A child’s return from residential eating disorder treatment is both exciting and terrifying for a lot of parents. So today we’re going to hear from a parent whose child is returning from residential treatment. Like so many parents, she is afraid of what could happen and feels very, very stressed about it. I’ll talk through what she should do to prepare for a return from residential eating disorder treatment, and also how to take care of herself gently and lovingly through this time.
The letter
Dear Ginny,
My child is going to return home from almost two months of residential treatment for their eating disorder. Before that, there was hospitalization and some seriously traumatizing eating experiences.
Of course, I am happy to have my child stabilized and coming home, I’m also terrified. How in the world am I going to keep them on the road to recovery?
I feel like it will be all too easy for us to slip right back into the eating disorder behaviors and I really don’t know what I’m supposed to do. I can’t sleep, and I can’t believe that I’m this stressed out about something that really should be a good thing.
What should I do to make this work? How can I prepare for their return from residential eating disorder treatment?
Signed, Hannah
My response
Oh, Hannah, I totally understand. And I want to start by saying that there is nothing wrong with you for having these conflicted feelings.
Having a child fall down the rabbit hole of an eating disorder and dealing with hospitalization and then residential treatment is incredibly stressful for parents.
I think we need to talk about this more regularly because I can’t even tell you how much you are not alone. Your feelings and fear make so much sense to me and I think they make sense to anyone who has been through what you’re going through.
⭐ Get ready for recovery and find out how you can prepare yourself for maximum success.
⭐ Find out the essential steps and family rules you need to have in place for recovery.
⭐ Make your home recovery-ready with six simple steps that anyone can do.
Planning for success – routine
The very first thing we need to talk about after residential treatment is routine.
You said that you’re worried about slipping into the eating disorder behaviors, and the most important thing is to maintain routines, schedules, and expectations when your child gets home.
For example, if you have your child for a meal and a snack each day, then serve them at the same time, and sit with them to ensure they finish the food you serve. And as they eat more frequently at home, keep up your schedule of feeding and monitoring.
This is a real bummer. Of course, it would be great if your child came home from treatment and you could relax. But unfortunately, it doesn’t work that way.
It typically takes at least a few months after residential treatment for your child to gather momentum in their recovery. Residential treatment was about stabilizing them, but the real work of recovery takes place at home.
And during that time your involvement can make the difference between forward momentum and stalling or, worse, slipping backward.
I often recommend that parents who are expecting a child from residential treatment to think through a schedule that is fairly close to what was happening in residential.
At a minimum, you should plan on meal times, bedtime, and time for connection.
Feeding
Your child will need to eat with you regularly, so plan out both when you will eat together and what you will serve.
I try to make this plan as detailed as possible so that parents aren’t scrambling when their child gets home or downshifts to a lower level of care, such as from Intensive Outpatient treatment which typically begins at 7 days per week, all day, and then shifts to 5 days a week and ultimately switches over to regular outpatient in which your child is eating all or almost all meals at home and just goes in for treatment appointments with their providers.
I suggest that you actually plan out a menu. This may sound like a pain, but I promise it’s better than feeling as if you are underwater, trying to manage your kids’ eating disorder and plan meals at the same time.
During the intensive stages of recovery, I think it’s a lot easier if parents know exactly when and what food will be served every day. You will have plenty to do during the week without worrying about meal planning.
Bedtime and social media
Next, I strongly recommend that you establish and enforce bedtime. This is not easy, but it can make a significant difference in recovery.
Usually, the thing that keeps our kids up at night is social media or other phone and computer use. This is why it may seem harsh, but you may want to impose a timeout on your wireless Internet connection and bedtime blocks on your child’s phone.
I know this may seem drastic, but sleep is absolutely essential to your child’s recovery, and their phone and other electronics are the most common reason for lack of sleep right now.
Kids absolutely hate this, but I think it’s an important boundary to enforce. I know that it’s tempting to not hold firm on any non-food boundaries, but I actually think it’s better to establish some non-negotiable non-food boundaries. Parent-child boundaries are actually essential to healthy relationships.
This isn’t about you being rigid or mean; it’s actually about you loving your child enough to hold them in the safety of the boundaries you set for their health and wellness.
Connection
Finally, I suggest that you intentionally plan to connect with your child emotionally at least once per day. You might have never done this before, but it’s actually a great practice with anyone you’re in a relationship with.
You see, it’s all too easy to put our emotional connections on auto-pilot, assuming that people know how much we love them because we’re doing all the things like taking them to treatment, serving their food, paying the mortgage, taking out the trash, and all the other things that go into raising a family.
But relationships don’t run very well on autopilot, and recovery starts with weight and nutrition, but it sustains when there are deep emotional connections.
How to do it
I suggest that you set aside at least 20-30 minutes of time each day when you sit together in the same room and either talk or do something together. Put your phones in a different room. Some people connect well over puzzles, coloring, light yoga, and other activities. Other people connect over a cup of tea and conversation. Maybe it’s a slow walk around the block with your dog.
Put this time on your calendar when your child comes home and for the duration of early recovery. I mean, I’d love it if you do it for as long as your child lives at home.
This shows your child that their recovery is more than eating, and you are dedicated to the care of their whole self, not just their caloric intake.
This time does not need to be deep and meaningful every time to be effective. If you walk the dog together and spend the time talking about how silly your dog is, that’s connection! If you’re working on a puzzle and you spend the time talking about how hard the puzzle is, that’s connection!
A few ground rules:
Avoid asking a lot of probing questions. This is time for connection, it’s not an interview. The best approach is to be comfortable with silence so you make space for your child to open up to you.
Don’t use this time to criticize, correct, or discuss anything that is contentious between you. While I’m not afraid of hard conversations, it’s best to hold this particular time sacred. Don’t use it to make your plan for the next day or any other business you have in mind. Focus on the pleasure of being with your child.
That said, it might not always feel pleasurable, and that’s OK, too. If your child is sharing hard feelings like being sad, angry, jealous, or anything else, listen to their feelings with compassion and empathy, and avoid the tendency to try and fix or otherwise make the feelings go away. Your child’s recovery is dependent upon them feeling difficult feelings without hiding them, so don’t be afraid when they come up!
Managing your emotions
I’ve given you some ideas about structuring your child’s return from residential, and I hope they are helpful!
Now let’s take a few minutes to talk about how you’re feeling.
A lot of times when a child is in a medical emergency parents go into a state of high functioning. We are often capable of amazing feats of caregiving and sacrifice during the emergency.
But emergency mode is simply not sustainable. It sounds to me as if you are suffering from symptoms of burnout.
Now is the time for you to make a shift from approaching your child’s care like a sprint to that of a marathon.
It’s simply impossible for you to sprint during the next few stages of recovery. You’re going to need to slow your pace.
To help your child recover, we need to support your emotional management. The fact that you’re having trouble sleeping is common, but it’s also not sustainable.
I’m going to guess that you’re experiencing racing thoughts and worries about what will happen, what has happened, and what could happen. These racing thoughts make a lot of sense, but they are also exhausting.
The reason I suggest the three steps above: feeding, boundaries about sleeping and phones, and connection, is because, for the most part, you need to let a lot of other things go.
Racing thoughts and rumination will not save your child, nor will they support their recovery. You cannot save your child by thinking about everything that has and can go wrong.
So I suggest you establish some boundaries in your own mind.
⭐ Get ready for recovery and find out how you can prepare yourself for maximum success.
⭐ Find out the essential steps and family rules you need to have in place for recovery.
⭐ Make your home recovery-ready with six simple steps that anyone can do.
Here’s how this works:
First, you need to notice that you are having racing thoughts or worries. This can take practice, so I suggest you spend a week or so just trying to notice when you’re doing it.
Now, this is key: when you notice yourself doing it, I want you to be kind. Don’t say “Oh man! Again!” No, I want you to gently and kindly say “Oh! I’m worrying. OK.”
Once you start noticing your worries, you can move on to the next step, which is setting boundaries with your thoughts.
So you say “Oh! I’m worrying. OK.” and then you say “I have a lot of worries about my kid right now, and that makes sense. But when I worry like this I sap my energy, so I’m not going to do that right now.”
You say this kindly and with compassion. I’d like you to treat yourself exactly as I suggest you treat your child when they don’t want to eat or have some other eating disorder worry.
You acknowledge the worry, say that it makes sense, and then say that worry is not going to run your life.
Practice, not perfect
This approach to worry sounds deceptively simple. Practicing this is a lifelong process, but it works!
The more you notice and respond to worry differently, the less it runs and interferes with your life.
Hannah, of course your child’s return from residential eating disorder treatment is stressful. What I’m suggesting here is a two-fold approach. First, plan for your child’s return by putting a structure in place that will support recovery.
Second, manage your thoughts and worries. Worries always make sense, but when they run our lives we end up struggling, unhappy, and not sleeping.
I hope these ideas help you move into this next chapter of your child’s recovery.
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