What comes first? Nutrition or cognitive change?

So my session today went as well as could be expected. She said ‘you’re restricting’ I said yes, she said ‘it will lead to binge purging’ I said yes, she said ‘you need to get back to structured eating’ I said ‘yes’ she said you need to increase your carbs’ I said ‘yes’, she asked if I could do that, I said no. 

I know what I need to be doing but I can’t make myself do it. I told her I hated sessions like this as it’s just a waste of everyone’s time. I asked her could we do something else rather than just go back and forth on something I already know, and said no, that we need to get my weight and eating stable first. My goals are 3 meals 2 snacks a day – the same goals I’ve had since the beginning of time (well, ED recovery time!) and I’m fed up of it. 

If I could manage the stupid eating part then I wouldn’t need help with the rest would I? Maybe if I felt better about my body I wouldn’t restrict to try lose weight, but she says I have to maintain normal eating first. If I could handle stress better I might be able to stick to routine, but she says I have to be able to do routine before we address the stress.

I have complete faith in her that she is an excellent counsellor, highly trained and experienced when it comes to ED. I know she is the professional here, but I just don’t get this bit, and it ends up with me going round and round in circles.

If I have a ‘bad’ few weeks behaviour wise we just have short sessions, in and out, get back on track, but if I’m doing well she’ll love me forward. Maybe the idea is to give me support for doing well rather than ‘indulging’ me in behaviours and attitudes I know are negative. So if I want to move on I just show her a good food diary, but how do I get back on track with that?

Argh, I’m stuck stuck stuck tonight. Would love to hear other people’s experiences of CBT stylee approaches and whether this sounds familiar?

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17 thoughts on “What comes first? Nutrition or cognitive change?

  1. JFDI!! This is what my counsellor throws at me, just fucking do it.. at that point, I want to bounce him but I know he’s right, so I push on through muttering obscenities all the way xxx

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  2. https://faithfoodfear.wordpress.com/2016/09/08/feeling-stuck-in-therapy/

    Oh my gosh yes!! I know so many times I’ve regretted even going to therapy because nothing was accomplished and was a waste of her and my time.
    It is the knowing what you need to do, but not following through or doing it.
    One thing that helped me, is that I am big on excuses, or being “too busy” at work to eat, it just isn’t at the top of my list so it doesn’t get done. I’ve made a conscious effort to make eating deliberate. That has seemed to help.
    Or, do something totally off the wall, have pizza and beer with dinner, go out to a mexican restaurant. Mix it up. It may go horribly wrong, but even so maybe breaking that cycle of “how are you?” “how’s eating?”…… or pick a topic to talk (body image, being resilient, etc).
    Thinking of you and have faith in you!!!

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    1. So reassuring to read your post and know others feel the same! (Not great for you obviously sorry but helpful for me!) I tried to get her to focus on something else-I had brought a fear food list in that she asked for- but she said I just needed to focus on getting lunch back in- but maybe I could push this more next session. Thanks for the suggestions x

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  3. I had that conversation for probably a year or two. It was always a battle and, in fact, we would go through the same thing and laugh about it, that is, when I got my sense of humor back.

    As far as your title, although it’s probably rhetorical, nutrition first. I couldn’t even begin to think clearly or reasonably until my weight was restored and I had loads of therapy. I know that probably isn’t encouraging but it got me through. I’ve actually been maintaining at a weight I like for well over a year now.

    I never had an end to that battle though till I did the type of recovery that I talk about in my blog. I needed that black and white accountability and it worked for me. It is a difficult and long road with a simple plan of action: eat, normalize, work on the head stuff.

    I always wanted immediate results, sometimes still do. I keep getting reminded how many years I had an eating disorder (30+) so to think it would go away in a few months really was a wee bit unreasonable on my part, lol. It’s the process, not the end result that is important. Maybe you can consider your steps toward recovery as banking experience to help the next person along….

    That helps me. Feeling better and having a calmer mind also helps.

    Be well and keep on keeping on, as they say. 🙂

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    1. My weight is restored and has been for a year now but it doesn’t stop me wanting to be thin or hating my body. But this isn’t constant- I do have better patches- usually coinciding with my better eating patches- sigh- I just need to keep on keeping on- you’re right- one foot forward x

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  4. No experience to share, sorry. This blog sounds like you are fed up frustrated and having a bad time just now. But at other times you have been happy, making progress and pleased. So you can do it☺️ Just dust yourself down, take a deep breath and start again. Why? Why when you have done this so many times before? Because when you succeeded you were happy, you know how to succeed so you know how to be happy and being happy is a nicer place to be, isn’t it?

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  5. MQR xxx yes it sucks, why is it so hard sometimes? I hear you omg AMEN sister. I am going on meds to try and get loose from those very compelling and seductive thoughts. You deserve care, you deserve the food, you deserve a life free from this shite and every time you stick to the meal plan you are on the way to that freedom. Some people say that the food is medicine for the illness that is ed. You have a really established eating disorder, its going to take a lot of fighting. I know how hard it is because I’m there too. It feels endless but we can not give up. These are the things I tell myself too – that it is the path to freedom, that I’m just doing my best today. I have been a bit plagued by thoughts lately and my dietitian just told me to ‘maintain’ where I’m at. In some corner of my brain I’m aware that regular eating and food is what gives me the quality of life that I prefer, that I know that my humanity – my ability to be kind, to enjoy life and other people and abilities I don’t yet have but would like 😉 i.e. being patient and forgiving (haha) will only come if I can eat regularly. Really, long term, this is where the fight is at for me. I need to fight every day not to give into the urge to restrict or to fall under that trance of distorted thinking which values my ability to restrict, purge, lose weight. Sometimes its easy, sometimes its hard. Sometimes I’m in that place where I believe that something bad WILL happen if I eat but I try and commit to choosing to eat at least something at the right times when I can… I also find it helps to ring the ED helpline here in Ireland and go ‘ARRRRRGH’ sometimes after I talk about it I am able to find my way back to the meal plan – they also have an email service you can fire and email off to them because you’ll be on holidays here later and you’ve been invited by your Irish friend 😉 or maybe there is a service like that in UK? B-eat or one of those? http://www.bodywhys.ie/supportServices/email-support/ xx

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    1. As always, thank you. The quality of life thing is so important- and youve just given me inspiration for a post! I think wordpress is my equivalent of the email line- you guys let me rant, but then do an excellent job of getting me back on track!

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  6. I always did better when I stopped focusing on food so much. Sounds weird, maybe just me. But when I took the pressure off of meeting goals as far as what to eat and when to eat I did better. It taught me to listen to my body and develop a relationship with food that way. I do still restrict at times. But other times I over indulge (not in a b/p type of way). I’ve noticed for me it usually balances out. Just wanted to share my experience. You’ll get it all balanced and figured out, recovery is not 1 size fits all 🙂

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    1. Thanks for this, it’s a hard one isn’t it, knowing whether to focus on food or not. I have made massive progress in other areas e.g. assertiveness, boundaries, stress management etc. through counselling, but yet continued with my eating disorder, so I know it is something that I need to face head on, but having too specific goals e.g. add bread, does seem to freak me out more than just general ones- eat lunch. Just need to keep working and trusting to get it figured out I guess!

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  7. I’m so sorry you’re having a hard time. Therapy is supposed to stretch us and lead us to a healthier place, so some tough love is appropriate. It’s hard to admit that she’s only doing this to better you. If you’re having a hard time with her reasoning I ask her to try something different. Recovery is really freaking hard! Keep going when that means baby steps. It helps me to make lists of things I can’t have without recovery (I actually just did this two days ago). I think it puts your dreams and goals into perspective and shows how much you would miss out if you continue. You CAN do this! We have to push through the hard stuff to receive that positive changes that will come only if recovery happens.. 💕

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    1. Thank you. I think I’ll ask her at my next appointment and see what she says, and then maybe I just have to trust her approach. I completely see why recovery is worth it but it just doesn’t stop me struggling to add bread into my meals – I’m weight restored too so I’m cautious about any more weight gain.

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  8. Having just re-read this comment it was clearly ED talking, and not me! Being cautious about weight gain is what got me into this mess! Good idea for me to do an updated list for me to refocus my motivation- thank you!

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  9. hey there, I havent personally struggle with an ED but I have been to therapy for depression and anxiety. Often times I would have a bad session and feel totally lost, like the woman I was seeing just truly didnt care. Then I would have a good one and feel like she was rewarding me for getting better. But I wasnt better! The last time I saw her she told me there was nothing more to talk about and she thought we should stop our sessions. I was in awe because I was still hurting and grieving. I left therapy in the dust and started working on myself the best way I knew how. 4 years later and I’ve never been healthier, happier, and more in tune with myself. Hang in there as best you can! time heals and we are stronger than we think when we have to be.

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    1. Thank you for the inspiration. It’s nice to know other people have had similar experiences, and it’s so great to read about people who have taken ownership of their progress. I’m so glad you’re in a better place.

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