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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Hi, I am currently in DBT for a moderate-severe anxiety

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Hi,

I am currently in DBT for a moderate-severe anxiety disorder; however, my history includes an eating disorder (which I was first diagnosed with as an adolescent). My anxiety has improved tremendously, but my eating disorder has started to re-emerge; quite frankly, I think this is the most obsessed I've been with my weight since I was 17. I'm in my late twenties now.

I've tried telling my DBT therapist about this via my DBT diary card -- at one point, I actually flat-out said I was way too obsessed with my weight. Other times, I've relayed stories about arguments/difficulties I've had due to my fear of eating certain foods, etc. Not once has she addressed any of the eating disorder-related diary card entries. In fact, I think she is actively ignoring them. I am trying to understand if she thinks I am using the eating disorder to avoid talking about other things, or if she wants me to bring it up verbally in a session. While the thing about avoidance may have been true initially, it has gone way past that now, and I'm not sure what to do to get her to address it with me.

Some backstory here -- I have a very difficult time bringing things up in therapy -- partly due to a fear of intimacy, and partly because I'm afraid the therapist will think I am bringing up the "wrong" topic. So typically I let the therapist guide the session (which is actually pretty standard in DBT). What I'm trying to say is, even if I had the opportunity to bring up the eating disorder in a session, I don't think I would have the courage to. I started using the diary card to get around my fear of bringing things up verbally. I did that once and it worked -- the next few times I tried to do that, she made up something about how she hadn't had a chance to read my diary card prior to the session, and read it with me sitting right in front of her. I can't tell you how dreadful that was to me. Now I'm scared even to put down things in my diary card. I'm just not ready to initiate difficult topics of conversation within a session, if that makes sense. I'm happy to put it down in my diary card and then talk about it if she brings it up, but I can't just bring it up myself - I'm not there yet. Writing these things in my diary card to begin with was a HUGE step for me. Anyway, any advice/insight you can give me would be much appreciated.

DoctorZ :

Hello I believe I can help you with your concern

DoctorZ :

I am sorry that you are having this difficulty with your therapist, that is truly unfortunate and unprofessional on the therapist's part.

DoctorZ :

Now you mentioned that the diary card worked once before, but a few times after it did not work as well or she read the card right there in front of you, may I ask were the other diary cards about similar topics or different topics?

Customer:

The first times I used my diary card to communicate something difficult were about different topics -- my being upset about something she had said, self-injury, etc. Other times have been about the eating disorder. I've probably had at least 1-2 entries per week related to the eating disorder, for the last few months. I actually really like my therapist - she has helped me quite a lot for anxiety. But I guess I feel like she doesn't get the eating disorder? Not sure what to think.

DoctorZ :

A few months is a long time to not address it even though she has seen you write 1-2 entries per week related to this. You are obviously having anxiety and obsessive thoughts over this, so your therapist should be adept to treat this since she has helped you with your anxiety so much. It is possible that she is trying to get you to speak up and be more assertive, but after a few months that seems like a drastic plan.

DoctorZ :

Are you only in DBT individual therapy or are you in DBT group therapy as well?

Customer:

Currently I am only in individual therapy -- I did the group for about 8 months but stopped due to scheduling conflicts

DoctorZ :

Okay, well there are some options that you can do. I know this is not something that you enjoy, but it may be better than verbally bringing it up. You can write down your obsessions, anxiety, and concerns about your thoughts on this eating disorder and give it to your therapist during the session, this will confirm that she reads it and brings it up. You can also try emailing her a long letter addressing this issue before the session and ask for your therapist to bring it up during the next session.

DoctorZ :

In addition, you can try asking if a family member or friend would accompany you to a session and have them bring it up, but I would use that as a last resort. Or you can try working on certain techniques before hand and bring it up briefly, but verbally with your therapist, although you said that may not be ready for that yet.

DoctorZ :

For instance the What if worksheet may help you in seeing yourself being more verbal as a positive and you are more than welcome to try and work on it

Customer:

Thanks -- I can try one of the things you suggested, but why do you think she has been ignoring me so far?

DoctorZ :

Well I do not know her, so I cannot say with 100 percent accuracy. But it is possible that she is trying to force you to be more assertive and verbal by not bringing it up in therapy. She may be hoping the anxiety pushes you to talk about it first. This is a form of exposure therapy which has CBT and DBT principles, but I think because this has gone on for a few months, which is a very long time, this tactic will backfire and just cause you more anxiety and to retreat more.

DoctorZ :

And the other option is that she may have become complacent in her therapy with you and is only skimming over the diary cards or not even reading them, which is unethical. Some causes of this behavior is if this therapist is very overworked or has other personal issues that are diving her time.

DoctorZ :

But you said that you really like your therapist and feel like she is helping you, so I am leaning more towards the first possibility

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