For Professionals

Pregnancy and Eating Disorders

2008-05-07T20:05:24-07:00

I've been thinking quite a bit about the effect of pregnancy on recovery from an eating disorder. I have had clients whose resolve to feed themselves adequately, or stop purging, increases dramatically once the pregnancy is discovered, as would seem to make sense. But I am currently dealing with a young woman whose symptoms have become much worse; she has just been hospitalized in order to stabilize her medical situation, and hopefully, help her gain strength and motivation to continue caring for herself on an outpatient basis. So why is pregnancy a positive motivation for some and a significant stress for others?

One factor, I believe, is the extent to which the pregnancy was planned and is welcomed. Nicole, Erin, and Sarah, just to name a few, either desired children and sought the pregnancy, or adjusted happily once the pregnancy was confirmed. They are also in their mid to late twenties, in stable financial situations, and therefore more prepared for parenthood. My client, by contrast, is only 23 and on her third pregnancy in as many years. Although she and her husband seem quite happily married, they have really had very little time to establish themselves as a couple before the children began to appear.

Another issue for my client involves her medication. As soon as the pregnancy was confirmed, her OB doctor took her off her psychotropic medications - understandable and likely necessary. However, without the support of the medication she has not been able to control her irrational thoughts. Although she recognizes, at times, that it makes no sense to throw out the food in her house, at other times she is unable to fight back against the paranoia. While in a therapy session she can admit that her slightly rounding belly is a good thing, indicative of the growing life within; at home she can only see that she is getting fat.

Finally, I believe my client may be more isolated, lacking the positive support environment that supports and even rejoices in new life. Her own parents offer little encouragement. She has had precious little time to establish her own friends.

Perhaps for any eating disorder sufferer, pregnancy is both a positive AND a negative, as it can be for any individual. I would think it would be normal for feelings to range from joy to despair to ambivalence or frustration. If you are a professional who has treated individuals with eating disorders who became pregnant, I'd welcome your thoughts and comments. Until next time, Gail

Miracles Do Happen!

2008-04-03T20:28:58-07:00

I'm very excited to let you know that one of my long term clients, Kathy Christian, has just become engaged. Her fiance', Joe Locke, proposed last weekend over dinner at the top of the Amway Grand, the swankiest restaurant in Grand Rapids, Michigan. Kathy has a lovely ring on her finger and a grin a mile wide.

Of course couples become engaged every day - so why am I writing about this one? Well, to really understand the significance of this event you need to know a bit about Kathy's history. She has been my client for fifteen years, and has suffered with her eating disorder for nearly twenty. The fact that she has survived that long of a battle puts her in elite company already. But there is more: Kathy has a severe abuse history, probably one of the ugliest I've ever encountered. About eight years ago she had to cut off all contact with her family in order to keep herself safe. In fact "Christian" is an assumed name, one she chose after she committed her life to Jesus Christ.

As is true for all of us who call ourselves Christians, her life did not magically get better once she took the step to commit her life to Christ. In fact it was her family's anger at that decision, and her father's rageful attack of her, that brought her abusive past to light. After seven years of therapy and numerous hospitalizations, I finally understood the reason that she'd not been able to recover. Once the reality of her situation became clear to me she was both ashamed and in fear for her life. What followed is a story we hope to publish one day, because all of the twists and turns read like something out of "Law and Order - Special Victims Unit". Suffice it to say that she is extremely lucky to be alive.

She has experienced PTSD, depression, anxiety, and numerous medical complications from her eating disorder. Although she had made steps towards recovery over the past months and years, each step forward was often followed by a half a step back. She despaired of living her life the way it was unfolding, and especially hated the idea of living alone. I often told her that it would take a loving, caring partner in order for her to heal completely from the trauma of her past. And I assured her that such a man existed, at the same time I prayed that I wasn't misleading her in that belief.

And then Joe came into her life. He is everything I would have wanted, and that Kathy has needed, to complete her life. She has made unbelievable progress forward just in the past three months, and as she does, her medical complications continue to resolve. Right now they are making plans for a summer wedding; and I'm proud to say I'll be walking her down the aisle.

So you see, dreams can come true . . . miracles do happen . . . and when the road seems dark, if you trust in God, he really will bring you through. When Kathy doubted God in the past, I often reminded her of the promise in Jeremiah 29:11: "For I know the plans I have for you . . . plans to prosper you and not to harm you, plans to give you hope and a future". Congratulations Kathy and Joe, and may God give you a long and happy life together. You deserve it! Until next time, Gail

"Back from the Brink" a huge success!

2008-03-22T18:19:49-07:00

This past week we hosted Buddy Howard in Grand Rapids, Michigan. His presentation: "Back from the Brink: A Father's Perspective on Recovery from an Eating Disorder" was heard and appreciated by an audience of 75. Buddy was part of a panel of parents talking about their recovery experiences at the NEDA conference in San Diego last September. He is a warm and engaging speaker with a message of hope and inspiration for all; but it truly resonates with the men in the audience. Should you wish to sponsor such a presentation for your event Buddy can be contacted via email at hyddub_1999@yahoo.com. Buddy is heading up the technology campaign for NEDA and we are proud to be making a $300 contribution to this cause.

Nicole Tieri Cornell, aka "Scooter Girl", also made an appearance and shared a few selections from her brand new CD, "Tales from Magnolia Drive". Nicole has made several appearances for NEDA and has shared her ongoing recovery story. The newest chapter involves adjustment to pregnancy and the expected arrival of her first born this June.

Finally, this event served to launch creat-ed, a brand new non profit organization based in Western Michigan. Creat-ed stands for the Coalition for Research, Education, Advocacy, and Training for the Prevention of Eating Disorders. Creat-ed was founded by myself in association with one of my long term clients, Kathy Christian. Kathy has a history of nearly 20 years of struggling with her eating disorder, and she continues to be saddled with many physical complications. In fact I wanted to wait to launch this until her health was better. But she has a burning desire to be sure that her struggle stands for something, and a determination to keep fighting that is bringing her closer to recovery each day. It was largely due to her persistence that our organization was born. Working together on this has been exciting and challenging. We're both very proud of our first event, and of the hard work that made it happen. Until next time, Gail

Happy 20th NEDAW

2008-03-03T20:01:57-08:00

This past week marked the 20th Annual National Eating Disorders Awareness Week. I am proud to say that I've participated with NEDAW almost from the beginning. I remember attending an organizational meeting with Anita Sinicrope Maier and Margo Maine at the NAAS conference in Columbus, Ohio back in 1986. NEDAW has grown exponentially since those humble beginnings. This year there were coordinators across the nation who planned all kinds of events for professionals, students, and the general public, all in an effort to raise awareness regarding eating disorders. We have a wonderful event planned to occur right here in Grand Rapids, Michigan on March 18. More to follow . . .

NEDAW always reminds me of my father. Ten years ago I planned events for the week in Michigan, but was unable to attend when I was called home due to my father's death. That fall at the EDAP (now NEDA) conference I was presented with an "Outstanding Coordinator" award for my work in helping to pilot the "Go Girls" curriculum. I dedicated my award to my father, "the original 'go girl' in my life." I'm so thankful I was raised by a dad who, in his own unsophisticated way, encouraged me not to take no for an answer. The role of a father in the development of his daughter's self esteem is vital, as is his support and encouragement when she is attempting to recover from her eating disorder.

For our event we are bringing in a dad, Buddy Howard, to tell the story of his daughter's recovery from his perspective. Although we believe his messages of hope will be appropriate for all audiences, we are especially encouraging fathers to attend. If you live near Grand Rapids, Michigan please plan to join us at 7 p.m. March 18 in the Loosemore Auditorium on the GVSU downtown campus for this special occasion. Until next time, Gail

Happy V-Day

2008-02-15T18:31:30-08:00

Valentine's Day came and went without much fanfare at our house. It was a normal, busy work day - although I did have special calls and messages from my husband and children. Then when I arrived home I picked up the newspaper and was reminded of "V-Day", celebrated with a local production of "The Vagina Monologues" and its theme of halting violence against women. What touched me even more were the messages of support and encouragement sponsored by local businessmen. I thought too of an event earlier this week, described to me by a client, which was held to support Breast Cancer Awareness, and attended by many young men in her community.

All of that started me thinking: do we have the same support by men for our cause, Eating Disorders Awareness? Although there have been a significant number of male experts in the treatment and research fields, there have been precious few men championing the cause of awareness and prevention, with Michael Levine being one notable exception. And thankfully, during the past several years, more and more men have stepped to the foreground to become spokespersons about the devastation these diseases can render. Often it has taken incredible courage to do so since their own wounds are still raw from the battles recently fought by their wives, mothers, or daughters.

Unless men know someone touched by these illnesses, they can be overlooked or trivialized by them. Perhaps at one time the same thing was true regarding violence against women, or breast cancer. Eating Disorders Awareness Week is just around the corner. Let's be sure we aim our messages at men AND women, because doing so will strengthen our movement. Until next time, Gail

God Bless the USA!?

2008-02-06T18:14:31-08:00

I missed posting last week because I was in Norfolk, VA where my husband and I welcomed home our son from a six month deployment in the Persian Gulf. He has been in the Navy for nearly 4 years, but this was his first actual deployment. What an experience it was to stand on that pier, along with about 1,000 other family members and friends, to greet them. First off the ship were the officers, so our anticipation heightened as we saw them hug and kiss wives and children. Next came the 32 new fathers for a first meeting with their 34 new babies born while the ship was away. Lastly came a steady stream of the 800 or so enlisted men and women and soon we had our arms around our son. It brought tears to our eyes and made us swell with pride.

All of this has given me a new appreciation for the families who sacrifice so much while their loved ones are in the military. Although I'm not a big fan of this war, I am grateful for those who are willing to serve, and those left behind supporting them. While there we also toured the base, and were amazed and awed by the sights of the largest Naval base in the world. And we were astounded at hearing what it costs to run just one large ship for one day in one conflict.

President Bush has again proposed a budget of billions for defense spending while proportionately very little has been allocated for education and health care. So what does this indicate about our priorities as a country? Do we REALLY support "family values"? Frankly I think we can do better. Again I urge you to make your voice (and your vote) count this year! Until next time, Gail

On the issue of Professional Boundaries: a response to Carolyn Costin

2008-01-22T17:23:19-08:00

I received the following thoughtful response to Carolyn's post, dated 11/8/07:

Caroline, you wrote: "The key, for me, is that although there are guidelines, at some point we also have to trust the things that we know. . . . I do my best to keep true to my profession and my humanness at the same time." I almost agree with you wholeheartedly, and now we have evidence based scientific research to back up the use of our humanity in our practices. Appropriate boundaries between patient and psychotherapist are essential in any psychotherapy and particularly in the field of eating disorders.

However, the topic is often discussed in terms of content. I believe that when a patient wants to know about my private life or wants to include me in her private life (weddings, funerals, births, graduations, award events, etc.) the patient wants and needs a particular psychological emotional experience from sharing the experience with me. In other words, it’s not the information or event that is the issue. The sharing of our humanity is the point. Again, I agree with you. There's no need to share "dirty details." The value is in right brain to right brain communication, not content. Allan Schore, http://www.allanschore.com/ in his fantastic research on affect regulation, is showing affective neuroscience, neuropsychiatry, trauma theory, developmental psychology, attachment theory, pediatrics, infant mental health, psychoanalysis, psychotherapy, and behavioral biology that right brain communication is received by the right brain and actually changes brain structure to allow developmental progress. The discoveries revealed by the increased sensitivity of neuroimaging validates what many sensitive clinicians have known for a long time. Honesty, caring, empathy, sharing spontaneous imagery, acknowledging physical responses to clinical material make for effective connection, growth and increase possibilities for healing. http://www.biosynthesis.org/html/allan_schore.html My pause in wholehearted agreement with you, Caroline, is a slight shift of emphasis. I believe, with the backing of neuroscience, that we can’t keep true to our profession without keeping true to our humanness. P.S. As part of my practice, I've attended a wedding, but not the reception. I’ve visited a new mother in a maternity ward. I’ve applauded from the audience when a person received a hard won and well-deserved award. I’ve called patients in fire areas during Southern California fires to check on their well being. I ask to be notified regarding outcome of surgery. Joanna Poppink, LMFT, Los Angeles psychotherapist, specializing in adult eating disorder recovery.
joanna@poppink.com

I'd still love to hear from other professionals regarding this important issue. Write any time! Until next time, Gail

Class Action Lawsuit filed in Michigan re: Eating Disorders

2008-01-19T13:29:39-08:00

Attention all therapists and treatment providers with clients who reside in Michigan: There has been a class action lawsuit filed in Wayne County on behalf of eating disorder sufferers who have been denied coverage and benefits for inpatient treatment by Blue Cross Blue Shield of Michigan. The denial of coverage must have occurred within the past six years. It does not matter if treatment was to occur in Michigan or in another state.

There are currently 19 individuals and their families being represented; others are being encouraged to join. If you as a therapist are aware of clients who were denied needed treatment, or who sought treatment and had to self pay, encourage them to contact Peter Macuga at Macuga & Liddle, PC: 313-392-0015; or his co-counsel, Robert Roether robertroether@cs.com . Although it is certain this process will require some energy, and therefore it would be best if clients contacted are recovered, I believe the process of being "heard" and hopefully, of being vindicated, could help empower individuals toward recovery as well.

As professionals treating individuals with eating disorders we are well aware of the tremendous physical and emotional suffering that can be caused by a denial of needed treatment. We don't want to wait until a lawsuit is brought for wrongful death. Let's step up now and make a difference! Until next time, Gail

The Great Debate of 2008

2008-01-15T06:37:35-08:00

Today is Primary Day in Michigan. I stopped answering the phone last night because of the onslaught of pre-recorded messages from various candidates, especially on the Republican side. As you may have read or seen on the news, the Democratic primary is only represented by Hillary Clinton, because the state of Michigan broke some rules by moving the primary earlier in the season. As a result John Edwards and Barak Obama withdrew their names from the ballot, and some of Michigan's delegates may not be seated at their respective conventions come fall.

This is an election where important issues are being discussed. Topics like the war, national security, abortion, and immigration rights are on everyone's radar. I want to encourage us all to keep national health insurance, and mental health parity also in the foreground. Although it will take more than a supportive president to bring change to the health insurance system, a president who cares about these issues will certainly increase the possibility of insurance for all, and full treatment for all conditions. (That's such a radical sounding statement isn't it?)

I currently have a patient who came to the US from Germany just three years ago. She is amazed and perplexed by our fragmented insurance system in the US. Seeing the issue through her eyes, and listening to what the rest of the civilized world provides in countries that truly practice "family values" has reminded me that we can do much better here. I also have a patient who is joining the class action suit being brought against Blue Cross in Michigan for denying appropriate care to those individuals with eating disorders. She is now nearly well, and strong enough to join the fight. She hopes to save someone else from the devastation she experienced when her much needed residential care was denied mid-stay.

It seems as if this Presidential Race is all about change. We could be in for a radical change: the Democratic party will likely present either the first African American or the first female nominee for President. And yet there is the fear that, no matter whom we elect, it will be "same old, same old" in Washington, where radical change is often very difficult given the stagnant nature of the system. It's easy to get disallusioned and think it doesn't really matter who becomes President: my voice won't count for anything. But don't we teach our clients the importance of using their voices? And isn't it our responsibility to speak up and speak out on behalf of those who are too depressed, too ill, or too weary to do so for themselves?

During this election season, which stretches on for another 10 months, I urge you to remain abreast of the candidates and their stand on health care. We can't afford another season in which eating disorder sufferers are denied the care they so desperately need. Until next time, Gail

New Year's Resolutions

2008-01-06T18:19:14-08:00

It has been some time since my last posting . . . apologies to all, especially my contacts at Gurze, who have been incredibly patient with me. In addition to the extra events and travel during the month of December my family was plagued with some illness. All of this made it difficult to find the time or energy to post. When the time for New Year's Resolutions hit, I thought to myself that "doing better with my blog posts" was an excellent thought. That was six days ago, and the "thought" never crossed my mind again.

This led me to reflect for a bit on the process of change. Why do some great resolutions never materialize? I don't think it's for lack of sincerity. Many times I have sat with a client who voices the intention to change which is heartfelt and genuine, who leaves with renewed energy, and returns the following week to report lack of progress. I know my thought was sincere. What helps us translate thoughts into changed behaviors?

As we know from the study of Stages of Change Theory, in order for change to occur, the individual must have passed through the "thinking" stages of pre-contemplation and contemplation and be ready for action steps. Then too, change is more likely to occur if goals are clear and measurable, and small steps towards the larger goals are identified. Finally, it can be very helpful to state goals for change aloud and to be accountable to someone regarding progress.

So readers, I'm ready for action. I am committing myself to posting on this blog twice per week for the next three months. I hope you will keep me accountable. I would also value your partnership with me - if you have a question or an issue which you want addressed, please let me know. But even if I don't hear from you, I will do my best to meet this goal. Best wishes for a wonderful 2008! Until next time, Gail