In a sense, automatic thoughts are just the tip of the iceberg. Lurking beneath the surface are some implicit rules by which the patient operates. These rules spring from deeply held assumptions, beliefs, and values.
Dr. Christopher Fairburn has come up with a list of the most common of these attitudes:
-”I must be thin, because to be thin is to be successful, attractive, and happy.”
-”I must avoid being fat because to be fat is to be a failure, unattractive, and unhappy.”
-”Self-indulgence is bad because it is a sign of weakness.”
-”Self-control is good because it is a sign of strength and discipline.”
-”Anything less than total success is utter failure.”
In therapy we bring these attitudes to the surface, analyze them, and challenge them. We try to discover both the advantages and the disadvantages of holding on to such beliefs. For example, there are reasons why people may base their feelings of self-esteem on their weight. After all, measuring weight and judging oneself accordingly, is a simple task. Weight is one thing about themselves that people can have some control over. Besides, gaining weight gives a good excuse for failure in other areas of life: “Of course no one asks me out; I’m a fat pig aren’t I?”
The downside of this attitude is that the patient will never be satisfied with her weight-and thus herself-for long. Focusing on weight distracts one from working on real problems in forming and keeping relationships. By concentrating on dieting, a person can avoid having to deal with issues of low self-esteem or other bad feelings.
In therapy we look for insight into how these attitudes arose. What influence did the patient’s family, friends, and social forces have on her thinking? When did these beliefs begin? How did they take root and grow? What else was going on in her life at the time the attitude started? One way to shed light on such questions is for the patient to talk to friends of long standing, or look at old family photos or diaries.
The desire to be in control often overwhelms the patient’s ability to think clearly. She believes that if she can’t control her body functions, such as hunger, menstruation, or sexual drive, then catastrophe will result. Such an attitude is one of the hardest to shake.
*78/35/5*
