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Hope Is Essential When Working With People Who Have “Chronic” Eating Disorders

by John Levitt, PhD

I never use the word “chronic” or “difficult” when describing a person who has been struggling with an eating disorder for a long time and who has required medical stabilization numerous times. These people may have been in and out of eating disorder treatment, and they may require more or different care from others, but they always have hope. I believe that if we lose sight of the hope for a person, we damage their chance of recovery.

After more than 40 years of working with people who have eating disorders, I have learned that the vast majority of them can be treated and a significant portion do actually recover. Most people who have eating disorders are not stuck intractably, destined to continue their disordered behaviors for life.

What I have found, however, is that personal therapy that is specifically designed to support these people through their recovery is critical. While we may need to rely on hospitals and treatment centers to medically stabilize these people, they often only fully recover when under long-term care from a trained psychotherapist.

I understand how scared and exhausted parents can be by their child’s eating disorder. It’s not easy to parent a child who has an eating disorder, and repeated trips to the hospital and/or treatment center(s) can be emotionally and financially draining. I understand why some parents may lose hope that recovery for their child will ever be possible; but at that point, I’d like those parents to seek their own therapy so that they can bring hope and strength to the parent-child relationship.

In fact, if parents are feeling really run-down by the care required to support a child who has an eating disorder, I encourage them to not only seek therapy, but also to go on vacation, spend time building other relationships and hobbies, and expand their lives even as their child pursues recovery from an eating disorder. It may sound strange to tell a parent who has a child who has an eating disorder to go on vacation, but sometimes that’s exactly what is needed for the parent to have the strength and resilience to continue providing the care and acceptance needed for healing.

There is no magic bullet in eating disorder recovery, but if there were, it would be in the form of ongoing supportive and fully accepting relationships. A therapist can be one of the people who can provide this unwavering acceptance of the person who has an eating disorder, and that is a big part of how healing takes place. The therapeutic relationship is key to providing a safe space for the person to find his or her own motivation to recover.

It’s important to know that there is no single definition of recovery, and it’s also important that we find ways to enable the person who has an eating disorder to define what recovery will look like for them personally. We don’t make much progress when we push our own ideas of what recovery is, because each person has their own thoughts, opinions and internal motivation. We don’t succeed in long-term recovery by forcing our own ideas of what the person needs to do, but we can make great progress by helping the person tap into their own vision of recovery.

Someone who has an eating disorder really benefits from having people who believe that they will recover. Parents, therapists, and others can provide this belief, hope and acceptance. What we work towards is helping the person accept some of that hope into his or her own mentality, and to begin to feel true hope in their own future after an eating disorder. Remember that having an eating disorder is not a crime. It cannot be punished away, and instead needs to be treated with respect of the person’s own perspective.

When a person who has an eating disorder begins to have self-determination and thoughts of a future without an eating disorder, then we see tremendous change in both behavior and mental condition. This takes time. I can’t put a definite timeline on it, but most of my clients come to see me once per week, sometimes for a year or even more. This is the long-term investment that people must make in full recovery from a challenging mental disorder like an eating disorder. The good news is that when the investment is made, people can and do recover from eating disorders – even the most “chronic” or “difficult” cases.


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John L Levitt, PhD, CEDS, FAED, FIAEDP, is the coeditor of the book, Self-Harm Behavior and Eating Disorders: Dynamics, Assessment, and Treatment , and was on the Editorial Board of Eating Disorders: The Journal of Treatment and Prevention Email: levittj@aol.com Phone: (847) 370-1995

See Our Eating Disorder Treatment Guide For Parents

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Yoga for eating disorders: downward dog

woman doing downward dog yoga pose eating disorder relief

People with eating disorders often find it helpful to do yoga poses like downward dog. Yoga can be a soothing eating disorder treatment that you can do in the comfort of your own home. It’s effective because eating disorder symptoms often include a dissociation of mind and body, and yoga brings them together. Your child should have a number of tools available for managing anxiety, and one of those tools may be a few simple yoga poses that can help ground and center your child.

It’s wonderful when we can participate in full-length yoga classes, but sometimes a single pose is all we need to reconnect with our grounded base of strength.

Downward facing dog helps facilitate deep belly breathing which calms the nervous system and relieves anxiety, fatigue, overwhelm, and stress. It can also create positive energy in the body to counter-balance anxious, negative energy that can lead to eating disorder behaviors as coping mechanisms. By adding some visualization to the pose, you can help your child process anxiety in a healthy, healing manner.

emotional regulation

Downward Dog with Visualization and Release

  1. Begin on your hands and knees, and set the intention of calming your anxiety by using your body as a conduit for release.
  2. Remember that anxiety is just negative energy that, when contained, builds feelings of fear. Through movement, you can allow the energy to move through you rather than keeping it stuck inside your body and mind.
  3. Spread your fingers wide and press firmly into the floor as you curl your toes and lift your hips to create a V shape with your body.
  4. Lift up through your pelvis and visualize anxiety streaming out of your body. If the anxiety is “cold,” it may fall down through your fingers, toes, and the crown of your head, where it can curl up like a snake in a cave under the earth. Alternatively, if the anxiety is “hot,” you may find that it wants to release up and through your shoulders, spine or pelvis, where it can disappear into the atmosphere like a dragon’s steamy breath.
  5. Breathe in and out deeply and calmly in a soothing rhythm as you continue your visualization of the energy flow.
  6. It’s OK if tears flow – that’s a sign that you are releasing! Let them flow.
  7. Hold the pose for at least 3 minutes.
  8. Gently return to your hands and knees and repeat the pose or try another pose if anxiety is still present.

Practice this pose together with your child any time that anxiety and stress are making eating disorder behaviors flare up. Or, if you prefer, sit next to your child and talk them through the process of releasing negative energy from their body. Build your toolbox of coping behaviors throughout eating disorder treatment to support your child into recovery.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate eating disorder recovery.

See Our Eating Disorder Treatment Guide For Parents

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Why yoga is an excellent practice while in eating disorder recovery

Jennifer Kreatsoulas writes about how yoga practice can integrate with recovery from an eating disorder and eating disorder treatment

by Jennifer Kreatsoulas, PhD, CYT

As an athlete in early recovery from an eating disorder, I first started practicing yoga as a physical activity that wouldn’t tempt me to overexercise or become obsessed with burning calories.

Initially, my yoga practice was purely physical. I focused on learning the asanas or poses. I remember the thrill of observing how, with consistent practice, I could twist and fold a little deeper or balance on one foot a little longer.

But unlike other forms of exercise that had been triggering for me, I found that yoga is much deeper than the physical body, and deepening my yoga practice was healing, not exacerbating my eating disorder behaviors.

It was exciting to be a member of a community and make new friends who were also experiencing a greater appreciation for what their bodies were capable of. Little by little, my relationship with my body changed. I learned to reframe my strength and to release my grip on numbers—how much I should weigh, how much I was allowed to eat, and what size jeans I had to wear.

Today I’m a yoga therapist specializing in eating disorders and body image. I have found that integrating yoga concepts into eating disorder recovery can have a significant impact on how someone feels about – and within – their body.

Most of us in the West think of yoga as a physical exercise, but what many people don’t realize is that the physical exercises are in pursuit of mental health and relaxation. Using breath control, simple meditation and specific bodily postures, we learn to truly live within our bodies rather than observe them from the outside and judge them based on appearance. By integrating our whole selves – body, mind, and soul – those of us in recovery find a deep level of healing from our eating disorders.

In my work, I help others develop yoga practices and tools based to incorporate into their recovery. These tools and practices provide a sense of empowerment and space for healing. They also cultivate self-reliance, a motivation for recovery, and a renewed and/or improving the relationship with one’s body. For these reasons and more, Yoga can be beneficial of individuals recovering from an eating disorder.

Here is a list of some of the general benefits of Yoga based on my own life, what clients have shared, and current research.

  • Improve overall sense of self
  • Quiet the eating disorder voice
  • Redefine the relationship with your body
  • Cultivate compassion and curiosity about your body
  • Explore moments of feeling comfortable in your body
  • Strengthen your self-expression
  • Reframe how and why we feed our bodies
  • Expand your world to be so much more than food, symptoms, and body image
  • Help manage depression and anxiety
  • Cultivate self-reliance
  • Increase self-worth
  • Enhance physical strength and health
  • Improve organ function
  • Calm the central nervous system
  • Establish new beliefs grounded in health versus disordered eating
  • Complement traditional forms of treatment and therapy

These benefits are truly transformative and can make a significant impact on your child’s ability to fully heal from an eating disorder. If you are a parent of a child who has an eating disorder, I encourage you to support your loved one’s interest in adding yoga to their recovery. As a supportive therapy, yoga can cultivate resilience and infuse your child’s recovery with new energy, concepts, and motivation. They will also learn new ways to relate to and experience their bodies.

It is important to understand, however, that some of today’s yoga marketing and studios, or certain aspects of them, can actually obscure the deeper meaning of yoga, make it challenging to feel at ease. Therefore, parents should carefully evaluate the yoga studio environment before enrolling their child who is in recovery from an eating disorder.

Like all fitness endeavors today, yoga has fallen prey to the social media imagery promoting a particular body type. The yoga selfie craze can breed body comparison, and the hyper-focus on yoga as fitness can encourage competition with oneself and others.

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Also, when marketed as fitness, there’s a risk that the essence of Yoga—the aspects that guide healing and self-empowerment—can get lost in translation. As a result, old workout patterns and motivations may resurface, causing more damage than good in the short-term.

It is not uncommon to find people who are on the spectrum for disordered eating teaching yoga classes. Depending on where they fall on the spectrum, some yoga instructors may inadvertently make comments about nutrition, including recommending juice cleanses, vegetarian or veganism, or other eating behaviors that can be dangerous for someone who is in recovery. If attending an in-person class, you may want to discuss this with the studio to determine which teachers are likely to be least triggering to your child.

In early eating disorder treatment, it’s best to avoid heated studios, as your child may not be physically restored enough for this environment. Also, classes in heated studios tend to be more physically demanding. If your child has a history of trauma, I also recommend you seek out yoga teachers trained in trauma sensitivity. You might also consider your child works with a yoga therapist with a background in eating disorders to help guide his or her experience in a supportive way.

Luckily, for the long-term, there are many, many yoga options available, including a plethora of studios offering a variety of styles, books, and DVDs, YouTube videos, and other apps for home practice. The Internet makes yoga philosophy easily accessible and readable, as well as information about other practices like mantra, meditation, breathing exercises, and grounding techniques.

Yoga is not a quick fix; rather it’s a lifelong practice that complements and supports our ongoing healing. It reminds us that we are so much more than an eating disorder and the disarray this disease brings to our lives. To quote the famous yogi B. K. S. Iyengar: “Yoga allows you to rediscover a sense of wholeness in your life, where you do not feel like you are constantly trying to fit broken pieces together.”


Jennifer recently released a 3-part video series that is a wonderful option for someone in recovery. If your child is building a new relationship with his or her body and would benefit from a thoughtful yoga practice, consider this video series as an excellent (and affordable!) tool.


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Jennifer Kreatsoulas, PhD, CYT, is the founder of Chime Yoga Therapy and specializes in eating disorders and body image. In addition to her private yoga therapy practice, Jennifer leads yoga therapy groups at the Monte Nido Eating Disorder Center of Philadelphia, is cofounder of the Body Kindness Project, and a partner with both the Yoga and Body Image Coalition and the Transformation Yoga Project. She is the creator of the home video series Yoga to Strengthen Body Image and Support Eating Disorder Recovery. Her writing on the topics of yoga, body image, motherhood, and eating disorder recovery can be found on her blog as well as a variety of publications, including YogaLiving MagazineRecovery WarriorsWomen For One, The MightyThe National Eating Disorder Association blog, and several other influential online publications. Jennifer has been featured in the Huffington PostWomen You Should KnowMedill Reports ChicagoPhilly.com, and the DailyDot. Connect with Jennifer: www.ChimeYogaTherapy.com.

See Our Eating Disorder Treatment Guide For Parents

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A letter to give medical doctors when your child is in eating disorder recovery

It is unlikely that your child's regular physician has specific training in eating disorder treatment. Provide this letter to help your doctor understand

Very few medical doctors are trained in eating disorder recovery, and it is unlikely that your child’s regular physician has specific training in eating disorder treatment beyond identifying the minimum weight threshold that indicates anorexia. This means that many doctors inadvertently trigger eating disorder behaviors due to a lack of knowledge about how to treat someone who is in recovery. This lack of knowledge is not from a lack of caring. It’s just that very few doctors become well-versed in eating disorders unless specifically trained.

We can’t protect our children from a world that triggers eating disorders, but we can do something to help prevent accidental triggering from people whom we trust to care for our kids. We created a letter for you to provide your child’s medical doctors to minimize triggers at the doctor’s office. It may surprise you to know that many people in eating disorder recovery find doctors visits very triggering.

Of course, you should edit this letter to fit your circumstances. If your child is under the care of a physician for their eating disorder, definitely add that information. The goal is to provide reassurance to the doctor that your child’s eating disorder is being treated appropriately.

Please review this letter with your child’s treatment team to gain their feedback.

Dear Dr. _____________________,

My child, _______________, is coming in for an appointment with you on ___________. Before we come in, I wanted to let you know some important information.

_______________ has been diagnosed with an eating disorder. We are working closely with a psychotherapist and dietitian who are trained to work with children who have eating disorders. _______________ doesn’t physically look “sick,” or the way that most of us think someone who has an eating disorder looks.

Here are some requests we have before coming into your office. I would really appreciate it if you could share these requests with your staff to minimize any triggering events for _______________ during our visit.

Please do not weigh _______________. I would really appreciate it if your staff members do not even suggest stepping on the scale. You can probably guess that being weighed is a major trigger for _______________. If you feel that you cannot provide care without body weight, please contact me immediately to discuss this further.

Please do not comment on _______________’s appearance – positive or negative. We were surprised to find out that one of the most triggering comments for someone in recovery for an eating disorder is “you look really healthy!” We have learned that all comments about physical appearance can be difficult to handle for someone who is in recovery from an eating disorder. We have been working on saying things like “it’s great to see you again,” or “I’m so happy to see you” to replace the common greeting of “you look great!”

Please do not make any diet or exercise recommendations on this visit. Both food and exercise are a part of _______________’s eating disorder and recovery. We are working hard to support new, healthy habits around food and exercise. It’s a sensitive area right now, so it would be very helpful if we leave details about both to our dietitian at this point in recovery.

If you have any concerns about _______________’s physical health as it relates to the eating disorder, food behaviors or weight, please discuss them with me privately either before or after the office meeting so that we can work with our therapist to address them in a safe environment that will best benefit _______________’s eating disorder treatment.

I deeply appreciate your understanding in this difficult matter. I know you have a lot on your plate, and I can’t tell you how much it means to have your support!

Sincerely,


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate eating disorder recovery.

See Our Eating Disorder Treatment Guide For Parents

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Questions To Ask Before You Send Your Child to Local Eating Disorder Therapists or an Eating Disorder Treatment Center

by John Levitt, PhD

If you have a kid with an eating disorder, then you probably have a lot on your plate. Finding the right healthcare providers is critical to helping your child recovery, but it can be challenging to identify which professionals or treatment centers will be most helpful.

Unless it is medically prohibited, it’s a good idea to begin your child’s eating disorder with local resources that allow you to maintain a regular home and school environment for your child during eating disorder treatment.

Beginning with your local treatment providers allows you, as a parent, to learn the skills necessary to support recovery at home. These skills are critical to full recovery because while inpatient centers can treat the symptoms of eating disorders very well, there is a long tail of true recovery.

Even if the eating disorder behaviors and symptoms get under control in a few weeks-months, there may be many more months, or even years, required to achieve remission and, ideally, full recovery.

Questions To Ask Your Child’s Eating Disorder Therapist

There are many professionals who are available to guide and support you in helping your child recover from an eating disorder. It is very important, however, to make sure that the professionals you choose are actively trained and experienced in treating eating disorders in particular vs. those that are generalized psychotherapists. While well-meaning, general practitioners of psychotherapy may not have the specific knowledge that may be necessary to help your child heal as quickly and completely as possible. Here are just some of the questions to ask therapy providers:

  • How long have you been practicing psychotherapy?
  • What is your licensure?
  • How long have you been treating eating disorders specifically?
  • What has been your eating disorder treatment training?
  • What is your experience treating eating disorders?
  • What is your treatment approach and how does it apply to the treatment of eating disorders?
  • What are your typical treatment outcomes with the eating disorder patients?
  • In your experience, how long does it generally take you to see symptom/behavior recovery?
  • Why do you believe that you can you help my child more effectively than someone else?
  • If you don’t have much experience in eating disorders, who do you consult with?
  • How are you getting training and experience in this field?
  • When you organize therapy, what do you do to organize your approach to treatment? That is, what is your general treatment plan? This goes beyond the form of therapy (CBT, DBT, etc.) this is about having a treatment plan with specific goals toward eating disorder recovery.
  • How are you going to include me, the parent(s), in treatment and recovery?
  • What resources or guidance will you provide me with to optimize the recovery process?

The most important thing for parents to know about these questions is that they should be welcomed and expected by your child’s therapists. Parents are a critical part of eating disorder recovery, and they have both a right and a need to ask meaningful consumer questions about what they can expect from the therapist who is working with their child. Don’t abdicate responsibility for this. Setting up the right therapy for your child makes all the difference in their recovery path.

Questions To Ask Yourself When You Are Considering Sending Your Child to an Eating Disorder Treatment Center

I recommend being judicious about anyone sending their child away from home. Before making the decision to even seek a treatment center, consider these questions:

  • Why do I think my child should be in a treatment program?
    • Is this my idea or a recommendation from the therapist?
    • Has the therapist/parents sought second opinions or consultation on the child’s treatment progress?
  • What makes me think this is the best next step to take?
  • Have I done adequate research into the pros and cons of the treatment centers/programs?
  • Do I have a realistic understanding of what treatment centers/programs can and cannot achieve?
  • If the local therapist isn’t succeeding, does that mean I need a treatment center or just a different therapist?
  • Has my child’s therapist involved me in my child’s treatment?
    • Do I understand the skills I need to have to help my child heal?
  • Have I followed my child’s therapist’s recommendations regarding changes in the home and in my parenting?
  • What is truly motivating this decision?
    • Frustration? Our child’s well-being? Not knowing what else to do?
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Questions to Ask Eating Disorder Treatment Centers

If you believe that an eating disorder treatment center/program is essential to your child’s recovery path, then consider asking the following questions of the treatment center:

  • What is your treatment approach? On what evidence is your treatment approach based? What is the data suggesting the effectiveness of your program?
  • Specifically how do you treat people with my child’s type of eating disorder? What is the general treatment plan/approach?
  • What is the daily schedule, and who specifically will be working with my child?
  • Can I see my child’s clinical team’s credentials and interview them?
  • In addition to the clinical team, who else will be working with my child? What are their credentials?
  • How do you control for the fact that sometimes eating disorder treatment clinics are learning opportunities for how to become better at eating disorder behavior? What control systems do you have in place to avoid this?
  • What is your success rate in terms of full recovery after a person leaves the treatment center? What are your extended outcomes? What is your relapse rate?
  • How do you involve parents in treatment? What are we to do while the child is in treatment?
  • What are we expected to do in order to prepare for our child’s return home?
  • How will you know when what you’re doing with my child isn’t being effective? If such a situation were to arrive, what are the alternatives?
  • How do you ensure that a person who goes through your program is successful beyond the program?
  • How much does treatment typically cost? How much is usually the parent’s share of costs? What happens if we are unable to afford the treatment or continued treatment?

Treatment centers and programs are generally run by very good people who are trying to do very good work; but without parental involvement and ongoing treatment after the child returns home (or leaves the program), the rate of relapse may be quite high. Parents, as consumers of these programs, need to be thoughtful about their reasons behind sending their child to the program and realistic about their expectations. Parents need to remember that they are employing the program/providers to treat their child.

Finally, parents should try to keep in mind that the treatment centers/programs represent a lot of money and a lot of time, and a lot of heartache and concern for one’s child. The parent definitely wants to make sure that they understand what they are getting for their your financial, emotional, and loving investment and commitment.


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John L Levitt, PhD, CEDS, FAED, FIAEDP, is the co-editor of the book, Self-Harm Behavior and Eating Disorders: Dynamics, Assessment, and Treatment, and was on the Editorial Board of Eating Disorders: The Journal of Treatment and Prevention Email: levittj@aol.com Phone: (847) 370-1995

See Our Eating Disorder Treatment Guide For Parents

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What I want parents to think about before sending their child to an Eating Disorder Treatment Center

parents should carefully consider the implications of sending a child away to a treatment center for eating disorder treatment

by John Levitt, PhD

I often get calls from parents asking me about how to get their child into a (usually inpatient or residential) eating disorder treatment program, but I almost never get calls from parents who want to know how they can avoid sending their child to a treatment center.

I think many parents assume that a treatment center is the only option for their child, but that’s often just not the case. There are definitely times when an inpatient or residential treatment center is the best option for their child’s eating disorder recovery, but it’s important to know that the potential costs for sending one’s child to a treatment center (financially, personally, and socially) are possibly very high — and relapse rates can also be very high as well!

Treatment centers are run by good people who are generally doing good work. That said, treatment centers are businesses, and you as parents are the consumers. Don’t be afraid to be a smart consumer. Ask a lot of questions. Ensure you understand what you are getting into. That is, make sure you know what you will be paying for and what outcome(s) you can expect. Parents should become the experts on what they are “buying” before taking the leap to send their child anywhere!

First, it’s important to know what treatment centers can – and can’t – do. Treatment centers are places where your child can stabilize his or her eating disorder symptoms. Their weight will hopefully improve and likely stabilize and their eating disorder symptoms will likely be reduced or even eliminated completely while they are staying at the treatment center.   Associated symptoms of depression and anxiety and so forth are also likely to improve.

That said, when they get home, they are faced with the same life stressors and conditions that may have at least bred the eating disorder, or minimally, were associated with the eating disorder prior to going to going to treatment!   Once home, this is where the true treatment begins. Your child needs to learn to live with a sense of self-worth and self-efficacy that is enduring and resilient across people, places, and situations — and they often won’t find that in a treatment center. You just can’t practice all of the requirements of life in a controlled setting. Full treatment does not happen in a program, it happens in life.

I recommend that parents ask treatment centers a variety of questions such as: how long does it usually take to stabilize a child’s eating disorder(s) (including issues related to mood etc.), how will the treatment center ensure that you, the parent(s), are an essential part of the treatment, and how will the treatment center prepare your child, and the parents, for the child’s return home — ensuring the maintenance of their treatment gains.   In addition, even at admission or pre-admission, parents should ask about what will be needed upon the child’s return home; after completing that treatment. That is, what will your child need following their stay at the center? You should not receive vague answers to any of these questions because they are critical to efforts to achieve full recovery.

I understand how frustrating it can be to have a child who has an eating disorder at home. I understand the desire to send the child “away” to get better because you just don’t know what else to do. But I would be very judicious about sending one’s child away. As long as your child is going to return home to the parent, that parent is going to need to get his/her own tools and support to continue the healing process.

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Parents need to be educated, supported and trained to support their children in healing from an eating disorder. Some treatment centers build that into their programs. Ask them about it.  Make sure that they will involve you and make up your mind to be involved!

Also, don’t be afraid to ask about the costs involved. Many eating disorder treatment (e.g., residential) centers are running 60 days. That’s a long time for your child to be away from home and away from school. It’s can also be about $60,000 plus. That doesn’t take into account post-center treatment. That can be equivalent to your child’s college tuition.

I don’t want to discourage parents from using inpatient or residential treatment centers. I just want parents to understand what is involved in some types of treatments, carefully review the alternatives, if any, and enter treatment with realistic expectations and get their questions answered! It’s important for parents to be really clear about what is realistic to expect.


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John L Levitt, PhD, CEDS, FAED, FIAEDP, is the co-editor of the book, Self-Harm Behavior and Eating Disorders: Dynamics, Assessment, and Treatment, and was on the Editorial Board of Eating Disorders: The Journal of Treatment and Prevention Email: levittj@aol.com Phone: (847) 370-1995

See Our Eating Disorder Treatment Guide For Parents

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Getting a dog for your child who has an eating disorder

Getting a dog for your child who is in recovery from an eating disorder

Have you ever heard about someone getting an emotional support dog? Getting a dog for your child who has an eating disorder can be a great way to help them heal. Dogs provide unconditional love and affection. This can help your child during the healing process.

Eating disorder treatment includes professional care. Your child’s treatment team will support the development of a healthy self-image. Your child will learn self-care techniques and build self-worth. But even the best care team will tell parents that true healing takes place at home. This puts parents and siblings on the front line of care.

Getting a dog can help eating disorder recovery

This pressure can be a bit intimidating. It’s hard to provide the constant affection, reinforcement, and attention that will support eating disorder recovery. Luckily, there are four-legged-friends who would be happy to help you with in-home care for your child’s eating disorder.

Pets have been shown to support trauma recovery, reduce anxiety and depression symptoms, and provide life purpose. Petting a dog can lower blood pressure and heart rate and increase levels of endorphins and oxytocin.

We’re focusing on dogs, but of course, there are many options when it comes to pets. Dogs just happen to be easily available, trainable, and loyal. They can be a very good addition to your child’s eating disorder therapy. But, of course, getting a dog is not a simple decision.

Dogs as emotional support companions

There is significant evidence that demonstrates dogs are excellent emotional support companions. This is important in eating disorder recovery, because eating disorders are complicated emotional disorders, and they require a multi-pronged emotionally intelligent approach. While professional support and family support go a long way, a dog or other beloved pet may make all the difference in the moment-to-moment recovery moments.

A relationship with a dog can build a safe connection. This connection can cause a release of oxytocin, which positively impacts emotional security. Interaction with a dog can also lower cortisol (stress) levels. These combined actions make connecting with a dog deeply healing for a person who is in recovery from an eating disorder.

Listen to this Podcast for more about this: Oxytocin, dogs, & pets in General as attachment figures, Therapist Uncensored episode 95

Dogs offer companionship, reduce anxiety and loneliness, increase self-esteem, and improve overall mood.[1] Dogs have also been shown to increase the following behaviors, which reduce depression and anxiety:

  • Physical activity
  • Time spent outdoors
  • Sense of agency and autonomy

Studies have even shown that a single 12-minute visit from a dog among hospitalized patients with advanced heart failure produced small but significant health improvement.[2]

Here are some ideas about how to go about getting a dog specifically to support your child’s healing process.

Before getting a dog during eating disorder recovery

Before you get a dog, you want to establish your goals. We’re going to assume the primary goal is to provide a loving companion for your child who has an eating disorder.

A dog will provide comfort and companionship. It can also help your child build a sense of self-worth and self-efficacy. To do this, your child should be responsible for your dog’s care. It’s important to ensure that your child is interested in getting a dog and is willing and committed to caring for it.

Deciding to get a dog is a family decision that will impact everyone. If someone in the family is allergic to or intolerant of dogs, then come up with another idea. Make it clear that if the family agrees to get a dog, there is no going back. Having a dog is a commitment for that dog’s life.

Care guidelines

A dog can be a great way to give your child a sense of agency and accomplishment. But to do this you really need to set up clear expectations about the dog before you get it. Vague expectations will have a double negative effect. First, you will get frustrated and resentful if your child fails to take care of the dog. Second, you child will feel ashamed of themselves and frustrated with you for not being clear in advance. These are not great outcomes, especially on top of an eating disorder. So clarity going into the dog process is key to success. At a minimum, your child should commit to the following caregiving tasks:

  • Maintaining a clean water bowl
  • Feeding the dog 1-2 times per day
  • Walking the dog at least twice per day

Feeding may be as simple as putting a cup of kibble in a bowl. But some dogs have digestive problems, which may require a special diet. In such cases, your child may need to prepare simple foods for the dog, such as boiled chicken and rice. You won’t know these details until you live with the dog, so it’s best to be prepared for all possibilities.

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Additional dog care requirements

Your child will also need to clean up after the dog. this means daily poop-duty. There’s also the likelihood of random vomiting, diarrhea, and peeing-in-the-house accidents. These are unpleasant but expected aspects of dog ownership that your child should be aware of and agree to handle.

Grooming varies based on the type of dog you get. If the dog is going to be inside your home, you should require your child to bathe the dog every few weeks and brush it daily. These duties may increase if the dog is prone to shedding.

Some dogs develop barking or other bad habits that your child will need to address through research and training. Almost every negative habit can be addressed. But it will require your child to learn some new skills. This can actually be a great thing for a child who is in recovery for an eating disorder.

Create a care plan for the dog before you bring it home. Set this up as a contract between you and your child. Print out the care plan and have your child sign and date it to affirm the care they will provide the dog.

Picking a dog

You may be interested in a particular breed of dog. You may decide to find a designated emotional support dog (more on that later). A great alternative, however, is to adopt a rescue dog. Many children/teens respond very positively to the idea of rescuing a dog that has been abandoned.

While almost everyone thinks they want a puppy, the reality is that puppies require a great deal of care. This will not work well in a busy family with multiple commitments. Instead of a puppy, consider adopting a fully-grown 2-5 year old (or even older) dog.

Benefits of getting an older dog for eating disorder recovery:

  1. You avoid the puppy years, which, though adorable, are also very disruptive. Just like having a baby, having a puppy includes frequent bathroom accidents and hyperactivity. Puppies need training for basic skills like house training, walking on a leash, behaving well around other dogs and children, etc.
  2. You can observe the dog’s personality and behavior as it will be for most of its life. Puppies are bundles of energy. It’s only after they hit about two years old that they achieve the steady personality you can expect.
  3. You can observe whether your child has a connection with a particular dog’s personality. Dogs are just like people – they all have a unique personality. You want to find a dog that will fit into your child’s (and your) life.
  4. Chances are good that your child will leave home soon. Adopting an older dog means that your child gets the benefit of having an animal. But you aren’t left taking care of it for a decade after your child leaves home.

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Other considerations when choosing a dog

In addition to the type and age of the dog you get, you should also take into consideration some other key concepts:

  1. Size: remember that puppies grow into full-sized dogs. If you live in a smaller home or apartment, take your dog’s size into account and consider whether they will (literally) fit into your life. If you travel frequently or move every few years, remember that it is generally easier to have smaller dogs. Larger dogs are more expensive to feed, travel with, and can be harder to board. Rental properties also often have size limits on dogs.
  2. Energy: different dogs have different energy requirements. Realistically consider how much time and energy your child can devote to exercising your dog, and choose accordingly. Older dogs generally need less exercise than younger ones, and smaller dogs generally need less exercise than larger ones. Dogs tend to get into trouble – such as digging through trash cans, barking all day, and chewing expensive furniture – when they are under-exercised.
  3. Intelligence: most people assume they want a very intelligent dog, but remember that most highly-intelligent dogs require mental stimulation in addition to physical exercise. Working dogs like Australian Shepherds and Border Collies may develop negative behaviors if they don’t get the stimulation they need to avoid boredom.
  4. Health: some purebreds have a tendency to develop certain health conditions. Whenever possible, become aware of the weaknesses of your breed before making your choice. Also be sure to check the credentials and breeding history of your breeder.
  5. Grooming: some dogs require specialized grooming and care. For example, Pugs, Maltese, ShiTzus, and others require regular grooming that can get expensive if you don’t learn to do it yourself.
  6. “Aggressive” breeds: there is quite a bit of bias against some of the dog breeds that are considered “aggressive.” These include Pit Bulls, Rottweilers, German Shepherds, and Dobermans. While these dogs can all be wonderful companions, you should know that it may be harder to board, groom, and get dog walkers and other caregivers for your pet. These breeds are also more likely to be prohibited in rental homes and apartments.

Top emotional support dog breeds

Most dogs are naturally adaptable and likely to bond well with your child. However, there are certain dog breeds that are particularly likely to provide the deep emotional connection that will support your child’s recovery from an eating disorder. The following ten dog breeds are commonly considered to be the best temperamental fits for emotional support:

  1. Labrador Retriever
  2. German Shepherd
  3. Poodles
  4. Yorkshire terrier
  5. Beagle
  6. Corgie
  7. Pug
  8. Cavalier King Charles Spaniel
  9. Pomeranian
  10. Golden Retriever

Just a reminder on the point we previously made, many of these dog breeds are high-energy in the first 2-5 years and can add significant stress to your household.

Labrador Retrievers, for example, are wonderful dogs, but there are a lot of them in the shelters and adoption system due to their high-energy, sometimes destructive behavior in the first few years. This holds true for almost all of the dogs listed here and mixes, such as Goldendoodles and Labradoodles. They are wonderful dogs, but if you do choose a puppy, be prepared to invest significant time and energy in training and exercising them.

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Bonding

Once you have selected a dog, help your child bond with the dog by insisting upon the care plan. Try to avoid stepping in to take care of the dog.

Caring for the dog, even when it is inconvenient, is part of your child’s therapy plan. Caring for an animal provides a sense of ownership and agency. Your child will benefit from sticking to the care plan.

Support your child in building their bond with the dog. Support their interest in training ideas, grooming lessons, and even getting the dog certified to be a therapy dog. Doing this will mean the dog can visit sick people in the hospital or elder-care facilities.

Of course, if all your child wants to do it lie around petting the dog or taking selfies with the dog, that’s OK, too!

Emotional support dog information

All dogs of any breed and age are able to provide emotional support. You may have heard of emotional support dogs, also called emotional support animals (ESA), which are prescribed by a therapist, psychologist or psychiatrist.

ESA dogs are not specially trained to respond to specific medical conditions. Therefore, they are not required to complete specialized training and are not allowed the same access as a licensed service dog.

The main benefit of getting an ESA is to circumvent certain housing and travel restrictions against pets. In other words, there’s nothing special about ESAs except that a therapist has provided a letter saying you need one.

How to get an emotional support animal (ESA)

  1. Get an official diagnosis from a licensed mental healthcare provider
  2. Request an emotional support animal (ESA) prescription. This is typically a letter from your provider that states you need an emotional support animal.
  3. Choose an animal. There is no official designation or training required.
  4. Keep the prescription/letter on-hand in housing and travel situations.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate eating disorder recovery.

See Our Eating Disorder Treatment Guide For Parents

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For information about dogs available for adoption, what to think about before adopting, and more, visit Petfinder.com


References

[1] Dhruv S. Kazi, Who Is Rescuing Whom? Dog Ownership and Cardiovascular Health, Circulation: Cardiovascular Quality and Outcomes, Oct 2019

[2] Cole KM, Gawlinski A, Steers N, Kotlerman J. Animal-assisted therapy in patients hospitalized with heart failure, American Journal of Critical Care, 2007

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Yoga for eating disorders: tree pose

People with eating disorders often find it helpful to do yoga poses like tree pose. Yoga can be a soothing eating disorder treatment that you can do in the comfort of your own home. It’s effective because eating disorder symptoms often include a dissociation of mind and body, and yoga brings them together. Your child should have a number of tools available for managing anxiety, and one of those tools may be a few simple yoga poses that can help ground and center your child.

One pose that can be very helpful is tree pose. This balancing pose requires focus and is best performed with a strong sense of the ground. Literally grounding one’s self during a strong urge to use eating disorder behaviors may, with practice, reduce urges and triggers.

Vrksasana (Tree Pose)

1) Start Standing (use a wall for support if you need it)
2) Root through your right leg and place your left foot on your ankle, calf, or inner thigh (AVOID PLACING YOUR FOOT AT YOUR KNEE).
3) Keep hands at hips, heart center, or extend your arms to the sky.
4) Stay for 5-10 even breaths and switch to the other side.

Do this pose with your child any time you notice your child is feeling emotionally dysregulated, anxious, or dissociated. This is not a competition – it’s OK if you can only get your foot to your ankle. It’s OK if you wobble and topple. Just keep practicing together, breathing deeply and focusing on the ground beneath your foot as a stabilizing force. Build your toolbox of coping behaviors throughout eating disorder treatment to support your child into recovery.

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate eating disorder recovery.

See Our Eating Disorder Treatment Guide For Parents

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Yoga for eating disorders: crocodile pose

People with eating disorders often find it helpful to do yoga poses like crocodile. Yoga can be a soothing eating disorder treatment that you can do in the comfort of your own home. It’s effective because eating disorder symptoms often include a dissociation of mind and body, and yoga brings them together. Your child should have a number of tools available for managing anxiety, and one of those tools may be a few simple yoga poses that can help ground and center your child.

Yoga has been shown to be an excellent auxiliary treatment for eating disorder recovery. Many people with eating disorders disconnect their minds from their bodies. They learn to ignore our body’s natural communication, needs, and desires. Yoga can be a great way to gradually reconnect the mind-body signals.

As a parent, having a few simple yoga moves to do with your child while they are in recovery can be a great way to help them make the mind-body connection. It’s also a great way for you to connect with your child, which is so critical to the healing process.

Makarasana, or Crocodile Pose, helps to facilitate diaphragmatic breathing (also known as belly breathing) by immobilizing the chest. When you engage in “belly breathing” you facilitate a relaxation response in the body, which makes this pose excellent during times of stress and anxiety. This may also be a great pre-meal pose to help your child get grounded before going to the table.

Here’s how to do it:

1) Lie on your belly and rest your forehead on your hands.
2) Mindfully breathe into your belly.
3) Stay here anywhere from 30 secs to 5 minutes.

Pretty easy, huh? You can even do this while sitting at a table or desk. Build your toolbox of coping behaviors throughout eating disorder treatment to support your child into recovery.

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate eating disorder recovery.

See Our Eating Disorder Treatment Guide For Parents

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Art therapy for eating disorders: a guide for parents

Art therapy is frequently used in treating eating disorders because it’s a great way to help people express their feelings. Most people who have eating disorders repress dark feelings like sadness, anger, frustration, and jealousy. But these feelings are all a natural part of being human.

In recovery, a person must learn how to process these negative feelings without using their eating disorder behaviors to cope. Art therapy is one way to help people who have eating disorders tap into these deep unexpressed feelings.

When a child is struggling with an eating disorder, they are also struggling with self-worth, emotional instability, depression, moodiness, and anxiety set amongst generalized adolescent angst. As a parent, it can be very challenging to handle all of those feelings and contain them.

But the good news is that we don’t have to contain our children’s feelings. We just need to help them find healthy ways of expressing their feelings, while simultaneously seeking professional support as needed. But, of course, professional support is limited – we are the ones who actually live with our teenagers day-to-day, seeing their ups and downs, and struggling to find equilibrium in the face of constantly changing emotional states.

Art therapy toolbox for parents

There are professionals who are trained and experienced in giving kids art therapy. Of course this does not replace those important and trained professionals. But parents don’t have to be therapists or artists to support kids in recovery. Instead, we just need to build a toolbox of things we can do with our kids to support them in feeling and expressing their emotions.

And while many parenting toolboxes are virtual and have more to do with mental exercises, this time you get to create a physical toolbox of art supplies. Here are some things you want to have on hand … maybe you have some of these left over from your kids’ childhood!

  • Paper, canvas, wooden boxes, cardboard shapes
  • Pens, pencils, markers, paint, glue, paintbrushes
  • Felt, buttons, sequins, glitter, fur, googly eyes
  • Collage images (e.g. words, nature, shapes) from magazines

Whether your toolbox is simple or elaborate isn’t as important as the fact that you have art supplies ready to go.

Dive in

Even if neither of you is artistic, the act of putting color on paper can be very therapeutic. When tested with cancer patients undergoing chemotherapy, weekly art sessions improved depression. In other studies, making art has been proven to provide a sense of control to patients with mental illness. Making art helps our kids with self-expression while enhancing coping skills, reducing stress, and boosting self-confidence.

Art therapy doesn’t have to be stuffy or skilled. Even the most basic art skills can become a powerful form of self-expression. Remember when your kids were small and you would pull out the craft box for them? Reinstate that activity, perhaps once a week, and just sit down with your children and some paper, colored pencils, paints, and anything else you have. Work side by side.

This doesn’t have to be “heavy” or “therapeutic” – just enjoy the act of making art together. You don’t have to talk about eating, not eating, anxiety or depression. Just be creative and enjoy each others’ company for a little while.

Dealing with big emotions

One word of warning: if your child is currently in a bad place emotionally, don’t be surprised if they create art that expresses their negative emotions. In fact, this is absolutely healthy. Your child is using art as it is meant to be used – to express emotions that are hard to communicate using words. Your child might also be using their art as a way to test whether you can handle the full expression of their emotions. Hint: handle it! This is an essential part of healing.

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Many teens find that art and writing are great ways to both express themselves and find out whether anyone (especially their parents) is paying attention to their emotional distress and can actually handle their needs.

This is a tough place to be. When you love your child, you do not want to come face to face with the ugly demons they feel inside. But remember that we all feel ugly demons sometimes, and most of the time artistic expression is not a cause for alarm. Art therapy is helpful in treating eating disorders exactly because it helps people get in touch with their feelings.

It is important that you do not express alarm at what your child creates. Instead, talk to your child about how the art makes them feel, and what they are trying to express with the art. Help them talk about their feelings.

If you are concerned, or if it appears your child is in deep distress and/or traumatized, consider sharing the artwork with your child’s eating disorder treatment team so they can help your child process the pain they are feeling.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate eating disorder recovery.

See Our Eating Disorder Treatment Guide For Parents

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Yoga to strengthen body image and support eating disorder recovery

Yoga is frequently found to be helpful in recovering from an eating disorder. People who struggle with disordered eating tend to be disconnected from the body, and yoga is a great way to reconnect and rebuild a loving relationship between the two.

As you support your child in healing from an eating disorder, however, you may find that not all yoga classes are appropriate for them. Unfortunately, many yoga teachers unknowingly trigger people who are in eating disorder recovery with talk of restrictive diets such as veganism, vegetarianism, juice cleanses, and other recommendations that are distressing and even dangerous for someone with an eating disorder.

There are some yoga instructors, however, who safely work with people in eating disorder recovery, providing a wonderful practice that can help them build a new relationship with their bodies and selves. Jennifer Kreatsoulas is one of those yoga instructors. In fact, she specializes in working with people in recovery from eating disorders.

She recently released a 3-part video series that is a wonderful option for someone in eating disorder treatment. If your child is building a new relationship with his or her body and would benefit from a thoughtful yoga practice, consider this video series as an excellent (and affordable!) tool.


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Jennifer Kreatsoulas, PhD, E-RYT 200, RYT 500, is a yoga teacher and yoga therapist specializing in eating disorders and body image. In recovery herself, Jennifer is extremely passionate about helping others reconnect with their bodies and be empowered in their lives. Jennifer works with clients in person and via Skype. She also teaches yoga at the Monte Nido Eating Disorder Center of Philadelphia and is a partner with the Yoga and Body Image Coalition. She leads trauma-sensitive yoga classes and teaches weekly flow yoga classes. Jennifer contributes regularly to eating disorder and body image blogs and the YogaLiving Magazine. Website

See Our Eating Disorder Treatment Guide For Parents

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A perspective on eating disorder recovery from a therapist

by John Levitt, PhD

In 40 years of working with eating disorders patients, I can say without any doubt is that there is no easy panacea for those struggling with recovering from an eating disorder. Ultimately, the only way someone truly gets better is through building his or her recovery in the actual aspects of their life. Indeed, if you’re not experiencing life, building relations where you feel cared for, engaging in work or school, or building a lifestyle that is meaningful, it is very hard to sustain and effectively recover from an eating disorder.

Eating disorders serve a protective purpose for the individual. There are some who use it for other reasons, but in my experience most people use it to serve a social/relational purpose or as a way to manage their emotions or manage their self-worth. These purposes are, in fact, meaningful and intense for the person who has an eating disorder.  Consequently, an individual can appear recovered behaviorally (i.e., reduction in eating disorder symptoms), but that’s often only when the challenges of treatment and recovery truly begins.  These challenges generally don’t occur in the treatment center, but only through the experiences of living life itself.

I think it’s really important that we reevaluate our perspective on eating disorder treatment and recognize that treatment centers represent an opportunity to learn new tools, but they are not the complete solution.

You can take your child or loved one to a treatment center or program and they will generally learn behavioral tools, stabilize their disorder, and begin their journey towards recovery.

The healing, however, has to continue when they come home.

The healing has to continue for life.

I also think it’s important to balance the need for a child or adolescent to begin their “recovery” in the context of their developmental needs. That is, they need to become “their own person.” When parents push unwilling children into treatment centers against their will, children will often push back. As a result, it can be very frustrating, and economically difficult, for parents who are in this situation – spending hundreds, if not, thousands of dollars getting their loved one treatment. They are desperate to help their children, and often financially commit themselves to their loved one’s recovery even though their child might resist their efforts.

There is no easy answer or solution for eating disorder treatment and recovery. I think it’s very important for family members, including the child, to talk these ideas through with someone who is qualified to provide them with an honest assessment of where their child is in their disorder and recovery, what the child and family’s options are for recovery, and what is realistic to expect from a treatment center, program, therapist, group, and/or other approaches to recovery.

I recommend that parents focus on providing a consistent, safe and secure environment where recovery can take place, and strive to empower their child to continue a healthy life while pursuing recovery. This is really difficult, and I encourage parents to learn not just about the eating disorder behaviors, but also about the underlying triggers and situations that can lead to eating disorders.

For example, it is very important for parents to learn how to set limits, but also how to praise and encourage their child both during and after treatment. Kids don’t get better if they don’t have hope; and fundamental to hope is the belief that recovery is possible and likely in a caring environment.

A lot of parents think that the baby and toddler years are hardest, but I believe that later years, such as ages 10-18, are when kids may need the most intensive parenting. This isn’t any longer about watching them learn to safely walk, eat and crawl. Now it is about the child learning about their life while being in an emotionally safe environment. It’s not as obvious, but children need just as much care throughout adolescence as they did during infancy. They need a safe, consistent environment so they can take the next step in their life.

As a therapist, I am grateful and honored to the individuals and families who have allowed me to enter their lives and be part of their recovery. In my approach, I focus on treating all eating disorder patients and their families with kindness and hope. I believe, and have found, that generally people get better over time in the context of a good healthy human interaction; which I believe effective therapists offer families who are going through eating disorder treatment.


John L Levitt, PhD, CEDS, FAED, FIAEDP, is the coeditor of the book, Self-Harm Behavior and Eating Disorders: Dynamics, Assessment, and Treatment, and is on the Editorial Board of Eating Disorders: The Journal of Treatment and Prevention. Email: levittj@aol.com Phone: (847) 370-1995

See Our Eating Disorder Treatment Guide For Parents

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About CBT and DBT for eating disorder treatment

by Charlotte W. Thomas, LCSW

Cognitive Behavior Therapy (CBT) is a great first line and evidence-based treatment for many diagnoses – depression, anxiety, and of course, eating disorders. For many individuals, including children and adolescents, who are newly diagnosed with an eating disorder, CBT should be considered as a best-practice starting place.

In a simplified way, Dialectical Behavior Therapy (DBT) can be described as a working partnership between CBT and mindfulness practices that guide individuals away from the polarization of thoughts, emotions, and behaviors. This practice of pulling away from polarization is where the ‘dialectical’ of DBT comes from. DBT also places more focus on behaviors and eliciting new behaviors than CBT, which places more emphasis on thoughts.

DBT has been demonstrated through rigorous peer-reviewed research protocols to be effective in helping individuals who struggle with issues based on severe and or chronic emotion dysregulation. This emotion dysregulation often leads to behavioral responses such as self-harm, suicidality, substance abuse, and disordered eating.

When to consider DBT for an eating disorder

For parents trying to find the best source of treatment for their child, DBT should be considered when one or more of the following exists: more standard forms of treatment (such as CBT) have been tried and haven’t worked; there are multiple problematic behaviors happening (eating disorder behaviors plus substance abuse or suicidality, for example); or you have been aware for a long time that your child struggles with very intense emotions and feels overwhelmed or debilitated by them.

One of the really lovely things about DBT (and there are so many lovely things about DBT) is that we have a well-designed structure within which we can flex significantly based on individual need, rather than diagnostic classification. This means we use DBT for all clients, regardless of the type of eating disorder they present. In our case, approximately 40-45% of our clients fall into the Binge Eating type of disorder and another 40-45% into the Restrictive types of disorders (this includes restriction as primary with binge/purge subtype), with the remaining 15-20% as fitting Bulimia Nervosa.

Family involvement

At our clinic, we deeply integrate the family into eating disorder treatment. For example, all adolescent clients attending our program attend a weekly DBT skills group using DBT materials adapted for adolescents. Parents attend a skills group simultaneously, though separately.

This allows parents to learn and practice skills while supporting the skills practice of their children. Parents are invited to join the individual sessions approximately once per month, and parents are often offered additional support on site which may include extra parent-coaching sessions, individual therapy, and family therapy.

Finding the right therapist

The other thing I can’t highlight enough is the importance of finding a therapist who has expertise in both eating disorders and the therapeutic paradigm (in this case, CBT or DBT) that you are seeking.

Both CBT and DBT are highly complex treatments that require years of training and ongoing supervision and consultation to practice well, not to mention the expertise required for understanding eating disorders well. Don’t be afraid to ask to see the individual’s resume, CV, training credentials, or professional disclosure statement.

If you were seeking treatment for a heart condition, you would be unlikely to go to a physician who was a urologist, but had “read a few books on cardiology.”

I strongly believe we all need to practice the same vigilance when talking about something as scary and challenging as an eating disorder. Don’t be afraid to ask questions that will help you to find the best fit for your child and your family, regardless of the therapeutic strategy you are choosing.

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What parents should know about eating disorders

Something I learned when I was first training in the world of eating disorders, and learning FBT as my first and primary tool, was that parents did not cause the eating disorder and the child/adolescent did not choose the eating disorder. It is something that has happened through an as yet not well-understood combination of genetics, biology, and environment.

This dovetails well with the core assumptions of DBT: “People are doing the best they can, people want to improve, and people need to do better, try harder, and be more motivated to change.”

Nobody chooses to start an eating disorder and nobody carries the blame! Adding a key DBT slant, you (and your child) did not choose to be here, and yet you must work to move forward, to heal, to focus on recovery.


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Charlotte W. Thomas, LCSW, is Program Manager at the Portland DBT Institute. Charlotte’s professional interest is in treating eating disorders and associated needs including borderline personality disorder, depression and anxiety. She has experience in private practice mental health settings, providing individual, family, and group services for teens and adults. At Portland DBTI, Charlotte is the Program Manager for the Pathways to Mindful Eating program. Website

See Our Eating Disorder Treatment Guide For Parents

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Use caution with intuitive eating for eating disorders

When a brain is hijacked by an eating disorder, thoughts often revolve around the body. Feeding and not feeding the body, and worrying about the weight gain associated with eating, are constant companions when you have an eating disorder.

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One path out of eating disorders is learning Intuitive Eating, a practice in which your child will learn how to feed their body on demand, exactly what it wants and how much, without worrying about the weight implications. This can be very difficult and scary to a child who has an eating disorder. Learning to trust their body is a major undertaking, and it should not be taken lightly.

Eating intuitively takes time, patience and practice. It may lead to weight fluctuations, which could be a trigger for your child. Yet other people may find a way to turn Intuitive Eating principles into another version of their eating disorder, and a way to lose weight.

This is why it is important to work with a dietician who is has training in working with eating disorders and who can can monitor your child to ensure the principles of Intuitive Eating are being utilized correctly and healthfully. A meal plan designed by an eating-disorder-savvy RD is the first step out of an active eating disorder, and people should only try Intuitive Eating after they have stopped engaging in eating disorder behaviors or are being supervised in eating disorder treatment by someone familiar with the complexity of this style of eating.

The point of Intuitive Eating is to let go of body weight as a measure of self worth, and to let the body do what it will based on adequate nutrition – not too little, not too much – exactly what it needs.

Below are some comments from Christy Harrison, RD, who uses the principles of Intuitive Eating when working with clients (including children and adolescents) who have eating disorders.


From Christy Harrison, RD: 

Intuitive Eating is about letting go of the societal standards of “perfection” around food choices, weight, and body shape.

It’s about letting go of the idea that you must be a certain size to be happy. It’s about letting go of feeling not good enough because you ate a slice of chocolate cake, which would have made you really happy had you not been feeling shameful and guilty for eating it.

Intuitive eating is about letting go of all that guilt, all of the expectations, all of the days you spent crying in the changing room at the mall because someone suggested that being a bigger pant size meant you failed at life.

None of this is true.

You are good enough, you are wonderful, and you deserve to be happy. Intuitive eating can help give this to you, but you also have to do the work.

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You have to consistently practice breaking down the diet mentality in your head and fighting back against diet-driven thoughts. You have to do the work to let go of weight loss as the ultimate goal and weight gain as the ultimate “failure.”

You have to give yourself a chance to be happy, and letting go of weight loss can do that for you. You can do that, for YOU.

Intuitive eating can’t work its magic if you don’t let go of weight loss. The goal of weight loss doesn’t work. It’s time to try something new.


christy harrison rd eating disorders

Christy Harrison, Intuitive Eating Coach & Anti-Diet Dietitian

Christy Harrison is dedicated to helping people make peace with food. She works with people of all ages to support them in building a healthy relationship with their bodies and with food. Website

Christy has an excellent podcast called Food Psych. In this episode, she interviews Evelyn Tribole, one of the founders of Intuitive Eating.

See Our Eating Disorder Treatment Guide For Parents

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Involving parents in eating disorder recovery

an interview with Sonia Seguin of Body Brave

Sonia Seguin, who is 5 years recovered from an eating disorder, founded Body Brave to support eating disorder recovery. Body Brave offers peer support, psychotherapy, yoga, meditation and other mind and body methodologies. We interviewed Sonia to find out more about how she went through her eating disorder and how she believes parents can and should be involved in the healing process. Her comments are below:


I developed an eating disorder when I was in my late teens and early twenties. I struggled with various forms of eating disorders for about eight years and went through the gamut of eating disorder treatment options, including inpatient. I finally found recovery through a combination of tools that I picked up along the way. I’ve been recovered for about five years now.

This summer, I launched a recovery business with husband. My mom is a psychotherapist and my dad is a medical doctor and they have since joined the team. We work to help individuals and families deal with eating disorders, primarily through a peer support model in which people who have eating disorders and their parents can talk about all sorts of things and get support across a broad range of subjects.

I want both parents and their children who are dealing with an eating disorder to know that eating disorders are very prevalent, and there is nothing to be ashamed of. As parents, you can just try to address it as quickly as possible.

I know that for my parents, it took a little time for them to process the reality of my eating disorder. My mom went back through every minute of her life to review where she had gone wrong. What she had done. There’s a real tendency for self-blame, but nobody is to blame.

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I think eating disorders need to be addressed very deliberately and never in isolation. I think that getting outside help, rather than trying to solve it just within the family system, is ideal. Emotions run so high, and it’s a confusing time for everyone.

I also think that parents need to make sure they take care of themselves, and that their voice is heard throughout the process. So many parents are kept out of the process. My parents were given a 50-50 chance of recovery for me, and very few ways in which they could help me. That is just unacceptable. Parents are such a big part of our lives, and I don’t see how that is useful at all.

Parents should set clear boundaries for themselves. It’s not all about the person who has an eating disorder – it’s also about the parents and other family members. For a while, all of the focus was on me and my eating disorder, and it was very harmful for my parents. When one person gets an eating disorder, it’s like the whole family gets an eating disorder.

Most of all, I want parents to know that I am aware my parents made some mistakes; I also know that I did, too. I love them, and our relationship is loving. Working on this business together is a real indication of the fact that we can heal.


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Sonia Seguin, founder and owner of Body Brave, suffered from an eating disorder during her late teens and early 20s and was able to achieve recovery through a unique combination of tools and skills. She brings her experiences of recovery to Body Brave in the form of peer support. With a team that comprises both medical professionals and meditation and yoga teachers, Body Brave offers one-on-one peer support, professional counseling, public workshops as well as phone and video counseling for those not in the area. She holds a Master’s in Business and Economics from Wilfrid Laurier and is a trained Yoga and Meditation teacher. Website

See Our Eating Disorder Treatment Guide For Parents