Updating the 8 Keys to Recovery with expert Carolyn Costin

Carolyn Costin: [00:00:00] Some people think of it like a drug addict or something. But the thing is in those programs for drugs and alcohol, those people can truly get those things out of their life. Like I can’t drink because I’m an alcoholic and I’ll go on a binder. I’m an addict. I have an addictive personality or, or brain chemistry and I can’t do it.

They can get that out of their life. You cannot get food out of your life. You have got to learn how to deal with it. So it’s very different than a.

Sam Ikin Host: Today we’re talking with Carolyn Costin. She doesn’t really need much of an introduction in the eating disorder world, but in case you don’t know who she is, she’s one of the most well known names in eating disorder recovery treatment. And her book Eight Keys to Recovery from an Eating Disorder is a pioneering work that she published more than a decade ago.[00:01:00]

And it’s still regarded as a central text in the field. It gives important insights and practical steps for people who face that daunting task of recovering from an eating disorder. Carolyn also developed the first recovery center which is exclusively for eating disorders in the United States. And her model of care has been replicated all over the globe.

And that’s what brings her to Australia. She’s an advisor to our very first eating disorder recovery center. That’s Wandi Nerida on Queensland Sunshine Coast. And she’s also working with similar centers, which hope to open up shortly in other States. We haven’t spoken to Carolyn for a few years so it was an absolute pleasure to have her back on the podcast to talk about the work that she’s been doing and to share a little bit of her own journey and recovery from an eating disorder.

Carolyn Costin: From my own bout I guess you you could say with an eating disorder many many years ago I turned that [00:02:00] into a lifelong career and a passion to help other people get better So way back when I was suffering, I’m I’m 69 now I got an eating disorder when I was about 14 and honestly ever since then I have been learning and helping others learn and all along, growing up kind of with the eating disorder field, and so I’m very known for my work as an activist, as an author, as a clinical director, and kind of as a pioneer in the eating disorder field.
Aside from that, I feel like I’m a very compassionate person, soulful, kind, curious person.

Sam Ikin Host: We love those virtues. You definitely are a pioneer in this field, and I think last time we spoke you said that how you kind of, you’re a bit of a savant when it comes to recovery. You kind of just knew what to do.

And that is where the eight [00:03:00] keys to recovery came from. How did you Fine, like how did you determine what the eight keys were going to be a huge book? I mean people still that still must be flying off the shelves.

Carolyn Costin: Yeah, it’s so interesting how many how much people love this book and I almost didn’t write this book. Basically Norton and Sons, which is a big publishing house and the in the US, they they came to me and asked me they have a series Eight Keys to Depression, Eight Keys to Migraines, Eight Keys to Anxiety.

And they asked me if I would write the eating disorder one. And I first said, no, I don’t know, eating disorders and self help, you know, you need a team, you need professionals. They bugged me about it for a while. Long story short, I ended up writing it with a former client who had become an eating disorder therapist herself.

And she, uh, I was [00:04:00] talking to her and anyway, I said, how would you like to write this book with me? And we decided to do it and then we realized oh my gosh, we have to keep this name eight keys and there’s two thousand 455 keys to getting better. And so how are we going to do eight? And honestly, I sat back and thought about what are the main things that I think, the main overarching topics that I think someone has to work through and come to the other side to be recovered from this illness.
And by that time, I already had 30 years or so in the field. And I was running, uh, the first residential treatment center in the U. S. And I looked at that and I thought, what are the ingredients? And so I took from my private practice and from the success at my residential treatment centers, What I thought were the most important things I did to [00:05:00] help people recover.

And that’s how we came up with the eight main overarching things, but they include a lot.

Sam Ikin Host: Yeah, they do. Um, that’s right. They’re quite, they’re quite big keys, right? They’re, You know, you’ve got, you’ve got a lot in, in each one. Can you tell us about some of the, well, I mean, talking more broadly than just the book, what are some of the most important components of your approach to recovery? And I think you’ve developed a model of care, which is used, is being rolled out across Australia and is, uh, pretty much seen as worldwide best practice.

Carolyn Costin: Well, I mean, that’s a nice thing to say. I mean, I think, um, So my treatment centers had really good success. So that was one thing. I mean, I, I thought I was doing a good job, but I spent a lot of time and money and, and hired the top professionals in the eating disorder field to help me.

And, um, I would say there’s a few [00:06:00] components that make the treatment I think a bit different than what you see a lot and I’ll start with the first one, which is that everybody who walks into my office comes in and they have an eating disorder self that has developed over time for all from all these Vulnerabilities and risk factors, but they also still have inside there what I call a healthy self. The one they were born with the one that kind of knows better the one that can feed their sister or a mom who can feed her daughter, but she has anorexia nervosa and can’t feed herself.

People who have eating disorders have a whole side of them that knows how to take care of other people. In fact, they’re pretty good at it. Um, but they’re not taking care of themselves and I came to this in in my own healing years ago realizing that I had this voice inside my head that was telling me to do things that I would never tell [00:07:00] my own sister or my best friend to do.

So, I, I, when I started helping people, I started using this concept that, you know, talk back to that voice. And the, the idea of it is to get with a person who has an eating disorder and strengthen their healthy self. Don’t just start fighting the eating disorder voice because it fights back. And if it gets too afraid of you, it just starts lying and goes underground and becomes quiet.

So, I align myself with the healthy part of the person and say, look at this part of you that’s sort of taken over. How do we get you back in control? And so, what I do is, I integrate the eating disorder self. I don’t go after a client and say, we’re going to get rid of this. And if you talk to clients around Australia, where I’ve been working now the last few years, a lot more, they will say, they finally realized they could get better.

They finally, uh, [00:08:00] Aligned with something and didn’t fight treatment so much because people will say, and I said when someone first approached me with my eating disorder so many years ago um, and they were talking about, you know, getting rid of this and that. And I thought, that’s me you’re trying to get rid of.

So now what I say, we’re not trying to get rid of that part of you. We’re going to integrate it back into your core self. So it’s not this split off part over here acting independently. We’re not going to get rid of that part. We’re going to get rid of the behaviors it thinks it needs to use because your healthy self can learn better behaviors.

Sam Ikin Host: That’s why we say that recovery is possible because that part of you will always be there, but we’re going to change it or modify it or control it.

Carolyn Costin: Exactly. And I think you can be recovered and that’s what I think first brought my, first brought me to the attention of the former CEO of Butterfly. Um, two [00:09:00] formers ago, uh, Christine Morgan discovered that there were these, um, families who had sent their daughters to America to be treated.

And after they were coming back and saying, oh, we believe we can be recovered now. And they were doing better, and some of them had been in and out of hospitals here in Australia. She flew over there to see what was up, and she’s the one that originally put me on my book tour here, and got me working for Butterfly and all that.

Sam Ikin Host: Yeah, so your approach is known for being holistic, and we say this all the time, uh, and I, you know, we say it so much probably doesn’t mean anything to us anymore, but holistic and person centered, why, why is that so important?

Carolyn Costin: Well, I think uh, what has happened? Okay, so the holistic thing comes from You have to take a variety of aspects in terms of healing somebody.

And I think what, what’s [00:10:00] important is to include things in the treatment like that. Some people think a woo woo, but there’s a lot of research behind them. For example, like meditation, meditation actually, or mindfulness helps strengthen the prefrontal cortex. I’m going to talk science here for a second.

Sam Ikin Host: Go ahead. Yeah, we love, we love it.

Carolyn Costin: It’s super important because it helps calm the amygdala. The amygdala part of our brain is the emotional, the alert, that part of our brain that’s high in people who have, um, anxiety. Two thirds of people with anorexia nervosa and bulimia nervosa are also diagnosed with anxiety.

So when we talk about things like meditation and mindfulness. We’re not talking about it just because it seems like fun. These are things that actually can contribute to someone getting better. Or things like yoga, which involves being in your body, and only using your body and [00:11:00] moving your body in ways that are good for you.

Which is also super important. But it’s not just that. Holistic, I think, is also encompassing things like, especially residential treatment. Thanks for watching! Making sure there’s exercise, um, there’s gardening there, there’s equine therapy there. You can use evidence based treatments, but our evidence based treatments, um, only go so far, and they only work in certain situations. We need more tools in the toolbox.

Sam Ikin Host: Following on from the holistic approach, the GP is obviously part of it. Your holistic recovery team, I would suppose, uh, you know, maybe they’re not a huge part of it, but they’re definitely a very important part. Um, and we’ve got a healthcare system at the moment, which is just so busy and it’s getting busier and busier.

And you know, we, we, uh, at a loss as to how we can fix that, but you’ve got healthcare professionals who are time poor and undertrained and overworked. And you have [00:12:00] patients who are struggling to get access to the specialists that they need. Can you see a way for your approach to be integrated? At the front line. For people who are first looking for that care or for who are just seeing um, you know, the, your, your, your frontline and healthcare specialists.

Carolyn Costin: Yeah, well, I, I certainly am aware of that. I’m aware of that myself being here and looking for a GP myself for the months that I live here. I found out firsthand, but also So when participants are leaving Wandi Nerida and going back and needing to be hooked up with ongoing care, and look, one of the things that I’m doing, my whole career really is, aside from helping Australia and doing trainings here in Wandi Nerida, I’m training eating disorder coaches and I’m doing that because this is what happened in the chemical dependency field 50 some 60 some years ago [00:13:00] that drug addicts and alcoholics and it was hard to find specialists that just treated that and, and all this.

And, and so, you know, AA was developed and they have sponsors and they have sober coaches. There was none of this in the eating disorder field. And so what I’m doing right now is I’m taking people, most of whom have recovered themselves, but a few come in whose daughter or sister or something like that had an eating disorder anyway.

And I’m putting these people through a, quite a rigorous course with training and an internship and supervision, training them in this philosophy. They use the eight keys books. These are people that are less money than licensed professional and they know how to use this material. They, they just have to stay in their lane.

They’re not psychotherapists, they’re not dietitians, so they don’t prescribe a meal plan, they don’t deal with trauma or [00:14:00] underlying issues, but they can meet with people with eating disorders and help them get through a meal. Get through a meal without purging it, text them in the middle of the night if they feel like binging and purging.

They go to their house and help them cook meals, help them grocery shop. It’s a, it’s astonishing what has happened with coaching just in the, I think, what is it now, six or seven years that I’ve had the business and there’s a lot of Australian coaches, still there’s not enough.

Sam Ikin Host: I just ran into a couple of coaches, um, at a conference, an eating disorder conference in Melbourne, and they are so well across this. So you’re saying hopefully these people, or these people that you’re training might be able to take a bit of the load off some of the health people? I think they can.

Carolyn Costin: I mean, obviously I need to train more. I think they can take the load off and I think they can, um, and they’re less expensive also.

Sam Ikin Host: And how, how would somebody, [00:15:00] if they were interested in that, is, is it something you’d need a lived experience to do?

Carolyn Costin: No, I know a few coaches who do not have their own lived experience. Most of them know somebody who had an eating disorder, which is why they’re, and usually it’s a family member. But there’s a few, like I’ve had nurses.

I’ve had, um, psychotherapists take the course and learn how to, really, this is a course that you don’t even get when you’re a therapist, trained in eating disorder because this is a course that came out of my 40 years being in the field doing, I ran inpatient hospital before I ever opened residential.

But it’s all these questions like, what do you do when you’re sitting having a meal support for a person and you see them, you know, stick their almonds in their Ugg boots, you know? What do you do if they say, um, I’m just not going to eat that food because I ate too much for breakfast? What do you do if a client drops her food on the ground and pretends like it’s ruined?

[00:16:00] All these things that therapists aren’t trained how to do that. Nobody even trains dieticians how to do that. So, this is a course that’s very practical and it deals with exposure. You know, when people have, if you think of an eating disorder, parts of it as a phobia, especially in anorexia nervosa, phobia of fat, phobia of weight gain, but even people in the other diagnostic categories, everybody needs exposure.
You can’t just talk about these things and get better.

Sam Ikin Host: What is one of the most important things that you would like somebody who is currently struggling with an eating disorder? To know what, what advice would you have for them?

Carolyn Costin: Well, I will, I always think the most important thing is helping them understand that they have a healthy core self in there that really can step up. And I would ask them, you know, if they have a story about, you know, I just ate pizza and, or I ate pizza last night and now I feel ashamed [00:17:00] and I, um, feel like I need to not eat all day or something like that. I always ask them, what would you say your best friend who said that? And it’s astonishing. Nobody ever says they would tell their best friend to throw it up or starve the whole day.

It’s astonishing when you start using this technique. So I would ask them to learn about. This idea of eating disorder self healthy self and the integration if you’re struggling and I know this is hard But look for a provider that you feel like you can trust you feel like understands the illness and and and do your part By being honest and telling them the truth because other otherwise you’re like going to a doctor and bringing someone else’s Blood tests or urine samples, you know.

Sam Ikin Host: Yeah, and when you say provider, what kind of a professional?

Carolyn Costin: Well, therapist, dietician, GP, psychiatrist, because the providers say counselor, coach, because [00:18:00] it’s open like that, there are so many different, um, providers. And, you know, I would say, um, I, I hope that there becomes a kind of an online, um, ongoing connection for people when they leave treatments.

And I know Butterfly is looking into this right now. I don’t know the status of it, but for example, when people leave Wandi Nerida, they want to stay connected in a way. Now we have a alumni group, which is really nice, but I think connected in a way where maybe they have some kind of intensive virtual, um, intensive outpatient program provided online or, or things like that. There’s a lot of that in America now. I don’t think there’s much or any of that here. I don’t know. Am I wrong?

Sam Ikin Host: No, you’re right. You’re right. I think, but, but what I hear from a lot of people who are starting the process of recovery, you know, they’ve realized they need help is that [00:19:00] once they find a good provider, whether it’s a dietitian or a, or a psych or even a GP, once they find the one person who is really good, that then snowballs into them finding all the rest.

Carolyn Costin: I would say I have several. So clients doing this in Australia, where they’ll find, um, a therapist who isn’t necessarily an eating disorder therapist, but the therapist who can deal with their depression, their trauma, um, what the underlying issues. And then they get a coach who’s specifically trained. And like the CCI coaches at my institute are specifically trained in helping people go through and changing, it’s behavior modification, exposure, work and all that.

Sam Ikin Host: So what do you think that carers or people who know someone who they think might have an eating disorder or people who are looking for some, looking after somebody, um, who has an eating disorder, what is something that they need to know? [00:20:00]

Carolyn Costin: I think what happens a lot is they get into battles. And these battles become between them, let’s say a family and their daughter, and I think they need to start to have that concept of aligning with your daughter in dealing with the eating disorder.

Be careful to just go, um, you know, all out trying to get rid of hating the eating disorder, because that’s a part of your daughter’s ego system. That’s a part of her psyche and that part will feel rejected. So, figure out a way where you can use the language that I talk about in the Eight Keys book about, oh, your eating disorder voice is giving you a hard time right now, or, you know, I, I can see you’re being really beat up right now, you know, how can I help you talk back to that part of you?

The same kind of things, look, I always teach parents, [00:21:00] I want to teach you to do what I am. Have been doing for her that has helped her get better like why not? Why wouldn’t I and I didn’t write the eight keys book for parents? But a lot of parents tell me that it’s helped them to better align um with their with their kids or spouses align with their partners because that book really gets into the mindset of there’s a lot of recovered people who contributed quotes and things in that book So I’m bold enough to say, don’t, don’t believe if you hear that your daughter or son will always have to manage their children. Eating disorder for the rest of their life that, that’s said a lot here. And I would say, just don’t believe that you, you can find evidence, a lot of evidence elsewhere that shows that people can be recovered from this.

[00:22:00] You’re your kid, even people who have been, someone asked me the other day, well, what about people in their fifties who’ve had an eating disorder for 30 years, I, I have patients like that. Uh, I mean, I think, I don’t, I don’t think it matters the years it, what, what kind of matters is, does the person kind of give up?

I always say, you know, the people who aren’t getting better give up trying because they think it’s not worth it or they think it’s not going to be there for them. Human beings are incredibly resilient and an eating disorder, although it is an illness, but it is something that Has this whole behavior, it’s not like cancer, it has a behavioral component when you can get that person to change those behaviors, when they see enough reason to change those behaviors, and enough way out, and enough guideposts along the way to change those [00:23:00] behaviors, once the behaviors are changed, there’s no eating disorder.

Sam Ikin Host: When you treat people with different diagnoses, and we know there’s a very diverse range of people who suffer from very diverse eating disorder diagnoses, do you treat them all the same, or do you have separate streams?

Carolyn Costin: There’s a lot of things that are similar and in all the diagnosis, and I’ve worked with people Um, I didn’t have separate tracks So I’d sit them all in a room and say look we’re all here because we have an unnatural relationship with food We are doing something with food and then going into an office and saying I’d like to stop doing that, you know, or I’d like to start doing something else with food. So a lot of the stuff about eating disorder self and healthy self and being able to respond to things versus reacting to things, learning how to separate yourself from your, your thoughts and your emotions. So you don’t [00:24:00] overreact, like there’s so exposure work, there’s so many things you can do through all the diagnoses.

The causes are different and so when you’re dealing with underlying issues, this is why treatment has to be individualized as well. It’s why you have to have individual therapy sessions when you’re in a group treatment center, because your reasons, your particular jigsaw puzzle, With your risk factors that have come together to make the perfect storm of an eating disorder or whatever it is, binge eating, ARFID, bulimia, whatever, those can be addressed in, uh, individual sessions where you really get into the root of stuff that’s going on with you and, you know, Maybe stuff about your past and, and all that.

Um, but in a, in most of the group dynamics and most of the exposure kind of work and most of the concepts that help people get well, like conscious eating even is a part [00:25:00] of the eight keys. Everybody can learn to be a conscious eater. It’s a bit of a takeoff from intuitive eating because intuitive eating, I realized, and I, I love the two women who wrote that book.

They’re colleagues of mine and. Um, I think they did, uh, uh, a real service to the field with intuitive eating, but if you have an eating disorder and it’s full blown, you, you, you can’t rely on your intuition yet. Your intuition has gotten all off. Someone with anorexia might say, Oh, I just, you know, feel, I get in touch with my feelings and I feel like I only want an apple all day.

Or someone’s intuition in terms of, uh, someone with binge eating disorder. Conscious eating is way off in terms of what they need or what’s satisfying for them or when they’re full. So conscious eating takes intuition in part but also knowledge and awareness. So you can be on a meal plan and restoring weight and still be a [00:26:00] conscious eater according to the guidelines.

So, I try to make the book and the work and the treatment centers deal with the commonalities that can be done in group work and then the individual stuff that can be done in sessions with providers when you have your individual work done.

Sam Ikin Host: Yeah, okay. That, well, that makes a lot of sense. What are some of the things that are most misunderstood about eating disorders?
We know there’s, uh There’s a lot of stigma and there’s the stereotypical, you know, young, wealthy white woman with anorexia nervosa. Um, but what do you think people, and I’m talking about all people, um, including people who with the lived experience, their care as health professionals, what’s one of the things that is the most misunderstood about it?

Carolyn Costin: Uh, I think the fact that people can be recovered. I think the fact of how different it is from an addiction, because some [00:27:00] people think of it like maybe a drug addict or something, but the thing is, in those programs for drugs and alcohol, those people can truly be recovered. Get those things out of their life.

Like I can’t drink because I’m an alcoholic and I’ll go on a binder and I’ll, you know, or I can’t ever, you know, have fun with drugs like other people because I’m an addict, I have an addictive personality or, or brain chemistry and I can’t do it. They can get that out of their life. You cannot get food out of your life.

You have got to learn how to deal with it. So it’s very different than a, Normal kind of addiction, even though with binge eating disorder, we’re looking at now and there’s research pointing to there might be some factors that are quite similar to, um, addictive behaviors, especially with certain foods that are binged on and give a big dopamine hit.

And then that dopamine starts to crash and the person craves it again. So there’s a [00:28:00] little bit of that. But it’s still not saying get food out of your life, you know? So I think, I think there’s people don’t really understand the difference in that. I think they misunderstand how long it takes. It’s kind of a slow process to slowly get better.

And I hope people will understand this concept of integrating these two parts that have become split. Integration takes some time and I think, um, you don’t go into a treatment center and become recovered. You know, even if you go into a treatment center, you’re going to need some time afterwards.

Sam Ikin Host: Well, let’s talk about treatment centers.
At the moment, I understand you’re in Australia, and part of the reason why you’re here is because you are advising on Wandi Nerida.

Carolyn Costin: For the last three years, I’ve been going up there a couple times a year and doing weekly, uh, supervisions on Zoom when I’m back in the States.

Sam Ikin Host: Wow. [00:29:00] Well, it’s very nice to have you.
In the country. Now, before we finish, um, What do you see as the future for eating disorder treatment? And recovery. Um, and I guess, do you see that improving dramatically in the near future?

Carolyn Costin: Oh, I never see anything improving dramatically in the near future. I’ve been around too long. Things, wheels turn slowly.
Uh, but I do, I do think, here’s what I’m kind of hopeful about. I think that we, we were too far on the, Culture side for a while, all the culture and, you know. Uh, back then it used to be television shows and magazines and billboards. And now it’s more Instagram, Facebook, TikTok, but whatever, the media, the cultural influence in terms of, especially with young [00:30:00] girls and getting them to dislike, distrust their bodies, not feel good about themselves, wanting to lose weight and we we had such a big focus on that and then the genetics came and the brain scans and the serotonin reuptake inhibitors and all this and we got very biochemical, and looking at genes and all that. And I think we went a bit too far that side. And I, I’m hoping I, uh, and I think I’m seeing people coming together and say, look, we, we need a balance of these approaches.

We, everything sort of needs to be looked at and people need to be seen as individuals. One of the things when you have treatment programs is. Protocols can become very generic, and I think we have to be careful of that. And so, I feel like that’s starting to happen, this integration of the, all the different pieces.

I hope residential treatment in Australia picks up because I think [00:31:00] it’s really sad that people have outpatient treatment or hospital and hospital is super expensive and super medical, medical. It’s just medical and it’s unnecessary. A lot of people need 24 hour care, but they don’t need to be hospitalised. So I’m hoping that residential changes the landscape. Okay. Um, here in Australia, um, but I’m going to say that residential done right. It can’t just be called a residential and act like a hospital. It has to really have a residential feel that incorporates what I was talking about earlier, a more holistic approach, an approach that allows individuals, and we didn’t talk about this, to come together. Come in very ill and then slowly gain competencies and get more freedoms so that by the time they leave the treatment center, they are preparing meals They are going grocery shopping. They are cooking. They are portioning their food They are doing things they will have to [00:32:00] do when they come home Because as it stands now when you go into a hospital program You don’t do any of those things.

And so you don’t get exposure to the daily life activities that you have to do to be recovered from an eating disorder. And that’s why I’m hoping the residential treatment’s going to lift the bar in that, like what’s happening at Juan de Nerida, where people are, um, able to engage in those behaviors as their healthy self is getting stronger and engage in those behaviors enough where they have enough experience under their belt so when they do discharge, they can keep that going.

Sam Ikin Host: Look, we’ve gone so far over time, Carolyn. I mean, we could, I could talk to you for ages, but we, we are going to have to wrap it up. But thank you so much for your time. It has been wonderful. So lovely to hear from you and to have you, you know, sharing your story as openly as you always do. Uh, it’s been, I think, four years since we had you on the podcast, so it’s really nice to have you back. And thank you so much for your time. Very much [00:33:00] appreciate it.

Carolyn Costin: Thank you. Thanks for having me. It’s what I love to do so I, I want to help Australia, a whole other country, taking on now. But I, I, I love being able to see changes happening in the field. And so anyway, thank you. Thank you for having me.

Sam Ikin Host: To find out more about Carolyn and what she does, you just need to search Carolyn Costin Institute, and you’ll find all of the links to all of her books and all of the treatment programs that she’s had anything to do with. And yes, we’ve got a link in the words bit. To find out more about the center that she’s working with in Queensland on the Sunshine Coast, that’s Wandi Nerida, go to wandinerida.org.au. There’s even a super easy inquire now button right in the middle of the page, and you just need to click and ask for a little bit more information.

And if you’re concerned about an eating disorder for yourself or someone that you love, The best place to go is to the National Helpline. You can call 1 800 334 [00:34:00] 673, that’s 1 800 ED HOPE, for a free, confidential conversation with one of their specialist counsellors. If you’d prefer to chat online, go to butterfly.org.au and follow the prompts. This podcast is produced for Butterfly Foundation by Ikin Media with the support of Waratah Education Foundation. Our executive producer is Camilla Becket. As always, please drop us a comment or leave us a rating wherever you’re listening to this podcast. We’d really appreciate it until next time, I’m Sam Ikin.