Dr. Joy Jacobs is a clinical psychologist and published author who provides individual, family and group therapy for children and teens with eating disorders, body image concerns, and/or weight concerns. Joy's goal is to help families build active, well balanced lifestyles to reach their personal "best." Read MoreSubscribe in a reader
I write today as a parent first and a psychologist second. Words are not coming to me like they usually do. The senseless tragedy at Sandy Hook Elementary has shaken us all to the core. As I write this post, the tears continue to flow. I sometimes wonder if the tears will ever stop.
But instead of resisting the tears, I embrace them. They represent the connectedness of humanity. Those children were our children, those teachers our teachers, their loss is our loss…except that most have us have been spared the sight of their empty seats at the kitchen table, their teddy bears collecting dust, the memories of their eyes lighting up at school pick-up each day, and the bedtime cuddles that every parent wants to hold onto forever. On December 14, 2012, the parents of those Sandy Hook first graders had no choice.
What does this have to do with family-based treatment? Everything.
As a psychologist, I choose to practice this method—a method that can be excruciatingly difficult, challenging, and exhausting. Why? Because it saves the lives of children. I have seen it first-hand.
One of the stark realities of parenthood is that we are often powerless to prevent bad things from happening to our children. We want to shield our kids from so many things and are often unable to do so. Usually the stakes are not life and death. It was at Sandy Hook, and it is in eating disorders treatment.
We know that more people die of eating disorders than any other psychiatric illness.
We also know that there are treatments that can prevent this dire end, but only if those treatments are implemented.
Thankfully parents do have power in treatment decisions. If you have a child who has been diagnosed with an eating disorder—or who you suspect has an eating disorder—trust your instincts. Talk to other parents, read. You are the expert in your own family and, in this case, you have the opportunity to save your child’s life. If only the Sandy Hook parents could say the same.
Each family that I have the privilege of working with is heroic in its own way. Refeeding a child is hard work—which is probably the understatement of the year to those who are in the midst of it. When you, as a parent, are confronting the fear of eating induced by an eating disorder, monsters feel like they are being unleashed in your own home, from a child you used to think you knew. Wrestling your child back from the all encompassing, vice-like grip of an eating disorder is a Herculean task. As overwhelming as it may feel, however, it is doable. Don’t run for the hills. Instead, read the inspiring story below.
A very young patient of mine developed a fear of eating after having a medical incident which involved choking episodes. The fear of choking led to a gradual elimination of many and finally all foods and liquids and significant weight loss. When this patient first walked into my office, none of us—myself, her parents, her pediatrician—were certain if hospitalization could be avoided. She was immobilized by fear. The great news is that, with proper intervention, this patient is on the road back to health.
At first, every meal and every snack was a battle. That meant, getting to school late some days, homework left unfinished, later bedtimes, earlier wake-up times, school lunch with mom and disruption of almost all of the family’s typical routines.
At times, the parents feared that they had or would lose their daughter forever. They worried that confronting their daughter’s anxiety head on—by asking her to eat her most feared foods— would send her over the edge, never to be recaptured. Despite their fears, they hung in there. With love and kindness, but also with firmness and consistency, these parents became my heroes this week. Their daughter is now enjoying her favorite foods again, eating lunch with friends at school, and the fears are starting to become a distant memory.
Below are some of the key elements of this family’s refeeding success that may help to inform your own family’s refeeding strategy:
The battle is not over yet, but it certainly has been a great start. This family gets five gold stars on my imaginary sticker chart. I hope it will help you build your own.
As an eating disorders therapist specializing in FBT, I read a recent New York Times essay with great interest (Sibling Rivalry: One Long Food Fight) http://nyti.ms/QCW9aK. In the essay, the author describes growing up as one of four brothers, each competing at family meals to get the biggest hamburger, largest slice of piece, or other favorite food. He goes on to recount many other examples of siblings competing for the largest portions of treasured dishes, all the way from the human kingdom to the animal kingdom.
It is our biology to crave delicious food and to outwit others to get it…except when it is not. If you are a parent trying to refeed your child, such memories may seem distant and treasured. Family mealtimes can fuel a new brand of sibling warfare when one child at the table refuses to eat or an eating disorder otherwise rears its vicious head.
I have heard countless stories of siblings caught in the crossfire of a brother or sister’s eating difficulties. This can be especially evident and stressful at mealtimes. There are simply too many unique examples to recount them all here. Suffice it to say that eating disorders are wily beasts. They will stop at little to have their way. At meal and snack times, for example, the eating disorder will point to different portion sizes, types of food, and timing of meals and snacks of siblings to distract parents from refeeding and to interfere with the necessary tasks of recovery.
In these circumstances, externalization can be a particularly useful tool, for all members of the family. Instead of getting sucked into the twisted logic of the eating disorder, remember that the EATING DISORDER has temporarily taken over your child/sibling. You are working to bring back your child/brother/sister; they are not present at the moment—the eating disorder is. Negotiating with the eating disorder-- by cutting back on a portions, taking away a feared food, or otherwise altering the refeeding plan, due to fear and bullying by the eating disorder--will only lengthen the struggle of the whole family to kick the eating disorder to the curb.
When you remember that your treasured loved one is not in charge right now, the eating disorder is, you are able to respond with firmness, kindness, and clarity. This spares siblings from becoming further bait in the eating disorder war and maximizes the opportunity for them to offer the kindness and crucial support that will eventually help their loved one on the road to recovery.
Holiday meals are a time for us to come together with loved ones in shared celebration. When an eating disorder takes a seat at the table, food can literally go flying, sending everyone into a tailspin. Celebration quickly becomes the last thing on the family agenda.
If your child has been diagnosed with an eating disorder, you may be more aware than ever of the differences you see in eating style between this Thanksgiving and last Thanksgiving. As upsetting as it may be to see these changes, try to be truly present at mealtime. Put your anxiety to the side for this special meal and decide to be an observer. Take mental notes. Note where there is progress and where improvements could benefit your child. Are food choices become more variable or more restrictive? Are portions appropriate for your child’s growth needs? Are there any rituals you notice with respect to how or when food is eaten? Is your child participating in the social aspect of the meal or is the focus strictly on food or avoidance of eating (i.e., shuffling food around the plate, hiding food in the napkin, lots of participation in cooking but not eating, etc.)?
Please share with me your observations from the holiday mealtime.
Most importantly, use your observations to further refine your refeeding strategy and even the most difficult meal, even if it is upsetting or not ideal in some way, can be utilized for future recovery.
Today I sponsored a free Q & A on FBT for parents with questions on FBT and eating disorder treatment. Among the themes that emerged were the following:
I will be following up with the families who took advantage of today’s session and do my best to combat the above challenges.
Effective eating disorders treatment should not have to be a luxury. Our kids’ lives depend on us all doing more and better.
This time of year is a time when I feel especially grateful for the amazing individuals and families I have been blessed to work with over the years. Times were not always easy for them—and I tend to see families in their darkest hours—but time and again the will to survive, recover, and thrive has triumphed, helping light win over the darkness.
As a way of giving thanks to you and relief to families struggling to refeed their child in this very busy and food-laden time of year, I am offering 20 minute question and answer sessions regarding FBT, free of charge, on Monday, November 19 between 3-5pm Eastern time. The first 6 families to email me will receive slots. While I cannot provide treatment to you over the phone, I can offer you information and refeeding tips to help smooth your journey through the holiday season.
I will only be able to respond to the first six requests. All other requests will be put on a list for any future similar sessions.
May this upcoming holiday bring you hope and encouragement, even in the midst of struggle. Thank you, my readers, for joining me on this journey.
A Good Start
We all grew up hearing “breakfast is the most important meal of the day.” When you have a child with an eating disorder, every nutritious meal is vital. That said, it all begins with breakfast.
Start the day on the right note and follow through meal by meal, snack by snack.
If breakfast gets derailed for one reason or another, retool the plan and get back on track immediately.
A good breakfast can set a great tone for the rest of the day.
Speaking of breakfast, Share Our Strength has started a No Kid Hungry campaign. Share Our Strength can connect a child in need to 10 breakfasts for a $1 donation (or 180 breakfasts for an $18 donation). For more information on this and how you can participate, you can review program information at http://www.nokidhungry.org/.
My day today started in the best way possible, with a note of appreciation and gratitude from one of my “moms” (meaning, the mom of a family I am working with utilizing family-based treatment) thanking me, in essence, for helping to re- empower her as a parent when an eating disorder threatened to rob her child of life. Previous treatment experiences had been disempowering; FBT, in contrast, validates both the rights and responsibilities of parents.
This is one of the most rewarding aspects of family-based treatment, empowering families to restore life to a loved one. It can sometimes be excruciating and thankless, but comes with infinite rewards—the most important of which is life.
My Mother’s Day Wish for all the moms out there is that you find the support and resources that you need to extricate your child from the grips of an eating disorder. You can do it, even when you might think you cannot. We will talk more in future posts about how to solve some of the practical obstacles that present themselves in FBT. Motherhood can sometimes be a thankless endeavor. Today, I give thanks to the amazing moms who have crossed my path. You are an inspiration.
©2011: Joy Jacobs
Whatever your politics, may you find inspiration and hope in the story of Barack Obama. His rise to the presidency is testimony to the tremendous power of family.
If you are fighting an eating disorder or helping a loved one in the fight, please reach out to everyone you can for support. Parents in the midst of refeeding, please call on extended family to help you out with errands, provide respite care, or to provide a sympathetic ear.
You are not imposing.
As said so simply by our future president (and repeated by Madonna and thousands of fans only minutes later at Petco Park in San Diego) “We are one.”
When we combine forces, anything is possible.