Identify their hunger signal and yours and if you’re in a group, have each member identify how hungry they are both emotionally and physically.
Meal guidelines
The actual process of a challenge meal should not be emotionally heavy or food focused. Try to steer the conversation away from inspecting or commenting on the food or body or fullness. Instead, talk about lighter appropriate topics like the weather, the atmosphere in the room, how their day was, sports – a movie or TV show. In a group, playing a game can be very helpful. Some favorites are “contact” or thinking up famous peoples’ names in alphabetical order.
Eating the meal should not take more than 30 minutes. Sometimes clients will try to cut food into tiny pieces or take very small bites or eat very slowly. This will require an intervening prompt from you. Something like “please take normal bites” or “that’s cut small enough, let’s start the meal now” or “we’ve got 15 minutes left, please keep up the pace so we can finish the meal on time” are some prompts you might use. It is our job to help them contain and combat their ED voice. We state the prompt clearly, yet quietly so others’ don’t over-hear and we say it neutrally and without judgment. If they’re still playing with their food and interventions aren’t working, I usually just let it be rather than getting into a struggle with them in public and process what happened later.
If they’re getting an especially challenging meal and they’re anxious about it, I will suggest they can cut their meal in half and just start with the first half. After the first half, we can check into hunger cues and see how they are with continuing. I often tell clients that I believe it is more important that they feel successful in eating a challenge meal, but perhaps less of it, than eating too much and feeling overly full and triggered to purge. This is true in an outpatient therapy setting. Residential or partial hospitalization has more containment and ability to monitor clients after the meal, so that’s a different story. But for my purposes, I don’t believe feeling overly full is in the client’s best interest.
After the meal
Once the meal is complete, be sure to sit at the table for a while and discourage any bathroom use. You can ask them how their meal was and how they feel emotionally. Ask what the experience was like and if they’d get the same meal next time or if there’s something else they might like to try next time. Focus on their success and offer any authentic praise for challenging themselves and their ED. If they have some regret or guilt, help give them the words to combat the guilt internally. Something like: “This is one meal, it was enjoyable and my body knows how to process it.” Or “I’m defeating ED one meal at a time. I need food to nourish my body. I am proud of myself for standing up to ED.” Another favorite “this is what normal looks like. People go out to eat and enjoy food and they’re okay so I can be okay too.”
The more exposure, the more the client will get used to eating food and eating it in challenging settings. This helps lay the foundation for less social isolation and more ability to tolerate food and restaurants. Really and truly, one meal at a time really does make a difference. Supporting a client through a challenge meal shows them that they are capable and gives them a successful experience to remember when they’re ready to try it on their own.
What have been your experiences with challenge meals? Comment below.
If you want to learn more about challenge meals, I’d be happy to help. Contact me at 610.314.8402 or TiffanySpilove@yahoo.com
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