Recently, my friend and I were discussing the pros/cons of her stepping up the level of care in her treatment. Interestingly, “eating in program” was on both the pro and con list. She thinks it’s easier to eat while in program (as opposed to on your own), but that some of the food sucks and you have to eat things you don’t like (or are not comfortable with).
I can definitely relate to this. When you first start a higher level of care (like IOP, PHP, IP – anything involving a meal), the amount of food you have to eat (and keep down) is a little overwhelming. At the same time, there’s a little bit of relief that comes with eating at program. You don’t have to make the decision of what to eat yourself. You really don’t even have to take any responsiblity for eating. The meal is structured, dietitian-approved, and you could spend the next couple of hours processing the horror of the meal if necessary (although hopefully not).
While thinking about this, I decided that there are four stages of eating in treatment (in this sense):
- Eating at program is really hard. It’s more food than you would eat on your own (or not purge). You’re struggling with acting on symptoms at home, and meals at program are much more “normal” and overwhelming than you’re used to.
- Eating at program is still hard — but for a different reason. You are actually starting to eat more normally at home, and it really feels like too much when combined with all the food at program. You feel guilty for not compensating (or not purging).
- Eating at program is easier. This is because
a) you’re used to the meals by now
b) you’re taking food risks at home (eating fear foods, going out to eat with friends, challenging food rituals, etc.)
The food at program feels reliable and safe in comparison. - Eating at program is boring — and even annoying. You’ve eaten a veggie burger every week for two months and feel that you could go the rest of the year without eating yet another yogurt. You would rather be eating at home — not because you want to restrict, binge, or purge, but because you want to eat something better (that you actually like) or be eating with other people.
I could probably come up with more stages, but these four are the most obvious to me. I’d love to hear your thoughts…
11 comments
C. Gamez, MA says:
Mar 15, 2010
Great job on the post. As a therapist at an inpatient facility, I get how difficult it is for some of my patients to deal with the eating component of treatment. I see the struggle in their faces. I hear their stories. While I validate that the journey as a whole is difficult (not just the eating component), what I also hear are the many ways that make this struggle a little easier.
1. Accepting that everybody at the table is struggling not just me and that makes it somewhat easier.
2. Distraction is a wonderful skill.
3. Table games? Who knows the ABC game?
Other ideas that have helped my patients cope with difficult meals is to have a picture of a loved one with them. Thinking about that loved one or maybe even dedicating a meal to that person brings an element of personalization and ownership to that struggle.
So what I’m saying is that this isn’t an “either/or” issue (i.e. eating at program is hard or easy) but rather “both/and” (i.e. eating at program can be difficult and it’s also doable). Now that’s grey thinking!
C. Gamez, MA
http://www.FamilyInsights.net
greythinking says:
Mar 17, 2010
Cesar,
The photo idea is very interesting – I haven’t heard that before! Do you think it helps because it helps patients keep in mind that they are cared about? Or that this meal and their recovery are important? I could see it helping for those meals when you are so stuck in the ED and are obsessing over the food. It could help you stay mindful that it’s just a meal, food is just food, and that you have a life & people who care outside of the eating disorder.
So… would you say that “eating at program is both hard and easy” would be a stage between my #1 and #2? Or do you think that grey thinking is a part of most of the stages (depending on the meal, fear foods, stresses, other stuff in life)?
Thanks for your insight!
grey
Carolyn says:
Mar 16, 2010
How funny. I remember those “steps!”
The only difference is, as a (recovering) bulimic, I had another stage 1: Where eating was difficult because it was way more than I would ever normally keep down, but way less that I wanted to eat (because I was used to purging). I would start the meals resentful of how much food was there, and finish them hungry and resentful that I should be allowed to east as much as I wanted as long as they were making me keep it down.
Of course, that was part of the treatment, and thank God for that, because by the time I left, I was able to eat a regular meal by myself for the first time in years! IP saved my life, and taught me to maintain my weight for health. When I left I was healthier and less sick feeling than I could even remember.
greythinking says:
Mar 17, 2010
Carolyn,
It’s great to hear another perspective – I hadn’t thought about finishing and being hungry. I actually have a couple of questions about that. Were you physically hungry after the meal? Were you really hungry at the beginning of the meal, too? Or did the meal itself just trigger the urge to binge? Or… was it all-or-nothing thinking, like “well, already ate this much and screwed up, might as well go all the way…” And, as far as hunger/fullness goes, do you think that treatment taught you to read those signals correctly, or do you think that your body had to actually re-learn hunger/fullness for normal eating?
So many questions, I know
grey
A toxic relationship | Grey Thinking says:
Mar 17, 2010
[...] out of denial – I just wrote a whole post about eating disorders and denial. The article suggest asking yourself questions like, “Does [...]
Stina says:
Mar 19, 2010
I’m about to start a treatment program on Monday, and obviously a source of anxiety is the food they are going to have me eat. I have to say, it is a bit of a relief to have someone tell me what to eat, but I’m already wondering how much I’ll end up relying on what they give me vs. being able to decide for myself. . and I have to admit – I’m terrified the food will be gross
healthcare » Blog Archive » A toxic relationship says:
Mar 20, 2010
[...] out of denial – I just wrote a whole post about eating disorders and denial. The article suggest asking yourself questions like, “Does [...]
PTC says:
Mar 21, 2010
I’ve thought about how much it was SUCK (understatement) to have to go to a program and be forced to eat so much food. Thank God I’ve never had to do that. I also think about how I don’t think I could just start eating “normal” amounts of food and meals on my own, and even if I really decided that I wanted to change, I’m not sure I could do the whole eating thing on my own. I don’t want to think about that though.
Sarah says:
Apr 21, 2010
I think the funniest stage is when you reach the ‘boring’ part. You never thing food will get boring, but when you’re eating the SAME freaking veggie burger that you’ve had thrice a week for three months you about gag at the sight – and not because you’re struggling to eat it or not purge. Or the smell of a supplement turns your stomach not because of weight-gain aspects, but because you’re So Freaking Sick Of It. I think its one of the most powerful motivators in recovery. It seems strange, but for a while I wanted to get better because I wanted to be able to make my own food decisions and NEVER have to drink an ensure again, or eat a garden-burger or any other predictable thing. Even now all I have to do is SMELL a supplement (I work at a hospital, so that happens fairly often) and I’ll feel motivated to follow my MP so that I don’t end up drinking them anymore.
Rick says:
Apr 24, 2010
I’ve thought about how much it was SUCK (understatement) to have to go to a program and be forced to eat so much food. Thank God I’ve never had to do that. I also think about how I don’t think I could just start eating “normal” amounts of food and meals on my own, and even if I really decided that I wanted to change, I’m not sure I could do the whole eating thing on my own. I don’t want to think about that though.
Simon says:
Apr 25, 2010
Great job on the post. As a therapist at an inpatient facility, I get how difficult it is for some of my patients to deal with the eating component of treatment. I see the struggle in their faces. I hear their stories. While I validate that the journey as a whole is difficult (not just the eating component), what I also hear are the many ways that make this struggle a little easier.
1. Accepting that everybody at the table is struggling not just me and that makes it somewhat easier.
2. Distraction is a wonderful skill.
3. Table games? Who knows the ABC game?
Other ideas that have helped my patients cope with difficult meals is to have a picture of a loved one with them. Thinking about that loved one or maybe even dedicating a meal to that person brings an element of personalization and ownership to that struggle.
So what I’m saying is that this isn’t an “either/or” issue (i.e. eating at program is hard or easy) but rather “both/and” (i.e. eating at program can be difficult and it’s also doable). Now that’s grey thinking!
C. Gamez, MA
http://www.FamilyInsights.net