Ingredients for treatment
When you take a pill, it has "active ingredients" and then fillers and colors and binders and such. The medicine itself usually doesn't take up that much of the pill.
So, with eating disorders, what are the active ingredients in treatment?
Food. Emotional support. A place to be for 50 minutes of the week where you are not doing eating disordered things. Learning. Coaching. Monitoring. Venting. Projecting. Challenging. Reframing. Transference. Modelling. Communication. Interaction. Lots of things.
Food, oddly enough, is not a big part of most eating disorder treatment. Some approaches literally don't "talk about food" and the patient's eating is left up to them. Even more hands-on treatment, with nutritional counseling, may talk about food but the patient is free to do as they wish where it comes to actually eating. And inpatient care - even the best and longest in duration - does try to keep one completely fed for the duration but sends you home to finish the job on your own. With Family-Based Maudsley treatment the food part of the treatment is the first order of business, isn't optional, is supposed to be fully balanced and enough for steady weight gain, and goes on for 6-12 months.
There are other aspects to treatment; FBT/Maudsley is not "all about food," of course. There are therapy appointments, the parent is put in an authoritative position, the family works together instead of as bystanders, co-morbid conditions that inhibit recovery (e.g. anxiety, OCD, and depression) are identified and addressed, cognitive techniques, behavioral techniques.
FBT/Maudsley also lacks some things that might be the "active ingredients" in other treatments: blame, shame, guilt, separation from family, seeking the "underlying issues," the choice to continue to starve.
What is the active ingredient in FBT/Maudsley? Is it food, only? Is it the way relationships are changed? Is it the duration?
Or is it the lack of other things usually given? Could it be this unique combination of ingredients, or could some of these aspects work with other approaches? Does every patient need all the ingredients, or will some only need one or two?
So, with eating disorders, what are the active ingredients in treatment?
Food. Emotional support. A place to be for 50 minutes of the week where you are not doing eating disordered things. Learning. Coaching. Monitoring. Venting. Projecting. Challenging. Reframing. Transference. Modelling. Communication. Interaction. Lots of things.
Food, oddly enough, is not a big part of most eating disorder treatment. Some approaches literally don't "talk about food" and the patient's eating is left up to them. Even more hands-on treatment, with nutritional counseling, may talk about food but the patient is free to do as they wish where it comes to actually eating. And inpatient care - even the best and longest in duration - does try to keep one completely fed for the duration but sends you home to finish the job on your own. With Family-Based Maudsley treatment the food part of the treatment is the first order of business, isn't optional, is supposed to be fully balanced and enough for steady weight gain, and goes on for 6-12 months.
There are other aspects to treatment; FBT/Maudsley is not "all about food," of course. There are therapy appointments, the parent is put in an authoritative position, the family works together instead of as bystanders, co-morbid conditions that inhibit recovery (e.g. anxiety, OCD, and depression) are identified and addressed, cognitive techniques, behavioral techniques.
FBT/Maudsley also lacks some things that might be the "active ingredients" in other treatments: blame, shame, guilt, separation from family, seeking the "underlying issues," the choice to continue to starve.
What is the active ingredient in FBT/Maudsley? Is it food, only? Is it the way relationships are changed? Is it the duration?
Or is it the lack of other things usually given? Could it be this unique combination of ingredients, or could some of these aspects work with other approaches? Does every patient need all the ingredients, or will some only need one or two?
Laura,
ReplyDeleteI think every person will need different "ingredients" for their own recovery. There are typically different underlying neurological conditions that accompany EDs, and those do need to be addressed because symptoms are often a misguided attempt to self-medicate.
For me, the thing that finally broke down the anorexia monster was the inevitability of eating and recovery. In treatment, I told myself that fine, fine, I'll eat this buttered bagel, but when I get out, I'm going back to dry toast with sugar free jelly. When I was recovering at home, I knew that the bagel was going to stay buttered (or cream-cheesed or peanut buttered). I had to surrender to this fact. There was no way out. I knew I wouldn't be going back to the "old ways". This brought me more anxiety at first, but I'm starting to see glimmers that it might be worth it.
Carrie