F.E.A.S.T's Around The Dinner Table forum

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We have been on a long break from CAMHS FBT and CBT for Ed daughter as she has been refusing to engage with it consistently over the year. In the sessions out d is usually very hostile, sometimes completely unresponsive and on her last session physically aggressive. We are going back tomorrow (New years Eve) and I am wondering how other people have found this type of therapy at this stage (she has been weight recovered since August). How can we support her in accessing the therapy she really needs but does not want? Medication is not a possibility as she has refused this and CAMHS won't go against her wishes, despite recognising that her high anxiety is a huge barrier to accessing the therapy. We could extend the break from it further and see if her state improves with time. Ideas and experiences gratefully recieved.

First of all, well done on the weight restoration. It is the vital first step and you've done it! Keep up the good work and keep the food going in.

Re the therapy, is it only your daughter who hates the appointments? Ours were so stressful that we all grew to dread them, and they were, in the end, divisive and counterproductive and it was a good idea to stop, but it did leave us vulernable to a lack of support when our daughter sufferered a relapse. Is your daughter recieving good medical monitoring from someone with up to date knowledge about EDs, either through your GP or CAMHS? If so then perhaps for now she can can continue the break from formal therapy and concentrate on normal age appropriate activities like school and friends, as long as the nutrition keeps going in. On the other hand if the FBT people are helpful, what is to stop YOU going along and working on strategies to help her during this time? Would they allow that, or does it have to be all the family or no one?

Fiona Marcella UK
We don't enjoy the sessions either to be honest as they are always stressful; I am dreading tomorrow's session. She has been shouting all morning about not wanting to go. She says it is not helpful. I know she dislikes hearing the honesty about what is going on from our perspective. I suppose it's the only time she really hears how things are.

I think maybe sessions just for us, to help guide us would be good. I really wish she could access the cbt side of the therapy though. There had been talk of us trying to lead this if the therapist showed us how but the psychiatrist suggested this would be too much with us still having aggressive pushback to refeeding.

Maybe there is little point in continuing with her attending weekly CAMHS. Nobody else is monitoring her medically though currently but maybe her GP could take this on temporarily if we stopped FBT with her.
First things first - are you sure she is really weight restored?  Anxiety makes people rigid and angry when they are expected to change behaviors, and anxiety typically gets better with weight gain and improved fat intake in patients with eating disorders.  Of course weight gain is not a magic bullet, but something about the level of pushback you are describing makes me wonder if you're really there.  

Many patients are hostile during phase 1 of FBT and a bit beyond.  They don't stay hostile forever, but if the hostility makes both parents and providers back off, then anorexia wins, of course.  So try ignoring the hostility and giving it less of a voice.  You can't change what your daughter does but you can change how you respond to it!  - Rebecka P
What Dr. P said.

I spend time alone with our FBT at the end of each appointment.  In the worst of re-feeding, sometimes that was just the cheerleading or the hope I needed that things would get better or that I was doing the right thing.  If your FBT agrees, perhaps during the worst of your D's resistance you could tell her that you will be attending the appointments with or without her and ED will recognize that resistance is futile, you are moving ahead with therapy regardless.  At worst you will get the support and guidance you need.

Thinking of you!

Colleen in Ontario

Single Mom to DD#1 (20), Autism Spectrum Disorder (diagnosed at 16 1/2), Generalized Anxiety Disorder, Social Anxiety, Panic Disorder
and DD#2 (17), In solid recovery from Restrictive AN, Managing Social Anxiety, Generalized Anxiety Disorder, Panic Disorder, ASD, finished with IP and FBT, successfully managing school and life

If, at the end of my days, I can say I saved the life of not only my child, but helped to save the life of someone else's child as well, then I have lived a good life.