Detailed table of contents

My book has, of course, a table of contents, but someone asked me for a more detailed one, to help them find sections they previously read. So here goes. Page numbers refer to the Janurary 2020 version (other versions will be reasonably similar).

I haven't taken the hours required to format the levels of heading/sub-headings in the following table. I suggest you do a search (Ctrl-F) to help you find a bit you are looking for.

For the shorter table of contents, with links to pages on this website, click HERE.

Contents

Chapter 1: How this book can help you……………. 1

The practical and emotional tools parents are asking for…………………………… 1

What you will get from this book…… 2

Is this book for you?………………………. 3

Don’t just read this – get clinical support………………………………………………… 4

How to use this book…………………….. 5

Take the best and leave the rest… 5

Jump to the chapters you need most right now…………………………………. 5

Videos and other resources that complement this book……………………… 6

With a little help from my friends…… 6

Our story in less than two minutes…. 6

Chapter 2: How does an eating disorder affect you and your child?…………………………………… 8

What it’s like for parents……………….. 8

What’s going on in your child’s mind?………………………………………………………….. 10

What it’s like on the way to recovery………………………………………………………….. 14

How the body interacts with thoughts and behaviours…………………………………… 15

Fight, flight, freeze………………….. 15

Rewiring the brain…………………… 16

Malnourishment messes up the brain……………………………………………… 17

Additional effects of malnourishment for those with an eating disorder……………………………….. 17

Chapter 3: Your part in diagnosis…………………… 20

Eating disorder or ‘just’ disordered eating?………………………………………………. 20

Getting a referral for diagnosis and treatment………………………………………….. 21

What are the main eating disorders?………………………………………………………….. 22

‘Not thin enough’?………………………. 24

Anorexia, bulimia, binge eating: artificial distinctions…………………………… 25

An unlikely worst-case scenario……. 25

What to tell the doctor to get help fast……………………………………………………. 26

What you don’t want your child to hear from a doctor……………………………… 27

While you’re waiting for a diagnosis………………………………………………………….. 28

Chapter 4: Treatment: the essentials……………… 29

The road ahead…………………………… 29

Food for weight restoration and stability………………………………………….. 30

Train the brain: practice ‘normal’ 31

Unconditional love………………….. 31

Medication…………………………….. 31

When does psychotherapy have a role?………………………………………………. 32

Disorders that ride on an eating disorder’s coat tails………………………… 32

Family therapy for eating disorders 33

How long before my child is well again?……………………………………………….. 33

Chapter 5: What parents need to know about the causes of eating disorders…………………… 36

Your child didn’t choose to have an eating disorder……………………………….. 38

When people in recovery blame their parents………………………………….. 38

Parents with an eating disorder.. 38

Why? Why us? How to let go…… 39

The Serenity Prayer…………………. 39

Chapter 6: Practical steps to help your child beat the eating disorder…………………………….. 40

Food and love……………………………… 41

The two main elements of treatment………………………………………. 41

Force-feeding? Of course not…… 41

Give your child containment and ammunition against the eating-disorder voice………………………………………………….. 42

Hear how your child speaks in code 43

Remove choices: Magic Plate………. 45

‘You’re making me fat!’……………….. 46

Meal plans: should your child determine the menu?…………………………. 46

Do parents benefit from a meal plan?………………………………………………………….. 48

What if my child doesn’t eat?………. 48

Don’t expect perfection…………… 48

Plan B: when Plan A fails…………. 49

How long should we persist with a meal?………………………………………………… 51

You sit at the dinner table till everything is eaten…………………………. 51

Set a time limit……………………….. 53

Call a halt and move on…………… 54

Tracking your child’s state of mind……………………………………………………… 55

Which approach is best?…………. 56

Be kind to yourself………………….. 56

How much food? Which foods?……. 57

Go fast……………………………………. 57

How frequently should your child eat?……………………………………………….. 58

Calories or portion sizes………….. 58

Should parents weigh food and count calories?……………………………….. 59

‘My tummy hurts’…………………… 60

Your child’s food preferences…… 61

Yummy foods and eating ‘too much’…………………………………………….. 61

Eating differently from the rest of the family………………………………………. 62

Colds, stomach bugs and diarrhea……………………………………………………… 63

Target body weight……………………… 63

Individualised, or ‘one-size-fits-all’?……………………………………………………… 64

How to use a growth chart to predict an individualised weight target……………………………………………………… 64

Physical state………………………….. 65

Periods…………………………………… 65

Mental state…………………………… 65

The extinction burst – the eating disorder’s final fight……………………….. 66

Should your child be told a target weight?………………………………………….. 66

Fluctuations……………………………. 67

A chubby-looking stage……………. 67

Was your child previously classed as overweight?……………………………….. 68

Weight target discussions between clinicians and parents……………………… 68

Weighing your child: open or blind? 69

The practicalities of weighing…… 72

Hiding food and lying………………….. 72

Eating rituals………………………………. 73

Exercising, moving and standing….. 73

School………………………………………… 75

Bedtime……………………………………… 76

Purging and bathroom visits………… 77

Bingeing……………………………………… 78

Post-meal anxiety……………………….. 81

Running away…………………………….. 81

Self-harming and suicidality…………. 82

Being cold…………………………………… 83

Compulsive behaviours……………….. 83

Body-checking and fat talk…………… 84

Clothes……………………………………….. 85

Protection from the internet………… 86

Baking, recipes and images of food 87

Protect your child from triggers……. 87

Your self-care………………………………. 87

Planning how you will take charge.. 88

A checklist to help you prepare.. 88

Juggling work and other commitments…………………………………. 88

How to be nimble, make U-turns and still be a rock……………………………. 89

How to tell your child that you’re taking charge…………………………………. 89

Conclusion: parents take charge…… 92

Chapter 7: How do you get your child to eat in spite of the eating disorder?………………… 93

The great bungee-jump thought experiment…………………………………………. 93

Your child’s resistance is driven by fear……………………………………………….. 93

Ready for the bungee jump?……. 94

Planning the challenge………………… 95

Logic doesn’t work………………………. 95

Education: the dinner table is not a lecture hall…………………………………………. 96

Eating prompts work best……………. 96

Conversation topics: pick with care. 97

Distraction: a firm favourite…………. 97

Reassurance: suprisingly not reassuring………………………………………….. 98

* Pause for self-connection *……….. 99

Trust me, I’m an expert………………… 99

Shock tactics: short-lived gains, high costs………………………………………………… 100

Death and destruction…………… 101

Shouting, intimidating, blaming: counterproductive…………………………….. 101

Threats, punishment, and ‘consequences’: unnecessary…………….. 102

Consequences: a euphemism for ‘punishment’?……………………………… 103

Revenge……………………………….. 104

Bash the eating-disorder demon, not your child……………………………….. 104

A blunt instrument………………… 104

Rewards and bribes: handle with care……………………………………………………….. 104

Incentives: a nudge in the right direction…………………………………………… 105

Visualisation: access to inner resources…………………………………………. 106

Praise: complex and risky…………… 106

‘It’s your medicine’: worth a go….. 108

Damage limitation: blame something other than your kid…………………………… 109

Teamwork: have a break, make a graceful exit……………………………………… 109

Containment: stay close…………….. 111

Humour: the best relaxant…………. 111

Feelings: a good start………………… 112

Empathy: powerful when focused on the task……………………………………………. 112

* Pause for self-connection *……… 115

Selective hearing, body-swerving and translation skills……………………………….. 116

Mirroring: model calm confidence 116

Defusing fear: remove the fear of fear……………………………………………………….. 117

Notice indicators of progress……… 118

Wait a few minutes……………………. 119

How long should you persist?…….. 119

Focus on the current step in the present moment……………………………….. 120

Let your kid save face and maintain some dignity…………………………………….. 121

All singing from the same hymn sheet……………………………………………………….. 122

Giving uncritical acceptance………. 123

Putting it all together………………… 124

Chapter 8: See the tools in action: mealtime scenarios………………………………………… 126

What to say, and what not to say when you are supporting your child to eat……………………………………………………….. 126

Setting the scene………………….. 127

I’m not hungry………………………. 128

Quantities and ingredients…….. 128

Calories………………………………… 129

Calculations………………………….. 129

The hospital/Mum/Dad don’t do it like you………………………………………… 130

You’ve changed my meals……… 130

Hiding food…………………………… 131

My weight…………………………….. 131

Got to go………………………………. 132

Hygiene………………………………… 132

Self-hate……………………………….. 132

Lashing out…………………………… 132

Emotions that distract from the task……………………………………………… 133

Suffering and despair…………….. 133

Be a fly on the wall: a lunchtime scenario…………………………………………… 134

Principles……………………………… 134

The set-up…………………………….. 135

Preparation…………………………… 135

During meal preparation……….. 135

Getting her to the table: first attempt……………………………………….. 136

Getting her to the table: empathy……………………………………………………. 136

Getting her to the table: escape……………………………………………………. 137

* Pause for self-connection *…. 137

Onwards……………………………….. 138

‘I hate my life!’……………………… 139

Howling in the bedroom………… 139

Calling it a day … for this meal.. 140

Failure?………………………………… 141

Sitting at the table………………… 142

‘I’m not eating this!’………………. 142

Flying food……………………………. 143

‘Do I have to eat this?’…………… 144

Eating successfully………………… 145

Butter, hygiene, and ‘you gave me more’…………………………………………… 145

Feeling too full………………………. 146

The last crumbs…………………….. 147

A gift…………………………………….. 148

Sticking by her………………………. 148

Finishing……………………………….. 149

After the meal………………………. 150

Debrief…………………………………. 151

How typical was that?…………… 151

Chapter 9: How to free your child of fears and rules: exposure therapy…………………….. 153

Desensitising to fear foods…………. 153

When to introduce fear foods…….. 153

The magic of desensitisation……… 154

Plan or surprise?……………………….. 155

Rip or tug the Band-Aid?……………. 156

Respond flexibly to present needs. 157

Can challenges be too stressful for your kid?………………………………………….. 158

Virtuous circles and lasting improvements………………………………….. 159

Example: working systematically through a list of fear foods………………… 159

Example: from packaged food at home to the ability to order anything in a restaurant………………………………………… 160

When can exhausted parents take a break?……………………………………………… 161

Exposure therapy for other anxieties or phobias………………………………………… 162

How to make exposure work for you……………………………………………………….. 163

Positive experiences have more impact…………………………………………. 163

Plan for one variable at a time.. 163

Repeat in a variety of situations 164

Transformed through exposure: from fear to fun……………………………. 164

Be a fly on the wall: a desensitisation session…………………………………………….. 164

The set-up…………………………….. 165

In the kitchen……………………….. 166

Next step: the milk………………… 167

Anxiety on the rise………………… 167

Spilling milk, then the banana challenge……………………………………… 169

Tears…………………………………….. 169

The finale……………………………… 170

Debrief…………………………………. 170

Reinforcement………………………. 171

The end………………………………… 171

Chapter 10: The work towards full recovery……. 172

Steps to independence and total recovery…………………………………………… 172

You’re in charge of your child’s independence………………………………. 173

Practice ‘normal’…………………… 174

Too soon or too fast………………. 174

What to do about school?………….. 175

Is school a mood-booster for your child?…………………………………………… 175

Back in the lion’s den?…………… 176

School as carrot and stick?…….. 176

Academic support…………………. 176

Meals during school hours…….. 177

‘Health promotion’ in schools: why, oh why?……………………………………….. 177

Risk-reduction programs in schools……………………………………………………. 178

Getting school staff on board…. 179

How both schools helped us….. 179

Re-introducing exercise……………… 180

Activities…………………………………… 183

Eating out…………………………………. 183

Holidays and school trips: risky or beneficial?……………………………………….. 185

Rule-based or intuitive eating?…… 187

What if your child eats ‘too much’?……………………………………………………. 189

When to ditch the scales?………….. 190

Addressing depression, OCD and other anxiety disorders……………………… 191

Trauma and re-engaging with life to the full……………………………………………… 191

Normal teenage behaviour or eating disorder?………………………………………….. 192

The balance of autonomy and containment…………………………………….. 193

Caution versus your child’s self-confidence……………………………………….. 194

Fixing your child’s mindset…………. 195

Towards a relaxed body image…… 196

Letting time do the healing………… 197

Dealing with relapse………………….. 199

Events that rock the boat…………… 201

Relapse prevention, plans and contracts………………………………………….. 202

Prepare your child for independence……………………………………………………….. 203

Safeguards as your child leaves the nest…………………………………………………. 203

Is your child ready to leave home?……………………………………………………. 203

Safeguards if your child is not yet recovered…………………………………….. 204

Safeguards if your child is well.. 204

Is there such a thing as total recovery?…………………………………………. 205

What’s the future like for the parents?……………………………………………………….. 206

Chapter 11: Partners, friends, family and work: help or hindrance?………………………………….. 208

The logistics: how can you care for your child and attend to your other commitments?…………………………………. 208

Single parents…………………………… 210

Your spouse or partner………………. 210

Teamwork is precious……………. 210

Who’s the weakest link?………… 211

Couples under pressure…………. 213

Compassionate communication within a couple…………………………….. 214

Help for partners in conflict…… 215

Siblings…………………………………….. 215

Prevention for your other children 217

Family and friends: how to make good use of them………………………………………. 219

We need others…………………….. 219

Who to tell about the eating disorder?……………………………………… 221

How much should your child’s friends know?………………………………. 222

Links with other parents in the same boat…………………………………………………. 223

Keeping your partner in the loop……………………………………………………. 223

Work and money………………………. 224

Chapter 12: Which treatments work?…………….. 226

The parent’s quest for good treatment………………………………………… 226

Eating disorder treatments that are likely to cause harm………………………….. 227

The sad legacy of psychoanalysis……………………………………………………. 227

The tragedy of waiting for motivation……………………………………. 228

The best evidence-based treatment……………………………………………………….. 229

Lip service and well-meaning ignorance…………………………………………. 230

Principles validated by research…. 231

Family therapies: they’re not all the same……………………………………………….. 231

Family therapy at the Maudsley Hospital……………………………………….. 231

The origins of Family-Based Treatment (FBT)……………………………. 232

The New Maudsley Method: not the same as the Maudsley Approach 232

Family therapy that is not designed for eating disorders………………………. 233

Systemic family therapy versus FBT……………………………………………………. 233

Family therapy: the first line of treatment for children and teens with anorexia and bulimia………………………… 234

How effective is Family-Based Treatment (FBT)?………………………….. 234

It doesn’t work for everyone….. 235

Family therapy for anorexia in young children……………………………… 235

FBT-TAY for anorexia in young adults…………………………………………… 235

FBT for bulimia……………………… 235

FBT in those ill for over three years: no evidence…………………………………. 235

What happens in family therapy?……………………………………………………. 236

FBT therapists: who they are and how to find them………………………….. 236

Should your child like the family therapist?…………………………………….. 237

Is it OK to tweak the method?.. 237

Individual therapies…………………… 238

Cognitive behavioural therapy (CBT) adapted for eating disorders… 238

Adolescent focused individual therapy (AFT)……………………………….. 239

More individual therapies for adults…………………………………………… 239

Psychotherapy as an adjunct to family therapy………………………………. 239

Therapists don’t have your parent-power………………………………………….. 241

Why would your child engage with therapy?………………………………………. 241

How to identify effective treatment providers………………………………………….. 241

The no-brainers…………………….. 242

A checklist to assess a treatment provider……………………………………….. 242

Therapists who previously had an eating disorder…………………………….. 245

Clinicians rich in human qualities……………………………………………………. 246

Disagreements with clinicians……. 246

Dropping unhelpful treatment……. 247

No good treatment locally?……….. 248

Family treatment the DIY way……. 248

Parent-coaching, home support and day treatment………………………………….. 248

Hospitalisation and inpatient treatment………………………………………… 250

Eating disorders inpatient units 250

Medical (paediatric) wards…….. 251

Tips: when your child is in an inpatient unit……………………………….. 251

Hospital emergency units………. 256

Parents and clinicians in partnership……………………………………………………….. 256

Tell your clinicians about this book……………………………………………………. 257

Plan ahead to make sessions fruitful…………………………………………. 257

More family therapy without children, please……………………………. 258

Parents want advice………………. 258

Parents with eating disorders… 260

Empowering parents…………….. 260

Your clinical team: is everyone on the same page?……………………………. 261

When you’re excluded from your child’s therapy………………………………….. 262

Confidentiality………………………. 264

Children above legal-age thresholds……………………………………. 265

Therapy, coaching and emotional support for parents…………………………… 266

Therapists who will help you flourish………………………………………… 267

My own hunt for support………. 267

How to choose the right person for you………………………………………………. 268

Chapter 13: Powerful tools for wellbeing and compassionate connection………………… 270

‘I’m sorry, and I love you’…………… 271

Silent empathy………………………….. 272

Connect before you correct………… 273

Keep tracking……………………………. 274

Keep checking: use question marks……………………………………………………….. 276

Keep your ‘but’ out of it…………….. 276

Open question or empathy guess? 277

More tools to help you connect….. 278

Kindness…………………………………… 279

Be interested: ‘Yes!’ and repeat….. 279

Guess deeper: feelings and needs. 280

Be interested: feelings……………….. 280

Feelings are not dangerous and they pass……………………………………… 281

Feelings are nobody’s fault……. 282

Be interested: what are the deep needs?……………………………………………… 282

Needs to look out for…………….. 283

How to enquire about someone’s needs…………………………………………… 284

Be interested: make use of the chatterbox……………………………………….. 285

Validate feelings and needs……….. 286

Signs that your child ‘feels felt’. 287

You can’t do it wrong if you are genuinely interested…………………….. 288

And now at last, ‘Correct’!…………. 288

Soothing……………………………….. 288

Educating……………………………… 289

Action…………………………………… 289

Make skillful requests……………. 289

How to express yourself effectively……………………………………………………….. 290

Don’t air your chatterbox thoughts. Stick to facts…………………………………. 291

Can you express your feelings?. 291

Your child is not your therapist. 293

Advice-giving: check first (in triplicate)!……………………………………. 293

Self-compassion………………………… 294

What for?……………………………… 294

Pause and notice…………………… 296

Kindness……………………………….. 296

Allow……………………………………. 297

Our common humanity…………. 297

Nurture………………………………… 298

Get compassion from others too… 299

When to do self-compassion………. 299

What if the feelings are overwhelming?………………………………… 300

Examples of self-compassion……… 300

In the heat of the kitchen………. 300

Recharge and continue………….. 301

Nurturing the good stuff……….. 301

Wrap-up…………………………………… 301

Chapter 14: Love, no matter what: how to support your child with compassionate communication……………………………….. 303

Food is medicine, and love is life… 303

Unconditional love and acceptance……………………………………………………….. 304

‘Love her even when she’s down’……………………………………………………. 304

What is unconditional love and acceptance?…………………………………. 304

Uncritical acceptance: therapeutically essential……………….. 305

Love? I’m too mad at her to feel love……………………………………………… 305

Love as a value and love as a feeling………………………………………….. 306

Coping with your emotional depletion……………………………………… 306

Teamwork helps us criticise less 306

Judgemental thoughts: my story… 307

Wanting her to have motivation……………………………………………………. 308

Letting go of judgements, accepting my child as she is…………… 308

She loves you, even when she loves you not…………………………………………….. 309

Why does your child ‘hate’ you?……………………………………………………. 310

Your child really needs love……. 312

Showing up even when you’re rejected……………………………………….. 312

Does your child reject your touch?……………………………………………………. 313

Where’s their emotional intelligence gone?………………………… 313

What to do with your child’s anger……………………………………………………….. 314

Is your child’s anger better out than in?…………………………………………………… 315

Is your own anger better out than in?……………………………………………………….. 316

It’s not about you (even when she’s mad at you)……………………………………… 316

Punishment, sanctions, consequences and ultimatums………………………………… 317

‘Take that, eating disorder!’…… 319

Rewards and incentives can backfire……………………………………………………….. 319

If you still want to use rewards………………………………………………………. 320

Incentives…………………………….. 320

How to be effective……………………. 321

You don’t have to walk on eggshells……………………………………… 321

Teenage rudeness or eating disorder?……………………………………… 321

Containment: you are neither doormat nor bully………………………… 322

Requests………………………………. 323

How boundaries and limit-setting work……………………………………………. 324

When you don’t like a behaviour – your choices…………………………………. 325

The art of the ‘difficult conversation’……………………………….. 327

Example: cutting off the Wi-Fi.. 328

Dealing with aggression…………….. 330

Immediate response to violence: protection and self-connection……… 330

De-escalating violence…………… 331

Give yourself a break…………….. 332

Welcome the tears after the fireworks……………………………………… 332

‘Am I fat?’ How to respond………… 333

Your child is genuinely suffering 333

An opportunity to change your child’s mindset……………………………… 333

‘It’s not useful to talk about it’.. 334

Our aim is health and happiness……………………………………………………. 335

‘Can’t you see? You’re underweight!’………………………………. 335

Empathy and validation…………. 336

Common needs behind the ‘Am I fat?’ question……………………………….. 336

A Band-Aid: ‘You’re not fat’……. 338

‘But YOU are fat!’ Model unconditional positive regard for your body……………………………………………. 339

Hysterics, panic attacks and extreme anguish……………………………………………. 340

Trapped in their nightmare……. 342

Comfort and reassurance: what works and what doesn’t……………………………… 343

Soothing……………………………….. 343

Interdependence: it’s OK to need others………………………………………….. 344

Jumping to the rescue…………… 345

Reinforcing what?…………………. 346

Clingy, or needing comfort?…… 346

Self-soothing: tools for your child……………………………………………………. 347

Helping your child feel good in herself……………………………………………………….. 347

Model self-compassion………….. 348

Praise can backfire………………… 348

Positive affirmations: a hard sell……………………………………………………. 349

Gratitude and celebration……… 349

Show you care for what he cares about…………………………………………… 350

Hold a mirror up to your child’s resources……………………………………… 351

Should we fight perfectionism? 352

‘I’ve noticed’: the power of having a witness……………………………………… 353

Top up the emotional bank account with love……………………………………… 354

Sick, mad, bad? What model are you using?……………………………………………… 354

The externalising model: separating your child from the eating disorder……………………………………….. 355

Be kind to the eating-disorder part……………………………………………………. 357

Teen books about eating disorders: take care………………………………………….. 358

Inspiration from someone who’s recovered…………………………………………. 359

Educating and motivating your child……………………………………………………….. 359

Heart-to-heart talks…………………… 360

Activities and time together………. 360

Modelling: do as I do…………………. 361

Parent and child: our common humanity…………………………………………. 362

Mending, apologising, and regrets 362

‘I’m sorry’: the blame game…… 363

The ingredients of mending…… 364

Help your child to mend the relationship………………………………….. 366

Chapter 15: How to build up your own resilience and wellbeing………………………………….. 368

New ways to deal with adversity… 369

Acceptance: work with reality, not against it………………………………………….. 370

Example: furious about your child’s treatment…………………………………….. 371

Letting go of resistance………….. 372

Acceptance leads to creative solutions………………………………………. 372

Letting go of a single strategy… 373

Example: acceptance and letting go at mealtimes………………………………… 374

Trust that you have resources…….. 375

We readjust and grow…………… 377

The fear of losing one’s mind…. 377

The body drives the mind: relaxed and alert…………………………………………………. 378

Imagery to help you get grounded and peaceful…………………………………….. 379

Mindfulness………………………………. 380

Good-enough Zen……………………… 381

Coping in the moment……………….. 382

Being in the moment…………………. 382

Turn thoughts around: ‘is it true?’. 383

What to do with fear…………………. 383

Trauma and overwhelming fear 385

Post-traumatic stress or post-traumatic growth?……………………………. 385

Mistakes, blame and self-acceptance……………………………………………………….. 387

Regrets: a powerful alternative to shame or guilt………………………………. 387

Regret your behaviour, love yourself……………………………………….. 388

Your brain reacts to threat – live with it………………………………………….. 389

Mistakes can turn out fine…….. 389

Do you compare yourself to others or do you use their help?………………. 390

When others judge or blame us 390

Refuel: attend to life-giving needs. 391

Yes, we can stretch………………… 391

Is it selfish to attend to your needs?…………………………………………. 391

Maintain the power to your child’s life-support machine…………………….. 392

Food, exercise and sleep……….. 392

Helper’s high………………………… 393

What will feed your soul?………. 393

Sadness, mourning and … joy…….. 394

Writing a diary: self-help or rumination?……………………………………… 395

An attitude of gratitude…………….. 396

Joy……………………………………………. 397

Thank you………………………………… 400

Resources………………………………… 401

Endnotes………………………………… 402