I’d like to introduce you to Share Holland, who is a Licensed Professional Counselor Candidate and an EDIT™ Certified III – Eating Disorder Treatment Clinician. I supervised Share while she was working with me at my previous office location in Denver. She is a knowledgeable and compassionate therapist, who incorporates mindfulness into recovery. You can contact Share with any comments or questions, including how to get started with individual sessions (see bottom of article).
– Dr. Dorie
What happens for you when I tell you this: You should lose weight. You should gain weight. You should eat more green vegetables and less carbs. You should exercise more. In other words… You are not OK as you are. How does that feel?
Lisa Dion, the creator of a neurobiological-based form of play therapy, says that when we hear a “should,” our sense of Self is threatened. When shoulding on yourself, or when others should on you, your Authentic Self is directly challenged. You’re denying who you are in the moment and not seeing your own wisdom. This can create an internal dilemma between who you are and who you think you should be. The result is that the autonomic nervous system becomes activated trying to handle the discrepancy (Dion, 2015).
Most clients in eating disorder recovery are already receiving a ton conflicting “shoulds.” These endless shoulding on yourself voices will often activate the trauma response in the body, especially when their actions don’t happen to match up with their perceived “shoulds.” If clients in eating disorder recovery are hearing endless “shoulds” regarding food, their weight, and following a specific plan, their nervous systems may be over-activated to the point of fight, flight, freeze, or collapse. Because their sense of Self is threatened, they are operating out of fear and are caught in their lower parts of their brain. These clients may not be able to access their prefrontal cortex and cerebral cortex, which are the parts of the brain that can hear rationalization and reasoning.
This is why I would postulate that nutrition plans, cognitive behavioral therapy, and psychoeducation do not always work. These reason-based approaches can only reach the outer parts of the brain, which are not able to take in new information when a client is stuck in fear and their nervous system is dysregulated. Shoulding on yourself and others can make eating disorder behaviors worse, not better. Eating disorders have the highest mortality rate out of any other mental illness (Sullivan, 1995, p. 1073-1074). Something needs to change!
I believe that the common practice of trying to be rational with the eating disorder as if it’s a problem that needs to be fixed, solved, or eradicated is outdated. Given what we know about the brain, this cognitive approach can only help to a certain degree.
As a therapist, I don’t believe that clients should be different than they are – I look at the deeper wisdom in the eating disorder, guiding my clients to reflect about how their eating disorder was the best strategy that was created to deal with reality at the time. By seeing their eating disorder as brilliant strategy rather than an illness, many clients begin to feel safe enough to share their struggle, start shifting away from the fear response, and change their perspective of the eating disorder and ultimately of themselves.
As soon as we allow what is, without judgment, we, as therapists can begin to untangle the shame and secrecy associated with this disorder, releasing clients from the added pressure of “shoulds.” Eventually, when the pressure to change and be different is lifted and the nervous system is calmer, I begin to ask clients:
What are other ways that help you feel calm or connected?
When do you feel loved? What helps you love yourself?
What do you value? Where do you have a felt sense of purpose?
The truth is, clients already know all the answers – they are often hidden underneath all of their “shoulds.” As therapists, we are simply offering them a way to reconnect to that which they already know.
Dion, L. (2015). Integrating extremes: Aggression and death in the playroom. New York, NY: Aviva Publishing.
Sulivan, P. (1995). Mortality in anorexia nervosa. American Journal of Psychiatry, 152(7), 1073-1074.
Want to stop “shoulding” on yourself? Contact Share Holland, MA, LPCC – the author of this blog article. Share is an EDIT™ Certified III – Eating Disorder Treatment Clinician, and has a specialty in mindfulness-based recovery practices at her office in Boulder, Colorado. EMAIL SHARE
Interested in a FREE consultation with Dr. Dorie? Dr. Dorie is passionate about her method of Eating Disorder Intuitive Therapy (EDIT)™ to help people overcome eating disorders and addictions. She provides customized counseling for eating disorders and alcohol / drug addiction at her Positive Pathways treatment center in Evergreen, Colorado – and EDIT™ eating disorder training and certification for coaches and clinicians worldwide. CALL 303-494-1975 – EMAIL DR. DORIE – GET CERTIFIED