I saw my counsellor yesterday and I had to admit what has been going on in terms of my behaviours. It wasn’t exactly fun. We discussed, as we always do, that not eating sufficiently, regularly and with freedom will always bring me back to binge/purging and that there is no way out of this without accepting that I need to expand my eating and I need to tolerate the weight gain. I still get frustrated with these conversations as if I could tolerate the weight gain I wouldn’t be in this mess, but I just can’t seem to manage it. But she’s right in that there is no other magic solution, so I either get disharged or commit to what she is offering.
What is available to me now is a 10 session structured CBT programme as part of research project. It’s based on research showing early success with a ten session version of CBT-E (typically 20 sessions). I have had variations of CBT-E now and when engaged and active with it, I did respond quite well. However, it was always my slightly adapted version in that I while I managed the structured eating of 3 meals and 2/3 snacks (that 3rd one at night is always tricky!), I never committed to extending my diet, and therefore was continuing to restrict. Had I been particularly underweight this might have been addressed, but as I was always teetering around normal no-one ever seemed to challenge it, and therefore ED kept his nasty claws in enough to keep me trapped. My current counsellor is on to this though and has clearly stated that I can choose 3 dislike foods but everything else has to be considered (only 3 – you can imagine my panic levels right now…). The research is solid, or at least as good as it gets in ED outcomes with a 42% abstinence rate from binge/purge behaviours at 3 month follow up and significant improvement in self-reported psychopathology.
I really want to be part of that 42%. I’m sceptical, but that’s perhaps to be expected given my history. But equally maybe my knowledge and skills gained over that history might help. Really, the only thing standing in the way between me and a life free of ED is me.
We had a good (sniffly sobby) discussion and I signed up. I should start in a month or so. I do 4 weeks and if I can’t make the dietary changes and abstain from purging then I am discharged at that point. Tough love, but it makes sense. No point continuing with other aspects if eating commitment doesn’t happen. I’m scared that this is my final offer, and that if it doesn’t work I shall be on my own to figure it out. But at the same time I’m aware that I have been very privileged to have had all this help so far. If I can get to 10 weeks behaviour free (including restriction) that will be the longest period in quite a while, which might just give me the boost to keep it going. I’m mostly petrified and stressed about it, still debating whether I do actually want recovery (as only perhaps other people with EDs will understand) but there is a glimmer of determination that hasn’t been around for a while so hopefully that will grow. We’ll see.