National Eating Disorders Association

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Is this therapy working right?

Our 12 yr. old daughter is in a facility. Her general anxiety led to an eating disorder. The therapists are trying to get her to open up about her feelings and feel better about herself. My spouse and I simply want to know first what is going on psychologically. Is it reasonable to expect a therapist to be more of a sleuth, observing words and behavior to get at the underlying motivations? And if so, why is that not happening and why are we left on our own to figure that out? If that's not their job, why not? Isn't therapy partly about discovering the underlying motivations for unhealthy behavior?

Hi joejoe!

Hi joejoe!

Thank you for sharing and welcome to the forums! I think your questions would be best answered by the therapists themselves. In my experience, a portion of therapy focuses on behavior in the hopes to change how you react to your situation because that is just as important as the causes of the situation, so it is likely they are taking this approach for a specific reason related to EDs. I wish I had more advice to give you, but I am no expert and can only tell you what I have heard from my therapists and honestly think your daughter's medical team is the best source of information.

Please keep posting here on the forums and keep us updated!

Thanks for the response.

Thanks for the response.
We also feel we need to apply some pressure to our daughter who seems to be enjoying the cushy situation of being at an all day facility so she can avoid school. Their approach is to be extremely gentle. However, if she's not motivated to work on herself so that she can move to a half day program and resume school, shouldn't pressure be applied?

Hi joejoe,

Like Stormy said, welcome to the forums and thank you for asking these questions! I'll echo Stormy and say that the best people to answer these questions would be your daughter's treatment team, since they know all of the details about the specific situation. There are a number of different treatment methods for eating disorders, and especially because your daughter is so young, the approach might seem gentle compared to what your perception of treatment for adults is like. I'm not sure if your daughter entered treatment recently, but the therapists could also be trying to start out more gently so as not to come on too strong and then have your daughter push back. It could be that they have to establish a sense of rapport--help your daughter feel more comfortable and able to open up and talk, and then they can lean in more after establishing a foundation. I would definitely ask them about their approach and ask them to explain the basic goals/plan so that you know what's going on. Try to remember that the therapists are licensed and trained, so they have the background and experience to know what they're doing.

You should also ask the treatment team your question about "applying pressure", and ask what you can do to help with the treatment process. I'm not a professional, and I don't know your daughter so I can't offer more specific advice. At the same time, try to remember that your daughter's health is of the utmost importance right now, and getting her on a lasting path to recovery will be extremely vital for the future. My younger sister has struggled with generalized anxiety disorder for much of her life, and first went into treatment for an eating disorder when she was even younger than your daughter. Because she received great treatment and was able to make connections with good professionals, when she had ED relapses later in her life, she was in a good position to get back on the road to recovery. Your daughter's health (mental and physical) is just as important as her education.

I hope this helps! You've already made some great steps by getting your daughter into treatment, and it's good that you're asking questions and are so invested in her recovery. Please keep us updated on the forums, and let us know if other questions come up! Good luck to you and to your family, joejoe! :)

Frustrated with treatment protocols

My daughter is now on PHP level care after being on residential care for a short duration for her binge eating and depression. Her father and I feel at odds with some of the methods used by her treatment team. My daughter is an overweight teen and we feel that some of her depression comes from her being so. We were advised by her treatment team that exercise should not be regularly practiced and have approved only occasional light levels of exercise. The problem is that that philosophy does not fit at all into our family dynamic. I am a fitness instructor at a barre studio and avid runner, her father regularly runs and hikes and younger brother plays football and runs. Our daughter has never been very enthusiastic about doing these activities but we have tried to encourage her to try some of these activities in the hopes that once she tries them past the first few novice attempts she might begin to enjoy them. It is frustrating seeing her continue to insist on such an inactive lifestyle. She spends hours laying on her bed and watching Netflix and we feel her time spent in residential treatment reinforced those behaviors. We want her to experience more physical activities and be in good enough physical condition that she can actually start to enjoy the activities our family plans. My husband and I enjoy spending time in the outdoors and we hope to instill that love in our children as well. I understand why they don't want our kids to take exercise too far and become compulsive in their behaviors but I don't understand why when they have them in a safe residential environment they can't teach our children healthy exercise habits including how moods and energy and performance in school can be improved with safe levels of physical activity. My daughter came out of residential treatment lazier than she was before she got in and now uses her treatment team as a scapegoat for her lazy behaviors. We recently returned from a weekend trip to St George Utah where we spent part of a day exploring some of the shorter hikes in the area. My daughter returned from PHP today reporting that our family outing was not approved, that she is only approved for light walks around the neighborhood. Our hikes were basic hikes, nothing crazy. I feel like they do more harm than good in dictating what we do for a bonding family activity and that needing to ask for approval for such an activity is a bunch of bull. Does anyone feel like their kid came into their treatment with a handful of problems and came out fully convinced they had 10 additional problems. I am fed up and wondering if maybe I made a mistake taking her to the center in the first place and maybe would have been better off getting a private dietian/psychologist. Any suggestions or thoughts.


Just to clarify, as I’ve come to understand it, depression and anxiety are widely accepted by many psychologists and psychiatrists as being caused by chemical imbalances that are often genetic and beyond the individual's control. Although mood can certainly be influenced by external factors (i.e. positively by moderate exercise or negatively by social stress), it may be the case that your daughter being overweight is not a major cause of her psychological disorder. Personally, I think it would be best for your daughter if you listen to her treatment team and allow her to abstain from active family outings, as directed, until she is in a better place in her recovery. Thats just my opinion though. Additionally perhaps you could try to devise some less strenuous family bonding activities. Not only is this best for her recovery, as outlined by her professional treatment team, but it may actually also make her feel more included and supported by her family (which is certainly a necessary element in many individuals' recoveries).

Hi valeriebmorton,

I completely agree with what Cosmia had to say.

If you disagree with aspects of your daughter's treatment, perhaps you and your husband could arrange a meeting with her treatment team. Does the treatment center offer family therapy? It might be good for you to learn more about their approach and why they are making these decisions. They might have had other parents express similar concerns in the past, so they might have a good way to explain things and answer your questions.

And, regarding what you said about people entering treatment and coming out of treatment with additional problems, I think it's common for people to learn that they do in fact have other co-occuring problems. It's very common for people with EDs to also have other disorders, including anxiety disorders and mood disorders. These problems aren't the result of treatment, it's just that people gain insight into other mental health issues and struggles they're dealing with through the treatment process. I'm not a professional, but it's my understanding that in order to properly treat the ED, other underlying issues must be addressed and treated as well.

I'm sorry to hear that you're frustrated by the treatment and by the ED recovery process. It is certainly a challenging situation for individual sufferers and for their families, and if EDs and mental health treatment are new territory for your family, it can be all the more overwhelming. But I encourage you to voice these concerns with the professionals, especially if you're considering changing treatment options.

Finally, if you haven't yet, you might check out NEDA's Parent Toolkit: . This guide is great at explaining and discussing EDs (including what causes EDs, how families can help those with EDs, and it even explains some of the neuroscience behind EDs.)

I hope this is helpful. Please keep us updated. Good luck to you, your daughter, and to the rest of your family.