Expert: Joanna Lhulier, Psy.D. - 5/5/2008

Question
Hi! I am writing to get your opinion on being in treatment for anorexia.

I'll try to give you a history, although it's long & I'm not sure I can do it justice. I've been struggling with anorexia for 20 years (I'm 32 now) I was hospitalized many times from ages 20-25, complete with medications, tube feeing, ECT, a heart attack at age 24 & a court ordered hospital stay. A nightmare really. I received residential treatment a few years back which really helped me get a grip on things. I did well for almost 2 years - I found freedom I did not think was possible. Somehow, In the past 2 years I've let it slip back into my life. I was in counseling & seeing a nutritionist regularly but I've felt like my heart isn't into.  I chose to discontinue counseling last month because I know all to well that if I am not motivated to progress, no one else can do it for me. I am not in denial about having eating issues but I definately don't see it as serious as everyone around me. The way I see it is that I'm not where I need to be but at least I'm not where I used to be. I'm content with "sitting on the fence" so to speak because I'm afraid that challenging myself will push me over my limit. I feel fragile in terms of staying off the slippery slope. I had a hugely difficult time gaining weight in residential treatment & it took me a full year. The thought of having to go through the weight gaining process again while maintaining my "life"(ie work)seems out of reach. I'm 5'5" & about 97 pounds.

So, I guess my question is - What are you thoughts on putting counseling "on hold" until you know that you are in a place that you will benefit from it? I'm not looking to keep losing weight - I just get so frustrated & feel guilty for wasting my counselor/nutritionist's time (not to mention my money) when I know full well my motivation is not there & gaining weight is not something I am ready to commit to.

Any insight would be appreciated!

Answer
Hi Alexis-
You are in a difficult spot.  I understand that you have fought long and hard and are tired. And you feel that you have earned a break, and you have, but not from counseling or treatment.  I do not agree that you are sitting on the fence.  To me, it sounds like you have inched your way over hoping that people will not notice.  Feeling overwhelmingly frustrated and guilty about wasting time and money in therapy usually means that something is going on in your heart and you need to study it with your therapist/counselor. To some, it may seem that your problem is about gaining weight, but we both know that it is more than that.  I would imagine that your problem has a lot to do with the fact that you do not feel you are worth the fight, or you think others have given up, or something along those lines.  It is ok that you are not willing to commit to gaining weight, your goal in therapy should be about figuring out why you are not invested.  You can ask yourself "what is going on that makes me feel like I am hitting a brick wall?"  Your focus does not need to be entirely on your weight. But don't get me wrong, it needs to be monitored.
Please consider returning to treatment, Alexis.
Dr. Lhulier