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David Akiva
David Akiva, BA, MA,
Category: Mental Health
Satisfied Customers: 167
Experience:  Counselor; Behavioral Consultant
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I'm 31 and almost wish I was bulimic, as I can not control

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I'm 31 and almost wish I was bulimic, as I can not control my eating. I am not very overweight, but need to lose about 10 kilos, however, whenever I start to try, I eat and eat and eat. I feel like body issues plagued my teenage life, and have continued to be a major obstacle throughout my adult life - I need this to stop. What can I do? I need concrete answers.
Duddy :

Welcome, I am a professional counselor, Behavioral-Consultant and relationship expert.

Duddy :

Do you mind if we chat for a few minutes so I better understand your situation and needs?

Duddy :

...

Customer:

Sure.

Duddy :

Thank you very much.

Customer:

I just don't know where to go, how to fix this.

Duddy :

Please tell me more about what your experiencing and feeling.

Customer:

Found myself this evening googling how to make myself vomit - which I didn't do - and realised how sad and ridiculous it is! I'm an adult, with a little daughter;

Customer:

I'm just sick of it.

Duddy :

So we need to find you a solution here for you and your daughter.

Customer:

My sister was anorexic for years, but got over it. Now she is slim, and beautiful, and I'm the overweight siter with no self control

Customer:

Sister.

Duddy :

Don't worry about typos I make lots also in chat.

Customer:

ok

Duddy :

So how are you feeling about this?

Customer:

Frustrated at myself, that I can't get a grip, can't get over this.

Customer:

I want to go on a diet, lose 10 kilos, be gorgeous and get on with my life.

Duddy :

Do you mind clarifying what you mean by body image issues?

Customer:

I don't really like myself. I know I need to lose weight, and until I do, can't feel good about myself.

Duddy :

or body issues.

Customer:

It affects everything - I don't even want to go out and get a job, even though I have just got a great new Diploma, because I don't think people will hire me 'looking like this'.

Customer:

Yet I know I'm not overweight, I just am not happy

Customer:

It's been like this since I was 13, so 18 years now.

Duddy :

Why do you think you can't like yourself until you loose kilos?

Customer:

I just cant. I'm not acceptable to myself, to my husband, to society in general.

Duddy :

I understand the problem but what are its causes?

Duddy :

What is your marriage like?

Customer:

Anorexic sister, yoyoing mother and father, and judgemental (french) husband

Duddy :

I see that is fast concise information. Thank you.

Customer:

My marriage is ok. It has its ups and downs, but we are good together. He is a perfectionist though, and very hard on himself, and on those around him

Customer:

great self control, will power etc

Duddy :

What does he think about your body image issue?

Customer:

He says he wants me to be self confident, and happy, but the fact is that he judges me and puts subtle pressure on me. And not so subtle. And he is sick of hearing about my isses, which is why I find myself chatting with a stranger

Duddy :

I hear you.

Customer:

Tonight I ate the healthy diet soup I made myself - and the left over spagghetti carbonara for my daughter, a cornetto ice cream and a chocolate biscuit. SO quickly I didn't enjoy any of it

Duddy :

As part of brain storming here with you, I'm starting to think of 2 parts to a preliminary or tentative answer....

Duddy :

1) I'm thinking that short term cognitive behavioral therapy is indicated for your body image issue....

Customer:

Go for it. And we have no money, so unfortunately weekly sessions are out of the question, much as I would love that kind of support

Customer:

I live in Singapore, just moved here from France. Where can I get ?short term cognitive behavioral therapy?

Duddy :

2) I'm think that it is good to have a realistically healthy body, so behavioral relapse prevention around unhealthy eating, patterns is also indicated. Both are evidence-based practices that get results in just a few months....

Duddy :

First, I need to make sure that you know what these suggestions are....

Customer:

OK. Am listening

Duddy :

Let me take a moment to get you some links....

Customer:

thanks

Duddy :

This is what I mean by cognitive behavioral therapy (CBT):

Duddy :

http://www.mayoclinic.com/health/cognitive-behavioral-therapy/MY00194

Duddy :

Back in a moment..

Duddy :

This is relapse-prevention. Originally designed and researched to provide optimal behavior change intervention for drug and alcohol use, it is now state of the art in changing every conceivably life interfering behavior including bad eating habits:

Customer:

I had a look at that

Duddy :

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=9741&cn=353

Duddy :

What are your thoughts on CBT?

Customer:

Seems sensible, I guess I just have to find someone here who does that? But these things generally cost a fortune, don't they?

Duddy :

Here is a very good audio interview with the founding researcher who of relapse prevention. The interviewer is week, but the interviewee is one of the leading experts in behavior change of this century (he passed away a few months ago):

Duddy :

http://www.blogtalkradio.com/negotiate

Customer:

The relapse prevention stufff looks good.

Customer:

And like things that I can put into practise by myself.

Duddy :

CBT is evidence-based. In part that means it gets results in 7-10 sessions. You will take a major role in the processes as well. I'm not sure what CBT therapists in you area charge. In north America they charge from 80-$120 USD per hour.

Customer:

Ok. So not affordable at the moment, but maybe one day? I kind of need a magic wand, so I can just snap out of this stupid behaviour, get a grip and move on. I can't put anymore money into it, i just cant

Duddy :

They also know behavioral relapse prevention. But they target negative thoughts and feelings for positive change in addition to behavior patterns...

Customer:

Ok. So the advice you have for me - which is good, but kind of expected - is that I can't do this on my own, but need to see someone. Right?

Duddy :

I have no marketing interests or affiliations here. I just know as a therapist that counseling is incredibly important to effectively change long standing body image issues and their life-interfering affects.

Duddy :

You can definitely make eating habit changes on your own but CBT may be indicated for longer standing body issues.

Duddy :

I have another suggestion...

Customer:

No, I appreciate what you say.

Customer:

What is that?

Duddy :

You may also want to look into research or clinical trials in CBT related to body and eating issues. You could then get very high quality clinical intervention, say at a research hospital or university for free.....

Customer:

Wow, that is a great idea. Is that something I can find online?

Duddy :

You could also find a CBT therapist in training and under clinical supervision and get a greatly reduced hourly rate and also very high quality of intervention as they precisely control and supervise for clinical hours.

Duddy :

Let me do a search. Singapore right?

Customer:

Good idea. Yep, singapore

Duddy :

http://www.sgh.com.sg/clinical-departments-centers/pain-management-centre/interventional-procedures/pages/cognitive-behavioural-therapy.aspx

Duddy :

That's one source..back in a second..

Customer:

Part of me thinks - if I'm going to spend money on this stupid issue again, I should get one of those stomach staple operations, or those balloons in my stomach, because then I'll be thinner, and it won't be an issue.

Customer:

I'm going to have to go - it's getting late. Thank you for your help, and if you have any further advice, please email it to me.

Duddy :

No problem. It's hard to find therapists to know their training. I'd call the hospital and talk to senior CBT therapists about area research programs and suprvised doctoral students you can work with....

Duddy :

Have I answered your question here? Anything else I can provide you with?

Customer:

Yes, you have. It is a sensible answer, and good advice, although I admit I was crossing my fingers for an online miracle that even I know doesn't exist! Many thanks.

Duddy :

I wish you all the best!

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