Today is L’s review and her Biology exam. The exam goes well, thanks to her hours of revision. She is dreading the review. She knows it will be challenging, that I will be really straight with her and tell the team that she seems totally stuck. Her weight is down again – her BMI at her third review was 18.5. Today it is 17.9. This is not good.
The usual pleasantries start the process. L always goes first, saying how she thinks things are going. I spoke to her case co-ordinator earlier and told them what I thought. Her therapy team talk about her care plan and they ask me where I think we are. I take a deep breath and hold L’s hand. I am frank in explaining that, in my view, L doesn’t want to put on weight and wants ‘better’ not to involve ‘heavier’. She wants to continue restricting and counting, controlling and keeping everything at bay that is a threat. That recovery to L is about everything but taking a bite of a fear food, and as such, she does not want to recover, if that involves eating. I think we need to be honest – that this is not recovery. It is waiting for a day when recovery happens without L having to eat. When she wakes up happier and her world view has changed. We all know, even L, I think, that this day will not come, and waiting for it is an excuse to to do the hard things now. To eat the food that is so terrifying and to keep eating until it loses terror. To watch the weight chart go up to a weight restored figure and then to start the long path of retention and undoing the behaviours that led us here.
My suggestion is new and radical. That for four weeks, L eats exactly what I tell her when at home. There will be no negotiation, no choices, no tussles over a milkshake. That I am in charge and L knows this, as do the team. They are happy with this. L agrees, passively as usual. When I add that this includes snacks, she reacts, but as always, resistance is passive. At home she is mutinous. There is a storming up to her bedroom, as she realises all the exit doors are being locked. It is as if we have spent months at the edge of the water, helping her paddle, watching her swim nervously with water wings, seeing her experiment with water, but always staying in the shallow wend, never jumping in or swimming from choice. This next stage is a surprise attack, the equivalent of throwing her in and hoping for the best. I expect big battles, swearing, hysteria and weeping. I am ready.