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Failing at treatment

So it turns out commitment isn’t enough in the end. I tried my best. I really did, I promise I’m not lying to myself or the world out there when I say that. I ate all the scary things and broke all my rules. I’ve done it day in and day out for the last 7 weeks. I’ve gained a little weight and didn’t freak out about it. I caught myself body checking nearly every time and talked myself out of it. I’ve kept my food diaries and attended my appointments.

But, and this is what it comes down to, I purged three weeks ago once, then again once last week, now this week twice. My therapist was flexible the first two weeks it happened because she could see how hard I was trying but if it happened this week then game over, treatment is done. Its officially not effective for me so there’s no point in me still attending. I will be discharged and that’s it. That’s the way the treatment approach works, that what makes it effective apparently. I’ve had my chances, and I have been very fortunate with all the help I have been offered, I know how lucky I am. But the reality is that the treatment available hasn’t worked for me and I have to accept that now.

I can sound rational about it but inside I’m petrified. When I first sought help my greatest fear was that I would reach out and it wouldn’t make a difference, and in some ways that fear is coming true. But in other ways that’s not actually what’s happened. My life is so much better for the treatment I have received: I am so much more open about my difficulties. My dark little world has lots of wonderful chinks of light in when I look for them. My weight is relatively stable and for the possibly the first time since I was 9 I am not trying to lose weight. I can skip a run when I don’t feel like going. I can keep most foods in my house without binging on them (still not 100% there but so much better), I can eat in restaurants or in others’ houses without purging. I can drink an iced coffee and trust the world won’t end! had an ice cream in the sun last week and didn’t cry! Miracles are happening!

I could lie tomorrow at my session and say nothing happened, that I didn’t use behaviours. Believe me I am tempted to do that, but really what would I gain from that? And I respect my therapist too much to abuse the service in that way. The reality is that the best evidence based treatment there is out there has not worked, and so continuing is just wasting resources that could be spent on someone who does respond to it. I have made so much progress, but I am still purging on a regular basis and maybe now I need to take stock of where I am, make sure I don’t slip backwards, but also accept that maybe this will be a part of my life forever. I can keep fighting to maintain the progress I’ve made, but I think I’m too tired and too beaten to keep trying and failing with getting rid of behaviours completely.

Maybe this will change in the future. Maybe I’ll be ready to try again on my own. I’m not discounting the possibility of full recovery for me, but I can accept that the conditions of the treatment available is to stop purging and I haven’t been able to do that. So I will be honest tomorrow, and I will accept the consequences of failing at treatment for now. But if stop for a moment, close my eyes and take a breath I can find peace with this. I can be okay. I will be okay.

10 thoughts on “Failing at treatment”

  1. If this treatment approach were the way I was getting treatment, I would have been done so quickly. I have had more skips and lapses than I care to admit, but I am assured my overall progress is good and my team will stay with me on this journey. I am so sad to read that is not being offered to you. I hope you can find a therapist that doesn’t work like this—even if it’s the “best evidence-based” treatment, different approaches work for different people!
    I just know how much I needed and still need my therapist (&dietician) and am hoping for you there is another way to get those resources.
    Hang in there, you’ve got this.

    Liked by 4 people

  2. Be honest, she knows you are trying. I believe in you, don’t be so hard on yourself. You need a therapist who will work with you though the good times and bad times. You can recover, never give up hope.

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  3. I always feel compelled to comment on your blog because I genuinely identify with your journey. Again, as already commented, it might well be the best evidence based programme but it still doesn’t mean that all other approaches will not be successful. Also it doesn’t detract from your progress either because clearly you’ve made lots from what you’ve documented so far.
    Time in reflection, it is definitely worth finding another therapist who will work with your journey and recovery no matter a few blips. Blips are part of it, I do not know of anyone in recovery who has just marched through it on a linear none-blipping way. It’s hard for us people with Ed’s, we cannot just give up like any other person who struggle with a misuse of a substance. And an Ed is definitely misusing food with its complicated associated behaviours to control feelings, emotions and life.
    I still don’t think this is the last port of call unless of course, you feel it is.
    A mentor and ex-therapist who is still a massive source of guidance always says “make it the best it can be in any situation.” I live by this and it gives me acceptance in the moment on each day.
    I’m in a quasi state as you know but at this time, it’s okay, I do the best I can within this because full recovery for me is something I’m not ready or wanting due to a whole host of reasons. My biggest reason is unfortunately, it still serves a purpose in my life to cope because I don’t have a whole lot of other things that make my day genuinely satisfying. But I accept it, and I can live with it. I get days where I would like it differently but then I just remember it’s better than it was and if I choose full recovery, it’s available to me should I want the next step.
    I dunno, it’s such a complicated life, i often think if I knew the exact reason why it happened, I might recover fully. But now I’m at an age where I don’t even think I’m ever going to be in possession of those facts as memories get rewritten and life experience has become blurred with the passage of time. I just know I’ve only had a fraction of my life without it, so as much as I hate to say it, it feels like part of who I am now as much as my personality. And that’s really tragic xx

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  4. I’ve got no nice frilly words to make you feel better, but do know this: you’re not alone. I read this and felt every word impact me like tsunamis of sheer frustration. And grief…

    Frustration: that the system does not yet recognise that folk with eating disorders are not one homogeneous blob and that one size does not fit all. That it still seems like a good idea to discharge those that are struggling from specialist services as if they just need to get their act together before they try again. As if anorexia isn’t the biggest killer of all psychiatric illnesses. As if allowing someone to get more unwell is some kind of treatment intervention. This is beyond bonkers. On what planet does this make sense? On what planet does this not just embed a feeling of shame and of failure and of being “just not good enough”?

    Grief: Because those feelings of shame; the heavy burden of feeling I’ve failed – not only myself but all those who love and care about me – sit in my stomach like a lead weight despite being able to rationalise why I feel this way and how the system is bonkers. But I know it’s not enough to just know. If knowledge was all it took I’d be cured by now. Instead I try (unsuccessfully) to not grieve the lost years; the potential that was; the relationships lost. I try to look to the future – like you do, but I feel your uncertainty; fear; disappointment.
    One thing someone once said to me is that nobody ever fails treatment it is the treatment that fails them. I’d say this is a case of this theory in action:
    You have not failed. Honestly my dear, you are turning up and willing to work at finding a way through this crap-fest of an illness and there is no perfect way through! Any treatment that does not factor in slips, lapses and relapses is really not fit for purpose. The problem we have is that the evidence base for effective treatments for adults with eating disorders is still in it’s infancy and so we’re stuck with the essentially incomplete NICE guidelines.

    The NICE guidelines state:
    If individual CBT-ED, MANTRA, or SSCM is unacceptable, contraindicated or ineffective for adults with anorexia nervosa, consider:
    one of these 3 treatments that the person has not had before or

    eating-disorder-focused focal psychodynamic therapy (FPT)

    Personally I don’t think the NICE guidelines go into enough (any) detail re. chronic eating disorders (/Severe Enduring Eating Disorders – SE-ED). It has been noted that there has not been enough research done in this area. Therefore there is little to no evidence on which to base a specific treatment pathway for those with SE-ED. This is a failure of the system to get a grip on the realities of those with SE-ED; a failure to effectively fund research so that we will be able see evidence-based treatment for chronic eating disorders in our lifetimes.

    I wonder if the article below might be of interest to you and perhaps help to put into perspective the battle you have faced in comparison to someone who has not lived with an eating disorder for many years. I strongly believe that there should be a different treatment pathway for those with a chronic form of ED. That’s not to diminish the need for those with a shorter form of illness – early intervention is key, we know this to be true. But perhaps an acceptance that it’s just common sense that if a person’s been ill for many years then short interventions that focus on symptom abatement are not going to cut the mustard, so to speak.

    “It is clear that a 14 year old adolescent with a 3 month history of anorexia nervosa would present differently to a 40 year old woman who has battled the illness for 25 years with multiple hospital admissions and has attempted cognitive behaviour therapy several times.” (Touyz & Hay 2015)

    Severe and enduring anorexia nervosa (SE-AN): in search of a new paradigm:

    https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-015-0065-z (not sure how to embed a link so you’ll have to copy/paste to browser – sorry!)

    I also think that folk really don’t understand how very powerful the purging (and bingeing) part of anorexia can be. Frankly I think many see anorexia and bulimia as two distinct & separate illnesses. This is generally how the illnesses are depicted in soaps and even documentaries, I guess it keeps it simple. Life however is not simple (don’t we know).

    In my own experience and that of living with folk whilst IP – and in fact just being on social media – there is much crossover and, of course, there is anorexia binge/purge sub-type (my label – gotta love a label). If I’m honest then I think that it’s the b/p part of anorexia that makes it all the harder to make recovery progress. The b/p Trapdoor. So if someone is going to discharge you from specialist services for finding it difficult to deal with the most difficult symptom then I find that….Geeez!! I’m tempted to say it’s negligent but I know the way the system works and have had to fight for continued support myself (and may well have to fight again). It makes me so mad because people are suffering with their illnesses and suffering further thanks to the very system that is supposed to be helping them. Grr. Rant. Rave.
    Sorry for the rant, but your fight, worries, fears, shame, disappointment, tiredness…All of it. It’s all a reflection of my own life; and that of God knows how many more. And it shouldn’t be. It’s research that’s required. It’s creativity; thoughtfulness; pragmatism.
    Folk shouldn’t be left feeling they have failed treatment when in reality it is the treatment that is failing them!
    You haven’t failed. The system is failing you. You’re right to hold onto hope. Hold on tight.

    Liked by 3 people

  10. Hey 🙂 I know you wrote this post a long time ago, I’ve sort of had a big break from writing too, but I really hope you’re doing well. Just reading this, I really don’t think you’ve “failed”. Agreeing with a therapist to not purge feels very stressful and a lot of pressure to cope with. You’re not a failure and I know that recovery is 100% possible for you. Really hope you’re well. Len (used to be umbrella adventures) X

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