Olivia has recently been discharged from a six-month inpatient stay. During the initial transition period, she adhered to her meal plan, worked with the outpatient team and life returned to some form of normality. However, a recent family bereavement appears to have sparked a potential relapse. Restricting and exercising are building up. Marcus arrives home from work to find Oliva preparing to go out for another arduous run.
Marcus: Hi Livvy, you there? Sorry I’m a bit late, traffic tonight was awful. What a week with work too. I could kill a large glass of Sauvignon. Do you fancy joining me?
Olivia: Not right now, I’m gonna go for a quick run before dinner. I may a have a glass with dinner. I’ve made a tuna salad. It’s in the fridge. Just begin without me, if I’m a bit late back.
Marcus: Looks like you’re gearing yourself up for another arduous exercise work-out. I’ve noticed that you’ve really upped the game on the exercise since losing your Gran.
Olivia: I don’t really want to talk about that. I’m going for a run. I won’t be long.
Marcus: OK…I don’t want to get into this right now. You are obviously determined right now. It is important, however, that we address all of this. You have done really well, put in such a lot of effort with the treatment and I feel that it’s all gone a few steps back. Now is not the time to address that but if it’s OK with you, let’s discuss this either during dinner or if that’s too difficult at a time when you feel at your calmest. I would like it to be this weekend.
Marcus recognizes the futility, or even danger, of starting an emotional exchange at that particular time. However, he does reflect on her recovery efforts as well as a potential relapse and emotional challenges after losing her grandmother. He sets boundaries, i.e. that this conversation is very necessary but respects Olivia’s autonomy, giving her the options in the near future of when it will occur.
Marcus: (the following day) You’re look a bit more chilled today, Liv. Following on from yesterday’s chat, how do you feel about having a walk along the seafront so we can chat about some concerns I have?
Olivia: That’s one way to unchill me!!
Marcus: I know that this is difficult for you; it’s difficult for us both. I obviously can’t talk for you, but from my perspective, I’ve noticed some increased anxiety that are morphing into eating disorder behaviours, more so since you lost your Gran. I know you were really close to her and these things are difficult enough without also adding recovery from an eating disorder into the picture.
Olivia: I do think you are jumping the gun a bit. So…I went for a run last night. What was the big deal? I have been sticking to my meal plan, haven’t I?
Marcus: I have noticed you giving yourself increasingly smaller portions and I’ve been recognizing some red flags during the last month. Like I said, you worked so hard in the Unit and you appeared to be in a much better place during the early transition weeks. It would be such a shame to lose that and for you to have to go back there.
Olivia: That will not be happening! I hated it in there.
Marcus: I just feel we are not out of the woods yet and I feel I need to be totally honest in what I’m seeing and feeling. It looks to me as if you are struggling with your feelings and emotions and this is resulting in some familiar old choices.
Marcus uses empathy and reflections as well as affirms Olivia’s previous efforts in recovery. He empathizes over current difficulties with her recent bereavement but nevertheless, he airs his concerns in a compassionate, firm manner.
Olivia: It is difficult. Don’t worry. I will get back on track.
Marcus: I know it’s difficult and I have no doubt that you intend getting back on track. Making the changes you have already made was never going to be easy. I want us to have that life we spoke about during therapy and I know, deep down, you want that too. I feel we’re on a bit of a dangerous slippery slope right now. OK, I hear you say, your daily run should not be any cause for concern; smaller portions shouldn’t be any cause for concern. However, from past experience, it all could quickly snowball with these behaviours increasing rapidly and the eating disorder completely taking over once again. The impact of these behaviours increasing concerns me; not only for your wellbeing but for our lives together, our future.
Olivia: Are you threatening me??
Marcus: No, I’m not threatening you. I am gently reminding you of the life goals you speak about. For instance, think about where you would like to be in five years’ time. On the one hand, you talk about wanting to start a family together and you also want to go on a road trip to the States next year, yet it seems as though the illness still has a hold on you. What will life be like if you’re still struggling with this illness? Take the road trip, remember when we first met seven years ago and the holiday we took around Australia. That was brilliant, we had such a great time. How would that experience have played out had Annie Anorexia taggled along with us?
Marcus reminds Olivia of life goals. He uses reflections and rolls with resistance using a gentle but firm stance. He develops discrepancy between future goals and current behaviour and uses visualization techniques encouraging Olivia to look forward to the future as well as looking back at a time when the eating disorder did not have the current strong hold around her neck.
Olivia: I do hear what you’re saying. It pisses me off but I do hear you.
Marcus: I am not trying to bully you. I will bully the ED though. I want us to move forward without the demon and I want to support you in the best way I can. I cannot do it for you. However, I can do it with you. Tell me, what are your thoughts on how we can turn this impending blip around again? How can I help you kick its ass?
Olivia: Not too sure. Maybe a good start, would be to mention it at my next session. I haven’t brought it up with Claire (therapist) yet. You are right in some ways – I have been feeling a stronger pull to some old ways, but I don’t know….
Marcus: OK, lets put this conversation on hold for the rest of the day and enjoy the day. I do trust you to make the right decisions with regards to your health and the future.
Marcus separates the illness from Oliva. He feels that their conversation has reached a point where he is comfortable in using open questions to explore further. He also feels as if he has planted the seed for now. He would like them to spend the remainder of the day engaging in non-eating disorder talk and activities but not before affirming his trust that Olivia can beat this.