Sunday 13 March 2011

Watershed Weekend... phew...

It's been one of those watershed type weekends where you all end up being forcibly moved onto the next level of recovery. Having been in Limboland for a few weeks, I knew we needed to get over the next hurdle but, like many things with anorexia, it doesn't always happen when or how you planned it. To cut a long story short, we're making changes this week with a view to addressing those nasty niggly problems that are still well and truly embedded in the eating disorder. Basically, if we don't, then they will stay and Ben will stay in Limboland for as long as we put off working on them...

Another thing that has left us in Limboland for a while is that I'm not totally convinced our CAMHS team know what to do next. We've spent the last 4 or 5 sessions not really achieving anything and with no clear focus. So it's time to make a private appointment with our psychiatrist to ascertain where we are, where we go from here and what we need to do to get there - without compromise.

By 'without compromise' I mean far less of this "We'll only do it if Ben finds it helpful" approach which, in retrospect, sometimes has the effect of doing what the eating disorder "finds helpful" i.e. staying put and keeping a firm hold on the OCD-like problems that are still controlling Ben's behaviour and preventing him from moving on.

One of these is the obsession with being weighed every week. Yes, his parents and the professionals need to keep a firm eye on his weight at this stage while he is still teetering on the brink of a 'healthy weight range', but, to be honest, it's only feeding the eating disorder by letting Ben know what that weight is. So we are going to try drip-feeding 'blind' weighing in. It was suggested at our CAMHS meeting on Friday and Ben recoiled in horror. Because it wasn't thought "to be helpful to Ben" to take the decision out of his hands and say, tough, we're going to blind-weigh you anyway, they decided not to. After a lot of thought and consultation with my very dear friends on the ATDT Forum, I have decided that the only way forward is blind weighing - and the longer we don't, the longer we pander to the eating disorder.

We can phase this in by doing it every other week to start with, a bit like weaning a child off a dummy / soother. Ben will have the 'safety net' of knowing that we have promised him that we won't let his weekly average weight gain spiral over and above the recommended 0.5kg weekly maximum (and of course we will monitor it the other way, too, for our own peace of mind). So far, having talked this calmly and senisbly through with Ben this morning, he seems quite open to this idea. I believe he can see how the obsession with numbers is fuelling the OCD side of the eating disorder. Also, if his weight goes UP, it's tended to mean that the CAMHS session is completely wasted as all we do is try to allay his fears that his weight is about to spiral out of control.

An example is Friday. When you look at it over the long-term i.e. the past 4 weeks, Ben has actually only gained 0.6kg OVER THE ENTIRE PERIOD which is well, well below the recommended 0.5kg per week. Ben gained 0.5kg on Friday and immediately hell broke loose as, last week, he'd been eating more AND exercising more (another sticking point), yet had gained 0.5kg. So the eating disorder was screaming at him that this 'proved' that he needed to eat far less (and exercise more). The entire CAMHS session was trying to get into his head the fact that the body doesn't work like this and you need to look at it over the long term, etc etc. But by then Ben was in a bit of a state - and the meeting simply went pear-shaped.

So blind-weighing will enable the precious CAMHS sessions to be put to more profitable use. It will also mean Ben gets to see what his weight is over the long term, not the short term. And it will hopefully mean he gradually loses the obsession with figures.

My dear ATDT friends say that when they introduced blind-weighing at this (what I call third) stage of recovery, positive things started to happen very quickly afterwards.

So that's the plan.

The only fly in the ointment is that the pych. is going on hol for two weeks so we'll be dealing with the nurse for a couple of sessions. However I shall still push for blind weighing.

This is just one of the MANY things that have come out of this brain-pulverising weekend and I will talk more during the week.


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