Unimpressed by the note of urgency in my voice, Molly stared off into space, hypnotically twirling a long strand of red hair around her finger. "Yeah, I've seen this on a made-for-TV movie. You're gonna ask me to keep a food journal, right? And then we're gonna talk a lot about calories and you're gonna try to convince me that I'm doing a bad thing and have to stop."
Well, yes actually, I was going to talk about calories and food journals, with the intention of getting her to stop the behavior. But she wasn't having any of it.
"Here's what I don't get," she said with more animation, "If I'm already obsessed with what I do and don't eat, isn't talking about it just going to make me more obsessed?"
"The point is," I said—totally missing the point—"what you're doing is really unhealthy and can significantly harm you. It's scaring your family. (It's scaring me!) The goal is to talk about what you're doing, so you can stop doing it."
As often happens when using a symptom-oriented approach with clients like these, Molly figured out how to be "compliant" in the short-term. She kept food journals, maintained a stable weight, agreed to a "safety contract" detailing a reasonable number of calories to consume, and learned to be even more secretive about her bingeing and purging. Within four months of disclosing her behaviors, she convinced her parents that she was "fine" and dropped out of treatment.
The Battle for Control