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  • Laura Machado, PsyD

Open Letter to the Parents of My Patients with Eating Disorders

Dear parents,

You are the true heroes in this story. When I think of the work you do, I literally get chills because I know the depth of your long-term positive impact. I know that this work would be nothing without you.

To the parents who are managing your child’s nutrition doing some degree of shopping for, plating, and supervising eating: It is because of you that your child’s brain is thinking better. It is because of you that, when I meet with your child weekly, we can do the work we do such as improving body and self image, increasing recovery motivation, and treating other conditions like anxiety or OCD or depression. In other words, without you keeping the food part stable, your child could not engage in therapy in the way they do. Without you keeping the food stable, I could not be adequately treating co-occurring conditions. I see your child 1-2x per week for just an hour. You are living with your child, lovingly parenting, tracking the food all day, every day. You are literally the pillar of your child’s treatment. And I want you to know that any improvement you have seen in your child is mostly due to their improved nutrition, which is mostly due to you. You are literally saving your child’s life and setting them up for as fast and thorough of a healing process as possible. This can be thankless work at this time, but it truly is making all the difference.

To the parents who keep in communication with me in person, over the phone, and by email: I want you to know how important it is that you have taken your child’s struggles seriously. There are many kids with eating disorders out there who don’t have parents like you. You have picked up the phone and called me, called a pediatrician, called a dietitian. You have met with me and graciously given me your input and collaborated on goals. You have sat with me to review treatment plans and listened to my perspective. Bottom line: you are involved. Your child will never be able to have the story later that their parents dismissed their eating disorder. Additionally, because of your involvement, I am able to get your input and guide treatment in a way that will work for your child and your family. This is invaluable information. Because you are an active part of your child’s treatment, therapy is able to be so much more individualized and effective. You are literally the pillar of your child’s treatment.

To the parents who have sent their children to a higher level of care: Sometimes outpatient isn’t enough to break the behavioral pattern of an eating disorder. The longer that behavioral pattern remains, the more entrenched it gets. Time is of the essence and we need to break that behavioral pattern to get your kid the best chances of being free from the eating disorder forever. Sometimes, to do this, we need to resort to a higher level of care - like residential, or a day treatment program. You have not sent your child to a higher level of care without thought. You have discussed it with multiple clinicians, other parents, sought second opinions, mulled it over. And when it became necessary to do to ensure complete nutritional rehabilitation, you bravely told your child that they had to admit to a higher level of care. Your child might have melted down, cried, screamed, begged, and they might have even made a very convincing argument that it was not necessary. And still, you chose to believe in your child and not allow any sort of chronic eating disorder or partial recovery. You held your child to a high standard of complete recovery. And so, although maybe your heart broke, you made the call to a higher level of care. That takes courage.

To the parents who are questioning their own beliefs about food and weight as they learn about eating disorders: I really applaud you! It is not necessarily intuitive that we would worry when your child doesn't snack and celebrate when your child spontaneously eats cookies. And yet, when you learn about what it takes to recover from an eating disorder, everything most people learn about food and weight from society is challenged. So many of my patients tell me about how hard it is to recover when their mom or dad continues to diet; and you, by challenging your own beliefs about food, by learning about Intuitive Eating or Health at Every Size or the neurobiology of eating disorders, you are setting up an environment that is supportive of recovery. Seriously, this is priceless and life saving.

To all my parents: I want you to know you take a risk by picking a therapist for your kid. I know that you’re investing quite a lot in me and a lot of hope is hinging on this treatment. I know that, and I take my role seriously. I am a clinician but I am also a mom. As a clinician, I will do my best to provide thoughtful treatment. As a clinician, I know that a child’s best chance at recovery includes involving the parents as teammates with the clinician. As a mom, I believe that parents should have a clue about what is happening in the therapy room. Thank you for trusting me. I will always seek to team up with you, meet with you and communicate with you regularly.

You have my deepest respect,

Laura Machado, PsyD

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