The Psychological and Emotional Factors that make it difficult to succeed at Weight Loss - How a Therapist can help.

Many people struggle with being overweight. The Center for Disease Control (CDC) estimates that currently over 2/3 of adults in the US are overweight. There is a lot of information available to help people attain and maintain a healthy weight.

· Dietary plans and programs to lose excess weight and maintain a healthy weight.

· Exercise programs to safely increase metabolism.

· Techniques and strategies for controlling food intake, and managing cravings to overeat.

· Support group programs to help with information and motivation.

Yet many people have difficulty making use of these resources on a consistent basis so they can achieve success. The following are factors that often interfere with success and are not typically addressed by weight loss programs. A brief description of how a psychotherapist can help with each of these factors is also provided.

1. Demoralization, a sense of hopelessness about the problem, lack of faith they can succeed.

Many people have developed a reliance upon eating as a source of comfort that has become second nature to them, and they feel helpless to change it. People who view themselves negatively as weak or lacking in willpower can have a hard time feeling hopeful that they are capable of success. In addition, people who have experienced abusive treatment earlier in their lives may unconsciously use their weight as a protective shield to keep others distant, to avoid further hurt. People who have been sexually abused or exploited may use weight as a means of shielding themselves from unwanted sexual interest from others.

• A therapist can help people gain an understanding of the origins of their overeating - to soothe painful feelings, fill a void of unmet emotional needs, provide relief from hurtful experiences earlier in their lives. This makes it possible for people to see their overeating as an understandable coping response to difficult and painful circumstances, rather than something about which they should feel shame. It allows people to view their habits as behaviors they can begin to manage rather than something beyond their control.
• A therapist can help people understand how their low self-regard and lack of confidence is a consequence of prior experiences of people responding to their difficulties (including their weight) in harsh, punitive, coercive, or shaming ways, and not a reflection of their capabilities.
• A therapist understands that a big change in altering eating habits and improving health can involve anxiety and fear about letting go of established habits and the comfort they have depended on.  Having a therapist, interested in understanding their fears and self-doubts, accompanying them on this journey to health makes it possible for people to begin to face them with hope.  This is in itself a step towards releasing the grip on them of past traumatic and humiliating experiences.  With the therapist’s supportive presence, people can decide for themselves if their fears are valid in their current lives, and if they are ready to push themselves to make changes.

2. Procrastinating about getting started or jumping into action without enough preparation.

Making an important change like developing healthy eating habits and getting to a healthy weight can create anxiety that may lead to endless procrastination about starting or to jumping into action without sufficient planning.  In addition, past unsuccessful attempts to lose weight can make it difficult for people to want to try again.

• A therapist can help people see that their anxiety about a big change like altering eating habits is a normal part of the process and not a sign of weakness or that failure is inevitable. Therapy sessions can be a place where the fears are examined and understood - generally relating to challenges that will need to be addressed in order to succeed.  The therapist can assist people to commit to the changes and the challenges and sacrifices they will entail.
• A therapist can help people gain an awareness of how their habit of overeating will be triggered by the circumstances and experiences in their daily lives.  The therapist will help them adopt alternative coping responses to these high-risk times so they will be able to free themselves from their habit. This is an important step in people gaining confidence in taking control of their habit.
• A therapist can help people realize that past unsuccessful attempts at weight loss are learning experiences, not failures, from which important information will be gleaned that will help in being better prepared for the next attempt.  This will help in building confidence that success is possible.

3. Fears of being open to support from others.

Prior experiences of important people responding to them, and to their weight, in harsh, punitive, or humiliating ways can make it very difficult for people who want to lose weight to reach out to others (healthcare providers, family, friends, fitness experts) for needed support for fear of encountering further disappointment.  They may fear that important people in their lives will view them as selfish and resent or abandon them for their efforts to turn their lives around.  These fears can lead to what appears to be a stubborn refusal to acknowledge the serious implications of their weight and overeating and to resist any appeals by others to make changes.  It can also result in the approach some take of trying to do it alone, of hiding their efforts to lose weight.  This will be counterproductive, as they will be missing the benefits of concrete support from people who can really help.

• In therapy sessions, people have a direct experience of the therapist’s understanding and expertise in helping them overcome this daunting challenge.  This experience of their problem being dealt with skillfully, without judgment or disapproval, will give people hope that they can experience similar support from others in their lives.

4. Staying with it, dealing with setbacks.

An important factor in success is not giving up when the inevitable setback or lapses into overeating do occur.

• A therapist is committed to being with clients on this journey, so when they slip or fall, the therapist is right there to help them get back up and continue on this journey towards improved health. A therapist views lapses into old habits as potential learning experiences and opportunities to improve or refine plans rather than failures or evidence of weakness.   This approach is an important factor in people not giving up, viewing themselves as failures and weak when lapses do occur.
• A therapist will keep in mind that achieving and maintaining a healthy weight is a life-long process, not a short-term goal.  This will be important in helping people set achievable goals about weight loss that they can sustain for their lifetime.
• A therapist can help prevent people from adopting a restrictive, self-depriving attitude towards food and eating that will undermine motivation over the long haul.  A therapist will assist people to not succumb to the idea that food is the enemy and help them make good food and healthy eating a part of a fully satisfying life.

To talk more about this challenging topic, you can contact me at either paulboscolcsw.com or (302) 832-1282 X204

Therapy with a Chronic Pain Patient

This article provides an account of how psychotherapy can make a real difference in the life of a person living with chronic pain. By describing the actual treatment of a chronic pain patient, the article shows how therapy can complement the efforts of medical providers in assisting people in living fuller, more meaningful lives. The description of the actual patient has been altered to protect the person’s privacy.

Introduction

Living with chronic pain is such a difficult challenge because so many factors can influence the person’s pain experience. Over the past several decades, researchers and medical providers who treat chronic pain have become more aware of the importance of psycho-social factors  - daily stress, family relationship difficulties, lifestyle issues, job dissatisfaction to name a few – in a person’s recovery from injury and leading a full life. In fact, studies of factors that lead to recovery vs. continued suffering and disability have consistently shown that factors such as maladaptive beliefs and coping styles, lack of emotional support, job dissatisfaction, and depression are stronger predictors of continued suffering and disability than the severity of the physical injury. These concerns cannot be fully addressed by medical providers however much they may try to take these into consideration. This article presents how psychotherapy can help with these factors and assist a person living with chronic pain in leading a fuller, more satisfying life.

Description of the Patient

Florence is a 59-year-old married, African-American female with three adult children. She presents as attractive, younger than stated age, lively, articulate, stylishly dressed, and with an engaging sense of humor. She is a college graduate, who had a career as an administrative assistant until she became disabled due to Lupus at age 41. Since then, Florence has been trying to establish her own mixed-media art business, has had volunteer and leadership positions in a community service organization, and has attempted to establish a connection with a church. However, she has felt unable to fully pursue these interests because of her strong sense of obligation feeling unfulfilled in life and living with a sense that life has been passing her by.

Florence reports that she was a relatively healthy and active working mother until she began to experience symptoms of lupus around age 40. Since that initial diagnosis, Florence has encountered other complications: Arthritis, Raynaud’s Syndrome, Fibromyalgia, Chronic Fatigue, Gastric Reflux and Sleep Apnea. She has twice undergone double knee replacement surgery and surgery on both her feet.

Florence has viewed her medical problems as evidence she is “broken”, “useless”, a “burden” or “liability”’ to her family and has lived with the fear that they will give up or abandon her. She has developed a pervasive pattern in important relationships – such as her marriage, her family of origin, her children, medical providers, and her artist colleagues and studio owners – of trying to “keep pace”. She would work her needs around what others wanted, trying to please and make it easier for others. When Florence began therapy, she would report how her efforts to help or please others would leave her exhausted, sore and unable to function for days after. She frequently talked about how she would try to “keep pace” with what others needed until her body “gave out”. Her focus on pleasing others left little time for her own interests: her art, participating in a church, singing in a choir. It was hard for Florence to feel entitled to measure that would help her chronic medical problems – pacing herself, getting regular safe exercise, getting sufficient rest, and limiting activities (like standing for long periods of time, lifting) that exacerbated her pain. She frequently reported feeling not understood by her medical providers, and not reassured by their responses to her questions and concerns. However, she continued to try not to “ruffle feathers” and would leave medical appointments with lingering doubts.

Her Sense of Self

Florence grew up the youngest of four children in a family environment where she felt deprived of security and love. Her mother was depressed and angry throughout Florence’s childhood, in large part due to difficulties in her marriage to Florence’s father. Her father was an absent figure in her life due to his work and alcoholism. Florence grew up feeling unwanted, at times hated by her mother, who would often tell her children she never wanted kids. She doubted that she mattered to her father. She came to think of herself as the “odd one” in the family, the least appealing, least capable, as inferior. From an early age, she developed the pattern of trying to please others to protect herself from feeling unloved and unimportant, and to gain some sense of acceptance from her family. Florence left home at age 16 and married her husband after becoming pregnant with her eldest child. She entered her marriage anticipating she would finally feel loved and wanted. But she soon found herself feeling undeserving and only important if she could please her husband. This intensified with her husband’s devotion to his work, his over involvement with his family of origin, and his emotionally reserved nature. Florence increasingly feared that her husband would abandon her if she did not please him or keep pace with his agenda. Her efforts to make things easier for others only intensified her her loneliness and lack of self-regard, and left her feeling increasingly hopeless about her future and the future of her marriage.

What the Therapist Did That Helped

· Therapy provided a consistent and sustained relationship where the exclusive purpose has been to assist Florence in leading a fuller, more satisfying life, and fulfilling her aspirations in life. Florence experienced someone – in this case her therapist – as genuinely wanting to understand her experience rather than encouraging or criticizing her inclination to seek the favor of others. This allowed Florence to let go of her need to prove her goodness and worth in session by talking about her endless efforts to please others. This, in turn, opened the door for Florence to share, in a more authentic manner, her own lack of self-regard, distrust of others, and her lack of real fulfillment in her life.

· Therapy has helped Florence gain insight into the origins of her automatic people pleasing: to protect herself from hurt and rejection, earlier in her life, by attending to the needs of others. This allowed Florence to see her habit as an understandable reaction to difficult circumstances and as a coping response over which she could gain some control.

· Florence’s therapist helped her understand that her sense of inferiority and unimportance was a consequence of her experiences with family members earlier in her life. The therapist provided the space for Florence to begin to question the validity of her low self-regard. This helped Florence be more open to the idea that being herself was valuable in its own right, and that her unique perspective, talents, and interests were elements to be nurtured, not dismissed as defects or liabilities.

· The therapist helped raise Florence’s awareness of how much she had been oriented to gaining the favor of others in her daily life. This made it possible for Florence to begin to judge for herself if her automatic people pleasing was counterproductive to her desire to improve her life.

· The therapist helped Florence look for opportunities to let go of her protective habits of pleasing others, keeping peace in order to more directly confront difficulties in important relationships in her life – family member, medical providers, colleagues. Florence began to experience herself as standing up for herself. This bolstered her faith in her inner strength and resilience, increased her self-respect, and diminished her feelings of failure.

As therapy progressed, Florence has been able to accomplish the following:

· Florence has been able to impress upon her husband and adult children how committed she is to her art, the importance of church involvement to her emotional and spiritual well-being, and the necessity of taking better care of herself physically. Her husband’s positive response, in particular, has helped F. feel more secure in his commitment to her.

· Florence has joined a church where she has become an active participant in religious studies and a member of the choir. Having a spiritual home and contributing to the spiritual growth of others has strengthened her sense of goodness as a person.

· Florence resigned from the studio/gallery where the policies, expectations, and the physical layout of the building were hindering her creative process, creating increased physical pain, and providing little benefit in terms of sales. Working at her home and developing her own business website has been a more satisfying arrangement for her.

· Florence was able to attend to her physical warning signs that something was not right following her earlier knee replacement surgeries. She persisted in sharing these concerns with her medical providers, did not allow herself to be placated by responses she found neither reassuring nor convincing, and she sought other opinions until her concerns were satisfied. It was ultimately determined corrective surgeries were needed and these subsequent procedures were successful.

· Florence has been more comfortable letting go of her urge to be at her family’s beck and call. She has gained confidence in her ability to decide for herself her obligations to her family and has been more at peace with the limits she sets with her family.

When Loving Support Encounters Discouragement and Frustration

One of the more noble aspects of being human is the capacity to be compassionate and supportive to others. It is human nature to want to help a spouse, partner, adult child, relative, or friend who is experiencing a setback in life, is facing a health or financial crisis, is having difficulty starting a career or achieving independence. But what if your efforts to be supportive to a loved one start to take a toll on you? What if all your efforts leave you increasingly uncertain about your loved one’s true intentions, more doubtful that the other will make good decisions, do the right thing. What if, in spite of your best intentions, you start to wonder if you are not part of the problem? 

How do you maintain a supportive relationship with someone experiencing difficulties in life without becoming discouraged and getting dragged down by that person’s problems?  A first step can be to identify signs that your support efforts have crossed over to enabling.  Here are some of the more common signs that I’ve encountered in my work with clients struggling with this challenge:

· Discouragement and a sense of hopelessness continues to grow in spite of all your efforts and love.

· The person is not progressing in terms of bettering him/herself, improving his/her life, and you find yourself bailing them out of one bad situation after another.

· Your relationship with the person you are helping seems one-sided; the other is giving nothing back.

· You are neglecting your own needs (e.g. health, exercise, healthy eating, financial, or social-recreational) in your efforts to help.

· Your feelings of guilt or shame about the loved one’s problems, or behavior causes you to isolate yourself, withdraw from people who know and care about you.

· You’re covering up, lying for the person you’re trying to help, protecting that person from the consequences of his/her actions-decisions. 

· Even though you do not want this, resentment towards the person you are helping continues to grow; you are finding it increasingly difficult to maintain patience-compassion towards the other; or you are walking on eggshells around the person trying to keep peace. 

· People who know and care about you are expressing concern that the help you’re providing is too much for you; they worry about the toll they see it taking on you.

If you find you are experiencing some of these signs, it may be time for you to step back and re-examine your role with your loved one. It can be a time to ask yourself questions such as:

· How do I step back without abandoning the person I care about?

· What help can I offer that doesn’t just depend on me?

· What changes can I make that might motivate the person I care about to do more for him/herself?

· What are the limits to what I can offer so I am not dragged down by the other’s problems?

· How can I take better care of myself?

· Where can I look for support in my efforts to find a healthy balance in my efforts to help and take care of myself?

These are not easy questions to answer when it involves someone you love and care deeply about and that person is jeopardizing his/her future. It is often helpful to confide in trusted family or friends about your struggles. In many cases, it is helpful to have a support group or a therapist as resources for developing a more balanced approach to this challenge. A support group or therapist can help you decide how to be available to help within reason, to resolve uncertainty about your limits to the help you are willing to provide, and to gain peace of mind that you are doing the best you can.