1.4 Who is Your Patient Eating?

Emotional Eating
By Heather Hamilton, PhD.  |  ©2022BreakThrough!  Ongoing series – Mental Health Wellness in Recovery from Obesity, Type 2 Diabetes & Dysregulated Eating Behaviors.

WHO IS YOUR PATIENT EATING?

The BreakThrough! program (Hamilton, 2015, ACA & NBCC, 2018) goes beyond behavioral change to focus in-depth on recovery from mental health conditions & disorders that lead to cycles of impulsive, emotional eating. The course is structured, capturing over 150 topics relevant to sustained recovery. However, a key question I keep in mind when building client rapport and exploring their history & environment (family) of origin is: “Who” is my client eating?” There are a lot of why’s and what’s relevant to emotional eating, but this article centers on “who”.

Assuredly, not every patient struggling with type 2 diabetes, obesity or illness, will present with a negative emotional legacy or self-defeating self-view. That said, because of the nature of BreakThrough! and our focus on recovery from food addiction, these two negative factors, legacy & self-view, present for approximately 88% of our client population at intake.

FAMILY / ENVIRONMENT OF ORIGIN

Family of Origin Theory (FOT) is based on Adler’s observations that our early family environment and experiences significantly influence the development of our personality, our thoughts, emotions, preferences, and behaviors [1]. His work in large part led to the understanding of how a person’s sense of inferiority or superiority is influenced from birth. He recognized that parents, mentors, teachers, and peers play a critical role in the development of our identity (self-view), resilience, drive, and ultimately, our happiness.

For various reasons, (including the questionable mental health of parents), some clients may have endured, rather than enjoyed childhood and adolescence. Unfortunately, the resulting low self-esteem, harsh inner critic, and mood disturbances (such as pervasive depression, anger, or anxiety) often shadows them when they leave home. Typically it’s not until things begin to go wrong, or they experience deep disappointment, that they have reason and motivation to question their thoughts and feelings.

Unchecked, a negative legacy can overshadow our patient’s lives; influencing many of their decisions and actions. When I’m comfortable with patients and have secured their trust, I’ll ask something along the lines of “Who are you eating?” or “It sounds to me like you’re eating your “mother”, “father” “friend” “teacher” etc. I ask the question when I already know the answer (relational triggers), and sense the client’s ready to take introspection/recognition to a deeper, therapeutic level. The rather shocking question is almost predictably followed by silence, recognition, insight, and tears. When the tears, sorrow, mourning, and even anger abate, that’s an opening and opportunity to begin positive cognitive restructuring.

COGNITIVE RESTRUCTURING & THE NOW

Exploring the past to get into “NOW” is critical to long-term recovery. For that reason, several sessions focus specifically on developing a strength-based narrative that allows for the separation of the inherited self-view and an accurate self-view. It’s extremely rare that participants in BreakThrough! have issues with character or personality. Typically our client base exemplify traits, such as being kind, nurturing, loyal, dependable, and loving, even while struggling with their own stuff.

A milestone of success is when clients recognize they’ve tied their sense of self to a legacy of negative influences (or a particular person) in the past, but they don’t have to continue that way. They can choose to develop a new and supportive narrative. To develop emotional resistance while working on a an accurate self-view (restructuring) our participants develop & practice short “go-to” statements such as

“THAT MIGHT HAVE BEEN TRUE THEN; IT’S NOT TRUE NOW!”

or

“I AM ENOUGH; I’M JUST LEARNING TO MAKE HEALTHIER CHOICES.”

In summary we explore influences from the family or environment of origin so it becomes easier for our patients to identify particular vulnerabilities to psychological distress. This recognition helps them recognize and manage their responses to situations that prompt impulsive and compulsive mood-altering behaviors.

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