In today’s blog post, Wendy Wright, LMFT, CEDS-S, CIEC shares an in-depth look into the complicated and emotional nature of a return to daily life after a residential treatment program.
I have a wish for the world of eating disorders: I wish that people 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, and assessed to show the presence of 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 — which is impossible to see from the outside. Weight can be a marker, and lab values can show medical distress, but these are just small parts of the process. This reason is why the recovery process is so stressful for the system of sufferers and support persons. It can lead to much guesswork, assumptions, mind reading, 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 the eating disorder 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 emphasis, then, dominates the conversation. For instance, you may find you and your loved one arguing about feeling/being fat or eating too much.
But eating disorders are not about the size of a thigh, an arm, or a belly, nor are they about the food eaten or not eaten. Food, body, and exercise are place holders for deeper messages, messages that your loved one may or may not even be aware of sending. This messaging continues long past the time in a treatment center, and keeping this in mind as you or your loved one return 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.
Three Phases of Eating Disorder Recovery
Over my years of experience, both personal and professional, I’ve identified three phases of the recovery process. I want to teach you how to name these and give you clues that will show you where you or your loved one is 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.
Let’s take a look at these phases:
1. Stabilization Phase: Before treatment begins, chaos reigns. Days are ruled by fear, silence, or screaming fights, while nights are ruled by anxiety, loss of sleep, and tears. The stabilization phase involves the brain, the body, and life as a whole. It is nutritional with a focus on restoring balance in the what, when, and where of eating. It is medical, allowing the body to heal and restore with nutrition and rest. And it is emotional, allowing space from difficult life dynamics in order to take a pause before re-engaging. Recovery work can feel chaotic and overwhelming if stabilization is skipped or short-changed.
It is important to see a treatment center stay, or program care at a partial hospitalization or intensive outpatient level as a starting line, not a finish line. Or, for those who are entering treatment for a second, third, or more, admission, it’s another segment of the journey. After stabilization, things are better but not done.
2. Integration Phase: This phase is the big “now what?!” moment. Once stabilization is reached, integrating new patterns, new balances, and a new flow into daily life is the next step. It is not easy or quick. Let me repeat that: This phase is not easy or quick!
As with learning any new skill, time and repetition are your friends. And speaking of friends and family, it can be very helpful to enlist their aid in “coming alongside” in this process. Now is the perfect time for group and family support sessions. If you are the caregiver, ask about specific ways you can help. Maybe there is power in just being there. You can also help to support the slow pace and 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. Examples include automating your meal times, your grocery deliveries, and your therapy sessions. I find it very helpful to normalize the struggle! The integration phase is about feathering in new coping skills to old life patterns.
3. Engagement Phase: Now, you are living with all your senses engaged. When eating represents enjoyment, you smell the food, you taste the food, and you engage with bites meaningfully and mindfully. It’s the moments when sharing a meal with friends becomes about the people and the relationships rather than 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.
Don’t miss the companion ED Matters podcast with Wendy: When a Loved One Returns Home from Residential Treatment.
You don’t have to endure this treatment and recovery process alone! If you need help as you navigate caring for a loved one with an eating disorder, the Recovery Roadmap Series can serve as your guidebook. Reach out with any questions.
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