Building trust and compassion
Often people who have recovered say that what helped was having people around them they could trust, and who remained calm and compassionate. In section 3 we discussed how to manage our automatic reactions to the illness. In this section we consider how to build a trusting relationship.
Working Together
One of the major problems of providing support for someone with an eating disorder is that you as a supporter and the individual with the eating disorder themselves are not on the same page. As discussed in Section 2, the individual with an eating disorders does not feel ill but sees the eating disorder as a means of coping and feeling in control. You, on the other hand, see it as a destructive illness.
If we apply the model of change (glossary) to these perspectives it is clear that you are both at different stages of change. You want action- stop the eating disorder. However, the individual with the eating disorder does not want change i.e. they are in the precontemplation phase. These different agenda can lead to “rhino” like clashes, bargaining through accommodation , or “kangaroo care”, or helpless, hopeless disengagement (Ostrich). A vicious cycle develops (Figure).
Figure This shows how a vicious circle can develop from the interpersonal reactions to the illness that can eventually lead to a lack of trust, fragmentation and isolation.
Problems with Social Reciprocity.
People with anorexia nervosa are often in a frozen, shutdown, “rabbit in headlights” state with expressionless, flat faces. Without the non-verbal social glue signals unease develops. Close others can feel as if they are interacting with a robot, facing hostility or contempt making it difficult to reciprocate with warmth. Others are in a high alert mode, sensitive to threat, paranoid and mistrustful of others and ready to strike at the least provocation. It is as if you are walking on eggshells.
You might be interested to see how much our facial expressions impact on our communication, by watching the video of the “still face paradigm” on YouTube (https://www.youtube.com/watch?v=apzXGEbZht0). A young infant clearly shows his distress towards the lack of facial expression of his mother. When similar experiments are done with adults, the observer of a still face subjectively reports the experience to be unpleasant and their blood pressure and stress increase.
Watch Jenny Langley’s video and tune in to the story about smiling
The Dolphin and St. Bernard: Strategies for helpful communication
We continue with animal metaphors to overcome these problems in social communication.
The dolphin metaphor encapsulates the idea of gently nudging the individual to safety, from the dangers at sea. The person with AN considers AN o be their life belt and will not remove it until she feels safe. Your approach is wisely balancing a hand off approach with a safety net at hand. This might at times involve swimming ahead and leading the way. At other times you might swim alongside with encouragement, or swim behind, showing trust and confidence.
The St Bernard response is consistently calm, warm and compassionate providing nurture and hope rescue. For a detailed description of the animal metaphors please see Treasure et al., 2017).
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We have recently added a herd of elephants to illustrate good support care. Elephants work as a team to protect their vulnerable members and connect, tails to trunk, for joined up care. Building a strong and collaborative network (professional and nonprofessional) is a key resource.