For Professionals

First Do No Harm

I'm eager for some input from my fellow therapists. Yesterday I saw my youngest patient to date, a seven year old. I suppose this isn't breaking news - I've been hearing and reading more about eating disorders in children, and I've attended presentations given by specialized treatment facilities for patients younger than 10. I've also treated several 11 year olds and currently have a 9 year old on my caseload. Still, I found it a bit unsettling to sit across the room from a young girl so tiny her feet dangled over the edge of my easy chair, never reaching the floor. I wondered if I am up to the challenge of helping someone so young. I am determined to intervene slowly and carefully, and above all, to do no harm.

In the interests of protecting the confidentiality of this little girl and her parents I do not want to describe the situation in too much detail; and in fact I have not yet gathered enough information to have a clear picture. But so far I can say there is anxiety about eating and distortion regarding body image. There is a strong fear of fatness, both re: becoming fat herself and being near others she sees as far. Although there has been no weight loss there has been failure to gain such that she has dropped from the 50th percentile to the 25th over the past year. There were no feeding difficulties as an infant or toddler. She describes herself as a very "picky" eater and parents confirm she has eliminated many foods she was eating a year ago.

I would welcome input from anyone experienced with treating children this young. Obviously her parents are important allies in the process; they are clearly invested and capable. Should the primary focus be with parents, supporting them and empowering them to help her? Should we keep her out of the process entirely? Would a family focus be best? Or are there indications for individual therapy as well?

I will welcome your thoughts. Until next time, Gail

Sink or Swim

I live in a beautiful area surrounded by lakes; so maybe it's for this reason that when I use metaphors in therapy they often involve water. When my clients express surprise at the difficulty involved in changing their behavior I will explain that doing so is like swimming upstream - intially it will take much more effort to swim against the current of established routines. They may also feel as if they are expending great effort without marking much progress forward; but if they continue, eventually the current will change and their new, healthier coping mechanisms will now carry them forward.

Another metaphor I've referred to frequently is the eating disorder as a life jacket. Imagine you are out alone in a large lake and your boat sinks. You jump from the boat just in time to avoid going under; and initally, you are panicked. You have no idea if anyone knows where you are; and you don't know in which direction to swim to find the shoreline. Suddenly a life jacket floats towards you; and of course, you grab the life jacket and put it on. Although it's bulky and awkward, you are grateful for it's support and even its warmth. It allows you to float and rest in the water as you survey your situation. As hours pass and no one comes to your rescue to cling tightly to this inanimate friend, knowing you would not have survived until now without it.

But as more time goes by, you notice the heaviness of the jacket; and now the water soaked vest is cold, rather than warm. You are beginning to realilze that it's getting dark, and no one is likely to come for you; so if you hope to survive you are going to have to swim for shore. As you try to move through the water you discover that the life vest is making it difficult, if not impossible, to make headway. Although it's frightening to consider you think about striking out without the vest. Hesitantly, you slip it off and paddle away a few yards, just to see how it feels. But it feels too scary to head out without it, so you swim back to it and put it back on. The next time you strike out without the jacket you go farther, but once again, return to the safety of floating in the vest. One day you swim so far without it that it's almost lost on the horizon; and although you now know which way to swim for shore, you can't bring yourself to leave the jacket completely behind.

Finally you realize you have wasted too much time returning to the jacket over and over, and you make the bravest decision of your life. You decide to head for shore and not look back. Of course there are some rough moments, but as the shoreline comes closer and closer you find your confidence and strength only increasing; until at last, you reach your destination, safe, sound, and full of self confidence.

I hope this metaphor is useful to you and your clients. Sometimes identifying the positive benefits of a very dangerous and dysfunctional behavior, and thereby, normalizing ambivalence, can act as a catalyst for change. Until next next time, Gail

The Obesity Epidemic - NOT!

Last week I attended a one day workshop entitled "Obesity and Compulsive Eating - Helping Without Harming" taught by Jonathan Robison, PhD, MS. Jonathan is an engaging and knowledgeable presenter who is a strong advocate of the Health at Every Size movement. He suggests that the effects of weight on health "have been dramatically overblown, and have done more harm than good". Over the course of the day long workshop he gradually dismantles the position of the traditional medical community re: obesity and advocates instead the Health at Every Size paradigm. HAES has three main tenets: 1) thinness is not intrinsically healthy and beautiful nor is fatness intrinsically unhealthy & unappealing; 2) people naturally have different body shapes and sizes; 3) dieting usually leads to weight gain, decreased self-esteem, and increased risk for disordered eating. HAES also advocates self-acceptance; movement (rather than 'exercise') and normal eating (based on internal cues) as its three main objectives.

All of this should be "music to the ears" of us as professionals who treat eating disorders. But as Jonathan so wisely pointed out, in order to practice this we have to be this - we cannot advocate self acceptance to our clients and continue to disparage our own bodies, or obsess about our weight or eating habits. Nor can we talk about the evil of weightism while secretly passing judgment on obese individuals. Attending this workshop should be required for all health care professionals. I urge you to check out Jonathan's web site: www.jonrobison.net :and to attend one of his seminars when you get the chance. You'll leave inspired and equipped to challenge the myth of the Obesity Epidemic. Until next time, Gail

Mental Health Parity in Michigan

The (Michigan) House parity bills HB 4390, 4391, 4392, and 4393 were scheduled for a hearing in the House Insurance Committee but that hearing has just been postponed. It will be rescheduled just as soon as the Michigan Legislature reaches a budget agreement. If you live in Michigan it is still an excellent time to send an email, a letter, or make a telephone call in support of this legislation to a member of the House Insurance Committee. If the bills make it out of committee with favorable support a full House vote could be scheduled within a week. For the most current information please check out (and bookmark) this page: michiganparity.googlepages.com/parityactionalerts.

As those of us treating eating disorders are all too aware, treatment can be a long and challenging process. We cannot afford to have that process interrupted by an arbitrary limit to benefits, or a cap on inpatient stays, which has been designed to contain costs. If there is no limit to treatment for cancer, there can be no such limit to treatment for eating disorders under parity legislation. Many states have enacted parity bills.
Call or write now to support these bills in Michigan. Until next time, Gail

Congratulations Scooter Girl!

This weekend I was in New York attending the wedding of Nicole Tieri (popularly known as Scooter Girl to American Idol fans) and Julian Cornell. It was a wonderfully festive, witty celebration full of all kinds of special touches. Nicole and Julian's family and friends were there of course, along with some representatives from NEDA. It was fun to connect again with Lynn Grefe, who has encouraged Nicole to use her story and her talent to be an ambassador for eating disorder prevention. Also present were Buddy and Kathy from Raleigh North Carolina, who have generously underwritten the production of Nicole's first CD. Buddy and Kathy are also involved with NEDA, and met her at the NEDA conference in Denver two years ago. I couldn't help but think the guests represented Nicole's past, present, and future; and in many ways, it was a living testament to the "village" it takes to help someone with an eating disorder find health and healing. I'm honored to have been a part of that community. God bless Nicole and Julian! until next time, Gail

Passages

The months of May and June seem to be "transitional" months at our practice. Many of our clients are finishing a semester of school, leaving on summer trips, heading for camps, or coming home for the summer. There are proms, graduations, and weddings to attend. Some of our older clients are becoming pregnant, having babies, or even watching their children leave home. Each of these transitions from one life stage to another, normal as they are, create stress for our clients. As a result many times the eating disorder symptoms flare up, and therapy is needed until the passage can be navigated safely.

Summer is also a time when some of our former patients come in for a "visit" or "check-up". The visits with those former patients are some of my favorite sessions. It's so good to see young women and men progressing on their paths towards maturity. As therapists we have the chance to assist our clients not only in overcoming an eating disorder; but also in helping to shape their futures. I consider that a great privilege. Until next time, Gail

Calling all Professionals: I Need Your Help!

It has again been a couple of weeks since I posted on this blog. Spring tends to be a very busy season at both my home and my practice, and this year has been no exception. But I also find myself struggling just a bit with continuing to post -- when I was asked to host this blog I envisioned a forum in which professionals could exchange ideas. But in fact it's been more of a monologue, and my creative juices are running a bit dry. So I would LOVE to hear from you if you have ideas for subjects that you would enjoy discussing with others. Please write soon! Until next time, Gail

Equity for Female Athletes

It's been awhile since my last post. There is a phenomenon in Michigan called "Spring Break" and I was enjoying mine. While I was out of the country there was a long awaited decision by the US Supreme Court not to hear the case re: gender equity in high school sports in Michigan that has been winding its way through the system for the past nine years. This decision means a lower court decision stands, and as a result, there are eight sports seasons which must be switched next school year to promote equality between girls and boys. This case was initially filed by two Grand Rapids mothers of female athletes claiming that the schedule as it existed cut down on opportunity for exposure, and therefore, for college scholarships, for female high school athletes. Supporters of the change are overjoyed, although obviously the change comes far too late to benefit their daughters; while opponents raise other questions. Will having both boy's and girl's basketball played in the winter, which will mean competition for gym time, coaches, and referees, really result in better equity? Or will girls' sports be overshadowed by the boys? Sadly, even with all the steps forward with gender equity in my lifetime (my clients can scarcely believe that I went to high school before Title XIX), no one seems to think that the girls can go head to head with the boys and come out on top.

And another sad note for female athletes is in the news - Don Imus is being called on the carpet, and rightfully so, about his racist and sexist comments towards the Rutgers Women's Basketball Team. Such comments about their male counterparts would never be tolerated. Somehow a two week suspension doesn't seem like more than a slap on the wrist . . .

Is it any wonder that our clients don't feel validated as young women, and fall into the trap of turning their frustration towards their own bodies? As my friend Michael Levine has so wisely said, all of this will continue until we learn to take girls seriously for their ideas, not their bodies. Until next time, Gail

Addendum: as the whole world knows by now, Don Imus was subsequently fired for his comments. Congratulations CBS on taking the right position on a very important issue.

There's No Place Like Home!

My husband is a high school music teacher, and it's musical week at our school. Because he's the orchestra conductor his presence is required at all dress rehearsals and performances. So several years ago I decided I might as well be there too, and I volunteered to serve as stage manager. It's fun mixing it up with high school kids in this way; and I get to live out my fantasy of being involved in a Broadway production. (By the time the week is over I know why the life of a Broadway musician or actor is only for the young and hearty!)

This week we are doing one of my all time favorite shows, "The Wizard of Oz". I vividly recall watching this movie as a child when it was televised, year after year, often on Thanksgiving night. I was afraid of the witch and the flying monkeys; but I delighted in the land of Oz (in color!) and the ultimate victory of Dorothy and her friends over the Wicked Witch of the West. And I celebrated with Dorothy when she made it back to Kansas, safe and sound.

Now that I'm an adult I think Dorothy is a pretty plucky heroine. After all, she has the courage to face the Wizard and ask for what she needs. She leads her friends on the journey through the enchanted forest in their quest for the witch's broom; and she faces her fears and stands firm when her friends are threatened. When she and Scarecrow, Tinman and Lion return to the Wizard in triumph, expecting to be rewarded, they learn instead that what they were searching for was actually within each of them.

I have a plaque expressing that sentiment on my office wall. Along with a picture of Glinda the Good Witch it says: "You don't need to be helped any longer. The power was yours all along." It's been my privilege to encourage that sense of empowerment in the clients I see. Until next time, Gailwmicted@aol.com

Thanks Zoe! You made my day!

Recently I had the privilege of writing a letter of endorsement for a former patient, Zoe, who is a semi-finalist in a college scholarship program sponsored by Discover Card. Zoe was asked to write an essay about "Overcoming Obstacles" and she chose to describe her recovery from anorexia. Zoe was a high school freshman when she was my patient. Typical of so many who suffer from this disease Zoe is an extremely bright, capable, gifted young woman with incredible drive. What began as a simple diet in an attempt to better herself spun out of control and became deadly. When I first began seeing her she was just beginning to accept the fact that she did, in fact, have anorexia. As someone who had prided herself in not being susceptible to peer pressure or societal expectations re: beauty, she was openly asking the question "How did this happen to me?" And although she recognized that she needed to make changes in order to recover she struggled mightily to be able to make those changes.

All of this probably sounds quite familiar to those professionals and family members reading this post. Zoe's struggle, like the struggles of so many sufferers, strongly suggests a genetic predisposition and susceptibility to a brain disorder brought on by dieting. In the right individuals that's all it takes.

Fortunately Zoe's story has a very happy ending. She did recover; in fact, she states she is seldom troubled by obsessive thoughts re: weight or food. Her course of treatment was quite brief by national standards, less than a year from start to finish. She avoided hospitalization, recovering through a combination of outpatient approaches. She credits a spiritual experience at a summer camp as the beginning of her recovery process; and she is fortunate in that she has a committed, caring family with the means to support her treatment.

I hope Zoe's story brings inspiration and hope to others who are looking ahead at what seems like a mountain they must climb. Trust me, you can do it - and one day you may look back at your recovery with the same sense of accomplishment and pride that Zoe has. It may even bring you a college scholarship! And thanks for asking me to write that letter, Zoe. It was great to reflect back on our work together.
Until next time, Gail