I'm in Eating Disorder Treatment Again

But I'm wondering if I need to be.

my bestselling memoir, “Where the River Flows”

I’m giving away signed copies of my memoir on instagram, be sure to enter before March 8th using the instructions linked below!

I've spent 18 years in therapy developing intimate self-knowing. So I better damn well act like it.

This month I've entered into intensive therapy for my Eating Disorder. But after a couple of weeks, I'm starting to question if this is what I need. I'm realizing that for the first time in my life, I'm comfortable making choices about my treatment based on really, truly, full body knowing myself. I know what I need, and what I don't.

Theme of the Month: You know yourself best. It's ok to act like it.

As I told my mailing list today, March’s theme is to trust yourself: you know yourself better than anyone else, and it’s ok to listen.

Subscribe to my private e-mail list for “theme of the month” newsletters.

The theme this month, for me, is honoring myself. Listening to my inner voice and trusting that the wise one I've developed will parse through the critical, insecure, and child-like ones. Standing up for myself when I am being asked to do something that feels out of integrity, doesn’t align with my values, or simply isn't right for me. Knowing that just because one medicine is reliable, valuable, and helpful for another, doesn't mean I have to take it.

When I came back to Seattle in January I knew I needed to seek out therapy.

(read more about my decision to come home here)

It had been almost six months since seeing my last therapist, and with a resurgence of depression, anxiety, and Eating Disorder (ED) symptoms, ya girl knew she needed support.

Based on my insurance and therapists that have expertise/knowledge in EDs, my options were narrowed down to about three people in Washington state. Not kidding.

Eating Disorders are pretty "niche" when it comes to clinical understanding (and desire to treat—EDs are notoriously one of the most difficult and treatment-resistant diagnoses), so I knew that the odds of finding an individual therapist with ED expertise would be slim.

Only one of the providers I found was accepting new clients, but it was on a waitlist basis. Not ideal, but worth investigating. I was, as I said in my february newsletter, in "investigation mode." My goal was to see what was available to me, sit with my options, and make choices based on what felt accessible, stable, and hopeful.

We did a brief consultation, and at the end the therapist said, "I could certainly help you with your depression, anxiety, and Eating Disorder. But I have two concerns. One, I'm on a waitlist structure right now, which means every week you'd have to wait to see if I get a cancellation. That wouldn't really provide you with stability, and I'm hearing that's important. Two, while I know you said you're experiencing Eating Disorder symptoms, what I’m really hearing is a lot of grief.”

»Read more about that conversation here: the missing piece in western psychology

“What I’m really hearing is grief.”

I started sobbing. Fuck. Therapists really have a way of cutting through my bullshit. And when they hit something true—something hidden, something locked away for fear it might kill me, I feel it.

We hung up, and my only other investigation lined up was an intake with an Eating Disorder treatment program. It was the same program I did ED treatment with almost 7 years ago, so the know-like-trust factor was already there. This program saved my life and transformed my relationship to food and body—surely they might be able to offer support at this next phase in my recovery.

»to read more about my experience in treatment, read my memoir “Where the River Flows.”

When the intake was done, the counselor suggested I enroll in their Intensive Outpatient Program, effective immediately. I was surprised. I knew my ED symptoms had flared but didn't expect her to recommend that level of care. Nonetheless, she was the professional, my insurance covered it, and I wanted support. It seemed like a no-brainer, and I said “ok,” on the spot.

From the day I started program, my gut has been telling me I should have sat with her recommendation longer.

Not because I don't still struggle with my Eating Disorder—I do. Not because I don't need help navigating my symptoms—I do.

But because what I need right now is a space to grieve and move through the damage my divorce did to my sense of lovability, the ways in which my Eating Disorder is trying to cope with that sense, and the intersection of the two.

Eating Disorder treatment is designed around a system of neutralizing food and body and deepening skills for living. And while this system is powerful and life-changing for those who need it (including the version of me that needed it 7 years ago), it doesn't feel like the system I need today. 

Reckoning with this conflict has been unsettling.

I've been honest with my providers in the program. My goal is not to squirrel out of treatment of deny care that is being provided. I remind myself daily, this is my choice. I chose to be here because I want to be well. And in that same vein, I get to choose if this is the path to that wellness.

I’ve dialogued about my care with my individual providers and made sure I (the person receiving the care) was included in that dialogue. In the past I deferred entirely to authority, essentially erasing myself as an adult with any sort of autonomy or self-knowing. And at times, I operated so closely to an unhinged, scared child that I needed that deference. But now, I feel secure enough in my personhood and symptoms that I feel fairly confident to say “yes, I need help for this,” and “no, that’s not what I need.”

It’s confusing to have done so much work in therapy just to use that work to find the right therapy. Talk about a paradox.

Thoughts of "is this just my Eating Disorder resisting treatment?” have come up. Thoughts of "do I even align with this approach to recovery anymore, and is this merely a values mesh?" have come up. Thoughts of "is it simply too intensive of a level of care?" have risen too.

I committed to engaging with the program and, as I said before, investigating. Observing and taking stock without judgment or making decisions while in an emotional state. Calling trusted loved ones to process without seeking answers. These are the skills I learned all those years ago in treatment: to observe mindfully and non-judgmentally, regulate my emotions before decision-making, and lean on my support system to help me at difficult junctures.

In group one night this week I felt a pang of resistance when my nutritionist told me I had to eat desert because it “seemed like a food rule.”

Confession: Yes, I still have neuroses around specific foods, and I am aware that these are disordered. And, its a far cry from the literal cries I experienced years ago when I was asked to eat a slice of bread with butter.

I was frustrated.

I felt like the massive forest fire I'd stopped and slowed wasn't enough: I'd have to put out the small fires too. I'd have to be free of burns. Clean and crisp, perfectly "not-disordered," a package just as tight as the one I sought to wrap with my Eating Disorder.

"I worked so hard in treatment the first time around to let go of perfectionism," I said to my nutritionist.

"And now that I'm here again, witnessing how far I've actually come, I feel like I'm being asked to find perfection in recovery. But what if I'm ok with me? What if I'm ok with who I am? Ok with the mess? At what point do I get to be a person?"

*I want to note how FUCKING BADASS nutritionists and therapists in Eating Disorder recovery are. My experience is not meant to be a commentary on practitioner effectiveness—y’all are superheroes and I know how difficult and treatment resistant this disorder presents.

Later that night, I called my mom. (Eyo—more growth from a woman who once screened phone calls from “mother” for fear of her wanting to solve my problems).

»read more about healing my relationship with my mother in my book

"Ultimately, my goal is wellness,” I told her.

“That's the light. The direction. And I get to choose the path that takes me there. And while treatment might be one path, I'm starting to wonder if it's the right one for me, for now. I'm wondering if that therapist I spoke to weeks ago was right. That while I'm experiencing a flare in my Eating Disorder, it's a symptom of what I really need to pay attention to: my grief.”

I still haven't made a decision. Ultimately, though, I will do what is best for me and what I need. And for the first time in my life, I feel capable to make decisions based on what I need, not what I think others expect or want from me. Until then, I'm committed to showing up in the program—it's still my time and I'm not going to waste it. 

It's my time. It's my recovery. It's my life. And I'm not afraid to act like it.

XX
Rachel

This is just a tender thanks after all these years for being here, for reading my words, and for saying “same, here.” After years of producing free content and writing on social media, this newsletter/Substack is a way for me to keep showing up and seek reciprocity for my work.

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