Change is an unknown expectation in life. Life is about expecting the unexpected. The only thing that is certain is change. Whatever way you choose to spin it, we can all understand that change is inevitable. We grow older. Relationships both begin and come to an end. And for many of us, this idea that everything may ultimately be completely out of our control is unsettling. If you’ve been diagnosed with an eating disorder (or many other diagnoses), change is terrifying. And research supports this, as it has repeatedly been shown that the development of an eating disorder is often based in seeking control in a world filled with potential feelings of powerlessness or ineffectiveness.
As the recovery journey begins, that need for control, stability, predictability, lingers (or even gets stronger). Treatment teams can change as you move within levels of care. Your motivation for recovery might not always look the same. There could, conceivably, be physical changes within your body. As you progress in recovery you will likely experience a phasing out of support needs. One of the most frequent statements made between myself and my treatment team has been, ‘I wish I had a crystal ball.’ Because even though I may not have control over the path of my recovery, the response of my body, or the relationships with the people around me, with that crystal ball there would at least be some predictability.
Changes in Treatment Team Members
Recovery requires vulnerability, trust, and strong interpersonal relationships. It takes time, commitment, and sometimes just the grace of the universe to bring the right people together to develop an effective treatment team. Unfortunately, recovery is not linear (insert eye roll) and as level of care changes, so do treatment team members. Even in an outpatient setting I’ve found that providers I once had a strong connection with no longer meet my needs, financial resources have required shifts in team members, and sometimes providers just aren’t a good fit anymore.
And these shifts can be overwhelming, heartbreaking, and incredibly frustrating. When receiving a higher level of care you spend a lot more time with your providers as a result of the setting and limited duration of residential or PHP programming. In that time, there is a high level of trust that is established much more quickly than in an outpatient setting. Your providers get to know you, and you get to know them-really well, but preparing to step down and the eventual end to these relationships can be incredibly difficult. The possibility of sudden discharge as a result of insurance eliminating funding turns this into a sudden shift and an even more difficult transition.
For me, this change resulted in an overwhelming anxiety about the unknowns of what living a recovered life in an outpatient setting looked like. I had made progress in my recovery, but I had done so in a structured setting, with nearly constant accountability, and a treatment team that had been by my side every day for eight weeks. I was fortunate to be discharged to a well established treatment team, who went above and beyond in the care that they provided-yet, this was a change that I still struggled to adjust to. And initially, my response was to self sabotage in an attempt to prevent this change from happening.
When that didn’t work I learned that it was necessary for me to communicate with everyone about the anxiety that I was experiencing and to actually express what I needed to make this transition successful. Collaborative meetings between both teams prior to stepping down ensured that everyone had the same focus on my recovery. A structured outpatient schedule provided me with predictability and accountability similar to what I had become accustomed to. And the knowledge that while I hopefully wouldn’t need to return, establishing that if outpatient did not go well I would always be accepted back, reduced the fear that I was eliminating treatment options from my future and forever saying goodbye.
Responding to Physical Changes
If anyone has advice on how to respond to this change, I’ll gladly accept it. But, in all honesty, this has been one of the more difficult pieces of recovery for me. When I started this journey I didn’t think that the development of the eating disorder was strongly based in body image or sense of self. I still don’t believe this was the root of my eating disorder, but so many of the messages that I received as a child attached themselves to the physical appearance of my body; and letting go of that messaging has been its own challenge.
One message that the eating disorder thrived on was, ‘your body needs to express your need for care.’ As I have learned to verbally express my need for care and support, I have recognized that there are alternative methods to receiving the care that I need; and that people actually want to love, care for, and support me. This has been incredibly beneficial in learning that I myself am important, as a human, outside of needing to be cared for in recovery.
The other message, ‘demonstrable femininity is dangerous,’ and the eating disorder drove me to both hide my body and to hide within my body. As I have taken the time to find myself and who I am outside of the eating disorder, I have also become more aware of how I choose to express myself externally. I am proud of my tattoos and my piercings. My full, long hair is my favorite feature. Body hair is no longer something that I am ashamed of. And non-binary clothing is a wardrobe staple. Expressing myself in a way that makes me feel more seen has allowed me to feel just a bit more comfortable in myself and my body.
Changes to Recovery Motivation
Here comes that phrase again, ‘recovery isn’t linear’ and neither is the motivation to recover. Some days you’ll wake up feeling like you can take on the world, while other days your only intention will be making it through the day. I have been told over and over again that you don’t have to push yourself everyday. My first reaction, ‘That is absolutely ridiculous, if I’m not pushing myself, if I’m not specifically working toward something, what’s the point?!’
I am a purpose driven individual. My strongest moments in recovery have been when I have a clear goal, a strong vision for my future self, and can clearly envision what living a recovered life looks like. I wish I could say that this was a constant. That I always know my why, but I don’t. Sometimes that recovery vision gets lost and the steps that I need to take to be successful are overwhelming. When I lose that ‘why’ I often lose my motivation to recover.
Learning how to keep going without actively working to achieve something has taken time. Now I have days, sometimes even weeks, where I don’t have (what I would consider) ‘big’ wins. Sometimes my wins are just making it through the day following my meal plan, verbalizing when I need extra help, or honoring my need to just rest. Past me felt like if I wasn’t actively making progress or overcoming major challenges each day, then I was failing. And this sense of failure often meant giving up on myself. It has taken time and a lot of work to shift that mindset; and while being highly motivated in recovery is great, allowing yourself to rest and reset at a baseline is also pretty wonderful.
Phasing out Treatment Needs
I have developed a strong, open, honest, trusting relationship with my outpatient team. They were the first people to experience the 100% uncensored, emotionally vulnerable, version of me. They have seen me at my highest highs and my lowest lows. And I [quite literally] trust them with my life. These humans are safe. I know that in those relationships I will always be accepted as I am; and that’s something that I find difficult to predict and establish in relationships outside of the treatment space. For that reason, one of my greatest fears and hesitations with recovery has been the idea of phasing out my frequency of sessions and therefore, having to rely more on my natural support system than an established team.
Until recently, I thought I was prepared for this. ‘Suddenly’ the structure of scheduled appointments, the predictability of having external accountability each day, and the ability to reach out for support at a moment's notice wasn’t there. And I realized that I still didn’t know how to provide my own internal accountability. I realized I still didn’t have the same level of trust established within myself, my friends, and my loved ones as I did in my team.. And I realized that as much as I wanted it, I was still not emotionally ready to begin phasing out my structured treatment needs. I view myself as highly independent. Un-needing. Self-sufficient.
But, I struggled. I went back to the safety of old behaviors until things returned to normal. I have made growth in my recovery and my authentic self recognized that this really wasn’t working. I also recognized that I need and [want] the support of others. For the first time since I began treatment I was open, honest, and vulnerable with my partner about the eating disorder fueled thoughts, urges, and what I needed for support. And they showed up. They showed me love, acceptance, and helped make the difficult decisions with me. This unrequited support is exactly what I needed to begin to develop trust as I phase out my formal treatment needs. I now know that I am supported, cared for, and accepted. Because as much as we may want to believe-none of us were meant to go through this life alone.
These are all just my own experiences on this journey. I am in no means an expert in the eating disorder field. I don’t expect your experience to perfectly mimic mine. And I certainly can’t guarantee that what has been beneficial for me will be impactful for you. My hope is that by sharing my experience we can find a commonality. A sense of understanding. The opportunity for personal exploration. And the courage to step outside of comfort zones into a world that might be unfamiliar, unpredictable, and perhaps slightly out of control.