Home For the Holidays

Kim had gone a month without bingeing and purging when she came in one morning angry, frustrated, and tearful. “I don’t understand it. I have been doing so well, nearly a month without bingeing and purging and I binged and purged four days this week. I feel like all of my heard work is for nothing. I feel like I’m back where I started from.”

After giving Kim time and space to express herself we traced back through the week, looking for any triggers which had previously sent her to the grocery store for cookies, ice cream, cake and subsequently to hours in the bathroom purging over the toilet. Kim could not recall anything particularly stressful during the past week. Her work had been rather quiet and she had gone to her twice weekly yoga class, an activity which she found centering and calming.

Kim then started talking about her travel plans for Thanksgiving. I immediately noticed a change in the tone and rhythm of her voice and in her posture. Her voice became flat and lifeless and she sunk into the chair. I asked her how she felt about going home for holiday. “It’s Thanksgiving,” she cried. “I dread it, but it’s not like I have a choice. I have to go home.” “I hear that you feel forced to go home, but tell me more about how you feel about it. Can you be more specific,” I asked. “I hate Thanksgiving. It’s my least favorite holiday. My family, including my parents, sisters, aunts, uncles, cousins, and grandparents are all there. I feel like everyone is staring at me, watching what and how much I’ll eat and wondering if I’ll then excuse myself from the table to purge it all up. It’s not only the one meal, but it’s having to be at my parent’s home for four days. I feel trapped.”

Through further exploration it became clear that Kim expected this Thanksgiving to be like the past ones. Even though she was at a different place in her recovery and had found more effective and healthy ways to deal with emotions which made her uncomfortable she felt pulled to her old coping mechanisms of bingeing and purging. These were the ways she dealt with uncomfortable feelings when she was growing up with her family.

Kim was playing the old tapes in her mind, expecting that she and her family would fall back into familiar patterns. How could Kim and I work together so that she could be her full adult self, the one she was valiantly striving towards, among her family in her childhood home. Together we came up with several ways that Kim thought would help her through her family visit.

Developing and following through with a plan of action helped to give Kim a sense of self-efficacy and control. Kim decided that before her trip, she would talk with her parents and express her concerns about falling back into self-destructive patterns. This would give all three of them the opportunity to come up with ways that her family could support her new healthy coping mechanisms. For example, instead of having only the typical bags of chips and boxes of cookies, they could also have foods that Kim had now been incorporating into her meals. Kim could also ask her family not to comment on her weight, no matter if it was up or down.

Kim also told me about past Thanksgivings where various family members rehashed disagreements, resulting in raised voices and hurt feelings. This was very unsettling for Kim and often led to a binge and purge. If this were to occur this year Kim could excuse herself from the table and go to her bedroom or a quiet place in the house. We went over ways in which Kim had learned to soothe herself, such as deep breathing, yoga, reading a book, and listening to music.

Kim also decided to return to the city one day earlier, on Saturday instead of on Sunday. Sometimes it is better to make the vacation shorter so you leave wanting more and looking forward to the next visit.

Having a plan of action helped to calm some of Kim’s anticipatory anxiety. It helped her to see that she was not back where she started from. She was no longer a helpless child but a young woman with the ability to make choices. Kim felt hopeful that thisThanksgiving could be different.