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Selfish or Self-saving?

beth-hartman-mcgilleyMonte Nido & Affiliates Expert Advisory Council Member and Associate Professor at the University of Kansas School of Medicine-Wichita Beth Hartman McGilley, PhD, FAED, CEDS is a psychologist in private practice, specializing in the treatment of eating and related disorders, body image, athletes, trauma, and grief. In her writing, Dr. Hartman McGilley speaks to the stress and pressure many of us experience in our every day lives in an effort to be all things to everyone, and reminds us of the importance of saying “no”.

As the holidays near, most of us are in some form of panic about “what needs to be done before.…” Before the relatives come; before the office Xmas party; before taking finals; before the turkey is done; before the year is over. In truth, for too many, this mad rush to “make our lists and check them twice” is a year round ordeal—a revolving door of self-imposed demands that daily dumps us on the threshold of our self-esteem with nagging feelings of deficiency. It drives some to distraction and others to destruction. Either way, it diminishes our precious capacity to be wholly present, and intra- and interpersonally attuned. What good is a completed list with a depleted list maker? One version of this is the “be all things to everyone” persona. Recognize yourself anyone?

Given that we tend to become what we focus on, I prefer to turn this dilemma inside out and explore what it looks like to “be some things, to someone, some of the time!” One tool I offer my clients, to enliven and embody the qualities they admire in others, is to become shameless spies! I ask them to think of a few people who carry themselves and conduct their lives with the character and integrity to which they aspire. And then set out on spying missions to bear careful witness to how those people inhabit their bodies, how they hold others in their gaze, how they negotiate daily demands, how they communicate in simple matters as well as the profound. Once we have a living template for how those cherished qualities manifest in others, we can try them on and in ourselves. Over time, we can develop our own versions, and they become part of our internal and interpersonal fabric.

One of my most spy-worthy friends is Dr. Margo Maine. A prolific writer and passionate advocate, activist and therapist in the field of eating disorders, Margo wastes no time in revolving doors! She has mastered the fine art of living exceedingly productively with what I once heard called “joyful stress.” She is equally facile hitting the gas pedal as she is in using the brakes. “Yes” and “no” are equal opportunity answers depending on the question, and more importantly, how it impacts her in the moment and the longer term. While some may hear that as being self-centered, it’s quite the opposite. I liken it to the metaphor of putting your own oxygen mask on first if a plane is going down. We are only as effective as we are well sourced. If we aren’t connected to self, our relationship with the Divine is compromised (and vice versa). It’s an act of respect and regard for another to manage ourselves—our time, our energies, our money, our hearts. Our word counts, and when asked to do something we’re unlikely to complete, it’s a LOT easier to say no and then yes, than it is to say yes and back pedal our way back to no! Memorize this people pleasers!

Margo was recently distinguished as a recipient of the Connecticut Women’s Hall of Fame Women’s Wellness Honorees. All honorees were challenged to answer, in 20 seconds, the following question: What is the single most important thing a woman can do to increase her well-being? She answered: “The most important relationship in a woman’s life is her relationship with herself. Our self-talk can diminish or empower us. In a culture so demanding and dismissive of women, we need to rebel and stop apologizing for not being perfect, and start telling ourselves we are good enough as we are—simply good enough!” Simply. Good. Enough. See how that mantra could burst you out of the revolving door? How would you answer the question for yourselves?

There’s a seriousness to this dilemma that can’t be made pretty, and I offer this to the healers and wholers of the world—no advanced degree required. You, who keep the porch light ever blazing for those in need, who foster and serve the young skin- and fur-clad lost souls, who bathe the feet of the old and dying, who are woke and speak up to indignities. You, who are Mary Oliver’s Wild Geese, walking “on your knees for a hundred miles through the desert, repenting,” whose nature is so given to giving, it becomes “your place in the family of things.” Your heart doesn’t operate on the clock and the wellspring of your spirit has no depth gauge. You answer the calls, you welcome the tears, you speak truth to power. For you to say “no,” or “not now,” or “not again,” will feel like bending your fingernails backwards. Do it anyways. Give what you give to the person who sometimes needs it the most—yourself. It’s not selfish. It’s self-saving.

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.

 


3 Rules to Maintain Recovery During the Holidays

jennifer_yoga-9076Jennifer Kreatsoulas, PhD, E-RYT 200, RYT 500, is a yoga teacher and yoga therapist specializing in eating disorders and body image. Recovered herself, Jennifer is extremely passionate about helping others reconnect with their bodies and be empowered in their lives. She 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. In this week’s blog post, Jennifer offers some tips to help maintain recovery during the holidays.

The holidays can be a season of conflicting emotions and desires. For me personally, I feel joy and overwhelm, excitement and anxiety, carefree and out of control, happy and unsettled. After years of persevering to make my recovery a priority during the holidays, I’ve observed that emotional collisions can significantly affect hunger and fullness cues.

So not only are feelings at odds with one another, but the natural sensations that we in recovery work so tirelessly to understand and honor, can also become confusing to decipher. If all this goes unchecked, we may find ourselves on a downward spiral of eating disorder thoughts and behaviors before we ring in the New Year.

Trust me, this is not to diminish the sheer guts, courage, and perseverance it takes to maintain recovery during the holidays. We are bombarded in ways that may be very uncomfortable, overwhelming, and outright triggering. All those external factors can flood our minds and emotions, which is exactly when we want to take refuge in the eating disorder. Disconnect. Numb. Distract. Sound familiar?

Years ago, my therapist told me that recovery is about having choices. When we are ruled by “ED head,” we do not have choices; everything is off limits or has a consequence associated with it, which seriously limits our range of choices. Her words have stuck with me and made a big difference in my relationship with my recovery, including during the holidays when it may be enticing to numb out.

But, I have a choice, and YOU have a choice: We can get pulled under or commit to doing our best to not let that happen.

Here’s 3 rules that I live by to help me choose recovery when I want to check out, like during the holidays. Pick the one that resonates with you to help you maintain recovery during the holiday season and beyond.

No. 1. Have a safety net to keep you honest. I have a pact with myself that, unless I am actively continuing forward in my own healing, I cannot work with others in recovery. In this way, my work keeps me honest. It’s my safety net. It’s the thing that keeps me in check from getting off my recovery path. When old fears show up and tempt me to starve, my work keeps me honest. When the urge to drop weight or obsessively body check comes on strong, my work keeps me honest. I think of my passion for my work and the trust I am asking of my clients, and know that, if I do not choose recovery, all that goes away.

What keeps you honest? Who or what is vitally important to you and can be your safety net? It’s ok to use external motivators to get us through intense times. Continue to ask yourself this question until you find the answer. Hold that answer in your mind and heart, and look to it to help you stay on course. You will be thankful for that safety net, and you will feel renewed by a sound sense of purpose. I promise.

No. 2. Recognize struggle, but don’t settle. There’s no shame in struggling. In my opinion, the struggle is work not failure. It’s just as worthy of an experience as a struggle-free day. The important thing about struggle is not settle in or for struggle.

We can get caught up in telling ourselves a narrative about how hard we are struggling and literally get sucked in so deep that struggle turns into a downward spiral. Sometimes a relapse is what we need to ignite the healing process, but other times, maybe even most times, this is not the case. Keep yourself honest about the struggle and don’t settle to let it take over you or your holidays. This is the time to rally and call on your supports, do activities that are empowering, carve out quiet time, or see friends who are uplifting. We all have our tricks for pulling ourselves out of a funk. You deserve to take the time to do those things, no matter how hectic the holiday season is. You deserve to not settle.

No. 3. Resolve to evolve. Just because the holidays were difficult last year or the past 15 years, that does not mean that this year will be or must be the same. We have the choice to do the holidays differently this time. We can resolve to evolve.

Reflect on what’s been hard in the past for you. What’s made the holidays challenging? How did you use the eating disorder? Look hard at your choice, patterns, and habits this time of year. What small shift can you make in how you respond to a triggering person, place or thing? What are some ways you can respond that don’t involve taking it out on food or your body? This is about playing offense instead of defense. In other words, the holidays can leave us feeing out of control, but we can flip that thinking by taking charge. When we are in charge, when we remember we have choices, when we resolve to evolve, we empower ourselves and make recovery a priority.

I recognize that these rules ask a lot. They require we work hard and stay connected to present moments that are uncomfortable and maybe even painful. But these rules also inspire a proactive attitude and a committed effort to incorporate recovery into our lives, not keep it off to the side or treat it as another “job.” We must remember that we have choices, and this holiday season, let’s all do our truest best at maintaining recovery by staying honest, not settling, and resolving to evolve.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


That Voice in Your Head: Don’t Take It Out on Your Body

Jen Gaudini

Expert Advisor to Monte Nido Jennifer L. Gaudiani, MD, CEDS is nationally known for her work on the medical complications of eating disorders. She recently opened the Gaudiani Clinic, a unique outpatient medical clinic specifically dedicated to adults with eating disorders. Dr. Gaudiani shares her work with clients who are faced with “that voice in their head” in this week’s blog post. 

That voice in your head is as familiar as it is judgmental and unkind: “You’re not good enough. You’re not thin/disciplined/organized/accomplished enough. You’re not meeting expectations as a partner/sibling/parent/child/professional/student. You haven’t done enough today to deserve rest and self-care.” So many people walk around every day with some version of this voice in their heads. And all too often, the next step is to take it out on your body, imagining the voice could be satisfied, or “good enough” could be achieved, if somehow the ideal body shape/size/nutrition plan/exercise regime could be accomplished.

Of course, this logic is pure nonsense, borne of endless marketing schemes, haunting images of people who don’t even look like that themselves, and a society that seems to keep getting more demanding while offering less compassionate support. The truth is: when you eat a wide variety of foods, and plenty of them, practice moderation (most of the time), and move your body in ways that bring you joy and help you stay strong, your body will take the size and shape that was pretty much genetically predestined. Love it or not, that’s the body you have, and only you can be its caretaker over the years. Totally separate from your body (really!), you can learn to use a kinder voice in your head, gently recognizing accomplishments and disappointments without judgment. Everyone needs self-care, just like everyone needs air to breathe.

I’ve been an internal medicine physician who specializes in eating disorders for eight years, and I’ve taken care of some of the sickest adults in the country. I’ve listened to a lot of stories from extraordinary people who developed a life-threatening mental illness as the voices in their head became intolerable and forced them to numb themselves through starvation, purging, binging, and substance use. Everyone’s story is different, but almost everyone I’ve cared for talks about that voice in their head.

You might be one of the lucky ones who rarely hears the voice, or who naturally (or after lots of work) has learned to answer judgment with kindness, and keep emotional struggles separate from body image. Or you might have struggled for years with this relationship between soul and body, going on diets (that aren’t sustainable and don’t work but sure cause a lot of crummy days in the process), thinking a certain size or shape will make everything else better. (They don’t.) Or you might have developed disordered eating or an eating disorder like anorexia nervosa, bulimia nervosa, or binge eating disorder. You’ve suffered terribly, as have those who love you, as the eating disorder turns the voice in your head into a fiendish, cruel, jealous, and insatiable presence. Even as that voice tells you nothing bad will happen to you as long as you just keep restricting, binging or purging, you actually end up with a disorder that carries the highest death rate of any mental illness.

My message is this: the voice in your head can be costly, really costly. You can choose to answer back to the voice when it tries to play its same old song: “I am enough. I’m doing what I can. I’m proud of the way I stood up for myself today. It was painful when I had that argument with my boss/mom/daughter, but I think I learned something, and I didn’t aim to wound. I’m going to put my feet up now even though there are a ton of things on my to-do list, because I need a break.” Your body deserves enough delicious, varied food to fuel it adequately, and the activity you do should be a celebration of the ways your body can move…never a punishment or an atonement. Keep working to untangle the voice in your head from the care you give your body. Body and soul will thank you in the long run!

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


Does Body Image Always Have to be the “Last Thing to Go”?

jessyka-young-edtny-mnnewyork-02

 

Monte Nido Assistant Clinical Director Jessyka Young, LMHC explores the use of yoga therapy in eating disorder treatment in this week’s blog post. She explains how yoga can help clients to listen to and become attuned to the signals and needs of their bodies.

“Body image is the last thing to go”. This statement seems to be an old adage in eating disorder treatment and recovery. I know that I am guilty of telling countless clients this.

Since becoming a yoga therapist, I’ve found myself questioning whether body image has to be the last thing to go, or whether there are ways to give clients a different perspective and appreciation of their bodies while they are in treatment. If we can change our thoughts about food, why can’t we change our thoughts about our body?

I’ve had the fortunate opportunity to do yoga therapy sessions with clients in our PHP and IOP program at Monte Nido San Diego. The yoga therapy I am trained in is called Phoenix Rising Yoga Therapy. It is a trauma-informed, client-centered modality that uses the body as a tool for increased awareness. In my experience, the body can be a direct gateway to one’s true self or soul. I’ve had a client refer to our sessions as individualized “Body and Soul”, a group I have run at Monte Nido for over three years and which many clients say is particularly effective in connecting to a deeper, healthier “Soul Self”.

Another client wrote to me about our yoga therapy sessions, “I have never really listened to my body, in fact I tried my hardest not to. But you gave me the space and opportunity to do that.”

Bessel van der Kolk, MD writes in The Body Keeps the Score, “One of the clearest lessons from contemporary neuroscience is that our sense of ourselves is anchored in a vital connection with our bodies.” In eating disorder treatment, clients have accustomed themselves to not listening to their bodies’ messages and cues. What if, instead of waiting for the recovery process to deliver body acceptance, there were a way to actively work on rebuilding the connection?

Interoceptive awareness, the signaling and perception of internal bodily sensations, is often defective in those suffering from eating disorders. Yoga is a great way to help increase interoceptive awareness and aid in the healing process. Just as we use exposure work to challenge our clients’ distorted thoughts about food, I believe body work can be a form of exposure work; exposing clients to the reality of their body in the present moment, the physical sensations, emotions, thoughts, and memories. Yoga therapy is a mindful, nonjudgmental approach to body awareness, allowing clients to gain a new perspective of their body in order to integrate all parts of themselves.

To give you a taste of what yoga therapy is like, here is a short activity:

Ask yourself the question, “What do I need to do today?”

Allow your answer to come to mind naturally, and just go with the first thing that pops into your head.

Close your eyes and take 3 deep breaths, in through your nose and out through your mouth.

Inhale and raise your arms up over your head, exhale swinging your arms down, and fold forward, letting your head and arms hang heavy. Repeat this 2-3 more times.

Come up to stand and start twisting side to side, allowing your arms to hang heavy, as if they were wrapping around your body with each twist. Do this several times at whatever speed feels right for your body.

Roll your shoulders, backwards and forwards a few times.

Scrunch them up towards your ears on an inhale, and let them drop on an exhale. Repeat this 2-3 times.

Then take your hands and rub them together, creating some friction. When you start to feel some heat, place your hands anywhere on your body that is calling to you (i.e. your face, neck, heart).

Keep your hands wherever they landed and take another 2-3 deep breaths, in through your nose and out through your mouth.

Ask yourself the question again, “What do I need to do today?”

Notice if the answer has changed, or the intention.

What happens when you listen to your body for the answer?

I believe the body holds an incredible amount of wisdom, and that by working directly with it we get to extract and develop that wisdom to be used as a tool for healing. I am grateful to work for a company that incorporates yoga into its programming, and I hope to continue the conversation and exploration of how yoga can help our clients heal.

“Yoga teaches us how to be “in” our body, use our body, and take care of our body with understanding, awareness and acceptance.”

– Carolyn Costin, Yoga and Eating Disorders: Ancient Healing for Modern Illness.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


Men with Eating Disorders

doug

Doug Bunnell, PhD, FAED, CEDS is an expert clinician and leader in the eating disorder field. He brings over three decades of experience and a wealth of knowledge to his role as Monte Nido Chief Clinical Officer. He shares important information about treating males with eating disorders in this week’s blog post.

Most of what we know about eating disorders is based on what we know about women with eating disorders. Most of what we know about men with eating disorders is based on what we know about conventional models of masculinity. Most of what the two of us know about either of these topics is heavily influenced by our own gender, sexual identities, and ethnic backgrounds. These are the limitations that we, as psychotherapists, bring to the room when working with males- an underserved population in the world of eating disorder treatment. By examining the differences and similarities between how males and females with eating disorders present clinically we hope to shed some light on issues to be aware of as clinicians and how we can move towards a more comprehensive treatment of the eating disorder population.

Conventional wisdom tells us that one in ten people with eating disorders are male, but data suggests that 25% of diagnosable cases occur in males and that males have higher rates of disordered eating (Hudson et al., 2007). As is, unfortunately, easy to imagine, it is suggested that under reporting is a result of stigma, lack of sensitivity and detection, and gendered perceptions of eating dieting. The lower occurrence of eating disorders in males may, however, also be attributed to gendered differences in the risk and maintaining factors for eating disorders .

A difference in biology, brain organization and temperament, for example, are factors that appear to insulate men against risk. Mood disorder vulnerability also seems to put males at a lower risk as they have a greater tendency towards externalization as opposed to the female tendency for internalization- a trait that can serve as fuel for the eating disorder. Generally speaking, men present with less harm avoidance, less drive for thinness, and less body dissatisfaction; with what we know about eating disorders, this discrepancy should also account for the lower prevalence in the male population. That being said, it falls on us, as clinicians, to make sure we bring a certain awareness of clinical features and differences into our female-normed assessments to work against the risk of underestimating rates and severity.

One feature that is similar in both women and men with eating disorders is that men with ED present differently than men without ED- they may be struggling with depression or other impairments. The many ways that males and females differ in eating disorder presentation, however, lie in the manifestation of the illness; for that reason, it is of the utmost importance that we, as clinicians, maintain an acute awareness of our language during assessment. It is not as pertinent, for example, to assess for a “fear of fat” with a male client as males tend to idealize a body that has less fat and more muscle, therefore they tend to fear “softness” rather than “fatness”. A preoccupation with the need to be “lean” might be more relevant to males with eating disorders rather than the drive for “thinness” often seem in females. Additionally, males with eating disorders may present with use of steroids and human growth hormone. These factors are all important when assessing males on a drive for muscularity scale, male body checking scale, and obligatory exercise scale.

In addition to maintaining awareness in assessment of males, it is equally critical to maintain acute awareness of the language we use in the treatment of males. For a clinician accustomed to treating females, it is likely common to use very emotionally charged language such as “opening up”, “sharing”, and even referring to “fat as a feeling”. Not only are men generally less familiar with eating disorders than women, for better or for worse, men have been socialized by an unspoken male code to not be weak or vulnerable and to prioritize leadership, work, and self-sufficiency. While it is an adjustment from the way we work with female clients, it does not have to be an obstacle in helping our clients. Instead, we can work with decisional balance- weighing the pros and cons of change versus the pros and cons of no change with our male clients. By leaving what works for female clients at the door, we serve our male clients better and respect their sense of masculinity- however that may look for any one individual.

As individuals working with an already stigmatized disorder, it is important to constantly learn and keep an open mind and consider how much additional bravery it takes for a minority of an affected population to seek out our help. While we have made great strides in the treatment of eating disorders, there is always room for improvement. By embracing the difference in our experience as treatment providers, we will be able to work more successfully with this underserved population and further contribute to the work we all do to counter eating disorder stigma.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


Why I Walk

tamie-gangloffMonte Nido & Affiliates Regional Outreach Manager Tamie Gangloff, MA, MFT led the West Chester, PA NEDA Walk last year in the hope of bringing people together to raise awareness about eating disorders. In this week’s blog post, Tamie shares some of her personal journey to living a fully recovered life as well as what inspires her to walk. 

Between 1995 and 2002, I went to treatment for my eating disorder several times. I had resigned myself to the fact that I would occasionally go to treatment and continue to manage until I would inevitably fall apart and need to go to treatment yet again… that belief changed in fall 2002. I was sitting in day treatment, listening to a woman speak about her devastating battle with her eating disorder and her recovery. This woman had fully recovered! She described a full life with love, work, play and family. The woman sitting before me was truly recovered in every aspect of her life including her relationship with food and her body. At that moment, my life changed. I made the decision to do whatever I could and whatever was suggested to me because I knew that I too could have that same full and free life.

Several years into my recovery, I started to speak out and talk about my struggles, but more importantly, my recovery. I wanted everyone to know that recovering was arduous and painful but not as painful as staying sick. I wanted them to know, if they did the work, they could also be recovered. I wanted to bust the myth that someone with an eating disorder will always be ‘in recovery’ and have to work hard at it everyday to merely “manage” it. That is not my truth or the truth of the many colleagues and former clients that live lives free of an eating disorder; where it is truly a thing of the past.

I walk because there is hope and, if I don’t walk, someone may not hear that message of hope that they need to hear. I walk for those that we have lost in this battle, including my friends and former clients. I walk for our youth! Last year, my family attended the walk and my niece was thrilled to be a part of it. She loved carrying the banner and being front and center in the walk selfie. While we were walking, I asked her what she learned that day. She said that she learned that she is beautiful and that everyone is beautiful. I walk so that my niece and nephew can live in a world without eating disorders.

I have been blessed to create and participate in countless eating disorder awareness events over the years. Last year, was my first year as the walk coordinator for the West Chester PA NEDA Walk. It meant so much to me because I struggled terribly with alcoholism and an eating disorder when I was a student at West Chester University. At that time, there was very little awareness or support for eating disorders. I’m so grateful to be able to help raise awareness so that others do not have to struggle as I did. We have many volunteers and attendees from WCU and I want them to know that there is hope.

I am grateful to work with many volunteers that are recovered or are new to working in the field of treating eating disorders. It is an honor to be able to mentor and work with these men and women. Remembering the walk from last year, I recall that there were several people who reached out for support and were able to get help for their eating disorders. That is what this is about. For one morning, an amazing group of people take a pause from their lives and join in our family to learn more about eating disorders, share resources, support one another, give hugs, sip coffee, stroll through the park and share hope. If just one person learns something new, feels supported and feels hope, then I have done my job!

The 4th Annual West Chester PA NEDA Walk is Saturday, November 5th! I hope you will join us! If you are interested in attending, please visit the West Chester PA NEDA Walk site. If you have any questions, contact me at tamiegangloff@montenido.com.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


Damsels, Witches, and Vampires: Attending to the Monsters of Anorexia

Monte Nido Eating Disorder Center of Manhattanmelissa-daum Primary Therapist Melissa Daum, LMFT uses metaphor to help explain the challenges of living with an eating disorder. In her post, Melissa sheds light on the “monsters” clients face as they work toward full recovery.

With Halloween upon us and the crisp chill of fall in the air, ’tis the season where our fascination with all things macabre is invited to come out and play. However as a psychotherapist, hauntings, possessions, and spells are not a seasonal novelty but a daily occurrence, as individuals come seeking relief from their inner demons and psychic pain. In my work with people in whom eating disorders are their primary symptomatology, I have found that certain monster metaphors recur again and again: The witch and the vampire.

Vampires, with their distinct dietary limitations and co-morbid sleep disorder, maintain perpetual youth by feeding off the blood of their victims. Vampires have no reflection in the mirror, and are both endowed with supernatural powers and isolated from human contact. These qualities make the vampire an appealing love object — he is untouchable and desiring, magical and dark. I have heard young woman describe their devotion to “Ed” as this kind of romance with an inner demon lover. He professes his undying love for her, and through him she perceives herself to be elevated from the trappings of her ordinary life, including her need for food.

While the vampire image expresses the romance an individual may feel toward her anorexia, the witch image has to do with her ambivalence toward womanhood. Witches are often imagined as female outsiders who are keepers of spells and sorcery. Witches can be glamour queens or hags, or both at the same time if she drinks the right potions. Usually witches were rejected or betrayed at an earlier point in time — Maleficent didn’t get invited to Aurora’s christening, the witch in Rapunzel had her garden raided by Rapunzel’s dad, the Wicked Queen in Snow White got demoted from being the fairest in the land — thus the witch keeps the damsel as a hostage for debts she is owed. Time stops for the damsel, often through sleep or imprisonment. This spell reflects the kind of frozen state anorexia promises.

Through the monster we arrive at a situation of bound up vitality. The reality of the anorectic’s internal hostage situation can literally cause a “hold up” with regard to her progress in treatment. It can be tempting to regard the eating disorder as the monster and the individual as the innocent damsel in distress, resulting in an oversimplified idea that one must kill the monster to be free. Instead, it may be more useful to imagine the eating disorder as a compromise to keep the monster and the damsel simultaneously satisfied (or simultaneously deprived). Thus we no longer have the binary structure of monster versus damsel, as the damsel is now a kind of monster in her own right — the shell of a girl, polite, pretty, and sweet, awaiting rescue.

Like all beloved monster stories, the monster is not always what it appears to be on the surface. When someone we care for is struggling with an eating disorder, the myriad of external complications can perpetuate avoidance of the competing pressures within. These painful inner loyalties must be attended to for psychic growth to occur.

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


CPR for the Soul

joeMonte Nido River Towns Primary Therapist Joe Sciarretta, MSW, LMSW  brings enthusiasm, truth and an appreciation for the challenges his clients face to his therapeutic practice. In this week’s blog post, Joe explains how Eating Disorder Selves develop to ultimately interrupt life, and how the whole person is uniquely cared for at Monte Nido. Special thanks to colleague Elizabeth Parks, MSW, LMSW for her thoughtful editing assistance.

At the heart of our treatment approach at Monte Nido is the idea that our clients are fighting a constant battle between two parts of themselves: their “healthy self” and their “eating disorder self”. The healthy self wants to stop using the eating disorder as an escape, lead a normal life and can see the eating disorder for what it truly is. On the other hand, the eating disorder self wants to cope with life by abusing food, losing as much weight as possible and denying the seriousness of the illness. This ever unresolved conflict between these two parts of self creates everyday inner struggles and arguments: “Do I go out to see my friends tonight, or do I stay in and purge to work on my stubborn thigh gap?”; “What’s more important: being skinny or being in school?”, “Do I risk telling my team about going off my meal plan, or do I keep it a secret as long as possible?”

As an eating disorder self progressively emerges victorious in mounting numbers of these mental sparring matches it grows in power, and over time, clients eventually lose relative touch with their healthy voice. Living long enough with an omnipotent eating disorder self, clients tend to forfeit a sense of who they really are and they begin to define themselves as “a sick person” or “the crazy person with the food problems”. As eating disorder selves continue to encroach on life’s territory, relationships fall victim. Essential connections become faded and frayed as loved ones stop trying to meaningfully relate after persistently being put second to the eating disorder. Soon, interests and ambitions have to be given up due to the debilitating consequences of prolonged symptom use – “I’ll do that road trip after I recover, so maybe I’ll come back to the idea in a few years. I’m just not ready yet,” clients say.

Ironclad commitments made to one’s self on one’s worst days to “finally kick this weird thing I do with food” turn into a series of broken promises, and years unwittingly spent obsessing over calories and weight. During unpredictable moments of clarity, as clients honestly and accurately examine their reflection in the mirror, they find that they are unable to recognize the person looking back. The eating disorder self has seemingly routed the healthy self, like how whiteout eclipses a misspelled word. They feel that their disorder is their identity, and that this once-removed “healthy self” has been irreparably broken. They feel that all that is left of them is an anxious, depressed, angry, hungry, selfish, weak, hollowed out human. “Why bother recovering?”, our clients usually ask, “All that’s left to recover is whatever scraps of me the eating disorder left behind, and honestly, that’s not a person worth bringing back. What kind of life would I have to look forward to?”

This is the state our clients usually arrive in when they start treatment: a superpowered all-encompassing eating disorder self and a faintly detectable healthy self. Upon admission, our clients often haven’t eaten a normally portioned meal, in a normal way, in months or years. At this point in a client’s course, the decision to use an eating disorder behavior is as simple a choice to them as putting one’s shoes on is to a person who doesn’t have an eating disorder. That’s a bleak place to begin, but OK, if that’s where we’re starting then that’s where we’re starting. As clinicians working in a team setting, we join with our clients and meet them in the midst of all the madness so that we can get down to the brass tacks of being helpful. To help someone in the middle of a raging eating disorder is a tall order. How, exactly, can we help? What can another person do to help someone that openly strives to do harm to themselves?

At Monte Nido, we aim to help in a unique way that gets right at the heart of the issue: we don’t try to destroy eating disorder selves (tempting as it may be), but instead, we pour all our effort into strengthening someone’s healthy self. Our philosophy is that a strong healthy self, not the direct acts of clinicians or loved ones, is the only thing that heals an eating disorder. Healing at Monte Nido is about a “reintegration of selves”. Simply stated, the healthy self replaces the eating disorder self by fulfilling its purpose. We condition a person’s’ healthy self for this monumental task in many ways, all of which are what you would expect from an eating disorder treatment center: we normalize eating, offer regular group and family therapy, provide nutritional counseling, psychiatry, and nursing support, as well as one-on-one sessions with therapists. These are the foundational basics, and they cannot be done without, but they are not what clients tell us is most helpful. The Monte Nido “fairy dust” (as we call it), and what helps most when trying to rebuild a healthy self, is this: we help clients find their soul.

Before I say anything else, let me plant a flag in the ground and say that I was a tough skeptic when I first arrived at Monte Nido. “Soul”, I used to think, “what a bunch of hippies. I don’t see how kumbaya is going to make any of this better.” But, over my time at Monte Nido I’ve had my mind changed. I’ve seen people sort of wake up again. It’s hard to describe, but you know it when you see it. At first, it only happens in brief flashes, but I’ve watched people come back to their senses, as though they had just crawled out of a long foggy hibernation. But the healing process isn’t about just stopping at someone’s historical baseline. We truly aim to take it a step further.

When we ask our clients “How did we help you? What did we do that really got through to you? What made you ‘wake up’?”, they give some surprising answers. What I hear most often in response to these questions is that we helped our clients find themselves again – their healthy self, their true self, or what we more aptly call a “soul self”. We reminded them of who they were before all this happened. We talk about not just what clients are recovering from, but what they are recovering to. We rekindle soul selves by talking about love and how to find it. We create sacred moments of silence and awe where we appreciate the simple pleasures of breathing and feeling our hearts beat. We honor people for showing up and paying attention in treatment, however long their stay with us. We openly model through the true-life stories of our recovered staff what the process of getting better looks like, feels like, and how it all comes together. We say the truth without judgement. We understand that not everyone wants recovery, and we compassionately respect each person’s right to choose how far they want to go. We witness people for who they are, regardless of their symptoms. We see the person beneath the illness. We slow down, then stop. We feel deeply what there is to be felt. We drop in. We connect.

After recently co-facilitating a few Body & Soul groups (our version of a body image group where we speak little of bodies themselves), I have come to better appreciate what we “do” at Monte Nido, and I think we “do” something more than simply “strengthening a healthy self”. Through our focus on human connection and what is sacred, I think we provide CPR for the soul. We witness the true spirits of our clients and help them see what they, and only they, cannot see: the vivacious, loving, loveable, competent, passionate, brilliant, sensitive, perfectly imperfect, and sometimes emotionally messy person that was there all along, but that had merely been overlooked or unjustly doubted. After working with many clients, I firmly believe that inside every person struggling with an eating disorder, there is a soulful human being eager to not only end the unwinnable food fight, but to find a purposeful life (this applies most of all to those who feel they are the exception to this phenomena). Finding and building that life requires food, patience, love, honesty, and a little bit of fairy dust: all of which are abundantly on hand at Monte Nido.

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


8 Keys Series: Eating Disorder Self & Healthy Self

Monte NidoKeesha - Circle Vice President of Clinical Programming Keesha Amezcua, MA, LMFT, CEDS shares about one of the most important concepts taught to clients during treatment. Based on the 8 Keys book by Gwen Grabb, LMFT and Monte Nido Founder Carolyn Costin, Keesha explains how the client’s understanding of the “Eating Disorder Self” and “Healthy Self” plays a crucial role in their recovery journey.  

One evening an old Cherokee told his grandson about a battle that goes on inside people. He said, “My son, the battle is between 2 “wolves” inside us all. One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego. The other is Good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith.” The grandson thought about it for a minute and then asked his grandfather: “Which wolf wins?” The old Cherokee simply replied, “The one you feed.” – Cherokee Proverb

Key 2 describes one of the basic and most important concepts we teach our clients at Monte Nido – the idea of the eating disorder self and the healthy self. Carolyn Costin, our founder, has always said that if a client leaves our program with only one thing, she wants it to be a full appreciation of this concept. This core of this idea is that the eating disorder self and healthy self are two parts of one integrated whole. It is not a good part and a bad part, a useful part and a un-useful part. It is not about an externalized eating disorder. It is crucial to know and believe this. We have to believe that every client is born with a core healthy self. This is the authentic, unashamed, loving part of oneself that over time can be lost, covered up and silenced by a variety of factors. In its place, an eating disorder self or critical self flourishes, fueled by the disconnection from the healthy self. This eating disorder voice is a part of the person. Its power comes from within.

Treatment doesn’t focus on the eradication of the eating disorder voice but rather on enhancing the ability contact it in order to acknowledge, explore and learn from it. Then once we have a thorough understanding of the functions it has served and the role it has played, we work to transform it, to reintegrate it back in to the healthy self. This transformation is done through good ol’ CBT techniques. In fact, a large part of our treatment philosophy is built on concepts and interventions found in CBT. This is because one of the main diagnostic criteria of eating disorders – the overvaluation of weight and shape – is cognitive in nature. The cognitive behavioral model suggests that most eating disorder behaviors stem directly from this irrational thought process. One key piece of this approach is the importance of helping client’s make early and significant changes in their eating behaviors. Helping reduce symptoms and behaviors helps clients to recognize the internal conflict between their healthy and eating disorders selves.

The eating disorder self relies on cognitive distortions. It gets its power from illogical thoughts. People with eating disorders become professional irrational thinkers. Their ability to alter a thought, an image, an experience can be quite impressive. They can be the blackest and whitest thinkers, “shoulding” all over themselves in catastrophic style. Usually, when we as clinicians find them on our doorstep, there is an over-developed eating disorder self and the faintest hint of a healthy self. They’ve jumped to the conclusion that if they eat a donut they’ll become a donut, wearing permanent labels like “Fat” or “Sick” and believing things like “thinner is better” or “emptiness feels good.”

It is our job to help reintroduce our clients to their healthy selves and to then strengthen that part of them. Ultimately, to have the healthy self heal the eating disorder self, we have to help our clients to reorganize their beliefs, rip off the ED self labels, and work towards a new set of healthy core schemas.

We find that the most effective way to do this is through the eating disorder self/healthy self dialogue. At Monte Nido, this is a daily practice with clients. We ask them to write down the eating disorder thoughts and counter each point with a healthy one. The critical part of this dialogue is ending with a healthy-self thought. This exercise is similar to a Challenging Cognitive Distortions worksheet in CBT. The goals are the same – poke holes in the irrational/eating disorder thought and strengthen the rational/healthy thought. We ask clients to share this dialogue in sessions and groups. We have them role play each voice with each other. The repetition builds momentum. Key 2 is essential, and we use it throughout the course of treatment. Helping clients practice, rehearse and internalize this concept and these techniques builds the foundation for self awareness, maintaining the capacity for seeing different perspectives, and, fundamentally, it helps them establish a sense of safety and ownership of their eating disorder. You could say that unlocking the healthy self unlocks the door to recovery.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


Writing Your Way To Wellness: Narrative Practice for Eating Disorder Recovery

gretaGreta Gleissner, LCSW is a NYC-based psychotherapist specializing in eating disorders. In recovery since 2001, Ms. Gleissner has firsthand knowledge of the challenges individuals face in the eating disorder recovery process, particularly during transitions. She shares how writing can aid in the recovery process and offers a prompt to get started in today’s post.

Research shows that writing not only improves one’s emotional health, but it has physiologically benefits. Since the 1980s, numerous studies conducted by psychologist James W. Pennebaker, PhD, have proven that writing about stressful emotions has significant positive effects on individuals coping with diseases, disorders, and trauma. Pennebaker demonstrates the evidence he and fellow psychologists have gathered in his book Opening Up: The Healing Power of Expressing Emotions, which includes therapeutic writing exercises to try. Another book by Pennebaker called Writing to Heal: A Guided Journal for Recovering from Trauma & Emotional Upheaval offers readers an even deeper personal exploration of how writing about emotional challenges enables healing.

But not just any story heals. It’s important to respect the power that words possess. They can do good, but they also can do harm.

For example, there are innumerable ways to tell the story of an eating disorder. You can cast yourself in countless roles. The narrative could be one based in dysfunctional family dynamics, or a critique of cultural ideals and pressures. You could construe yourself as someone with a broken brain, or blame yourself for creating the disorder. Or you could depict it is a repercussion of trauma, for which you are not at fault. Clearly, some of these stories would exacerbate the distress you feel in the lived experience of that story, while other ways of telling the same circumstances would feel uplifting and empowering.

“Writing Your Way to Recovery” is an ongoing series of blog posts from Eating Disorder Recovery Specialists  that offers glimpses into what ways narrative practice can support eating disorder recovery. Each post will include some research on the power of story in healing, and offer experiential exercises–a narrative piece to read, questions to reflect upon, and a prompt to write to–that apply to eating disorder recovery.

Narrative Practice

Some of the most profound writing derives from an author’s deep distress. Henri Nouwen, a renowned spiritual writer and teacher, spent seven months in a state of severe despair towards the end of his life. During that time, he kept a secret journal. His friend encouraged him to publish the it, in order to offer guidance and comfort to others suffering.

The Inner Voice of Love: A Journey Through Anguish to Freedom is a slim volume of passages that achieve what great writing has the potential to offer: they hold up a mirror to what readers need to examine in themselves.

Although Nouwen did not struggle with an eating disorder, the fears, anxieties, and pain he wrote about speaks directly to what many who do have an eating disorder experience in their pursuit of recovery.

Read the following passage twice through, out loud if possible.

Reading: “Trust the Inner Voice

Do you really want to be converted? Are you willing to be transformed? Or do you keep clutching your old ways of life with one hand while with the other you beg people to help you change?

Conversion is certainly not something you can bring about yourself. It is not a question of willpower. You have to trust the inner voice that shows the way. You know that inner voice. You turn to it often. But after you have heard with clarity what you are asked to do, you start raising questions, fabricating objections, and seeking everyone else’s opinion. Thus you become entangled in countless often contradictory thoughts, feelings, and ideas…

Only by attending constantly to the inner voice can you be converted to a new life of freedom and joy.

Questions

Meditate on, journal about, or discuss with a friend, family member, or therapist the following questions:

  • What kind of transformation do I long for?
  • What “old ways of life” am I willing to let go of?
  • What makes it hard to “trust the inner voice”?

Reflective Writing

  1. Get a piece of paper and a pen (write by hand, not on a screen).
  2. Set a timer for 5 minutes (you can write more later–but start by seeing what comes out in just 5 minutes).
  3. Take three long, slow, deep breaths.
  4. Start the timer as you read and respond to this prompt:

“Write what your inner voice–the part of you that wants a life of freedom and joy–is saying right now.” 

Be kind and gentle with yourself about whatever comes out–or doesn’t come! Writer’s block is normal, especially when beginning a writing practice. Give yourself another chance. Consider sharing your response in your next therapy appointment, with a trusted loved one, or just keep it for yourself.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.