User’s Guide | Rules | Contact a Moderator | Registration or Login Problems? | Eating Disorders Learning Center | F.E.A.S.T.



Custom Search of F.E.A.S.T. and Forum Content:
Register Latest Topics
 
 
 


Reply
  Author   Comment   Page 1 of 2      1   2   Next
toothfairy

Avatar / Picture

Caregiver
Registered:
Posts: 1,438
Reply with quote  #1 
I think this is brilliant, it was made by another parent advocate that has kindly allowed me to share.



Many of us (not all) here follow (or have followed and been successful with) the Maudsley approach (FBT), which follows these guidelines:

1. You prepare meals

2. Do not allow your child in the kitchen during meal prep

3. Your child should not go grocery shopping.

4. Toilet before meal and no toilet for at least an hour afterwards.

5. If purging is suspected, use an open door policy in the bathroom, or have them count or sing whilst in there. And no flushing

6. Do not negotiate - whatever you serve has to be eaten

7. Use whatever leverage you have - phone, Internet, tv - whatever they hold dear is to be removed if they refuse to eat, until they have eaten. If they're older and are not financially independent, this is your leverage

8. Separate the two - Your child is not the ED

9. Detach yourself from the situation during meals. Do not get drawn into emotional discussions. THIS IS NOT UP FOR NEGOTIATION

10. Remember that your child wants to recover - the ED is stopping them

11. Your child needs your permission to eat. They need you to stand up to ED as they do not have the strength to do so themselves

12. 3 meals and 3 snacks per day (supervised) - do not deviate from this. Add time limits to the meals (as a guide/goal!). Ours (and the hospitals) was 30 mins for meals and 15 mins for snacks. In the early days this could extend A LOT. I made my Ds meal times the same as they'd be at school so that when she transitioned back to full time it would be easier and less anxiety provoking.

13. High calories are needed throughout refeeding with lots of full fat dairy. Some need as much as 6,000 cals with hyper metabolism, but the norm would be minimum 3500-4000 cals (for you to track not your child)

14. When they know you will not negotiate, I promise you will see the weight lifted from their shoulders... If only for very short periods

15. BE THE CAGE that keeps ED away from your child

16. When food is eaten be mum / dad again and have cuddles if they'll let you

17. 24/7 supervision - I slept with my D for 4 months - this will protect against them purging through vomiting or exercise. Many patients will exercise alone at night for hours on end when nobody else is awake.

18. All sport may need to stop in the early stages, and
for those who compulsively exercised this could be long term.

19. Be consistent, consistent consistent!

20. Don't congratulate them after a meal or say 'well done' - just cheer inwardly! Likewise when (for girls) their period returns!

21. Learn from others. I found this website with stories of other parents journey through recovery to be extremely helpful - http://www.maudsleyparents.org/familystories.html

22. Recommended reading: 'Brave Girl Eating' by Harriet Brown

23. Be prepared for resistance, and lots of it! You will find your own way to manage this, but NEVER back down. Any compromise is a win for ED. Remember, you have to see the beast to slay beast!

24. Making decisions / choices is extremely difficult for them (painful to watch). This is true in areas outside of food too. If you've tried to hand over some control of a meal or snack and notice that they are struggling, that is an indication that it is too soon and that you need to be making those decisions for them.

25. Sometimes distraction helps during meal times. That can come in the form of games,TV, music. Whatever it is you control it and it only continues with eating.

26. Lean on us - you have 24/7 support here as FEAST/ATDT  is international

27. In some cases FBT isn't an option, generally if there are comorbids such as ASD and BPD (Borderline Personality Disorder) . It may just be that FBT needs to be tweaked, or that a different approach is needed. There are many here who have found ways to work around those comorbids or who can advise on an alternative approach which worked for them.

Hope this helps! Best of luck!

__________________
Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
Foodsupport_AUS

Avatar / Picture

Lead Moderator
Registered:
Posts: 3,113
Reply with quote  #2 
They are indeed some great guidelines. Family based treatment empowers the parent to re-feed their child in the way that they feel is most effective for them, their child and their situation. Though many of these strategies can be useful they are not truly principles of FBT, in fact they are thoughts that have been used by many re-feeding methods, hospitals and other treatment providers. 
__________________
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
Torie

Avatar / Picture

Caregiver
Registered:
Posts: 4,428
Reply with quote  #3 
Great post, thanks! xx

-Torie

__________________
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
BattyMatty_UK

Avatar / Picture

Caregiver
Registered:
Posts: 1,353
Reply with quote  #4 
Tooth, can I cut and paste those into my blog?
__________________
Bev Mattocks, mother of 23-year old male DX with RAN 2009, now recovered. Joined this forum in 2010 - it was a lifesaver.
toothfairy

Avatar / Picture

Caregiver
Registered:
Posts: 1,438
Reply with quote  #5 
Batty -
Yes, go for it !
Xxx TF

__________________
Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
mamacy

Caregiver
Registered:
Posts: 1
Reply with quote  #6 
So new to this.  We don't even have an official diagnosis. My daughter is 12 and has lost 20% body weight since January.

Why not let her help with food prep or grocery shopping? This has been cherised mother/daughter time.

If it's not right to let her I'll stop, but I'll miss the time.
Foodsupport_AUS

Avatar / Picture

Lead Moderator
Registered:
Posts: 3,113
Reply with quote  #7 
Mamacy welcome to the forum, sorry that you have had to find your way here. 

It is generally not recommended that someone with an ED help with food prep and grocery shopping, even though they often will wish to dominate this. Part of the reason is that it validates the food rules that eating disorders create and perpetuates the anxiety about eating. It is common for someone with an eating disorder to be very fixed on certain brands, types of foods with severe anxiety associated with any change to the routine. Although early on it may seem that taking away the choice would increase the anxiety, in the long term it often relieves.  Most people really struggle with increasing their food intake, if your daughter has lost that much weight then she is likely to be seriously ill already, and the thing she needs more than anything is food and lots of it. 

Take your time to read around the forum and the FEAST website and waste no time in getting a full assessment of your daughter and a diagnosis. 

__________________
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
noo72

Caregiver
Registered:
Posts: 16
Reply with quote  #8 
oh my goodness, what an amazingly helpful thread.
 

i am now grasping that it really is up to me to initiate the correct approach with my 15 yo d (rather than waiting for the Dr to come up with a plan) based on the great advice i have got on my own thread.

tooth fairy, i wonder if you, or anyone can else tell me if i can get the main 'rules' of the maudsely approach in a published/ official looking document or even a book which i could photocopy and show her relevant pages?
my dd will argue with me and her dad til she is blue in the face but seems to accept 'medical advice', so i wonder if i could share some of the rules for recovery with her, she would object less. if she thinks its just another on elf my ideas, she's going to kick off.  i do realise that i have to be in charge, and she shouldn't be able to negotiate, but i'd like it to be a painless as possible. and she might actually listen (she has so far, to 'medical' advice)
BattyMatty_UK

Avatar / Picture

Caregiver
Registered:
Posts: 1,353
Reply with quote  #9 
Thanks Tooth! [smile]
__________________
Bev Mattocks, mother of 23-year old male DX with RAN 2009, now recovered. Joined this forum in 2010 - it was a lifesaver.
tina72

Caregiver
Registered:
Posts: 222
Reply with quote  #10 
Hi noo72,
you are so right: you are in charge to fight it and nobody else is worth waiting for.
To get the rules officially, get these two books:
Eva Musby: Anorexia and other Eating Disorders: how to help your child eat well and be well.
Lock/Legrange: Help your teenager beat an Eating Disorder.
Tell her that you have informed yourself and that you have read the best books to help her and that you are knowing what to do.
Don´t discuss with her. That is wasted time. She cannot see that she is sick and she cannot understand all that. Her brain is not working correct.
Make your husband read the first one at least so that you are pulling at the same rope.
If you can fixe these rules in your house, it will be much easier soon. At first there is some battle about it, but very soon they accept it because they see that everything becomes much more easier. Keep on going. You are doing the right thing.

Thanks for that toothfairy, that is great. Do you mind if I translate it into german and post it here?

Tina72
Torie

Avatar / Picture

Caregiver
Registered:
Posts: 4,428
Reply with quote  #11 
Quote:
Originally Posted by noo72
tooth fairy, i wonder if you, or anyone can else tell me if i can get the main 'rules' of the maudsely approach in a published/ official looking document or even a book which i could photocopy and show her relevant pages?
my dd will argue with me and her dad til she is blue in the face but seems to accept 'medical advice', so i wonder if i could share some of the rules for recovery with her, she would object less. if she thinks its just another on elf my ideas, she's going to kick off.  i do realise that i have to be in charge, and she shouldn't be able to negotiate, but i'd like it to be a painless as possible. and she might actually listen (she has so far, to 'medical' advice)


Noo, it is really tricky to find anything written that is safe to share with them.  I wonder if you could print this out, highlight the parts you want to quote, and ask the team tomorrow if they agree with these rules.  Then you can TELL your d the rules are from the doctor or whatever.  Just a thought. xx

-Torie

__________________
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Foodsupport_AUS

Avatar / Picture

Lead Moderator
Registered:
Posts: 3,113
Reply with quote  #12 
Noo72 I think you need to be aware these are not RULES of FBT . They are principles of treatment that are commonly used in both FBT as well as many inpatient and outpatient programs. 

The whole point of FBT is that it entrusts parents with the goal of re-feeding their child and assumes that they know how to do this. That is they know how to feed their child and know their child best. What "rules" are utilised is very individual, but the rules of the treatment itself are very few. The number one thing though is that in phase 1, parents are in charge of the feeding. 
http://www.feast-ed.org/default.asp?page=FBT_MaudsleyApproach
http://www.maudsleyparents.org/whatismaudsley.html
http://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/Printable%20FBT%20Information%20Sheet.pdf
https://en.wikipedia.org/wiki/Maudsley_family_therapy

__________________
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
deenl

Moderator
Registered:
Posts: 831
Reply with quote  #13 
I would be inclined to see this list as a list of ideas and choose what works for you. I don't disagree with anything on the list but I do think it is important to have a certain flexibility in HOW you approach your goal. THE GOAL is not flexible; regular meals, nutritional rehabilitation, reducing ED behaviours, FULL weight restoration and seeking treatment for remaining issues, if any. For example, in our recovery journey we have...

Quote:
Originally Posted by toothfairy
1. You prepare meals 2. Do not allow your child in the kitchen during meal prep 3. Your child should not go grocery shopping.
YES, we did these.
 
4. Toilet before meal and no toilet for at least an hour afterwards. 5. If purging is suspected, use an open door policy in the bathroom, or have them count or sing whilst in there. And no flushing 6. Do not negotiate - whatever you serve has to be eaten 7. Use whatever leverage you have - phone, Internet, tv - whatever they hold dear is to be removed if they refuse to eat, until they have eaten. If they're older and are not financially independent, this is your leverage
NOPE, none of this worked for us. If fact, the strained atmosphere made it more difficult for him to eat. So we had clear expectations at each and every meal that he would eat, used safe foods with adequate calories and tried to keep the atmosphere as calm and supportive as possible. It was all very much similar to how our disciplinary style has developed over his lifetime. We knew our kid best and how to get him to do what needed to be done. But we closed loopholes when needed, for example, we had to frisk him after meals for a couple of months.
 
8. Separate the two - Your child is not the ED
YES, it was so unlike our kid that this happened naturally. We just knew something was wrong.

9. Detach yourself from the situation during meals. Do not get drawn into emotional discussions. THIS IS NOT UP FOR NEGOTIATION 10. Remember that your child wants to recover - the ED is stopping them
Not really an issue for us
 
11. Your child needs your permission to eat. They need you to stand up to ED as they do not have the strength to do so themselves
Also a NO. If we had indicated something like this his stubborn, temporarily illogical mind would have refused to eat just cause we said so. But we did have unsaid expectations of eating shown by providing meals on a strict schedule, day in, day out.

12. 3 meals and 3 snacks per day (supervised) - do not deviate from this. Add time limits to the meals (as a guide/goal!). Ours (and the hospitals) was 30 mins for meals and 15 mins for snacks. In the early days this could extend A LOT. I made my Ds meal times the same as they'd be at school so that when she transitioned back to full time it would be easier and less anxiety provoking.
In the beginning, YES, but later, before he could eat out and about we would skip a snack in favour of socialising or an outing. We considered the balance between the snack and the positive effect on mood. We also had a timer but it was more a guideline and there were no consequences for being late.

13. High calories are needed throughout refeeding with lots of full fat dairy. Some need as much as 6,000 cals with hyper metabolism, but the norm would be minimum 3500-4000 cals (for you to track not your child)
ABSOLUTELY

14. When they know you will not negotiate, I promise you will see the weight lifted from their shoulders... If only for very short periods 15. BE THE CAGE that keeps ED away from your child 16. When food is eaten be mum / dad again and have cuddles if they'll let you 17. 24/7 supervision - I slept with my D for 4 months - this will protect against them purging through vomiting or exercise. Many patients will exercise alone at night for hours on end when nobody else is awake.
Personally, these were not issues for us.
 
18. All sport may need to stop in the early stages, and for those who compulsively exercised this could be long term. 19. Be consistent, consistent consistent! 20. Don't congratulate them after a meal or say 'well done' - just cheer inwardly! Likewise when (for girls) their period returns! 21. Learn from others. I found this website with stories of other parents journey through recovery to be extremely helpful - ttp://www.maudsleyparents.org/familystories.html
All YES, in this house

22. Recommended reading: 'Brave Girl Eating' by Harriet Brown
Haven't read this but did read extensively. I do think that there needs to be at least one 'expert' in each family. 

23. Be prepared for resistance, and lots of it! You will find your own way to manage this, but NEVER back down. Any compromise is a win for ED. Remember, you have to see the beast to slay beast!
For us, this was too strong of an attitude and allowed ED a win by elevating the ED resistance and strengthened the ED sensations. We did, of course, try it and I think it is very important to do so but for us, creating a very calm atmosphere allowed the ED sensations our son felt to be dampened enough for him to resist them so that entailed compromise, a bite or two left on the plate, a meal swopped, very slow introduction of fear foods. We felt stuck for a long time but it has worked out in the end.

24. Making decisions / choices is extremely difficult for them (painful to watch). This is true in areas outside of food too. If you've tried to hand over some control of a meal or snack and notice that they are struggling, that is an indication that it is too soon and that you need to be making those decisions for them.
YES, we need to coach our kids with choices and general emotional and social aspects for a long time afterwards.

25. Sometimes distraction helps during meal times. That can come in the form of games,TV, music. Whatever it is you control it and it only continues with eating. 26. Lean on us - you have 24/7 support here as FEAST/ATDT  is international
YES
 
27. In some cases FBT isn't an option, generally if there are comorbids such as ASD and BPD (Borderline Personality Disorder) . It may just be that FBT needs to be tweaked, or that a different approach is needed. There are many here who have found ways to work around those comorbids or who can advise on an alternative approach which worked for them.
This is what we did. We took the principles and adapted the procedures. Our son said himself that he feels 88% recovered. Can't tell you how happy I was to hear that. I have full confidence that he will get to 100% and that we will adapt and tackle any remaining issues.


This is a great list from Toothfairy's friend (thanks for sharing TF) to help clear the mind and hone your approach, especially in the beginning of the journey. As long as you are 100% clear and committed to your goals, I would encourage you to blend this list with your knowledge of you child. Expect a certain amount of trial and error.

There is a huge learning curve in the SKILLS you need;
- the words you use, your tone of voice (I mimicked Eva Musby's calm and gentle voice and my kid glared at me and said "I'm not f*ing two, ya know". I had to take her ideas and personalise it to me),
- your physical state (I had a (faked) calm voice but noticed I was stomping around, not exactly chill),
- what you do when they are having difficulty (do you nudge the fork, say a favourite phrase, spoon feed, increase distraction, remind them of an incentive, just give them more time?),
- how do you juggle the rest of the family and your other responsibilities
- the skill of self care
- loads more I can't remember right now.

You will learn these skills and more through experience. There is no right way to the goal, read a lot, try stuff and you'll get there.

Warm wishes,
D

__________________
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, tons of variety in food, stepping back into social life. Sept 2017, back to school full time for the first time in 2 years. Happy and relaxed, just usual non ED hassles. 

  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal. (but don't give up on the plan too soon, maybe it just needs a tweak or a bit more time and determination [wink] )
  • We cannot control the wind but we can direct the sail.
BattyMatty_UK

Avatar / Picture

Caregiver
Registered:
Posts: 1,353
Reply with quote  #14 
Wise stuff, Deenl
__________________
Bev Mattocks, mother of 23-year old male DX with RAN 2009, now recovered. Joined this forum in 2010 - it was a lifesaver.
Torie

Avatar / Picture

Caregiver
Registered:
Posts: 4,428
Reply with quote  #15 
Here's my question, Deenl (and others):  How is a person - especially a person new to this topsy turvy ED world - supposed to figure out whether the things on this list are impossible / ill-advised in their particular case ... or if they are in the "seems impossible but gotta find a way" category?

Many of these things seemed nearly impossible in the Torie household ... and yet doing them saved my d's life.  And this was an easy case compared to most everyone I have read here.  Others have persisted through hell and high water (and fire and assault) to make them possible.

And yet.  For some (like you, for instance), the list really does need to be modified.

I hope I am making sense, rather than being offensive in some way.  I know that FBT/M really does not work for everyone, but I worry that someone might not push through hard enough because it is so hard - so very, very hard - to travel this path.  So tempting to say no, nope, not for my kid, this isn't gonna work here ... because of how freaking hard it is, how long it takes, how slow the progress ... even though it really would work with more time and practice.

And yet for others it wouldn't and doesn't.

Hope that makes sense.  xx

-Torie

__________________
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
EC_Mom

Caregiver
Registered:
Posts: 217
Reply with quote  #16 
Torie, your post just made realize that part of what might work in one family vs another may have as much to do with what the parents can manage to make themselves do vs. the effect it has on the kid. This may be obvious to everyone else, but I guess I always thought that "what works" depends on the kid. I did the full-on, magic plate, every bite, even until 1am, even if I spoon-feed while climbing back and forth over my kid in bed as she turns to avoid me, for hours at a time. If I hadnt' been able to do that, would she not have recovered? Would we have found another way that would also have worked? This post is the first time I realize that maybe we would have. 

So yes, food needs to go in, tons of it, and parents' tolerance for kids' distress will need to be pushed to the limit. But maybe that limit means different things and as long as food goes in it doesn't matter so much?

I don't want to mislead any newbies, this is more a philosophical thought from the position of blessed recovery. For newbies, it is important to require all food, all the time, high calories. But from a philosophical perspective maybe that limit is more flexible than I thought?
deenl

Moderator
Registered:
Posts: 831
Reply with quote  #17 
That's the $1,000,000 question, Torie. But short of time but will reply later.

Warm wishes

D

__________________
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, tons of variety in food, stepping back into social life. Sept 2017, back to school full time for the first time in 2 years. Happy and relaxed, just usual non ED hassles. 

  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal. (but don't give up on the plan too soon, maybe it just needs a tweak or a bit more time and determination [wink] )
  • We cannot control the wind but we can direct the sail.
Foodsupport_AUS

Avatar / Picture

Lead Moderator
Registered:
Posts: 3,113
Reply with quote  #18 
We tried most things on this list at some point. Some of them worked a bit, others not so much. Each and every eating disorder is different as is each and every child and situation. I am a sole parent, and the sole breadwinner for the family. I run my own business and also have a parent who developed a life threatening illness soon after my D did. No partner, D's father left when she was 18 months old and hasn't been seen since.  My father died before she was born. Like her father, his parents haven't been seen for many years and live in another country.  My friends work like I do. My D like some others here frequently expressed a desire to die from the get go. She made a number of suicide attempts over the first few years of her illness. So for us there were some practical aspects which limited some aspects, access to services which limited others.

Quote:
1. You prepare meals
Not too much problem with this one

2. Do not allow your child in the kitchen during meal prep
Open plan house and D needed to be within eye shot at all times. She may not have seen what was happening at all times, but boy was she listening for things. 

3. Your child should not go grocery shopping.
This sometimes worked and not at others. D was not safe to leave alone, so at times there was nothing else for it. Her insistence on certain brands was typically very strong. She was often unable to eat brands that were not on her personal list. 

4. Toilet before meal and no toilet for at least an hour afterwards.
Having had multiple hospital admissions where this was the routine, she didn't fight this at all. Although she used to spit small amounts of food early on in her illness, I don't think she has ever used vomiting in her illness. 
5. If purging is suspected, use an open door policy in the bathroom, or have them count or sing whilst in there. And no flushing
Again not a problem for us.

6. Do not negotiate - whatever you serve has to be eaten

A huge problem. How often do you try life stops till you eat, and find out that life just stops? Before D's initial hospitalisation, initially I just tried getting her to eat more, no success, we then tried a meal plan, unable to follow it. She deteriorated rapidly and was hospitalised for 3 weeks for medical instability. She was unable to eat on discharge, water only, and despite a call back to the hospital on the day of discharge was only readmitted 4 days later, having lost 3kg in four days. This was a recurring pattern. For the first six months or so she could only eat knowing that if she was unable to she would get a NG tube. Around six months in she would agree to try to follow a hospital like meal plan at home, but continued to struggle to eat it. 


7. Use whatever leverage you have - phone, Internet, tv - whatever they hold dear is to be removed if they refuse to eat, until they have eaten. If they're older and are not financially independent, this is your leverage

When they just want to die there is no leverage. She would just sit, and sit, and sit, and sit. She knew that this would result in rehospitalisation but her ED was just too strong. 


 
9. Detach yourself from the situation during meals. Do not get drawn into emotional discussions. THIS IS NOT UP FOR NEGOTIATION

Absolutely agree with this one, but ED is a tough one. D never discussed anything during meals. She said nothing, but also didn't eat. Unlike many we had no yelling, not plate throwing etc. Attempts at spoon feeding met with pursed lips. She made no movement when given instructions. She did nothing. When sitting down at the table she would either start to eat, and complete the meal without negotiation, or not eat at all. 

 
12. 3 meals and 3 snacks per day (supervised) - do not deviate from this. Add time limits to the meals (as a guide/goal!). Ours (and the hospitals) was 30 mins for meals and 15 mins for snacks. In the early days this could extend A LOT. I made my Ds meal times the same as they'd be at school so that when she transitioned back to full time it would be easier and less anxiety provoking.

All meals were supervised, no problem with that either. She needed someone to sit with her at all times when eating and was quite clear that she couldn't eat on her own. Even when we were doing much better and she was weight restored she still couldn't eat without supervision and reminding.  ED stopped her from taking all responsibility for this. 

 
14. When they know you will not negotiate, I promise you will see the weight lifted from their shoulders... If only for very short periods

Hmmm. Won't or Can't is not exactly negotiation. That is usually where is stopped. It didn't relieve either of us. 

 
16. When food is eaten be mum / dad again and have cuddles if they'll let you

I would argue that we are mum/dad all the time. Definitely essential not to blame them for the illness. 

17. 24/7 supervision - I slept with my D for 4 months - this will protect against them purging through vomiting or exercise. Many patients will exercise alone at night for hours on end when nobody else is awake.

When she wasn't in hospital we shared a room for 4 years. She was reluctant to leave even at the age of 17, ED was always very hard on her at night. 

18. All sport may need to stop in the early stages, and
for those who compulsively exercised this could be long term.

All sport stopped at diagnosis. The compulsive exercise was a tough one. She frequently was in trouble in hospital for this one, and yet another reason she needed eyes on at all times. Probable around 2.5 years for the compulsive exercise needing management. 
 
20. Don't congratulate them after a meal or say 'well done' - just cheer inwardly! Likewise when (for girls) their period returns!

Definitely. D struggled with many things being said, over and above this including concepts of being sicker or less sick. Medical checks at times were an issue on the same line, don't congratulate for gaining weight either. 

23. Be prepared for resistance, and lots of it! You will find your own way to manage this, but NEVER back down. Any compromise is a win for ED. Remember, you have to see the beast to slay beast!

Never backing down at times can be an issue. Realising that you need to work another way around an absolute Can't is important. In my D's case most of the time when the beast came out it produced absolute shut down. There was no negotiation but also no progress either. Essentially this meant in the end at least some form of negotiation as to what could be tolerated. So we worked on meal plans. She knew what foods would come each day in which order. She knew how much she was meant to be having. She also knew that I tried to increase the quantities, both amounts and adding in things like butter but we never discussed this and it was never spoken of. 

25. Sometimes distraction helps during meal times. That can come in the form of games,TV, music. Whatever it is you control it and it only continues with eating.

This definitely did help, when she was eating. Our particular thing was Friends. All 239 episodes. We still have a number of "in" jokes about it. 
 
27. In some cases FBT isn't an option, generally if there are comorbids such as ASD and BPD (Borderline Personality Disorder) . It may just be that FBT needs to be tweaked, or that a different approach is needed. There are many here who have found ways to work around those comorbids or who can advise on an alternative approach which worked for them.

D spent so long in hospital early on we couldn't get FBT going at all at the start. The hospital D was attending referred all patients in area to the local CAMHS who offered FBT, however we were not in their area and the only support we could get in the first 18 months was someone who was a psychiatrist experience in ED's and was willing to support FBT but did not do it himself. This was reconsidered both 18 months and then three years in, with visits to therapists who would offer FBT. In the end we didn't use this path as it was not clear how this would really change what we were doing at the time. D was close to weight restoration at both of those times having lost some weight in the interim and I managed to re-feed her back up again with our current supports. 


 


__________________
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
Mamaroo

Caregiver
Registered:
Posts: 129
Reply with quote  #19 
Quote:
Originally Posted by Torie
Here's my question, Deenl (and others):  How is a person - especially a person new to this topsy turvy ED world - supposed to figure out whether the things on this list are impossible / ill-advised in their particular case ... or if they are in the "seems impossible but gotta find a way" category?

Many of these things seemed nearly impossible in the Torie household ... and yet doing them saved my d's life.  And this was an easy case compared to most everyone I have read here.  Others have persisted through hell and high water (and fire and assault) to make them possible.

And yet.  For some (like you, for instance), the list really does need to be modified.

I hope I am making sense, rather than being offensive in some way.  I know that FBT/M really does not work for everyone, but I worry that someone might not push through hard enough because it is so hard - so very, very hard - to travel this path.  So tempting to say no, nope, not for my kid, this isn't gonna work here ... because of how freaking hard it is, how long it takes, how slow the progress ... even though it really would work with more time and practice.

And yet for others it wouldn't and doesn't.

Hope that makes sense.  xx

-Torie


This is an excellent question! I've been thinking a lot about that one lately. When my d became ill, I tried refeeding the traditional FBT way (of what I understood of FBT at that stage, not seeing an FBT specialist yet), with a slight success, we got her weight up from 35kg to 36kg (78% of the weight she should've been), however the distress of that weight gain along with the fact we had poor medical support at that stage meant we didn't know (or expect) how to handle her distress at the weight gain. I actually congratulated her on gaining a kilo (I can hear you all laughing at me now). Along with a terrible dr telling her that her weight is fine, she just became more stubborn, would hide food in her pocket, spit it out, etc. And losing a lot of weight very quickly.

I think this stubbornness was actually a snapshot of her state of mind. The more malnourished she became the more rigid her thinking was, which made FBT much harder. She was eventually hospitalised at a weight of 32kg (70%). The percentages I give, is based on my estimate of what her weight was supposed to be based on the historical measures I took when she was younger. Now my d has always been very tall (95% plus on the percentile), so the Drs compared her weight with an average child's chart, which meant they didn't see her as underweight as I did. Also her vitals were still fine at 34kg (74%), so looking back, I can see her brain was in a worse place than her heart.

We eventually used FBT-Deenl style to refeed and I used to think that my d didn't fit into the traditional FBT mould. However, when she gained enough weight to be about 90% WR (again based on my estimate of her correct weight), I noticed I could use traditional FBT to get her to eat. Suddenly magic plate and LSUYE worked! All that I can conclude was that her brain started to heal and became more flexible again. Maybe some children's brains are more affected by the illness than other children's, with the result that traditional FBT could only have worked at the very beginning of weight loss, when it was hardly noticeable, when she started cutting out sweets, but was still eating all her meals and snacks. Very hard to force a child to eat dessert. But looking back, I should've stopped all the dancing and gymnastics then and there. Oh hindsight!

__________________
D became obsessed with exercise at age 9. Started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for a year and WR at age 11. Challenging fear foods now.
toothfairy

Avatar / Picture

Caregiver
Registered:
Posts: 1,438
Reply with quote  #20 
Hi Tina, 
Yes  please translate in German and link here, I would be very grateful x

__________________
Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
toothfairy

Avatar / Picture

Caregiver
Registered:
Posts: 1,438
Reply with quote  #21 
Hi Noo72,
I havent got a book to offer, I would not ever give my child any kind of book or instruction list as it feeds into the disorder.
Anorexia will always find fault with whatever you produce , so the answer is not to engage.

" I know what you need, so eat this"

" I do not engage with anorexia"

I advise -No talk about food fat calories size weight shape....



__________________
Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
Kali

Avatar / Picture

Moderator
Registered:
Posts: 628
Reply with quote  #22 
Hi, I'll take a stab at this also. I think it really illustrates that you have to find out what works for your child and your family and then run with that ball. We all have slightly different experiences working within the same guidelines. Also want to point out that my d. was nearly 18 when diagnosed and wanted to leave home for college after recovery so we may have done some things differently because of that.

1. You prepare meals
During weight restoration, all meals were prepared for her. Because she was a young adult, AFTER weight restoration I encouraged her to learn to cook or to go and pick up takeout and bring it home for us to eat. We also spent alot of time after initial weight restoration discussing portion sizes. At that point she served herself and I commented if she didn't take enough and she put more on her plate. The nutritionist also worked with her to help her understand and implement full nutrition and portion sizes.

2. Do not allow your child in the kitchen during meal prep
During weight restoration, she was not in the kitchen when meals were prepared.

3. Your child should not go grocery shopping.
During weight restoration she did not go grocery shopping however afterwards I encouraged it and we went together. I emphasized that only full fat and no diet or low calorie products could be in our kitchen. I did buy the brands she preferred; I don't care if she eats yogurt A or B as long as it has enough calories and nutrition.

4. Toilet before meal and no toilet for at least an hour afterwards.
For 11 weeks to help break the purging cycle.
5. If purging is suspected, use an open door policy in the bathroom, or have them count or sing whilst in there. And no flushing
After the 11 weeks of no toilet for an hour after meals, I did frequent toilet checks after she was in the bathroom but found no evidence of purging.

6. Do not negotiate - whatever you serve has to be eaten
I'm not sure how to answer this one. Some days were better than others and I chose my battles carefully. Later on, when she was doing better there were some times where she was really struggling where I let her substitute another food for the one she was having trouble with. I ate the same portions and food as she did, so if she said she was very full and I was also, I knew not to have a big argument about it because she was telling the truth. I did not force fear food like ice cream and frozen yogurt, I focused more on broadening her diet to include more variety in food choices and making sure she was fully nourished. 

7. Use whatever leverage you have - phone, Internet, tv - whatever they hold dear is to be removed if they refuse to eat, until they have eaten. If they're older and are not financially independent, this is your leverage

My d. was as I said nearly 18 when diagnosed and spent her 18th year in treatment and at home. I wanted her to have a phone so that I could communicate with her. I did use incentives rather than taking things away. "After you finish eating you can..... When you are recovered you will be able to ......... fill in the blanks here. My leverage is the close relationship I have with my daughter and my efforts to become the sort of person you would want on your side as a support person if you had a serious illness. If my daughter had cancer and chemotherapy was not working I would not be taking her internet access away or not allowing her to watch TV.

8. Separate the two - Your child is not the ED

Yes

9. Detach yourself from the situation during meals. Do not get drawn into emotional discussions. THIS IS NOT UP FOR NEGOTIATION

Yes. I would state my opinion once and then if she continued to try and discuss I would say I told you what I think let's talk about something else.

10. Remember that your child wants to recover - the ED is stopping them

She really did not always want to recover but that didn't stop me from trying to feed her.

11. Your child needs your permission to eat. They need you to stand up to ED as they do not have the strength to do so themselves

Yes. When I heard what I call ED chatter; for example looking at her plate and telling me all the things she didn't like, or wanting to drink water instead of a caloric drink I calmly stated the opposite. You need to have juice with your meal. One big thing I had to stand up for was always using full fat milk and yoghurt. After a while I found I was able to help her over ride the voice.

12. 3 meals and 3 snacks per day (supervised) - do not deviate from this. Add time limits to the meals (as a guide/goal!). Ours (and the hospitals) was 30 mins for meals and 15 mins for snacks. In the early days this could extend A LOT. I made my Ds meal times the same as they'd be at school so that when she transitioned back to full time it would be easier and less anxiety provoking.

We did 3 meals and 2 snacks a day at home and I did not have time limits. The treatment center did, so that by the time she came home she was accustomed to the goal of eating in a certain period of time.


13. High calories are needed throughout refeeding with lots of full fat dairy. Some need as much as 6,000 cals with hyper metabolism, but the norm would be minimum 3500-4000 cals (for you to track not your child)

3700 calories a day was the sweet spot.
14. When they know you will not negotiate, I promise you will see the weight lifted from their shoulders... If only for very short periods

No, the weight was not lifted from her shoulders because there was no negotiating about eating. As she got closer and closer to being weight restored...she was in distress.

15. BE THE CAGE that keeps ED away from your child

16. When food is eaten be mum / dad again and have cuddles if they'll let you

Not sure I understand this one since I am always the mom. Especially so when I was helping my undernourished daughter to eat.

17. 24/7 supervision - I slept with my D for 4 months - this will protect against them purging through vomiting or exercise. Many patients will exercise alone at night for hours on end when nobody else is awake.

She had supervision for 3 months while she was in residential treatment. But I think in the beginning the exercise compulsion was very hard to break.

18. All sport may need to stop in the early stages, and
for those who compulsively exercised this could be long term.

No sport or exercise for an entire year.

19. Be consistent, consistent consistent!

Yes

20. Don't congratulate them after a meal or say 'well done' - just cheer inwardly! Likewise when (for girls) their period returns!

Yes

21. Learn from others. I found this website with stories of other parents journey through recovery to be extremely helpful -http://www.maudsleyparents.org/familystories.html

Yes

22. Recommended reading: 'Brave Girl Eating' by Harriet Brown

Yes, and a lot of other books as well. Eva Musby's book was very helpful with the actual question: how do you get them to eat?

23. Be prepared for resistance, and lots of it! You will find your own way to manage this, but NEVER back down. Any compromise is a win for ED. Remember, you have to see the beast to slay beast!

I chose my battles carefully but was not afraid to step on the tail of the tiger when it was necessary.

24. Making decisions / choices is extremely difficult for them (painful to watch). This is true in areas outside of food too. If you've tried to hand over some control of a meal or snack and notice that they are struggling, that is an indication that it is too soon and that you need to be making those decisions for them.

Yes, decisions are difficult in a variety of different situations. I sometimes wondered if the area of the brain which houses the ability to make choices is also impacted by the illness. In order to help her relearn to make choices, I would limit them. Letting her choose between 2 things for example. Because she is a YA I want to help her with strategies to make decisions instead of making them for her.

25. Sometimes distraction helps during meal times. That can come in the form of games,TV, music. Whatever it is you control it and it only continues with eating.

Yes! And Foodsupport, Friends THE ENTIRE SERIES was also watched in our house! Although I didn't control or use distractions as leverage to continue eating.
26. Lean on us - you have 24/7 support here as FEAST/ATDT  is international

Yes!

27. In some cases FBT isn't an option, generally if there are comorbids such as ASD and BPD (Borderline Personality Disorder) . It may just be that FBT needs to be tweaked, or that a different approach is needed. There are many here who have found ways to work around those comorbids or who can advise on an alternative approach which worked for them.

I have come to believe that each family needs to find their way to what works for them, it is not a one size fits all type of illness although there are some guidelines like the ones here which certainly are helpful.


28: My addition: Setting up a professional team: Some families have found that setting up a team is helpful. The team can consist of: The FBT therapist, a nutritionist, a GP who is specifically trained to work with eating disordered patients, other types of therapists (DBT, CBT) a psychiatrist to evaluate whether medication can help, a therapist for the parent to see individually to help them cope..a stint in residential treatment, PHP or IOP, one of the weeklong programs at CBL or UCSD, CAHMS, or whatever help is available and accessible for the family. If you do not find support people at first who "click" with your family or seem to be helpful, keep looking.

Kali

__________________
Food=Love
Torie

Avatar / Picture

Caregiver
Registered:
Posts: 4,428
Reply with quote  #23 
Quote:
Originally Posted by Mamaroo
 We eventually used FBT-Deenl style to refeed and I used to think that my d didn't fit into the traditional FBT mould. However, when she gained enough weight to be about 90% WR (again based on my estimate of her correct weight), I noticed I could use traditional FBT to get her to eat. Suddenly magic plate and LSUYE worked!


It seems that extremely low weight does make FBT/M MUCH harder / less effective.  That's one reason it makes me so crazy to read about people getting the bad advice that everything is okay (don't do anything) early on when home treatment would likely be more effective and "easier."

I think it also helps if the sufferer is younger rather than older so that we're still bigger, stronger, and more intimidating.  And they haven't had as much life practice fighting / rebelling.

Finally, I know it makes a big difference if your professional "help" is worse than no help at all, or if they actually provide useful backup.  Sometimes an NG tube is needed, and other times the threat of one is enough.   The pros have tools that make it possible to force the kid to consume enough nutrients, while we can only "require."

But still ... some kids are just different.  Kinda like ARFID is just different than AN.

For most, though, I think the recommendations in this thread are spot on.  I'm a little concerned that this discussion could erode the confidence of new folks and lurkers who would mostly be well-served by following the advice TF posted.  After all, it's REALLY hard to keep on keeping on and very tempting to think "my kid is an exception" because it is ALWAYS so very hard.

So yeah, there are exceptions.  There really are.  But for most of us, this is darn good advice. xx

-Torie

__________________
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
LauraCollins_US

Avatar / Picture

F.E.A.S.T. Outreach Director
Registered:
Posts: 5,902
Reply with quote  #24 
I love this thread for a number of reasons. One, it is so refreshing to see parents sharing their own experiences and strategies with one another: very powerful. But also because of the conversation about what FBT is, what "Maudsley" is, and what real families in the real world DO.

It was pointed out above, and I want to underline it as someone who spends a lot of time both in the parent community and the professional community, that the term "Maudsley" and the term "FBT" (Family-Based Treatment) are ones to be used carefully. Maudsley is a hospital in London, and not a method, and is used to mean so many things now that it probably isn't useful any more. FBT is an approach that psychotherapists use to treat eating disorders, not something parents do. Parents have a role, the essential role, in FBT but we don't "do" FBT.

And weirdly enough, FBT doesn't have rules or methods. It is a way that therapists structure how they support a family toward their son or daughter's ED recovery. That structure involves delegating some things to the parents, and how the patient is supported through phases of treatment, and how the siblings are involved, and how the family is returned to normal functioning.

FBT is not ONLY what parents do, nor is it ALL parents do.

As parents we often focus on one of the parts of FBT: being put in charge of feeding during the first phase. And much of the advice we share with one another is about that part. And in that part not only are there no rules, it is our job as a family to choose and own our choices of what we do. So while other parents can share their experiences and strategies and what worked for them it is really important, to me, that parents not think that they are being "told what to do" or that they feel there are right and wrong ways to approach their role and their decisions. Parents need to find their own way for their family and that process of finding their way IS PART OF THE TREATMENT. Reaching out to other families to ask what they did is part of that, learning from peers is a way to learn a range of ideas and options to choose from. But there is no shortcut, or recipe, or rules. That would be great, but in reality may also leave a family feeling as if they've been let down or they failed. No one way of doing things is for every family. We each have different paths. That's the beauty of being in FBT-informed treatment, actually, that we as parents are being trusted to seek out, choose from, and create new ways to achieve certain tasks. To be seen as competent and confident by our kids and their siblings. To shepherd our families out of danger on our own skills and talents not just in the first phase but the all important 2nd and 3rd and then throughout life.

There is an impression out there that I hear, that people feel like "Maudsley Failures" when they hear other families talk about their experiences. That may be the greatest myth. There is no one or right way, and no other family can prescribe for another one what will work for them.

There are so many ways to succeed at being in FBT treatment, and in other treatments. In fact, there are as many ways as there are ED sufferers.

I feel very strongly that we as a parent community and this forum in particular do a great job at something that FBT has taught us all: that families are AMAZING at doing the work of saving their kids from ED when they are empowered, informed, supported, and trusted. Reaching out on forums like this, to learn what other families have done, is so valuable. Take that information and those ideas and take what works for you and yours and then share your experience for the benefit of others. All each of us has to offer is our own experience, and all any of us can take is the parts that apply and inspire and we choose to employ. That is the lifesaving value of our community!!!!



__________________
Laura (Collins) Lyster-Mensh
F.E.A.S.T. Outreach Director
tina72

Caregiver
Registered:
Posts: 222
Reply with quote  #25 
Nun endlich auch mal ein paar Informationen auf DEUTSCH. Sobald ich etwas mehr Zeit finde, kommt noch mehr dazu, versprochen.
toothfairy hat ein paar gute "Regeln" gepostet. Es ist nicht klassisch FBT/Maudsley, aber die meisten Regeln haben sich in vielen Familien bewährt. Sucht Euch raus, was für Euch passt, jede Familie und jede Essstörung ist ein bißchen anders. Ziel der Maudsley-Therapie ist es, sich selbst zu helfen und in der Familie einen Weg zu finden, die Kinder mit Zuversicht, Verständnis und Liebe wieder ans Essen heranzuführen. Es funktioniert!

1. Die Eltern bereiten alle Mahlzeiten zu.
2. Die Patienten sind während der Essensvorbereitungen nicht in der Küche.
3. Es ist einfacher, die Kinder nicht zum Einkaufen mitzunehmen.
4. Schickt die Patienten vor dem Essen auf die Toilette und lasst sie hinterher mindestens eine Stunde nicht ohne Aufsicht auf die Toilette (um Erbrechen zu Verhindern).
5. Wenn Erbrechen vermutet oder erwartet wird, überlegt wie es verhindert werden kann: manche hängen die Badtür aus. Oder die Kinder sollen zählen oder singen, während sie im Bad sind. Es darf nicht gespült werden (damit man kontrollieren kann, ob sie erbrochen haben).
6. Keine Diskussion: was serviert wird, wird gegessen. Alles.
7. Kein Handy, Internet etc. während dem Essen. Spielzeug gibt es erst wieder, wenn gegessen wurde. Das Leben stoppt, bis der Teller leer ist. Bei älteren Patienten: Autoschlüssel, Erlaubnis zur Party zu gehen, Taschengeld...was auch immer als Belohnung hinterher nötig ist. Es geht nicht um Strafe.
8. Versuche zu trennen: Dein Kind ist nicht die Essstörung. Dein Kind ist verborgen hinter der übermächtigen Krankheit. Du musst sie aus dem Haus jagen, um Dein Kind wieder zu finden.
9. Versuche beim Essen ruhig zu bleiben. Keine Diskussionen, keine emotionalen Debatten. Versuche Hilfe zu bekommen, falls Du es nicht schaffst. Ruhe und Mitgefühl sind der Schlüssel. Mit der Essstörung zu diskutieren ist sinnlos.
10. Denke dran: Dein Kind möchte die Essstörung los werden. Es leidet unter ihr. Die Essstörung will das verhindern. Sie hindert Dein Kind daran, gesund zu werden und ein normales Leben zu führen.
11. Manche Kinder brauchen Deine Erlaubnis zu essen. Sie brauchen das, um der Essstörung entgegen treten zu können. Sie wollen nicht "Schuld" daran sein, dass sie essen müssen. Nimm diese "Schuld" auf Dich.
12. 3 Hauptmahlzeiten und 3 Snacks zwischendurch - das ist notwendig zum Zunehmen. Alle 3-4 Stunden unter Aufsicht etwas essen. Wenn nötig, setze Zeitlimits - z.B. 30 min für eine Hauptmahlzeit und 15 min für einen Snack. Am Anfang wird es deutlich länger dauern. Ziel ist, dass alles gegessen wird.
13. Zum Zunehmen werden anfangs eine ungeheure Menge Kalorien benötigt und viel Fett. Das Gehirn besteht zu 80% aus Fett und braucht das, um gesund zu werden. Manche Patienten brauchen bis zu 6000 Kalorien am Tag. Der Durchschnitt liegt bei 3500-4000 Kalorien. Zunehmen ist sehr schwer, wenn man eine Essstörung hat.
14. Wenn Du die Verantwortung für das Essen übernimmst und sie sehen, dass es keine Diskussion gibt, nimmst Du ihnen einen Teil der Last der Krankheit ab. Es fällt den Patienten dann viel leichter, etwas zu essen.
15. Du kannst die Essstörung einsperren und aus dem Haus jagen. Du kannst Dein Kind vor der Essstörung beschützen.
16. Versuche ein normales Elternteil zu sein, wenn es nicht um Essen geht. Während dem Essen bist Du ein Krieger gegen die Essstörung.
17. Du musst Dein Kind 24 Stunden an 7 Tagen beaufsichtigen, um Erbrechen oder sportliche Aktivitäten zu vermeiden. Viele Patienten treiben heimlich excessiv Sport oder Erbrechen im Garten und vergraben es. Die Essstörung bringt unsere Kinder zum Lügen und zu unmöglichen und unerwarteten Verhaltensweisen. Wenn nötig, schlafe auch bei Deinem Kind.
18. Kein Sport am Anfang und für diejenigen Patienten, die excessiv Sport gemacht haben, heißt das für eine lange Zeit. Eine lange Pause ist nötig, um nicht wieder in alte Muster zu verfallen.
19. Sei konsequent, konsequent, konsequent. Keine Ausnahmen. Ein Loch im Netz lässt die Essstörung sofort hindurchschlüften.
20. Lobe den Patienten nicht nach dem Essen. Keine Glückwünsche, wenn etwas gegessen wurde oder die Periode wieder kommt. Die Patienten fühlen sich schlecht und schuldig, wenn sie gelobt werden. Feiere im Innern!
21. Lerne von den anderen Eltern hier im Forum. Vielen haben jahrelange Erfahrung (leider) und einen Schatz von Ideen parat.
22. Lies "Gramm für Gramm zurück ins Leben" von Harriet Brown. Es ist das einzige verfügbare Buch über FBT in deutscher Sprache und hat uns das Leben gerettet.
23. Erwarte Widerstand. Es wird eine Menge davon geben. Je mehr Widerstand, desto besser lernst Du das Biest kennen und kannst es bekämpfen. Die Essstörung mag keinen Pudding? Also gibt es morgen Pudding! Lass Dich nicht unterkriegen oder erpressen. Du wirst einen Weg finden, mit dem Widerstand umzugehen. Je besser Du das schaffst, desto geringer wird der Widerstand. Wenn die Essstörung merkt, dass sie bekämpft wird, rastet sie zuerst aus und zieht sich dann langsam zurück - es sit wie ein Dämon.
24. Entscheidungen sind schwierig, besonders in Bezug auf das Essen. Lass zunächst keine Auswahl, es wird gegessen was Du hinstellst. Später, wenn das Gewicht fast wieder hergestellt ist, biete eine Auswahl zwischen 2 Dingen an (z.B. Erdbeer- oder Kirschjoghurt, Brot oder Brötchen). Wenn das klappt, versuche es mit 3 verschiedenen Dingen, wenn nicht - Schritt zurück, dann war es noch zu früh.
25. Ablenkung kann Wunder wirken. Essen vor dem Fernseher z.B. oder ein Buch vorlesen. Aber es ist nur erlaubt, solange das Essen klappt.
26. Mach bei diesem Forum mit, du bekommst 24 Stunden Hilfe von netten Leuten aus der ganzen Welt!
27. In machen Fällen funktioniert FBT nicht, etwa wenn andere psychische Störungen dazu kommen (Borderline o.ä.). Es ist immer einen Versuch wert, aber wenn es nicht funktioniert, suche einen Plan B. Es gibt immer einen Plan B. Aufgeben gilt nicht!

Dear toothfairy, I have put it in german hopefully without changing too much.
Tina72

Previous Topic | Next Topic
Print
Reply

Quick Navigation:

Easily create a Forum Website with Website Toolbox.

F.E.A.S.T. Families Empowered and Supporting Treatment of Eating Disorders
is a 501(c)3 charitable organization committed to maintaining the Around the Dinner Table forum as a FREE service for any caregiver of a loved-one with an eating disorder.

P.O. Box 1281 | Warrenton, VA 20188 USA

US +1 855-50-FEAST | Canada +1 647-247-1339 | Australia +61 731886675 | UK +443308280031 

This forum is sponsored by F.E.A.S.T., an organization of parents serving parents and caregivers of patients of all ages with anorexia, bulimia, and other eating disorders. Information and advice given on this forum does not necessarily represent the policy or opinion of F.E.A.S.T. or its volunteers and is meant to support, not replace, professional consultation.

F.E.A.S.T. is registered as a nonprofit organization under section 501(c)(3) of the United States Internal Revenue Code.

Terms of Use | Privacy Policy | Community Rules | Forum Rules | F.E.A.S.T. Principles | YMadmin | WTadmin
Custom Search of F.E.A.S.T. and Forum Content: