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  • Em R

Preparing for Outpatient Step Down

Join Em for the third installment of her writing series as she moves through a higher level of care for ED treatment.


You’ve gotten the news you were hoping for. You have a date. You can start to think about returning to your life and your home in Iowa. To your partner, your friends, your coworkers, your family, your outpatient team. Everyone you’ve missed so much while you’ve been here. So, now that you’re here, “How’s it feeling?” How many times have you been asked this question the past few days. It’s probably been a lot, but have you been honest when you’ve answered.

I’m guessing the more you’re asked, the more anxious you get. The more that you begin to question if you’re really ready. If you can really continue to do recovery on your own. I’ll let you in on a secret, you can. And you won’t really be doing it alone. If this feels big, that’s okay. When you left you were deep in the eating disorder, but you’re ready to go back to your life. And while the people, the places, the things in this life will be the same; your head and your heart are in a new place.

The eating disorder voice has probably made itself louder. Showing up in areas that you weren’t expecting. Reminding you of the freedom you'll have; the opportunities that will present themselves to move more, to hide behaviors, and to venture back down that dangerous path of shame, secrecy, and total relapse. Telling you, “Just two more weeks, and then you can go back to the way things were before.” But settling back into your home and your relationship, into work and friendships, all of that is going to feel (and look) much different than they did before.

You are open to being more honest, more vulnerable, and more trusting in your personal relationships. You know that you can continue to feel safe in the fact you are loved and cared about - not just because of the eating disorder. That these people aren’t going to leave just because you’re recovering. You are a different person than you were 6 weeks ago. Continue to remind yourself that the eating disorder has no place in the life that you want to live. Remind yourself just how much you value independence, exploration, relationships. All of the things that are only fully accessible in recovery.

You are going to have to take responsibility for your own recovery. I know that sounds scary because the eating disorder taught you that you can’t trust yourself. It has constantly reminded you that you can only do this with professional support in place and that the only people you can rely on are those professionally bound to you; because they can’t just leave. You’ve put months of work into these relationships and have finally reached the point that you trust them. You know that you can’t rely on them forever. That part of moving toward recovery means learning to build trust in yourself. Trust to hold yourself accountable on the days that you don’t want to do it anymore. Trust to ground yourself when you start to spiral. Trust to love yourself enough to do this for you.

I know that beneath the nerves and excitement there’s also sadness. And I’ll bet that it’s going to be more than you were anticipating or that you want to let on. You’ve made some very important friendships while you were here. The people that you’ve spent this time in treatment with have a special perspective into your life that very few (if any) others do. In a matter of weeks total strangers became some of the people that you feel the safest with. That you can be your truest, most vulnerable, emotional self with. People you can show up for, share experiences that most others could never relate to, and trust that they will also show up for you. You can look how you want. Dress how you want. Share your poetry and your art. They are the people that you could finally be your authentic self around.

Make sure to remember what made you feel good. Running through puddles of mud and pine needles. Sitting on the edge of a cliff, saltwater blowing through your hair. Sleeping in the back of your car underneath the trees. Being held tightly by those you love. Sitting in a crowded restaurant with just your book and journal. Shouting your biggest wins and fears from the rooftops. Those memories are what you are recovering for. Yes, they were made in a city and with people thousands of miles away from home, but you can take these experiences with you. You can make new memories. You can continue to live this joyful life you’ve found.



**I started writing this letter to myself the day I got notice of my step down date. I was excelling with meal completion, excited to take on new challenges, and in a headspace that allowed me to see the potential of my life in full recovery. From the time that I started writing until now, when I’m prepared to share my experience with all of you, I have also experienced my lowest low since beginning treatment at a PHP level.

In just that week of time, I experienced emotions entirely new to me, had an uptick in the desire to engage in eating disorder behavior, struggled to quiet the voice inside telling me that I wasn’t ready, and began to lose hope that there really was a chance for recovery in my future. Tonight I opened my computer to this tab. The one that I started writing on when I was excited about recovery. I hadn’t looked at it since that first day. So I reread this letter to myself.

And I realized that dark place that I was just in, wasn’t going to last forever. That I had reasons to move toward recovery. That I had people who love me and care about me and are waiting for me to come home. That my purpose in life is simply being-I don’t have to be special, I just need to be me. So, I decided to finish writing. With the hope that you are able to find a similar peace in this message.


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