Strategies to motivate eating disorder patients

 Those who suffer from eating disorders are often wracked with denial and ambivalence about recovery, which makes these types of illnesses harder to treat. The concept of denial has been interpreted by clinicians and operationalized by research in so many diverse ways that it not only lost its original meaning as a defense mechanism, but also became a confusing notion. Research on denial often centers on a lack of agreement as to whether it is unconscious or conscious, a trait vs. a state, an indication of psychological disturbance or a functional coping mechanism.

Some professionals believe that the purpose of denial may be what holds a shattered self-esteem system together. Therefore, it is integral to have support available once the patient begins to acknowledge the illness. Helping these individuals find their motivation for recovery can sometimes be stymied by the circumstances under which they accept the need for treatment in the first place (i.e., being forced into recovery due to extreme malnourishment or other harmful symptoms). Recognizing that a problem exists, and then discovering their own reasons to begin the recovery process, can contribute to creating and sustaining motivation.

Before beginning to motivate someone toward recovery, it’s important to take a few precautionary steps:

·   The sufferer must be seen by a medical professional first so he or she can diagnose and assess the issues from a medical perspective, including the degree to which the individual is medically compromised.

·   The individual also must be assessed by a mental health or medical professional to determine the degree to which the individual accepts that the eating disorder is not functioning independent from his/her psychological and mental states.

·   Motivation is not possible when the patient is in an acute medical state.

Supporting motivation

Here are some ways professionals can help their patients find the motivation needed to begin recovery, and to set up a support structure that allows them to succeed:

 ·Do not prescribe too many behavioral changes during the early phase of treatment unless medical risk is heightened or you need to determine if the individual can do the work in an outpatient setting.

·     Remind the patient that this is not an easy—or fast—fix. Help them see that patience, understanding and empathy are critical to the process.

 ·     With every step forward, there will be steps backward. Don’t show frustration, and don’t let these setbacks discourage the sufferer. Keep focusing on the ultimate goal.

·     100% recovery is very difficult. However, recovery over time can occur. Helping patients, especially during the early stages of recovery, manage symptoms and continue to engage in life and relationships while living with an eating disorder is still possible.

·    There are varying degrees of “giving up” symptoms. As patients can never be fully cured, understanding the significance of giving up eating-disordered behavior is a milestone that once reached should be celebrated and supported.

·    Give the patient a safe space to verbally express feelings. Respond to the patient’s concerns and fears with empathetic messages.

 ·     Create reality check points along the road of recovery. Asking the patient “Is what you’re doing working for you?” and “Are you feeling OK?” are good ways to check on the progress of recovery without becoming overbearing.

Here are some suggestions of areas for therapists to work with family members on, in order to help them understand and interact with their loved one:

·     Structure sessions with loved ones around helping them express themselves and the truth of the situation in a way that shows support and concern, and expresses empathy and understanding. Otherwise, the denial will persist (the usual response will be, “You don’t understand”). Confrontation within a context of support and understanding may be crucial in the process of recognizing the problem.

·     Instruct families to be mindful of sending mixed messages about body image, both through words and actions. This includes behaviors such as stocking the house with “diet” foods or displaying fashion magazines with distorted images of women. While it might not seem like a big deal to someone without an eating disorder, someone in recovery can easily pick up on these messages, thus derailing the entire recovery process.

·     Remind family members that they also need to feel free to express their fears and concerns with their loved one. This needs to be done in a way that doesn’t place any guilt, but expresses their concern for their loved one and his/her overall health. Often, an expression of fear from a family member or loved one serves as a motivation point for patients.

·     Advise parents to change household behaviors to support recovery. Encourage them to spend more time as a cohesive and supportive group, and to focus on sharing and open communication during mealtimes so that a positive environment is created around food.

Judy Scheel, PhD, LCSW, is the Founder and Executive Director of Cedar Associates, a private outpatient program in Westchester County, N.Y., specializing in the treatment of eating disorders and other self-harm behaviors. The May/June 2012 issue of Addiction Professional features an article written by Scheel on eating disorders and motivation. Scheel’s e-mail address is jscheel@cedarassociates.com.