Episode 204: Chris sits down with renowned clinician, author, and speaker Carolyn Costin to talk about eating disorder recovery. Using Carolyn's book, 8 Keys To Recovery From An Eating Disorder, as a basis for the conversation, they share their knowledge, experience, and ideas for how to implement the key principles.
Carolyn Costin is a world renowned, highly sought-after eating disorder clinician, author, and international speaker.
Recovered from anorexia in her twenties, as a young therapist Carolyn recognized her calling after successfully treating her first eating disorder client. She was first to publicly take the position that people with eating disorders can become fully recovered.
After 15 years in private practice and running hospital programs, Carolyn was determined to improve the relapse rate and recognized a gap in the eating disorder field and thus opened the first residential facility for eating disorders which she ran for 22 years.
Carolyn’s contributions to the eating disorder field are extensive including six books, the most popular being 8 Keys to Recovery From an Eating Disorder. She opened the Carolyn Costin Institute in 2016 where she offers certification for Eating Disorder Coaches, as well as other training programs.
Carolyn continues to lecture around the world and is an active, passionate, inspiring force in the eating disorder field.
To learn more, visit Carolyncostin.com
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Chris Sandel: Welcome to Episode 204 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is seven-health.com/204.
Hey everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. This week on the show, I’m back with a guest interview, but before I get started with it, I want to announce the winner of this week’s book competition.
The winner is DD. Thank you. You’ll be receiving a book of your choosing from our Resources page, and we’ll be in touch about this very shortly. Reviews are really a huge help for the podcast; they help to increase our listenership, and they’re also a way for you to win a free book. All you need to do is leave a review on iTunes, take a screenshot of it, and then email it to info@seven-health.com, and then you’ll be permanently entered into the drawing.
As I mentioned a moment ago, this week on the show it is a guest interview, and my guest today is Carolyn Costin. Carolyn is a world-renowned, highly sought after eating disorder clinician, author, and international speaker.
Recovered from anorexia in her twenties as a young therapist, Carolyn recognized her calling after successfully treating her first eating disorder client. She was first to publicly take the position that people with eating disorders can be fully recovered. After 15 years in private practice and running hospital programs, Carolyn was determined to improve the relapse rate and recognized a gap in the eating disorder field, and thus opened the first residential facility for eating disorders, which she ran for 22 years, called Monte Nido.
Carolyn’s contributions to the eating disorder field are extensive, including six books, the most popular being 8 Keys to Recovery from an Eating Disorder. She opened the Carolyn Costin Institute in 2016, where she offers certification of eating disorder coaches as well as other training programs. Carolyn continues to lecture around the world and is an active, passionate, inspiring force in the eating disorder field. To learn more, you can visit www.carolyncostin.com or email her at carolyn@carolyncostin.com.
I’ve been aware of Carolyn for many years now. I first heard her name and became aware of her from reading Portia de Rossi’s memoir, Unbearable Lightness. Portia struggled with her own eating disorder and then ended up working with Carolyn, and that’s talked about as part of the book. Since that time, I’ve heard Carolyn on a number of podcasts, and I’ve also read her book 8 Keys to Recovery from an Eating Disorder.
During the start of the podcast, I outline with Carolyn what we’re going to cover as part of it, so I won’t repeat it here, but some of the highlights from the podcast from my perspective are Carolyn highlighting the importance of a strong therapeutic relationship between practitioner and the client and that it doesn’t matter if you’re following the best evidence-based practices; if the trust and the relationship aren’t as they should be, it’s really just not going to work.
She highlights the importance of working with clients that you have in front of you and finding ways to turn whatever traits they have into strengths, and she tells the story of a client with OCD and how she was able to use that in a positive way to assist recovery.
She challenges my idea of full recovery and actually takes it a lot further than what I had previously stated. Carolyn, as I said in the intro, was the first person to talk about full recovery from an eating disorder rather than it being a state of ongoing recovery like it is with the addiction model. It was great to have a conversation about this and for Carolyn to outline her beliefs and how far she thinks full recovery really entails someone to go.
These are just the tip of the iceberg, and there’s so much more helpful information as part of this episode, both for those struggling with eating disorders and for those who are coaches and practitioners in the field. I really loved this conversation. It felt like we could’ve easily gone on for another two hours and not even noticed it. So, let’s get on with the show. Here is my conversation with Carolyn Costin.
Hey, Carolyn. Thanks for joining me on the show today.
Carolyn Costin: Thank you for having me.
Chris Sandel: I would love as part of our conversation today to use your popular book and a book that I’ve read and really loved, 8 Keys to Recovery from an Eating Disorder, as the basis for a lot of our conversation. I also know at the Carolyn Costin Institute, for your coaching program, a lot of the modules follow the same keys as the book. So I thought we could use that to speak to both people who are suffering with and dealing with an eating disorder, but also the practitioners who are helping people out along that journey and who also listen to this podcast.
That’s an overview of what I’d like to cover, but I’m also very happy for us to go off in other directions and just see where the conversation leads us.
Carolyn Costin: That sounds good to me. I originally wrote that book for clients, but a lot of practitioners and family members and now coaches are using that book, so I think it’s good. We can probably cover a wide angle on it, so that’s fine.
Chris Sandel: Just so you know, I’ve never had an eating disorder, so I very much read this from a practitioner perspective. But there’s a lot of really useful information in there for practitioners. While it is definitely aimed at someone who is dealing with this, it doesn’t feel that it’s written in a way that makes it very difficult for a practitioner to take it in and understand how they can be using that helpfully in their practice.
Carolyn Costin: Right.
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Chris Sandel: I guess to start with, do you want to give listeners a bit of background on yourself, like a bio of sorts? Who you are, what you do, how you spend your days?
Carolyn Costin: Well, I’m a private practice psychotherapist who started out that way. First a teacher and then I was in private practice. This was so many years ago. In 1979 I started my practice. I had recovered from anorexia nervosa and was referred a client, and the person said, “She has that thing you had.” I was kind of reluctant to take the client because I was a little bit afraid. Would it trigger me? Those kind of things. After seeing her, though, I realized we had such a good bond. I had such a good way of understanding and asking questions that she had never been asked.
That really started my career, because after that, her family knew somebody else, and then somebody knew somebody. Ultimately, over the years, I ended up with a full practice, opening a few hospital eating disorder programs, and then realizing that hospitals were not the place for people to get better, and opened Monte Nido, which was the first residential treatment center in this country, where we could have a home-like setting and we could sit around the table and have meals and go hiking and have exercise class.
Now, residential treatment is becoming ubiquitous across this country, but then, it was a new thing. I sold that company in 2016, and now I have the Carolyn Costin Institute, where I train clinicians and dietitians. Also, probably my favorite thing is I’m training eating disorder coaches that are a lot like life coaches, sober coaches, but there were no training institutions for eating disorder coaches. So it seemed like a natural thing for me to do, the way I live and my philosophy – which I guess we’re going to talk about.
So now I have these coaches who are out there in the world, filling a gap between people who may not need to go into treatment programs, but they need more than an individual therapy session once a week. Especially the hands-on kind of help, like going to a restaurant or making a meal at home or going grocery shopping or things like that that are really hard for people with eating disorders to do, and nobody was helping them do that.
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Chris Sandel: Nice. The coaching aspect of it sounds fantastic, and I do really want to get into that as we go through the 8 keys. But I want to dig into your story a little bit more. You talked about recovering from an eating disorder. Can we talk a little about that? What was food like growing up in your household and as a child?
Carolyn Costin: It’s interesting. My father was always on diets, like the Sego diet. Most people probably aren’t even old enough to remember that, where you bought little canned meal replacement supplements. He was also kind of a womanizer. So I have an interesting background in the sense that he made some comments to me about my weight. But also, I think an interesting thing was he left my mother for a fashion model, so I’m this classic story – this woman who was modelling with Twiggy – and here I am, about 13 years old, and he leaves my mom for a fashion model.
So there’s that, but also, I fully agree that people who have a vulnerability to develop something like an eating disorder and something like anorexia nervosa, also there’s a temperament piece. I was that classic anxious, perfectionistic child. You combine my temperament with the culture I was in and the fact that Twiggy, here’s this famous model, my dad marries a fashion model and leaves my mom – I think I just had a perfect storm that created this ability – when everybody was going on a diet, I went on a diet and was the one who lost more weight than my friends and got all of this praise for it.
It was kind of set in place when I went off to college, and in my first year of college it was really quite bad. I came home pretty unhealthy.
Chris Sandel: When you said you came home unhealthy, did you think you were unhealthy at the time? Or in retrospect you can say you were unhealthy, but how did you feel at that point?
Carolyn Costin: Oh, that’s such a good question. I didn’t feel unhealthy physically. I was a runner and I was running, and basically I said, “My body is my body and you guys should leave me alone,” my family who was complaining or my friends saying I was too thin.
But what I did recognize is mentally I was struggling. I was actually more anxious in ways because I couldn’t go with friends to have meals. If anyone invited me, if I got asked out on a date, I would be really worried all the time beforehand – what was I going to do in front of this person if he took me out to dinner? Those kinds of things. I realized at some point that I wasn’t in control of it. It was in control of me.
That was a big turning point, when I realized I didn’t want to keep losing weight, but I was so afraid at this point of gaining weight. I think that’s really important because that happens a lot in anorexia. The person doesn’t really want to be 79 pounds. They don’t want to get so low and ruin their life. But they’re so afraid of gaining weight and becoming fat that they keep on losing.
I had, luckily, this realization – that was one of them; I think there are many in recovery – of, “Oh man, I’m not controlling it. It’s controlling me.” So I went off to see the school counselor at the university. Unfortunately, at that time, I think she was more fascinated with me than anything else because she had never seen anyone who had anorexia. She’d never even heard of it. She was quite stumped.
Ultimately, I didn’t get any help from her. The way I ultimately got better had a lot to do with my own challenging myself, my own reading of spirituality books, starting to follow some Buddhist principles about that we have a soul and we’re not just a body, and a lot of things like that that actually helped turn me around rather than any formal treatment.
I don’t say that very much because I don’t want people to think, “Oh, I don’t have to get treatment.” I think it’s different nowadays, and there’s a lot of available treatment out there. There really wasn’t when I was quite ill.
Chris Sandel: Had you come across even the term “anorexia”?
Carolyn Costin: No. This was before Karen Carpenter. Karen Carpenter was on the cover of Newsweek or Time Magazine in the early ’80s. Well, maybe mid-’80s, ’86, ’85, something like that. This was in the late 1970s. I had never heard of the term.
My mom took me to a doctor, and the doctor had heard of it and gave my mom an article for me to read, which I found incredibly distressing because I felt like someone had crawled inside my brain. [laughs] But there just wasn’t that much. There was a little around then, but there were no books out or anything like that. No journals devoted to this illness. It was a unique time.
Chris Sandel: How long did it take from the point at which you started to engage in these behaviors until that point where you’re like, “Okay, this is now a real problem and I need to get out of this”?
Carolyn Costin: I would say the whole process – it’s hard to say because you don’t know, when did it go from diet to disorder, and when did it go from disorder to recovered? It’s not like you wake up a day and you have an eating disorder and you wake up a day and it’s gone. But I would say my general estimate is that the whole process was about 7 years before I was really recovered – I mean where you don’t think about it, you’re not struggling one day at a time, you don’t scrutinize all the menus for the lowest calories. You actually become free again.
I really believe your brain, that gets hijacked, becomes released. I really do. That’s why I am a firm believer in saying people need to shoot for being fully recovered and not in this no-man’s-land of recovering or recovery, like the addiction model.
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Chris Sandel: I know you were one of the first people to talk about that. How long post you being recovered were you then starting to say, “Hey, I think that this is the thing that people should be aiming for?”
Carolyn Costin: Ooh, nobody’s ever asked me that question in all my interviews. How long? Let me think about that for a minute.
I started thinking about it I would say before I even would’ve used the term “recovered” because I felt like “I’ve gained weight back, I’m eating” – but still there are thoughts, and still something happens and you get triggered back. Still it becomes a coping mechanism. I was teaching high school at the time.
I think once I started doing more practice as a psychotherapist – it was probably that first case that made me realize, “Oh my God, I have something here. I have a knowledge that I need to share.” I started writing about it, and that was probably in the early 1980s I started writing. I thought I was going to write a book. Then The Golden Cage I think was the first book that came out, and it threw me off because I thought, “Oh well, the book’s been written.” Obviously there are hundreds of books now, but at the time, I put down my pen and paper – because I was writing on one of those legal pads back in those days.
But eventually I did end up writing, and as you know, I have several books now, because I thought from the perspective of someone who’s recovered, this is unique. Everything I was reading was from people who were studying it academically or were studying it in hospital programs and treating patients. But they said a lot of things about patients that I thought were, in a way, inaccurate, or at least were not getting to the depths and were not really helpful for the patients.
Chris Sandel: Can you give examples of that?
Carolyn Costin: For example, I had a well-known clinician at a lecture once talk about how she admired people with anorexia nervosa because of their willpower. I came up to her afterwards and said, here’s what you have to understand. It looks like willpower, but basically our brains have now obligated us not to eat it. What you have to teach someone who wants to get better is that they’ve lost their true ability to have control. They don’t have control like they think they do. If they did, what would be harder for someone with anorexia: to eat a cookie or not? What would be harder is for them to show they could eat it.
You have to do this, because if you keep saying, “Oh, you have such willpower,” that reinforces it. That makes that eating disorder self say, “Oh wow, look at all our willpower,” whereas I want to take that logic and challenge it and say, “You don’t have any willpower. You ended up in a hospital, for God’s sake. What kind of willpower is that?” Things like that.
Chris Sandel: When you did talk about full recovery, was there pushback on it? Or there wasn’t pushback on it because people weren’t even entertaining it and weren’t even thinking about the idea?
Carolyn Costin: There was immediate pushback, but I didn’t really know about it. I was treating people, and when people came to my office I said, “Look, I got better. So can you.” I didn’t even know there was a different philosophy or a conflict, but I started getting clients who were going to OA meetings, and they would come in and say, “In the meeting, I admit I am powerless over food.” I was like, “What? You’re not powerless. Here’s food, here’s you. Who do you think is more powerful?” I was astonished.
I didn’t know much about the 12-step program, so I started looking up the origins of the original 12 steps, then how it morphed into OA – which was started for binge eating disorder, people who were binging. I thought, okay, I have to come out with a different philosophy here.
We’re going back about 35 years ago. I spoke at an international conference called Recovered versus Recovering, and I brought five recovered patients with me who had been recovered for at least 5 years, one of them more than that, and announced to the audience that these programs that had opened up, these hospital programs around the country that were using the 12-step model – they did it because I can understand, there are addictive components to eating disorders. There are things that feel addictive. It looks like an addiction.
But on the other hand, you can’t get food out of your life. If you’re addicted to alcohol, you can get alcohol out of your life and you can say, “I can never have that, and if I do I’ll go off the wagon” and all those things. I thought, this is ridiculous to do with food. I have to teach people that they have to get back to a healthy relationship with food, and I firmly believed that if I could, everybody could.
That first lecture, the night before I was going to give it, some people came up to me and said, “I saw the title of your program, Recovered versus Recovering. I can’t believe you’re going to do that.” Then I got really nervous. But I did it anyway, and it got such an amazing reaction on all sides that they asked me to come back next year and debate their 12-step people – which I did. I think at that point, it was the highest attended ending keynote session they ever had. It was interesting.
And still to this day, it’s still a little bit going on. The new version of it these days is, is it a genetic disease? I still like to call it a disorder because I believe that you can get disordered and you can be recovered. I know genetics – like I said, my own temperament played a part. But I don’t think it’s predetermined destiny genetics. Like for me, for example, my genes are still the same. They didn’t change. But I’m recovered.
So I think it is a disservice to people who are struggling to put too much emphasis on the genetic part because what are they supposed to do about that? Except for temperament training, which I do. And that’s in Key 3. I do believe in it.
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Chris Sandel: I’m on board with you in terms of I believe in full recovery. I guess the thing is the caveat I always add with that is that you then don’t outgrow those temperaments in terms of – it’s not like you’ve had an eating disorder and you get over it and now if you participate in dieting, you’re not going to end up in the same place that you did before. If you start dieting and doing those behaviors, it’s likely you’re going to get back into an eating disorder because that’s just how you’re wired.
Carolyn Costin: I don’t even think that. Let me just say this. I think that there’s a problem there in assuming that somebody – because let’s say somebody has a problem. Let’s say they’re an athlete. I’ll give you an example. Recovered from an eating disorder for 10 years, doing really well, gets injured, a bad back injury, gains a lot of weight, and wants to lose that weight afterwards. Should she not be able to lose that weight because she once had an eating disorder? I don’t think that’s fair.
What I think is people like that – in my opinion, if you are really recovered and have dealt with your temperament and know how to mitigate it and know how to do things in a balanced way and watch out for any perfectionism or things like that, you could go on a diet. I certainly don’t advise dieting for people. However, there are cases where I think the field has gotten too overzealous about “nobody can ever lose weight again,” and I don’t think that’s fair to people who can do it in a managed and healthy way if something has happened in their life.
Or another example I have is a client who got diabetes. She had gained weight over the years, and she didn’t care that much about it. She was accepting that she likes to eat a lot of rich, wonderful foods, and who cares? But then she got diabetes and had a really hard time managing, and her doctor said, “We think if you lose weight…”
I said, “Let’s not focus on losing weight at all, but let’s look at changing your relationship to food because there are some things you’re doing that are a little bit out of balance. Let’s look at it. What do you think? What would you like to stop doing with food that you can’t stop?” “Well, I wake up in the middle of the night sometimes and eat a lot of chocolate cake.” There were behaviors that made sense to work on.
So she comes back to see me and she works on those behaviors, but she does it in a way that then she is no longer insulin dependent, she loses some weight, but she’s able to take it to that point. You see what I’m saying? I don’t necessarily want people to be doomed.
Interestingly enough, I have found that people who are recovered actually have some Teflon in terms of not taking it too far. Now, people might say, “But we know cases where people relapse.” I can say this, and I know people will be frustrated by it, but in my 40 years or so of being a psychotherapist with a specialty in eating disorders, the people who come to see me who have relapsed are people who, once you get into the weeds with them, didn’t really do their work in the beginning.
What I mean by that is they got symptom interruption and dealt with the symptoms, but they never really dealt with what you were saying, the underlying temperament issues – or other psychological issues that come into play. They didn’t really heal that. They thought they were over it because the behavioral symptoms were gone. So when they got triggered or challenged or something happened, they relapsed because that was their fallback. They hadn’t really gained other ones. Does that make sense?
Chris Sandel: Yeah, it does. Maybe me using the word “dieting” was the wrong choice of word, but I definitely find that if someone has a sustained energy deficit, that can be triggering enough, even if it is an unintentional energy deficit.
Carolyn Costin: Yeah, I think that could be. I had an interesting situation where years ago, I got a parasite from my travels – I do a lot of traveling, and I got a parasite. I was losing weight at a rapid pace. I lost 17 pounds, ended up in the hospital. There were a lot of rumors that I had relapsed and all this stuff.
But honestly – and I think people thought, “Now she’s going to relapse. She’s lost so much weight.” Interestingly enough, I was dreaming about roast beef sandwiches. I was dreaming about things I don’t normally eat. I was crying when the nurses came in and weighed me and said I had lost more weight.
All I would say is I just don’t think it’s inevitable. On the other hand, because of the temperaments like compulsivity, perfectionism, anxiety, harm avoidance – because of the temperaments, I certainly dissuade people from doing things like “Oh, I just want to lose 5 pounds.” I definitely think that people who have those temperaments have to be careful in anything they pursue.
But I can tell you that over time – and in Key 3, which really talks about the underlying issues, I’m a big believer in having people embrace their temperaments in the way that works for them. You probably know that if you went through the book.
Chris Sandel: Yeah, definitely. I think also what you’re speaking to is the longer someone is recovered and the more that they continue to do that work also, it makes all of those things I’m talking about a lot less likely.
Carolyn Costin: Yeah, that’s true.
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Chris Sandel: Let’s then move on to the book and go through the different keys as part of it. Key 1 is motivation, patience, and hope. Do you want to talk a little about that? And then I can be a little bit more directive in some of my questions.
Carolyn Costin: I wanted to start with that because people would always say to me – and actually, from the 12-step philosophy, they say you have to be willing to go to any length. There are quotes like that that I thought, wow, if I’d waited – or I was training therapists and they would say, “I’m doing more work than the client is,” and I would say, “That makes sense right now because they’re ambivalent about getting better. That’s okay.”
I think motivation is something that instead of the therapist coming to me and saying, “My client’s not motivated,” I would say that is your challenge as a therapist. That’s not something to be upset about. An eating disorder, no one comes in – I never met any patient who has come through my door, “Hey, I’m absolutely ready to get over this. What do I do?” It is fraught with ambivalence and fear.
My philosophy is that over time, what’s developed is this eating disorder self that’s protecting its ego state, that’s protecting its ability to stay around, and it will fight back any healthy self. The healthy self that a person was born with might say to somebody else, “You shouldn’t restrict your food that much. You could eat ice cream. We can all have some ice cream,” and yet the eating disorder self will say, “Oh, no, you can’t. You’re going to get fat.”
So motivation – I knew I had to write about it in the beginning, and I had to give people the idea that this is going to take time, and also give them examples of people who had recovered. It’s different now, but for a long time, treatment programs around the country would say, “We don’t hire recovered staff. We don’t believe in that.” I would end up seeing these patients over and over who said, “I never met anybody who was recovered.” I thought, what an awful thing. If you have depression or if you have cancer or anything and you never met anybody or read a book by or had your doctor talk about people they had treated who were recovered, that’s so sad, right?
So in that first chapter, I wanted to give examples of that, and I also wanted to talk about how motivation waxes and wanes. Two steps forward, three steps back sometimes because of the ambivalence and because of my philosophy that basically, you have this alter personality that’s been created – and you know it. When you start talking to clients with eating disorders, they get it. They know if they have bulimia, for example, they have this monster binge person inside that just takes over.
The idea is not to get rid of that part; it’s to integrate it so you become one whole person, because that part means something. It developed for a reason.
And that goes right into Key 2. Key 2 is all about how I don’t go to people and say, “I’m going to get rid of that.” I say it came for a reason. I want you to understand why it’s here and have the healthy self take over its job so that you don’t need it anymore, and it just fades from view, but becomes – the reason I say integrated is because I think if you fight it and try to get rid of it, it fights for its existence. I think if you teach your healthy core self that you were born with how to deal with whatever things the eating disorder is doing for you, then it integrates back and becomes not necessary except for maybe what I call an alarm system, telling you that something’s wrong, something needs attention.
Chris Sandel: Yeah. The idea that the inner critic is not all bad. It’s trying to alert you to things, but it’s then what you do with that in terms of the behaviors you keep up and then how much you put that in the driving seat. As you say, using it for what it’s useful for, but not letting it take over.
Carolyn Costin: Yeah. It reminds me on a deeper level of the difference between our ego and our soul. Eckhart Tolle says the ego is a wonderful servant, but a terrible master. It’s the same thing about the critic. It can help you be on your game better or improve things or succeed or have self-discipline, but once the critic takes over and has complete control, then it becomes an inhospitable person to live with.
00:34:05
Chris Sandel: Going back to Key 1, I know in the book you talk about the 10 different phases of eating disorder recovery, or even the 5 levels of motivation. I had Josie Geller on the podcast recently.
Carolyn Costin: Oh, I love Josie Geller.
Chris Sandel: Yeah, she’s amazing. I had such a great conversation. She’s done a lot around motivation and readiness. But we didn’t get a chance to chat about the 5 levels. Maybe just spend a bit of time on that, or talk about it a little bit.
Carolyn Costin: I think one of the things that’s really important – I don’t have it in front of me, but I think it’s –
Chris Sandel: Pre-contemplation, contemplation, preparation, action, and then maintenance.
Carolyn Costin: Yeah, thank you. The thing I think is really important about that, and one thing that I really listen to Josie about – I used to hear her speak about this – is that trying to force treatment on somebody who’s in the wrong stage actually does more harm than good. I think we forget sometimes, especially in a case like eating disorders where people get all up in arms and they get worried, “This person is so ill,” that we start to force treatment and make it not collaborative.
These stages, what’s really important is if you have somebody, for example, in the pre-contemplation stage, where they’re not really even thinking that they have a problem, I want to honor that. I certainly don’t want to put them in a level of treatment that’s just going to be a fight. I always tell therapists or coaches on training, if you don’t have collaboration on some level, you don’t have anything. You could be going into the session every day and saying, “We’re going to do this and this and this,” and they may be sitting there, but if they’re not on board at all, it’s not going to make any difference.
Having people begin to look at the cost-benefit analysis can shift them into the contemplation stage where they go, “Okay, I’m considering it.” Sometimes with pre-contemplation you just have to wait until there’s something that motivates them, something has happened in their life, or you can say, “Will you come for a while and listen to my story about being recovered and then you don’t have to keep coming?”
I’m very clear up front about it’s okay with me if you don’t get better. I still will have respect for you. I don’t get angry with you. I can’t take this away from you at all. I can’t make you stop. I hope I can make you want to stop.
Then you start shifting into those other categories like contemplation, where the person maybe does a risk-benefit analysis, where they look at, “Here are some things my eating disorder promised me – that I was going to get thin, that I was going to get more friends, that I was going to feel more in control. What’s the evidence for that?”
The book has a lot of assignments so people can try to figure out what stage they’re in. Sometimes people go back and forth in the stages. I would say the 8 Keys book is probably – well, I was going to say I think it’s probably most useful for people who are in the action stage, but I guess that’s not true because I’ve had some people who were given the book by other people and who were really in that pre-contemplation phase, but reading the book stimulated them to think, “Maybe I’m open.” It moved them a little bit forward. So I guess I’ll take that back. [laughs]
Chris Sandel: Maybe they didn’t know that it was a problem until they started to read it and then hear themselves in other people’s stories and think, “Oh, okay, maybe this is more speaking to me than I would’ve thought.”
Carolyn Costin: Yeah, I think that’s true. I think it’s true because there’s a lot of quotes throughout that book – well, one thing that’s fascinating, as you already know, is I wrote that book with a former client who had a really strong eating disorder for years. She recovered and became a therapist, and we ended up writing this book together so she can give perspective sometimes like, “Yeah, I know, when Carolyn said that to me, I doubted it too.” [laughs] It’s helpful, I think, for clients reading it to see that and hear that.
Chris Sandel: You talked about with Monte Nido. How often would you have parents ringing you and trying to get their child in, but them being in a complete pre-contemplation place and really not wanting to budge?
Carolyn Costin: It happened a fair amount, and I would often try to make sure that I got a good therapist assigned on that case to work with the person for a while. If the person is on death’s door, you have to get them in, if their lab values are off and their bone density is bad and they’re really emaciated, or they have a problem with their heart or something or with bulimia, then sometimes it’s like, “Get them in and I’m going to try and work on it when they’re here.”
But in other cases, what I would try to do is either talk to the outside therapist, get on the phone and talk to the client – sometimes I would ask the parent – let’s say it’s a daughter. “Who does your daughter listen to? Who has her ear?” They might say it’s a coach or it’s her best friend or it’s her boyfriend. I would say, have that person give her the book.
As a parent, if you’re already in a power struggle with your kid about this eating disorder and you give them the book, they’re going to want to throw it in the trash. So who do they trust? Have that person say, “Look, I just found something.” I would hope that once they started to read it, then there could be conversation.
And a lot of times I would get on the phone and strategize with the outpatient therapist too, about, why don’t you set some goals? This person does not want to go. They don’t think they’re bad enough. They don’t think they need residential treatment. Why don’t you set a goal that if they don’t gain a certain amount of weight – and give them 6 months, give them 4 months, depending on the situation.
What a lot of people do – and I’m a firm believer in this – a lot of people will yank that person out, take them away from school, put them into treatment, and they have so much resentment and hostility because they always claim, “I could’ve done it. I could’ve done it myself.” I like to give them a chance. A lot of times that makes parents nervous. It makes therapists feel like they’re giving in to the eating disorder. But I’ve been in this long enough to know this is a long range game. This is the tortoise versus the hare.
“Okay, I’ll collaborate with you. I’m listening to you. You say you can gain the weight on your own. Let’s see. How much time do you want to gain 5 pounds?” Sometimes I let them even pick. You win more in the long run when you get down to that point and you say, “Look, you said you were going to gain weight and you even lost. That means that you can’t even do what it is you say you want to do.” That’s far different from plucking somebody up and saying, “You’re going.”
But it takes a long range perspective, and honestly, it takes people in treatment centers not just wanting to fill beds.
Chris Sandel: Definitely. I’ve worked with many people who’ve had many times in treatment, and it never really sticks because for a lot of people in that situation, they will do whatever they need to do to get out of treatment and then they’ll go back to doing what they were doing before because of the fact that they were put there. They’re just like, “Okay, cool, I will play this game until I can get out of here and then I’m back in the driver’s seat.”
Carolyn Costin: Yeah. They’re very good at delayed gratification – at least people with anorexia nervosa. So believe me, they can put things on hold.
00:42:40
This is why I think it is so important to have individualized treatment also. We’re getting further and further away from that as treatment centers have rules and protocols and procedures that they try to do and grow and get big. Individualized treatment costs more. Individualized treatment with highly trained clinicians costs more. It concerns me a lot in this field, actually.
Chris Sandel: I was looking through on your site in terms of topic areas that you can do presentations on or do talks for, and one of them that really stood out for me was you talking about this real focus on doing things that had research to show successful outcomes and the things that have the best backing, but you then lose sight of someone being that clinician who is in the room with the person and who is able to do that dance, where it’s more of an art form, where you’re able to take in all these different things as opposed to thinking “No, this is the way we have to do X, Y, and Z because that’s what that piece of research showed and we’ve got to follow that protocol.”
Carolyn Costin: Yeah. The Academy of Eating Disorder Conference with ANZAED, which is Australia New Zealand Conference, is going on right now. I was actually supposed to be there speaking, but of course, with COVID it got cancelled and I had to do my talk on Zoom.
But I’ve been listening to some of the things and I listened to a real good one about this evidence-based treatment stuff. What’s difficult about it is – first, look at who’s doing the studies. Look at the percentages. Even the best studies, even if they help 50% of the people, you’ve got another 50%, which are the ones that we all end up treating. They’re the ones that don’t get better right away with things.
I think the thing that gets missed a lot is this idea of the therapeutic relationship, and there’s an enormous amount of research on the efficacy of the therapeutic relationship being one of the most robust predictors of success. You can have your CBT, your FBT or whatever models, but if you don’t have that, people drop out of treatment and they don’t even continue anyway.
Or you can have people who have a great therapeutic relationship and because of that relationship, as long as the person is trained and knows what to do with eating disorders in terms of making suggestions and holding goals and making sure the person gains the weight – all the things I was saying earlier – it’s not just about having a nice relationship, “Oh, I like you very much,” but it’s about having a good relationship which to me involves what I was saying earlier, which has a lot to do with collaboration.
I was asked to contribute to a book recently – which is another talk I was supposed to give which got cancelled – but I was asked to contribute to a book on trauma and eating disorders, and I said, “I will write a chapter in this book as long as I can write it on the therapeutic relationship.” Particularly when you’re dealing with trauma, if you don’t have that – trauma is all about the person being able to feel safe and how they were not made to feel safe, and now their neurobiology is wired that way.
So to me, creating safety is the very first thing, and that involves the therapeutic relationship. These kind of things often get missed in this world of “We’re just going to do this formulaic, evidence-based, manualized treatment.”
Chris Sandel: I totally agree, and I think that relationship is so crucial. Talking about trauma, just the trust piece and someone really feeling that they are able to trust you and that you’re in alignment with them. I mentioned Josie Geller earlier because that’s what’s drawn me so much to her work and her research, because it talks so much about that collaborative way of being with clients and how important that is in creating a good therapeutic relationship.
Carolyn Costin: Yeah. She was on this talk that I was listening to. She was bringing that up.
00:47:20
Chris Sandel: Nice. Key 2 we’ve already touched on a little bit: your healthy self will heal your eating disorder self.
Carolyn Costin: To me, if I could only teach one thing to new therapists, family members, a client, it would be this concept. The reason is because people really get it when you start talking to them about we’re all born with this healthy core self, and over time, an eating disorder is created through the things that we mentioned – psychological issues, temperament, genetics, diet culture, all these things.
Once that takes a life of its own, I start restricting. Then I overeat. I feel guilty. I purge. Then I realize, “Oh, that’s a good way to lose weight, and it’s also a good way to get rid of my anxiety.” So the next time I break up with my boyfriend, I go eat and purge. This whole thing starts developing a life of its own and habituates into what I call this alter personality.
You can even interview it. “What do you have to say? What do you think so-and-so should be eating today? What do you tell her?” It really has this whole world, a different set of rules and behaviors. You can ask that same person, “What would you feed your 7-year-old niece?” and it’s going to be different.
I like to point it out early on. If you would tell your niece she can eat pizza, why do you tell yourself that you can’t? Ultimately the healing is the client’s two parts of self talking to each other and working it out as opposed to someone coming in from the outside and saying, “I’m going to fix this. I’m going to make you gain the weight” or whatever. You can make people gain weight, you can make them stop binging and purging, in a treatment center, anyway, but like we already mentioned, they can leave and go back right to it unless something fundamentally has shifted internally.
Most people recognize early on that they have these two selves. It’s harder for people with anorexia because they don’t like letting go of control, and in the beginning they say, “What do you mean? This is just me” – until I say, “How would you feed your sister, or if you were babysitting?” or things like that, and then they get it. I haven’t had anybody not ultimately get it. I say, “The battle is not between me and you or your parents and you. The battle is between you and you. You have two conflicting ego states going on in your mind, and that is a hard thing to live with.” They always recognize that. They get that.
Chris Sandel: I think your explanation there of how you would feed a 7-year-old – I think taking it out of the realm of themselves is helpful. I think it’s easier to do it in writing or in role play.
Otherwise, I think if – maybe not everyone, but most times when I talk about this with clients, their inner voice is in their exact same voice, so it can be difficult for them to recognize because it’s not like they’ve got this other Mickey Mouse voice which is really obviously not theirs, or it sounds like their dad or their mom or whatever. It’s all in the exact same voice. So that part can make it confusing unless you start to try and pull it apart in the way that you were talking about.
Carolyn Costin: I’m really glad that you brought that up, because I think people confuse this a lot with another technique called externalization. It was written in a book by a good friend of mine who wrote Life Without Ed. Do you know that book?
Chris Sandel: I do. Jenni Schaefer?
Carolyn Costin: Yeah. It’s a good book, but she will admit that in her first book she wrote, she wasn’t recovered, and she wrote a lot about how she externalized it. “I’m getting a divorce from Ed,” putting Ed out there, calling it Ed. I said to her, “I have a hard time with that because when you externalize it, I have clients now showing up for treatment saying ‘Ed made me do it.’” Then what are you supposed to do? Who’s supposed to control Ed if you’re not the one? I say, “No, you are Ed. Ed is you. Don’t call it something else. Call it your eating disorder self. It’s a part of you.”
That’s why it sounds like you. It doesn’t have a different voice. You’re not schizophrenic. You’re not dissociative. This is a whole different thing.
In her second book, I wrote the forward to it, and she actually acknowledged that and talked about integrating as opposed to getting rid of.
I think it really helped me in my own work, dealing with myself. I wasn’t thinking “I’m going to get rid of this.” In fact, when people were trying to help me, saying “get rid of the eating disorder,” I thought, “They don’t understand. This is me. I can’t get rid of me.” But once I came to my own conclusion – and that was a whole different story. I remember I was in college and going to a party and having this argument with myself. I realized I had these two battling ego states inside, and that really informed my practice.
Like I said, if I only had one thing to teach, it would be that because I think you can help people get in touch with – I’ve never met anybody who doesn’t have a healthy self down in there somewhere. They have it. They can’t bring it out for themselves, but they can bring it out for others. Which is why I love group therapy, because someone in group will be very empathic and resourceful, helping someone sitting right next to them who’s having a problem. Then I say, “Why can’t you do that for yourself?” It’s astonishing how they take a step back and go, “Oh, wow.”
00:53:40
Chris Sandel: Then Key 3: it’s not about the food.
Carolyn Costin: Key 3 is going away from the 12-step notion about being a food addiction, really to focus on there’s a lot of issues that you are solving or trying to deal with, with this relationship you have with food.
Like for me, I got a lot of praise and I got a lot of success as soon as I started losing weight, and that was important to me. I had grown up with this perfectionism and being an ‘A’ student and getting my validation in an external way. So that was one.
Or looking at all the different temperaments. That’s in Key 3. Looking at the various psychological things that happen in your life, or how someone might have used food to fill up an emptiness or a depression or a trauma and use food as comfort. So it looks at all the ways an eating disorder can get started and all the ways that perpetuate.
But I think the most important part about that chapter is looking at your temperament and figuring out how it works for you as an asset or a liability.
When I looked at the first research on temperaments and they were saying people with anorexia are perfectionistic, I was thinking, well, I like to think of myself as more tenacious or detail-oriented. I tried to change the terms they were using so that I can go back to my clients and say, “Look, I know you have that. I had that too. But now I turn it towards other things – my roses or the slides that I’m going to do for a presentation or having the best treatment center. I can’t get rid of my genes, my genetic predisposition, but I can try to channel it in a way that’s useful.”
So I try to give people back themselves in a way that they can accept it. Even the person with bulimia nervosa who has an impulse control disorder, I like to talk to them about how they’re probably the most spontaneous one of their friends, who’s the first one to take a risk by jumping into the cold river and having a swim. People’s traits – and during this COVID-19, I’ve done a few interviews or – I don’t know what they’re called; maybe it’s called a podcast, I don’t know – where I suggested, think about your traits right now.
In my household, I’m the one who was more anxious because I have a predisposition to be that way. I’m the one who made sure we had all the masks and all the sanitizers, and when we go out we have our gloves and we have our masks with us. I was the one washing every item of groceries when they came in. I started laughing at myself, saying, “Oh my God, this is hilarious. This is my temperament coming back in a way that right now is useful.” So you learn where it can be useful for you and where you have to watch it and mitigate it.
Chris Sandel: This is the bit of the chapter that I really do love the most and is something I’ve talked a lot about with clients because in a lot of ways, they’re channeling these things into their eating disorder. Also, in a lot of ways they’re already using these helpful temperaments in their life in a healthy way.
So many people that I see are real high achievers, they’re really smart – they’ve got lots of amazing traits that if they can just put everything in that direction, this is the thing that will then help them to recover. It’s just really about aligning these traits with recovery as opposed to aligning it with the eating disorder.
Carolyn Costin: Even somebody who has OCD, I have used that and said, “Look, we’re not totally changing. Yes, there’s medications and things that can help, but you have this. So let’s use it to your advantage.” It’s interesting; people would think I’m whack, but I’ve had several clients who had anorexia and OCD, and we took that OCD to help them – “You have to get the right amount of calories in every day.”
Now, most of the time I don’t talk about calories. I try to get people away from calories, away from numbers on the scale, any kind of numbers. My philosophy is we want to be away from that because numbers don’t tell us anything. But I might use something like that to help someone who “Okay, I don’t want to lose any more weight. I really do want to run my track, and if I lose weight” – helping them use that ability that can get locked into following the rules to say, “You have to get this much in. I don’t even care how you do it. You count,” and give them something to place the OCD in a way that’s useful for them.
What I find happens is it doesn’t make the OCD worse, but as they gain weight and as they become recovered, they figure out other ways to channel the OCD behavior. I have a former client who wrote a book on this recently.
Chris Sandel: What’s the name of the book? Do you know?
Carolyn Costin: I don’t remember. Maybe by the end it’ll come to me.
Chris Sandel: Perfect. If not, you can let me know afterwards and I can put it in the show notes.
Carolyn Costin: Okay.
00:59:30
Chris Sandel: Then Key 4 is feel your feelings, challenge your thoughts.
Carolyn Costin: Yeah, and that’s where I get a little more – in some ways, there’s a bit of a – I’m going to say spiritual for lack of a better word – aspect to that chapter because learning to do those things – feel your feelings, but let them pass, and challenge your thoughts – takes a bit of a philosophical approach that really comes from a lot of Buddhist literature about stepping back, becoming the observer, and watching your feelings and watching your thoughts and realizing you are not your thoughts and feelings. You are a wise inner presence, and you have your thoughts and feelings, and they come and go.
Then you can talk about – I think a lot of people do behavior chain analysis, which I talk about in there, or they look at all the cognitive distortions or teach people how to deal with their thoughts, but one of the things I think is harder is teaching people to separate from them, to be able to stand back, to be able to do mindfulness practice. It doesn’t have to be meditation.
I started using yoga because it was mindfulness movement, taught by the right people. I had that in my treatment centers because many, many people had not ever imagined themselves as an observing soul presence that thoughts and feelings came, and they could watch them and they could learn how to respond versus just react all the time, react all the time. So that chapter is really about that.
Chris Sandel: Sitting down and trying to meditate for 5 minutes, it becomes very apparent that thoughts just keep on coming and that there is very little that you can do to stop that. Try your best to have a whole minute where not a single thought comes to mind, and even if you speak to the best meditators in the world, they are still pretty much unable to do that.
Carolyn Costin: Yeah.
Chris Sandel: I think for me, that is a fairly good bit of proof around the “thoughts think themselves.” Again, it comes back to when it’s in your voice and when it’s generating in your head, it feels like you are the generator of those things as opposed to just being a witness. But I do think that mindfulness or meditation is a good way to start to break that down and start to see that “Okay, maybe I’m not so much at the center of generation, but more the one that is experiencing.”
Carolyn Costin: That’s exactly right. I find that right now when I’m training coaches, this is one of the first places where they get stuck because when they have the quiz to this module, a lot of times they’re answering ways to help people deal with their thoughts and feelings – which is fine, and we have to do that – but leave out the part on helping them separate. Leaving out that part is the hugest chunk. It’s the hugest piece because it helps us to see that we don’t have to be reactive to things, that we can step back and watch them flow.
I’m glad that you point it out, because people often think “I can’t do it because I can’t stop my mind.” No, it’s just recognizing that you are not your chattering mind. It’s not that you have to stop it – although you do get better at having it be calmer or noticing getting back to your breath. If all you do is come back to counting your breath, you’re still helping guide it, in a way, to not run off with your thoughts and feelings.
The other part of that is really helping people not be so afraid to feel. A lot of people, when they stop their behaviors – over time their behaviors have guarded them from having to feel their feelings. So there might be a lot of crying if someone interrupts and stops themselves from let’s say purging after a binge, or eats the food when they’re afraid of it. Feelings come up, and getting people to feel great about something like crying, even – it’s so interesting in this culture.
My staff, one of the stories that will be told about me, I’m sure, when I die is how they’d come into staff meetings and I’d be talking about something and start to cry. New staff members go, “Oh my God, the clinical director is crying.” Well, I learned once – I went to see the Dalai Lama. I took the patients, by the way. We all went to see him. He was standing up talking to about 7,000 people and started talking about when he had to flee Tibet as a kid, and he starts bawling on the stage.
Then he just takes a few deep breaths and stops, and then goes on with his talk. I thought, wow, okay. It’s feeling it, getting past it – it’s when we don’t let it out, we hold it in, and it’s hovering around for a day or two days or weeks or however long.
Chris Sandel: Yeah. There’s a book called Burnout by Emily and – I’m forgetting Emily’s sister’s name – Emily and her sister Nagoski. They talk about completing the stress cycle, and that there’s many ways of being able to do that, but actually having a cry is one way to complete that cycle. So yeah, I’m definitely on board with you with that.
The other thing I think about with this as well is just how much our physiology can drive the kinds of thoughts that we naturally have or that automatically occur, or the kinds of emotions that naturally occur to us, like if you have a good night’s sleep versus you don’t have a good night’s sleep, just the thoughts and feelings that naturally occur after a poor night’s sleep. Or being hungry, how that naturally occurs.
There’s a great example in Robert Sapolsky’s book Behave where he talks about you put people in a room and you use some chemical to make the room smell like smelly garbage and you ask them a series of questions and they become more socially conservative. Just starting to realize we are not as in control of all of these things as we like to think.
Carolyn Costin: I know. It’s so true. We are so affected on an unconscious level. Just helping people to see that, just begin to open the door into a new portal so they have a chance to look at things unseen. That’s great. I hadn’t heard of that book.
Chris Sandel: It’s a complete doorstop. It is 700 pages or something along those lines. He is a remarkable speaker as well. You can do his whole Stanford course on human biology or something along those lines online.
Carolyn Costin: What’s it called, the book?
Chris Sandel: The book is called Behave and his name is Robert Sapolsky.
Carolyn Costin: I thought of the book, the other book. It’s called Crippled by Fear, and it’s something like “My struggle to overcome a life of disorders,” because she talks about both anorexia, bulimia and OCD.
01:07:40
Chris Sandel: Nice. In terms of the feeling your feelings piece, how did you deal with this at Monte Nido, and how do you deal with this in normal practice where someone has a real strong history of trauma? Even the idea of feeling your feelings can become so overwhelming that it almost feels like “this does not feel like it’s the safe thing to do.”
Carolyn Costin: It can be really overwhelming, you’re right, and they get flooded so easily with the way that they’ve been – like I said, the brain circuits are different.
But starting with that trust piece I think is really important. Interestingly enough, I’m a firm believer in yoga in this way, trauma-informed yoga. I have a chapter in my book called “Yoga and Eating Disorders” by David Emerson, who is a very well-known trauma guy and who has a program where he teaches trauma-informed yoga teachers.
It’s the kind of yoga where you’re not going around and touching people, and they don’t have to do all these moves, but they’re moving and holding in their body and being in their body. Not having to leave their body, just learning how to be in it. Even something as simple as doing Shavasana used to change how – I would have the yoga teacher come in and report at the staff meeting, and when someone was able to do Shavasana, we would see the notes in the chart that they were able to talk more, able to release more of the cognitive stuff in the room with the therapist. Because the body will keep you back from sharing things because there’s this overexcited amygdala response to things.
So that’s one way. Another way is visualization. I would often have people – and by the way, I don’t necessarily believe that people need to talk about everything about their trauma. What I think, and what I would always tell the patients and the staff that I train, is don’t think you have to go back and get everybody to tell you everything that happened. That can be voyeuristic on your part. What we have to figure out is, how did this land in the body, and how is what happened to them preventing them from doing things they can’t do?
Someone might say, “Because of what happened to me, I have this tremendous fear of” – this is a client I had from New York who would say, “I can’t sit in a movie theater unless I’m in the back row.” If she’d go to the movies and the back row was taken, she had to leave. “I’m always afraid someone is behind me.”
So we started to work on visualizations where she would imagine herself going into the theater and sitting in the back of the room and having the feelings come up. She was in the room with me, obviously, so at any point when she felt overstimulated, she could open her eyes, stop the visualization, we would do breathing, calm down again, start over.
Things like that where you help people – and we know that visualization lights up the same part of the brain as practice, which the Russians figured out a long time ago in relationship to sports and the Olympics. They would have people go and visualize, let’s say, the ski slope because if you visualize it and you keep going over it in your mind, your brain is practicing. Or we know that from practicing piano. All kinds of studies now that show us when you visualize doing something, the same neurocircuits in your brain get used.
So I would do that even with a client who would burst into tears on trying to eat pizza. I would have them do visualizations where we go to the restaurant and you’re in the restaurant and you visualize having a bite, two bites. Sometimes you don’t get through the whole meal and sometimes you do.
I think this is an undervalued and underutilized form of treatment that people do not realize how powerful it is.
Chris Sandel: That is something I don’t use a lot of, but because of that reminder, it’s something I want to start using. I think that’s a really great idea.
Carolyn Costin: I want you, if you start using it, to send me an email or a text or something and tell me what you think. I’m astonished by it. I mention it a lot now because I didn’t use it a lot in my practice in the beginning. People think, “Oh, it’s kind of a woo-woo, visualize” – you know what I mean? It goes in that category of like psychic whatever. But it’s not.
There’s a very good book by Norman Doidge. Do you know who he is?
Chris Sandel: Yeah, The Brain That Changes Itself or something like that.
Carolyn Costin: Yeah. It’s either in that book or his second book where he takes people who don’t know how to play the piano and takes one group and they get to practice for real and the other group learns it, but then they have to sit on their hands and practice just in their mind, and the two groups are – it’s unbelievable how close they are to being able to play the piano the same with the ones who practiced.
But you can’t do all visualization. There’s a formula, and I forget what it is. You have to do at least 50/50 or something like that. So I always joke with the clients, “We can’t only practice eating the pizza with visualization. We’re going to have to go do it a few times too.”
Chris Sandel: When you’re chatting about this – I hate having to cold call someone, in terms of calling up a company to deal with something. I will often visualize the person on the other end of the phone being really happy to take my call and it going really well, and it makes the experience when I do call much easier. So it’s not like I haven’t used it in my life and found it beneficial; just for whatever reason, I’ve forgotten about it and haven’t been using it with clients.
Carolyn Costin: Well, there are so many things, right? There are so many things to do.
01:14:15
Chris Sandel: Definitely. Key 5: it is about the food.
Carolyn Costin: Yeah, I thought that was pretty clever that I said it’s not about the food but it is. The reason is in the sense that when people try to say, “Oh, no, this has nothing to do with food” – well, obviously, it’s an eating disorder. You can deal with your temperament and all your underlying issues and all that, but if you don’t deal with your relationship with food, you’re not going to get better – period.
As I already said, it’s not an addiction to food, but you have to reintroduce food into your life. You have to be able to eat food without being triggered and thinking it’s horrible and you have to get rid of it. You have to be able to learn what stimulates your binges and how you can interrupt your binges or how you can prevent them. So many things about food.
I have this idea – it took me a while to figure out what to call it, but I knew I had to call it something because everybody has their own plan. Like intuitive eating. I had to come up with something, and mine is conscious eating. I think intuitive eating is an important part of conscious eating, but the problem with intuitive eating is when you get someone who’s had an eating disorder for many years, their intuition is way off. They can’t go inside. They don’t know their hunger and fullness. They think that they don’t need certain food or they say, “My stomach feels full after I ate an apple.” It’s something to shoot for down the road.
But I wanted to do conscious eating because I wanted to talk about these guiding principles – and they’re principles. They’re not rules. You don’t have to follow them. But if you want to be a conscious eater, intuition is going to be part of it, and learning hunger and fullness and all that, but also, I think it’s silly not to talk about we need to know about knowledge, too. I think nutritional knowledge is important. That’s why our parents don’t let us just eat Fruit Loops and ice cream for breakfast, lunch, and dinner. We have to get our nutrients in and our protein in and things like that.
I think what happened is when people first started fighting eating disorders, they saw so much restriction or people who would purge after they ate ice cream that they just wanted to make – how can I say this? Nutritional knowledge became way low on the totem pole. Also, it made it so that people newly into treatment, if they were on a meal plan, it would be like, “We’ll get to intuitive eating later.”
So I wanted to have a program, conscious eating, which – you can consciously eat if your dietitian prescribes a meal plan for weight gain for a while in the early stages of anorexia, and you can consciously eat without a meal plan and freely going by your intuition. What I found interesting is I sat down – I was obsessed with nutrition when I had my illness. A lot of people with eating disorders are. Then I was obsessed with nutrition when I became a therapist because at that time, there were no eating disorder therapists, much less eating disorder dietitians. So I studied nutrition a lot myself.
When I was writing this book, I realized I needed to come up with an assessment or a quiz to help people see where they fall on the line of being a conscious eater. It’s turned out really amazing. I think clients really get a lot out of it. The coaches use it; they give the clients an assessment. Dietitians also use it.
The clients see on these different scales, “Where am I in relationship to do I allow myself to eat foods that I enjoy? Do I not eat after certain times? Do I eat every few hours?” I forget all the questions, and I don’t even remember how many there are, but there’s a variety of questions. A person looks at their own way and their own relationship with food, and then it weeds out, what parts don’t we have to deal with because you’re okay on those, and what parts do we have to focus on?
I think it’s been really helpful, and people have felt very seen through this. I haven’t had anybody say, “That’s all wrong. The scores don’t match how I perceive myself.” For the most part, they say, “That makes sense to me, how it scores up.”
Then the person has a real good, easy way to set some goals. If you don’t ever add any food – if you’re very, very regulated, you could set the goal to add one different snack that you wouldn’t normally have. Just easy things to do, but it helps give it a structure. That’s what I’ll say.
Chris Sandel: Definitely. When I am working with clients, that’s the beauty of that one-on-one work, where you can have those conversations and work out what someone needs in terms of, are they needing more structure? Or actually, are they needing to have less structure and more spontaneity? Are they needing a lot more variety in terms of what they’re eating, or actually, is there something that’s much more important than variety for what they need at this point?
In terms of your comments around intuitive eating, I had this conversation with Elyse Resch, and one of the things she wanted to remind me of was intuitive eating is 10 principles. It’s not just hunger and fullness. So you can use the different principles as and when, and you don’t have to start with all of them.
I know reading through the Intuitive Eating Workbook now, a lot of what you’re talking about is in there, but I’m not someone who’s like “intuitive eating is the only way that it has to be done.” It’s like, let’s talk to the person in front of us and work out what’s best for them then and there.
Carolyn Costin: I think both of them have done a great job. Their first book – and they admit – was really stimulated by compulsive overeaters, and they didn’t realize how big it was going to be in the eating disorder field for all levels.
I’ve had a few pretty hilarious conversations with Elyse and Evelyn about – in fact, they told me, which was so funny, that they almost called their thing called conscious eating. [laughs] We got a good laugh out of that because when I first came up with conscious eating, she called me up and said, “How come you don’t like intuitive eating?” I said, “I do, but a lot of people just aren’t ready.” The second book and workbook have completely dealt with that issue, so I would agree.
01:21:30
Chris Sandel: Then Key 6, changing your behaviors.
Carolyn Costin: Yeah. A lot of times people are really motivated to change. There’s that whole ambivalence part that we talked about, the back and forth, the fears, but sometimes people are really ready. “I’m over this, I want to get rid of this,” and they’re really ready to change behaviors – and they do not know how to do it.
I have a series of lectures I give called How vs. Why, because I think sometimes therapists get way stuck on the “why” when these clients need you to help them with the “how.”
There’s some things in there – I think even the behavior change analysis might be in that part of the book.
Chris Sandel: Yeah.
Carolyn Costin: But also there’s some stuff about setting goals and there’s some stuff about rewards and consequences, which is kind of a hilarious thing to talk about. It’s this idea that I’d be working with people who really wanted to change – “I really want to stop binging and purging. It’s interfering with my life. I’ve had tooth erosion. I have all these problems. My boyfriend’s left me. I can’t.” That’s when the habitual addictive part comes in.
I think sometimes – and I just started doing this in my private practice, and that’s why I wrote about it – helping people, there’s no consequence for you doing the behavior. Now, in the book, I talk about rewards and consequences because my co-author, Gwen, was really into the rewards part. My feeling about it is the consequence part is way more useful, for a lot of reasons.
I think telling somebody “You can go get yourself a massage if you don’t purge” is a little – I don’t know. I don’t find it very motivating. I just think the consequence thing helps people who are really, really stuck because if you pick a consequence, they pick the consequence that would be a deterrent to them.
The funny ones I think I mention in the book are having Republican clients who decide, “If I purge this week, every time I purge, I have to give $15 to the Democratic Party,” or the opposite. Funny things like that. Or “Writing a letter to my boyfriend and admitting I’ve been purging, and you’re going to send the letter if I don’t do X, Y, and Z this week.”
It sounds weird, but what happens is I only do it in rare cases, and I only do it with people who are – I wouldn’t say rare cases, but I would say at a rare point in the treatment where they say, “I really, really need something to make me think. I need something to stop me. If I’m going to have to give money to a campaign that I don’t agree with, or if I’m going to have to support some organization that I don’t like or whatever, that’s going to stop me because the last thing I’m going to do is that.”
I think I write in the book about a client who used to watch these – I can’t remember, football or basketball games, one of those – that had done it with their family over years, and they always watched the games. I said, “Wow, what if, if you don’t gain the weight, you can’t watch the game by” – this Super Bowl game or whatever. It was only in a couple weeks. It wasn’t much he had to do. But motivating things to help people when at the moment, they are driven by this habitual behavior and they need something stronger.
That came to me early on in my practice, when people were just in tears and haunted by the fact – the ones that wanted to change and felt like something came over them and they couldn’t stop it. They would say, “It’s out of my control.” I would say, “I don’t believe that. I don’t believe this is out of your control, but I do get that it feels like it’s out of your control. That means the reward for stopping it isn’t strong enough, or the consequence for doing that isn’t strong enough.”
Like if I put a gun to your head, would you do it? People tell me they are absolutely not in control of their binging and then I say, “What if I held a gun to your head?” – which sounds pretty dramatic, but I get dramatic sometimes. They would say, “Of course I wouldn’t do it.” I’d say, “Okay. Then it is under your control. It actually is. But there’s nothing that seems worse than you not following through with the binge.”
Always, with clients, if they’re at a time, I let them decide on the consequence. Like I said, it’s not to be used lightly.
But that’s one aspect of the chapter. The rest of it is more about different ways to look at behaviors. Take a list of your behaviors, count how many times you do your behaviors, work on usually cutting your behaviors back. I even talk about distraction as not being a necessarily bad thing. I mean, who cares? Distraction can be fine sometimes. So that’s 6.
Chris Sandel: With the one where they’ve got to donate to a charity that they don’t like, how often would it actually occur that they weren’t able to keep up and they then had to suffer the consequences?
Carolyn Costin: Not often, but it happened. But honestly, when I’ve done this, it has really been a deterrent – although it has happened.
One girl had to put the money in this box in my office so that it would be a big amount. Every time she binged during the week, she had to come in and tell me and put the money in this box, and at the end we sent the money to the Republican Party. She was a Democrat. It was hilarious. It was hard for her, but she did it less and less. The first week was maybe three times – you know what I mean? It helped bring her attention to “I don’t want to do that,” especially as the money piled up.
If you do it with the wrong client – and you know right away because it doesn’t work and it’s not even in their mind, and they don’t take it seriously. You say, “Okay, this isn’t going to work for you and that’s okay.”
But interestingly enough, it’s been profound in cases where the person is just shocked at how much it worked. And you have to obviously have an incredibly good collaborative relationship, because the last thing you want is the client coming in and lying and having to lie about their behavior and say, “Oh, no, I didn’t do it.” That’s why this is a very tricky thing to do, and it has to be with a client that you have such good collaboration with over time, they know you’re not going to judge them if they don’t get it right.
Chris Sandel: Thank you for adding all of that extra context to it, because yeah, the fear when I hear that would be if you pull that out too early or not in the right setting, someone’s just going to lie. Or it just ends up souring things as opposed to it being something that is genuinely a motivator.
Carolyn Costin: Yeah. That’s why I said I use it rarely. I have to remind the coaches when I hear them talking about that, this is a rare move. And this is down further along in the eating disorder, when the person has maybe been struggling for a long time and they’ve gotten so far, but they have this addictive, habitual component which they can’t seem to tap.
That’s when I say, “You might be a good candidate for the rewards/consequences thing. What do you think?” Then I’ll bring it up and I’ll give them some examples, and they either go for it or they don’t. If you’re trying to convince someone to try it, it’s not a good move.
01:30:20
Chris Sandel: Definitely. You talked about the 3-step method for changing behavior in the book and that way of getting someone to raise their awareness by tracking their behaviors – however many times a day they will body check, or pick the behavior that someone wants to learn about, and getting them to do a time diary for a day and realize how often that thing is occurring, and also connected to how often it’s occurring, what are the consequences that happen with that?
Carolyn Costin: Yeah. I think people a lot of times don’t even realize how often it’s occurring, and they often don’t associate anything else to when it occurs. Sometimes when they do that, they see these associations.
Chris Sandel: I think that’s a really helpful bit of advice, tracking it for a day or an amount of time, noting what’s going on, and then you can start to make a plan off the back of that, like “How do I start to shift doing these behaviors?” and then noticing, what’s the difference now that you’re not body checking, for example? And how is that affecting your mood or your feelings around eating, etc.?
Carolyn Costin: And with all these things, always checking in with the client so you’re not just off on your own agenda. Checking back in, “Are you with this? Is this working for you? Do you still think this is useful?” Because sometimes we’ll get excited and come up with a whole plan, “We’re going to work this out,” and we keep pummeling through, and the client’s just going through the motions because they think they should.
I’m constantly training, both when I trained therapists and now with coaches, stopping and reevaluating, reassessing all the time and making sure, “Are we on the same page here?” We can often turn it into our agenda.
Chris Sandel: I think a big part of that, at least when I’m working with clients, is be really curious about these things. When they would do an exercise like that, be like, “Wow, I discovered this and this and this,” and it’s something that is useful for them. They’re taking things away from it and they’re like, “I can understand why this is really great for me and why this has added an extra dimension” as opposed to it just feeling like homework.
Carolyn Costin: Exactly right. When it starts feeling like homework, I think people think they’re just a number and you’re just giving them homework like everybody else. It has to be meaningful to the person. They have to be engaged in it.
Chris Sandel: Especially with this key, the whole component of it is how to change behavior, and if someone’s not engaged or going through the motions, that’s not going to lead to actual behavior change.
Carolyn Costin: Right.
01:33:25
Chris Sandel: Then Key 7 is reach out to people rather than your eating disorder.
Carolyn Costin: I think probably Key 2 and Key 7 are my favorites. No, I can’t say that. They’re all my favorites. [laughs] But in the sense of maybe if I only had two things to teach people, probably 2 and 7 because they’re very practical. 2 is the basic bottom line about eating disorder self, healthy self, and you’ve got to strengthen your healthy self.
Key 7 is you have to get that part of you reaching out to other people. You have to reach out to people rather than your eating disorder, both in a very literal way – and what I mean by a literal way is if you feel like binging, let’s say, you call somebody. Literally. But it also means dealing with people to fill in your relationships and to give you meaning in your life. It also means that, like reaching out to people to solve problems and all that. That’s part of it.
But the other part is really just a very simple, but difficult thing to do, which is “I feel like engaging in a behavior, whether it’s taking laxatives, skipping lunch, going and running 10 miles when I’m on an exercise-reduced plan, or whatever, and I’m going to text/email/call my therapist, dietitian, or coach” – and particularly coaches in that case, because coaches are not just assigned to a session in a room for a certain period of time. The thing about the coaches is they need to be available. A lot of them are available even around the clock because the time when the client needs help is not necessarily when they’re in the office.
I used to let my clients text me at all hours and trained all my therapists to do that, but a lot of therapists – I mean, it’s not their philosophy. They don’t think it’s important, they think it’s a boundary problem, or they don’t have time. They have too many clients. It just doesn’t make sense. So this is one way where coaches can help.
What happens is over time, you wean them off of you, whether you’re the therapist, dietitian, or coach, to where they start relying on other people in their life. But I always have them rely on the coach or the dietitian or therapist first because when people start this and they start reaching out to others – let’s say they call their boyfriend and he says something stupid or he says, “How could you do that again?” or “I thought you were over this,” then they reel and reel back and then say “It’s not worth it,” and we’re a few steps back.
So I always try to have someone available for them to reach out to and just walk them through the process and make very clear that even if you go ahead and let’s say binge, at least your healthy self called. That’s a step. That means the eating disorder didn’t take over, take total control. Your healthy self was present enough to make a phone call, let’s say to me, and we talked for a while, and then when you hung up the eating disorder took over again. But it’s a step. Try it again next time.
This is huge, and it’s another one of those underutilized things. I think people give lip service to it and say, “You could call a friend or call a support person” but I like to set very specific goals. In the book, it even talks about who are your people you could reach out to once you’re going to go beyond it being me? Even if it’s me, being a coach, I’m very specific.
I have to remind coaches – because I listen to all the coaching sessions. They have to do an internship before they get certified, so I listen to all the sessions, and I hear them sometimes in the session with, “Okay, text me if you need me” – which is nice, but to be more structured, say, “The next time you have the urge to binge and purge, text me.” The more it’s specific and the more it’s even written down as a goal – “I will text you before I take the laxatives” – then it’s very easy next time, in the next session, to evaluate. “Did you have any thoughts about it? Oh, I noticed you didn’t call me.”
I think it has to be specific as opposed to this vague “I’m here for you.” Then you start transferring that to other people. Who in your life could you start with? If they don’t have anybody, then I try to help them find somebody and bring that person in. If they say, “I really would like to be able to have my mom help me out, but she gets too anxious and she gets upset.” “Okay, bring your mom in.” Then I help the mom how to be the support person on the other end.
Chris Sandel: Yeah, I do think there’s so much that is counterintuitive with eating disorders, and it is very easy for people to say the wrong thing. And especially if someone is in the very early stages, that can be really detrimental. So the idea of bringing someone in and giving them support so they can be more helpful is a great idea.
I think you have something on your site as well, like a product that is aimed at family members. Am I correct in remembering that?
Carolyn Costin: Yeah. I have a family course now where I try to help families understand eating disorder self, healthy self. I have some videos of me working with clients, trying to help families understand how best to be able to respond. I do. Very good. You did your homework. [laughs]
Chris Sandel: One of the things that really stood out for me with this chapter was the “getting better feels bad.” I really do have to remind clients of that all the time, because I think there is this narrative of “I thought when I was going to make these changes, my life was going to get better.”
That is true, and with time that is going to be the case, but in the beginning, that’s just not what it looks like. It is messy, and it is difficult, and that doesn’t mean you’re doing something wrong. I think there’s this feeling of “This isn’t meant to feel this way. If I’m doing something that’s right that’s for my recovery, things should be feeling better. They shouldn’t be feeling more difficult. They shouldn’t be feeling worse.”
Carolyn Costin: I know. You’ve picked out some really great, choice pieces in my work. That is so important, and it’s really important to help families because families will come in and praise – somebody gains weight and they say, “I’m so proud of you.” Meanwhile, the person is feeling awful. To have people praise her for something that she feels awful about – so it’s being able to take a neutral stance and say, “How do you feel about what’s happened with your weight?”
There are so many aspects to it feeling bad. I try to make the analogy that I don’t know anything else – like if people come to a therapist and they’re depressed and they start feeling better, they’re grateful. They’re thankful. They thank the therapist. I don’t see anybody with anorexia nervosa who gains weight and then comes in thanking me. Not for a long time.
It throws you off balance. You’re getting rid of that ego state, the eating disorder self, who’s fighting for its existence, in a way. It’s a topsy-turvy time. But the nice thing is, you do get over it when they’re integrated, and then you don’t have that. But I think we do have to tell people what to expect in these stages of getting better. Because a lot of times people think, “This is where I’m going to live. I’m going to live in this place where I’ve given up my eating disorder, but I feel really bad now.” If that’s what recovery is, sometimes they can’t sustain it. I always go, “Oh, no, no, you’re not there. This is just another phase. You’re closer, but you’re not there.”
Chris Sandel: Definitely. That is a conversation I have a lot, like “No, you’re kind of still in that no-man’s-land where things are getting a little better, other things are getting a little worse, but this is not your final destination. This is not where we want you to stop. If you’re thinking that this is what life is going to be like forevermore, that’s not the goal and that’s not what’s going to happen.”
Carolyn Costin: Right.
01:42:30
Chris Sandel: There were two other things from this chapter I really liked. Obviously, the key is called reach out to people rather than your eating disorder, and you do mention that actually you can reach into yourself if you’re doing this through dialogues or journaling or mindfulness or visualization – things that we’ve talked about before, but I guess reaching out of your habitual ways of thinking and finding a different way of being within yourself. Is that what you’re getting at with those things?
Carolyn Costin: Yeah, because what’s really important – and it goes back to Key 2 – is how amazing people are and what amazing skills they have to help other people, not realizing, “How do you feel about other human beings?” “Everybody deserves a second chance. Everybody deserves, if they’ve made a mistake, to be forgiven,” but you’re not doing that for – you are people too.
Helping people realize the depth of resources they have internally – and it’s actually one of the hardest things because over and over and over I will find – because I’ve done thousands of groups now. I ran those treatment centers for 22 years, and seeing people astonishingly help somebody else and then start looking at their own thoughts and go, “I don’t know what to say back” – practicing helping them in group do it for others and pointing out and then having them come back around and do dialogues and stuff where they’re going internally and having those conversations internally is huge. It’s a really big thing, and it is hard for people.
I think we all have it to a certain degree, but in an eating disorder it’s quite obvious, the disparity between how they would treat and empathize with and forgive and have compassion for others and not themselves. So yeah, it’s a big part of it, but it takes a lot of guidance. People can’t just do it automatically, I don’t think.
Chris Sandel: Yeah. I would say what you’re describing is the case most of the time, but I’ve even found – I use a scale – again, this is from Josie Geller’s work that I found it, but it’s with Paul Gilbert’s Fears of Compassion. He has three different scales looking at receiving compassion from others, giving compassion to others, and showing compassion for oneself. I use that as a place to have a conversation. But I’ve had situations where people aren’t able to give compassion to others either, so that’s always a starting place to have a conversation around.
Carolyn Costin: You’re exactly right. I shouldn’t say that they can all do it for others because I’ve seen that too. Sometimes people are so guarded and it’s so difficult. I usually find it’s a vulnerability issue, that they can’t be vulnerable. Showing compassion for others can often make you seem vulnerable, and then you’re opening yourself up for attack.
People who have had to be so guarded – I was just helping a therapist with this the other day. Non-eating-disorder-related, but a person who used to work for me who has a different job now and called to get help with a person she’s treating like that, and just talking about how hard it is sometimes, and how do you hold up a mirror and say the truth about what you’re experiencing? You realize how guarded – and she must’ve been really wounded by people. Being able to say that rather than think, “Oh, she’s so mean.”
Chris Sandel: Then the final one from that chapter was the transitional objects. This was something I hadn’t thought of or heard of before, but I thought was really cool. Can you just explain that?
Carolyn Costin: Oh yeah, I forgot that was in that chapter. I knew it was somewhere in the book. I learned that from all my research on attachment. There are some interesting studies on attachment and eating disorders too, and also going to the therapeutic relationship.
If you’re working on something with someone, when they’re in the office sitting down with you, or on the phone with you or whatever, they’re right there, they’re present, they’re engaged, they might agree to do something, like “I’m going to go to a restaurant and try to order pasta for the first time and eat it and keep it.” But then they get there, and all those other feelings come up, fly out the window, and they’re not grounded or connected to you and the commitment they’ve made. They need something to serve as a transitional object between this commitment, their relationship to you, their trust that you’ve said it’s going to be okay, they’re going to be able to eat this pasta.
So having something – and I use rocks because I’m a rock collector. I collect rocks from all over the world, and I would have a bowl of them in my office and let someone, either when I thought it was time or else if they were asking about the rocks, I’d explain what a transitional object is.
It’s from early attachment research where the baby who was trying to feel – you want the baby to continue to feel safe and feel trust in the environment, so a mother would have let’s say a baby blanket you could use, and that baby always has the blanket. You see babies even getting older and not wanting to give up their blankie. They’re transitional objects. Or a pacifier as a transitional object from the breast to the bottle to the pacifier to giving it up altogether.
These are transitional objects that help the person feel connected. “I’m connected to Carolyn and the decision we made and the commitment I made.” So they bring that rock in their pocket to the restaurant, for example, and maybe put their hand in their pocket and go, “Okay, she’s here with me. I’m thinking about it,” to stay grounded and connected to something that might be difficult for them to do.
I love transitional objects. I don’t have a private practice right now; I do consulting and training coaches and stuff, so it’s been a while since I’ve given someone one. But it was a really great thing to do. And the clients taught me how much they used it. “I’m going in to have a conversation with my father that usually leads to me getting triggered and binging. I’m taking the rock in with me.” Or the client who put it on the back of her toilet seat in her apartment, so when she went in to purge, she said there I was, sitting on the back of her toilet.
There are all kinds of ways that people would use them. But it comes from attachment research, which I think is pretty interesting.
Chris Sandel: This was something that was new to me when I read it, so yeah, I think it’s a really great idea.
01:49:50
The final key, Key 8, is finding meaning and purpose.
Carolyn Costin: To me, that key – like I said in the book, all the other keys are “What are you recovering from?” This key, I think people need “What am I recovering to? Is my life going to be meaningful and have purpose? Why would I go through all this trouble to get better?” It really is, without a doubt, the spiritual chapter – the part about how do we recognize that we’re souls that happen to have a body instead of the other way around, and what do we do about nurturing those souls? What do we do to have a more soul-led life?
There’s all kinds of things about creating soul moments, about having different rituals. I think people have all these eating disorder rituals because we’ve lost important, more spiritual, if you will, or soulful rituals. I teach people about making an altar in your house – which doesn’t have to be religious, but it can just be a reminder of the different aspects of your life that you want to pay attention to, like nature, like your ancestors.
It’s a little complicated to talk about, and I found it the most difficult chapter to write because I thought, I’m not a theologian and I’m not a pastor. But I really believe that getting in touch with the fact that I am a soul and I am this presence underneath this body and these thoughts really helped me to put things into perspective – like the thoughts and feelings thing in Key 4.
I do find that people have grabbed onto this. If you talk to clients who’ve been to Monte Nido, they would say one of the most important things is that I opened the door to a more soul-led life for them. What they look for in terms of relationships, who they treat their bodies as the vehicle, their “earth suit,” so to speak.
I think it’s a reassuring chapter, and I think it’s important. Some people have said, “You talk about the soul and eating disorders? Isn’t that a little off?” I don’t do it because I think it’s fun or cute or whatever. I do it because I have found it to be profoundly helpful to people when they connect to this part.
So yeah, I don’t know what else to say about it. Do you have any questions about it? [laughs]
Chris Sandel: Even for me, when I read through it, the question of “What are you recovering to?” can very much be answered even if someone has no spiritual leanings. I think there’s a really big thing – as you talk about so much in the book, it’s like, what are we trying to get away from? But I think that lever of what is going on in your life that actually makes you want to recover, and what is going to pull you towards that because you’re like “Hey, I’ve got all of these amazing things going on; I need to leave this thing behind because I want to be able to be present and enjoy and experience those things more to their fullest”?
If someone’s into the whole spiritual end of the spectrum, great. But I also think even if you’re not that way inclined, you can still take a lot from the chapter.
Carolyn Costin: Yeah, that’s why I tried to define spirituality in a way about something that has meaning at a different level than just the individual you. Spiritual can come across as being religious or having to believe in certain dogmas and stuff. So you’re right; I haven’t found a better word. Soulful sometimes is a little bit better.
But you’re right, because I say actually even in the beginning, there’s different ways of finding meaning, and it could be becoming a teacher for young kids. It could be that you want to travel and see the world. But it’s something beyond just this mundane, “I’m eating this amount of calories and I’m running this amount of miles,” the regimentation that we have where we stop and forget.
That’s why mindfulness practices, beginner’s mind practices are in there, because stopping and realizing some things that we just rush past life – like being able to appreciate nature, being able to appreciate, “Wow, this is an apple that grows on a tree, and I can eat this and it becomes my body” – it’s just stopping for a moment and realizing the awesomeness of different things, whatever that is. Relationships, having a child, raising a puppy, going on a boat ride in the Caribbean, whatever it is.
I think we get bogged up in treatment and don’t poke our head out, or poke our head in, and look at some of those things that I really believe not only help people to get better, but more so I think it helps them to stay better.
Chris Sandel: I’ve actually done a couple of podcasts recently with research around psychedelics and eating disorder recovery, and I think a big part of that is about having that real meaningful experience on LSD or psilocybin or whatever the psychedelic is, and how that is then helpful. The research around eating disorders and anorexia is still ongoing, but in lots of other areas, there is a lot more robust research. But yeah, a big part of it is around this meaning piece that you’re talking about.
Carolyn Costin: I read Michael Pollan’s book, and I know people who’ve been involved in some of the research. I had two cases of chronic anorexia apply to be part of that Johns Hopkins study. I think it’s interesting because it’s kind of a reset button. When you step back and get this sense about the Universe and the connectedness of all things, it helps you not go into that default mode all the time. Obviously, they’re going to have to see, but I think it could be promising.
Chris Sandel: I’m the same. I’m cautiously optimistic, but I think it could be really promising for eating disorders and for lots of different mental health issues.
Carolyn Costin: You sound like you’ve had a lot of people on this podcast that I want to go listen to, so now I’m going to have to go find some of yours and listen to some of these people that you’ve brought up. Very interesting. I hope I add to the list of interesting people you have. [laughs]
Chris Sandel: You do, you definitely do. This has been amazing. We have covered a lot. Is there anything we didn’t touch on that you wanted to talk about?
Carolyn Costin: Oh my gosh, I love talking shop. That’s what people call it. I could probably go on, but there’s nothing really that stands out like I wish I really talked about it. I think it’s great that you used the 8 keys as a model. When they first asked me to write that book, I went, “8 keys? There’s like a million keys. I can’t write 8 keys.” Then I realized that I had these overarching concepts that could fit nicely into these 8 things, so I just put a lot of stuff in it.
So I don’t really think so. I appreciate the things that you brought out for me to highlight. Thank you very much for that.
Chris Sandel: Perfect. The final thing is just to ask, where do you want to be pointing people towards if they want to find out more information about you?
Carolyn Costin: I think the best, easiest way is carolyncostin.com, my website, because it talks about the courses that I offer, like the families course, training for therapists and dietitians, and also the coaching course that I certify people who want to work in this field as coaches. That’s probably it. CarolynCostin.com.
Chris Sandel: Perfect. I will put that in the show notes. Thank you once again. This is amazing. I’m really glad that we were able to do this and have such a long amount of time to dig into this in such detail.
Carolyn Costin: Chris, thank you so much. It was my pleasure. Take care, and I’m going to be listening in on your other things.
Chris Sandel: Carolyn really is amazing, isn’t she? I’m so glad we had the time to go through each of the 8 keys and do it in such great detail. For me, it was such an amazing experience when putting together the questions for this and getting to go back through and reread parts of the book and rediscover how good it is and how much information there is in there for practitioners and for those struggling with eating disorders.
We didn’t really cover it in the interview, but the book is packed with lots of writing exercises, and I do think it’s just wonderful. There’s a reason that it is one of the books on our resources list. If you haven’t read it, I highly recommend reading it. It’s called 8 Keys to Recovery from an Eating Disorder, and it’s incredible. Today’s call really just touched on the smallest fraction of what it covers.
That is it for this week. I will be back next week with another show. Until then, take care of yourself, stay safe, and I will catch you soon.
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