Working with Eating Disorders in a Solution Focused Way

Solution Focused Hypnotherapy can be effective in helping to reduce the anxieties associated with eating disorders. In some cases, it can help the client to regain some control and in others it compliments their journey back to health.

As a Solution Focused Therapist, I remain ‘non-expert’ at all times with my clients; choosing to believe that they are the best expert of not only their problem, but also their solution.

No two people with an eating disorder or disordered eating are the same. Granted there are similarities in presenting behaviours but the thinking that an anorexic came from a different family background to a bulimic and consequently should be treated differently just isn’t helpful in finding the solution to the individual’s issues.

It is my belief that you should not label an individual as one thing (anorexic, bulimic, obese etc) and then treat that same label in the same way for each labelled person.

I help my clients to look for the exceptions in their behaviours, helping them to empower themselves towards their own solutions.

I refer to neuroscience to support the knowledge that the client is experiencing a battle between their left prefrontal cortex (intelligent control) and their Primitive (limbic survival centre) minds. My aim is to help my client to engage their left prefrontal cortex (which interestingly is impaired when the primitive brain is active) so that they can make rational and sensible choices about how they behave and see their world. (See below my comment about the importance of the referred information being correct.)

We do know that a nutritionally-deficient body warrants certain controlling behaviours from the brain. The primitive mind becomes active when it perceives a problem (any problem), and lack of hydration and nutrients create a state of crisis. The primitive brain is not an intellect, so the behaviours that it dictates are often detrimental to the client and often are negative and continue to feed their problem. This is why it is crucial that the client is receiving all the necessary support they require to ensure that they are fed as a priority. In my studies with the National Centre for Eating Disorders, I have learned that nutrition is the priority when supporting a malnourished client towards their recovery. A malnourished brain will continue to dictate the same negative behaviour (abstinence, binging, purging etc) that the client is hoping to move away from. I note here that a malnourished brain does not necessarily mean an underweight body as you may expect.

I find that in my work with clients diagnosed with anorexia it is critical to their recovery that I am part of a supporting team. In many cases my work as a Solution Focused Therapist can complement and support the client as they work through the anxieties and fears associated with re-feeding. I insist that the client’s weight, food, and regular health screening is undertaken by someone other than myself. This allows me to work in a Solution Focused way and work towards the clients preferred future. Another note: the anorexic brain can be quite clever and can often tell you what it thinks that you want to hear. Some clients experience the anorexic ‘Voice’, which can be very powerful and critical making change extremely difficult in the early stages.

The Solution Focused approach thankfully complements pretty much any other therapeutic and medical intervention; however, I am always respectful of others and can only work with a client who is happy to do so and has the authority from their supporting team. The safety of my client is my priority, so together we make sure that the right support is in place to ensure they are receiving the treatment for their physical wellbeing that they require.

The Solution Focused way of thinking is as follows:

Solution Focused Therapy supporting tenants:

Change is constant and inevitable. Experience suggests that change is already happening even before a client sees a therapist. The therapist does not necessarily initiate change but focuses on changes that are already happening. Even in an in-patient psychiatric setting, most patients will explain how things are already getting better within 24 hours of admission (that is, if they are asked).

Small changes lead to bigger changes. Years of experience with many different clients suggest that, once clients experience positive changes that make a difference in their lives, the effects multiply. Conversations about possibilities serve to enhance further possibilities. It matters less where clients choose to begin making a difference in their lives. The very act of entertaining a future vision represents the key element in what is useful to many clients.

The past cannot be changed. Steve de Shazer (1985), a co-developer of the solution-focused brief approach, quoted Erickson:

“Emphasis should be placed more on what the patient does in the present and will do in the future than on a mere understanding of why some long-ago event occurred.”

Solution-focused therapists are very interested in the details of client’s past successes. De Shazer (1985), expanded on Erickson’s comments:

‘The past, particularly the problematic areas of the past, can then be seen as potentially detrimental to solution. Of course, past successes, deliberate or accidental, can be used in constructing a solution.’

People have the necessary resources. They are the experts on themselves. While solution-focus brief therapists see themselves as having expertise on a useful process, they see clients as being experts on themselves. If asked, clients see what is useful to them in their everyday lives. The therapist’s area of expertise still depends on the clients’ expertise concerning themselves.

Every human being, relationship, and situation is unique.  This process of fitting the therapy to the client requires the client’s input and feedback.

What people do has an impact on other people. The meteorologist, Edward Lorenz, coined the term ‘The Butterfly Effect’ (Butz, Chamberlain, and McCown, 1997). This proposed that a butterfly flapping its wings in China could alter the weather system in the United States. Lorenz’s tongue in cheek statement suggests that it can only take a small variable to make a big difference. In complex systems, small variables can generate unpredictable consequences. Human beings operate within multiple social contexts: friends, work, the church, the synagogue, the mosque, family, the local grocery store, the local fitness club etc. Given the complexity of human social systems, simple cause and effect thinking cannot accurately predict human behaviour. (See Tipping the Balance).

Every problem has at least one exception. There are times when the client is either doing something other than the problem, or when the problem is experienced as less important.

Changes come from many directions. Solution-focused therapists take advantage of the many resources the client can utilise by focusing on what happens that makes their lives better between sessions.

The solution is often not related to the problem.

Solution Focused Brief Therapy originated in the mid 1980 at the Brief Family Therapy Centre in Milwaukee and was created by Steve de Shazer and Insoo Kim Berg (as referred to above).

The aim was to establish a realistic solution to the client’s problem in as short as time as possible for lasting relief.

One of the brilliant Solution Focused Therapy tools that I use is call the Miracle Question. It allows the client to start to see their future without the presence of their problems. Because our brains can’t distinguish between imagination and reality this can be an incredibly powerful tool for the client’s transformation.

In early sessions with those with anorexia I choose, in many cases, to make some adjustments. Many clients are extremely anxious when we first meet and asking them to share their answers in the early stages can create a block. So, I ask the question but allow them to keep the answers to themselves until they feel comfortable enough to share. I have been lucky enough to chat with diagnosed (and labelled) anorexics who have told me that they were extremely embarrassed by their thoughts and feel extremely guilty (the Voice) in the early stages. So, asking them to share these with me is not always a positive and useful exercise. However, in time, as they start to see the changes that they are able to make, they become more confident, and together we are able to address the issues that are holding them back and start to plan for their preferred futures.

As part of a client’s initial consultation, I explain how their brains work referring to the left prefrontal cortex and the primitive brain. We look at the importance of sleep and nutrition and how together we can form an alliance that can support the client’s future. In many cases when we introduce this knowledge, we are empowering our clients. One of the reasons that I introduce the importance of nutrition is that many clients I see do not have the correct information in their intellectual brain to refer to when it comes to creating a more positive relationship with food. It appears perverse to help a client to regain the control of their intellectual mind for them to then refer to learned narratives, misinformed media, and unrealistic expectations that take them back to where they started. For example, to effectively lose weight we have to reduce the amount that we eat. They often choose to cut out vital food groups such as carbohydrates or fats; both of which are essential for brain function.

Hypnosis

We are lucky that we are able to utilise trance (hypnosis) in our sessions too. Many are initially sceptical about this, but soon realise the importance of this part of our sessions together. It’s also the ‘easy’ bit that clients look forward to. But, it can also be feared because clients assume that they will lose control – as you will see below, in fact the opposite happens. In trance you are more in control than at any other time. I find that many of my clients with anorexia won’t close their eyes in the initial sessions, but in time, as change occurs, they feel more comfortable to do so.

A trance can be induced in a number of ways. Normal daily activities that require repetitive movements and little awareness may induce trance-like states. For example, someone very familiar with cooking may enter a trance while cooking a simple meal, and some drivers are in trancelike states after a long drive.

We contrive this natural state in sessions; when your two brains (intellectual and primitive) come together and focus on the same thing. When this happens, you can ask the questions of yourself that you have yet to find answers to. It’s an extremely beneficial thing to do.

You may notice that your breathing slows, and your muscles become relaxed. You may sense a distance from where you are; the passing of time gets distorted and often you feel a pleasant, almost euphoric state of peace. The depth of a hypnotic trance varies, it can be very light or extremely deep. It gets better with practice.

“You do shift into a different kind of brain function when you go into a hypnotic state,” “It helps you focus your attention so you’re not thinking about other things, you have better control of what’s going on in your body, and you’re less self-conscious.” David Speigal

The combination of SFT and Hypnosis enables me to support my clients in the best way that I know how. Forming a collaborative front from which we tackle the problem together. I work with clients presenting with many problems, the majority of which are food related (hence my ongoing studying with the National Centre for Eating Disorders), following a blog that I wrote a few years ago about my own experience of parenting an anorexic teenager.

If you’d like to learn more about how I work or would like an initial chat, then please do get in touch.

I look forward to hearing from you.

Holly Stone

p: 07909 951338
w: https://www.hollystonehypnotherapy.co.uk/
e: holly@hollystonehypnotherapy.co.uk
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A useful article that supports my thinking: https://msutoday.msu.edu/news/2021/ask-the-expert-stress-eating

* I am aware that the priority with those who under eat is to restore health through feeding before any work cognitively can be effective. It is with this understanding that I feel I’m best placed to compliment other medical support systems and see my role as being especially useful to those who are facing the anxieties associated with the change back to health which comes with recovery as the brain starts to function properly again.

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