Suggestions for Family: The Holidays and Eating Disorder Recovery

This time of year is a challenging one for people in recovery. The holidays are moments of anticipated happiness and celebration largely centered on food and togetherness. The struggle to get better from an eating disorder revolves around painful emotions and isolation. It's no wonder these few weeks can be so difficult, but a few steps by that person's loved ones can go a long way. 

The most important message is understanding. Family members can quickly change the conversation about the upcoming days by choosing to ask how to help rather than assume the worst. Past experience of difficult holidays often prompt families to express their reservations right away. The negative message instantly isolates the person in recovery and makes her feel alone and hopeless.

The best first step is to ask questions about that loved one's concerns and to listen to her worries. The next step can be gently brainstorming for ways to ameliorate the situation. Small changes can make her feel much more cared for. But mostly, the experience of feeling understood pulls her away from the belief that the eating disorder symptoms are the only way to survive the day. The anticipation and anxiety before the day can ease when she is aware that someone else knows about how she feels. 

The process of having a series of conversations prior to the holiday needs to precede action. It's meaningful to help the person in recovery feel understood but will ring false if there are no changes come the actual holiday. Just a few steps to change the tenor of the day will help her feel not only understood but cared for.

Examples could be having specific foods at the meal that will make her comfortable, coaching other family members not to say harmful things or making time on the holiday to check in about meal plans, including even sitting down to a meal earlier in the day together. Prioritizing her recovery even on a holiday will show a level of caring she desperately needs.

The final piece of advice for a family member on the holiday is to emphasize their love for the person in recovery. The experience of loneliness on a holiday highlights her global isolation through the entire time of illness. Knowing that she could never enjoy those moments of closeness with family regularly confirmed how different and alone she has felt.

Fundamentally, that translates into a profound sense of being unlovable. Each conversation prior to the holiday will mean even more when the member in recovery hears that she is loved. Emphasizing that love leading up to the holiday and especially on the holiday itself makes it harder and harder to fall into the eating disorder symptoms. 

Although the three steps for families to support the person in recovery--understanding, care and love--are straightforward, maintaining this direct message still gets hard. The past still hovers over the coming events. The stress before the holidays can waylay even the best plans. A few stray negative comments can upend such a vulnerable situation.

The key is to remember how and why recovery is paramount in three small steps: set up conversations before the holiday; make concrete plans for the day itself; and don't forget to say how much you love her. 


Engagement in Online Eating Disorder Treatment

One significant difference between the pro-eating disorder sites and a pro-recovery online service would be participation.

The people seeking out a community to discuss and facilitate their own eating disorder are caught up in their illness and eager to share and learn more about being sick. Although the purpose is hardly positive, the personal drive to engage on these sites is strong.

But many people go into treatment under duress, and even the most motivated are ambivalent. The inherent nature of recovery will leave most people as reluctant participants at best. Therein lies the biggest problem with online eating disorder treatment: how to get people to join and stay. 

The first place to start is to explore what makes people stick with eating disorder treatment. Eating disorders are all-consuming illnesses that become one's fundamental philosophy of life and, ironically, best friend. Even when that person begins to recognize the sacrifices an eating disorder requires, it's scary and initially unthinkable to let it go.

Accordingly, treatment needs to be very engaging, intense and personal to compete. Therapists need be ready to talk, listen and connect. Discussions around eating disorders and recovery are rarely fun and easy, and any clinician must be ready for meaningful discussions. Therapists need to be real people; therapy relationships need to be genuine.

Similarly, many treatment programs have created a community for recovery even after discharge in order to reinforce and continue recovery. These communities often have their own language, vocabulary and way of interacting to help the person differentiate between the disorder and recovery. The treatment center initiates much of the contact and reminders to keep people invested in their lives and to avoid drifting back into the illness. 

An online treatment model would have to find a virtual replacement for this level of engagement and connection. The purpose of a care liaison is to be sure the person knows someone cares. This endeavor cannot be a money-making venture but a website aimed to help people get well.

In addition, the monitors or facilitators involved in online groups, meal support and forums need to be invested in recovery, real and engaged. An online service doesn't need to create new concepts of eating disorder treatment. It only needs to replicate the model in a new, more available setting. 

Any clinician or program knows that keeping the person in treatment involved and invested is the most crucial step towards recovery. Fortunately, there are many professionals whose job it is to determine what keeps people checking and connected to a website. A small dose of the knowledge of website developers and online marketers would provide the experience needed to point an online eating disorder recovery website in the right direction.

The information is out there to engage people much more directly and regularly than is currently available through more typical eating disorder treatment. And I think the opportunity to create that resource is necessary to provide affordable options for those in recovery. The combination of eating disorder treatment resources with website development and marketing can create a service that can really engage people in a new, available and meaningful way. 


A Liaison to Recovery: Thoughts about Online Support in Eating Disorder Treatment

A search for online support to help people with eating disorders reveals several viable options. Many residential treatment programs offer free online support. These options are support-oriented forums either moderated by a therapist or simply available without any support or supervision. In addition, there are a few attempts at online real-time group therapy for a fee. Several therapists have a treatment manual on their website with forums that include support specifically geared to use that treatment program. 

There are also many clinicians and programs which offer daily support meant to reach out to those in need. Twitter feeds, Facebook posts and blogs all provide ways people in recovery or seeking treatment can find helpful words, sayings and approaches to recovery from an eating disorder. The kindness, caring and compassion available online extend the reach for clinicians to provide necessary help to many people who wouldn't otherwise have access to that support. 

As I have written several times in this blog, increased ease of communication is a boon for eating disorder treatment. Text, email, and videochat allow the option of real-time support for illnesses that are relentless. Even the best therapy session can lose its potency when that person sits down to a meal an hour later. Yet a simple text of support and encouragement right before that meal can transform the experience of eating in the moment. 

None of these observations is novel to clinicians who treat people with eating disorders or to patients in recovery. What is currently unavailable, according to my research, is a treatment service that has thought through the best combination of online and real-time aspects of treatment that could be provided. 

A hypothetical service ought to include many facets. After requesting an initial consultation, the patient could have a first appointment in person or by videochat to understand the treatment available and to be placed in an appropriate level of care. Much as a consultation with a clinician or program, the purpose of the first appointment is to fully assess the person's treatment needs and connect her with the best options.

One of the biggest differences in a more complete online treatment program would be the self-initiated treatment in addition to regular weekly appointments. Regular weekly sessions or groups invite exploration about the eating disorder symptoms and triggers without support at each meal. Even meal support groups offer help at most a few times per week. Online groups or forums could offer support at each meal at any time of the day. In order to access this support, the person would need to reach out for help of her own afford, a difficult step to take.

A way to orient new people to an online program that involves self-motivation would be the addition of a liaison or primary caregiver in the program to the treatment team. This person could stay in contact with the patient several times per day, set daily goals and help her access support at difficult times of
the day. The liaison could be more easily available than clinicians and alert other members of the team to daily progress, information now only really available when a patient is in an intensive, expensive treatment program. 

The liaison can encourage a patient to log on to a real-time meal support chat or app, fill in the food journal or post a journal entry on a forum. Since people in recovery typically feel so isolated and alone in their pursuit of health, a primary point person on the team more available each day could help prevent a difficult day lasting a week until the next appointment or even leading to a relapse. 

This program can also be a service that a primary therapist recommends for a patient. Much as I described the components of an outpatient team earlier in this blog, an online service that provides support forums, real-time groups, as needed meal support and a liaison to check in daily with patients could offer much more of the treatment that promotes actual recovery. This service could fill in the gaps in outpatient care that makes people feel very alone in recovery meal after meal after meal.

Moreover, a well-planned online treatment community could really compete with the growing, powerful pro-eating disorder websites. The outrage against sites that encourage girls to embrace such destructive illnesses hasn't been very effective. In fact, the powerful message communicated by women and girls fully engaged in their eating disorder continues to grow while the recovery messages, like many public service announcements, remain sidelined.

Perhaps one of the reasons for this discrepancy is that pro-eating disorder messages have no ulterior motive: people promoting eating disorders are just spreading the word for what they feel is a viable way to live. But even the most well-meaning treatment websites are run by businesses seeking success or public service sites run by non-profits: organizations unlikely to drum up such an enthusiastic following.

The online presence for recovery has to come from patients as well. One hopes that a service like this one could spread the word more clearly that an eating disorder is a dangerous trap to fall into, not a key to successful living.