Dale Johnson: Well, just like last week, we have with us Hannah Carter. She serves as the executive administrative assistant to the provost at the Southern Baptist Theological Seminary, in Louisville, Kentucky. She’s also an adjunct instructor of biblical counseling at Boise college. She received a Master of Divinity from Southern Seminary and has been counseling and discipling women for over 13 years. She has been certified with ACBC since 2011 and prior to coming to Louisville, she served as a missionary to an unreached people group in Central Asia, for nearly five years. Hannah, I’m so grateful for you. Thank you for your work there at Southern Seminary and even from our discussion last week talking about eating disorders. I think it’d be important for us to continue some of that conversation. So, thank you for coming back and being with us today.
Hannah Carter: Yes, I’m so glad to be.
Dale Johnson: Last time we were talking a little bit about issues related to eating. I love the way that you frame it. You started with the idea: What does God give us as the purpose for eating? We don’t just start with the problem and try to understand the problem itself. We start with what God intended for eating—that we’re to eat to His glory. We are to eat for the sake of nourishment. We see provision that He’s given us through this process of eating, but then we see where that purpose is not used in a proper way. And we see the manifestation of sin in our hearts, in the ways that we eat, and in the consequences that ensue. And so, we can observe those problems within the framework of what God designed. And then, you went into a little bit about sort of a first session. Okay, so we don’t get overwhelmed as counselors, how do we approach situations like this, because there’s so much to think about? And you describe two different ways to triage what’s going on, the level of care and what needs to happen? Do we need to give referrals to physicians? All that good stuff is really important. You talked a lot about the variables and knowing this particular individual who sitting across the table. I think that’s one of the most valuable pieces, as you get to know them and build rapport with them, but you’re knowing this particular individual, not just seeing them as the problem of eating disorders. You’re seeing them as an individual and what they’re struggling with. And all the variables that built, what brought them into the room. Specifically, we want to pick up there. Okay, we see the manifestation of eating disorders in lots of ways. We can talk about obesity, or you can talk about what we consider to be, sort of, classic cases of anorexia and bulimia. But how do we as counselors get to the root of the problem? How do we dive down deep to find out, “Okay, what is behind this?” What are areas that are particularly important that you see to probe and evaluate the specific problem in this person, to find the root issues going on.
Hannah Carter: Over my years of counseling, I’ve learned about seven views that I really want to hone in on. I want to understand first their view of God. Do they even believe in Him? Where are they with Him and their relationship? Yeah, and just understanding from that angle. I also want to know what their home life is like. Has there been any loss in their home life? Have there been arguments or conflicts with their parents, that has maybe, for a teenager, kind of brought tension in their life and they’re internalizing a lot. Or is their home life great, and everything. I also want to understand their view of friends and friendships. Are they being bullied? Or are they in a good friend group? Do they have friends that encourage them or friends that maybe tear them down? What do they consider as a friend? And are they getting advice from a friend that may not be good? Just kind of understanding that whole angle. Also, just life in reality, are things in their life kind of constantly chaotic? Are they living kind of not wanting to face or accept some things in their life—any major crises that have been happening lately or in the past that maybe they’ve never dealt? With just kind of understanding that whole angle and how they view life in itself. Also, another view that I really want to deal with is food. You know, do they deny food? Do they see it as a gift from the Lord? Are there particular foods that are bad to them, that they only see calories and only see weight gain? Or are they like looking at a spectrum of food and that they’re thankful and seeking to serve and love the Lord with that food. Or are they using food to kind of maybe get what they want? Or restricting food in order to get the thinness and so forth? Another category is self—just kind of looking at body image. What type do they think their body is? Some of these questions I may ask from a different angle. I don’t want to put thoughts in their head, but I do want to find out kind of: What do they see? How do they see themselves? Had they heard someone else talk about them in a certain way, and maybe that’s played in their law and their thoughts? But yet, all of those areas are really important to gain a better understanding, and not just presume that you’re thinking the same way that they are, or that they are thinking the same way as God’s word teaches us. And lastly, authority. I feel like this is bigger, more so than before. But yeah, as a sense of authority, do they see the doctors as helpful? Or do they see themselves as the authority figure? They know the right weight that they’re supposed to be at. They know what is best. Are they loving and obedient to their parents and the help that they’re getting from their parents? Or are they kind of very standoffish to their parents, and so forth? And really gaining an understanding of those horizontal relationships will also help me understand where they see God as their authority, vertically.
And if those things are out of place, then we can understand they’re at the center and so forth. And a lot of these, you know, disorders and problems kind of persist when several of these views are out of place. Again, in thinking through all these different views, I’ve just found them really helpful, because it gives me an idea of really where they’re struggling and maybe helps me to understand their perspective more. Most people that are struggling with eating are not necessarily doing it just out of spite. It started from thinking and believing, and so you just kind of want to start to peel it back like an onion and get to their heart attitude and their posture before the Lord. I counseled some recently, just in a sense of learning: Do they accept instruction, or do they not? Proverbs 15:31 is very clear that whoever does not accept instruction will face misery, and not prosper. And so, I think we see that all through Scripture with Israel and Judah. And God warns us when we don’t accept instruction, and we don’t listen to God. That’s why He pleads for us, even in Deuteronomy, “Hear, O Israel, I am the Lord your God.” So, we really want to hear from the counselee, but also hear from God’s Word, so that we can engage with the counselee and help correct the things that we’re seeing that are not seen from God’s perspective, in a sense.
Dale Johnson: I love those categories, and anytime we can frame categories like this, it really helps us to think more clearly. And I think what you’ve done here is really helpful for us who engage in this type of counseling on a regular basis. I would encourage our listeners maybe to pause, go back, and listen to some of those particulars. It is helpful in lots of different counseling cases, but particularly as it relates to things like eating disorders. The last thing that you mentioned, Hannah, I think is really a brilliant way to approach this. You’re seeing a phenomenon that’s sort of specific to the culture in which we live right now. This issue of sort of rebelling against authority to some degree. Whether it’s, you know, “I don’t need to listen to the physician, he doesn’t know what he’s talking about. I can do my own caloric intake, and I can sort this out. And I know what’s best for me.” you know, some of that has to do with the separation of generations. Now, we have had those types of problems in the past, but now we have the internet and Google. And Google, or really AI now, becomes really their authority, where we can just find out anything about anything, and I can sort of drive this ship. And man, we’re seeing tons of deception happen. And again, the passage that you mentioned in Proverbs, where it sort of dulls them toward hearing instruction and the Bible warns that that’s a dangerous thing, so it is a really interesting phenomena that you brought up there. I think it’s something for our counselors to make sure that we’re paying attention to and that we don’t gloss over. Now any time that we’re dealing with cases like this, we’re always trying to think, “Well, you know, counseling in and of itself can be very helpful, but it’s not necessarily the end all; we need more. This is a problem that they’ve had in living, and we’re not going to fix this in one hour, you know, in a week or even a series of weeks.” We’re going to be helpful, but we need some other resources. I want you to talk a little bit about maybe what some of those other resources might be, that you would advise for the counselee as they deal with this eating disorder.
Hannah Carter: Sure, yeah. So, as you’re helping someone through their eating problem, we want to just balance things physically and spiritually, not just take one over the other. And in doing so, it’s helpful to have a nutritionist or a doctor, certain follow-ups that they’re having, so that they can gain an understanding of: What is good to eat? What does my body need? Because all of our body types are different. If there’s a teenager, and they’re in a growing phase, you want to make sure that they’re having enough of certain minerals, or milk, and all the kinds of things that our bodies need. Also, you cannot do this alone, you need the body of Christ. If it’s a roommate, you need other roommates to surround this person as well as the counselor, and as well as someone from the church. If parents are dealing with a teenager, you can’t do this alone. You need another parent to help you, to encourage you. You need someone in your church to come alongside and try to start bridging the gaps between the person that’s struggling with food to maybe a close friend. That is wise and so that they can have a peer kind of help come alongside them. That is the biggest thing because they didn’t get here overnight, and they’re not going to get out of this overnight. And so, it’s going to take a while to be able to walk through this. And so, you need help, so that you don’t wear out, and you don’t get weary.
Dale Johnson: Yeah, very good. And I think that detail—accountability, where you incorporate other people who are walking with them in normal daily tasks. Eating is something that, as we mentioned before, is a mundane thing that we do that is a part of our daily routine. And if we’re enticed to be deceived in those mundane things, we need people around us to help to hold us accountable at those different really important junctures, throughout the rhythm of a day. And that’s pretty important. One of the other things that you mentioned that I think is really worth highlighting is, of course, we would refer to physicians to help us here to evaluate: What’s the effect on the body? How bad is this, their weight? Are they at a very unhealthy place? And they can help us with a plan. Are we seeing consequences that can be damaging to the body, even long term—especially if they’re binging and purging, and that sort of thing? But you mentioned a nutritionist. I’ve found personally that nutritionists are some of the most helpful people when dealing with these types of issues, particularly with young ladies. One of the things that I found is that a nutritionist has a distinct way of getting caloric intake, in a way that’s not so offensive to someone who is afraid of eating certain things. And where, as you mentioned, you know, they need a certain level of nutrition. Maybe certain minerals and vitamins and that sort of thing. A nutritionist has a way of building that caloric intake over a day’s time, over a week’s time, and presenting it in a way that’s very helpful to the individual. And I found their work in this process is as helpful as any, especially if they’ve built up a long-term pattern of not eating healthy or misappropriating the way that they think about eating. A nutritionist can be very, very helpful here in getting us the right things without it being so overwhelming, because to that young girl’s mind often like, “You mean to tell me I need a plate that looks like my Thanksgiving plate at every meal, and that’s how I’m going to put on weight?” And nutritionists can really help her to think through that in a way to eat healthy, but to eat good. And that way, it’s helping her to maintain a weight. So, I would encourage what you said there, relative to the nutritionist. This is very, very helpful, as always. And these issues, you sort of alluded to it on the last answer that you gave, Hannah. Relative to some of the problems that we need to pay attention to, some of the obstacles, and the pitfalls as in any counseling case—we need to pay attention to that. We need to be aware of our own limitations, our own frailties, and our own blindness as counselors. But even more so, when we’re talking about issues that can have, you know, very strong consequences like something relative to an eating disorder. So, talk a little bit about some of the obstacles that we need to be paying attention to and be aware of as counselors who are engaging on this level.
Hannah Carter: Yeah. So, one of them is maybe not getting enough information. If you don’t have enough in the beginning, later on you’ll start to see some of that. If there’s kind of becoming a wall that’s coming up between you and your counselee, I would just be asking more questions. You know, how are they doing? What’s going on? What attitude have they had this week or how has their eating been, when you get food logs, and so forth, back—Just to make sure that they’re not hiding from you, or they’re being clear. But yeah, just being aware of them, of their mannerisms, and of their attitude, because that can point to something. And you want to make sure that you can see those things. The other thing is sometimes we can move, as we said previously, too quickly. We can want them to start eating, right? Just so that maybe the parent feels better, or the doctor feels better. And then, they can start cooperating with you just to check off the box, but they’re not doing it from a heart that desires it. And so, you want them to be fully on board in that way and move with you in that change and in that growth. My mom is a master gardener, and she’s taught me a lot about plants and different things. And one thing is that during the winter, she’ll take a cutting from a big healthy plant and replant it and allow it to start growing and provide roots. Well, when I was home recently, one of the cuttings was little and young, but it was already starting to bloom, and she plucked off the bloom. And I thought, “Oh wasn’t that going to be pretty?” And she was like, “Well no, it actually needs to use all of its strength to make healthy root systems. If it blooms, it will use the strength on the bloom instead of the strength to put down roots.” And so, as I was thinking about that. She was explaining that when plants are stressed, they will try to start blooming and provide seeds so that they can reproduce. And one of the things that hit me is with counseling. There is a sense of we want to see change. None of us want to be in the circumstance we are in. But we don’t want to go so quickly that we only see the bloom and there’s no root when drought comes. And it made me think of Psalm 1 and Jeremiah 17 where it tells us that we want to plant ourselves near the stream of water. A tree that’s planted by the stream of water will have the roots when the drought comes and not be anxious about it, because we’re steady and we’re firm. And so that’s what we want to do as counselors when we’re helping someone with an eating disorder or also honestly any type of problem. We want to see the fruit, but not aim for it too quickly and not get their hopes up, but also encourage them. It’s going to be a slow process. It’s not wrong to see green, it’s not wrong to see just a plant. The root is actually underneath, and it is gaining nourishment as we’re growing, and so that change may be slow, but it can be very steady and could be very helpful when times are rough. So, that’s just something that I’ve learned. And I’ve thought about this that as counselors we can want this so badly or even counselees want to change so badly and be tired of the circumstances they are in. But pruning, as Jesus teaches us in His word, is not bad. It’s good. We need to be okay with that. We need to see that as Him growing us more and more into His likeness.
Dale Johnson: Yeah, and I think places just like you know dealing with eating disorders. We have a tendency that we want to see behavior so bad, that’s sort of like the bloom. We want to see those behaviors so bad that we forget the root system. And I mean, I think well said relative to paying attention to obstacles. Listen, the way that we overcome obstacles is that we have to first acknowledge that they exist. And then start to identify, what are some of those particular things that we see as common trends with folks who deal with these types of issues of sin, rooted in their heart. And then we can start to overcome those and pay attention to those pitfalls and help to move a person forward. But as you said, slow and steady wins the race with helping them to grow deep roots. We want to see long-term faithfulness and we want to see them change for the glory of God. And their life will be radically different. This has been really great, Hannah. I really appreciate the time and some of your Insight. The Lord is using you to work with some young ladies and just as you have been growing and learning from that and helping to teach us what you’ve learned from the Word, I appreciate that.
Hannah Carter: Thank you. Thank you for your time today.
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