Here's what I've come up with - to be discussed with Ben at some point this afternoon. Remember, I have always positioned our Recovery Contract as something that is mutually agreed. Everything is discussed on neutral ground and no-one is permitted to dictate to the other, lose their temper, etc etc.
And this afternoon we will measure Ben's height to check everything is okay in that respect. Tomorrow we will weigh him and begin our "fats experiment" which, as you may remember, is to check that - what I believe to be a recent move towards a fat-reduced intake - does in fact include sufficient fat.
We will also be going back to "proper" calorie counting for a few weeks, just to get back on track.
Basically, everything I will be doing from today onwards is to ensure that Ben's recovery gets its momentum back. As I said to my H this morning: "I have met several former anorexia sufferers, now in their twenties, who are fully recovered and are adamant that they will always do whatever it takes to ensure ED never, ever enters their lives again, including the need to put on sufficient weight, maybe even more weight than they ever imagined they would need to do, and the willingness to eat challenge foods. These young people realise that "Food is Medicine" and they will do whatever it takes to stay well."
Then I added: "I can't for the life of me see why Ben shouldn't be up there with them, thinking and behaving like this. They are proof that it can be done. It's ludicrous to assume that he could never achieve that, given the right support and treatment. In fact it's more than ludicrous. The problem / trick is to get his mind and motivation on board - and get his enthusiasm for full recovery back. This is my primary job and driver for 2013."
Anyway, here is the new Contract (watch this space for an updated version with the following 'TBAs' sorted out):
- X,XXX calories per day (to be agreed)
- If fortnightly weight gain goals are not met, calories will be increased by 100 per day (and adjusted if necessary the following fortnight)
#2: Weight Gain / Maintenance
- A weekly average of 0.5kg is expected in line with BMI for age / weight / height TBA
- Maintenance weight is the mean within agreed tramlines TBA
- Fats to be the mean within government tramlines
- Weigh-ins are fortnightly
#3: Mood / General
- To agree to working through this with mum i.e. ‘points chat’
- ‘Do points’ daily again [we have lapsed to weekly]
- Make notes of current challenges / issues on mind / fears etc
- Check it continues on track, within agreed parameters
#5: Rewards – Points system
- 1 point per day Ben keeps to agreed calorie and fats total
- 1 point for every day Ben brings in ‘fatty’ challenge food to maintain fats total (diet / fat reduced foods don’t count)
- 3 points deducted for dishonesty / unacceptable behaviour
- 3 points for every social activity with friends: pubs, parties, movies, meals, etc (not Games Workshop, school teaching or charity shop). One social event min per week.
- 1 point for every PHAB meeting, school and charity shop
- TBA / discussed – what really does constitute a rewardable moving forwards challenge these days?
- 3 points every time he attends treatment sessions willingly and cooperates
- 2 points for doing 'homework' following treatment
- Up to 4 points for refusing treatment or non-cooperation