OP ED Blog (Optimizing Psychology for Eating Disorders) By Sandra Wartski, Psy.D., CEDS
Being ghosted has become common parlance among in the younger generations to mean that someone with whom you had been in close contact precipitously disappears. This process usually entails someone, either a romantic partner or friend, suddenly no longer answering texts and phone calls. Given that our current technology allows more continual contact at all hours of the day, this non-response is especially pronounced.
Ghosting is pure evasiveness, and it never feels good. Those doing the ghosting are usually avoiding conflict, whether this be in the form of a difficult conversation, disagreement or fear of hurting someone’s feelings. Those being ghosted often experience a range of emotions, including confusion, embarrassment, hurt and anger. Some situations allow for self-reflection but the many unknowns and the lack of closure make this process difficult. Many individuals who have been ghosted end up engaging in some self-recrimination and over-personalizing, but some learning and more letting go is what often needs to occur.
Most therapists have also experienced being ghosted at some point by a client. This might involve the experience of knowing a client who was coming to appointments regularly but then suddenly stops showing up. Contact is made but to no avail. Unlike the client who misses an appointment by mistake or has other priorities on a particular week, ghosting is a much deeper experience of avoidance. A therapeutic relationship is clearly in a different category than a significant other or a friend, but some of the complex emotions of being ghosted can emerge nonetheless.
We therapists may try to reflect what may have led to the retreat of a particular client. Did something go wrong in the last session? Maybe I misattuned to something important? Was something amiss with the match? Did the material become too overwhelming? Was there more fragility than I realized? Did they get scared of the work? Perhaps she was less committed to the process than I had thought? The questions can go on and on. Sometimes the reasons are ultimately revealed to be in a completely different direction, such as not having the finances to continue but being embarrassed to admit this, but very few times do we get any true answers.
In treating individuals with EDs, being ghosted can add on a host of additional worries and wonderings. ED clinicians often need to reflect not only on the typical treatment factors but also on the additional ED factors that contribute to the treatment complexity. Many of our clients with EDs have such longstanding dysfunctional patterns that have been hidden for so long that the process of entering treatment can be intimidating. The pull to revert to ED behaviors remains strong for a good long while, and the malnourished brain effects can be present for longer than is often realized. Our clients also live in a society that unfortunately reinforces some of that ED thinking and behavior, and this adds further to the potential hesitancy of the treatment situation. We are also asking them to work on habits and behaviors that come up every day, all day long – and this can indeed be quite overwhelming. Given all the complexities, it is actually surprising ghosting with EDs doesn’t happen more often.
When a client with an ED ghosted me recently, I went down this spiral of self-reflection, apprehension and questioning. My initial meeting with the 45-year-old professional woman with a 20-year history of Bulimia Nervosa went smoothly. She seemed eager to explore treatment and seemed truly amazed when I spoke of recovery being possible. She committed to weekly appointments and quickly experimented with shifts and changes we discussed. She would report about some of the changes being easier than she thought while others unleashed a torrent of unexpected emotions. As one month turned into several, she bravely marched forward to observe, to share, to be curious, to take baby steps and to attempt a more non-judgmental stance. Explaining to her husband that treatment would take “more than a couple of sessions” and committing to take care of herself for a change were not uncomplicated tasks, but she took them on with gusto. She was starting to feel better, both physically and emotionally, for the first time in decades, and she seemed excited to keep going.
But then she suddenly stopped showing up. At the first no-show, I wondered if perhaps some other crisis had emerged for her, as it had in the past, and she had perhaps forgotten to reschedule. I called and left a voicemail message, noting that I would plan to see her at our next scheduled appointment if no sooner reschedule was needed. But then the following week there was another no-show; again, I left a message, but this time with a bit more curious, tentative tone. After a third no-show, I then was resigned to assume that she had chosen to exit treatment for reasons unknown. I wrote her a brief note thanking her for the work and leaving an open door to her should she choose to come back. Then the why questions that likely come after most every experience of being ghosted began. Did I go too fast in terms of jumping on the recovery path? Was there a slip in symptoms and she felt too embarrassed to share? Did she (or I?) expect too much too soon – or not soon enough? Maybe she felt the eating changes she had made seem good enough and not necessary for additional fine-tuning? Did she have a resurgence of the purging behaviors but felt too ashamed to talk about it together? Was there another symptom we were getting close to but she wasn’t yet ready to reveal? The questions went on and on, but no definitive answers ever came.
We can use ghosting experiences as a time to reflect and explore but, without a two-way conversation, we don’t ever really know the facts. Just as we help our clients to know that we may not always get to know or understand why others do what they do, we therapists need to remember the same. We can’t know exactly what others are feeling or experiencing unless they tell us directly, and even then there can be nuanced obscurities that further confound the situation. But we can maintain that healthy dialectic of considering our own possible contributions and also leaving space for unknown factors from other. And this allows for balance, accepting the unknown and giving grace to ghosting.
Sandra Wartski, Psy.D., CEDS is a licensed psychologist who has been working with Eating Disorders over the past 25 years. She works as an outpatient therapist at Silber Psychological Services in Raleigh, NC. She enjoys providing presentations and writing articles on a variety of mental health topics, particularly ED-related subject matter. Send comments to email@example.com
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