A topic I have been talking to people about quite a bit recently is that of ambivalence. Outpatient eating disorder treatment is an interesting animal. Most everyone who walks through my doors is wanting treatment; it is only the occasional adolescent that is brought in against his/her will. However, in spite of this, many patients present as very ambivalent. They come in for treatment, and of course pay for it, but they don't necessarily follow what we recommend. So, from the total rational perspective, they are wasting their money, right?
But that's the tricky thing with eating disorders. As I tell patients, the "psychobabble" word is ego-syntonic. I think I have mentioned this before. But, in short, eating disorders serve a number of functions for the patient, so whereas on some level they want to get rid of their eating disorder, on another level, they really don't want to.
So, it is interesting to figure out how to challenge the ambivalence and point it out, without being somewhat offensive, perhaps. Fortunately, because the majority of patients we treat are motivated on some level for treatment, simply identifying the ambivalence is sufficient to break through it.
We can all talk endlessly, probably, about why one should not have an eating disorder. I think the more important question is this.....why is it "good" to have an ED? How does it "help" you?
Also, thanks to you who are still reading. It's been a rough couple weeks. I'll try to get more on track with posting, however. I still would love topic suggestions; sometimes my brain just can't come up with enough ideas!