This blog is based on Sarah Ravin, Ph.D. and Tarah Rogowski, Ph.D.’s webinar, A Circle of Safety: How Clinicians Can Collaborate with Clients and their Families to Prevent and Cope with Relapse, which they presented to the EDRD Pro community in September 2022.
Written by Kristen Nyampong and edited by Greta Jarvis
As eating disorder clinicians, we know that each person’s experience is unique. The road to recovery is progressive and non-linear, often involving relapse along the way. Relapse, defined as when a person returns to eating disorder behaviors and symptoms following a time of remission, is distinct from and more severe than a slip or lapse. This is an extraordinarily common experience, occurring in 35 to 41% of anorexia nervosa cases, 31 to 44% of bulimia nervosa cases, 20 to 50% of binge eating disorder cases, and 41% of other specified feeding and eating disorder cases. To support us in navigating and preventing relapse with our clients, Dr. Sarah Ravin and Dr. Tarah Rogowski joined us to present A Circle of Safety: How Clinicians Can Collaborate with Clients and Their Families to Prevent and Cope with Relapse.
Given that relapse most commonly occurs within 18 months after initial recovery, prevention and preparation should happen in eating disorder treatment before discharge and incorporate the following:
- A written strategy that includes subjective and objective signs that a client might be at risk for or is currently experiencing a relapse.
- Coping skills for stressors, triggers, and lapses.
- An action plan should relapse occur.
Dr. Ravin and Dr. Rogowski emphasize the client’s “circle of safety” – their family, loved ones, and treatment team – as a powerful tool in relapse prevention. This team should work alongside the client, maintaining open communication to identify signs and struggles that necessitate further support. When implemented early, intervention can help reduce the extent and severity of the relapse. Empowering the client to ask their “circle of safety” for help can also normalize the ups and downs of recovery, reducing shame and equipping them with effective coping skills for recovery and beyond.
Crucially, relapse plans should incorporate objective and subjective indicators of how the client is doing. Dr. Ravin and Dr. Rogowski suggest using green, yellow, and red lights, with green representing remission, yellow representing early signs of struggle, and red representing relapse. Green lights point to a stage in which the client, clinicians, and loved ones work on self-care and coping skills to keep the client in a healthy place. This may include regular meals with friends or scheduling appointments with their therapist as needed. Yellow lights signal the possibility or risk of a relapse. Here, the “circle of safety” knows to provide more frequent assistance, such as extra meals with family, nutritional supplements, or harm reduction strategies if slips or lapses do occur. Finally, red lights indicate a relapse – this is a time to fully encircle the client with support, which may include returning to a higher level of care.
At every stage, validating the client’s experiences nurtures healing and trust. Relapse prevention is an ongoing process and is most effective when approached with collaborative compassion and nonjudgement. The circle of safety should work with the client to consistently update relapse plans as they progress through the recovery journey, encountering new challenges and victories. These plans should be flexible and individualized: there is no single right or wrong answer that applies to all. Navigating the early stages of recovery can feel vulnerable and uncertain; a loving and trustworthy “circle of safety” walking alongside the client offers a nourishing environment as they build resilience and strengthen their healthy self.