tag:blogger.com,1999:blog-35229721911096622952024-02-18T20:58:11.113-07:00Within Four Walls<i>Eating Disorder Treatment and Recovery</i>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.comBlogger72125tag:blogger.com,1999:blog-3522972191109662295.post-5076193775613593712022-08-10T17:58:00.002-06:002022-08-10T17:58:22.533-06:00"Not a coping skills kinda therapist"<p>Recently, I've been hearing more than ever before the phrase, "coping skills" as it relates to therapy. And each time, I have the same basic response, which is, "I'm not a coping skills kinda therapist." And of course I explain what I mean by that, but I thought I'd comment on it here too.</p><p>Of course, to a certain extent, "coping skills" can just be a buzz word (phrase?) that takes off, which I assume has happened lately. And, of course, all therapy does include increasing coping skills in one way or another. But, when I say, "I'm not a coping skills kinda therapist," I mean that I'm not a therapist whose focus is teaching this or that coping skill. I guess my thought process is that, essentially, one can read a book and be taught coping skills, so why would I be charging people to do the same?</p><p>That probably means I should find some really good coping skills books, but, I promise, I tried for years to read self-help books so I could recommend them, and I just cannot. I mean, do you want to read about your work during your free time? No, me neither...</p><p>So, if I'm not a coping skills kinda therapist, what kinda therapist am I? Well, in graduate school, we had to "defend" our therapeutic approach prior to them letting us go out on internship. I had a firmly held belief that Interpersonal Therapy and Cognitive Behavioral Therapy worked together in eating disorder treatment. Now, I was warned to never try to defend this at the time. Butttttt, I'm stubborn, and it genuinely was my approach to therapy, so I did exactly that. And, against all odds, I passed. Shortly thereafter, it became more mainstream to see these two approaches, previously seen as somewhat opposite, as blending well. Whew!</p><p>It's been a long time since graduate school, and I work very hard to not speak in psychobabble, so here's a very short blurb of how I see IPT and CBT going hand in hand in ED treatment: Interpersonal therapy basically looks had how relationships have impacted a person (the very, very short version) and sees healing as existing in relationship. CBT challenges your thoughts and behaviors (pretty obvious how that applies to EDs). I believe that our experiences in our relationships impact our thoughts and behaviors. (Believe me, I had to say more than that perfectly clear sentence to defend it a the time!!) And, I believe relationships are what have the power to provide healing.</p><p>So, early in treatment, I am more CBT. The behaviors must change for reasons thoroughly discussed in other posts. But, the other focus is building a relationship where what I say matters, and a relationship in which healing can occur. And that is anything but "coping skills kinda therapy." I can teach a coping skill without any real relationship; again, a book can teach a coping skill. But, what I hope to be able to do is understand someone on a deep enough level that I can help them to make lasting change.</p><p>(On that note, if you ever want what I believe to be a massive challenge....try writing what you hope to accomplish as a therapist without sounding like a fluffy...well...ball of fluff. It's not easy to put into words.) </p><p>I will tack on...I do also believe both IPT and CBT help someone work through PTSD also, though believe it is MUCH MORE about the IPT and also body-focused therapies advocated for by Bessel van der Kolk and Peter Levine. </p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-51743827433801301142022-08-10T15:51:00.000-06:002022-08-10T15:51:06.507-06:00Social Media Often Seems Socially Acceptable Bullying<p> My dressage coach yesterday told another rider and myself to be sure to watch a particular ride from an international dressage show. I had been following scores, but had not watched any specific rides, because....as awful as this is to say.....dressage is not the most fascinating thing to watch, and I have watched A LOT of Grand Prix dressage by now. </p><p>So, I went and watched, and it was fantastic. But, as I explained to my coach today, these major events bring up two sides for me. One, watching the experts at riding can be phenomenal learning, whether it's what "to do" or what "not to do." But on the other hand, each major events brings the "armchair equestrians" out in droves, and, boy, are they brutal online.</p><p>I'm an amateur equestrian, which I think might well be synonymous with being an insecure equestrian. This sport is like none other; because you do not have full say over what is going on, and perhaps could argue that the 1000lb animal might truly have the most say, you literally never truly know "how to do" the sport; we are all truly always learning. And, it's a sport we can only practice so much each day; our partners can only tolerate 30-60 minutes per day, so there's no practicing for hours like there is in other sports. And, lastly, what an expensive sport! So, us amateurs work too; I am lucky to ride two horses per day. Many only ride one. Put all that together, and I would argue it's very hard to feel confident, and many days, competent. </p><p>So, I read the things that people say about the riders at the top....topics include to what extent they are abusing the horse, how awful they are as riders, how awful their training methods are purported to be, how the judges are not looking out for the horse, which leads to arguments that dressage is abusive and should not occur. I just watched a video that proclaimed that this one lesson by this one trainer for this one rider was evidence of "the downfall of dressage." Sheesh!! For one who loves her horses, this leads to a major internal "aaaack," as I then wonder, "Wait, am I like that? Do I do that? Do I do that and not know I do that? Is the sport I love actually abuse???"</p><p>And, when people stand up to the bullies, they are told, "So, you don't care about the welfare of the horse?!" Oh boy. Okay. Well. Essentially, it never ends. And yet it's so easy to get sucked into reading the threads, in hopes that eventually it will all make sense.</p><p>That has led me to assume those that rise to the top of this sport must be very brave individuals, as they are literally signing themselves up to be judged in a public forum. And not just by the judges they pay to ride in front of, but everyone with various agendas on social media. And, to be fair, I think this applies to any one of us, at this point, in a public role, because the bottom line is, if you put a human behind a screen, particularly without their name attached to their words, that human might very well be brutal.</p><p>Before social media, word didn't spread like it does now. There were not venues for trashing other people, building up into a frenzy at times. Yes, as a rider, I do observe those at the top and have my own opinions on what I like to see and what I do not, what I want to emulate and what I do not. I had that same experience with my first experience in the eating disorder field too; I learned what I'd never do in addition to things I continue to put to practice to this day. But it's hard for me to imagine sharing my views other than to ask my coach if what I'm thinking has any validity at all! But, whew, some people really get into it online, for sure.</p><p>But, here, I am talking about adults. Now, imagine it's a teenager, or a pre-teen, trying to figure out how to navigate what is being said online. They all think they can handle it, and I assume most will never experience the worst that is out there. But, for those who do? Sheesh, if reading strangers' reactions to the top riders can actually make me ponder whether riding my horse is abuse...well...I guess I just have to assume that a teenager can easily end up questioning themselves too. </p><p>My coach told me today, as I explained all of this, "You have to not read that stuff," and I guess I believe that might just well apply to the vast majority of social media. Humans are brutal when they are behind a screen, and I will continue to encourage everyone to go back to the "good ol' days" where interactions are face-to-face, not keyboard to keyboard.</p><p><br /></p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-78825064963747054012021-12-09T15:42:00.000-07:002021-12-09T15:42:04.286-07:00Understanding the new link between social media and mental health<p> I have been following the general public's reactions to this news about social media and its impact on eating disorders and mental health. And what I am seeing is that the real point is not truly being understood. For example, read the comments on the KSL article posted 12/9 on the topic.</p><p>Yes, it's well known that social media of any type has a questionable impact on mental health. Some research shows that social media can have a positive impact. Examples that I see of this in my practice is patients reporting interactions on pages designed to be support groups, or promote positive body image, or sharing podcasts that support therapy goals. These are clearly all positive places on social media. And, research backs this up. The study that I focused on, which looked at a number of studies (what is called a meta-analysis) showed that those who actively engage in social media, defined as talking to others on Messenger, for instance generally have a positive experience with social media. But those who "passively" use social media tend to have a negative experience. Examples of this are simply looking at others' content, perhaps hitting "like," or maybe commenting, but not directly communicating with others, tend to have more negative experiences. So, that covers what we have known for a while about social media; it can be positive, or it can be negative, BASED ON CHOICES THE USER MAKES.</p><p>The reason that was in bold, even though that makes it seem like I'm yelling, is the need to make this very, very important point:</p><p><u><span style="font-size: medium;">What we now know is that the social media platforms use algorithms that push upon young users content which is harmful. Meaning, what the teen is exposed to goes beyond what they are choosing to view. An algorithm is deciding what they should see, and the suggestions that are presented have the potential to be very damaging.</span></u></p><p>But, what does that mean? Truly the best example is the stories coming from various congressional members. They are going in and creating fake profiles of 13 year old girls, and then watching what happens on that profile. I believe the first to do it was Senator Richard Blumenthal, and now Utahan Mike Lee is reporting having done the same thing. </p><p>And what are they finding? See this quote from yesterday's KSL article: <span style="background-color: white; caret-color: rgb(68, 68, 68); color: #444444; font-size: 16px; letter-spacing: -0.14000000059604645px;"><span style="font-family: inherit;">"Why did following Instagram's top recommended account for a 13-year-old girl cause our Explore page to go from showing relatively innocuous things like hairstyling videos to content promoting body dysmorphia, the sexualization of women and content otherwise unsuitable for a 13 year old girl?" Lee asked Mosseri. "What happened?" </span></span>https://www.ksl.com/article/50308196/sen-mike-lee-to-instagram-youre-the-new-tobacco-whether-you-like-it-or-not</p><p>But then you read KSL comments, and people get hung up on each government official's overall political leaning and the generic understanding of social media. This means people are missing the point!</p><p>And the longer parents go missing the point, the more kids might well be exposed to the content that is pushed upon their children by an artificial intelligence algorithm. </p><p>Now, anyone can go to my Facebook page and see that I "got off" (as defined by having I believe 9 FB friends) Facebook (the only social media I have ever had) weeks ago, after months, likely years, of knowing it was toxic to me. I have no problem with others knowing I have social anxiety. And, for me, social media worsened social anxiety. Did it also provide a form of communication/connection? Sure. But more so it worsened my social anxiety, and let's be honest, social anxiety is not that much fun. So, I finally...finally...decided to stop my exposure to it; not an easy task in our society. I now really only see what horse-related companies are having sales, and for me, that is the perfect use. ;)</p><p>Is social media all bad? Absolutely not. But do we all need to better understand how it works and how it might impact us? I would argue the answer to that is a resounding yes! I fear all the news coming out is simply not sinking in, and for social media to eventually improve, it needs to sink in. </p><p>Pardon me while I leap off my soapbox. </p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-88505694820219654792021-11-22T21:01:00.001-07:002021-11-22T21:01:50.900-07:00More on Social Media<p>Given the last post, the next logical question is "What can I do, as a parent?"</p><p>This is, of course, a very tricky question, as we knowing parenting teenagers is tricky in general. But, I have found that teenagers do best when things are simply explained to them in straightforward terms. Especially once a teenager has developed an eating disorder, it is common to walk on eggshells around them, never knowing when the next explosion might occur...whether that is an explosion of anger, or tears. </p><p>But, as a professional, I never tiptoe. I just don't. And I have found that all clients, teens included, appreciate this the vast majority of the time. Teens are looking for direction. Sure, they want to believe they know all the things, but in the end, they also seek guidance from trusted adults. So, my suggestion is this:</p><p>First, explain what you have learned about social media and what they might have been exposed to. The response to this will vary, I'm sure, based on the stage of recovery from the eating disorder. Those later in recovery might easily volunteer what they have been exposed to, while those more protective of the eating disorder might deny. They might want the continued exposure, so they can learn ways to improve their eating disorder behaviors. </p><p>I'm guessing I don't need to say a lot about what to do if your teen is open about what they have experienced. Listen to what they have to say, and then ask them how they want to respond, rather than telling them what they should do. We all know that works better with teenagers, and humans in general.</p><p>If they are resistant, that probably is answer in and of itself; it likely means they are guarding the information on their social media. At that point, you have a couple options: 1) keep trying to talk to them, or 2) notify their treatment team. Reality is, sometimes teenagers are more willing to talk calmly to their treatment team than their parents, unfortunately.</p><p>As I stated previously, right now, we don't know well enough what teens have been exposed to via social media, but it is likely that more and more of that information will become clear over the coming months. Remember, the majority of clinicians are not aware of this new information about social media exposure. Your child's providers will be better able to help as they are made aware of your child's specific exposures. </p><p> </p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-46280176592570335582021-11-14T12:56:00.002-07:002021-11-21T19:07:49.161-07:00Parents: What You MUST Know About Social Media<p>As most of us know, a whistleblower, Frances Haugen, recently testified in front of Congress regarding her knowledge of some of the dangerous actions taken by Facebook, Instagram and WhatsApp. Whereas her testimony covered a number of topics, most relevant to my work is the fact that it appears <b>these companies use artificial intelligence (AI) to push diet and eating disorder content to young girls and young women</b>. The extent of this is likely to continue to unfold over the coming months, but for now, what we know is that, in spite of this testimony and news coverage, it continues to happen.</p><p>For years, eating disorder providers have known that social media is risky for those with eating disorders. Studies have repeatedly shown that involvement with social media correlates to worsened body image, which is a precipitating factor for the development of eating disorders. As a result, providers have worked with adolescents and young adult to try to alter their usage patterns. We have recommended parents monitor for concerning content, and we have worked directly with patients to choose to change the accounts they follow, with an emphasis on following more positive messaging.</p><p>But, what we have not known is that, regardless of how we encourage our patients to use a different approach in their intentional use of social media, the AI algorithms have forced upon these same individuals content that is not within their control. THIS is what is so important for parents, and providers, to understand at this time. <b>In short, simply being a certain age and gender is the trigger for being bombarded with pro-diet and pro-ED content, and there is nothing the user can do to change this.</b></p><p>Since this news came out, I have spoken to a few providers, including some at the top of the field, regarding their understanding of social media and its impact on those with EDs. And what surprised me was that NONE of them knew about this new finding, the impact of this algorithm. And we all agreed, this changes things in a massive way. No longer can we focus solely on encouraging patients to change their choices online, as simply doing that will not stop the barrage of eating disorder and diet content. So, what do we do now? There's not an answer to that question, but I pose some ideas below.</p><p>I have dug into the research on social media and eating disorders, knowing none of it has yet to address this new information. But here are some key takeaways:</p><p style="font-stretch: normal; line-height: normal; margin: 0px;"></p><p style="text-align: left;"></p><ol style="text-align: left;"><li><span style="font-family: inherit;">In 2021, the overall social media (SM) usage rate in the US was 74%. In the EU, 88% aged 16-24 use SM. Globally, the SM platforms with the highest number of user are Facebook (2.449m), WhatsApp (2B), Instagram (1B) and TikTok 800M (Statista, 2020)</span></li><li><span style="font-family: inherit;">From 2014-2017, Facebook usage in adolescents 12-18 increased from 47% to 75.1% of users. A 2018 study showed highest use for adolescents was Instagram. (Clinical experience says </span>that use of TikTok is also very high.)</li><li><span style="font-family: inherit;">In one study, 61.3% of females sought body image related products on SM. Engagement with health, beauty and physical health accounts have been shown to correlate with an increased drive for thinness. Finally, increased time on SM was associated with lower self-esteem about appearance, which was related to increase dietary restriction. </span></li><li><span style="font-family: inherit;">SM </span>usage<span style="font-family: inherit;"> was positively correlated with body image dissatisfaction, and also with restricting, bingeing, </span>purging<span style="font-family: inherit;">, laxative and diuretic use, and drive for muscularity. </span></li><li><span style="font-family: inherit;">Social media use increased pathology in those with lower self-esteem and higher social comparisons. Passive FB use, defined as viewing others' content, without posting one's own, and intensity of use, were linked to social comparison and poor self-esteem. Both of these were then linked to depressive and anxiety symptoms, which often underlie eating disorder behaviors. </span></li><li><span style="font-family: inherit;">Longitudinal research has shown: Greater social media usage predicted greater body dissatisfaction and increased appearance-related discussions with peers 18 most later. Body dissatisfaction did NOT predict SM usage, meaning that SM, instead, negatively impacts BI.</span><b style="font-family: inherit;"> </b></li></ol><div>An important detail in reviewing this research is the differentiation between correlation and causation. Many of the studies have shown correlation between SM usage and ED pathology. But, correlation is NOT causation. So, to clarify, the correlations above show that those who use social media more, also have higher levels of body image dissatisfaction and Ed pathology, but it cannot say that the SM uses CAUSES ED pathology. However, this is where we can bring in clinical experience, and clinical experience backs this research; many clients report that their social media use played a major role in their eating disorder development and maintenance. As a result, most, if not all, ED treatment centers terminate the usage of social media while in their treatment centers, and recommend limited to no use upon discharge. </div><div><br /></div><div>Fortunately, there is some data that is able to look at causative factors.<b style="font-family: "Helvetica Neue"; font-size: 11px;"> </b><span style="font-family: inherit;">The few experimental studies have shown that young adult men and women who were exposed to images of same-sex "attractive" strangers in mock SM profiles reported poorer body image than those exposed to "unattractive" strangers, and exposure to “fitspiration” images taken from IG led to a more negative mood and body dissatisfaction than did exposure to appearance neutral control images. These data reinforce the reality that exposure to problematic images on SM significantly contribute to ED pathology.</span></div><p style="text-align: left;">This is all research conducted at the time before we were truly aware of the impact of these AI algorithms. So, all of this data that has been based on the content that users voluntarily seek is only exacerbated by the new reality, which is that increasing amounts of this content is actively pushed upon teens and young adults, AND the SM companies know that and, to this day, have not changed it. </p><p style="text-align: left;"><b>Yes, to this day, users report that this content is still pushed upon this age group. </b></p><p style="text-align: left;">This changes the landscape for parents and providers. No longer is it as simple as encouraging our children and patients to choose wisely what they follow on social media. No, now we have to explain the reality that, <b>simply due to their demographics (age and gender) this content is forced upon them each time they use SM.</b> </p><p style="text-align: left;">Fortunately, as I have started to explain this to the girls and women I work with, the main response is anger. Nobody with an ED wishes it upon anyone else, so the women I work with are enraged about this reality. (I will add, some have indicated that TikTok is the worst offender, so I'd recommend to all of those with EDs...well, and probably everyone in general, but that's another post...to get off of TikTok.) And, I believe, that rage in the mind of the highly intelligent and powerful girls and women with eating disorders can then result in change. But we must get the word out. Talk to everyone you know about this situation...from parents, to teachers, to providers, to teens and young adults. Everyone needs to unite in the fight against this attack from SM companies; an attack based in increasing income to advertisers, seemingly without worry about the impact on these girls and women. Moving forward, providers will start to get a sense of how much this newly recognized exposure has impacted those with eating disorders, but for now, it is important that those working with individuals with eating disorders know that this is something to look at. </p><p style="text-align: left;">And yes, men are exposed to it also, just not at the same rates, it seems.</p><p></p><p></p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-31458421042628040632020-11-15T21:42:00.004-07:002020-11-15T21:42:56.794-07:00For Parents: First Few Weeks<p>Recovery from an eating disorder is a confusing process. Some improvements happen quickly, and others take much longer. And unfortunately, while you are waiting for those improvements that take longer, conflict around food continues in your home. That conflict is hard for you and your child with an ED, and it is also hard for your other kids. One of the things I monitor as families provide treatment at home is when siblings are starting to be overly impacted by the conflict, or by the ED itself. It can feel like everything evolves around food and the ED, and there's some truth to that. The ED is so loud and overwhelming in your child's head that of course it kinda leaks out everywhere, over all of you. </p><p>Let's start with the things that can improve quickly. Fortunately, many medical concerns can resolve quite quickly with improved intake of food and water. Orthostatic hypotension, blood pressure, heart rate, and lab values can all correct quickly, and most often do. (That is most true for patients who are not purging in any way. If intake improves, but purging continues, these values can remain unpredictable, and ongoing weekly monitoring is needed until purging ends. Fortunately, purging is not as common in teens as it is in adults.) For reference, teenagers that are hospitalized for issues related to vitals and labs often find all the issues corrected in just a few days; food and water is an amazing healer! Patient will also report improved thinking processes and energy with just a week of sufficient intake, and overall, they seem to be happier, though they tend to be very hesitant to admit any of these things. Medical risk decreases significantly, as long as ED behaviors do not continue. </p><p>However, as all of this medical progress is being made, the anxiety around food increases. The best way to think of it is to look at fear in general. Imagine something you are afraid of, and how you respond to it. Most likely, you avoid it. However, avoiding it only serves to continue, and potentially increase, your fear of it. So, for your child, he/she is fearful of food, and has avoided it. Now we are shutting down that option, and as you can imagine, fear shoots up. Without fail, those with EDs become convinced they will rapidly gain weight as a result of what we have them eat. They won't, but we cannot easily convince them of that, so don't even try to do so very hard. We just have to wait. And, what I have noticed over all these years, is that it takes about two weeks, on average, for that fear to peak and decrease. In two weeks time, we are able to prove that they can eat way more than they thought and barely gain any weight. We were not able to talk them out of their fear, but their body proves the fear to be wrong. Now, if only EDs were so easily convinced, right?? Treatment could then just be done. But, nope; they are very annoying disorders and they hang on as long as they can. The EDs "job" is to convince its host that we are all lying, and only it is telling the truth; it's truth is that food is bad and your child will gain lots of weight, among other things. And the only thing that can disprove that....is time. </p><p>So, your job is to outlast that obnoxious ED. While your child is screaming at you about what you are serving for dinner, you want to try to remember it is the ED screaming, not your child. And so you do your best to get mad at the ED for them, because they are not ready to be mad at it yet. You will want to closely watch your phrasing and express anger at the ED, not your child. Your child is frightened, though is not acting like the scared kid you might be used to. No, the fear is coming out as aggression and cruelty at times. But, it is not your child; it is the ED. And, of course, sometimes you just want to back down and serve something easier, or otherwise negotiate with the ED. But in those moments, if you have the resources within you (you won't always; we all have bad days), you want to stand up to that ED and make it clear it will not get to win, in that moment, or in the future. </p><p>But what do you do if the disorder has become too aggressive for you to stand, or is impacting siblings too much? First, you want to make sure the other kids are getting attention too. I know, I just told you you have to work EVEN HARDER. Believe me, I know this is not fair. At all. But your best protection against your other kids potentially learning that the way to get more attention is to be sick, is to make sure they get attention for being well. This makes your job even harder as I know you are tired. So, it doesn't have to be big stuff. Just little moments to show that you have not forgotten about them in the mess of the ED. And, if this level of ED chaos continues, we then start to look at whether a higher level of care is necessary. And that's not because you or your child failed; we just know there are some EDs that are really nasty, or maybe you are a single parent, and the expectation of managing the ED at home becomes too much. For many teens, once they realize their parents actually will send them to treatment, they are able to rein in some of the ED acting out a bit more, and it becomes more manageable at home. But for others, there are excellent treatment centers that can step in and help out until the brain is more healed. </p><p>I know this might sound more pessimistic, but I want to make sure you realize you are not alone in this battle and in how difficult it is. It is very difficult. But stay the course. Follow what the treatment team recommends, and recognize that it is unfortunately a bit of a waiting game. But recognizing that it just takes time can also be empowering. I know it's a cliche, but you do have to look at recovery as a marathon, not a sprint. There's a sprint off the starting line, just to get all the medical stuff managed, and the treatment team put together, but from there, it's about persistence...just putting one foot in front of the other until you reach the end. And the end does exist. I promise. Otherwise, I could never do this job. </p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-4357736402430859742020-11-06T12:30:00.002-07:002020-11-06T12:30:49.026-07:00For Parents: The Initial Session<p> So, you are about to do the first session with your son or daughter, and you don't know what to expect; or, you just finished it, and have no idea what just happened! ;) I thought my best approach would be to kind of walk through what is typically addressed Day 1.</p><p>My first job, even though I'm a psychologist, is to assess your child's physical state. I might do weird things like take his/her pulse, and I will annoyingly grill you on your child's most recent vitals, labs, etc. As I have explained before, I have a bit of an odd job, given my training. I'm trained in talk therapy, right? But, in eating disorder treatment, what comes first is physiology. So whereas you come in potentially expecting me to to dig into your child's thoughts and emotions, this is not going to be the priority at this stage, and hopefully this post will help explain why.</p><p>Eating disorders, especially those that have resulted in weight loss, are brain AND body disorders. Weight loss and/or starvation (you can have either or both), impact their brain heavily. It changes the way your child thinks, and the way he/she behaves. You have likely noticed they have become more anxious, more depressed, more obsessed (particularly on food and weight, of course), and they explode in anger like they never have before. There's a good reason for this. In short, the part of the brain that is impacted is the frontal lobe; that is the part of the brain that is responsible for rational thinking, impulse control and decision-making. I think it always helps a bit when I say it's the part of the brain impacted by substance use also. We expect somewhat chaotic, irrational behavior from those using drugs, but we don't expect it from the overly compliant kids/teens that end up with EDs. So, it is helpful to realize that that part of the brain is "hijacked." And therefore, our primary job is to repair that part of the brain.</p><p>In addition, what we know about kids and teens is that they tend to get sick very quickly, and they tend to recover very quickly. In all my years of doing this, I have rarely had to refer an adult for admission for medical monitoring. In kids and teens, this is more common. One of the tricks with kids and teens is that we have to look not only at the amount of weight lost, but also the amount of weight they should have gained during the time of their ED, but didn't. I realize that didn't make complete sense. Basically, kids and younger teens are supposed to be gaining weight all the time. So, when they lose weight, say 10 pounds, they not only "lost weight" but also "failed to gain." So, let's say they lost weight on the scale in six months; but, during that six months, they were also supposed to gain 5# naturally. So, at the time of the assessment, they have actually "lost" 15 pounds. Adults only have to look at weight loss, as they don't have the "failure to gain" variable. </p><p>In either case, the weight loss impacts the frontal lobe, and so we sees the symptoms I listed above. And, those exact symptoms, and the brain impairment, make it so insight-oriented therapy is not really possible at this stage. Emotions other than anger and fear are often shut down. The primary answer you hear to most questions is "I don't know." And often they don't know; their brains need healing. </p><p>And that means weight gain. Many therapists want to avoid talking about weight gain, because it upsets the client. And it does, very much. But, I approach working with teens by respecting their intelligence and their ability to understand science. I separate them from their eating disorder, and what i have found over the years is that, yes, the eating disorder has a meltdown about hearing about weight gain, but your smart child can understand why the brain needs to be repaired. Admittedly, they would prefer their brain could repair without weight gain, but sadly, I'm a therapist, not a magician. ;) So, we are left with weight gain as the cure.</p><p>So, initially, you will find this talk therapist mostly asking about medical indicators, and also asking the same questions the dietitian asks; what does food intake look like, what does energy expenditure look like, etc. And then I'll start to explain what I explain here in this post, and more. The goal is for both patient and parents to understand where we start, what the focus must be, and it gives me a sense of how willing the kid/teen is to consider engaging in treatment at home. I will often explain that there are two paths to treatment: one is treatment at home, with parents providing the structure, and the other is treatment in a treatment center, with the treatment providing structure. Kids/teens (and adults with EDs) like to make up path #3, which is something, "I'm fine, I"ll do what I want." Um, no. That's a mythical path; one of the two actual paths must be chosen. </p><p>The main task for parents and teens leaving that first session is this: 1) contact providers you have been referred to to create a full treatment team, getting in as soon as possible, 2) follow dietary recommendations, starting immediately (willingness to do so helps determine which of the two paths we will end up on), 3) separate the patient from the ED (asking parents and teen both to get mad at the ED while making it clear there is no anger toward the patient him/herself), and 4) for parents, begin to learn about Family Based Treatment, from the resources provided in my previous post. </p><p>That's kinda it. That's really all we can do in that first hour, unless there's a need for a medical intervention immediately. I know it's hard to walk out not having all the answers from any of us on the treatment team, but trust that those answers will come and you will make your way through this, one day at a time. </p><p><br /></p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-18397150126108218812020-11-06T11:51:00.003-07:002020-11-15T21:43:29.124-07:00Starting a New Series for Parents Providing Treatment for Low Weight EDs at Home<p> I realized yesterday that I have a higher than average percentage of teen clients at this point, and one of the biggest challenges in treating teens is that my job is to teach parents how to treat an eating disorder. This is no small feat for parents, as where, in that mythical parent school, did you supposedly learn how to treat an eating disorder?! And yet, here you are, living with an eating disorder that has taken over your child. It is a terrifying position to be in, and it will be one of the most difficult things you have ever done. But, it is also possible, effective, and, in the end, can be rewarding. I promise I'm not just saying that; this comes from years of helping parents do this exact thing.</p><p>The hardest thing about suddenly living an eating disorder is the reality that they hijack your child and turn him/her into someone you don't always recognize. Kind, well-behaved, honest kids begin to lie, manipulate, call you names, and express their hatred. My goal is to try to explain how the ED works, what essentially is likely going on in your child's head, so maybe the nonsensical can start to make just a bit more sense. Other resources, however, include Lock and LeGrange's "How to Help Your Teenager Beat an Eating Disorder," and AroundTheDinnerTable.org.</p><p>The idea of Family Based Treatment, which, to me, amounts to creating an ED treatment center in your home....no big deal, right?!....is to keep teenagers out of higher levels of care and allow them to remain at home with their families (even when they say they hate you). There are pros and cons to FBT and to treatment centers, and both are very good options. I won't try to speak for the creators/advocates of FBT, and I will fully confess that I do not follow closely how Lock and LeGrange described the treatment. I use the tenets that I have found work, and adapt the rest. For example, FBT initially called for no involvement from a dietitian, and I have never agreed with that. Due to the changes that happen during refeeding, I have always felt expecting parents to know what to do 100% with food was too high an expectation. I believe they have since loosened that messaging, but this is just an example of ways in which I have adapted the approach over the years.</p><p>I fully agree with the basic tenet that eating disorders CAN be treated outpatient, and I absolutely believe every patient should be given the opportunity to give it a try. I do not believe in a patient being diagnosed and immediately sent to a treatment center, unless that is what the patient wants. Many, many patients and families have succeeded at home, but it is definitely a lot of work. And parents need a lot of support as they experience a lot of unexpected hostility and anger from their child. I always take into account when that hostility and anger becomes too much either for parents or for siblings, and that becomes grounds for referral to a higher level of care when necessary. </p><p>If your child is referred to a higher level of care, it is not failure on your part! Some eating disorders are unbelievably nasty, and sometimes, overcoming them at home is simply too high an expectation. One of the key parts of eating disorder treatment is empathy not only for your child, but also for yourself. And, eventually, I will work with teens to recognize how much they need to empathize with their parents and the terror they have experienced while watching their child suffer. Good news...all the teens so far have come around to recognize how hard their parents worked, how scared they were, etc. Your kid may hate you now, but it's not forever!</p><p>Some of the things I will talk about in this series have been addressed previously, but I still am going to go over these things again, just so it is all in a string. If you are reading this and have something you want me to address, please feel free to email me at whoytphd@gmail.com, as I don't necessarily check for comments here (I know, I'm a poorly behaved blog writer. I thoroughly enjoy sharing this information; I do not thoroughly enjoy social media!😉) These blogs will also be sans pictures and images and the like, simply for the purpose of conserving my time! I hope you find this series to be helpful!!!</p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-90279874446729916462020-11-04T11:31:00.101-07:002020-11-04T20:53:13.826-07:00Tenacity and Facing Fears<p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil39VjUsOu_faOaVCro6hLIlhgkEZUgTYL9JTZpU9VHUlwbACstBq_JhhU0QeM5dJZ0TmYQwy7HJfP3PhEXLByeQmQftdyUhK632opcYpUxY4h7OpIGGxrrev1jdHbztX4BV6qjjuy0Flh/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="400" data-original-width="600" height="378" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil39VjUsOu_faOaVCro6hLIlhgkEZUgTYL9JTZpU9VHUlwbACstBq_JhhU0QeM5dJZ0TmYQwy7HJfP3PhEXLByeQmQftdyUhK632opcYpUxY4h7OpIGGxrrev1jdHbztX4BV6qjjuy0Flh/w567-h378/image.png" width="567" /></a></div><br /><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></div><br /><div class="separator" style="clear: both; text-align: center;"><img alt="" border="0" class="placeholder" id="ac9c899b419358" src="https://www.blogger.com/img/transparent.gif" style="background-color: #d8d8d8; background-image: url('https://fonts.gstatic.com/s/i/materialiconsextended/insert_photo/v6/grey600-24dp/1x/baseline_insert_photo_grey600_24dp.png'); background-position: 50% 50%; background-repeat: no-repeat; opacity: 0.6;" /></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;">The other half of my life (and it does feel like it takes 50% of my time!) is being an equestrian. As I share with my clients often, I too was gifted a healthy dose of anxiety, which I address through multiple paths. One of those paths is riding horses. I can have a million thoughts going through my head, but riding demands enough of my brain to, you know, remain on the horse, that it forces out all the other thoughts. Well, that is not COMPLETELY true. Part of my anxiety is social anxiety, so that still comes up when I am involved specifically in my sport, which is dressage. (Most people have no idea what it is, and I cannot easily explain what it is, soooo ask Google?) But I definitely have to battle a health amount of social anxiety as I fumble around in this sport.</span></div><p></p><p style="text-align: justify;">I started riding horses in 2013. I mean, I had ridden horses occasionally before, but never in any type of informed way. So, I started riding February of 2013, and by May bought my first horse (advisable? Probably not....but she stole my heart.) I rode Daisy for a year, and started conducting equine assisted psychotherapy with her as my co-therapist. Then another horse was coming into the barn; I took one look at her picture and somehow just knew that she would be an excellent co-therapist, and also that she was meant to be mine. I cannot explain it; it just seemed true. When she arrived, it only became more clear to me, though my husband, reasonably so given the cost of horses, was less convinced. ;) But here's the kicker: Violet had never been backed (often referred to as "broke"). Nobody had ever ridden her. So, sure, that's a great plan....let's take the brand new rider and have her buy an unbacked horse. Yep, great idea. (Hint: it's not a great idea and literally nobody advised this.) Neither of my horses now were typical dressage horses, but someone did say that V could like make it to Grand Prix (the highest level of the sport). So, stubborn ol' me decided that the really bad idea was still what was going to happen, and I bought her a couple months later, and she was started under saddle in spring/summer 2014. </p><p style="text-align: justify;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKX9z9x797wBLcl0g8EI5suQZRyvOk25QnhqRdrL-b9b3FB8VRk-9gtmng0zqlNN8GvJdOg5Thv_ry5ijnrfEUci6O3iafoWPIirvMAwu61ITTz4Z_R1j9YvHLaMqQs-4iF9MMt4m5R45-/" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: justify;"><img alt="" data-original-height="370" data-original-width="555" height="188" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKX9z9x797wBLcl0g8EI5suQZRyvOk25QnhqRdrL-b9b3FB8VRk-9gtmng0zqlNN8GvJdOg5Thv_ry5ijnrfEUci6O3iafoWPIirvMAwu61ITTz4Z_R1j9YvHLaMqQs-4iF9MMt4m5R45-/w282-h188/22309-0386_NL_FACEBOOK+IMAGE.jpeg" width="282" /></a></div><p></p><p></p><div style="text-align: justify;"><i>This pic is an example of the early not-very-good riding. I basically am just sitting up there hoping for the best!</i></div><div style="text-align: justify;"><br /></div><p></p><p style="text-align: justify;">I started to train in dressage in early 2016, and first showed in summer 2016. Let's just say it's been a rough road. Perhaps the main thing I learned from Violet was...how to not fall off...and persistence. That horse can change directions at the speed of light and so from seemingly Day 1, I just had to figure out how to stay on. I had a number of near falls where I literally would be shooting off her side, but would hook my boot under the saddle and pull myself back on her, because, let's be honest, hitting the ground hurts. I have no doubt that everyone watching the debacle of new rider riding new horse was thinking, "What does she think she's doing up there? She has no idea what she's doing." It was true! I didn't have any idea what I was doing. Normal, sane people buy horses that already are trained; that wasn't me. I was just stubborn, I guess.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0q-SnsKKpuxclpyqEAWgyYanZw15rrrvUVQy1Ke__fY6tc_ZpVduIJNVY7yDkq6HT1lSwQFsvfbNDoKPttv3w8uwgAP2-rCJxHhp4qqdYdVA-dwrzDJV1VNi4NwzNFFaDogmM7c7D6B0h/" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: justify;"><img data-original-height="1372" data-original-width="1748" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0q-SnsKKpuxclpyqEAWgyYanZw15rrrvUVQy1Ke__fY6tc_ZpVduIJNVY7yDkq6HT1lSwQFsvfbNDoKPttv3w8uwgAP2-rCJxHhp4qqdYdVA-dwrzDJV1VNi4NwzNFFaDogmM7c7D6B0h/" title="Nope, that's still not right" width="306" /></a></div><p></p><p></p><div style="text-align: justify;"><i>This pic illustrates getting the job done, but not competently. Leaning forward, horse unhappy.</i></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">In 2018, I took a huge risk and started bringing Violet out to San Diego so she and I could train with high level riders....international riders.....another massive challenge to the social anxiety. "Hi, don't mind me over here on the small horse (dressage riders are generally tall, and on tall horses) and no, I don't really know how to ride, just to be clear!" My very first ride in San Diego, I had to go into a ring with an Olympian and the next-in-line for the Olympics. Right. "Don't mind me. No, really, don't look at me. Please." By that time, I had made it up to showing third level, which wasn't too bad, and also means nothing to anyone who doesn't do dressage! (I tried to figure out how to explain the levels </div><div style="text-align: justify;">to my mother the other day, and this is what I came up with. You start out as a high school athlete (Training level and first level), then you become a college athlete (2nd and 3rd level), and then you make it to the minor leagues (PSG and I1), and then you are in the big leagues (Grand Prix). And then those who really excel in the big leagues go to the Olympics.) But I was a college athlete that had never been really taught how to do the sport correctly; I just kinda fumbled through doing it on a fairly fancy horse and so did acceptably enough, but I was not doing it correctly. Then I started training with Emma Weinert, an international Grand Prix rider. I returned to San Diego this winter to train with Emma, and then life happened and suddenly we were looking at moving somewhere, so we might as well consider San Diego so I could work with Emma full-time. </div><p></p><p style="text-align: justify;">Fast forward to this weekend. I had spent two years (Nov 2018 to now) trying to learn how to ride correctly, and did not advance up the levels as I worked on that. It was a lot of work as I had to completely change how I rode in order to do it correctly. But I had gotten lucky, and did indeed have a very talented horse, who also is quite unpredictable. 2020 happened, and horse shows were no longer a thing, so my focus was on trying to advance to PSG (Prix St Georges, if you are super bored and want to google), which I have equated to the "minor leagues." My eyes were set on a show called Spooktacular, which was 10/31-11/1/2020. We were gonna do it, no matter what, I thought. Then life threw enough barriers that by 10/27/20, I was being thrown around on horseback and said sadly, "I can't take this (extremely wild animal) into the ring this weekend." Violet had ulcers and had become aggressive and violent. I had given up about 40% and then started Google Image-ing "Persistence." I couldn't really find any quotes I liked, but one thing led to another and I found quotes about "Tenacity" and that is what felt right. And also seemed to describe what one with an eating disorder must have in order to recover. </p><p style="text-align: justify;">That night, I threw one final hail Mary in the form of very expensive medication at her, followed by another dose first thing on Wednesday, and somehow it magically made her sane (it really shouldn't work THAT well, especially since she had been on a less expensive version of the exact same medication). I cautiously thought, "well, maybe?" The next day, Thursday, she was okay again, and I thought, "Well, I guess so?!" And Friday we left for the show, where she also was good. BUT, we had never actually practiced for our "minor league" debut, as she had been that aggressive horse for the past three weeks. Just the next inadvisable thing in line, I guess! Somehow, I had confidence that it'd be fine. That was quite misguided confidence, I'll have you know! ;)</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-jtP6boff03ECTcv95XjIOGT6PB09oChc8XeNz0Ht8mG49eUYAPoKoTXg8JibAF-kfepvv7qk6JA0KOvSqzLQGVSxgJhoK9R67q5k7E2xXVC21xxh1H3eJNtb9SsaCPJ9t3l7UoBld_1_/s2048/V1+10%253A20.jpeg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: justify;"><img border="0" data-original-height="1808" data-original-width="2048" height="261" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-jtP6boff03ECTcv95XjIOGT6PB09oChc8XeNz0Ht8mG49eUYAPoKoTXg8JibAF-kfepvv7qk6JA0KOvSqzLQGVSxgJhoK9R67q5k7E2xXVC21xxh1H3eJNtb9SsaCPJ9t3l7UoBld_1_/w296-h261/V1+10%253A20.jpeg" width="296" /></a></div><div style="text-align: justify;">It was basically fine....if you don't have social anxiety, perhaps. I did ride into the show ring on both Saturday and Sunday. We completed the tests without any major issues other than that tiny rear in the back corner of the arena on Saturday (just to be clear, at no point does a dressage test call for the horse to rear, whether tiny or large, so that's a bit of problem). The judge skewered us in her written comments; my social anxiety took off at a gallop! I pondered dropping out of the show for the next day. Some kind friends talked me off the ledge, and we gave it a go again on Sunday. Was it significantly better? Yes, and no. No rearing is always a plus, of course, so that was cool. But again, I knew our score would not be particularly desirable. But this time, the judge's comments were fair and constructive, so the low score was way more tolerable. We had survived. We had done the inadvisable, and we had received a lot of encouragement along the way, and I would not have experienced those things if I had listened to my anxiety and bailed. There were some really cool moments, and a lot of errors. But, we had made it in the ring, she stayed in the ring, I stayed on the horse, and we played the sport in the most basic of senses, on a much larger stage than we had ever been in, with huge room for improvement. Let's just say we wouldn't be chosen as a starter in the minor leagues. We need a bit more practice. ;)</div><p></p><p></p><div class="separator" style="clear: both; text-align: justify;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6rjpCoU_pa3HCPJNzVwxUs7V2Uy8zEIYnZVw2FIpMvdSuh-d-y5CHSr1Avq5Mb7Rg64gllJVzPdZkhc2m8Ooz4PoPqrdqjw2f-HdrvBdHVvWvf8_F32vaz9ZaUlSH5gKPVCsrmu59JVAU/" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: justify;"><img alt="" data-original-height="400" data-original-width="600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6rjpCoU_pa3HCPJNzVwxUs7V2Uy8zEIYnZVw2FIpMvdSuh-d-y5CHSr1Avq5Mb7Rg64gllJVzPdZkhc2m8Ooz4PoPqrdqjw2f-HdrvBdHVvWvf8_F32vaz9ZaUlSH5gKPVCsrmu59JVAU/w320-h213/image.jpeg" width="320" /></a></div><span style="text-align: left;"><div style="text-align: justify;">What, you might be thinking, does any of this have to do with eating disorder treatment. Well, let's go back to that Tenacity quote: </div></span></div><p></p><p></p><div style="text-align: justify;">This quote drove me from Tuesday on in the battle to make it to something quite unimportant in the scheme of life...a horse show. This same quote, in my opinion, describes the experience, the process, of eating disorder treatment and recovery. The patients I work with must trust that we, as the treatment team, can share a game plan and a strategy, while they bring the strength and the determination. And it is hard to feel strong while fighting an eating disorder. It is hard to feel determined when there's a nasty voice in your head saying to give up, to not listen nor believe in the game plan. The statistics about eating disorder recovery present as "seemingly insurmountable odds," and certain the ED voice in your head feels insurmountable. But the odds are NOT insurmountable. As I say frequently, I could not do this job if my clients did not recover. I'm not crazy (Hmm, to those of you who know me, keep your opinions to yourself, LOL!). Ok, I am kinda crazy. But I'm not willing to work every day to treat something that is untreatable. Everyone can get better. I don't doubt that for one second. But it sure takes a ton of persistence, stubbornness, and tenacity.</div><p></p><p style="text-align: justify;">Same message for anxiety. Anxiety also convinces us that thing that are not true, are true. My anxiety convinced me I was being judged left, right, and center. I mean, I was technically being judged...by the judge....but I eventually realized all the witnesses were not judging me as harshly as *I* was judging me. So, simmer down, brain. Anxiety almost led me to not go back in the ring on Sunday, but in the end, I would then be a hypocrite as I allowed anxiety to stop me from facing the fear of judgement. And, sure enough, Day 2 wasn't as bad as Day 1. And even it was terrible and everyone judged me harshly, let's be honest, for me, as an amateur, it's "just a horse show." And lots of times the things we are fearful of are just not that big a deal in the long run; our brains are lying to us. And the only way past, is through. You must prove your anxiety wrong, and it is wrong the vast majority of the time. Whether that is proving that eating x,y and z won't make you gain x amount of weight, or whether failing on x activity does not make you a failure at life. Eating disorders lie, anxiety lies, and you can be tenacious enough to prove that to be true. </p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><br /><p><br /></p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-69026843093573821712020-11-03T14:35:00.020-07:002022-08-11T10:04:49.378-06:00Treating Eating Disorders and Trauma via Telehealth<p></p><div class="separator" style="clear: both; text-align: left;"><img border="0" class="placeholder" id="1eef80aa2bc4b8" src="https://www.blogger.com/img/transparent.gif" style="background-color: #d8d8d8; background-image: url('https://fonts.gstatic.com/s/i/materialiconsextended/insert_photo/v6/grey600-24dp/1x/baseline_insert_photo_grey600_24dp.png'); background-position: 50% 50%; background-repeat: no-repeat; opacity: 0.6;" /></div><div style="text-align: left;"><br /></div><div style="text-align: left;"><br /></div><div style="text-align: left;"><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtZSL-HaxO0RNBddsQH9P70lGrf_FslQ7iqkZ0aqY4q7LgKFmLn50MmUhTsuJa8L2yPg4bVWioiBfzru4VUyQaKmGwuvjQf3btxS2kKPYeh0OMIV6VfsEsaf7T-Q1pqTbHZKLbh4Yo4Z0q/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="333" data-original-width="500" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtZSL-HaxO0RNBddsQH9P70lGrf_FslQ7iqkZ0aqY4q7LgKFmLn50MmUhTsuJa8L2yPg4bVWioiBfzru4VUyQaKmGwuvjQf3btxS2kKPYeh0OMIV6VfsEsaf7T-Q1pqTbHZKLbh4Yo4Z0q/s16000/image.png" /></a></div><br /><br /></div><div style="text-align: justify;">Had anyone ever said I'd eventually move out of Utah and work in another state, I would have adamantly denied that was a possibility. My work, and the practice I created in Utah, was, and is, a huge part of my identity. But, sometimes life happens, and you are put in a position to which you must adapt. </div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">And so, adapt I did. And also, adapt, the clients I work with, have done. It has been incredibly rewarding to have the gift of being able to continue to treat the clients I was treating in Utah. I was not sure whether telehealth would really be an effective means for treating eating disorders and PTSD, but it has been effective in the majority of cases. I believe a big part of it working, both for my clients and for myself, is the fact that I return to Utah with some regularity. There have been a handful of clients over the past two years for whom I have not felt telehealth was a viable option; those clients I have referred to in person therapy. </div></div><p></p><p></p><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;">When I first moved, I in particular thought my days of treating adolescents might be done. In my, apparently old, brain, I thought the disconnection inherent in telehealth would not work for teenagers. However, after my first week, I realized, "Oh right. Teens spend lots of time talking to people virtually. Especially during a pandemic!," and my fears of not being able to work with teens were proven to be wrong. I have a higher portion of teen clients than ever before, in fact. A large part of that is due to working closely with an excellent physician, Dr Nikki Mihalopoulos (fortunately, she goes by Dr Nikki....cannot imagine why!). In addition, continuing to work closely with Andrea Addley, RD and Primary Children's Nutrition services has made all the difference. Whereas I am no longer able to fully "lay eyes on" my clients all the time and detect concerning changes, I have these local providers that communicate with me so well, so I am able to continue to do what I love to do.</span></div><p></p><p></p><p style="text-align: justify;">I truly miss seeing my clients in person every week. Yes, there are positives to doing telehealth! My commute is the best ever, especially since our house is relatively small, so the walk from the bedroom to the office is quite short, LOL! California living! And as we go along, probably most clients will get a "co-therapist" bombing sessions at some point. Mao, the cat, is excellent and sticking his, ummm, self in front of the camera, or sitting behind my head and looking on, potentially judgmentally, because he's a cat. Ruckus, the aptly named Australia Shepherd, participates in session whenever delivery people dare to approach the house, and Maizy, the Bernese? Well, she actually is pretty respectful and will just camp out on the floor quietly. </p><p style="text-align: justify;">I am fortunate in that the lack of commute to work and the shortened commute to participate in my hobby makes it so I can go to the barn every day. As time continues to pass, I will eventually develop a means for working with anxiety in equestrian athletes, but for now, I'm just soaking up the horse time and continuing to work with all of my Utah clients. I don't foresee building an eating disorder practice in CA anytime soon. I'd rather commit my time and energy to Utah, where there are not enough resources for eating disorder treatment, and I am ever thankful for my treatment team partners, and my clients, who allow me to do so!</p><p><br /></p><p><br /></p>Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-60926238884367574112020-06-07T13:28:00.000-06:002020-06-07T13:28:02.124-06:00Pursuing Passions: Career AND Personal (Plus, some local horse-related recommendations)Big changes are coming up for me and my practice. The story of how I have gotten to this place is one of those "what are the chances" kind of situations. But, as life has developed over the years, I have gotten more and more to where I believe that if something falls in your lap, you should go with it, and so here we go!<br />
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At the end of this month, I will be moving to California. Now, to my clients, it seems like I actually planned this, and kept it hidden, but that's the crazy part...I sure didn't! One of the things I talk to clients working towards recovery about is pursuing passions, as we know the ED kills those passions by taking time, energy and pleasure away, while focusing almost solely on the ED. Last year, I decided I wanted to go get better training in dressage, and so I went back and forth to San Diego for about six weeks; I would work during the week, and then fly to SD for the weekends. It was craziness, as I got to where I lost track of where I was and what I was doing...also, what season it was, since I was doing this in February!<br />
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So, this year, I decided to take the risk of upsetting my clients, and I set plans to go to SD for 5 weeks, continuing to see clients via telehealth. I was shocked when all of my clients took it in stride. All these years, I had told myself these stories about what would be upsetting to clients, and I avoided doing those things as much as possible. So, I learned a lot there that, as I tell clients all the time, I'm not actually psychic. ;)<br />
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Again, this was in February, so before COVID-19. My clients and I learned together that telehealth could work okay, though I do believe it should not be used with ALL clients. Anyway, I never intended to continue doing telehealth after returning from California. But, I returned right as COVID-19 hit and California and Utah shut down, so I guess the joke was on me!<br />
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After getting to San Diego in February, and enjoying the warmer weather, I had told my husband that we needed a 5-10 year plan for moving to San Diego; I was mostly kidding, as I also always said I couldn't move until I retired. I have come to hate winter, and, well, the Utah dressage community leaves a lot to be desired. But it was a 5ish year plan. My husband was already looking for another job when one came up in Escondido, which is about 20 minutes from the barns my horses were at. So, on a whim, he interviewed. Then, doors here in Utah closed, and we found ourselves left with the Escondido job versus looking wherever else in the nation. I ride horses, and he loves riding his motorcycle. Soooo, California is what was making sense (as long as you ignore all the downsides of living in CA, LOL!).<br />
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So, I returned to Utah, COVID-19 hits, and my husband gets the job offer. After a lot of back and forth on this, given my private practice in Utah, we eventually decided we'd do it...we'd make the move, but it certainly didn't feel real. At the same time, insurance companies decided they'd start covering telehealth given the pandemic. And, my clients had experienced what telehealth was like. It was all extremely strange timing. But, that is the timing that kinda makes you wonder if it is meant to be?? But I still didn't believe it was real. We put our house on the market. We had COVID-19 to deal with, wondering if my husband's job would be rescinded, etc. If you ever really want to have a good time, try selling AND buying a house in another state, during a pandemic. We learned you totally can buy a house remotely, as long as you enjoy high levels of stress! ;)<br />
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So, at the end of this month, we pick up our roots here, and relocate to San Diego. I will continue to provide telehealth to clients in Utah forever, or until there are enough ED providers that I don't feel like it is important for me to do so (I can't imagine that will happen anytime soon, sadly). With time, I will build up a practice in San Diego also, including plans for working directly with equestrians. I will be able to pursue my passion for dressage in a healthier environment. I have most definitely experienced the worst that Utah dressage has to offer, but also have had some wonderful experiences with some wonderful people. California dressage will be a whole new level of the sport, and we will be a tiny, tiny fish in a gigantic pond, but it will be so worth it to enter that intimidating environment.<br />
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For years and years, I was going to open my own treatment center in Salt Lake City, Utah. I bought the building to do it. I researched and planned, and I was going to do it. Then I got involved with horses, and that allowed me to slow down enough to realize that owning my own program would do two things I did not want: 1) It would make me an administrator, and I only want to work with clients, and 2) it would create paperwork nightmares, and paperwork is the only part of my job I detest! So, I put that dream aside, and moved on to new dreams where I pursued my love for horses and riding outside of work. My life is a wonderful balance now, and as much as I do not want to see my clients less often (I will return consistently for in person appointments, in addition to telehealth), I do feel like I am at least demonstrating what I talk about in therapy....that we must have passions and interests outside of parenting and work. So, onward!<br />
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Now, I do want to do some shout outs for anyone looking for resources in the Utah horse/dressage community. If you or your kiddo wants to learn excellent riding skills from moment one (a rare experience), please research Alpine Performance Horses/Jerusha Strikwerda. Her program is extremely high quality and also extremely affordable. For lower level dressage training, look to Rachel Kenyon Ebbens. Best Utah dressage shows: Millbrook Farms. Best farrier on the planet: Marcus Parker. The vets I found helpful were Mountain Point Equine and Morgan Freeman (yes, for real...). I guess that's all I have to offer on recommendations!<br />
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One of the things I can only imagine would be hard for my clients to trust is that I truly will return to Utah consistently. And I know only time can confirm that what I say is true. I remain extremely committed to treating EDs in Utah. I know there are not enough resources, and I will do all I can to continue my work here.<br />
<br />Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-32653482184019101032019-12-05T14:43:00.001-07:002019-12-05T14:43:41.042-07:00Treating Body Image ConcernsAhhh, body image! The concept that was completely befuddling for a few years of my career as a therapist. You see, there are so many ways that people have come up with to try to treat body image. There are body tracings, and using visual effects (somehow?!) to try to help those with eating disorders see themselves more reasonably. There are many other approaches, I am sure, but I don't search for them anymore.<br />
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I eventually realized, when it comes to body image, I truly have no idea how my clients see themselves, and they truly have no idea how I see them. So, discussing it has very little effect, in my experience. In my thesis, I used some body size scale by Stunkard and Stunkard (clearly, research was a big enough pain that i remember the names all these years later!), but would I ever use that with a client? No.<br />
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So then, what do I do when it comes to body image. I would say the main thing that changed my view of body image treatment was being told last minute that I needed to run a body image group at a treatment center I worked at many moons ago. When it's such an intimidating topic, it is NOT fun to hear last minute that it has just landed in your lap. My groups were fairly well known for being "no holds barred" and I sure didn't follow any script. So, as we sat outside, someone asked me something about body image. I don't even know what question I was asked. But, what came out of my mouth was something like, "The way I handle body image is to look in the mirror long enough to make sure I do not look like a freak. I know I won't always like how my body looks. But I tell myself, 'I have sh!t to do,' and I head off to work. Because working with eating disorders is way more important to me than what my body looks like." Now, when you work in a treatment center, or even individually with clients, you never know when what you say has an impact. I don't remember anyone really reacting to what I said in the moment, but over the next few years, I was told about how those words impacted members of the group, and changed their view of body image also.<br />
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I mean, we live in the US. Our society/media does not easily allow for positive body image. To try to get someone to love their body is truly fighting our culture. Is it possible? Sure! Is it my goal? Actually, no. For some, that's setting the bar way too high. My goal is acceptance, a neutral view of their body, but more so, a focus on what is actually important in one's life. The sh!t they have to do.<br />
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But, the other piece that I realized along the way was that body image concerns are often an indicator that the person is upset about something else completely. So, I've come to talk about body image concerns as a "translation" of some other emotion. "I'm stressed out about a test at school," or "I'm mad at ___," or "____ hurt my feelings" becomes "I hate my body." And why would I brain do this translation for us? Because if you make it about your body, then theoretically you can do something about it. (Theoretically being the key word here.) If it's about your body, then you can engage in an ED behavior to "do something" about it. It also is a translator for when you don't want to feel. You don't want to feel emotional pain, so you focus instead on your innocent body, and you beat it up.<br />
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The body image focus is very "effective" in some ways. It's an incredible distraction from stuff you don't want to think about or feel. But, focusing on your body doesn't change the actual problem, so it becomes this persistent thing that you have to focus on all the time. And that feeds the eating disorder.<br />
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These thoughts have come from my own work in this field. I don't know that they are backed up by research, or commonly espoused, though they may be. This is just what I have pieced together through my own experience, and through time with clients, and each time I present the idea, it seems to fit for my clients. So, if it fits for you, use it! If other body image approaches work for you, also brilliant! But, please, stop targeting your innocent body.<br />
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I should add...another effective body image approach, in my experience, is becoming an advocate AGAINST our society and its focus on body and weight.Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-9541653338775932222019-11-05T13:10:00.003-07:002019-11-05T13:10:59.616-07:00The Impact of Changing IdentityI am a bit surprised, looking back at the titles of past posts, that it seems I have not written on this before. After all, it is one of the biggest things faced by those in treatment/recovery from an eating disorder, and it is one of the things that can be really hard for family and friends to understand.<br />
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You always hear "self-esteem" as a mental health buzzword, right? But, where does it come from? What is it exactly? I sure don't have the exact answer to those questions, but I do know where part of it comes from, or at least I know where *I* think it comes from. In my opinion, self-esteem is closely linked to our identity, who we see ourselves as being. And that is something that develops over time. Think of teenagers and how prevalent cliques are in high school; why are they such a big deal at that time of life? Well, according to Erickson, the goal of adolescence is identity development. So we see adolescents putting themselves into groups, trying on different identities, and eventually (we hope) picking a path forward based on who they see themselves as being.<br />
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And, as I explain to parents frequently, it is really unfortunate that this is a prime time for development of an eating disorder, and the impact of that timing is that the eating disorder can become an identity. This is why you will never hear me say the term "anorexic" or "bulimic," as I will not label someone as their disorder.<br />
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Healthier identities will center around perhaps academic/work success, or athletic, musical or artistic success, or maybe will come from religious or political (used broadly here) views. But even those identities can become problematic. If one becomes overly invested in any one part of his/her life, it can then be traumatizing when that identity is lost, just as it can be, illogical as it seems, traumatizing to give up the eating disorder identity. So, think of someone fully committed to their job, or perhaps an athlete whose life consists of training, competing, performing, etc. When that is taken away, whether due to age or injury, it can leave a sense of emptiness and despair as the individual tries to figure out who they are without the career/sport/eating disorder. Anxiety and depression are not uncommon.<br />
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So, then what? A lot of the work I do is around finding out what else makes up a person's identity. If you have had an ED for years, unfortunately, it likely makes up the majority of your identity. So it is pretty intensive work to figure out what else will define you moving forward. But it is such important work. As the ED behaviors decrease, that hole must be filled with other things that are meaningful. You might look at what hobbies you used to have that got lost due to the eating disorder. Or, if you are an athlete or consumed by your profession, you might look back at what other things you used to do that you enjoyed; things that got pushed out by the high demand. For some, they cannot identify anything, and that's where the real work begins; the trying out of new hobbies, of new interests, trusting that eventually you will find something just as meaningful.<br />
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I can even say I went through this process to a certain extent. I used to work A LOT. My identity centered around being a therapist. And, even now, I can say I would absolutely be traumatized if that identity were to be taken away. My plan years ago was to eventually open my own treatment center, and do lots of training of new providers, while treating lots of patients. When I picked up the first hobby, running, I just did both. I worked a ton of hours, and ran a lot of miles, and nothing really changed. Now, I'd say that's because I wanted to run a marathon, but being a runner was not my identity. Then, horses came along, and the running was dropped pretty quickly, as I had met my running goals. Now, being an equestrian and an eating disorder therapist are pretty equivalent; both mean the world to me, and losing either would lead to significant suffering. But, at least I am more balanced now. I no longer want to open a treatment center as I know I would no longer have time to ride, and to do what I want to do with riding, I have to ride quite a bit (and drive quite a bit, LOL!). So that idea has easily fallen to the wayside. I'm completely content doing the work I do while also taking significant time to drive to and ride at the barn a lot. In fact, I have now started to look at how to combine my passions (beyond doing equine assisted therapy), which is what led me to go back to my therapy beginnings. I went off to grad school in Colorado and wanted to work with the US Figure Skating program; that eventually became unrealistic as I was 3 hours from the training center, and I walked away from the idea of working with athletes specifically. But, now I'm starting to reconsider how I could use my experience in treating eating disorders, and helping people change their sense of identity, to help athletes reaching the end of their careers. Do I ever expect that to be a big part of my work? No. But, it is something that has been, and would be, enjoyable to do.<br />
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Changing identity is certainly possible, but it is far from easy. As carers, it is important to understand, as illogical as it might be, how hard it is to abandon the ED identity if it has gotten to the point to where all your loved one thinks he/she is is an eating disorder (and the associated labels). I KNOW it doesn't necessarily make sense, but it is real nevertheless. Sometimes parents get confused why I am talking to their child about their hobbies, when it seems like I should be talking about ED behaviors. In the end, I do both, all for the purpose of achieving true, lasting recovery.Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-17654134551030152182019-10-31T17:35:00.001-06:002019-10-31T17:35:45.287-06:00"I'm sorry" and "dramatic"...tales of avoiding emotionsI hear "I'm sorry" in my office quite often. Which would be cool if my clients had reason to apologize to me. But usually, they don't. They are apologizing to me for crying, for being mad, for being sad, for showing any emotion other than happy, other than "fine." And that's sad. It's sad that we, as people, have learned that it is not quite right to show emotions in front of someone else, that to do so is burdensome. And, probably on a related note, it seems we, as people, have not necessarily learned how to respond when someone does show emotions. I don't know which is the chicken and which is the egg, but I feel pretty confident the two phenomena are likely related.<br />
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A linked idea is that of labeling feeling, or expressing emotions, as being "dramatic," or the like. Ask yourself, how often do you see someone showing emotion, and brush them off as being dramatic. How often do you think that versus say it out loud. Now, I live with a teenager, so I most certainly know that sometimes, someone showing emotion is, in fact, being dramatic. But, I also see that we, as a society, default to the "drama" label when really it is that we are having a hard time accepting/dealing with how the other person feels.<br />
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Almost without fail, when a client first starts to tear up, they quickly say, "I'm sorry," often with, "I don't know why I'm acting like this," or something of the like. And often, they label themselves as "stupid," or "dramatic." And yet, it never bothers me when people show emotion. In fact, I feel pretty confident that feeling is what makes us human, rather than robots.<br />
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So, how do we get to the point where we are no longer showing emotion? I am hesitant to say this next bit, because the last thing I would want to do is come across as the therapists of old, who seemed to default to the "easy answer" of "it's the parents' fault." It's most often nobody's "fault." Things are passed down intergenerationally, and so many different experiences can lead a person to shut down emotions. But, it is true that having parents that are not comfortable with emotion indirectly teaches kids to not be comfortable with emotion. It's generally not the intent, but instead, the fallout.<br />
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Certainly, there are some parents that might be very direct about it. They might directly tell their kids, and others in their lives, to stop feeling the way they do, or at least stop showing that they feel that way. They may respond with anger or maybe it is shame that leads them to tell others to "stop it." But the vast majority of the time, it's way more subtle. And it is likely that the parent doesn't even realize that he/she is uncomfortable with emotion, and thereby is teaching their child to be uncomfortable with emotion.<br />
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Kids learn to deal with emotion by having role models that show them how to handle them. And, oh my, there are all those memes out there now, from all the child therapy people, that illustrate perfect responses to your child's emotions. Those things make me shudder as the expectation is SO HIGH! I don't personally think the average person can have those perfect responses when his/her 3yo, or 16yo, is having a meltdown of epic proportions. So, please don't hear me as saying you should have those perfect responses. (And, you may respond in shock or dismay in the moment, but you can always go back and "fix it.") But, outside of those epic meltdown moments, your child will learn how to handle emotion as you prove that YOU can handle their emotion. If you are uncomfortable with your own sadness, then you likely will communicate to your child, by accident, that you are uncomfortable with their sadness. That might sound like trying to talk them out of how they feel, just as you try to talk yourself out of how you feel. It might sound like, "Oh, it's not that bad! Look at how lucky we are. There are people who have it way worse." It might sound like, "Oh, don't over-react." It might sound like, "I'll give you something to cry about." And, it might sound like dead silence. I'd say that, a lot of the time, it sounds like trying to talk someone (or yourself) out of the emotion that has arisen. I talk about this in therapy as using the brain to override the heart.<br />
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Now, where it gets tricky is that it's not an either/or, so I'm not saying we should never use our brains to manage our emotions. But, I would say that cognitive part, that rationalizing and talking ourself through it, often comes AFTER experiencing the emotion. Not as a means for avoiding experiencing it. The goal is to have both...both the ability to feel, and also the ability to soothe ourselves when our feelings might a little bit off. Anxiety, for example. Anxiety tells us all sorts of lies; we may have fear about things that might really happen, and often we have fears about things very unlikely to happen. So, in those moments, the goal is to feel the fear, not suppress it, but also be able to reassure ourselves of how unlikely our fear is. Same with talking to kids. Your goal is to listen to their fears, so you can truly understand where they are coming from, and THEN help them to see how unlikely their fear is to happen. Those who are blocked from dealing with emotion will go straight to the rational argument, skipping the emotion that is present.<br />
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This is feeling hard to explain, for some reason, so I really hope it is coming across in an understandable way. The one thing I will say about "being dramatic" is this...because some of you who put this label on yourself need to hear it...in my experience, those who actually are "being dramatic," do not see themselves as dramatic. Yet, those who label themselves as dramatic, rarely are.Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-69908960626120764102019-10-15T13:16:00.001-06:002019-10-15T13:16:04.759-06:00In the end, you have to take advantage of the help you are offeredParticularly in severe eating disorders, it is often the case that the client has been a therapy a long time. And, here's the thing...I really think that eventually, being in therapy, particularly with the same person, for a long time can eventually become counterproductive. Now, I don't have a set definition for "a long time;" it varies from case to case. But, whether it's multiple admissions to a treatment program, or meeting with the same therapist with little progress, I think the ED can accidentally become reinforced. Or maybe not the ED, as much as lack of progress with the ED. If not getting better becomes the norm, will you ever get better?<br />
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Eating disorders are hard in that I am quite confident nobody actually wanted one, and nobody chose one. I say frequently, "I'm pretty sure you didn't wake up one day and say, 'An ED! That's a brilliant idea!'" So, I'd never tell someone new to treatment that their ED is their fault, or that they haven't tried hard enough, etc. And again, this is a thing that doesn't have a defined timeline, BUT I would argue that somewhere in treatment, recovery DOES become the responsibility of the person that has the ED. There comes a point where everyone else has done almost all they can, and all that remains is the person with the ED choosing differently. This certainly still doesn't warrant any commentary about the ED being anyone's fault, or someone not trying hard enough. From what I see, it's often not that people who struggle to get better are not trying hard enough. It usually is that their ED is so obnoxious that their efforts pale in comparison to the efforts of the ED voice. BUT, even in that reality, the only way out still is to do the really hard therapy work (not just the changing behaviors work, though that is a huge part of it), so that eventually their efforts do overpower the ED. Even as I write this, I can see how confusing this all is. I can imagine some of you might be thinking, "Seriously, what is she even trying to say?!" Yep, it's that confusing.<br />
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Now I know you were just waiting with bated breath to see how I'd tie this to horses. Never fear! I have done it! But only because I really was pondering this on horseback.<br />
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I have two horses. One, I fit with hand-in-glove. She's been a real challenge to ride, but we are well matched and, the best way I can explain it is, even though I was heavily involved in backing (aka, breaking) her, she, in 5 years, has only gotten me off her back once, very early on (note: I just jinxed it). Now, mind you, there were rides where she tried (or perhaps she wasn't trying; it's probably not fair to blame her) a number of times, but she and I are just in sync enough that she was never able to unseat me (except in that big extended trot in a national level show when she was 4, LOL; nope, wasn't embarrassing at all, and no Mr. EMT, I didn't need you...hahahaha!). That's Violet. But then there's Daisy.<br />
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Now, Daisy is my heart horse. I chose her because, well, she chose me. She is my baby girl. But she has gotten me off a number of times. I mean, rearing does increase the chances of success when you are a horse (but rider was to blame), but overall, she and I just don't sync as well when I'm riding. She also is the first horse I rode consistently, and my first horse. What this means is she is the horse I ruined. I'm told we all ruin our first horses, but I hate that I ruined her. She had to suffer through years of really poor riding, and a couple years ago, she made it clear that she was DONE. And so I retired her. But then, as I came to understand how poorly I had been riding, and changed, I started to pull her out of retirement, to see if I could fix the damage I caused.<br />
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I never put her back in training with anyone, and have only taken a few lessons with her. Instead, my approach has been to take lessons on Violet, and then challenge myself to take whatever I have learned on V and train Daisy myself. I say almost every ride, "I broke you. Only I can fix you." Not that "she" needs to be fixed. Our relationship needed to be fixed. My communication needed to be fixed. And until this year, I truly did not learn much from lessons. I would do what I was told, because I'm super good at that, most days. If I rode with a big name trainer, my local trainer had to be there because I'd be so tense (in every way) during the rides that I would not remember a damn thing I had been taught, and the money would have been wasted.<br />
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And then I took my horses and went out on my own. Which had its pros and cons, but at minimum, required me to actually start thinking like a trainer when I was riding. I was either going to really learn what I needed to learn on V and apply it to Daisy, or I needed to quit. Now, this was assisted by eventually starting to ride with a big name trainer who was kind and taught in a way I totally get. And so I started to take all that I learned on V, and think about how to apply it to Daisy. I had to choose to really "get it," and I HAD TO if I wanted to fix all I had done to Daisy. (And V, to be fair.)<br />
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The coolest part is that I am now proving to myself that I do "get it," and I can train Daisy. Soon we will actually take a lesson again, because you can never figure out everything without eyes on the ground; but all in all, I have done what I set out to do...to actually take advantage of the help I have been given to truly LEARN how to train my horses (and myself). I didn't choose one day to ruin my horses. Hell no. But, I did. I cannot deny that if I want to change it. I, and only I, ruined my horses, particularly Daisy. And now, only I can "fix them." In the end, once you get help, only you can fix/get rid of your eating disorder. In the end, only you can choose whether you will seek a better life (even with its potential cons that your ED babbles on about all the time), and only you can choose to stay sick. You will need lots of help and support to help you get louder and more powerful than that ED voice, but the decision to get better will come in all the small moments between meeting with your providers. But, you can do it. It's possible. And, since I can guess what your ED might have just said to you...you are not likely to be the one that cannot be "fixed" (note: I don't believe there is anyone whose ED cannot be fixed. All EDs are treatable.)<br />
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<br />Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-84987923097713883492019-10-10T15:50:00.001-06:002019-10-10T15:50:17.557-06:00It's Been a Long TimeI must admit...I forgot I had a blog. So much so that it just took me 30 minutes to figure out how to log back into it! So, to catch up...<br />
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I don't know why I stopped writing blogs for my business. I will assume I got distracted, and eventually just forgot. But it came back into my mind after making some changes recently. Well, for years I have thought about writing a book. But then, conveniently, Jennifer Gaudiani has now written the book I would have written. It's called Sick Enough, and it is excellent.<br />
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But, a few weeks ago, I decided to get off social media. Now, I'm not off off it, as I swear you cannot actually know what is happening in the world if you are not on social media. So, I still have a profile, but I don't follow anyone, and just use it to keep up with companies and groups from whom I need information. And that step freed up some time, so I pretty quickly started to ponder the idea of writing a book again. I have a few topics I considered, but there's some barriers.<br />
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I could still write a book on eating disorders, and I think I know enough about them to pull it off. But, it seems 21 years of school burned me out on wanting to dive into the research and summarize some of it, etc. So, that kind of rules out the generally accepted book on an important topic.<br />
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In the intervening years since I last wrote consistently on this blog, I have become very involved in the sport of dressage. It is my absolute passion outside of work. And, oh, what a ride it has been. Through a series of events, I have ended up riding by myself the vast majority of the time, and that (is lovely and) gives me a lot of time to think. Over the winter, I started to think of the parallels between eating disorder treatment and dressage training/riding, and I thought, "I could totally write a book on this." But, let's be honest, who is gonna search for the topic "dressage and eating disorders."<br />
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Ok, so no book on EDs, no book on the parallels between the ED world and the dressage world. And then, lastly, this week, I decided I should write a book on "all the things your first trainer taught you that were wrong." Ah yes, another good one to do a Google search on, right? I suspect it would be an immensely helpful book, but perhaps not widely accepted, and it probably should be written by someone who knows way more about the sport than I do. Which cycles me back to really only knowing enough about EDs to do a book justice.<br />
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And so, painfully slowly, the dots finally connected in my mind, and I remembered this blog. I spend a lot of time on the road between work and the barn, and, as I said, I ride by myself, so I am fortunate to have a lot of quiet time to counterbalance my work life. I absolutely love my job and the real and genuine relationships I have with my clients, and I love my quiet time of riding, and, well, pondering life. I do think a lot about how training of horses overlaps with eating disorders, or treatment of eating disorders. (I really should probably just leave it at, "I think a lot." Because I do. For better or worse.)<br />
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I chose to get off social media after I accepted all it really did was increase my anxiety. I easily admit that I social anxiety, and I'm just not convinced social media can be good for that. But more so, I realized I didn't actually care about social media. What I care about is actual relationships. Actual communication. And that it was more important to me to have a couple people that I actually talk to, than 100 people who I didn't really talk with much at all (yes, even while on social media, I had very few "friends"...I tried to make social media as real as possible, only "friending" people I actually knew). So, that's how things are now. I have a couple people I talk with on the phone and go to meals with, and a few more I talk with through messaging. And, I have to tell you, my social anxiety is way less activated. But I miss using social media to express my humor; well, I guess that's really all I miss. In short, I recommend getting off of it. I think relationships between humans really could only be improved by the end of social media, which, I know, won't happen.<br />
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So, I'm not sure what topics I will be writing on moving forward. I can say, they mostly will be cooked up while driving on I-15, or while sitting on horseback. Yesterday, I had this whole half-baked idea about writing about fears because I have one horse that is usually unflappable, but girlfriend senses cold fronts and FREAKS OUT. My other horse spooks at....well....air. Literally, air, I promise you. She's a fun one. But this one (Daisy) is chill, except when a cold front is coming in. And so, my usually calm horse turned into a horse kite yesterday. What in the world do I mean by that, you ask? It's when your horse is so high-strung and freaking out about nothing that you swear she is no longer connected to the earth and instead is a 1000lb kite you are attempting to keep connected to the ground (you) by a measly lead rope. This used to be frightening to me. But now I know she's just having a moment, and she has zero intent to hurt me during her moment. And so I hold onto my kite string, and we walk calmly, and distract, and get her focused on work rather than....the wind, or barometric pressure, or whatever she was reacting to. And I guess that does parallel to ED treatment/recovery, because, so often, EDs lead you to "freak out about nothing." Or at least react to something that others do not understand, but it still scares the crap out of you. I couldn't remove the cold front for Daisy, just as we cannot remove facing food. Instead, she had to figure out how to be calm in spite of whatever was scaring her, and we did that through healthy distraction and focus on something else. And, in the end, that cold front came in, and she kept four feet on the ground while I hung out on her back. Whew.<br />
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Ah ha! Maybe you thought I couldn't do it (I wasn't even sure where I was going)...this tying of dressage training and eating disorder treatment. But looky there! It all came together in the end. ;) More to come. Because as I said, I think a lot. :)Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-80622681301865370372016-05-16T15:47:00.003-06:002016-05-16T15:47:48.644-06:00Just Keep On, Keepin' OnIt has been a long time since I have written a post here. Life, both professional and personal, has been very busy. Clearly! ;)<br />
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And I'm not thrilled about the content of today's post; it's kind of heart-breaking, actually. I was made aware by a client today that there are some really awful reviews of me online. One just posted last week. And it is hard to know how to respond to these. Well, in reality, there is no way to respond, and I guess that is simply what is difficult about the digital world; providers cannot respond to reviews like business owners can. The sites don't even make a space for doing so. So, I'm going to try to respond to some of the reviews. I'm not sure all the reviews are written by actual clients; only one can I actually identify who wrote it. And, sadly, there is an individual in my life, not directly connected to me, who has motivation to cause harm, so I can never know for sure if what is written is by actual clients, or by a non-client.<br />
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That said, I'll start by simply saying that if you are a past or current client with a complaint, I am more than willing to try to respond to your complaint as effectively as I can. I cannot resolve any complaints written on the internet, as they are anonymous. And even in the case where I know who wrote it, I really cannot contact the author without potentially then being accused of harassment. It's a tricky position, ethically. I WANT to be able to address concerns, but I don't know the avenue to do so.<br />
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So, to address some of the complaints:<br />
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When working with teenagers, I require family therapy. I will not work with a teenager without family therapy as part of the treatment process, and this has always been the case. Parents always see how I work with their kids, as they are in the session at least every other week. In therapy, I am equally confrontational of parents as I am kids; my goal is to address the problem and facilitate change, and never is a problem one-sided. As a parent, I imagine (and have experienced!) it is hard to be challenged, but it is equally challenging for the child to be challenged week after week to change dangerous behaviors. I also will not continue to treat a client that is not getting better under my care. Because I treat eating disorders, a higher level of care is always available, and if a client is not improving within 2-3 weeks, I refer to a higher level of care to ensure progress.<br />
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Another review boldly states I identify myself as atheist and have no tolerance for any other views. I am not atheist, and never have been, and I feel that alone adequately addresses that review (yes, I'm a little frustrated by bald-face lies). Quite honestly, it has never mattered enough to me to identify a religious stance (it's possible my Facebook page actually says, "H*&% if I know") My goal in addressing religious issues is to allow the client to process his/her own beliefs. My beliefs are not remotely relevant to a client's work, though I will answer when asked my if I believe in a particular religion or thing.<br />
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A couple reviews refer to me being immature. I guess I don't know how to best respond to that. I hope that is not the case, but it doesn't really make sense for me to claim I'm not. So, I guess all I can say is that, I'm confident I'm immature at times, but I welcome contact with anyone, and if I am then determined to be immature, I can respect that.<br />
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I would agree with those who say I am reactive and rigid. These things are true. I am reactive to my clients doing harmful things. I am reactive to clients lashing out at me, in the rare instances...less than 5...where that has occurred. I am reactive to people treating other people poorly. I am not a therapist who believes in sitting back and just listening; if I see something that i think is interfering with my client enjoying his/her life, I respectfully (or at least that is my intention!) challenge him/her. I fully understand my job would be "easier" if I just wouldn't challenge as much as I do, but I honestly cannot stomach taking people's money to mostly just listen. People hire me to help. And at times, my help is listening. But it is more than that also, especially with the population I treat. <br />
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Now for rigidity...I am rigid as a person. I tell clients this often, in fact! It works for me in this career as it is beneficial to be rigid with eating disorder behaviors. The other place I am rigid is in expecting clients to pay for services and for missed appointments. I understand that other providers let things like this go, and I am fully aware that my adherence to a strict payment policy opens me up for criticism. After all therapists are supposed to be always understanding and compassionate, right?! But, we also run businesses. It is surprising to me how therapists are often not seen as the professionals we are. And we are running a business. If a client late cancels or no shows, it effects our business. I go over my policies repeatedly so clients are fully aware of charges for late cancellations and no shows, but still, some are offended when I adhere to those policies. But, I believe that if we, as therapists, continue to allow people to cancel on us without consequence, we are only reinforcing that our time is not important. Now, this is not to say there are not valid reasons for late cancellations, and there is some flexibility in applying charges, but overall, I'm quite rigid with the financial policies. I do not want to be accused of favoritism, so all clients get the same penalty, which has frustrated a few clients. Overall, my time, a therapist's time, is important; not MORE important than anyone else, but equally important. I have managed to flub my schedule a couple times in my career (being rigid helps avoid this problem also). And, each time, I have given myself the same penalty I give clients, meaning I work for free when I next see the client. I am rigid, but equally rigid; I expect the same of myself that I do of others.<br />
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All therapists make mistakes (I hope!). At times, I have put myself in the position of apologizing for a reaction or an action, whether that was in group or in an individual session. I see those situations as (difficult and) an opportunity to demonstrate that repair is possible in relationships. I care deeply about the work I do, and the clients with whom I work. At times, the best action is to end a professional relationship due to incompatibility with a client, but the majority of the time, there is much to be learned from working through conflict/disagreement/hurt feelings, etc. Nobody is all good, or all bad. The vast majority of, if not all, humans are good with some kinda bad, and some really bad moments. I have had some really bad moments in my career, and for each one, I have tried to initiate repair. If that is what I am teaching clients to do, it is what I must do myself, even though it's hard.<br />
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To have my work, identity, and personality attacked is painful, but part of the job, I guess. I treat eating disorders. I do my best to not anger my clients, but to instead make it clear I will stand strong and fight their disorder tooth and nail. Sometimes, maybe that comes across in an unintended manner. As far as I know, I have not made as many clients angry as there are negative reviews, so that is part of what leaves me unsure of the reviews themselves. Regardless, I hope that this really long post (!) is in some way beneficial. Earlier today, of course I was tempted to just hang it up, take myself out of the public eye, but then, as I went on a walk to try to ground myself, I realized that what I would advise a client would be "keep doing what you are doing, with whoever wants you to do it with them, and let the rest of it go." If I do good work, I'll help people. If I don't, my career will die a natural death. If it dies a natural death, it is likely for the best. All this "being grounded" stuff is hard, but it's what I advise clients to do, to practice, so here goes....<br />
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<br />Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-52281277936970508362014-10-20T19:15:00.001-06:002014-10-20T19:15:19.621-06:00Detachment, without disconnection<a href="http://horseandman.com/wp-content/uploads/nuzzleHorses_OurPeople.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://horseandman.com/wp-content/uploads/nuzzleHorses_OurPeople.jpg" height="181" width="200" /></a>I recently completed a training that addressed attachment, detachment, connection and disconnection, and it led me to think of these concepts in a deeper way. Detachment sounds like such a negative thing. But, in reality, we all need to detach sometimes. So, how does connection/disconnection fit in? And how do all four go together?<br />
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Well, it's easy to think of being attached and connected. In that type of relationship, you are both physically and emotionally attached to the other person (or animal), and you are tuned in to that person/animal. You are aware of what he/she is doing.<br />
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But, can you be attached and disconnected? Sure. How that might look is that there is physical contact in the relationship, but no deeper awareness of the other, or awareness of o<br />
ne's impact on the other. It may look like you are connected, but if your mind is elsewhere, really you are not. You can imagine kids like this, perhaps. They might allow others to hold them, or hold their hand, but when you are with that kid, you know they are not really present with you. Maybe they look away, or they are playing a game with themselves, fairly oblivious to those around them. Sadly, adult partners can also be this way, and it can be confusing because it looks good on the surface, but doesn't feel good. And, lastly, I would argue an eating disorder can create this. It appears the one with the ED is present in relationships....they make the right moves....but, really, sometimes they are connected to their ED more than those in their lives.<br />
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So, now, detached and disconnected seems to go pretty much without description, much as attached and connected does. I think this is the person who is isolated, not letting the relationship in at all.<br />
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Okay, so that brings being detached, but connected. In the training, the task was to physically detach from the horse... meaning, we were to no longer touch the horse or communicate in any significant way....but, we were to remain connected. So, our task was to keep the horse tuned in to us, while we backed away. For another example, in dog terms, perhaps this is telling your dog to stay, while you back away. You want to maintain the dogs attention, without having to be attached.<br />
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So, how do we apply this concept to human relationships? In what situations might we need to detach, but remain connected. Well, a big part would be linked to our ability to bring our connections with us even when we need to be separate. So, can we hold onto the love from another, even when physically separated? Can we allow that love to comfort us, without the person being there? Perhaps there are times where we need to disconnect from the actions of another, but remain connected to them, rather than simply throwing the relationship away. I can see this definitely being present in some of the more extreme stages of an eating disorder. It feels terrible, but the family might need to detach from the person with the eating disorder, so they are no longer hooked into care taking or unintentionally reinforcing the disorder, while remaining attached to the person inside, their loved one. These family members would not walk away, but instead respond as soon as their loved one showed a commitment to change.<br />
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Now, all this is pretty much me musing "out loud." I'd be interested in what some of you think about this concept!Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-11531707001788310102014-09-10T19:02:00.004-06:002014-09-10T19:02:46.964-06:00But, What Do YOU Want?<div class="separator" style="clear: both; text-align: center;">
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I'm guessing this won't come as a surprise to anyone, but sometimes there are a number of power struggles involved in our lives. A good number of us really don't like to be told what to do. And, sometimes, this can become a challenge in therapy, as sometimes, the best intended suggestions can end up feeling like we are telling our clients what to do.<br />
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As you might guess, this is a not uncommon phenomenon with teenagers. Teenagers do not want to be told what to do! At least most of the time... So, being the therapist to a teenager carries the risk of just being the next adult in line to have authority worthy of bucking. And the last thing a therapist wants to create is<br />
a power struggle.<br />
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So, I often find myself asking clients what they want for themselves, who do they want to be? What are their values, morals, and beliefs? And, in going down this path, I find that it's not uncommon that the client actually wants the same thing that the person they are defying wants. The client actually wants to be a good student, a good worker, reliable, trustworthy, and to have good relationships. So, for example, rather than continuing to battle the parent over grades, the focus can change to the reality that the client wants to be a good student, or wants to be respected by teachers, or wants a particular job some day.<br />
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Of course, this can also be applied directly to eating disorders. What does the eating disorder client want more? To be thin? To feel in control? To be numb? To have good relationships? To enjoy life? To have integrity? To be honest?<br />
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If you will identify what you truly want, you can then measure your behaviors against that. Is what you are doing in any given moment consistent with your long-term desires? If yes, fantastic! If no, you have to decide whether this means your desire has changed, or something is overriding it. And, you have to distinguish between what you want in that moment, versus in the big picture.<br />
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This way, it no longer matters what anyone else wants, and whether you want to follow their direction; it only matters that you are pursuing what you want.Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-45012447925999567462014-09-10T18:11:00.000-06:002014-09-10T18:11:28.975-06:00Update, a long time comingToday, I was asked to write a blog post. Now, I asked the requestor to give me a topic, and her ever-helpful response was, "I dunno; you are the one with a PhD." Well, thanks for that help! ;) So, I will write two blog posts, in a flurry of posting!<br />
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<a href="http://i2.cdn.turner.com/cnn/dam/assets/121130110438-equine-therapy-child-vertical-gallery.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://i2.cdn.turner.com/cnn/dam/assets/121130110438-equine-therapy-child-vertical-gallery.jpg" height="320" width="240" /></a>First, an update:<br />
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Equine therapy session formally began on June 1, and it has been a wonderful thing to be a part of. Violet was added to the herd mid-June, and has been a wonderful addition. It is amazing what can happen with horses present. Often, my clients miss the grin I get on my face when they turn to see what one of the horses has just done that is perfectly timed. It is phenomenal to watch the horses work their magic, and I feel very honored to be a part of these sessions. Sometimes, it's a client learning a new skill with the help of an equine partner; other times, it is the horse and client standing forehead to forehead in silence. Throwing rocks has also become a favorite pastime, and fortunately, my corral has no shortage of rocks. There's just something to standing in nature, next to these beautiful animals, that is amazing; I love it.<br />
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In the downtown office, Angela Hicks is hard at work building up her practice, taking on a number of eating disorder clients. I am so thankful to have her on board to help decrease wait times for clients seeking treatment. It is so hard to tell someone with an eating disorder that they have to wait on a wait list, so it feels very good to be able to get people in quickly. And, it's fun to have a partner in crime!<br />
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So, that's the update. Now on to a post about a specific topic, in spite of receiving NO HELP from the person requesting a post!!! ;)Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-43416751907922481152014-05-30T20:47:00.000-06:002014-05-30T20:47:52.494-06:00What Does the Body Hold?<div class="separator" style="clear: both; text-align: center;">
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One of the reasons I have become committed to equine psychotherapy is the fact that it requires the use of the body, rather than simply talking. But, why is this so important? Well, most clients with eating disorders are very intelligent; they don't suffer from an inability to use their brains, even if their actions are not the most rational. The average eating disorder client can easily talk for an entire hour about all of their thoughts and beliefs, but can make it through that hour almost completely avoiding emotion. It's a challenge for us therapists, as our job is, you know, to talk. So, it's easy to get caught up in talking brain to brain, leaving out emotions, and the body.<br />
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<a href="http://ecx.images-amazon.com/images/I/51ofs8fSRiL.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br /></a>And maybe this sounds kind of "woo-woo," but I think it is true that our bodies hold onto emotions. Think of how many physical ailments can be linked to emotions. Headaches and stomachaches are easily seen as sometimes being the result of emotions. I have become very interested in Peter Levine's work with trauma, and he is probably the foremost person to convince me that our bodies hold suppressed emotion.<br />
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<a href="http://loving-community.com/wp-content/uploads/2013/03/Mar112013-shake.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://loving-community.com/wp-content/uploads/2013/03/Mar112013-shake.jpg" height="300" width="320" /></a>In short, Levine argues that we can use animal models to understand human trauma. (Disclaimer: this is my interpretation of his writings.) Levine specifically uses whiplash injuries as one of his examples. He indicates that many people who experience low speed car accidents that result in whiplash report physical symptoms that surpass what one would expect from the low speed rear-ending. This is where he brings in animal models. He argues that animals, who can be under pretty constant threat from predators, don't demonstrate trauma. Now, I don't know if this was his example, or just what I ended up using as an example, but think of a deer in the headlights. It is frozen, but then bounds off into the woods. Well, apparently, if we were to follow that deer, we would eventually find it shaking in the woods. And, Levine indicates that this shaking is the release of the emotion from the body.<br />
<a href="http://tcsoko.files.wordpress.com/2010/04/fear.gif?w=300&h=230" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://tcsoko.files.wordpress.com/2010/04/fear.gif?w=300&h=230" /></a><br />
Now, back to the car accident. Humans get into a low speed car accident, and then get out, get their insurance, call the cops, call loved ones, etc., and the emotion they might be feeling gets blocked by this flurry of acting. His argument is that if we were to stand on the side of the road, and allow our bodies to release the emotion, we would be less likely to have the effects of trauma. I am confident this is dramatically oversimplifying his stance, but this is the basics. He has written a number of books on trauma, any of which would provide more in-depth information on this concept.<br />
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So, now, back to the clients with eating disorders. Not everyone with an eating disorder has a clearly definable trauma history; that is not my stance. But, eating disorders do serve to block emotion. Rather than feel about something, you focus on food in some way or another. That effectively blocks the emotion inside your body. Often emotions are numbed completely and clients will report really not feeling anything anymore. But it's still there. The extent of blocking varies from person to person, but I'm arguing that, in order to achieve recovery, and general psychological health, the emotion(s) must be released. There are many avenues for achieving this, sometimes even including simple talk therapy. But, if the emotions are NOT being released through talk therapy, it might be time to look for something to add to you therapy work. Dance therapy, yoga, art therapy, physical movement, and equine psychotherapy are all possibilities; and I'm sure there are many more I've not listed. But the bottom line is this: Release the emotion from your body. Trust it will not consume you. And, in fact, understand it is consuming you more when you block it than when you release it.Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com1tag:blogger.com,1999:blog-3522972191109662295.post-67411550890769937642014-05-27T11:30:00.001-06:002014-05-27T11:32:10.591-06:00Why Equine Therapy...and What is it Anyway??<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6Axnou-U0hqyfkZM1oCCRNXkVzPm4oP9nKdJaUHm2aVcxdrh4PyITIUoes5I-eIrulmS19zGJ_C5YmrPAZtuuW-3_IglDixb4QG3QIwQbd5nHuxNybsNUHUukjRNTX0KMapjQFlwMnoW1/s1600/Shadow+Mountain+Equine+539.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6Axnou-U0hqyfkZM1oCCRNXkVzPm4oP9nKdJaUHm2aVcxdrh4PyITIUoes5I-eIrulmS19zGJ_C5YmrPAZtuuW-3_IglDixb4QG3QIwQbd5nHuxNybsNUHUukjRNTX0KMapjQFlwMnoW1/s1600/Shadow+Mountain+Equine+539.jpg" height="213" width="320" /></a><br />
Hmm, I have run into an unexpected difficulty in marketing Shadow Mountain Equine Psychotherapy (from this point forward, known as SMEP). As it turns out, the vast majority of people think equine psychotherapy means I am therapizing the horse. Hmm, quite a problem! So, to be clear, no, I am not a horse whisperer; whereas I am known to talk to horses, (and all animals...and myself...) they do not, in fact, talk back to me!<br />
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So, how to get out there that equine psychotherapy (aka, horse therapy, equine therapy, equine assisted psychotherapy, equine facilitated psychotherapy) is this very powerful form of talk therapy that simply uses horses as a co-therapist? This is proving to be tricky here in Utah. In Colorado, where I am primarily training, you can't hardly take a footstep without tripping over an equine psychotherapist, and the field is pretty well understood, I believe. In Utah (and on airplanes, it appears!), it is assumed I think I'm a horse whisperer. Umm, no. <br />
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Therefore, I guess I am left trying to describe some of the work. Work that oftentimes seems pretty indescribable, or at least difficult to represent how powerful it can be. In my office, I work hard to make sure I am not just talking to clients using their brains. While there is some benefit to cognitive therapy, the risk is that the highly intelligent people I work with will simply "overthink" themselves or their lives, but not necessarily make the changes they are wanting. So, I work to help clients experience, feel, and understand what is actually happening in their bodies. If you think about it, each emotion we have has at least one physical sensation that goes with it. Over time, you might have become really good at blocking the physical sensations (much as you maybe have become good at blocking the sensations of hunger and/or fullness), but I promise they are still there. The risk is that, in the office, clients will just think really hard about what they are feeling, which, in the end, often is not really feeling at all.<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXDel_gTEjwlotCbUeJp9EOrq14q2TGx16j74rW2mp_cWLwSsH7K4rfDzLdPul5pdb5TRIevJWuTBZslkbHenoUf7wqqpLY6AepLYuwBUfBtsEzQaIbLd-0hZV7rZrqjB9WcRnWDER5nDD/s1600/Shadow+Mountain+Equine+291.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXDel_gTEjwlotCbUeJp9EOrq14q2TGx16j74rW2mp_cWLwSsH7K4rfDzLdPul5pdb5TRIevJWuTBZslkbHenoUf7wqqpLY6AepLYuwBUfBtsEzQaIbLd-0hZV7rZrqjB9WcRnWDER5nDD/s1600/Shadow+Mountain+Equine+291.jpg" height="213" width="320" /></a><br />
Now, let's translate that out to the pasture/stall/wherever the horse is. So much emotion can be elicited simply by being around horses, and my task is to help you "feel into" your experience, rather than think about it. There's more to experience in a pasture than in an office. Every sense can be triggered, and in different ways each time; in comparison, my office looks, smells, and feels basically the same each time. Getting into emotion, sensation and feeling is simply "easier" in the pasture.<br />
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The part that's indescribable is the work the horses do. Mind you, horses are not really trained to be therapy horses. I cannot, as far as I know anyway, teach them what to do. They do what they do, and it's kind of amazing. Things I have seen:<br />
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<ul>
<li>A donkey come up and repeatedly head-butt a woman who was talking about being pushed around in her relationship.</li>
<li>A yearling come and rest her chin on the head of someone squatted down, crying.</li>
<li>A horse come through and repeatedly violate the boundaries of someone talking about.....having a hard time setting boundaries. </li>
<li>An active, fidgety horse stand stock still, not moving a muscle, while a woman leaned on him and cried.</li>
<li>Many, many horse hugs....provided by the horse, not the human.</li>
</ul>
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These are things that cannot really be described, and can only be understood when witnessed. These are the unsolicited actions of horses. I won't pretend to know why the horses act in these ways. I don't know what they do and don't understand. I just know I have seen it over and over, and thus believe in what they do, and the power it has with people. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFzet2HdxoFrWdTHYemZLNc4ct7-FFXZmuB_eGwMAHFIcZtvYjh-mbmeBA4mCFh3a-FxY2CVUEmlkzUp36HTUj0ULoD8ZA54AZBMJz5JdmldWNQc-ap137H7zH-buGOZCyke4JqbBWLWVT/s1600/Shadow+Mountain+Equine+131.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFzet2HdxoFrWdTHYemZLNc4ct7-FFXZmuB_eGwMAHFIcZtvYjh-mbmeBA4mCFh3a-FxY2CVUEmlkzUp36HTUj0ULoD8ZA54AZBMJz5JdmldWNQc-ap137H7zH-buGOZCyke4JqbBWLWVT/s1600/Shadow+Mountain+Equine+131.jpg" height="213" width="320" /></a>I worry that people see equine therapy as "woo-woo" or as not having sufficient backing. Honestly, the second is likely true, as there is little data to back it up right now. Many of us are working on that problem. But, I have no doubt that if we could hook biofeedback machines to clients working horses, we would see significant changes in heart rate, blood pressure, etc, as clients learn to use their relationship with horses to create calm, happiness, and connection. Someday the research will get there. </div>
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In the meantime, all I can say is that I am one science-minded woman...and I believe in equine psychotherapy. </div>
Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-3526519287530206812014-05-12T14:20:00.002-06:002014-05-12T14:20:40.680-06:00Shadow Mountain Equine Psychotherapy and the return of Angela Hicks, PhD!<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFlmjPNdzw26O5WYmvNgGskCLpXVFD0dZiEOt1cqnXDbu9nC8mi_t9_IQgi_aM-B3uGTLUhjL8taqdkfuIPHx0Ud9aJl5T-Y3Dw562XNpRLqASirBJCKGMKihg9sCts7d-3ObHj7ilCm4_/s1600/Shadow+Mountain+Equine+114.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFlmjPNdzw26O5WYmvNgGskCLpXVFD0dZiEOt1cqnXDbu9nC8mi_t9_IQgi_aM-B3uGTLUhjL8taqdkfuIPHx0Ud9aJl5T-Y3Dw562XNpRLqASirBJCKGMKihg9sCts7d-3ObHj7ilCm4_/s1600/Shadow+Mountain+Equine+114.jpg" height="200" width="133" /></a>Hi everyone! It has certainly been a long time since I have posted. A lot has been going on! Some major changes have happened around here, all for the good! The major news is that the week of June 1, I will begin to offer equine psychotherapy to clients with, and without, eating disorders. I have previously posted on how I see equine psychotherapy being relevant in the treatment of eating disorders, so I will not rehash that.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsrs9akXaXjxexDJCKvUYQ8Dk4YyFqlbbh7UajQjosSCZ483uiPjnusniNAJAp1uDFu_HXV1EW-Hcxd75ZmuPWo8zR-qFLHnFiEkL1QjeYIqMljiuXUC2wcT9vgg6albqPX43C2qIzE6MR/s1600/Shadow+Mountain+Equine+137+cropped+8x10.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsrs9akXaXjxexDJCKvUYQ8Dk4YyFqlbbh7UajQjosSCZ483uiPjnusniNAJAp1uDFu_HXV1EW-Hcxd75ZmuPWo8zR-qFLHnFiEkL1QjeYIqMljiuXUC2wcT9vgg6albqPX43C2qIzE6MR/s1600/Shadow+Mountain+Equine+137+cropped+8x10.jpg" height="160" width="200" /></a>What is interesting is that there are virtually no equine psychotherapy options in the Salt Lake valley. I'm aware of a couple programs that offer hippotherapy, which is more designed to treat physical disabilities, though I understand some small amount of psychotherapy might be done at these facilities.<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiswIrLVkMQeziLl8FtMhRcsV5fO5EwLPem6UYtKoG0GkaVTspnh5KlJRnlxVVQXCX-8PUsj5p1ez6yzmExQyVvCnU6kHmmpVGRr2MBblbGJ_2XTILsrgK8VZ1ys7pdCaBjGsSc68xoWRjb/s1600/Shadow+Mountain+Equine+255.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiswIrLVkMQeziLl8FtMhRcsV5fO5EwLPem6UYtKoG0GkaVTspnh5KlJRnlxVVQXCX-8PUsj5p1ez6yzmExQyVvCnU6kHmmpVGRr2MBblbGJ_2XTILsrgK8VZ1ys7pdCaBjGsSc68xoWRjb/s1600/Shadow+Mountain+Equine+255.jpg" height="133" width="200" /></a><br />
I feel strongly about the approach I am using in providing equine facilitated psychotherapy. What is emphasized is the clients' relationship with the horse, and using that connection to help facilitate change. Some other approaches use horses to complete certain tasks, such that the client can learn something. Unfortunately, this can take the client out of relationship with the horse. Therefore, in the approach I am using, the horse will not be forced to do anything other than be a horse. It is very hard to explain the power of equine psychotherapy; it really is something that must be seen.<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjziCG3CjCu1XPSAS25p2pHfnPFs3CbDdXzCxXq3uUjrBxDl4ouVRKfhLpUs4NJh9Z-oB6pJadhl3-n0bUYsfFa0QZdPfPtts3SFfsvK-_WdlyvIscgZcS9j9LbdcRNslzBWvrWnE9yMTQ-/s1600/Shadow+Mountain+Equine+144.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjziCG3CjCu1XPSAS25p2pHfnPFs3CbDdXzCxXq3uUjrBxDl4ouVRKfhLpUs4NJh9Z-oB6pJadhl3-n0bUYsfFa0QZdPfPtts3SFfsvK-_WdlyvIscgZcS9j9LbdcRNslzBWvrWnE9yMTQ-/s1600/Shadow+Mountain+Equine+144.jpg" height="133" width="200" /></a><br />
So, I hope you will all check out my new website: <a href="http://shadowmountainequine.com/">shadowmountainequine.com</a>. I am excited to get this phase of my work started, though my availability will be limited. I am very thankful to Keystone Equestrian Horsepark for their support of this venture. Check them out at <a href="http://keystoneteam.com/">keystoneteam.com</a><br />
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The other major change is that Dr. Angela Hicks is returning to part-time work with me! I am very excited about this, and welcome her back with open arms. She is completing her final stage of training to receive her PhD in Counseling Psychology; this will be her second PhD! So, she will have limited availability until the fall, but then will be back full force! Welcome back, Angela!<br />
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Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com1tag:blogger.com,1999:blog-3522972191109662295.post-68059910396687225432013-12-05T08:21:00.001-07:002013-12-05T08:21:40.239-07:00Weighing versus Intuitive EatingOften, weighing yourself is a big part of having an eating disorder. Sometimes many, many times a day. That number on the scale, and the one inside your pants, comes to drive how you feel, what you do, how you eat, and how you view yourself. Suddenly, that number on the scale seems to be driving everything.<br />
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But, it feels reassuring. It feels comforting to know what is happening with that number (though, let's be honest, only as long as it is not going up!). Your eating disorder is reassured by that illusion of control. So, it is hard to let go of the behavior. I have had numerous new patients argue with me that seeing their weight helps, not hurts--mostly because the client is too scared to not know the number. Being weighed by us is often a significant area of stress, and sometimes conflict.<br />
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And, of course, this is another area of great debate in the field. Should we show weights or hide weights. Do they hurt, or do they help? And how do you know from patient to patient?<br />
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At UCED, we do blind weights, for those with whom we need to do weights. Why? Because we also teach intuitive eating. And, weighing yourself and becoming an intuitive eater are pretty much diametrically opposed (which is why we do not weigh people who are practicing intuitive eating). But why is it so unlikely to work if you both weigh yourself and try to become an intuitive eater? Intuitive eating is based on trusting your body and learning to follow your body's cues. The goal is to eat when you are hungry, stop when you are full, and eat a variety of foods.<br />
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Enter, the scale. You jump on that "wonderful" little thing and it gives you a number. What if that number is higher than you want it to be? Chances are you will automatically change your eating behavior to compensate. You will restrict the amount you are eating, or the range of foods you allow yourself. And, as we have covered before, that restricting has a very high chance of then leading you to overeat. And the cycle of disordered eating continues. You are quickly taken right away from from following your body's cues, and intuitive eating has gone out the window.<br />
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So, what do we recommend? I highly recommend getting rid of your scale in the most glorious fashion possible. I have had patients confirm that scales don't bounce when dropped from significant heights and they do shatter when hit with another solid object! Send your scale out with a bang! Or, give it to a loved one so they can make it disappear. Take it to your therapist/dietitian/doctor. Or, put it in the garbage yourself, and wave good-bye.<br />
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Think of the freedom that can come when your mood and behavior is not dictated by a number on a scale. We are all much more than a number, and the number says absolutely nothing about us as people.Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com0tag:blogger.com,1999:blog-3522972191109662295.post-4453568017549483912013-12-02T17:38:00.005-07:002013-12-02T17:38:51.312-07:00UCED's Treatment Approach for Adolescents with Eating DisordersFor the past couple years, there has been a lot of research going into, and professional debate regarding, the appropriate treatment of adolescents with eating disorders. Eating disorder treatment, and the mental health field in general, is a hard field when it comes to finding concrete answers as to what is the best approach for treatment. In general, the focus is on identifying empirically/research supported treatments, and then using clinical judgement and skill to identify what will work best for a particular individual.<br />
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Recently, most of the focus in treatment of adolescents has been on Family Based Treatment (FBT), which is also known as Maudsley Method. Lock and LeGrange are the main forces behind FBT here in the US, and there are ongoing trials continuing to assess this treatment approach. The mindset behind the approach is keeping adolescents at home, rather than sending them to inpatient/residential treatment centers. Treatment centers certainly have their benefits and are needed in some cases, but our stance here at UCED is that every adolescent (and adult) should first be able to try outpatient treatment at home, prior to being sent to an inpatient/residential program.<br />
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One of the major tenets of FBT is the idea that parents know how to feed their children. If you go back in the history of the understanding of EDs, unfortunately, you will find a lot of blame on parents and families. The field as a whole no longer has this attitude towards families, but some long-held beliefs are hard to get past. Fortunately, FBT has shown that many adolescents can get better at home, with their families. However, as with any therapeutic approach, one size does not fit all.<br />
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Our approach with adolescents is to first give the teenager a chance to show they have the motivation to get better on their own. So, first we give them the opportunity to make healthy choices regarding food, with the support of their parents. A surprising number of teenagers actually will choose to get better without invasive intervention--a testament to the maturity of these young men and women, and their awareness that the ED is not serving them well. Because adolescents live at home and are supported primarily by their parents, in addition to friends, we involve parents in therapy frequently; typically every other session, although some teenagers choose to have their parents involved in every session. This approach, which teenagers typically are not thrilled to hear about initially, allows us to avoid the risk of the ED "splitting" the treatment team and the parents. Fortunately, most teenagers quickly realize family therapy isn't THAT BAD and come to accept it pretty quickly. (Sometimes parents end up disliking it more than the teenagers!)<br />
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If, with this structure, the teen remains unable to do what he/she needs to do in terms of food and activity, we transition to more of an FBT approach, which provides the parents with much more say in what the child is eating and doing. This is a tough transition for some teenagers, as the last thing they want is for parents to tell them what to do! However, on the flip side, this can provide motivation to do what they need to with food, so they can regain some control. This approach is often difficult for parents because they find themselves feeling pulled to "go easy" on their teen, which unintentionally ends up as negotiating with the eating disorder and allowing it to get away with ED behaviors. Therefore, parents need a lot of support in supporting their teens during this phase of treatment. Fortunately, there are a number of resources for parents in this situation; some include:<br />
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<ul>
<li>aroundthedinnertable.org</li>
<li>maudsleyparents.org</li>
<li>feast-ed.org</li>
</ul>
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Finally, there are some teenagers whose ED is so deeply entrenched that inpatient/residential treatment is what is needed. Fortunately, there are very solid adolescent treatment programs in the US, many of which use the FBT approach. At that point, we will help facilitate the teen's admission to a treatment program, and provide ongoing support for the family, as there is still work to be done to make for a successful transition back home.</div>
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It is terrifying to have a teenager with an eating disorder. Parents spend a lot of time blaming themselves and trying to figure out what they did wrong. Eating disorders are not so simple as to be caused by one thing, including parents and families. But, by working together, the teen and parents can rid the family of the eating disorder, and strengthen their bonds. </div>
Wendy Hoyt, PhDhttp://www.blogger.com/profile/11139631318003393952noreply@blogger.com2