For Parents: First Few Weeks

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. 

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. 

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. 

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. 

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. 

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. 

For Parents: The Initial Session

 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.

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.

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.

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. 

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. 

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.

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. 

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. 

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. 

Starting a New Series for Parents Providing Treatment for Low Weight EDs at Home

 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.

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.

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.

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. 

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!

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!!!

Tenacity and Facing Fears

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.

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. 

This pic is an example of the early not-very-good riding. I basically am just sitting up there hoping for the best!

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.

This pic illustrates getting the job done, but not competently. Leaning forward, horse unhappy.

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 

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. 

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. 

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! ;)

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. ;)

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: 

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.

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. 

Treating Eating Disorders and Trauma via Telehealth

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. 

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. 

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.

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. 

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!

Pursuing 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!

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!

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. ;)

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!

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!).

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! ;)

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.

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!

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!

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.