Eating disorders can make understanding why getting help/treatment is a good idea difficult.

The illnesses themselves carry denial and distortions, and, at least in the beginning stages can make people feel "better" about themselves and their lives. It doesn't make sense to us to pursue change by way of treatment if we perceive things as going well, right? Right.

And even when people are pretty firmly ensconced in treatment, they remain periodically confused about why it's necessary and what it's point is, as Laura points out.

I've found it helpful to talk specifically with people about why, exactly, they'd be in treatment. You know, there are always the obvious things that get people into treatment- weight loss, purging, excessive working out... of course, these are certainly worth noting and attending to, but huge discussions about them aren't usually very helpful, especially at the beginning of treatment since the distortions inherent in the eating disorder convince people that their perspectives are the correct ones and that anyone else is over-reacting or mis-seeing things.

I like to focus on quality of life things (quality of relationships in particular!), and I like to be as specific as we can be. It's helpful to "demystify" the reasons for coming to treatment. For instance, Laura, you say things are now going much better and that both you and your clinicians agree on that fact. You might spend some time delineating exactly what's going better, what's different, what's changed, what's allowed those changes to happen... those kinds of questions will help you in several ways: show you how far you've come, help you "chart" your progress so far and map future directions, and solidify the work you've done and make it concrete/grounded (important since sometimes people worry that the work they've done may somehow disintegrate or disappear suddenly, which is not the case when we've really done the work and understand how we did it).

I like to make treatment itself (how it's going, what's working well, what could be changed or improved upon, how people are feeling about treatment, what their hopes and expectations are at the moment...) a topic of conversation periodically. I figure it's like a tune-up on a car: if we maintain our car in good working order all the time, big, sudden, and very costly problems are WAY less likely to arise- we'll see tend to see things coming a mile away and have a chance to fix or adjust them as needed before they "blow up" when we're on the freeway.

If we keep track of how treatment is going, pay attention to what the person needs along the way, and make adjustments accordingly, we'll have a much better chance at treatment continuing to be beneficial for the person and for us to continue to have a good alliance and feel as though we are working together in partnership.

Comments

[Super Egg]

the word treatment creeps me out.

[Ann]

I like what you have to say about all of this. A lot of is is almost identical to what my T talked about today. I shared with her how that tape plays over and over in my head. She asked me something about feeling crazy and I told her that I actually feel pretty normal. And in fact I feel guilty for taking up her time, when maybe someone else needs it more. She told me that I'm definitely not a waste of her time, which made me feel really good. I trust her enough to believe her when she says something. She said it would be completely different if I came in each week saying I wasn't going to do anything or try anything she said. That I just didn't want to change. Instead, I try things even when they're scary or seem impossible, I truly believe this is all to do with the amount of trust that we've built working together this past year.

I'm scared about the next month when my T is gone and I start seeing the new one. She's not a new therapist just new to me. I'm going to miss my current T SO MUCH!!! I meet the new T at my next session in two weeks. My T's having her poke her head in so we can get acquainted prior to our first session. I really like this idea and I'm glad Gina thought of it, I'm just so sad that I don't get to work with her anymore. Gina's the first therapist I've stayed with for this long. It's scary for me to start over with someone new. I know that Kim knows about me and my situation b/c Gina has talked to her about me. Its just building that trust all over again. Everyone says I'll really like her that she great. And Gina has complete confidence that I'll continue improving and that we'll work great together. I think I got off subject, sorry for rambling. I guess I just needed to get that out of me.

My session today did help me to feel less guilty about taking up space/time that someone else could be utilizing.

Thank you so much for sharing! I really appreciate all of your insight.

[Laura]

That's a good idea - to make a list to figure out what happened, what changed, and what allowed those changes to happen. I have figured out what allowed the changes to happen. It'd be nice to chart what exactly has changed though and compare it to how I was living even just a month ago. That would make me feel accomplished and it would make me understand everything that has been happening as a result of 3 weekly appointments.

[Laura]

Ann, it sounds like you're being really open with your therapist. I think that's probably one reason why things have started to turn around for you. I hope you can continue to be open with Kim. I also have just recently decided to finally start talking to my therapist (as a result of Johanna telling me on here one time that you can talk about anything. There is no designated topic. Thanks!). Amazing how when you actually say out loud what is in your head, your therapist suddenly becomes way more helpful :)

[Ann]

Help! I don't know how to say goodbye to my T. I am so thankful for everything she has done for me and I really want her to know. I'm pretty sure she does we've talked a little about it in the past month. Its really hard to say goodbye to someone I'm so close to. I feel like my best friend is moving away and all communications are impossible. I've never trusted anyone as much as I trust her and its a little scary having to start all over learning to trust someone new. How do I get closure? What's the best way to say goodbye. I've never ended a relationship with a T this way before. My last T told me I couldn't come back, we didn't get along very well and she didn't like that I told her things that she was doing bothered me and made me feel like I couldn't open up to her. Not a good situation. Gina has been the complete opposite. I just don't want to regret how I say goodbye. Is this normal?