“All Life Stops Until You Eat”……..
This was revolutionary for me and for Stacey’s treatment team. Up until that point, Stacey’s treatment consisted of pleading with her, begging her, trying to convince her, and in general influence her to eat on her own. She was to follow a nutritionist’s meal plan. She was to choose the food, prepare the food (except dinner), plate the food, and eat the food entirely on her own. I believed that she could “do it” if she wanted to badly enough. Using family based treatment, all of this stopped. Completely. During all of the years of my treating her, Stacey had been eating on her own and also exercising on her own, despite offered direction and advice from the team. She was a runner. In essence, she ran the way she wanted to run. How much, how fast, how often. Now, it all stopped. Completely. No more running until she gained the 10 pounds she needed to, got into the suggested weight range, and began to menstruate normally again. We were squarely in Stage 1 of FBT and boy was it rocky.
Stacey was as furious as Mom and Dad were empowered by this new approach. Stacey’s parents began to see themselves as much more instrumental in their daughter’s recovery. They were freed from the chains of guilt and all the passivity that comes with it – they knew they did not cause this. They also began to believe that they could actually be the agents of change that turn this whole ship around. They started to give consequences if Stacey threatened to go off the plan. They truly embraced the mantra that all of their family life stops until their sick child eats. They had never had to consequence their daughter before as she as a “good girl”. No history of oppositional behavior, not an ounce. So they were in foreign territory and feared they were “making things worse”. But, they followed my lead and when the anorexia reared its head, they always had a consequence at hand. They learned to work together and rely on each other’s strength. One of them supervised all of Stacey’s snacks and meals. Stacey was required to hang out at home instead of driving her car and then exercising if she felt like it. The anorexia was miserable. Stacey was not that far behind. She yelled, she shut down, she threatened to run away from home, she threw the food on the floor. And yet, here was the miracle: she ate. All of it. Every time.
Her weight started going up. It took six weeks. Six weeks for her to get into her weight range. After years and years of gaining and losing, being hospitalized, and being followed by a team. Six weeks. Now, was she cured at that time? No. But what started happening was something I had never seen so clearly before. The anorexia began to leave the building – it started to visibly and palpably diminish. It started with her thoughts – I noticed that after Stacey had been in her weight range for a while she talked about different things during the session. I couldn’t believe it when I realized that an entire session had gone by without her mentioning her “disgusting thighs”. I asked her about it, almost afraid to bring it up myself. She said “Yeah, I still don’t like my thighs but I have other things to think about now”. I couldn’t believe it. There was now space for new things besides food and weight. She began to talk about her friends, and her struggle to be “popular”. She had always had some social anxiety, way before the anorexia started. And now, like a layer being lifted, the anorexia was disappearing and revealing what was always there – a sensitive, somewhat anxious girl who was afraid of not being quite good enough and being left behind. Despite years of me using my best tools and techniques, I had never been able to lift that obsessive/rigid layer like the weight gain was able to in a matter of months.
In our sessions, we began to focus on weight and food much less. We just didn’t need to anymore. When it came time to move into Stage 2 of FBT we were all a little bit nervous. Stacey handled it like a pro. She was motivated to run again and to “not be a baby” and have her parents supervising her meals any more. Over several months, she tried out a little bit at a time until she could eat her meal plan on her own. She worked with the nutritionist now (vs. her mom being the primary person working with the nutritionist) on creating more variety in her plan. She agreed on having 1-2 “fun foods” per week and she was always able to keep her anxiety from getting too high when she ate them. She said one day “I know that a cookie won’t make me fat”. When she got her period for the first time, there was a nice jump in her ability to tolerate new foods and an overall reduction in her anxiety over eating anything “not healthy”. She began to run again and this is where I got very nervous. She had a history of running to the point of exhaustion. However, this time it was different. After months of staying away from it, returning this time was different for her. She reported that she liked to run now as it “makes me feel strong”. She no longer counted calories when she ran and seemed to enjoy it vs. thinking about it as a chore. The ED voice that had lived in her head for years was gone. She said one day, pointing to her head, “I only have me up here now”.
I was amazed by all of these changes. I was still basically the same therapist, just adopting a new technique. But three things were now radically changed – I had no longer made it her choice whether to eat or not, I had empowered her parents to follow my lead in this, and I had given the parents structure and support throughout this daunting task. Unlike traditional FBT that only has one supervised meal during the assessment phase, I offered many supervised and coached eating experiences. This is where I saw so much change occur. Both in the growing strength and clarity of the parents and the growing weakness of Stacey’s disease, bending under the weight of the team’s demands. All of this led to a brain that was no longer starving. A brain which could now think and reason. It was truly a beautiful thing.
Stacey made it to college in the Fall. She had phone sessions with me and her nutritionist weekly for the entire first semester, saw me in person when she was home on all holidays, and was followed by her student health center where she was weighed weekly and this weight was passed on to her home team. She had a contract that identified potential consequences if there were any significant weight loss, which included taking a semester off if we felt she needed to. It turns out, she didn’t need to. She graduated from college and considers herself “fully recovered”. She continues to let me know how she is doing every once in a while. She is a strong, beautiful, kind, smart young woman. I am so grateful for my experience with Stacey. It changed everything for me and I have never looked back.