Monte Nido Vice President of Clinical Programming Keesha Amezcua, MA, LMFT, CEDS shares about The 8 Keys to Recovery from an Eating Disorder,by Gwen Grabb, LMFT and Monte Nido Founder Carolyn Costin, the philosophy that guides Monte Nido’s practice in supporting clients to becoming fully recovered in this weeks blog post. In her writing, she explains the first key, Motivation, Patience & Hope, for part one of this eight part series.
When talking about the 8 Keys to Recovery from an Eating Disorder, the first thing to note is that there are obviously more than just 8 steps in the process. The publisher’s directive to Monte Nido Founder Carolyn Costin was to create 8, and only 8, keys. So in her trademark creative way she packed as much in to each key as possible. The entire book is full of insight, wisdom and evidence-based treatment strategies. I call it Monte Nido in a book because each page speaks to what we do each day with our clients in treatment.
The first key – Motivation, Patience & Hope – is the starting point, even before a client steps foot in one of our facilities. We applaud clients and their loved ones for pursuing treatment in the first place. Just the idea of it can be daunting. It takes motivation to pick up the phone and make the call. Of course, it’s often not the client’s idea. They have been softly, or not so softly, nudged in to that idea. There is often an external motivating factor – school, a relationship, a job – that makes the idea seem like a good one.
Although, for recovery to truly take root the client has to find his or her own internal motivation for it. But if we waited to treat clients until they are truly motivated, we would sometimes be waiting forever. Treating eating disorders is often very similar to raising a toddler. With a 2.5 year old and a 1 year old at home, I find so many similarities and parallels between my personal and professional life. Take for example, tooth brushing. My daughter loves her toothbrush, and my daughter LOVES her toothpaste. At this point her fine motor skills are not quite developed enough to allow her to adequately clean her teeth, which results in a steady diet of toothpaste with very little actual brushing happening. So I am tasked with tenderly helping her, guiding her, teaching her. She does not necessarily love this part of the experience. Is she motivated for teeth brushing? Yes. Is she always willing to do what is necessary for it? No. It’s the same with clients at the beginning of treatment. They might be motivated for parts of it. They might be able to see the benefits and enjoy the relief that recovery provides in some areas. But they don’t always want to do all the parts of it. As clinicians, we have to be willing to step in to this discomfort with them. To model the healthy behaviors, to support them in doing what is needed even when it’s hard. To tolerate the kicking and screaming or silent refusals. To embrace the ambivalence and work with it. We have to gently elicit the behavior change. The research on motivational interviewing is pretty clear. Trying to directly persuade a client to change won’t necessarily resolve ambivalence. I can persuade my daughter to let me brush her teeth, but this will be a temporary fix, not a solution.
Motivation builds on itself. It’s like a freight train that starts slowly, building steam. Once it gets going, it’s a force to be reckoned with. But there has to be patience to allow the motivation momentum to grow. One of the core interventions we use is the eating disorder/healthy self dialogue. This intervention is the heart of motivational interviewing – synonymous with change talk. As clinicians, we are constantly looking for signs that of our client’s healthy self is present. Any time a client says something that is indicative of his/her core, authentic self we recognize this as a motivation for change, no matter how small. We hold on to these examples and help to foster more because motivation is also built on change.
Our weekly contracts help clients identify objective and measurable goals that are small and achievable. When a client meets these goals, there is a feeling of success and mastery, which then ignites more motivation. It takes creativity, great empathy and compassion for how difficult even the smallest of steps can be for a client. It also requires a balance of firmness and fearless on the part of the therapist
Confronting a client about change often seems like the right step. If we know that deep down they want to get better, then forcing their hand will just help them get there faster, right? Well, actually that’s wrong. And if a clinician falls in to that trap, we can quickly find ourselves in the midst of a powerful power struggle just as a client’s loved one often does. When we push clients to make changes before they are ready, we are missing the motivation part. At Monte Nido, we gently and steadfastly meet clients where they are at. And we start there.
But we always have hope. For me, that’s the easy part. As someone who has recovered from my own eating disorder, I know being recovered is possible. I don’t question this. It’s not an elusive idea. And I don’t just have my own positive outcome guiding this. I have seen and met many, many people on the other side. There is an army of us who know recovery to be true. This is how I am able to do this work. As motivational interviewing suggests, at Monte Nido we have respect for a client’s ability to choose. We reflect the privileges that recovery offers and the consequences of the eating disorder. On the hardest days, with the most resistant or ambivalent clients, I maintain hope that recovery is possible and that every client will choose it. Ideally today is the day. If not, I am confident that there will be tomorrow, which means there is always another chance for that choice.