Psychotherapy expert: Compulsive overeating

Vol XXVIII: Help me find a new therapist more qualified to treat my compulsive overeating.

April 12, 2009 16:55
dr mike 88

dr mike 88. (photo credit: )

Dr. Mike is a licensed clinical social worker (USA and Israel) in private practice in Ra'anana and Jerusalem. He is also founder and director of SmokeQuitters. He recently wrote a column called "Psych-Talk with Dr. Mike" in which the feedback from readers was excellent. He has decided to shift gears and invite readers to submit their questions concerning a wide range of topics: child development, adult problems, addictions, ADHD, adjustment problems, crises and transitions, trauma, phobia, mental disorders such as anxiety, depression, and bi-polar. He also welcomes questions concerning your marital or couple relationship, family issues, parenting, problems at work, self-confidence, shyness and much more. To arrange a consultation (Israel and international), call or e-mail Dr. Gropper at (972) 9 774-1913 or at [email protected] "I take pleasure having the opportunity to answer your questions in what I hope will be an informative and exciting weekly column in the Jerusalem Post-online edition. Look forward to hearing from you soon." Send your questions for Dr. Mike and please leave your comments on the Q&A below. * * * Psych-Talk with Dr. Mike: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 Click here for Volumes I-IV Click here for Volumes V-IX Click here for Volumes X-XIII Click here for Volumes XIV-XV Click here for Volumes XVI-XIX Click here for Volume XX Click here for Volume XXI-XXII Click here for Volume XXIII-XXIV Click here for Volume XXV -XXVI Click here for Volume XXVII * * * This column is intended solely to educate and is not a substitute for personal diagnosis or treatment. If you have a difficult problem, please seek advice from your own doctor or mental-health professional. * * * Vol XXVIII Q: I just read your article "Psych-Talk with Dr. Mike: Compulsive Overeating" in the Jerusalem Post from Jan. 25, 2006. How do I find a good therapist who knows how to deal with compulsive overeating issues? I have struggled with compulsive overeating my whole life. I have been to 8-9 therapists in the past 10 years for this. I have been with my current therapist from March 2008-June 2008 and again from Sept. 2008 to now. The reason for the break in therapy is that he moved from private practice to a county-funded program for which there was a waiting list for me to get into. While I thought I was gaining some ground during my first round with him, I no longer feel that it's working. He spends most of the session talking and some of that time he talks about himself. I quit my job in August and am looking for a new job. When I find a new one, I will no longer be able to see him because he now only has daytime appointments.  It will be a good time for me to start fresh with a more qualified person. But again, how the heck do I find that person? I have had a therapist doze off while I was talking, call me by the wrong name, talk about themselves too much, tell me that at 5' 2" and 220 pounds I don't look that overweight and that I shouldn't feel too self conscience and one that says that it's all in my head that folks treat me differently now that I'm obese from when I've been thin. What I want to know is that when I choose another therapist, what questions kinds of questions should I pose to ensure a better fit Please help!  A: You are certainly not alone in having had therapists who you felt truly did not understand your problem and somehow failed to really give you the help that you needed. After-all, finding a good therapist is no easy matter. It is probably one of the most important decisions that you will make in your life, and I can not overstate this point more emphatically. Nevertheless, people often choose therapists quite blindly, so I will try to address some of your concerns in my answer. For starters, I always recommend that someone looking for a therapist to get more than one name, perhaps 3 is a good number. Make sure that these people come highly recommended. It's also a good idea to ask the person that is giving you the name to tell you whether they or someone they know has actually been helped by this person. If so, get as much information about the therapist that you can. Call each therapist and ask if they are currently taking new clients since some therapists are filled and have waiting lists. The next thing is to ask the therapist if he or she has had any experience with treating your problem, and if so, how much experience. Is compulsive overrating a specialty area of practice for the therapist? I would also suggest asking what the therapist's treatment philosophy and approach is. Is it psychoanalytic, cognitive-behavioral, family oriented etc? These are important questions to know, because I would not recommend a psychoanalytic therapist for an eating and weight problem. I will explain more about this later. It is also important to ask what the therapist's rate is for a 50 minute hour so that you would know if you can afford this person's therapy. Don't hesitate to let the therapist know what you financial restraints are since many therapists are willing to be flexible and slide their rates to accommodate potential clients, especially in these tough financial times. Set up an initial meeting with each therapist. Like buying a new car, take a test ride and see how it feels. Seriously, you are shopping as a consumer here and you want to make the best possible choice. Some therapists in fact do not charge you for this first consultation unless you agree to continue with that person; then they charge you for the session. Come to the session with your questions written down. See how this person answers your questions, but perhaps most important, see how you feel with this individual. Do you feel that there is good chemistry to work on your personal problems with this person? Do you like the person? Did you feel the person's warmth and empathy, and did the therapist listen actively to your concerns without interrupting you, other than some appropriate questions to get to know what your problem is? It has clearly been my clinical experience that people suffering from compulsive overeating often have learned to use food to 'self-medicate' underlying dysphoric emotional states that they want to avoid. So, I would suggest that you seek two qualities in finding a therapist. First, find someone who can diagnose and rule out any mood and/or anxiety disorders such as clinical depression, post traumatic stress disorder, and bipolar disorder. I have seen, and the professional literature supports this that many compulsive overeaters are in fact suffering from mood swings that cycle up and down in the depression zone or from depression to mania. This needs to be evaluated. If this problem is diagnosed, a referral to a psychiatrist and the use of psychotropic medication that can stabilize moods can be a life-saver. I have also come across many clients who have both biological problems that affect their mood and also very real personal and/or relationship problems, perhaps with a spouse, or have suffered from a history of emotional abuse and trauma where both the biological and emotional issue needs to be evaluated and treated. Therefore, the therapist you choose should be someone that has both a psychosocial and biological orientation. However, what ever is the root of your problem, compulsive overeating clearly meets the criteria of an addiction with loss of control, compulsive use of food, and the inability to cut back on this behavior even when the individual is risking potential health problems such as heart disease, diabetes, stroke, hypertension, and impotency. Like other addictions such as drugs and alcohol, smoking, and gambling, once a person learns to use food in such a compulsive and over indulgent manner, compulsive overeating becomes conditioned or associated with all types of situations, people, and places where the behavior takes place. These subtle and not so subtle cues trigger the impulsive eating bouts that characterize compulsive overeating. One can see that regardless of the origins of the use of food to deal with emotions, the behavioral pattern has a life of its own. For example, many compulsive overeaters cannot refrain from binge eating when they are in the kitchen. The kitchen triggers an all or nothing perception of food that doesn't allow the individual to set limits and control his/her eating. When it comes right down to it, compulsive overeaters can't control their overeating because they use food to force back all the other things they feel. You may do this by overeating at every meal, or constantly snacking, or by choosing the wrong types of foods despite your best intentions. The bottom line is that somehow eating has been chosen as the preferred way to handle negative emotions. This psychological pattern makes you fall off the diet wagon time and time again. While diets offer limited help and only for the short-run, long-term treatment solutions are available. First, motivation to get the help is the crucial first step. I would strongly recommend -and this is my second point--that a compulsive overeater go to a psychotherapist who has solid training in cognitive behavioral therapy, relapse prevention, and in the treatment of addictive disorders. Knowing how you feel, while a crucial part of treatment, in itself is not enough. The therapist must be aware of how to help the compulsive overeater change their thinking about food and actions when exposed to food. Coping skills such as identifying the emotional and external triggers related to excessive food binging should be a core part of therapy. Assertiveness training should be taught to teach the compulsive overeater how to say no to temptations to binge, whether from situations when food is available or offered by friends and loved ones. Self-esteem issues need to be explored and self-confidence built up. Other goals of therapy should include using the skills of a dietitian-nutritionist to learn to keep a balanced diet, shop for food wisely, and prepare healthier foods. Regular aerobic exercise is strongly recommended after this person has been given the go ahead by a physician. Another goal of therapy is to help the individual develop a healthier body image and learn to feel good about daily achievements. Building support is also crucial. Besides getting this support from family members, friends, and co-workers, many compulsive overeaters are helped by attending compulsive overeaters anonymous groups, something that I strongly recommend as an adjunct to therapy. Good luck. * * * Send your comments >> Cafe Oleh experts have been chosen for their knowledge and reputation. Cafe Oleh does not take responsibility for any advice they offer.

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