Episode 4: The Family. The Home. The Environment of Recovery.
[Bouncy theme music plays.]
Sam: Hey, I’m Sam!
Ashley: Hi, I’m Ashley and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.
Sam: We believe that all bodies and all foods are welcome, we would love for you to join us on this journey. Let’s learn together.
Sam: Hi, Ashley.
Ashley: Hey Sam, how are you?
Sam: I’m well, we’re back. How are you?
Ashley: Oh, I’m great and really excited to be back. It’s good to talk to you again.
Sam: Yes, I feel the same way. We have a lot of really good things we can share today about the family and the home in eating disorder recovery.
Ashley: Yeah. That, um, you know, we’ve been talking about how to support our loved ones, and even how to support the supporters. You know, how do we give help to everybody involved? So, talking about the home environment and how we can make it a space where everybody can come and everybody can feel like their needs are being met and they’re being heard is so helpful and beneficial, I think.
Sam: I agree. Working with families in eating disorder recovery, one of, I think, the most requested things we get are these requests of what can I do practically in the home. Like, tell me what I can do, what I can change. You know, my hope today if there’s families out there listening, and by the way, I think that this episode could be helpful not only to families, but partners, caregivers, you know, roommates.
Ashley: Well, I’m even thinking like therapists, you know, like the people that help keep this kind of accountable for the clients and for their support system.
Sam: Yes. And if anyone is listening in who is struggling with an eating disorder, these are maybe just some ideas that could be helpful and these are ideas that can be brought to family therapy to talk more about. So, I think this episode could really help a lot of people, and it’s a way for people to access some of these suggestions. I mean, we know mental health is not as accessible as it should be. And my hope is that this episode can help families out there who maybe aren’t fortunate enough to have access to a family therapist or, you know, what they need. So, I did a talk on this, I think a year or two ago at the Renfrew Conference, and so I’m really excited to share what I taught. The presentation was actually for clinicians, but I really think it’s this is a great opportunity just to share this information with families as well.
Ashley: I love that, Sam, and I would love for you to just kind of share exactly kind of what you taught, and if you don’t mind, I might chime in and ask you some questions and maybe ask you clarify some things.
Sam: Okay, absolutely. Yeah. So, when we’re working with someone who has an eating disorder, you know, I was working at the residential level, so highest level of care of course, and we would usually have a family session as part of the discharge. And so that family session was a chance to really summarize all the different things that we hope will happen in the home so that the home environment can be a place where recovery can really thrive rather than the eating disorder.
Sam: And I often use the analogy of a plant. It’s like, if you think of the eating disorder as almost, like, a living breathing thing, we need to create an environment where this thing cannot grow. That this thing cannot thrive. And so, if you have a plant, there are certain things when you take those things away, that the plant will just not be able to get bigger, it will not be able to flourish. And so, there are things in the home environment that I truly believe—which plant do you want to grow? Do you want the recovery plant to grow or the eating disorder plant?
Sam: And let’s create a home environment where recovery thrives.
Sam: Because out in the world there are plenty of triggers, of challenges, that could potentially fuel that eating disorder. So why would we make the home environment just as challenging if we can make it easier? I think sometimes families, they say, “Well, shouldn’t my loved one be able to handle these triggers?” “Shouldn’t my loved one, you know, what are you, what have you taught them?” “Shouldn’t they know how to manage this stuff and why is this stuff still bothering them?”
Sam: And, you know, I think it’s just so important for families to understand that your loved one is going to have infinite amount of challenges and triggers.
Sam: And it takes time to get to a place where you’re really strong in your recovery. It’s not, it doesn’t happen overnight. It certainly doesn’t happen after a stay in residential.
Ashley: Right. Well, I’m even thinking it didn’t happen overnight, that their loved one just woke up with an eating disorder either, right?
Ashley: Like, you know, things perpetuated this. Different things happened over different time periods, you know?
Ashley: I’ve always kind of described it, um, go with me for a minute—as a snowball. So, if you are, let’s say, you know, you live somewhere where there’s a lot of snow and it’s just blanketing the ground and you’re wanting to build a snowman, right? You start with a little bitty snowball and you just kind of start rolling it around in the snow, right? And things are compounded upon other things, right? It is a process and it happens over time. And the weight of that snowball, really, or the base of that snowman, you know, it’s very difficult to lift, you can’t anymore and when you try to lift it and you just absolutely can’t, that’s typically, you know, metaphorically speaking, that’s when we come in for treatment, right? And so, it has taken it, may have taken years for this to build up to where someone is finally seeking treatment and the help that they so desperately need, right? And it may have taken different paths. So then, to come home from their stay in treatment, absolutely, it’s kind of going to be a similar way as we unravel all of the things that kind of built up the eating disorder. So I think that that’s helpful to remember, it’s going to take time and if we can put resources in place for our loved ones at home um I think that will help the recovery plant survive, or flourish, if you will.
Sam: Exactly. You know, that’s such a great point. You know, our brains, the good news is that our brains can unlearn these things.
Sam: And to remember that it does take time because, you know, they’ve learned diet culture, they’ve learned, you know, the eating disorder thoughts have been so loud for so long. So, we need patience, we need patience. So, I really do try to support families because I know how much they love their loved one and they want their loved ones to get better quickly and of course it makes sense. And so, patience is really key.
Sam: So, you know, one of the things we immediately talk about with families who are going home with their loved one is how can we make the home as safe as possible?
Sam: And you know, in treatment, we sort of figured out what really helps people stay on track in recovery.
Sam: We know that connection really helps in eating disorder recovery because eating disorders thrive in isolation. We know that eating together helps. We know connection and talking openly about feelings and needs help. So, one of the first things, and I’m going to get real practical here, this episode is gonna be really concrete, really practical for much of it—
Ashley: Yes, that’s great, yes.
Sam: —One of the things we tell families is, well, one of the questions we ask, actually, “Are you eating together or are you a grab and go kind of family? Are there, are there members of the family that they’re on their own with food and they take their food up to their room and eat in their room or are you eating together?” And usually, many families are busy. There are a lot of extracurricular things going on. There’s work, there’s school, there’s all these activities and it’s not uncommon for families to be a little scattered with mealtimes, with where they’re eating, when they’re eating. Whether or not they’re connecting when they’re eating. And so, I really challenge families to think about, you know, “What would it be like for your family to really make an effort to have as many meals together as possible, and to actually sit together at the table and talk to each other and eat with each other?”
Sam: And for a lot of families, this is a big shift because it just hasn’t been doable with schedules, with everything happening. But it’s really something we recommend.
Ashley: Yeah, I was gonna ask what is the typical response that you get from a family when you first ask or pose this question?
Sam: Yeah, I think with any change there sometimes can be some discomfort and some resistance, and I really do encourage families to figure out a way to make this happen as frequently as possible.
Sam: And even if it can’t—you know, we understand that there’s work schedules. There are there are things that sometimes parents or partners just can’t get out of. You know, maybe they work a shift where they’re not home during dinner. But there are ways to connect whether it’s over the phone, Facetime, let’s think of other ways you can connect during the meal. It could be a text before the meal, a text after the meal, a phone call during the meal or after. Or, let’s also think about who are some other supports that we might be able to bring in, that can eat with your loved one.
Ashley: Yes, I love that.
Sam: Yeah, because what we don’t what we don’t want are meals alone.
Sam: We know that this is just not really a good environment when you’re recovering from an eating disorder, is when you’re eating in isolation. And I know sometimes it has to happen, but we really want to try to come up with a plan of how we can minimize any meals alone. So, connection is key. Also, the schedule of meals, to try and eat meals generally at the same time, to eat snacks generally at the same time. So, reintroducing some structure, some predictability, to mealtime. Not in a rigid way, because flexibility is part of recovery, but especially early on in recovery, you know, that structure—the meal plan, the predictable times, all of that really helps the body relearn when it’s hungry, when it’s full. Because all of those hunger fullness cues are completely broken after an eating disorder has, you know, really taken hold.
Ashley: Right. I really love the term predictability here because I do think, sometimes, we know when a client has the eating disorder brain, they might receive information, it gets chewed up in there and they might interpret that as: “Well, you’re putting me on what exactly you said.” It’s not rigid, but they might interpret it as “This is a rigid time frame and I have to follow this, you know, or else.” But really it’s providing that predictability, it’s providing that over and over and over again moment to retrain the brain, or to help the brain learn a new pathway, which is the pathway of recovery. So I really like that you said that.
Sam: Yeah, I think it’s so important, you know, even, I think it’s not uncommon, especially for teenagers, you know, sometimes they might even sleep in and it can be really easy to miss breakfast, and I really talk to families about how important it is. You know, sometimes you need to set an alarm for breakfast, so that you get up and you and you eat together. Because if you’re skipping a meal in recovery, it’s really risky.
Sam: It’s really risky, and sometimes I’ll have clients who say, “Well, a lot of people sleep in and they just eat when they wake up, why can’t I do that too?” And the reality is, well, especially in the early stages of recovery, the risk is really just too high to be doing that. I mean, when you get more in the realm of intuitive eating, you might be able to sleep in and wake up and have a big brunch and really listen to your body and listen to your cravings and your cues. And in eating disorder recovery, it’s different. Because especially early on, it’s really important to have that structure so that you’re able to then eat lunch comfortably.
Sam: And then you’re able to eat dinner comfortably, and eat your snacks comfortably. Or it still might even be uncomfortable. Your body might still be learning. It depends on, you know, where you’re at in your healing process.
Sam: But sometimes, you know, families, it’s an adjustment. It’s sort of Saturday mornings, they’re getting up and they’re having breakfast together.
Ashley: Yeah, well I just think that that structure, it can be so helpful with that. Yeah.
Sam: Yeah. So, you know, it’s very easy to sort of give families sort of a list of directions, you know, it’s sort of like, eat meals at the same, you know, generally the same time eat together all of that. And really, I think the harder work is for family members, partners, to really look at their own relationship with food and their own relationship with their bodies.
Ashley: That does sound like hard work, Sam.
Sam: Yes. That’s the hard part. And making a shift in how you’re talking about food, making a shift in the way that you’re modeling your relationship with food. If you’re sitting down and eating together, but you’re saying, you know, judgmental things about the food or, you know, you are eating diet foods and actively trying to lose weight and openly talking about hating your body and eating differently from the entire family… That is going to have an impact on your loved one.
Ashley: Yes, yes.
Sam: And I understand there are medical conditions that might require family members to eat differently. You know, folks with allergies, folks with other medical conditions that require them to eliminate certain things. That’s different, and you know, that can be worked on in therapy. What I’m talking about is family members who are actively trying to change the shape of their body, and actively manipulating food, and buying into diet culture to do that. The reality is, it’s absolutely everyone’s choice if they want to go down those roads. And at the same time, you do need to be aware that it will have an impact on your loved one who is in recovery.
Sam: The eating disorder is always watching, always listening and will latch on to what is said, what is seen, and will latch onto the beliefs that fit the eating disorder’s agenda. So, if there’s someone in the family who’s really into diet culture or they’re on their own diet, that is going to have an impact. And it makes recovery harder. I’m not going to say it’s impossible, but I will say that your loved one will probably struggle and bring that to therapy week to week.
Ashley: Yeah. And I was just going to add here that it would continue to be a great thing for the support system and the person in recovery to have weekly therapy. Family therapy. This is not just, the client if you will, it’s not just their problem, right? Not that it’s a problem at all, but it’s not just on them. They are living in an environment where they do need that support. And so it would be so helpful loved ones, supporters, partners, roommates, family, to go to this family therapy and to keep unlearning and relearning new processes such as eating the same food that your loved one is eating, consuming the same food, consuming it together. And being in that space together. And just what you said, that might take some work on the part of the loved one, the supporter.
Sam: Sure. I mean, there might be initial resistance. And that’s okay, I think that that can be worked through. You know, the reality is that diet culture and dieting and diet beliefs are… they will make recovery a lot harder for your loved one. And it will just be an extra layer, an extra stressor that they will have to try to figure out how to cope with day to day. And this is what, this is what ends up filling up the therapy session, when they’re saying, “Oh I had such a hard time yesterday because, you know, my mom was talking about being on whole 30.” Or whatever, you know, whatever diet it may be. And then that sort of, it takes away opportunities to do the deeper work when the focus seems to be, how do we cope with these triggers in the home? And I just think it’s important for families to be aware of how difficult it can be to hear this stuff.
Ashley: Yeah. Sam, kind of on the same level here is if we’re discussing or not discussing food as kind of a moral issue, you know, food is not good or bad, or we’re taking out the diet food in the home. Could we even also discuss with them how we talk about our bodies as well? So not body shaming ourselves, not looking at ourselves, “Oh, I really need to go to the gym today,” you know, how do you teach family members about that as well?
Sam: Right, well, I—you’re absolutely right. This is definitely part of the work in families, not moralizing food and not moralizing movement. You know, and body shaming of course, which includes, I think, most family members instinctively know not to body shame their loved one with an eating disorder, we would hope.
Sam: Unfortunately, that’s not always true in every family, but you know, it’s not only that. It’s, you know, whenever you’re body shaming yourself, or body shaming someone on tv, or body shaming someone in public, you know, that all has a negative impact on your loved one as well. And I think sometimes there are parents that think, or family members that, think “Oh, well it’s okay if I sort of make fun of my own body.” And I want people to be aware that, again, that eating disorder is always listening. And when you’re making comments about your own body, that eating disorder is trying to figure out how that comment relates to them, relates to their own body. And, you know, your loved one is creating meaning out of what you’re saying. So absolutely the body shaming, body comments, even compliments such as, oh you know, you’re watching a tv show, “oh doesn’t she look great, It looks like she lost so much weight.” Or saying things that equate weight with health, you know, to say, “Oh it’s so great that she’s finally taking care of her health.”
Ashley: Oh yeah.
Sam: And to make that assumption that just because someone, a celebrity, has lost weight, that somehow that must mean that they’re healthier in some way. And we have no way of knowing if someone is engaging in health promoting behaviors by the size of their body. We have no idea how they’re losing weight or why they’re losing weight. But it’s that assumption, and that link between weight and health, that continues to fuel the eating disorder thoughts. So, all of this stuff, I think, is so ingrained because of our culture. It can be really hard to catch, and the first step is awareness and to be able to gently remind each other in your family when this stuff is popping up, because it’s not always conscious that we’re even engaging in it.
Ashley: Right, right.
Sam: And to be able, in therapy, to work on “How can I call you in in these moments when I notice you are body shaming and you might not realize it?” Or “You’re strengthening my eating disorder beliefs without meaning to.” A lot of this stuff happens unwittingly. I think a lot of family members, the intention is to not cause any harm.
Ashley: Absolutely, absolutely.
Sam: And so this stuff is hard to catch. So, being able to really get comfortable pointing it out to each other, without getting defensive, without getting angry, or being able to tolerate those emotions when they pop up and make that shift when needed. It can be uncomfortable emotionally.
Ashley: I just want to say this, for anybody that is listening to us right now and may be having the realization like, “Oh my word, I’ve done this, oh my word, I’ve body shamed myself in front of someone, I’ve moralized food, I’ve moralized movement in front of my loved one, oh my goodness, I can’t believe I’ve done that,” right? What we’re what we’re here to do today is really not to offer any shame whatsoever. It’s simply to help you build on your awareness. And so my encouragement for anybody listening today is take what you’ve heard and maybe let’s start with just ourselves. The next time I’m watching a tv show and I do see somebody on the on the show, and I make a snap judgment about their weight or about their appearance, simply notice that, right? Like, just simply start noticing that. Or if I’m at the grocery store and I see someone—um whatever, you know, and it sparks a judgment in my brain, “Oh, I think they look disheveled. Oh, I think they—well, that’s somebody from high school, they’ve put on weight,” right? Whatever, simply notice what is coming up in your brain. And I think that that’s the first piece of this awareness, is to just simply notice when these moments are happening for ourselves. Because you said this earlier, Sam, but it is so ingrained in us to talk about appearance, it is so ingrained in us to talk about our bodies, you know, like, I’m thinking of the holidays and thinking how people might say, “Oh I just ate so much over the holidays, I’ve gotta start new in the new year,” right?
Ashley: It’s so ingrained in our culture, and so maybe the first step for any of us listening, professionals as well—notice. Just simply practice noticing when you have those judgments or you have those thoughts come up in your head.
Sam: Yeah, yeah. That’s the first step, is awareness.
Sam: And we’re not always aware, a lot of it is subconscious.
Ashley: Yeah, it is.
Sam: Because this is just how we, you know, how we’ve been conditioned. So, I have so much compassion for people out there who are actively trying to unlearn this stuff because it’s not easy.
Ashley: Yeah, yeah.
Sam: And as you’re trying to unlearn it, you’re still getting bombarded with it.
Sam: It’s everywhere. It’s everywhere. So, you know I think self-compassion is key, patience is key. You know, while we’re talking about body shaming, I think also it’s really important to bring up, you know, in families, to be mindful of what you’re watching on TV.
Sam: What kind of media are you bringing into the house? Because what we know about media is that it really does have the power to increase anxiety, to increase body image disturbance, to increase urges to engage in disordered eating. So, you know, at the residential level of care, we’ve figured a lot of this stuff out through the years, where there’s certain channels that we have blocked on the TV. There are certain magazines we don’t even allow in the building, and there’s a reason for it. There are certain websites that are blocked in the computer room, because why would we want to fuel the eating disorder when someone is actively trying to recover?
Sam: So, if you’re a family who really enjoys shows like Biggest Loser or Revenge Body or, you know, any kind of like makeover show where there’s before and after and there’s weight loss at the focus or appearances at the focus of the show, I think it’s worth unpacking. And, to think about what impact that might be having on your loved one. And I really do encourage families to watch something else.
Sam: That’s all there is to it because it’s just not worth it. Even if you’re watching it for entertainment or you think it’s amusing, be aware that these shows have an impact, and they can strengthen the eating disorder.
Ashley: Yeah. And, I’m thinking also maybe instead of watching TV if, you know, instead of watching these shows if there isn’t anything else, play a game together. Do something where you’re, you know, you’re sitting around the table together, you’re creating more of that connection in that relationship.
Sam: Yes, I agree. And sometimes it can be helpful, families will even make a list of things that they could do, you know, after dinner or just do together as a family because it can be hard to think of things on the spot. And so, it can be helpful just ahead of time to just create a list of ideas of things that you can do together as a family that have nothing to do with food, weight, appearance, and really creating connection. It’s really about creating connection with each other. So that can be really helpful for families too. It’s interesting because families who come into treatment, you know, one of the side effects of families who really work hard together to help their loved one recover, is that they actually feel a lot closer at the end of it.
Sam: And that’s really a cool side effect of, you know, recovering from an eating disorder, is that the family oftentimes learns different ways of communicating with each other, different ways of existing and connecting with each other and their relationships. And although the eating disorder is, you know, such a challenging, difficult, horrible thing to go through, at the same time, sometimes it can pull a family together. And families are incentivized to just learn different ways of being with each other and talking with each other. So that’s really cool to see. Yeah.
Ashley: That’s awesome.
Sam: So, you know, especially for folks who—one of the last things I’ll say, because I know we need to wrap up soon—but you know, I know after the meal can be really difficult for a lot of different folks with eating disorders. Whether it’s, you know, folks who are working on re-feeding and they’re working on getting to a safe weight, or folks who really struggle with urges to purge after eating or they struggle with feelings of fullness. It can be really, really helpful to have a plan about how you will connect as a family after a meal or really any time when urges are really, really high. And I don’t necessarily think it’s about finding ways to distract your loved one. Although I know we hear this a lot, it’s sort of like “When my urges are high, I really just want to be distracted.” And distraction can be helpful in certain cases, and at the same time, I really think that it can be more powerful to create situations where emotions are okay, urges are all okay, we can sit together while you’re experiencing these things emotionally and we can still do things that promote connection and promote being in the present. So it’s really not about ignoring urges and pretending like they’re not there, but it’s about spending time together in a way where it’s safe to talk about those things if they do come up.
Ashley: Yeah, I love— Sorry, Sam, I want you to go ahead. I love that so much. I feel like when we have that safe space to talk about what’s coming up for us, I feel like what that does for us is that it builds our kind of core ego strength. It helps us see that I am a valid human being for having feelings and emotions, especially maybe right after we’ve had a meal together or any time. But I’m valid for having these emotions and I have a safe place where I can kind of release them, talk about them, just let people know I’m having them. And what that does for me, is that tells me that I’m okay, that tells me that I am normal, that tells me that I don’t live on an island by myself where nobody ever understands anything that I’m going through. So, I just I just love that idea of creating that safe space to be authentically who you are right after that meal, instead of using that time to distract yourself from having those emotions.
Sam: Right, right. And, you know, for anyone out there listening who’s thinking “Well, distraction really helps me. And that really got me, you know, pretty far in my recovery.” I want to validate that, absolutely. Distraction, all use distraction from time to time and it can be really helpful, you know to sort of tolerate when we’re feeling an urge and we’re trying to just get through it and wait for that urge to sort of go down on its own. But really I do think it can be so powerful to be able to talk openly and honestly about exactly what you’re feeling in the moment, emotionally and physically.
Ashley: I mean, how seen do you think somebody could feel if they could do that, you know? And when we feel seen, when we feel heard, honestly we breathe deeper. We are more relaxed. We don’t have that burden to bear on our shoulders.
Sam: Yeah, and actually, being validated, being seen, being validated has a calming effect most of the time.
Ashley: Yeah, it does.
Sam: Has a regular regulating sort of effect. And I think sometimes the fear, you know, parents have their own fears about seeing their child in distress, being able to tolerate their child in distress, and tolerating their own emotions that come up, when in reality, when you can really sit with someone and hear them out and validate them, what we often discover—and as therapists, we know this because we do this for a living—is that when you validate someone and someone feels heard and understood on a deep level, it’s calming and healing to them.
Ashley: Yeah, yeah.
Sam: That’s the side effect of being validated. So, I really do try to encourage families to lean into emotional experiences rather than trying to avoid them or distract from them. Because in my opinion, I think it’s just more effective, you know, to approach rather than avoid.
Ashley: Yeah, that’s great. This is great. I really, really hope that this has given our listeners some very practical tools today to kind of take home and begin utilizing.
Sam: Absolutely. And in addition, I also want to remind families that, you know, ideally we do want an eating disorder team to be assisting families along the way. That no family should, you know, ideally we don’t want families to have to, you know, take on recovery all on their own. But having that team, the dietician, the therapist, maybe a psychiatrist, you know, a doctor, a primary care physician, where a lot of these difficult conversations can happen in sessions. Where, you know, with the providers who are specialists. So, I do want to remind families if you do have access to treatment, that really an interdisciplinary treatment team is really the way to go.
Ashley: Yeah, yeah. I couldn’t agree more with that.
Sam: Yeah, to have that support. So well, thank you so much, Ashley.
Ashley: Yeah. Thanks Sam. This was great. I really enjoyed this conversation and hearing from you.
Sam: Me too. Me too. I will see you next time.
Ashley: That sounds great. Take care everyone.
Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders.
Sam: We’re looking forward to you joining us next time as we continue these conversations.
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