What therapeutic approsches helped you most with food-related issues?

I was having a conversation with a friend about some of the things she is doing with her therapist with regard to her efforts to lose weight and keep it off (she has not had WLS).  So, I started thinking about the differences in how therapists work with people on weight issues, especially people who are obese rather than just a little overweight.

We all have different "demons" when it comes to food, but I'm wondering what things people here have found most (and least) helpful if they have addressed their weight and eating issues with a counselor.  Some people, for example, respond well to primarily addressing the behavior side of things whereas others respond better to focusing on the underlying issues first.  Some people find that counseling didn't really help at all in their efforts to address their eating issues.

Care to share?

Lora

for me it was  dealing with underlying issues, once i got over that hurdle i was in like flint,:)

 I haven't gone into great detail with any therapist I've seen, relating to my weight problems. For me, the therapist helped me to see what was going on at my life during those periods of distress. What was I doing? Was there anything I could have done differently at the time? Was I aware of what was going on or was it an out of body experience? 

I had some traumatic childhood moments(violent death in the family, emotional/physical neglect, etc.), which were covered up with depression and not admitting there was anything wrong. Part of my depression and part of this trauma increased the overeating, and eventually led to anxiety about everything in my life. 

I started seeing patterns in my life, and they usually coincided with significant weight gain/loss...always a see-saw. ;)

For me the issues aren't clear until I have addressed my eating.  As long as I am eating compulsively I am unable to work on why I am overeating, if that makes sense.  One thing that helped me the most was a 12 step program.  I heard people tell me "If you want to know why you overeat, stop overeating."
I am motivated to work on things because I know the alternative is to start eating destructively again.

Yes, that makes sense.  It is the same with alcohol and drug abuse.  If I have a client *****veals that (s)he is addicted to drugs or alcohol, I "insist" (inasmuch as it is in my power to do so, since the client is ultimately the one who makes the decisions about his/her own life) that we deal with the substance abuse first so that the client is able to deal with the underlying issues.  Not all therapists, of course, take the same approach, though.

Lora

for years (literally) I wouldn't even say the word "weight" in counseling. When I decided to have surgery we started talking a little more about it - but by then all of my "stuff" was out in the open.
We just recently started talking about weight again, because of my lack of confidence in success with WLS. So far, the underlying issues haven't even come up, we address the behavior and ways to change it. I'm quite sure he'll drag up the other though

 My experience was somewhat similar.  I had always been overweight (although not morbidly obese), but because the bulk of my weight was trauma-related (and I was so unhappy with the weight and so ashamed that I had allowed it to happen), I did not discuss my weight except once or twice "in passing" until right before I decided to has surgery. By then, we had already spent (literally) years talking about both traumas.

Lora

 Thank you Lora for starting this thread. Very enlightening and informative. 
I definitely believe that therapy is good for those of us with eating issues. Would you recommend an eating disorders counselor or a general psychologist?

I think that anyone who has a lot of experience dealing with weight management and eating disorders is the best bet, regardless of whether it is a counselor or psychologist.  The problem is that, unlike physicians where it is easy to go to your insurance web page or the phone book and find one with the specialty you need (there is no chance of getting someone who primarily deals with obstetrics when you need a gastroenterologist, LOL), it is much more difficult to find out a counselor or psychologist's specialty area.  Yes, any counselor should be reasonably competent to help clients with general weight issues, but someone who has invested in extra education in eating disorders, and has worked with more ED clients, is more likely to be more helpful than someone who has not.  (I believe that is also particularly true, BTW, for people with trauma issues.)

For someone who has never seen a counselor or psychologist, BTW, is is perfectly acceptable to call a counselor and ask about his/her education and experience level in particular areas before you make an appointment.  They will not be (or should not be) offended if you opt not to make an appointment because you are looking for someone with more experience with a specific issue.

Lora

 I've found therapists to often assume that excess weight is something that is a symptom of mental illness, and food addiction.  I have been addicted to diet coke (an addiction that seems to be past tense three weeks' post-op), but other than that, I have never had significant food issues.  My excess weight is due to a terrible genetic legacy and a lack of connection to food that continues to this day.  If there is a therapeutic target in there, it's about a lack of self-care, a culture of duty and self-denial that has permeated my life.

For that issue, it's been necessary to really understand that my ticket to heaven is not dependent upon the ways in which others want me to do good, but instead, on the good that I can actually get done in a way that honors my body and my life.    It's also been necessary to have someone challenge my thought patterns so that I don't get so tied up in the thoughts that got me here.   

I'm not sure I'm willing to go back to therapy right now, but I am watching things.  If I do go back to therapy, I'll need the exact same approach that I've always needed, because they operated on my stomach, not on my brain.