Decisions about when to change treatment are important, and they ought to be considered carefully.

There are times when someone wants to decrease the frequency of therapy or some other aspect of treatment. The desire to do this can be motivated by a variety of things- for instance, when enough progress has been made and can be sustained with less treatment at that point.

Sometimes, though, someone feels the need to cut back on treatment because he/she is worried she's "taking up too much time" or "costing too much money" or "it's been TOO long in therapy" or something else related... and none of these are sound reasons to make decisions about altering treatment.

So, Ann, when you're thinking you "don't need" to go back to therapy, you want to look carefully at your motivation. You're right to take note of the difference between your thoughts about this and what your clinicians are saying. And another thing I've found useful in assessing whether someone should change treatment, is to assess the quality of your emotions about this issue. In my experience, when it's a good time to make changes in treatment (by which I mean when decisions are based on what's truly right for someone's recovery process), people feel a kind of neutrality about the issue and about discussions regarding the issue. They aren't defensive, or guarded about discussing options, and talking about it doesn't feel provocative or hugely agitating.

It's just another opportunity to be scrupulously honest, and a very important one at that!

Comments

[PTC]

I've been having these same thoughts. My T has been on vacation for 2 weeks (will be gone 3 wks total) and I feel like I don't need to go back to her. I like her and she's helped me so far, but I kind of like the no therapy thing. I guess that maybe my reasons for not wanting to go back aren't worthy of not going back, but who knows. I go three times a week and when I go I like going, but when she's not here and I don't go, I like not going. I feel like I don't need to go. At least I know I will be fine when she's on her maternity leave, even though others are trying to get me to go see her covering person while she's out. I don't think I need to.

[Laura]

The same tape plays over and over again in my head too Ann (referring to your comment on the day before's post).

The disconnect between how I'm evaluating my situation and how others (friends, professionals) evaluate the situation has happened a lot for me. Interestingly, it's usually just when I think that there's nothing that wrong and I'm fine that others start voicing their concern more loudly. Sort or recently, I was thinking that I don't need a dietitian or a therapist anymore. Just as I was about to tell this to my therapist, she starts telling me about how she and the dietitian are getting more worried because blah blah blah. That was a shock to my system. How were they getting more worried just as I was starting to feel a lot better and like how I was doing things? This type of situation has happened a lot in the past. Also, a year or so ago, just as I was feeling ready to quit talking to my dietitian ("because even though I'm not normal with food, I should know better by now. Now, I know what to do, I just don't do it. So it's just me making bad choices now."), my dietitian starts using the word "severe" to describe my eating disorder and starts on some big campaign to get me to see a therapist as well. That was also a shock to my system.

So why did I listen to the dietitian when she told me to see a therapist? Because in the past I have NOT listened to others when there's been a disconnect between what they see and what I see. I've listened to myself. And I can always tell (in hindsight) that the others were right. I realize that if I had listened to others and not myself from the very first instance in which there was a disconnect, I'd be a lot better off today probably. 100% of the time, I can see that the OTHERS were right and I was deluded. But I never saw that in the moment. So, by making the mistake of not listening to others, I've learned to listen even when I don't see what they see - even when there's a disconnect. I really just decided to "trust the process" even though I constantly felt like "I don't have a real eating disorder and all this help and all these appointments are unnecessary." I think trusting the process despite a lot of confusion on my part at times is the reason why I'm doing better now than I ever have in the past. Now, for the first time, I feel like I'm doing a lot better and the professionals agree (no disconnect).

I'm in the beginning of my third year of ED treatment. Most of the time I'm confused. Most of the time I couldn't articulate to others why all these appointments are necessary. I've sort of learned that even though I don't get why this is all that worthy of these appointments, I go anyway. I go anyway because even though I don't totally know why I have to go, I also know that not going is the wrong answer...

[wendy]

I have the opposite problem. I struggled with my eating disorder for so many years alone, that when I finally have gotten help I am very fearful of letting go of the help. In some ways I know how far I have come, but I have been anorexic, bulimic, and obese and then anorexic again. I have been stable the last couple of years weight wise, but eating normally still feels wrong and I still feel fat, even though I am not. I still desire to be on a diet, even though every day I choose not to diet. We have spread my therapy to every other week and I am just about getting used to it. I don't think I will ever feel ready to leave and feel like it is one of the reasons that I have been stable weight wise for the last couple of years. Soon we will spread it out more, but I feel extremely anxious and agitated when I think about it. My therapists see me as much healthier than I see myself or feel at times. I know how much Ed pops up during the week. It is a weird place to be. Part of me wants to scream when they suggest spreading it out more and part of me wants to be the good girl and just go along with trying to spread it out so I won't be a burden and they can help other people who might get better faster than me. My dietician also came back from maternity leave today and I was grateful she's willing to work with me again, but felt guilt when she told me I am the only client she is working with. I did not want her to come back just for me. I know most of the gals I talk to with eating disorders really don't want to be in therapy, but I do not want to do with out it and I I work very hard in it.