Motivation: the first step in recovering from an eating disorder

One of the hardest parts of recovering from an eating disorder is finding and maintaining the desire, motivation and will to recover. In March when I blogged about a friend I called “Jane” (Knowing when to express concern about a friend’s eating disorder), her anorexia had taken a turn for the worse and she was scared. She was on the verge of seeking in-patient treatment, but was having a hard time committing to what she knew would be an extremely difficult and destabilizing process.

 

Today, almost three months later, Jane is still struggling with the decision. Last week, she admitted to me, “I kind of lost my way again.” A month before that, she wrote,

 

My doctor is going away for 2 weeks and he wants me to go to Renfrew [treatment center], but it is a very difficult decision to make. Even though I UNDERSTAND that if something/someone can help me, it is me - making a leap and just going there. Honestly, I do not see any other real way out for myself. And it is getting more and more difficult to deal with. I just have to push myself to Renfrew so they will give me a push to start my life all over again. As a different person. It is kind of scary, 'cause I do not know who this person will be. You know what I mean? Too much was invested into the person I am now, even though it was all negative.

 

Jane’s dilemma is wrenching but not uncommon. It got me thinking about motivation, and how we can help motivate family and loved ones to take the leap of faith required to enter treatment. Marcia uses a technique called Motivational Interviewing (MI). I thought that the basic techniques of MI might be of interest to many of you. The idea behind MI is that the impetus to change has to come from the eating-disorder sufferer herself. The best thing you can do is help move her toward positive change by helping resolve the ambivalence she feels about abandoning a behavior that has become who she is.

 

This site, Motivational Interviewing: resources for clinicians, researchers and trainers offers a lot of good information. The “interaction techniques” page offers a handy acronym that captures the fundamental techniques of MI: OARS: (1) Open-ended questions, (2) Affirmations, (3) Reflective listening and (4) Summaries. The rowboat oars image, the site explains, “gives us power to move, yet it is not a powerboat. We don't zip from one place to another, yet with sustained effort OARS can take us a long way.  

 

I like the way this introductory page differentiates between the MI techniques that therapists use and the spirit of MI, which you can absorb and try to keep in mind as you talk to your eating-disordered loved one. Here’s a very condensed version of the information on the site:

· Motivation has to come from the person himself, not from outside. There’s no room for coercion, bribing, cajoling or guilt-tripping. You want to mobilize your loved one’s values and goals to stimulate change.

· It’s your loved one’s task to voice and resolve his ambivalence. You may try to facilitate this process with open-ended questions.

· Your job is not one of direct persuasion. Usually this just leads to increased resistance.

· MI is a quiet asking and listening technique. Forget about aggressive confrontation or arguing: these are the opposite of motivational. This technique may seem slow and passive, but the change comes when your loved one is really ready, not because you’ve forced the issue.

· Your job is directive, meaning you are there to help your loved one zero in on the cause of her ambivalence about healing and resolve that deep divide over wanting and yet being afraid of the task of recovery

· Readiness to change is not always a permanent condition, it comes and goes with different interpersonal interactions. Your loved one’s resistance might be a sign that you’re assuming he’s ready when he’s not yet there. Be patient.

· Think of your relationship to the loved one you are helping not as a parent-child or other hierarchical relationship, but as a partner or companion relationship. Respect your loved one’s freedom of choice. Until she decides she wants to change, it is not going to happen.

Nancy

Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home, Gūrze Books,www.childhoodeatingdisorders.com.

 

Comments

[MaryJo Briggs]

Nice info!
Mary Jo

[Melody McCasland]

Interestingly enough, I found motivation to be overrated on my recovery journey. Everyone talked about being motivated to make the change, but I wasn't, and I knew I never would be. The truth is that recovery is painful and difficult. Who is motivated, who WANTS, to do painful and difficult things? Pretty much no one. So what I had to be was committed. I had to decide that recovery wasn't going to be any more miserable that my eating disorder, and I had to commit to doing every single thing in my power to support my recovery for a period of time. Once I got through the miserable part, then I could be motivated to keep what I've gained.

I think too many people waste too much time on motivation and dedicate too little time to making a commitment and seeing it through. I knew from putting myself through hell with the eating disorder that I could get through this too.

Sometimes, yes, my focus was on "For how much longer did I agree to do this recovery thing? When can I quit?" But those times became fewer and farther between until, at the end of my three-month commitment, I just enjoyed my recovery and wouldn't dream of giving it up.

The truth is that recovery is hard and that the beginning of recovery is awful. The truth is also that that passes if given enough time to do so.

[Ednutrition]

Hi Melody,

Thank you for this great, real-world answer. It puts things in perspective to equate the torture and difficulty of the early stages of recovery with the eating disorder itself. You're right! Both are horrible, so why not pick the one that at least holds the promise of a healthy future over the the one that doesn't?

I completely understand what you are saying, and yet somehow feel we are talking about the same thing, or a very similar thing. If you substitute the word "motivate" for "making a commitment" wouldn't either work? Until someone makes the commitment to go through recovery, or is motivated enough to make that commitment, nothing happens. It's really hard to get to that point, whatever you want to call it. But I admire the fact that you said, "I'm going to do it," and stuck to your decision. That's real commitment.

Thanks for your comment!
Nancy

[Mary Ann Young]

My 20 year old daughter has been living at home for over a year now with full blown bulimia. She is going weekly to psychotherapy and we are doing family counseling but the missing link to her recovery still seems to be motivation or just not really wanting to get well. (Or wanting to be thin more than she wants to be well).
I am curious how much of a motivator the consequences of this horrific disease have been for anyone. I am trying to make her responsible for replacing food, paying for her binge items, cleaning up after herself,making her own excuses to her friends,etc. It is a daily struggle to not give up after so much time and I never feel I know if I am enabling her or if I am going too far with "tough love". If the physical consequences have not impacted her at this point I am wondering if anything will.