“I understand it – logically I get it – but I just don’t feel like that’s true”.
Therapy can be really effective at shifting your head – your beliefs, your logical space, what you agree must technically be true. However, it can be a lot harder to shift your heart – what you feel to be true. Similarly, often we understand what you need to do in therapy, but the how is much more challenging. It takes a lot for someone to really believe that they are important and deserve to care for themselves, which is especially common in people with eating disorders.
There is new research suggesting that the schema therapy approach may benefit people with eating disorders, particularly around achieving this emotional shift. So, what is it all about?
What is schema therapy?
Schema therapy is a type of treatment that incorporates elements of CBT, Gestalt therapy (translated as “the whole”), psychodynamic and attachment theory. It argues that human beings need a lot of things – shelter, somewhere safe to sleep, access to food and clean water. We also have core emotional needs – the need to feel safe, worthy, and heard; the need to be ourselves; the need to feel guided and supported, and the freedom to be carefree and play. These are all essential for growing up well and strong. When we are young, we rely heavily on others and the world to provide these needs – but sometimes our needs are unmet, and sometimes chronically so. Examples of unmet needs may be as serious as trauma or abandonment, or more subtle, like repeated experiences that left you feeling let down, lonely, unsupported, or without a voice. They could also include major life events, like adjustment to changes or grief and loss. Some people may also personally struggle to understand their needs and voice them, even if those around them are generally supportive and encouraging.
Growing up, we try to make sense of our world, and sometimes, “rules” can develop. We might conclude that, in order to survive or feel okay, “I must not put my needs first”, or “I cannot trust others”, or “It’s not safe to feel my emotions”. Often, these rules were once true when people were younger, and following them may actually have kept them safe. However, over time, and especially if our environment changes, these rules may no longer apply. Yet we often continue down the same path as if that is truly our only choice.
Over time, the negative impacts of “following the old rules” can pile up. These rules often don’t allow you to ever rest, or be easy on yourself, or trust other people, or really understand what you most value in life. And not acknowledging your needs doesn’t mean they aren’t important.
One model of mental illness is the idea that suppressing or ignoring your needs time and time again can lead to intense distress. It’s really hard to know what to do with distress, so we might try to drown it out, convince ourselves it’s not real, or try to think our way out of our pain. We might tell ourselves off for daring to need something. And the needs just get louder. And instead of listening, we shut down, or get depressed, or try to drown out the noise with busyness and distraction. In schema therapy, these are called “coping modes”.
How might Schema Therapy relate to eating disorders?
In eating disorders, ignoring our needs can mean that we turn to coping modes to try to find peace and self-worth in harmful ways, often through dieting, and pretending our bodies can survive without care and rest. Treatment can often help convince us, on a logical level, that this is harmful and we need to learn new ways to live, but a part of us (a coping mode) feels that trying something new is just too scary and unsafe. And sometimes we get so practiced at these ways of living, it almost feels like they are outside our control, and near-impossible to “switch off”.
In order to switch off this autopilot, schema therapy helps tap into some of the past experience where we first learnt our “rules” and coping modes, to make sense of what is happening in the present day. It helps connect to the emotional core of these memories, rather than sticking to our logical space. It strives to understand the impact of early experiences, and deeply validate the distress that comes from unmet needs. Essentially, it tries to go underneath the eating disorder which has evolved to cope with distress. It also always acknowledges that change is not an easy process! It’s okay to be daunted and afraid, or even angered by the journey! It also helps empower what we call your “Wise Mind” or your “Healthy Adult” that can take charge of recovery and start to listen to your needs.