New Maudsley Skills Workshops for Local Counsellors & Carers
Golden Guidelines for Carers
These workshop capsules have been created from scenarios considered in previous workshops and are designed to help carers to review and reflect on specific areas that can prove extremely difficult.
In this very short capsule we describe some golden rules, or guidelines for carers
Guideline Number One
Remember your loved one is ill and be aware that eating disorders can come with a high level of medical risk. This is not a lifestyle choice or a teenage fad. Your loved one is not doing it on purpose. Be an informed carer and learn the warning signs that your loved one might be in medical danger and know what to do if things are deteriorating fast. When medical risk is high be prepared to step in, take over and get help. It is not just about weight, but a BMI of under 15 seems to represent a real tipping point when the eating disorder has a really strong grip. When medical risk is back in safer territory you can step back and let your loved one gradually take more responsibility for their own welfare. A useful expression is “Do with your loved one” rather than “Do unto your loved one”
Guideline Number Two
Look after yourselves first. An exhausted carer cannot be an effective carer. Regularly review your “time out”, things that help you relax, get you out in the fresh air, make you laugh etc. Also, your support network. When friends or family offer help, accept it graciously and give them a specific task. So often people want to help but don’t know how. Have a list of jobs in your mind that you can dish out to willing helpers. By looking after yourselves you are role modelling that self-care is very important and that there is more to life than the eating disorder.
Guideline Number Three
Remember that the eating disorder has a purpose. (Control, safety, my friend, I am good at this, I don’t have to grow up, I get lots of attention, it is my identity etc). There is a great saying “every behaviour has a positive intention”. If you try to just take away the eating disorder you risk leaving a void. Recovery is a very gradual process in which your loved one will learn to adopt their own new healthier coping strategies.
Guideline Number Four
Try not to focus all your attention on the eating disorder behaviours. Your loved one is still there, just being masked at the moment by the power of the eating disorder. Try to notice your loved one and her attempts to fight back against the eating disorder. Notice the smallest effort to make changes and try not to show your disappointment when there are setbacks. These are an inevitable and important part of the recovery journey. “Every mistake is a treasure”
Guideline Number Five
Do not try to fix your loved one. The danger is you end up arguing with the eating disorder voice and you are unlikely to win that argument. As a first step consider how you might make small changes to your own responses to the eating disorder behaviours. Are you being bullied by the eating disorder voice, are you accommodating or enabling some of the eating disorder behaviours? Most of us do this to start with because we fear that not doing so might make things worse and we want to keep the peace. Gradually making small changes to your own caring behaviours can have a significant positive impact on family life and role models that change is possible.
Guidleline Number Six
Support your loved one, sometimes with comfort, sometimes with gentle challenges. Just double check every now and then: “Am I comforting the person or the illness?” Once your loved one is ready you can help your loved one to make plans and set realistic goals. If you try to push for change too quickly this can bring out the eating disorder voice. If you try to offer assistance and it is rejected, don’t be disheartened, it might just be too early. Be Columbo and take the step down approach. “Help me understand” “I am curious to know” “Have I got this wrong”
Finally you might relate to this:
Columbo: “You know, sir, it’s a funny thing. All my life I kept running into smart people. I don’t just mean smart like you and the people in this house. You know what I mean. In school, there were lots of smarter kids. And when I first joined the force, sir, they had some very clever people there. And I could tell right away that it wasn’t gonna be easy making detective as long as they were around. But I figured, if I worked harder than they did, put in more time, read the books, kept my eyes open, maybe I could make it happen. And I did. And I really love my work, sir. “
So, the moral of the story is let’s all keep working together collaboratively, sharing ideas, keeping up with new research and using our voice where we can, then together we can make a difference to your loved one’s recovery journey.