Eating disorders: listening, not lecturing, is the key to recovery. We must stop the failing copy and paste approach and instead have hope.

The maxim “insanity is doing the same thing over and over again and expecting different results”, is often (probably wrongly) attributed to Albert Einstein. It has never been more apt in how it relates to the approach taken to eating disorders.

Week after week, I meet with clients who have experienced the ‘support’ being offered through the NHS or private providers - sometimes as inpatients, sometimes as out patients - and the approach hardly varies. It is built around a medical model which focuses on weight and food. In many cases it starts by rightly stabilising key vital signs - including potassium levels and critical vitamins - and helping people out of physical danger. But then it loses its way. 

It becomes all about lecturing and hectoring. Telling people why what they are doing is wrong, or bad, or dangerous, or selfish, or all of those things. I know clients who were asked over and over again “do you want to die?”, or “do you want your parents to go to funeral?”. It’s medieval. It’s dreadful. It’s cruel. It is failing people. 

This model - which is based on repetition and doesn’t have enough (if any) interest in asking open questions and listening to the experience of those answering - is about behaviours and process. Three meals a day. Three snacks. Weight-ins. Family members becoming the food police. No moving from the table for at least 30 minutes. No doors on bedrooms. Nothing allowed to be left on the plate. No space to talk about how we are feeling (“you are too under-nourished to have therapy and know what you are feeling”). It’s not rocket science to understand why people say whatever is expected to stop the ‘support’. They will often say anything to make it stop. To put an end to the cruel treatment. The shaming. The shouting. They just want to be discharged so they will often pretend they are feeling fine. They will eat what is instructed for a time to get away. 

Of course, there is logic in some of these ideas but eating disorders are not about logic. They are about emotions. Feelings. Pain. Sadness. Insecurities. Trauma. Coping mechanisms. I am yet to meet a client who didn’t know how many calories they should be taking in each day, or anyone who needed nutrition lessons or advice - often they know more than those charged with “teaching” them. They know that they are a train that is taking them towards their death but they cannot get off.

Imagine thinking that shouting at someone who is poorly in the hope they will start to feel better is a good idea. Imagine thinking that is ethically sound. Imagine seeing people relapse and relapse and then in effect blaming them for not getting better. Imagine labelling them “treatment resistant” and thinking that the right answer was to repeat it all over again. Copy and paste. Shout some more. Say this is the only option. Imagine doing that. Imagine doing that and hoping for a different result this time. 

Of course, it is not the only option. In desperate times, with their loved ones literally starving to death, parents and others rightly reach out to hospitals for help. The fact that eating disorders kill more people than any other mental health condition, reminds us how critical it is to make sure physical health is looked after. But an eating disorder is a mental health condition not a physical health condition. We need to work on the underlining reason(s) that the eating disorder is required - find out what purpose it serves and then talk about it, calmly, gently and compassionately, and see if we can soothe this pain and distress without the need to reach for an eating disorder solution. 

This work has to be built on listening to the expert - the person with the eating disorder. The therapist needs to facilitate discussions that help the person explore what is going on - what is under the surface. The therapist needs to offer unconditional positive regard. The therapist needs to build trust and embody empathy, not judgment: kindness not discipline; and for younger clients, needs to help the young person feel comfortable and be able to smile, laugh and savour life - not be told off like a child and patronised. 

Increasingly, I see clients and their families who have built their own support model - having been failed over and over by the ‘support’ offered by eating disorder units and services. This model is  based upon compassionate, listening, empathetic private therapy, which focuses on feelings and not food, and the physical health safety net of regular blood tests and blood pressure checks at the GP. This combination offers a basis for the person with the eating disorder to feel safe (physically and emotionally) to help them get to the root causes of their distress and then try to move forward. To get off the train. 

One other thing that is vital and if so often missing from most of the ‘support’ being offered is hope. We need to focus on the hope and optimism that we can kick the eating disorder into touch. That we can work together to no longer need it to deal with life. Hope is the fuel we need to move forward. Hope of better times. Hope of recovery. Hope of a future. 

Having started by nearly quoting the world’s most famous scientist, I end by quoting from the world’s greatest television programme (IMHO): The West Wing. “Hope is what gives us the courage to take on our greatest challenges, to move forward together.”