Duty Of Care

[moonbeam]

Yesterday, my T told me she was concerned for me. That I am not eating enough for my body to function and she is concerned by feelings I've expressed in sessions recently. She is worried that the depression has been getting worse and I've stopped eating unless forced. Not because I forget but because I won't let myself eat though I rarely feel hungry.

She says inaction would make her an accomplice and she isn't comfortable with that. She has spoken to my GP about arranging me to see a nutritionist and wants me to eat 3 meals a day until our next meet up and says all therapy sessions going forward will start with food discussions.

I don't want to lie to her. The logical part of my brain says its a good thing and is her encouraging self care. The illogical part is scared of this all.

She thinks its the same part of my brain that encourages SI. Which I haven't done in over 3 months. That its a new form of self hatred. Its driving me crazy. I can logically understand everything she is saying but I can't stop the part of me that says I'm not allowed to eat. Or play games I like. And if I do the urge to punish is really strong. I know the dangers, I know its why I am getting headaches and fatigued and all of it. But it hurts to fight my own brain. Especially since she said told me that I now feel even more like I can't trust myself.

I don't need to be told to practice self care. I just don't know how anymore.

 

[anonymous]

I presume she will have to refer you for an inpatient eating disorder programme or recommend a section for you if you are seriously endangering your health but at least they can look after you and when you're a bit better, teach/show you how rather than just tell you.

 

[rightkindofme]

I would have a hard time with a therapist controlling that much of my life. How do you feel about her jumping in with parental-type guidance?

If it feels like an ok level of caring-about-you don't worry about me having a hard time. :)

 

[Cool Cat]

She says inaction would make her an accomplice and she isn't comfortable with that. The illogical part is scared of this all..

I would rank my therapist breaking confidentiality as one of my biggest fears too.

I dont know what to say about self-care, I have that 3 meals a day problem too. My T just looks at me and say "Please, eat"

 

[moonbeam]

I presume she will have to refer you for an inpatient eating disorder programme or recommend a section for you if you are seriously endangering your health but at least they can look after you and when you're a bit better, teach/show you how rather than just tell you.

I don't have an eating disorder. At least I haven't. Its not about the food its about punishing myself. Today I had to have dinner with my in laws and had to eat so the whole time my brain kept saying "don't enjoy this."

I didn't really see it as parental type guidance either. But she is so far from my parents that few would make a comparison.

I don't know how I feel about it all. Mostly very shaken, by her thoughts, my brain and feeling I can't trust my thoughts or anything.

 

[Changing4Best]

My MD contacted my psychiatrist once to tell him that I was getting my controlled substance from her (making sure I was not getting it from him too) as it was handling both Restless Leg Syndrome and anxiety. When it comes to legal stuff, they are required to do these things, or they can get into trouble or even lose their license or even go to prison. They don't have a choice in the matter. My T even had me sign a paper that explained these things to me and that I had read it and all that.

 

[Springer80]

You say you don't feel hungry and you forget to eat. I understand that. If your anxious and caught it dissociative states for long periods, then food doesn't enter your head because hunger doesn't register. You have to make sure you don't get weak though. If your tired all the time and you don't have the energy to cook the when you do get a window of opportunity/energy to buy food, buy stuff that's easy. I doesn't matter if it isn't the best, most organic, cooking- from- scratch type stuff. I used to get canned soup, rice pudding stuff like that. It serves a purpose whilst your feeling like this.

If it's more an eating disorder thing, that stems from ptsd then I'm not so sure what to say. You have to treat the ptsd, the root of the trauma first, otherwise pushing yourself into a diet your 'supposed' to have isn't likely to work.

Ultimately don't be too hard on yourself and don't let medical professionals make you feel bad or responsible for this.

Your body does very weird things in order to purge or cope with intolerable emotion but it also knows it's own limits if you listen to it and it can bring you back to your balanced self if you take the time and allow it to feel the pain it needs too in order to get better.

Learn to listen to that part of you that desperately needs to rest. Give yourself time.

Back in September my abuser died. I'd been going through some serious health problems prior to that. I'd been off work for 15 months. I'd been back in different employment for 14 months after that but I still felt like hell. A major thing that I finally felt about a month after the funeral was that I was still hurt by what had happened to me. For years the idea of shame would come up in therapy and I would 'no, I definitely know I'm not ashamed, I've always known it wasn't my fault.' But then I still acted like I was, I still hid myself, my feelings and I couldn't understand why.

Finally I understand the distinction that was always there. I was ashamed of how much he hurt me. Of how much I was hurt emotionally by what had happened. I felt ashamed of my own vulnerability and scared of the emotional things I really needed.

Your therapist and GP are technically correct in worrying about your physical and nutritional health but lets face it, it's not the main event. However, that doesn't mean that you should be damaged now by your bodies inability to want food. You'll come through this and when you do, you'll want to live life to the full, for as long as you can.

Much love XX Take Care. Be kind to yourself,

 

[RussH]

I am going to take a completely different track and agree with your therapist. If I read your post correctly you will not allow yourself to eat. If that is the case, then your therapist is taking the decision from you. This is a tool they are using to circumvent your denying yourself the right to eat.

Now you have this authority figure in your life giving you the right to eat as part of your therapy. This is a good thing because getting the proper nutrition will help you in your over all healing.

 

[rightkindofme]

@RussH I can totally see your point. The only thing is, some people are highly contrarian. If someone elects themselves my authority I will do the opposite of what they command.

People are so complicated.

I really hope it works well for you @moonbeam!

 

[RussH]

@rightkindofme Thank you for your quick response. I don't think the therapist is electing themselves as a authority figure; when we decide to see them as our therapist we are voluntarily accepting them as an authority figure in our lives.

 

[Chava]

I've shifted between self injury, starvation, drinking, and back around many times. Starving makes progress in any area nearly impossible, I'll say that much. But I also know it is physically hard to eat sometimes. If it's hard for you now, talk with nutritionist about ways to make it more manageable.

In the past I've had nutritionists who had really no idea of what I was trying to deal with....they'd give me their massive food plan, all these sickening numbers and details. I'd get overwhelmed and give up in less than one day. My last nutritionist had some very general and simple goals for me starting out and we spent most of the time talking about how to make it manageable...like substitutes that are good for when I really can't eat enough, what I need to be sure to get, like protein in my breakfast, how to prepare food while hating food and cooking (and chewing, swallowing, having anything in my stomach, needing anything and taking care of myself)...anything that would simplify any part of it...she was great.

So yes, keeping up some sustenance and nutrition is important. I do it even when I don't want to, which is often. I'd be really annoyed if my current therapist was in on the details of my meals, but that's because she's a trauma therapist. I gained weight and left the eating disorder therapist. How do you feel about your therapist being involved? I'm surprised the nutritionist wouldn't just be the one to weigh you and talk about meals, and report to therapist if you are okay with it....but I know there are all kinds of possible arrangements out there. As Russ said, maybe it will be helpful to have someone helping make the decision for you and tell you that you are worth it and that you need to eat and survive. ? Sometimes I need reminders and permission to take care of myself.

Anyway, it's complicated, but I know starving was both self-injurious and self-denying. I hate needing anything, and seem to default towards basic survival level, which in itself might be some trauma default. But any of these things were also numbing when I couldn't tolerate stuff or felt stuck or hopeless. I had to start eating better because panic attacks and heart stuff was getting really unmanageable. If you can work on the eating stuff right now you can likely decrease the chances of horrid panic attacks and stuff later. Just go one meal or one day at a time and use the help of the nutritionist to make it more manageable.

 

[rightkindofme]

@rightkindofme when we decide to see them as our therapist we are voluntarily accepting them as an authority figure in our lives.

Whoa. We have 100% different views on therapy and therapists then.