[DR. CRISTINA CASTAGNINI] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at practiceofthepractice.com/network. Welcome to Behind The Bite podcast. This podcast is about the real-life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. Well, welcome to today's show. So much eating disorder treatment, well at least for adults, is done for the individual who has on and that makes sense. for someone who has an eating disorder, most of their life can revolve around their eating disorder. They can spend hours of their entire day making sure that they engage in their eating disorder rituals and behaviors and it really can rule their entire life. But so many people who have them are in relationships with other people. So imagine if an eating disorder has such a monumental impact on an individual's life, then of course, it would affect their partner and their relationship. This could lead to so many problems over time, problems like resentment or feeling disconnected. Really there's so many ways in which eating disorders and body image issues can and really do impact relationships and I don't think it's really discussed enough. I certainly haven't discussed it enough on this podcast, which is why I am so excited to discuss this more in depth with our guests today. Dr. Kim Lampson is here and she has a passion for helping people with eating disorders. She has a joy in teaching that is culminated in her partnering with the Gottman Institute to develop Gottman Red, a new therapy for couples in which one or both partners have an eating disorder. Her interest in helping people with eating disorders developed after her own recovery from an eating disorder. [DR. CRISTINA] She began her career with a full-time private practice, which she's had for many years. Then 12 years ago she joined the faculty at Northwest University and is now a professor of psychology with a part-time private practice specializing in couple’s therapy. In addition, she's available to provide supervision, training and workshops for therapists wanting to learn more about Gottman Red. Well, Dr. Kim, welcome to the show. [DR. KIM LAMPSON] Thank you so much. I'm so happy to be here. [DR. CRISTINA] Well, I'm really happy that you're here. As we talked offline before the show this topic that we're going to talk about today, I'm really excited about because I work with people who have eating disorders and also couples. This is going to be fantastic because we're talking about both today. For the audience, could you just share a bit about your own personal history and how you got into the field? [DR. KIM] Sure. I had an eating disorder when I was in college and had a pretty long recovery journey. Took me about eight years to get over my eating disorder and felt like I was very alone during that time and wished I had someone who could really understand what I was going through that I could talk to, could help me. Back in those days help wasn't like it is now. There really weren't that many options for treatment. So I thought someday I'd really like to be able to help people who are going through the same struggles that I went through. Time passed and I ended up getting really interested in psychology and therapy and working with individuals and families and couples, decided to go back to school and thought, well, I may as well combine my personal experience with my professional interest. So I specialized in treating people with eating disorders for many years. As time passed, I also started working with more couples and got involved with the Gottman method of couples therapy and the Gottman Institute and John and Julie Gottman asked me if I would develop a therapy for couples where someone had an eating disorder. I thought that would be great. I'd really like to do that. That's been my sabbatical project and a new therapy was born. [DR. CRISTINA] So for anyone listening who, like, what is the Gottman Institute, would you mind explaining a little bit more about what that is? [DR. KIM] Sure. The Gottman Institute was started by John and Julie Gottman and the Gottman Institute trains therapists in doing Gottman method couple’s therapy. It also provides a lot of resources for couples who want to improve their relationship on their own. They offer help for couples with substance abuse help for couples going through affairs and trauma but they really didn't have an offering for couples in which one or both have an eating disorder. So this is was a gap that this therapy's designed to fill. [DR. CRISTINA] Well, I told you when we talked earlier, I'm thrilled you had your sabbatical because this is an area which is much needed. For anyone listening, if they're in a relationship and they are struggling with an eating disorder, I'm sure they, they know how their eating disorder is impacting their relationship, maybe not. What are some of the ways you see couples really struggling when one person has an eating disorder or body image issues? [DR. KIM] I think there's two areas that really, really impact a relationship. By the way, about 87% of adults with eating disorders are in a committed relationship or married. So this really does affect so many relationships. The two ways would be when it comes to sexual intimacy and touch and when it comes to eating together and with sexual intimacy and touch, people with eating disorders may feel uncomfortable for a whole variety of reasons with their partner being with them in an intimate situation. Frequently, it could be after a binge person feels really uncomfortable, might feel like their stomach is descended, not want anyone to see them, to touch them. This may not feel what they might say is in the mood to be intimate with another person, not want to disclose the real reason for that make up excuses partner feels rejected. This could happen over and over again to the point that it causes a lot of tension in the relationship. Often when people are anorexic, they lose sexual desire just because of changes in their body due to low body weight and it may be uncomfortable. So their desire for intimacy really plummets, which also causes stress and the relationship for the couple. Really hard for couples to talk about this, it's hard for couples to talk about it even when there's not an eating disorder issue present. One of the parts of the Gottman research that's interesting is they found that in our country, most adults in committed relationships that are sexual have a hard time discussing sex with each other. Our countries might be different, but in our country, it seems to be really difficult. Then you throw in the eating disorder into the mix and it makes it even harder because people don't want to say "Hey, I don't want to have sex tonight because I just binged, or I don't want to have sex tonight because I'm feeling fat." Only have the partner argue with them about that or say, no, you're not fat or why you say that, or, I don't care if you binged. So it just doesn't go to a real good place so people just refuse or say no or avoid and it causes tension because it's not talked about. Then the other area has to do with eating together. Eating together can be a problem for a whole variety of reasons. If a person restricts there suddenly becomes a lot of foods that they're afraid of or not acceptable so that restaurants they can go to are very limited. Social eating gets awkward and person may refuse going out to eat, may refuse going over to friends' houses where they don't know what's being served, not give the real reason for it. Those kinds of issues begin to really stress a relationship. [DR. CRISTINA] Oh sure. Do you find that most of the time the person who doesn't have the eating disorder is aware that their partner has an eating disorder or is it something that maybe they know something's off but it's not really known what's going on? [DR. KIM] Sometimes they know and sometimes they don't know. It's interesting you mentioned that because the timing of disclosure really does affect their relationship. Some people are afraid to tell their partner until after they're married and then will confide in their partner. That is a hard thing for the partner to accept at that point. They may feel betrayed, may feel tricked, unhappy that they didn't know this ahead of time. Sometimes people hide it from their partner for years and partner just knows something isn't quite right, doesn't understand why their partner goes into the bathroom after eating and takes a shower every night. Doesn't know that they're purging. So it's a hard thing to talk about. People with eating disorders may have been treated pretty harshly by family members or other people in the past and are just really afraid of rejection or ridicule or judgment by their partners so keep it inside. [DR. CRISTINA] Yes, because it seems like there would be two, as you're talking, it seems like there would be two components to this. One is addressing the eating disorder itself, but also how that affects the partner who doesn't have the eating disorder. [DR. KIM] Oh, definitely. The partner who doesn't have the eating disorder is really, really impacted by the eating disorder. Most partners have no idea what an eating disorder is, don't understand it, think maybe it's just about wanting to be thin or wanting to look good or wanting to be really fit, which is why the person's compulsively exercising or healthy is the rationale they hear when the person limits their food intake, but not understand that it really is a way to try to deal with emotional pain, that it really is much deeper than that and that the person with eating disorder is using these behaviors as a way to cope with really, really hard things in their life. A person who doesn't have an eating disorder or never has had one, I think has a really hard time understanding that. Like how could throwing up help you cope with things in your life? It just doesn't add up in the person's mind. So there needs to be a lot of education so that the partner can be empathetic and compassionate. [DR. CRISTINA] I mean, it sounds like, so when you came up with this treatment through the Gottman Institute, and so I'm wondering if anyone's listening going, okay, so I am struggling with an eating disorder. My partner doesn't know. If they wanted to say, consider this treatment that you've created, what would they encounter? How is this treatment different than say, normal couple's therapy if they were to go see a couple's therapist or say, seeing someone like myself who works with an individual with eating disorder treatment? How is what you've created different? [DR. KIM] There are interventions in this therapy that are unique to eating disorder of people. Let me see if I can explain it a little bit. A couple who would be looking for help would learn traditional Gottman method interventions, which help them communicate in their relationship and managed conflict more effectively. Then after that would learn some tools to use to talk specifically about eating disorder behavior. For example, one of the interventions is called aftermath of the behavior. It's an exercise where the person who has the eating disorder may have just engaged in their behavior. So say maybe they just threw up their food and it's really struggling with that or they just had a huge binge and they're really struggling with that or they've lost more weight and are really struggling with that. Typically, would keep that inside, maybe confide in a support group, maybe confide in a therapist, but oftentimes try and deal with it themselves. This exercise is structured so that the partner will learn how to listen, help the person process what happened when they engaged in this behavior so that person's asked to think about what they felt at the time, what they felt after, what might have triggered it. And the partner's there to support, comfort, empathize, not judge, not ask a lot of probing questions, but be able to walk alongside the person with eating disorder so they can maybe make a different choice in the future. There's intervention like that. Then there are interventions that the partners work on together, one of them has to do with perfectionism in couples talking about perfectionism and how they may each struggle with that issue and how they can come up with an activity to work on together to combat perfectionism in their relationship. Another has to do with building self-esteem so that the members of the couple talk about their own issues with worth and their struggles with feeling good about themselves and support each other in feeling good about who they are on the inside, not so much how they look or their accomplishments. There is an activity called recipe for connection where couples identify ways to connect that don't involve eating disorder behavior. So if say a couple was used to connecting by going to a favorite restaurant for breakfast and the person with binge eating disorder would go to that restaurant and binge every time, time, maybe they need to come up with a new activity they can do together that isn't triggering for the person with eating disorder, that would be fun and they could look forward to. So it's those kinds of interventions that help the couple really talk about eating disorder specific behaviors and issues. There's another one called the vulnerability leap, which is a trust building exercise where the couples are given a list of questions where they choose a question, they're ready to answer and share with their partner. Some of them have to do with hiding eating disorder behaviors or not talking openly about any new disorder or honestly about it either partner and confiding in each other. Yes, this has been a struggle for me, this has been hard for me and this is what I did and this is why and slowly building trust in each other and in their relationship. So those are some examples of the kinds of eating disorders, specific interventions people would work with in this therapy. [DR. CRISTINA] Those sound really effective as I'm listening because I think that's the biggest hurdle is really how do you get the communication going? How do you get the dialogue open? Because there's so much secrecy with the eating disorders and so much shame. I can see how that would be really helpful to getting things up and open with somebody like yourself, helping them through that and giving them the tools. [DR. KIM] Couples I've worked with really feel relieved and they feel like, wow, we finally have a way to talk about these issues we haven't known how to talk about. So I think it really does help them. If you read the literature about recovery from eating disorders, it does indicate that people who have a supportive partner recover faster, that really can make a huge difference. So I think if we can strengthen a couple relationships, I'm really hopeful that will help people who might have given up on trying to get better willingness to try again. [DR. CRISTINA] So do you find that there's, I mean, I know it's just more new, but do you find that there's a difference between couples where the person had the eating disorder before the marriage versus maybe the eating disorder started sometime maybe during the relationship, maybe this part of the dynamic in the relationships? [DR. KIM] I don't know the answer to that from my own work with couples, but I have read a little bit about that in the literature. The risk for couples where it started before they got, say, committed or married is that the relationship may have formed around the eating disorder so it could have become an integral part of that relationship so that the partner felt like it was their job to help the person recover and almost their mission in life was to help the person recover and maybe even felt like a little bit of a white night. So I know nothing else has worked, but I'm going to do this so if we get together or we get married, I know I can help you get over this eating disorder. Then works really hard to do that almost like they're the person's therapist, which is not a good role for a partner to be in. So those couples have to be willing to change that eating disorder is no longer an integral part of their relationship in order for the person to recover. When the eating disorder develops after people have been together for a while, then sometimes the partner feels guilty or says, did I do something or was it my fault? Or is it something about this relationship that wasn't good so that my partner developed an eating disorder? So those kinds of issues would have to be worked out. [DR. CRISTINA] Yes, I can see if that would be complicated because really looking at like, why did the eating disorder develop in the context of the relationship? Is there something else going on there that needs to be looked at that would get really that would get complicated, I would think. [DR. KIM] Yes, it's a little complicated and the research that I read also that in committed relationship or a marriage when stress in the relationship goes up eating disorder behaviors increase. No one knows which comes first, is it the eating disorder causes the stress or the stress causes eating disorder behavior, but they are positively correlated so when one goes up, so does the other. I don't know what all of that means, but it's worth thinking about and I'm sure couples think about it too. And there can be a risk of blaming or saying it's this relationship that's making my eating disorder so bad and it can be some difficult conversations. [DR. CRISTINA] Well, I was just thinking before you came on that so many of my patients now don't fit the "norm" of what people think of who has an eating disorder. We typically think of the young teenage girl and so many of my patients now are more middle-aged females and going through like menopause or the different body changes and things like that. I'm just wondering if they had an eating disorder when they were younger and then they're going through hormonal changes older and all that stress, sometimes they tend to come up again when they're going through this. So I'm wondering the eating disorder comes up again during that time and they're married how to manage that. Or even other hormonal changes when a woman gets pregnant that can bring up a lot of things too and eating disorder behaviors from the past or new ones can come up during, like you said, times of stress, times of big change that have nothing to do with the marriage, but navigating these big times when women's bodies are changing and they're going through all sorts of internal stresses themselves. I don't know if you've encountered any of that yet, or? [DR. KIM] Well, I don't think it matters what the person's age is for the work that I would do with a couple or it doesn't even really matter if their behavior meets the diagnostic criteria for eating disorder. If the behavior's disruptive to their life, if it's affecting their quality of life and the quality of their relationship and that to me says it's worth working on as a couple and dealing with. So it's really about being able to communicate and collaborate and understand each other's position. The other part of, I think we need to talk about too is that the person with eating disorder really needs to understand the impact the behaviors have on the person they're in relationship with. But when a person's single and has an eating disorder, they can pretty much do whatever they want to do with their behavior and with their eating disorder. It affects their life primarily but if you're in a committed relationship or you're married or you have a family, it doesn't only affect you anymore. You can't have it in isolation. So you really have to think about the impact this eating disorder has on the people you're in relationship with and think about recovery through that lens that maybe making some changes will be necessary because you love this person or you love your family and you want everybody to have a little easier time. Because an eating disorder does bring stress not only to the person with eating disorder, but to their partner and to other family members too. [DR. CRISTINA] So even thinking about the process of big decisions with recovery and what impact that can have on the whole family unit or the couple in terms of if somebody has to go into treatment for weeks or months the impact that can have financially or just being away from each other, that's huge. [DR. KIM] It is huge. It can be a big financial stress and if the person goes away for months for treatment, which may be necessary and important, then it leaves the other partner as a potentially a single parent or the only person earning income during that time. It can have huge implications for the family. And sometimes it doesn't happen only once. It can be several times where the person goes in for treatment, then comes home for a while, that needs to go back, comes home for a while, needs to go back. So it is disruptive for the family and can cause a lot of financial stress. The important thing is people can talk about that and figure out how they're going to to work with that and work on it together. The thing about eating disorder recovery is that it's not fast. I'm not telling you something you don't know. The average length of time is three to five years for people who are actively engaged in treatment and therapy but that's the average. That means for some people it's longer than that. For some people it's shorter than that. Statistically about 40% of people with eating disorders have a chronic course, meaning they're going to struggle with it for a long, long time. So a partner or someone with an eating disorder may need to be prepared to have this be a part of their relationship indefinitely. So it's so important that the couple can talk about that, can envision their future together, what it may look like if the person is still managing their eating disorder five or 10 or 15 years down the road. There is an exercise in this therapy called co-constructing the eating disorder narrative where each partner projects into the future and basically says, this is what I'm thinking things may look like, whether recovery's part of the picture or it's not. Then the two can talk about that together and see how they feel about it and how they think about it. One of the issues that comes up for people is when someone has eating disorder and then they go in for treatment, most of the time they come out as a transformed person and they work through issues. They become healthier. They may think about life differently, they may have new perspectives, but there often is this narrative that the partner has or family member has that the person will go back to the way that they were like before the eating disorder got bad or before it started. But that may not be the case and typically is not the case. So couples need to talk about, well what will this look like because after recovery my partner may seem a little different than when we first got together. So how can we manage that? That's another issue that couples need to face. [DR. CRISTINA] I can imagine there would need to be some extensive therapy when somebody comes out of treatment just to manage how to communicate differently or interact differently or not treat the person like, I don't know how they were before so that they can allow them to be comfortable in the changes that they've made. [DR. KIM] Well, the other thing I hope will happen someday in the treatment world is that this couple's therapy will be part of treatment. The idea of people going off to treatment and then coming back when they're married and have a family, I don't think is ideal. I think it would ideally be they could do the work while they're living in the situation that they're in or their partners actively engaged with them in the process. So as one person makes changes, the other person can feel like they're a part of that change process and often partners feel left out of what's going on in treatment but they're not allowed to talk to the treatment providers. They may not have releases from the person in treatment for the provider to talk to them and they don't know what's going on. They feel shy out of that process and then are expected to adapt when the person comes home and have a really hard time with it. [DR. CRISTINA] I think I find that too. I find a lot of family members and loved ones are very much feeling like they're in the dark and they want more information. They want to know what they need to, I get this question all the time, what can I say or what shouldn't I say? Or what is this all about? Or there's so many questions they feel like they're walking on eggshells like, I don't want to say the wrong thing, I don't want to do the wrong thing, lots and lots of just feeling unsure about so many things. I think you're right, like having that be all part of the treatment because it really is, because if you've never had an eating disorder, you don't really realize some of the things you're saying just being a loving, caring person can be very triggering. [DR. KIM] Exactly. I mean even saying to someone who says, do I look fat and saying, no, you look really healthy. Maybe the exact wrong thing to say but the person has understood why it's the wrong thing to say. [DR. CRISTINA] I know everyone's, what do you mean if I say you look healthy? That's so triggering. But having that understanding or someone has, I hear this all the time, someone has binge eating disorder, well I'm just trying to be supportive and helping them by talking about what they're eating or not eating and it's like this the worst thing probably you could do for somebody. But just having that education, that awareness and having that be all part of it can be so helpful. [DR. KIM] It makes a huge difference. So I think partners and family members really want to help, but they often don't know how to help and you're exactly right. Typically say the wrong thing, say nothing instead of saying the wrong thing and then that doesn't feel helpful either. There is another exercise we do in the in the Gottman Red therapy, which is called the OWL conversations and OWL stands for Orchestrated With Love. OWL conversations is a checklist of topics related to eating disorder behavior and body image and exercise. Each partner is asked to check off the conversations they would like to have but haven't had with their partner. Then the therapist uses that checklist to guide the couple to talk about those issues. So the couple learns how to talk about these sensitive areas. They don't have to feel like they're walking on eggshells all the time because they've tiptoed in with some help and some support and realized, okay, we can be open about this. We can have open honest conversations and do it in a way that's loving and kind and not critical or lying. [DR. CRISTINA] That's great. I really like the interventions you're talking about. I don't know if anyone listening is going, oh, that would be fantastic because I think that's a lot of it is this fear of like, if I bring this up, what's the fallout going to be like because, especially like you said, if they have family of origin where maybe they got shamed or ridiculed for opening up and talking this is going to be all very unsafe. [DR. KIM] I think when people know what to do and know how to be helpful, they're much more likely to do it. [DR. CRISTINA] That's fantastic. So you created this and so I'm assuming you're not the only one who's providing this treatment to people. How many therapists are there out there that are giving this treatment to people and couples? [DR. KIM] Well, there are just a few now. I am a professor at Northwest University in Kirkland, Washington and we are doing a pilot study of this therapy there. So the therapists who are part of the pilot study have all been trained in using it. Some of them are available to do some therapy, but they are all doctoral students at Northwest University and some of them are at the training clinic, they're called New Hope and they do this therapy there. I know the therapy and I'm planning to do a training for other therapists either in the fall or in January of next year. So I'm so excited to teach this to more therapists so that people can do it in other states and around the world and help people with eating disorders and their partners. [DR. CRISTINA] So for any eating disorder therapists listening, who are interested or even if you know other people listening or interested in finding out more about how they can get help for themselves is there a way to get in contact with you or find out more? [DR. KIM] Yes, you can email me at drkimlampsongmail.com. It's D-R-K-I-M L-A-M-P-O-S-N@gmail.com and I'm keeping a list of people who are interested in training and people who are interested in receiving the therapy. [DR. CRISTINA] Do you have any upcoming talks or brochures or literature that people can read more about it or anything they can access there's all on your website? [DR. KIM] Well, I've not put a lot on my website about it, but I was thinking I could put together a summary of information for people who are interested. If they'd like to just have a little printed summary about the treatment, I'm happy to send that to people. I have a talk hopefully coming up at the IAEDP conference, the International Association Eating Disorder Professionals. I put in a proposal to present there in, I think it's in the winter or spring next year. I'll find out if they accept my proposal. So it's all in the works. It's a pretty new thing and I'm just now really getting the word out and the Gottman Institute is helping with that as well. [DR. CRISTINA] Fantastic. All right. Well, Dr. Kim, this has been really great. Thank you for sharing all this information. This is like I say, cutting edge. This is new and much needed. So any final words before we end today? [DR. KIM] I think the thing I just want to say is that if you're in a relationship, committed relationship, married relationship, and you're struggling with an eating disorder and you're feeling discouraged, I want you to know there's some hope for you and for your relationship. If you're the partner of someone who has an eating disorder and has felt and hopeless and frustrated to also know that there is some hope for you too and to not give up. To my own experience now that life without an eating disorder is so much better than life was an eating disorder. Even if it takes a long time and the struggles really hard, it's really worth fighting for recovery. [DR. CRISTINA] Well said. I love that, the hope is real. That's the main message of this podcast too, is to know that recovery's possible and to not give up hope. So thank you so much for that message. That's wonderful. [DR. KIM] You're welcome. [DR. CRISTINA] This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.