Caring for a Loved One with an Eating Disorder

Jenny Langley is an experienced carer, trained by Gill Todd RMN, MSc to deliver the New Maudsley Carer Skills workshops in the community. She was awarded the Royal College of Psychiatrists Carer Contributor of the Year in 2016. Gill Todd was Clinical Nurse Leader for Eating Disorders at the Bethlem and Maudsley NHS Foundation Trust. Now retired from the NHS, she runs carers' skills workshops and trains facilitators to run the workshops. Janet Treasure is a leading figure in the field of eating disorders. She is a psychiatrist at South London and Maudsley Hospital, and is an international expert with extensive academic and clinical experience.

Contents

Preface

Section One

Chapter 1 Introduction and background to skills-based caring

Chapter 2 Practical issues for running the workshops

Chapter 3 Facilitator delivery style, values and spirit

Chapter 4 Facilitator guide to Motivational Interviewing and emotional processing

Section Two

Introduction

Module 1 - Starting off and setting the scene for recovery

1.1. Welcoming the carers

1.2 Introductions

1.3 Agreeing ground rules for the group

1.4 Emotional response to caregiving

1.5 The Readiness Ruler

1.6 Working with a joint understanding – basic facts and recovery

Module 2 - Psychoeducation and developing empathy

2.1 Considering causes and maintaining factors

2.2 Considering ambivalence with a focus on the benefits of an ED

2.3 Understanding the trap of an eating disorder: the toxic effect of prolonged starvation and repeated habits

2.4 Building empathy for the challenges of weight restoration – the metabolism effect

2.5 Building empathy for the sufferer – coping strategies and the crap day exercise

2.6 Externalising the illness, part one: how have Edi’s personality traits changed through ED?

2.7 Externalising the illness, part two: introducing the red balloon/ blue balloon metaphor

2.8 Building empathy for the sufferer – popping the balloon

2.9 Externalising the illness part three: visual exercise

Module Three – How the Eating Disorder Impacts on Interpersonal Relationships

3.1 Exploring the Animal Metaphors

3.2 Which 'Animals' Does Edi Interact with at Home and Outside the Home?

3.3 Considering How Edi Responds to the Animals

3.4 Creating a Productive Partnership

Module Four – The Cycle of Change and Introduction to Communication Skills

4.1 Stages of Change Model

4.2 Decisional Balance

4.3 Readiness Ruler and DARN-C

4.4 OARS (including LESS is More)

4.5 Advice giving

Module Five – Advanced Communication Skills

5.1 Emotional Intelligence

5.2 Emotion-Focused relationships using Attend, Label, Validate, Soothe (ALVS)

5.3 The Reassurance Trap and Rolling with Resistance

5.4 Five Key Principles: DEARS, Developing Discrepancy, Expressing Empathy, Amplifying Ambivalence, Rolling with Resistance, Supporting Self-efficacy

5.5 Ambivalence Empowering Carers When Edi is in Pre-Contemplation or Facing a Lapse When in Recovery

5.6 Hopelessness: Empowering Carers When Edi Feels it is All Too Much and May be Expressing Suicidal Ideation

Module Six – Working as a Herd of Elephants – Collaboration Between All Carers

6.1 Making the Most of Family and Friends network

6.2 Partners, Single Parents and the Exhausted, Isolated Carer

6.3 Siblings and Peers

6.4 Making the Most of the GP Appointment

6.5 Going to A&E in an Emergency – including Medical Risk Assessment

6.6 Collaborating with School/ Work/ University

6.7 Building Empathy with the Care Team – the Changing Places Task

6.8 Encouraging Collaborative Care Using Motivational Language with the Care Team

6.9 Letter-writing to Repair Ruptured Relationships

Module Seven – Exercises for Carers to Plan for Change

7.1a Simple Reflection Exercises

7.1b Carers Reflecting on the Impact of ED on their Everyday Lives and Role-Modelling Self Care using SMART Baby Steps.

7.2 A Five-Step Approach to Planning for Change, Incorporating using a Spider diagram and Planning SMART Baby Steps

7.3 Completing the Accommodation and Enabling Scale for Eating Disorders

7.4 Accommodating Scenario – Using OARS and the ABC Model

7.5 Enabling Scenario – Using the ABC Model to Create a Menu of Options

7.6 Carers Managing Their Own Emotional Responses

7.7 Considering the Concept of Reasonable Risk

7.8 Coping Strategies for Carers – Maintaining a Heathy Balance

Module Eight - Coaching Edi to Make Their Own Changes

8.1 A Five-Step Approach to Plan for Behaviour Changes

8.2 Using the ABC model to Understand a Behaviour and Consider a Menu of Options

8.3 Using DARN-C to Elicit Change Talk

8.4 SMART Planning for Behaviour Change

8.5 When the Carers Face Unexpected Resistance

8.6 When the Carers Face Chronic and Unrelenting Resistance

Module Nine – Reclaiming Core Family Values and House Rules and Boundaries

9.1 Reclaiming Normal Core Family Values

9.2 Considering house rules and boundaries that are non-negotiable.

9.3 Talking is a Good Consequence

9.4 Core Values and Boundaries – Adult Sufferers

Module Ten – Managing Undereating, Re-Feeding and Overeating

10.1 Eating is Non-Negotiable for Everyone

10.2 Carers Understanding that Re-feeding is a Huge Task

10.3 The Key Steps to Restoring Regular Eating Patterns

10.4 The Nutritional Risk Ruler

10.5 The Nutritional Risk Ruler – When Medical Risk is Very High

10.6 Talking About Gaining Weight

10.7 Communication around Mealtimes – Calm and Warm

10.8 Meal Support

10.9 Communication and Coaching for Rigid Rules and Compensatory Behaviours Including Overeating and Purging

10.10 Refusal to Eat with the Family – Using the ABC Model to Create a Menu of Options

Module Eleven – Managing Longer-Term Difficult Behaviours and Stumbling Blocks

11.1 Tolerance of a Healthy Weight

11.2 Body Image Issues

11.3 Self-Harm

Module Twelve – Relapse, Contingency Planning And Moving on

12.1 Timeline Example for Edi

12.2 Forward Planning for Difficult Life Events, the Carer Perspective

12.3 Ups and Downs of Recovery

12.4 Looking Forward and Stepping Back

Index