One of the goals in working with someone suffering from Anorexia is helping the person decide for his- or herself to regain weight, rather than the decision to weight restore be forced onto him or her by others. It is always important to validate to the person suffering from the eating disorder that they are likely to feel very ambivalent about changing, and at the same time to communicate to him or her that we belief change is possible. The change needed for people with Anorexia is of course to stop dietary restriction and other weight control behaviours and regain weight to bring their Body Mass Index to somewhere above 19.
As with making many decisions in life, using pros and cons is a helpful tool, and often when helping someone with Anorexia we use two elements, the current pros and cons of change, and the future pros and cons of change.
Let's start with looking at how we develop a list of current pros and cons of change. First we invite the sufferer to list all the reasons why they don't want to change and are frightened to do so. This list might include the sense that having an eating disorder makes the person feel special, that restricting eating helps the person feel in control and strong, that the eating disorder is familiar and therefore feels safe, and that with weight restoration thighs, stomach etc will change shape. Next the person is encouraged to think about why it would be beneficial to change i.e. weight restore. This list might include getting rid of the effects of being underweight such as always feeling cold, thinking about food all the time and sleeping poorly. It might also include being able to think and concentrate better, having a broader focus in life, being able to socialise without anxiety and so on. The effect of change on all areas of life need to be considered - relationships, physical and psychological well-being, work performance, ability to engage with other interests and so on.
Developing the future pros and cons list involves taking the perspective of five years into the future. The person is encouraged to think about how they would like their life to be in five years' time (less for younger people). We ask questions such as "What job would you like to be doing?" and "Would you be active socially?'" and so on. The person suffering from Anorexia is invited to consider how still having the eating disorder would affect some of her or his future aspirations and goals.
After this, a person is ready to make conclusions about change by weighing up both current and future pros and cons, and decide whether or not to take the opportunity to change i.e. weight restore. A list of conclusions can be drawn up and this can be referred to when motivation is slipping a little.
The last step is to "take the plunge" and start the process of eating more. It can of course be hard - but it is altogether possible!