Being the "Perfect Patient:" Why Seeing a Therapist Can Be Scary In Recovery

Being the "Perfect Patient:"  Why Seeing a Therapist Can Be Scary In Recovery
I was recently talking to my therapist about her role in the documentary I'm working on.

For a long time, I was hesitant to ask her to be interviewed for the film. For one, I wasn't very clear on the legalities of her appearing in it and discussing things I'd divulged under confidentiality. While I'm very open with my story, and she'd only be asked on-camera about things that are already public, I didn't want to put her in a difficult or compromising position.

For another, I feel bad asking anyone to be interviewed for the film. For many, being on camera is stressful and anxiety-producing, and I feared that by asking her I'd place a certain amount of pressure or expectation on her to do something she wasn't very comfortable with. And even if someone has no problem being on film, there's no denying it's a pain in the neck to try and schedule an hour or two out of your day to sit in front of some hot lights with a giant camera in your face.

Eventually, however, I realized it was extremely important for me to involve her in the project. The majority of the film focuses on things I attribute my recovery to: yoga, my yoga teachers, my friends and family, the hospital, writing. By not presenting this important character in my life- my therapist- I was unintentionally creating a storyline that could give the viewer the idea that I didn't get any professional help for my eating disorder.

It's important to me that people understand that while yoga is a powerful healing tool, it is not a replacement for the help of a specialized professional. Yes, yoga helped me open up, it gave me a purpose and a passion, and it offered me a community to help me heal- but I still did a lot of work with doctors and therapists who have huge amounts of experience with eating disorders and mental health in general. And in a world where there's already a great amount of stigma around seeing a therapist, I don't want to be a contributor to that.

In fact, by involving her in the film, I had an opportunity to help break down that stigma.

For many people, therapy is something to be shoved in a closet and rarely discussed. Therapy is something you are sent away to or reduced to needing only when you are broken and weak. Therapy is something for people who need to be told how to feel and behave, and don't have any personal autonomy. While to many of us who have spent a great deal of time in the mental health sphere these ideas may sound ridiculous, I've met far too many people who hold these ideas close to their heart.

And to be honest, when I first began seeing a therapist, I held onto some of these ideas. In particular, I felt as though I was being "sent away" to be "fixed" somehow, because there was something deeply wrong about me as a person. What I couldn't see is that therapy is simply a tool and an instrumental resource for individuals in recovery.

By pulling my therapist out of the shadows, and giving her a face and a name in film, I hope to humanize and honor this individual in my life, as well as decrease the stigma around seeing a therapist.

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As I was chatting with her, my therapist asked me how I overcame my original reluctance to participate in therapy. For months, I sat in silence in her office, desperately wondering what I was supposed to do or say. It took me quite awhile to open up and begin taking advantage of the resource I was being offered, but once I did, it helped me far more than I ever imagined it could.

I think my original difficulty stemmed from my shocking introduction to therapy. It wasn't a decision I made on my own, or something I discussed with my family beforehand. Towards the beginning of my freshman year of high school, my parents noticed I was engaging in self-harming behaviors, as well as isolating myself from my friends and family. When my mother discovered I was purging in secrecy- her first real indicator that I was struggling with disordered eating- she to the initiative to seek out professional help.

While today I'm grateful for my parents' willingness to provide me with resources such as therapy, at the time I felt angry, misunderstood, and like I was being sent away to be fixed and promptly returned a better, more agreeable person. This played a large role in my reluctance to fully engage in therapy in the beginning, but it wasn't the only factor. During this period of my life, my perfectionism was in full power over me. I didn't want to talk about the things I was struggling with, or admit to the behaviors I was feeling compelled to engage in, for fear that it would ruin my perfectionistic image I was trying desperately to  maintain.

I went into therapy with one goal in mind: How can I appear to be the perfect patient so that they'll let me stop coming here?

Once I was admitted to the hospital for my eating disorder in the spring of that year, my obsession with being the "perfect patient" grew only greater. The atmosphere of my treatment ward sent one message loud and clear: If you behave, you will get out of here. That meant eating your food, sitting still, and telling every therapist and doctor you came across that you were doing just fine, thank you very much. And more than anything else in the world, I wanted to leave that sterile segment of hell and never return.

So for a few weeks, I did just that. I became the perfect patient. I ate piles of bland hospital food and more peanut butter than I thought existed in the entire world. I chugged glasses of chocolate almond milk while nurses watched warily nearby. I allowed myself to be pushed around in a wheelchair, even though I wanted desperately to get up and run around or jump or play or even just walk. I told therapists sent to my bedside what I thought they wanted to hear, and I laid perfectly still every time they took my vitals, praying to any god that would listen that they came out okay.

Not because I particularly wanted to be healthy, mind you. I just wanted to get the hell out of there.

Once I was released, I had to continue seeing an outpatient doctor who specialized in eating disorders. In the beginning, I saw her every-other-day. She'd take my weight, my vitals, and assess how I was progressing in my weight restoration and physical recovery. There was a great deal of pressure during this time: if my vitals were even a little off, or my weight teetered downwards even a little bit, it meant another week of every-other-day visits. The goal was to see her once a week, then every other week, then once a month, and so forth.

But the pressure of these visits and the anxiety they created worked against me. I would grow so anxious when they'd take my vitals that it would skew them, or get so nervous in the hours before the appointment that eating became difficult and I'd get weighed on an empty stomach as opposed to a full one the week before. I felt as though I was constantly being told that I wasn't being good enough.

This was only made worse by the atmosphere of distrust that hangs over ED treatment. ED-specialists are often trained to not trust their patients, because the disorder can evoke manipulation and lies in the patient, who may try to desperately cling to their disorder by manipulating the weight that appears on the scale or the vital readings taken by the doctor. Luckily, I was so desperate to be the "perfect patient" and to never see this doctor ever again that I never partook in these behaviors, but I was accused of them.

This destroyed me. I remember one specific time that the doctor came into the room and told me my urine sample seemed diluted, and she accused me of drinking excessive water in an attempt to increase my weight for the scale. I sobbed for hours after, knowing no one would believe that I hadn't done it, knowing I was being painted as a bad and manipulative person, and knowing that it meant only greater scrutiny in the future.

Knowing all this, and understanding the headspace I was in at the time, it's no surprise to me that therapy was difficult to truly take advantage of.

It was a time where I felt as though everyone was out to get me. A time where I felt like no matter what I did I was in the wrong. And ultimately, it became a time where I would rather not talk about my feelings and struggles than to have them draw even greater attention and scrutiny to me than there already was.

And so I sat quietly in therapy. Because anything I said I feared could land me right back in the hospital.

I can remember one day in particular that my therapist was asking me general questions, like, "How have you been doing lately?" and "How are you dealing with your emotions?" I was responding with mumbles and "Fines," looking around the room and avoiding eye contact. By this point, I was over it. I was over therapy. I was over doctors. I was over hospitals and questions I felt I shouldn't and couldn't answer honestly. I was over observed meal times and arguments over food and stupid art projects like paper-mache snakes meant to symbolize "shedding our outer skin."

Being the perfect patient was as impossible as it was exhausting.

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My therapist looked at me and said, "I'm happy to work with you, but I'm not going to be patronized."

Bam. The thing about therapy is that the therapist doesn't really seem like a real person most of the time. They're calm. They're collected. They ask gentle questions and provide some advice. But they aren't really supposed to share too much about themselves, or inject too much of their opinion into things. Because of this, and my perfectionism, I'd come to see her not as a resource, or even a real person with emotions and feelings, but as an obstacle in between me and freedom.

I immediately started crying.

"I'm sorry," I choked out, "I'm just so tired of talking about this."

And it was true. I was so exhausted by it all. I felt as though no one could see me anymore, only my disorder. I felt as though no one saw anything that I was- a painter, a writer, a good student, a friend- and instead saw only the manipulative liar eating disorder patients are often painted to be. More than that, I was tired of sitting in front of doctors and nurses and therapists, telling them what I thought they wanted to hear just so they'd get off my back and let my life regain some sense of normalcy for once.

I just wanted to feel as though I could answer, "How are you?" honestly for the first time in over a year.

All of this came pouring out of me at once. It was probably the first time I'd shown that much emotion in that room before, and I'd been seeing that therapist for the entirely of my recovery. Something about that day broke through a wall I didn't know existed at the time. I came to see my therapist as not only a real person, someone who genuinely cared about me and how I was doing, but also as a safe place for me to explore the feelings I'd kept bottled up out of fear of being punished by my treatment team. I left feeling lighter, freer, more understood than I had in a long time.

I'd come to see that no good comes from being the perfect patient- largely because it doesn't exist.

In speaking with other ED patients, I now know that this phenomenon of seeking perfection in recovery isn't something I've experienced uniquely. It's remarkably common, and all too dangerous for those who desperately need the support of a specialized therapist. If patients don't feel as though they can release the false pretenses of perfectionism in their therapist's office, where are they supposed to feel that they can- especially when modern-day ED treatment is largely based upon a reward system wherein "good behavior" and weight restoration are rewarded with less and less scrutiny and contact with their team?

The phenomenon of the perfect patient is something I see rarely discussed, despite its importance.

Patients need to understand that therapy is a space to practice the messiness of life. It's a space to talk about the reality of recovery, without fear of punishment or being "tattled on." The fact of the matter is, eating disorders thrive in secrecy, and if patients don't feel comfortable expressing the reality of their emotions and feelings in the safe space of a qualified therapists's office, then we're doing them a disservice by not creating an environment where they fully understand the intention and spirit of therapy.

Therapy is not like seeing your probation officer. They do not want to punish you or judge you for what you're experiencing during recovery.


No. Therapy is a tool to help you process the emotions and experiences that come with releasing the grip of an eating disorder. Therapy is a safe space to practice being messy. Therapy is a place where you can allow yourself to not be perfect, and to exercise what it's like to sit with imperfection.

Four years down the line, I have a profound respect and gratitude for the support of my therapist. I'm deeply grateful that she remains in my life, and that I have someone I feel comfortable going to with things I don't discuss with even the closest friends or family.

And I want others to have the opportunity to forge a connection like that, too.