Thoughts, Not Actions

 

Deborah Beck Busis_2014-2015

Written by: Deborah Beck Busis, LCSW

Recently I had a session with my client, Jenny.  Among others skills, Jenny and I are working on her not having dessert before dinner. In session, Jenny told me that she was distressed because although she was able to resist dessert before dinner, on many occasions she was really tempted earlier in the day and wanted to give in.  “I shouldn’t be having these thoughts!” she said to me.  In a previous session, Jenny had told me that she had committed to going on a run with a friend one day after work. Although she was really tempted to cancel, Jenny ended up going.   I reminded Jenny of this during our session and I asked her, “Did you feel really bad about having thoughts about cancelling the run?” Jenny thought about it and said that, no, she didn’t feel bad about it. Read more

In Session with Debbie: Mistakes

I’ve been working with my client, Rachel, for about a month. In session last Thursday I found out that one night earlier in the week she had gotten into her kids’ Halloween candy and ended up eating way too much of it. Rachel told me that this made her feel really terrible and made her question whether or not she could even do this thing (i.e. lose weight and keep it off). It was clear to me that Rachel was being extraordinarily hard on herself about making this mistake and she was catastrophizing, thinking that because she messed up once it meant she couldn’t ever get it right.

I first reminded Rachel that learning to diet really is like learning any other skill and that mistakes are an inevitable part of any learning experience. I asked Rachel if there was another skill she has learned in which she wasn’t terribly hard on herself when she made a mistake. Rachel told me that several years ago she taught herself to sew. “I made a lot of mistakes in the beginning and none of my early pieces turned out exactly how I wanted them to.” I asked Rachel what she did when this happened, and Rachel said that she just took time to figure out what went wrong and how to correct the mistakes the next time. “And imagine if every time you made a sewing mistake, you told yourself how terrible that was and questioned whether or not you could ever really learn to do it.” “I probably would have given up,” she told me. But because Rachel was accepting of those mistakes, she learned from them, got better, and eventually learned to sew everything she wanted to.

The reality is that thinking she’ll never make a dieting mistake is just as far-fetched and detrimental as it would have been if Rachel thought she should have learned to sew without ever making a mistake. I also asked Rachel how long she’s been struggling with her weight. “It seems like my whole life,” she told me. “At least 30 years.” I reminded Rachel that she’s only been working on these new ideas for a month¬ – and asked her if it seemed realistic to expect that she would get everything down perfectly in 30 days, after over 30 years of not doing these things. “No,” she admitted with a laugh.

I knew that it was important for Rachel to recognize ahead of time that she is going to make mistakes and she can’t have the expectation that she’ll be perfect. If she expects to be perfect, then each mistake will feel like a huge failure and demoralize her greatly. And the more demoralized she feels, the harder it will be to get back on track. If, by contrast, she makes a mistake and is kind and accepting towards herself, she’ll be in a much better position to recover immediately.

Rachel told me that she understood what I was saying but still didn’t think that she would be able to remember it when she made a mistake. I agreed with her that just hearing this one time in session likely wouldn’t make that much of a difference. What she needed to do was write down these ideas and practice reading them every single day. The more she reads them, the more they will get in her head, and that’s when it can really start to make a difference. Rachel made the following Response Card and committed to reading it every single day for the foreseeable future:

Response Card - Rachel

In Session with Debbie: Facing Dessert

I’ve been working with my client, Joe, for a few months and he has been doing exceptionally well at getting his eating under control. When I saw him last week, he told me about a number of events he had been to over the past week and described how well he had done at them. As I was listening, I noticed that he said one phrase multiple times: “And I didn’t have any dessert.” I asked him about this, and Joe told me that the few times he tried to have dessert he ate way too much, so now he just doesn’t have it at all.

I discussed with Joe that while this may work as a short-term strategy, avoiding dessert would very likely not enable him to lose weight and keep it off long-term. The reason for this is because Joe is being all-or-nothing about dessert – either he doesn’t have any or he has too much. While it has (temporarily) been working for Joe to have no dessert, I knew he wouldn’t be able to stick to that forever. Joe really likes dessert, and so it’s practically a guarantee that at some point he’s going to get very tempted and end up having some. And if he doesn’t know how to stay in control, he’s going to eat way too much, reinforce bad habits, get off track, and jeopardize his weight loss and his sense of control. I also didn’t want Joe to be fearful going into dessert situations, wondering whether or not this would be the time he wouldn’t be able to resist. I knew that if Joe didn’t learn to eat a reasonable amount of dessert, he would continually boomerang between having none and having too much, which would likely eventually lead to weight gain.

I told Joe that I thought it was really important for us to start working on him having reasonable portions of dessert, and although he was wary, Joe agreed to try. I asked him if there was a dessert opportunity coming up this week, and he told me that he was going to a barbeque over the weekend that would almost certainly have a table full of desserts.

Joe and I then spent the rest of the session preparing him to go to the barbeque and have one dessert. We first discussed some strategies: Joe would look at all the desserts before deciding what to have, he would put whatever he was going to eat on a plate, and he would sit down and eat it very slowly and mindfully, savoring every bite. Joe and I then discussed what he wanted to say to himself before and after he had his one dessert, to ensure that he was able to maintain his control.

Before he ate dessert, Joe decided that he would read his Advantages List and remind himself why it was worth it to limit himself to just one. After he ate dessert, Joe decided that he would read the following Response Card:

Joe emailed me Saturday night and told me that the barbeque was a success! For one of the first times in recent memory, Joe was able to face an entire spread of dessert and not be all-or-nothing about it. Joe said that reading his Advantages List and Response Card greatly helped him keep his head in the right place and he left the party feeling so proud of himself. Joe agreed to keep working on the skill of having one dessert and knows that this will help him ultimately keep weight off for good.

In Session with Debbie: Realistic Perspective

This week, I had a session with my client, Joe.  Joe has been doing well the last few weeks but when we met yesterday, he wasn’t in a good place.  Very dejectedly, he told me that he had had a really bad day yesterday and was now struggling and feeling defeated.  When I heard this, my first thought was not, “Uh, oh, that’s bad. How can I help him recover?”  Rather, it was more along the lines of, “That’s interesting. I wonder if that’s entirely accurate.”  I knew that Joe, like many of the clients I work with, tends to be very hard on himself and sees mistakes as an all-or-nothing thing: once he makes one mistake, it means the whole day is bad.

To find out whether or not Joe was accurately reporting how yesterday went, I asked him to take me through the day and tell me what he ate.  He told me that he had his normal breakfast, lunch was a sandwich and some other things he had brought from home, but then dinner got messy. Although he ate the healthy food his wife had cooked, he ended up taking seconds and eating too much.  He also then got tempted by the ice cream in the freezer, and despite not being hungry, ate some straight from the carton which really made him feel mad at himself.

I pointed out to Joe that it sounded like the whole day until dinner went well.  “And was there any food earlier in the day that you wanted to eat but didn’t?” I asked him. Joe told me that he had resisted bagels and muffins at an office breakfast and walked by the vending machine three times that day without buying chips.  “So yesterday, you ate a healthy breakfast, then resisted bagels and muffins, ate your healthy planned lunch, and resisted chips three times. Is that right?” I asked him.  Joe agreed that this was correct.  “What does this tell you about your earlier assertion that yesterday was a really bad day?” I asked him.  Joe admitted that perhaps that wasn’t entirely true. “But I still got really off track at dinner time,” he said.  I agreed with him that it was true dinner and after dinner didn’t go as he would want, but that in no way negates all of the other good work he did that day.  Focusing only on the parts that he wished had gone better was taking a negative, distorted picture of how the day really went. If we counted up all of his eating experiences yesterday, the vast majority were ones he could be proud of.

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I discussed with Joe why it was so important for him to maintain a realistic perspective on how yesterday really went.  “If you say to yourself that yesterday was just a really bad day, how does that make you feel?” I asked him. “Terrible,” he said. “If, by contrast, you say to yourself that dinner and after dinner got a bit messy but the whole rest of the day went really well and you were able to stay on track and resist many cravings up until dinner, how does that make you feel?” “Better,” he admitted.  The problem with dieters telling themselves, inaccurately, that a whole day was bad is that, like Joe, it makes them feel terrible and defeated.  This saps their motivation and makes it much, much harder for them to get back on track and do what they need to do. If, however, they keep mistakes in perspective and are able to see that often the whole day wasn’t bad, it makes them feel much better and less defeated, which keeps their motivation up and makes it easier to do what they need to do.

Once Joe was able to see that yesterday really wasn’t the crushing defeat he was making it out to be in his head, he clearly felt a lot better and told me he was much more confident that today would go well. I reminded him that at this point, we really only needed to troubleshoot dinner and after dinner because he mostly was able to be very successful the rest of the day. Nothing Joe and I did in session changed what had happened yesterday, but once he was able to view the day realistically, what did change entirely was his attitude and his mood – which would directly impact his ability to stay on track and keep moving forward.

Eating While Driving

One of the early skills we work on with clients is the skill of eating everything slowly and mindfully. This is such a helpful skill in so many ways: when dieters eat more slowly, it gives their stomachs a chance to catch up with what they’ve eaten and they get fuller faster; it allows dieters to be satisfied with less food because they get so much enjoyment from the food they do eat; it helps cut down on mindless eating and snacking, which can reduce overall calorie intake, and so much more.  In order to put this skill into place, one of the guidelines we give dieters is, as best they can, no eating in the car.  We work with dieters on not eating while driving for three important reasons.

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First, when dieters are driving, hopefully the vast majority or their attention is on the road. This means that their food is getting a fraction of their attention at best. And when dieters eat without paying attention, they don’t feel as satisfied physically or psychologically and they often want to eat more.

The second reason we work on not eating while driving is because many dieters we’ve worked with tend to do secret eating while driving.  I’ve had many dieters describe to me how they stop at the fast food drive-thru and eat a meal on their way home from work (before coming home to eat dinner with the family), or how they buy a big bag of something sweet or crunchy and snack their entire commute home.  Something about being alone in the car, when no one is watching, gives dieters a false sense that what they’re doing doesn’t really “count” in some way. But of course, our bodies don’t know if 100 people are watching us eat or no one is watching us eat; they process all calories the same regardless.

A third reason we work with dieters on not eating while driving is because, if they eat while they drive, it tends to reinforce the notion that they have to or should eat every time they feel like it, or at the very moment they start to experience hunger.  Unless our clients are driving far distances or have terribly long commutes, most of them are not in the car for long stretches of time.  Working on delaying eating until they get to their destination is a helpful tool in teaching dieters not to fear hunger.

In order to help dieters put this skill into place, sometimes we have to be creative.  One of my clients was a sales rep who drove from place to place each day and spent most of his working day in the car.  We worked out a strategy where he could eat in his car – just not while he was driving. We decided it was perfectly reasonable for him to eat lunch in his car, as long as he was parked somewhere.  Another client of mine really loved to break up her drive home by stopping in at a convenience store and chatting with the clerk with whom she had become friendly.  In this case, we decided it was reasonable for her to continue doing this, but the only thing she would buy would be water (and we agreed that water was the only food/beverage that was okay to consume while driving). We also agreed that if she ever broke this and got more than water, she’d have to cut it out entirely (at least for a period of time).

Eating in the car can be a difficult habit to initially break, but once dieters are able to get themselves to stop doing so, it can do a world of good.

In Session with Debbie: Party Plans and Leftovers

This past weekend marked my client, Liz’s, 40th birthday and she had a party to celebrate.  In session last week we spent time thinking through the party and making a plan for it.  Liz, who loves chocolate, told me that her friend was going to make a special chocolate cake for the party – one of Liz’s very favorite desserts.  Liz and I came up with a plan for what and how much she would eat during the party, and Liz decided that she wouldn’t have any dessert at the actual party and instead would wait until later that night when everyone had gone home to enjoy a piece of cake.  Liz knew that at the party she would likely be distracted and wouldn’t really be able to savor the cake in the way she wanted to, so having it after everyone left would enable her to get much more enjoyment from it. If Liz was tempted to eat cake during the party, she decided that she would just remind herself that she wouldn’t be able to fully enjoy it right then anyway, but she was going to get to eat it very soon.  It wasn’t that she wasn’t having it, she just wasn’t having it in that moment.

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Liz and I also discussed how she wanted to feel when she went to bed that night.  Liz told me that on many previous birthdays she wound up eating way too much and went to bed feeling mad at herself, physically stuffed, and vowing to do better next time. Liz knew that she wanted to feel satisfied and proud of herself when she went to bed that night, and staying on track was the way to make it happen. Liz and I made a number of Response Cards relating to her birthday and the party, and Liz committed to reading them, plus her Advantages List, before it began.

When I saw Liz this week, I asked her how her birthday and the party had gone. Liz reported that the party had gone very well. She stuck to her plan, felt great about it, and finally achieved her goal of going to bed on her birthday feeling really proud of herself.  However, Liz told me that despite this success, trouble set in a few days later.  As per her plan, after enjoying a piece of chocolate cake after everyone left the party, Liz then put the leftovers in her freezer. She told me that for the next few nights, the cake called out to her and she had strong cravings for it, until on Tuesday she finally broke down, took out the cake, and overate the leftovers.

I first reminded Liz that even though she had trouble with cake later in the week, that in no way negated her great success at the party and how much credit she deserved for staying on track during that time.  Liz and I then spent time figuring out why she was able to be so successful during the party but then less so later on.  I had a theory – Liz was able to resist the cake at her party and enjoy just once slice after it was over because that was her plan. She knew exactly when she was going to have it and exactly how much she was going to have.  The exact opposite was true with the leftover cake. Liz had this highly tempting food in her house and no plan for exactly when she would have it (or how much she would have).  Because of this, every time Liz thought about having the cake, she wasn’t able to say to herself, “I don’t need to have it now, I get to have it tonight/tomorrow/Wednesday night, etc.” which made resisting so much harder.

To help with this, Liz and I decided that, at least for the foreseeable future, whenever she had highly tempting food in her house she would have a plan for when she would eat it. That way, it would be much easier for her to resist at any given moment because she would be able to remind herself of exactly when she was going to eat it.  The next time, we decided, Liz would make a plan both for the party and for the leftovers.

In Session with Debbie: Motivation

This week I had a session with my client, Jon. I’ve been working with Jon for about three weeks and the whole time he’s been struggling; it’s been really hard for him to get himself to work on the skills we talk about in session. This week Jon told me that for some reason he just doesn’t feel committed to this process and was wondering whether or not he could actually do it. Or, more accurately, whether he could commit himself enough to actually do it. Upon hearing this, it was clear to me that the first thing we needed to do was figure out exactly why it might be worth Jon putting in the effort to lose weight.

Jon and I went over the Advantages List we had made during our first session and he realized that there were several things on there that in theory would be nice, but weren’t especially compelling or motivating to him at the moment. I had him take off all of the items that didn’t feel extremely important to him and we discussed what was left. Jon realized that he had three main things that felt very important to him: 1. Reducing his risk of heart disease, cancer, and diabetes (he has family history of all three); 2. Increasing his stamina, especially for the bike trip he and his wife are planning in a couple of months; 3. Getting rid of his beer belly.

Jon and I then did something I usually only do with clients when they’re feeling unmotivated or reluctant: I asked him about the disadvantages of working on losing weight. We knew why he wanted to do it, now we needed to see exactly why he didn’t want to. Jon identified three major disadvantages of working on losing weight: 1. He wouldn’t get to eat what he wants, when he wants it; 2. He would have to limit his food intake, both in terms of quantity and, to some degree, variety; 3. He would have to think about food/losing weight all the time.Advantages          Disadvantages

To help him get some clarity on his disadvantages, I asked Jon, “Before we started working together, did you think about food and losing weight? Did you spend time feeling badly about what you were eating and did you have thoughts about needing to lose weight and knowing you needed to do something about your eating?” Jon said yes, he had thoughts like that all the time. To this end, I reminded Jon that although he identified having to think about food and losing weight as a disadvantage, the truth was that either way he was going to think about it. Either he was going to have to think about it ahead of time to help him make healthy choices, or he was going to think about it after the fact, when he had overeaten and was feeling terrible about it.

I then reminded Jon that although it was definitely true that he would likely have to eat less food if he was working on losing weight, it actually didn’t mean that he had to get that much less satisfaction from his food if he was really tuned into all the bites he was taking. Jon and I discussed the benefits of really working on eating everything slowly and mindfully, and how much more satisfaction he can get from eating in that way.

Jon and I also discussed the fact that when he was feeling unmotivated, part of what might be happening is that he was focusing too much on what he wasn’t getting – spontaneous food decisions, more food, greater variety – and not enough on what he was getting – feeling in control, smaller beer belly, better health, increased stamina. Jon agreed that trying to change his focus from the negative to the positive would be helpful.

Jon and I then assessed everything we had talked about up to this point. We went over again the real and important advantages of working on losing weight, and the real and undeniable disadvantages of doing so. I asked him, “Which is more important to you? Which do you want more?” Jon thought about it for only a few seconds and answered that, no question, the advantages of losing weight felt much more important to him; that’s what he wanted more. He told me that with these things in mind, he felt more committed to the process than he ever had before.

In Session with Debbie: Hunger

Like many dieters before her, my client Jill was having trouble sticking to her food plan in the evening. She told me that she would usually eat what she had planned but then would wind up taking seconds and eating more. In order to figure out what was going on, I first asked Jill whether or not she thought she was hungry when she took more food. “Is the desire for more food coming from an emptiness in your stomach, or more of a desire to eat stemming from your mouth or head?” Jill thought about it and reported that she wasn’t entirely sure, but thought it was likely that, at least some of the time, it was coming more from her mouth than from her stomach.

I discussed with Jill the difference between physical satisfaction and psychological satisfaction. The fact is that most dieters feel physically satisfied well before they feel psychologically or emotionally satisfied. After they’ve eaten a reasonable amount of food, physically they’ve had enough and their bodies don’t need more. But they often want to keep eating more for a variety of different reasons: because they enjoyed the taste of the food, they didn’t pay enough attention to the food they did eat, they want to continue being social at the table, they’re trying to procrastinate getting on with their next activity, they’re thinking about a stressful situation and want eat to calm themselves, and so on.

Jill and I also discussed that if she finished eating and wanted more food, it could also be because the food she did eat hasn’t yet registered in her stomach. To help with this, we decided that every time Jill finished her planned meal and wanted more, she would set a timer for twenty minutes. During those twenty minutes, Jill would first do the dishes and then leave the kitchen and read a magazine or play a game on her phone until the timer went off. Once it did, she would then ask herself if she still wanted more food, and, if so, where the desire for more was coming from. Was it coming from her stomach or from somewhere else?

Because Jill thought that sometimes the desire for more food really was coming from her stomach, I then discussed with Jill what level of fullness she thought she was shooting for. Was she trying to feel pleasantly full and no longer hungry, or was she actually trying to feel stuffed? Jill thought about it and realized that she often was aiming for a level of fullness that meant that she couldn’t fit in another bite. I discussed with Jill that that was likely overfull, and that what actually might need to change is her concept of what reasonable fullness entails. Jill agreed to closely monitor her level of fullness over the next week and make an effort to stop when her stomach felt full but not stuffed.

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We discussed the fact that, at least initially, it might cause her some discomfort to have to stop eating before she wants to, although she can train herself to get used to feeling only full instead of overly full. I reminded Jill that being overweight is hard too, (it’s hard not fitting into her clothes, feeling heavy in her body, having knee and back pain) so either way she’s going to experience discomfort. Jill knew she’s rather try to put up with the very momentary discomfort of not eating more food as opposed to the completely pervasive discomfort of being overweight.

With these new things – paying attention to the difference between physical and psychological satisfaction, setting a timer for twenty minutes after she finishes eating, shooting for full instead of overly full, and reminding herself that either way there’s discomfort – Jill had a lot of new strategies to help her keep her evening eating under control.

In Session with Debbie: No Exceptions

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My client, Helen, has been struggling recently. When she came in to see me this week she told me that the previous week hadn’t gone very well and she had a number of off-track days.  She said that she was still making food plans the night before, but was increasingly finding it difficult to stick to it.  Some of the time, she would make substitutions that seemed legitimate (subbing one fruit for another, or one snack for a different one of equal caloric value) and some of the time she just threw out the plan completely.

To help Helen reset and refocus, I suggested that for the next three days, she makes a plan and sticks to it with no exceptions and no substitutions. Because of her struggles, Helen’s sense of discipline and self-efficacy had taken a hit over the past week, and so in order to help her build it back up, it was critical that she prove to herself once again that she can make a plan and follow it 100%. Once Helen is back on track with sticking to her plan, then she can resume being somewhat flexible and making reasonable substitutions.  I reminded Helen that it should only take a couple of days to get her back in the “sticking to my plan” mindset, and she agreed that it would be helpful to do so. Helen and I also discussed the fact that there would probably be some element of relief in knowing she was going to stick to her plan because it means, at least for the next three days, she is relieving herself of the burden of making spontaneous food decisions and therefore alleviating the struggle about whether or not to eat something.

I then asked Helen a very important question: What thoughts might get in the way of you sticking to your plan 100% over the next three days? Helen responded that the one thought she might have would be, “I’m not going to stick to my plan because I don’t feel like eating what’s on it.” To help Helen overcome this thought, she made the following Response Cards to read at least once a day, every day, for the next three days, and more frequently if she was tempted to stray from her plan:

I need to eat in response to my bigger goals (losing weight, being healthier, feeling better about myself, feeling comfortable in my body, etc.), not my smaller goals (eat what I most feel like eating at any given moment).

I’ve planned this food because I like it. Even if I don’t especially feel like eating it, it will still taste good because it’s something I enjoy.

It’s okay if I don’t get to eat exactly what I want at all times. If it’s something I really want, I can plan to have it tomorrow. It will taste good then, too.

Once I start eating, I’ll be caught up in the enjoyment of what I am eating and won’t remember the other thing I felt like eating.

It’s critical for me to prove to myself that I can stick to a plan 100%. Once I do, I can start making substitutions again if I feel like it. This is not forever. It’s only for three days. I can do it!

With these helpful Response Cards, Helen felt confident that she could stick to her plan for the next three days. She reminded herself that she did it before and she can do it again – and when she does, she’ll stop struggling and start feeling great again.