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Teaching Families that Integration (Not Eradication) Leads to Recovery

Reposted from Eating Disorders Blog with permission; Adapted from original article by Anna Kowalski and Abby Gold.

Having worked at Monte Nido for 16 years, I have certainly earned the privilege of not working weekends, but my passion for all things family keeps me coming back on Saturdays, either for Family Weekend or our standard Saturday Family/Alumni Group.

Over Family Weekend we have a ‘families only’ group, a particular favorite of mine. It is a time completely designated to the parents and family members of our clients; a time for them to speak up, cry, and share their feelings of overwhelm, sadness, fear and anger with others who have been or are currently in the same position.

In a recent ‘families only’ group, there were some truly desperate and hurting parents in the room—parents who have been in and out of treatment with their daughters for years, parents who are starting to wonder if this is a battle they will ever win.

In a moment of bonding, they were sharing the names they had all created for their daughters’ eating disorders.

“Satan,” one father said.

“We call it The Enemy,” another mother chimed in.

While I did not want to jump in the middle of this display of empathy for one another’s years of despair, I felt an obligation to help give them another option.

I asked if I could share a philosophy that would help them to both join with their daughters and relieve some of the anger and sadness that they had in holding onto the idea that their daughters had been ‘taken’ from them.

“This philosophy,” I explained, “will not involve a slaying of The Enemy, or a light of God that can exorcise Satan.” The families almost looked disappointed, as if they didn’t believe anything else would solve the problem of their lost daughters. “I am offering you the concept of the integration of two selves, two selves that have been needed for survival…” Curious, furrowed brows took over the family members’ faces.

Enter Eating Disordered Self/Healthy Self…

I frequently hear clients say that the Eating Disorder is “too big” for them to battle, that the ‘hold’ the eating disorder has on them is “too strong,” a feeling that clearly aligns with the group beliefs that their daughters are being held captive by their eating disorders.

I offered the parents the same perspective we teach clients—that the eating disorder is an owned yet split-off part of self, not an outside entity; that the more their daughters engaged in eating disorder behaviors, the stronger the voice telling them to do so became, until eventually that voice took on a life of its own. When we see this split-off part as the “eating disorder self,” and then identify the “healthy self” as the part that knows behaviors like vomiting, restricting, or purging are not good things to do, we create space for a conversation between these two selves—a conversation that paves the way for integration. As the healthy self learns from the eating disorder self, it eventually gathers enough strength to be able to do the job of the eating disorder self in a more adaptive way. And this, I emphasized to the families, gives the daughters their power back, thus allowing the parents and family members to get out of what would otherwise be a losing battle. Instead of feeling defeated by the eating disorder, clients are left empowered by knowing the work is within them.

But now I’ve told a group of distraught parents that there is nothing they can do to ‘fix’ their child or ‘make them get better.’ Telling parents they can’t fight off the intruder doesn’t leave much hope. So I told a story about my high school boyfriend.

I would sit on the phone for hours, crying over this boyfriend, over how he treated me and how he hurt me. And witnessing this, my parents were naturally extremely disapproving of him. They fought him, called him names, and that made me furious. I was not going to let him go; I loved him. But as soon as my parents joined with him and accepted that being with him was my choice, I was only left with myself—with my desire to be with him and with my knowing that he was awful. I had to then make a conscious choice in the fight with myself, not my parents, knowing that I too realized he was not the one for me.

The laughter in the room at this moment was palpable. Humor on this journey—in addition to all of the honesty and hard work—is necessary for the family to recover.

I talked with the parents about the way that the eating disorder, though maladaptive, has allowed their daughters to cope. We discussed how we use Thank You Letters and Gratitude Letters to the eating disorder in order to let go and realize there are other coping styles that are much more effective and not destructive to their bodies and souls. The integration of the perfectionism, drive, and tenacity that served the individual’s eating disorder is re-harnessed into their healthy self, and is used for the healing.

This was a humbling moment for all of the families in the group, and an opportunity to begin to learn how to slow down and look at how to support their loved one in getting their needs met in a healthy way. It is my hope that these families, clients, and everyone else out there affected by an eating disorder understands that the journey to a recovered life is not about eradicating the eating disorder, but about reintegrating that part of the Self. This concept had never been clearer to me than when Carolyn Costin and I were at a conference in Chicago. She said, “I would have never taken a pill to get rid of my eating disorder.” If she had, it could have eradicated the amazing drive she used to create Monte Nido.

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