Relapse Prevention and Wellness Planning

Written by Melinda Lericos, LPC

I am Melinda and I run our relapse prevention and wellness planning groups at Thalia House. To say relapse prevention is my passion in eating disorder treatment would be an understatement. Many providers fear talking about relapse because they don’t want to trigger thoughts of relapse or remind clients of their old behaviors. However, I truly believe that if we do not prepare our clients for the potential of relapse and provide them with tools to recognize and reduce those behaviors we are setting our clients (YOU) up to fail at their recovery.

It is for this very reason and passion that I have spent the past several years running our relapse prevention group at Thalia House while curating a curriculum that I know sets our clients up to succeed in their recovery, even when it is not easy to stay committed or it doesn’t “feel good” to keep choosing.

I frequently get asked the question, “What do you cover in your relapse prevention group?”  To answer that question, I have decided to start a blog series on our relapse prevention group to cover 1) what you, as a client, can expect to cover and 2) how this group can be used with your individual outpatient team.  This blog post will serve as the initial overview into the flow of the group and I will expand from here. As the series continues, click on the links in this page to learn more about each area of the group process.

Our group starts with an educational foundation of stages of change and styles of motivation. We work together to identify where each person is currently struggling to move forward in their recovery and what their unique motivators are for their life without ED. We then work together to demystify the idea of a “perfect recovery.” We explore the continuum of relapse towards recovery and normalize the ups and downs, the non-linear path, that leads to living a whole-hearted and values-driven life. Together we break away the shame of “doing recovery right” and we create space for things to be whatever they are in this moment.

From there we take some time to figure out what things will inevitably make the recovery process not perfect. We identify internal emotional triggers and external environmental triggers. We gain insight into how our behaviors try to keep those triggers exiled but ultimately end up harming us. Along with internal and external triggers we address conflict management and conflict resolution. Relationships are a HUGE part of recovery (and relapse). Learning how to navigate conflict in relationships inter-personally and intra-personally is vital to long-term sustainable recovery.

After we get a handle on all of the ways we anticipate the desire for behavior use to arise, we take an inventory of how we justify using our behaviors. We break down all the reasons, all the excuses, for returning to negative coping skills and we create a plan of new skills to use when we get stuck in these patterns.

Once we have a deep understanding of what triggers us to use behaviors, what justifications we create to continue using behaviors, and what motivations we have to challenge our eating disorder / what we have to lose if we go back to using we move into the last part of the curriculum: Wellness planning. In wellness planning we look at 6 areas: Nutritional, Physical, Behavioral, Cognitive, Emotional, and Interpersonal. In each area, every individual identifies signs that would alert others to behavior use. This is used to create accountability within the support system. We explore what functions or needs would be met by using behaviors in each area. We look at resistance to change and create a plan with skills to help bring each client back into recovery and out of their behaviors.  We also look at resilience factors to relapse such as medication management, sleep, exercise and more.

The hope is that this plan can be shared with providers and support systems to aid in long term behavior change and accountability for those who will be doing life with our client in the future.



Mindful Eating

Written By: Lynette Morris, RD, LD

Hunger is the enemy to a person suffering from an eating disorder. Hunger
threatens the maintenance of a low body weight or triggers a binge eating
episode and fullness is equated with weight gain and being out of control. One
way a person with anorexia responds to hunger is by switching what is normal
for what is abnormal. Feeling hungry all the time becomes normal and feeling
satiated or full feels abnormal. The feeling of hunger not only reassures the
person with anorexia she is not going to gain weight, but also gives her a false
sense of security that everything is going to be all right.

How is it that food and eating have become such a common source of
unhappiness? And why has it occurred in a country with an abundance of food?
The fundamental reason for our imbalance with food and eating is that we've
forgotten how to listen to what our bodies are telling us. The problem lies in our
mind. It lies in our lack of awareness of the messages coming in from our body,
from our cells and from our heart.

At Thalia House, we teach the residents to listen to what their bodies are telling
them about hunger and satisfaction. We call this Mindful Eating or intuitive
eating. Intuitive eating is necessary for a recovering person to be able to develop
and maintain healthy eating patterns and body weight.

Eating intuitively helps us become aware of who in the body/heart/mind complex
is hungry, and how and what is best to nourish it. It also involves paying full
attention to the experience of eating and drinking, both inside and outside
(environment) the body. We pay attention to the colors, smells, textures, flavors,
temperatures, and even the sounds (crunch!) of our food. We pay attention to the
experience of the body. Where in the body do we feel hunger? Where do we feel
satisfaction? What does half-full feel like, or three quarters full?

We educate the person with the eating disorder to understand that their
preoccupation with food, the insatiable hunger, and the periods of uncontrollable
eating are normal responses to prolonged starvation and the maintenance of a
low body weight. The person with bulimia or compulsive eating will understand
that the desire to eat large quantities of food in the evening is the bodies
response to food restriction during the day.

It is possible, as one recovers from an eating disorder to gradually regain the
sense of ease and freedom with eating that we had in childhood. At Thalia
House our mission is to help set the residents up for success in recovery when they leave; to make peace with food, honor their hunger, and respect the
wonderful things their bodies can do.

Stages of Change

Written By: Melinda Schneider, LPC

Do you ever have those moments when you notice that your life seems to be more difficult than those of your peers but you are not sure why? Or those moments when you know why, but you are not sure you want to change yet? We have ALL been there at some point, with some behavior or another.

Often times, knowing what stage of change we are on, can help us move forward in growth sooner than if we stayed unaware or in denial. When working to prevent relapse, evaluating a stage of change can help in reestablishing motivation and benefits of staying in recovery.

So what are the 5 stages of change?

  1. Precontemplation
    1. The costs of the problem behavior are not yet recognized. The individual is in denial and is not seriously considering changing their behavior. They may have made previous attempts to change, but have since given up.
  2. Contemplation
    1.  The individual is experiencing ambivalence about change. They can see reasons to change their behavior, but they are still hesitant. The problem behavior continues.
  3. Preparation
    1. The individual has decided to change their behavior, and they begin to think about how to do so. During this stage they will begin to make minor changes to support their goal, but they might not have completely ended the unwanted behavior.
  4. Action
    1. Significant steps are taken to end the problem behavior. The individual might be avoiding triggers, reaching out for help, or taking other steps to avoid temptation
  5. Maintenance
    1. The changes made during the action stage or maintained. The individual may continue to face challenges, but at this point they have successfully changed their behavior for a significant period of time. ­

Take some time to see where you are with your recovery story currently.

What stage do you think you are on right now? Why? Do you feel like you have been “stuck” on this stage for a while now, or have you seen growth recently? What has helped you get to this stage, and not be at a previous stage? What might it take for you to move forward to the next stage?

Intuitive Eating: Why Something That Sounds So Simple Can Be Quite Difficult

Written By: Amy Smith (Counseling Intern)

March is National Nutrition Month! Nutrition and food fuel our bodies and, while eating seems simple and pleasurable for some people, it can be difficult, complex, and often times scary for someone struggling with an eating disorder. Part of the recovery process is learning to eat intuitively based on natural hunger signals instead of relying on the rules of the eating disorder. This means getting reconnected with our body and tuning into what sounds satisfying in the moment. For many who struggle with disordered eating this can be a daunting challenge as eating disorders create detachment between body and mind.  

We are bombarded with messages from so many different sources including media, social circles, and advertisements that tell us what we should and should not eat. Foods acquire a label of “good” or “bad”, “healthy” or “unhealthy”. What we eat becomes less and less about energizing our body so we can be engaged in the world and more about our worth as a person. We begin to lose faith in our body’s ability to sense what we need. We ignore the intuition of what would satisfy our body. We become fearful of our body’s wants and desires and try to shut them out altogether. We say to ourselves, “How can I trust my body? It’s craving a piece of chocolate cake and I just read an article about how terrible it is for you! I have no willpower!” And, eventually we might get to the point of saying, “I can’t believe I ate that piece of chocolate cake; I am a terrible person.”

The truth is our bodies are incredible machines, each one different, unique, and special in its own way. Intuitive eating is about learning to trust our inner wisdom that we were each born with.  The more we can block out the food myths that society conveys and find a way to honor what our body is telling us, the closer we become to eating intuitively. This action leads us to freedom from worries about food and what that means about us as a person.  However, this is easier said than done for many people, not just those that struggle with eating disorders.  How can we ignore the onslaught of messages that say we must police what we eat and, instead, listen to our inner voice? It requires a leap of faith.

Intuitive eating and recovery from an eating disorder in general can feel like jumping off of a cliff. On the top of the cliff you are safe, but afraid and miserable. The eating disorder is familiar and provides a false sense of security that, if you follow the rules, you will feel worthy. “Just stay; who knows what will happen if you jump?” the eating disorder says. Turning to your inner voice, wisdom, and natural body signals can also feel as scary as jumping off that cliff. You may have to jump off that cliff day after day, but it will eventually get easier. And soon enough, you’ll begin to feel that inspiring parachute open up as you glide through the air and see the beauty that surrounds you and the wonderful beauty inside of you. You will land with your feet on the ground and with a renewed sense of self-worth. Your worth lies within your inner wisdom, your very own special and incredible voice.

Imperfect Or Human

Written by: Melinda Schneider, LPC, Thalia House Admissions and Primary Therapist

You are imperfect. But guess what, SO AM I. Every single person, creature, or thing, is IMPERFECT.  Each one of us has our flaws, our quirks, our goofy imperfect tendencies that make us HUMAN. That’s right I said it, “imperfection is what makes us HUMAN”. Now, I know I am not sharing with you something you did not already know. Deep down we all understand that perfection is an unachievable goal. But sometimes I think we forget that if we were to achieve perfection (which again is not possible) it would actually make us NOT human.

So why do we try, sometimes at the cost of our physical life, to achieve perfection? Well, there are a lot of reasons some tries to achieve perfection and one blog post cannot touch on them all, but on a big picture note, people strive for perfection because we believe that perfection is what produces self-worth. Deep down, our culture has taught us that perfection produces worth, and worth is what creates connection, purpose, meaning, and all the things we want and value in life.

But what I want you to walk away from this post with, is the understanding that

                “Perfection does not produce self-worth. And self-worth does not produce connection or a meaningful life.”

In our attempts to achieve perfection, we are actually sacrificing the very things we are trying to gain. Self-worth derives from acceptance of who we are and of our imperfections. Connections are made when we open up about being imperfect, and we honor and validate the imperfections in other people. Meaning and purpose come when we let ourselves put energy into the things we value, instead of the attempt to perfect those things that don’t matter to us.

 So consider this week, how can I use my imperfections to build connections and relationships that matter in my life? How can I begin to honor and value other people’s imperfections? And how do I create meaning in my life without striving for perfection?