Love, no matter what: how to support your child with compassionate communication as you treat the eating disorder

This is a section from Chapter 14 of ‘Anorexia and other eating disorders – how to help your child eat well and be well’

Has it become difficult to recognise your child? Do you struggle to help her as she flips between depression and aggression? Are you finding it hard to give unconditional love, and are you confused about rewards and punishment? In this chapter I offer you resources and examples to help you communicate with compassion and build connection.

In this chapter I propose to address typical difficulties we parents experience in our connection with our children when they have an eating disorder. I’ll share what served me well with my daughter, and continues to do so.

If you skipped Chapter 13 this one should still make sense in most places, but you’ll get a better grasp of matters relating to communication if you first read Chapter 13.

As always, take what’s helpful, and discard the rest.

“My feeling, with my daughter, is that each time she goes through a mood swing or a difficult time, if we handle it calmly and compassionately and she gets through it just fine, she is learning from that. It means the next time something goes wrong, she is more likely to get through it a little more easily.”[i]

Food is medicine, and love is life

Compassion and inner power to support your child out of anorexia

Biologically-speaking, I imagine that all your child needs in order to recover is food. But humans need their souls nourished too, and a parent’s love is life-giving. Otherwise, inpatient units would have a higher success rate than they do: after all, nurses can be pretty good at getting the calories in. I believe that because we matter enormously to our children, everything we do for them is extremely significant. Because we support them, they’re able to take on major challenges in spite of their fears. We make things seem safer, calmer. We make things normal. We ask our children to trust us. In addition, our love heals their battered self-esteem, counteracts their self-hate and guarantees that we will not abandon them.

Nurturing our connection with our child may be a powerful weapon against an eating disorder. It’s also intensely what being a family is all about.

I find this quote from a young person in recovery very moving, given the sufferings brought on by the illness:

“What an amazing gift the eating disorder brought me and my family – the gift of communication, of love, of acceptance.”[ii]

Unconditional love and acceptance

Love me when I least deserve it - unconditional love - anorexiaUnconditional love and acceptance of your child is one of the most important tools in your toolkit, both for your own benefit and your kid’s. It’s natural for us, in our suffering, to have all kinds of judgemental thoughts, and it’s easy for them to leak out and spoil our work. I’m proposing to give you some of the principles that helped me, and also to be transparent about the mental twists and turns I underwent before I could be totally present to my daughter and offer her unconditional love.

‘Love her even when she’s down’

I once spent an hour with a generous young woman who told me about her journey through, and out of, anorexia. As we parted company, I thanked her for all the tips and insights she had given me, and then I asked her, ‘What is the one most important thing I should concentrate on? One thing that will make the biggest difference to my child?’

She answered without hesitation. ‘Love her at all times. Even when she’s down. Even when she’s at her worst.’

I still get a lump in my throat when I think of this, and everything it implies.

What is unconditional love and acceptance?

Unconditional love is about loving our children, irrespective of what they do or don’t do. Love, no matter what.

It’s about them mattering to us. Making them know that they are wanted, special, significant, valued, appreciated, missed, and enjoyed.

I don’t know about you, but I thrive on unconditional love, and I’m a grown-up. I want my child to be nourished by it.

I believe that it is because of our love for our kids that Family-Based Treatment has been shown to work[iii]. I believe the treatment is about putting love into action. Even the best residential units can’t give kids that kind of love.

My child is more important than what she does. My relationship with her matters more than any of her achievements or behaviour. Or to put it another way, ‘I’m her mum!’

Here’s how I saw it, when times were hard: it’s easy to show her my love when all is sweetness and light, but I believe that she needs it most when her behaviour is out of order. These are the times when she has no resources to hand: her only tools are abuse, defensiveness, lies. If she had better ways of getting what matters to her, she wouldn’t be getting in such a state. In fact, many times, she’s done a great job of achieving her aims peacefully. Right now, she is lost. I am the person she needs to turn to. I am her anchor, her rock. I will not add to her stress, uncertainties or self-loathing by criticising her. In fact, because of the state she’s in, she will be expecting me to judge her, so I will take extra care to show her my uncritical acceptance.

How about the behaviour? If she has my love, is she going to think it’s OK to behave without any consideration for me?

‘Connect before you correct’. I will address the behaviour later, if necessary. But only once our connection is restored.

By Louise Docker (Flickr) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

You may find it hard to get your head round these issues and to work out what’s best for your child. Society doesn’t provide many good models, so parents can find it hard to believe that love and acceptance work better than rewards, punishments and forceful displays of authority. The last thing we want is to create a ‘spoiled brat’ because we’ve been too ‘permissive’. Some parents have become masters of unconditional love and they are delighted by how well it works, but to them it’s an abnormal, temporary way of parenting which is only appropriate to eating disorder settings. I disagree. Nonviolent Communication principles were developed with all human beings in mind. You don’t need to have an eating disorder to thrive on connection and mutual respect.

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Uncritical acceptance: therapeutically essential

What my young friend told me, when she urged me to love my child at all times, ties in perfectly with a piece of advice that emerges from research:

“Noncritical families seemed to succeed better overall in refeeding their children than those with more hostile and critical ways of interacting.”[iv]

For Family-Based Therapists (FBT), modelling ‘uncritical acceptance’ towards patients is an essential therapeutic task. They’re not just giving the acceptance, they’re modelling it, so that we, the parents learn.

[Jumping to another section of the chapter…]

Compassion and inner power to support your child out of anorexia

Coping with your emotional depletion

When you bring to mind loving moments, you might find you instantly stiffen, remembering how awful your situation is. You might also realise that your actions are nowhere close to your values, because your kid is pushing all your buttons. We’ve surely all been there. We have too much on our plate and we are emotionally and physically depleted.

If right now you’re so depleted that you’re out of touch with any sense of love for your child, if you’re beating yourself up about it or sensing judgement from others, give yourself some kindness. Try applying to yourself the standards of acceptance and compassion that you apply to others. The reason you’re in this state isn’t that you’re a terrible person, but that you care so very much about your kid.

If you’re regularly on the receiving end of aggression or if your child is very unwell, you may be experiencing fear over and over again. Your limbic brain sees danger, driving you to fight, flight or freeze in an attempt to make you safe. There’s no space for love in this state. The result is you can feel disconnected from any sense of caring. As one parent told me, ‘All that hate wears you out.

You cannot will your limbic brain to stop reacting, but you can create a terrain where it is less likely to sense danger, or where you can quickly move to a compassionate state. So build up your resources. When your child rejects you, you need to refuel frequently, to top up with whatever it is that makes you feel human. As much as possible, get people to help you with some of the mealtime work, act as though you are full of love (fake it till you make it) when you have no one to take over from you, and urgently get yourself regular doses of tender loving care from other sources. In Chapter 15 I will offer you more tools to take care of your emotional well-being, build up your resilience and access your compassionate self.

For more on this topic: read the chapter on Resilience

Teamwork helps us criticise less

Feeding your child at home is a lot easier with teamwork. There are times we need to get someone else to do mealtime duties while we take a break and refuel. James Lock et al write:

“An overly burdened parent may show exhaustion and frustration by becoming more critical of the patient. Encourage the more energetic and perhaps less critical parent to find ways to support his or her partner in the difficult task of taking on the illness.[vi]

If you’re exhausted it’s practically impossible to be the person you want to be and act the way you wish to be. Make it a priority to find help.

[Jumping to another section of the chapter…]

Dealing with aggression

 

Immediate response to violence: protection and self-connection

There are things you can do to de-escalate violence, and with practice (which we tend to get plenty of) you’re more likely to do them instinctively. Your guiding principle throughout is to seek to be in touch with needs: your child’s and yours.

In violent situations the first step may be to protect yourself or others. You can firmly ask for a stop to any level of violence which is unacceptable to you: ‘Don’t kick me!’, ‘Put the knife down here[xv]!’

You’re probably doing this already, as shouting ‘Stop it!’ is a pretty natural reaction.

If you are able to, though, start with a need, as it may already help your child connect with you: ‘I want safety! Move away from your brother right now!’ or ‘I really want us to treat each other with kindness. Please use polite language!’

As soon as you can, give yourself emergency self-compassion. This will make it easier for you to concentrate on the behaviour and keep criticism out of the way.

In the space of one breath your mind might go, ‘Gosh, I hate this! I’m so pissed off! [Feeling] She’s a monster! Poor me! I really feel like shouting at her, no, I’d really like to punch her, to hurt her like she’s hurting me. And make her pay for what she’s doing to me! [Noticing your chatterbox thoughts] Now I’m remembering that every time I’ve felt like this, I’ve discovered that I really want to care for her and support her because she’s suffering and needs me. Is this going on now?… checking… Yes, I really long for her to be well – I can touch that now… [In touch with your needs] I’m going to see if I can stretch a tiny bit. Yes I want to support my little kid. I can say one empathic thing.’

It’s easier to do this when you’ve previously spent time reflecting on this type of situation: it gives you a shortcut for emergency situations like this.

After that you’re ready to give your child an empathic response – verbal or silent.

Let me give you an example. You ask your child to do something and she flares up: ‘I hate you, you stupid bitch!’ and she starts kicking you. In a flash, you go into self-compassion, noticing your reactions and drawing power from your desire to be safe and treated with consideration.

You say, very firmly, ‘Don’t kick me. Kicking is not OK.’ You don’t have to be ‘nice’ about this, because this really matters to you and it’s non-negotiable. Your firm, intense tone of voice may be all that’s needed for your child to stop kicking, or you may need to move out of her way or to reach for her leg and hold it still (taking care not to dig your fingers in as pain would increase her stress).

Assuming that this succeeds in getting your child to pause and maybe even give you eye contact, you might say more gently, ‘I can see you’re upset, so use your voice. Tell me what’s going on.’

This may not create instant peace but it’s a step on the road to de-escalation. Whereas you’d be pouring oil on the fire with knee-jerk responses like, ‘Don’t you dare call me a bitch!’ or ‘If you kick me one more time I’m cutting your pocket money!’

De-escalating violence: the empathy / self-compassion loop

I imagine that in the middle of violence, few of us have access to a deep well of empathy. If you have no idea what to say, I suggest you pick a few words your child said and reflect them back.

For example, your kid screams ‘I hate you! All the other mums let their kids onto Facebook! You’re a control freak!’

After taking a breath to self-connect, you could reply, ‘You wish you could use Facebook?’, or ‘You wish I treated you like other mums treat their kids?’ or ‘You’d really like more control?’

It doesn’t matter exactly what you say or which part of her tirade you pick: you’re signalling that you’re open to hearing her, and this in itself is going to help because if she’s shouting, she probably wants to be heard.

As soon as you can, see if you can touch the place in you where there is love for her and for yourself. Your words and body language will soon be more congruent.

What happens after that? You may need to continue giving empathic responses, avoiding the temptation to justify yourself or to correct your child. If you’re not confident with words, remember there is always silent empathy.

She may stop yelling but continue throwing new accusations. Each time, you de-escalate with a compassionate reflection. You may need to keep breathing, giving yourself self-compassion at every step, in order to get the strength to stretch your patience a little further, just enough for the next rung in the ladder.

With time, you may feel a little more grounded, and the more you can model this, the sooner your child will calm down. Finally, you’ll see a sign that she’s finally connected to herself and to you: a sigh, a relaxation, a change in the tone of voice, or even tears.

Don’t even attempt a rational conversation until you see this sign.

Some time after this demanding exchange, you may well need to go find someone to give you some compassion for what you’ve been through.  If you want to be in top form for your child’s sake and your own, this goes in the category of ‘essentials’, not ‘luxury’.

Does empathy condone aggression?

For most of us parents from traditional (punitive) backgrounds, it is extremely counter-intuitive to give our children an expression of our love when they’re behaving appallingly. We have to step out of a well-worn groove to create peace, not war.

Whenever your child behaves with aggression, she is likely to interpret whatever you say or do next as judgemental or punitive. She does not expect love and support. This makes it difficult for you to create the very connection she so needs to be herself again.

This is not permissive parenting: your needs matter equally as much and you can choose to attend to them. But the timing is important: make your requests once your child has left her zone of reactivity and your connection is restored (‘Connect before you correct’). At this stage you can safely have a conversation about how you’d like her behaviour to be different.

Note that there are periods when our children are in such deep suffering that they are never really free of reactivity and don’t have any space to consider our needs. You can never ‘connect’ enough to get to the ‘correction’ bit. In this case you need oodles of self-connection and self-care.

When you’re still hurting after the fireworks

Sometimes we keep our own needs on hold for the whole length of a difficult interaction, promising ourselves some self-care as soon as the situation is de-escalated. So now, go ahead. Look after yourself, go lick your wounds. But first there is one last effort to make: make your exit in a way that your child won’t interpret as rejection or punishment.

Suppose you’ve planned to go for a fun outing to the shops with your daughter in the afternoon. But she has a rage over lunch and although it’s not the first time, today you’re vulnerable. You’re feeling upset, discouraged and hugely sad.

You could say, ‘I know that having lasagne for the first time freaked you out. So I don’t blame you for how you reacted and I’ll keep supporting you. At the same time (I don’t say ‘but’ because that would imply what I’ve just said is irrelevant or untrue) all my sense of fun has left me. I’m not at all in the mood for an outing. So I’d like to call it off and tomorrow, we can talk about it again. Now I’m going to my bedroom to read. This isn’t to cut you out but because I reckon I’ll feel better with some quiet time and after that I’ll be more there for you as well. How does that sound?’

For more on this:
After charged interactions, you could choose to have an empathic conversation with your child in order to take care of yourself, your child and your relationship. You might also be looking for solutions or agreements so that whatever happened won’t happen again. Read an example HERE “Empathic dialogue after a bust-up”.

‘Am I fat?’ How to respond

Michelin man-Am I fat - Anorexia question

We’re regularly presented with questions, tears and hysterics which seem to come not so much from our child as from her anorexic voice (or perhaps from our child and her anorexic voice battling each other). ‘Am I fat?’ is usually the main one, but also, ‘Are you going to make me eat cheese?’; ‘How many calories in this?’, ‘Will this make me fat?’ and ‘How much more weight do I have to put on?’ There may be some more subtle questions, but to me, fat-related concerns plus anxious or aggressive body language indicates that anorexia is probably at the helm.

You have probably noticed by now that reassurance doesn’t work and only feeds greater levels of doubt and anxiety. Even if your kid gets a flicker of pleasure from hearing that she is actually dangerously underweight, a moment later, the fear springs back up: ‘But I’m fatter than this morning. I can feel it here, see, here? You’re making me fat!’

So what to do? The guiding principle is to refuse to engage in this type of conversation. This is anorexic talk fuelled by high anxiety, and we want to take the focus off it and help our kids be calmer. Wherever the eating disorder rules, information, logic and reason fall on deaf ears. Worse, you could get yourself sucked in a long discussion, covering all the areas anorexia thrives on, and find your kid only gets more anxious.

“ED will NEVER hear that the way they look is ok or ‘normal’.  Never.  This is something I am still learning.  ED constantly wants to engage me in the discussion of ‘I’m fat’ or ‘My stomach is huge!’  Just for grins, one day, I had her and I stand side by side and lift our shirts.  I said, ‘Which stomach is bigger?”  Answer:  Hers!  Now, you must all know that I am objectively MUCH larger than her. But, still the voice in her head says something very different.

That was the day I stopped having those conversations. Now, I either ignore the comment, or simply say “we’re not discussing that.”[xvi]

I still squirm when I recall that I once produced a colourful chart to prove to my daughter that she couldn’t possibly get fat on what we were giving her. It showed the humongous number of chocolate éclairs needed to put on just half a kilo. There they were, looking ever so pretty on the chart, providing logic and reassurance. She looked at them and nodded wisely. Then she refused the next meal.

So what do you say, if you don’t appeal to rational thought? There may be no harm in saying, very firmly and just once, ‘No, you’re not fat’.

Perhaps if you don’t say it, your child will jump to the conclusion that she is definitely fat. It’s difficult to know for sure, and I imagine that one single ‘You’re not fat’ can’t do much harm.

More importantly, you can choose to distract: ‘It’s not good to have this kind of discussion. Can you give me any white clothes that need washing?’

“Countering a distorted cognition with actual facts is useful when we are as matter of fact and brief about it as we can be. ‘You look perfectly fine to me. Did you notice that the azaleas are blooming?’[xvii]

You might also sense that your child could use some empathy before you distract: ‘Sounds like you’re having a hard time right now / Is your anorexic voice bugging you at the moment? You want to know you’re OK, and that we know what we’re doing, and taking good care of you? Yes, darling, we really are looking after you, and we really good at it. Come on, let’s think of something else. Help me wrap up Dad’s presents.’ It may help your child to know that although she can’t help asking these big ‘chatterbox’ questions, you’re not judging her, and you’re still by her side.

You could cover up mirrors for a while, or just insist that your child doesn’t undress in front of a mirror. With my child I held back on removing mirrors, thinking that with time and exposure, she might learn that she was OK, that her brain regularly played tricks on her, and that the distress passed.

I once went to a hypnotism show. People on the stage genuinely saw a pink elephant coming onto the stage. They knew it was impossible, you could see the disbelief on their faces, but clearly, they could see, smell and touch the elephant. I told my daughter about it, and put it to her that the human brain can very convincingly play tricks on you. After that, it sometimes helped, in the middle of a crisis, to say, ‘Remember about the hypnotism? You can’t believe what your brain is telling you right now. Anorexia does this stuff to your brain. It will pass. Come and do something else with me.’ I realise that by doing this, I was, to some extent, appealing to her rationality. I wouldn’t normally expect this to work at a moment of high anguish, but in this case, it did seem to help.

I guess that at times when your child is not full of fear, there is a place for rational talk and information: after all, eating disorders therapists do that in sessions. You don’t want to engage in anorexic discussions, but when anxiety is low, when the anorexia is starting to recede and your kid’s rational brain is engaged, it may be a good time for some education. Your child may never have thought that the reason her tummy is round after a meal is there’s food in it – it’s not suddenly grown a billion fat cells. She may never have thought that gaining height also means gaining weight. She may not be aware of water retention and monthly cycles. This information may help her self-soothe next time she’s triggered. If you’ve chosen for her to know her weight, I should think she needs to know about normal variations as well as growth.

Hysterics, panic attacks and extreme anguish

Sometimes the ‘Am I fat?’ questions aren’t so much questions as hysterical episodes. They can morph into expressions of utter despair such as ‘I’ll never get better’ or ‘I can’t do this any more!’ Or they can take a more threatening tone: ‘You’re useless! When I come home out of hospital I will stop eating and I’ll lose all the weight I put on.’ From some parents’ reports, children can also have panic attacks. Sometimes the storms fall into a pattern – same time every night, when alone and changing into night clothes in front of the mirror, for instance – and we can plan distractions as a preventive measure. But at times these extreme episodes come without warning.

If your child has massive, uncontrolled outbursts of emotion, you might be wondering if it’s best to give him some time alone or to keep offering some kind of support. Especially if your kid is shouting for you to back off because he hates you. And you might be getting tied up in knots about what to say and not say, because nothing seems to make things better.

[Jumping to another section of the chapter…]

Requests: ask for what you want

Walking on eggshells - when your child has anorexia

Stop walking on eggshells

We parents know what it’s like to walk on eggshells. Eating disorders often make our sons and daughters react violently and unpredictably, resulting in a refusal to eat. And so, we become terrified of saying the wrong things, and we pussyfoot around.

What if she doesn’t want to tidy her room, or clean her hamster’s cage, or stop hitting her sister? What if she storms off when Grandma’s expecting a birthday visit? It’s bad enough having a hard time around meals six times a day, what can we do about all the ordinary situations? Should we show her who’s boss and demand what we want? Or should we say ‘Yes’ to everything because the poor thing has already lost control of her autonomy around food and health?

Whether your child has stayed in the same ‘stuck’ place for a while or whether she’s on the road to recovery, remember that you can make requests, and that these can nurture connection.

In Chapter 13 I introduced you to the principles of making requests, and now I propose to go into a few more details that might be particularly helpful with your child.

[Jumping to another section of the chapter…]

Comfort and reassurance: what works and what doesn’t

There are plenty of instances where children appear to hate being in our presence. But what about all the other situations where our child wants comfort?

Sometimes we question our most basic instincts. Should we reassure? Should we protect? Should we give support when our child is in distress? Should we give all the closeness she asks for? Should we – and I’m including dads in this – should we mother?

We’ve already seen that reassurance is pointless when a child is agonising around anorexic questions, like ‘Am I fat?’ But does that mean reassurance is generally a bad thing?

Soothing

Comforting your child - anorexia

It’s a great gift when a child comes to his parents for solace. We know how to soothe, how to make those little ‘hmm’ noises that show we care, how to hug and enfold. This is how we nurtured our children from the day they were born, and gave them the experience of ‘secure attachment’[xxii]. Is it ever not right for parents to comfort their children? I hope not.

Our children can become so isolated in their own private hell, pushing us away and thinking of us as enemies, that any opportunity for closeness is precious. If your child wants your reassuring presence at bedtime, or even at all times, count yourself very, very blessed.

And so I’m filled with dismay when parents say a therapist has advised them to back off and let their child deal with his anxiety all by himself. When a child is persistent in his attempts to get help with his demons, if he keeps signalling he wants you to soothe him, I’m horrified this may label him as ‘clingy’. I’m appalled that parents can be considered ‘over-protective’, ‘co-dependent’, or accused of ‘babying’ their adolescent. I hate pronouncements that a child is ‘insecurely attached’ and I hate that parents, all too often, are made to believe their love is harmful.

Here are the arguments: ‘Your child must learn to be independent’; ‘Your child must learn to tolerate distress’; ‘If you give your child attention, you’re rewarding his (anxious) behaviour’; ‘You don’t want to reinforce your child for being fearful’; ‘Your child is seventeen and seventeen-year olds should sleep by themselves’.

Is your support turning your child into a clingy, dependent child? Is it stopping him from being a normal, independent adolescent? No. The eating disorder is.

Interdependence: it’s OK to need others

I would hate my child to think that there’s virtue in bearing her sorrows or fears alone, when just across the room there are people who love her and who can ease her burdens.

Can you think of any times that you’ve been anxious? Were you perhaps longing for someone’s smile, someone’s presence, and were you – as I have been – grateful and empowered when you got it? Our children spend month after month after month in agony. They’re grappling with issues of life, love, abandonment, hopelessness and death. Emotionally they regress, just as we all do when we’ve been ill or miserable for longer than we can bear (‘When we stress we regress’).

Imagine that you were being held at gunpoint in a hostage situation. At some point, your mother or father is allowed to visit you. Would they not hold you tight? Can you imagine them refusing to hold your hand, on the basis that you need to learn to stand on your own two feet?

I value taking responsibility for ourselves, and at the same time we are social, interdependent human beings. It looks like it is essential for us to connect with others for support, kindness and empathy. It’s incredibly difficult to overcome fears all by ourselves at any age: self-soothing can only go so far, and that means, not far at all. As parents under extreme stress, I’m sure you can relate to that.

I’ve spent a lot of my own life being an island, believing only in the value of autonomy. The day I sought support from kind people, I became infinitely more able to be the person I wanted to be. It enabled to be stronger, more compassionate, and far more capable of giving my daughter what she needed. I would love my child, likewise, to experience and value interdependence[xxiii].

Of course, seeking comfort from others is not the only way to deal with anxiety, and it’s good for our children to experience a range of tools. There’s self-compassion, mindfulness, self-talk (as in CBT) and there’s the wonderful tool of distraction. For me, getting comfort from another human being is right there at the top. It’s tragic that in our society it often gets mixed up with judgements of weakness or deficiency.

When you welcome your child and help soothe her, you’re saying, ‘Your needs matter to me’. When you comfort her when she seems as clingy as a three-year old, you’re saying, ‘I love and accept you the way you are, right now, at this moment.’ If you turn her away or ignore her, she may learn that her needs don’t matter or are somehow shameful. You want to teach autonomy, but the message your child receives when you turn away is more likely to be, ‘I don’t matter. I am alone. I give up.’

Jumping to the rescue

You may have been told to back off on the basis that children need to learn to tolerate difficult thoughts and feelings. Some parents get admonished for ‘jumping to their child’s rescue’.

Is there anything wrong with wanting to contribute to any living creature? I can’t think of anything more beautiful.

When therapists talk of not ‘jumping to your child’s rescue’ I believe this is their worry: are you trying to protect yourself from your own suffering when you see that your child is in pain? If the answer is yes, then the danger is that your actions will not effectively contribute to your child’s wellbeing. And they won’t do a great job for you either, because it is not in your power to change your child’s feelings. So spend some time in self-compassion, connecting to the values that you hold dear, and see what emerges.

The next difficulty with ‘rescuing’ is that it might not serve your intentions. Does it actually contribute to your child’s wellbeing? The answer is ‘Yes’, of course, if you’re yanking your kid off the path of a speeding car. But if your child is experiencing fear or discomfort, my answer is, ‘It depends’. It depends if the experience will leave him stronger or more terrified. Your child will benefit from dealing with fear if he’s well supported and learns that fear is manageable. He will gain the confidence that he can achieve challenges and have internal resources. But if he’s left to deal with fear alone when you are nearby and could easily help him, I’m concerned that he may form a belief that the world is a lonely and terrifying place.

I believe we’re ideally placed, as parents, to judge how much protection and hand-holding our kids need. We sense when it isn’t appropriate for them to be faced with a situation they are not equipped for. That’s why films come with age-ratings. That’s why we don’t let young children watch late night news. That’s why schools have anti-bullying policies. At the other end of the spectrum, we sense when our children are likely to flourish if they manage something in spite of fear. Every success you’ve experienced with exposure and desensitisation works on this basis.

If you’re confident that you have your child’s needs at heart, then surely you can trust your instincts and give her a good balance of challenge and protection. Isn’t that what you’ve been trying to do since she was born?

A good friend I made along this journey, found the perfect analogy:

“I was thinking back of the time my daughter started kindergarten and looked at me to check if I was feeling OK with this new place. I pretended to feel totally OK with it (even though I felt nervous leaving her in a new place) and that made her feel OK with it and enjoy it. I recognised the need to show my child confidence that she can again engage in life and enjoy it.”

Reinforcing what?

Behaviourist principles predict that pleasant feelings reinforce behaviours. Some parents have been told that if they give their child comfort, they are providing something pleasant – a reward – in response to a fear, and that this will reinforce the fear. My understanding is that it doesn’t work this way[xxiv].

Imagine you’ve just been mugged, and you’re standing on the street, shocked and shaking with fear. Scenario A: a kind person rushes over and holds you with love, and gradually you become calmer. Scenario B: people turn away to make sure you don’t get any ‘rewarding’ attention, and you spend the night on your own, trembling. Which scenario is most likely to return you to a calm state when you’re out in town?

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Clingy, or needing comfort?

Perhaps your child never seems to have enough of you? She follows you everywhere, wants to sleep close to you, needs frequent physical touch. A typical teenager, hidden away in her room, she is not.

I’d like to tell you a short story of clinginess, if you’ll forgive me for making a parallel between your child and my dog. My dog had five extremely clingy days after we got him neutered. He needed constant contact. If he wasn’t on someone’s lap, he just stood there, shaking, looking shell-shocked. At night he either stood motionless or paced up and down the room, only to fall briefly asleep while one of us stroked him. After a night of this, feeling slightly foolish, I abandoned my husband, and set up camp with my dog on the guest bed, where he instantly went to sleep.

I did this for a few days. Was I creating a rod for my own back? Would he forever expect to share my bed or lie on my lap while I worked? Had I fallen into the trap that if you give someone an inch, they take a mile? Nope. After a few days, suddenly he was fine. Back to his old self, to his doggie cushion on the floor, his walks and his world of doggie smells and lampposts.

In short, my dog needed a comforting touch for whatever pain or shock he was feeling, and once the need had passed, he moved on. (I was amused to talk to a great big macho man recently, who had done exactly the same thing for his great big macho dog.)

If you experience your child as clingy, I suggest you try and give her 100% of what she seems to need. I trust that kids want to grow and become autonomous. Give them a safe base, a place of nurturing and comfort to which they know they can return any time, and they’ll step out into the beckoning world.

As always, your own needs count as well. When we call a child ‘clingy’ it can be a way of saying we’ve run out of patience. We’re running on empty. Notice if you don’t have the resources to be present to your child as much as you’d like, give yourself compassion and explore what other support is available for her, and for you.

Self-soothing: tools for your child

I believe that children learn to self-soothe in their own good time, when they feel secure and when they’ve experienced, time and again, what it’s like to be soothed by their loving parents. At this stage they may welcome some tools. I’ve heard of older children using techniques they’ve learned in therapy or using relaxation recordings. One of my own favourite self-soothing approaches is to get ‘in flow’[xxv] with an absorbing and satisfying activity, playing music being an almost guarantee of quick results. So I find the following account from a mother particularly moving. Her daughter, age 7, was battling both OCD and anorexia:

“A while back I gave her a little lap harp. She said, ‘Mom, every night my head is full of worries about what I’m going to have to eat tomorrow. But if I play the harp, I just think about the song and the notes and the worries are gone.’ Later she said that when she has a bad dream that wakes her up, which happens almost every night, ‘I just play the harp and it turns the witches into angels.’” [xxvi].

 

[Jumping to another section of the chapter…]

Eating disorder - should you use the carrot and stick?

‘Take that, Eating Disorder!’

Some parents have been taught to separate their child from the eating disorder (ED). Over here is my lovely child, and over there is evil anorexia. This imagery is great if it helps you to support your child without blame. But with some parents I see that this can backfire: because ED misbehaved, ED and the child are made to suffer. ‘ED refused breakfast, so there was no TV and no video games[xxxv]. ED has to learn that eating is non-negotiable.’ If it helps you to see ED as an entity, then notice that ED likes to deny your child anything that might make her feel good. Strife and punishments play right into ED’s hands. I imagine you’ll go further by imagining yourself as being on your child’s side, rather than thinking in terms of making ED suffer.

I am devastated at the idea of punishing a kid for behaviours that are driven by their eating disorder. Would you punish a kid in a plaster cast for limping? A kid with leukemia for losing his hair? If you still believe your kid has will power over her behaviours, read about what other anorexia sufferers are driven to do, notice the similarities, and weep.

Rewards and incentives can backfire

Sometimes we ask our children to take on a really hard challenge, such as finishing off a meal for the first time, or eating food on their fear list. There is an attractive logic to giving them all the help we can, and parents sometimes hunt around for incentives.

When you’ve eaten your muffin, we’ll go to the cinema’ is quite different to ‘If you’ve eaten your muffin’. The first may work as an incentive, creating a hopeful and positive mood, while the second automatically creates a punishment (‘We will not go to the cinema’) if your child doesn’t manage the muffin.

If you’re going to offer rewards, I suggest you check they are only for tasks that are well within your child’s capabilities. Set him up for success, not failure. Think ahead what you will do if your child doesn’t succeed. What if he heroically manages two thirds of a muffin and then gets stuck? Will you give him two thirds of a cinema outing?

Rewards are not just used as incentives, but as positive reinforcement. You reward the behaviour you want to see repeated. You make your child feel good, and he’ll do more of the same to keep the pleasant feeling coming. It’s a benign form of manipulation, or an elementary form of behaviourism. Most things in society are set up for positive (or negative) reinforcement: golden stars in schools, awards in every field of excellence, bonuses at work.

And yet, a great number of studies have shown that rewards backfire, gradually killing off the desired behaviour[xxxvi]. On the whole, rewards replace intrinsic motivations with far less powerful external ones.

We’re in an unusual situation with anorexia. When it’s strong, sufferers seem to have no intrinsic motivation. Not a jot. The illness makes them not want to get better. Even if they do have a drive for health at some level, it is completely overpowered by the strength of anorexia. So shouldn’t we give them some kind of incentive, even if it’s of the weaker, external, kind?

My husband and I have been down the ‘rewards’ route. It seemed like the only way to go, the only tool in the box, and it was the focus of family sessions in hospital for months. But it was a blind alley. We tangled ourselves up in charts, ticks, stars, points, rewards, money, percentages, more money, bargaining, more ticks, more money, more maths, arguing, new charts, more arguing and the longer it went, the less behavioural change we got. We used rewards for targets such as sitting or wearing warm clothing, and somehow our purpose got lost as our points system and Excel charts took on a life of their own. And so did her wardrobe. How many shirts can a girl own?

As far as I’m concerned, rewards are a recipe for failure. But you must absolutely not just listen to me. Many parents have found them extremely useful. There are stories of kids who have eaten, or overcome a compulsive behaviour, because their desire for a reward was stronger than their fear. And when you’re working on desensitising to a fear, you only need a few successes. The key here is that incentives may help get someone out of a rut.

You may be able to make rewards truly incentivising if your child is on board – if he has some motivation to accomplish a particular task, if he welcomes a tool to help him do something he’s already willing to do. This makes you into a partnership, and you’re less likely to get rebellion or manipulation. In her book ‘Please Eat’[xxxvii], Beverley Mattocks describes successes when her son became enthusiastic about earning points (which led to cash). To do this he had to succeed in challenges which they agreed on in a ‘contract’ which they revised regularly. It seems crucial that this contract was a joint affair, not something imposed by parents.

When we started using rewards, our daughter truly welcomed the help because she wanted to manage Christmas away from the hospital in the company of our extended family. It was a success, the only success we ever had with rewards. The system failed when we continued to use it on things we wanted her to do, for which she had not the slightest motivation.

And so, I have put my trust in the many other tools I am sharing with you in this book.

[End of extract from the chapter]


In this chapter:

  • Food is medicine, and love is life
  • Unconditional love and acceptance
  • Judgemental thoughts: my story
  • She loves you, even when she loves you not
  • Empathy for your child
  • Give your child containment
  • Is your child’s anger better out than in?
  • Is your own anger better out than in?
  • It’s not about you (even when she’s mad at you)
  • How much of your truth can you share?
  • Behaviours you don’t wish to accept
  • Dealing with aggression
  • ‘Am I fat?’ How to respond
  • Hysterics, panic attacks and extreme anguish
  • Welcome the tears after the fireworks
  • Requests: ask for what you want
  • Turn conflict into dialogue
  • Comfort and reassurance: what works and what doesn’t
  • ‘I want you to be happy’: fixing, advising or contributing?
  • Helping your child feel good in herself
  • Rewards and covert punishment
  • Sick, mad or bad? What model are you using?
  • Teen books about eating disorders: take care
  • Educating and motivating your child
  • Heart-to-heart talks
  • Activities and time together
  • Modelling: do as I do
  • Parent and child: our common humanity
  • Mending, apologising, and regrets

Buy

* Go to: Table of contents *

Next  chapter: How to build up your own resilience and wellbeing


Endnotes

[i] From Gobsmacked, posting on the Around the Dinner Table forum.

[ii] From a letter by L on the F.E.A.S.T. website.

[iii] Carl Rogers made ‘Unconditional Positive Regard’ a foundation of the Person-Centered approach he developed. Marshall Rosenberg, the creator of Nonviolent Communication (NVC) studied under Carl Rogers. To me this explains how Family-Based Treatment, with its principle of ‘uncritical acceptance’, works so well with NVC.

[iv] James Lock, Daniel Le Grange, W. Stewart Agras, Christopher Dare: ‘Treatment Manual for Anorexia Nervosa. A family-based approach’, quoting from research by Eisler, I., Dare, C., Russell, G. F. M., Szmukler, G. I., Le Grange, D., and E. Dodge. 1997. Family and individual therapy in anorexia nervosa: A five-year follow-up. Archives of General Psychiatry, 54, 1025-1030. http://www.ncbi.nlm.nih.gov/pubmed/9366659

[v] Marshall Rosenberg, the creator of Nonviolent Communication gives an entertaining demonstration of love as a feeling. If you want a giggle as well as a challenge to what you consider ‘nice’, jump to exactly one hour into a video of a workshop he gave in 2000. Or watch the whole three hours, it’s well worth it. http://tinyurl.com/d8syz3g

[vi] James Lock, Daniel Le Grange, W. Stewart Agras, Christopher Dare: ‘Treatment Manual for Anorexia Nervosa. A family-based approach’.

[vii]  ‘La guérison intérieure par l’acceptation et le lâcher-prise’ by Colette Portelance. Translated roughly as ‘Inner healing through acceptance and letting go’. http://amzn.to/14iNRHD. There doesn’t seem to be an English language translation of this book, but if you can read French, it’s the best I’ve read on the subject.

[viii]Parenting Your Anxious Child with Mindfulness and Acceptance: A Powerful New Approach to Overcoming Fear, Panic, and Worry Using Acceptance and Commitment Therapy’ by Christopher McCurry, could have been written for us parents working on refeeding our kids, or exposing them to fear foods. Well worth reading. http://amzn.to/UGHdWc

[ix] Kate’s letter on the F.E.A.S.T website is worth reading in its entirety.
For another account from a child about what was going on in her when she rejected her mother, read LM’s letter too.

[x] Dr Sarah Ravin’s blog: ‘Emotional Anorexia’: http://www.blog.drsarahravin.com/eating-disorders/emotional-anorexia/

[xi]Parenting from the inside out’ (http://amzn.to/14E9X8J) is the title of one of Daniel Siegel’s books for parents. I’d recommend his more recent book, ‘The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s Developing Mind’ (http://amzn.to/WIHRW2) for its highly accessible account of the workings of the brain and the practical advice to help you connect with your child using the kind of tools I talk about in this book. Dan Siegel also has a whole series of short videos on YouTube:  http://tinyurl.com/b9ken5p

[xii] ‘It’s all about her feelings’ is a point Bon Dobbs makes very eloquently about loved ones with Borderline Personality Disorder when describing symptoms which have a lot in common with those of anorexia. http://www.anythingtostopthepain.com

[xiii] Even as I write words like ‘rude’ or ‘abusive’, I’m aware that I’m straying from objective description to judgement. I’m trying to write in ordinary language, but if I was speaking to someone I wouldn’t say, ‘Please don’t be so rude.’ It would be better to say, ‘It’s not great for me when you raise your voice, point at me, and when you say ‘I hate you’ [Observations] because I’d like us to work things out together [Need]. Please, let’s sit down and you can tell me what’s going on [Request]’.

[xiv] Bon Dobbs provides great clarity around the concepts of boundaries, limits, rules and threats: http://www.anythingtostopthepain.com

[xv] I hope you don’t need to know this, but talking about knives, I once learned that if you want someone to surrender a weapon, you’re more likely to succeed by asking them to put it down in a neutral place than to hand it over to you.

[xvi] From ‘Minnesota Mom’, posting on the Around the Dinner Table forum.

[xvii] From ‘IrishUp’, posting on the Around the Dinner Table forum.

[xviii] Beverley Mattocks, author of book ‘Please Eat’. (http://amzn.to/195YWhF), learned from her son Ben that when he used to beat his head against the wall and shout, it wasn’t so much the anorexic demon driving the behaviour , but himself trying to fight the demon.

[xix] For a helpful description of panic attacks, see http://www.nomorepanic.co.uk/articles/symptoms/ and for some tips you may use as parents see http://www.nomorepanic.co.uk/articles/coping/

[xx] Marshall Rosenberg, creator of NVC, said, ‘If we ask two questions, we will see that punishment never works. First: What do we want the other person to do? Second: What do we want the other person’s reasons to be for doing as we request?’ : http://www.nonviolentcommunication.com/freeresources/nvc_social_media_quotes.htm

[xxi] One of many quips attributed, I believe, to Marshall Rosenberg.

[xxii] Read Dan Siegel’s books to understand the importance of ‘secure attachment’ and how children develop this partly through being seen and being soothed by their parents. Dan Siegel also has a whole series of short videos on YouTube:  http://tinyurl.com/b9ken5p

[xxiii]I came across the concept of ‘interdependence’ through NVC. If you’d like to reflect more on the subject, there are some NVC telecourses you can check out.

[xxiv] Behaviourism works very well on dogs – in fact most of us have heard of its early days with Pavlov’s dogs. So you may enjoy this short video from dog trainer Kikopup, explaining how you cannot reinforce fear because fear is an emotion, not a behaviour, and therefore a frightened dog should be comforted: http://tinyurl.com/cx9q6ao

[xxv] The concept of flow and its relationship to happiness and wellbeing comes from Mihaly Csikszentmihalyi in his landmark book ‘Flow. The Psychology of Optimal Experience’ http://amzn.to/YPF1y7

[xxvi] Music Maker lap harp: http://www.lap-harp.com/musicmaker.htm. This quote is from a mother on the Around the Dinner Table forum.

[xxvii] Watch this TED talk by Brené Brown: ‘The power of vulnerability’ on shame and connection. http://www.ted.com/talks/brene_brown_on_vulnerability.html

[xxviii] For the difference between self-esteem and self-compassion, and to understand the importance of self-compassion, watch Kristin Neff’s TED lecture ‘The Space Between Self-Esteem and Self Compassion’ on http://youtu.be/IvtZBUSplr4

[xxix] For a short article on praise from an NVC perspective, see Inbal Kashtan: ‘The Sweetest Game in Town: Contributing Without Praise’ http://www.baynvc.org/articles/contributing_without_praise.php

[xxx] From a girl suffering from anorexia, commenting on my website.

[xxxi] Martin Seligman: ‘Authentic Happiness’: http://amzn.to/15xu2gf. See also his website: http://www.authentichappiness.sas.upenn.edu

[xxxii] The concept of flow and its relationship to happiness and wellbeing comes from Mihaly Csikszentmihalyi in his landmark book ‘Flow. The Psychology of Optimal Experience’ http://amzn.to/YPF1y7

[xxxiii] I first came across the concept of an emotional bank account in Steve Covey’s ‘The 7 habits of highly effective families

[xxxiv] Usually attributed to Mahatma Gandhi.

[xxxv] I’m a huge fan of the Around the Dinner Table Forum, and I’m seriously sad when a bunch of parents there advocate this form of punishment as absolutely the only way to get a child motivated to eat: it saved their child’s life, but I’d like newcomers to know there are other options that have worked for other parents.

[xxxvi] Daniel H Pink: ‘Drive. The surprising truth about what motivates us’ published by Riverhead Trade

[xxxvii] Beverley Mattocks: book ‘Please Eat’. http://amzn.to/195YWhF

[xxxviii] Alfie Kohn: ‘Unconditional Parenting’ published by Atria Books. Alfie Kohn is the person to read if you want to understand the problem with rewards, praise, punishment and “consequences”. If you work in education, do check out his other books too.

[xxxix]Hold on to your kids’ by Gordon Neufeld and Gabor Maté. This book doesn’t mention either Compassionate Communication or eating disorders, but it could be a manual for either. If you or your partner recoil at anything faintly new-agey, you’ll be safe with ‘Hold on to your kids’. Many of the terms I’ve used here are straight out of that book.

[xl] From LV’s letter to the F.E.A.S.T website

[xli] For an very complete list of pros and cons about the externalising model (i.e. seeing your child as separate from their eating disorder, and talking to your child in those terms), I highly recommend this paper: ‘Alienating patients from the ‘Anorexic Self’:  Externalizing and related strategies’ by Kelly Bemis Vitousek, University of Hawaii, Seventh International Conference on Eating Disorders, London, April 6, 2005 http://tinyurl.com/bh9fjgs

[xlii] Cathy Cassidy: ‘Summer’s Dream’. Fiction for girls age 8 or so upwards, portraying a girl’s descent into anorexia.

[xliii] You might be tempted by this simple game that creates prompts for story ideas: Rory’s Story Cubes http://www.storycubes.com/products/rorys-story-cubes/

[xliv] I’ve come across the concept of ‘apologising’ to your child in an eating disorders treatment called Emotion-Focused Family Treatment (EFFT).

 

 

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