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

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I was thinking about making this post and calling it Make Do and Mend, but I had a vague memory that there had been a thread on the subject before. There was. This one. And I started it!

Well we're still making do, if not always having the energy to make the opportunity to mend things that are difficult to mend like the health services and "the system". Note I delibertely didn't put "the NHS" or OUR system here - I truly believe that the problems involved in tackling eating disorders are far bigger than the individual problems of one country's system or certain ways of funding health services.

D doesn't live at home any more and is subject to the whims and inadequacies of a different healthcare set up than is available here. This has certain great advantages, like not having to pick apart the damage done by the history of treatment here before even starting on the now. I was very pleased when she started therapy (DBT), really for the first time, as an adult on an adult basis even though it wasn't specific therapy for eating disorders as that isn't on offer where she lives. I'm now disappointed that she has quit the service after feeling too pressured. Disappointed that she couldn't take the pressure and disappointed that the service couldn't work out before-hand that someone with a present diagnosis of Avoidant Personality Disorder was going to find pressure hard to deal with and offer her something more tailored to her needs.

But we plod on and I hope that D is learning, as an adult with her partner by her side, to make do and mend for herself. That particular therapy course may have been wrong for her, or she may have been wrong to give it up just when it was getting tough, but what's done is done and she isn't sitting in her room sulking, she's going out to find more support of the kind she originally asked for (life skills, employment skills, organisational skills).

Maybe I need to take a leaf out of her book and get back to doing more mending myself.
Fiona Marcella UK
Hello Marcella, thank you for this post. I'm sorry your D has quit DBT for the time being, but it is good that your D is taking some actions to manage her own treatment and life. I am hoping that DBT might be an option for my D after leaving IP, but I can see that it is also quite demanding and seems to require quite a bit of willingness for the patient to engage (particularly in the telephone relationship with the therapist).

Actually, when I read your mention of Avoidant Personality Disorder, I looked it up and have never seen a collection of symptoms that fitted my 17-yr old D more perfectly. Of course some of them might be exacerbated by the ED/ adolescence, but they appear to have been with her for years. Has this dx helped your D get appropriate treatment in any way? Have you heard of/ been able to access Mentalization-based therapy?

The diagnosis came with the treatment in that it was this DBT service who gave it to D. Previously she's had various other diagnoses depending on who she has been seeing. Until she told me that she was backing out of therapy I'd have said it was a helpful label if only part of the puzzle. Now that I know that she won't be getting any direct help for it I'm not so sure.

D was offered Mentalisation Therapy as an alternative when she was first assessed and chose the DBT because she felt that there was more evidence for it than for Mentalisation. I don't know whether that was a good call or not as I don't really know what is involved in Mentalisation. I do think that the DBT skills that D learned were positive in themselves and that the group work was positive and I hope that she can build on that whether within formal therapy or not
Fiona Marcella UK