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

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blehbleh
My 11 year old D is weight restored (yay!!!) and back to her old self in most ways except for eating independently and participating in therapy.  I have no plans to start handing over control of her eating any time soon, because she just isn't ready.  So we will continue feeding her and full supervision.

My questions are around FBT therapy.  D cannot stand our FBT therapist, my husband thinks she is ineffective, and I do not think she is knowledgeable about the latest research NOR does she know my daughter at all.  The T weighs her, but it is super painful to have the whole family staring at them and my daughter shrinks away from the T the whole time.  And the T's scale is not super accurate since D is wearing clothes and shoes, so I'm not sure the weigh-ins are that valuable. 

I attribute our fast refeeding success to this forum, reading books, and generally being a psycho mom, not from our therapist.  One thing that our T is good at, however, is suggesting potential other ideas - so far she has suggested me getting my own therapist, neuropsych testing for our daughter, the 5-day program at UCSD, and a separate CBT therapist for D.

My husband and I are feeling like we are spending tons of $$$ at this point and getting nothing out of it...FOOD and TIME are what is working for us.  D is only 11, she doesn't even know how she is feeling, why she wasn't eating enough, etc.  She doesn't have body image issues and says she never was trying to eat less.  She doesn't seem to have strong hunger cues and probably wasn't fueling her body enough for growth and sports.  

D does not participate in the sessions, she gets anxious leading up to it and depressed afterwards.  During the week, she spends hours asking "when can we stop therapy?  it doesn't work for me, it makes me feel worse, i will never tell a stranger how I'm feeling, there is nothing wrong with me except I hate therapy."  We have explored switching to a new FBT therapist who might "click" better for D, but the ones who are highly recommended where we live are not accepting new patients.

So, I am wondering: since D is weight restored and our FBT therapy is not working for us, if we can/should stop FBT therapy (still maintaining full supervision of food).  We could have D start seeing a T for her social anxiety, with the understanding that her T would keep an eye out for any ED related thoughts or behaviors.  I see a couple of holes in this plan: (1) we need to weigh her weekly because she has recently returned to playing soccer, and for some reason I am nervous about weighing her at home.  (Well, one reason is that I don't want D to know we have a scale in the house.)  and (2) the social anxiety T is not an ED specialist so I wonder if that could cause problems.

I guess I am looking for your thoughts on whether we can move forward without FBT therapy, and transition to individual therapy for D, or whether we should just keep slogging it out.  Or maybe we stop ALL therapy until she is older and more able to participate??  I don't want to spend thousands of dollars per month on therapy for a kid who is too young to benefit from it, but we don't want to drop the ball and give ED any opportunity either.

Thank you for taking the time to read and reply!  xoxo
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Ellesmum
I’m struggling with the idea that your d is not weighed in private. Mine when weighed was taken to another room. I’d be upset in her shoes. 

I only use our therapists really for medication as uk doctors can’t prescribe for under 18’s and school cover.  D finds it fairly helpful to talk privately with one of our team. It doesn’t sound like you gain much if anything and you’ve done a fantastic job.
Ellesmum
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debra18
My experience with my daughter is that she was 11 when she got sick and now turned 13. I never took her to a therapist and did the refeeding myself. I took her to the pediatrician for medical monitoring but weighed her at home. I started her in piano lessons and recently got her a piano. This has helped tremendously with the anxiety and letting go of ED. I stopped weighing her and am going by state and how she looks and comparing to pictures of before she got sick. She gets her period every month, mood is very good and all meals at home, including two high calorie drinks are supervised. I know many people wouldn't agree with this but it is what is working for us. 
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Ellesmum
Yes I stopped weighing for a time, CAMHs asked to last time and called me privately later, they also said it’s time to talk about exercise and weight maintenance as she was now within healthy range, I disagreed strongly and now I’ll stop weighing again.  My eyes hold the evidence as do her clothing sizes.  I feel strongly that d needs more right now than less.
Ellesmum
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Elibean1
Also in the UK, with similar system to Ellesmum and a 12 year old D.  We were given a diagnosis of ARFID, and I wondered whether your girl might have done too as she didn’t have body image issues? 

Anyway, we don’t have FBT therapist but we’re doing ‘family CBT’ which basically meant all three of us, or sometimes me and D (older sibling not required!) talking about the week, D bring weighed privately and having some alone time to tackle anxiety via CBT. 

Recently, well over growth curve weight now, they’ve suggested only seeing D once a month to weigh and check in and are basically working with her via us parents. D much prefers it. 

Sounds like the main thing you get from FBT now is the weighing? I think if it were me, I’d ask our family doctor to do that bit, but keep the therapy for anxiety! 
Elibean
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HopeNZ
Hey blehbleh, congratulations on an awesome job with the refeeding!

I would encourage you not to dispense with your FBT therapist if you see any value at all. Like your d, ours really doesn't like our T and all but refuses to engage with her. She was 13 when she got sick, had no body image issues, and is not given to introspection. Our T was fantastic with that practical problem solving during stage 1 but otherwise the sessions often seemed somewhat pointless as my d watched the hands of the clock ticking. But I have to say stage 2 would have been so much harder without her! In many ways we've found stage 2 much harder than stage 1 and our T has been worth her weight in gold. Our d still refuses to open up to her and just about tolerates the monthly weigh-ins.

BUT the T has been a great ally for me. She's the bad cop to my good cop as we try to navigate greater independence and responsibility for meals with my d; she delivers hard truths which my d just won't hear from me; she's suggested various changes to our sessions when things need a shake-up (fortnightly/monthly, all of us/just my d, 10-minute weigh in only/hour long session etc). She's also a great sounding board for me. 

Perhaps you can sound your T out on how she sees her role changing as your d progresses? 

Good luck 🌺
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blehbleh
Hi Hope, thank you for your reply here and on my other post, which I now see was pretty similar!  It sounds like you have found a fantastic T.  Unfortunately, ours never seems to really DO anything in our sessions.  She definitely has not offered any practical problem solving advice for meals during Phase 1.  We are sort of approaching Phase 2, and she has suggested that D could try having lunch at school one day per week, but no specific suggestions as to how to do that (I found that advice here on the forum).  I like your advice on getting our T to clarify her role.  
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Mcmum
Hi there. We have a 10 year old son with an. He too doesn't engage with fbt therapy at all but we use it for  (blind) weigh ins and also a sounding board /bit of emotional support for us. My non ed d doesn't come any more as it was all getting a bit intense, like you say.
The most important thing to my mind with a child so young is that they are not going to be their full size and weight for a decade . Consequently, the main thing is feeding and vigilance . I have no intention of giving my s any control for years. Most 10 and 11 year old just eat what they're given with a few limited options : this chocolate bar or that one.
My s also has social anxiety but we're working on that ourselves with exposure and reassurance.  Camhs suggested art therapy but I suspect with food, time and encouragement here , he will get better at coping.  We're trying to work on strategies to help him.
Both our kids are very young.  With fbt or without we have many years ahead of feeding and nurturing . Have considered just seeing gp surgery for weigh ins as this causes stress at home.  For now ,he has no inhibitions so I can see he's at a good weight.  Mood is good and I am feeding a lot. Especially as mamabear says, FATS.
I suggest that most 11 year old wouldn't engage in therapy . They are too young to verbalise with a stranger how they are feeling.  Trust your instincts and feed, feed, feed xx
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Mamaroo
My d hardly participated in therapy and given food and time she is back to her old self. She hasn't been weighed since 2017, like Debra I go by state not weight. If you don't get any benefit from your therapist, then I would say you can do this on you own.
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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tina72
My d was 17 when we started FBT and she never engaged in the therapy part as there was no need for that. The most important part of FBT is refeeding in my eyes and that works for you and you know how to do that. So to answer the topic of your thread I would say in our case it was not a question of age. Some kids do not need any therapy but food.
Congratulations for that by the way! Your plans to keep feeding and not back off and start phase 2 too early sound perfect.
We stopped seeing the FBT therapist after 4 months because she went to maternity leave and we had no other possibilty. But that was o.k. She said you are ready to do that on your own and although I did not believe it then she was right.
So my 2 cents are:
If the appointments make more stress than comfort leave it. If you do not want to cancel it totally you could say you would like to have a 3 months gap (or 6 months). Get her weighed at the GP or pediatrician (I recommend blind weighing but yes, ask for privacy and get her weighed in underwear if possible). Keep feeding and get her slowly back into life.
To be honest, I learned much more here from other parents than from any therapist....🙂
Keep feeding. There is light at the end of the tunnel.
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deenl
HI blehbleh,

We did not have access to an FBT therapist but we did use a family therapist for just my husband and I. Really it was just so we would find an hour in the week to sit down away from everyday life and discuss what we needed to do. Mostly we were the ones who came up with the ideas (from here) and we just tweaked the plans during the meeting.

Our son became ill at 12 and had no body image issues. This is pretty much the norm for younger children. He has never had any sort of therapy except food and tips from mom and dad (mostly from all the reading I do!) He is doing really well now.

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, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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.
  • We cannot control the wind but we can direct the sail.
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Ronson
Hi 

fbt did did not help my d - she also shrank away from therapist and seemed worse.  So now she is weighed fortnightly (blind weigh but shoes off) at the gp - 5 min appt no stress.  I see therapist every 6 weeks and talk them through d progress.  She sees them every 6 months for medication review. This works for us.  For us trying therapy with d almost reinforced the behaviour. Things have been much better for us this way.  Also no scales in house with gp weighing. 

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mamabear
My daughter got sick at ten. After a horrendous inpt month from hell we took her home AMA. 

we then had 2 or 3 Skype sessions with an awesome therapist who basically agreed with us that we didn’t need her- that we just needed to feed our D.

my D never went to therapy.
We also had no psychiatrist or dietician. 
We had a GP who agreed to basically say to my d what we told her to ( trust your mom and dad). 

We live 8 hours from any FBT. my D is now 19 and has been in a strong recovery for years now.

Go with your  gut on this. 
I am not saying therapy can’t be a great thing for some- but bad therapy is worse than no therapy. And none of us have endless money to keep throwing at therapy that the kid will not engage in 
Persistent, consistent vigilance!
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Foodsupport_AUS
There are lots of kids who have recovered without therapy and others who have not. My D has had extensive therapy, and although related to her eating disorder much of it does not. In part it is about teaching her better strategies at dealing with anxiety (60% of those with AN have an underlying anxiety disorder) and in my D's case managing her severe depression. You can always look at therapy again down the track. Not wishing to express or share her feelings can be an issue, and certainly is something that my D's therapist has worked on. Her reluctance to do so was a part of her eating disorder. 
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.
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Elibean1
Agree with both last posts....it so depends on the child, the situation/need and on whether a good enough therapist is available.

very much a generalisation but we were told that often, the younger the child the less they respond to or able to engage with therapy. Our clinical psychologist at ED service works ‘through us’ and just checks in with D once a month. If we had difficult-to-talk-about dynamics within the family, we would all of course benefit from family therapy (like any family without ED). D may well benefit from trauma therapy in regard to her relationship to her body (which has ‘let her down’ in her mind, medical trauma) but this isn’t the right time.

It’s so individual. And for what it’s worth, both myself and D’s dad are therapists! 
Elibean
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