I am sixteen and have been struggling with anorexia for about three years. About a year ago, my parents sent me to an adolescent treatment center. Since then, my recovery has been going much better. I have actually been able to admit that I have a problem and am beginning to identify and deal with my thoughts and feelings. I have also learned how to set boundaries and find ways to fulfill my needs other than resorting to eating disorder behaviors. My problem is that although I am close to being completely healthy it is the “last five pounds” that are really killing me, and my parents are getting very frustrated. They do not understand how it is that I have come so far and now, according to them, all I want to do is keep my eating disorder. How can I get my parents to understand that in some ways an eating disorder is a choice but in many other ways it is also an illness and I do not always have control over my behaviors? I know that I cannot shift the blame of my actions onto my eating disorder, but I just do not want my eating disorder to be blamed on me. I am an incredibly “closed” kind of person and find it difficult to trust people and commit to anything. While I was at the center, I had the most amazing therapist and found that I was able to trust my therapist and allow my true self to show. I was comfortable enough to allow myself to be vulnerable. This in turn helped me to uncover many underlying issues and discover so much about both my life and myself. I have not had good experiences with finding therapists back at home and have been seeing the same one for about a year now but still do not feel at all comfortable with them. I just do not have the same bond. Should I just give up on therapy altogether if it’s making things worse? What am I supposed to do if my parents implement some sort of consequence for not going to therapy? I don’t know if they will ever acknowledge how I feel concerning therapy. I know I am a basket full of issues but I promise this will be my last question. A year ago when I left residential treatment, I convinced everyone not to send me to their transitional care program—well, it was more like my eating disorder did. Anyhow, coming home turned out to be a big transition for me that I just wasn’t ready for and was struggling for quite a while. Now that I am at a point where I do not need inpatient stays or hospitalization but still need some support, do you think it would be a good idea to go to the life program? Would it just make things more difficult when I come back home again? Is this idea just my eating disorder tricking me into believing that I miss being in treatment so much that I want nothing more than to go back? – Nicole
While I don’t know your parents, I am a parent myself and can see both sides of this issue. Let me first try to help you see your parent’s position – not to say they are right, but to help you understand what is likely causing them to do what they are doing right now. Then, I want to look at your side of the issue.
The overwhelming majority of parents who bring their daughters to residential treatment love their daughters to the point they would die for them. I feel the same way about my two children. When anyone or anything poses a serious threat to the well-being of my son or daughter, I become very frightened. That fear causes me to spring to action to take control of the situation as a means of protecting them. The more frightened I get, the more intense I become in gaining control of the situation in order to keep them safe. I can grow very angry with those who hurt or endanger my children.
There are times when my son/daughter is both the person I am trying to protect and the person I am upset with. Let me use an example with my son, which – thank God — isn’t actually happening, but helps to explain what I mean. Suppose my son started to party and get drunk. As a parent, I see the huge risks to him (i.e. addiction, killed in a car crash, no future in terms of career or healthy marriage/family, etc.). I would be very frightened by these risks to him and would want to get control of the situation to protect him.
Control is a primary way to protect someone. For example, if you were walking a young child across a parking lot – you might hold her hand. Why? Because when you hold her hand, you have control over her. She cannot dash out in front of a car and be hurt or killed, because you can control her. If she tries to shake your hand loose and run through the parking lot, you grab even tighter and may get angry with her for trying to get loose. She gets angry with you because you are not letting her loose.
In the fictional story about my son – how can I gain control when he is the one placing himself in danger?
I begin by doing everything I can to get him to stop—not because I enjoy controlling him, but because I am trying to protect him from himself. Suppose he went in for substance abuse treatment and did well. After his release, I see him drinking a beer. He isn’t getting drunk, but I have an instant fear reaction.
If he drinks a beer, he is in danger of relapse – which means he would be at risk for all of those bad things I am trying to protect him from. As I said – if someone is trying to hurt my children I get fearful – and get very angry with the person who is trying to hurt them.
When he is the person doing something that would hurt himself – I become frightened and seek control – and I become angry with him. I become angry with my son because he is doing things to hurt my son (he is both the attacker and the attacked).
Reacting out of fear and anger often leads to bad choices and behaviors. In my attempt to protect him, I may do and say things that are wrong – that may make it worse and push him away. In my fear and anger, I may make it even more likely that he will start to drink again.
That may be why your parents are making a big deal about five pounds. To them, it may be like having a child with a history of substance abuse taking a glass of wine with dinner, shortly after getting out of substance abuse treatment. They likely see the five pounds as meaning that you are vulnerable to relapse – relapse means you will suffer and could even die. This leads to fear and a strong desire to control the situation to prevent danger. They also become angry because their daughter is putting their daughter at risk – you are putting yourself at risk.
Of course, eating disorders are complex – and it isn’t as simple as all of that – but they may be acting out of fear that leads to anger, which leads to control and blame. There may be other issues I don’t know about, but this is likely a bit of what is happening.
Again, I don’t know the specifics in your family, but that five pounds may be the rope in a tug-of-war you are having with your parents over control. The more they want you to gain the weight, the more you hold onto those five pounds. When you feel them tug on that rope (weight), your natural instinct will be to tug back in the opposite direction. The conflict and power struggle becomes a bigger issue than the five pounds, unless there is some health issue that I don’t know about, or unless you are purging or doing something dangerous to your health to prevent gaining that last five pounds.
You mention that you feel blamed. Blame is a dead-end street that will not solve anything in this case. Two Christian psychologists (Henry Cloud and John Townsend) make it clear that there is a difference between blame and responsibility. Blame is what happens when someone does something bad – breaks a law or does something immoral. Blame is what happens when some type of damage happens due to something a person did on purpose. Blame very often involves punishment. In the legal world, blame can cause someone to be put in jail or have to pay money as punishment for what he did. Blame often involves anger and accusations about motives. Outside of the court system, blame usually is not helpful.
Responsibility has to do with roles and tasks. In sports, team members are assigned to different positions and each position has a job to do – a player has a responsibility that goes with that position (e.g., a goalie in soccer has the job of blocking shots). With your eating disorder, both you and your parents have responsibilities. You have to work hard in therapy, to keep eating according to a meal plan, etc.
I doubt the five pounds is very important in terms of your health. However, it is your role to work with a therapist to figure out if there are unresolved issues that are causing your difficulty with the five pounds, such as: wanting to hold on to just a little bit of your eating disorder in case you need it, the five pounds being your way of winning in a power-struggle with your parents, or the five pounds is essential for you to feel good about yourself. These issues are far more important than the five pounds, and it is your role to explore this and work through it. Notice I didn’t say they these issues are bad or that you are being willful and bad – or that you need to stop it right now! Rather, they are issues that you need to deal with in therapy in order for you to have a normal, happy life.
Your parents have a responsibility to love you, support you, and help you. They have a responsibility to speak the truth to you – but always in love. They also have an equal responsibility to listen to what you say and take it seriously. They need to understand that recovery is not always a 100% perfect situation-it can take time. Recovery from an eating disorder is not an all or none situation. Recovery does not mean you are either totally recovered or you are not recovered at all. Rather than focusing on the five pounds (unless there is a health issue involved), it will be important to focus the issues that the five pounds are a symptom of. If you are not restricting, binging, purging, or practicing any other dangerous ED behavior, it doesn’t seem to me that the five pounds is an urgent issue. However, the issue causing the struggle with the five pounds might be urgent.
You asked how you could get your parents to understand. Part of it is trying to understand where they are coming from – don’t assume that they are simply being insensitive and controlling. Try not to be defensive, but honestly seek to listen and understand what they are saying. Repeat back what you believe they are saying and why, to show that you do hear them. Then tell them your position using the skills you’ve learned – for example, “When you….I feel….”
Therapy is also very important in dealing with this conflict. Your therapist can help your parents understand and can help you and your parents to communicate. I do believe that the conflict you are having with your parents is very important to deal with in therapy and would strongly suggest that you ask your parents to go to therapy sessions with you to work through the problem. This may involve looking for a therapist to do this, but it is very important. Don’t let the anger build.
Do not give up on therapy! In inpatient treatment, a bonding takes place with a caring staff (including your therapist) as well as with other residents who share the same kinds of struggles and with whom you can identify. Many residents find they are in the first place they feel accepted, understood and safe – and that is an incredible feeling.
In the Bible, there is a story about Jesus going to the top of a mountain with three of his disciples Peter, James and John. On the mountain, Jesus’ true glory shone through as He became bright and shinning. Peter wanted to build a tent and stay there, but Jesus led them back down the mountain right into the midst of a horrible situation. From this story, we developed the term “mountaintop experience.” Christian youth camps can be like this as well. Mountaintop experiences are awesome and important, but just we come down from the mountaintop and things are never quite as good as they were on the mountaintop.
Christian inpatient treatment can be this type of mountaintop experience. It is easy for many residents to feel very strongly about their therapist and believe that he or she is the only one that can understand them and help them. Although the therapist you had is a tremendous therapist, he is not the only one who can help you. He or she becomes associated with the entire experience of the program. He is the one who helps you through the difficulty of coming into a treatment center far away from home where you don’t know anyone. He helps you face other challenges on a daily basis and is often there to support you throughout the day. He helps you have the ability and courage to confront family members about issues and supports you through that whole process. You see him a whole lot more than you see your therapist at home, as he is part of the family that includes other staff and residents in your home group.
Therefore, the inpatient treatment therapist can become a very hard act to follow. It is important not to compare him with your therapist at home, because the home therapist will often come up short. When you are in therapy at home, if you are constantly thinking about how your inpatient therapist would respond to a specific situation or what he would say – you will become upset when your home therapist is not responding in the same way and you won’t be able to give your home therapist a fair shot. You have to also recognize that your home therapist doesn’t have the same role as your inpatient therapist, as he or she isn’t a part of your daily activities the way the inpatient therapist is.
Having said that, you do have to feel comfortable with your therapist at home — and have a sense of trust. You have to feel that he or she cares about you and listens to you. Therapists have different styles depending upon their own personality and what they were taught about therapy in school. Some are very relaxed and informal and others are more serious and don’t show emotions very much. You can choose a therapist that matches the style you like best. It is important – however – not to have a therapist who simply tells you what you want to hear. A good therapist will say things in a caring way – which you may not want to hear.
I would suggest talking to your current therapist about this. Take a risk, be vulnerable with him/her, and give him/her the chance to respond. You have to ask yourself — is your inability to bond with your therapist due to the fact that you really cannot relate to him/her as a person or to his/her style — in spite of giving it an honest attempt – or are you blocking the bonding because you won’t open up to any therapist who isn’t the one you had at residential treatment. There are three key realities in this situation: you need a therapist right now, it cannot be the one you had while inpatient, and the home therapist will probably not compare favorably to your inpatient therapist (at least for a while). Therefore, it is important to find one that you can relate to, one you feel cares about you, and you feel like you can eventually trust as you work with him/her. Like any relationship, your relationship with your therapist will take time.
You are not a basket full of issues – but are asking excellent questions! Your last question is a tough question to answer without knowing a much more about your situation, but I can give you some guidelines. The first guideline is – have you and your family worked to find a therapist that can do family therapy to deal with your conflicts? If not – that is the first step. The second guideline is – would going to the transitional care program help you resolve the conflicts that are causing you problems right now, or would going to it simply be a temporary escape from the problems? If it is just an escape, it isn’t going to help.
I am not sure where you live – and therefore – I don’t know if you have a large number of therapists to choose from, or only a few.
If you and your parents agree that there isn’t anyone in your area who can provide effective family therapy – and help to resolve the problems you are experiencing – then transitional care may be an answer to help you and your parents to move past these issues.
You also mention that you need support and this is absolutely right! However, your primary support has to come from the area that you live in. Ultimately you have to have support nearby, that you can experience as you continue through your high school years and then in college or wherever you go after high school. Not all support has to be in therapy. Some people focus too much on therapy support – and neglect other types of support. A healthy church youth group, for example, can provide happy, fun and good experiences that can be as effective a weapon against the ED as a therapy group – not that you have to choose one over the other. Issues such as insecurity and worth can be greatly improved in healthy social groups (both formal groups like a youth group, and informal groups, like a group of friends who share your good values and desire for a healthy life).
You are 16 and need active healthy experiences like any other 16-year old. Unless someone is in a crisis, therapy to the exclusion of these everyday healthy experiences can make things worse. As it says in Ecclesiastes – there is a time for everything – a time to deal with issues in therapy and a time to focus on anything but problems and issues – to just have fun!
You do need support – the question is where you get it. Ultimately, you have to find the support and help at home.
God Bless You,
David Wall, PhD