We met with Dr. R. last night. It's been a while since I went with N. We seem to talk about the same things now. I brought up the issue of N's prayers. We also discussed the continued problems that N has in the morning -- with choosing a shirt causing the anorexia to resurface in force. Once before, Dr. R. suggested that N choose his shirt the night before. We tried that, but it just moved the conflict to nighttime. And then, N was extra tired and still hadn't chosen a shirt. We'll need to discuss some other solutions to that problem. We talked about keeping score in N's battle with the anorexia and even posting points as the battle wages each day. We'll give that a try.
We also talked about setting up an incentive system. Several months ago, N's therapist suggest trying something like this. We did and it didn't work. But at that point my son was still declining rapidly. The incentive catapulted us into a terrible match with his anorexia. I've been thinking more about trying it again. He is doing a lot better. He isn't weight-restored, but we are within 8 to 10 pounds. The anorexia resurfaces here and there in force, but more and more the battle stays under the surface. I can see it happening, but our son is winning more often.
I have really mixed feelings about this. Presuming that anorexia has a medical cause and is not a choice, then I'm not sure it is realistic to tie his getting better to a reward. It would sort of be like saying, "we'll get you a new game if you will get better from the flu." Obviously, that is ridiculous! However, there are times when N is waging that internal battle with the anorexia where extra strength (and motivation) could help immensely. Sometimes he is able to make a choice about how he acts or reacts even though it is extremely hard. I think it might be okay to put incentives with things that N can do something about. I also think that there should not be ANY penalties. I recognize that sometimes N is unable to make the right choice because his brain is basically malfunctioning. Just like it would be silly to reward someone for getting better from the flu, it would be as silly to penalize them if they didn't get better.
N really wants a wii (for our family, not just for him). I was thinking we could tie "wii dollars" to things like getting to school on time, finishing his homework, and getting to bed on time. Eventually, after he has reached his weight goal, we could switch the incentives to things like eating all of your snacks on your own, or being on time to school for a whole week. Ultimately, he could earn wii dollars for each day that he listens to his body (eats intuitively), though that could be hard to measure. I'm not sure about this and need to think about it. I'll ask my fellow parents on the Parent's forum if they have ever tried something like this. If an incentive would give N just a little extra strength to fight past the anorexia sometimes, then it would be worth it. Plus, if it speeds up his recovery, or simply helps to maintain his recovery, then the cost of the wii might actually save some money in treatment costs (which really is the least of my concerns, but worth mentioning).