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The Continuum of Trauma

Trauma is becoming a household concept in the past decade, as we see the many atrocities that are going on around our world and in our own communities. Now many organizations are placing a significant focus on raising awareness of how trauma affects individuals, families, and communities. We hear a lot about trauma and PTSD, they have become buzz words we use to describe war scenarios, domestic violence, and other tragic life events. We hear the word and maybe we have a clear concept of what it is or what we think it isn’t, but the surprising reality is that trauma can be present anywhere at any time. How so? Well, it happens on a continuum.
In the mental health community trauma takes two forms, Big “T” and Little “t”. It’s fairly intuitive, the Big “T” traumas are the classic examples of trauma, it’s the BIG events, like car crashes, sudden death of loved ones, natural disasters that sweep away communities, sexual or domestic violence. Makes sense right? These are the jarring events that leave us questioning, searching, lost, confused, and angry (all at once or in progression). They are the events that are readily recognizable as overwhelming, the events that have awareness groups rallying in line to support survivors of the tragedy. There’s an outcry to help these survivors and an increasing inventory of programs and services available to inform, normalize, and process the aftermath of the Big T.
Little ‘t” traumas are often overlooked. Its death by a thousand cuts… it’s the little inconveniences that send you into a sneaky hate spiral (click here for a hyperbolic explanation of the sneaky hate spiral). It’s all the little jarring things that happen throughout the course of the day, week, or month that progressively add up. Without the necessary skills or supports in place to counter or process these “mini” stressors our systems (mind, body, spirit) get overwhelmed. Little “t” can be things that are recognizably stressful like a new assignment at work or be the minutia that builds and ultimately overcomes us, leading to the same mental chaos as the Big “T”; the problem is that we don’t realize our systems are overwhelmed by all these “small” things until our health or sense of peace suffer.

The beauty of it is that solutions are available. Since this is a therapist writing for a therapy blog, I’ll bet you are thinking I’m going to recommend it as a first line of defense. Surprise, that’s not the case! What I would recommend is slowing down, easier said than done, but give it a try. We spend so much time and place so much emphasis on being perfect and having it all together all the time that we forget to step back and appreciate the little positive moments or don’t take time to process and rebound from the little negative ones.

Try the tips and tricks below to help manage the Little “t’s”; if that isn’t enough, therapy is always an option. There is no shame in asking for help or in seeking new tools and resources to get you over a hump.
• Breathe – use the power of breath to literally breathe life back into yourself
• Body Check – keep an eye on where you hold your tension, the more aware you are the easier it is to see when your body is feeling overwhelmed, even if your mind is telling you to push through it. When you feel it, take a step back and let yourself recover.
• Find an Outlet – everyone’s is different. If you don’t find joy or peace in running don’t run, if yoga isn’t your thing don’t do it. The goal is to find a thing that works for you.
• Put it in Perspective – it takes a little practice but try the rule of 10’s. When you are feeling anxious or overwhelmed ask yourself what impact the outcome of whatever you are focused on will have, really… will this matter in 10 minutes (the guy that cuts in front of you on the freeway), will it matter in 10 days (the balloons you forgot to pick up for the birthday party), will it matter in 10 months (the exam you did poorly on or the job interview that didn’t go so well), will it matter in 10 years (the relationship with your friend or significant other that is in a rocky spot).
o In short, put the level of energy you give something some perspective. Life isn’t perfect and it doesn’t have to be. Some of the best moments are in the mishaps and I am pretty sure no one is on their death bed commiserating over the person that cut them off in traffic 40 years ago. Essentially, let the small things, be the small things.
• Find a Friend – countless studies have been conducted showing how social support mitigates the negative impacts of stress. Meaning the Little “t’s” don’t build as quickly or as uncontrollably when we have healthy social supports to help us process (or vent) our stressful days. Side note: don’t let the venting become the premise of the relationship, that doesn’t do anyone any favors. Allow yourself one cup of coffee and one conversation, then move on.
When you feel like these basic tactics aren’t enough, it might be time to seek professional help. When Little “t’s” overwhelm us we often become anxious or depressed, which can skew our decision making and behaviors, which in turn keeps us in a rut. This is where a professional can help you peel back the proverbial layers and help you reverse or counter the things in your life that aren’t working for you. It’s always OK to ask for help and there is always light at the end of the tunnel.

Be kind to yourself, be kind to others, and keep it moving.

More Information on Trauma:
http://www.prolificliving.com/100-positive-affirmations/
http://www.trauma-pages.com/
http://www.nctsn.org/resources
https://www.psychologytoday.com/basics/trauma
http://www.helpguide.org/articles/ptsd-trauma/emotional-and-psychological-trauma.htm 

 

Written by Ashley Steelman, MSW

Ashley

 

The Courtship of Therapy

[fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][vc_social_links size=”normal” email=”” facebook=”www.faceboook.com/prosperityedwell” twitter=”@ProspEDWELL” google=”” linkedin=”www.linkedin.com/in/heatherbprosperity” youtube=”” flickr=”” instagram=”” behance=”” pinterest=”” skype=”” tumblr=”” dribbble=”” vk=”” rss=””]psychotherapist-berkeley-ca-2_zpsf3e71077A couple of years ago a friend and I started dating churches. We were both looking for a safe and sacred space to grow, question, and feel connected to something more than ourselves. It’s a church, how different could they really be? SOOOOO DIFFERENT my friend, and so began our journey of courting churches. We went to… a lot; some were too big, others too small, some too rigid, others too righteous, and others still who were too “cliquey”, too passive, or too vanilla. Eventually, we landed in one we liked, it was just the right size, focused on what we viewed as important, had activities we were interested in and a message we found engaging; in essence we finally felt in sync with our spiritual path that was facilitated by the church’s mission and objectives.

Though church and therapy aren’t a one to one connection, I believe one thing to be true, we are all looking for acceptance and connection. Spirituality is one of many ways to find peace and centering. But what happens when we need just a little more help? When we need an objective and supportive voice to help us process our past, present or future? Therapy is a valuable mechanism to help people do just that.
Much like the quest for the right church, the quest for the right therapist can be a daunting one. Every therapist (at least ones worth their salt) will view and use themselves as a tool to help their clients along their journey. To do this we, use our personalities, our strengths, and evidence based practices to encourage and challenge our clients to reach their personal goals. That means our personalities matter just as much in the process, liking and trusting your therapist will get you a lot farther in your growth and development than if you were “out of sync” with the person across the couch.
The idea of therapy can be very intimidating. It can mean being vulnerable (potentially for the first time), it can mean letting go of people or things that no longer serve you, it can mean realizing there are different ways to view and interact with the world (aka HOMEWORK!); but most importantly, it can mean a new beginning, an end to unnecessary burden, and a new appreciation for the human experience.

Since this is such a personal and powerful journey, you need to make sure you are choosing the right partner for the job. Therapy is a partnership, it requires two people to be in sync and is most effective when there is a strong alliance in the relationship. How do I find this you might ask? Like dating a person or finding a church, it is okay to court your therapist or multiple therapists (as many as you want for as long as it takes). You’ll know you’ve found the right one, you’ll feel it, trust the feeling.

Below are some tips and tricks for finding the right therapist for you.
Identify Your Need (i.e., what are you looking to address?)
You don’t have to have this fully fleshed out, you and your therapist can work on identifying the specifics, but knowing what you want to work on will help you scope your search.

  • Do you want self-work or couples work, or both?
  • Do you have a unique need, perspective, or stressor (e.g., LGBT, challenges with the Military Life Cycle, Self-Harm, etc.)
  • Do you have a known diagnosis (e.g., Anxiety, Depression, Eating Disorders, Addiction, etc.)
    Ask Around / Look Around

Mental health problems affect nearly every family in America, and by extension, nearly every family in your community. I am a firm believer that everyone can benefit from one hour a week to talk about themselves and process what is going on in their world. If you are comfortable, ask around!  Chances are someone you know is going to or has gone to a therapist; if you feel comfortable asking for a referral go for it! Remember there is no pressure to stick with the referred practitioner if they aren’t the right fit for you.

There are many sites available to help you search and select the right therapist for you. You can always do a good old fashioned google search, but some of my favorite sites are:

  •  Psychology Today https://therapists.psychologytoday.com/rms/prof_search.php
  •  Good Therapy http://www.goodtherapy.org/find-therapist.html
  • Theravive http://www.theravive.com/cities/locations.aspx

My Therapist is… (Think about the characteristics your ideal therapist would have)
Knowing what you are comfortable with and what personality styles work best for you will help you narrow your search, do I want young, old, male, female, high energy, low energy?

  • Do you prefer a man or a woman, some people feel more comfortable with a same sex therapist (i.e., a survivor of sexual trauma may feel more comfortable with someone of the opposite sex as their abuser)
  •  Do you prefer a certain age (someone older or younger)
  • Do you want someone more enthusiastic or calm (think about your personality and who you feel most comfortable with)

Time and Place

  • Everyone has spinning plates, engaging in therapy is a commitment of time and energy. Make sure you account for convenience and potential competing priorities.
  • Be mindful of your location, what commute is reasonable, accounting for traffic.
  •  What does your schedule look like, what are your normal work hours, what days and times work for you? Many therapists operate outside of the normal business hours (9-5) to accommodate their client’s schedules.
    Test the Waters

Once you have done a little research on your end and found a potential partner for your journey, it is important to do a test run. You wouldn’t marry someone you’ve never met; give the new relationship a try, see how you feel. The right therapist for you will be able to meet you where you are (cognitively and emotionally) and put you at ease with the process.
1.Give the office a call
– Is the call answered or responded to in a timely manner?
– If you talk to the therapist about setting up an appointment, what is your sense of their personality? First impressions mean a lot, trust yourself!    IMG_1498
2. First Visit
– Were your first impressions validated?
–  Is the space comfortable for you to be in?
–  Do you feel comfortable talking to this person, therapy is not an interrogation! It should   feel conversational at first, you’re two people getting to know one another.
Be Patient!
What happens when I do all this and the therapist and I are not in sync? Nothing… and that is okay! It just means that that therapist was not the right partner for you in your journey. Therapy is a sacred space for you to work in, it can be an amazing and self-empowering journey; so if the first therapist is too this, and the second is not enough that, keep going! With each experience you will hone your skills and be better informed of what you need and want in your therapeutic relationship.
Don’t give up, give it a little time, court your way through the candidates until you find the one that is right for you![/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

Elephant in the Room

[fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][vc_social_links size=”normal” email=”” facebook=”www.facebook.com/prosperityedwell.com” twitter=”@ProspEDWELL” google=”” linkedin=”https://www.linkedin.com/in/heatherbprosperity” youtube=”” flickr=”” instagram=”” behance=”” pinterest=”” skype=”” tumblr=”” dribbble=”” vk=”” rss=””]I feel it, do you feel it? That uncomfortable silence and sense of dis-ease that comes when you or someone you love is suffering, but no one is talking about it. Not with a broken arm, or with cancer, or with just a rough day full of identifiable little inconveniences. This suffering is all-together different, it’s silent, because we are silent, it’s the elephant in the room… mental illness.

There is a definitive shift in the air, we are as a nation focusing more on emotional wellness and preventative care than ever before. Part of this is because people were tired of hiding, of suffering silently, and part is a result of the natural connectivity that recent technology provides. We are unveiling ourselves in a society that can be both supportive and condemning. In short, this unveiling is terrifying, not knowing what you are going to get once your vulnerability is out and you’re left exposed to the harsh voices of the masses. Despite this, the unveiling is critical to the wellness of the individual and community as a whole. Talking about the real issues takes away their power and helps us become better advocates for ourselves and for others who need a strong voice.

The Reality:

Mental health problems affect nearly every family in America, and by extension, nearly every family in your community.

The Good News:

  • Recovery is possible! There are many successful interventions, treatments, and services available to people with mental health problems.

The Bad News:

  • Many people with mental health problems do not seek or receive treatment because of stigma, fear, or lack of awareness of resources

The facts below are intended to arm you*:

  • 1:4 Adults suffer with mental illness
  • There are over 200 conditions classified as mental illness
  • 1:20 Americans has a significant mental illness (Depression, Schizophrenia, Bipolar Disorder)
  • 50% of all mental health disorders show their first signs before 14 years of age; 75% of all mental health disorders show their first signs before 24 years of age
  • Those with mental illnesses are 10X more likely to be victims of violent crime
  • Only 20% of children receive treatment for their mental health diagnosis; Only 38% of adults receive treatment for their mental health diagnosis
  • In 2011, 8 million adults reported dual mental health and substance abuse disorders
  • 45% of people with one diagnosis will meet the criteria for having another 2 disorders
  • Mental health and substance abuse disorders, that are untreated lead to more deaths than breast cancer, HIV/AIDS, and traffic accidents combined.

Stigma hurts everyone!

stigma pic

Mental health disorders do not have a single cause (many factors contribute to mental illness and emotional wellness). Stigma is a major barrier to treatment, i.e., people who suffer with mental illness do not seek treatment, for fear of discrimination or lack of understanding about mental illness.

Stigma Contributes to Which can result in
    • Negative Stereotypes
    • Worsening of symptoms
    • Shame
    • Acting out
    • Isolation
    • Self-harm
    • Discrimination
    • Self-medication

 

Not seeking treatment can prolong the suffering of an individual with mental health problems and impact their ability to effectively function in school or at work; additionally, mental health problems often strain relationships, which often leads to additional negative outcomes.

 

What you can do to reduce stigma:

 

  • Know the facts
    • Mental illness is actually quite common, it affects 1:4 families and 1:17 people have a mental illness diagnosis in America at any time
  • Speak Out
    • When you hear someone reinforcing a negative stereotype, take the opportunity to educate them
  • Discrepancy
    • Recognize that people are not their diagnosis. As opposed to “she is schizophrenic” say “she has schizophrenia”
  • Open the Conversation
    • Make it okay to talk about mental illness and emotional wellness; the more these topics are addressed the less stigma there is associated with mental health problems.
  • Practice Compassion
    • Engage others with empathy and respect; reduce language like nuts, crazy, loony, etc.
  • Help People Seek Support
    • We all go through rough times, it is okay to ask for help. Encourage the individual to seek treatment or help them find resources.
  • Give People a Sense of Hope
    • Remember there are successful interventions and services available to help almost all mental health diagnoses. Encourage the individual to find a professional to help them address their mental health

No one wants to talk about the elephant in the room; mental illness isn’t cute, it isn’t fun, it’s downright scary and can have some pretty awful impacts. Chances are you or someone you know is suffering and it’s not necessary. Help is out there, it’s available and accessible. Together we can stop the suffering by starting the conversation. Let go of the dis-ease and become who you are meant to be. #StoptheStigma

* https://www.morningsiderecovery.com/mental-illness/stop-the-stigma-infographic/

mental illness

 

Written by Prosperity’s Ashley Steelman, MSW[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

Diet Downfalls

food

These days, there are as many diets as there are types of breakfast cereals (read: too many!). Unfortunately, most diets create a false connotation of the word diet, incorporating some aspect of restriction, food/nutrient avoidance or fasting. However, the original definition of diet was simply “habitual nourishment” (Webster’s Dictionary). Any time one avoids or restricts food intake in any way, there is risk of missing out on key nutrients that are essential for health. The best diet is one that includes a variety of all foods in moderation (unless of course medical reasons prohibit one from doing so). Read on to find out the downfalls to some of today’s most popular diets.

Gluten Free
There is nothing inherently wrong with gluten, which is found in wheat, rye and barley. Yet recently it’s gotten a bad rap and has become the latest food group to avoid. For those with Celiac Disease, gluten damages the lining of the intestine causing malabsorption and a slew of other symptoms. Those with an allergy to gluten can have a variety of reactions, some of which are life threatening. For folks in these two camps, it is imperative that these individuals completely avoid gluten. Others, however, choose to eat gluten free (GF) for a variety of other anecdotal reasons. Unfortunately, those following the diet, no matter the reasons behind it, are at risk of many nutrient deficiencies.

Gluten free products are known to be low in nutrients that are typically found in whole grain, wheat-based products, such as B vitamins, calcium, iron, zinc, magnesium, and fiber. Wheat based products (i.e. bread, cereals, crackers, etc.) are mandated by law to be enriched with many of the aforementioned nutrients while GF products do not fall under such regulations. Therefore, a diet made up of mostly GF pre-packaged items will provide less nutrients than their wheat based counterparts. This is especially important for children and adolescents following a GF diet who are still growing and developing.

In addition, a lot of GF products are made with added sugars and are higher in cholesterol, calories and fat. So a 1:1 switch from gluten-containing to GF products will not necessarily bring about improved health, except when medically necessary.

Therefore, any individual on a GF diet should seek counsel from a Registered Dietitian/Nutritionist in order to ensure that their new intake pattern provides all the necessary nutrients required for optimal health.

Low Carb Diets
Low carbohydrate diets have become the go-to approach for improving health and losing weight. There are many different low carb diets out there. The premise is generally the same – reduced carb intake, increased protein/fat intake. Proponents of the low carb diets claim that carbs cause weight gain and therefore should be limited and/or avoided. Unfortunately, the science just isn’t that simple and more current research is debunking the myth that carbs are “bad.” Like it or not, carbs are essential for every bodily cell’s proper function. The brain can only use carbohydrate for energy and if you’ve ever followed a low carb diet, your brain has taken notice. Many low carb dieters complain of brain fog, headaches, blurred vision, difficulty concentrating and reduced cognitive abilities. Newsflash – it’s because the brain is in need of more carbohydrates! In addition, carbohydrates provide necessary energy to the muscles during exercise and many grain-based carbohydrate foods are excellent sources of other vitamins and minerals that one misses out on when reducing carb consumption.

This isn’t to say one should consume carbs like they’re going out of style – our culture’s portion sizes have certainly led to carb overconsumption. However completely eliminating carbs or entire food groups, such as grains, altogether isn’t the ideal response. Carbs should be present at each meal & snack (again, think about feeding the brain), yet moderation is key. Choosing high-quality, fiber-rich carbs such as whole grains, fruits and vegetables will provide required nutrients and lasting energy to help you get through your day. Low carb diet followers often weight-cycle after repeated bouts of carb-avoidance and falling off the wagon. Research and years of client testimonials prove that low carb eating is extremely difficult to sustain life-long.

Cleanses & Detoxifying Diets
Typically these diets consist of mainly liquids and promise to bring about quick weight loss and flush toxins out of the body. Many believe it is necessary to cleanse the body and clean out the gut in order to lose weight and feel better. Cleanse and detox diets provide inadequate protein, fat and carbs, which means followers of these diets are typically miserable during the process (see above about feeding the brain). Like the low carb diets, these types of regimens are also not sustainable and any weight lost is typically regained as soon as regular food intake is resumed. In addition, the claims of flushing toxins out of the body are unsupported by research.

Vegan
Regardless of one’s reasons for going vegan, this diet presents a number of nutrition risks. It’s vitally important to be aware of the nutrient deficiencies inherent in this diet so as to properly compensate for them. Often, vegans fall short in their protein, B-12, calcium, iron, omega-3 and vitamin D intake. Because most of these nutrients are most abundantly available in animal products, it can be incredibly difficult to meet one’s daily needs through plant-based foods and grains. It takes a lot of pre-planning and finesse to ensure that all nutrients are represented. Therefore, vegans should be seen by a physician to monitor vitamin and mineral levels in addition to seeking the assistance of a Registered Dietitian/Nutritionist.

 

By Kate Grefenstette, RD

 

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Awareness

Today ends the National Eating Disorder Awareness week and in it’s cessation I have a few thoughts to share in the spirit of bringing “Awareness”.

At a bloggers brunch today with some amazing women, it was asked “Why do people choose eating disorders?”

I almost stood up and started preaching. But I did remain seated and said politely “People do not choose to have eating disorders”.

So first, I would like to shout from the rooftop that a person chooses an eating disorder like someone chooses to have cancer.

An eating disorder is a disease that takes years to overcome. With only 50% reaching full recovery for life. 10% of people with this disorder die. This is the top killer out of all mental illnesses. (check out: http://www.nationaleatingdisorders.org/get-facts-eating-disorders)

But people choose to go on a diet – including children. Well children don’t always choose to go on diets, but their parents sure do. Many parents have their children eat what they eat. Case in point, as an eating disorder expert, I have had countless patients whose parents put the family on a Gluten Free diet, Vegan diets, all organic diet, and on and on. No child should ever be on a diet. They are growing and need a variety of foods for their best health (not including allergic or medical conditions). Teaching kids that there are good and bad foods influence children and hence there is a sense of shame in what you eat. There should be no guilt for anything we eat. Food is not a morality issue.

I have found that around the ages of 10-12 when a girls body is going through puberty, the messages they receive about their body is paramount. The average person should gain about 30 pounds during the course of puberty and everyone’s bodies grows differently. This is the time that many girls then think that they need to lose weight. Body dissatisfaction often starts around this time and is so prevalent amongst our children.

Parent Tip: Do not make negative comments about anyone’s body – especially your own.

Fact: 95% of diets fail. If diets didn’t fail, we wouldn’t have so many people in our world on diets and the diet industry wouldn’t be making an enormous amount of money.

Stay tuned for Kate Grefenstette, RD to write a post on the negatives of the different diets out there.

My hope is that we can start seeing food and our bodies not as the enemy but just a part of our humanity.

th

 

 

 

Body + Mind + Spirit = Your Complete Self

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At Prosperity, our therapists are all trained to help a person understand and change the way they think. If our thinking is negative, distorted and unhelpful then so will our behaviors. There is a lot of evidence that confirms changing our thinking creates change in our lives. But, our minds are just part of ourselves.

Prosperity also understand the importance of a healthy body. Without being physically healthy it is hard for a person to be in good spirits or have a quality life. We aim to help you restore and improve your health through proper nutrition, education, and proper medical care. And yet, our bodies may be in good shape, but deep within your spirit there may something missing, maybe not feeling fully connected to yourself.

We believe that knowing, understanding and listening to your inner being brings a different level of change. Harmony. Joy. Peace. Wellness.

We welcome the opportunity to work in conjunction with other providers to give each person a chance to experience wellness at all levels.[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

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?