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

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Playball40
I'm getting a little frustrated with my daughter's therapist.  I like him and he is part of a team here in town, but they really don't practice the Maudsley FBT.  Most of that I get from here.  Anyway, he is trying to help my daughter with her perfectionism and anxiety.  Please know, my daughter has always been a perfectionist.  She never had social anxiety which she seems to have more now with the anorexia.  Anyway, he is talking about her location on the infamous "chart" and she is at around 25%.  We have no historical data because of the longevity of her restricting (since she was 6).  I will say she gained NO weight from age 9 - 11 so MAYBE 8-9 would be our best estimate. 

I told him (and yes it was in front of her) that no, as her mother, I know she is not 'weight restored' - I believe to really eradicate ED and allow her brain to heal we need to keep going.  His answer was she is "medically" out of danger.  WTF??  Her brain is not medical???  Grrr...........

Anyway, my daughter is an artist.  She really wants these rather expensive blending markers (they are almost $100).  She doesn't have the money (she has some) so I told her she had to gain 4lbs and I would give her the $$.  Effectively $25 per pound (which is still cheaper than therapy).  She resisted (like anything that is difficult) but she agreed.  She ended up eating McDonalds for breakfast with a hash brown and soda.  She also ate a chocolate cup cake for snack.

So........is this going to backfire in my face?  Has anyone else had to bribe their kids to promote weight gain?
Caroline
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sk8r31
Might I suggest a 'reframe' to think about motivation instead?  Providing the markers to your d can act as an external motivator to get her to eat what she needs to in order to become WR.

My d was 17 when we went to UCSD for their 5 Day Multi-Family program, and learned about contracting.  Every family left with a contract that was individual and meaningful to THEM.

Our contract provided external motivation in the form of financial incentive for crossing off fear foods, and eating them without fuss.  For us, this meant that d was served a fear food every day.  She had her 'top 10' fear foods listed in order, and we served something from the list daily, though not the most feared thing every day.  

When d could eat, without complaint or comment, each fear food 3 times in a row, it was struck off the list.  When all 10 were off the list, then we provided her with an iPad.  This was a pretty hefty incentive, but....we were willing to give it a try.

I resisted this at first, when we were in the contract-making stage, because it seemed to me to be a 'bribe', and went against my instincts as a parent.  But the therapist actually supported the idea, saying that if this was very motivating to our d, it was worth trying.  And you know what?  It worked...took about 2 months for all the fear foods to be struck off the list.

So it may well be worth using the special markers as a motivator for your d to gain the necessary weight.  Is there a way to provide one marker for each increment in weight, or are they a pack?  Or can you purchase the pack in advance, and give her one as she reaches each incremental goal?  Just thinking that it might have a greater effect if the goal could be reached in steps.

Wishing you the best,
sk8r31
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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Playball40
Great suggestion Sk8tr!  <question - what kind of skating do you do?>
Caroline
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iHateED
We also attended the one week family therapy at UCSD.  Our contract was sooooo long .... 7 pages I think!   We had to cover every loophole!   We used short term and long term incentives as motivation to eat and to get her weight up.    I agree with Sk8tr, some of it must be short term rewards.   Also, you must include that those 4 lbs must be maintained for some length of time or she will gain the 4 lbs, get the markers, and then drop them immediately.    What will you do if that happens?  Just something to think about.  
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sk8r31
Yes, IHED, it is good to think of short & longer term incentives, and try to anticipate any potential problems...such as losing the weight again, after receiving the markers.

I agree that there should be something in place to try to ensure that weight stays on.

BTW, Playball40, I skated singles as a kid, and then adult synchro for a bit later in life.  Now I'm mostly just a dedicated fan, though occasionally I do lace up the skates when time & energy allow.  

Do you play ball, and if so, what type?
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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momtobeauty
The blending markers (my daughter has them and our set was also a small fortune) might have the added bonus of providing a good distraction after meals. My daughter spent hours doing art after meals and it really helped with the discomfort.

My opinion about "bribery": we all get rewards for doing difficult things and sometimes our kids need a bit of motivation. I did have one occasion where I tried to bribe my d for eating with a fashion item she wanted and she just bought it herself instead of eating a muffin (this is when she was refusing all food) and then every time she wore the item I felt like an idiot. I guess make sure she needs your help for the incentive to work. Another thought about bribing to eat- it might be better to give the incentive based on eating rather than gaining (I dunno) because that is the effort. Kind of like rewarding for studying instead of for getting an A. But honestly, I don't really know. When they are not eating, I think anything is worth a try that might work because they can't reason.
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Playball40
So I'm thinking based on your answers that maybe it should be about behavior more than pounds.  If we can motivate the behavior hopefully the pounds will follow, right?  My daughter is only 12 so she's not really in a position to go 'buy them herself'.  She needs my input on this one.  You guys are awesome as usual.  Do you guys just use a template or come up with the "contract" verbiage yourselves?

Sk8tr - did you skate ice or roller?  I skated for many many many years on a speed team (roller and then inline).  Also did a little derby - but not too much as an adult.  As far as ball, I played and coached softball.  Now a days, I don't do much of nuttin'! Occasionally get out and bike.  I miss it though. 
Caroline
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Bottle
Medically out of danger-as I also had to point out to our frustrating consultant when she said my D had gained enough initially-means "not about to drop dead at any minute" . I asked her if she really thought that was okay. She didn't answer.
Bottle
D2 RAN as part of Pervasive Refusal Syndrome with a history of not walking for a year and being non verbal for a short while too. Considered to be Aspergers by everyone that has worked with her and by us but still awaiting a diagnosis that'll help us access support services she needs.
D1 recovered RAN and D3 doing pretty well considering the mayhem around here!
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Foodsupport_AUS
"Medically out of danger". One of the most frustrating and unhelpful phrases you hear. Our loved one's hear "gained a lot of weight and are now fat". I think it is what allows everyone else to not be so keen to push on towards full weight restoration, but it allows our loved ones to remain in the grips of their ED.
D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
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Psycho_Mom
Hi,

If you feel the t is helping with perfectionism/anxiety (CBT is shown to be most effective therapy for this, btw) then perhaps he could just do that, and keep his ill-informed nose out of her nutritional rehabilitation--you are in charge of that!! 

As for "bribery". Having life and all activities stop until the kid eats enough, and then begin again after eating, is a form of bribery I suppose. It's also how life works and how people unencumbered by ed behave: they do stuff, it takes energy, they eat so they can do more stuff. Offering a reward in addition to getting to have a life seems...like the lesson that life requires food might get lost. On the other hand, if nothing else works, and bribery does, then most definitely, do what works!!

best wishes,


D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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sk8r31
When we created a contract for WR, we had the help of the treatment team at UCSD.  The resources that they gave us to work with came from a book called Parenting Your Out-of-Control Teenager, which was not geared towards eating disorder behavior per se.  We came up with our own language and guidelines, based on what was important/appropriate for our d and our family.  It took a long time to create...and we did have input on it after completion from the treatment team to 'tweak' it.  Basically, we needed to make it as specific as possible, in order to avoid potential loopholes.

Having made one contract, it was much easier to create a second, when our d was ready to leave for university.  We still got input from our T and MD, and they both had a copy on file.

On the FEAST main site, there is a sample college contract.  Obviously not appropriate for your d at her age and stage, but it might give you some ideas.

I think you might be right to target behaviors, rather than specific weights.

Best of luck, as you move forward.

BTW...I was an ice skater.  Huge respect for roller though...

Warmly,
sk8r31
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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EC_Mom
Bribery is GOOD! If it helps her eat, it's great! If you have any kind of leverage, use it! This is not "normal" childrearing, it is (I think Colleen says) "parenting on steroids". It's an exceptional situation that breaks all the rules, so rules against bribery can also be chucked while you battle this nasty illness.
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