Dishonesty in treatment and recovery from an eating disorder

[David Baxter PhD]

Dishonesty in treatment and recovery: working the stages of change in eating disorder recovery
by Kate Daigle
August 17, 2012

Recovery from an eating disorder is a complex and difficult process. I believe that it takes a combination of several factors to fully recover: honesty, accountability, compassion, and determination. Treating eating disorders is also challenging because treatment may require holding all of those factors all at once and finding a balance with them in the therapeutic process.

Many people enter counseling because they want to create a new way of living their lives. They have a desire to change. The readiness to change, I think, it probably the single most determining factor in actually creating a change. There are several stages of readiness to change, and clients may show up in any of these stages.

The stages of readiness to change are:
1. Precontemplation ? at this stage, almost all of the desire to change is external to the client, meaning they might be forced to come to therapy, they might be ambivalent about it, they may change only if the external pressure is significant enough ? but this type of change is typically short-lived if not internalized. People in the precontemplation stage might feel ?demoralized and don?t want to think about their problem because they feel that the situation is hopeless. ?There is certain comfort in recognizing that demoralization is a natural feeling that accompanies this stage-and in realizing that if you take yourself systematically through all the stages of change, you can change.??

2. Contemplation. People in this stage realize they might be stuck and desire for things to be different. ?People acknowledge that they have a problem and begin to think seriously about solving it. Contemplators struggle to understand their problem, see its causes, and begin to wonder about possible solutions.? Often, people in this stage are not quite ready to risk taking action, and as a result can stay in this stage for a very long period of time.

3. Preparation. This is the stage where people begin to make changes ? within the next few weeks or a month. This intention is made public, perhaps by involving loved ones or support systems. It is important to feel solid in this stage and to develop a foundational plan for how to follow-through with the change; moving too quickly through it might decrease the person?s chances for success.

4. Action. This is a ?busy? period where behavior is overtly changed and modified. These changes may be more visible to other people (for example quitting smoking or decreasing eating disorder behaviors), but some of the internal work of this stage and prior stages might not be as overtly visible.

5. Maintenance. This stage is where changes and steps taken up until this point are consolidated and continually reintroduced to the client. These might be solidifying new coping mechanisms and preventing relapses. This is the longest stage of change and requires commitment and ?active alertness?.

6. Termination: The final goal! This is where prior issues or struggles are no longer present and recovery feels solid. In eating disorder recovery, this may mean that behaviors have been eliminated for a long period of time (years) but that alertness is still required to take care of oneself and prohibit a relapse.

Change involves not only modifying behaviors but learning to cope with and manage emotions in a healthier way. Lying and dishonesty in treatment and recovery from an eating disorder can come up commonly in several stages of change. Those where the most committed action is involved ? Preparation and Action stages ? can create confusing and conflicting emotions. When the eating disorder is directly confronted and perhaps threatened, it can try to take back control in such a direct way that it may manipulate the client into being dishonest or lying to their therapist or support system. This is an attempt to remain ?safe?, even though it may be maladaptive.

Why is this? There are a few reasons why dishonesty creeps up in recovery. It may be that the client wants to be ?perfect? at recovery, or to please their therapist or loved ones because external validation may feel like the primary form of inner comfort. If they are struggling, they may feel like they are disappointing those who are supporting them.

It also may come up as the client begins to realize the enormous loss that is felt when an eating disorder is taken away. This change requires forming new relationships with the self and learning to cope in healthier, more fulfilling ways. If the client has used the eating disorder to cope with an inner hunger or emptiness, thinking that this needs to be let go can be terrifying. It is when the client has ?fed? that inner hunger in a more loving way that the eating disorder loses its power.

It is important for clinicians to recognize the signs of dishonesty in recovery. This is a great time to enact change in the eating disorder behavioral process and to show compassion for the struggle that the client is experiencing. Holding clients accountable and challenging them is a crucial part of the recovery process. Parents and loved ones can learn more about their role in this process in an article written for parents called Your Role.

It is possible to fully recover from an eating disorder. Sometimes this might mean going through a few of the stages of change several times, or staying in one for a period of time before you are ready to move on.

 

[jenX]

And what of the possibility of "lying and dishonesty", countertransference, or even incompetence on the part of the therapist. Therapy is intersubjective; rarely is it either all client or all therapist behind any problematic patch in the process.

This post refers to "the eating disorder", bizarrely, as if it's a separate entity with a will of its own that can recognize it's being "threatened" and may somehow take back control from the individual. Why not instead follow correctly on from the idea that "Preparation and Action stages — can create confusing and conflicting emotions" or at least stir up emotions underlying the disordered coping? It should be made clear that all are part of the individual.

And why no mention of the quite typical situation wherein the awakened emotions are associated originally with experiences the individual will have to integrate at some point if recovery is the goal, experiences distressing enough for the person to have coped by dissociating and then converting them to the now-maladaptive behaviours?

The point of treatment isn't to swap one type of "coping" for another, an interim solution that indeed leaves the possibility of relapse and constant monitoring for triggers that may not even be recognized. It's to identify and integrate unprocessed experiences and the associated emotions, freeing the individual to live fully in the present and have the self-knowledge to manage their emotions in an aware and healthy way.

 

[David Baxter PhD]

And what of the possibility of "lying and dishonesty", countertransference, or even incompetence on the part of the therapist. Therapy is intersubjective; rarely is it either all client or all therapist behind any problematic patch in the process.

No single article can be expected to cover all aspects of therapy, therapists, and the therapeutic environment. There are other threads elsewhere in this forum that address the issues you mention. This one is addressing the specific question of how eating disordered clients can help or hinder their own recovery.

This post refers to "the eating disorder", bizarrely, as if it's a separate entity with a will of its own that can recognize it's being "threatened" and may somehow take back control from the individual. Why not instead follow correctly on from the idea that "Preparation and Action stages — can create confusing and conflicting emotions" or at least stir up emotions underlying the disordered coping? It should be made clear that all are part of the individual.

Therapists who specialize in treating eating disorders often use that type of reference as a deliberate metaphor and strategy for helping clients to recognize that they "are more than their eating disorder". To facilitate this, some therapists refer to the eating disorder by the name "Ed". For some clients this may be quite helpful: e.g., "I have an eating disorder and it often feels that it controls me but I am much more than that disorder. I do not have to give Ed control. Ed is strong but Ed is not all-powerful. Ed can be defeated. I can defeat Ed and take back control of my life."

And why no mention of the quite typical situation wherein the awakened emotions are associated originally with experiences the individual will have to integrate at some point if recovery is the goal, experiences distressing enough for the person to have coped by dissociating and then converting them to the now-maladaptive behaviours?

The point of treatment isn't to swap one type of "coping" for another, an interim solution that indeed leaves the possibility of relapse and constant monitoring for triggers that may not even be recognized. It's to identify and integrate unprocessed experiences and the associated emotions, freeing the individual to live fully in the present and have the self-knowledge to manage their emotions in an aware and healthy way.

Therapy typically does address those issues. In fact, for certain issues or certain clients that may well be the primary goal.

But again, this is an article about a specific issue and not an attempt to cover all aspects of psychotherapy or all disorders.