Saturday, February 16, 2019

I have written before about my extensive use of metaphors in my working with clients and when I act as an advocate in regard to eating disorders, body image and mental health. I do this so frequently, that many times clients enter sessions with a metaphor of their own and use it as a means of connecting. Metaphors allow for a common language, for words to flow more easily at times, or for complicated feelings to be depicted in a revealing or unique way.

There is one such metaphor that I often return to with clients when discussing the process of change. I typically use this metaphor with clients who are currently embarking on the journey toward recovery. Recovery can have a different meaning for different individuals. Overall, I think of recovery as a time when an individual’s life is no longer impaired by thoughts or behaviors that have been maladaptive and have previously impacted functioning.

This is no simple feat and there is a common misconception that an individual can never truly recover but must learn to live with some aspect of a struggle for the rest of his or her life. I hear this almost every time I speak about eating disorders and especially when I share my story. Someone or other asks the question about whether I still struggle, and pronounces disbelief when my answer is no. While there are many thoughts on recovery versus being recovered and how this changes depending on the particular struggle or diagnosis, above all I do not believe that people will necessarily suffer for the rest of their lives. I have seen and research has shown that thoughts, urges and behaviors can stop.

For some, behavioral change may still mean abstinence from—let’s say—a substance. This is typically most recommended. For others, the behavior can be relearned so that it can be integrated appropriately and in a healthy manner—for instance, as in the example of one who struggles with shopping as a maladaptive behavior or addiction. That person may learn to shop again after thorough support and exposure therapy, rather than never shopping again in his or her life. Some individuals find solace in knowing that the recovery process is ongoing, while others experience hope when visualizing full recovery.

The recovery process and end result are concepts that come up often in my line of work. People typically are impatient and vacillate around hopefulness; at times an individual may feel hopeful or inspired but then this may quickly change, and the feeling of hopelessness or difficulty imagining change may be strongly present. When clients speak with me about the process and the way hope ebbs and flows and urges to use maladaptive behaviors are high, I tend to use the swamp metaphor—inspired by a colleague—from my toolbox.

I tell clients that the process of recovery or of changing a behavior is like entering a swamp. Perhaps when the swamp is first entered, it seems to have clear waters—this relates to the feeling of excitement that one may have at the prospect of change. This is typically part of the “honeymoon phase” when change and hope feeling exciting.

Or perhaps the swamp looks dark and ominous from the get-go. The initial dive may not feel exciting but may instead feel forced; this typically resonates for clients whose loved ones had a strong hand in recommending therapy or treatment. It did not feel like a choice but instead like a push. In either case (and there are many more initial feeling states), the swamp is sticky, humid and uncomfortable and movements are slow and take a fair amount of effort.

At a certain point in recovery or the change process, the individual may find a rhythm and engage in actions that will ultimately result in the change s/he wishes to achieve. This is typically what leads to impatience; it feels as if efforts have been made but internal changes may not be experienced.

The person may even feel emotionally worse because behavioral changes were made, but the feelings that originally led to the maladaptive behavior originally are still present. So now, the person is not using the coping skill that helped manage his/her emotional experience and is still left with the thought and feelings. Think of a toddler who uses the pacifier to self-soothe and needs to give it up; the need for self-soothing still exists and there will likely be a lot of tears due to no longer having the physical coping mechanism.

I typically say that this is when the person is right in the middle of the swamp, unable to see where s/he started and also unable to see the shore (recovery), feeling tired and having trouble remembering why s/he is doing so in the first place.

Individuals are then tempted to “build a bridge to nowhere”; they try to build a bridge to take themselves out of the swamp. Envision that this bridge is built in a “U” shape and only lands them farther back within the muddy waters. It has not helped. If anything, they are now 10 feet behind where they had been.

We can call this a lapse; the individual uses a behavior thinking it will help or as a means of distracting from the painful process. This is common—hoping to escape or feeling the pull of the behavior—but does not work. Instead, the journey requires grit and it requires remaining in the swamp through it all, some days through tears, some days being able to see the sun.

When I’ve shared this with clients, some emphatically shake their heads, stating that this is exactly how it feels. We return to the metaphor to determine where they feel they are in the swamp, and use the language to discuss the pain of the process. I have found the use of metaphors to be connecting not only in my work, but in all my relationships. This metaphor in particular depicts the nature of the process and can allow for understanding as so much of the recovery process can seem irrational and can leave people feeling misunderstood. When we can take the opportunity to connect using some type of common language, and practice listening—not just hearing—we can decrease judgment and better support those around us.

By Temimah Zucker, LMSW

Temimah Zucker, LMSW, is the assistant clinical director of Monte Nido Manhattan and works in private practice specializing in working with those who struggle with eating disorders, body image and mental health. Temimah also speaks nationally on these subjects. She lives in Teaneck with her husband and two dogs. She can be reached and you can learn more at www.temimah.com