146


Chapter 6 At times you will encounter a person who believes he or


she is ready to change but is unable to follow through with your recommended intervention(s). This does not mean that you must stop working with the patient. If you think that continuing to meet with the patient will put you or the patient in danger, then discontinuing your care is appropri- ate. But if the patient is simply taking longer to change than what you or family members predicted or hoped for, it is helpful to adjust your (and, if possible, their) expectations, continuing to work with the individual on his or her terms. In some cases, motivation to change is high but con-


founded with an equal or greater reluctance to change. MI by the registered dietitian nutritionist (RDN) can explore this ambivalence on the surface level of food and eating behaviors, but when it stems from fear of failure and other emotional issues, it must be addressed by the mental health professional. Focusing solely on food interventions can be appealing to the patient, as it is distracting from more painful, existential issues, but it prevents true recovery. It is wise to consult with other treatment team members, a trusted colleague, or a supervisor in these situations to help you evaluate whether to push the patient to attempt eating interventions or to support the patient in maintaining the status quo until barriers to action have been addressed in therapy. Explain to the patient and family that conscious motivation and desire are not the only factors in eating disorder recovery, just as weight restoration and balanced eating are not the only goals.


Coping Skills


If patients can see that their eating disorders are harm- ful, then why is that not motivation enough to change? In addition to the mood-stabilizing chemical changes that eat- ing disorder behaviors offer, they also provide temporary relief (distraction or escape) from the stresses of life. Eating


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