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Treating the Family System

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When an eating disorder strikes an individual, his or her entire family is affected. According to an article by Abigail Natenshon, MA, LCSW, GCFP, 87% of eating disorder patients are children and adolescents under the age of 20. As many in this age group still live at home, the eating disorder develops and plays out within the family dynamic. It often takes on a life of its own and can be the cause of many battles at meal times, family gatherings, holiday events, and can even affect extended family and school environments. Family therapy is an essential part of eating disorder treatment and is necessary to ensure everyone who is a part of the family system is cared for.

The Family System Theory

Developed by Dr. Murray Bowen, family systems theory posits that the family is a unit and the emotional connections fostered by thoughts, feelings, and actions create an interdependent environment. This interconnectedness helps the family to become cohesive and supportive of its members. If there is unrest and tension, emotional connections can become more stressful. If there is a member of the family who tends to take on the emotions of the other members and may take on an accommodating role, leading to overwhelm and isolation. This is the family member who may become more susceptible to addictions, depression, anxiety, eating disorders, and illness.

There are eight concepts to the family systems theory:

  • Triangles: A three-person relationship system
  • Differentiation of self: Variation in how people are susceptible to pressures to conform to the group
  • Nuclear family emotional system: Four basic relationship patterns (marital conflict, dysfunction in one spouse, impairment of children, emotional distance)
  • Family projection process: The way parents transmit their emotional issues to children
  • Multigenerational transmission: Differences in differentiation across generations
  • Emotional cutoff: Managing emotional issues by cutting off family members
  • Sibling position: Impact of sibling position on behavior and development
  • Societal emotional process: Emotional systems govern behavior on the societal level

Family systems theory can be used to help clinicians understand the dynamics of the family presenting to work through one member’s eating disorder.

Family Involvement in Eating Disorder Treatment

Comprehensive treatment plans at all levels of care will involve family therapy. Center for Discovery residential programs involve the family weekly in a therapeutic way, not only in family therapy but also at meal times by facilitating therapeutic family meals. The purpose of these activities is to observe family dynamics at meal times and in social situations in order to best prepare the family for realignment and a return to balanced interconnectedness.
Some clients benefit from a type of family therapy called Family Based Therapy (FBT, also known as Maudsley). This outpatient approach, which places the refeeding process in the hands of the parents and moves the family through phases of treatment as recovery develops, has proven to be very successful for adolescents with anorexia.

In outpatient settings, family therapy is usually recommended in conjunction with individual therapy, nutrition services, and group work. As the eating disordered member reintegrates back to the system after being away at treatment, therapy is needed to help the family adjust once again. An eating disorder has the potential to isolate family members from one another, create discord in the system, and indeed can be either sustained or eliminated depending on the dynamics of the family system. It is important for clinicians and parents to know that parents do not cause eating disorders. The entire system needs attention and support to thrive again.

Natenshon, A. Family Treatment is Cornerstone of Effective Care for Eating Disordered Children. Treating Eating Disorders, www.abigailnatenshon.com

The Bowen Center for the Study of the Family. www.thebowencenter.org

When Perfection is Imperfect

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What is perfection? Current society would have us believe that it is the Stepford Standard, that anything less than keeping up with the Joneses makes us substandard, less relevant, not good enough, or just plain not enough. Webster’s defines perfection as “having all the required or desirable elements, qualities, or characteristics” and “completely free from faults or defects”. Maybe it’s just me but I feel like these definitions are in conflict.  Why can’t I have all the required or desirable elements, qualities and characteristics, AND still have faults? Why can’t I be perfectly imperfect? Perfection can be found in the faults, in the quirks that make us who we are and the experiences that we grow from that have been less than perfect.

Is it even possible for anyone or anything to be truly perfect (i.e., without flaws)? Rationally, I think most would agree that it’s not. Rationally, we know that it is part of the human experience to be flawed, to make mistakes, to rise from the proverbial ashes. But how can we rise if we’ve never been burned? Rather, in perfectionism we are consumed by the flames, the need for this unattainable perfect. Why is accepting imperfection so hard? Brene Brown has done an amazing job of addressing this question, in fact much of her work focuses this very topic.

The point of this post is not to delve into imperfection, but rather how we know when our need to be perfect, to be “completely free from faults or defects” is getting in the way of this thing called life. Society tells us that if we aren’t the highest performers, if our parties aren’t the biggest, the best, the ultimate event that has Gatsby in envy, then we aren’t doing it right.

How does this happen? How do we miss the point of the very thing we are trying to achieve? It’s simple, we forget to think about the intent of the goal itself. And, when we forget about the intent (the desired end state or outcome) we go into the perfectionistic planning mode. If you are prone to this mentality then you know how time consuming and crazed the planning gets around a desired goal. The flaw here is that the obsessive planning, the extensive preparation and painstaking compulsion to think about everything that should happen, everything that might happen, the need to think (aka obsess) about all of the knowns and unknowns, gets in the way of the goal. Not to mention it makes the process of reaching the goal exhausting. Essentially we run ourselves into the fire of worry about the “what if’s”, all the while missing the point of the event.

Take this for example, say you want to get friends together for a game night. The idea being that you would get folks together, maybe have some food, maybe some drinks, and everyone has a night full of commercial worthy fun. The perfectionist dives immediately into the planning and organizing of the “perfect” game night. Sending out the fancy semi-formal electronic invitations with the “perfect” play on words that “perfectly” captures the theme of the night. Then to the food, drinks, and venue prep. The perfectionist struggles with letting everyone bring a dish (what if two people bring the same thing, or some other catastrophe happens?!), people can bring a side but no matter what the “perfect” host needs to have the “perfect” culinary item that could make Martha Stewart green with envy. Everything must be organized, “perfectly”… heaven forbid the drink cooler not match the centerpiece. The games, must be selected with care, to facilitate the most fun of course. And then amidst all the planning and preparation for the “perfect” party, the home must be spotless. Above all cost’s this house must not look lived in!!! In the perfectionist frenzy, you stop thinking about the intent of game night, and start obsessing on the need for “perfect”, the rave reviews; you’re looking for the 5 star yelp review for what started as a means to connect with your friends/families.

Rather than connecting, you’re disconnecting. There’s no room for fun and friends when there’s a “perfect” party on the horizon. If you think your friends can’t feel the anxiety of your perfection obsession aura puts off, let me tell you, in no uncertain terms, they can. Your “perfect” planning is imperfect. It’s driven by an unattainable need to be “perfect”. Did you ever stop to wonder what perfect was?… in this case it’s not the best party favors, or the game selection, or the food, or the drinks. What makes game night perfect is the intent. You are creating a space for people that you know and love to come together and have fun (that’s the intent, that’s the desired outcome). It doesn’t matter if people love the food, or find a speck of dust under the coffee table, or if no body plays games at all on game night. What matters is that you brought people together for an evening of levity.

Some of the common cognitive distortions associated with perfectionism are:

  • Black-and-white thinking – “If this is not perfect, I am a failure.” Or “Only lazy people ask for help.”
  • Catastrophic thinking – “Everyone is watching me, if I make a mistake they will think I am stupid.” Or “If my presentation isn’t flawless, I will lose my job”
  • Probability overestimation – “Even if I study a lot, I still won’t do well on my exam.”

What happens in the above statements is that there is no room for life; because perfect isn’t defined and the intent hasn’t been identified, there is no way to determine success. There are always things we can do differently or do better in the future, that’s part of the learning curve of all life’s situations. Perfectionists have a hard time thinking about what success looks like ahead of time, instead they look retrospectively and judge themselves harshly for the things they “should” have known, never accounting for the fact that these things could not have been known at that time.

Here are some questions to ask yourself to make sure you aren’t going into a perfection obsession.

  • What is the intent? (really think about it)
  • Are the thoughts and actions you are engaging contributing to or detracting from the intent?
  • Are you enjoying it? (If the answer is no, ask yourself 1. Why am I doing this (i.e. is it aligned with my intent or my need to be perfect)? 2. What about this am I not enjoying? 3. Could I approach this differently to feel better about this?
  • Am I being competitive? (With myself? With someone else?)
  • Am I willing to ask for help? (perfectionists tend not to ask for help and/or have trouble truly delegating, also known as micromanaging)

 

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

 

Ashley Steelman, MSW

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]

Diet Downfalls

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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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