On today’s episode, Dr. Karen Nelson is joined by Lisa Bonahoom, licensed marriage and family therapist here at Melrose. Karen and Lisa will discuss how parents and guardians can support a child struggling with an eating disorder by sharing practical tips and information to help support your child's recovery journey.
On today’s episode, Dr. Karen Nelson is joined by Lisa Bonahoom, licensed marriage and family therapist here at Melrose. Karen and Lisa will discuss how parents and guardians can support a child struggling with an eating disorder by sharing practical tips and information to help support your child's recovery journey.
Click here for a transcript of this episode.
Dr. Karen Nelson: [00:00:00] 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 Lisa Bonahoom. Licensed Marriage and Family Therapist here at Melrose. Lisa and I will discuss how parents and guardians can support a child struggling with an eating disorder. We will share practical tips and information to help support your child's recovery journey.
Now, before I begin, I invite you to take a deep breath and join me in this space.[00:01:00]
Lisa, welcome to the podcast. So happy to have you here with me.
Lisa Bonahoom: Thank you. I'm excited to be here.
Dr. Karen Nelson: Well, just really looking forward to our topic today about practical tips and guidance for parents and guardians who potentially have a child struggling with an eating disorder. And before we get started, I would love it if you could introduce yourself and tell us about your role here at Melrose.
Lisa Bonahoom: Sure. All right. Well, my name is Lisa Bonahoom. I am a licensed marriage and family therapist. I was previously working in outpatient at Merrill's for several years, and recently transitioned up to the higher level of care, which means I'm seeing patients in either inpatient, residential, or our PHP program, otherwise known as ‘day programming.’
Dr. Karen Nelson: We want to, you know, help the listener develop more of an understanding and quite frankly some empathy for what kids and adolescents are going through as they're moving through [00:02:00]recovery from an eating disorder. So let's maybe talk a little bit about the prevalence of eating disorders in children. Tell us about the average age range of when an eating disorder may typically start for a child or an adolescent. What do we know about that?
Lisa Bonahoom: At Melrose, I'm typically seeing kids as early as eight or nine. I think most frequently we see eating disorders evolve in kind of preteen, early teen years. And I think that evolution, that timeline, really makes sense when we think about what's going on with our bodies during that time as well. Bodies are changing and developing. We're going through puberty. So whether or not you have an eating disorder, we're all so self-conscious of those changes and ‘I'm developing and they're not, or they're developing and I'm not –’
Dr. Karen Nelson: That’s right.
Lisa Bonahoom: And so I think it makes sense why we [00:03:00] see such an emergence in those years as bodies are significantly changing. I do believe it's getting younger, quite honestly. And I think there's a lot of different reasons for that. Children tend to have more exposure to social media. I think they're getting iPads sooner. They're getting cell phones sooner. All of this kind of wrapping into why I think we're seeing eating disorders happen earlier and earlier.
Dr. Karen Nelson: Let's maybe take some time and explore what might it be like for a family with a child who has an eating disorder. What might the family be experiencing?
Lisa Bonahoom: It's a great question, and they are experiencing so many things. I think when families come to us, they are experiencing shock. ‘We had absolutely no idea. We never saw this coming.’ And again, this makes sense too, [00:04:00]because so many of the behaviors associated with eating disorders can be attributed to other things, other conditions: puberty, being a teenager, development. So I think oftentimes they're experiencing shock, a lot of times feeling some guilt and shame. Like, ‘We shoulda, woulda, coulda.’ Like, shoulda caught this, shoulda caught it sooner, shoulda known, and I really see my role is helping families kind of move through that and place that aside and explaining all of the really valid and real reasons they didn't know it was an eating disorder and didn't catch this. I mean, this is devastating. Families are watching their children struggle in significant ways. These kids who were previously great students can't get their homework done, they're no longer social, they're not eating with their [00:05:00] family, really scary things happening. So I think fear is another big piece of what they're struggling with when they come to us.
Dr. Karen Nelson: Well, I like how you describe that aspect of kind of secrecy around the eating disorders. It's a common thing that I will talk with families around also where you had mentioned maybe some shame of feeling like, gosh, I didn't know. Of course you didn't.
Lisa Bonahoom: Right.
Dr. Karen Nelson: Because the eating disorder is in the business of keeping this underground.
Lisa Bonahoom: Eating disorders are incredibly creative. and manipulative and, you know, I always remind parents, not your child. This is, you know, your child's not manipulative and all these things, but eating disorders really are.
Dr. Karen Nelson: Tell us a little bit more, Lisa, as you potentially have parents come in, hear that their child does have a diagnosis of an eating disorder. What might that conversation look like?
Lisa Bonahoom: Yeah. So I think usually the [00:06:00] initial conversation entails a lot of psychoeducation, meaning I'm explaining what an eating disorder is and is not, right? Because there's so much misunderstanding around eating disorders. So a lot of it is delivering accurate information, explaining what it is, explaining what treatment looks like, and oftentimes kind of reviewing what some of those medical consequences can be. Parents might come in and like, ‘Hey, my kiddo has been struggling with anxiety for six months. And this is really new for us.’ And exploring that correlation or that link, we see very high rates of depression and anxiety in kids that struggle with eating disorders. So helping them understand the other symptoms their child has been experiencing and how those are connected to the [00:07:00] eating disorder, and then also really reviewing what we're going to be doing with their kid while they're in treatment.
Dr. Karen Nelson: What have you heard from parents? You know just kind of what it's like for them to hear this? I mean it makes sense that they might want to focus in on some facts and you and I both know emotion just swirls around the room, right, when we hear this really big diagnosis given to us as a parent. What have you witnessed or what do you notice about that?
Lisa Bonahoom: Yeah. I think for a lot of parents, it feels shattering is what I think of. It's heartbreaking. In some ways, there can also be relief with the diagnosis. ‘Oh my gosh, that's what it is. Like I'm so appreciative we finally know what's going on, and how to treat it, where to go for help.’ So I think it's a [00:08:00] combination of feelings. You know, of course shock and fear, but then also some relief like, we can finally start treating it now.
Dr. Karen Nelson: Absolutely. And it sounds like through some of those conversations that you're having with parents, psychoeducation, holding the emotion, you're just kind of helping them come to terms with, this is the diagnosis, now thankfully we know what we're battling. Instead of this kind of elusive, undescribed thing, you know? I love that you bring that up. A lot of parents share that with me, like, ‘I knew something was off because of course I know my kid, but I didn't know it was that. Oh my gosh, now thank heaven we know what it is.’ And that's where Melrose comes in. We're experts at this, like, we gotcha. Like, we can, we can take you there to that path of recovery.
Lisa Bonahoom: Yep. Absolutely.
Dr. Karen Nelson: Well, let's talk about treatment and kind of what is – actually, that's a really good question. What is [00:09:00] the best treatment for eating disorders in teens and adolescents?
Lisa Bonahoom: Sure. At Melrose with adolescents and teenagers, we're using FBT: family based therapy. This is the therapeutic approach designed by Locke and Le Grange. The one thing I explain to families when I'm talking about FBT, because I think when I say, ‘We're gonna be doing family based therapy,’ people really conjure up this image of like, kind of traditional therapy, right? We're gonna like sit on a couch or –
Dr. Karen Nelson: That’s right.
Lisa Bonahoom: Or you know, maybe we're gonna sing kumbaya.
Dr. Karen Nelson: Right. We're gonna sit in a circle and all share our feels.
Lisa Bonahoom: Exactly. And really, FBT is not those things.
Dr. Karen Nelson: That's right. Exactly.
Lisa Bonahoom: So, I always explain it's a very specific approach for adolescents who are struggling with eating disorders. And it heavily involves [00:10:00] parents. Parents are viewed as the number one asset in the fight against the eating disorder. So, FBT, very specific approach to eating disorders. It has nothing to do with like a traditional family therapy.
Dr. Karen Nelson: Absolutely. Yeah. And so I, I like that you name sometimes the name of family based therapy can kind of conjure up an alternative image than what it was. It is an eating disorder treatment. So, family based therapy is an eating disorder treatment to heal eating disorders in children and adolescents.
Lisa Bonahoom: Absolutely. So, if you're working with a family that's coming in and they've done family therapy and there's expectations that we're maybe going to get into nitty gritty things they got into previously in family therapy, you know, whose job it is to take the dog for a walk or unload the dishwasher, and I have to explain, nope, nope, nope, nope, nope.
Dr. Karen Nelson: That’s right.
Lisa Bonahoom: Not family therapy – family based therapy. This is different guys.
Dr. Karen Nelson: Absolutely.
Lisa Bonahoom: Yeah.
Dr. Karen Nelson: So [00:11:00] let's maybe talk about what that might look like or give us some kind of like, an insider peek of what does family based therapy look like?
Lisa Bonahoom: Yeah. So family based therapy is broken down into three phases. I think the phase we're working on the most in my level of care in inpatient or higher levels of care is phase one, which is focused primarily on weight restoration and symptom interruption. With phase two – we transitioned to phase two once a kiddo has gotten into their goal weight range. And at that point, we're slowly transitioning control of eating back to the adolescent. Phase three of family based therapy is really more developmentally age-appropriate work. You might be into some of the factors that contributed to the eating disorder in the first place, but we're really dealing with more normative issues. Being back in [00:12:00] school, issues with peers, maybe some body image stuff.
Dr. Karen Nelson: So there may need to be a lot of support for the parents. Is that right?
Lisa Bonahoom: 100%. I really try to acknowledge that in a way, FBT is really weird. Here we are folks, and I'm going to ask you to feed your 16-year-old as if they were three years old again. You are now in charge of three meals, three snacks. You are in charge of picking out what they're going to have, preparing it, portioning it out, serving it, and supervising the meal. So this is an absolutely hands on approach that can feel pretty awkward for all parties involved. So I kind of try to name that. from the get-go, that this is a little weird, right? And yeah, that parents are taking on, they're doing a lot – [00:13:00] parents are doing a lot of heavy hitting with this approach.
Dr. Karen Nelson: I think sometimes it can be helpful in that space where, like you said, the norm of the family is changing. Where mom and dad are, like you said, re-feeding or taking control of eating experiences for a teen or even an older adolescent. We do offer a lot of support here at Melrose: obviously individual therapy with their therapists, their kind of general individual team. There's other resources as well. We have something called the Family Learning Series. Tell us about that.
Lisa Bonahoom: We do, yeah, so that's a program that runs one evening per week, and I think the nice thing is it's virtual, so it's more accessible to families. That is a support group designed for parents and kids. It's run by a therapist, and it really offers logistics for at home. What does this look like at home? How do I actually implement [00:14:00] FBT at home? What do I do if they're refusing? What do I do if they don't complete the snack? So I think really offering support for what this should look like at home, and then also giving families the opportunity to connect with other parents and families going through this. Which I think ends up being incredibly valuable for people to see they're not in this alone.
Dr. Karen Nelson: I think it is a good distinction to make, that we do have something, like you'd mentioned, family learning series, and then we also have a Parent in Support of Others support group that we offer here at Melrose. And that is for parents or other caregivers?
Lisa Bonahoom: Yep. So that could be parents, other caregivers, significant others. It doesn't need to be a patient who's an adolescent or a teenager. That could be a patient of any age. So yeah, we have one specifically targeted for parents with adolescents, but then you can also [00:15:00] participate in one that's a little bit more broad and for patients of all ages.
Dr. Karen Nelson: I think another aspect that we do offer as patients are, if an adolescent is diagnosed with an eating disorder welcomed into treatment, parents are given access to a variety of videos to help them learn and understand more about family-based therapy. What is FBT? What are some skills or tips? Or – they also, right, have access to that?
Lisa Bonahoom: Yes, they do, and I think watching those videos can be really useful, especially in the beginning. Most of the time, families and parents are coming in and there's no eating disorders 101. What the heck is this? What does this mean? What does treatment look like? And so I think those videos can be great resources for supplemental information and kind of fill in the gaps between what families are hearing from providers and during appointments and [00:16:00] yeah. I mean, it's like learning a new language, right? Families have nothing to compare this to. One of the tips that I usually give in the very beginning is trying to create a light atmosphere, right? ‘Here we are. We have a kiddo with an eating disorder.’ So presumably they're experiencing really significant anxiety and stress around having to eat. So, what can parents do to create an atmosphere that's light? Is it, you know, playing a game during the meal? Is it listening to a song or a podcast? And I will generally I advise parents to avoid discussions around food, weight, nutrition, bodies, diet. Like, those topics we don't want to touch during the meal. Again, they're already really anxious, so I'm usually thinking of, how can we keep this kiddo out of their head right now? [00:17:00] What can we engage them in?
Dr. Karen Nelson: Are those things that they're talking about in therapy with you? Or where may they get some of those tips?
Lisa Bonahoom: Yeah, I will try to prep parents in a session and let them know like, ‘Hey, when you go down and you eat lunch in the cafeteria with your kiddo, here's some things to keep in mind.’ Otherwise, I think oftentimes these are things that are being communicated in both individual sessions with your therapist or dietitian and during the family support groups. And I think this sometimes feels a little weird for parents to hear initially too, but I'll encourage them: Match what your kiddo's eating, right? Like if your kid is sitting down and having lasagna and cheesy garlic bread, can you have lasagna and cheesy garlic bread too?
Dr. Karen Nelson: For sure. I love that. To just maybe decrease some of the anxiousness. Modeling. I think about modeling how as parents we do become just really good models. Normalizing. Or what do you think?
Lisa Bonahoom: [00:18:00] I think it's all of the above, right? We don't want a kid sitting down to have a fear food or a food that eating disorder is telling them is bad or unhealthy, and then mom or dad sits down and has a salad with salmon, right? It kind of is reinforcing the idea, ‘Well, if they're not eating it, something is wrong with it.’
Dr. Karen Nelson: Good point.
Lisa Bonahoom: So yeah, I think both, you know, modeling and normalizing by eating the same food your kid's eating.
Dr. Karen Nelson: So, so important.
Lisa Bonahoom: I think that's a big piece of what we try to educate parents on as well. Which can be a paradigm shift, really. Like diet culture is rampant in our society. We use these terms so loosely and nonchalantly. Good food, bad food, healthy, unhealthy, that's okay, that's junk. And really having to retrain parents to avoid those labels, [00:19:00] avoid those terms. And we're looking at food as food is fuel, all foods fit, not good, not bad, not healthy, not unhealthy. And this takes time, right?
Dr. Karen Nelson: Yeah. Well, once a child is diagnosed with an eating disorder, there often may need to be weight, or there could need to be weight restoration happening. Why would we focus on weight restoration first? Okay. This is incredibly important. We know from research, getting into your goal weight range is the number one predictor of long term health and recovery from an eating disorder. You cannot attain a full recovery while being at an unhealthy weight with an unhealthy brain. There's a really big emphasis on getting kids back to a healthy weight so that they can continue to grow and develop. So that their [00:20:00] bodies can go through puberty and their organs and bones and muscles can heal and be restored. So, we focus on that first, because the more time that goes by, the sicker they're becoming, the more their organs are deteriorating. It's really important to get them back to a healthy weight first. The goal weight range is a highly specific, highly individualized number based only on that child's health history and growth charts. So, our wonderful dieticians at Melrose take a look at those growth charts since the day that child was born. They're looking at the data and the graphs. And based on all of that information and all of that data, they're able to calculate where that child needs to be currently in order to be at a healthy weight. The vast majority of these [00:21:00] kids, because they have an eating disorder, they don't want to get into their goal weight range. That's terrifying! The eating disorder is filling their heads with all of these lies as to what negative things will occur when they're in their goal weight range. So that in turn makes parents really anxious, parents really scared. So almost always the child disagrees with their goal weight range, but it's even more difficult if we don't have parents on the same page. Because it's so critical that we're presenting a united front: parents and treatment team sending the same message. Yes, we all agree. This is the healthy weight. This is the goal. This is where we're going.
Dr. Karen Nelson: As parents are maybe learning more about the importance of goal-weight range, any tips you might give parents on how to have that conversation with their child? Because I could see how, you know, I leave Lisa's office. And then this starts to become an argument where the [00:22:00] child is, you know, ‘Oh my gosh, mom, I can't do that.’ And, and mom is worried because my child's upset. How do you coach parents on that? How do they respond to their child if they disagree?
Lisa Bonahoom: Yeah. Yeah. So it's tough. You know, one thing I will offer up to families is, you can blame me. I'll take it. I don't have to go home with your child at the end of the day. You can blame me. You can blame the treatment team. And ultimately there's truth in that these parents aren't doing anything. Their treatment team isn't advising them to do. Right? And if you are coming in to treat a tumor and your team of providers is saying you need six weeks of chemotherapy, parents are going to do the six weeks of chemotherapy whether or not their child wants to, right? And so, you can put it back on us, like, ‘Your treatment team has decided,’ ‘Your [00:23:00] treatment team agrees, in order to fully recover, we have to do this.’ So, it's okay to validate your kiddo, and I think that's an important piece of this too. And their distress does not change the goal that we're working towards.
Dr. Karen Nelson: Well, and I think that part of, we are the experts. And it sounds like you do a beautiful job of really educating them. You said, I'll take the blame. I'll take one for the team, right? Like, it's okay to be mad at me as your therapist. And the eating disorder is mad at us. And I like that, you know, differentiation. The eating disorder is being ultimately challenged when we're in a space of weight restoration.
Lisa Bonahoom: You bet. I'll explain to families and kids, at the end of the day, an eating disorder is, it's a disease. It's an illness. And the number one goal of any disease or illness is to stay alive. And I almost [00:24:00] always talk to families about the fact that there will be bumps. I strongly believe the hard work always happens at home with eating disorders, right? When families are up in inpatient, there can be such a sense of relief that, all right, other people are taking care of this right now. That's not to say it's easy for the parents. But you have staff 24/7 supporting you. And so, really, I'm trying to prep families with this prior to discharge. Out of the gates, I let them know this: The second you walk out these doors, we are running a tight ship that there's no negotiation, there's no concessions, there's absolutely no wiggle room for that eating disorder. And kids are going to try to push the limits, and eating disorders are absolutely going to see what they can get away with.
Dr. Karen Nelson: [00:25:00] Any suggestions? If a child is really angry or crying or upset, saying, ‘I can't eat that mom,’ or ‘I won't eat that dad.’ What might a parent do?
Lisa Bonahoom: One of the things I'll coach parents on is it's okay to validate, right? And again, I think that's important. ‘I'm sorry this is so hard for you. I can see that you're struggling. I know this is a fear food. I know this is so scary for you. And we have to do it anyways.’ So I think absolutely okay to validate, but also still very important that we're sending the message, ‘We have to do this no matter what your emotions are doing.’ And it's okay to take a break, right? If emotions are really high and people are about to say nasty things to each other or they are saying nasty things to each other. You know, I'm a big believer in like, let's step away. Everybody maybe needs a five minute break and then we're going to come back to the table.
Dr. Karen Nelson: That's awesome. But [00:26:00] the goal will always remain three meals, three snacks.
Lisa Bonahoom: The goal will always remain the three meals and the three snacks.
Dr. Karen Nelson: We just can't deviate, right?
Lisa Bonahoom: We cannot deviate, just like you wouldn't deviate if this was their inhaler or this was their insulin or this was the antibiotic.
Dr. Karen Nelson: I think that's one of the things that I'm just always so impressed with each and every one of my patients is their ability to do hard things. To be uncomfortable, and then do it anyway. We watch people do that all day, and it's really remarkable. And it makes sense that there may be a lot of emotion attached to all of that.
Lisa Bonahoom: Oh, I mean, a hundred percent. You know, and I'll remind parents too, especially when kids are in IR: We're taking the eating disorder away from them. Of course, this is going to be intense and stressful and overwhelming and all of those things. And I also try to remind parents that you guys have done this before, right? If you're experiencing a [00:27:00] tantrum or a blowout at home, ‘Hey, you've done this before. You've had a three year old that throws a fit in Target. You've had a three year old that throws a tantrum and is sprawled out on the floor, refusing to put on their pajamas, right? So to not let that eating disorder trick you into thinking you don't have the ability to do this. You've done it.’
Dr. Karen Nelson: It sounds like it could be pretty exhausting for parents and guardians and loved ones as they're really focused in on working on recovery at home. What pieces of advice or recommendations or encouragements that you may give to parents to keep going?
Lisa Bonahoom: Yeah, it is. I think oftentimes this work is its own full-time job. And I know a lot of times in our culture especially, self care can get an eye roll. If parents fall apart during this process, the ship sinks, right? So [00:28:00] is there a way for parents to take turns if mom needs a night off, if dad needs a night off. Like, hey, is there any way that we can honor that? Is there a grandparent that could help out with a meal that we can trust to hold the line? But, you know, essentially just how can you take care of yourselves during this incredibly stressful time?
Dr. Karen Nelson: So true. Well, and I think too, as we kind of practice these eating behaviors in the home, demonstrating to the kids that it's not an option. This is the meal. It is in front of you. I get it's hard. And we're doing it anyway. So kind of creating that boundary. I mean, do you think that that consistency does help with recovery? Or what have you noticed?
Lisa Bonahoom: Oh, absolutely. Eating disorders are opportunists. So, they are constantly looking for an opportunity to – doesn't matter [00:29:00] if it's two chips, one bite of a cheese stick, a pretzel. The eating disorder is, again, they're sneaky, they're creative, they're manipulative. They might smear food under a plate. They might put food under the table for the dog. They might say they need to use the bathroom but actually have, you know, their tater tot hot dish in their pocket. There might be a cheese stick up their sleeve. It doesn't feel great telling parents this, but it's so necessary. You have to remain suspicious and vigilant. This is a very sneaky illness. So if you're not there providing supervision during all meals and all snacks, let's just assume it's not getting done.
Dr. Karen Nelson: What would a parent do if they discovered, ‘I think she put the tater tot hot dish in her pocket and and dumped it out into the toilet.’ How might [00:30:00] a parent respond?
Lisa Bonahoom: Yeah, well I think, absolutely needing to approach their kiddo and let them know that they know what happened. ‘I see what's going on. I'm on to you. You're not able to get away with this.’ And then ultimately replacing however many calories you think they fed the dog or flushed down the toilet or stuck up their sleeve. We're replacing them for the amount of food that they missed.
Dr. Karen Nelson: I love that. So just consistency and follow through.
Lisa Bonahoom: Yes. Absolutely.
Dr. Karen Nelson: I share with parents a lot, of course we don't want our kids to hurt. And I get it that those mealtimes are really intense. And it can feel like, ‘Well, it's just a cheese stick and she really doesn't want it. And so what if I'll just skip it this week?’ What happens if they skip it? What do you notice may happen?
Lisa Bonahoom: Yeah. So we will absolutely see a snowball effect, right? In normal [00:31:00] circumstances, it wouldn't be a big deal, right?
Dr. Karen Nelson: That's right. It wouldn't be a big deal.
Lisa Bonahoom: Like, hey, you don't feel like having that cheese stick? Cool. This is so different. Again, it's such a paradigm shift. The eating disorder is always looking for a way to remain in control. So if the parent does not respond to the kid hiding the cheese stick, now the eating disorder knows. It works. And it is going to keep using it every opportunity it gets. And so, again, that's why I'm saying, I'm not kidding you guys, the second you leave these doors and step out of this clinic, no negotiations.
Dr. Karen Nelson: It’s game on.
Lisa Bonahoom: Yeah, it's game on.
Dr. Karen Nelson: What about the comment – I get this one a lot in family sessions – ‘Well, my sister didn't have to eat the cheese stick.’
Lisa Bonahoom: Yeah.
Dr. Karen Nelson: How come I have to eat that, you know, full piece of garlic bread and Janie doesn't have to?
Lisa Bonahoom: Yeah, and that is so difficult. So [00:32:00] again, if I'm the parent and I'm in this situation, I'm validating, ‘That is hard. Janie didn't have to eat the breadstick and you do and I acknowledge that that's difficult and you don't want to eat the breadstick. And Janie doesn't have to restore weight. Janie is not recovering from an eating disorder. Janie has very different nutritional needs than you do right now.’ And again, I'll kind of reframe with this medical analogy that I'm not going to skip my insulin because no one else is taking insulin. I'm not going to forgo my inhaler because no one else at the dinner table is using an inhaler. Right?
Dr. Karen Nelson: Let's talk about – we had kind of mentioned that word self care for parents. And we just know that as a parent is supporting their child through recovery, most likely they're going through a lot. And so help us [00:33:00] understand how you may talk to parents about just the importance of taking care of themselves through that process.
Lisa Bonahoom: Yeah, I think again, I will talk to them about, they are in a leadership role with this treatment. They are driving the boat here. They are an incredibly important asset in the fight against the eating disorder. When we're doing family based therapy or FBT, you know, parents are considered the number one asset, the number one mechanism. And so, if you're getting three hours of sleep, if you're not eating, if you're not staying hydrated, if you're not maybe going to your own therapy or your cycle class, whatever it might be, how are you going to have enough left over to fight this incredibly difficult fight? Teaching them in that way, and then I think it can also [00:34:00] be really helpful to connect with other people going through a similar experience. So, this is where I might refer them to one of our support groups where they can connect with other families and other parents and, you know, it can be so valuable. ‘Hey, we had this situation last night. Have any of you experienced that?’ ‘Oh yeah, we have, and this worked or this is what I did with that.’ Sometimes I think information holds more weight when it's coming from somebody else actually living this experience than a provider in an office.
Dr. Karen Nelson: Do you think there are any kind of practical ways that friends or family may be able to support parents who are helping their children recover?
Lisa Bonahoom: If I'm working with a family and, you know, they've got a grandparent that lives nearby and they think this individual can hold the line, they might take dinner [00:35:00] off and Grandma or Grandpa, or both Grandma and Grandpa, are in charge of dinner tonight. Or maybe it's having family help out if there's other siblings with carpooling or spending time with other siblings. Maybe it's not monitoring a meal, but coming over after a meal so mom and dad can go for a walk, or run to Target.
Dr. Karen Nelson: With no kids? What's that luxury, Lisa?
Lisa Bonahoom: I'll tell you when I get there. I don’t know yet.
Dr. Karen Nelson: I know. Same. Same. But having – literally having a break, taking – so the emotional load is not always a hundred percent on the parents.
Lisa Bonahoom: Yeah. Definitely. I think that's really important and it's hard to, I think of when you have a newborn, like the last thing that crosses your mind is taking a break. And yet I think it's one of the things that we so need in that [00:36:00] time period, right?
Dr. Karen Nelson: For sure.
Lisa Bonahoom: Is some breaks. And so –
Dr. Karen Nelson: Oh my gosh, yes.
Lisa Bonahoom: Trying to kind of remind parents and nudge them in that direction. Like, ‘Hey, are you taking care of yourself?’
Dr. Karen Nelson: You know, Lisa, there's definitely parents and guardians listening today. Anything particular you'd like to share as we're just getting ready to close? Last minute thoughts?
Lisa Bonahoom: I think one of the things that's so important for families to hold onto is that recovery is absolutely possible. Sounds kind of cheesy, but I think in the throes of it, it can feel like this isn't worth it. ‘Hey, we are all unhappy. We are all crying and fighting. My kid hates me. Is this really worth it?’ And 100 percent it is. And I always remind families and kids if recovery were not possible, we wouldn't exist. You and I wouldn't be doing this difficult [00:37:00] work.
Dr. Karen Nelson: So true.
Lisa Bonahoom: We sure as heck wouldn't be making families and kids do this extremely difficult work. So I think holding onto hope that a full and complete recovery is possible. You will never look back five years from now, 10 years from now and say, ‘Hey, I really wish we would have just kind of let Jane keep that eating disorder.’ This is always, always worth it. So.
Dr. Karen Nelson: And the final question that I get to ask most everyone, is there anything I haven’t asked today that you'd like to share.
Lisa Bonahoom: One thing I do want to share, and I think this is just – this comes up so often in my work with families, is that we talk a lot about distress tolerance and parents being put in this incredibly difficult role of having to tolerate their child's distress.
Dr. Karen Nelson: Yes.
Lisa Bonahoom: And we know as parents, it makes you want to poke your [00:38:00] eyes out or pull your hair out. You don't want to see your children hurting, right?
Dr. Karen Nelson: You got it.
Lisa Bonahoom: And reminding parents that tolerating your child's distress is not lack of caring. That especially in this context, this is a pro-recovery behavior and it is showing that eating disorder, no matter how hard you dig your heels in, no matter how big of a tantrum you throw, we will never give up.
Dr. Karen Nelson: Wow. I love that place of, when it's hurting, we're probably doing it right.
Lisa Bonahoom: Yeah.
Dr. Karen Nelson: When we're challenging the eating disorder, you nailed it, right?
Lisa Bonahoom: Yep.
Dr. Karen Nelson: Like you probably picked the perfect food if they're having a tantrum. That's the challenge food we need to work on.
Lisa Bonahoom: That means you're doing something right.
Dr. Karen Nelson: And never give up hope.
Lisa Bonahoom: Yep.
Dr. Karen Nelson: I love it. Well, Lisa, thank you so much. I just [00:39:00] so appreciate your conversation. Just so wonderful and helpful today.
Lisa Bonahoom: Oh, thank you. It's been fun.
Dr. Karen Nelson: 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.
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.