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4 posts from October 2009


A personal note from Sandee Nebel, LMHC


Today's article explores a topic that most people don't like to think about - relapse. As you'll read below, feedback from an objective person can sometimes provide important clues that you are on the slippery slope to relapse.


Feedback is just as crucial to our efforts at the White Picket Fence Counseling Center, and we would like to hear your feedback about this newsletter. Are the articles relevant to you? Are you getting helpful information? Do you feel comforted and supported by the topics we are writing about?


Please contact us via the website with your thoughts. And while you're at the website, feel free to check out our new team bios and photos.


Best regards,


Feature article: Preventing relapse


Relapse. No one likes to talk about it, but not talking about it won't keep it away. In fact, the opposite is true.

According to the Transtheoretical (Stages of Change) Model developed by Prochaska and DiClemente, once someone has passed through the active stage of recovery they enter a maintenance phase, when the entire focus is on preventing relapse.

As you move away from actively focusing on your recovery towards integrating recovery into your day-to-day life, there may be triggers hiding everywhere, such as:

  • Small things, like a friend arriving late for a visit or someone taking too long at the checkout counter
  • Big things, like uncovering new issues in therapy
  • Normal human emotions, like grief, overwhelm, anger, sadness, abandonment, shame and guilt
  • Unexpected reactions from your loved ones to the changes you're making in your life
  • Fear of living without the eating disorder - your long-time companion
  • New compulsions and obsessions that move in to replace your eating disorder

One of the quickest ways to slide down the slippery slope into full-fledged relapse is to isolate from others and keep everything to yourself. It's too easy to get trapped in a pattern of negative thinking and to start believing your own perception because it's the only one that you have.

That's why it is so crucial to put a support system in place, whether that is a buddy, a support group or a therapist. They can help you to keep your thinking clear so that you can choose whether you're going to follow the downward spiral or pull yourself back up; because you always have that choice.

So stay connected and stay the course. Yes, recovery is challenging, but there are so many beautiful moments in discovering who you really are underneath your eating disorder. Don't give in to the addiction just because you don't see that beauty right away. No matter what your economic situation or how other people respond to your changes, you are giving yourself a priceless gift when you choose recovery.

Slips and relapses can be part of the recovery process but they don't have to be. When they do happen, the important thing is to learn from them and grow from them.

Recommended resources - Relapse Triggers Worksheet

As all unhealthy food behavior begins with a trigger, it is helpful to identify a few of your triggers. Jot down a few examples in each of these categories:


Environmental Triggers (e.g., seeing or smelling food)

Biological Triggers (e.g., hunger, thirst, cravings)

Mental Triggers (e.g., thinking about food, reading a description of food, euphoric recall, deprivation, imagining eating in the future)

Emotional Triggers (e.g., anger, sadness, anxiety, stress, frustration, boredom)

Social Triggers
(e.g., people who urge you to eat or uncomfortable social situations)

Upcoming events

Expressive Arts Workshops (Music, Collage, Guided Imagery) - we are bringing these back as soon as the days are a bit cooler!

Eating Disorder Recovery Group - Anorexia and Bulimia - Women with eating disorders 18+ (Currently starting a waiting list for this group)

Mom's of Individuals with Eating Disorders Workshop - With dietitian and counselor as facilitators

Relapse Prevention Group for Emotional Overeating - Monthly group for those in maintenance and action stages of recovery

Relapse Prevention Group for Eating Disorders - led by dietitian and counselor - now registering

Teen Esteem:  A Group for Teen Girls - new group forming!

Emotional Overeating Groups - Two evening groups offered - accepting names for waiting lists

Change Your Thinking - New monthly workshop series - the workshop on cognitive distortions was a success and we are making it into a series so you can really work on changes in greater depth.

Mindful Eating Workshop - Many people have shared with us how this workshop has helped to change their behaviors with food and eating.  It is designed for overeaters who could use benefit from more conscious eating.  Pre-payment and registration available to reserve a place.