Archive for the 'Article' Category

What is IFS?

No Gravatar

The Internal Family Systems (IFS) model of therapy has been developed over the past two decades by Richard Schwartz and is based on the concept of self-leadership as the ideal. IFS relies on a client’s own intuitive wisdom and therefore offers a safe, nonpathological, and empowering approach to psychotherapy. Schwartz believes that any client can benefit from the techniques used in IFS therapy, but that it is particularly helpful for the client who has been humiliated and feels worthless, or for those who have suffered loss or been devastated by trauma.

The basic premise of IFS is that internally, an individual is constantly listening to many different voices and is engaged in various thought patterns and emotions, which are similar to complex external relationships he may have with other people. When a person believes himself to be “thinking,” he is often having an inner dialogue with one or more of his parts. As people develop, their parts develop and form a complex system of interactions among themselves, and the functioning of this internal system can be examined using the systems theory. The IFS model posits that each individual is composed of many internal parts, and that the Self is the true core of each individual. The Self is not only viewed as separate from the other parts, but the goal of IFS is to for the Self to be recognized and respected as the leader of the other parts. Schwartz uses a board room analogy to illustrate the ideal role of the Self at the head of the table and in the position of chairman, with the parts in the chairs around the table. The parts are all respected and important in their roles, but the chairman (Self) does not give up his seat at the head of the table to any of them.

IFS also contains spiritual components in reference to the Self as being similar to the soul of a human being. Schwartz promotes that all individuals have at their core a true Self that innately possesses qualities such as curiosity, compassion, calmness, confidence, courage, clarity, creativity, and connectedness – natural leadership qualities. As individuals go through life and experience various events which their system perceives as traumatic, or other extreme emotional consequences, their true Selves become obscured by these new emotions and beliefs, which become their parts. IFS assumes that the intention of each part is something positive for the individual, such as protection or motivation, therefore there are no “bad” parts. The goal of IFS therapy is not to eliminate the parts, but to help them find less extreme roles. The goal for the individual is to be able to separate his true Self from the parts, view the parts with compassion and curiosity, and regain his innate sense of calmness, confidence and clarity.

The parts in the IFS model of therapy are those separate internal characteristics of an individual that are not qualities of his true Self. They could be emotions or beliefs such as anger, fear, shame, or distrust, which have been programmed into a person by external events or messages, and they all have a reason for being there or an ingrained role to play. For instance, if a girl grows up in an abusive environment, she may eventually come to believe that she is worthless and is not deserving of being treated with kindness and acceptance. Through IFS therapy, her worthless part can be separated from her true Self and be seen as only a part of her. Then perhaps her true Self can be curious about how the worthless part came to be, what it is telling her, and how she can develop compassion for it. In this way, her true Self can come to acknowledge and respect the worthless part, and either unburden it of its feelings of worthlessness based on the abuse she suffered, or give it a more helpful role to play in protecting her. Schwartz believes that after an individual’s true Self becomes curious about one of his parts and begins to acknowledge and respect it, he can begin to have compassion for its purpose in his internal world.

One of the most important aspects of the IFS model of therapy is the safety of its use with the client, and the safety the client feels in referring to any undesirable emotion or characteristic as only a part of him. In IFS parts sessions, the client is in control of which parts to address and to what depth, so the therapeutic process is safely client-driven. Likewise, most clients are more accepting of referring to an undesirable trait as only part of them, and not their true Self. For instance, the woman who was abused as a child may be more comfortable saying, “Part of me is still very angry at the person who hurt me when I was a little girl,” rather than, “I am still very angry at this person.” The difference is that while it is healthy to acknowledge the anger and hurt, it may be liberating to accept that the adult woman is not obligated to carry it around with her and allow it to affect every aspect of her life if it is only a part of her, and not her true Self.

Debbie Parrott, MSW, P-LCSW

Southlake Counseling


The Dangerous Downside to the DSM-IV

No Gravatar

For many who suffer from deadly eating disorders, the Diagnostic Standards Manual (DSM-IV) has become a bible of sorts.

Let me explain.

The DSM-IV is the official diagnostic tool that standardizes how to diagnose and address certain sets of symptoms for healthcare professionals the world over. So, for instance, if you are diagnosed with anorexia nervosa in Nevada, but then travel to Singapore, the healthcare professionals in Singapore will be able to reference your diagnosis and treat you appropriately. And if you then travel on to Canada, the healthcare professionals there will be able to take up where your Singapore team left off.

This is the upside to the DSM-IV.

However, as I write this post, the DSM-IV is once again undergoing scrutiny and tremendous revision, and a new version is anticipated by May 2012. While revision to the DSM is normal and does happen every so often when new information becomes available and our knowledge of mental illness increases, for those of us with eating disorders, and those of us who treat eating disorders, the revisions simply cannot come fast enough.

If you have an eating disorder, or suspect you have an eating disorder, you are likely all too familiar already with the stringent diagnostic criteria the DSM-IV outlines to categorize the severity of your illness and the impact it is likely to have on your overall health and wellbeing. For instance, a diagnosis of anorexia nervosa comes only when the individual can meet the following criteria:

Refusal to maintain body weight at or above a minimally normal weight for age and height (weight drops beneath 85% of ideal or fails to achieve expected body weight for age and growth rate)
Intense fear of gaining weight or becoming fat, even though underweight
Undue influence of body weight or shape on self-evaluation or denial of the seriousness of the current low body weight
Amenorrhea (the absence of at least three consecutive cycles), with periods reappearing only with hormone administration

From the very first bullet point we can see where the problems begin. Insurance companies look to the DSM-IV to determine whether they are required to pay for care, and how much care they must pay for. Doctors cannot provide care (for the most part) without the promise of reimbursement, and they frequently must rely on insurance coverage for that reimbursement. So an individual suffering from restricting-type disordered eating is literally forced to lose 15% of his or her body weight before being eligible for care! Furthermore, it is very common for individuals suffering from restricting-type to label themselves as “not sick enough” to even reach out for help or support until they can meet all four of these diagnostic criteria.

After my own eight-year battle against an eating disorder and almost two decades treating individuals for disordered eating and eating disorders, I can assert with utmost authority that eating disorders come in all shapes and sizes, and that eating disorders can be deadly at any stage of illness…and the dangerous downside to the DSM-IV is that current standards do not reflect that*.

I will give you just one final example to prove my point. The DSM-IV currently lists the following criteria as a prerequisite for a medical diagnosis of bulimia nervosa:

Recurrent episodes of binge eating: Eating, within any 2-hour period, an amount of food that is definitely larger than most people would eat under similar circumstances; A sense of lack of control over eating during the episode; Inappropriate compensatory behavior in order to prevent weight gain (vomiting, laxatives, diuretics, enemas, fasting, excessive exercise, etc.)
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
Self-evaluation is unduly influenced by body shape and weight
The disturbance does not occur exclusively during episodes of anorexia

Yet there have been documented instances of death due to cardiac arrest after only three purge incidents. The DSM-IV criteria gives individuals who suffer from purging – and their insurance companies – free rein to assume that they are not in need of critical care until they have been purging at least twice a week for 3 months.

Some individuals who suffer won’t make it that long.

If you are suffering from any level of disordered eating, if food has taken a place in your life beyond simply giving your body the nutrition it needs to function, if you feel trapped or imprisoned by your food-related thoughts and behaviors, and if you know, deep down on the inside where no one else but you can see or hear that you are struggling regardless of what the DSM-IV criteria are, then you need to get help.

You deserve help. Life is too short to live with an eating disorder as your constant companion. And life is too precious to lose it to an eating disorder when help and hope is available.

Here at The Southlake Center, we know what it feels like to live through an eating disorder. We know how dangerous eating disorders are, and how deadly they can be. If you will let us, we can help you say a permanent “no” to your eating disorder, and say YES to your own unique and precious life!

Be Well.

Kimberly

* There is a diagnostic category in the DSM-IV called “eating disorders not otherwise specified (EDNOS)” that allows for less severe symptoms that do not fit into the three major categories of eating disorders (anorexia, bulimia, binge-eating disorder). However, many insurance companies have been slow to recognize this category and incorporate it into coverage provided to policy-holders.

Infertility: When to Say When?

No Gravatar

Most couples facing infertility treatment never expected to have difficulty conceiving a baby. Month after month of trying leads to a trip to an infertility specialist and before you know it you are in the midst of infertility treatments. You begin with monitoring your basal body temperature then move into taking some medication and before you know it you are making difficult decisions about things like surgery and using donors. It can all come at you very quickly and make you feel out of control. Dealing with infertility on a daily basis can take an enormous toll on you physically, emotionally and financially.

Which treatments to try, for how many cycles and how much money to spend? All are very difficult questions. The answers are different for each couple. What may feel right for one person might feel very wrong for another. It is important to honor your individual circumstances. No one has walked in your shoes, and though loved ones and medical professionals may give you advise, you are the only one that can decide when the time is right to grieve your reproductive loss and move on to explore the other options that may be available for building your family.

Struggling through all that comes with infertility can leave even the most grounded person feeling that they have lost control over their life. It can help to take a step back and have a conversation with your partner about your goals, ethical beliefs, physical and emotional stamina and financial situation in order to put you in a proactive mode instead of feeling that you are always reacting. Some topics worthy of discussion include:

Ethical Beliefs – It may be that you are ok with IUI, but IVF doesn’t feel right, or perhaps you are comfortable with IVF and a donor egg, but surrogacy is pushing the envelope for you. Think ahead as to what could be coming down the road so you will be prepared when the next option is presented.

Financial Investment – As much as you may hate to put a price tag on a child the reality is that infertility can be a very expensive endeavor with no guarantee of a successful outcome. Most people have a limit on what they can spend. It is wise to set a budget early on with an agreement not to go over it without additional discussion. As much as you may dread it you should also discuss what your contingency plan is. It may be that if you are not able to have your own child that you might consider some form of adoption in the future which may have a significant financial cost as well.

Time investment – Life can feel like it is at a stand still when you are going through infertility treatment. Your whole schedule is planned around injections, blood draws, ovulation, etc. Things like vacations are difficult to plan, not knowing if you will or won’t be pregnant. Again, it can be helpful to set a time table for yourself knowing that you will reevaluate your feelings when you reach that point. It is also important for women who are getting older to realize that some of their other family building options such as adoption may be threatened if they wait to long.

These are difficult decisions to make as an individual; they become increasingly complicated when trying to make them as a couple. It is rare for a couple to always be in agreement. Infertility can take an emotional toll on even the strongest of relationships which is why it is important to talk through these issues early on and to continue to communicate throughout the process. If you are really having trouble coming to a consensus get some assistance. Some couples find it helpful to work through these decisions in counseling with a therapist specifically trained in reproductive health issues (you can locate qualified Infertility Counselors at  www.ASRM/MPHG.org)

In the end only you will know when “enough is enough” and you are ready to move on. Trust in your judgment and expect that you may second guess your decisions in the future. “If we had just tried one more cycle…? If you do decide to walk away from infertility treatment be prepared to mourn the loss of the dream you had for yourself. Acknowledging the loss will allow you to grieve so that you can move on and explore other options such as adoption, fostering or deciding to live child free.

Erin Clark is a therapist who specializes in working with women and couples struggling with issues related to infertility, pregnancy loss and adoption. If you found this article helpful you can reach Erin through from our Contact Page

Supporting a Loved One Struggling with Infertility Can Be Confusing

No Gravatar

How Do I Support Her Through Infertility?

Supporting a loved one struggling with infertility can be difficult. How do I help? What do I say? When your spouse, friend or daughter is struggling through the ups and downs of infertility it is hard to know how to help.

For the woman who is struggling with infertility the emotional toll, to say nothing of the physical toll, can be immense. Every month brings the opportunity for new hope and despair. It is difficult to accept the fact that there is nothing you can do to fix the problem or to stop the hurt, but there are things that you can do to help:

Offer to lighten the load: Trying to juggle work and home responsibilities in the midst of infertility can often feel overwhelming. Be specific with your intent. Instead of saying, “Let me know if there is anything you need.” Offer to bring over a meal for her on a day that you know will be particularly trying, such as after an IVF treatment.

Ask her about her treatment: Most women are consumed with thoughts about their infertility and would appreciate the opportunity to talk about what they are going through. If she is not in the mood to talk she will likely let you know, but she will be glad to know that you will be there when she is ready to talk.

Keep asking: Unfortunately for many women the infertility struggle can be a long one lasting many months and sometimes even several years. As time wears on the emotional strain deepens. Try to avoid questions like, “Are you pregnant yet?” which can make her feel like a failure if the answer is no, and opt for something more supportive like “How are you holding up? It is helpful to know that you have people that will be there to support you regardless of how long it takes.

Don’t minimize her feelings: A platitude such as, “Well, at least now you know that you can get pregnant.” or “There’s always next month.” doesn’t erase the fact that she is hurting now. What may seem like a small set-back to you could feel huge to her. Don’t assume you know how she feels, even if you have struggled with infertility yourself. Each person’s reproductive story is unique.

Run interference: For a woman trying to have a baby it seems that everywhere she goes there are babies and everyone she knows is pregnant. Handling situations like family gatherings and holidays where it is likely that the focus is going to be on children can be especially painful. Try to anticipate people or places that might be difficult for her. Help her to steer clear of those things or give her an outlet if she needs to escape.

Be present: Sometimes empathy is the only tool in your arsenal. Being a shoulder to cry on or crying with her will help her through her grief and let her know that you care.

You may not always do or say the right thing to your special someone who is struggling with infertility, but what really matters is that you let her know that you love her unconditionally and will be there to support her whenever and however she needs.

Erin Clark is a therapist who specializes in working with women and couples struggling with issues related to infertility, pregnancy loss and adoption. If you found this article helpful you can reach Erin through from our Contact Page

Food Allergies on the Rise

No Gravatar

More than 12 million Americans suffer from food allergies.  Young children make up the highest percentage by age, with about one in 17 children under the age of 3 (5.6% of that age group) currently dealing with a food allergy.  Children aged 1 to 18 represent about 4% of cases and adults represent a slightly lower 3.7% of cases, according to the Federal Register.  And, while no cure has been officially found, there is new hope with current research that cures will be found in the near future.  Duke University, for instance, is having good results with therapies to eliminate peanut allergies.  And, luckily for many, most milk, egg, soy and wheat allergies are outgrown with age.

As a dietitian, I am seeing more and more clients trying to manage a food allergy…and it seems there is more to the story than just a higher diagnostic rate.  There actually seems to be an increasing number of individuals developing food allergies.  The CDC reports food or digestive allergy increased 18% among young people between 1997 and 2007.  And, between 1997 and 2002, childhood peanut allergies doubled.

Theories about why food allergies are on the rise include (but are not limited to):

  1. genetic susceptibility;
  2. the “hygiene hypothesis”(overuse of antibiotics, vaccinations and antibacterial cleaners leaves our immune systems open to attack other perceived toxins, such as foods);
  3. a lack of vitamin D, which plays a role in the immune system;
  4. an imbalance of omega-3 fatty acids to omega-6 fatty acids;
  5. and, the way foods are heavily processed.

Food allergies occur when the body mistakenly identifies a particular food as a health threat.  Unlike a food intolerance which causes a digestive response, an allergy involves a complex immune response.  Ranging from mild to life-threatening, the severity of a food allergy differs depending on the individual.  For some, a minute amount of food ingested or inhaled (perhaps if a child smelled a nut) can cause a reaction – even anaphylaxis (multi-factorial body response that can be fatal).  For others, it takes a larger volume of allergenic food for a reaction.

Food allergy causes about 30,000 ER admits and 150 deaths annually, according to the FDA.  Peanut and tree nut allergy represent the leading causes of fatal and near-fatal allergenic reactions.  And, although there are more than 160 foods that can cause an allergic reaction in humans, the top eight allergenic foods include peanuts, milk, eggs, tree nuts, wheat, soy, fish and shellfish.  The top eight cause about 90% of reactions.  New evidence points towards sesame as the 9th most allergenic food.

Sensitive individuals may react with hives or an eczema flare from skin contact.  In others, eating an allergen could trigger runny nose, coughing, wheezing, cramps, diarrhea, nausea, vomiting, a drop in blood pressure or a change in heart rate.  If someone has asthma, it increases the risk of a severe response.

Although there are different types of immunological responses, one of the most common causes the body to produce antibodies to attack the allergenic food protein.  These types of allergies are also called immediate onset, type 1 hypersensitivity or IgE-mediated food allergy.  They cause symptoms within seconds or up to a few hours after eating an allergenic food.  These allergies can be diagnosed with the usual medical tests such as skin prick test or RAST blood test or via an elimination diet (where the potential food is avoided for 1-2 weeks and then re-introduced to determine if a reaction occurs).  This type of food allergy is often inherited.

One type of immediate onset food allergy is Oral Allergy Syndrome (OAS).  This condition is caused by the cross-reactivity between pollens and the certain raw fruits and vegetables upon which the pollens are found.  Itching, burning, tingling and sometimes swelling of the mouth, lips, tongue and throat can occur.  In severe cases, it is possible to have an anaphylactic reaction.   Common foods implicated with OAS include: apples, almonds, apricots, bananas, carrots, cherries, cucumbers, hazelnuts, kiwis, melons, parsnips, peaches, plums, potatoes, sunflower seeds, tomatoes, various spices and zucchini.  For the estimated 36 million people with ragweed allergies, for instance, it is important to be aware about OAS.

In the “delayed onset” or “non-IgE-mediated food allergy”, delayed onset of symptoms occurs after a food is eaten (usually 4 to 24 hours).  While there are several types of this allergy, symptoms often exist in the first few months of life (infancy) and most are outgrown in one to three years.  An infant may refuse food, have failure to thrive, seem colicy, pull legs up or have reflux, diarrhea or blood in the stools.  Diagnosis is achieved with an elimination diet.  If an infant is breastfed, the mother would need to eliminate trigger foods from her diet (or use a hypoallergenic or amino acid-based formula).  Elimination of milk products is usually done first.  Since at least half of infants with a milk allergy are also usually allergic to soy, it may be recommended to a nursing mother to avoid both milk and soy.

Other types of food hypersensitivities (allergies and intolerances) exist and involve varying responses from the immune and/or digestive system.  Several GI disorders have been linked with food hypersensitivities, including irritable bowel syndrome, eosinophilic esophagitis and celiac disease.  Additionally, other diseases and conditions, including fibromyalgia, atopic dermatitis, migraines and even depression may have connections with how our bodies respond to certain foods.

Various therapies and/or treatments exist to manage food hypersensitivities.  If you or your child suffer from food hypersensitivity (or suspect one), here are some tips:

  • Work with a specialist, such as a board certified allergist to do appropriate testing in order to get a correct diagnosis.
  • Work with a dietitian specializing in food allergies to develop a safe eating plan.
  • Read food labels diligently to ensure you know what is in your foods.
  • Choose cosmetics like California Baby and high quality supplements (such as Nature Made vitamins) that do not contain allergenic ingredients like milk, soy or nuts.
  • Research! Learn about treatments and educate yourself.

Excellent sites to learn more:

Julie Whittington is a Registered Dietitian in the Lake Norman area. Contact her at juliewhittingtonrd@yahoo.com.