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How to Stay on Course in Recovery While Transitioning Between Levels of Care

Jillian Lampert, PhD, RD, LD, MPH, FAED

Vice President, Communications

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Challenges with Transitions Between Levels of Care

  • Your loved one might be ready
  • Your loved one might not be ready
  • Both of those can happen in the same day.
  • Treatment team may be new
  • Treatment team may not be new
  • They may have significantly more time at home
  • They may have return to school or other activities (athletics, work, extra-curriculars, etc.)
  • They/you may need to pack more meals
  • They may have more independence. They may need more supervision .
  • Opportunities for more practice! More opportunities for ED thoughts and behaviors to slip in
  • More unexpected things might will happen
  • May feel like things are going well, solid, great, etc. and underestimate need for vigilance and persistence
  • Transition may have been premature, meaning less support/treatment engagement at a time that more support is needed
  • What else?

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13 Tips for Supporting Your Loved One

  1. Accept your limitations. You can’t make your loved one want to get better.
  2. Accept your loved one for who they are. Remember that they are an individual; they are not their eating disorder.
  3. Be sensitive and be firm.
  4. Compliment strengths that have nothing to do with appearance, eating, or food.
  5. Seek support for yourself.
  6. Respect how and where your loved one wants their eating disorder discussed. You absolutely need and deserve

support, and you can get it while also honoring your loved one’s need for confidentiality.

  1. Ask your loved one how you can support their meal plan – or how they can help you support their meal plan.
  2. Plan non-food related activities for the times right after meals to help redirect attention and energy.
  3. As much as possible, try to focus on the other things life—not just discussions of weight, eating, exercise, and food.
  4. Be a good role model when discussing food, body, and weight—your own and other people’s.
  5. Set an example: participate in family treatment (if recommended), talk openly about your feelings, and actively identify and resolve problems.
  6. Convey that you believe in them.
  7. Recognize that recovery is a process. It takes time; it’s seldom logical or linear.

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Transitions are hard. They just are.

Persistence is key

Vigilance is important – but so is balance

Slips will happen; things will go wrong – it’s how you deal with them that is key

Lean into the temperament traits that are being taken advantage of by the eating disorder – stick to recovery – stick with progress

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Overall Treatment Pitfalls and Guidelines

Pitfalls

  1. Not getting enough information
  2. Overconfidence with progress
  3. Not using time in treatment to try challenging things
  4. Not soaking up as much information as you can
  5. Not planning for the next steps
  6. Not taking care of your own needs—becoming exhausted or overstretched.

Guidelines

  1. Ask, ask, ask – don’t be afraid to ask
  2. Celebrate – but remain resolute and vigilant – and celebrate
  3. Take risks and encourage your loved one to try things that are more challenging while they have the support of treatment
  4. Keep learning as much as you possibly can to help your loved one
  5. What is the next level of care? What preparations are needed?
  6. Allow yourself time for self-care. If you have a partner, tag team your child’s recovery and seek out your own treatment as needed.

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Some Specific Common Pitfalls and Guidelines to Prevent/Address

Pitfalls

  1. Forgetting parts of the meal plan when your child is not in programming.
  2. Not providing 100% supervision for all meals and snacks.
  3. Not providing structure to help interrupt ED behaviors (e.g. over-exercising, binge eating/overeating, purging).
  4. Not adhering to the meal plan while traveling, having company, during special occasions, etc.
  5. Allowing the eating disorder to influence food choices.
  6. Giving your child choice over food before they are ready for it.

Guidelines

  1. Meal prep and/or create a list or schedule for meals outside of programming.
  2. Have family meals.
  3. Eat and exercise together (following doctor’s recommendations). Ask your child to wait an hour after each meal before using the restroom.
  4. Plan ahead – consult the dietitian or other treatment members for help.
  5. Discuss food choices with a dietitian. Engage in distress tolerance activities for yourself (e.g. take 5 minutes to regroup, deep breathing, tag team with another family member).
  6. Discuss timing for giving autonomy back to your child with a dietitian.

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More Common Pitfalls and Guidelines to Prevent/Address

Pitfalls

  1. Returning to physical activity too soon, or not taking it slowly enough
  2. Keeping clothes that no longer fit.
  3. Engaging in food debates/allowing your child to negotiate food choices.
  4. Inadvertently helping your teen body check.
  5. Tolerating weight loss or allowing your child to slip too far below their goal weight range.
  6. Not taking care of your own needs—becoming exhausted or overstretched.

Guidelines

  1. Follow the recommendations of your doctor and treatment team.
  2. Donate ill-fitting clothes.
  3. Lovingly and firmly refuse to get into these conversations. Say “This meal/snack is not up for discussion. What will help you get through it?”
  4. Lovingly and firmly refuse to get in these types of conversations. Say “I hear you are struggling with body image right now. What coping skills can you try/how can I best support you?”
  5. Follow the recommendation of your treatment team and ask for help.
  6. Allow yourself time for self-care. If you have a partner, tag team your child’s recovery and seek out your own treatment as needed.

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What to Say: Advice from Individuals in Eating Disorder Recovery

Ask if I would prefer for you to listen or to give advice.

Say: “I have felt similar to what you are feeling when .”

Ask: “How can I help you when you are upset?” (Ask about this when I am calm.)

Say: “Help me understand .”

“I” Statements (I feel, I notice, I wonder).

Separate me from my eating disorder and express anger at my eating disorder or symptom rather than at me.

Talk about things I can look forward to in the future or motivations for recovery.

Give me space when I am upset and then come back to it later without forgetting.

Say: “Do you want me to help you use your grounding skills?”

Say: “Do you want me to breathe with you?”

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What to Say: Advice from Individuals in Eating Disorder Recovery

Say: “I’m here to talk whenever you are ready.”

Talk to me about things that are unrelated to my eating disorder and food.

Talk about the positive things my siblings are doing or how my pets are at home.

Say: “It’s nice to see you.”

Say: “I/We miss you at home.”

Talk about how the eating disorder affects the family versus how I affect the family and explain that you love and care about me.

Talk about progress that you are noticing (not about my body/weight) and that you are holding hope for me.

Provide encouragement when I feel hopeless.

Say: “I acknowledge you have been working hard.”

Provide validation.

Recognize recovery looks different.

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What Not to Say: Advice from Individuals in Recovery

  • Getting angry with me for using symptoms.
  • Bringing up how I looked before my eating disorder or
  • when I was in the worst place with my eating disorder.
  • Talking about weight, diet and appearance at all (even with yourself ).
  • Showing pictures of what I used to look like.
  • Saying: “I understand.”
  • Saying: “You look so healthy.”
  • Talking about the future relapses I may have.
  • Jokes about food to help lighten the mood.

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  • Saying: “Why can’t you just ?”
  • Saying: “Why is this so hard?”
  • Using “you” language (You always , you can’t stop ).
  • Shaming me for my behavior or making me feel like I
  • did something wrong.
  • Bringing up things I am missing out on.
  • Making comments about my appearance.
  • Saying: “Calm down.”
  • Saying “Just breathe.”

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What Not to Say: Advice from Individuals in Recovery

  • Saying: “It’s been so much easier without you at home.”
  • Thinking that I will be the “old me” right away.
  • Setting unrealistic expectations and expecting recovery too soon.
  • Assuming reasons for not eating or assuming I am not trying.
  • All-or-nothing thinking (if I use a symptom then I’m relapsing and if I complete a challenging snack or meal then I am recovered).
  • Saying: “Take this bite for me.”
  • Assuming I have used symptoms.
  • Not talking about food during meals.
  • Making food judgments.
  • Saying: “You used to .”
  • Saying my eating disorder is for attention or my choice.
  • Saying: “You did (accomplishment) so you can beat this ED” /“You’re smart, you can beat the ED.”
  • Talking about how my behavior affects you in a way that makes me feel guilty (when I always feel guilty).

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https://www.etsy.com/market/ed_recovery_cards?ref=lp_queries_external_top-3

Even Etsy knows how hard it is! They have things to help!

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What can you do for YOU? Create a Parent/Guardian Relapse Prevention Plan

  • Five things I have learned that will help my loved one and me in recovery:
  • I have the following five strengths and/or values that serve my loved one in recovery:
  • My loved one has the following five strengths and/or values that serve him/her/them in recovery:
  • 10 things I can do alone or with others when I am feeling hopeless or frustrated that will give me strength and energy to continue to support my loved one:
  • I have identified the following three people I can depend on for support when needed:

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Include What Has Changed/You Have Learned in Your Parent/Guardian Relapse Prevention Plan

  • Five changes I/we have made in the home that support recovery (such as supervised meals, sitting at the table until meals are completed, no bathroom use after one hour after meals/snacks have ended, etc.) are listed here:
  • My loved one’s warning signs are (e.g. isolation, hiding food, using the bathroom immediately after meals, stating they “already ate”):
  • I commit to the following five actions when I or someone else notices a warning sign:
  • I have shared this plan with these three trusted people and integrated feedback as necessary:
  • I understand that while my loved one is in the pre-contemplative and contemplative stages of change, it is primarily my responsibility to ensure my loved one is consuming the proper amount of nutrition without eating disorder behaviors.

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�Thank you!�For more information:

Visit emilyprogram.com or email me at jillian.Lampert@emilyprogram.com�

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