emPATHETIC
emPATHETIC
Understanding Obesity/Overeating Through Empathy
What if the key to understanding obesity and compulsive eating lies in our ability to empathize with others, to challenge our stereotypes, and to step into their shoes? This isn't just hypothetical, it's the compelling perspective shared by our guest, Francesca, a psychotherapist with a passionate focus on trauma, eating disorders, and addictions. From her unique journey transitioning from media to therapy, to her exploration into the intersection of world religion and Jungian depth psychology, Francesca's insights probe deeply into our understanding of empathy and its potential to transform lives.
You'll be engrossed as we shed light on the often neglected link between childhood trauma and eating disorders. The manifestation of this trauma in adult relationships highlights the critical necessity of establishing healthy boundaries. Francesca guides us through this complex terrain, providing insights into how we can better empathize with those wrestling with trauma. Moreover, I open up about my father's struggle with compulsive eating, a poignant narrative that has deepened my compassion for my clients.
As we navigate the healing process, we delve into the three-pronged approach of EMDR therapy. Francesca underscores the importance of identifying negative beliefs, tapping into early experiences, and connecting to physical sensations. It's an awakening to how our judgments can unknowingly hinder others' healing and the transformative power of love, compassion, and understanding. Wrapping up our conversation is a thought-provoking discussion about humility and the empathy borne from stepping into another's shoes. Join us on Empathetic, as we challenge perspectives and deepen our understanding of compulsive eating, obesity, and the power of empathy."
Hello, my name is Kacie Winters and you're listening to emPATHETIC, the podcast where we pierce our perceptions with people you may consider pathetic, but the realities of the past. Today we're gonna walk a mile with a counselor for people that are obese. Actually, I used to be a counselor. I'm not a good one, I would say, but I would sit across sometimes from people that I just didn't know right, complete strangers, and they would pour their hearts out, tell me things that like you would only see in the movies and hear about, and you're just standing and sitting in front of these people and then think you have maybe some wisdom or understanding about what they can do in order to help it, and then put all these pieces kind of like back into their chest after they've, you know, poured it all out. And then they walk out of your office and you just sit there, almost sometimes traumatized yourself, and I don't know how to explain it, sometimes to a space of especially with somebody that, because I am so empathetic it was, it was difficult sometimes to not feel their pain. You know, it was difficult for me to set a boundary or like cut off the umbilical cord that, honestly, I was using to nurture them for a while. It's a challenge to do, at least for me. Some people can do it beautifully. But it was so heartbreaking because these people would come and they just kept saying I don't know why he'd make any choices over and over again. I know, I know what to do. And they would point to their brain and they'd be like I know the steps I need to take in order for me to lose weight. I know what steps I need to take in order for me not to be an alcoholic anymore. I know it, I just can't do it. And I would think to myself oh my gosh, if I ever was in their shoes, legitimately, had been born with their genetics, had been had their parents, had been nurtured in the same exact way, I would be doing exactly what they were doing, exactly what they were doing. And in fact I wanted to say I am amazed at the things that you, the good choices that you are making. That's amazing. I don't know if I wouldn't just be like huddled in a corner in a fetal position, just rocking, with all the trauma that some of these people endure, and I realize this is.
Kacie Winters:I've been reading Adam Grant's book Think Again and it's about changing perspectives. It's like understanding our perspective and how we change our perspective, and one thing that he called out was something called counterfactual thinking, and it is just that it is thinking about. If you were in their shoes from the beginning, then you may have a different perspective of them now. Maybe your stereotypes would change. And he did this. He tried to motivate people in all different kinds of ways to change their perspective on different things, for example, like Red Sox and the Yankees, and they talked about like, oh my gosh, you Red Sox people hated the hated the Yankees, Yankees Red Sox fans, and they called each other basically the exact same things, and then, once it got to be a place of, well, if you were born in Boston, if you were born in New York, would you maybe think differently about those people? Well, yeah, I guess I probably would. That's counterfactual thinking, and I think today's podcast is about gaining the knowledge and understanding from a professional that helps us realize that we just happen to be where we are because of the journey to now, and if we had really been born in different circumstances, in a different country, in different skin, with different genetics, we wouldn't be any different than those people. It's a beautiful thing, it's also terrible, and I think, as a human, your job is to just be aware of that and to understand that part of you. So join me today with some counterfactual thinking with my dear friend Francesca.
Kacie Winters:With every podcast, we start with a breath and wonder where am I in my empathetic journey? Do I have a lot of empathy to give typically? Do I have more empathy today than I had yesterday? Or as a kid? Do I want to empathize more with people? Or is there like just specific people, that there's just no way? Just, wonder everyone. Listeners, I am so excited and happy to introduce you to Francesca. Francesca, let's start from the beginning, right, or just start with you. What do you want the listeners to know about you past, present, future, all the things.
Francesca:I'm a psychotherapist in private practice, and I've been in private practice since 2013. And before that I had a part time practice as early as 1993. I'd worked in hospital administration as well as clinical, but I really love private practice and my specialties are trauma, eating disorders, addictions in adult children of alcoholics. I specialize in something called EMDR therapy, which stands for eye movement, desensitization and reprocessing, and it is a psychotherapy that was designed for people who have experienced trauma, to help them heal and get over the trauma. The other thing that I'm really passionate about in therapy is attachment and attachment trauma, and that is when the early care providers were either inconsistent, unavailable, neglectful, abusive and trying to help individuals, because that's a form of trauma as well. And in addition to being a psychotherapist, I am a mythologist. I have a master's degree in professional psychology, class of 1993, lindenwood University. I have a doctorate in mythological studies, which is a blend of world religion and Jungian depth psychology, which is based on the work of Dr Carl Jung, and my undergraduate degree is in radio and television.
Kacie Winters:Southern Illinois.
Francesca:University in 1982. And I sold broadcast announcements for a while, was deeply unhappy and did not feel fulfilled and went back to graduate school. I'm a first generation Italian-American big family. My parents are deceased, but I'm close to my siblings and when I'm not hanging out with them I like to cook. I'm a voracious reader. I love podcasts, including yours, but I've recently found the joy of audiobooks. So, when I'm commuting. I'm listening to audiobooks, but I read about it just a book a week and I like to travel.
Kacie Winters:Fantastic, so thankful you're here. Like I said before, you just bring me joy and make me smile, and your energy is just so beautiful. I want to start with your work with specifically with individuals that are obese, and your work with them, your background with them. Just tell me more about that kind of work.
Francesca:I started working right out of graduate school at a place called the Raider Institute and they were at the time this was 1991, they were a national provider of eating disorders, inpatient eating disorders programs, and they were what they called multi-modal and multi-disciplinary, which meant that they had lots of different kinds of therapies psychotherapy, family therapy, psychiatrist, primary care physician, a dietitian, an exercise physiologist and so they were receiving all these different approaches to treatment and there were all these different clinicians. And my favorite part of the day was when all the clinicians got together once a week and talked about the cases. I was hired as a family therapist part-time and I was working in the evenings doing multiple family groups and patient psychoeducation. After about six months I got promoted to be an inpatient therapist, so I was working individually in groups and I had amazing training. What made the eating disorders program at Lutheran Medical Center, which is where I was, the Raider Institute, different than other programs? Was they also treated binge eating disorder or what they called back then compulsive overeating? Most of them only focused on anorexia and bulimia nervosa. Sometimes now wonder about the wisdom of having those three populations together, because the people who struggled with compulsive overeating were often maligned, or the people. Maybe in group someone with anorexia might say you're my biggest nightmare, and so I don't necessarily know how I felt about the wisdom of having everybody put together, but I did learn about the importance. It was not about treating the weight or weight loss, it was looking at the underlying issues. So after a few years of that I got promoted to director.
Francesca:I was the director for a while, but when I was working on my doctor the hospital felt that I couldn't travel.
Francesca:So I became a therapist in the hospital that traveled around working with all the different people in the psychiatric department, and at the time the hospital was building their surgical weight loss program and not surprisingly, they noticed that they were having a lot of very negative outcomes and they wanted to experiment.
Francesca:They were a leader in the field. They wanted to experiment what would happen if they developed a post-surgical psychotherapy program to address the issues that these patients had. And it was not only so successful the outcomes improved but they became a market leader and I was invited by the American Society of Bariatric Surgeons in 2000 at their international conference I'm figuring I'm going to step into a room with 35, 450 people. It was bariatric surgeons, program directors, therapists from these you know dietitians from these different programs because they saw that it was really important for these patients to have psychotherapy support. And then in my private practice I started doing post-operative and pre-operative surgical support for these people as far as psychotherapy, and I've always treated people for binge eating disorder compulsive overeating in my private practice- how do you build trust and empathy with your clients when you're working with people that have these eating disorders and stuff?
Kacie Winters:what is your method that you use to make sure that you're building trust and empathy with?
Francesca:them. That's really important, and we can think of it like a tree. If all we wanted to do is treat the leaves of the tree, the tree's going to still die. We need to treat the roots and people who struggle with obesity or any sort of weight problem. Their entire lives, people have been telling them they need to lose weight. Everything would be okay if they lost some weight. People are foisting weight loss schemes onto them, which is not helpful in any way, and so building that trust and empathy is helping that individual know we're going to address the reasons why they're eating, because food becomes basically the drug of choice.
Francesca:It's a comfort, it's a solace, it's a way of dealing with stress, anxiety, anything, and letting that individual know I'm not here to help you lose weight. I am here to help take around and see what's causing the stress that is causing the eating. Yeah.
Kacie Winters:Yeah, that's amazing. Let's talk about trauma and the link to adult obesity. What have you noticed? What have you researched?
Francesca:What have you seen? Trauma comes from a 17th century Greek word that means the wound, and trauma is basically defined as a deeply disturbing or distressing experience in the psychological emotional consequences thereafter. And it's been getting a lot of press lately. I think a lot of stars have talked about their trauma. Lots of people have come forward about childhood trauma and so it's gotten a lot of press and goodness lately that it's kind of coming out of the shadows. But so often people who struggle with compulsive eating and obesity had a lot of childhood trauma. Whether it is psychological, emotional, sexual abuse, religious trauma, there's a variety, but sometimes it's the absence of care. It's that attachment trauma that I've talked about when the care providers are neglectful, unavailable or inconsistent.
Francesca:They might get great attention sometimes, but for whatever reason what the care provider is struggling with, they may not get something for a period of time, and so I'm working on both of those, whether things have happened like assaults or abuse, car wrecks, emotional traumatic experiences or if there's been neglect and working with that individual to kind of treat those early childhood experiences.
Francesca:And for many people these traumas happened in adulthood. And for people who struggle with obesity, Casey, it's also really important to recognize that these individuals also have trauma about their weight. People are chiding them or maligning them or treating them terribly, rejecting them because of their physical appearance, Right.
Kacie Winters:It's interesting. You and I have worked together before and I've I'm kind of going off script here for a second, but because it reminded me of a time where it was it's really hard to, as a therapist, pour into clients and pour into their empathy and pour into them and and build that trust and and then it's, it's. It's very difficult to have them walk out or walk away or or to just kind of like you know, is there a boundary that you have to set with your empathy? Is there? Is there a space that you create that like helps you to just make sure that you are still a healthy adult but still able to empathize and pour into these people when, when they need it? Like, how do you balance that?
Francesca:That's. That's a really important consideration. When we think of the different eating disorders. There's parallels in the way the individuals treat their personal relationships. People who struggle with anorexia and nervosa may have very rigid boundaries with the people, in the way that they don't let any food into their bodies. They don't let people into their lives either. There's there's a wall. People who have bulimia and nervosa may be very impulsive with their relationships. They may let people in for a little while and then push them away or reject them in the way they do with the food. They binge and then they parts the food. People over eaters often have boundaries that are far too permeable. They may be people pleasers. They may let people walk all over them. So it's very important that I model really healthy boundaries. I have very healthy boundaries anyway.
Francesca:I mean, I I'm not going to be taking calls at midnight you know I've office hours People kind of know what those boundaries are and by really demonstrating those healthy boundaries and trying to help these clients know what their healthy boundaries should be with their family members. So it's very important that I demonstrate boundaries for myself right, you know, and to not be available all the time and to to know what those boundaries are. But it helps the clients then to recognize what their healthy boundaries are. Now I probably have a lot of very deep empathy.
Francesca:I am also the child of an obese father. He, you know, he grew up in war torn Sicily, which I think contributed a great deal to his compulsive eating. I mean, there were many times where there was food insecurity because in war torn Italy there wasn't always food Right. When he came to the United States, you know he's a very thin as a young man but he gained weight in adulthood and I know that he really struggled with that, about being an overweight person and the physical consequences that went along with obesity. And so I have a great deal of compassion, not only for my patients but because I am a child of a parent who struggled with obesity and compulsive eating.
Kacie Winters:Well, that must make it easier for you right To empathize and understand. And just when, when people are pouring out their hearts and their, their traumas to you, and then you're receiving all of this, it's do you feel like it's helped you to not judge, is there a space of like you? You're seeing all these things, you're seeing their journey, they're explaining this all to you. You're seeing, kind of, the result of all these things, and then you're able to look at it and go, aha, I'm like I, I get it, I understand, I am with you, I feel you, I absolutely, I have a deep, deep, deep kind of compassion for my clients and a deep kind of compassion for people.
Francesca:And I have a lot of compassion when I see things happen. When I'm in a plane and I see the way a flight attendant might offer the seat belt extender, right. I mean, not too long ago it brought tears to my eyes. I saw a flight attendant curl it quietly into her hand and just offer it to the person, with no one seeing it happen. And you don't always see that kind of compassion, right yeah absolutely Um.
Kacie Winters:so let's talk about you. You talked a little bit about EMDR. Can you talk more about that? And then the other techniques that you use in order to support people with these issues?
Francesca:Yeah, emdr, which stands for eye movement to sensitization and reprocessing, was developed by a psychologist in 1989 who was working in the Bay Area with traumatized Vietnam veterans. And these guys were not sleeping. And she started working with moving her fingers in front of their eyes and, and after about 12 sessions these guys that were so traumatized they had not slept through the night in 20 years started sleeping again. Wow, and all she was doing was just the eye movements. But after a great deal of research, what she learned was that something was happening called bilateral Stimulation, which means the right and the left hemispheres of the brain were being alternately stimulated. Additional research showed that the trauma is stored in a part of the brain called the hippocampus and the emotions around the trauma is stored in the amygdala. And what the bilateral Stimulation was doing was stimulating the hippocampus enough to bring back the memories, but soothing the amygdala enough for the client to approach them Dispassionately, with not of a lot of emotion in the moment. And she described it as looking at scenery on a train. There's enough of a distance from you so that that you do not feel frightened by what you are seeing, or you don't. You don't feel too emotionally connected to it either, but you're also kind of encapsulated in this safe container and that that's something that we we need to create. There's lots of ways. Emdr is not the only way to get there. There's a lot of experience somatic Experiencing, which was developed by Peter Levine, and that's really noticing the body and what is happening in the body in that moment.
Francesca:And Mind. Body therapies are extremely important because trauma lives in the body and a lot of researchers have shown that. We want to look at any of the distorted thoughts that are present and you know, and what those distorted thoughts, how those might lead to emotions and how those emotions might lead to various behaviors. We want to also there. There's another mode of therapy called dbt, which stands for dialectical behavioral therapy. That was designed to try and help patients tolerate really difficult emotions and be able to tolerate distress and and and and. I think a lot of distress tolerance and being able to process difficult emotions needs to become very, very important. And of course, being a young Ian, I'm also very concerned with dreams and so a lot of times patients will bring their dreams in and we may work with the dreams and a lot of times just being able to Witness and be there and again, as I mentioned, I'm very concerned about attachment and working to heal the attachment trauma.
Kacie Winters:Hmm, when you do Mdr with with patients. Can you explain what that looks like as far as like, maybe give an example of a session that you did with your patient or where they were able to See? See the trauma in the past, not experience it as it's happening now, but be able to articulate the feelings that were associated with those?
Francesca:a really good example of that would be a client is now struggling with a coworker and In that struggle with a coworker they feel like they're not good enough, and then they go home and they binge eat, hmm. So we look at the negative belief and it might be something like I'm not good enough, and we try to come up with what would you like to believe that you don't believe now, and that might be something like I am good enough, I'm perfectly adequate, or I'm better than good, sure. And then we look to see how true does the positive belief feel? It's usually very low, hmm, and and we want to pick something where it's worth. It's not really believable yet.
Francesca:And so then we look for what is the emotion that you feel in that moment? It's generally shame and adequacy, sadness, fear, anxiety, something like that. And and then we try to look for an early experience where they felt like that before. And that's what we target. You know that the current distress is now right, but we need to go back to the past to heal the now so we can make it better in the future. So it's kind of three pronged approach, sure, and so they might come up with something like well, when I was in the third grade I had really bad handwriting and the teacher shamed me in front of the entire class by showing my penmanship paper.
Francesca:Hmm to everyone in the class. So we now okay, let's call back that, that third grader Mm-hmm, we're gonna fill that in your body, located in our body. We, we come up with a distress level. How strong does the distress around this particular incident feel?
Francesca:And we start the bilateral stimulation and they're either looking at a light or they're holding these little tappers that they hold in their hands, that, alternately, that give them a pulse in each hand, and when I'm doing it online, we tap on their body. Mm-hmm, you know, they tap on their body and I tap on my body in time with them. And then we'll go for a period of time and then I will say what did you notice, mm-hmm? And then they'll come up with something. Well, I noticed that that was really mean of the teacher and she shouldn't have shamed me like that. Okay, go with that.
Francesca:And then we tap some more, and we generally get to a place where they will see that they're not shameful, that they're not bad, that the bad penmanship does not mean that they're not worthy, sure, you know. What's tricky, though, is generally for someone who's had a lot of trauma. There are many situations clustered around these beliefs. So when I first started doing EMDR therapy many years ago, we tried to come up with like the 10 worst experiences that have ever happened and we systematically worked through those. Now we look at clusters of belief, maybe all the experiences that are surrounding I'm not good enough, or all the experiences that may say I'm not lovable, because there's generally a group of themes and they might be personal inadequacy, lack of safety, personal responsibility like this is my fault, you know or I'm alone in all of this and so we kind of try to work through the themes as opposed to the individual incidents like we used to do.
Kacie Winters:I think it's important as a therapist, and seeing all these people's journeys and understanding all the things that have led up, right, it's not that this adult that has had all these wonderful things happen to them and then now they're sitting in front of you and I think, when we don't empathize with people, we're only seeing this little, tiny snippet of their life and not really seeing all the other things that have created it up until then.
Kacie Winters:And I think it's important. Sometimes I joke that we should wear our biggest fear on our shirt, right, because then people would be more open to ask those questions or more understanding or more empathetic of those people, because then they're going to realize this is a fear, this is what's going on with them right now. I can understand that, as opposed to I can't understand why they're so overweight, right. And so, as a therapist, I think it's really important for us to hear from you. How do we approach, like? What is our tendency, especially with people that are obese? What is our tendency? To kind of think, what have you heard from your clients that people have said that maybe are really traumatic or not understanding or not empathetic towards them, and what can we learn from that? What can we understand from that People?
Francesca:who struggle with obesity have heard so many well-meaning bits of advice that are not helpful Things like push yourself away from the table just stop eating when you're full.
Francesca:Always leave something on your plate.
Francesca:Those are never helpful bits of advice, and the best thing that we can do is to love and support the person and give an individual an opportunity to talk about what's on their mind.
Francesca:Now, of course, we can't become therapists for our friends and family we can direct them to therapy but sometimes it's just that love and compassion to allow someone to express what they're feeling. One of the things that people who struggle with compulsive eating are doing is they are pushing down the things that they cannot say with the food. The food is a way to stuff down the things that they are unable or not allowed to verbalize, whether it's abuse they can't talk about, or whether it's an overbearing family member that does not allow them an opportunity to express their feelings. So they need an opportunity for expression. Now, a lot of people are traumatized, but we can't see it. Somebody who has 100 pounds above a healthy body weight is unable to conceal whatever. So not everyone has 100 pounds above a healthy body weight has been traumatized, but a lot of people are, and so we want to give them the opportunity to talk about what's bothering them.
Kacie Winters:What suggestions are things that you have that you want to depart us with today, with wisdom, just to help those people that are going through this? Help family members that know people that are needing some help. What are your words of wisdom for that?
Francesca:When you know, when all you have is a hammer, everything looks like a nail, and I happen to sing psychotherapy as the answer to everything.
Francesca:I'm a psychotherapist. I think psychotherapy is the answer to everything, so encourage people to get help. Now there are two agencies I don't know how many of your listeners are in the St Louis area, but there are two agencies that will offer sliding scale therapy or even free therapy if necessary. One of them is something called Walters Walk and the other one is called Casadeh Saloud that will offer very low cost therapy. It's not everybody has an availability to do that and as a therapist I know I have a three month waiting list right now to get in to see me and many of the clinicians that I know are completely filled with long waiting lists. And if it means getting on a waiting list, get on a waiting list to see someone, but certainly getting help.
Francesca:There's also some really amazing areas for free help. One of them is AA for people who have struggled with chemical dependency. For people who struggle with overeating there's overeaters, anonymous. There is the adult children of alcoholics. There's Alenon. So there are a lot of other opportunities to get some help in the meantime if there aren't therapists available. But I think getting professional help is crucial.
Francesca:It is really crucial for people to begin this healing journey.
Kacie Winters:Okay, I cannot thank you enough for being here today. You always make me smile, you always have these wonderful bits of wisdom that I have taken with me for years, and I'm just so thankful for the opportunity that we get to share your amazing, beautiful brain and heart today with my listeners, and I can't thank you enough.
Francesca:Thank you, casey, it was a pleasure being here.
Kacie Winters:Thank you so much, listeners, for counterfactually thinking with me today. The call to action today is who is it? Who is your arch enemy? Who are the people that are just like, oh God, it's them again. Is it maybe a different college that you went to, like your arch rival sports team? Is it your neighbor that you just can't seem to understand? Who is it? Who is it? And then, just for as long as you're comfortable, think about if you were born in their shoes, would you maybe be doing the same thing as them? Would you maybe be thinking or supporting the same thing? I don't know. That's humility, pretty cool, try it out. I'm Casey Winters, and this was empathetic. We hope we were able to peer surf perceptions today with some reality. Thank you so much for listening. Thank you.