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Insights from the Herd

Horses always teach us a lesson or two on mindfulness and dealing with our our feelings. During this one particular session, Solveig, our newest mare in the herd, met barn-kitty, or Mr. Barney. This time, our session focused on starting new relationships and relational competence. Solveig approached Mr. Barney cautiously, while Mr. Barney, a more seasoned barn and herd guest, proceeded to greet her trustingly. Solveig was respectful, kept the distance, respected both physical and emotional boundaries, and more importantly, was open and honest in the newly budding friendship.

Pondering on their interactions, I am wondering:

  • How do you approach new relationships?
  • How do you deem if they are safe, physically and emotionally?
  • How cautious are you?
  • Do you have preconceived ideas on who the other person is, or even, who you *should* be in relationships?
  • Do you show your true self?

As a result, Solveig and Mr. Barney are continuing to build a solid, cross-species friendship while being trustworthy co-therapists for the equine assisted psychotherapy sessions. Hope your relationships bring you the same joy as theirs!

Written by Ioana

What is Family Based Therapy (The Maudsley Approach)

Family Based Therapy (The Maudsley Approach) sees the parents of the ill person as the best ally for recovery. In this evidence-based approach, parents are seen as the most committed and competent people in the patient’s life and therefore best qualified to find ways to fight the illness, to regain healthy weight, and end unhealthy behaviors. The Maudsley approach can mostly be construed as an intensive outpatient treatment where parents play an active and positive role in order to: Help restore their child’s weight to normal levels expected given their adolescent’s age and height; hand the control over eating back to the adolescent, and; encourage normal adolescent development through an in-depth discussion of these crucial developmental issues as they pertain to their child.

Phase I: Weight Restoration The Maudsley Approach proceeds through three clearly defined phases, In Phase I, also referred to as the weight restoration phase, the therapist focuses on the dangers of severe malnutrition associated with AN, such as hypothermia, growth hormone changes, cardiac dysfunction, and cognitive and emotional changes to name but a few, assessing the family’s typical interaction pattern and eating habits, and assisting parents in re-feeding their daughter or son. The therapist will make every effort to help the parents in their joint attempt to restore their adolescent’s weight. At the same time, the therapist will endeavor to align the patient with her/his siblings. Most of this first phase of treatment is taken up by coaching the parents toward success in the weight restoration of their offspring, expressing support and empathy toward the adolescent given her dire predicament of entanglement with the illness, and realigning her with her siblings and peers. Realignment with one’s siblings or peers means helping the adolescent to form stronger and more age appropriate relationships as opposed to being ‘taken up’ into a parental relationship. Throughout, the role of the therapist is to model to the parents an uncritical stance toward the adolescent – the Maudsley Approach adheres to the tenet that the adolescent is not to blame for the challenging eating disorder behaviors, but rather that these symptoms are mostly outside of the adolescent’s control (externalizing the illness). At no point should this phase of treatment be interpreted as a ‘green light’ for parents to be critical of their child. Quite the contrary, the therapist will work hard to address any parental criticism or hostility toward the adolescent.

Phase II: Returning control over eating to the adolescent The patient’s acceptance of parental demand for increased food intake, steady weight gain, as well as a change in the mood of the family (i.e., relief at having taken charge of the eating disorder), all signal the start of Phase II of treatment. This phase of treatment focuses on encouraging the parents to help their child to take more control over eating once again. The therapist advises the parents to accept that the main task here is the return of their child to physical health, and that this now happens mostly in a way that is in keeping with their child’s age and their parenting style. Although symptoms remain central in the discussions between the therapist and the family, weight gain with minimum tension is encouraged. In addition, all other general family relationship issues or difficulties in terms of day-to-day adolescent or parenting concerns that the family has had to postpone can now be brought forward for review. This, however, occurs only in relationship to the effect these issues have on the parents in their task of assuring steady weight gain. For example, the patient may want to go out with her friends to have dinner and a movie. However, while the parents are still unsure whether their child would eat entirely on her own accord, she might be required to have dinner with her parents and then be allowed to join friends for a movie.

 Phase III: Establishing healthy adolescent identity Phase III is initiated when the adolescent is able to maintain weight above 95% of ideal weight on her/his own and self-starvation has abated. Treatment focus starts to shift to the impact AN has had on the individual establishing a healthy adolescent identity. This entails a review of central issues of adolescence and includes supporting increased personal autonomy for the adolescent, the development of appropriate parental boundaries, as well as the need for the parents to reorganize their life together after their children’s prospective departure.

A Sum of All Parts

As far as I can think, everything has parts to it. The solar system, continents, our government, a business, a family, our body and even our own personality. When we talk about “our personality” we talk about it like it is one entity. But have you ever noticed, that you have a lot of different types of parts to your personality?

Maybe there are times when you can be laid-back and times when you are ultra competitive. Maybe a time when you are in control and show leadership traits and times when you are the student and an observer. I have noticed from patients that they also struggle with different parts of themselves that may be at conflict.. Such as, wanting to be loved, accepted and connected but there is another part that may be pushing him/her to be isolated, distant and disconnected.

What parts can you identify in you? What are the most helpful and what are the most hurtful? How did these parts develop?

Tackling Thanksgiving without Trepidation

As Thanksgiving approaches, you may be feeling nervous about the big meal. We’re all aware that Thanksgiving is known for its spread of delicious foods and heaping plates. For someone with an eating disorder, such as bulimia or binge eating disorder, this can bring on intense anxiety and fear. But it doesn’t have to! Here are a few tips to help you work through Thanksgiving with minimal anxiety and maximum joy… ·

Regular meals on Thanksgiving day. Don’t fast all day to “save up” for the meal later on. Having a normal breakfast and/or lunch (depending on when you have your Thanksgiving meal) will keep you from being famished and subsequently bingeing on the delicious buffet. So if your big meal is at lunch, have a balanced breakfast and plan on having dinner as well. If your big meal is at dinner time, eat a balanced breakfast & lunch (and even an afternoon snack if you’re hungry). ·

Recruit support. Whether you’re getting together with family or friends, seek out someone who can hold you accountable at the meal (i.e. make sure you eat and/or keep you from bingeing). If you aren’t going to be eating with people whom you aren’t comfortable holding you accountable, talk to someone on the phone before & after the big meal with whom you are comfortable sharing with. ·

Review your portions. If you have a meal plan, think about traditional Thanksgiving foods and how they might count as part of your typical meal plan. The following tips can help you gauge how to portion out your foods on the big day: o The size of a woman’s palm (width & thickness) = 3 ounces turkey o Thumb tip (from the knuckle up) = 1 tsp oil, butter, salad dressing o Tennis ball = ½ cup of stuffing, sweet potatoes, mashed potatoes, cooked veggies o Egg = ¼ cup gravy or cranberry sauce ·

Rate your hunger. Before the meal, check in with yourself to see just how hungry you are. Be mindful about how you build your plate to satisfy your hunger. When dessert arrives, ate your feeling of fullness in order to determine what portion of dessert you desire. For pies, a 1/8 slice is the traditional serving. To visualize this, think about the space on a clock between the hour-hand at 10:30 and 12. ·

Rein in the alcohol. Too much imbibing may make you more prone to bingeing. Best to keep it at one to two drinks over the course of four hours. One drink equals: o 5 oz wine o 12 oz beer o 1.5 oz liquor ·

Ration up leftovers. Pack up leftovers in pre-portioned amounts and/or send them home with guests if having them in the house is too much of a temptation to binge.

Written by Kate Grefenstette

Getting down to a child’s level

I had the opportunity today to do some early prevention work with a group of ten darling and chatty 7year old girls during their Brownie meeting. For those of you who don’t know, the development of an eating disorder tends to start around the age of 7-10 years old. Almost every time I ask one my clients when they had their first thoughts about their body, starting to develop self-esteem issues and even start disordered eating, the majority say it is around those ages. What I didn’t tell these little girls yet (might wait till girl scouts) is that they are about to hit some hormonal changes which will cause some of them to be more “chubby” and NO that does not mean they need to diet. Their body is doing exactly what it should be doing. What I did talk to them about was my favorite topic – understanding your self-worth. I had my work cut out for me, they had yet to hear the words “self-esteem” or “self-worth” and had their hands raised to tell me something about their dogs or toy and thought that just maybe this would be over their heads. But I persisted.

I luckily I had a penny in my pocket that looked like it had a few rough days. They understood that a penny is worth 1 cent. Even if it was a brand new penny or a sad looking penny it didn’t change its worth. And like this penny, if they did bad on a test or lost a race or finished first, their worth doesn’t change either. We went to discuss what is worth money and what is not. Hmm, maybe a toy that they have had forever isn’t “worth” much to them, but their mommy they couldn’t come up with a value. We were able to discuss how all humans are born with the same worth. We all born precious, unique and imperfect. Yes, even Obama has the same worth as them and even the person sitting right next to them. When asked what is special about Obama they said the differences are that he is taller, has a bigger house, works harder and is older. But could also see that he was born making messes in his diapers, crying, and probably threw some temper tantrums too.

To show them that they are all unique, I had them put their thumb print on the middle of a page that symbolized their heart and then draw how they see themselves with the heart as their center. I am not an art therapist, but do want somebody to interpret why one girl drew herself as a cat, but the rest did an amazing job. They took magnifying glasses to study each others heart to see the differences and similarities.

I may not have made an impact on whether they have a future eating disorder. But I do believe they heard for the first time that they are perfect just the way they are even if they never reach first place.

By Heather Baker, LCSW