Tuesday, January 5, 2016

Movement and Recovery in Binge Eating Disorder

By Rochelle Rice, CSP, AS, MA
One of the most powerful things you can do is ditch the “all or nothing” mantra when it comes to movement and ease into a program that supports you and your BED recovery. 
But how? 
Let me introduce you to four powerful steps you and your health professionals can take to build and sustain your recovery.
Whether it is you or your health professional that begin the process, let’s begin with a few safe questions to ask yourself before you get started on your journey.

Lay the Groundwork

1 – Would you like to discuss exercise during your session? If no, please skip to #3.
2 – What words are you most comfortable with when talking about moving your body?
  • Movement
  • Activity
  • Active Lifestyle
  • Active Living
  • Exercise
  • Activities of Daily Living
  • Other
3 – What activity did you enjoy most as a child?
4 – Do you currently have a favorite activity, sport, or active hobby?
5 – Are there stairs in your home?
6 – Is your spouse/partner/significant other active? 
7 –Are your children, nieces, nephews, godchildren, etc. active?
8 – What is your greatest fear, barrier, or concern about being active in your life?
The answers to these questions will set a solid foundation from which to build a patient driven, vibrant conversation about movement.

Identify Words with Impact

Often, we stay stuck using the same words to describe recovery. Creating new possibilities with diverse words expands the mind and invites more space and breadth into the process. Words with impact which are patient driven – chosen by you – will help you and your health professionals create a dynamic dialogue during your recovery. You can list all the words with impact that are meaningful to you or chose a few here that can be used in your discussions with your family members, coworkers, and health professionals. Words with impact are lively, energetic, and can rouse the imagination to create a dynamic shift in your thought process. 
  • Accomplish
  • Astounding
  • Bold
  • Breakthrough
  • Compliment
  • Courage
  • Daring
  • Dazzling
  • Effortless
  • Enthusiastic
  • Flexible
  • Free
  • Gain
  • Growth
  • Health
  • How to
  • Imagine
  • Incredible
  • Life
  • Love
  • Magnificent
  • Monumental
  • Nailed
  • Obtain
  • Prevent
  • Promotion
  • Quick
  • Relief
  • Revamp
  • Solve
  • Soothe
  • Value
  • Win
You can also ask yourself a few key questions in the process. “Do I need compassion?” “Do I need passion?”  “Do I need more knowledge?” It will be helpful to clarify if you prefer and need cheerleaders or quiet supporters where the outcome is not based on weight. Be fearless in describing exactly what you need and don’t hesitate to adjust as you move along in your recovery.

List Your ABCs 

To nurture and support your recovery, give yourself permission to explore many movement options, even if they seem crazy at first. To open up possibilities, I invite you to create your Buffet of Movement©. Start with the letter A and list a non gym activity that begins with the letter A. Continue all the way through the alphabet. (Example: A: archery, B: bowling, and so on). If you have children or a spouse/partner, get them involved as well. Be creative and have fun with the list. Nothing is off limits. Next, to learn how to do the movement, try local recreation centers, DVDs, and even YouTube. You do not need to spend a lot of money to get started.
Post your list in a prominent place so you can use it frequently and wisely. Tune in to your body and listen.  Do you need stretch, strength, or cardio activity? Do you need to be indoors or outdoors? Do you need fast or slow movement? Choose wisely and over time this process will become not only easier, but a powerful foundation of the success of an active lifestyle.
Be sure to adjust your movement to match seasons as well. This will resonate well with your body depending on what types of movement you enjoy. For example, if you live in a four season region, you may try swimming/water sports in the summer, hiking in the fall, cross country skiing in the winter, and yoga in the spring. If you live in a two season or one season region, adjust the activity to be outdoors during the cooler part of the day and indoors when it gets too hot or humid.

Master Your Breath

One of the most significant tools that support recovery is the power of the breath. There can be a great deal of stress, fear, and concern during recovery, but proper understanding of the breath can add valuable benefits to your health. Breathing supplies oxygen to the body, helps control the temperature of the body, and cleans the body by removing the carbon dioxide. Diaphragmatic breathing assists in helping the body return to its natural anatomical state. To do this, begin by lying on your back. Place your right hand on your heart and your left hand on your abdomen at or slightly below your navel. If it is activating for you to touch your abdomen, place a book on your abdomen. As you inhale through the nose, feel the abdominal wall rise (your left hand or the book). As you exhale through the mouth, let the abdominal wall soften, gently drawing the navel to the spine. You will see your left hand or the book move slowly toward your spine. Repeat this entire sequence three times and slowly work your way up to three minutes. 
You can play quiet music to help relax and regulate your breathing and the breathing should be practiced when you are not stressed. The physical body will then be familiar with how it works and it will be easier to call upon this breathing skill at the beginning of a stress-induced situation. Most importantly, be mindful of your breathing around triggering people or situations. Discuss your breathing with all of your health professionals and incorporate it into your sessions. 


When it comes to movement and recovery in BED, the most important thing to remember is to give yourself permission to explore the possibilities and feel the joy. Share the work you have done here with your health professionals and continue the conversation about a patient driven approach. When the information is learned and mastered from the inside out and supported and nurtured by your community, you will experience an increase in self esteem and self confidence that transcends Binge Eating Disorder. As your body gets stronger and more flexible, you will continue to adapt to a number of different activities. Embrace the movement! You are certain to enjoy a lifetime of activity as you continue in your healing process.

Engaging the Embodied Self in Dance/Movement Therapy

By Stacey McGinn Hurst, LCPC, BC-DMT, GL-CMA

Re-inhabiting the body, filling it up with the Self, and inviting all parts of the psyche back into the container of its owner are essential to eating disorder recovery. How do therapists invite an individual to create a more harmonious relationship with his or her body, when the body has become a battleground where no truce is in sight? From the work I’ve done with men and women over the years, it appears to me, that eating disordered behavior is a metaphoric crime committed against the Self through the body, where food is used as the weapon to attack or defend against various issues of the psyche. This article will look at the ways an eating disorder manifests on a body level and how dance/movement therapy, a body-based form of psychotherapy, can be used as a viable treatment modality for those struggling with such a disorder. In conjunction with dance/movement therapy, Internal Family Systems model (IFS) created by Richard Schwartz, a primarily verbal therapy approach, can co-facilitate to yield positive changes within the client with an eating disorder. 

Separate, Divide and Concur

As Anita Johnson writes in her book, Eating in the Light of the Moon (2000), “…food is not the real issue. It is a smoke screen. It is the red herring.”1 As clinicians, clients, and loved ones, we must not become distracted by the food; instead, we must look deeper towards the root causes and reasons why an individual uses food to self-regulate. Dance/movement therapist, Anne Krantz (1999), writes, “The eating disorder represents a symbolic enactment of a struggle in which the woman’s body has been disconnected from her emotional life. Inhabited by painful conflicts which the eating disorder fails to resolve, her body has become a barrier against feeling and growth.”2 
Undeniably, there is disengagementwhere emotions are differentiated from the felt sense of the body. Whether an eating disorder manifests as a keeping in, a keeping out, or a keeping separated, a compartmentalization of sorts, is occurring. But how is this possible when neurobiology has now discovered the truth behind the body-mind connection? It is an inseparable and interconnected whole, both intra and interpersonally.3 We can understand this in another metaphor. It is as if the road still exists between the body and mind, but the individual who has an eating disorder, does not travel down that road any more. “Blockades and barriers” have been erected on the road to keep the “disconnect” and compartmentalization in place, in order to manage the emotional content.
The difficult dynamic to understand, is the relationship between the individual’s Self and his/her eating disorder. Originally, the eating disorder began as a way to help the Self cope with life’s stressors and the internal emotional conflicts that often arise. However, over time, this is without a satisfactory resolution, as Krantz (1999) points out above, due to the disconnecting nature of the disorder. The eating disorder’s original, positive intention and way of coping with life, through blockades and barriers, goes painfully awry. It is often at this point when an individual will enter therapy, either on his or her own or with the encouragement of loved ones. These individuals will often appear either shut down or hyper-aroused physically, emotionally, and/or cognitively and may complain about a “war going on in my head”- if they are able to get the words out to explain the inner turmoil. 
An example of what “hyper-arousal” looks like on a body level is described in the following vignette of a first session with CW, a now 53-year-old female with anorexia nervosa:
She enters the space appearing exceptionally thin and tired, with a forced smile on her gaunt face. Her upper chest hollowed, sunken, and enclosed. Her eyes are strangely alert, yet not present. Her hands twist as she wrings her wrists. And she speaks with a high-pitched, young-sounding voice marked by a frantic and pressured nature. I can sense the fear she is holding, as evidenced by extreme tension in most every area of her body. Her body-mind is rigid and she appears to hover above the couch, even though she is sitting. I make note of my own body’s response of held breath, discomfort, an uncertainty of where to begin, and the intense rigidity in my musculature. During this first contact with CW, I become aware of her body’s unwillingness to contact the floor/ground.  She struggles to be in connection with the environment, her own body, or me. Disconnection is pervasive. 
It is often here, where the therapist and client together, begin the journey to create an internal (emotional) and external (behavior) shift. The goals are to identify and remove the blockades, to create a truce between the contending parties (Self and eating disorder), and to develop inner harmony within the client’s body-mind-spirit. If you are a therapist or a client who is familiar with eating disorders, you know this is easier said than done. 

Where is the Self?

From Schwartz’s development of the Internal Family Systems model based on his work with hundreds of clients over the years (many of whom struggled with eating disorders), he concludes that everyone has a “Self.” He further described the Self as possessing qualities such as clarity, confidence, connection, and centered-ness. It is experienced and described by his clients as a “state of calm well-being” where one feels free and openhearted and in the present.4 From this concept we can then ask: Where is the Self while all of this “warring” is going on? We can imagine that the Self is being guarded and protected deep within the body – too protected to believe that a change can be created in this powerful storm. The very thing that is the client’s best ally, right now, is perceived as the enemy: the body. To try to rationalize or convince otherwise is a fruitless struggle usually ending in disappointment and not moving any closer to the end goal, that of inner harmony. The Internal Family Systems model would have us understand the individual’s eating disorder as a cluster of parts in the system known as protective “fire fighters” that are used to control the emotional intensity of the body’s/Self experience.5
We can also conceptualize the Self through a Gestalt/relational lens; as an entity that is only known through being in relation to the other and, therefore, exists when it is experienced through the body’s boundary.6 Philippson describes the Self of an individual with anorexia as “…beneath the skin, and alienates the area between the skin and the body identified as self.”7 Therefore, a body-based, relational approach to the development of a strong and vibrant core Self would seem imperative, especially for the individual struggling with an eating disorder. 
In order to connect with the Self of the client, the therapist must assist in discovering and dismantling the eating disorder fueled blockades and barriers, which keep the splintered parts in place. These parts function to protect the Self from being overwhelmed in a variety of different ways; most often holding and containing negatively experienced emotions. Simultaneously, the therapist can foster growth and inner resourcing of the client’s Self through various body-based methods used in dance/movement therapy that model to the client and his or her parts that he or she is capable of being with, and connecting to, the emotional content that surfaces.

Dance/Movement Therapy Approach

As a dance/movement therapist, grounded in Schwartz’s Internal Family Systems model and Miller’s Relational-Cultural Theory 8, my observations have shown me that inner harmony can only be experienced when all parts of the Self are residing fully within the body-mind. All parts understand their functional roles in the system leading to compassion and appreciation for one’s inner gifts throughout the intrapersonal system and within relationship to another. The ultimate result: all barriers and blockades are “down” and the system is connected and flowing. 
In my experience, even though mental knowledge is power, the progression of reconnecting is incomplete when only processed through the verbal realm. Rather, employing the wisdom of the body is an even greater tool that can be harnessed within the individual to bring forth empathy and healing in the body-mind-spirit. Through the body, the individual can experience connection intra and interpersonally in the corporeal realm, and can develop the ability to hold and accept the emotional content between the Self and the skin.9
According to the American Dance Therapy Association (ADTA) dance/movement therapy (DMT) is the psychotherapeutic use of movement to further the expression of the inner aspects of an individual physically, emotionally, spiritually, and cognitively.10 Its approach is body based, bottom-up and top-down, as described by Bessel van der Kolk in his latest book, The Body Keeps the Score.11 With a high level of what van der Kolk and other scientists call “interoception”12 and dance/movement therapists call “kinesthetic awareness”13 dance/movement therapists are trained to attend to both their own felt sense, as well as to their clients’ emotional, body-based experience. This is known as “kinesthetic empathy.”14 
Through the use of these tools and others, the dance/movement therapist can facilitate the increased development of the client’s body felt experience through a range of movement spanning from functional to expressive movement. The development of a felt sense is critical for the person who is attempting to recover from an eating disorder so that he or she can connect to and regulate his or her emotional state more effectively. By gently turning towards the body and its wisdom, the client begins to recover long forgotten and disowned aspects of the Self, leading to less animosity between the Self and the eating diroder and to a greater sense of integration. 

How it Works?

Dance/movement therapy seeks to fully integrate all aspects of the psyche and reconnect the body-mind, so often disconnected in the individual with an eating disorder. Through the use of: (1) basic movement tasks (walking, aligning the spine, feeling the feet on the floor); (2) body orientation (awareness in space surrounding the body and orienting to body parts in connection with each other); (3) breath work (various ways to work with the breath to regulate and increase internal awareness); (4) grounding techniques (weight sensing, bouncing, yielding into the earth, imagery); to the more complex (5) full body dance expression (a signature of dance/movement therapy). This 50-year-old approach taps into the individual’s expressive, creative, and healing potential, thus empowering the individual to literally move towards inner harmony.15 As Krantz notes, “The dance therapy process allows a fundamental change in the client’s relationship to her body by active psychophysical expression of experiences connected to the symptoms and thus, provides release from the symptom.”16
One of the most powerful sessions I recall having with CW, occurred when we were mindfully walking around the room. This is simple for most individuals, but for CW, it was a major challenge. As I said earlier, it seemed as if she would hover above the couch to keep her body out of connection. We discovered this was a physical manifestation of her lack of trust that anyone or anything could support her. As we walked, on this particular day, I ask her to really feel her feet on the ground; to sense the bottoms of her feet yield into the earth. I invited her to allow the earth to support her. As we walked, she began to cry tears of joy. She said, “This is the first time I’ve ever experienced connection to anything that feels safe. I know the earth will always be there for me. And now I can actually feel it.”17 This was a transformational moment for CW. She began to really notice herself in relationship and started to increase her ability to trust herself, the environment, and me. 
Within the dance/movement therapy session, the therapist and client track the wisdom of the client’s body knowledge trusting that it will ultimately guide the client back to health if nurtured in a safe, trusting, therapeutic movement relationship. Dance/movement therapist Jessica Young defines the therapeutic movement relationship as: 
…a shared presence of body, mind, and spirit between the dance/movement therapist and client where healing occurs within the safe containment of a creative collaboration resulting in a resonance.  Fundamental to the work of dance/movement therapists and rooted in the tenets of humanism, it is born out of one’s ability to kinesthetically attune and respond to the implicit and explicit movements of another, informed by knowledge of one’s own body sensations and movements as well as continual observation and assessment of the client’s movement.18
In order to engage in such a relationship, dance/movement therapists have training in advanced and codified systems of movement analysis, to understand the body’s movement language in order to meet the client in the non-verbal, corporeal realm. Through the body’s physical expression, the therapist can facilitate increased self-awareness, self-compassion, and self-expression while assisting the client to learn his/her body’s own personal language.
Dance/movement therapy can bring the disowned parts of the Self back into connection and back to its residence in the physical body. The internal contention that formerly took place on the battleground of the body can come to an end as the Self gains strength and brings internal compassion towards the wounded parts once suppressed through eating disordered behavior. 
Years later, after many sessions with CW, we now have a connected, safe, trusting, therapeutic relationship. She has also established a much greater connection to her Self and her body. Her posture is more erect, her eyes are open and more engaged, her voice is stronger, and her upper body is more open and relaxed. She is slowly discovering that her body is a safe place in which to dwell, and she has developed ways to decrease the antagonism she feels between her Self and her parts. She is now able to resource strength, stability, and confidence within herself through body-based techniques such as grounding, accessing breath, and increasing her body awareness. She is more apt to listen to her body’s expression with compassion, as she learns how to hold space for herself and her wounded parts, without turning to eating disordered behavior that once formerly disconnected her and perpetuated her inner battle. Today, the war is over and the battleground is cleared of debris. In her words, “I am calm, healthy in mind, body, and spirit. My face is filled out and my eyes are present. I feel so grateful.”19

The Body Speaks: Dance/Movement Therapy Creates Movement Toward Eating Disorders Recovery

By Susan Kleinman, BC-DMT, NCC, CEDS
“Movement never lies. It is a barometer telling the state of the soul’s weather to all who can read it.” – Martha Graham 1
When the body speaks but the mind is not listening, conflict is created. Movement toward Eating Disorders recovery requires connection to one’s body. Individuals with eating disorders, however, ignore the experience of living in their bodies and often attempt to hide their authentic selves by putting on a “false front,” numbing their emotions. Patients’ tendencies to control and conceal bodily-felt experiences and connections with inner feeling states create a challenging dilemma for therapists.

Challenging the Dilemma

Movement defines us from the first kick in our mother’s womb until our final breath. We participate in a dance of life, communicating through our bodies long before we learn to speak using verbal language.2 Agnes De Mille quoted the famous modern dancer, Martha Graham saying, “There is a vitality, a life-force, an energy, a quickening that is translated through you into action and because there is only one of you in all of time, this expression is unique, and if you block it, it will never exist through any other medium and be lost.”3
Historically, therapists have always attempted to assist their patients in experiencing feelings through innovative means: Jung planted creative therapeutic seeds with his active imagination in relation to dance, art, and musicWilhelm Reich theorized about energy which led to the development of bioenergetic analysis; Jacob Moreno, best known for creating group therapy and psychodrama, developed training methods which were sustained and passed on by countless clinicians; and Harry Stack Sullivan and Frieda Fromm Reichmann each influenced Marian Chace, known as the mother of dance/movement therapy.4 Chace said simply of her philosophy, “Somewhere in any emotional experience, the body enters.”5

The Transformative Power of Working on a Body Level

Many individuals with eating disorders describe the experience of being in their bodies as disembodied, as if living with a stranger or an enemy.6 Patients’ ways of being in their bodies and their willingness to access their own unconscious material are part of their sense of self and play an important role in terms of the degree to which they will be able to heal. 
Over fifteen years ago, Lewis, Amini, and Lannon, acknowledged the importance of embodied therapy. They said:
“When a person starts therapy, he isn’t beginning a pale conversation; he is stepping into a somatic state of relatedness. Evolution has sculpted mammals into their present form: they become attuned to one another’s evocative signals and alter the structure of one another’s nervous systems. Psychotherapy’s transformative power comes from engaging and directing these ancient mechanisms. Therapy is a living embodiment of limbic process as corporeal as digestion or respiration.”7
Dance/movement therapy (DMT) provides a medium for patients to re-claim authentic connection with themselves in both actions and words. This can lead to long-lasting change associated with the ability to sustain recovery.

Dance/Movement Therapy 

Dance/movement therapists weave together dialogues that facilitate transformation of everyday movements into expressive communication.8 This process opens a pathway to re-establish connection with the body by experiencing and expressing feelings and identifying how emerging awarenesses parallel and reflect unique behavioral patterns. These experiences are explored through both nonverbal and verbal reflection.9 
An example of an experience in an individual Dance/Movement therapy session follows:
C. and I, together, created a movement phrase. Through C.’s choice of movements, we focused on how she repeatedly and unconsciously corrected her body placement by straightening her slumped position. Exploration of this habitual movement cue revealed it related to C.’s need to please others by “standing up straight to look pretty.” She acknowledged that she couldn’t sustain this false stance in her life behind this mask, the demand to look pretty.
This insightful connection between C.’s expressive movements and the parallels in her life provided valuable information for C. to explore further in her primary and family therapy sessions. Most important, because C. was able to bring both her mind and body equally into the therapeutic frame, she eliminated the option to return to her default mode when she felt vulnerable. 

Dance/Movement Therapy Concepts

When faced with difficult therapeutic situations, therapists often look to external techniques or modalities to determine their responses, rather than trusting their own sense of self. According to Daniel Siegel, “Responding to the patient’s nonverbal signals, including tone of voice, facial expressions, eye gaze, and bodily motion, can reveal the otherwise hidden shifts in states of mind. Resonating with these expressions of primary emotions requires that the therapist feel the feelings, not merely understand them conceptually.”10
Three concepts that underlie the process of Dance/Movement Therapy are rhythmic synchrony, kinesthetic awareness, and kinesthetic empathy.
Understanding and practicing the use of these concepts can help clinicians discover and trust their innate ability to ‘attend’ empathically, respond authentically, and translate non-verbal experiences into cognitive insights.11,12
 Renfrew 251 (5)Renfrew 259 (2)
Picture 026
Use of these concepts also can lead clinicians to access their own creative process and to recognize that “all they need is within them now.” This same concept can be passed on to their patients.
  • Rhythmic Synchrony manifests in the clinicians’ ability to attune to their patients. When clinicians are in synchrony with their patients they are more attuned to their clients’ emotions. They are also more likely to understand and address the distress that lies beneath the patients’ anxieties and resistance.  
  • Kinesthetic Awareness represents the individual’s ability to experience one’s own feelings and sensations inwardly. If one is detached from listening to one’s own body, it is likely that others will respond with the same degree of detachment in their relationship.
  • Kinesthetic Empathy is the ability, on a body level, to understand what others are feeling. This has significant relevance to the therapeutic relationship and the journey patients and clinicians undertake together. 
The following case of M. provides an example of how one can embrace and integrate these concepts into recovery.
M. was diagnosed with anorexia nervosa. In addition, she experienced severe anxiety, the result of an extensive trauma history. In residential care, she presented as quiet and passive. She described herself as “fat” and “disgusting.” Her frightened demeanor, evidenced by the light, barely connected way in which she quickly whizzed through space and the tiny voice she used when speaking, spoke to the manner in which she experienced living in her body. By her own admission, she was constantly trying to get away from herself and was, in fact, a runner. She had difficulty tolerating being in any situation for extended periods of time. Our first session lasted only 20 minutes. As our relationship grew, she was able to sustain 50-minute sessions. On one particular day, she seemed more anxious than usual. She picked at her cuticle, shook her leg repeatedly, and jumped whenever she heard a noise. I asked her what it meant to her to be grounded. She explained, “I think grounding makes everything around me smaller and more dense.” In decoding this perception further, she went on, “It makes me concentrate, focus, and slow down, but this can be scary for me.” We attempted a variety of techniques including breathing to make it safer for her to embody feeling grounded by walking side by side and slowly pacing in one direction and then another in rhythmic synchrony. However, these movements were not terribly effective. Noting the two large chairs nearby, I thought that perhaps it would be helpful to push a chair, like a walker. M. indicated that she was willing to try. Together we pushed our chairs forward at the same time in a type of dance, moving forward, back, turning, etc.  M. became calmer and exclaimed, “something clicked in my brain!” Although unable to understand exactly what it was that had “clicked,” M. did understand she felt calmer, the chatter in her brain lessoned, and her nervousness diminished. Several days later, we met again and repeated the experience with the chairs. She informed me that it DID indeed help her again get in rhythm with herself and she felt more at ease. M. learned a specific form of grounding, unique to her, that was critical in her ability to integrate the technique of grounding into her life. She felt more understood, both by herself and in our therapeutic relationship as a result of our expressive work together. Because she felt  less vulnerable, M. revealed several issues with which she also wanted help. 
The last several weeks we met, we worked reviewing, repeating, and exploring her soon-to-be transition home. We practiced walking together, guiding our chairs, and exploring how she could practice this after discharge. I heard from her weeks later. “I am home and still trying to adjust. I went to Target and thought about you as I pushed the shopping cart. That helped me relax and concentrate on our experience of pushing the chairs instead of focusing on the people around me and feeling anxious. Trying so hard to use the tools you gave me.”


By its very nature, an eating disorder blocks patients’ vitality by shutting down their natural life forces. The use of Dance/Movement Therapy provides a powerful medium to reclaim those life forces through both actions and words, often leading to long-lasting changes needed to sustain recovery. Inviting individuals with eating disorders to be the “choreographers” of their own lives, encourages them to discover their unique, natural movements that are so integral to the expression and embodiment of their authentic selves.13