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I can hear the police sirens and honking cabs as Jamie walks quickly down Santa Monica Boulevard, trying to find a quiet place to talk on her lunch break. I sit in a comfortable chair in my quiet Atlanta office, phone to my ear, as I wait for her to locate a hotel lobby where we can talk in “private” for our weekly phone session.

I’ve been working with Jamie for two years, as she finished college and transitioned to life in Los Angeles. She’s a 22-year-old, exotic beauty with dark hair; tan, thin and model-gorgeous. She’s also incredibly bright, sensitive, insightful, creative and funny~ although she is unaware of these gifts at the moment.

Since moving to Los Angeles, she’s gotten some modeling and acting gigs and holds a glamorous executive assistant job at a tony entertainment firm. She and her wild roommates take advantage of the all-night-every-night-party-scene; Jamie has no shortage of interested men.

And yet this exciting lifestyle, to which most college girls in America aspire, is destroying her. The focus on appearance, status, fashion and thinness, along with nightly partying has caused a ramping up of her eating disorder.

In today’s phone call she detailed her most recent bad day. She woke up at 5 a.m. on Tuesday, hung over, stomach stuffed from an alcohol-fueled eating binge the night before. She dragged herself out of bed and set off for a 9-mile run, her first attempt of the day to undo last night’s damage. Exhausted, she pushed herself through the run, feeling slightly better afterwards. The endorphin high plus a Starbucks Venti non-fat latte fueled her morning, but she ate nothing all day. By 4:00 she had burned many calories but consumed only a few. The combined work stress, low blood sugar, and extreme fatigue led her to the vending machine. After downing several candy bars, her eating disorder was off and running.

Unable to concentrate at work, at 6:00 she grabbed a couple slices of pizza and headed to the local grocer, filling her cart with ice cream, frozen treats, bread, peanut butter, boxes of sweet cereal, and lots of milk. Back at her apartment she inhaled the food, and in a carb-induced trance she headed to the bathroom to empty her stomach of its contents.

The sane part of her watched this ritual with revulsion, berating herself: “This is so wasteful, Jamie. You could have fed a family for a week with what you just ate. You are sick and disgusting!” She cleaned up the bathroom, brushed her teeth and fell into bed, spent and depressed. When her roommates arrived and invited her out for another night of partying, she declined, promising herself a 12-mile run in the morning.

She repeated her nightly vow: “Tomorrow is a new day. Tomorrow I will be Good.”

Some readers might think Jamie is superficial or selfish or lacking integrity. The truth is that she has tremendous depth and compassion for others. She is one of those big-hearted souls who loves animals, kids and helping people; she will probably start a charity someday. But her eating disorder leads her to act against her own value system, to appear to the world to be someone she is not.

My task with her is this:

1. To express my unwavering and unconditional love and concern for her, whether she has had a “good” or “bad” week.

2. To approach her behavior with curiosity: no disgust, no judgment.

3. To applaud the small victories such as saying, “No,” to her roommates. She listened to her body and needs to do more of that.

4. To help her de-construct the “bad” days and understand how each decision led to the next and exploring and then challenging the faulty beliefs that led her to self-destruct.

5. To brainstorm with her about how someone without an eating disorder might approach each of those decision-points.

6. To explore ways to self-soothe that involve neither food nor over-exercise.

7. To be the Holder of Hope that there will be a day when she will show the world her true amazing Self.

Our work is nothing less radical than brain surgery without a scalpel. Jamie is tired of her eating disorder and hungry for a new perspective. She desperately wants to think and feel differently.

I am not an uh-huh-type therapist; my approach is active and engaged especially since we are on opposite sides of the country. Without benefit of body language, I infuse my voice with energy and possibility. After we have re-wound the tape on her bad day and re-played it with a different outcome, I feel the tension and self-loathing in her voice starting to dissipate.

There are deep silences as her heart digests love, compassion and hope.

Like other forms of nourishment, I hope she can take it in and keep it there…

Dina Zeckhausen is a nationally-known psychologist who specializes in treating adults, teenagers and children with eating disorders and body image issues.  She is a regular ShareWIK.com columnist and the author of the children's book, "Full Mouse, Empty Mouse: A Tale of Food and Feelings."  You can visit her on the web at dinazeckhausen.com and MyEdin.org.

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© ShareWiK Media Group, LLC 2009