Rather than a specific therapy, there is a philosophy that appears to hold the key to binding all this treatment and recovery stuff together, Interestingly enough, an anthropologist named David Reynolds introduced me to this “philosophy” several years ago. Dr. Reynolds, who last I heard lives in Hawaii and holds a faculty position at UCLA’s medical school, wrote a book in 1984 called Constructive Living. The good professor chronicled specific “treatment” approaches taught in Japan referred to as “Morita Therapy”. He then took these concepts along with another approach, “Naikan Therapy,” interpreted and summarized their essence and translated his findings in a book titled “Constructive Living.” Having both personal and professional experiences with what is now referred to as Constructive Living, it’s become an integral part of the program philosophy at our eating disorders treatment facility. In fact, I have remained both teacher and student with respect to most of the concepts suggested by, what I would describe as part of a recovery lifestyle. Over the years I’ve come to appreciate all the parallels between a 12-Step oriented philosophy and a Constructive Living one. I encourage you to keep an open mind and give careful consideration to what follows. It is intended only as a brief and simple description of what these principles entail.

*Morita therapy is credited to Japanese Psychiatrist, Dr. Morita and is the principle impetus for Constructive Living therapy. Naikan therapies are attributed to another Japanese physician. It centers on the practice of a specific focus for meditation and reflection. It is akin to the concepts of “mindfulness” and gratitude – both corresponding elements in a 12-Step philosophy. A more detailed explanation of these techniques can be found in the book by David Reynolds Ph.D. Constructive Living published in 1984.

There are a few basic elements that deserve mention before we proceed with the proposed “laws of human behavior” to be outlined. Many of these fly in the face of what most of us mental health professionals were taught – at least as it applies to psychotherapy. I want to add a little disclaimer here and propose a couple of ideas to consider regarding this Constructive Living (CL) approach.

- The CL approach is not psychotherapy

- CL is basically a form of discipline

- Progress is better measured by behaviors rather than feelings

- Feelings usually follow Behavior

At first glance these concepts will seem simple enough. However, there is more to this stuff than meets the eye. There seems to be an implied assumption in the world of mental health treatment that goes something like this: if we can change how someone feels, or if we can change what thoughts they have, then we can get someone to change what they’re doing. I suspect most of us hold onto the belief that goes something like this – if a therapist or someone I looked to for help could fix how I feel, then maybe I would be able to– you fill in the blank. Try this one on for size: “If or when you can help me feel better about my body I will buy shorts and exercise.” “When I don’t feel so big I’ll let myself eat.” ”When I’m not so nervous I’ll speak in front of the class and be able to do the presentation.” “When I get [aka feel] motivated I’ll study.” No doubt we can make an endless list of “when I feel, I will.” Experience has shown repeatedly when we put a “state of mind” as a condition for doing something we’re likely to be stuck in the problem. Conversely, when we develop the discipline of doing what needs doing despite the feelings or intrusive thoughts we are moving toward the solution. Let’s take a moment and look at the basic tenets of this philosophy and think about them. I’ve taken the liberty of paraphrasing some of the CL principles David Reynolds talks about in his text. They are:

1. Feelings are not directly controllable by self will
2. Feelings need to be recognized and accepted “as is”
3. Every Feeling, no matter how unpleasant, has a purpose
4. Feelings fade over time unless re-stimulated
5. Feelings [and thoughts] can be indirectly influenced by behavior
6. We are responsible for what we do no matter how we feel

If you really consider these, they tend to appeal to our common sense and really don’t require a degree in rocket science. However, taking a more detailed view and truly contemplating these you’ll notice a much more profound meaning. What is being proposed are a set of what could be called, universal truths about the human mind and how it operates. It suggests trying to control our feelings by directing energy into simply “willing” ourselves to feel something is a wasted exercise. Try sitting down in a chair when you’re feeling sad and “will” yourself to feel happy for any extended period of time. Try willing yourself to fall in love with someone you’re not in love with. Likewise, controlling your thoughts by imposing self-will is quite limited as well. Ever tell yourself not to think about something? I usually will end up obsessing about something the more I try or I’m told to not think about it. The “magic sauce” in all this is that our thoughts and emotions can be indirectly influenced by what we do. In other words, what we do has the greatest [probable] impact on what we think and feel over time. The cart is placed before the horse when we get it backwards by insisting we fix our feelings first. Believing our feelings and thoughts must be changed before we’re able to change our behavior can be a very costly mistake.

If pressed to define the “end game” of all addictive behaviors I would say eating disorders and addictions are about fixing feelings. In other words, we engage in addictive behavior to change [or hoping to change] how we feel. Buying into this assumption it would be reasonable to conclude – “recovery is about transcending our need to fix how we feel and doing the next right thing no matter what we’re feeling.” This challenges the belief that controlling our feelings and thoughts is the primary goal of traditional psychotherapies. Instead we’re proposing the reverse – controlling our actions and letting the feelings and thoughts take care of themselves. “Doing is believing” as I like to say.

Feelings and thoughts, as we’re reminded, are never constant. Much like weather patterns, our emotions and thoughts are always changing. They come and go. In this sense, nothing stays the same. Trying to exert control over these is like trying to control the weather – not possible. Behavior, with very few exceptions is within our control. Being consistent with what we do is achievable. The few exceptions I know of have to do with some physiological stuff – like holding your breath for five minutes or not shivering in the cold weather or making yourself fall asleep when you suffer with insomnia, and so on. It’s a short list.

CL, Perfectionism, and Eating Disorders

Just a brief note to those who tend to sit on the perfectionist side of the ED fence – “sometimes the “what needs doing” is about “what needs to not be done.” Most of us who suffer with some form of an addiction or compulsive disorder tend to display the trait of dichotomous thinking and behavior. In other words, we tend to be all or none types, thinking and doing in terms of feast or famine and living in a black and white world with little room for any shade of gray. This being the case, some will need to use more restraint in their recovery program, being less perfect with certain elements and being mindful of not “over-doing”. Others may benefit by being more vigilant or compulsive with recovery behavior. As it relates to an eating disorder, this balance will work best combined with a prescribed food and exercise plan, a balancing of work and play along with our overall recovery activities. Given these extremes, we see people who either weigh and measure their food to the nearest atomic particle, the over-doers, or skip weighing or measuring entirely and “count” only the amount of food they consume when sitting down – as if standing and eating doesn’t count. Ok, a little extreme, but maybe not. Finding the middle ground and the right shade of gray is a big part of the learning curve.

The discipline with this approach rests with the assumption that most of us know at any given time what needs doing based on our circumstances at that moment in time and space. I suspect in “recovery-speak” this translates to “doing the next right thing.” Again, sounds simple doesn’t it? Unfortunately, simple doesn’t always equal easy. Sometimes restraint and doing nothing is the next right thing and other times doing what we need to do despite our discomfort is called for. We usually know what our truth is but that doesn’t mean we have to like it.

Author's Bio: 

Dr. Lerner is the founder and executive director of the Milestones in Recovery Eating Disorders Program located in Cooper City, Florida. A graduate of Nova Southeastern University, Dr. Lerner is a licensed and board certified clinical psychologist who has specialized in the treatment of eating disorders since 1980. He has appeared on numerous national television and radio programs that include The NPR Report, 20/20, Discovery Health, and ABC’s Nightline as well authored several publications related to eating disorders in the professional literature, national magazines, and newspapers including USA Today, The Wall Street Journal, New York Times, Miami Herald, Orlando and Hollywood Sun Sentinels. An active member of the professional community here in South Florida since finishing his training, Dr. Lerner makes his home in Davie with his wife Michele and daughters Janelle and Danielle and their dog, Reggie.

Professional Memberships:

- American Psychological Association [APA]
- Florida Psychological Association [FPA]
- National Eating Disorders Association [NEDA]
- National Association for Anorexia and Associated Disorders [ANAD]
- Binge Eating Disorders Association [BEDA]
- National Association for Anorexia and Bulimia [ABA]
- Florida Medical Professional Group [FMPG]
- National Association of Cognitive Therapists
- International Association of Eating Disorder Therapists [IADEP]

Prior and Current Affiliations:

- Founder and director of Pathways Eating Disorders Program [1987-1994]
- Clinical Director, Eating Disorders Unit at Glenbeigh Hospital, Miami, Fla.
- Clinical Director, Eating Disorders Unit at Humana Hospital Biscayne, Miami, Fla. [1982-1987]
- Founder and CEO, Milestones In Recovery’s Eating Disorders Program, Cooper City, Fla. [1999- current]
- Florida Physicians Resource Network [2005-current]