Cruel to be kind
Laura had such a great blog post today on the relationship between eating disorder professionals and their patients:
A doctor I admire wrote something on an ED message board this week: “You do not need to be the patient’s friend, or confidant, and you shouldn’t be someone she wants to bring home for dinner right now, as anyone that is doing their job with her will be working against the ED behaviors, and that is bound to make her angry.”
You know what? I don’t want to be friends, either.
I think that one of the reasons that eating disorder treatment is so challenging is that the professionals are somewhat fighting the patients (and vice versa). Adolescents in treatment against their will is one thing (and probably a great challenge), but even adults who choose to be in treatment struggle with the process. It’s the nature of the illness. The relationships that I have with my ED professionals are much different from those I have with other practitioners. 
Take my dentist for example — I’ve never argued about having a cavity filled. I’ve never argued that “the cavity isn’t a big enough deal to be taken care of” or “that’s not fair, I had to have a cavity filled last time.” On the flip side, there’s my poor dietitian. I couldn’t tell you how many times I’ve argued that I’m “not sick enough to need to see her” or how it’s “unfair that I can’t bring salads to outpatient group while other patients can.” It’s not that I don’t trust her professional opinion…. it’s just that I kind of dislike it.
My dietitian sticks to her bottom line and doesn’t compromise with my eating disorder — and that’s a large part of why I like her so much. If she let me get away with everything (eating salad for every meal, not following the meal plan, not making a weight goal, etc), then I wouldn’t have the respect for her that I do now. I don’t see her just because she’s awesome and I want to hang out. I need for her to be my dietitian and to tell me what is and isn’t okay, even when I fight her. It’s actually that process that really helps me:
I act on symptoms –> She’s not okay with that –> I rationalize why it’s okay or sulk or something –> she’s still not okay with it
By not compromising with my eating disorder, I know that she cares about me and my well-being…. and I respect her and like her because I feel that she cares.
Unfortunately, the majority of professionals that I’ve had aren’t quite like this. They were more of the “that’s okay if you didn’t meet your goals, sweetie, you tried and that’s what counts” type. Maybe they thought that I’d respond better to always being comforted… but nope.
Oddly enough, the professionals I like are the ones who make my eating disorder angry. I respect them and trust them more since they’re not compromising with my eating disorder. And there are lots of times that I complain, don’t follow their recommendations, and am generally pissed off — but I still like them. It can’t be a fun position for them to be in, but I am really thankful for professionals who continue to care about me and act in my best interest, even when I’m throwing an ED temper-tantrum.
I love the ED temper tantrum imagery and I also LOVE the cartoon although I would be in the line for a Non-hugging doc…
As usual you make some important points. I’ve never really thought about the difference between therapists as professionals as compared to dentists or doctors, but it is funny, you are right, you never question the necessity of a filling or importance of routine tests, they are the ones who have attended medical or dental school and they must know what they are doing.
When we see therapists we assume we are the experts – clearly we know ourselves better because we are privy to all of the internal dialogue that we have had with ourselves. We arrogantly assume that we know better, we second guess their treatment recommendations, and we blithely fuel the distorted thoughts commonly found in people with eating disorders.
I’m hesitant to use this term, but when treatment professionals don’t challenge our thoughts, and don’t confront us, they are almost functioning in a codependent manner. As uncomfortable it is to be called on our crap, I don’t think I would want it any other way…
[...] This post was mentioned on Twitter by Terri D, EllieMellie. EllieMellie said: another thought provoking post… RT @greythinking New Grey Thinking post: Cruel to be kind http://bit.ly/cajAbH [...]
YESSSSSS!!!!!!
SO TRUE!
I have wasted so much time seeing people like J who would say, “well, that makes sense that you BPed, if your dad was calling me I’d be puking too.” Uh….okay….and now what?!
I NEED GOALS and reality checks!
blah, sorry, can you delete my comment?
Laur,
Do you want me to delete the first comment? I like that one
I gave J your website, so she prob read it. ha ha. oooooooooooh well.
I love your posts!
I brought back my blog, but it’s not nearly as cool.
I’m honored to be mentioned! I know I can sound like a one-note Sally and I hoped this would connect. I agree with your thinking and admire the way you phrased it.
Laura,
Thank you! Reading your posts and hearing your perspective always gets me thinking.
It’s the professionals who call us out who are the best. They don’t fall for excuses and they know eating disorders are no joke. I trust tough-love providers much more than those who give in. Otherwise, that person is going to get stepped on and the eating disorder won’t back down and work won’t get done. It was always kind of funny to me seeing fellow patients so angry at certain providers, when they were only pointing out the obvious. We’re all guilty of acting like a bratty two-year-old when the eating disorder doesn’t get its way, though. The good providers don’t care if we get a little angry at them because it’s what’s best.
I have found this such a brilliant piece to read that has really made me think deep and hard into my practice (i am a health consultant and I train health professionals in behaviour change therapies). Interestingly, I am doing a study on the impact of compassion on behaviour change around risky behaviour and ED. This has really struck a cord with me as I am now wondering where the line is between offering compassion and maintaining the ‘not ok with your behaviour’ approach. Thank you for sharing.