Summer is the season of balmy weather, sandals and sundresses, cookouts and lazy evenings lounging by the pool with your best friends. But for individuals who struggle with an eating disorder, summer can be a season of heightened anxiety and stress. As the weather warms up and the tank tops and swimsuits come out, we all become more aware of our body weight and shape. Pressure to conform to unrealistic standards can be overwhelming, challenging self-confidence and sometimes resulting in dangerous behaviors and deteriorating health. In this podcast, Mirasol clinicians discuss the challenges of summer for teen clients in residential treatment, and the tools we use to help them power through these challenging times and develop a more positive self-image.
Diane Ryan, Executive Director
Jodi Tudisco, Clinical Director, Mirasol Adolescent Program
Jenna Jarrold, Primary Therapist
Sharon Davis, DBT Therapist
Sarah Lind, Primary Therapist
Rachel Nelson, Art Therapist
Anthony Hackworth, Dietitian
Arsenio Aguirre, Neurofeedback Technician
Nikole Corcoran, Counselor Assistant Supervisor
Download Audio: M4A
Jenna: "I think the level of self-consciousness goes up for clients in summer in general, with the idea of just wearing shorts, let alone a bathing suit. We have clients who will refuse to put on a bathing suit or even a T-shirt, and that's how challenging it is for them. So it brings up a lot and it also gives us a lot to focus on and work with in therapy and in groups."
Jodi: "We recently did an outing to Lake Patagonia, and the first challenge was letting the clients know that they would need to bring their bathing suits, and when we got there, it was, 'okay now everyone needs to go change into their bathing suits, even though you're going to put your clothes on over it', and that was the first point where we started to have clients really struggle. It was challenging just to put on their bathing suits in the bathroom, even with their clothes over it."
Body image ... is one of the biggest challenges and one of the biggest barriers to recovery for our clients.
Arsenio: "Sometimes we have clients who have had sexual trauma, and the way they deal with it is to put on weight, because they don't want to be attractive, they don't want to be seen, they don't want any attention at all. So there are so many different layers to it."
Jenna: "That's when you have to help them learn how to do some reality checks in terms of the distortions they have around the way their body looks. Sometimes we do a body map exercise here that helps challenge some of those thoughts. The body image stuff I think is one of the biggest challenges and one of the biggest barriers to recovery for our clients."
Jodi: "It's always the last thing that we're working on, and they don't usually have that down by the time they leave, it's something they're going to continue to work on."
Diane: "And it's different than other issues that clients come to treatment with. They're absolutely willing to say that they hate their bodies, which I think is a really interesting thing for clients who are not forthcoming about how they feel about a lot of things, about their identity. And I think that's because of social acceptance. Certainly for teenagers, variety is not a value. The fact that there are different flowers to make a beautiful bouquet ... that's not a message that really resonates with them. They want to be the same, and they want to be this idealized image that is created by Photoshopping, and you would think that everybody would understand by now that everything is Photoshopped, but I don't think that they do, and I think that they're aspiring to this ideal, and finding themselves lacking, and they think it's always going to be this way."
Jodi: "We've shown videos, we've had TED talks, for the clients to really see what the social media does, what the magazines do, but ultimately there's just a small percentage it resonates with, and the rest don't care. You have this really profound documentary that you want to resonate with them and the rest are like, 'I don't care, I still want to be skinny like that, I still want to look like that.'"
I don't expect them to walk out the doors of Mirasol when they discharge loving their bodies every minute of every day. It's how to manage the days or the moments when you're not loving your body, you're not liking your body, and how you let it affect your mood, or your day, or your life ...
Jenna: "It's important to be realistic with the client. I don't expect them to walk out the doors of Mirasol when they discharge loving their bodies every minute of every day. It's how to manage the days or the moments when you're not loving your body, you're not liking your body, and how you let it affect your mood, or your day, or your life or your activities or your productivity — all of those things."
Nikole: "I think it's also taking the focus off of the body and discovering those other parts about you that can build the confidence. Some of the body stuff just goes away when they start to discover these other parts of themselves."
Diane: "If something is bothering you about your body, it's not about your body at all. It's a parallel to 'it's all about the food.' It's not about the food at all. You may think it's all about your body, you may be focused on that, but if you have deep disturbance about how you look, there's something else going on."
Jodi: "What we try to emphasize here is the living. How is it getting in the way of you living your life? When you're living your life, you're not thinking about your body, you're thinking of the experience, and you're enjoying the experience."
Rachel: "We do an emotional body map, so what are you feeling in each body part, and what are the thoughts related to that? And then I have them do a body image reflection on the part that's the most triggering to them, and that unveils all the emotion and gets them talking about the things they're taking out on themselves. I think if they can learn to do that, it will still come up, but they'll know what to do about it."
One of the things that seems to work is to create a sense of what your body can do, to shift the focus from what you look like, to the wonderful things your body can do.
Sharon: "There are several DBT tools that can actually help clients live their lives and be able to focus on things besides the body image. One example that clients say helps them a lot is 'opposite action,' where they notice what emotions come up with their body image, whether it's fear, or disgust or shame, and then recognizing that 'because of these emotions, I have the desire to hide my body.' And so instead of hiding their body, they acknowledge the emotion and do the opposite. So they put on the shorts, they put on the swimsuit, and they go out and live their lives. And the interesting thing that happens with this tool is that although in the beginning they may be experiencing those same emotions — the fear, the disgust and the shame — eventually, they continue living their lives, wearing the swimsuit, wearing the other clothing, and the emotions can begin to shift and become less strong for them."
Jodi: "That for me is the thing we emphasize the most: showing them that their life is bigger than their body. There's a whole big world out there. And it's also about growing yourself personally, and growing your self-confidence, and your self-esteem and your self-worth ... all of those things."
Diane: "One of the things that seems to work is to create a sense of what your body can do, to shift the focus from what you look like, to the wonderful things your body can do. And that's one of the reasons we do adventure therapy, because you have to have a body to move through a cave, and you have to have a body to set up a campsite. And I think that clients are able to get, on a cellular, kinesthetic level, that they are participating in something that's greater than themselves, and their body is the vehicle to do that. And they really do love being outdoors, and that can be a beginning place, because if you find out what your passion is, then you're much less likely to be captured by 'what do I look like today?'"
That for me is the thing we emphasize the most: showing them that their life is bigger than their body. There's a whole big world out there.
Moderator: "I'm thinking back to one hike we did with the teens, and didn't we have one client who came over the hill from the Bug Spring Trail and saw all of Tucson laid out in front of her ...
Diane: "Yes, she had a real 'aha' moment, when she saw how big the world was, and she remarked on how small her eating disorder was relative to what she was seeing, and she was never going to look at it in the same way ever again. And that's one of the reasons we do adventure therapy, because we put them in the position of doing something they've never done before and looking at the world in a new way."
Jodi: "One of our clients working in the garden had the same experience. All of a sudden it clicked that there's just so much more in the world than me and my eating disorder. And I remember that client that came back from the hike. She absolutely said that it shifted for her and that it gave her a whole new perspective about the world, and who she was in that world. It was really profound actually. It was beautiful!"