The need for both empathy and ‘Tough Love’ in eating disorder interventions
By Shannon Calvert
Eating disorders treatment often involves interventions that are challenging to the patient. Inpatient treatment frequently involves life-saving, confronting interventions (e.g., insertion of a naso-gastric tube (NGT); restraint to prevent removal of the tube, use of the mental health act). Day treatment involves meal support, persuading patients to eat foods that are challenging to them. Outpatient treatment often involves self-monitoring, regular eating and homework. These interventions can be conducted punitively, with disrespect and disdain for the patient, or they can be used supportively and collaboratively. When applied in a threatening or dismissive manner, such treatment can add to pre-existing trauma, hindering one’s physical and mental recovery. Alternatively, compassion and explanations can alleviate the inherent distress.
I will discuss my own experiences, illustrating when practices have been detrimental vs helpful and will outline some recommendations for treatment: a) Where challenging and confronting interventions are deemed necessary, application must be in the context of life-saving/life-enhancing intervention; b) The importance of treatment at all levels of care being guided by empathy, compassion and open, honest communication; c) Providing the individual (and carer) with a clear rationale for using the intervention(s) and the risks of not doing so.
In conclusion, ‘tough love’ can be necessary in treatment and, so is the equal importance of compassion and dignity towards the individual. That equal balance saved my life.