BED7787 - SECTION 7: HANDS-ON EXERCISES FOR PATIENTS SUFFERING FROM BN, AN, ED-NOS AND BODY IMAGE PROBLEMS
Many times patients suffering from body image distortions, BED, or eating problems need to "hold-on to something therapeutic" between sessions. Sometimes, these patients benefit from doing hands-on exercises between sessions.
These exercises are taken from Ms. Celcer's book, Mujer-Cuerpo, Dieta: La Voz de la Obsesion. There were designed to benefit a certain subtype of patients in helping them become more comfortable with their body.
Experience indicates that psychological, hands-on exercises are more effective if patients create a relaxed mood when doing them. The first step, then, is for the patient to create a relaxed ambience for herself or himself before she begins the exercise.
These exercises are not just a relaxation technique; they are a way to enter into the thoughts and feelings of the patient. They may serve as a tool for professionals in the field, a springboard to certain topics, feelings or thoughts.
The Voice of the Obsession
Your patient is torturing himself. He thinks his abdomen is not toned enough. She believes she is too fat. The Voice of the obsession is berating and humiliating your patient.
The Voice of the Obsession is a familiar voice to many eating disordered patients. It would be an illusion to believe that just because the patient has come into treatment the voice of his/her obsession will abate.
This exercise’s objective is to transform the voice of the obsession form one that berates the patient into a friendly voice that alerts the patient that ‘something’ inside of her requires supportive attention.
As a healthcare professional, you can first help your patient figure out exactly when the voice of the obsession has begun to berate him or her. Help him or her locate the moment. What was going on before he/she began thinking he/she was fat? Ask him/her to play the events surrounding the beginning of him/her berating him/herself, in detail. Maybe he or she can locate the moment, maybe not.
What is important in this context is to understand that The Voice of the Obsession is talking. Your patient needs to hear the voice out and, take care of it. The Voice of the Obsession is trying to say something to your patient. What is it?
Ask your patient to do the following:
1) Breathe a few times until he or she feels the tension is leaving his/her body.
2) Realize that the voice of the obsession is at work.
Your patient needs to realize that, once again, he/she is torturing him/herself. Whether your patient has, in reality, eaten or not, binged or not, purged or not, the truth is that he/she is now torturing herself. Your patient needs to get in touch with that fact that he/she is mentally torturing him/herself - without further berating him/herself for the act of berating him/herself.
3) Play the last few hours in her head to get clear about when exactly he/she began to torture him/herself. What prompted the self-attack?
The trigger for the self-berating could be a conversation (with another person or inside his/her head), it could be a thought, a feeling, a conversation inside his/her own head, with him/herself, a smell, a certain thought, Was it prompted by eating something ‘forbidden’? Was it prompted by not following a certain rule about exercising?
4) Your patient needs to remember the feelings he/she felt before beginning to torture him/herself with the topic of food, eating and body. What was he/she feeling before he/she began to torture herself?
You can model for your patient letting him/her know that feelings are acceptable. You can and go down a list of feelings. He or she may not be used to thinking of these feelings. They may be too forbidden for him or her to accept. You can ask your patient if he/she felt:
Patients with BED may have a narrow window of feelings they accept, and sometimes an inability to assess their real size. They do not look in the mirror - so they do not have to see their real size. Envy or tiredness may be feelings that they don’t recognize in themselves.
5) Ask your patient to suspend judgment.
6) Ask your patient to try not to be afraid of his/her own feeling.
He or she needs to congratulate him/herself for having found those feelings inside himself. He or she needs to congratulate him/herself for having been able to put them into words.
7) Ask your patient to reflect for three minutes on why those feelings sent her running into the voice of the obsession. The voice of the obsession acted like refuge for your patient, a refuge from more real feelings.
8) Your patient can decide whether to talk about this exercise with you or not during the next session.
Sometimes, patients cannot locate an exact moment when they started to berate themselves. In such a case they can still do the exercise without exact knowledge of the time.
9) When your patient feels that he/she has gotten what he/she needed from the exercise, he/she can go on with her day, feeling, hopefully, relieved from psychic pain.
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