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.


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.

Articles for the Soul


Join us in reading soulful articles we have cultivated from across the web. If you have found an article you feel is inspirational, explores current research, or is a knowledgeable piece of literature and would like to share with us please send an e-mail here.

Negative Thoughts: 3 Causes. 7 Solutions Psych Central

Power Pose: A Pathway to Strength Chime Yoga Therapy

How to Be Good Enough Angie Viets Blog

9 Simple Ways to Love Yourself Psych Central

 7 Ways Yoga Lowers Stress and Anxiety Psychology Today

What If? Don Blackwell Blog

10 Simple Ways to Practice Self Love NEDA Blog


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

Honor Her

Don_Blackwell-e1458872942147Don Blackwell is a Trial Attorney with extensive experience in the eating disorder community. He has a unique perspective which he often shares through his honest and heartfelt writing. In his post, Don reminds us that re-discovery of our “authentic self” is possible.

The more hearts I listen to the more convinced I become that we not only come into this world living, doing, playing, creating, dreaming, loving (and needing to be loved) in ways that are unique to us – that define us – we are meant to leave it having stayed true to them. They are the personality and preference traits that form the DNA of our Authentic Self. Some of us are the quiet, contemplative type, while others are restless and boisterous. Some love being in a crowd, while others of us seek solitude. Some love to be held, while others manifest their desire for independence almost from birth. Some of us intuitively color in the lines, others never will! Some love the outdoors, while others prefer the peace and quiet of their room. Some are writers, some are readers – others are both. Some are patient, others not so much. Some are sharers – of things and affection – while others are not.

As children, we explore, discover and playfully embrace these many facets of our self. We sense their power and our frailty, but neither keeps us from greeting each day with a renewed sense of wonder, adventure and anticipation. We feel our feelings openly and we love the same way – fully and unabashedly. Regrettably, however, as we grow older, many of us begin to question whether that self (our self) is good enough, strong enough, aesthetically pleasing enough, well-rounded enough and you-fill-in-the ______ enough to be part of the group we want, get the job we want, find the mate we want, have the lifestyle we want, earn the degree we want, have the friends we want, be the child we perceive our parents to want – and, invariably, we begin to tinker with it – with us. Some even go so far as to box pieces of themselves up like leftovers from a gourmet meal and stick them in the deep freeze, forgetting they’re even there.

We begin to think, dress, speak, feel and act in a different way – ways that others, who we wrongfully perceive to have this Life thing figured out (or who profess to have the right to dictate our view of self) dress, speak, feel and act. We change our hairstyle, make-up, accessories, behaviors, friends, beliefs, belongings, jobs, faith, the music and books we like, our hobbies, etc. We want to belong, to be accepted, to fit in. We want it desperately, mostly because we fear the alternative. More often than not, however, the farther we move away from our truth, the more impenetrable the accompanying darkness seems to get. The sense of joy we knew as children is replaced with what, at times, are overwhelming feelings of discouragement, sadness, loneliness, frustration – a loss of control. Where do those feelings come from? My sense is that they (and the behaviors sometimes used to numb them) are an inevitable by-product of becoming disconnected from our self.

If I’m right, the journey out of the darkness is less about change than it is about re-discovery and re-connection – a two-step process that first requires identifying the “you” that came into this world followed by a passionate commitment to welcoming that person and all they have to offer back into your life! Simply put, the pre-worldly-adorned “you” is precisely, uniquely – beautifully – the person you were intended to be all along and you and the world need to be re-introduced to her sooner, rather than later. The good news is: Because she is integral to who you are, you can be assured that, regardless of where you may be on your life journey or how many layers of others you may have piled on top of her, when you make the choice and commit to the work necessary to find your way back home, your Authentic Self will be eagerly waiting in the doorway for your arrival with warm, welcoming and open arms.

Homework Assignment: It’s easy to lose sight of “her” in the darkness. So do her a favor: Reach out to 5 people you trust, who knew you as a child, and ask them for the three character traits about you that first come to mind when they think about the childhood you. Maybe it’s a teacher, a pastor, a friend, a sports or arts coach, a sibling or parent. Then write them down. The ones that make you smile are the bread crumbs that will lead you home.


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

Why Not Gratitude Instead of Guilt?

Angie - Color Head shotAngie Viets, LCP is an eating disorder specialist who has dedicated her career to helping her clients recover. In her writing, Angie shares her personal journey with an eating disorder as well as her professional experience in the field. She offers the idea of replacing feelings of guilt with gratitude in this week’s blog post.

My mother would cringe before I ordered my food, apologize to the waitress, and then lower her head in embarrassment. “May I order the pasta primavera with chicken and substitute extra veggies for the pasta. Oh, and how do you prepare the chicken and vegetables? Actually, would it be possible just to steam them?” When bound tightly by my eating disorder, these were typical modifications. These days, I like to make substitutions, just not related to food.

Dinner growing up always had a side of bread and butter. This is a little strange to say, but if my emotions were being served for dinner, guilt would be the standing side. Always. I don’t know if feeling guilty is just part of being a woman, a cradle Catholic, or that I’m prone to people-pleasing (or perhaps a combination of all of those things). I’ve concluded the origin is irrelevant and that what I know for sure, is that I can go to guilt faster than any other emotion.

Historically, I just bought whatever guilt was selling. At some point, I got sick of that and tried out the whole self-compassion thing: “Don’t be so hard on yourself… You can’t make everyone happy… You’re doing the best you can…” All of this was ok, but it never seemed to kick me fully out of the guilt grip.

In the middle of a rant about how guilty I was feeling, for God only knows what, a friend said to me, “Haven’t you had enough guilt to last a lifetime?” Immediately, I felt my whole body soften and say, “Yes. Yes. Yes.” He then went on to say, “So, would you be willing to give that up?” Hell ya, I want to give it up! So then and there I decided this sweet talking lovey voice just wasn’t quite enough to kick me out of guilting myself. I needed another approach.

Then this happened:

Thoughts: “I’m feeling so guilty that I didn’t volunteer to do lunch duty at my kids’ school. I never feel like I’m doing enough.” And then the leap occurs. “I’m such a terrible mom.” Seriously, my guilt spirals are rapid and seemingly automatic – I’m guessing you can relate if you’re still reading. And all of the sudden, I heard a voice in my head say, “Instead of feeling guilty, I wonder if you could feel grateful.” What? Grateful?! Oh right, because I’ve had enough guilt to last a lifetime.

Maybe I could give gratitude a chance to be a permanent side on my plate. Hell, everyone talks about how transformative it is. Back in the 90’s Oprah had us all doing gratitude journals – Oprah! It seems gratitude is a powerful antidote for much of our self-imposed suffering. So, I decided to give it a shot.

“I’m grateful that I have kids that I care enough about, to want to show up for them (even at stupid lunch duty). I’m grateful they’re young enough not to be mortified by my mere presence at their school. And, I’m really grateful lunch duty is optional!” Done, subbed gratitude for guilt.

This technique seems to help shift you into a different mode altogether, like changing lanes on the highway. I’ve been trying this out with the clients in my psychotherapy practice and I can see their energy shift when they switch lanes.

Here are a few examples:

Side of Guilt: “I feel crummy that my parent’s are still giving me money and that I can’t support myself.”

Side of Gratitude: “I’m grateful that my parent’s love and care enough about me that they are willing to help me in this way.”

Side of Guilt: “Every time I’m around my co-worker she just dumps all of her problems on me. I end up feeling used and resentful. But she’s going through a tough time and I know I would feel guilty if I stopped listening to her.”

Side of Gratitude: “I’m grateful that my body is a good messenger of what lifts me up and what sucks the life out of me. Although it may be awkward at first, I’m grateful I can limit my time with her, or better yet, express my feelings to her about this pattern.”

Side of Guilt: “Every time I relapse I feel so guilt-ridden and like I’m letting not only myself down, but also my family and friends.”

Side of Gratitude: “Today, I’m grateful that I always have the opportunity to begin again and that my recovery is this important to me and my support system.”

Going from guilt to gratitude is a leap – I get it. And, I’m not suggesting this is easy, or that it will feel super authentic initially. But let’s think about the difference between standing in front of the mirror thinking, “I hate my thighs,” to saying a positive statement like, “I like my legs.” Your head will immediately be saying, “BS, you’ve hated your thighs since high school.” But what if you said, “I’m grateful I have legs that are functional enough to walk me through my life.” That might be a bit more palatable.

I think wallowing in guilt sucks enough that we should give this gratitude gig a shot. It’ll be a practice for sure, just like anything else. And anyway, haven’t you had enough guilt to last a lifetime?

Love + Light,



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

A Glimpse into the Soul: Emily Dumas

Emily DumasEmily Dumas, MA, LMFT is the Clinical Director of the Monte Nido Eating Disorder Center of Philadelphia. Emily has extensive experience in the eating disorder field and uses a collaborative and integrative style in her therapy in order to tailor her approach to each of her client’s needs. Get to know Emily more by taking a glimpse into her soul…

Share about your background and what led you to Monte Nido:

I have witnessed several friends struggle with eating disorders during different stages of my life. With that experience, I realized there is no area that goes untouched- relationships with self and family, issues with mental health, physical and emotional development, etc. The complexity of the eating disorder and addressing all factors plays an integral role in treatment and recovery, which contributed to my desire to study developmental psychology for my undergraduate degree and family therapy as a graduate student. As a clinician, I found that a collaborative and integrative approach was most effective and allowed treatment to be tailored to each individual. As my experience with eating disorders grew, I found myself desiring a more comprehensive, family oriented treatment for my clients. When I learned that Monte Nido was looking to expand to Pennsylvania it seemed like a perfect match for my theoretical framework.

What does your typical day look like at Monte Nido?

Each day is slightly different due to the program schedule and different occurring events. I typically take care of program administration duties in between checking in with staff members, spending time with clients in the milieu, eating snacks and meals with clients, as well as leading a few groups each week. I also meet with potential new clients and their families who might be apprehensive to start treatment. I love the ability to spend time getting to know clients throughout their treatment: it is a hands on approach that assists me in supervising staff and with making clinical and program decisions.

In your own words, please describe the philosophy of Monte Nido.

The Monte Nido philosophy is about helping clients reconnect to their “soul self,” which we believe is the key to who they are. Clients are often enmeshed with their eating disordered self and have lost touch with their authentic self. As clients move through treatment, they strengthen their healthy voice and begin to develop a life outside of their eating disorder. Monte Nido believes that food is a mandatory part of healing, although it is just a piece of the recovery process. We look at underlying issues and help clients reclaim their relationship with food and themselves in order to grow and heal.

How does your team work together and how do roles overlap?

One of the aspects I love about Monte Nido is how our staff has become a family. We work cohesively as a team; this allows the client to integrate themselves into our family and trust our treatment recommendations. We believe that it takes a village to support a client through the program and we have created that village in our team. We are constantly communicating with one another to keep everyone on the same page. Our roles are often fluid, as we all jump into meals, groups, and check- ins and utilize each others strengths to support one another and help the milieu grow. The family dynamic that we foster in MN is mirrored in my supervision and management style through honoring each individual’s own style, approach, and voice. From program coordinator to mental health worker to clinical therapist, to assistant clinical director… No ones voice is louder than another.

Share a special moment/ experience you’ve had at Monte Nido.

Since our site is brand new, my team has done all of the work necessary to bring our first clients through the door. I have had countless moments that touched me as a clinician, a director, and even more importantly as a person. If I had to limit it to just one distinct moment I have had thus far at Monte Nido, I would say graduation ceremonies are a truly special experience. Graduation is a pause in the treatment schedule where both staff and clients come together and authentically connect with one another in a happy, hopeful, and bittersweet ceremony. Graduation has been a place where each of us to tap into our soul selves in order to celebrate and honor our client in transition.

What is unique about Monte Nido?

At Monte Nido we meet the client where they are, we do not get into a power struggle with the eating disorder, we practice truth without judgment, and always work together as a family. We conceptualize each client as a whole person and assist them in creating their own treatment plan and weekly contracts. Not only are our clients a part of our family, their supports and outside providers are also welcomed into treatment and become a part of our extended family in order to best understand and assist each client heal.

Share three facts about yourself.

  1. My family’s heritage and culture is a big part of who I am. I speak fluent Spanish as my mother is from Chile and comes from a long line of strong women.
  2. My husband and I adopted a dog from Chile and his name is Clemente.
  3. I love to travel! Some of my favorite trips include: Spain, India, Greece, Turkey, Argentina, and, of course, Chile.

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

Combating “Fine”

Jen GaudiniExpert 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 expertise in this week’s blog post where she discusses her work with patients struggling to ignore their eating disorder voice telling them “I’m fine”.

One of the greatest and deadliest ironies of eating disorders is that the eating disorder voice often tells you, “You’re fine.” No matter that trusted and loved people in your life say how worried they are and point to evidence both physical and psychological that you’re not You anymore, the eating disorder voice whispers so convincingly, so cruelly, “Actually, you’re fine. There’s no need to let up on your rules. In fact, tomorrow let’s take it further.” Your mother might have been crying earlier that day about how worried she is, your therapist might be threatening to terminate the relationship unless things turn around, you honestly aren’t feeling that great, but just one call from one poorly informed doctor’s clinic that briefly tells you, “Your labwork came back, and it’s fine,” and BOOM, the eating disorder says, “See? I told you. Push onwards.”

The disorder will use any available evidence to prove to you that you’re fine: you’re still getting good grades, you’re still a star employee at work, your blood tests look normal, you get admiring comments from (terribly misguided) people on the street about how thin you look, you’ve seen sicker looking people than you online…or the greatest argument of all: you yourself have been sicker than this before (however you measure that), and see? You’re fine right now.

Without a doubt, this denial of illness is one of the hallmarks of eating disorders, one of the greatest barriers to seeking help, changing behaviors, and confronting coping mechanisms. Feeling like “I’m fine” is one of the devastating cruelties of these diseases, both to sufferers and to their loved ones, and treatment teams. It’s a torment to be restricting, bingeing, purging, compulsively exercising, using substances, or some combination of these…and still have that deep belief that you’re not enough, not “there” yet (at whatever goal the disorder set that day), not sick enough to stop. And it’s a torment to those who love you, hearing you say (argue! insist!) that you’re fine, when it’s so very clear that you’re not.

So how can you try to combat “fine”? Because I assure you, having been an internal medicine physician who specializes in eating disorders for the last eight years, that if you have an eating disorder, you’re not fine. Medical complications from eating disorders occur at all shapes and sizes. One of my greatest passions is using my medical knowledge of objective body suffering—whether measurable or not—to break through denial and help motivate recovery. There are two stories I like to tell my patients, to help combat “fine.” I share them with you so that you can use these too, maybe ease the eating disorder’s hold on you today, maybe strengthen a recovery you’ve been working so hard towards.

The first story tries to answer the cry of “But I’m not as sick as I have been!” Please don’t compare yourself today to your sickest day ever (thinnest, lowest potassium, weakest, most critical) and decide you are fine by comparison. Imagine instead that you are comparing yourself today with either a truly well past version of yourself, or an imagined potential well self. Everyone’s vision of this is different, but let’s imagine that someone who is truly fine can do some or all of the following: eat joyfully, enjoy a wide variety of foods in a wide variety of settings, have room for spontaneity and connection, not worry about your body’s shape or size, not use a critical inner voice, keep emotional challenges separate from body image, and do physical activity for joy and strength, rather than as an atonement. Ok, now compare yourself with this vision of fine. Depending on how far off you are, that’s how not fine you are.

The other story is what I like to call the “house on fire story.” It uses a metaphor to help you understand and challenge your “I’m fine” philosophy, when you find yourself arguing that you can’t be that badly off because you can still (fill in the blank…). Imagine someone standing outside their burning house. The fire department roars up and says, “We’re here to put out your fire!” The person says, “Oh, I don’t have a fire.” The fire fighter says concernedly, “I see the smoke, I feel the heat, I see the flames. What do you mean?” The person says, “Well, if I had a fire, it would be so hot that the sidewalk would be bubbling, and because my sidewalk isn’t bubbling, clearly I don’t have a fire.” At this point, the fire fighter understands the person to be mentally ill and proceeds to put out the fire! I like this story because it sheds light on how absurd (even if, in the moment, compelling) many of the “I’m fine” arguments actually are.

Ultimately, look at yourself as a whole person. Not one single number. If you have an eating disorder, no matter what shape or size you are, no matter what your blood work says, you are not fine. The more you fight the eating disorder’s attempts to convince you you’re fine, the sooner you can move back towards the things in life you truly care about, and return to being a whole you.

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


The “WTF” of Recovery

JenniferJennifer Kreatsoulas, PhD, the founder of Chime Yoga Therapy, is a yoga therapist specializing in eating disorders. In recovery herself, Jennifer is exceedingly passionate about helping others connect with their natural gift of resilience through yoga. In addition to her private practice, Jennifer is also a yoga therapist at Monte Nido Eating Disorder Center of Philadelphia. She works with individuals one on one and leads yoga therapy groups and seminars. Jennifer shares about the importance of checking in with yourself and being aware of your feelings in her writing.

Like you, over the course of my healing journey I’ve been told countless times that my eating disorder thoughts and behaviors serve to distract me from painful feelings. Years in, I’ve come to understand my illness is a silent temper tantrum, a quiet way to express unhappiness, sadness, anger, hurt, pain, and disappointment. Recovery, then, is the process of learning how to use our voices instead of our bodies to express feelings and emotions.

I know, you’ve heard it 1,000 times: It’s about the feelings, feelings, feelings!

I went through a phase of questioning how much of my thoughts and behaviors served to numb feelings or were simply habit. Let’s face it, if you do something repetitiously over and over again, it becomes a habitual way of life. Research has shown that the brain physically changes as a result of an eating disorder. In the simplest of terms, prolonged symptom use paves new neural pathways in the brain, essentially hardwiring in those thoughts and behaviors, which is why they feel natural and habitual. Luckily, “pro recovery pathways” can form, and as a result of a strong commitment to new behaviors, the “eating disorder pathways” eventually become less and less traveled.

After a few slips and backslides, I came to the hard truth that it was dangerous to call my eating disorder a habit. Doing so let me off the hook. It allowed me to disconnect from my feelings and became an easy excuse for restricting or obsessive bodychecking. It also allowed me to settle for a life as a functioning anorexic. But that was not the life I really wanted. Not at all.

The only way to rise above this new habit of mine, was to get back to the feelings. Ugh…the feelings, feelings, feelings! But I needed a new way to decode my eating disorder thoughts and behaviors–one that allowed me to look at my feelings but that didn’t smack of the trillions of times I was asked about my feelings in treatment or therapy.

This is what I came up with: WTF. Or, “What’s the Feeling?” WTF is a catchy acronym (for obvious reasons), so why not put it to work in a very productive and helpful way?

I use WTF to check in with myself and keep on top of the feelings bubbling under the surface. I say WTF to myself when I am arguing with myself about what to eat for lunch or what I see in the mirror. I also say it to myself when I am avoiding a hard conversation or feel drawn to isolate.

I know it’s hard, painful, tiring work, this healing journey. Just because it’s hard doesn’t mean we can’t smile or even chuckle to ourselves once in awhile. So ask yourself, WTF. Say it over and over until you feel what you have to feel. Let “WTF” become a positive and lasting habit for your recovery.

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: Motivation, Patience & Hope

Keesha - Circle

Monte Nido Vice President of Clinical Programming Keesha Amezcua, MA, LMFT, CEDS shares about The 8 Keys to Recovery from an Eating Disorder,by Gwen Grabb, LMFT and Monte Nido Founder Carolyn Costin, the philosophy that guides Monte Nido’s practice in supporting clients to becoming fully recovered in this weeks blog post. In her writing, she explains the first key, Motivation, Patience & Hope, for part one of this eight part series. 

When talking about the 8 Keys to Recovery from an Eating Disorder, the first thing to note is that there are obviously more than just 8 steps in the process. The publisher’s directive to Monte Nido Founder Carolyn Costin was to create 8, and only 8, keys. So in her trademark creative way she packed as much in to each key as possible. The entire book is full of insight, wisdom and evidence-based treatment strategies. I call it Monte Nido in a book because each page speaks to what we do each day with our clients in treatment.

The first key – Motivation, Patience & Hope – is the starting point, even before a client steps foot in one of our facilities. We applaud clients and their loved ones for pursuing treatment in the first place. Just the idea of it can be daunting. It takes motivation to pick up the phone and make the call. Of course, it’s often not the client’s idea. They have been softly, or not so softly, nudged in to that idea. There is often an external motivating factor – school, a relationship, a job – that makes the idea seem like a good one.

Although, for recovery to truly take root the client has to find his or her own internal motivation for it. But if we waited to treat clients until they are truly motivated, we would sometimes be waiting forever. Treating eating disorders is often very similar to raising a toddler. With a 2.5 year old and a 1 year old at home, I find so many similarities and parallels between my personal and professional life. Take for example, tooth brushing. My daughter loves her toothbrush, and my daughter LOVES her toothpaste. At this point her fine motor skills are not quite developed enough to allow her to adequately clean her teeth, which results in a steady diet of toothpaste with very little actual brushing happening. So I am tasked with tenderly helping her, guiding her, teaching her. She does not necessarily love this part of the experience. Is she motivated for teeth brushing? Yes. Is she always willing to do what is necessary for it? No. It’s the same with clients at the beginning of treatment. They might be motivated for parts of it. They might be able to see the benefits and enjoy the relief that recovery provides in some areas. But they don’t always want to do all the parts of it. As clinicians, we have to be willing to step in to this discomfort with them. To model the healthy behaviors, to support them in doing what is needed even when it’s hard. To tolerate the kicking and screaming or silent refusals. To embrace the ambivalence and work with it. We have to gently elicit the behavior change. The research on motivational interviewing is pretty clear. Trying to directly persuade a client to change won’t necessarily resolve ambivalence. I can persuade my daughter to let me brush her teeth, but this will be a temporary fix, not a solution.

Motivation builds on itself. It’s like a freight train that starts slowly, building steam. Once it gets going, it’s a force to be reckoned with. But there has to be patience to allow the motivation momentum to grow. One of the core interventions we use is the eating disorder/healthy self dialogue. This intervention is the heart of motivational interviewing – synonymous with change talk. As clinicians, we are constantly looking for signs that of our client’s healthy self is present. Any time a client says something that is indicative of his/her core, authentic self we recognize this as a motivation for change, no matter how small. We hold on to these examples and help to foster more because motivation is also built on change.

Our weekly contracts help clients identify objective and measurable goals that are small and achievable. When a client meets these goals, there is a feeling of success and mastery, which then ignites more motivation. It takes creativity, great empathy and compassion for how difficult even the smallest of steps can be for a client. It also requires a balance of firmness and fearless on the part of the therapist

Confronting a client about change often seems like the right step. If we know that deep down they want to get better, then forcing their hand will just help them get there faster, right? Well, actually that’s wrong. And if a clinician falls in to that trap, we can quickly find ourselves in the midst of a powerful power struggle just as a client’s loved one often does. When we push clients to make changes before they are ready, we are missing the motivation part. At Monte Nido, we gently and steadfastly meet clients where they are at. And we start there.

But we always have hope. For me, that’s the easy part. As someone who has recovered from my own eating disorder, I know being recovered is possible. I don’t question this. It’s not an elusive idea. And I don’t just have my own positive outcome guiding this. I have seen and met many, many people on the other side. There is an army of us who know recovery to be true. This is how I am able to do this work. As motivational interviewing suggests, at Monte Nido we have respect for a client’s ability to choose. We reflect the privileges that recovery offers and the consequences of the eating disorder. On the hardest days, with the most resistant or ambivalent clients, I maintain hope that recovery is possible and that every client will choose it. Ideally today is the day. If not, I am confident that there will be tomorrow, which means there is always another chance for that choice.


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