Welcome Home From Treatment!
(and we are all a little nervous, too!)
A Look into the Complicated and Emotional Nature of a Return to Daily Life After a Residential Treatment Program
By Wendy Wright, LMFT, CEDS, CIEC
I have a wish for the world of eating disorders! I have many times said, “I wish that people diagnosed with eating disorders had purple hair – and then it got less purple as they got better”!
Why? If you are in this recovery process, you and your loved ones are very aware that there are only a few areas that can be measured, quantified, assessed to show the presence, or lack of, a disordered relationship with eating. So much of an eating disorder lies in the functioning of the brain, the intrusive, repetitive thoughts, and the deeper meanings under words and behaviors. This is hard to see from the outside. Weight can be a marker, lab values can show medical distress, but these are just small parts of the process. This is why it’s so stressful for the system of sufferers and support persons. It can lead to much guesswork, assumptions, mindreading, and frustration. If we can understand more about the phases and processes of an eating disorder, and the recovering of life after one develops, it will help.
Treating the Brain, Not the Body
I reframe this recovery process as “treating the brain, not the body.” So often, the focus is on the body, the actual external appearance, or the internal dialog about the perception of the external experience. This then dominates the conversation, you find you and your loved one arguing about “I am fat”, “no, you are not fat”, or “I ate too much” “no, you did not eat too much” or “My clothes look horrible”, “no, your clothes look fine”… sound familiar? But eating disorders are not about the size of a thigh, an arm, a belly, nor or they about the food eaten or not eaten. Food, body, and exercise are message holders for deeper messages, messages that your loved one may or may not even be aware of sending. This continues long past the time in a treatment center, and keeping this in mind as you return home, or your loved one is returning home, can make a real difference. Having a deeper understanding of the thoughts, fears, and uncertainties that exist along the path of recovery can help build connection and authenticity.
It’s important to understand the subcontext here, to translate the statements through the eating disorder lens. “I am so fat” can possibly be speaking from a deep fear of rejection or shame of not being good enough. A comment like, “I ate too much” is likely not about the actual quantity of food consumed, but a way to ask if one is acceptable in your eyes. The mention of a food, such as “sugar” with a tone of distress or disdain, can be a way of expressing “I don’t know what is wrong with me, but I can channel the hate to this food and then feel better about myself for a moment.” This is another time to recognize that eating disorders are not about food, and thus rearranging food stuffs doesn’t help. You may want to help your loved one by joining in avoidance of foods that stir up fear for him or her. This isn’t that useful! It actually validates the belief that micromanaging each bite of food can bring peace to their life.
The goal is to create calm and neutrality around food, body, and exercise, and take space away from the panic triggered by extreme beliefs of the disorder. Someone with an eating disorder typically lives in a state of fear of failure, in a state of panic that disaster is about 5 seconds away at all times. This is a perfection story that screams in their head.
Over my years of experience, both personal and professional, I identified three phases of the recovery process. I want to explain how to name these phases and give you clues that will show you where you, or your loved one, are in the process. I find it very helpful to use the word “process” because it is just that, an experience that can take years. Yes, years. If you are in it, you know what I am talking about. As you can see from the earlier dialog snippets, the underlying, deep and internal thought processes maintain an eating disorder mindset. This is why the work of recovery involves, of course, restoring nutritional and medical stability, plus deeper thought work in the form of therapy, support, and time. And, measurements are less clearcut, more subjective, as we will discuss in these phases. One phase that is often underestimated in terms of time and effort is the middle, the Integration, phase. This is the time for many thought changes and practice of these changes.
Let’s take a look at these phases:
Three Phases of Recovery
Before treatment, chaos reigns. Days are ruled by fear, by silence ,or by screaming fights. Nights are ruled by anxiety, loss of sleep, and tears. The sufferer feels hopeless to make changes, the support system feels powerless to help. Sleep is disrupted, work/school is not manageable, medical complications create a crisis. Structured treatment at the right level of care helps.
I love the visual representation of the chakra system. This gives such a great testament to the importance of a strong foundation. This is also true for eating disorder recovery work. The foundational needs of security, safety, shelter, nourishment have to be met before moving up the hierarchy of life issues. This is also reflected in the classic hierarchy of needs by Abraham Maslow.
This stabilization is of the brain, body, and life. It is nutritional, restoring balance in the what/when/where to eating. It is medical, allowing the body to heal and restore with nutrition and rest. It is emotional, allowing space from difficult life dynamics in order to take a pause, take a breath, take 10 breaths, before re-engaging. Recovery work can begin to feel chaotic and overwhelming when stabilization is skipped or short-changed.
If you are in the stabilization phase you will want to find the highest level of support and structure that helps you separate from your racing, intrusive, repetitive thoughts. This means others may make as many decisions for you as is needed. You may notice an odd mix of relief and resentment. Relief at getting care, having someone else decide what you will eat, having help. Resentment at having someone else making decisions for you!
As the support person, you will see your loved one likely exhibit signs of fear, paranoia, and irritability. Your loved may be trying to do life without what possibly became their major coping skill. They are going from having almost 100% of their life and thoughts consumed with eating disorder thoughts to an abrupt halt to these thoughts. They are experiencing a blank slate when it comes to how to cope. They may also be experiencing some deep and genuine relief, and they may say they feel “better” or “recovered”. You may all come together with a hope, an expectation
that this will be over, done, and behind you once a treatment program is completed. It is not.
It is important to see a treatment center stay, or program care at a Partial Hospitalization or Intensive Outpatient level as astarting line, not a finish line. Or, for those who are entering treatment for a second, third, or more, admission, another segment of the journey.
After stabilization, things are better, but not done.
This is the big “now what?!” moment. Once stabilization is reached, integrating new patterns, new balances, new flow into daily life is the next step. This is not easy or quick.
Let me repeat: This is not easy or quick!
As with learning any new skill, time and repetitionare your friends. And, speaking of friends and family, it can be very helpful to enlist their aid in “coming alongside” in this process. This is the perfect time for group and family/support sessions. If you are the support person, ask about specific ways you can help. Maybe there is power in just being there. Help to support the pace, regardless of speed, help to build communication about SMART goals and balanced expectations.
In this phase, you may experience feeling flooded by the sheer number of decisions you have to make every day around food, body and exercise. Your eating disorder thoughts are still present, and likely strong! You will benefit from the support of your outpatient providers and your support system in reducing variables. Automation is a key tool when it comes to “decision overwhelm” or “decision fatigue.” This can include automating your meal times, your grocery deliveries, and your therapy sessions. I find it very helpful to normalize the struggle. This phase is about feathering in new coping skills to old life patterns. Imagine if you decided to walk backward 24/7! It’s that big of a change, and that much of a new brain skill.
For the support person, literally, practice walking backward for a day! Maybe not really, but even for a few minutes [safely!!] can give you a sense of the mental and emotional challenges your loved one is facing 24/7. This is why they may have mood shifts, energy shifts, and uncertainty. You can also support by either attending sessions or setting up weekly “chats” about how things are going, identifying problems and solutions.
This is advanced caregiving , a description I first heard from Dr. Adele LaFrance in a training for Emotion-Focused Family Therapy. This is a life skill that can be learned, and it benefits from planning and intention.
Tips for the Integration Phase
I want to encourage you by repeating this one more time: this does not happen overnight, it’s not easy, it’s not quick. But, it is realistic, it does happen, and it is exciting! And, it brings you through to the next phase…
This is exciting! This is living with all your senses engaged. Eating represents enjoyment – you smell the food, you taste the food, you engage with bites meaningfully and mindfully. Sharing a meal with friends becomes about the people, the relationships, and not the food or how you will have to make up for eating it.
This phase begins to grow during the integration phase, and then lasts a lifetime. Your life takes on the qualities you long for, intentionally integrated, mindfully intuitive, authentically connected.
What does someone in this phase look like? In this phase, language around food shifts to “what am I hungry for?” “what tastes good?” “who will join me for this meal experience?” Instead of collecting recipes, looking for that “perfect meal” with the magical power to solve life problems, you are able to smell the food in season, know if you want more bitter or sweet, know if you want cold or hot. You are able to laugh and enjoy the preparation and the meal, and you remember the conversation and the people instead of the calories and the plan for compensation.
You will notice that, instead of almost 100% of thoughts given over to food/body/exercise categories, your thoughts are filled with your own values and meaning!
As a support person, you may notice more sustained eye contact and more engaging conversations from your loved one. You will notice they can more easily identify their likes and dislikes, dreams and ambitions. You will find communication more fulfilling.
It is a process
Knowing where you are in the journey can help you stay grounded in those recovery tasks, while knowing you won’t be stuck there for the whole journey. Keep these phases in mind as you work on your own recovery, or support someone in their work. No matter where you are in this process, it is a process, a proven route to recovery. I have helped many individuals, families, couples, and other support persons walk this path.
You do not have to do it alone.
This is a companion article to the EDMatters Podcast titled “When Your Loved One Returns Home from Residential Treatment”, during which Kathy Cortese, LCSW, ACSW, CEDS interviews the author, Wendy Wright, LMFT, CEDS-S, CIEC and Financial Wellness Coach.
About the author:
Wendy Wright, LMFT, CEDS, CIEC, is a psychotherapist and consultant based in Denver, CO. She has over 18 years of experience in counseling those with eating disorders/disordered eating and those who love them. She is a Certified Eating Disorder Specialist [CEDS], CEDS Supervisor, and a Certified Intuitive Eating Counselor [CIEC]. She can help you decode the underlying meanings and functions of food, body, and exercise thoughts.
Wendy also offers financial wellness coaching, too, and helps you name the blocks that get in the way of your best financial life.
When she is not helping others find freedom in their relationships with food and finances, she is likely on her yoga mat, the ski slope, or a hiking trail!
You can find her at wendywrightcounseling.com, for in office and virtual sessions and groups.