On today's episode, Dr. Karen Nelson is joined by Dr. Linda Wondrasch licensed clinical psychologist at Melrose. Part of eating disorder recovery is having a relapse prevention plan. Dr. Karen Nelson and Dr. Linda Wondrasch will discuss what a relapse prevention plan looks like, signs of when a relapse may be occurring, and the immense role friends and family play in a person’s recovery.
On today's episode, Dr. Karen Nelson is joined by Dr. Linda Wondrasch licensed clinical psychologist at Melrose. Part of eating disorder recovery is having a relapse prevention plan. Dr. Karen Nelson and Dr. Linda Wondrasch will discuss what a relapse prevention plan looks like, signs of when a relapse may be occurring, and the immense role friends and family play in a person’s recovery.
For a transcript of this episode click here.
[00:00:00] Dr. Karen Nelson: Eating disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that we'll find the opportunity for healing. Hi there, I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose Center, welcoming you to Melrose Heals, a conversation about eating disorders. A podcast designed to explore, discuss, and understand eating disorders and mental health.
On today's episode, I'm joined by Dr. Linda Wondrasch, licensed clinical psychologist here at Melrose. Part of eating disorder recovery is having a relapse prevention plan. Linda and I will discuss what a relapse prevention plan looks like, signs of when a relapse may be occurring, and the immense role friends and family play in a person's recovery.
Now, before I begin, I invite you to take a deep breath and join me in this space. [00:01:00] Well, Linda, welcome to the podcast. I'm so excited to have you here with me today. But before we begin, I would love it if you could introduce yourself and tell us about your role here at Melrose.
Dr. Linda Wondrasch: Well, my name is Linda Wandrosch, and I am a clinical psychologist. I work primarily on the higher level of care portion of Melrose. So I do inpatient, residential, and partial.
Dr. Karen Nelson: Wonderful. And so for our listeners, what is partial? So they may know inpatient, right, is when they're, you know, at our facility. They're staying there 24 hours a day getting care. But what is partial? What does that look like?
Dr. Linda Wondrasch: After you finish inpatient, we typically refer people to partial, which is an outpatient program that runs Monday through Friday. So you come in at about 7:30 and you do a full day of programming and a breakfast, a snack, a lunch, a snack, and then you go home and you practice your dinner and your evening snack there.
So you sleep at home and you're with us all day.
Dr. Karen Nelson: Okay. [00:02:00] Absolutely. So it becomes kind of that natural transition that if you were inpatient, right, staying at our facility 24 hours a day, then you're transitioning to, you're sleeping at home and have some weekends, right? Weekends are also at home?
Dr. Linda Wondrasch: Weekends are on your own. Yes.
Dr. Karen Nelson: But you're still with us many hours of the kind of work day, per se, to continue to practice those recovery skills.
Dr. Linda Wondrasch: Correct.
Dr. Karen Nelson: Wonderful. Well, as we start our conversation today, we're going to be talking about relapse prevention. And so, I mean, kind of the million dollar question: What's a relapse? Like how do we even define that?
Dr. Linda Wondrasch: It's difficult to define because there's a difference between a lapse and a relapse. So a lapse is a slip up. You sort of roll up your sleeves and you figure out what went wrong and you go back in and keep trying. But a relapse is sort of like throwing in the towel. And so, we want to teach people to visualize a slip up as a mistake that we learn from versus a reason to go right back to the eating disorder.
Dr. Karen Nelson: [00:03:00] Maybe to kind of help our listeners be able to, you know, separate the two. A slip up feels more maybe short term or, you know, maybe I'm engaging with a couple symptoms of the eating disorder returning. And is a relapse like a longer amount of time, like that I'm re engaging with symptoms? Or maybe help us kind of understand that a little bit.
Dr. Linda Wondrasch: Yeah. Our patients tend to have personality styles that are characterized by black and white thinking. So they're either all in or they're all out. And the eating disorder tends to sort of take advantage of that. So for instance, a slip up might be missing breakfast in the morning. That is not the end of the world.
Dr. Karen Nelson: That's right.
Dr. Linda Wondrasch: And nothing to panic about. But sometimes the eating disorder will tell that particular patient, well, you slipped up. You might as well throw in the towel for the whole day. But that's not the case. What the research tells us is if you slip up, but you can get back on track within three hours, you'll be fine. So what you don't want to do is allow the eating [00:04:00] disorder to gain any momentum.
Dr. Karen Nelson: I love the way you described that aspect of all or none thinking, right? And that the eating disorder often is in that space of all or none. Kind of the fancy words, right? The clinical terms that they make us learn when we're in school. It's called dichotomous thinking, right? That all-or-none. But good point. You know, the eating disorder is in the business of keeping you sick and stuck. And so if there's a slip of maybe utilizing one symptom, maybe this urge to kind of keep going or, or continuing to use eating disorder symptoms rather than engaging in recovery-like behavior.
Let's talk about, is it important to help our patients know the difference between the two? Or what do you think about that? The difference between like a slip up or a lapse and then a relapse. What do you think about that?
Dr. Linda Wondrasch: Definitely. As I said, both our patients and [00:05:00] their support people tend to think that this is supposed to be fine because you're in treatment. This is supposed to be over. And this, as I said, is about disease management and learning to manage the symptoms. I have patients who have been in recovery for many, many years and will still slip up every once in a while. They're just good disease managers because they've been practicing for a long time so they're able to get right back on track. So sometimes if life is particularly stressful, they might purge. But they regroup, they take a look at what happened, and they're back on track the next day.
Dr. Karen Nelson: I love that. Well, and I think something that I like to bring up with my patients is rather than focusing on the slip up, right, of how quickly I can then return to recovery behaviors. Again, the eating disorder wants to keep us sick and stuck, and it often sends us a lot of messages about, ‘I'm bad, I did the wrong thing. Oh my gosh, I can't [00:06:00] believe I engaged in that behavior.’ And I can get sucked into that thinking. And recovery is about acting opposite, right, like, ‘Okay, yep, this behavior showed up, and I'm going to continue to work on recovery, even if I had that urge that broke through.’
Dr. Linda Wondrasch: Absolutely.
Dr. Karen Nelson: Well, what do you think about maybe helping our listeners know what might be some signs or symptoms of relapse?
Dr. Linda Wondrasch: Like any disease or any mental health issue, be aware of situations that are stressful. It's more likely to crop up then. If you start weighing yourself more often, mirror checking more often, utilizing food rituals, lack of flexibility with meals and snacks, skipping snacks or skipping meals, going back to websites that glamorize eating disorders, isolation, changes in mood. I mean, there's just so [00:07:00] many. Cutting food into small pieces, eating alone.
Dr. Karen Nelson: I mean, like you said, there can be many potential warning signs. Sometimes a way that I like to almost help my patients maybe be aware or be prepared is if the behavior starts to feel familiar. In kind of like, a not good way of like, ‘Oh yeah, I remember I was doing this when I was really in the depths of my eating disorder. I was only eating alone or I skipped family dinner. I just would never come. Or I'd go to a restaurant and I'd only order a dinner salad. I wouldn't order a full meal.’ Is it those types of things that we might be looking for?
Dr. Linda Wondrasch: Sure. Or lying. to people about whether or not you're using symptoms, hiding your eating disorder. Key to recovery is asking for help when you know you're starting to struggle. Maybe getting back [00:08:00] with your team if you're not engaged with your team at the moment. To be well aware that anytime stressful things – particularly transitions, our patients really dislike transitions. Change. Conflict. That's what you use your outpatient team for. Go talk to them about your conflict or your change or what you're worried about and let them help you problem-solve that so your eating disorder doesn't do your talking for you.
Dr. Karen Nelson: There is a 41 percent chance that someone may relapse – so meaning continuing to, you know, or – or reuse their eating disorder in an 18 month period following discharge from higher level of care. So if someone has been inpatient for higher level of care, there's almost a 50 percent chance that they're going to relapse within that first year and a half. I think it's so important for us to name that. Number one. Literally, just name it, right? We become aware of it and then we plan for it. And [00:09:00] so, does that become a conversation that you do then start to have with your patients? Or help me. Like, what do you notice about that or how do you even start bringing that up?
Dr. Linda Wondrasch: We talk about that endlessly.
Dr. Karen Nelson: Endlessly. That's right.
Dr. Linda Wondrasch: We have groups about relapse prevention and we talk about it with patients that are about to leave. We talk a lot about how to manage urges, how to manage triggers, ways in which there are triggers everywhere with eating disorders. There are commercials, they're in the environment, they're amongst your friends. But one of the things we think is really important is to not have to use that muscle in your home. And so we will talk to the patient about how to make that home environment as safe as you possibly can. Don't have scales. Be wary of full length mirrors. We ask support people not to talk about their diets or about their bodies or other people's bodies. To just – sometimes we'll ask people to go home and redecorate your bedroom. [00:10:00] Or paint something or just change things up. I always tell patients that when you stop using symptoms, those symptoms were managing your emotions. And so your emotions are going to rise to the surface and you're going to feel everything. Have a chair that you can cry in.
Dr. Karen Nelson: Yes. Oh my God. I love it.
Dr. Linda Wondrasch: Yeah. Go find a chair or a corner where you can just sob. If you're hurting, you're healing. So don't run away from strong emotion because it will overwhelm you. It'll pass.
Dr. Karen Nelson: Yeah. Wait, I want to say that again. That was a beautiful statement. If you're hurting –
Both: you're healing.
Dr. Karen Nelson: That's right. I'm gonna start to cry. Like that is straight up true, right? Because, you know, I was just chatting with another therapist earlier today and we were talking about – we just know that the eating disorder shows up to manage all the [00:11:00] delightful and undelightful emotions that we have as humans. And when I minimize the frequency of using the eating disorders, I love it that you're naming for your patients: You're going to feel and it's going to hurt. And we have to create space for you to tolerate that. Absolutely. So not as like a time out chair. Remember when our kids are little, we have a time out chair. It's like my healing chair.
Dr. Linda Wondrasch: And make it be comfortable and make it be cozy and make there be a beautiful view out the window and just go there anytime you're feeling awful because you will feel awful. And sometimes I think that people avoid recovery because they're scared of feeling – nobody wants to be uncomfortable. Nobody. I don't.
Dr. Karen Nelson: That's right. Amen.
Dr. Linda Wondrasch: You don't. Nobody does.
Dr. Karen Nelson: That's right.
Dr. Linda Wondrasch: You know, but that will pass. It's – you'll come to an end with that. And the eating disorder is just a circle going nowhere.
Dr. Karen Nelson: [00:12:00] Acknowledging what relapse might look like for someone who's experiencing an eating disorder, but are there potential signs or symptoms that I might want to look out for if I'm a support person? If my child is struggling, or if my partner or my loved one, what might I look for?
Dr. Linda Wondrasch: Well, I often will tell families who are usually pretty scared when they're discharging from a higher level of care, the weight tells the story. So every week, your job is to make sure that your support or your loved one is getting to those outpatient appointments to get their weight because their weight is going to tell you how they're doing. They – and again, also to be looking for anything – if your loved one starts to get quiet or starts to isolate more or starts to avoid meals or snacks or just seems more down or more anxious than usual, something else might be going on. And you don't even necessarily –[00:13:00] if you're noticing something that worries you, you don't even necessarily have to call out the eating disorder. You can just say, ‘Hey, is there something going on?’ You just – ‘Is there something that I can do to support you?’ Most of the time people don't want to talk about their eating disorders with their parents.
Dr. Karen Nelson: Well, not the topic, right? That we want to bring up.
Dr. Linda Wondrasch: Not usually, but you can – all you have to do is just show up and just say, ‘What do you need from me right now? Because it just seems like something's off.’ If they're out exercising more often, or spending more time in their room, or anything like that, it's a sign that, not necessarily, but it's a sign that there could be something going on.
Dr. Karen Nelson: For sure. Well, I think too, you know, we talk a lot on the podcast about uncomfortable conversations. You know, I don't particularly want to bring up things with my partner or kids that might feel uncomfortable, right? We might just think, ‘Oh it’ll work itself out.’ I hear that a lot. ‘Well, I just thought it would like [00:14:00] just go away on its own.’ Probably not. That if I'm seeing something, I want to just name it. Not in an accusatory way or in a shaming type of way, but just saying, ‘Gosh, you seem different. You seem off. Are you okay?’ And I love that? That you're bringing that up, of saying, can I support you? That feels so compassionate versus, ‘Are you using the eating disorder?’ Right? This kind of shaming space of saying, ‘I see you. And are you okay?’
Dr. Linda Wondrasch: And eating disorder is so frustrating for families. It's scary and it's frustrating. And I often will tell parents, imagine what it's like for your kid.
Dr. Karen Nelson: That's right.
Dr. Linda Wondrasch: I mean, it's manipulative and angry and you get inpatient with it. But yelling is just going to make it dig in harder. So just be as patient as you can and you also can tell patients that this isn't forever. So what I mean by that is some of the [00:15:00] research tells us that you're – first of all, we can't take your eating disorder away. It's yours. And I always will tell patients that. Ideally it'll go from your screaming in your ear on your shoulder to your back pocket.
Dr. Karen Nelson: You know that aspect of – it's probably one of the skills that I immediately start with as I'm, you know, working with a patient. I exclusively work in outpatient, but we talk about that aspect of how feelings come in waves. They just naturally do. No feeling will remain at the height forever and ever. It will naturally dissipate. The eating disorder is a genius. Because it gets you as that emotion is starting to trickle up and it says, ‘Hey, I know what to do. Let's not feel that.’ The reality is though, is that if I hang on and wait and tolerate, that emotion will dissipate on its own. And man, is that hard to do, right?
Dr. Linda Wondrasch: Oh, it's awful.
Dr. Karen Nelson: We just couldn't name that.
Dr. Linda Wondrasch: It’s awful. And I feel for folks that [00:16:00] haven't really felt their emotions for a long time, it's awful. But you also don't have to do it alone.
Dr. Karen Nelson: Yeah.
Dr. Linda Wondrasch: I mean, make sure – it's also a really good idea to find a mentor, meaning somebody who has recovered from this illness and those folks are everywhere. And let that be somebody that you can call when you're crying and you can't tolerate the distress. Have people that you can reach out to in the moment. And you don't have to tell them that you're suffering. You can just say, ‘Hey, what's going on with you?’ Sometimes taking the focus off yourself is actually useful.
Dr. Karen Nelson: As you were mentioning, you know, the particular statistic around, you know, those 18 months post treatment for someone that has been discharged from a higher level of care, there's an increased risk that they may relapse. Tell us about – I'd love to hear your thoughts about how it is that that period of time becomes the most fragile or potentially risky as someone is transitioning. What do you think about that?
Dr. Linda Wondrasch: [00:17:00] I think there are a number of reasons. First off, most of the time, anorexia monopolizes all of their time. And I shouldn't just say anorexia. I should say all eating disorders monopolize a lot of headspace. And when they're in their eating disorders, they've now isolated from peers who they feel have moved on with their lives. We're talking about very intelligent young people who are usually behind academically and are not sure what they want to do with their careers. They tend to be folks that have spent so much time managing their eating disorders, they feel like they'll never catch up to peers. That they're not good enough to be with peers. Their world has become very small and part of the recovery process is getting them out there and getting them doing things. You find that many of them are so far behind. We've got women in their 20s that have never been on a date.
Dr. Karen Nelson: That's right. They missed out on some of those life things.
Dr. Linda Wondrasch: They missed out on so many things. And now they're [00:18:00]embarrassed. They're behind their peers and they're afraid to try new things because remember, they feel like they have to be so great at everything. So one of the things I do with a lot of them is try to teach them to knit.
Dr. Karen Nelson: That's right.
Dr. Linda Wondrasch: I teach them to knit. It's a skill that requires a lot of trial and error and a lot of practice and it works really well with folks who are busy. Have busy brains. And so I try to get them engaged in something unrelated to the eating disorder and something they can do with their busy brains and something they can be good at. I encourage them while they're in higher level of care, check out volunteer sites. If you are involved in a church, there's all sorts of opportunities to volunteer. You have to give them something else to do. Something that's meaningful, so that they get really involved in something that starts to mean more to them than their eating disorder in a way in which they can be successful.
Dr. Karen Nelson: I love that.
Dr. Linda Wondrasch: So that's key for relapse prevention is getting really involved in [00:19:00] your life or in something that you're passionate about.
Dr. Karen Nelson: For sure. Well, let's talk about, as you are potentially preparing with a patient for, you know, discharge from a higher level of care, how might you help them in treatment kind of prevent a relapse when they go home?
Dr. Linda Wondrasch: Well, I think we work diligently on how to manage urges. So urges will crop up in an urge to do anything. Use a symptom, purge, whatever you're talking about, restrict. Urges usually don't last more than about 20 minutes. People find that hard to believe, but they really don't. They can be shorter, they can be longer, but generally speaking, they're 20 minutes. I often will tell folks, think about your eating disorder as a science experiment and you're the researcher. And so you are going to learn how your eating disorder works, when it tends to operate, what [00:20:00] skills work with it, how do you tweak it? So take it away from you and just look at it. When do these urges tend to crop up? And when they do, go set an oven timer for 20 minutes. If you make it 10 minutes and you still use a symptom, you still won. Right? And so maybe next time you'll get 11 minutes, maybe the next time you'll get 13. But during that 20 minutes we design a whole long list of alternative activities, other things you can do in that 20 minutes in order to manage your symptom use.
Dr. Karen Nelson: And we're going to help you identify coping skills, right? What am I gonna do? We've talked about, I love that you bring this up. One of the other terms that we may – or other ways that we talk about those urges, we call it urge surfing, right? Of like, there's actual data that says these urges last for about 20 to 30 minutes. And if we can hang on and ride the wave of that. The likelihood that [00:21:00] we're going to engage in a symptom goes way down, meaning eating disorder symptoms. And so working in therapy to develop, ‘What am I going to do? Maybe I'm going to call my therapist and leave her a voicemail. I'm going to, you know, take a five minute shower. I'm going to paint my nails. I'm going to, you know, listen to a quick meditation.’ And so we can name, like, painting your nails? Is it going to feel as good as engaging with this symptom? Absolutely not. But the end game is, imagine a time where the urge becomes less and less, and potentially the urge is extinguished all the way, right? And so I love it. The other piece, we may need to use more than one skill, right? And so my patients will say, well, you know, I tried to manage the urge and I went for a walk for three minutes and it didn't go away. I bet it didn't. And so let's build [00:22:00] a list of skills to use to kind of manage those urges.
Dr. Linda Wondrasch: Absolutely.
Dr. Karen Nelson: Such an important point. I'm so glad you brought that up, Linda. When we talk about, you know, kind of these urges to use eating disorders, they often come from being triggered. We use the word triggered a lot in eating disorder therapy. Help our listeners know, what's a trigger? What might that look like?
Dr. Linda Wondrasch: It can be anything. I mean, really a weight loss commercial.
Dr. Karen Nelson: Right.
Dr. Linda Wondrasch: Your friends talking about what they ate or what they didn't eat. A parent being on a diet. Somebody mentioning something about your body. Being late for work. Being criticized for something. Our folks tend to be very sensitive people and their feelings are hurt easily. Feeling invalidated can be a trigger. They're everywhere. The eating disorder takes advantage of you every opportunity that it possibly can. And just to acknowledge that a [00:23:00] trigger is taking place when you start to think about symptom-use as a way to manage whatever problem you're going through in the moment.
Dr. Karen Nelson: Right, and identifying that piece, right, in the moment. This is like, it's a wave of emotion. The trigger is triggering emotion. And so how do I urge surf? How do I ride out that emotion and not engage with the eating disorder? And that's part of our relapse prevention, right? How do we talk about that? How do we maybe even name and plan for things that –
Dr. Linda Wondrasch: You can say it out loud: ‘I'm being triggered right now.’
Dr. Karen Nelson: That’s right.
Dr. Linda Wondrasch: ‘I know that's what's happening.’
Dr. Karen Nelson: Well, let's talk about kind of developing that personal plan. We often talk about it as a relapse prevention plan. And so that personalization feels important. Or I mean, is it more general? Or help me know about that. What would you say?
Dr. Linda Wondrasch: Well, absolutely. It needs to be more [00:24:00] personal. A lot of times when you ask patients, what do you like to do? They'll tell you, I don't know. I haven't done anything but this for a very long time. Well, your assignment then is to go out and talk to three friends. And ask three friends what they like to do in their free time and try some of those things. Ask your parents what they like to do in their free time. Ask me what I like to do in my free time. I'm far older than you in most cases.
Dr. Karen Nelson: That's right. No, no. We're the experienced therapist here.
Dr. Linda Wondrasch: Right. What I like to do may not be what you like to do –
Dr. Karen Nelson: That’s right, that’s right.
Dr. Linda Wondrasch: But ask around to find out what people like to do. What have you always wanted to try? What did you do prior to the eating disorder? And I really do, a lot of times I'll put people on dating apps and you don't ever have to go on a date. But it works really well because they think nobody wants them.
Dr. Karen Nelson: Yeah.
Dr. Linda Wondrasch: And in [00:25:00] reality. If you – we'll spend a couple of sessions, or they'll spend some sessions with occupational therapy, just building their profile in a meaningful way, and lo and behold, they get all kinds of hits.
Dr. Karen Nelson: That's right.
Dr. Linda Wondrasch: So that builds self esteem, and it gives them very safe ways to practice having conversations with these folks in a very safe setting. And it's been so effective. It really has.
Dr. Karen Nelson: So, two things I heard: Linda is an advocate for dating apps and texting.
Dr. Linda Wondrasch: Yes, it's a nice place, a nice, safe place to start.
Dr. Karen Nelson: Totally. If my expectation is that I have to be perfect at it and I have to immediately leaving treatment, I'm supposed to have this, you know, cultivated group of, you know, best friends. Uh-Oh. Right? Like it takes work to develop connections.
Dr. Linda Wondrasch: And to what degree do our folks compare themselves to other people?
Dr. Karen Nelson: Amen.
Dr. Linda Wondrasch: ‘Other people really [00:26:00] seem to have it together and I don't.’ Well, don't compare your insides to other people's outsides.
Dr. Karen Nelson: I love that.
Dr. Linda Wondrasch: You have no idea what's going on with other people. You're just making assumptions about what people are showing you.
Dr. Karen Nelson: Let's talk about the importance of, why is having a support system so important in recovery? What do you think about that?
Dr. Linda Wondrasch: Well, the support people are wonderful for distraction.
Dr. Karen Nelson: Good point. Absolutely.
Dr. Linda Wondrasch: And they're wonderful for reminding you of why you matter. And they're wonderful for – I tell my folks quite a bit that you think about this 90 to 100 percent of the day. And people without eating disorders think about food, body image and weight less than 7 percent of the day.
Dr. Karen Nelson: Good point.
Dr. Linda Wondrasch: And so a lot of times you'll project onto other people, meaning you think other people really think this is amazing what you're doing here with your eating disorder or that the eating disorder somehow tells you that other people are impressed with [00:27:00] this or think this is wonderful. And in reality, they don't. And you may also think that other people are judging your weight or judging what you're eating. But remember, you're thinking about this 80 percent more than everybody. Nobody cares what's in your grocery cart. Nobody cares what you get at a restaurant to eat. They just – it just doesn't matter. And in fact, when you go out to eat and you're the only one that's just ordering soda, that's kind of annoying.
Dr. Karen Nelson: I might have used another word.
Dr. Linda Wondrasch: People get tired of that, you know, they get tired of that.
Dr. Karen Nelson: For sure.
Dr. Linda Wondrasch: And your support people are the people that help you see the things that are really meaningful about you. And so another activity I use a lot is: Text five friends or five people that you trust. And I want you to ask them, my therapist told me that I had to do this, so it doesn't look like you're fishing for compliments. But have them name a few things about you they love. Unrelated to your appearance and then I make them come back to me and read it all off.
Dr. Karen Nelson: Oh my gosh. [00:28:00]
Dr. Linda Wondrasch: Mm hmm.
Dr. Karen Nelson: So good. I’ll be stealing that one.
Dr. Linda Wondrasch: And it works really well. It does. Sometimes patients will cry.
Dr. Karen Nelson: I bet.
Dr. Linda Wondrasch: Because they don't even want to look at it because it's so in contrast to what the eating disorder says.
Dr. Karen Nelson: For sure.
Dr. Linda Wondrasch: And it never has – they talk about how kind they are and how smart they are, and how fun they are, and all the things that the eating disorder tells them that they’re not. ‘Well, they're probably just saying that.’ Well, so all your friends and family are liars.
Dr. Karen Nelson: Right.
Dr. Linda Wondrasch: Well, no.
Dr. Karen Nelson: Probably not. I mean, I think it's so good, how you so beautifully acknowledged all the lies that the eating disorder tells us and all of the destruction that happens when they believe what the eating disorder is telling them.
Dr. Linda Wondrasch: And how do you not? You have this thing screaming in your head a hundred percent of the day. I mean, how do you not buy into that and how validating for them? You're not going to believe many of the things I'm telling you right now. I have an hour a day. You know, but slowly, slowly, slowly, and when they start to come back and [00:29:00] repeat the things I've said, repeat the things they've learned, I know it's starting to integrate. That's such a good sign, right? Or they try something that I encourage them to try and it's effective because experiential experiences are the most meaningful in eating disorder recovery. So not me telling them or you telling them over and over and over again, but them actually experiencing it.
Dr. Karen Nelson: Trying it out.
Dr. Linda Wondrasch: Trying it out.
Dr. Karen Nelson: One thing that I wanted to pause and make sure that we touch on, Linda, is we have talked about just somewhat of the chronic nature of eating disorders, but I also very much want to help our listeners know and appreciate the ability for healing and recovery in that space. And I'd love it if you could maybe speak to that a little bit. That yes, eating disorders may have this kind of chronic nature where some of those thoughts might kind of linger in my brain. And healing and recovery is possible. Thoughts on that?
Dr. Linda Wondrasch: Oh, for sure. The [00:30:00] majority of our folks do get better.
Dr. Karen Nelson: They get better.
Dr. Linda Wondrasch: They absolutely do. And the majority of our folks who do get better don't ever come back. And so that's the good news. And you're not seeing the people that are in recovery because the folks that are in recovery are so proud of their recovery that it's hard to get them to come back. Like we've tried to get speakers, like recovery speakers, to come in and it's sometimes difficult for me to convince them to do that because they're so protective of their recovery. Because it's also, I'll tell folks that sometimes it's the hardest thing you'll ever have to do in your life and so you've peaked with the hard stuff at 17. And because it's so difficult, the rest of your life is going to feel kind of easy and now you've got all these skills that the average person doesn't have, and ways to cope with difficult things, and a new level of empathy for people that struggle. So rarely does a person with an eating disorder just have an eating disorder. I call it the triad. It's always generalized anxiety [00:31:00] disorder, major depressive disorder, and an eating disorder. And so when your eating disorder gets better, oftentimes the depression and the anxiety get better. So once you've been healed, you have the ability to empathize and you're really a rock star. Like, people will listen to you. Like, I've recovered. I always will say if I get a resume, which would never happen, but if I had a resume from somebody who said I recovered from an eating disorder, I'd hire them in a minute. You're a hard worker. You're disciplined. You know how to do difficult things. You do your share of the work. You're fussy. These are just wonderful qualities. And the majority of our people do get better. They absolutely do. And the other thing I would add is these are – many of them are like, ‘Oh, what if this is genetic. And what if I have a baby and that baby –’ You're going to be great.
Dr. Karen Nelson: You're going to be great.
Dr. Linda Wondrasch: You're way more prepared than the average woman for raising little kids. And staying away from the topics that are [00:32:00] triggering and you know how to get help and you're a role model for the solution if something should ever happen. So, they're just amazing people with a real appreciation for suffering and a real appreciation for hard work. And the ability to care about others and not to judge people. I mean, I can't say enough positive things. And a level of appreciation for everything. It's just, it's a wonderful thing. I've been doing this forever. What do you think keeps me in it?
Dr. Karen Nelson: That's right.
Dr. Linda Wondrasch: Every once in a while somebody will show up that I worked with as an adolescent and I'll get to hold their baby.
Dr. Karen Nelson: Wow.
Dr. Linda Wondrasch: Uh! Or they'll send me an email about the impact that I had on their life and what they're doing now. And those stories are just miraculous. The people that get well do so well and are so happy.
Dr. Karen Nelson: And it's so important. You said it [00:33:00] again so beautifully. They're living the solution. They're living it.
Dr. Linda Wondrasch: And they're examples of the solution. They're like, wow. I mean, think of the people that you can help if you're willing to share that you did it.
Dr. Karen Nelson: That's right.
Dr. Linda Wondrasch: You're a miracle. You're a walking miracle.
Dr. Karen Nelson: You’re a miracle. And not giving up in that space, right? As we were acknowledging, as we're moving through recovery, it's hard. And there may be moments that I might want to listen to the eating disorder again, but we are living proof that we see stories of recovery every day.
Dr. Linda Wondrasch: Mm hmm.
Dr. Karen Nelson: If there is someone who has moved through eating disorder treatment and then finds themselves in a space of relapse, so they may have gone through a higher level of care, you know, progressed through outpatient care, but now are noticing that there may be some relapse in eating disorder symptoms, what might you say to that person?
Dr. Linda Wondrasch: Tell anybody. If you've been through a higher level of care, and you've been through an outpatient program, [00:34:00] everybody around you that loves you is probably aware of it. Tell somebody.
Dr. Karen Nelson: Tell somebody. You bet. Start the conversation. Absolutely. And working to, like you said, re-accessing or working to either, if you still have an ongoing treatment team, reconnecting with them.
Dr. Linda Wondrasch: Sure.
Dr. Karen Nelson: Or, you know, reaching back out to a previous therapist.
Dr. Linda Wondrasch: We would love to hear from you before it gets to a point where it's all the way back to where it was before.
Dr. Karen Nelson: Beautiful. Is there anything, Linda, that I haven't asked that you'd like to mention today?
Dr. Linda Wondrasch: Oh, I have one thing that works really well for support people. I call it the calendar method. So this works particularly well for people who are married. For adults or for an older adolescent who lives with families because it feels less intrusive. And basically I encourage people to put a calendar up in your house that everybody walks [00:35:00] by all the time and have the person struggling note on that calendar every day, with just an X or an O, if it's a good day or a bad day. And obviously the patient has to agree to that. And so everybody sees it all the time. So it's less intrusive, but you're keeping yourself accountable. And then you get to decide as the adult, how you want to be approached and how many X's on the calendar warrant a question. So for instance, if you have three X's in one week, does that warrant some questions from your support people. And so it's really important when you're coming up with a relapse prevention plan that everybody's on board, particularly that patient if they're an adult. Works really well with married couples, because no married couple wants to have their spouse acting as their father or their mother or their, you know, boss. But basically they're inviting you into their recovery. And so you can start that [00:36:00] up at any time. Particularly if things are more stressful than usual. And then just ask the question, ‘Hey, you've had a rough week. Is there something going on? Can I support you in some way?’ And that's worked pretty well.
Dr. Karen Nelson: It feels so important, right? Keeping the conversation going. Even like subtly. Of it's just out there and maybe not too intrusive, but we have a plan. If I see more than three X's, I'm gonna check in with you. Genius. I love it. Absolutely. Well, Linda, I've just really loved this conversation.
Dr. Linda Wondrasch: As have I.
Dr. Karen Nelson: I appreciate you. Thank you so much.
That's it for today. Thanks for joining me. We've covered a lot, so I encourage you to let it settle and filter in. And as I tell my patients at the end of every session: Take notice, pay attention, and we'll take it as it comes. I'll talk to you next time. To learn more about Melrose Center, please visit MelroseHeals.com.
[00:37:00] If you or a loved one are suffering from an eating disorder, we're here to help. Call 952 993 6200 to schedule an appointment and begin the journey towards healing and recovery. Melrose Heals: A Conversation About Eating Disorders was made possible by generous donations to the Park Nicollet Foundation.