REFLECTIONS
By E. L. Eufinger
“H
ow are you?” AskWhen the relaxation ends, I ing this question alask Mariko to sit up. To my surways feels ridiculous, prise, she does, keeping hold of especially with someone underthe ice. In the last 10 minutes, it going eating disorder treatment, has melted through her fingers, but I say it automatically. dripping onto the carpet. “Average,” Mariko responds I give it one more shot. quietly, tucking a strand of limp, “Could you tell me more jet-black hair behind her ear as about the ice? Is it to distract she bends to select a yoga mat you?” and two pillows. Her dark eyes meet mine. “It’s “Average” is code for somejust another thing to be mindful thing much worse. Though she of.” is in group treatment, it’s just us “Ah,” I say in relief. The clues today. Her group tends to be come together. I know what to small—and volatile. I blink in do. surprise as she chooses her spot, We straighten our legs out to unrolling her mat quite close to the sides. Her fingers cradle ice, mine. mine the air. We stretch forward. “Any injuries to be aware I feel my way along. “Focus of today?” I ask. your attention on the ice, its “Just don’t do anything size, its shape . . . how it bewith knees.” The bitterness comes smaller with each moLearning a new mindfulness technique in her voice is subtle. I bite ment.” back the comment I would Minutes later we’re in butfrom a patient with an eating disorder. have tossed off anywhere else: terfly pose, the remnants of tough workout last night? It’s that piece dripping onto her very likely that Mariko did work out—and that she’s not sup- socks. “Notice the cool wetness passing from your hands to posed to. Starving bodies don’t need to burn more calories, and your feet.” Mariko has a history of doing aerobics long after putting her She picks up the next piece. We stretch our legs to the front, daughter to bed. hands resting on legs. I encourage her to observe how it feels “No knees, then,” I say. to hold a new piece. “Feel the flat surfaces, the long edges.” She’s brought a cup with her. This is not unusual. Clients ofDuring the session, Mariko’s fingers turn fiery red. They ten bring food or drinks they’re required to finish—but when must burn with cold by now. Water drips onto her clothes, Mariko reaches inside the cup, I hear the brittle clicking of ice but she doesn’t avoid getting wet. What kind of suffering is and look closer. There’s no beverage. She pulls out a piece of driving her to this? I’ve felt distressed before, but never a mind ice and, without a word, curls up on her side, cradling the cube state so punishing I would take a knife to my own skin for retenderly in her palm. lief. That’s what this is, the ice standing in for her “tool” of I’m mystified. Mariko knows the drill. She’s been here for choice: needles, knives, fingernails. It’s a safe alternative to selfmonths, and we always start mindful movement class the same harm. way: in a pose that eases digestion. Apparently, Mariko has We end lying down. The last piece of ice has melted, and other plans. Mariko gazes at her empty hands. Her fingers tremble. “Do . . . your hands hurt?” When we finally sit up, Mariko looks at the puddle on “No,” she says, barely glancing up. the carpet. “Sorry about that.” The silence hangs for a long moment. Sweat breaks out “Not a problem,” I reply. on my brow. I decide to be direct. She rolls up her mat. I feel compelled to reach out in some “Then what is the ice for?” deeper way. But as Mariko walks out, carrying her empty cup, “Distress tolerance.” all I say is, “Take good care of yourself.” I take that in—and have no clue what to do with it. She looks back for a moment, and I can see the words sound Mariko’s mood is not conversational. odd to her—as if they represent a difficult concept, not easily “Okay. I’ll . . . start our music.” understood. A soothing Indian raga fills the dim space. I lead her She nods politely, and we go our separate ways, she to lunch through the opening relaxation. “Soften your feet . . . your where she will be monitored to make sure she eats, me to welankles.” come my next group. I wonder how to explain the wet spots I’m at a loss. This is a movement class. How can we move on the floor. ▼ if she’s holding ice? Should I just let her rest? Will she ignore E. L. Eufinger is a mindful movement teacher at an eating disorder treatment me if I ask her to sit up? Her group has a reputation for being center. Reflections is coordinated by Madeleine Mysko, MA, RN: mmysko@ comcast.net. Illustration by Anne Horst. challenging. Have I met my match today?
Distress Tolerance
72
AJN ▼ May 2015
▼
Vol. 115, No. 5
ajnonline.com
By E. L. Eufinger
“H
ow are you?” AskWhen the relaxation ends, I ing this question alask Mariko to sit up. To my surways feels ridiculous, prise, she does, keeping hold of especially with someone underthe ice. In the last 10 minutes, it going eating disorder treatment, has melted through her fingers, but I say it automatically. dripping onto the carpet. “Average,” Mariko responds I give it one more shot. quietly, tucking a strand of limp, “Could you tell me more jet-black hair behind her ear as about the ice? Is it to distract she bends to select a yoga mat you?” and two pillows. Her dark eyes meet mine. “It’s “Average” is code for somejust another thing to be mindful thing much worse. Though she of.” is in group treatment, it’s just us “Ah,” I say in relief. The clues today. Her group tends to be come together. I know what to small—and volatile. I blink in do. surprise as she chooses her spot, We straighten our legs out to unrolling her mat quite close to the sides. Her fingers cradle ice, mine. mine the air. We stretch forward. “Any injuries to be aware I feel my way along. “Focus of today?” I ask. your attention on the ice, its “Just don’t do anything size, its shape . . . how it bewith knees.” The bitterness comes smaller with each moLearning a new mindfulness technique in her voice is subtle. I bite ment.” back the comment I would Minutes later we’re in butfrom a patient with an eating disorder. have tossed off anywhere else: terfly pose, the remnants of tough workout last night? It’s that piece dripping onto her very likely that Mariko did work out—and that she’s not sup- socks. “Notice the cool wetness passing from your hands to posed to. Starving bodies don’t need to burn more calories, and your feet.” Mariko has a history of doing aerobics long after putting her She picks up the next piece. We stretch our legs to the front, daughter to bed. hands resting on legs. I encourage her to observe how it feels “No knees, then,” I say. to hold a new piece. “Feel the flat surfaces, the long edges.” She’s brought a cup with her. This is not unusual. Clients ofDuring the session, Mariko’s fingers turn fiery red. They ten bring food or drinks they’re required to finish—but when must burn with cold by now. Water drips onto her clothes, Mariko reaches inside the cup, I hear the brittle clicking of ice but she doesn’t avoid getting wet. What kind of suffering is and look closer. There’s no beverage. She pulls out a piece of driving her to this? I’ve felt distressed before, but never a mind ice and, without a word, curls up on her side, cradling the cube state so punishing I would take a knife to my own skin for retenderly in her palm. lief. That’s what this is, the ice standing in for her “tool” of I’m mystified. Mariko knows the drill. She’s been here for choice: needles, knives, fingernails. It’s a safe alternative to selfmonths, and we always start mindful movement class the same harm. way: in a pose that eases digestion. Apparently, Mariko has We end lying down. The last piece of ice has melted, and other plans. Mariko gazes at her empty hands. Her fingers tremble. “Do . . . your hands hurt?” When we finally sit up, Mariko looks at the puddle on “No,” she says, barely glancing up. the carpet. “Sorry about that.” The silence hangs for a long moment. Sweat breaks out “Not a problem,” I reply. on my brow. I decide to be direct. She rolls up her mat. I feel compelled to reach out in some “Then what is the ice for?” deeper way. But as Mariko walks out, carrying her empty cup, “Distress tolerance.” all I say is, “Take good care of yourself.” I take that in—and have no clue what to do with it. She looks back for a moment, and I can see the words sound Mariko’s mood is not conversational. odd to her—as if they represent a difficult concept, not easily “Okay. I’ll . . . start our music.” understood. A soothing Indian raga fills the dim space. I lead her She nods politely, and we go our separate ways, she to lunch through the opening relaxation. “Soften your feet . . . your where she will be monitored to make sure she eats, me to welankles.” come my next group. I wonder how to explain the wet spots I’m at a loss. This is a movement class. How can we move on the floor. ▼ if she’s holding ice? Should I just let her rest? Will she ignore E. L. Eufinger is a mindful movement teacher at an eating disorder treatment me if I ask her to sit up? Her group has a reputation for being center. Reflections is coordinated by Madeleine Mysko, MA, RN: mmysko@ comcast.net. Illustration by Anne Horst. challenging. Have I met my match today?
Distress Tolerance
72
AJN ▼ May 2015
▼
Vol. 115, No. 5
ajnonline.com
