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Family therapy when your child has an eating disorder

Family therapy when your child has an eating disorder

Family therapy when your child has an eating disorder may be the most important and the hardest thing you’ve ever done as a parent. Family therapy can help your family build belonging and resolve conflicts more easily. It can have a lifetime of benefits, including supporting eating disorder recovery.

But while therapy is ideally a safe space, when it’s family therapy, parents rarely feel safe. In fact, they usually feel uncomfortable at first. That’s because family therapy addresses family dynamics. And because you are the parent, and thus the head of the family, your behavior and parenting choices are naturally going to be evaluated and discussed. 

In family therapy, your child will get the lion’s share of talking time, for reasons I’ll explain shortly. This may make you feel shut down, shut out, disrespected and even furious. You want to be prepared for these feelings to show up. Because while they make perfect sense, they can get in the way of making progress. Family therapy is an opportunity to deepen your relationship with your child and support their recovery. It will be hard, but it will be worth it.

What is family therapy?

Family therapy is when family members are guided by a trained, licensed therapist to improve communication and resolve conflicts. Family therapy is different from family-based treatment (FBT), which is used for eating disorders. While FBT is about feeding, family therapy is about family dynamics. 

Family therapy is designed to help families:

  • Increase empathy and understanding 
  • Set and hold healthy boundaries
  • Build belonging and communication
  • Develop problem-solving and conflict resolution skills

If your child’s eating disorder treatment team has suggested family therapy, it’s best if you are informed and prepared. Here are the five steps you should take to prepare for family therapy: 

1. Set your goal

You want to go into family therapy with a clear goal. And while it may seem like the obvious family therapy goal is to fix your child’s eating disorder, that will not work. This is because family therapy is about working on your family dynamics, not solving a particular problem.

Family dynamics are the patterns of interactions among family members. It involves each person’s roles and relationships. Within families people adopt roles that can become fixed and unhealthy. And there are multiple dyads, triads, and other inter-relationships. These all need to be addressed individually and collectively. 

Family dynamics can either be supportive or a significant cause of stress. When we shift family dynamics from stressful to supportive, we can supercharge recovery. Thus, your goal in family therapy is to build more supportive family dynamics.  

2. Don’t expect equality

Family therapy is nothing like any other therapy you’ve experienced. If you’ve done individual therapy, you had 100% of the time to explain yourself and process your feelings. If you’ve done couples therapy, you had about 50% of the time. But in family therapy, your child’s experience of being a child in your family takes center stage.

You need to enter family therapy with a very clear understanding that this is not an equal playing field. While you may not realize it, you spent many years in a position of power over your child. That’s simply what it means to be a parent. Even if you felt powerless at times, the very nature of the parent-child dynamic is that you held tremendous power over them when they were a vulnerable infant, toddler, and child. This early dynamic shapes how they see you and relate to you, no matter how much things have changed since then.

In family therapy you and your child are not peers with equal perspectives. You will not get equal time. The therapist will encourage your child to express themselves and how they felt in the family. And that is where the healing begins. The more open you are to learning about your child’s perspective, the greater your success will be.

3. Don’t debate the “facts”

There is a good chance that your child will bring many stories and grievances to family therapy. They will have complaints about things you did and things you did not do. It is natural and normal to want to debate the facts of the situation. 

For example, if your child says you never cared about them, you will want to tell them all the ways you did care about them. If your child says you loved their sibling more, you will want to tell them the times you prioritized their feelings. 

But the facts are not the issue. And debating the facts will derail family therapy. Work on your own emotional regulation and prepare yourself to hear facts that you don’t agree with. Because you don’t have to agree with the facts. What you need to do is see the small vulnerable child who is asking you to witness the pain they experienced in childhood. What feels like criticism of you is actually a request for care from you. 

All children experience pain in childhood. No childhood is perfect. And you didn’t have to get things right in the past to be close with your child today. You just have to listen to their grievances with compassion and empathy and love them for who they are. The more you witness their pain with compassion and acceptance, the less they will suffer.

4. Don’t get defensive

It’s OK. You’re probably going to get defensive. It’s natural and normal to feel defensive when a child says something went wrong. But your goal is a deeper and more supportive relationship with your child. So you need to manage your defensiveness and not let it get between you and the vulnerable child who is asking you for emotional care.

Defensiveness sounds like this: 

  • But I did all this for you …
  • That’s not what happened
  • But what I meant was …
  • What I was trying to do was … 
  • I can’t believe you would say that
  • You’re wrong
  • What else was I supposed to do?

These sorts of statements will want to tumble out of your mouth. But it’s best to manage your defensive impulses. Your goal in family therapy is to deepen your relationship with your child. And these defensive statements will not help and may even make things worse. Defensiveness from you will shut down the therapeutic process.

Work on your defense triggers in advance with a therapist or coach who can help you process your feelings with compassion and understanding. Practice managing your defensive impulses so you can hear about your child’s experience without getting defensive.

5. Listen & validate

Of course you want your child to understand you. But don’t start there. Healing begins when your child feels understood. When that happens, they will be able to see you in a new, softer light. But if you try to keep the focus on your feelings, a wall will remain between you. 

You’ll need to listen far more than you speak during family therapy. I don’t want you to repress your feelings. This is about managing your emotions during family therapy so that you’re able to hear what your child has to say. If sitting in family therapy is going to require strenuous repression, then it’s too soon for family therapy. Take more time with your own therapist or coach first so that your own feelings are well on their way to healing before you do family therapy with your child. 

During family therapy you mostly want to make validating statements. When your child speaks, they are opening a door to a relationship with you. They’re saying “can you see my pain?” And the correct answer to this is some version of “I believe you, and I’m sorry for your pain. I love you, and I will always love you.”

Practice validating your child’s feelings. As I said before, you’ll be tempted to focus on the facts and details, but instead focus on the feelings they are sharing with you. Listen for feelings like: 

  • I felt sad when …
  • I’m angry about …
  • I wish you had … 
  • I’m not sure that you love me …

Hearing your child have these feelings can be heartbreaking. Anticipate that your child has big feelings that will come out in therapy and practice responding to them with validating statements before you go.

I know that family therapy when your child has an eating disorder is hard. But there are tremendous benefits if you can do it. The best thing you can do is keep your goal in mind and be prepared. 

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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Questions to ask eating disorder treatment centers

Questions to ask eating disorder treatment centers

It’s not easy making the decision to send your child to an eating disorder treatment center – you probably have a lot of questions. There are so many factors to consider and so many options out there. And right now there’s added stress because so many centers are at capacity and have waiting lists. 

I’ll review the basics of what it means to send your child to an eating disorder treatment center. Before we dive in, it’s very important to say that this decision is yours to make. Nobody should make the decision on your behalf.  My goal is to help you weigh your options. And I have confidence that you will make the best choice for your unique situation.

Sending your child to an eating disorder treatment center will be hard no matter what. But ideally, you should feel on some deep level that this is the best right decision for you, your child, and your family right now. It doesn’t have to be a perfect decision to be the best right decision right now. Just do your best – that’s all anyone can do!

To write this article I consulted with John Levitt, Ph.D., an eating disorder therapist who has been in the field for more than 40 years. “Treatment centers represent a lot of money and a lot of time, and a lot of heartache and concern for your child,” he says. “You definitely want to make sure that you understand your options.”

Why send your child to an eating disorder treatment center?

I’ll give you the questions to ask an eating disorder treatment center. For now, let’s start with the reasons why you might be considering an eating disorder treatment center for your child. Here are the top three reasons I hear:

1. Your child is in danger. You have the help of professional dietitians, doctors, and therapists, but there is no reduction in the behaviors. Despite your best efforts and professional care, your child is in serious physical and/or emotional danger.

2. You don’t know what to do. You feel overwhelmed by your child’s eating disorder and simply don’t know what else to do. It seems like a treatment center is the only choice. 

3. You are burnt out. You have been working hard to stabilize your child’s behaviors. You’re driving all over town to appointments, and facing endless arguments and stress over meals. At this point, you are overwhelmed and frustrated by the disorder. You have reached the end of your rope

I support parents who are facing one or all three of these conditions. And I see eating disorder treatment centers as one tool in the toolbox of recovery. They are definitely an option to address these issues.

The benefits of an eating disorder treatment center

“Treatment centers are places where your child can stabilize their eating disorder symptoms,” says Levitt. “Their weight will hopefully improve and likely stabilize. And their eating disorder symptoms will likely be reduced or even eliminated completely while they are staying at the treatment center.”

This is very good news! The main benefits of an eating disorder treatment center are: 

  • Medical and psychological stabilization
  • Your child will be assessed and monitored
  • They will feed your child regular meals and snacks
  • Your child will be physically safe and prevented from acting on purging and self-harm behaviors
  • They will provide activities and skills training to support recovery

A treatment center is ideally a safe place to get into remission from eating disorder behaviors. Your child will most likely be stabilized and make some progress toward recovery. 

The drawbacks of an eating disorder treatment center

One of the benefits of treatment centers is that your child is stabilized in a safe environment. But a drawback is that eating disorders develop in the outside world. So returning home after treatment can sometimes trigger a relapse. 

“Even if the eating disorder behaviors and symptoms get under control in a few weeks or months, there may be many more months, or even years, required to achieve remission and, ideally, full recovery,” says Levitt. “When they get home, they are faced with the same life stressors and conditions that were associated with the eating disorder prior to going to treatment. Home is where the true treatment begins. Your child needs to learn to live with a sense of self-worth and self-efficacy that is enduring and resilient across people, places, and situations, and they often won’t find that in a treatment center. You just can’t practice all of the requirements of life in a controlled setting. Full treatment does not happen in a program, it happens in life.”

In addition to the fact that there will still be work to do when they get home, there may be other drawbacks. I’ve interviewed many people who have spent time in treatment centers, and some of their complaints include:

  • It felt abandoned, isolated, and/or traumatized
  • Inadequate treatment and support
  • Being scared by/not liking the other residents
  • Developing unhealthy relationships and learning new behaviors from other residents
  • Feeling controlled and dominated
  • Not liking the staff and therapists

These drawbacks aren’t meant to discourage you. And many treatment centers actively try to counteract these drawbacks. But it’s important to consider them as you weigh your options.

Questions to ask an eating disorder treatment center

“Treatment centers are run by good people who are generally doing good work,” says Levitt. “That said, treatment centers are businesses, and you as parents are the consumers. Don’t be afraid to be a smart consumer. Ask a lot of questions. Ensure you understand what you are getting into. That is, make sure you know what you will be paying for and what outcomes you can expect. Parents should become the experts on what they are “buying” before taking the leap to send their child anywhere.”

It’s best to interview treatment centers before making a commitment. Here are some questions to ask:

  • What is your treatment approach? On what evidence is your treatment approach based? What is the data suggesting the effectiveness of your program?
  • Specifically, how do you treat people with my child’s type of eating disorder? What is the general treatment plan/approach?
  • How long does it usually take to stabilize a child’s eating disorder, including issues related to mood etc.
  • What is the daily schedule, and who specifically will be working with my child?
  • Can I see my child’s clinical team’s credentials and interview them?
  • In addition to the clinical team, who else will be working with my child? What are their credentials?
  • How do you control for the fact that sometimes eating disorder treatment clinics are learning opportunities for how to become better at eating disorder behavior? What control systems do you have in place to avoid this?
  • What is your success rate in terms of full recovery after a person leaves the treatment center? What are your extended outcomes? What is your relapse rate?
  • How do you involve parents in treatment? What are we to do while the child is in treatment?
  • How will you ensure that I am an essential part of the treatment, and how will you prepare my child, and the parents, for the child’s return home?
  • What will my child need following their stay at the center?
  • How will you know when what you’re doing with my child isn’t being effective? If such a situation were to arrive, what are the alternatives?
  • How do you ensure that a person who goes through your program is successful beyond the program?
  • How much does treatment typically cost? How much is usually the parent’s share of costs? What happens if we are unable to afford the treatment or continued treatment?

“You should not receive vague answers to any of these questions,” says Levitt. “Because they are critical to efforts to achieve full recovery.”

Download The Questions

You can download a free PDF with these questions and other notes you can use to guide your evaluation of an eating disorder treatment center.

Free download Evaluation Sheet For Eating Disorder Treatment Center

What about the cost of eating disorder treatment centers?

Of course your primary concern is your child’s health. And your child’s health is priceless. That said, treatment centers are very costly, which is why you want to be a smart consumer here. Not because you are nickel-and-diming your child’s health. Not at all. But because this is a major commitment and it makes sense to ask questions. 

I wish treatment centers had a 100% success rate. But the truth is that eating disorders are complex and challenging to treat. And residential treatment is typically just one step on the path to recovery. So it pays to be a thoughtful consumer.

“Don’t be afraid to ask about the costs involved,” says Levitt. “Many treatment centers are running 60 days. That’s a long time for your child to be away from home and away from school. It can also be about $60,000 plus. That doesn’t take into account post-center treatment. That can be equivalent to your child’s college tuition.”

The point here is to ask questions. Of course if your insurance company will cover everything that’s a different situation. But if the cost of treatment will fall on you and impact other financial goals that you have for yourself, then weigh the costs and benefits as clearly as possible. 

Making a decision

I wish there were a simple answer to whether to send your child to a residential treatment center and which one to pick. This is something many of my clients grapple with. And the truth is that it’s a difficult decision to make. In the end, the best you can do is do your research and make the best choice you can right now. 

Remember: it doesn’t need to be a perfect decision to be the right decision for you at this moment. Your best decision may be to send your child to residential treatment. And also, it’s OK if that doesn’t feel right for you right now.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

The quotes from John Levitt, Ph.D. are from a series of articles published in 2017 including this one.

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What parents need to know about Family Based Treatment (FBT) for eating disorder recovery

FBT for eating disorder recovery

Erin was terrified when her 13-year-old daughter was diagnosed with anorexia. She spent a few months just trying to get her feet under her as she navigated the care system and tried to figure out what she was supposed to do to help her daughter get better.

“I felt like I was running through quicksand,” she says. “It was awful. Professional advice ranged from ‘wait and see’ to residential treatment, and neither option felt like the right one for us.”

Eventually, she was relieved when she was referred to a practice providing family-based treatment (FBT) for anorexia. “When I found FBT I just knew that was what we needed,” she says. “Our therapist helped us get our arms around the disorder and treat our child with respect and firmness. It made a world of difference, and she started to get better faster than I thought was possible.”

Erin’s experience with FBT is what every parent who has a child with an eating disorder wishes for: efficient recovery at home. And while FBT isn’t a fit for every child who has an eating disorder, it has been very effective for many families facing anorexia.

FBT-Informed Parent Coaching

for a Child or Teen with Anorexia

Eating disorder recovery

Approximately 13% of adolescents will develop an eating disorder by the age of 20. Eating disorders have been reported to be the third-most common chronic condition among adolescents. Despite this, research into the best treatment for eating disorders has been chronically underfunded. Therefore, evidence-based treatment trials for adolescents with anorexia nervosa are few, and study sizes tend to be small. As a result, many parents facing an eating disorder feel isolated and frustrated with the system of care.

Because it is one of the few anorexia treatments with scientific validation, FBT is considered by many to be the first-line treatment for adolescents with anorexia. There is also some evidence for its use with adolescents with bulimia.  In this article, I’ll review:

  • The evidence for FBT for eating disorders
  • How FBT can be used to treat eating disorders
  • What you should know if you’re thinking about FBT for your child’s eating disorder

What is FBT?

Family-based treatment (FBT) is also sometimes known as the Maudsley method or Maudsley approach. It is considered by many to be the first treatment of choice for adolescents with anorexia. FBT is a manualized outpatient therapy designed to restore adolescents to health with the support of their parents. The primary focus of FBT is weight gain and it is seen as a viable alternative to residential treatment for that outcome.

Who does FBT work best for?

Family-based treatment (FBT) is an effective intervention for adolescents with anorexia nervosa. Also, preliminary evidence suggests that it may be efficacious in treating adolescents with bulimia nervosa.

Qualified therapists use FBT with all sorts of eating disorder populations. As of 2018, eight scientific studies have evaluated FBT in 657 patients with anorexia. And while it has been tested in multiple demographics, the majority of scientific evidence so far indicates positive outcomes for people who fit these criteria:

  • Adolescents <18
  • Female
  • Anorexia
  • Illness duration <3 years
  • Medically stable and fit for outpatient treatment

FBT has also been evaluated for bulimia. As of 2018, three randomized controlled studies have evaluated 295 patients. These studies have indicated positive outcomes compared to individual therapy, though the results are less dramatic than those for anorexia.

How to provide Family-Based Treatment

Many parents will cobble together an FBT-like treatment for their child with an eating disorder. However, true FBT is a detailed program based on a manual. Therefore, it contains specific elements in an outpatient setting and requires sessions with a trained therapist. Studies have evaluated short-term FBT (10 sessions over 6 months) and long-term FBT (20 sessions over 12 months). FBT is delivered in 3 stages with decreasing levels of parental control over feeding.

The second session of treatment includes a family meal. During this meal the therapist can observe the child’s eating patterns and family behaviors. At each session, the therapist will weigh the person who has an eating disorder. Following that, they meet with the family to discuss progress, including a review of weight gain. These meetings begin on a weekly schedule and decrease over time. 

The central premise of FBT is that families can be central to eating disorder recovery. And while it is not a fit for every family, many find it very helpful.

Stage 1 of FBT is designed to replace inpatient treatment for an eating disorder. Eating and weight gain are the priority, similar to how they form the foundation of inpatient treatment. Typically the person with the eating disorder is able to continue attending school and participating in activities as long as they are eating and gaining weight.

FBT-Informed Parent Coaching

for a Child or Teen with Anorexia

Principles of FBT

Family-based treatment for eating disorders is organized around a few basic principles:

1. Agnostic view of the illness

FBT makes no assumptions about the cause of the illness. Previously, families were blamed for eating disorders. To counteract this, FBT takes a strong position that families are not to blame. Rather, FBT focuses entirely on resolving the primary symptom of not eating. FBT is not concerned with identifying the underlying factors. Instead, it aims to get adolescents to gain weight and stop using their eating disorder behaviors.

2. Externalize the illness from the patient

FBT emphasizes that the eating disorder and the child are not one and the same. The idea is that the eating disorder has “taken over” the child and is driving their thoughts, feelings, and behaviors. Parents are asked not to blame their child or believe that the eating disorder is the child’s choice. The goal of externalizing the illness is to reduce parental criticism, which has been shown to harm treatment outcomes.

3. The therapist takes a nonauthoritarian stance

The role of the FBT therapist is to take an active role in guiding the family through the recovery process. However, an FBT therapist does not tell the family exactly how to go about helping their child recover. The therapist partners with the family to help them figure out how best to refeed their child. The therapist models an uncritical, supportive, and compassionate stance toward the patient. Meanwhile, they take a firm, zero-tolerance approach toward eating disorder behaviors. 

4. Parents are empowered

In FBT, parents are empowered as the best resource for their child’s recovery. Essentially, they are seen as the main agents of change in their child’s therapeutic process. Therefore, FBT success rests in the parents’ confidence that they can handle the eating disorder. The therapist works to put the parents in charge and communicate confidence in their ability to beat the eating disorder.

5. Unwavering focus

FBT has a pragmatic, unwavering focus on symptom reduction. It is designed to quickly and single-mindedly focus on weight gain. And, in the case of bulimia, ending binging and purging. Therefore, problems associated with the eating disorder like depression, anxiety, irritability, body image issues, trauma, loneliness, and more are not addressed in the first phase of FBT. The belief is that many of these secondary problems will lessen with the return to physical health.

What are the three phases of family-based treatment?

The FBT treatment for anorexia consists of three phases.

Phase 1

Phase 1 focuses on rapid weight gain. In cases of bulimia, the focus is on ending binge and purge behaviors. Parents are told that the disorder makes it hard for the child to make healthy decisions about food and eating. They are empowered to take over decisions about eating, much as would be done in inpatient care. Parents are responsible for deciding what their child eats, when, and how much is eaten. They typically also curtail any physical activity, much as would take place in residential treatment.

In the second session of FBT, the therapist will coordinate a family meal. During this meal, they will instruct the family on how to be more effective with the eating disorder. The goal of this meal is to give parents the confidence that they can encourage their child to eat more than they intended.

Phase 1 continues until the following conditions are met:

  • Steady weight gain
  • Eating disorder symptoms have begun to recede
  • The child is eating without significant resistance

Phase 2

During the second phase, parents will gradually give eating decisions back to the adolescent based on what is age-appropriate. This phase is introduced gradually and managed carefully.

fbt-informed parent coaching anorexia

FBT-Informed Parent Coaching

for a Child or Teen with Anorexia

Phase 3

During the third phase, the therapist reviews the adolescent’s progress and ensures the family is on track to get back to normal family life. The therapist offers skills to support ongoing development. Additionally, they will help the child navigate change without reverting to eating disorder behaviors to cope.

Is FBT right for your family?

Family-based treatment can be more effective than other treatments for anorexia, especially in cases where it’s caught early. However, if it’s not a good fit for you and your child is not gaining weight, you should know within four weeks. If that is the case, you may want to try other treatment options. It’s not a failure on your part, it just means FBT is not the right treatment for your family. FBT is great when it works, but it’s not the only path to recovery. There are alternatives, and you should not feel ashamed if FBT is not the right fit for you.

What do parents say about FBT?

When it is a good fit, FBT is very effective, and parents rave about it. Parents who succeed with FBT say recovery is faster and more effective than alternative treatments. But even parents who found FBT efficacious say it is time-consuming and emotionally challenging. Implementing Phase 1 of FBT can be a full-time job for parents, and it can last up to 3 months or even longer. Therefore, in some families, one partner will take a leave of absence from work to administer the treatment.

The risk of parental burnout with FBT is high. Burnout is a major risk for any parent who has a child with an eating disorder. Also, it’s serious because parental burnout has negative consequences for eating disorder treatment outcomes, whatever the modality. Therefore, parents report that having support makes the job easier.

That’s what Erin found helpful. “We had a great therapist, and I was active on parent message boards,” she says. “But I found that parent coaching was the real game-changer for me personally. Having a coach helped me work on my side of the equation and learn better communication skills. It made me much more influential over the eating disorder.”

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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A log parents can use to track eating disorder symptoms and treatment

Keep a log of eating disorder symptoms and treatment

If your child has an eating disorder, then it may help you to keep a log of eating disorder symptoms and treatment. This is a useful tool to support you in seeking treatment, recognizing progress, and, when necessary, making decisions to switch to new or different treatment. A mental health log can help parents keep track of their kids’ mental health and support them in making strategic decisions to support recovery. 

There are many benefits to keeping a mental health log of eating disorder behaviors and treatment. The three most important reasons are so you can: 

  • Maintain your focus and know what’s working and what’s not working
  • Share your notes with treatment providers to keep treatment on-track
  • Recognize when things are getting better or worse

An eating disorder is a constantly moving target, and getting from day to day can be a major undertaking. But if you don’t have a tool to pull yourself up from the weeds and see the big picture, you can’t make strategic decisions. And impulsive decisions based on your feelings alone are often much less effective than decisions that are made in a more strategic manner. A log that tracks eating disorder symptoms and treatment will help you keep everything straight.

Why keep an eating disorder treatment log?

Managing a child’s eating disorder is a big undertaking. There is so much information and many details to keep track of. Since you have other things on your plate and you’re more likely to forget details in stressful situations, it helps to write down what is going on. Doing this will help you keep track of medications, rules, and expectations so that you aren’t wasting time trying to remember what was said or tracking down different pieces of paper, medication bottles, and other things to help jog your memory. 

In times of stress, it can be dangerous to rely on memory, since facts become distorted with pressure and time. Keeping a detailed log of eating disorder symptoms and treatment means you have the information you need at your fingertips.

What is an eating disorder tracking log?

A log for eating disorder symptoms and treatment can help parents keep track of all the little and big things that take place during the various stages of having an eating disorder. Whether your child is in a very active eating disorder or in early, mid, or full recovery from an eating disorder, a log can be helpful. 

An eating disorder symptom log should track the following:

  • Eating: for example, what and when did you serve food, and what was eaten. You may also include how it was eaten (e.g. easily, slowly, fast, reluctantly, etc.)
  • Other behaviors: for example, track whether your child is purging and, if so, how often. Same with over-exercise. You can also observe whether body image issues are becoming more or less frequent. 
  • Conversations you have with professionals: this should include notes from your meetings with therapists, doctors, dietitians, etc. This should include information about the treatment they recommend and suggest and why you did or did not follow it.
  • Distressing events: you should take note of major events such as self-harming, anxiety attacks, and aggressive behavior. Describe what happened and approximately how long it lasted and its intensity.
  • Conversations with important adults: note things that people like coaches, teachers, family members, etc. have said to you about your child’s behavior. Sometimes it’s hard for us to see what’s going on, and these comments, when written down, give us insight.
  • Appointment notes: if your child is being monitored by a medical doctor you can keep track of vital signs like weight, heart rate, etc. Also, take note of any recommendations and suggestions. If you chose not to follow the doctor’s advice, state why.
  • Medications recommended and/or prescribed: keep track of what was prescribed, when, why, by whom, and at what dosage. Also track when providers adjust medication or if they make a recommendation that you disagreed with. Note any positive impact of medication and possible side effects.

In addition, you should have a quick-reference sheet showing you the providers’ names and phone numbers and any medications your child is on. 

How to keep a quality log

You already have a lot on your plate. A parent who has a child with an eating disorder is facing tremendous work in terms of treatment and care. You’re already doing the planning, scheduling, coordinating, budgeting, and decision-making. This is a lot of work. 

So you don’t have to turn keeping a mental health log into another tedious job for yourself. But you should have a system for jotting down your notes at the end of every day. As things improve, you can reduce this to every other day, then once per week, and so on. Remember that eating disorders can be effectively treated and you probably won’t have to do this forever. But it will be a tremendous help to you if you keep track of what’s going on. Aside from anything else, a good mental health log will give you the peace of mind that you are on top of your child’s care. 

log eating disorder symptoms

What format to use

Start by thinking through the format you will use for your log.

Some people really like paper and a pen for keeping notes. If so, get yourself a dedicated notebook and a pen and put them in a place where your child will not find them. Unless you are approaching the log as a group effort, you might want to hide it so your child cannot stumble across it. For some kids, a treatment and symptom log will bring on feelings of being vulnerable, observed, and exposed. 

If you prefer a digital record, then you have several options. You can set up a spreadsheet or a document, or even just use your note-taking app on your smartphone. Whatever you use, keep in mind privacy concerns, and password-protect your devices so your child doesn’t accidentally see your log if you don’t want them to. 

Once you know whether you’re going paper or digital, consider a standardized format. Not everyone likes this, but many people find it helpful to have a list of what they should be logging. To help, I’ve created a document with everything you need to get started. 

log eating disorder symptoms

Getting in the habit

In the beginning, make it a habit to jot down a few notes every day. New habits are hard to start, but once you get going, they get easier. Here are some tips for starting a new habit: 

  1. Get ready: gather the supplies you need and set up your worksheet, cheat sheet, or whatever you’re using to keep your log
  2. Set a goal: it’s very hard to build a habit if your goal is undefined. Commit to daily notes or, if that’s not possible, a note every time you do something like visiting the pediatrician or dietitian. 
  3. Set up a cue: if your goal is to make a note every day, set up the specific time and location. Many people will set a reminder on their smartphones to make sure this happens. Another option is to make the cue something like when your child goes to their therapy session, after dinner, or something else that reliably happens.
  4. Set up a reward: it’s best if you feel successful when you complete your habit each day. This could be something simple like giving yourself a quick hand or temple massage, scrolling through your phone for 5 minutes, or getting a hug from your partner. 
  5. Have a plan B: while you really want to stick to a regular plan to create a habit, it can be helpful to build in your plan B. This is what you will do if you don’t meet your goal. For example, can you set a second reminder on your phone? If you forget to do it after dinner, can you do it before you go to bed? Establish this in advance so it feels like a more formal and thus acceptable backup plan.

The log is not a journal for your feelings

Journaling your feelings about the eating disorder might be very helpful for you. A journal can help you process your difficult emotions and thoughts about your child’s disorder. However, this mental health log is not the same thing as a journal. I suggest you keep the two concepts separate. Remember that a good log might be helpful for you to show to your child’s treatment providers. So you want to limit your personal thoughts and feelings.

Keep the log factual, and process your feelings elsewhere. Use a reporting approach: stick to the facts! You can even use a reporter’s prompts to structure your notes: 

  • What happened?
  • Where did it happen?
  • How did it happen?
  • Who was involved?
  • Why did it happen?

Privacy considerations

Your child’s private health information is sacred. I already mentioned this, but carefully consider whether you plan to share your log with your kid. And, if not, make sure they have no way to accidentally stumble upon it. I really can’t overstate this. What you are doing is not wrong. However, it could be hurtful for your child to discover your log without adequate preparation. Here are a few options for thinking about how you set this up: 

Keeping an open log

You may choose to make the log open and accessible to your child. This means you share with them that you are keeping the log and are willing to show it to them upon request. However, it does not mean your child is keeping the log for themselves. If their therapist suggests they journal or maintain their own notes, that’s separate from what you are doing. Even if you are providing your child with access to the log, make sure that it is your responsibility to record your observations and notes. 

Keeping a private log

A more common approach is to keep a private log. In this case, you keep your log private and in a secure location that your child cannot access. You are gathering very personal information, so it is essential that you take this very seriously. There are ways in which an eating disorder symptoms log can go awry, including: 

  • The child with the eating disorder finds it and feels criticized, triggering a relapse or new symptoms
  • Siblings find the log and make fun of the child or become worried about the child’s health
  • Other people, from nosy neighbors to extended family members find the log and catastrophize the situation, possibly even accusing you of wrongdoing if they don’t understand what’s going on

This is why it cannot be overstated: if you keep a handwritten log, make sure that it is hidden securely in a place that nobody will find. If you keep your log on digital devices, make sure they are password-protected to make sure nobody can access them except for you. Don’t fall into the trap of relying on weak passwords that your children are likely to guess! Do not use anyone’s birthday, name, or classic combinations like 12345, abcdef, or the all-too-common mistake of using the word “password” as your password.🤣

Get started!

Keeping a mental health log of eating disorder symptoms and treatment can really help you uncover patterns of behavior. It will also help you recall facts and information that you’ve received in the past and jog your memory about why you have made the decisions you have made. Finally, it can be very helpful when you’re talking to new treatment providers who need a history of what has taken place so far.

You can get started here

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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The risks of accommodating an eating disorder

The risks of accommodating an eating disorder

Rachel was at the end of her rope. After years of trying to help her daughter Lily claw her way out of anorexia, it simply wasn’t getting any better.

Sure, there was COVID to blame. The pandemic made Lily even more socially isolated, and online treatment didn’t seem to be as effective. But overall, Rachel knew that Lily’s problem pre-dated the pandemic. And she was worried that it would extend way beyond the pandemic if something didn’t change fast. 

“The truth is that I’m completely burned out,” says Rachel. “This is my last hope. If this doesn’t work, I really don’t know what I’ll do or how I’ll keep this up. Something’s got to give.” 

Rachel has decided to try a treatment program called SPACE that focuses on changing her own behavior rather than trying to change Lily’s behavior.

“It’s just been a brick wall to try and convince Lily to recover,” says Rachel. “I know I’m not supposed to say this, but she just isn’t choosing recovery. She’s not taking any steps on her own to get better.”

Rachel is struggling under the caregiving burden. “When she was younger, she was a bit more self-sufficient, and being at school motivated her,” says Rachel. “But now she’s done with school, and she’s doing almost nothing. She lives with me, and I try to feed her six times per day like I’m supposed to. She’s nowhere close to feeding herself, and I can’t see her being able to get a job or move out.”

Rachel, like so many parents and caregivers, is terrified for her daughter. She’s also frustrated and fed up. Her diligent, valiant work feels like a drop in the bucket. The eating disorder is powerful, and she’s losing hope.

What is accommodation?

When someone is afraid of something, they naturally want to avoid it. 

Parental accommodation is a way that parents make it easier for their children to avoid doing the things that scare them. 

If your child screams when they see a spider, you whisk it away quickly and then soothe your child, trying to calm them down as soon as possible. This accommodation makes perfect sense.

But the next day, your child asks you to check under their bed for spiders before going to sleep. This, too, makes sense to you. You accommodate their wishes – it’s not a big deal! 

But the next day, your child asks you to check that their windows are locked tightly and check under the bed, scan the walls, and peer into the darkest corners of the closet with a flashlight to ensure there are no spiders. 

The accommodation snowball effect

You can see where this is going. Your child’s fear of spiders makes sense. But their avoidance of possibly encountering a spider ever again is becoming a problem. Even though you sense it’s wrong, you can’t imagine not accommodating them because they get so upset just thinking about spiders. It seems faster and easier to do what they ask than to convince them to go to sleep without it.

Sometimes you try to talk your child out of it. You prepare deeply-researched and highly-rational arguments to persuade them that spiders aren’t scary or dangerous. Sometimes you lose your temper and yell that you aren’t their personal spider valet and you won’t do this tomorrow night … this is the last time! 

But, of course, the next night, your child cries and seems so terrified that you give in one more time and look in all the nooks and crannies. Later they come into your room at midnight, wake you up, and beg you to check again.

You’re half asleep, and it seems like less trouble to just look than to try and convince your child there are no spiders, so you grudgingly get up, stomping your feet and huffing as you walk to their room and look in all the corners for spiders. 

You’re feeling angry, but you can’t see a way out of accommodating your child’s avoidance of possibly seeing a spider. You feel trapped and frustrated, stuck in a web.

How does accommodating impact eating disorders?

I started with a spider story because it feels less charged than an eating disorder. Eating disorders are complex, multi-layered mental disorders. Also, parents are not responsible for either their child’s fear of spiders or their eating disorder. It typically doesn’t work that way.

But parents may be responsible for accommodating their child’s anxiety-driven eating disorder behaviors.

Parental accommodation is called a “maintaining factor” in eating disorders. This means that it is not the cause of an eating disorder. But accommodation can make it easier for an eating disorder to dig its heels in and stick around for the long haul.

Eating disorder accommodation examples

There are many ways parents accidentally accommodate eating disorder behaviors. Let’s break down how accommodating can sneak into some of the common eating disorder recovery goals:  

  • Goal: have the child eat regular, healthy meals.
  • Accommodation: the child cries and yells at the dinner table. The parent becomes so distressed that they excuse the child before the meal is finished.
  • Goal: cut down on ingredient checking and calorie counting
  • Accommodation: the child refuses to eat until they know exactly how many calories are in the yogurt. It just seems easier and faster to tell them.
  • Goal: have the child eat various foods, not a limited menu of “safe food.”
  • Accommodation: when serving meals, the parent doesn’t offer new foods. They know their child will throw a fit or simply refuse to eat. Sometimes they try to add something new to the plate, but it goes so badly that they rarely do this.
  • Goal: have the child eat comfortably with other people.
  • Accommodation: the child becomes so upset about the idea of multiple people at the dinner table that the parents feed the child separately. Or they excuse the child from family meals because they are so distressed.
  • Goal: for the child to accept their body and not worry about its appearance.
  • Accommodation: when the child asks if they look bad, the parent freezes and ignores the question. Then, when the child doesn’t stop, the parent says in a falsely cheerful voice, “you’re just being silly – of course you’re beautiful!”
  • Goal: the child attends scheduled meetings with professionals.
  • Accommodation: the child insists that the therapist is useless. The nutritionist makes them eat unhealthy food, and the doctor is fatphobic and clueless. The parent spends hours every week convincing the child to attend just one more meeting. They use bribes and rewards, which work only some of the time.

All of these parental responses make perfect sense. If you do these things, you are not bad! Occasional accommodations make sense. But it can be a problem if parents repeat the same accommodation at every meal and/or the list of accommodations keeps growing. We want to stop accommodating eating disorder behavior even though it’s really, really uncomfortable for both the parent and the child. 

How can parents stop accommodating?

Parents can stop accommodating eating disorder behaviors, but it takes some careful thought, a solid strategy, and practice. It’s not a good idea to remove all your accommodations at once. A strategic, steady approach is best. 

First, you need to understand how you are accommodating the eating disorder behaviors and why you are accommodating. You will naturally think you are accommodating to avoid your child’s distress. But you are also accommodating to avoid your distress about your child’s distress. Make sense?

When your child yells and screams or slams their door in your face, you feel upset. You worry that your child will never get better. Of course you do!

This is what drives the accommodation. You want to avoid your child’s upsetting outburst, so you do whatever you can to avoid it. 

Start with you

Understanding your own worry is the first step to addressing and ending accommodation. Because ending accommodation is all about what you do. How your child responds must be relatively unimportant and not change your approach. 

You will take unilateral action to remove your accommodation lovingly and compassionately. And your child is going to be distressed. Both of you will be able to handle this distress. But you may need some support to prepare and get through it.

Next, you will pick a specific accommodation and make a detailed plan to stop doing it. You’ll tell your child what you’re going to do, why you’re doing it, and when you’ll begin doing it. 

Finally, you’ll follow through. You’ll stay steady even in the face of your child’s worry and anguish. This will be hard, but you know that continuing the accommodation, while possibly easier in the short term, will not help in the long term.

You’ll stay dedicated and single-minded in your commitment not to accommodate eating disorder behaviors anymore. Over time, your child will learn your boundaries. Your child will feel less anxious. You’ll interrupt the anxious cycle of an eating disorder and invite recovery to take root.

Rachel and Lily

Rachel was terrified of ending even her most minor accommodations. For example, she told Lily what was in her smoothie every day. This was happening even though it was exactly the same every day.

She made a plan and told Lily that she would not answer smoothie ingredient questions anymore. Lily asked a few times on the first day, and Rachel was near tears but held her boundary lovingly. 

The next day, Lily asked ten times and started to cry when Rachel held her compassionate boundary. She refused to drink her smoothie. Rachel worried that she was making a mistake or doing it wrong.

But on the third day, Lily asked Rachel once, then, shockingly, drank her smoothie. 


“I nearly fell out of my chair,” says Rachel. “I couldn’t believe it didn’t keep getting worse.”

Lily asked about the smoothie ingredients every few days throughout the next few weeks. And if it was an especially stressful day, she asked several times in a row. But Rachel was confident that not reviewing the ingredients was the right thing to do to help Lily recover, so she held her boundary lovingly and firmly.

Over time, Rachel removed more and more accommodations. Some were easier than others, but she could see the benefits. Mealtimes were less stressful for Rachel, which meant she could better support Lily through the stress of eating. 

“I feel more hopeful today than I’ve felt in five years,” says Rachel. “This is the biggest improvement I’ve seen in a long time. I feel like I’m really getting the hang of not accommodating her eating disorder behaviors. I’m focusing on controlling myself rather than trying to control her.”

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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

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Treat the parent, help the child recover from an eating disorder

Treat the parent, help the child recover from an eating disorder

Alicia knew she had to do something soon. Her daughter Eden had been stuck in a restrictive eating disorder for a few years. Eden was medically stable and in treatment. But Alicia knew that she was still deeply affected by her eating disorder. And the eating disorder was taking up a lot of space in the family and for Alicia personally. Alicia wanted to make sure she was doing everything in her power to keep things from getting worse. 

Alicia started a parent-based treatment called SPACE (Supportive Parenting for Anxious Childhood Emotions). The program included 12 Zoom calls, plus homework and practice in between. Alicia learned ways to support Eden without accommodating anxiety-driven eating disorder behaviors. At the end of the program, Alicia noticed improvements in her daughters’ eating disorder behaviors. And she gained a new perspective on how she was parenting and skills to support Eden’s recovery.

“I was unsure how I could actually do anything to change the eating disorder. Mostly I was afraid to even try. But deep down I had a suspicion (A dream! A fear!) that there was more I could do. In SPACE training I became aware of how much I was accidentally accommodating the disorder. And in fact, it was those moments when I felt like I was being most supportive and loving that I was accidentally making things worse,” says Alicia.

“Now, I am really supportive … even more supportive than before. But I also have really good boundaries and I’m not getting into dangerous waters by accommodating Eden’s anxiety. I no longer avoid the hard things we need to do to get better,” says Alicia. “When I first learned what I had to do I thought it would be harder to parent this way. But in fact, things are running more smoothly now than they were before.”

Parent training for eating disorder recovery

As a parent, you did not cause your child’s eating disorder, but you have a critical role in recovery. New research is revealing that you can help treat your kids’ anxiety-driven eating disorder behaviors, improve your relationship, and boost your child’s flexibility and resilience by participating in SPACE parent-based treatment. These skills will last a lifetime and might change the course of your child’s recovery from their eating disorder.

SPACE is about learning to recognize parental accommodation and establish a new way of responding to anxious behaviors. When applied in eating disorder situations, SPACE can address anxious behaviors like food restriction and rituals, body-checking, and body comments. It teaches you to focus on your behavior rather than your child’s behavior since that is what is within your control. Parent training can be done either as part of a group or one-on-one. The skills taught in SPACE for eating disorders include: 

1. Creating a daily routine of consistent family meals and building family connections.

2. Identifying which eating disorder behaviors are coming from anxiety and how your responses accommodate the anxiety.

3. Creating a plan for which accommodations you want to target and how you will respond differently to anxiety in the future.

4. Implementing your plan and removing your accommodation for one anxiety-driven behavior at a time.

5. Practicing and refining your approach and choosing additional targets.

How SPACE works

The SPACE parent treatment program was developed and validated by scientists at Yale University. Its original use was with kids who have anxiety disorders and obsessive-compulsive disorder (OCD). A more recent version of SPACE was developed specifically for kids with avoidant restrictive feeding intake disorder (ARFID). SPACE has also been evaluated in children who have ASD, ADHD, and challenging behaviors like physical violence and threats of suicide.

The evidence-based parent treatment usually takes place over the course of 8-16 weeks. Parents join one 1-hour meeting per week and complete homework and practice between sessions. The first several sessions focus on parent education, and the additional sessions involve the parents implementing their plans and refining their skills.

Is anxiety a factor?

If anxiety is a factor in your child’s eating disorder behaviors, then SPACE can be appropriate. Many eating disorder behaviors are driven by anxiety, including:

  • Food avoidance: eating only at particular times, in particular places, a very limited list of foods, etc.
  • Food rituals: measuring, counting, arranging, hiding, mashing, throwing food, etc.
  • Body checking: weighing, pinching, measuring, etc.
  • Body talk: frequent questions like “am I fat?” “will this make me fat?” “I’m so fat” etc.

If your child is not medically stable and/or is in Stage 1 of family-based treatment (FBT), then your targets will not be food behaviors. But if your child is home with you then it may be appropriate to apply the treatment to body checking, body talk, or other anxious behaviors that are not directly linked to the eating disorder.


I provide SPACE parent-based treatment for eating disorders because it gives parents evidence-based skills to treat anxiety-driven eating disorder behaviors. It’s an excellent option for dedicated parents who want to do more.

“There’s a sense of action and empowerment in SPACE, and I found myself feeling more hopeful than I’ve felt since Eden first started showing signs of an eating disorder,” says Alicia. “I felt so powerless so many times in the past few years, and this is the first time I’ve seen real progress in a long time.”

“I felt really connected to the other parents in my SPACE group,” says Alicia. “It was as if we could all take a collective deep breath and feel less alone in all of this. I think we were all like shaken soda cans in the beginning. We looked fine on the outside but we were ready to burst. By the end, we were sharing our successes and sometimes laughing together. There was a real sense of community and shared safety.”

Setting goals

A key goal of SPACE parent training is seeing a reduction in anxious behaviors. Parents identify the eating disorder behaviors they want to see reduced and then work towards their goals by changing their (the parents’) behavior. You can help treat your kids’ anxiety-driven eating disorder behaviors with this parent-based treatment. Target behaviors might include: 

1. Food refusal goals might include expanding the list of “safe” foods. 

2. Food ritual goals might include eating a meal without hiding food.

3. Weight ritual goals might include not using the bathroom scale.

4. Body talk goals might include fewer meltdowns over body appearance.

5. Treatment resistance goals might include less debate and negotiation about treatment plans and participation.

At the end of SPACE treatment, parents review the goals they are achieving and the goals they still have. The parents’ focus remains on ending their accommodation of anxiety-driven eating disorder behaviors since parental accommodation is a “maintaining factor” in eating disorders. But the results of the treatment will also be apparent in the child. There is good evidence showing that SPACE parent treatment results in a reduction in the quantity and severity of anxious behaviors by the child.

What results can I expect?

Could SPACE parent treatment be what your child needs to get further into their recovery? That depends on many factors, including how entrenched your child’s eating disorder is, your own ability to commit to and follow the treatment, and the consistency with which you practice your new skills at home. 

Kids may need to continue their own treatment even when parents change their behavior. Eating disorders are complex and multi-factorial, so the ongoing involvement of a therapist, dietitian, and physician may be necessary for the foreseeable future. The main opportunity with SPACE parent treatment is for you to know that you are doing everything in your power to support your child’s recovery and nothing that will interfere with recovery.

Some parents who complete SPACE treatment see improvements very quickly, but while things will feel easier and you’ll feel more confident in your own behavior, this is not a miracle treatment. It will take time for you and your child to learn a new way of relating to anxiety-driven eating disorder behaviors.

Facing difficulties

Sometimes your child’s behavior may get worse before you see improvements. This is a known phenomenon called an “extinction burst.” You’ll learn the skills you need to stay steady in the face of anxiety escalations and will work on your own emotional regulation in times of stress. Anxious behaviors are driven by “body-up” sensations and are therefore not intentionally manipulative or coercive, but to parents, that’s exactly what they feel like. 

Your desire to reduce your child’s distress and disruption will feel overwhelming at times, but you’ll have the knowledge and skills you need to respond without accommodation. Being a sturdy, strong parent when your child desperately wants you to accommodate their anxious demands will take time and practice. The SPACE parent-based treatment helps you treat your kids’ eating disorder behaviors and face these difficulties with confidence.

Extinction bursts don’t typically last long, and if you can stay the course, maintain the plan, and practice your skills, both you and your child will feel better soon. The result is fewer anxiety-driven eating disorder behaviors, confidence that you are doing the right thing, and a more connected and relaxed relationship with your child. 

Give it time

Learning to hold yourself steady in the face of a powerful anxiety-driven eating disorder escalation is hard. While every parent wishes for overnight success, SPACE parent-based treatment is more about consistent improvement. You might not see the magic happening every day, but if you stick with the plan you’ll see big changes over time.

A major side effect of SPACE treatment is a reduction of “caregiver burden,” which is significant with eating disorders and can impede recovery. You’ll feel more confident and less overwhelmed and hopeless. And that alone is a major benefit of the SPACE parent-based treatment to treat your kids’ anxious eating disorder behaviors.

That’s what happened with Alicia. The first few weeks of SPACE challenged everything she thought she should be doing to support Eden. But a few weeks later, she could sense a difference in their relationship. “There was a lot less stress at mealtimes and other times we spent together,” she said. “I didn’t even realize the burden I was carrying. But now I see that I was trying to do everything right, and I was constantly walking on eggshells, afraid to make things worse. I worried all the time. But then I learned that my avoidance had actually empowered the eating disorder. Now that I know how to safely stand up to anxiety, I feel stronger and more effective.”

“Eden is still seeing her therapist weekly, but she is firmly in recovery now,” says Alicia. “We still have work to do individually and as a family, but I’m at least sure that I’ve reduced my accommodations and am doing everything in my power to keep Eden healthy.”

You can learn more about the SPACE treatment for parents who have kids with eating disorders here.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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

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When your child is dropped by their eating disorder dietitian

When your child is dropped by their eating disorder dietitian

Sometimes a person who has an eating disorder is dropped or discharged from the care of a Registered Dietitian (RD). Parents may wonder why this happens and whether such behavior is ethical given how fragile their child is.

It’s undoubtedly hard for parents to hear their child has been discharged. If your child is under 18, you may be the one who the dietitian informs that they are terminating treatment. In this case, you will likely get the reasoning directly from them. But if your child is over 18, there’s a good chance that you will get the news second-hand. Your child will tell you their version of why they’ve been dropped or discharged by their eating disorder dietitian.

In either case, the news can be shocking, bewildering, and painful.

Grace’s story

That’s what happened to Grace*, a client of mine whose daughter Casey* is 19 years old and has bulimia. “We’ve had a terrible week because on Monday Casey’s dietitian dropped her,” she said, shaking her head in dismay. “Why would a person do that? Casey is getting worse – she’s in terrible danger. So why would her dietitian, who has been working with her for over a year, drop her right now?”

Grace was in tremendous pain. Casey had spent the week raging against her dietitian and her whole care team. Casey’s eating disorder symptoms, which were already getting worse, ramped up to levels Grace hadn’t seen before. Her daughter was medically in danger, but because she is over 18, Grace had limited options. 

Things had been getting worse for Casey for a while. But knowing she was seeing a dietitian in person every week helped Grace feel a bit more secure. “I admit that those weekly sessions gave me hope,” she said. “At least I knew that Casey was being monitored and talking to someone who could help her.” 

“I don’t know what we’re going to do now,” she said. “I’m really at the end of my rope. And I’m so angry with the dietitian for putting us in this situation.” 

I completely understand Grace’s feelings. As we talked, we tried to understand what being dropped by the dietitian during eating disorder recovery meant for them.

Trying to find out what’s going on

I had a pretty good idea that what was going on is that Grace’s daughter’s dietitian had hit a point in treatment at which it felt medically and ethically unsafe to continue treating Grace in outpatient treatment. 

There had been months of weekly dietitian meetings and continued signs of medical instability. It sounded as if the dietitian had hit the point at which her training and expertise were at their limit. But it’s never simple, so I reached out to Leslie Schilling, MA, RDN, CEDS-S. Schilling runs a private nutrition therapy and wellness coaching business. She is also a supervisor for other dietitians working with eating disorders. 

“Ending treatment with a client is such a nuanced situation,” says Schilling. “I work really hard to avoid discharging a person from my care. Because I know how difficult it is, and it may feel like abandonment.”

“That said, there are times, particularly in a situation in which the person clearly needs a higher level of care, that I may have them sign a form or agreement acknowledging that I have recommended a higher level of care and they are choosing to continue working at this level of care instead,” she says.

“Many people don’t realize that dietitians provide a service called medical nutrition therapy. This includes some medical components like reviewing lab values, food-drug interactions, and systems assessments,” says Schilling. “And, if we see someone who is extremely medically compromised and needs to be in inpatient care, we could be at risk if we continue to treat them.”

emotional regulation

Why does it happen?

There can be many reasons a person may be dropped by their eating disorder dietitian. Here are the most common reasons: 

1. Lack of specialty

Sometimes a dietitian will start working with someone without realizing how serious their eating disorder is. Maybe when they started the eating disorder was not recognized or disclosed. But then the RD realizes the person has an eating disorder. If the RD is not an eating disorder specialist, then they would probably refer the client to someone who is qualified to treat them. 

2. No team

If a dietitian is working with someone who has an eating disorder alone, they may decide that they cannot continue without the addition of a team. This is typically a medical doctor, therapist, and possibly a psychiatrist. If a client refuses to work with a team, the dietitian may need to make some difficult decisions about the ethics of continuing care alone.

“In most cases when supporting someone with an eating disorder, I do not recommend that a dietitian work alone – you really need a complete care team,” says Schilling. “I am not a therapist, and I can’t work on certain aspects of the eating disorder the way a therapist can. I also can’t admit someone to a hospital with a low glucose level, although I can read that in their lab work. Working without a team is not a good idea when we’re dealing with an active eating disorder.”

3. Personal reasons

Sometimes a professional will begin working with someone and then need to disengage for personal reasons. This could be for family reasons like pregnancy or elder care, moving to a new practice or out of state, retiring, or a number of other situations. 

In these cases, the dietitian rarely leaves their client hanging and will typically give their client plenty of notice and provide them with referrals to other professionals. Sometimes emergencies or illnesses mean a dietitian must end treatment abruptly. While not ideal, these situations are sometimes unavoidable. This is one of the reasons why eating disorder dietitians prefer to work with a team.

4. Ethical issues

There are cases in which a dietitian must make an ethical determination about care. “At a certain point, a dietitian may need to evaluate whether their client needs a higher level of care, particularly if they are medically compromised,” says Schilling.

“Sometimes there are other things that take priority over seeing the dietitian, like acute mental health concerns or stabilizing someone medically. I’ve often stepped back while other members offer more support until the client becomes stable enough to resume nutrition therapy,” she says. 

Schilling says this situation usually begins with the dietitian exploring the issue with the patient’s treatment team, and then talking to the client about recommending a higher level of care. “If the client really wants to keep working with me, or doesn’t feel safe entering a higher level of care, then I’ll use a form or waiver that clearly states my recommendation and the client’s preference to continue working together despite my recommendation,” she says. 

She says this is important since dietitians provide medical nutrition therapy and may be at risk of liability. “If we recommend a higher level of care and the client refuses to sign the waiver, then we will still give options and referrals. This is a tricky situation that would need to be discussed with the dietitian’s professional supervisor if they have one and the patient’s treatment before discharging from care. This isn’t a decision a dietitian would make hastily.”

Thinking it through

Schilling, who supervises eating disorder dietitians in addition to treating eating disorder clients in her practice, says that it’s rare that a client would be let go without extensive conversations, attempts to make progress, and referrals to other professionals or a higher level of care.

When Grace started to think about it, we were able to deduce that this is likely what happened with her daughter Casey. Casey’s entire team has been recommending a higher level of care for months, in fact almost since they started working together. Casey’s dietitian introduced a treatment contract over six months ago, which is a way that a dietitian tries to establish treatment milestones and move a client forward in their recovery.

Grace told me that Casey complained bitterly about the contract. And while we don’t know if Casey was offered a waiver to continue care under the dietitian, it’s very likely that the dietitian hit an ethical issue in treating Casey.

Grace says Casey complains that her team is pressuring her into a higher level of care, and Grace herself has been desperately trying to get Casey to enter inpatient treatment.

In fact, that’s a big part of the work we’re doing together. I’ve been coaching Grace to build influence in their relationship and have more effective conversations about Casey’s eating disorder and treatment.

Next steps

With a bit of clarity, Grace understands the dietitian’s choice. “I still hate it,” Grace says. “It puts me in a really bad place.” 

Grace is going to have some tough conversations with Casey. Based on our understanding of why the RD released Casey from her care, we can guess that Casey is severely medically compromised. 

Grace needs to get really clear with Casey about how treatment needs to proceed. There is no easy solution here because of Casey’s age. But Grace is not willing to give up. “I’m fighting for my daughter’s life right now,” she says courageously. “I’m going to figure out how to get her the help she needs.”

*Names have been changed to protect privacy

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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Why I think eating disorder treatment often doesn’t work

Why I think eating disorder treatment often doesn’t work

Many parents who have a child with an eating disorder face years of treatment that doesn’t seem to work. It’s frustrating to try so hard and spend so much money and energy working against an eating disorder that won’t budge. So what’s missing? Why is this so common?

First, of course, eating disorder treatment works for many people. But it’s also true that eating disorder treatment doesn’t work for other people.

I’m not criticizing any of the hard-working professionals in the eating disorder field. Nor do I suggest we throw out what’s already working, but I do wonder: what’s missing? What else could we be doing to make a greater impact on shortening the duration and reducing the severity of many eating disorders?

What’s missing?

A big part of the problem is that eating disorder research is chronically underfunded. So compared to almost any other serious condition, there is relatively little scientific data to work with, particularly with non-anorexia diagnoses. Most of what we know about treating eating disorders comes from small studies, trial and error, and is the result of tremendous effort by parents, professionals, and people who have/had eating disorders. 

My unique perspective on eating disorders comes from a combination of research and lived experience. I had an eating disorder for most of my life. Since recovering, I’ve been dedicated to understanding, decoding, and writing about eating disorders. 

My coaching work with parents who have kids with eating disorders has shown me just how frustrating traditional treatment can be. Meanwhile, my work with professionals shows me how much they care and how much they want to help. And in talking with people who have/had eating disorders, I know they’re frustrated, too. 

So what do I think is missing from most eating disorder treatments? Why does eating disorder treatment often have frustratingly elusive results?

Here are some of my current opinions and thoughts about why eating disorders remain so difficult.

emotional regulation

Why an eating disorder?

When working with a family that has an eating disorder the first thing I want to know is “What is driving this behavior?” When eating disorder treatment doesn’t work, I wonder whether we understand what’s driving it.

Eating disorders don’t come out of nowhere. They have a reason and a purpose. When we address the reason and purpose for the eating disorder we can treat it more effectively.

When a child rejects food, binge eats, or purges, I want to know what’s going on beneath the behavior. What’s driving it? 

*I realize that in FBT the premise is that we don’t worry about the “why.” I’m trained in FBT and agree that when we’re facing a medical crisis, we need to address the medical crisis (e.g. weight suppression) first and foremost. We need to get the medicine of food into the body. But to ignore the “why” is missing the big picture in a mental health condition like an eating disorder.

The old way of thinking about negative behaviors was that the child was “abnormal,” “manipulative,” or “looking for attention.” But what we’ve learned from recent developments in neuroscience is that in fact, behavior is a way for a person to meet a primal need for emotional safety. 

💡 Emotional safety: when a person’s nervous system, beliefs, and thoughts are cohesive, calm, secure, engaged, relaxed, and open to other people.

Once we learn to address emotional safety, we can help the person feel better. And most of the time when a person feels better they will have less need for the behavior and be in a position to learn cognitive skills for managing the urge to perform the behavior. It is virtually impossible to utilize cognitive skills and knowledge when you lack emotional safety.

💡 Cognitive skills: using your prefrontal cortex to acquire knowledge, manipulate information, and reason.

Diving in with cognitive skills for managing eating disorder behaviors is where most treatment begins. But its effectiveness is limited because an eating disorder is not typically a cognitive, conscious process. It does not arise from conscious thought. Therefore it’s not a choice. It is in response to the need for emotional safety. 

A bottom-up behavior

Treatment often involves telling people that their eating disorder is dangerous, will hurt their health, etc., and provides strategies for overcoming urges. This may give us insight into why eating disorder treatment often doesn’t work. While these top-down approaches may be perfectly logical and technically useful, they are all cognitive. And since eating disorder behaviors are bottom-up vs. top-down behaviors, they often fail to make a difference. 

💡 Bottom-up: arising from the nervous system, primitive areas of the brain, embedded memories, etc

💡 Top-down: arising from conscious thought; using cognition and language

I believe that almost all eating disorders begin with bottom-up issues. Therefore to help a child recover from an eating disorder we need to address bottom-up processes. This is done using something called emotional regulation

💡 Emotional regulation: the act of noticing, accepting, and processing signals from the nervous system to achieve a calm, engaged emotional state.

Once they have learned emotional regulation, a person’s urges for eating disorder behaviors are greatly reduced. In this place, they are available to do cognitive work on the eating disorder. 

Bottom-up processes drive most compulsive behavior. Therefore until we address these processes, we will not be successful in our top-down treatments.

💡 Compulsive behavior: a behavior that is not driven by logical, conscious choices, including most eating disorder behaviors. The person feels “driven” to complete the behavior even if consciously they do not want to and/or are ashamed of the behavior.

Why the eating disorder exists

Unless medical weight gain is needed, rushing into mental health treatment without understanding the “why” of the eating disorder is typically an exercise in frustration for everyone (the child, parents, siblings, treatment providers, etc.). 

You can tell your child that they need to eat or stop purging for months and years with very little impact. This isn’t because what you’re saying isn’t true. It’s also not because your child is hopeless or disrespectful. It’s because treatment is working on the wrong end of the equation

The more we push cognitive processes in eating disorder treatment, the deeper the eating disorder may dive. It can be incomprehensible that with all this knowledge and expensive treatment a child still doesn’t get better. Especially because many times the child is engaging in treatment and telling you they want to get better. But once you understand the role of top-down vs. bottom-up processes it makes a lot of sense.

Typically we focus on the behaviors of making them eat, stopping the binge or purge, etc. And don’t get me wrong: parents can and should set up structures for behavioral change. But without understanding and addressing the “why” or the driver of the eating disorder, which typically lives in the emotional (non-cognitive) system, we will likely see very little change. 

Seeking behavioral compliance without understanding why the behavior exists is a recipe for frustration and ineffective treatment.

Bottom-up treatment for eating disorders

I’m not suggesting that all eating disorder treatment is ineffective. After all, I teach behavioral strategies to my clients. And many people do recover using current standards of care. What I do think we need to see happen however is the addition of bottom-up treatments.

Today we have the power of neuroscience. We understand the nervous system in ways we never did before. Research and insights from people like Drs. Daniel Siegel, Tina Payne Bryson, Pat Ogden, Peter Levine, and Stephen Porges help us understand behavioral problems through an entirely new lens.

This new lens is being applied in many areas, including treatment for ADHD and autism. It’s revolutionizing the way we treat addiction. I believe it should be applied in the treatment of eating disorders. And parents and professionals who are doing this are seeing positive results.

I don’t think we need to overthrow current treatment, but I do think we’re missing out on huge opportunities to treat the bottom-up side of eating disorders. Here are the things I’d like to see added to treatment:

Professional therapies

Today most treatment focuses on medical (weight and bloodwork), psychological (cognitive therapy), and nutritional. These are all necessary and helpful. But I’d like to see an expansion into therapies that address the nervous system. These can include things like: 

  • Somatic therapy
  • Hypnotherapy
  • EMDR (eye movement desensitization and reprocessing)
  • Vagus nerve exercises and toning
  • Yoga
  • Mindfulness meditation
  • Trauma-informed massage and bodywork

These therapies don’t rely on cognitive processes but instead tap into the body to soothe and regulate the nervous system. Just like with traditional therapies, it is important to check the professional’s credentials, training, and track record in working with trauma and eating disorders. One caution is that working with the body like this requires a great deal of skill and conscious attunement. This is still a new and growing area of treatment, so pay attention to how it feels and seek another option if you sense it’s not having a positive impact.

Parent treatment

Today most treatment focuses on the child who has an eating disorder. When parents are involved, it’s typically in the areas of feeding, possibly attending some family therapy (cognitive), and getting the child to treatment appointments. These are necessary and helpful. 

But I’d like to see an expansion of the parent role into learning how to use emotional co-regulation to help the child. Our children are not born with the ability to self-regulate. They learn how to do this with our support and through repeated experiences of co-regulating with us. Parents who learn to intentionally co-regulate with a child who is struggling with behavioral disorders can make a huge impact. It takes some training and practice, but it can also transform your relationship and ability to support your child’s recovery.

To get started, you can download my eBook: Emotional Regulation Skills for Parents Who Have Kids With Eating Disorders. In this eBook you’ll learn how to recognize the different emotional states and how to respond, plus powerful worksheets to help you get started.

A new way forward

My experience in working with parents and professionals is that everyone desperately wants to help kids recover from eating disorders. I do not believe there is a lack of trying or love in the treatment of eating disorders. But I do think there is room to expand professional treatment and empower parents to engage more fully in effective treatment. 

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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Does intervention work for a child with an eating disorder?

Does intervention work for a child with an eating disorder?

Michelle has watched her daughter Marisa slip further and further into an eating disorder; now she wants to hold an intervention for her child. “I can’t sit by and watch this anymore,” she says. “It’s absolutely killing me to see her hurting her body so much, and I’m tired of walking on eggshells.”

I completely understand Michelle’s concerns. Eating disorders are a very serious mental illness, and we know that early, effective treatment can really help. Michelle has tried many times to have conversations with Marissa. but she feels constantly shut-down and has no idea how best to proceed.

After doing some research and finding a treatment program that she thinks will be a good fit for Marissa. Michelle is ready to stage an intervention to make it happen.

Why people use interventions

Interventions are often used in the context of people who have drug and alcohol dependencies. Their families and friends will gather. Sometimes a facilitator will be there. They surprise the person with addiction and share why they think the person should get treatment.

Interventions have been made very visible through popular television shows. Notably, A&E’s Intervention, which has aired for 20 seasons. “It follows one/two participant(s), who are dependent or are addicted, documented in anticipation of an intervention by family and/or friends. During the intervention, each participant is given an ultimatum. Go into rehabilitation immediately, or risk losing contact, income, or other privileges from the loved ones.” (Wikipedia

An intervention is a structured conversation between loved ones and a person with addiction. The intention is for loved ones to tell the person how their actions impact them. They also state why they believe recovery is important. The goal is to inspire the person with addiction to accept treatment as the best next step.

The challenge with using interventions with eating disorders

Eating disorders are deeply complex mental disorders. While substance addiction is based on a substance that can be removed from the person’s life, eating disorders are not something that can be solved with abstinence. People cannot be abstinent with food, and asking a person who is deep in an eating disorder to abstain from their behaviors can have serious repercussions. The eating disorder is a coping mechanism for emotional despair. Abrupt abstinence can leave the person without a safety net.

And while loved ones certainly can and should talk to someone who has an eating disorder, they need to be very careful about dangerous assumptions and misunderstandings about eating disorders. This is especially true of parents, who hold tremendous power in the relationship with their child. Parents and loved ones can accidentally encourage the eating disorder behaviors. In fact, eating disorder interventions can exacerbate and reinforce some of the very conditions in which eating disorders thrive.

An eating disorder intervention goes sideways

This is what happened when Michelle brought her husband and other kids together to intervene in Marissa’s eating disorder. While she had all the best intentions, the intervention quickly went awry. “Almost immediately things went wrong,” says Michelle. “I thought that starting by talking about her weight and disordered eating behaviors was the way to begin, but Marissa instantly shut down. It was as if I could see the shades go down over her eyes, and she just tuned us out.”

Michelle and the family doggedly pursued the intervention, reading letters imploring Marissa to go into treatment. But Marissa just sat silently, not engaging at all. “She sat back against the sofa and crossed her arms,” Michelle said. “She pretty much just ignored us. And when we finished what we had planned, she just asked if she could be excused and left the room.”

Michelle was devastated. All her careful planning had done nothing to change Marissa’s behavior. And now Marissa was spending even less time with the family. “She now refuses to eat any meals with us because she says we’re all watching her,” says Michelle, in tears. “I just don’t know what to do.”

What went wrong

While interventions may work for some people who have a child who has an eating disorder, they can also backfire like Michelle’s. Michelle did everything right according to common beliefs about interventions, but the problem is that the very premise of an intervention for a child who has an eating disorder is problematic.

Unlike substance addiction, eating disorders don’t have a “villain.” If someone is dependent on alcohol, an intervention makes the alcohol the villain. In this way, it’s not that the person themself is flawed, but that the alcohol is an evil outsider that needs to be tamed and eradicated.

But eating disorders are not substances – they are behaviors. The person who uses the behaviors has a mental illness. This means that the only possible “villain” in eating disorders can be interpreted as the person themself. In other words, rather than telling someone to stop using alcohol, you’re telling someone to stop a behavior that to them is essential to who they are.

While it is popular to separate the eating disorder from the person, the fact is that eating disorder behaviors are inside of the self. The “drug” is their own beliefs, fears, cravings, and behavior with food and exercise. With eating disorders we cannot separate the “drug” from the person like we can with substance addictions.

Questions to ask yourself if you’re thinking about staging an intervention for a child who has an eating disorder

If you are thinking about staging an intervention for your child’s eating disorder, consider these questions first.

1. Do I believe (on any level) that eating disorders are a personal choice?

This is a core belief about eating disorders that is false. It’s often hidden, so really sit with this question for a while to uncover whether this belief exists anywhere in your subconscious. Eating disorders are mental disorders with serious causes and health impacts. A person with an eating disorder is in tremendous psychological and physical pain. They are not choosing their disorder. It is the only way they can tolerate living right now. Interventions frame addiction as something over which the individual has power and control. A person who has an eating disorder does not have power and control over their eating disorder.

2. Am I using words like stubborn, controlling, and manipulative when I describe my child?

These are words that are commonly used by people when they talk about people with eating disorders. But they are misguided. Again, eating disorders are mental illnesses. They are not a choice, and they are not something your child is doing to you. They are something that your child is experiencing. And it is awful to live with an eating disorder.

An intervention is a well-meaning attempt to get the person who has an addiction to see their behavior from their loved ones’ perspective. But this is in fact an emotional manipulation tactic. The purpose of an intervention is to carefully control the meeting so that the person goes into treatment as a result. I encourage you to look carefully at how interventions can be seen as manipulative and controlling.

3. Is this intervention based on television shows I’ve watched?

Remember that Intervention is a television show. It is the product of a company (A&E). The company and everyone involved in its production make money from the product. A&E produces and markets a family’s pain in exchange for profit. A television show is not a good guide for managing your family. It cannot replicate the complexities of your family dynamics any more than a holiday special captures your family’s unique experience of the holidays.

4. What is my goal of the intervention?

This is an important question in any eating disorder situation. What is the goal? When you stage an intervention, your goal is to get the person into a specific treatment that you believe is best for them. But the underlying goal is for your child to recover from their eating disorder. Next, broaden the scope of your goal even further. This is a mental illness, which means your child is in pain and your goal is for your child to feel better. With the goal of “feeling better” in mind, consider that you have many options beyond a single treatment approach.

The fact is that eating disorders are poorly understood, poorly researched, and thus have many treatment options that may or may not work. Going into an intervention with your child assumes that you know what’s best for their eating disorder, but nobody actually knows what’s best. We simply don’t have enough data to say with clarity what is the best treatment for your child’s distress. The more you can engage them in treatment, the more likely you are to find a path that works for them.

Reassuring Michelle

Now that the intervention is over, Michelle is even more worried about Marissa. Mainly because she worries that the eating disorder is getting worse and she has run out of ideas about how to help. The intervention was her best attempt to help Marissa, and it didn’t work.

But there is a huge gap between “I tried something and it didn’t work” and “I can’t do anything.” In fact, there are many things parents can do to help their child feel better. You are not limited to formal eating disorder treatment, and a conversation about mental health isn’t a one-time event.

So first Michelle needs to know that she didn’t do anything wrong in attempting the eating disorder intervention. She made the best choice she could at the time. The next thing she needs to know is that the intervention wasn’t her last chance to help Marissa. The TV show suggests that the intervention is the last step, and that the family has now done everything possible to help. But the truth is that there are many other steps towards healing from an eating disorder.

What parents can do instead of an intervention

There are many things parents can do instead of staging an intervention for a child who has an eating disorder. Here are some recommendations.

1. Talk about feelings (often)

Most parents are understandably alarmed by the food and exercise behaviors of an eating disorder. This makes total sense. And they are dangerous and should be monitored and treated by a professional if at all possible. But if your child refuses treatment, you can still help.

Remember that an eating disorder is a mental illness that causes physical symptoms, not the other way around. This means that treatment is about learning to feel and process feelings more effectively. This can start at home. Begin by talking to your child often about their feelings. Find ways to frequently check in with them about how they are feeling. Build their (and your whole family’s) emotional literacy by making conversations about feelings completely normal.

2. Spend more time with them

They may reject your overtures, but find ways to spend more time with your child anyway. A person who has an eating disorder is very lonely and feels both a deep desire to be seen and a fear of being seen. Take short walks together, run errands, cook, garden, read, color, play games, do puzzles, or just sit together. Normalize spending time together, and make it low-key and not stressful. If they’re interested and willing, consider journaling together, which will bring together spending time and talking about feelings.

3. Take them to get regular check-ups to monitor their health

Your child may be resistant to treatment, but it will be harder for them to refuse to visit a doctor regularly for a health check up. In fact, they may even offer to do this instead of getting treatment for their eating disorder. Of course your long-term goal is for them into treatment for their eating disorder. But getting regular health check ups can help you feel more secure if your child absolutely refuses treatment.

Important note: weight is a huge trigger for anyone who has an eating disorder. Ask the doctor to do “blind weight” so that your child cannot see and does not have to experience the number on the scale. Also tell your doctor to only talk to your child about their weight with your express permission.

4. Encourage them to see a therapist or dietitian

Of course you really want them to seek full treatment for their eating disorder. But lots of people with eating disorders struggle to see themselves as “sick enough” for treatment. However, they may recognize that they struggle with anxiety or depression. In this case, find a therapist who can talk to them about anxiety and depression but who is also trained in eating disorders. Asking your child to see someone once per week may be an easier route to treatment than enrolling them in a full program.

Similarly, even if your child refuses psychotherapy, they may be interested in seeing a dietitian to help them with their nutrition. Most people who have eating disorders are deeply interested in nutrition, and will be willing to talk to someone about that. One caveat: make sure the RD you select is trained in eating disorders. You don’t want to see someone who could exacerbate the problem. We have a directory of eating disorder therapists and dietitians who can help.

5. Pursue therapy or coaching for yourself

There are a lot of things that parents can do instead of an intervention to help a child with an eating disorder. So if your child completely refuses any form of treatment, you can still make a difference. Therapy or coaching can help you start to see the conditions that might be causing the eating disorder. It can also help you change your own behavior in important ways.

For example, parents can learn to support their child without accommodating the eating disorder. They can also work towards achieving any of the other four recommendations here. A therapist or coach can help you talk about feelings and spend more (and less stressful) time together. They can also help you try different approaches to get your child in for regular check ups, psychological, and nutritional counseling.

There’s so much you can do!

Michelle worked with a coach to help her learn more about eating disorders and open conversations with Marissa. Over time, she was able to help Marissa enter treatment for her eating disorder. Michelle thought an intervention was the only way to help her child with an eating disorder. And while the initial intervention did not work, Michelle didn’t give up. Michelle’s approach after the intervention created significant improvements for her whole family, including herself.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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Clinical hypnotherapy for eating disorder recovery

3 Ways Clinical Hypnotherapy Can Help in Eating Disorder Recovery

by Bonnie Killip, Master Clinical & Medical Hypnotherapist 

Have you ever wondered if hypnotherapy can help with eating disorder recovery? If traditional eating disorder recovery is not progressing, it may be worthwhile considering hypnotherapy as a treatment option.

As a Dietitian and clinical and medical hypnotherapist, often my consults start with addressing people’s questions, concerns, and often skepticism around what hypnosis is. Let’s start by clearing up the common misconceptions. 

Hypnotherapy is not a trick nor is it mind control and it is also much more than meditation or relaxation.

Full disclosure: I’ve been one of the skeptics 

Until a few years ago hypnosis was not a part of my life. It wasn’t even on my radar. A no-nonsense biomedical scientist, I was only interested in evidence and randomized controlled trials (RCTs). 

I did not believe in using personal stories or anecdotal evidence. I believed in nothing that lacked piles of peer-reviewed literature and meta-analyses. 

In fact, if I’d even heard the word hypnosis, I’d have most likely tuned it out. Now, I cannot imagine my life without what hypnosis has brought and continues to bring to my world both personally and professionally. Actually, I can, but I’d rather not!

After 15 years of living with anorexia nervosa, clinical hypnotherapy not only saved my life – it gave me a life. 

And that’s no longer the most interesting part of my story. Because I now work daily with others who have fallen out of touch with their inner guidance. These people are in positions where all else has failed and they’ve all but resigned themselves to their eating disorders. To live a life of attempting to maintain pseudo-physical health while never being entirely well. 

Hypnotherapy for eating disorder recovery

I now have the daily privilege of facilitating people of all ages and life circumstances. I work with all types, from anxious and confused 10-year-olds to perfectionist and overachieving 16-year-olds, to successful 65 year CEOs and 87-year-olds. All of them want to begin the part of their lives where they are finally free to be themselves. 

I have both personally experienced and seen first-hand how hypnotherapy can help with eating disorder recovery.

Clinical and medical hypnotherapy offers a direct means by which we can bring about change in an area a person could not change through education, willpower, threats, or motivation alone. The profoundness of what this means in terms of someone’s day-to-day experience of life is high. Because information and knowledge is only part of the picture. It is not until we can put this into practice that we can experience the true benefits. 

Clinical and medical hypnotherapy is an effective eating disorder treatment because it:

  1. Treats the non-logical brain. Eating disorders are non-logical, so it can help to treat them on that level.
  2. Rewires neural pathways. Eating disorders can create rigid neural pathways that need to be loosened in order to recover.
  3. Feel good now. Recovery typically feels like chaos, so any method of feeling good during the process helps.

How does hypnotherapy work for an eating disorder?

Hypnotherapy is individually tailored to each person. It can be a powerful way to change beliefs and disruptive behaviors. The focus is on building the skills people need to function at their best versus rehashing past trauma or searching for a cause.

In hypnotherapy, a person is empowered to work on an unconscious and conscious level to change beliefs and behaviors that are interfering with their life. For example, if a person is afraid of food, we would work on decreasing the fear response both subconsciously and consciously. By experiencing the fear and moving through it in the safety of hypnotherapy, the person acquires confidence and fear patterns are reduced or eliminated over time. 

This works because the brain cannot tell the difference between an imagined scenario and a scenario that is taking place in the physical world. While it could take months of careful psychotherapy to get a person to face a fear food at the dinner table, we can face the imagined fear food in hypnotherapy rather quickly.

If a person is struggling with binge eating and/or purging behaviors, we could explore the unconscious fears underlying those behaviors. We would practice facing them in a safe, secure environment. 

The actual practice of hypnotherapy may include: 

  • Trance induction (direct or indirect)
  • Suggestion
  • Metaphor
  • Conversational hypnosis
  • Neurolinguistic programming

Hypnotherapy is specifically outcome-focused. We precisely target exactly what it is a person wants to change and then go about bringing about that change.  

Here is some more detailed information about the benefits of hypnotherapy:

1. Treating the non-logical brain

An eating disorder is not a logical problem.

Ask anyone with an eating disorder if they are choosing to feel those feelings or do those behaviours. I can guarantee they’re not. There are powerful emotions driving them to not eat, to binge, to over-exercise or whatever it is for them.

If the eating disorder was something you could fix through logic, information and understanding you’d have done so.

Clinical hypnotherapy offers a means by which we can re-establish rapport with the unconscious mind. In more science-y terms, we work with our autonomic nervous system. The goal is to restore back to what your body has known how to do all along before the outside world made you question the innate wisdom of your body. 

We’ve all had the experience of being children, and as children, we had no problem connecting to our bodies’ messages. And we have no problem communicating this. As a baby, we don’t think “I’m hungry but I can see mum is tired and busy at the moment, so I’ll just wait”. Nope, we scream and yell until we get that need met! 

Reconnecting with our bodies

If we want to be a successful adult, we have to at some point move on and meet those fundamental human needs for ourselves. If we do not, we become disconnected from the signals our body is sending. The body may even stop sending signals. Because, after all, “what is the point of telling her to eat if she will not do it, anyway?”

When we get out of the way, our body is free to do what it has evolved to do. It will steer us towards health naturally and without our micromanagement. You don’t have to think about when and how quickly you want your heart to beat or your lungs to breathe, do you? There are things your unconscious knows how to do much better and with much more ease than your conscious mind. 

2. Rewiring neural pathways

Hypnosis offers a direct means of altering neural networks and neural rewiring.  

When it comes down to it, this is the crux of eating disorder recovery, and it’s why hypnotherapy can help. 

At some point, recovery becomes recovered. And recovered is an entirely fresh way of not just behaving but also, crucially, of thinking and feeling.

The behaviors of an eating disorder often begin as a coping strategy. They are compensation or an attempt to meet a need (to be healthy, good, more confident, or better liked. But with time it turns from conscious choices into unconscious patterns. Hence why it is a disorder. Because the thoughts, feelings, and behaviors are no longer under the conscious volition of the person. 

The eating disorder then persists at an unconscious or habit level because neurons that fire together wire together. 

In recovery we change the structure, not just the function, of the mind. And there are many ways in which we can do this. Exposure therapy and cognitive behavioral therapy are the most well-known treatments. But hypnosis often offers a means of changing the structure more quickly and safely than either of these. 

Bypassing the habits of an eating disorder

Hypnotherapy bypasses the need for the involvement of the conscious mind. It goes right to where the issue is being maintained: the unconscious mind. The eating disorder thrives not in our prefrontal cortex but in our lower brain areas such as the amygdala. 

When I was sick I’d been told by so many therapists and doctors that my brain had changed because of the illness. That I’d been sick so long it most likely wasn’t possible that I could ever fix the damage or recover. What I know now is that the very fact that my mind changed to accommodate the illness meant it was more than possible for it to change back. It could even improve and rewire in all the ways it needed to to be not just free of the illness, but healthier than ever before.

 I just needed the means by which to do this. It turned out clinical hypnotherapy helped me recover from my eating disorder. 

3. Feel good now

Take a moment to answer this question:

If your child could feel great or good about eating, would they have a problem eating?   

The answer is always a resounding yes. And this is why recovery can be so hard for loved ones to understand. It may be hard to imagine, but choosing recovery from an eating disorder is choosing chaos and pain. 

To everyone outside of the disorder, recovery is short-term chaos with long-term rewards. But the person in the disorder doesn’t feel like the chaos will ever end. It feels like you are choosing indeterminate chaos and pain with no guarantee that it will have been worth it. 

The resistance to the chaos and pain is why recovery can go on and on and on for many people. I know this was my experience until I did eventually find the help that could help. And a lot of this has to do with the fact that it never feels good. If there are no wins, we lose heart, back down, and find ourselves back in old behaviors.  

How motivated, inspired, and excited are you to jump into shark-infested water just because someone tells you the island on the other side is incredible? Not much, I imagine. And that’s what it feels like for someone with an eating disorder. Eating feels unsafe, and we are asking them to do it 6 times a day as though it is nothing. Therefore, the way to truly help someone is not by focusing on all that is wrong. Instead, we must increasingly allow them to experience wins that show how recovery is worth it.

Achieve a relaxed, calm state

In hypnosis, we experience eating in a relaxed and calm state. We support the circumstances and situations which in their everyday eating disorder state of consciousness produce extreme anxiety and panic. This teaches the nervous system that they can get through these things safely and feel less panic when eating.

The power of hypnosis is that our minds produce exactly the same response whether we are in a dangerous situation in real life or we imagine being in a dangerous situation on the inside of our minds. Take a moment to imagine biting into a juicy lemon to get a sense of what I mean here. If you really imagine it, you will salivate and maybe make a scrunched-up face.    

Take-home message

We don’t know all there is to know about the intricacies of eating disorders. But we know enough to know that education, shame, and blame do not heal. 

We know that eating disorders are on the rise. And even our gold-standard treatments often fail those who seek to recover. 

If you’ve tried one treatment path and it hasn’t worked, it may be time to expand and experiment with other options. Keep in mind that clinical hypnotherapy is an option. It’s a viable tool that I believe will only become more widely used as we improve our understanding of the human mind and what truly drives our behaviors. 

Thanks, Mom!

I could never capture in words just how thankful I am that my mum looked outside the box of what was offered to us for years and years and booked me into that first hypnotherapy session. 

Kids are great hypnotic subjects because they enter a hypnotic trance easily. They go farther and get a lot done when they get to be the creators of their destiny. I truly believe that building rapport with our unconscious mind is one of the greatest determining factors in how far we go in life. To re-establish this at a young age if it is lost or teetering on the verge of being swamped from ever-increasing messages from the outside world over what to eat, how to look, think, feel, and do, is inconceivably valuable.

Clinical hypnotherapy with a licensed professional offers a safe and controlled environment in which your child or yourself can try out fresh ways of being, something we often don’t otherwise get in the day-to-day rush of life.   

Eating disorders are complex, but please do not let complexity lead to undertreatment.

Bonnie Killip Fuelling Success

Bonnie Killip is an Accredited Practising Dietitian (APD), Master Clinical and Medical Hypnotherapist, and Master Neurolinguistic Programming Practitioner. She offers practical and usable nutrition education for those in recovery from eating issues. As a clinical and medical hypnotherapist, she can help kids reconnect with their inner guidance and develop the internal skills and resources to set them up for a life of emotional regulation, self-love, resilience, and happiness. Website: Fuelling Success

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7 steps to find a great therapist for your child who has a mental health condition

If your child is facing a mental health condition like an eating disorder, suicidality, self-harm, substance abuse, anxiety or depression, it’s easy to feel overwhelmed. And while your child’s pediatrician may help you get an initial diagnosis and point you in the direction of therapists and/or treatment programs, it’s still up to you, the parent, to make the right choice for your child.

First, consider how you will approach finding a therapist for your child. To do this, gather your insurance details and find out how many sessions are included, what is your deductible, what therapists are included in your policy?

Before interviewing a therapist, consider getting the following details up-front:

  • Where is the therapist’s office? Is it reasonable for you to get your child there at least once per week?
  • How many times per week does the therapist want to see your child, and what time slots do they have available? Will this schedule be feasible for you?
  • Will there be a co-pay or are you paying out of pocket? If so, can you afford this therapist?

We recommend identifying at least three different therapists to interview for your child. To find these therapists, you may have to call around from the list your insurance provider gave you, and be prepared for therapists who are not currently taking new clients, who don’t have time slots that work for you, or who do not work with children who have your child’s condition. This can be frustrating work, so be prepared.

Once you begin interviewing therapists, stay organized! Keep detailed notes of the therapist’s name, rate/co-pay, recommended treatment plan, and any thoughts and details you get out of your interview. You will think you’ll be able to remember which therapist you like without notes, but it’s really much better if you document your interaction. Also, if the therapist you choose ends up not being a good fit after a few months’ treatment, you may want to revisit your notes.

Here are seven steps to help you find a great therapist for your child who has a mental health condition:

1. Check their credentials

There are many types of therapists, so it’s important to start by understanding what the different credentials mean. There are two main types of licensed therapists: Licensed Clinical Social Worker (LCSW) and Licensed Marriage and Family Therapist (LMFT). Both have a master’s-level degree and at least to years of supervised clinical practice. Both are qualified to assess, diagnose, and treat the full range of mental and emotional disorders in the Diagnostic and Statistical Manual through the use of psychotherapy. The difference between these two licenses is blurry, so it’s best to ask your prospective therapist why they pursued their particular license.

You may encounter professionals who are in pursuit of their licenses, which means they can charge less. The trade-off is less experience. If you work with a professional who is not yet licensed, you want to be very clear about their level of training and understanding, particularly as it relates to your child’s current status.

There are professional certifications for specific challenges such as eating disorders and substance abuse. If your child has a specific diagnosis, you can ask your prospective therapist whether they have any certifications or specific training in that area.

NOTE: if disordered eating and/or body image is part of your child’s condition, it is important to find a therapist who follows a non-diet approach/weight-neutral approach. Ask specifically whether the therapist is familiar with these approaches. The therapist should be aware of the dangers of a weight-based paradigm. Do not work with a therapist who promotes weight loss as an outcome, regardless of the eating disorder type (e.g. binge eating disorder). This is an outdated approach to eating disorder treatment and can be very harmful.

2. Ask them questions

The single best thing you can do when evaluating a potential therapist for your child is to ask a lot of questions. Choosing a therapist is not like choosing a car to buy – it’s not just about lining up cost and features and selecting based on rational criteria. Therapy is a relationship, not a transaction so it’s important for you to understand your therapist’s motivations, approach, and philosophy.

One of the best ways to evaluate how your child’s therapist will treat your child is to evaluate how they treat you when you ask questions. If they seem disturbed, bothered, or put out by your questions, that may be a sign of impatience. On the other hand, if they treat you with compassion and respect, while still maintaining professional boundaries, you can make an educated guess that they will treat your child in the same way.

3. Talk about expectations

It is perfectly reasonable for parents to ask a prospective therapist about what can be expected from the therapy process. There’s a good chance that the therapist’s answers will be somewhat vague since every therapeutic intervention is unique in its own way. Nonetheless, you should feel reassured that your child’s therapist has expectations for recovery and will follow a path that they believe will achieve certain milestones along the way.

4. Find out how you’ll be involved

The old model of childhood therapy was to keep the parents at a distance. The concept was that if a child was in therapy then their parents had done enough damage and needed to stay away so the child can heal. This approach is generally not recommended anymore since parents can be an essential component of healing from and managing a mental condition.

Your child’s therapist should be able to give you an idea of how often they will communicate with you and whether there will be any family sessions incorporated into the treatment plan. You should also find out how the therapist wants you to communicate with them if you observe any dangerous or concerning behavior at home.

5. Ask for a treatment plan

It doesn’t need to be typed up as a proposal, but your child’s therapist should be able to communicate with you what their treatment plan is based on your child’s condition. The treatment plan is designed to guide your child towards reaching recovery goals. It will also help your child’s therapist measure progress and make treatment adjustments along the way. A therapy treatment plan is not a rigid model, but it is a map to help the therapist, child, and parent all get on the same page about treatment.

6. Listen to your gut

Remember that therapy is a relationship, not a transaction, so one of the most important things, when you select a therapist for your child, is to listen to your gut. If you have an uneasy feeling or are unsure whether the therapist is a good fit for your child and your family, it’s OK to keep asking questions and interview some other professionals to test the waters.

It’s also OK if you engage a therapist and disengage later due to a lack of fit. Remember that the therapist’s work is likely going to disrupt some established patterns for you and your whole family, so when you’re evaluating a therapist, it can help to look closely at whether you really don’t like the therapist or if it’s just that you and your child are uncomfortable with the necessary changes that take place during recovery.

7. Listen to your child

Your child is the one who is working with the therapist the most, so it’s important to listen to your child. Of course, some children are very resistant to therapy in the first place, so you have to listen very carefully to try and tease apart their resistance to recovery vs. their resistance to the therapist.

If your child is complaining about the therapist, that’s not always a sign that there’s a poor fit, but it’s definitely worth letting the therapist know what’s happening at home, and what the child is saying about therapy.

A child may seem engaged during therapy and be making progress, but then they speak poorly of the therapist to others. This is tricky, but don’t shy away from having open-ended conversations with your child about their experience with therapy and the therapist so you can help guide them towards health and healing.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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Get answers to your questions about eating disorder treatment

We held a Q&A webinar with eating disorder therapist John Levitt, Ph.D. on May 5, 2019. Here are some important questions he answered for us.

1. Do you have any advice about FBT for eating disorders?

Answer recap: FBT (family therapy) is one of the evidence-based therapies available for eating disorders. It’s effective for a certain group of patients. Its primary outcome is to cause weight gain.

2. Should I send my child to residential treatment for an eating disorder?

Answer recap: The purpose of a program is to stabilize and refeed to manage the critical side effects of an eating disorder. I’m concerned about sending a child away from their family and recommend asking: how is the family involved, and how does the family sustain recovery when they return home? Often a local treatment program can achieve the same goals.

3. What should I do if my child is in treatment for an eating disorder and the behaviors aren’t stopping?

Answer recap: If your child is in a treatment center and their behaviors aren’t stopping, it’s important to understand why that is. Ask questions, and understand the goals and treatment plan.

4. Parents are doing their best, why isn’t child recovering from their eating disorder?

Answer recap: Your child not recovering doesn’t mean you’re doing anything wrong. Most people recover from an eating disorder, but it can take time. Recovery depends on many factors, including how long they have had the eating disorder. It’s OK to sit down with the therapist and ask how treatment is going. You should have some sort of treatment plan to guide the process.

5. What is evidence based treatment for an eating disorder?

Answer recap: Evidence-based treatments have been tested with group studies in which there have been random assignments to different treatment types. Certain therapies have been statistically proven to be more effective. It’s important to ask the therapist or treatment center what it means to use “evidence-based” treatment and how do they use it?

6. Why, if the eating disorder behaviors are under control, does my child still need therapy?

Answer recap: When someone recovers from an eating disorder, they may still have trauma symptoms, anxiety, depression, self-harm, and other residual symptoms that existed in addition to the eating disorder. These conditions and symptoms can be a good reason to continue therapy beyond eating disorder treatment.

7. If my child has trauma and an eating disorder, will an eating disorder treatment center treat both?

Answer recap: If possible, find an integrated treatment approach that addresses eating disorders and other challenges like trauma, self-harm, etc. Be sure to ask your treatment team or therapist whether they are using an integrated approach.

8. How do I find a good therapist for my child who has an eating disorder?

Answer recap: Ask a lot of questions! The therapist is a guide, and it’s their job to facilitate recovery with the child and the parents. We should be available to answer parents’ questions. If your child is not responding to treatment, it’s not always because the therapist isn’t “good,” but it is important to talk to the therapist about the treatment plan and that they can communicate with you and your child.

9. Our therapist told me to be patient with my child who has an eating disorder – what does that mean?

Answer recap: I’d ask “what does ‘patient’ mean?” and try to find out what the therapist is asking for. Yes, treatment takes time, but you should see some results. If your child is medically compromised, you don’t have time to be patient. But if you’re talking about therapy, it’s a process. It does take time. Ask what you should be doing while you’re “being patient.”

10. My child’s in treatment for an eating disorder, what should I be doing?

Answer recap: Ask your child’s therapist! You should receive suggestions from the program or therapist regarding what they think will be helpful. Your outpatient therapist should regularly give you recommendations about what to do. I suggest parents provide support, love the child, supervise the food, weight, eating, and be mindful of purging. If the child is at a more acute stage of eating disorder behavior, parents may need to be more active in preventing the behaviors.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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A mother’s perspective: insights and experience gained in supporting my daughter in her recovery

Eating disorders are not well understood, isolating, frustrating, and painful. And that goes for the person who has it as well as the people who love and support that person. When a child develops an eating disorder, parents can easily become overwhelmed by treatment, fear, and frustration. It can help to hear stories from other parents who have gone through the recovery process.

This eBook was written to provide a mother’s perspective of her daughter’s eating disorder recovery. This eBook is provided courtesy of Recovered Living, a recovery coaching service that, from this mother’s perspective, was a critical element of her daughter’s recovery from an eating disorder.

A mother's perspective - insights and experience gained in supporting my daughter in her recovery

Following are a few excerpts from the book, but it’s well worth reading in its entirety for more details and perspective.

What I learned about recovery

“(To me) owning recovery involves eating, feeling emotions, building relationships and participating in life – everything an ED denies.”

“My daughter was told that recovery is harder than she could imagine … and supporting her in her recovery has been so much harder than I imagined, too. I can see why those who recover can accomplish anything they choose in life because I think I could tackle most things now and I’m only the support person.”

“My daughter initially struggled until she found a recovery coach who stated outright that becoming fully recovered was possible. For her, the knowledge of being able to recover was the foundation to her decision to commit fully to recovery, but even then the pull of the ED was still very, very strong.”

“Learning to own recovery includes allowing feelings to be felt; good and bad.”

“Real recovery comes from being able to emotionally step back in life; a life the ED is accustomed to numbing them from.”

My own relationship with food & weight

“I previously thought I had a good relationship with food, but I was silently a watcher of my weight and a dieter, although I never openly dieted or talked about my weight. I hadn’t realized that my own self-esteem was tied to the size of my clothing.”

“… for me, addressing my own issues around food, body image, and weight has been crucial.”

“Eating what I want, doing what I want, and being me, without judgment based food eaten and what the bathroom scales say, is freedom – just like I want for my daughter.”

“I could never imagine going back to how I was before, which is how so many other mothers I know live. The sense of freedom is very liberating.”

Walking on eggshells

“I have never walked on so many eggshells in my life since an ED took up residence in our home!”

“… no one told me we did not need to walk on eggshells. Only after we found her recovery coach did I learn that this behavior was actually the ED exerting control over the whole family …”

“If an ED had its way, it would zip everyone’s lips. Talking can help draw my daughter our and temporarily away from her ED because she can’t withdraw and be present in a conversation at the same time.”

Siblings and friends

“It has been tough on (her brother) and early in her recovery he did ask a few times if he was ever going to get his sister back.”

“… there aren’t many teenage girls who have the fortitude, maturity or innate wisdom to stand by a friend when an ED is pushing them away.”

“… for my daughter, a big part of her second half of recovery has been about building new friendships and connecting with people who contribute to her growth and joy.”

What I learned about treatment

“Recovery involves learning and learning leads to growth. (This is) why having a recovery coach specialized in ED recovery has been vital for my daughter, as no one else could provide this type of expertise.”

“My experience shows a person in ED support needs to be specialized in the area, not dabble in it as part of their job description, because ED work is a career path that has chosen them and not the other way around. Having a recovery coach or therapist who has recovered themselves is also a prerequisite in my opinion …”

“I joined a Facebook group set up to help mothers navigate recovery, but within a couple of months I realized it was more harmful than helpful because the group embraced a victim and sympathy mentality which I likened to a “stagnant pond” environment where nothing positive could grow from.”

“Fortunately my daughter’s recovery coach offers her own online support group and this makes a real difference. It is free to attend and has been gold.”

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Best care package ideas for a person who has an eating disorder

care package ideas for eating disorder recovery

Do you know someone who is being treated for an eating disorder? Do you want to show them that you care? A care package is a great way to connect with someone who has an eating disorder. It’s a wonderful reminder that people who love them are cheering them on. Top ideas for care packages include:

  1. Art/craft supplies
  2. Boredom/anxiety management items
  3. Comfort items
  4. Writing supplies
  5. Personal notes and mementos

Why send a care package to someone who has an eating disorder?

An eating disorder is a serious illness. However, unlike other illnesses like a broken arm or even cancer, most people don’t really understand eating disorders. Like all mental illnesses, eating disorders carry an unnecessary stigma, which can make it hard for friends, family, and loved ones to know how to respond.

People who have eating disorders can feel lonely and isolated. They may feel ashamed or guilty about their illness. But just like anyone who is facing a medical challenge, friends, family, and loved ones can really help by showing up, talking, and helping to care for someone who has an eating disorder.

Sending a care package is a great way to show support for someone who has an eating disorder. Whether the person is in treatment at a care facility or at home, it’s a loving, wonderful way to show that you care.

Sending a care package to an eating disorder treatment center

Eating disorder treatment facilities are a place where eating disorder recovery takes place in a managed care setting. These facilities make an effort to make the living conditions home-like. But just like any situation when you’re away from home, it can feel a bit institutional, and it’s nice to receive packages.

If you’re thinking of sending a care package to a person in an eating disorder treatment facility, it’s a good idea to call the facility and ask about their policies first. Unfortunately, not all facilities accept care packages, and many will check the package before it is given to the person in care. It’s best to know what you can and cannot do before you start putting a care package together.

But if you can send a care package, then I recommend that you do. Everyone I’ve spoken to who received a care package during eating disorder treatment was grateful and appreciated the thought and care. A care package is a great way for family members, loved ones, and friends to connect with a person while they are recovering from an eating disorder. They are a great way to remind someone that you are thinking about them, love them, and support their recovery.

Great care package ideas for eating disorder recovery

I asked people who have been in eating disorder treatment what they want. Here’s what they said:

Art/Craft Supplies

  • Sketchbook/Pads of art paper
  • Gel pens
  • Markers
  • Watercolors
  • Colored pencils
  • Coloring books
  • Macrame yarn/thread/string
  • Knitting/crochet/embroidery supplies

Boredom/Anxiety Management

  • Word searches/Crossword puzzles
  • Puzzles
  • Fidget spinners
  • Silly putty/slime/play dough
  • Stress ball
  • Slinky
  • Rubik cube


Just like home


  • Journal
  • Gel pens
  • Stationery and stamps
  • Stickers


  • Letters, postcards, and cards
    • Avoid requests to “hurry home” or “get better soon.” Instead focus on messages like “I’m proud of you,” “I’m rooting for you,” etc. Funny and corny are good choices, too!
    • Avoid images of food or bodies, which may be triggering.
  • Photos of loved ones, pets, and favorite places
    • Avoid images of the person in recovery. Remember that they may be sensitive to their appearance.
  • Personalized pillow or blanket. For example, add a custom quote or favorite pet’s face.
  • Paint/design a personalized inspirational message
  • A souvenir from a favorite place you have traveled together. For example, a miniature Eiffel Tower, London Bridge, snowglobe, etc.

Restricted Items

  • Food and drink items are typically restricted.
  • Each treatment center may have items that they do not allow residents to receive. It’s a good idea to check with the treatment center before sending a care package to ensure delivery.


The BuddyBox, developed by the Blurt Foundation, is a care package designed to make the recipient feel good. The contents are carefully selected to avoid psychological triggers. Blurt is an organization dedicated to helping people who have depression. But the BuddyBox is gender-neutral and applicable for many types of mental health conditions. BuddyBoxes are available as a monthly subscription or a single box.

Wrapping and delivery

One of the best parts of getting a package in the mail is unwrapping it! It’s so exciting to get a gift! Therefore, here are some ideas for getting creative:

  • Wrap the gift in gift wrap with a bow
  • Add confetti or glitter to an envelope
  • Add stickers on the outside of the envelope or package
  • Find a pop-up card, card with googly-eyes, or a singing card
  • Use a map of a favorite place, like Disneyland, London, or your home neighborhood, as wrapping paper
  • Use sheet music of a favorite song as wrapping paper
  • Enclose a personal voice recording or recording of a favorite song
  • Have a cousin, niece or nephew draw a picture on the wrapping paper

What to write in a card to someone who has an eating disorder

Once you have planned everything for the gift or care package, the final touch is a card or note. But what can you say to a person who has an eating disorder? And are there things you should not say? Here are some ideas for what to write in a card:

  • I’m thinking of you and can’t wait to see you again!
  • I’ll always remember when you/we …
  • We’re all behind you and support you
  • I believe in you
  • This is hard, and I’m so sorry
  • I’m here for you
  • Call or write to me anytime
  • I’m so proud of you
  • We’re looking forward to having you back home when you’re ready
  • Can’t wait to watch Riverdale with you for the thousandth time!

These may be obvious, but here are a few things not to say in a card to a person who has an eating disorder:

  • Can’t wait to eat cake with you again!
  • I wish you weren’t there
  • It’s ridiculous that you’re there
  • Hope they aren’t being too mean – haha
  • We’re having tons of fun without you
  • I found someone else to do things with
  • I started a new diet and lost a ton of weight
  • So much has happened since you left

Understanding eating disorders

A care package is a wonderful way to show someone that you care. But the greatest gift you can give a person in recovery is your understanding and acceptance. Our society is very uncomfortable with eating disorders. It can feel very lonely to have an eating disorder even though they are fairly common.

Disordered eating is common

Recent estimates say eating disorders impact about 10% of the population. But disordered eating, which is a milder but still serious form, is very common. Estimates put it at up to 80% of the population. Above all, knowing that disordered eating is common can help you be more understanding of your loved one.

Disordered eating is societally-driven

There are many factors that contribute to an eating disorder. But we cannot ignore the fact that our diet culture drives many of the behaviors and drivers of eating disorders. Therefore, understanding the societal drivers of eating disorders can help you be more compassionate towards your loved one.

Eating disorders heal in community

While eating disorders are often treated privately and in treatment centers, the healing takes place in the community. Every person needs to eat, and eating is a part of our social fabric. When neighbors, friends, and loved ones understand eating disorders, they are less likely to make unintentionally hurtful comments. In other words, when communities commit to understanding eating disorders, they are healthier for everyone.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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What’s new in eating disorder treatment? An interview with Jennifer Rollin, MSW, LCSW-C

We sat down with Jennifer Rollin, an eating disorder therapist and founder of The Eating Disorder Center based in Maryland, to find learn what’s new in the treatment of eating disorders.

1. What do you think has changed about the way we treat eating disorders in the past 10 years?

I think there have been a lot of changes in eating disorder treatment, and we still have a ways to go. One of the big things is a shift towards more evidence-based treatments. We now have a higher emphasis on treatments that have been demonstrated by research to be effective. This will hopefully lead to improved care.

We have also seen the incorporation of Health at Every SizeⓇ (HAESⓇ) principles into eating disorder treatment. We’re experiencing a push towards more weight-neutral care, and are reducing the fat phobia that has been deeply steeped into so many treatments in the past. Providers are finally recognizing is that eating disorders impact people of all body sizes. We’re working hard to eradicate fat phobia in the eating disorder treatment space because it is incredibly harmful.

I think some residential treatment centers are lagging behind, especially in terms of supporting males who have eating disorders. We have two local treatment centers, and only one of them accepts males. Residential treatment has a long way to go in terms of equalizing eating disorders in terms of gender, race, size, and abilities. We are seeing a shift in terms of providers being more welcoming to people of all shapes and sizes, but we still need a lot more education that people who have eating disorders can be any body size, race, class, and gender.

We still need a lot more progress in terms of being welcoming to people in all types of bodies. A lot of people who have eating disorders don’t ever seek treatment because they don’t fit the stereotype and don’t seek treatment or when they do, they are not treated appropriately. Diet culture has completely normalized disordered eating so people don’t even realize they have a problem. Larger people who have eating disorders are often seen as someone who’s trying to “be healthy” and “lose weight.”

2. How do you work with adolescents who have eating disorders?

The first thing that’s most important when working with anyone, but especially teenagers, is building a relationship. It can be hard to earn teens’ trust, especially if they don’t feel a connection with their therapist or healthcare provider. We can have all the best clinical skills in the world, but if we can’t connect with a teen, we won’t get buy-in or trust, and then we won’t be effective. Personally, I think it helps that I’m younger, and I work to keep in touch with teen trends so that they feel I can relate to their world and, therefore, their deepest struggles.

When we’re working with a teenager, we have the benefit of being able to work with the family, which can really help treatment. I will utilize the family in the treatment process as much as makes sense. We have to look closely at the family dynamic and determine the best way to work in partnership for optimal treatment.

Sometimes I will use modified Family Based Therapy (FBT), especially if I’m working with a younger child and it’s a purely restrictive eating disorder. I find it’s most helpful to modify treatment for each child and each family system. Anybody who says that any one treatment is a panacea for eating disorders is problematic – we must look at each case individually. Not everything is appropriate for everyone, and not every family can or should take on FBT.

3. How do you involve parents in a child’s eating disorder treatment?

This totally depends on the person and the situation. I always share with parents that they can be involved as much or as little as they want. Sometimes I need to push for more involvement if I feel it will serve the child’s recovery. I am the child’s therapist, but I will send weekly email updates to parents, and I encourage parents to email updates to me so that I can be aware of what’s going on at home. I will invite parents into sessions and sometimes do family sessions, depending on what makes the most sense. But I always remain aware that my client is the child.

It can be very tricky to navigate fat phobia and diet culture. Parents are so well-intentioned and love their kids, but I can still see that they are trapped in our societal expectations regarding weight. A HAES-informed recovery process involves accepting the body as it is, but I still have great parents asking whether they can help the child lose weight in a healthy way. This is where we still have a lot of catching up to do in terms of educating people about the futility and dangers of intentional weight loss.

When treating a child who has an eating disorder, I become very aware of parents’ thoughts about weight. I take a gentle educational approach and tell parents that in my professional opinion, any focus on weight loss is not helpful for anyone, especially someone who is in recovery for an eating disorder. I know parents want what’s best for their kids, and diet culture has convinced them that certain foods are bad or higher weights are bad. Parents just want to do the right thing, but unfortunately, even though they are trying to help, they don’t understand that it can hurt.

I sometimes recommend that parents meet with a HAES-informed dietician who can help them understand these concepts. The analogy is that having diet foods in the house, talking about dieting, and focusing on weight loss is like going on an alcohol bender while living with someone who is in recovery for alcoholism. We have to be mindful of what we do when we live with someone who is in recovery.

4. What do you think parents most commonly misunderstand about a child’s eating disorder?

I think the most common misunderstanding is that an eating disorder is a choice. Even if parents have been told that it’s not a choice, it’s hard to accept that. We naturally want to understand responsibility and want kids to recover. Well-intentioned parents may feel upset when a child doesn’t follow a recovery plan exactly, they will say things like “you have all these skills, why aren’t you using them?” But this is where it gets tricky. An eating disorder is not a choice, but recovery is. This means that the eating disorder can slip in at any time and take over, and a person who is in recovery has to exert tremendous effort to constantly make the choice to recover. It’s so helpful to know that recovery is a process, not an event. And recovery looks different for every single person.

Of course you’re concerned about your child, and of course you’re disappointed when you see them struggling. But parents need to understand that they are going to have these feelings, but they don’t always need to say them out loud, especially with their child. Disappointment is normal, but parents can unintentionally make kids feel they are disappointed in them for struggling.

I have some clients who feel very guilty for making their parents’ life complicated and scaring them. And it’s true that parents do have to work harder when a kid has an eating disorder, but if the child had cancer, the parent would do it and recognize it wasn’t the child’s fault that they have cancer. That’s what I’d love to see when a child has an eating disorder.

I see some parents who are resigned to the idea that their child will always be sick. Then I have parents who think that if the weight is fine, the child is fine. We have to find a balance and recognize that you can’t judge an eating disorder based on someone’s physicality. Ultimately it’s a mental illness, and we can’t tell how healthy someone is based on how they look or their behaviors.

5. What is advice would you give a parent who has a child who has an eating disorder?

First, have compassion for yourself. A lot of parents blame themselves for a child getting sick. It’s natural to think about what could have been done differently, but ultimately parents have to move forward. Make time for your own self-care. Helping someone in recovery can be emotionally draining.

Second, have compassion for your child, and have compassion for the eating disorder behaviors. Sometimes eating disorder behaviors are the best way your kid can cope in the moment. The eating disorder is serving a purpose for them, otherwise they wouldn’t’ have it. Your child is trying to help themselves – they’re just going about it in a way that is not helpful.

Clearly, I’m passionate about helping people to recover from eating disorders, but I also believe in starting with radical acceptance, which is a concept in Dialectical Behavior Therapy (DBT). Acceptance doesn’t mean you like it, it just means you acknowledge it’s there and you don’t have to make it the enemy. The eating disorder is currently a part of your child. When we make it the enemy, it can feel disapproving or critical to the person. Instead, seek ways to reduce anxiety and help your child meet the needs that their eating disorder is currently meeting, in other more life-affirming ways.

jennifer rollin eating disorders

Jennifer Rollin, MSW, LGSW is a Psychotherapist specializing in eating disorders and body image. In addition to her psychotherapy practice, she also offers recovery coaching via phone or Skype. She has published numerous articles regarding children, adolescents and eating disorders. Website