In the previous episodes, I spoke about Gemma’s family’s journey until getting to my office. This last chapter focuses more specifically on how parents can support Gemma in three main aspects of her recovery journey: the nutritional one; disentangling food and feelings; and the ambivalence between building a bigger life and sustaining an illness that shrinks it. Psychoeducation about the illness to both Gemma and her family is an important first step. An eating disorder (ED) is a solution that becomes a problem. It is a toxic friendship where the goal post for acceptance is forever changing and Gemma is never quite good enough. It is a severe mental illness where for each day it goes unchallenged, it gets more entrenched in Gemma’s thoughts, feelings, and behaviours. Fighting an ED will take every single drop of patience and perseverance they can find within themselves. Separating the person from the problem is another important turning point. Gemma is not the problem; the problem is the problem. It may sound like a semantic detail, but it makes a huge difference when using words like fight and battle. Gemma cannot fight herself, but she can fight the ED. Setbacks and ambivalence are parts of the process, and a lot of learning stem from those. But they are difficult to tolerate. Parents are programmed to solve their children’s problems. So many times, have I heard parents say that if they could eat their child’s way back to health, they would. But they can’t. Parents can only swim alongside Gemma, supporting her to stay afloat whilst she fights the hardest battle of her life. Recovery depends on a child who is only just getting in touch with the complexity of their emotions, their relationships, their mood swings, and their bodies. And, as parents, it is very important to manage and regulate their own emotions, in order to provide that support. Support that will often be counteracted with resistance and lack of cooperation from Gemma. Nutritional: Because an ED is so intertwined with difficult emotions and feelings, Gemma’s parents felt confused and blamed when I recommended a family-based approach, especially at the start of treatment. However, because of the lack of nutrition and the denial of the problem, Gemma was not in the right mindset to engage in individual therapy. Eating needed to come first, and without support and supervision, Gemma could not do it. Research shows that, for restrictive eating disorders, early weight gain in the recovery process is related to better prognosis and treatment outcomes. For that reason, the initial part of the treatment generally involves recruiting parents to be responsible for preparing and serving meals. That involved also deciding Gemma’s portion sizes. It is meaningful that an ED clinician trusts parents’ ability to feed their children, something they have been doing so successfully for so many years, but now a task which leaves them feeling so uncertain and inadequate. Before and after meals also require support and supervision. Gemma’s fear and anxiety will be peaking before meals, and she will be left with the guilt and the physical sensations to deal with afterwards. It is important the decisions about what support looks like, or what is helpful and unhelpful, are made outside meal times. When there is food in front of them, logic and reason give space to a tunnel vision of calorie counting. Disentangling food and feelings: An ED can be seen as an avoidance strategy: the more Gemma thinks about food, the less she thinks about her emotions. Have you ever considered what your children have learnt with you about how to express and manage emotions? Our children look up to us to know how to respond to unfamiliar situations. For instance, do you talk about feeling sad, or vulnerable? Do you blame others for how you feel? Do you put on a brave face and suck it up? Do you explode in anger, or lock yourself in the bedroom so you can cry privately? Of course, how parents manage their own emotions is just one piece of the puzzle. Another one is the fact that we live in a society that tries to bury any hint of negativity, invalidating genuine emotions. Part of the treatment for most mental illnesses involve establishing a healthier relationship with how we feel. Sitting with our emotions is a term I use most days in my work as a therapist. It means acknowledging what we are feeling, naming it, and tolerating it. It means not using strategies to avoid or shortcut our feelings because they are uncomfortable, while also being curious about what that emotion is telling us about what matters to us. Building a bigger life: Eating disorders, similar to depression and anxiety, tend to make the sufferers’ comfort zone increasingly smaller. Some children will stop going out, as the world is too unpredictable. Or maybe they will miss out school trips, parties, and other social events due to the inability to feed themselves adequately. Some will only eat with their parents, or maybe only one of the parents, putting tremendous strain in parental relationships. An ED, in a roundabout way, offers the child a bubble in which they are protected from the stressors of real life. And, although they do want a bigger life, it feels impossible to get from A to B. Being able to talk about the ambivalence between living a small and controlled life and a fuller and unpredictable one is a big step. Usually, parents resist acknowledging that there are any positive aspects in having an ED, and prefer to focus the conversation on everything the child is missing out. However, that will make the child resist even more opening up. Understanding the role of the ED as one of protection and avoidance will help parents support Gemma in grasping her challenges much beyond the piece of chicken left untouched on the plate. Most of the time, open communication is the best tool parents can have in this process. Expressing empathy about the inherent ambivalence about change, and being open to listen to the pros and cons of having an ED can be much more helpful than directing the conversation into a particular direction. Needless to say, there will be good and bad days, successful and failed attempts. It is important that parents offer encouragement and reassurance that this will be overcome, without minimizing how overwhelming and difficult it is for the young person. Parents’ ability to listen can be more valuable than their need to talk about what they think is right and wrong. It is important to allow the arguments for change to come from the young person, so that those reasons are in sync with their own values and the future they wish for themselves. If you have any further questions about eating disorders and how to support your loved one, I'd love to help? Or are you struggling with an eating disorder and would like support to overcome it? Get in touch today.
