Archive for the 'Eating Disorders' Category

Family-Based Therapy: Three Steps to Anorexia Recovery, Part 2

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As we continue our exploration of the application of Family-Based Therapy for recovery from anorexia nervosa, it might be helpful if we first do a quick review.

In Part 1 of this series we discussed why parental involvement in a child or adolescent’s recovery process is so vital to recovery success. Children need their parents. Parents want and need to be involved. Beyond these simple relational facts, research results have proven that a parent’s active involvement in a child’s recovery process is often a major determinant of a successful outcome.

There are three main stages for implementing a Maudsley or Family-Based Therapy (FBT) approach. The first stage is weight restoration. This phase is nearly guaranteed to strike fear into the hearts of even the most stalwart parents. The basis of this fear and trepidation, accordingly to treating professionals and parents active in the FBT approach, is a simple misunderstanding. Maudsley Parents, another parent support and advocacy organization, explains that the confusion comes in when a parent sees food as different from medicine. FBT treating professionals are able to clear up much of the confusion and fear when they explain to the parents that food is medicine, and as such it is both medically-prescribed and absolutely necessary for the reversal of the anorexic adolescent’s malnourishment.

During the weight restoration phase, the treating team, which often and ideally includes a medical doctor, therapist, dietician, and psychiatrist, coaches the parents on the proper administration and dosages of “food as medicine.” With coaching and support, parents learn how to empathize with the pain, fear, and anger their adolescent may express, while continuing to insist that the child take in proper dosages of the necessary medicine. Family mealtimes and parental supervision of caloric and nutrient intake is a vital part of the success of this phase. Simultaneously, siblings are taught how to support the patient, and the treating team works to help the patient reintegrate with siblings and with the family unit. Parents who persist and learn the skills necessary to successfully navigate the weight restoration phase find that it is tremendously healing and nurturing for both the patient and for the family unit as a whole.

The next phase is one parents will look forward to during the entirety of phase one, because in phase two parents begin turning control of eating back over to the adolescent. The family unit’s ability to transition to this phase is dependent upon the patient’s continued weight gain, acquiescence to continual increases in food intake, and a positive change in the demeanor and dynamic of the family unit. Often at this phase, everyone from the patient to the parents to the siblings is feeling relief that the eating disorder symptoms are being effectively and consistently addressed, and this relief changes the family interactions for the better, reducing resistance and strengthening resolve. Parents can then begin to give the patient more control over food choice and eating. There is a trust bond that is mutually demonstrated and earned again with each meal as parents see that the adolescent is both willing and medically able to make their own sound and healthy food choices. The patient is also able to eat away from the parents to such an extent as they are able to demonstrate the same healthy choices with friends, peers, and other family members that they do in the home. While this phase can feel stop-and-start especially at first, the entire family is encouraged by the patient’s progress through dependence to interdependence to eventual independence in making healthy nutritional choices and practicing effective body care.

During phase three, the focus moves beyond the food to a re-establishment of a healthy adolescent identity. This is the most exciting phase when parents, siblings, and the patient begin to see the real fruits of persistence with the FBT approach. Here, the adolescent is able to maintain 95% of their ideal weight consistently. Signs of desire or intent to self-starve have abated. The patient has newfound ability to navigate mealtimes with relative ease whether in the home or while out with friends or family. Privileges around food come back into alignment with other privileges that signal a growth from child to adolescent into the teen and young adult years. Often there is a much increased closeness within the family unit and signs of the fear, anger, and resistance that characterized much of phase one and into phase two have vanished (also easing residual parent concerns that phase one and two supervision may somehow irreparably harm the parent-child relationship – research results show that for most families the exact opposite is the case). With weight restoration and stabilization and mealtime autonomy also comes a willingness and ability on the part of the patient to look at some of the underlying triggers and issues that may have contributed to the anorexia. In phase three, the patient can begin or resume work with a therapist and other treating professionals to further discuss healthy life coping skills, identity development, and pursuit of life dreams and goals.

Emergence from phase three shows a young, bright, promising future where the anorexia used to be. The entire family continues to exercise vigilance even amidst beaming smiles and a huge, long sigh of RELIEF.

At Southlake Counseling, we have more than twenty years’ experience with successfully treating eating disorders, disordered eating, body image, self esteem, recovery, health, and wellness concerns in children, adolescents, young and mature adults. Our caring, compassionate, professional and highly trained staff partner with you and your family to smoothly navigate all three phases of the Family-Based Therapy (FBT) process. Discover how rewarding and satisfying it can be to become an active participant in your child or adolescent’s health and wellness by contacting us at www.southlakecounseling.com

Be Well,

Kimberly


Published on Monday July 26, 2010 in Eating Disorders. 0 Comments Tags: , , , .

Family-Based Therapy: Three Steps to Anorexia Recovery, Part I

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When I read the words “three steps to…” I usually think, “Oh, here we go. Someone is about to tell me that something very difficult is really very easy.”

Rest assured, that is not going to happen here. I am a licensed treating professional with more than two decades of experience treating eating disorders, but I am first and foremost a parent too, and I know that all individual or family-based positive change takes persistence, patience, effort, and time.

So what I am about to share with you is not easy at all – but it is very possible, and it is highly effective. In this two-part blog series on implementing Family-Based Therapy (also called the Maudsley Method) for recovery from anorexia nervosa, we will examine the reasons behind the newfound acceptance and popularity of a family-based approach to treatment, as well as the three steps every family will follow to implement family-based therapy in the home.

The role of the parent in eating disorders recovery has long been a controversial one. In the past, treating professionals have commonly regarded parents as, if not the main culprits, at the very least a large part of the problem. Parents have been cordoned off from the treating area, banned from the therapy room, locked out of the kitchen.

Today that thought process is changing. Efforts from concerned parents such as Laura Collins, the author of “Eating With Your Anorexic” and founder of the F.E.A.S.T. parent support and advocacy group, and treating professionals like Dr. James Lock, co-author of the “Treatment Method for Anorexia Nervosa: A Family-Based Approach,” have reassured parents that they do have a place in the treatment process – and a vital role that only a parent can fill.

Additionally, there is a growing body of scientifically-sound research that highlights the efficacy of involving the parent in the adolescent’s recovery. The message is clear – parents can learn, parents can help, parents are needed.

For parents of an anorexic child or adolescent, this is very, very good news!

For single parents who are concerned that the process won’t work without a parental team, there is even more good news. Recent research has shown that the FBT approach can work equally well with a single parent head of household. The main determinant of success is not dual parenting but rather parent education, commitment, and involvement in the process.

Stay tuned next week for Part 2 when we examine the three phases of FBT, what a parent can expect during each phase, and a big picture look at a typical outcome for families who adopt the FBT approach.

At Southlake Counseling, we have more than twenty years’ experience with successfully treating eating disorders, disordered eating, body image, self esteem, recovery, health, and wellness concerns in children, adolescents, young and mature adults. Our caring, compassionate, professional and highly trained staff partners with you and your family to smoothly navigate all three phases of the Family-Based Therapy (FBT) process. Discover how rewarding and satisfying it can be to become an active participant in your child or adolescent’s health and wellness by contacting us at www.southlakecounseling.com

Be Well,

Kimberly

Published on Monday July 19, 2010 in Eating Disorders. 0 Comments Tags: , , , .

My Steps to Recovery – Saying No to ED and Yes to Life!

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I have been asked numerous times over the last twenty years about HOW to recover from an eating disorder and IF it is REALLY possible.  I am here to tell you that Recovery is not only possible, but can become a reality for you, too.

In honor of Mental Health Month I wrote this post to answer that question and to give you some words of encouragement – I recovered from an eating disorder after suffering for over 8 years and now use that experience to help others recover.  My way was only my way and no indication of what will work for you, but my experience may give you some ideas for recovery, as it does contain things I often find useful in working with my clients.  Recovery is a very personal experience, so take what you can use and leave the rest.

What did it take to stop?  Honesty, openness, and willingness. And a lot of hard work and persistence.

Has it been worth it? Absolutely. Today I am free of being controlled by unconscious urges with food and compulsive exercise.  I know how to respond so I don’t have to engage in the behavior. I am more self-aware, healthy, and centered. I also realize that food is just food and weight is just a number on the scale.  Neither can bring me true happiness. And I have finally accepted people don’t like me or dislike me because of my body, but because of who I am as a person.

Is it perfect? No, because perfect doesn’t exist, and I live in a world where focus on body, diet, and perfection is idealized. I need to maintain a certain acceptance, willingness and awareness. But this is such a small price to pay for having freedom.

How did I do it? I am actually working on writing the story of my recovery, but to give you the shortened version, this is what I did and the steps I took.

1)     I accepted that I had an eating disorder and I needed help.  I also came to realize it was not my fault, and I had no need to feel ashamed. An eating disorder is a real medical condition. I didn’t ask to have one, I just developed it due to a combination of many factors; genetics, triggering events, family issues, and peer pressure.

2)     I retired my “Cinderella Complex” and came to accept and realize that no one was coming to save me.  I would have to develop responsibility for saving myself.  Looking outside myself was not the answer, I had to look within and discover my true self.

3)     I came to understand that although it was not my fault, it was my responsibility to do whatever it took to learn to control the urges I had and the actions I took. Thus, I needed to make a decision on how I was going to approach the problem and then begin to do it.

4)     I decided that I would do whatever it took to reach recovery and regain my life. I reached a point where I realized that living with an eating disorder was really no way to live. I could learn to eat in a healthy way, manage my urges, and learn to tolerate my feelings without necessarily acting on them. As Goethe once said, “The moment one definitely commits oneself, then providence moves too. All sorts of things occur to help one that would never have otherwise occurred. A whole stream of events issue from the decision, raising in one’s favor all manner of unforeseen incidents and meetings and material assistance which no man could have dreamed would have come his way. Whatever you can do or dream you can, begin it. Boldness has genius, power and magic in it. Begin it now.”

5)     I took the time to educate myself and learned all I could about eating disorders and what was needed to live without one.  I fully accepted it wasn’t about the food or the weight. I accepted that I couldn’t do it alone and that I needed to practice humility and ask for help.  Being responsible for my recovery didn’t mean I had to do it on my own.  I could be vulnerable, admit my imperfections, and live to tell about it.  I could also allow people to help me.

6)     I did self-monitoring for 6 months, an average of five days a week. I learned SO much about myself, my patterns, and my responses to situations, whether I was tired, lonely, angry, or feeling anything else.

7)     I took medication to moderate my anxiety and depression – it didn’t help me to eat, but it enabled me to lift the depression and anxiety I had experienced since childhood, so I could stay motivated with my practice of all the tools I had learned from others, and developed on my own.

8)     I began to focus on the things in my life that were the most important to me and surrounded myself with positive and encouraging people. I learned to identify my true feelings, and noticed that if I expressed myself in appropriate ways, and set good boundaries, I was less likely to be triggered.  Self-care became a huge part of the process.  I learned how to put myself and my needs first and let go of feeling guilty when I said NO. I practiced  meditations, relaxation techniques and learned to enjoy exercise as a way to move my body rather than punish myself for what I had eaten.

9)     I decided that I was willing to accept that this might take a while, but what did I have to lose?  I could either keep living the way I was, which was in misery, or I could begin to practice all the things I was learning and take some risks.

10) I Learned not to beat myself up when I did slip. I came to realize that we DO slip on the road to recovery, or most of us do. So learning to be a little(or a lot)  more compassionate and accepting with myself was a big part of the process.

11) I Learned to measure my recovery not by the scale, but by how fast I got back on track with my life, how little I berated myself, how much I was able to congratulate myself and enjoy all of my accomplishments.

12) I kept a gratitude journal.  In the deepest darkest days of my depression, anxiety, and ed behaviors I didn’t think there was anything to be grateful for.  I was wrong.  When I began to focus on all that I was and everything that I had, a small light started to shine.  As Helen Keller said “Keep your face to the sunshine and you will not notice the shadows.”

13) Even after my symptoms subsided, I stayed in therapy to discover my true self, who I was without the eating disorder.  How could I be myself if I didn’t know who I was? Look for my upcoming book… How can I be myself when I don’t know who I am TM.

14)            I found a passion and purpose for being- my career and helping others recover and focusing on having my own family. Finding a reason to recover was important.

15) Today I live with the full understanding that yes, my eating disorder could come back at any time. However, this way of life has become an opportunity for self-growth, centeredness, awareness, and acceptance. Today, I have the tools I need and the commitment to use them.  Every day, I Say Yes to Life !

The good news is there really are pathways out of being controlled by ED and other compulsive behaviors. The challenge is that it takes time, commitment, awareness and practice. But then, to be good at anything usually does. I have lived many years free from Ed behavior and am lucky enough to work every day with amazing people who are also on this journey.  If you are on this path, struggling, or just need someone who really understands, give me a call.

To your success and happiness,

Kimberly

Kimberly Krueger, MSW, LCSW is a therapist and the founder and director of Southlake Counseling and The Center for Self Discovery in Davidson, NC. Kimberly may be reached at kkrueger@www.southlakecounseling.com

Southlake Counseling is Lake Norman’s leading behavioral health treatment center, providing a full range of clinical services to children, adolescents, and adults. Southlake services include therapy, psycho-educational and psycho-social assessment, consultations, health education, nutrition, wellness and coaching programs for those suffering emotional, behavioral, health, and educational challenges.


Published on Monday June 21, 2010 in Eating Disorders. 0 Comments Tags: , , .

Your Say Yes to Life Monday Motivator: “Fat” is Not a Feeling But I FEEL Fat!

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We all have “fat days”. Even if you are a man reading this, you probably are not scratching your head wondering what a “fat day” is. You know.

We all know. 

Fat days are like cold-and-flu season, garden weeds, or your dog’s next teeth-cleaning appointment – they are going to come. Inevitably. There is no sense trying to run and hide.

But what can we do? If having “fat days” is more about management than elimination, and we are all going to “feel fat” from time to time, then where is the dividing line between the inevitable and its amount of influence over how we feel about ourselves, our bodies, and our lives?

Once again, it boils down to knowledge…and choice. First, we have to understand and decode where “feeling fat” comes from and what it means to us. Next, we have to decide if this business of “feeling fat” still works for us, or if we would prefer to make a new choice in how we understand and deal with fat feelings, and fat days, in our daily lives. 

So where do we start? We can begin by exploring where feeling fat even comes from, how it started, and why it is so much a part of our culture today that we often accept it without question – and even welcome it in as a helpful, rather than harmful, regular houseguest.

In 1995, the Discovery Channel reported the sad but fascinating results of the introduction of western television programming into the culture of the little island of Fiji. Prior to receiving access to westernized shows like “Melrose Place” and “90210”, only three percent of Fijian females suffered from eating disorders. Three years later, 74 percent of Fijian girls reported feeling “too big” and 62 percent had gone on a diet.

We may not think the environment around us gets under our skin, but we don’t have to look very far to see how much influence it actually has on our day-to-day routines and perceptions of ourselves and others. We feel fat because anti-fat messages are everywhere we are. Billboards, television and movies, advertisements, even our daily dialogues with each other are full of labels like “thin” and “fat”, “good” and “bad”, “healthy” and “unhealthy” – and almost none of it is backed up by actual scientific facts.

In fact, most of the steady diet of fat-bashing that we take in has one purpose and one purpose only – to induce dis-ease so that we will spend our hard-earned cash to fix a problem that is all in our heads!

Okay, so now we know. We have been told to feel fat, and we have – up until now at least – very obligingly obeyed. But now we really do feel fat – so what options do we have to extricate the word “fat” from the very real and valid feelings we are having underneath?

First, we can start to access our power of choice by working hard to understand what “feeling fat” means to us. We have to recognize that “fat” in and of itself is NOT a feeling . More accurately, “feeling fat” it is an edgy little ache that grabs our attention long enough so we will trace it back to its source and deal with the real root issue. So when we feel fat, we can instantly snap to attention and begin our sleuthing process – tracing it back, and back, and back, until we uncover what triggered the fat-feeling so we can deal with that and move on to recapture our sense of health, wellness, and balance.

If you are struggling with or in recovery from an eating disorder, you may already be familiar with the technique of naming your fat feelings. This is a very helpful approach that involves building your emotional vocabulary. There are five major emotions – anger, fear, disgust, sadness, and happiness – and about a million permutations of each. For instance, if we know it is not “fat” that we are really feeling, could it perhaps be “anger”? Or is it instead a permutation of anger – maybe “rage”, “annoyance”, “hostility”, “displeasure”? In this way you can take your power back by naming what you are really feeling, and investigating what your real emotions are trying to tell you so you can work through them and return to peace and equanimity again.

You might also want to try another code-breaking exercise to figure out what “fat” really stands for in your life. In this exercise, you will complete two sentences. First you will write down: “Thin =” and complete the sentence with appropriate descriptions of what “thin” means to you in that moment (examples might include: good , happy, desirable, successful, popular, attractive, etc). Next, you will write down “Fat =” and complete the sentence with your assessment of what fat feels like to you in that moment (examples could include: disgusting, irresponsible, lazy, unattractive, unacceptable, lonely, unsuccessful, etc.). In this way you can backtrack to discover what you are really feeling, and begin to deal with those feelings.

At Southlake Counseling, we understand how painful “feeling fat” can be – we have spent years honing our skills for battling back against our culture’s focus on the socially-acceptable prejudice of weight-ism and helping others to do the same. If you are having trouble completing the exercises above, or if you try your hand at them and find that strong emotions are coming up and you need support to work through them, visit us at www.southlakecounseling.com. Let us help you to start your New Year off on an empowered note by saying “no” to feeling fat in 2010 – and saying YES to feeling what you really feel, owning your right to have and express your true emotions, and doing what you need to do to live the life of your dreams!

Be Well,

Kimberly

Published on Monday December 21, 2009 in Eating Disorders and Monday Motivator. 0 Comments Tags: , , , .

Your “Say Yes to Life” Monday Motivator: Finding a Reason to Recover, Part III

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I hope you have been enjoying this three-part series on Finding a Reason to Recover. To recap, in Part I, we explored what a “reason” is and how to decipher the reasons we have for the choices we make. In Part II, we looked at the word “choice” and how the very natural human emotion of fear factors into the choices we make to stay stuck or move forward.

For the conclusion of our series, we will explore what it means to “recover”. Accepted definitions of this word include: “to get back, regain, to compensate for, recover losses from.” 

These definitions might resonate if we developed an eating disorder as an adult, and we have strong memories of what life was like, what we were like, and who we were before the eating disorder set in.

But what if we have been struggling with the eating disorder for so long that we can no longer recall who we were or who we could be again without that influence controlling our lives? Or what if we were very young when we first became ill, and today contemplating life without the eating disorder feels identical to contemplating life without….us?

In this context, recovery can feel like a scary, even impossible, concept to grasp.

So here is where we must start pulling together our reasons and our choices to stay stuck or break free and assemble them on the foundation of our sense of self – our personal identity. If we don’t have a personal identity, or don’t remember it anymore, then here is where we must start, because the simple truth is that we cannot recover, regain, or get back anything if we don’t know what – or who – we have lost.

If you enjoyed significant time free from your eating disorder before you became ill, then now is the time to put your memory to work and remember what life was like. What were you like? What did you enjoy doing? What did you look forward to? Whose company did you seek out? What did you think about when you woke up in the morning and went to sleep at night? How did you spend your time and energy? What were you curious about, fascinated with, interested in? Who were you? So spend some quality time this week getting to know you B.E.D. – Before Eating Disorder.

If you developed the eating disorder before you had a strong sense of self, then examine the people around you, especially the people whom you value the most and look up to. What do they enjoy doing? What do you admire about them? If you could be anybody, go anywhere, do anything, who/where/what would you turn your attention to? What causes move your heart? What makes you long to reach out and help someone else? Whose friendship do you enjoy and why? What societal groups tug at your heart strings and why? Who could you be – who would you be – if you had time and energy free from managing the demands of your eating disorder to be YOU? Spend some time envisioning you A.E.D. – After Eating Disorder.

Understand as you do this wonderful, vital work of reconstructing “you” free from the eating disorder’s influence that the priceless gift hidden within the hard work of recovery is the opportunity to wipe the slate clean – or to keep what is good from your past and discard what is harmful now and replace it with something better. You can literally create a fascinating new reality for yourself built on the strength of your determination to overcome your life-threatening disease and the knowledge that if you can recover from an eating disorder, you can do anything you set your heart and mind to achieve.

This is the best reason to do the hard work of recovery that you will ever find. Inherent in choosing to recover is the knowledge that you are worth recovering for, that life is worth recovering for, that you matter, and that there is a place for you and work that only you can do in this world. And even if you don’t feel that way now, don’t believe that now, or don’t see that in yourself now, if you long to be able to one day, then that is a good enough reason to invest the time and energy you have been giving to your eating disordered thoughts and behaviors into recovering from them instead.

Marian Wright Edelman, Founder and President of the Children’s Defense Fund, said it best when she stated, “It is time for every one of us to roll up our sleeves and put ourselves at the top of our commitment list.”

She didn’t say “when we feel like it, when we believe it is okay, when we have earned it.” She simply said “It is time” to do it. Now. Today.

It is always a good day to choose to recover. At Southlake Counseling Center, we know exactly how much courage, determination, and vision that decision requires, and we have dedicated our lives to supporting you in your recovery journey as we first were supported by caring and skilled others in ours. So contact us today at www.southlakecounseling.com to find out how to make 2010 the year that you say “goodbye” to your eating disorder and YES to your own precious, purposeful, and powerful life!

Be Well,

Kimberly

Published on Monday December 14, 2009 in Eating Disorders and Monday Motivator. 0 Comments Tags: , , .