The first appointment for someone with essentially untreated Anorexia Nervosa is a complex and intricate moment. These people are usually young, very trapped and hopeless. They frequently have met clinicians who have weighed them, threatened them, explained the dire consequences of the illness. Ultimately, these clinicians relent after facing the stubborn will of anorexia.
The longer this battle continues between a relatively new case of anorexia and ineffective professional help, the more hardened anorexia becomes and the more unwilling the patient is to be open to any help.
In addition, anorexia completely isolated this person from their lives. Although they can seemingly go to school, have friends and interact with the world, their entire mind is co-opted by obsessive thoughts about food and weight. There is no escape and the illness feels like a permanent prison.
The goal of that first meeting with someone with untreated anorexia is to try to help them feel understood and cared for. The endless string of ineffective attempts to care for them have already backfired. No one seems to understand. Everyone ultimately is the enemy and it feels like life is slipping away from them.
People who feel this way won’t benefit from an attack or a threat. They won’t respond well to a poorly conceived message that stems from fear or frustration.
They are looking somehow and someway for care and understanding, for attention and compassion, for comfort and love.
A clinician needs to understand that there are no magic answers in that first appointment. There is nothing one can say that will immediately break down this wall. That’s not the goal. The only hope is to start to find some way to show a modicum of understanding and care, to see them realistically and to meet them where they are.
The only real measure of success is whether or not there is any connection, any real human moment that transpires. This person may or may not come back again. Often sent to the appointment under duress, they assume they won’t follow up with someone they didn’t choose in the first place.
But maybe that first conversation can open a door and give this person the idea that there is a way out of anorexia. That would be a true success.
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