We had a meeting with the pscyh yesterday. She is incredibly skilled at being diplomatic and subtle - and also digging us out of a hole without actually appearing to be doing so. I'm not saying she was 100% for us and contradicting the Assistant from last week, but she took elements of each, explained them in more detail to Ben and worked with us on coming up with a workable solution which Ben was able to handle without freaking out.
Yes, Ben had arrived within the healthy weight range, but it was right at the bottom of that range. Ideally and professionally we would all like him to weigh more.
Ben believes he looks the same as he did before the eating disorder kicked in, but that's not strictly true - he is still thin. She asked him how he felt about himself during that pre-eating disorder period and he said he felt healthy, fit and reasonably happy - and he said they'd calculated BMI in biology lessons and his came out at 20 at the time.
The psych explained that, although a BMI of 20 was middle ground for a boy of 15 years old, now he's nearly 18 years we'd really be looking for a higher BMI. For full grown men, a reasonable BMI is between 21 and 25 (implying that ultimately he will need to aim for that).
She also explained that his current BMI was still quite a way below 20. So, in effect, the 'recovered' Ben WOULD need to weigh more. Especially if he wanted to resume his previous sporty activities and allow a buffer zone for any other blips and dips.
Over the next few weeks the psych will work on the perceptions that are still distorted so he is better able to handle any weight gain and, ultimately, be as care-free about weight, eating, etc as any other boy.
But meanwhile it's not a disaster if he remains where he is for a while, weight-wise. However he is not permitted to go BELOW this weight and should view it as a MINIMUM not a middle range (i.e. not Weight Restored).
Also we would all use this next year to really iron out all the little glitches that could, at worst, result in a relapse when Ben goes away to university in September 2012.
My thoughts on this? As one of my ATDT Forum friends put it last night, we seem to have achieved "a good balance between FBT and the non-coercive British approach of treating the patient with respect and allowing them the right to choose their own treatment - which seriously inhibits the treatment of anorexia".
I think we can work with that. I could have done without the "being allowed to remain where he is weight-wise, for a while" stuff, though, when modern evidence-based treatment focuses on full nutrition first and foremost, followed by the rest.
Having said that, the general outcome was to get Ben to understand that - yes, he's arrived in the healthy zone, but he's at the bottom end and must never go any lower. Higher isn't a problem and ultimately we're aiming for a middle ground which allows for fluctuations in either direction.