Counselling for Eating Disorders in Men

Person-Centred Dialogues

Richard Bryant-Jefferies

• Publisher: CRC Press
• Year: 2018
• eBook ISBN: 9781315358543
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

According to the Eating Disorders Association there is a general lack of recognition of eating disorders in men, making it more difficult for male patients to access specialist services, although clients with problems connected with over-eating, under-eating, and poor eating form a significant proportion of counsellors' lists.

This book focuses on men whose eating patterns have generated side-effects on other aspects of their lives such as work, health and family. By adopting the unique approach of the Living Therapy Series, using fictitious dialogue to illustrate the person-centred approach, the reader is able to experience directly the diverse and challenging issues surrounding patients. This is difficult to achieve with conventional text books. Counselling for Eating Disorders in Men provides vital insight for trainees and experienced counsellors, as well as men suffering from eating disorders, their friends and families. It will also be of interest to members of support organisations.

PART 1

Keith realises he has an eating disorder

CHAPTER 1

Setting the scene

The doctor’s surgery was busy; it was the evening rush. The doctors had been over-running and there was a backlog of patients waiting to be seen. Keith looked around, the only place left to sit down was in the corner, but it was a small space and, well, he knew he wasn’t going to fit into it very easily. It served to remind him why he was there - not that he needed reminding.

He’d mentioned his weight to his doctor at different times in recent months and, well, it had never gone any further than a kind of ‘blokey’ discussion about how some people just are big, and how perhaps he should cut down a bit on his fatty food intake. Nothing more than that. However, he had seen a different doctor a few weeks back and she seemed more concerned. She gave him a leaflet about obesity and suggested that he really needed to do something about it. In talking about it to her she recognised that he was actually feeling quite depressed about it. He had lost his motivation recently, everything just seemed an effort. Some days it was really difficult to go to work. And he didn’t always sleep well; he often woke up and felt quite drained in the morning. Things weren’t easy with his wife, either. Their sex life had, well, basically it didn’t exist. She said his size put her off. Quite why she felt that now he didn’t know. He’d always been big, so why the problem now? Yes, he’d put on more weight; yes, he was over 20 stone now, but he’d generally been around 17 stone for a long while, and she’d not complained so much in the past. Anyway, he thought, she’s not exactly petite.

And then there was all the fuss about it in the papers and on TV. He knew he was overweight, he didn’t need to be told that. But it wasn’t easy. Too much temptation. He’d always had what he considered a healthy appetite and hadn’t really thought too much about what he ate. Only now, well, now it was becoming more of a problem to him and he wanted to try and do something about it.

And there was a sense of shame and embarrassment. The thought of having to talk about his weight to someone was offputting, and he wasn’t sure that it felt easier because it was a woman, or whether that made it seem more difficult. He knew it somehow didn’t feel right, irrespective of whether it was a man or a woman.

So, here he was, about to see a counsellor to talk about losing weight, and about his feeling depressed about it. He wondered whether he really needed the discussion.

He looked around the waiting room. Yes, for sure, he was probably bigger than anyone else, but there were a lot of overweight people around. He looked over to the seat that was free, and the two people either side, both of whom amply filled the seats they were sitting on. They weren’t seeing a counsellor, so why was he?

Counselling session 1: exploring the problem

His thoughts were disturbed as he heard his name being called. He looked over to where the voice was coming from to see a slim, white, middle-aged woman with dark hair, looking around the waiting area.

‘Hi, that’s me.’

‘Hello, would you like to come through?’

Keith followed her along the corridor.

‘We’re in here, come in and take a seat, whichever you prefer.’

Keith nodded and moved over to the seat on the left. ‘Thanks.’ It was a relief to sit down. He got tired just standing some days. He realised he was quite hot and took out a handkerchief to wipe his face.

‘So, we spoke on the phone when we arranged today, and I told you about the counselling. Did you have any questions, anything that you were unsure of?’

‘No, no, thanks.’

‘And you’re OK with confidentiality as I described it and as it’s described in the leaflet that the doctor gave you?’

‘Sure, yes, I understand.’

‘And I just need to confirm that you agree to counselling.’

‘Yes, I mean, I don’t know if it’s what I need, maybe I should be at Weight Watchers or something.’

‘You feel something more directed at your weight would be more helpful?’

‘Don’t know really.’ Keith lapsed into silence. He felt uncomfortable. He didn’t want to talk about his weight, you didn’t, not like this.

‘Not sure what would be most helpful.’

‘It’s sort of that, but, well, it’s not something, you know, that’s easy to talk about.’

‘Not easy to talk about weight?’

Keith felt himself looking down. No, it wasn’t easy. Somehow he sort of thought it would be difficult, but actually, sitting here now, it was suddenly a lot more difficult than he had anticipated. He felt ashamed of having to be there. Eating problems - they were women’s problems. Men were supposed to be big. It’s not a problem. At least, that was how he had seen it, and now his understanding was having to change. It just didn’t seem right.

Feelings of shame, of it not feeling right to have to think about having an eating or a weight problem, are experiences that are likely to arise in men. The client is expressing important features of men’s experience. They need to be warmly accepted and empathically understood by the counsellor. This understanding may be more difficult for a female counsellor to convey than a male counsellor. At least, the male client may believe that a male counsellor would understand more easily. The female counsellor is likely to have to work at communicating her empathy for what the male client is experiencing and communicating.

It’s a woman’s thing. No disrespect, but women talk about their weight, worrying about what size they are. You don’t do that if you’re a man, not like that. I mean, where do men go? You only ever hear of women going to Weight Watchers. I’m sure it isn’t just women who go, but, well, somehow that’s how it sort of feels. Don’t know that I really want that.’ Keith didn’t want to be with a lot of fat women. He was sure that men went as well, but he didn’t really feel much motivation to find out.

‘No disrespect taken.’ Rosie smiled. ‘And I really do hear you saying how it just doesn’t feel like a manly thing to talk about weight as a problem or to worry about size. And you don’t want to be with other women.’

Keith shook his head. ‘No, I don’t know what I want. I accept I’m overweight. I know that. I know I’d like to be left alone to sort it out for myself, but I also know that I can’t. I don’t like it, but I need help.’

‘You know you need some help.’

‘But where to begin?’

‘Where do you want to begin, what can I try and help you with?’ Rosie wanted to leave the start open for Keith to take whatever direction he felt he needed to.

As a person-centred counsellor Rosie will be seeking to apply the non-directive nature of the approach. This will mean accepting that the client knows what he needs to talk about, what he wants the counsellor to hear. It is linked to her trusting of his process, that he will use the counselling sessions in ways that will meet his needs, serve to fulfil his agenda. She does not know what aspect of Keith’s weight problem he most needs to talk about, and very likely he will begin to talk about those aspects of it that he feels safest to express. That is fine, and offers an opportunity for trust to build so that, in time, he may feel more able to explore other aspects of himself that might otherwise feel too painful or embarrassing to disclose. Here there are only six sessions, however, the person-centred counsellor will not hurry the client. The time will be used by the client who will set the pace and the direction.

Keith sat, what was there to say? He was too fat, that was the simple fact, and what was he going to do about it? The thoughts went through his head as he tried to think of what to say. What did he want to say? ‘I need to lose weight, it’s getting me down. Doctor thought it would help if I talked to someone.’

‘Mhmm, so your weight is getting you down.’

Keith nodded. It had been a struggle to get up again that morning. He’d managed to and had got off to work. He worked at a local supermarket. He wasn’t a store manager, anything like that, but he had responsibilities for some aspects of the business. It was OK, but seemed quite boring some days. Same sort of routine. Just seemed such an effort.

‘Yeah, makes everything a struggle, at least, it does these days.’

‘So it’s more of a struggle now than it was?’

Keith nodded. He was looking towards the window, he hadn’t really made any eye contact with Rosie. He didn’t feel at ease. It felt strange to just talk about himself like this. He had noticed she was quite slim and, compared to him, well, certainly smaller - not that that was too difficult, he thought to himself. It didn’t feel right, that was what kept coming back to him, it just didn’t feel right, sitting here with a woman he didn’t know to talk about his weight. It didn’t help his mood.

Rosie was aware of Keith seemingly avoiding eye contact. She accepted that was how he needed to be. Why should she expect him straight away to want to look in her direction? Counselling was stressful, it was often something new for people, who could find the nature of the dialogue difficult to adapt to. She knew she could respond to his body language, but not this early on in a session. It would probably make her client more defensive, feel that whatever he did was being analysed, which it wasn’t.

Keith continued to let thoughts pass through his mind as he looked towards the window. Yes, he thought, it’s a struggle, everything’s a bloody struggle these days. He took a deep breath and let it out with a heavy heart.

Rosie watched Keith’s breathing. ‘Just seems all too much, sometimes.’ She felt she wanted to empathise with what she felt he was still communicating by the way he was breathing and the expression on his face - what she could see of it.

Keith nodded. ‘Yeah, it just gets me down. I mean, I’ve always been big, that’s me, ever since I was at school.’ He pushed away memories that this sentence brought to mind. ‘Just how I am, but, OK, I have put on more weight recently. I’ve mentioned it before to my doctor. I usually see Dr Jones and, well, he never really said much, told me to cut out fatty food a bit. He’s known me a long time, maybe that was the problem. The new doctor - straightaway she was giving me a leaflet, giving me some ideas and, well, sending me to see you. She also told me that she thought I was depressed about it. She told me some of the symptoms of depression and, well, yeah, I’ve got them, but they’re not new. I mean, makes me wonder how long I’ve been depressed.’

‘You feel like you might have been depressed for a long time?’

‘Well, made me think. Maybe I have been, I don’t know. But she said she wasn’t going to give me anything, thought it better for me to see you. So here I am.’

‘Yes, she mentioned in her letter to me that she wasn’t going to prescribe anything, but wanted you to have an opportunity to talk it through and explore things with me, and see how that went first.’ Rosie felt it appropriate to link what had been said to the letter, so that Keith was clear about what the doctor had said. In fact, Rosie had mentioned this before when she’d spoken to Keith on the phone.

Overweight and depressed. That’s me.’ He shook his head. ‘So, what do I do?’

‘That’s you, overweight and depressed, and now it’s a matter of what can you do about it?’

‘I’ve got to do something, it’s just that, well, it’s all such an effort. I get so tired sometimes. And eating, well, it’s so easy. And working in a supermarket doesn’t help. I mean, it’s bad enough to be surrounded by food, but I see all the offers, you know, the pasties reduced at the end of the day, that kind of thing. And I’m always taking stuff home. Well, it makes sense, but then I eat what’s there - so does my wife, Sal; though I think she’s more controlled than me, and she tends to go for the sweet things more than me, though I do eat them as well. I go more for the savoury foods. Once I start it’s hard to stop. I mean, take yesterday, they had these meat pies on offer, deep-filled, really quite chunky. They’d reached their sell by date. Now, I could have taken one home, but I took two. OK, so the kids’ll have some, sure they will. But that could have lasted for at least two days, but no, it’s all gone. I’ve eaten at least one whole pie, and a bit of the other. I can’t help myself. Anything like that and I’m there. And, yeah, I do like a fry up, and I guess I eat a lot of meat, and the fat. It’s what I like, what I’ve always done. Now, well, now I know I have to do something but I just can’t seem to feel motivated. Rather have something to eat.’ He shrugged his shoulders. He had now turned to face Rosie.

‘Mhmm, no motivation to break the pattern, and if anything it just leaves you feeling like having something else to eat.’

Keith was nodding though unaware that he was. He was listening to what Rosie had said and, yes, that was exactly how he felt. Stupid, he thought, trying to eat less and all you want to do is to eat because it’s too much effort. ‘What do I do?’

‘You sound desperate for an answer, Keith. It’s OK if I call you Keith?’

‘Sure.’

‘And call me Rosie.’ She paused, and brought the focus back ‘Yeah, desperate for an answer.’

‘I’m sure the doctor’s right, I’m sure I am depressed, but whether it’s because I’m overweight, or because ..., oh I don’t know, maybe it’s everything, just gets me down.’

‘Everything gets you down?’ Rosie sought to clarify what Keith was saying, and she emphasised ‘everything’ as that seemed such a key word in what Keith had been saying.

‘Here I am, 30 years old, married, two kids, secure job, should be feeling good about things, but I don’t know, I can’t seem to feel enthusiastic about much. Just sort of plod on, I guess.’

‘Just plodding on, can’t feel enthusiastic’

‘And that’s not me. I mean, it is, but I wasn’t always like this. I mean, yeah, OK, I had a crap time at school, lots of kids do, so I’m not blaming that. But I was, I don’t know, happier? Is that what I mean?’ He took a deep breath and sighed. ‘I don’t know and it gives me a headache thinking about it. Goes round and round, you know, round and round. I eat to distract myself sometimes.’

‘So, eating is a way of stopping you thinking?’

‘Sometimes.’ Keith stopped, and, yes, sometimes he ate because he ate, that was all there was to it, habit, he supposed. These were the thoughts in his head in response to the dialogue that had just taken place, anyway.

‘Sometimes.’ Rosie nodded slightly and waited to see how Keith might want to develop this, or if he felt he needed to focus elsewhere. She maintained her feelings of positive regard for him. As she observed him before her, yes, he was overweight, no doubt about that and size was something that could make such an impression on people, and trigger all kinds of assumptions about the person. And yet their personhood isn’t fat, just their body. Yes, it will have contributed to shaping their self-concept, no doubt, and/or their self-concept may have played a part in shaping their body, but the body was not the person. We are so visual, she thought to herself, and Western well, no, maybe all cultures, or most of them, were so oriented to the visual image of a person, how they should look. So much pressure to be a certain way. So much other added temptation to be different as well. What a society. All the glamour magazines pushing for sleek bodies, whilst constantly advertising junk food in their pages. No wonder people end...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Foreword
• Foreword
• Preface
• About the author
• Acknowledgements
• Introduction
• Part 1: Keith realises he has an eating disorder
• Part 2: Terry confronts his eating disorder
• Author’s epilogue
• Appendix: Rogers’ seven stages of constructive personality change
• References
• Useful contacts
• Index