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This is a narrative from an individual who suffered from disordered eating for many years. Her story is used with permission. After reading the story, please identify examples of how the client/author:

1. Externalizes the problem 2. Maps the problem 3. Deconstructions the situation 4. Re-authors the story

My Journey I am a firstborn child, perfectionistic in many ways, compulsive in others. I have always been high achieving, setting my sights high and often attaining my goals. In some ways, looking back, there were a lot of signs in my life pointing to an eating disorder. I was diagnosed with anorexia nervosa in June 1996, just after my sophomore year of high school and 2 months before my 16th birthday. I had been playing competitive tennis for a few years, and during my freshman year, I had achieved high honors in the sport. After a successful freshman year, during which I surprised a lot of people with my performance on the court, the pressure was hot. I spent the following summer (1995) on the tennis court 7 days a week, at tennis camps and in tennis lessons. When school started in the fall, the pressure didn’t let up. My father was convinced I would join the ATP tour. I felt, at the time, that I had no choice but to try my best to please him. Pleasing my father meant continuing to play tennis every day, putting up with his incessant coaching, and never feeling that I was doing anything right. My father is also perfectionistic, compulsive, and goal-driven. I never heard that I was doing a good job. Every stroke I hit on the tennis court could have been better, according to him. I also had a tennis instructor who had a reputation for pushing his students so hard, that many times they walked off the court in tears. I never gave him the satisfaction of crying in front of him, but his attitude did not make the situation easier. I don’t blame my father for my eating disorder, and I want to make this clear. In fact, he has changed a lot of his behaviors and thinking after my diagnosis and during my recovery. I admire him for working so hard to change so many entrenched habits, and I realize how lucky I am to have a father who is willing to change for his daughter. These recollections represent the pain of the time while I struggled with my eating disorder. Please don’t confuse this part of my story with blaming or hating my dad. By the time my sophomore tennis season came around in the spring of 1996, I was a mess. I, unconsciously and however erroneously, had figured out that my father could make me play tennis and could make me study and get good grades, but he couldn’t make me eat. Not eating became my undeclared act of rebellion. I never consciously sat down and decided to not eat; it really did just happen. But I did enjoy the results, and that

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fueled the fire for the development of my eating disorder. Pretty much as soon as pre- season tennis practices began in March, I began restricting what I ate. I used every excuse I could think of, and made up some creative ones, to avoid eating. As I was continuously playing tennis or running to stay in shape, I lost weight rapidly. Friends, neighbors, and strangers started to notice almost immediately, but it wasn’t until June 1996, after another successful tennis season, that my mom drove me to the doctors’ office. The pediatrician recognized what was going on and immediately recommended therapy with a psychologist who specialized in eating disorders. I saw the psychologist for a few sessions and a couple painful family sessions before I decided I was done with her. I continued to see the pediatrician, however, throughout the summer. I worked for the parks and recreation department that summer, at the pools and with a children’s park program. I worked a ton of hours to avoid being home with my family, especially for mealtimes. Dinnertime had become a war zone at my house, and I preferred to avoid the situation at all costs. By the end of the summer, and my 16th birthday in August, the pediatrician decided that since I wasn’t eating anything at home, he would arrange for me to eat 3 meals a day at the local hospital, with the nurses on the pediatric ward. My high school was accommodating to my situation, and helped to arrange the special schedule, allowing me to make cross-town trips for lunch everyday. I think the arrangement worked for about a week before I started hiding and throwing away food. I’m not naïve enough to think that the nurses didn’t know what I was doing. In fact, I later learned that they spoke to my pediatrician about the situation. The only person I was fooling was myself. The arrangement continued through Christmas 1996 and New Years 1997, though it was completely useless. I was so far into my illness that I didn’t know how to get out. So, I kept getting deeper and deeper in. I honestly remember thinking that what I was doing to my body was harmful, but this was coupled with the teenage belief of infallibility, and the fact that I felt the disease had taken me over. Everything came to a head during the first week back at school, after the Christmas break. I had an appointment with the pediatrician, and he asked me, as he had many other times before, if I wanted to go into the hospital. I had negated this idea so many times before, saying that I was “fine” or wasn’t “sick enough” to be in the hospital. But this particular day, I was exhausted, both emotionally and physically. The world was so dark that I didn’t see any way out. I agreed to go into the hospital, to the pediatric ward where I had spent time eating 3 meals a day for the past 4 months. All I remember about that day was the crying that accompanied my decision and the incredible darkness that felt like it was all around me. I was in the hospital for a couple days before a child psychiatrist came to visit me. From what I am told, she took one look at me and decided I was going to an inpatient treatment center someplace. Again, from what I was told a long time later, there was not an inpatient treatment center for anorexia in the state that would treat an illness as severe as mine. Therefore, the doctors looked in other states, and UIHC was the first hospital who

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called back and said they had an available bed. I was on that pediatric ward for about 2 weeks before my mother and I flew to Iowa City and I was admitted to the eating disorders unit. I spent a full 3 months on the inpatient unit at UIHC. My memory is sometimes spotty when I think about the first few weeks there. I was told at one point that this was because, as the rest of my body shrank from malnutrition, my brain did as well. This impacted my memory to some degree. I do, however, remember the shock of going from a loose pediatric unit to a lock-down psychiatric unit. I spent the second half of my junior year of high school in Iowa City. Thanks to my teachers at home working closely with the teacher in Iowa, I kept up with the necessary classes and was caught up with my class when I returned home. Since my family was in Montana, and I was in Iowa, most of the family counseling was done via conference calls. My family flew out once during my stay, and then my mom flew back out to Iowa to stay with me during my 2 weeks of outpatient treatment before I returned home for good. I was discharged home to a psychiatrist who also served as a therapist. I worked with her intensely during that summer and during my senior year of high school. I applied to Grove City College in Grove City, PA in the fall of my senior year. I was accepted into the early decision program and knew before Christmas that I would enroll there the following fall. Grove City College’s byline is “An Ivy League education, but not at an Ivy League price.” I declared molecular biology as my major, intent on the idea that I wanted to be a pediatrician when I “grew up.” Needless to say, molecular biology is one of the most challenging majors on the campus, and I actually had to declare the major with my early decision paperwork to be ensured a spot in the program. It was a relief for me to know where I was going to attend college the next fall, and it was also a relief to know that Grove City College was 2000 miles away from my family in Montana. I needed the distance so badly, and was determined to leave my eating disorder behind in Montana while I moved to Pennsylvania. Things didn’t happen exactly as I had expected. I learned a lot of valuable lessons during the fall of my freshman year of college. I learned how to study and work hard, which was the demand of the college and the molecular biology program I enrolled in. But I also learned how to hide behind studying, lab reports, and class attendance, and to let taking care of myself fall to the wayside. I was determined to not tell anyone in Grove City of my struggles with an eating disorder. I was sure the slate would be clean as soon as I left Montana. But anorexia was much more stubborn than that, and I relapsed severely during that first semester away from my family. I got off the plane at Thanksgiving time to see my mother struggling to hold back tears as she looked at what I had wasted away to. I returned to see the psychiatrist who had followed me after my release from UI and was sternly told that I had the 3 weeks

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between the college’s Thanksgiving and Christmas breaks to get my act together and start eating, or I was going back to UIHC. I managed to pull myself out of the relapse and eat. I think I did it mostly out of fear for returning to UI. The high-achieving atmosphere of GCC was hard for me to cope with. I saw a myriad of therapists and doctors during the 4 years I spent at Grove City College. Some were disasters, and others I still miss working with. I’ve come to understand that I learned a little bit from each one. The psychiatrist in Montana agreed to follow me from a distance, so I always had her input as well. Her consistency in my life was a blessing, and she always put extra effort into staying in touch with me. During my college years, my weight and health went up and down dramatically. I eventually replaced my molecular biology major with a double major in religion and sociology. This was one of the hardest things for me, because it represented recognizing that I was not taking care of myself while I studied so hard for my classes. Religion and sociology were still highly demanding majors, but not as intense as molecular biology. By the time I graduated from Grove City College, I had made peace with my decision, and was ready to take another step in my life. During the last semester of my senior year, I was offered a merit fellowship to complete my Masters of Social Work degree at the University of Central Florida in Orlando. I accepted their offer, and again thought I would leave anorexia [the monster] in Pennsylvania this time, while I moved to Florida. The disease followed me again, and during the next two years of working towards my Masters degree, I had some serious “falls.” I also came to some important realizations. I learned how much I loved what I was studying in my social work classes, and this was a large motivation for me to leave my illness behind. I learned that I loved working with children, which I already knew to some degree, and I realized that I couldn’t be an effective social worker, or an effective mother (another goal of mine), if I practiced my eating disorder. I also worked closely with a Licensed Clinical Social Worker who specialized in treating individuals with eating disorders. She is a “recovering bulimic” and she still, two decades into her recovery, uses this terminology. Working with her brought a lot of things together for me. My experience in Iowa, along with the numerous therapists and doctors I have worked with along the way, all planted seeds of health in me. Only with this therapist did these seeds begin to sprout and I actually saw the past interactions come to fruition within me. I am greatly simplifying all the work I did with her in those 2 years, because it is impossible to elaborate in this short space. The bottom line is that I did make a conscious decision, this past spring, to live beyond the limitations anorexia has placed on me for the past 9 years. I currently work as a clinical social worker at the teaching hospital associated with the University of Florida medical school. The hospital system is similar to UIHC in its technology and grandeur. I accepted this position after my graduation from the Masters

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of Social Work program in May 2004. I now live 2 hours from Orlando, but still meet with the therapist once a month, to “check in” and make sure everything is going okay. In my recovery, I think there have been three specific turning points. For me, these turning points have really taken an active role in my life in the last 2 years. Slowly, I have learned that there is more out there than what anorexia limited me to during all the years I practiced my eating disorder. 1. The first is working closely with a therapist (the one in Orlando) who emphasized

self-care to me during every session. My self-esteem was so low that I didn’t think I deserved anything except my eating disorder. By helping me to focus on small things for myself, instead of the big picture, I relearned how to take care of myself and not punish myself for things I felt I needed to take responsibility for, but in truth I had no control over. I remember especially making grocery lists with her, planning each item I would pick up and each aisle I would go down. We would track my entire shopping trip, and focused especially on what I would do while waiting in line to check out, which was the worst part for me.

2. The second turning point that has helped me immensely is the relationship I have with an amazing friend in Seattle, WA. We got to know each other while we were camp counselors during our college years, and have stayed close ever since; especially during the last couple of years, when I have had some of the hardest fights with anorexia. We have had innumerable long phone conversations, some where all I did was sob because everything hurt so much. During these times, she would just talk to me, encourage me to just cry and let everything out, and she never was too busy to speak with me. Her support was invaluable during this time, and even though we were 3 time zones apart, it always felt that she was right there with me, as my strongest supporter for health.

3. The last turning point is actually more of an economic principle, a cost-benefit analysis. The limits that anorexia placed on me while it controlled my life did not outweigh the benefit (which amounted mostly to the attention I gained during my illness) of “being sick” for me any longer. I realized life was much bigger than the limited view anorexia had provided for me during the past years. I really want to see what is out there…I am invested in my career as a social worker, and have considered using my experience to provide support for people suffering from eating disorders on a professional level. I know I love working with children, and pediatric oncology is a particular passion of mine. I think, most of all, I want to open myself up to other people. During my eating disorder, I was so focused on myself, that I did not take the opportunity to really get to know other people, the gifts they bring to the world, and the contributions each provide.

Looking back over my journey, and ahead into the next one, I feel in one sense that I lost a lot of time while I was caught up in my eating disorder. I was very self-centered during that time; I focused purely and selfishly on myself. But I also feel that I have gained a huge amount of knowledge during my illness. I have fought vivaciously for every gain I have earned over this disease, and this alone makes each victory that much sweeter. I

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wouldn’t trade my experience for anything, partly because my family is so much healthier now than a decade ago. A few months out of my treatment at UIHC, my mom said to me one day: “You know, I’m glad we have all gone through this hard time with your illness. I’m sorry that you had to get sick, but I’m so glad we learned so much as a family during your illness.” I was absolutely livid at this statement. I was appalled that my mother would even begin to broach the subject of my eating disorder with a statement like that. As I have grown and matured, and moved beyond my illness, my thoughts have changed. I wouldn’t wish a disease like anorexia nervosa on my worst enemy, but I also wouldn’t change my battle with this disease. It was incredibly painful, and I think there will still be painful days ahead. But the enormous sense of accomplishment that I feel after coming full circle with this disease is worth all of the hurt accumulated along the way.

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