Weight gain and physical/mental health

[Stephanie]

What I will tell you is that likely a lot of the questions that you answer will be generic questions that everyone else would be asked. Kind of like filling out paperwork before you go to a new physician for the first time. If there's something you're not comfortable answering, just say so. But if I had to make an estimate I would say it's to give the doctor overview of the most important things they need to know to be ready to meet with you.

[Heather]

I would be surprised if in one brief and introductory appointment, any qualified provider told you they were or were not identifying you as having or not having an eating disorder. This isn't something, like say, a blood test for HIV, where someone can run a simple test and get a simple answer.

Rather, at most, what I'd expect is someone saying something -- and ONLY if they spoke with you in at least some depth, as much as a half hour or hour can provide, anyway -- like, "It does sound to me like you may have an ED," or "I'm not sure an ED is really your issue here," or -- and probably more to the point -- "In order for me to properly evaluate you for something as complex as an ED, we'd need more than one initial introductory appointment."

(Sorry to be late with that reading list for you, btw, I'm behind with things this week. Doing my best to get there!)

[Atonement]

Hi!

Sorry, it took me a while to reply too. This ended up being an incredibly busy work week.

The appointment went well, I suppose. It's hard to say I felt like I made too much progress, though. Since I was meeting with the assistant and she didn't provide much feedback, I kind of feel like I kind of have to start over again next week. I mean, I know she's going to give my doctor a report, but it isn't the same thing, you know?

But hopefully next week we'll be able to really get started.

[Stephanie]

One thing I will caution and remind you of is that any type of therapy generally happens in baby steps. By this I mean don't expect to feel like things are solved in just a couple of appointments, it will take some time. And don't get discouraged, you made such huge strides just getting an appointment.

[Atonement]

Thanks for the reminder.

I'm not really in a rush or anything, I'm just looking forward to having my session with my actual doctor. I'm not necessarily in a hurry to cure myself or anything, I just want to be established with the person I'm going to talk to regularly. I feel like having that relationship and knowing who you're going to be talking to makes me feel a lot better.

She did take about 10 minutes to come in and meet me, at my request, which I really appreciated. Also, I got to see her office, which was a little more comfortable. Her assistant had a desk with 2 chairs in front of it, kind of like at the bank. The doctor had a nicer room with a couch and armchairs, which I feel will be a more comfortable setting.

Overall, I've been doing better. I have made a couple changes. I'm eating whatever I want, but trying not to eat more than is comfortable afterward. I've also been adding in fruit a couple times a day, which I've actually been enjoying. I forgot how good high quality oranges and grapes taste. So much of my life the fast few years was getting things that wouldn't spoil quickly. But now, I have time to go to the grocery store a couple times a week, so why not?

[Stephanie]

It sounds like for now you're in a better space, I'm glad to hear that. Wishing you all the best luck, and as always we're here to support you. (And yay for healthy fruit snacks!!:) )

[Heather]

I'd also add that while I know it can be emotionally draining, I think talking to more people about something we keep secret because we feel ashamed is pretty much always a good thing. Basically, I think that that, as a practice, is in and of itself therapeutic, and in and of itself offers us benefits.

[Atonement]

So, I met with the actual therapist yesterday, and I don't know...

I'm not sure what I expected, but I'm also not sure if this is what I'm looking for.

I might be looking at this the wrong way, but I feel like the whole session was kind of focused maybe in a way that you guys mentioned it shouldn't be in a potential eating disorder scenario.

1) When talking about avoiding binging episodes, she used the phrase "You do need to have self control"
2) She asked me about my weight loss goals. Now, I guess she might have just asked this to get a feel for where I was and what I was thinking. To her credit, she didn't say anything negative about me focusing more on not gaining than losing, but still I kind of feel like she would've encouraged dieting if I had asked.
3) She suggested that I plan my meals for the upcoming day, and that plan needed to be a contract with myself. I don't know. The Idea of preplanning everything I put in my mouth and not being able to deviate from it sounds a lot like a diet, even if it doesn't involve counting calories.

So, I'm not sure I'm ready to call this a bad fit, but I'm also not sure it's a good one. She doesn't have any appointments available for 2 weeks anyway, so I'm kind of considering moving down the list. What do you think?

Sunshine, since you've had successful therapy for an eating disorder, does this sound like the kind of things your therapist worked on with you? Does this sound appropriate?

In a lot of ways, I feel like I am doing better. I've been basically practicing HAES with a few slip ups. But I know from past experience that I probably DO need the external support and check ins because it really is so easy for me to slip into not being conscientious

[Sunshine]

Hey there,

I am very sorry, you must have either misunderstood me or I must have not expressed myself clearly. I have unfortunately never had any kind of proper therapy, I've been on my own with the help of a very good GP and quite a lot of information that comes with my job (I work in healthcare like you, but I am not a nurse. I also live in the middle of nowhere and the problem with therapy here is that it would be connected to my employer, so theoretically, my colleagues would be able to get into my records and well, that's not what I want, you know. I am still trying to figure out how to get around that one without a massive commute that isn't realistic for me right now. Not so much for the eating disorder now, I feel like that is pretty okay at this point, but for something I experienced last year that was probably mild depression and is still impacting me plus also anxiety shit).

My GP used to not say much (he was in the town where I went to uni, I don't see him any more unfortunately. At that time I was still stupid and I didn't get counseling or therapy through student services which I totally could have. Big mistake). You see, he wasn't trying any kind of intervention because that's not what he's trained for, he was just being supportive and validating. He recommended therapy and when I said "yeah you're right but I can't deal with this in depth right now, I have exams, whaaaaa!" he let me find my own way patiently. He was an old, old-school guy, very relaxed, very non-judgmental, very laid-back and positive. The only real advice I got from him was not focusing so much on things that stressed me out and that I was bad at (like trying to control my eating) but on stuff that I loved and was good at.

It sounds to me as if your therapist might at this point be focused on weight loss or a change in your eating behavior as the primary goal of your therapy. Is it that? Did you two by any chance talk about your goals? Do you think you could have that conversation with her?

I can't really say whether her approach is "right". I am not a therapist myself. I don't think there can be any general approach that works for everybody. But from what you said above, I get the impression that you two just maybe might not be on the same page yet.

[Heather]

Not a lot to say here, IMO, because reading this, my feeling sounds like yours: I think your instincts are right here and this isn't a right fit for you. If you're asking me, I'd say to keep shopping and move on to screening some other therapists.

I'd also vote for you seeing what you can do to work to trust your own instincts: if it doesn't feel right, it's usually because it isn't. You can trust yourself!

Also, found you a couple things to look at that I think might be helpful to bear in mind as you're looking for therapists with this:
• http://effectivehealthcare.ahrq.gov/ind ... layproduct (you'll likely notice the recommendations about HAES: this is all not my area of expertise, sex ed and sexual health are, but purely from an opinion basis, I agree on the HAES opposition to BED treatment as being weight-oriented or about planning food, and since you also know you have an affinity for HAES, I'd say asking a therapist how they feel about HAES as an approach would be a good move for you. If they say they don't, you can probably know that by that token alone, they may not be a good fit for you, since you know this has been something that very much IS)
• http://echo.unm.edu/wp-content/uploads/ ... otocol.pdf
• http://www.apa.org/monitor/mar02/binge.aspx (bit on the dusty side -- 2002 -- but figured reading it might still be useful to you)

[Atonement]

Thank You, Heather and Sunshine.

Since we couldn't do appointments for the next 2 weeks anyway, I decided to email another therapist that I had gotten in tough with. Hopefully she will have an opening on one of my days off between now and then. If I like her better, I can just cancel the appointment with this current one.

Honestly, though, I might cancel regardless. I've already shelled out $60 to her office, and honestly I feel like she's acting as if I came to her with "I want help losing weight" rather than "I think I have an eating disorder". We talked about my tactics to avoid overeating, and she didn't suggest anything that I didn't already know. Honestly, I feel like she's almost ignored my suspicions about the eating disorder.

And honestly, I don't know for sure, but I do have to wonder if she would've taken the same approach if I'd been suspecting anorexia or bulimia. I feel like some people see those as "real" disorders whereas they see binging as just being impulsive and weak willed.

And, I dunno. I think I'm generally a fairly strong person, and I think "Impulsive" is the last thing anyone would call me in anything other than eating.

PS. Another thing I forgot to mention was that I told her about the feelings of disgust I have about my weight sometimes and how sometimes I when I see unposed pictures of myself, I sometimes think "This is how other people see me every day. They much think I'm disgusting".

It was like she almost completely skated over it. She said, "Well, you can't think about those things all the time, just like you can't think about [some other thing we talked about. I don't remember what it was, but I remember it being something stressful but true] all the time."

I could be overanalyzing this, and maybe I'm creating these impressions because this is something I'm really insecure about. But I almost felt like she was implying was that the feelings of self disgust were something with factual basis rather than something my insecurity was feeding. Not that I think she meant "I think you're disgusting" but rather that I was right to be insecure because fat is gross and feeling that way is normal. You know what I mean?

[Atonement]

Good news. The other therapist that I was emailing had an appointment on Tuesday.

This way, I'll be able to get a "second opinion" and will be able to compare approaches. And It's not going to cost me any extra money, since I had originally planned to go next week anyway.

I already sort of have better feelings about this one, partially because she communicated with me directly. I REALLY didn't like the way the first therapist had someone else do the initial visit. I know she discussed it and read the notes, but I really feel like that first visit is SO critical, and jumping into the session without having done it with her just kind of felt wrong. The whole visit seemed detached.

One thing, though. Should I tell tell her about my experience with this therapist? I don't want to sound like a therapist jumper who leaves every time she doesn't want to hear something. But at the same time, knowing my feelings about the kind of treatment I want would really help.

[Stephanie]

Hey they Atonement. I'm sorry to hear your experience with the other therapist was not a good one. Please know, as Heather said, you really need to stick with your gut instinct. I often think of going to therapists and counselors like I think of trying on shoes or looking for clothes. You may try something the first time and go "WOW. This is totally comfortable for me" but more often you have to do a little shopping around. When you find the one that is comfortable for you and makes you feel like you can work with them and together get to the root of the problems you want help with, you know you found the one.

I'm glad you're feeling more positive going into this therapy appointment. Often our first impression stands with us throughout. I would say it's okay to tell them about the first appointments you had. Explain that you were uncomfortable with them, they will understand. It may help them to understand some things that make you uncomfortable as well, so they can try to avoid those triggers and help you work through the feelings about those appointments as well. I really home this appointment, whether this is the therapist for you or not, is more positive

[Sunshine]

PS. Another thing I forgot to mention was that I told her about the feelings of disgust I have about my weight sometimes and how sometimes I when I see unposed pictures of myself, I sometimes think "This is how other people see me every day. They much think I'm disgusting".

Question: Do you think other people your size are disgusting? Because one of the things that helped me was realize how I had double standards; I would look at myself and go "oh my god, I look horrible" but when I saw other people with similar or bigger bodies, I did not experience anything like that.

Chances are good that other people are much less put off by your body type as you yourself are at times, not more (just like other people don't notice and / or are bothered by acne half as much as the person who has it on their face).

That feeling of disgust around your own image is pretty shitty and I am sorry your therapist brushed it off like that. I am glad you have other options and I am keeping my fingers crossed that the next one will be a better fit.

Can I just say how much I admire you for getting help so fast and putting so much effort into it? That must have taken a lot of energy.

[Atonement]

Sunshine, you are absolutely right. I have noticed the same double standard. There are plenty of girls bigger than I am that I think look wonderful.

I wish it were just about looks though. I feel like I would maybe have an easier time letting this go if it WAS just about looks, and I could have some kind of guarantee that I wouldn't come down with any of the diseases that are frequently blamed on weight. But obviously, that's not how life works.

Just the other day I treated a young man who fit the stereotypical image of health (Thin, didn't smoke, drink excessively or do drugs, with normal cholesterol) who was recovering from a massive heart attack. So, even if I was perfect, there are no guarantees.

As for finding another one so fast, it was kind of luck. I had emailed her when I was first searching for a therapist, but she was on vacation so I decided to go of the other one. So, all I had to do was email her again and ask if she had another opening.

[Heather]

Just FYI, a therapist usually won't charge for an initial screening appointment: that that other one did would be one more vote against her in my book.

[Atonement]

Really? I had no idea.

The therapist I've already seen actually charges MORE for the initial consult than the office visit. According to her website, if I hadn't had insurance, it would've cost me $175 for the initial visit with her assistant and $150 for all visits thereafter, but with my insurance it was a set copay for either type of visit.

I honestly can't remember if I paid my first therapist for our first visit or not, since that was going on 5 years ago. But ever since her, I've been going to school therapists, which have been free. So this is the first time I've paid in a while. I'll have to see what this new therapist says. She did't say anything about bringing payment.

[Heather]

Yipes! IME, charging for a screening appointment is atypical. Effectively, it's a job interview where the patient is doing the interviewing, so just like a job candidate doesn't get paid for that time, a therapist won't typically charge.

I can't find anything online that talks about standard protocols or ethics with this, alas.

[Atonement]

I just wanted to check in.

I met with the new therapist today and it was SO MUCH BETTER.

I said everything that I needed to say, and I really feel like she understood me and what I need. She asked all the right questions and zoomed on the important points so well that I barely even needed the checklist I brought with me.

I'm going to be cancelling the appointments with the first one and following up with this therapist from now on.

Interestingly, though, she did charge as well. I wonder if it's a regional thing, or maybe its because of newer insurance laws (I know in regular healthcare there was a rule put into place within the last 3-5 years or so where medical offices are not allowed to waive copays. Maybe it's the same now?)

But either way, I didn't keep track of time, and she let me keep going for probably over an hour and a half. So, I'm majorly impressed so far.

[Sam W]

Hi Atonement,

Thanks for the update! And I am so glad to hear that this therapist was a better experience!

[Sunshine]

Congratulations on finding a good therapist! You deserve it, and I hope she will continue to be a good fit.

I wish it were just about looks though. I feel like I would maybe have an easier time letting this go if it WAS just about looks, and I could have some kind of guarantee that I wouldn't come down with any of the diseases that are frequently blamed on weight. But obviously, that's not how life works.

Just the other day I treated a young man who fit the stereotypical image of health (Thin, didn't smoke, drink excessively or do drugs, with normal cholesterol) who was recovering from a massive heart attack. So, even if I was perfect, there are no guarantees.

No, there are no guarantees. All we can do for ourselves is manage risk factors, and I do not need to tell you that weight is only one of many. There is so much else you can do for your health, and I am sure you can find plenty of things that are more conductive to your overall well-being than obsessing over your body fat. (Besides, how big a risk factor for what kind of health problem your body fat actually is depends not only on how much you have of it, but also what kind and where it's located on your body, but you know all that, so I'll shut up now).

While I by no means want to deny that being overweight can be detrimental to people's health, I do think it is strange how this particular risk factor is discussed in- and outside the medical community as opposed to other ones. I have heard plenty of doctors report with glee on how drunk they were last weekend, then in the next sentence speak in extremely disrespectful and judgmental tones about an obese patient (and in some cases, follow that up by a smoking break). Why is alcohol consumption, which is at least as dangerous as being overweight, if not more so, so much more socially acceptable? (Or not sleeping or deliberately overworking / not managing stress or starving ones self). Also, people aren't usually shamed for having diabetes or high blood pressure and I can't think of anyone who would argue that if I went and told diabetics that they can and should love and accept their insulin-deficient (or -resistant) bodies, I would condone diabetes and stand in the way of treating it.

I am keeping my fingers crossed for you. And I'd like to express my admiration yet again for how fast and well you managed to get help for yourself.

[Heather]

SO HAPPY to hear about finding someone that feels like such a good fit for you.

(And per the charge for an initial screening visit, it may be that there are some regional/insurance differences, or that my own experiences with this, friends I have who are therapists who don't charge people for initial screenings, aren't in line with broader practice. Like I said, I tried to find some places that listed general protocols for this, and didn't have any luck.)