Why telling people what they should do doesn’t work
What happens for you when I tell you this: You should lose weight. You should gain weight. You should eat more green vegetables and less carbs. You should exercise more. You are not OK as you are. How does that feel?
Lisa Dion, the creator of a neurobiological-based form of play therapy, says that when we hear a “should”, our sense of self is threatened. When we should ourselves, we are directly challenging our authentic self. We're denying who we are in the moment and not seeing our own wisdom. This can create an internal dilemma between who we are and who we think we should be. The result is that the autonomic nervous system becomes activated trying to handle the discrepancy (Dion, 2015).
Most eating disordered clients are already receiving a ton conflicting “shoulds”. These endless voices will often activate the trauma response in the body, especially when their actions don’t happen to match up with their perceived “shoulds”.
If eating disordered clients are hearing endless “shoulds” regarding food, their weight, and following a plan, their nervous systems may be over-activated to the point of fight, flight, freeze, or collapse. Because their sense of self is threatened, they are operating out of fear and are caught in their lower parts of their brain. These clients may not be able to access their prefrontal cortex and cerebral cortex, which are the parts of the brain that can hear rationalization and reasoning.
This is why I would postulate that nutrition plans, cognitive behavioral therapy, and psychoeducation do not always work. These reason-based approaches can only reach the outer parts of the brain, which are not able to take in new information when a client is stuck in fear and their nervous system is dys-regulated.
Eating disorders have the highest mortality rate out of any other mental illness (Sullivan, 1995, p. 1073-1074). Something needs to change.
I believe that the common practice of trying to be rational with the eating disorder as if it’s a problem that needs to be fixed, solved, or eradicated is outdated. Given what we know about the brain, this cognitive approach can only help to a certain degree.
Can we, as therapist, not add another element to how we think these clients should be different than they are?
Can we look at the deeper wisdom in the eating disorder and ask how was the eating disorder was the best strategy that was created to deal with reality at the time?
By seeing it as brilliant strategy rather than an illness, many clients begin to feel safe enough to share their struggle, start shifting away from the fear response, and change their perspective of the eating disorder and ultimately of themselves.
As soon as we allow what is, without judgment, we, as therapists can begin to untangle the shame and secrecy associated with this disorder, releasing clients from the added pressure of “shoulds”.
Eventually, when the pressure to change and be different is lifted and the nervous system is calmer, I begin to ask clients:
What are other ways that help you feel calm or connected?
When do you feel loved? What helps you love yourself?
What do you value? Do you have a felt sense of purpose?
The truth is, clients already know all the answers. As therapists, we are simply offering them access to our nervous systems until they can learn to regulate themselves and reconnect to that which they already know.
Share Holland, MA, LPCC, EDIT Certified Therapist
Dion, L. (2015). Integrating extremes: Aggression and death in the playroom. New York, NY: Aviva
Sulivan, P. (1995). Mortality in anorexia nervosa. American Journal of Psychiatry, 152(7), 1073-