I realized yesterday that I have a higher than average percentage of teen clients at this point, and one of the biggest challenges in treating teens is that my job is to teach parents how to treat an eating disorder. This is no small feat for parents, as where, in that mythical parent school, did you supposedly learn how to treat an eating disorder?! And yet, here you are, living with an eating disorder that has taken over your child. It is a terrifying position to be in, and it will be one of the most difficult things you have ever done. But, it is also possible, effective, and, in the end, can be rewarding. I promise I'm not just saying that; this comes from years of helping parents do this exact thing.
The hardest thing about suddenly living an eating disorder is the reality that they hijack your child and turn him/her into someone you don't always recognize. Kind, well-behaved, honest kids begin to lie, manipulate, call you names, and express their hatred. My goal is to try to explain how the ED works, what essentially is likely going on in your child's head, so maybe the nonsensical can start to make just a bit more sense. Other resources, however, include Lock and LeGrange's "How to Help Your Teenager Beat an Eating Disorder," and AroundTheDinnerTable.org.
The idea of Family Based Treatment, which, to me, amounts to creating an ED treatment center in your home....no big deal, right?!....is to keep teenagers out of higher levels of care and allow them to remain at home with their families (even when they say they hate you). There are pros and cons to FBT and to treatment centers, and both are very good options. I won't try to speak for the creators/advocates of FBT, and I will fully confess that I do not follow closely how Lock and LeGrange described the treatment. I use the tenets that I have found work, and adapt the rest. For example, FBT initially called for no involvement from a dietitian, and I have never agreed with that. Due to the changes that happen during refeeding, I have always felt expecting parents to know what to do 100% with food was too high an expectation. I believe they have since loosened that messaging, but this is just an example of ways in which I have adapted the approach over the years.
I fully agree with the basic tenet that eating disorders CAN be treated outpatient, and I absolutely believe every patient should be given the opportunity to give it a try. I do not believe in a patient being diagnosed and immediately sent to a treatment center, unless that is what the patient wants. Many, many patients and families have succeeded at home, but it is definitely a lot of work. And parents need a lot of support as they experience a lot of unexpected hostility and anger from their child. I always take into account when that hostility and anger becomes too much either for parents or for siblings, and that becomes grounds for referral to a higher level of care when necessary.
If your child is referred to a higher level of care, it is not failure on your part! Some eating disorders are unbelievably nasty, and sometimes, overcoming them at home is simply too high an expectation. One of the key parts of eating disorder treatment is empathy not only for your child, but also for yourself. And, eventually, I will work with teens to recognize how much they need to empathize with their parents and the terror they have experienced while watching their child suffer. Good news...all the teens so far have come around to recognize how hard their parents worked, how scared they were, etc. Your kid may hate you now, but it's not forever!
Some of the things I will talk about in this series have been addressed previously, but I still am going to go over these things again, just so it is all in a string. If you are reading this and have something you want me to address, please feel free to email me at whoytphd@gmail.com, as I don't necessarily check for comments here (I know, I'm a poorly behaved blog writer. I thoroughly enjoy sharing this information; I do not thoroughly enjoy social media!😉) These blogs will also be sans pictures and images and the like, simply for the purpose of conserving my time! I hope you find this series to be helpful!!!
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