THE “URGE”:
A REAL PERSONS’ EXPERIENCE
Leonard Lipson, M.A., Psychology
Over
the past four articles, I’ve described the three primary
stages of the “Urge”:
1) The experience of it (the thoughts, feelings and behavioral
changes) as the desire emerges, which is followed by 2) our
experience of reacting against the desire, of trying to maintain
control and finally 3) our experience accompanying resolution,
whether that resolution is control or loss of control. This
description involved a lot of words for something that commonly
occurs in seconds. Perhaps an example from real life will give
you a better feel for how you can use these words and theory
to help your patients.
I think a quick caveat is necessary.
As noted in my last article, “The Urge” is one of
14 Pieces that make up MAT (Medical Adherence Training). If
it could do the job by itself, I wouldn’t have bothered
to create the other 13. I would have spent the time on the golf
course, indulging my favorite addiction. Becoming skillful at
recognizing your experience (and your patients in recognizing
theirs) during the three phases of the Urge we’ve discussed,
is a great step in the right direction that may produce moments
of greater control, all by itself. Alone however, it will not
produce long term, consistent control. It can connect with other
Pieces and if enough of these are combined, you have the foundation
for meaningful change. Working with the experience of the “Urge”
is a great thing to do but it is not a panacea.
Jane was a mid-thirties, single,
professional woman, who lived alone. She was highly intelligent,
could be intensely focussed but sometimes did not sustain her
efforts enough to reach her full potential. She had been struggling
with her weight for virtually all of her life. She knew it both
contributed to and was a result of, low self-esteem. Over time
she had acquired considerable knowledge about dieting but her
knowledge, insight and determination weren’t enough to
create control. As is so common, the depth of her hopelessness
in regard to controlling her weight was profound.
EMERGENCE – Breakfast
was her time of greatest danger. She knew she had to eat to
avoid sharp changes in blood sugar and to avoid uncontrollable
cravings later in the day. The night before, she’d warn
herself that she should eat sensibly in the morning but these
warnings were rarely heeded. The morning would come and she
would begin to feel directionless and a little detached, a sense
of moving along by habit, propelled by the demands of her schedule.
Whatever food caught her eye seemed magnetic. Rolls and bagels
were on every street corner. Her qualities of focus and determination
were applied towards gratifying the Urge and she was propelled
towards the food with increasing strength the more she thought
about it. The Urge didn’t have a clear physical location
in her body. It was a more global, diffuse pull.
RESISTANCE – Her
struggle could be intense. She described an incident wherein
she took crackers out of the cupboard, put them on the counter
and then walked away. She returned and put them back in the
cupboard. Then she came back again, took them out, ate a few
and put them back. Then she did it again.
The most outstanding feature
of her Resistance failing to protect her was detachment, the
emotional distance between what touched her inside / personally
and the thoughts, feelings and behaviors of her Resistance that
seemed to happen away from her, as though she was observing
someone else. She would recite to herself the consequences of
eating poorly that meant something to her: “I’ll
hate myself tomorrow”, “I won’t lose weight
this way”, “I’m ruining my body”.
RESOLUTION: No one succeeds
or fails at maintaining control every time. Even those in the
population whose weight is ideal, have moments in which the
“Urge” dominates. How often and how badly is what
makes the difference. Jane did not give in to every “Urge”
she experienced nor, obviously, did she create perfect control.
What is particularly fascinating
about Resolution: OUT OF CONTROL is that whatever you say, do
or feel that overcomes your Resistance (effort to fight the
Urge) and results in poor eating, tends to be consistent. People
rarely have completely different thoughts, feelings or behaviors
(the three aspects of experience) each time they have an “Urge.”
There are usually no more than three thoughts, feelings or behaviors
that occur within each individual. They repeat these same thoughts
or feelings or behaviors each time they have an Urge and can’t
stop themselves from gratifying it. Let’s look at Jane’s.
OUT OF CONTROL: She’d
tell herself that: 1) if she didn’t have the roll or the
potatoes that came with the eggs, she’d be hungry later
on, 2) despite her considerable knowledge about dieting, (indeed
perhaps because of the depth of the conflicting information
she possessed), it wasn’t clear what was right for her,
so control couldn’t begin until she decided how to do
it and 3) “I don’t care if it’s bad for me.
I want it.”
She’d feel rebellious,
stubborn and hopeless. She’d often hide her eating or
explain to others why she was eating as she was and that it
was really an exception to how she wanted to eat but today’s
circumstances mandated today’s poor eating.
IN CONTROL: Thoughts -
1) “Being in control increases my self respect”.
2) “I’ll regret this tomorrow.” 3) “Life
will go on tomorrow, even if I don’t have what I want
right now.”
Note that the Thoughts that worked
for her addressed her issues. #1 dealt with her diminished self-esteem.
#2 used her intelligence / foresight to advantage, as well as
lightly touching on her need to connect behavior in the present
with future consequences so as to motivate herself to create
long term, positive results. #3 addressed the rebellious, stubborn,
child-like demand for immediate gratification.
Feelings that worked for her
included being sick of fighting the battle with weight and losing,
feeling in control and, particularly, staying alert and aware
in the moment.
Action involved keeping a journal
of her eating, something I’m not a big fan of ordinarily
but I recognize that it does help some and I never discourage
those who wish to do so. This is a useful tool with those for
whom detachment is a prevalent feature during Resistance. Writing
an eating plan a day or sometimes two days in advance was also
helpful for her in cutting down the number of “Urges”
she experienced and in dealing with them when they came.
If you have questions about anything
from these five articles, I’d like to see them. I’d
be glad to clarify or expand as needed. The next article will
offer some suggestions and guidelines for working with the “Urge,”
so that even without the other 13 Pieces of MAT, you can do
something specific to help your patients.
Print
This Article
Archives
