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

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qurtis
I was wondering what other parents think of group therapies for AN? Specifically in the recovery phase? We have been offered group Cognitive Remediation Therapy for our daughter. She developed anorexia aged 11, we discovered it around 5-6 months later, got into an ED service really quickly .. unimaginable horror for a few months, with laxatives, self harm, screaming etc..then plodding reasonable progress over next six months, a relapse almost to Square 1 after a holiday abroad.. a few months of stagnation and fear, then gradual forward progress behaviourally (in terms of eating), and in the last 1-2 months a real cognitive shift: for the first time ever, now aged 13, she is able to say she wants to be well. I can't tell you how grateful I have been to hear that. She is moving forward, working with us more in confronting fears and ED habits.. 
We were having family based therapy until Dec, when our lovely therapist left, and this left us with a short break and a chance to think about the way forward in terms of therapy. She has been offered a cognitive remediation therapy group - I think CRT is great .. my only concern is the group aspect. We are worried she will start comparing herself to others, learn new 'tricks' etc.. the children will of course be at different stages in recovery and I anticipate some will be stuck/chronic in presentation and my fear is that she will then begin to feel she is not as good as them.
 What do people think about group therapies during the recovery phase of AN? Should we hold out for 1:1 CBT/CRT even though the wait might be much longer?
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Enn

I think CRT is great! My d went to one group session and then did not want to go back. The therapist did some work around rigidity one on one for her. 

I think in the group they do keep them busy and I do recall there was a sheet given to the members that it was private and confidential and they had to respect that and signed the form. My d was 13 at the time and over one year in. 


the group my d had was geared towards her age and 1 to two years older. 

Would it be an idea to talk to the group organizer so that you can get a better sense of what exactly happens and how they may mitigate the issues you are concerned about!

When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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ValentinaGermania
qurtis wrote:

.. my only concern is the group aspect. We are worried she will start comparing herself to others, learn new 'tricks' etc.. the children will of course be at different stages in recovery and I anticipate some will be stuck/chronic in presentation and my fear is that she will then begin to feel she is not as good as them.
 What do people think about group therapies during the recovery phase of AN? Should we hold out for 1:1 CBT/CRT even though the wait might be much longer?


I wish I could say that all your fears are not real. But they are hitting the nail on the head. I would not do it. The risk is real. We stopped all contact to other anorexics here. Your d is very early days in recovery, all new and fresh. Why not moving on with FBT? What makes you think she needs other therapy but food?
Keep feeding. There is light at the end of the tunnel.
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Torie
Hi qurtis,  Sorry, I don't remember if your d is weight restored?  Purging?  Without knowing that, I can't really comment about what would likely help at this point. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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qurtis
Thanks all..
 yes, She's technically weight restored.. she was a bit overweight prior to anorexia but is now what seems a good weight for her.. period back, developing physically again.. mood has also been improving..
 not purging.. she tried it once way back and hated it. 

Valentina, she struggled to engage meaningfully with FBT for a long time and really only started engaging in the last month or two, I suspect some of this had to do with finding out our therapist was leaving. She continues to talk about things she discussed with the therapist and is trying to implement some of those ideas now. We found FBT v helpful as parents. She has thankfully maintained progress since the therapist left but says she wants to work on her thoughts .. in terms of eating, we are making slow steady progress and to be honest it was beginning to feel as if we'd got as far as we were going to get with FBT.. feels like we kinda know what we are doing in terms of slowly getting back to eating normally.. so I think we all felt a new approach would not be a bad idea.. 
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PurpleRain
Hello qurtis, I'm more or less in the same place about therapy. My D is 14, WR + for almost 7 months, doing much better in every way. But she has been anxious literally all her live (not terribly but yet, it's there) since she was born, so I've been thinking about CBT. it's expensive where I live and not covered by my very basic insurance, and I'm very weary of bad professionals being harmful more than helpful so I'm looking for the "real deal" that I've read about (individual sessions, group sessions and coach available). There are very few near me, so I'll start calling them and asking them a LOT of questions. I'm not sure it's the way to go, if it's early days, so I'll love to hear what others have to say.
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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ValentinaGermania
qurtis wrote:

Valentina, she struggled to engage meaningfully with FBT for a long time and really only started engaging in the last month or two, I suspect some of this had to do with finding out our therapist was leaving. She continues to talk about things she discussed with the therapist and is trying to implement some of those ideas now. We found FBT v helpful as parents. She has thankfully maintained progress since the therapist left but says she wants to work on her thoughts .. in terms of eating, we are making slow steady progress and to be honest it was beginning to feel as if we'd got as far as we were going to get with FBT.. feels like we kinda know what we are doing in terms of slowly getting back to eating normally.. so I think we all felt a new approach would not be a bad idea.. 


Then give it a try but think about a 1:1 with a therapist. Last thing you need now is a setback because she feels triggered by other patients that are more sick and thinner then she is.
My d did not engage with FBT too and she never engaged with any therapy later. She just did not know what to say because she did not know why she got sick. She wanted to close that book at one point and get a normal teenager life back. But that started about 1 year after WR so maybe your d just needs time to get brain recovery started.
It is for sure no fault to try a new approach.
Keep feeding. There is light at the end of the tunnel.
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Torie
THis is more a gut feeling than based on knowledge of available research, but personally, I would be inclined to wait for the 1:1 option.  It sounds like your d is eating well and doing well overall, and she is still young so that she still has plenty of time under your watchful eye.  Kudos to you and your d for all the progress you have made!

Please keep us posted. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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ValentinaGermania
PurpleRain wrote:
But she has been anxious literally all her live (not terribly but yet, it's there) since she was born, so I've been thinking about CBT. it's expensive where I live and not covered by my very basic insurance, and I'm very weary of bad professionals being harmful more than helpful so I'm looking for the "real deal" that I've read about (individual sessions, group sessions and coach available).


Purplerain, my d was the same, very anxious from the day she was born. As she got older and we could talk about that more now she is adult she explained to me that it is due to her brain and her thinking.
We worked on that in the last 2 years like with fear food. We made a list what she is afraid of and thought about ways how to tackle that step by step. For example she was afraid of using public transport and we practised that with increasing steps and now she can use all public transport to get to University 50 km away. She is very proud of herself and what she has achieved and that helped her with self esteem which was our second big problem here.
Maybe this would work there too?
Keep feeding. There is light at the end of the tunnel.
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qurtis
Thanks it's so useful hearing ideas and experiences.. hearing your experience Valentina, we had thought one option might be we just carry on on our own and see how we go, maybe like you say she just needs more time at a sensible weight and maybe the shift in cognition wad more to do with weight restoration than anything else .. I'd say she's been WR for almost a year, period returned over a year ago.. 

Having a review session at clinic next week to make a decision, and I wanted to go armed with all your ideas and suggestions🙂 
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ValentinaGermania
I really do not want to keep anybody from having any therapy but I want to say that sometimes time cures a lot with ED. As long as there is progress with eating and fear food and she gains normally she might just need some more time to get back to normal. Parents are often a bit inpatient and think that their kids must be back to normal at WR (and often professionals say that they are cured once the weight is back). To give you a time line, my d was WR about 6 months after IP, then we needed another 12 months to work the fear food list down and she was back to normal and no ED behaviour left about 2,5 years after diagnose. We are now 3 years after diagnose and doing only relapse prevention.
Keep feeding. There is light at the end of the tunnel.
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PurpleRain
 I have used that before Valentina (exposure therapy), for example going to talk buildings (she started to feel anxious about it after a big earthquake here), and now she can do it, same with needles (not so easy to do exposure unless you need it but she ismu h better at it when she need vaccination or blood work, still doesn't like it but she can do it). I guess time at a good weight and maturation (she is only 14 after all) would help. At the moment I go with: first weight, then state, then everything else. 
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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Enn

https://www.verywellmind.com/cognitive-remediation-therapy-for-anorexia-nervosa-4003481

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869183/

CRT has  good evidence in AN.
please don’t discount other adjuncts to therapies. Do your research and ask questions of all that you consider.

When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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qurtis
Thank you Enn, will check those out. I am sold on CRT as a therapy, but not on the idea of doing it in a group setting. My concern about the group was not so much what happens in the group but what might happen outside the group. So my daughter's primary interest when she heard about the possibility of a group was that she would meet others in the same boat, people who would 'understand'.. which is  understandable..but  my fear is what happens if they exchange numbers etc, link up on social media or real life, and that's where damaging conversations might happen..
..and within the group just the eyeing each other up, inevitable comparisons..who seems to be the 'best' anorexic..
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Enn

I understand the issues with the group stuff. I also think that if they are professionals doing the group they are aware of those interactions as well. Our kids will compare I think,group or not. That is why I suggest talking to the organizers directly and asking how they would figure that out. 
My feeling also is if you don’t try it  you will never know and if you don’t try it may be an opportunity lost. I know here if d did not wish to go back she did not. There was no cost for us. My d did not wish to see the other kids and felt vulnerable with them so did not go back. They did have specific work to do while in group . I think she missed out to be honest. 

I understand your concerns just thinking that the group may be better than you think or not but until you dig further or even try it, I don’t think you can truly know.
Just offering up a different perspective to consider. I know it is a hard decision and I wish there was a crystal ball to tell us exactly what is the best path forward.
💐

When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Torie
I agree with Enn that it would be valuable to speak with the organizers to help decide between the group option (available sooner) vs. waiting for the individual option.

My own opinion is colored by my family's experience with D's "friend" who was never diagnosed with ED, but did aid and abet and give comfort to my d's ED, cutting, suicidal ideation, etc.  I would give a lot to be able to go back and change things so that they never met; not meaning to be melodramatic, but I really felt that this "friend" endangered my d's life and made her recovery more complicated and difficult.  It also strained family relations because we had to single this "friend" out as someone who was welcome to visit our home where we could supervise, but she was not allowed to spend unsupervised time with our (teenage) d.  xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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qurtis
That sounds like very sensible advice .. thank you.. will try and have a thorough discussion of all my concerns when we meet them next week. Fingers crossed we make the right decision! 
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Scaredmom2019
Just want to chime in that I had ALL the same fears when my D started ED intensive program. I was dead against any group stuff as I feared she may get worse, make unhealthily friends, get worse ideas etc etc. I followed the advice and did the groups anyway. My D has not made any friends though she is friendly with all. She also has not shown any more symptoms etc. They had strict rules about group talk and what can be shared to avoid that issue. Just wanted to let you know that I was super apprehensive about it and I went just fine. Good luck! Hard decisions to make!
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qurtis
Really good to hear that scaredmom, thank you 
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Aggie
We did group therapy, I voiced all my concerns about it having an adverse effect but went along with it because I trusted the specialist who recommended it and I'm sorry to say it set us back hugely. We were doing well at that point with refeeding, she was compliant and positive but the effect it had on her was that it made her think she wasn't as good an anorexic as some of the others and became determined to try harder. We had a big u-turn at that point and I so regret being talked into it.
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