 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to the next episode of The Therapy Show with Bob Cook and myself Jackie Jones and following on from the theme that we've been covering over the last few weeks. This week's podcast is working with the child with eating disorder. Yes, whether it be bulimia or anorexia or traits of any of those things, yes. Yes. Again, somebody who I haven't worked with, I've not worked with anybody with eating disorders, it's never come up. You must have done it some ways, even if it's maybe unhealthy eating, maybe issues around food, but not an actual disorder. Well, we need to get to a continuum then. Yes. Eat it. It's like all these things, isn't it? There's a continuum. Yes. Or from what you might call unhealthy eating babies or the way up to a disorder where the person feels driven unconsciously to a place where they either starve themselves or overeat levels of obesity on the other level, which we can call the disorder. And that's, this level is very fixed as this level is much more flexible and they feel they have some ability to regulate their habits, if you like. So you will have worked somewhat, you will have worked. Yes. People on those continuums. On the continuum. Yes. Not the disorder as in a diagnosed disorder. Yeah. But if you've got a disorder like anorexia or bulimia, and they feel so fixed and black and white where they actually, you're in a power battle to death, well then we're at a disorder level. Yes. Yeah. But you will have worked somewhere on that spectrum. Yes. Are you surprised if you haven't? I am probably on that spectrum myself. Yeah, I think, you know, I think, I don't know how I'm a geologist, but many, many, many, many people struggle with eating issues. Yeah. On that continuum. And then if you like, you might look at a disorder level where it becomes a more battle for survival and more of a battle really for life or death. Yes. Yeah. Yeah. So yes, on the continuum, definitely. Definitely what people have done out of the eating patterns, haven't they? Yes. Yeah. Yeah. Okay. Great. So this is what we're doing. Would you say that the, the, the spectrum, maybe the upper end of it is, it's a form of self harm? That's an interesting one. By definition, it is. But you know, it is also driven. So yes, save alcoholic, you know, an alcoholic, people call self harm. Yeah. A driven smoker self harm. I mean, in that definition, yes. And they're usually driven to do that. So yes, it is. But at its, at its essence, people have, who are overweight to the obesity level or start themselves. They're, they're defences against trauma. And trauma. And trauma, we then have a continuum, don't we, as well, there's all the continuance. Yeah. So, you know, we can talk about, you know, neglect being trauma. We can talk about evading the psychic trauma. We can, we can have definition of trauma. But I think eating disorders at these sorts of levels are defences against trauma. Yeah. However, we define trauma. Yeah. Because it's the way of controlling things. It's their attempt to cope. Okay. In a world which is so frightening for them. So if we look at eating, eating issues as a whole, then I remember way back, probably, I would think, in my first three or four years of clinical practice. So we're going back a long time. I worked with somebody who was anorexic and was in this yo-yo-ing phase of, and back then, so we're talking about, oh, God, late 1980s, perhaps 1990. And most hospitals at that time had sick stone as the sort of mark. Half point, yeah. When a person goes to the hospital and then they, you know, they may force feed them or, or, or, or, so they get, you know, up to a reasonable weight. Then they go back out of hospital again, and then they go back into this process. So you get a yo, what I call a yo-yo in process. And this woman was in that. And I don't really know how much I helped her to tell you the truth, because what happened was that as we started to explore the her history. Remember, I'm a beginning therapist many ways. I, I, and she started to talk about some of her early history. A mother, a mother phoned up and said that she was going to take her out of therapy and take her to the cheetah royal prairie, where she would have this very expensive therapy, which she did. So I never know what, quite what happened to her, but I do know that is a perfect example of what I think is the premise of working with people, leading problems. In other words, it got acted out in front of me. Usually the internalized parent, which is bearing down on the child. So it's a power battle. You, you say control. Yeah. And food becomes the battleground. Yeah. Yeah. The transaction analysis, the internalized parents and the younger self. Yeah. Makes perfect sense. That got enacted out, where the internalized parent in reality stopped the therapy and took her away. Now, I was very, very, very early on in my life as a psychotherapist. Be a very different ballgame now. But I did learn something back then before the parent came along and sort of ended there being some ways. But I learned that people who, how can I explain this? What I've just said to you, I'll just repeat it again. The food becomes the battleground between the parent and the child. Yeah. EA terms. Yeah. Yeah. 100%. And I would imagine used as leverage and bargaining and all sorts of things. If it's the battleground, it's a weapon to use. Yeah. Because think about, I mean, you were right, right at the beginning, you were completely correct, right at the beginning of this podcast when you talk about the subject of control. And that is what kind of person control. Now, very few things, especially when they're being in this battle against the parent. But one of the, one of the things I can do is control what goes in and out of their body. Yeah. So in that sense, you're correct. It's a battle for control. So at least you can do many other things. You can tell me off, you can talk to me, you can define me, you can do X, but you can't dictate what goes in and out of my body, because I'm not going to allow you to. I'll start myself, although I've read my dad, or I'll read myself to death. Yeah. Yeah. Because would you kind of group the same things together if you're talking anorexia and bulimia and those sorts of things with, you know, four beers around food or the texture of food or the act of swallowing food? Would you put that under eating disorder umbrella if there was such a thing? Eating challenges or eating issues or eating problems. And they're all part of the same process as well, I think, in terms of what I've just said, it's that it's a struggle of full control. And of course, phobias and everything else comes off the back of this. Yeah. And the internalised parents and the younger self. Yeah. Now, well, so if you're working with somebody with eating issues, whether it's anorexia or bulimia or overeating, you, you are, I can explain that you, again, it's a slow work. So it's a long, long therapy. And yet in its essence, you're helping the client get hold of their younger self. And you're helping them to promote autonomy. In other words, to be able to think, feel and be the A's they are in the face of this heavily internalised parent. Yeah. So you have to take on internalised parents. But of course, you need, first of all, to get the, on the side of the, in TA terms, again, the younger child. So they feel protected enough to be able to stand up to the internalised parents. Yeah. And food has become the battleground, like I said earlier. Yeah. Yeah. Yeah. I don't, I don't know why, but I keep thinking about permission and, and, you know, giving them permission. To what? I'm not sure. That's what I'm thinking about. I'm trying to work it out rather than be, me being embroiled in that battleground as well between the internalised parents and the child, to kind of give the child permission to have that autonomy to, you know, there doesn't need to be a battle with the internalised parent to give them permission. But I'm not sure what the permission is for. Well, it's permission to be themselves and to have feelings and have thoughts and have a sense of a life outside the parent. So, yes, in a very simplistic framework, yes, a much more complex framework, though, is how you do that. How you get to that place where somebody's got such a highly, highly destructive internalised parent, though it may not seem like that to the real parent, but anyway, how do you get to a place where they feel psychologically protected and strong enough to be able to stand up to that parent and take, you know, to get, yeah, in some ways, yeah, verbal permissions, that's part of the process. So permissions is corrected, but, you know, the framework is how you do it. Yeah. Yeah, because it is really complex when you're talking about, again, it's two parts of the self, isn't it? To a certain extent, the parent's part, there's an impasse going on where there's this internal dialogue constantly around everything. Is it because it's just focused on the food issue? Well, I remember kind of mine who binged regularly and purged herself, so you're in that cycle. Yeah. And she would talk about, oh, you know, I just found myself by the fridge. Oh, it's three o'clock in the morning, I just found myself opening the fridge. But let's look at a statement, you know, people many times and often will use food as a way of eating their feelings. So if you trace back and you said to your clients or said to my clients, oh, gosh, so let's go back, say half an hour before you found yourself at the fridge. What were you thinking and feeling? And I remember her saying, well, I was feeling like, I remember saying this, though it's not a feeling, it's a thought, but anyway, she said, I was feeling like I hated myself. And I feel I was feeling a level of self-disgust. And I was feeling so worthless and so futile in the life that I wanted to not be in this planet. So what does she do? She goes and eats. The function of the eating in this level is to eat the feelings away. Yeah, I find it fascinating how we as human beings work out ways to do things like that. You find it fascinating. Yeah. So in other words, do you find psychological defences to trauma, to neglect, to all the things we've been talking about in his podcast in many ways, defences, fascinating. Yeah. Okay. I don't think we work it out, you see. No, that's what I mean. It's not a conscious thing, is it? I just find it fascinating. Yeah. Well, good. That's probably what was the motivation behind you trying to be a psychiatrist for four years and what you do now. Quite possibly. Podcast. Even now, I am in awe of all those human beings and how we survive and thrive to use your words by doing certain things. I'm not really a forager. I'm not a forager, but let's go back to some of the instinctual drives he talked about. You know, I do think there's an innate instinct drive, you know, to live and to actually survive and to, you know, often in ancient words called physis, the actual drive to be in this planet. And I think we have developed psychological defences to enable us to psychologically survive the best we can to function. Yeah. And that might mean splitting off between thinking and feeling. You know, it might mean many things that we put in unconscious compartments that we deal with later, even though we may have flashbacks and triggers, but at least we're surviving in a certain way. Yeah. It doesn't mean that survival is actually particularly wonderfully whole, but at least we are still in this planet at a psychological level. I think that's a bit, I find fascinating. We work out, you know, with what we've got available at the time, how to survive and at the time it makes perfect sense. So, you know, what triggered that for me was you saying eating their feelings. And at some level, that made perfect sense. Great. So then, instinctually, you know how to work with eating disorders. Yeah. Because what you, what, if we take that fascination of yours, you, what you are going to do is enable them to express what they ate in emotional ways. In other words, you go back to half an hour before they found themselves in the fridge and you help them express what they weren't able to express whatever reasons which you work out in therapy. And as you start to do that, and as they start to deal with what they've eaten, if you like, or not expressed, you will get to the healing process. Yeah. This here, Bob, is why I love my job, literally this. But what we're talking about. The insights, you know, other human beings that were all unique and amazing. And, you know, I do believe that ultimately we all want to be here. You know, that need to survive and exactly like you said, be on the planet. Now, that's amazing. I don't know if it's fascinating for you, but it's amazing that in the most to read for a human condition psychologically, that we wish to be on this planet, even if we deaden ourselves to life. Yeah. People have been used people have been highly traumatized. The way they cope is to an inverted commas. Basically, what however we talk about is to deaden themselves to light to those feelings trauma. So they can psychologically live. And of course, the problem, the problem is, as they start to do that, and they start to relate to the world in different ways than relationships or other parts of themselves get triggered. And then that compartment where they've hidden parts of themselves away starts to leak out. Yeah. Yeah. Part of working with eating disorders to help the person find find enough autonomy and strength to be able to give them, I'll use your word, give themselves permissions to grow up and be the A's they are and self define themselves rather than in this internal battle with their internalized parents who doesn't actually allow who doesn't allow them to grow up. Yeah. Which again, you know, it must be exhausting to be in a world where there is that internal conflict and battleground all the time. That's right. Now that will get enacted down in the therapy room. So any therapist listening to this, you're absolutely right, Jackie, about permissions, but you need to put protection in first. Yes. And you need to test that out. In other words, the relationship needs to be strong enough for the client to feel that they are protected by you in the work or the service of healing, which means taking on the internalized parent and and therefore allowing, if you want to use those words, the client to take charge of their own autonomy and be the A's that they are today. Yeah. But it will mean more than anything else, taking on the internalized negative parent. Is this the permission protection importance? Well, that's, yeah, yeah. And that's a very good way of looking at it. But by being potent and involving yourself in that therapeutic process and giving the verbal missions and standing up to the internalized parent, you're providing a different environment, if you like, for the person to understand themselves, empower themselves, and inverted commas grow up. Yeah. Yeah. So there's another treatment plan of working with people, but you see, it's not linear. It'll take quite a long time. Yes. Yeah. Yeah. When you're doing these processes in the therapy room, do you explain to your client what's happening? Do you feedback after that what we've just actually done is? Well, I tell you what, working with the eating sort of, yes, the answer is yes, but in a way which is accessible to them. Yeah. So, you know, okay, many people listening here might not have been trained in transactional analysis, but the transactional analysis is a model of parent and child from the three parts of the self. I will often do what I call it ejective therapy to give themselves a shared language to understand very complex processes like what we're talking about. Yes. And I think the PAC model is a really good way to explain that. Yeah. Yeah. Yes, I do. But often in the service of the client, I may teach them what I call ejective therapy, that PAC model, which I think is very useful when we talk about internalised parent, which is bearing down on child. Yes. Yeah. Yeah. Now, the therapist, this is where I like the model, the therapist becomes hopefully one of the new internalised parent figures. Yeah. Can you teach that from an ejective therapeutic place? Yeah. I think that's important to have that understanding for when they're outside of the therapy, you know, to me, that they can literally visualise what's going on when they feel that urge, that drive, that compulsion to do certain things. Absolutely. Yeah. Coming from the younger self, the younger self, which has been so defined by the internalised parent. Yeah. What happens is they move to adapt, either being perfect, pleasing, it's a really big thing for people eating sorts, to get by in the world. And what's not happening is, is they're not separating out, being appropriate with the age they are now. They stay as a younger child, if you like. Yeah. And food is a really good way to push down feelings. Yes. Yeah. Literally swallowing that it is. Yeah. And the other one, another thing about eating disorder, it's a very good way to structure time. Yes. So they structure time, instead of feeling, you know, they're coming bored or feeling all these feelings, they can structure time by eating something. Yeah. Or not just eating something, eating lots of something. Yeah. I think one of the things that comes up, you know, with a lot of my clients, I don't know whether it's related around foods that I'm seeing them for, but that, you know, food is connected with an awful lot of life events, whether that's, you know, when we're celebrating or when we're commiserating or, you know, to me, I need to comfort myself. So we eat food or, you know, I'm celebrating my successes. So we eat food. It's kind of like a cultural thing sometimes as well. Food. Of course. You know, we're getting into the whole concept of the cultural parent and you're perfectly right. But eating, eating is a way we structure time. Yeah. Yeah. Even literally structuring time, breakfast, dinner, tea, the day is structured around food on a literal sense. Yeah. The A-book by Kathy Leach was written about 10 years ago, which I was looking at this podcast and it was called The Overweight Patient, a psychological approach to understanding working with obesity by Kathy Leach. And she's a TA therapist and she gives a TA model for working with eating issues, but particularly the overweight patient. And she takes, very well, I've just been talking about, which is the battle against the internalised parent, which is giving them certain commands XXX. So when I just think of my parents, for example, I would think my mother every day of my life, when we're eating, if I left any food, we'd say you better eat up all that food. Just think of all the people starving in Biafra who was back then in the 1960s. Yeah. Yeah. I developed a guilt complex. So as you can see, there's a lot in this. Yeah. Explore the stories and the parental slogans and the cultural, the parental cultural norms. Yes. As I say, the younger child then survives usually by adapting, pleasing or being perfect and staying young. And the therapies around enabling them through permissions and protection to take autonomy, autonomy, I'll put it grow up because I mean, psychologically and develop new healthy patterns of eating. Yeah. Yeah. It's worth looking at that book. It sounds interesting. Yeah. It's only about £20. It's paperback. Yeah. It's about 10 years old, 2011, I think, or maybe 2009. But it's ageless in a way because it explains how to use the PAC model when working with overweight clients and talks about what I've been talking about for the last, or we've been talking about for the last minute, which is the internalised parental battle with the regressed child's ego state. Yeah. Bob, as always, you're a wealth of information. Good talking to you. You blow my mind every session. I'm so pleased that we're doing this together. Oh, good. It's fascinating. Is that the word from you or amazing? Absolutely. It blows my mind. I'm fascinated. Yeah. Well, I've enjoyed talking about these things and, you know, there's many, many, many, many things. I think that it would be to some time or other to talk about methods in the psychotherapy room, like the two-chair technique or visualisations of metaphors. So there's so many podcasts we've got lined up. But I have enjoyed particularly talking about the last two, which has been working with the eating challenges and the one previously, which is working with sexual abuse and the road to thriving. From surviving to thriving. Yeah. Love it. So we're going to keep the next episode title a surprise. Yes, because we've got so many topics we thought both of you and myself can actually look at which one's next. And yeah, let's keep it a sense of anticipation. Oh, yes. Which I think, you know, if we're talking about psychotherapy, I think quite often we're dealing with a person's anticipation or lack of anticipation. But let's keep the anticipation process going. 100%. So we're keeping it behind closed doors. Absolutely. So looking forward to the next podcast, whatever that may be. I shall see you very soon, Bob. Take care. Take care. Bye. Bye. You've been listening to The Therapy Show. Behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.