Dr. Karen Nelson continues her conversation with Dr. Amanda Ihlenfeld, around the importance of cultivating and maintaining healthy boundaries in eating disorder recovery.
Dr. Karen Nelson continues her conversation with Dr. Amanda Ihlenfeld, around the importance of cultivating and maintaining healthy boundaries in eating disorder recovery.
For a transcript of this episode click here.
Dr. Karen Nelson -[00:00:00] Eating disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that we'll find the opportunity for healing. Hi there, I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose Center, welcoming you to Melrose Heals, a conversation about eating disorders. A podcast designed to explore, discuss, and understand eating disorders and mental health.
On today's episode, I'm continuing my conversation with Dr. Amanda Ihlenfeld, licensed clinical psychologist here at Melrose. We'll continue to discuss how to cultivate healthy boundaries and the importance boundaries play in eating disorder recovery. Now, before I begin, I invite you to take a deep breath and join me in this space.
Amanda, I'm so [00:01:00] excited to have you back with me on the show. Deeply appreciate all of your insight. I liked last time how we were talking about this idea of creating and setting boundaries and how quite frankly that can feel kind of hard and that would be lovely if we maybe explore that a little bit. Any aspects that might come up in therapy where you've had discussions with people talking about why boundary setting can be hard.
Dr. Amanda Ihlenfeld - So, I think we have to, like, when it comes to setting boundaries, we have to be really aware that there, for some people, there may have been times where it was legitimately unsafe to set boundaries. They might have grown up in an environment where there was punishment for setting boundaries. Maybe they had a really difficult or traumatic experience when they did try to set a boundary. And so it does actually feel unsafe to set a boundary, and that is a [00:02:00] hard thing to undo, right? Because we have this experience that validates like, no, setting boundaries is wrong. It's going to get me in trouble in some way. It's going to be painful. And so part of what we do in therapy is we work on how do we set boundaries in the moment that we're in? The experience that somebody might have had where the boundary setting was unsafe is absolutely valid and it is justified to feel the way that they feel. And in the present moment, if they're not in that situation, we need to learn skills to manage the situation that we're in now.
Dr. Karen Nelson - What do you potentially talk about with patients as you're maybe coaching them in developing or setting a boundary? What topics may come up?
Dr. Amanda Ihlenfeld - Sometimes start with even just identifying what their values are. Right? When we can identify what our values are, it's easier to see what some of those non-negotiable boundaries are. So, for example, if I have a value that [00:03:00] says, I don't steal, it's going to be pretty easy for me to say no to someone if they ask me to rob a bank.
Dr. Karen Nelson - That's right. Excellent example.
Dr. Amanda Ihlenfeld - I don't have to make up an excuse.
Dr. Karen Nelson - That's a hard no.
Dr. Amanda Ihlenfeld - Oh, I'm getting my hair done that night. Or something like that. I just don't steal and rob banks, right?
Dr. Karen Nelson - Yeah, just don't do that.
Dr. Amanda Ihlenfeld - So identifying what our values are, even when it comes to the values we hold around ourselves, in our time, in our space, in our emotions, all of that stuff becomes really important because it becomes a guidepost to figure out where do I want to start practicing some boundaries?
Dr. Karen Nelson - I think the piece that I often talk about, my favorite thing is to say, notice and pay attention, I literally say that every session with patients. And then I use the word experiment a lot. And having some of these opportunities to, as a patient identifies what their values are, it's so cool that we can maybe tee them up a little bit when they're like, well, I don't think I have [00:04:00] any boundaries.
And then you share the example, well, would you rob a bank? Well, of course not. Okay. We're starting right there. And many times my recommendation is if boundaries feel like something I need to be working on, probably not going to go into the most chaotic, overwhelming, intense relationship first. I may start with literally practicing it in therapy. Right?
Dr. Amanda Ihlenfeld - Absolutely.
Dr. Karen Nelson - Or, I don't know, what comes up for you?
Dr. Amanda Ihlenfeld - I will oftentimes send people with the homework to say no over the course of the next week.
Dr. Karen Nelson - Yes, same. Yes.
Dr. Amanda Ihlenfeld - And to say no about something that is so simple and basic. So if somebody says, you know, hey, will you hand me this thing that's across the room?
Dr. Karen Nelson - Right.
Dr. Amanda Ihlenfeld - Even just saying no.
Dr. Karen Nelson - Yeah, right.
Dr. Amanda Ihlenfeld - You know, are you capable of handing them the thing that's across the room? Yes. And saying no is totally fine.
Dr. Karen Nelson - That's right.
Dr. Amanda Ihlenfeld - Or, hey, can you stop and pick this [00:05:00] up for me when you're out and about? Like, no, I can't. That's not part of what I was planning on today and I wasn't planning to make that stop, right? And so even little things like that it seems like not a big issue, but it really is about getting comfort with setting small boundaries so that we can build up to the bigger ones.
Dr. Karen Nelson - For sure. I think also, many times my patients will share with me, they can identify relationships that they may feel more comfortable with practicing boundaries, right? So, you know, maybe I have a best friend and when she, like you said, if she asks like, hey, you know, are you up for meeting for coffee on Saturday? Like, oh, actually, no, that's not going to work for me. Those experiences are invaluable because they give us this learned, like confidence. Like, Oh my gosh, I just did that. Right. And we're high fiving. I'm like, yeah, you said no, [00:06:00] you know, I'm so excited. Sometimes it even starts earlier than that. Sometimes we literally will role play. We will talk about setting boundaries literally within session. I did a role play with a patient, this was years ago, where I would, make a recommendation like, hey, I think we need to, and it was all pretend like, hey, I think we should see each other twice a week. And then her saying, well, actually once a week is only going to work for me. Great. That it feels kind of silly and nuanced, but actually, those lived experiences build confidence. Like, it's okay for me to do that.
Dr. Amanda Ihlenfeld - Absolutely. And when I do similar things in sessions with my patients, we get to process then what that felt like.
Dr. Karen Nelson - Such a good point.
Dr. Amanda Ihlenfeld - We get to talk about where did you feel that in your body, because it's important to be aware and noticing when we are holding boundaries, what that feels like. [00:07:00] You know, for a lot of people it might feel like, you know, some tension in their shoulders or it might be a tension in their midsection and then a pulling back.
Dr. Karen Nelson - Yes!
Dr. Amanda Ihlenfeld - I hear that one a lot. And so we're trying to put together like some of the cues and clues that are going to let us know, this might be a time where I need to set a boundary…
Dr. Karen Nelson - That’s right.
Dr. Amanda Ihlenfeld - …because they might not have any awareness of what that is outside of that because they've never been allowed to practice it.
Dr. Karen Nelson - For sure. A patient of mine, one of the things we talk about, she said, I think I've started to learn every time my leg starts tapping, something's happening, right? Like my body is kind of instinctually saying, I'm not sure, something's happening here. And we've just kind of grown to incorporate that into her awareness of like, oh, maybe parts of this feel uncomfortable. How might I set a limit that feels comfortable for me?
Dr. Amanda Ihlenfeld - Yes.
Dr. Karen Nelson - So good. Let's transition into, you know, [00:08:00] talking about boundaries in connection with eating disorder recovery. I'm so glad you brought up the intersection that happens when we may have patients who are struggling to set boundaries in relationships or can feel potentially used or overwhelmed and a lot of emotion is triggered. Those absolutely become spaces where they may want to engage with eating disorder symptoms to manage that discomfort.
Dr. Amanda Ihlenfeld - Absolutely.
Dr. Karen Nelson - I mean, we say it all the time on the podcast, and I think it's so important to reiterate, eating disorders are not about food. They express themselves through food.
Dr. Amanda Ihlenfeld - Right.
Dr. Karen Nelson - Right? The eating disorder is there to manage, numb out, distract, comfort, nurture, all of this emotional dysregulation that may be happening for a variety of reasons. Right?
Dr. Amanda Ihlenfeld - Right. And that's one of the things that is so difficult about eating disorders.
Dr. Karen Nelson - That's right.
Dr. Amanda Ihlenfeld - Because they are functional to [00:09:00] some degree. They help us to manage and tolerate really challenging situations, and if we don't learn how to cope outside of that, the eating disorder being the only option, then we get stuck.
Dr. Karen Nelson - That's right.
Dr. Amanda Ihlenfeld - And that's where, you know, a lot of problems can come up.
Dr. Karen Nelson - For sure. Well, and I think, you know, just acknowledging - I was chatting with a patient a couple of days ago, and I'm like, let's just be really nurturing. Right? And say, of course, you don't want to feel bad, right? If you're in a situation where you're feeling kind of used or overrun, if someone is really pushing, you know, their needs and agenda onto you, and I haven't quite learned how to self advocate yet or set a healthy boundary, probably not going to feel real good.
Dr. Amanda Ihlenfeld - Right.
Dr. Karen Nelson - And you and I have been therapists for a real long time now, I can, I can confidently say I have never met a human that walks into my office and is like, I hope I feel awful today. Right? Like no one's…[00:10:00]
Dr. Amanda Ihlenfeld - Right, like nobody's like signing me up for that.
Dr. Karen Nelson - No. Let me have the worst day of my life, Karen. I just, I mean, I feel like that'd be a fun go around.
Dr. Amanda Ihlenfeld - Right.
Dr. Karen Nelson - Uh, no. Of course not. And so, I think it's so important for us to develop a space of kind of compassion and understanding. Right? And it sounds like you beautifully do that with your patients of like, of course. Of course I want to feel better. And if my only way to feel better is to use the eating disorder. Now I'm stuck.
Dr. Amanda Ihlenfeld - Right. Right. And so really what we're doing with boundaries is we are working on building confidence. We are working on building a skill set that is going to help them to have other options. That's what we want. We, we never want someone to be without options.
Dr. Karen Nelson - That's right.
Dr. Amanda Ihlenfeld - And if the eating disorder is what they are relying on primarily or really the only thing, then they don't have those other options and it is going to feel incredibly [00:11:00] uncomfortable.
Dr. Karen Nelson - Absolutely. Absolutely. Tell me about, you know, let's maybe explore this a little bit more. Any examples or, you know, components that you might be able to share with our listeners of, of how might rigid boundaries or lack of boundaries keep the eating disorder in control? Any examples that you could give us?
Dr. Amanda Ihlenfeld - When I think about having more of those rigid boundaries, oftentimes, I think of people, I've heard it described as being overbounded as well.
Dr. Karen Nelson - Good one.
Dr. Amanda Ihlenfeld - And so when we're overbounded, essentially what we're doing is we are trying to hold people in relationships as far away as we possibly can. There is something that feels incredibly safe about that.
Dr. Karen Nelson - That's right.
Dr. Amanda Ihlenfeld - Because if people are not able to get close to us, then I don't have to change. I don't have to deal with discomfort. I don't have to learn a new way of doing things. But [00:12:00] man, is it lonely. It is so lonely. And so one of the things that I think can happen is when someone is struggling to reach out to their supports, maybe they have put boundaries into place where they are not allowing support people to understand where they're at in recovery, understanding what their needs are, what's helpful for them or not helpful for them. That can end up feeling really isolating because people can't get close enough to help them and support them, and then they're left to do it all on their own. And so there are times when those things that, when we are overbounded, that it really is a detriment to our recovery.
Dr. Karen Nelson - Well, I think that place of wanting to potentially feel safe, right? If I'm, you know, overbounded or if I have a lot of rigid boundaries, I don't let people in, there's some safety to that.
Dr. Amanda Ihlenfeld - Absolutely.
Dr. Karen Nelson - Then I don't gotta get hurt, right? Absolutely.
Dr. Amanda Ihlenfeld - Yeah. I don't have to change. I don't have to learn something new.
Dr. Karen Nelson - That's right.
Dr. Amanda Ihlenfeld - I can stay with what's comfortable. I [00:13:00] know the eating disorder, so I'm going to stay doing what I know.
Dr. Karen Nelson - That's right. That's right. And then I walk into a place where I'm starting to explore releasing some of those eating disorder behaviors. It makes sense that we might need to rewrite the script for how I handle things. For sure. And how vulnerable it feels, right? We know that in eating disorder recovery, having the love and support from others around us increases the likelihood that we're going to recover and that we're going to stay recovered.
Dr. Amanda Ihlenfeld - Absolutely.
Dr. Karen Nelson - Right? That recovery doesn't happen in a vacuum. Right. And so those experiences where patients may be really hurting or suffering and may potentially need to reach out to loved ones can feel really scary.
Dr. Amanda Ihlenfeld - Absolutely. And I think there is this fear of the eating disorder also being taken away that really gets in the way for people.
Dr. Karen Nelson - Absolutely.
Dr. Amanda Ihlenfeld - Because they're, if that is their [00:14:00] coping strategy, who would want to lose their Coping strategy?
Dr. Karen Nelson - You got it.
Dr. Amanda Ihlenfeld - Right. And so holding, being overbounded in some ways really allows them to stay in the space of being comfortable.
Dr. Karen Nelson - For sure.
Dr. Amanda Ihlenfeld - With what they've been doing. And even though it's not effective, it's familiar.
Dr. Karen Nelson - For sure.
Dr. Amanda Ihlenfeld - And boy, do we like familiar.
Dr. Karen Nelson - That's right. And let's be real clear, overbounded, I don't want people to get kind of tripped up on that word. That's just another way that we can say having really rigid or inflexible boundaries.
Dr. Amanda Ihlenfeld - Absolutely, yes.
Dr. Karen Nelson - Sometimes the kind of mental picture that I'll give patients is, are your boundaries, you know, you know, prison wall, right? Are you fully contained? Is there any way in or out? Lack of boundaries might be, I have no walls at all. People are kind of just flowing in and out, people can run into my yard, and healthy boundaries, you know, I would describe those as maybe, you know, a fence with, oh, gates, many gates, right? I can kind of let people in.
Dr. Amanda Ihlenfeld - Right. I think [00:15:00] that's really important to note. I'm glad that you said that, too, because when we talk about having more of those porous boundaries, another way of saying it is being underbounded.
Dr. Karen Nelson - Yeah.
Dr. Amanda Ihlenfeld - Right? When we have that, we have people coming in and, and there's a lot of vulnerability. It's hard to, sometimes it's hard to decipher what's mine and what's theirs. How am I feeling? So when we talk about those emotional boundaries, that's where we can get really tripped up too, especially in relationships of, well, my partner, this person that I know, like they're feeling this way, so should I be feeling this way? And so it gets so enmeshed and entangled when we can't separate that, it's hard to take care of ourselves because we don't know what we're actually taking care of.
Dr. Karen Nelson - Good point. For sure. It can get all mixed up. Let's talk about kind of ways to decipher, I know that I have healthy boundaries or okay boundaries. Some of the questions that I'll encourage my patients to kind of [00:16:00] check in with themselves is, you know, does it feel good? What's mine? Does it hurt? Other ones that I may encourage them to really kind of breathe into. Is this my responsibility? Or is this someone else's? Right? I promise you, we may be lulled into thinking I'm responsible for other people's emotions, you are not. Right? And that is tricky when we're trying to maneuver relationships. Anything come up for you as I say those things or, you know, ways that you might help your patients decipher if I'm making a healthy boundary? Does it hurt? Do I feel good?
Dr. Amanda Ihlenfeld - Sometimes I will ask people if they want to spend time with that person?
Dr. Karen Nelson - What a good question!
Dr. Amanda Ihlenfeld - Right?
Dr. Karen Nelson - You know, because As basic as that is, right?
Dr. Amanda Ihlenfeld - I mean, we are drawn to people who can help us feel safe. And typically safety indicates that we have healthy boundaries. And so if you get an uneasy feeling or you're kind [00:17:00] of dreading going to see someone or spending time with them, that's giving you information. Be curious about that. Don't just blow it off. Be curious and say, What's up with that? Why am I having this feeling? Because I didn't feel like this when this person asked me to do something, and now this person's asking me to do something, and I don't really want to do it. I want to ignore their call, or I don't want to respond to their text. That is good information to have.
Dr. Karen Nelson - For sure. So, we shouldn't just ignore those, you know, thoughts or feelings because they might be negative or unwelcomed, they're really there. Right? No emotion is good or bad. Feelings are just there to give us information. And if I ignore those maybe warning signs, I potentially then might be walking into a relationship that might not feel so good.
Dr. Amanda Ihlenfeld - Exactly.
Dr. Karen Nelson - Is it ever fun to set boundaries?
Dr. Amanda Ihlenfeld - Absolutely.
Dr. Karen Nelson - Yeah, tell me.
Dr. Amanda Ihlenfeld - I think it can [00:18:00] be fun to set boundaries. When we are like, when we're starting to get comfortable with it, like I think sometimes people start to have fun with it and they want to set them and they want to set them around things that they never thought they would set boundaries around another time.
Dr. Karen Nelson - Absolutely.
Dr. Amanda Ihlenfeld - I one time talked to somebody who, somebody asked them to borrow a book, and they just didn't want to. They really like their books. They didn't want it to get, you know, the pages to get crinkled or, you know, turned down or whatever, folded. And so they said no and they loved it.
Dr. Karen Nelson - Right. I did that!
Dr. Amanda Ihlenfeld - Right. They loved it. They're like, I love it. I did this. I felt really good about it and my books look really nice yet.
Dr. Karen Nelson - That's awesome.
Dr. Amanda Ihlenfeld - So I do think that it can feel really good. I think as parents, right, we can work on setting boundaries with our kids in ways that are really, really kind of fun. You know, so sometimes when I'm [00:19:00] talking to my daughter, for example, you know, I might set a boundary because she's asking for something that I'm not really sure even I want to do.Could we do it? Maybe, but maybe it's just not one of those days where I want to do something. So then we get to have fun coming up with other ways to do what she wants to do, right? That might actually work for both of us. And we might have a lot of fun in the process, and it might take us somewhere we didn't expect.
Dr. Karen Nelson - So good. What do you think happens when you potentially have set a boundary or does it ever happen that you set a boundary but you maybe didn't really want to?
Dr. Amanda Ihlenfeld - I think that sometimes we can set boundaries that we think we are supposed to set. We might feel compelled to say no to something because we're worried about what other people might think or how they might feel about it. And so we say no to a situation or a request and we don't like how that feels because we're not doing it because that fits for [00:20:00] us. We're doing it because we're feeling pressured in some other way. And so I think that when we talk about boundaries, one of the most important things to understand is what is my intent? What am I trying to do with this boundary? Is it serving me or am I doing it because I feel like I need to or because somebody else would want me to do this? Dr. Karen Nelson - You know, thinking about if I am a person, we were talking about that aspect of maybe being, you know, kind of having really rigid boundaries or kind of overbounded, right? I have the prison wall around me, nobody's getting in. If I identify like, oh, maybe this is sometimes harmful to me because then I don't have the connection or relationship that I really want. How might I make less rigid boundaries or what, what do you think some steps might be?
Dr. Amanda Ihlenfeld - So it's a process, right? So, the goal of boundaries is to figure out where a [00:21:00] healthy boundary is for us. That's going to vary person to person, right? Some people, our boundaries are going to be a little bit farther out than others. Some people, we feel comfortable letting them in a little bit closer. It should be, we should note that it doesn't matter what situation we're in or what relationship that we're in, it is always appropriate to have boundaries. So even if it's a close relationship or a partnership, something like that, there is never the expectation that we don't hold any boundaries. That's really important, even if the person's very close to us. I think the goal when we have maybe more rigid boundaries and we want to work on, bringing them a little bit closer and being more flexible is doing it slowly. Oftentimes people will run into this pendulum-like effect…
Dr. Karen Nelson - Yes, good point.
Dr. Amanda Ihlenfeld - …where they will hold these rigid boundaries and they kind of keep people farther away from them and then they notice, well, [00:22:00] I do feel kind of lonely. I think I want to change this up. And instead of doing it slowly, they just jump into, okay, I'm going to be open with everyone, and I'm going to talk about everything, and I'm going to be, you know, super comfortable with everyone. And while they feel more connected, they end up feeling vulnerable. And that can cause them to shut things off and kind of go back to that other, like, rigid boundary again. And that's kind of like emotional whiplash sometimes. It can be.
Dr. Karen Nelson - Absolutely.
Dr. Amanda Ihlenfeld - So we want to slowly bring it back. We want to maybe give people, like, more opportunities to show us how they respect our boundaries. We want to give ourselves more opportunities to set boundaries and be curious and aware and noticing how they interact with our boundaries. Are they trying to get around our boundaries? Are they trying to push at them? Are they proud of us for setting boundaries, right? And so I think it's, it's a slow [00:23:00] process and that is what is going to feel the most comfortable to most people. It's going to be less jarring that way and it's going to make them feel like they are really honing in on the precise boundaries that they need in the relationship. Well, I think another aspect that comes up is when someone is attempting to discern where their boundaries or where their boundaries or where their limits are, it does take a lot of kind of introspection, self-reflection, awareness.
Dr. Amanda Ihlenfeld - Absolutely.
Dr. Karen Nelson - And then there's this thing that happens when I may be struggling with an eating disorder, I may numb all of that out, right? And so a lot of times my patients will say, you know, part of the desire to be engaging with the eating disorder is that it keeps them kind of distracted and insulated. And doing this work of kind of boundaries and checking in with myself, I do need to be able to kind of tap inward. And that can feel kind of scary. [00:24:00]
Dr. Amanda Ihlenfeld - Absolutely.
Dr. Karen Nelson - Well, and I think, so the importance of, I like how you were describing, kind of the slowness and the practice of it, right? It isn't just kind of a whiplash rebound effect of like, Oh, well, Karen said I have rigid boundaries. I just need to let everybody in, right? This ain't that. We're not doing that. And the complexity of as I'm working on maybe setting limits around boundaries, I also may be working on eating consistently.
Dr. Amanda Ihlenfeld - Yes.
Dr. Karen Nelson - Right? Like it's all kind of happening together. I don't know. Thoughts on that?
Dr. Amanda Ihlenfeld - Yeah, I think they go really nicely together. When I'm working with someone to get more on a consistent eating schedule, right, one of the boundaries they sometimes need to set with others is, this is my eating time. And that can feel real awkward, right?
Dr. Karen Nelson - So hard!
Dr. Amanda Ihlenfeld - They might have friends that don't eat as consistently as they do, and so they want to go out and do something fun, but that interferes with their time.[00:25:00] And so learning how to set these healthy boundaries not only helps them to feel more confident in general, but now we're also taking care of what our needs are in terms of eating disorder recovery.
Dr. Karen Nelson - That's right. And those become actually really important experiments. You know, sometimes if my patients are like, well, I don't know what I need. And I'm like, well, I know what your recovery needs, so we're going to start right there. Right? Or noticing when they might feel triggered. Right? You know, if I go hang out with, you know, some family and I notice there's a lot of emotion and distress, maybe I am going to set a boundary and say, you know, I'm only going to be spending limited time with you for the time being, as I'm working on eating disorder recovery.
Dr. Amanda Ihlenfeld - Right. And that is something that we are constantly encouraging. There are people who struggle with other people, maybe in their lives, close to them, who have unhelpful [00:26:00] views on food, or body image, that kind of thing. And so, being around those people, even though they might absolutely love those people, and they want to have good relationships with them, they might know that where they're at in recovery it is not going to be effective for them to have a good relation- or a close relationship with that person at that time because their eating disorder is going to get triggered.
That's right.
Dr. Amanda Ihlenfeld - And so being able to set those limits and say, I love you and…
Dr. Karen Nelson - And.
Dr. Amanda Ihlenfeld - …I can't be with you right now for my own recovery is incredibly empowering and so crucial to getting to that place of recovery and relapse prevention.
Dr. Karen Nelson - For sure. For sure. Well, Amanda, I can't thank you enough. I've just so deeply enjoyed our conversation. My final question that I get to ask is, is there anything that I haven't asked that you'd like to say today? [00:27:00]
Dr. Amanda Ihlenfeld - I don't know if there is. I guess I would just really end with the post-it…
Dr. Karen Nelson - That’s right!
Dr. Amanda Ihlenfeld - …that we talked about. We cannot set boundaries and caretake others at the same time. Those are really the two things that do not go together.
Dr. Karen Nelson - For sure. And you deserve to take care of yourself.
Dr. Amanda Ihlenfeld - Absolutely.
Dr. Karen Nelson - Thank you again.
Dr. Amanda Ihlenfeld - Thank you for having me.
Dr. Karen Nelson - We'd love to hear your feedback on our episodes, the topics we cover, and anything you'd like to hear me discuss on the show. Our email address is melrose at parknicollet.com. If you or a loved one are suffering from an eating disorder, we're here to help. Call 952-993-6200 to schedule an appointment and begin the journey towards healing and recovery.
To learn more about Melrose Center, please visit melroseheals.com.
Melrose Heals, a conversation about eating disorders, was made possible by generous donations to the Park Nicollet Foundation.