A few weeks ago my buttons got pushed. Oh yes, I sure did get triggered. In March, I was invited to be a guest on the NPR radio program, "Voices in the Family," hosted by Dan Gottlieb. I am a psychotherapist with 30 years of expertise in treating trauma, shame and eating disorders, and was paired with a professor of research to discuss eating disorders. At some point about halfway through the show, I realized that I was in an old, familiar territory -- that place that's ruled by the righteous principles of right and wrong; black-and-white thinking with no shades of gray.
My colleague's tone took on what we in Philly would call "ateetoode," conveying a sense that he was right and anyone who differed from his point of view was wrong. "The audacity," I thought. "Why does he need to assert his beliefs in such all-or-nothing terms -- especially when the research shows that one approach does not work for all?"
My colleague asserted that a specific way of treating eating disorders that relies on cognitive behavioral therapy (CBT) was the single best approach to helping someone recover. He was emphatic. In fact, he said that it was better to use this approach above and beyond all others, even if the therapist didn't know anything about the disorder.
After 30 years in the field my real life experience in the trenches suggests something quite different. I know for sure that, of all symptoms treated in psychotherapy, eating disorders are amongst the most difficult to treat, usually requiring active use of the therapeutic relationship along with every morsel of clinical skill one might have. All the clinicians I know would concur that it takes way more than any one skill base to help release someone from the grip of an eating disorder. The techniques referenced by my colleague are undoubtedly helpful, but insufficient on their own. Research measures only what is measurable, and leaves out many variables. The research published between 1980 and 2005 reports that, at best, CBT only helps 30-50% of the bulimic population. The findings related to treating anorexia nervosa are said to be "sparse and inconclusive."
I was outraged and reminded of past experiences with arrogant and condemning "authorities" in graduate school and family therapy training. Why was it that, if I differed from certain teachers or supervisors, I had to be condemned and made wrong? What is it that allows some people the audacity to presume that what they believe trumps all other beliefs?
I remember the booming voice of my professor condemning me for using my informal name while working with a teenage girl. He humiliated me for not having figured out that the "correct" way would have been for her to call me by my "proper name." He couldn't tolerate that we approached situations differently. And then there was the chief psychologist of a prestigious clinic who proclaimed me as "cavalier" because I wasn't exhibiting signs of anxiety during my final oral presentation. Please!
We've all had them -- those harsh arrogant voices conveying that if you agree with them you are "right" and if you disagree with them, you are plain and simply "wrong." Their dismissive tones can cut us down in size and kindle self-doubt. When faced with these circumstances, some of us feel instinctively embarrassed and want to disappear. Over the years I have learned that, despite these initial impulses, it is actually in talking it through with others that has helped me to rebound and reground within.
Thirty years later, I now trust my instinct alerting me to someone else's know-it-all attitude that dismisses and diminishes, holding rigid, right/wrong ways of thinking. All the years of practice at respecting my voice and holding compassion for when I've been slighted, have made it easier to navigate these kinds of life moments. When I offer myself a supportive, strengths-based approach, I increase my chance of emotional resilience when most needed. Remember -- just because someone says they are right, doesn't mean that they are -- and the corollary also follows that just because someone says you are wrong, doesn't mean that you are.