Episode 55 Embodiment in eating disorder recovery and mental health treatment with Rachel Lewis-Marlow

[CHRIS McDONALD]

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Welcome to the Holistic Counseling Podcast, where you discover diverse wellness modalities, advice on growing your integrative practice, and grow confidence in being your unique self. I'm your host, Chris McDonald. I'm so glad you're here for the journey.

Welcome to today's episode of the Holistic Counseling Podcast. I'm your host, Chris McDonald. I hope you're doing well today. We're coming off the holiday from Thanksgiving this week, as I record this today and of course diving straight into the holiday season, which can be challenging with so much more on our plates. I just want to send you that reminder as a therapist to take care of you and find those healthy ways to unwind. I know one way, I decompresses through movement and breath through daily yoga, which helps me stay connected to my body, helps me release stress and today's guest understands the importance of embodiment and treatment. That's Rachel Lewis-Marlow.

She's here today to share her body-based program called embodied recovery for eating disorders. Rachel Lewis-Marlow is a somatically integrative psychotherapist, dully licensed as a licensed professional counselor and a massage embodied work therapist. She's also certified as an advanced practitioner in sensory motor psychotherapy, has advanced training and 30 plus years of experience in diverse somatic therapies. She is co-founder of the Embodied Recovery Institute, which provides training in a trauma informed, relationally-oriented, I think I can't say that too fast, relationally-oriented and somatically integrated model for eating disorders and treatment in her private practice. Rachel specializes in working with people, recovering from trauma, eating disorders and associate disorders. Welcome to the podcast, Rachel.

[RACHEL LEWIS-MARLOW]

Thank you so much. It's a pleasure to be here.

[CHRIS]

So can you share a little bit more about yourself and your work?

[RACHEL]

I'm not sure what more to add.

[CHRIS]

I was going to say, I did share a lot about your background.

[RACHEL]

Yes. I think that maybe what I would just add is that I've been weaving the mind and body together, feels like for most of my life. I think it's an evolving practice and I feel really honored to be able to meet with people who are on a recovery or an embodiment journey or a growth and healing journey. It's just real honor that our paths meet and that I get to accompany them for a part of their journey in a way that brings them into maybe a more collaborative relationship with their bodies, innate capacity for healing.

[CHRIS]

Absolutely. I found it interesting that you're a massage therapist in addition to a licensed mental health therapist. how do you think that's helped you as you became a mental health therapist? Has this changed your perspective on things or give you a different perspective?

[RACHEL]

I think it very much has given me a different perspective or maybe it was the different perspective that brought me to body work first. Then, or I don't know, it was a very securous route, but what brought me into my graduate degree in counseling was that I was working with bodies and people in relationship with their bodies and realizing that I could facilitate change and support change, but it was often temporary in response to how my body was helping to resource or co-regulate theirs through touch and really had to dive into not just to how they were in their bodies. That was a lot about how they were in the world and their relationship with themselves as well as their physical surroundings.

So I also was really aware of how to facilitate change through a somatic to somatic dialogue and different principles of facilitating change. I wanted to understand the correlate in how to facilitate change in a cognitive to cognitive dialogue or an emotion to emotion dialogue, or crossing those, what is it to go from cognition to body or emotion to cognition, or sort of these different kinds of dialogues that we can have with different ways that we have organized human experience.

[CHRIS]

I know on the video, on your website, you talk about the sensory sensory motor psychotherapy training. So, I guess, was that a turning point for you?

[RACHEL]

That was a weaving. That was a place where I got language. I got cognition and accurate language to describe what I had been experiencing all my life. It was a way of stitching, what they call stitching, your bottom up and top down processing.

[CHRIS]

Could you just share what that means for those who may not be aware?

[RACHEL]

To stitch it, yes, it would be, how do we take maybe a new experience that we might be having in our bodies, let's say when we have a felt sense of safety, maybe for the first time, and we can feel that ripple through our bodies, we can feel energy either discharging through heat. We can maybe feel trembling. Maybe we feel emotion that comes up, but how do we allow that new felt sense experience to build cognition? How do we allow that to make meaning from that present moment, new somatic experience, to build belief about who we are and what the world is like for us to be a versus more of a top down process where we just sort of look at cognitive distortions, or we do fact checking? We see that this thought doesn't really add up with the evidence, but we don't necessarily have a felt sense of that being true. So this way of stitching of linking our felt sense experience or emotional experience and our cognitive meaning making is how we do that. Did that make sense?

[CHRIS]

Yes, definitely. So why do you think the somatic approach is more helpful in the treatment of eating disorders?

[RACHEL]

Well, I guess I would hesitate to say that it's more helpful, I think ---

[CHRIS]

Or is it a different way?

[RACHEL]

I think it's a missing piece of it because, and I think it's an essential missing piece. Like it's really essential because while I was just listening to the podcast with Jennifer Franklin, and one of the things that she articulated is that most of the information that is going from the body between the body and the brain from the gut to the brain is coming from the body up. It's not going from top down. So we learn, we know about who we are and what the world offers us long before we have language. Those foundations are there. If we do not provide people with experiences to have a new somatic organization through new somatic experiences then what we're asking people to do is just constantly swim against the foundational current of what their body is telling their brain.

That requires a source of will power and fuel that's not sustainable. So that's why we have so much sort of relapse and recidivism in higher levels of care is because we can get people to maybe challenge the eating disorder voice, but we don't ever help them really listen to the eating disorder voice as an expression of what the body is telling us about our nervous system, about our sensory processing system, about the way we've had to adapt to stay connected with available attachment figures, navigating those conditions of attachment, which is something to our bodies. So we have to give them that, those experiences that help them help the body have a conversation in its native languages of 5 cents perception into sensation. Did that answer your question?

[CHRIS]

Yes. Can you bring your microphone closer because I think you faded out a little bit that less. So I was trying to listen very hard.

[RACHEL]

Oh dear.

[CHRIS]

It's okay. We'll take a second. Okay, all right. So tell me what is embodied recovery for eating disorders?

[RACHEL]

Well, it is a weaving together of many different theoretical maps and therapeutic maps to help us understand how eating disorder behaviors are an expression of neurological dysregulation and what is impacting our body's capacity for co-regulation and self-regulation. So it's a way.

simply put it's a way of assessing the underlying somatic foundation for eating disorder behaviors and eating disorder thoughts so that we can build interventions that speak directly to the body in its own language and shift those foundations. So we look at movement patterns. We look at birth history. We have four different principles basically that the body plays a much larger role than just looking at the genetics or resourcing it through nutrition. We have to examine what is the birth history, the prenatal history that impacts our sensory processing system and our attachment system.

We look at the eating disorder, that recovery is a function of how fully we can embody our body's attachment capacity or the ways in which we attach and the ways in which we defend and through our sensory systems. That behaviors are not a commentary on the body. They are not motivated from what we think or feel about our bodies, but that eating disorder behaviors are motivated by how our body is feeling and that we can resource of the body in many different ways, in addition to food. Sometimes we have to give the body nourishment through our sensory systems and through our relational system, before it has the capacity to handle the very complex activity of eating, of feeding, ingesting, digesting, and eliminating.

[CHRIS]

So I guess, what are some of the interventions that would be based in this program? I know you mentioned movement patterns. What else is there?

[RACHEL]

Well, so there are a lot of different ways that we might work or, well, I guess one thing that we would say is that this is not a specific technique. It is a weaving of techniques and it's a way of understanding the importance of expanding the multidisciplinary treatment team to include occupational therapists, body workers, movement, mindful movement providers that we want to increase embodiment through a variety of different ways based on what's going on with this person individually. So it's complex and nuanced and so we might do things. We might say, let's work with using maybe a weighted lap pad or doing something that might increase proprioception, which is the way in which we know where we are in space through compression of joints and deep muscle. We might use proprioceptive input prior to eating, to help regulate the nervous, a nervous system so that the nerve is neuro accepting more safety in its environment, in its internal and extra environment.

Therefore the nervous system is supporting digestion. Digestion function is going to shut down. There's nothing in the body that's going to want to effectively digest food. So for some people we might be using weighted products. For other people who might be doing something that engages maybe smell, or we also might do something that works with sound like the same sound protocol, which was developed by Steven and that helps to adjust setting up the nerve so that we have a larger window of tolerance. We have more resilience and a larger capacity to support digestion.

[CHRIS]

I hadn't thought about eating disorders and trauma and how trauma can affect digestion. I guess I hadn't made that link. So that makes a lot of sense with eating disorders.

[RACHEL]

Well, when the body is, when the default setting of the body is that it needs to be prepared to disconnect from its environment because there's something dangerous there, like it needs to fight, or it needs to flee that is not a situation when the body is going to put any energy into thinking about, well, what do I want to eat? Or how do I prepare it? Or how do I actually digest it? The body doesn't secretly digest it enzymes when it's running away from a bear. If we think of trauma as the, sort of the chronic footprint of fear in the body, our nervous system is running based in a fearful setting then yes there's not going to be bottom up support for what we might call normative eating.

[CHRIS]

I know you mentioned the word embodiment a lot. So can you share, what is your definition of that?

[RACHEL]

Yes, thank you. We came up with this working definition of embodiment as being the intersection of awareness and body. So the intersection of consciousness and our physicality. So it's based on sort of these two different kinds of awareness. One is the awareness of our bodies. So we build mindful awareness of body sensation of our interception or appropriate section or vestibular functioning. But then it's also awareness of our world through our bodies so that the seat of our awareness can be expanded. So I may be able to, like one of the exercises we do with people to help them get a felt sense of this is to say, look at an object where the seat of your awareness is in your eyes and you will know things about that based on that. But if you face the seat of your awareness now into your fingertips and you touch that object, you will know something else about it.

So you're shifting the seat of awareness. We can do that with the sort of infinite options or opportunities to sit within our bodies. What is it to know our bodies or know the world, look out into the world when our muscles are tense or to hear somebody say, if we squeeze all of our muscles tight and we cross our legs and we hear somebody say, oh all of your feelings are welcome here. Well, I'm going to hear that really differently. If my muscles are relaxed and the support of the chair underneath me, and I feel the support behind me, hear someone say, all of your feelings, welcome here, it's going to sound really different.

[CHRIS]

It does. It feels very open when you say that too. It's like, ah, yes.

[RACHEL]

Yes. This really speaks to how somebody can believe something to be true for somebody else, but not for themselves. Because when that cognition is incongruent with their somatic organization, it does, the words don't make sense. Literally they don't, they're not congruent with the internal sensations. They don't make sense. They can see outside them, oh, it makes sense because I can see it for you, but I can't feel it for me.

[CHRIS]

Yes.

[RACHEL]

So that's part of what we're working with is how do we help people expand their vocabulary of movement and of embodiment? We don't want someone to always be wide open to things. There are sometimes we want people to be like braced and hold and say no to something and reject it but we want them to be able to have choice and be able to turn that off when there's something ---

[CHRIS]

Not be closed off to everything.

[RACHEL]

Right, and to be able to know the difference between protecting and being protected and being safe because digestion and bottom up support for eating really only works when we are in a situation of safety and safety means that we can connect to something that is resonant, that is nourishing whereas protected means that we can separate from something that is hurtful or harmful. A lot of times people will settle for protection. They will say, well, I feel safe when actually what they're describing is being protected. They'll just try and focus on the separating from something harmful, separating from rejection, separating physical harm, separating from judgment, but that doesn't help them connect. It's a different set of somatic skills and somatic experiences that go with connecting to something.

[CHRIS]

Does that go along with the relationally oriented or is that a different part?

[RACHEL]

Yes, yes. So we really are looking at what are the conditions that have been placed on relationship? Is it something that's like, well, I can connect with people and I can be welcome as long as I don't get angry or as long as I don't ask too much or as long as I am really helpful or ---

[CHRIS]

Conditions.

[RACHEL]

Conditions, which that impacts how much of myself, my capacity do I embody? Are there places within myself that I separate from, in order to not be separated from you?

[CHRIS]

Yes, that's really interesting. I know you mentioned that you wanted to talk about the role of the providers, embodiment in eating disorders, recovery and mental health too. So tell me about that.

[RACHEL]

Well, I think this is essential. Oftentimes, when we present this work, one of the first questions providers will say is, well, what do I do for my clients? What skills do I teach my clients? We are often having to slow people down and say, the first, the last and everything in between that you do is you show up in your own embodied self.

[CHRIS]

Love it.

[RACHEL]

Because what we're working on is building the capacity for co-regulation and we cannot ask our clients to go someplace that we aren't willing to go.

[CHRIS]

Yes, totally agree. That's so powerful, isn't it?

[RACHEL]

It is.

[CHRIS]

Because I think you're right. I think people go into a lot of these trainings, like, oh, show me the techniques and what do I do? An intervention. Yay. It starts with you, doesn't it?

[RACHEL]

It does. That's, it's hard. It's hard work. And I will say, like, we talk about sort of three levels of somatic providers. There's like the somatically aware that understands this is important, but isn't really about facilitating that somatic experience. They know that it's important and they know how to refer to somebody and include somebody. We need those people on the team because not everybody can do this work and we need people who can monitor vital signs and get information about meal plans. That's a different process. It's an important one.

Then we have people who maybe are more somatically oriented where they know how to facilitate it for their clients, but it's still a top-down approach. They're mostly using cognitive cues to facilitate that. Then there's the integrated, somatically integrated provider that's using their own somatic organization in an intentional and nuanced way to have these corrective energy to energy, breath to breath, movement to movement conversations.

[CHRIS]

What's involved with the training for therapists, for the embodied recovery for eating disorders?

[RACHEL]

So we are actually now just enhancing this training to be sort of a three tiered training. The first tier is a very introductory training it introduces to the models to the different sort of therapeutic and theoretical threads that we weave together. So it gives this whole theoretical outline and the principles of embodied recovery through an introduction. We have an online module for that. Then we also are going to be starting to offer it in person as well, hopefully next summer. After that we have a tier two, which is more about clinical applications. So it's through experiential trainings that people will get a deeper dive into the somatic organization of attachment.

We're going to be offering classes in sensory processing and autism and eating disorders, building blocks of movement. So there are a variety of different trainings that will be offered next year. Starting next year, we have one that's ongoing, that'll be finishing the beginning of the year. Then eventually we'll be doing a third tier, which is really about proficiency and facilitating skills. We have a two group curriculum that will be teaching there as well as individual practitioner skills. So it's quite a lengthy process and it involves people's own experiences with embodiment and what their practices are, what their attachment strategies are. So there's a lot of self-study as well as how do you work with clients?

[CHRIS]

So what have you found are the barriers to embodiment?

[RACHEL]

Well, there are a number. It can start at conception depending upon the conditions of the conception. Was it consensual? Was it not? Was it a wanted child? So there's that, it can be prenatal distress in the birth mother's environment, in a war zone, what's the amount of cortisol running through the birth mother's bloodstream? Injury, illness, physical trauma, but also attachment injuries after birth, right in the birth process and after birth, whether that is any neglect or rejection, bullying in school.

But it can also happen from attachment injuries that are more community based when you are in a marginalized community and your attachment figure maybe your faith community, or maybe it is your institutional marginalization, institutions of racism or gender discrimination. All of these things can impact our embodiment of how we embody our own physical being and then how do we embody spaces. So issues of marginalization, gender dysphoria, all of these things can impact our embodiment.

[CHRIS]

That is something you talk about in your training?

[RACHEL]

Yes, absolutely.

[CHRIS]

Okay. Because I can see how it could be very difficult for some clients to get to that space of full embodiment.

[RACHEL]

I don't know if, how many people ever get to full embodiment all the time, I mean, because, or maybe we should say we are always fully embodied. It's just, what are we embodying? Are we embodying fear? Are we embodying conditions of worth?

[CHRIS]

Or do we fade in and out of embodiment?

[RACHEL]

Yes, absolutely. There are situations where it makes sense for us to disembody, because it isn't a safe place to be. So we leave. The question is, can we come back again?

[CHRIS]

That's the question.

[RACHEL]

Yes, is there enough safety for us to return?

[CHRIS]

So I guess with this training, is there strategies to help clients who disassociate?

[RACHEL]

Absolutely, yes.

[CHRIS]

Because I've seen that more and more with trauma clients.

[RACHEL]

Yes, absolutely. Again, the first thing that we explore is are you dissociated as a provider?

[CHRIS]

Oh no, it comes back to us again.

[RACHEL]

It does. It does, because if we're asking someone to come into the room and into the moment and we aren't there, or we are running a script about, am I doing this right, how is insurance going to pay for this? How do I write my note? Oh my God how do I ---

[CHRIS]

When do I get to eat?

[RACHEL]

When do I get to eat? Does this fit with the treatment goals? Am I doing a good job? Our own conditions of worse, our own conditions of that we have to perform, achieve in order to have worth in our field, all of that comes into how we show up in the room. Half the time with dissociation what's happening is we jump into cognition because people can be cognitive and be completely disassociated from their body, but they can hold a conversation and manipulate words in a way that makes it sound like we're making progress, but they may not even be in the room yet. Energetically they are somewhere else at some other time.

[CHRIS]

Unfortunately, in therapy sometime therapists, we're not always there.

[RACHEL]

Yes. I mean, we're trying to back to back, we've got 45 minutes to do something. It's like, we're working with people who haven't been in their body in 50 years and somehow we're supposed to do something in 45 minutes.

[CHRIS]

Do it now.

[RACHEL]

Yes, it sounds a little silly when we put it that way, doesn't it?

[CHRIS]

Yes, it does.

[RACHEL]

But in terms of dissociation, a lot of times, the first thing is can we help people perceive and orient towards something benevolent? Can we help them build the capacity to recognize and connect with benevolence? I often think about the quote Mr. Rogers said about his mother always, always look for the helpers. In any situation, no matter how bad it is, if you can't find the safety, you have nowhere to go. Sometimes it's relative safety. If I'm sliding down the bank of a ravine, I'm going to grab hold of something. It may be of a Poison Ivy vine, but it's safer than cracking my head on the rocks below.

[CHRIS]

True.

[RACHEL]

But if I can't and, then do I have what I need to recover from the Poison Ivy?

[CHRIS]

Yes. So I guess, is it looking for some resource in their life or in the moment?

[RACHEL]

I think it's in the, I mean there is that resource in their life, but that's not going to necessarily impact their somatic organization and that bottom up support for belief that I can connect, that I'm lovable, that I'm savable, that I have worth. That comes from in the moment, can the muscles around their ears soften enough to hear the prosity of my voice and that my nerve, their nervous system can register that there's something out there that is sometimes available. That is benevolent. That's what we're building. You have to build that capacity first. Does that make sense?

[CHRIS]

That makes sense. So what is a holistic strategy or is there other ways that you use to embody yourself?

[RACHEL]

Oh, I do a lot of, and sometimes it's just checking in with my breath, seeing if I can feel my feet, even as I'm doing simple things like washing the dishes or sitting at a stop light. I kind of like, oh wait, can I feel the chair beneath me? Or am I holding myself up? So I do that as a practice all day long is, am I aware of my breathing? Am I partnering with my breath and my body? Do I trust it to hold me up or am I forcing it to do something? So I certainly meditate. I do Chingong, I ---

[CHRIS]

Ah, love Chingong.

[RACHEL]

Instant lovely. So there, I think it's a practice. It's a way of being. How do I take time to, especially now in the world that we live in that to get my eyes away from a computer screen and feel the muscles that move my eyes and let them find a nice neutral setting so that the muscles in my ears and my jaw and my neck can also relax?

[CHRIS]

I never thought about the muscles in my eyes or my ears so that's really tuning in, isn't it?

[RACHEL]

Yes.

[CHRIS]

So what's a takeaway you could share today that could help listeners who might just be starting their holistic journey?

[RACHEL]

Well, I think maybe it's that there's no one path and that therapy and therapeutic are different, that anything can be therapeutic if it helps bring you into a more embodied relationship with yourself and your world and gives you more options. I think recovery is an additive process. So there's no one way to do it and there's no, what works for you is going to change over time.

[CHRIS]

That's true too. I just got to say that you have a very lovely, soothing voice. I think it's helpful just listening to you.

[RACHEL]

Oh, thank you.

[CHRIS]

So what's the best way for listeners to find you and learn more about you?

[RACHEL]

Well, the Embodied Recovery Institute has a website, it's www.embodiedrecovery.org. As I said, we're going to be doing some updates, hopefully in the next couple months to explain more of those additional course offerings. But that's a good place to get a sense of what we're about.

[CHRIS]

Thank you so much for coming on the Holistic Counseling Podcast, Rachel.

[RACHEL]

Oh, thank you so much. I really appreciate.

[CHRIS]

I will be putting all that in the show notes as well, so people can find you through there.

[RACHEL]

Great. Well, thank you so much. I appreciate it.

[CHRIS]

Thank you so much to my listeners for continuing to support the podcast. Are you looking for a supportive, engaging holistic community? Come join my Facebook group, The Holistic Counseling and Self-Care Group, where you will gain support, connection and more resources on adding holistic practices, both professionally and personally. Just remember to tap the plus button to subscribe on this podcast and be sure to rate and review wherever you get it. This is Chris McDonald, sending each one of you much light and love. Until next time, take care.

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