The Simplest Tool for Recovery is the Most Effective

While working with people with eating disorders, I am reminded time and again that the most simple tool is the most effective one. Eating disorders may be known as intractable and very challenging to treat, but the food journal is a critical part of any success in recovery.

Initially, the journal provides a daily accounting of what someone’s eating disorder looks like. Although eating disorder symptoms are somewhat consistent from person to person, the exact way a person thinks about food and eats through the day can change. The eating disorder thoughts tend to be the most dominant thoughts in a person’s mind so the journal also gives insight into a day’s worth of thoughts.

Allowing a clinician to look at the journal symbolically represents an opening of the eating disorder itself into treatment. The therapist can ask specific questions to better understand the process involved and the decisions that are made by the eating disorder rules. The process of asking questions, giving answers and even making small suggestions to change the eating behaviors show that there can be a dialogue around the disorder, something usually very new to the person in treatment.

People often say to me that writing out the details of their food each day is the most personal thing they could imagine doing. The act of writing the journal and then sharing it allows for an intimacy not usually possible because the eating disorder dominates one’s life. Exposure of the central power of the illness invites change and progress.

When I think over the duration of my practice, any person with a moderate to severe eating disorder who I have seen make progress has committed to the food journal for a period of time. The tedium of writing down food combined with thoughts and feelings are worth pursuing for the true benefit that this tool provides. As long as the food journal is a part of recovery, there is nowhere the eating disorder thoughts and symptoms can hide.

The Competing Forces in the Mind of Someone with and Eating Disorder

In more severe eating disorders, there are competing forces inside the person vying to determine the course of daily life. One side is focused on living a full life replete with personal and professional goals. The other side is solely preoccupied with food, calories and, above all, weight.

Intractable eating disorders occur when the eating disorder forces dominate thinking and thereby daily decisions and behaviors. The short-term goal of treatment may be medical and nutritional stabilization, but getting better ultimately means quieting and weakening the eating disorder forces.

Similarly, developing a successful plan for recovery also involves competing forces when caring for the person with the eating disorder: compassion and firmness.

The true forces aimed at living life are grounded in the actual person themselves. That side of the person is extremely saddened and frustrated by the inability to focus on daily life and pursue long term goals. Any human being would experience powerful compassion for this person and how much suffering has come with a severe eating disorder. In the face of so much confusion and criticism during the illness, compassion provides sorely needed caring which is necessary to nourish the person emotionally back to health. It also helps bolster the energy needed to combat the eating disorder forces.

On the other hand, firmness, directness and even strength are necessary to combat the eating disorder forces. They are wily, stealthy and insidious. If subtly ignored, the eating disorder will take weakness as a sign to only push forward. Their sole purpose is to ignore actual life and magnify food and weight into the only things that matter.

The person is often ignorant of the difference between their own thoughts and the eating disorder and will take attacks against the eating disorder as personal attacks. Even in the face of this kind of rebuff, continuing to push back against the eating disorder is essential.

The combination of compassion and directness is a delicate balance. It will only be successful when a therapeutic relationship has a strong foundation of trust. Differentiating between these forces and approaching them in the correct way is the most important way to care for someone working in recovery.

Why It’s so Hard to Find Help for an Eating Disorder

This time of year seems to be a season people are much more likely to contact me to start treatment for an eating disorder. I’m not sure why I receive the most contacts in June and July, yet it appears to be the same every year.

One common refrain from these contacts is how hard it is to find clinicians who are trained to treat people with eating disorders. I often hear that people have seen several therapists, frequently for a sufficient period of time, and found the treatment to have limited focus on food and eating. After a series of failed attempts, it’s hard to keep trying.

Even if i don’t have availability, people are just as grateful to be pointed in the right direction. A true referral to someone trained to treat people with eating disorders is hard to find, even in a town like New York that is packed with mental health practitioners.

The unfortunate truth is that there is no standard certificate or training to treat people with eating disorders. Despite the increased incidence of these illnesses in recent decades, there is still no way to ascertain if someone is actually trained. Any clinician can claim the expertise and have no true training.

The same is true for psychiatrists as well. My training came from participating in the UCLA eating disorders program for two years where I was trained by doctors who helped create the field in the 1980’s. But in many ways, finding that training was just by luck.

For therapists, claiming this expertise is a quick way to increase clients. There are so many people searching for therapists who know how to help people with eating disorders that this claim will lead to increased work, even if that work is completely ineffective.

Psychiatrists tend to be much more wary about claiming this expertise. Unlike most psychiatric illnesses, people with eating disorder have many medical problems that often go beyond the knowledge base of a psychiatrist and bring more medical risk into practice than psychiatrists prefer.

Overall it makes finding experienced clinicians difficult. The key is to ask more details about someone’s training, practice and experience. It’s perfectly acceptable to know how much of someone’s practice is people with eating disorders and to know if they themselves were trained by experts. The road of treatment is hard and it has to begin with a treatment provider able to open up a path to wellness.