Seven Key Developmental Needs Series: Self-Definition

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Melissa McLain - 03 - TOP CHOICE
Senior Director of East Coast Clinical Programming Melissa McLain, PhD, CEDS will be sharing about the seven key developmental needs for adolescents throughout a blog series. In her writing, Dr. McLain explains the first key, self-definition, and how Clementine supports the adolescent throughout her recovery journey in learning and defining her sense of self.

Adolescence has been referred to as a period of “storm and strife”. However, at Clementine, we would prefer it to be one of growth and perspective. Within that, we understand that there are key developmental needs that are extremely important to be mindful of, and sensitive to, during this pivotal period. In fact, the Center for Early Adolescence has defined these needs as the following: Self-Definition, Meaningful Participation, Competence, Creative Expression, Physical Activity, Social Interactions and Structure. To clarify how Clementine programs meet these seven needs I’ll be doing a series of blog posts on each one. We’ll start today with self-definition.

One of the seven essential developmental needs of an adolescent is that of “self-definition”. Well that makes sense, doesn’t it? As we know, adolescents are working hard to observe the world and their place in it. Throughout adolescence they have an ever-emerging understanding of their individual identity. Whether or not an adolescent has an eating disorder, we must acknowledge that this process goes hand in hand with puberty- which means an adolescent is getting to know their “self” just as their body is changing in new and unknown ways.

When an eating disorder is present in adolescence this process of self-definition becomes even more challenging. An eating disorder can quickly become the strongest “identity” for a teen. It may be more comfortable to be known as the “thinnest person in the room” rather than the complex parts that make up their self. Many of our teens discuss how scary it can be to move away from their eating disorder when it has played a central role in their identity.

However, the advantage of adolescence is that it is also a time of great flexibility. We have seen so many adolescents come to Clementine and work hard to redefine their fledgling sense of self. The true gift of recovery is a new self-identity free from the eating disorder. When a teen can understand and embrace their “healthy self”, it allows them to also develop hope and excitement for their future and what their new identity, and new body, will provide for them along the way.

For more information about Clementine adolescent treatment programs, please call 855.900.2221, visit our websitesubscribe to our blog, and connect with us on Facebook, Twitter, and Instagram.

To visit or tour a Clementine locations with one of our clinical leaders please reach out to a Clementine Admissions Specialist at 855.900.2221.


The Intersection of Mental Health and Medical Treatment of Eating Disorders

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Joel Jahraus
Chief Medical Officer of Clementine adolescent treatment programs Joel Jahraus, MD, FAED, CEDS specializes in medical management of patients with eating disorders. He has been a board certified physician for over 30 years and is a recognized expert on diabetes and the medical complications of eating disorders. Dr. Jahraus shares his experience of treating patients with comorbid disorders. He explains how he uses a systematic approach in order to establish a strong rapport with the patient and then is able to assess and treat the complex case.

Over many years of treating medical complications of eating disorders I have watched an interesting trend of patients claiming to have more and more medical comorbid disorders. In fact it is not uncommon for me to see someone who says they struggle with food allergies, irritable bowel syndrome, lactose deficiency and gluten enteropathy. This creates a complexity that is challenging to say the least. It requires a well-coordinated effort between medical and mental health clinicians to truly evaluate the validity of the medical illness claims and their integration with anxiety, depression and other comorbid mental health disorders as well as the eating disorder itself.

Fortunately relatively definitive and objective guidelines are available to assess each of the comorbid illnesses. Yet too often patients come in either self-diagnosed or without a complete work up and have fully come to believe that they indeed have a food allergy or IBS. In addition there are often family issues related to medical disorders where the individual is told to even expect that they will have these disorders due to family history of the same. Given the typical challenges of refeeding with gastrointestinal symptoms and heightened anxiety this can easily throw the patient’s recovery off course. I have found that there are several caveats that will set the stage for a better-informed patient and family that often mitigates some of the challenges of refeeding. Education is power and food is medicine so I begin with that premise. Then I use a systematic approach to build trust with the patient as we progress through a workup:

1. I validate the patient’s concerns and reassure them that I will be sure to evaluate their physical concerns and help them understand physical versus emotional symptoms and how these symptoms are related to each other. I provide examples of emotional symptoms causing physical illness like stress and anxiety causing high blood pressure or stomach ulcers. I want them to understand that I am not dismissing their symptoms as “just emotional” but rather that finding their true cause will allow us to help them feel better whatever the cause.

2. I review the work up (or lack of one) regarding each condition and then outline what is needed to be complete and have an accurate diagnosis. I also tell them that even if they do have a physiologic medical illness it may well improve with achieving a healthy body weight and maintaining healthy nutrition and healthy eating habits while eliminating eating disorder symptoms.

3. I order appropriate consultations and testing as indicated and review the results with the individual outlining both medical and psychological treatments that will help them including the use of stress relaxation and medical and psychiatric medications whether prescription or over-the-counter meds including nutriceuticals and complimentary therapies.

4. I assure the individual that we will proceed through treatment with regularly scheduled appointments for follow up so they don’t need to worry that they are simply being dismissed.

With this approach I have had significant success in evaluating and treating these increasingly complex cases. We all know how rewarding it can be to have an individual so restricted by the complex medical and psychiatric illnesses associated with eating disorders to suddenly find new life and relief from the burdens of physical and emotional pain and worry!

 

For more information about Clementine adolescent treatment programs, please call 855.900.2221, visit our websitesubscribe to our blog, and connect with us on Facebook, Twitter, and Instagram.

To visit or tour a Clementine locations with one of our clinical leaders please reach out to a Clementine Admissions Specialist at 855.900.2221.


Healing Injuries that have Occurred “Around the Table”

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Amanda MellowspringClementine Director of Nutrition Services Amanda Mellowspring, RD/N, CEDRD is a Certified Eating Disorder Registered Dietitian with over a decade of experience in program development and clinical application working with eating disorders at various levels of care. She shares how the food exposures and challenges at Clementine help clients in their recovery process.

Most often by the time an individual admits to one of Clementine’s residential treatment programs, the client, the family, and their peer group are afraid, frustrated, and exhausted. Oftentimes, many emotional injuries have occurred along the way. Many of these have occurred surrounding food.

With eating disorders, food is the vehicle through which feelings are expressed that otherwise may not be spoken or heard. For this reason, food symbolically consumes the family and the peer group for these individuals. Family meals become tense if not obsolete because of the frustrations and anxieties associated with food selection, preparation, quantity, and behaviors at the table. Dining with friends is no longer a fun way to catch up, laugh, and share stories. It becomes a terrifying task of eating enough of the “right” things to seem “normal enough” and not ruin everyone else’s fun as her mind races with thoughts of hidden calories, special orders, and comparisons.

In healing these injuries, it is vital that each client at Clementine, not only achieves a state of health and wellness with appropriate food intake and nutrient balance but that she also begins to experience freedom in her experiences with food.  Food exposures and challenges with staff, with family, and individually are all important ways of doing this. This aspect of recovery takes practice in self-confidence with nutritional needs and honesty in honoring all of the aspects of food that make it enjoyable in our lives. Being able to cook a meal with mom and dad, go on a picnic, order in for a movie night, or go out for ice cream on a pass are all examples of ways that Clementine clients have practiced this healing.

During these exposures clients are not only practicing eating foods they like and desire in appropriate quantities to support their body’s needs, they are also challenging messages regarding comparisons with others, seeing calorie information posted in restaurants, managing herself while others around her may feed themselves differently, and working to be present in the moment socially and emotionally to enjoy the opportunity to be with friends or family.

The Clementine dietitian works closely with the entire treatment team and family to ensure that the dynamics surrounding these injuries at the table are acknowledged and approached with compassion for both the client and her family members.

Obtaining a state of health and awareness of how to nourish one’s body appropriately is vital in recovery, while healing the injuries that have occurred around the table offers peace and serenity for these individuals allowing them to move forward in their life and recovery without the wounds of the eating disorder.

 

For more information about Clementine adolescent treatment programs, please call 855.900.2221, visit our websitesubscribe to our blog, and connect with us on Facebook, Twitter, and Instagram.

To visit or tour a Clementine locations with one of our clinical leaders please reach out to a Clementine Admissions Specialist at 855.900.2221.


Bright Yellow Beach Ball

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BerthaTavarezClementineBlogDr. Bertha Tavarez, Clinical Director of Clementine adolescent treatment programs, speaks to the benefits of experiential therapy techniques to be utilized within a therapeutic relationship as well as among professional colleagues. 

I was recently invited to present at the 10th annual Latin American Eating Disorder Conference in  Mexico. I was encouraged to present a clinical topic that was “different”, “new” and “cutting edge.” I decided to create a presentation on experiential therapy techniques and how to incorporate them into eating disorder treatment. Soon, my creative wheels were turning, and I planned on several therapeutic demonstrations, work samples, and props that may facilitate warm up therapy exercises.

I combed through a labyrinth of Walmart aisles looking for the perfect prop that I could use as an ice breaker. The prop needed to be accessible enough to quickly flow through a large audience with the power to break the monotony of hours of lecturing. Did I mention my presentation was at the end of the day? In a moment of inspiration I saw it! Among a myriad of seasonal toys I spotted a bright yellow beach ball with a large smiley face stitched on. The plan was to throw the ball at a person in the audience, asking them to state their name and one word that best represented their inner self before passing it to another person, and another, and so on.

The next morning, I boarded an airplane with my bright yellow beach ball safely stowed. After the beach ball was scanned for explosives residue (true story!) I was on my way to the conference, softly whispering talking points to myself as I took in the sights of the bustling city of Monterrey. I arrived in time to sit in on a presentation on the epigenetics of eating disorders. As I marveled at the research studies being presented, I stared down at the bag containing my ball, and became flooded with thoughts about how my bright yellow beach ball paled in comparison to talks of ventricular enlargement.

After a welcoming introduction, I approached the podium with a mixture of trepidation and resolve. I stated that no presentation on experiential therapies can be devoid of experience and action, and with a brief explanation, and a flick of the wrist, I tossed the bright yellow beach ball into a sea of audience members. Soon, the room lit up with a choir of voices. “Ana, Intelligent!”, “Carmen, Loving!”, “Sandra, Patient!” For days these people were introducing themselves by their titles and affiliations, but for one moment they connected on a universal human level with the help of one unsuspecting prop.

 

For more information about Clementine adolescent treatment programs, please call 855.900.2221, visit our websitesubscribe to our blog, and connect with us on Facebook, Twitter, and Instagram.

To visit or tour a Clementine locations with one of our clinical leaders please reach out to a Clementine Admissions Specialist at 855.900.2221.


An Open and Informed Medical Approach

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LaurenOzboltClementineBlog

 

Medical Director of Clementine Lauren Ozbolt, MD is board certified in adolescent, adult and child psychiatry and oversees the psychiatric care and attending psychiatrists at all Clementine locations. Dr. Ozbolt explains how she uses a systematic approach in order to establish a strong rapport with the adolescent and the family in order to recommend the use of psychopharmacology.

After years of treating patients with eating disorders, I know the word “psychiatric medications” often sends chills down one’s spine.  Furthermore, the idea of using psychiatric medications in adolescents is frequently the stuff of parental nightmares. It is true that some adolescents have been scarred by memories of taking psychotropic medications without explanation or have felt “bullied” into taking medications.  I find that many teens are terrified of psychotropic medications and have false preconceived notions about how medications work.  As one young girl timidly told me, “I will be a zombie.” (Cue Walking Dead episode)

Thus upon meeting a new adolescent at Clementine, I typically don’t introduce the idea of taking psychotropic medications for the first few weeks of treatment (provided they are psychiatrically stable).  I find it is much more valuable at this stage of the game to establish rapport.  I really want to take the time to get to know the patient, focus on the nutritional aspects of treatment and try to gain a better understanding of the function of the patient’s eating disorder.

After seeing the adolescent daily for several sessions and establishing rapport, I then may make medication suggestions.  Psychotropic medications can be very helpful in the treatment of certain eating disorders targeting such symptoms as anxiety, depression, obsessive thoughts and food preoccupations.  I spend a great deal of time providing education about the medication, how it works in the body, risks, benefits and side effects.  I will often tell the adolescent what they will find if the “google” the medication and why or why not this may apply to them.  I never push a medications though, and often suggest that they take a few days to think about the medication and discuss it with their parents.  I similarly, give the parents the same extensive psychoeducation and rationale for my recommendation.  If the adolescent decides not to take psychiatric medications, again, I never push or try to convince her to take medication. I don’t believe in trying to convince people to take medication they don’t want to take—especially an adolescent who is in the separation-individuation stage of development where opposition is the rule.  Instead, I support the adolescent in their decision all the while, leaving the option for medication open.  I find this open approach coupled with a relationship that fosters trust and mutual respect sets a firm foundation for change.

 

For more information about Clementine adolescent treatment programs, please call 855.900.2221, visit our websitesubscribe to our blog, and connect with us on Facebook, Twitter, and Instagram.

To visit or tour a Clementine locations with one of our clinical leaders please reach out to a Clementine Admissions Specialist at 855.900.2221.