How to motivate recovery from an eating disorder

Rachel is beside herself. “I know I need to wait for her to be motivated to recover, and I can’t do it for her, but this is excruciating!” Rachel had been watching her daughter Brooke struggle for over 12 months, and despite expert treatment for her eating disorder, there is little improvement. “This is impacting every aspect of our lives,” says Rachel. “I feel like a complete failure, but it doesn’t seem like there’s anything I can do to help.” 

Rachel is not alone. So many parents feel helpless when their children have an eating disorder. It is true that your child needs to embrace eating disorder recovery for themselves. But there are also many things you can do to motivate their recovery from an eating disorder. 

The good news is that motivation is an interpersonal experience. In other words, you can motivate recovery from an eating disorder, and unfortunately you can also have a demotivating impact on your child.

In this article I’ll review the principles of motivational interviewing, a well-known, scientifically validated method of behavior change. It’s supported by over 200 randomized controlled trials across a range of target populations and behaviors including substance use disorders, health-promotion behaviors, medical adherence, and mental health issues. And the good news is that it outperforms other common methods of treating a broad range of behavioral problems and diseases.

What is motivational interviewing?

Motivational interviewing is a way to support change by building intrinsic motivation. It is widely recognized as far more effective than what most people do, which is to educate and advise someone when we want them to change. With motivational interviewing, you stop trying to directly change your child’s behavior and start building their inherent motivation to change. It is effective because the greatest changes come from within.

Motivational interviewing is also helpful because it allows you to have more realistic expectations of yourself and your child. Many people misunderstand motivation and don’t realize that it is interpersonal. That is, while motivation is an internal experience, it is heavily influenced by the outside environment. Your words and behaviors can either increase or decrease motivation.

And the good news is that parents who use motivational interviewing are more likely to succeed at increasing their child’s motivation. They’re also less likely to become frustrated by their child’s resistance to change and relapses. This leads to significantly lower levels of parental burnout, which can negatively impact recovery.

How not to motivate someone

Most attempts to motivate other people to do things fail. But this doesn’t mean people can’t be motivated. It just means the traditional approach doesn’t work. The traditional way that people try to motivate others is: 

• Tell them what to do
• Explain why they should do it
• Give them health information and statistics
• Attempt to persuade them
• Negotiate with them
• Confront them
• Beg them

Unfortunately, these traditional approaches have a predictable effect on the person you are trying to motivate. Most likely, when you try traditional approaches to motivating your child to recover from their eating disorder they will feel: 

• Angry
• Agitated
• Oppositional
• Defensive
• Helpless
• Overwhelmed
• Ashamed
• Trapped
• Disengaged
• Dissociated

How to help your child recover from an eating disorder with motivational interviewing

You can have a tremendous impact on your child’s motivation to recover from their eating disorder if you use motivational interviewing techniques. First, you need to be clear about the fact that eating disorders are not educable disorders. In other words, all the education in the world will not motivate your child to recover. That doesn’t mean you can’t provide education. But it does mean that you should not mistake education for motivation. They are entirely different things. 

Second, it doesn’t work to bully, convince, or beg a person to change. While some people will temporarily stop their eating disorder behaviors with this approach, it does not lead to lasting change because it is inherently not motivating. 

Third, keep the focus on you. That’s right. You want to motivate your child to recover from an eating disorder, but the only person you can actually control is you. So make sure you’re keeping your attention on what you are doing. It’s all too easy to focus on what your child is doing. Instead, think about your impact on your child. 

So what should you be doing? Motivational interviewing is more motivating than giving advice and education. It’s also something active that you can practice and work on while your child recovers from their eating disorder.

Motivational interviewing: the RULE acronym

Here are 4 principles of motivational interviewing. They spell the acronym “RULE.”

R: RESIST telling them what to do

Avoid telling, directing, or convincing your child about the right path to good health. Use a collaborative process to motivate them. If you try to control your child you will shut down intrinsic motivation. Your child must maintain a sense of agency, the belief that they are in charge of their own body and life, in order to recover. This means parents need to focus on collaboration rather than coercion. Think in terms of dancing, not wrestling. You can still absolutely ask and expect your child to do things they don’t want to do, but don’t mistake that for motivation.

U: UNDERSTAND their motivation 

Your child needs to feel as if you understand how difficult it is to change and that you can tolerate their distress while they face this difficult change. Seek to understand their values, needs, abilities, motivations and potential barriers to changing their behavior. Try to understand what your child is communicating with their behavior. Don’t rely only on words, or you will miss important feedback. Behavior is a sign of emotional and physiological distress. Understanding is essential to this process because compassion, empathy, and understanding are essential to motivating someone to change.

L: LISTEN with empathy

Show them that you care about who they are and what they think and say. Here are three ways to do this: 

1. Ask open ended questions. Closed questions elicit a yes or no answer and will restrict the flow of the conversation. Open-ended questions allow them to tell their story and expand themselves. Examples of open-ended questions are “What do you think of …” and “How shall we …”
2. Use affirmation and validation. Show your child you understand their point of view by validating what they have said. Highlight their key skills, strengths, goals, and competence. Examples of affirmation and validation are “I can understand …” and “I get it …” and “It makes sense that …”
3. Reflective listening and mirroring. Listen carefully and repeat back or rephrase in slightly different words. This creates a sense of safety. This is much more effective than asking questions. You can say things like “What I’m hearing is …” or “You’re having a hard time with …” or “It feels as though …” or “It sounds like …” or “It seems as if what you’re telling me is …” or “What I’m hear you saying is …” or “I get the sense that …”

E: EMPOWER them

Work with your child to build agency and self-esteem by recognizing progress and strengths. Nobody can possibly be motivated if they feel disempowered, and yet this is so often what well-meaning parents and experts do when they give traditional forms of “motivation” like advice and information. Instead, build the sensation that they are capable of change and growth. Help them feel OK about who they are and what they are dealing with. And talk about their success now and in the past. Use a Growth Mindset to empower the sense that they can recover from their eating disorder. 

Expect resistance and relapse

One part of motivational interviewing is to expect resistance and relapse and not be thrown off by it. Resistance and relapse are part of every recovery journey. So if parents become upset and dysregulated when it happens, that can be demotivating to your child. 

Common signs of resistance are:

• Excuses
• Hostile
• Pessimistic
• Reluctant to change
• Argumentative
• Challenging
• Discounting progress or potential
• Interrupting

Expect these to show up, and respond as if you are not surprised. Instead, maintain your own emotional regulation and confidence that while this is hard, your child can do hard things. Have faith in your child’s ability to overcome resistance by themselves with your unwavering support. 

Likewise, parents should expect relapse into eating disorder behaviors that you thought were behind you. Relapse is not a sign of failure, but a part of progress. You are not going back to the beginning, you are already on your way. Stay confident and strong in your belief that your child can handle this. The goal is not to avoid relapse, but to manage it effectively. 

On the road to recovery

Rachel already feels better. “I felt so helpless before, but now I can see ways that I have been unmotivating,” she says. “I totally fell into the habit of educating and advising. But I can see how that’s not motivating her or making her feel good. In fact, it’s probably making her feel less powerful over this eating disorder.” 

With this attitude, Rachel is well on her way to improving her ability to motivate Brooke into recovery from her eating disorder. Parenting a child with an eating disorder isn’t easy, but Rachel’s doing great!

For privacy, names and identifying details have been changed in this article.

See Our Guide To Parenting A Child With An Eating Disorder