But, unfortunately, the "perfect patient," in my experience, rarely gets better. After all, what you want to hear is rarely what is really going on. What is really going on is incredible pain, torture, a horrible battle with an eating disorder. There's nothing pretty about this. And soon you start to see evidence of the "perfect patient." The concrete data (ie, weight, vitals, etc) doesn't match what the patient is reporting. The smile is strained and often barely held. You find there is not much depth to conversations. And, most of this is simply because your approval, acceptance, is what is so desired.
So, the "perfect patient" must learn that you will approve and accept them, even if everything isn't, well, so perfect. It become a challenge to balance the need for high expectations, which I believe are necessary for full recovery, with challenging the presentation as a "perfect patient." It is a challenge to balance the need for following a meal plan 100% with a patient's desire to tell you they did it when they didn't, just so you won't get mad. Really, I guess it all comes down to honesty and authenticity, and the trust that is built from keeping high expectations while also encouraging honesty. It is a balance, indeed. I also thinks this links to the patient's need to learn that, even if you do get upset with them (read: their eating disorder), you can work through it. They don't need to fake you out for you to be okay with them. You can simultaneously be upset at their eating disorder behaviors, and like them as a person. Said another way, you can dislike their ED, while liking them just fine. This is often a hard concept as the ED has become so ingrained as a part of the patient. But, separation is key.
I'm pretty sure nobody has ever said that recovery from, or treatment of, an eating disorder is very easy. It is hard, but oh-so-rewarding work.