When I first started learning how to treat people with eating disorders, I was a psychiatry resident at UCLA. A colleague and I were the therapists in a weekly group therapy session as part of an intensive outpatient program. The age range of the women in the group was 18 to forties. Calling us the therapists was generous. We learned as much from the patients, if not more, as they did from us.
I have been thinking about this group lately, more than for some time. In particular, when asked why I treat people with eating disorders, I speak about this group as the initial experience that began a quest to understand and help people with these illnesses. But recently, I have come to wonder whether I actually picked this specialty or, much as people find themselves trapped in an eating disorder, it picked me.
As an impressionable and nervous resident, participating in this group therapy was a formative professional experience. After a few months, the patients who were more experienced in treatment settings had had sufficient time to vet the new trainees and determine that I, in eating disorder program lingo, "got it."
No stamp of approval was more potent. I had been accepted as a member of the club. I was now deemed worthy as a therapist. I had magically cracked some sort of code of empathy. I understood the complexity and confusion of having an eating disorder. The concept of not eating or of throwing up one's food, in the context of a complex life, made sense. Somehow, I had crossed over and now was one of them.
I wasn't aware of any of this at the time but instead felt a heady, out-of-body sense that something significant has changed. It felt as if I had something special and had a responsibility to do something with it.
Interestingly, my new status spread from patients to the clinicians who ran the program. I became one of their chosen residents and, over time, was invited into a small cohort of trainees considered capable of working with people with eating disorders.
The rest of the story is less interesting except that I have devoted my career to treating people with eating disorders. The effect of that initial group was to initiate me into the mindset and confusion of an eating disorder and to teach me how to use my own kindness, empathy and compassion to help a cohort of people left with limited treatment options, even in New York City, perhaps the most therapized city in the world.
I have since learned hat the concept of "getting it" is central to most programs and patients alike. It has many uses like normalizing the confusion of the disorder, helping someone so alone feel a part of something and serving as shorthand for a therapist to trust. But the term can also signify the recalcitrant nature of the illness and the powerlessness the eating disorder thoughts brutally reinforce.
In the next post, I will address the concept of "getting it" more carefully. Years after understanding its potent effect on me, I am curious to see more clearly the true meaning of this term.