recovered is possible. As a therapist, I know this is an important message to share with clients. To think one can never fully heal from an eating disorder is a daunting, if not overwhelming, belief for an individual who is suffering.
When you know you can be recovered, that the illness can be gone, a thing of the past, it is easier to suffer through what it takes to get well because all the suffering will eventually come to an end.
"Over the years, my clients have consistently told me this awareness was
an important key in their getting well."