By Andrew Walen, LCSW-C, LICSW, CEDS
When clients come in for treatment for their eating disorder, everyone involved - from the client and loved ones to their treatment team - are in crisis mode. We’re all busy figuring out what are the symptoms, what are the stressors, triggering events, underlying mental and physical health diagnoses, and how to help alleviate the client’s immediate suffering.
For those of us in the treatment field working with insurance companies and oversight organizations that review the quality of care provided, we hear over and over that we must think about discharge planning from the moment the client comes into treatment. It’s hard to do, seems counterintuitive, and even onerous at times. We just want to dig into the work of helping the client recover, and honestly its all the client typically is thinking about too.
In reality, the preparation for ending care is every bit as important as the work done in active treatment. Therapy ideally is not something we engage in forever. We should be teaching the tools of recovery, so the client becomes their own therapist for the rest of their lives. The best therapists are the ones who don’t allow their clients to become treatment dependent. So, while it may not seem like a task we want to engage in, we have to start working on relapse prevention and discharge planning from the start.
Let’s talk about relapse prevention and what that means. Originally used in the field of addiction treatment but now universally accepted for all mental health concerns such as eating disorders, there is a concept of the Stages of Change. The stages represent how we see a client engage offers of help to recover. They are:
- Precontemplation – the client has no awareness or belief that they are struggling
- Contemplation – they client has some awareness of a problem and is considering seeking help
- Preparation – getting a list of resources to get help and preparing physically and emotionally to get that help
- Action – in the process of treatment and recovery
- Maintenance – the client is in a state of recovery and doing well
- Relapse prevention – the client is ensuring their recovery by actively using their recovery tools and being mindful of possible pitfalls that could lead to a lapse in old behaviors or full relapse
The last stage is something a lot of people miss out on altogether and is why so many return to old negative behaviors to cope with life’s downturns. That sense of invincibility creeps in during the maintenance phase, and many don’t do the work necessary to plan for the unexpected.
The following is a quick look at what you can do now to start preparing for that wonderful day when you no longer need treatment but still need to remain mindful of relapse prevention.
- Eating disorders begin with negative thoughts about yourself, your body, the world around you, and your future. First step in prevention is to be aware of your thinking. Keep a regular journal and review your writing periodically. Notice patterns of negative thoughts that may be creeping back in and start to dispute them with your rational, healthy, and coping skill thoughts.
- Pay attention to possible triggers that could lead to relapse such as people, places, and things. Are you surrounding yourself with folks fixated on diet talk? Are you in a gym that is promoting weight loss at the holidays? Does your office have a bunch of fashion magazines lying around that promote the thin-ideal and fat shame others? What changes can you make here?
- Develop a group of like-minded recovery-oriented relationships both in-person and online if necessary. If you find yourself slipping into old patterns of compulsive exercise, comparison thinking, compulsive thinking about the quality of food, or other eating disorder patterns, practice asking for help from them.
- While people, places and things may be external triggers you are familiar with, are there internal triggers you can identify as well? Examples include: emotional states, feeling physical pain or illness, loneliness, isolation, unmet hunger cues? If you recognize these, what are the coping tools you learned in treatment? Go back to the basics!
Relapse prevention techniques are varied and plentiful. Working with your therapist from the start to identify what really worked to help you in the act of treatment must become a tool in your toolbox to return to time and again during the course of your life. Whether it’s a way to identify irrational thoughts and dispute them, practice acceptance skills, self-soothing strategies, or behavioral interventions, have them at your fingertips. While you may dip in and out of a lapse into a behavior for a moment, using your learned skills can help you avoid a full relapse into your eating disorder.
And while we certainly hope you don’t need to return to therapy, know that we’re always there if you need us.
The Body Image Therapy Center is located in Baltimore and Columbia, Maryland and Washington, D.C. If you or a loved one needs help with an eating disorder, you can reach us at [email protected] or by calling our intake line at 877-674-2843.