Empowering the Healthy Self

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Clinical Director Zanita Zody, PhD and the Clementine Portland team help clients to empower the voice of their healthy self in order to challenge the eating disorder self voice. In her blog post, Dr. Zody gives insight into how to strengthen the healthy self voice and support client’s journey to full recovery.

Anyone who is intimately familiar with an eating disorder knows how damaging and destructive that voice can be. “You are disgusting,” “I can’t believe you ate that,” “If you don’t exercise every day you will get soft and gross.” This voice taunts and torments in a way that no one should have to endure. For those of you who have held on to hope and seen it first hand, you have also heard the voice of the healthy self; reminding you that there is more to life than the eating disorder. “I know how hard it is to nourish your body but it is worth it,” “your value is not determined by the size of your jeans,” “your friends like you for who you are, not how you look.” Differentiating between these two voices and empowering the healthy self (HS) can be an important part of recovery.

It is widely accepted that Cognitive Behavior Therapy (CBT) is one of the treatments of choice for eating disorders. CBT challenges distorted and irrational thoughts that lead to maladaptive behavior. Reiff and Reiff (1998) found that individuals with a DSM-defined eating disorder think about food and weight between 70% and 110% of the day (dream time accounting for the additional 10%). The voice of the HS can be used to challenge those ED thoughts and behaviors. Initially, this voice may be difficult to identify so it can be helpful for the therapist to point it out. From there, the individual can start journaling dialogues between the HS and ED or engaging in them internally. However it is done, the HS should have the last word.

Fear and uncertainty often accompanies the reduction of eating disorder thoughts and behaviors and in their absence emptiness is often felt. Returning to the eating disorder or other self-destructive behaviors may fill this void. On the other hand, if the healthy self is simultaneously nurtured and strengthened, there will be no room left for the eating disorder. It is also important to honor and respect the eating disorder as it is part of the individual and has served an important function in his or her life. Discovering what that is and allowing the healthy self to take over those responsibilities in adaptive and supportive ways can help lead to lasting recovery.

Reiff, D. and Reiff, KKL, “Time Spent Thinking About Food.” Healthy Weight Journal 12(6) (November/December 1998): 84.

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.

 

 


A Day in the Life of Clementine Pinecrest Staff

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The staff at Clementine Pinecrest work hard together to support their clients on their journey to full recovery. Clinical Director Bertha Tavarez, PsyD shares an inside look at what it’s like to be part of this special team in this week’s blog post.

At Clementine Pinecrest in Miami, FL, our office is embedded in a diverse treatment space where clients receive care and where they rest after a long day. We form part of the Clementine home, each member a thread that is weaved into a tapestry of healing and recovery. The staff shares one communal office, a living, breathing organism on its own. On any given day, the staff office is filled with inaudible sounds: laughter, insurance calls, parent update calls, and consultation among others! At Clementine Pinecrest our doors are as open as our hearts. No walls divide us and we are just a shoulder tap away from connection. We believe that this level of connection among the staff gets effortlessly transmitted into the undercurrent of our client community. Clients have often joked that Clementine Pinecrest staff is, well, “squad goals.” It’s empowering to know that we as providers are modeling the power of connection.

If I had to pick one central philosophy for the Clementine Pinecrest house it would be, “We are all responsible for the energy that we bring into the room.” We teach this lesson to our clients in sessions and groups, but most importantly we practice what we preach. We write each other gratitude notes on a regular basis. I can’t tell you how wonderful it feels to see a bright colored envelope placed on my desk as I am walking in to start my day. We also leave room for fun and creativity, and catch the clients off guard when we sing a rendition of “Let it Go!” A Clementine birthday is a special affair, as we spend weeks planning themed parties for unsuspecting staff members! It is an honor for me to be a member of this amazing team!

 

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.


Seven Key Developmental Needs Series: Meaningful Participation and Positive Social Interactions

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IMelissa McLain - 03 - TOP CHOICEn the second post on the seven developmental keys series, Senior Director of East Coast Clinical Programming Melissa McLain, PhD, CEDS shares about the next two keys: meaningful participation and positive social interactions. Dr. McLain explains how Clementine adolescent treatment program supports adolescents in learning to meaningfully engage with themselves, leading to positive social interactions with others as well.

The Center for Early Adolescence has defined fundamental developmental needs during adolescence as the following: Self-Definition, Meaningful Participation, Competence, Creative Expression, Physical Activity, Social Interactions and Structure. Today I want to write about the combination of Meaningful Participation, and Positive Social Interactions and how those can be integrated in treating adolescent girls.

Meaningful Participation:  Research from the Center for Early Adolescence stresses that adolescents “need to participate in activities that shape their lives.” That is, they need opportunities to identify, develop, and use individual talents, skills, and interests in the context of the real world. They need to participate in activities and experiences that allow them to reflect on and shape their personal values, beliefs, and goals. They need opportunities to make positive connections between their personal priorities and the needs and interests of others in order to become contributing members of the local and global community.

Positive Social Interactions: Though the family remains of primary importance to early adolescents, they need increasing opportunities to experience positive social relationships that allow them to explore emerging ideas, views, values, and feelings with peers and adult friends.

When we treat teens we consistently ask them to “meaningfully participate” and thus “show up” while spending time with us in treatment. We are working to engage them in their individual, family and group therapies, in their school time, in their social time with their peers and in time spent engaging in exposures and challenges.

It can be quite a challenge to fully participate in life when an eating disorder is taking up so much of one’s time. However, the great gift of engagement is connection. We find that oftentimes, even while in the midst of doing what may be the hardest thing they have ever encountered in their life before, our teens are gifted the experience of fostering and enjoying true connections with their family, their peers, the staff, and, most importantly, themselves. Being able to meaningfully engage with their newly discovered “healthy self” fosters improved self-esteem and oftentimes results in an increase in positive social interactions. As Daniel Siegal says in Mindsight, “The brain is a social organ, and our relationships with one another are not a luxury but an essential nutrient for our survival”. When treating adolescents, we feel privileged to be able to foster this improved connection with self and others.

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

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


What If My Daughter Develops an Eating Disorder?

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angie-color-head-shotAngie Viets, LCP is an eating disorder specialist who has dedicated her career to helping her clients recover. She shares her personal journey with an eating disorder as well as her professional experience in the field throughout her writing. In today’s post, Angie offers the unique perspective as a mother to a young daughter growing up with society’s pressures around body image. 

I’ll be honest – I worry about my sweet girl getting sucked into a world where she’s controlled by an eating disorder. Mothers have a fierce protective instinct to shield their children from harm. It is no wonder then, that the illness that consumed my every thought and decision, had damaging effects on my health, and robbed me of opportunities, would cause anxiety.

A study by the Keep It Real Campaign in 2012 reported that 80% of 10-year-old girls have been on a diet. Another study found that 50% of 3-6-year-olds worry about being fat. People often don’t realize this, however, eating disorders have the highest mortality rate of all psychiatric illnesses, as well as a high incidence of suicide. Given these grim statistics, how could I not want to spare her from this disorder; not to mention a world that is oozing with airbrushed images of objectified females.

I have a vivid memory of my daughter sitting on the kitchen counter as a toddler with nothing on but a pair of underwear and her brother’s football helmet. She’s smiling, perfectly content in a world that has yet to bombard her with messages about how she ‘should’ look. Her little tummy is full and round, just as it should be, and she’s unaware that as women we ‘should’ suck our stomachs in (who the hell came up with that idea?). I took a picture of her because I want to remind her that we ALL start out this way — playful, present in the moment, without a single worry about the body that is so miraculously allowing us to move and thrive.

My sweet Sophie is eight. In her eight years, she’s made two comments related to her body that stopped me in my tracks. The first time was in the dressing room at Gap when she realized she no longer wears a clothing size corresponding with her age. At age 8, she wears 10’s or 12’s. She genuinely seemed confused as she looked to me for an explanation.

We stopped. Right then and there, in the middle of the dressing room and had a talk sitting criss-cross applesauce on the floor. “Honey, the people that make clothes make up random numbers for what size might work for your age. It’s just a guess; that’s all. And sometimes, those guesses might work for you, but maybe not.” Her little wheels were turning, “Oh, like when people guess that I’m in the fourth grade instead of the second grade.” Relieved, “Yes, just like that.” My message was intended to let her know that her body was not “wrong,” nor had she “done something wrong.”

The other comment came when she realized she was going to be a base, instead of a flyer on her little cheer squad. “Mom, I want to be lighter so I can be a flyer. Were you a flyer when you were a cheerleader?” Internally, I was panicking because my desire to protect her is so strong and, the reality is, weight is one variable when coaches make those decisions.

Taking a deep breath, I said, “Here’s the deal sister, you are one of the oldest girls on your team, not to mention one of the very tallest girls, and that’s how they decide. If you were on a squad with girls that were older than you, you would be a flyer. And yes, I was a flyer because I wasn’t strong enough to be a base. You, on the other hand, are strong, and are likely one of the strongest girls on your squad.” She buckled her seatbelt, smiled, and flexed her guns while saying, “So what are we having for dinner tonight?”

My momma brain is highly emotional. My therapist brain, however, is logical and knows some things for sure:

  1. There is no one more qualified to know what to do if their daughter developed an eating disorder than someone who has recovered, and who has dedicated their career to helping others recover. I know the warning signs. I know early intervention is key. I’ve got this!
  1. We talk in our family about diversity, and how special it is that not everyone has the same skin color, religious beliefs, sexual orientation, or body type. Wouldn’t that be boring if we were all the same?
  1. We talk about strengths that are completely unrelated to appearance and more values-based. I ask, “Tell me what you did today that made you feel proud of yourself?”
  1. We also talk about when we felt ashamed, embarrassed or sad. My husband and I model this for them, saying things like, “Ugh, I felt so embarrassed today when I said something dumb in front of my colleagues.” Normalizing and actively expressing emotions, helps them get into the routine of this, so they don’t bury them and find maladaptive ways for coping.
  1. We don’t label food as “good” or “bad.” If I’m with a group of women, whether my kids are in earshot or not, if diets or body shaming comes up, I either change the subject or walk away. I don’t want them to think this is “normal” conversation. Not cool.
  1. We don’t go on diets in our house or eat separate meals from our kids. I grew up with a family member who would prepare beautiful meals and then as we all sat down to dig in, she would warm up a frozen Weight Watcher’s meal for herself. What kind of message does that send? Um, really?? So confusing!
  1. I also know that although my daughter sometimes seems like a mini-me, she’s not an extension of me. She’s her own little independent self. Yes, we share similarities, but we also have very separate stories. By the time I was her age, I had already gone through a significant trauma. Between my personality and environment, I was a prime candidate for developing an eating disorder. We are different in this way.
  1. Last, and probably most important of all, is that as mothers we desperately want to wrap our children, no matter what their age, in a protective cocoon, but we can’t. Truth be told, we wouldn’t want to either. Aren’t some of our deepest hurts and biggest failings where we learned the most about ourselves, witnessed our strength, and increased our humility?

Rumi says, “The wound is the place where the light enters you.” My professional passion and purpose were born out of my pain and suffering. The years I spent in solitude with my eating disorder, and what I learned from my hard-won fight to recover has driven me like a mad woman on a mission to help others. So do I want my child to have an eating disorder, hell no, but I also know I don’t want to dismiss the beauty of what could possibly be the outcome of any of her struggles.

So, to my mommy tribe out there who worry about their babes, let’s grab each other by the hand and join in a shared mission to support each other when we hurt over their hurts. We are all in this together!

Love + Light,

Angie

*Note – Please know that I’m not dismissing the risk for males developing eating disorders – I have two beloved son’s and intend to address boys in a future post.

 

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

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


Meet Our Team: Jeanette Alonso

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Clementine Family Therapist Jeanette Alonso has been an integral part of the Clementine treatment team since the doors opened in 2014. Jeanette provides families and adolescents the support and care needed to heal through her family therapy sessions. Learn more about Jeanette and her work at Clementine by reading this week’s “Meet Our Team”…

 

What is your name and what are your credentials?  

My name is Jeanette Alonso. I am a Licensed Mental Health Counselor.  I am a Family Therapist at Clementine Pinecrest and have been since it opened its doors in October 2014.

Please give us a brief description of your background.

I attended the University of Miami where I received a Bachelor of Arts in Psychology with a minor in Human and Social Development and then went on to complete my Master’s in Mental Health Counseling at UMiami as well.

Prior to OPC & Clementine, I worked exclusively with Post-Traumatic Stress Disorder and sexual trauma conducting individual, family, and group therapy where I developed an expertise in Trauma-Focused Cognitive Behavioral Therapy as well as other evidenced based practices aimed at children, adolescents, and adults.  I also received certifications in Play Therapy and Infant Mental Health. In 2010, I began working at the Oliver-Pyatt Centers and worked within all programs: residential, intensive-outpatient and transitional living where I developed a specialty in the diagnosis and treatment of eating disorders. I then moved into a family therapist role when Clementine opened in 2014 where I get to work closely with families and adolescents in critical need of support at a higher level of care.

What does a typical day look like for you at Clementine?

Typically my day begins by meeting with team members to discuss the most updated clinical information on each of my cases. I then hold family sessions indoors or outdoors (weather permitting). Sessions are either done in person or via computer with parents.

In your own words, please describe the philosophy of Clementine.  

Each client and their treatment is highly individualized and specifically addresses the needs of the client. No one client is treated the same and treatment follow up and goals are all developed from a multidisciplinary approach that captures every overall aspect necessary to treat the ED. The family oriented, loving, and warm environment is the backbone of all the work and dedication that goes into treating the ED.

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

“Teamwork is the dreamwork”. The close team approach is essential and at Clementine the team is always in close contact via email, phone, personal meetings, and shared office space that constantly lends itself to continuous process and discussion on how to best manage each client and family’s individual needs. As a family therapist, my role at times may overlap in similarity to the primary therapist role.  My specific role, however, involves more one on one contact and support to the parents as well as sessions that involve both client and parents that aims at solely focusing on the family system and the role of the ED.

What is your favorite thing about Clementine?  

My favorite aspect of Clementine has been the people I have worked with, the passion and dedication to saving lives, and the outcome stories of so many brave and beautiful women and girls that have gone on to live lives free of EDs.

What are three facts about you that people do not know?

I am terrified of lizards, I used to sing in the church choir and can actually sing, and my driver’s license says my height is 4’11” but I’m actually and inch shorter!

 

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

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


The Heart of Clementine Nursing

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vanessa-hernandezClementine Adolescent Treatment Program Nurse Vanessa Hernandez, RN shares the important role nurses play in supporting the adolescents on their journey to being fully recovered. She explains the strong rapport built with the adolescents and the nurses’ willingness to be by their side every step of the way.

The very core of Clementine Nursing is muddling through the intricacies of their life, their recovery, and their medical care right along with them. It’s countless hours of teaching. You have to maximize that learning brain and boy, are they open to learning! “What is going on with my body and why?”

Ahem, well..

Clementine Nursing is owning up to the inevitable awkwardness of the conversations, medical visits, complaints, and procedures–and letting them know, it will all be okay.

“Listen, we’ll get through it together.”

It’s slowly, but surely; detangling the responsibility of their medical care from their parents, onto yourself, and eventually; onto themselves.

Clementine Nursing is setting high standards for my girls, because they are the smartest, most willing ladies in all of Miami.

They can recite every skill in their DBT workbook and their medications. They can willingly sit out from yoga and sip a cup of Gatorade because they’re feeling dizzy in that moment, and self-care comes first. They can sit through receiving their Dexascan results and understand exactly what Dr. Jahraus is telling them.

They can do all this, because their nurses took the extra minute to teach and because they know they must honor their bodies by giving it what it needs.

The heart of Clementine Nursing lies in the art of building their own sense of security in their bodies, their knowledge, and their processes. It’s building enough rapport with them that they can come to you with any complaint–and they definitely will!!

It’s building enough rapport within themselves that they can access the underlying factors of their physical ailments.

“What emotions am I feeling right now that might be driving this stomach pain I’m experiencing?”

“What is the reason I am requesting this Miralax, because I feel guilty over ordering dessert, or because I truly need it?”

We poke and prod. We ask insightful questions. We have embarrassing sessions.

We use therapeutic insight and weave it into nursing knowledge to see them holistically.

To us, they are not their weight, vitals, or medications.

Their bodies haven’t failed them. Their eating disorders have.

They are powerful young ladies, claiming their voices, their health, and their lives.

The heart of Clementine Nursing allows us to see this since their first day.

And the true reward, is when they begin to see it for themselves.

 

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

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


The Moment of Discovery

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Nancy Mensch Turett is the founder of WholeView, a consultancy to empower leaders to generate health across their personal, professional, and public life-spheres through holistic thinking and action. She will be contributing a series of blogs sharing her personal story of supporting her daughter on her journey to being fully recovered.  In part one of her series, she tells of the “Moment of Discovery”.

When colleagues invited me to offer my perspectives about eating disorders (ED) publicly, my immediate reaction was sure, this makes sense. I’m a professional communicator. I help other leaders find their holistic voice and share their insights broadly to generate health and well-being. I should follow my own advice. And it’s certainly true that ED demands a WholeView — it develops from a perfect storm of factors, manifests in several forms, and can be cured only through a holistic approach to treatment.

Before I jump in, given that there were many dark and difficult times, you should know that there’s a happy ending: my daughter is well. Thriving. As is the whole family. More on all that in future postings. Also, importantly, with her crisis behind us, my daughter is in favor of my sharing experiences and insights that might be helpful to other families. Her only caveat: that I use just my nickname for her, “Rosie.”

OK, so I resolved to share my story. But how to tell it? Where to begin? Like every family’s, our ED odyssey is long and winding. In some ways, it started at the start of Rosie’s life. It definitely continued through most of high school.

There’s so much to share. So my story will be told in chapters, with a different installment each month until I’ve filled in the chapters from beginning and end. Today, however, I start in the middle, at the Moment of Discovery, for the many other moms and dads out there who are sitting there right now, disbelieving, shell-shocked, and terrified. That fateful time when you suddenly realize that your lovely, loving, and “healthy” child is in fact terribly ill.

Discovery for me happened on a sparkling, below-freezing day in January 2010. I’d been looking forward to a “girl’s day out” – a special time when Rosie and I say bye to all the “boys” (3 brothers, one dad) to follow our own agenda, i.e., Shop. Lunch. Shop. Chick Flick or maybe Mani Pedi. Deliciously mother/daughter.

It couldn’t have been more than 11 AM when the day started to sour. In the car with Rosie, I was enjoying the bright snow and munching on a protein bar. When I offered Rosie a bite she turned to me from the passenger seat of the car and screamed NO. And a minute later she told me to stop chewing – that it sounded disgusting. Telling myself Rosie was just behaving the way 12 year olds are supposed to behave, I tried not to be alarmed.

But the first stop of the day was a wreck. We had planned to design stationery together. Parking the car and brightly cautioning Rosie to watch out for the ice, I got no lighthearted “ok mom” or even a “you don’t have to tell me that any more.” Rosie turned away and walked to the door of the shop. Once inside, Rosie refused to speak with the salesperson offering options for custom cards and simply glared at me. Feigning cheer, I excused us and promised to come back another time soon.

Having jettisoned the first part of the day’s plan, I suggested we move on to lunch. Silence. OK, let’s listen to music rather than chat en route to the deli.

Our easy tradition was to order a couple of items together to split. This time, no such thing. Not only didn’t Rosie want to share, she couldn’t even decide what she wanted. Conscious of the line of customers waiting behind us, after just a bit more cajoling, I put in an order. Something easy, like a turkey sandwich and a bag of those salt and vinegar chips Rosie favors. At the table, she couldn’t manage to take a bite. Actually, she couldn’t manage to stay seated. Pacing around the little restaurant, Rosie was clearly uncomfortable with the simple concept of eating lunch. I felt sick but smiled and ate and didn’t make a big deal of it when Rosie consumed nothing but a few chips and a can of Diet Coke. But still tried to file it away in my brain as just one of those tween things… no big deal.

Next up was to be the highlight of the day: Shopping for a special-occasion dress for Rosie. Given how much she loves dressing up, I anticipated our both having a great time while Rosie tried on a variety of frothy numbers. This was our first time clothes shopping together since before Thanksgiving, and Rosie, at 12 and a half, was clearly getting taller and I figured, developing a woman’s shape. Having mentioned her desire to lose her “baby fat” over the summer, and just having gotten her first bra, I hadn’t thought it odd that I hadn’t seen her undressed for a few months. Rosie was just private about her body as I was too on the cusp of adolescence. Totally normal.

With a few items she and the salesperson selected, Rosie went into the dressing room to try on the first dress. What transpired next was surreal: A young girl came out in a form-fitting dress. With Rosie’s face but a stranger’s body. Thin. Very thin.

As I’m telling myself this is not good, others in the store, staff and customers alike, ooh’ed and ahh’ed at Rosie’s appearance, saying things like “you look amazing” and “you should be a model.” No she didn’t and no she shouldn’t.

I slipped outside to call my husband. I did my best not to break down right there on the sidewalk when telling him that something was very, very wrong. Our Rosie – our healthy, smiling, never-complaining, lovely child was not well. How could she — seemingly overnight – morph into a too-thin, very-tense, and apparently humorless pre-teen? What did we do wrong? What should we do now?

And then I got a grip. I told myself that my daughter is sick. That I don’t know how or why it happened but it was important that her mom and dad keep as calm and steady as possible. I cannot say we always achieved this goal, but keeping in mind that our behavior would affect her sense of things helped a lot.

Driving home in the car together, it was already dark at 5:00 so there was nothing to look at but the lights on the highway ahead of us. I didn’t know what to say. Rosie filled the space easily. While she didn’t mention the new dress, or the shoes, or the special event it was all for, she spoke with elation about now “being” a “2” or maybe even a “0” (a size I hadn’t known existed). Any spark of hope I had that she wasn’t sick was extinguished.

I was frightened about what would lay ahead for Rosie. But resolved that we would get her well, ASAP.

That evening, we called an eating disorders specialist and the next day, my husband and I were sitting in her office. The doctor asked many questions, and as we answered each with a “yes” I began to weep with fear and worry. At that meeting on that Sunday, we learned four important things:

  1. Our daughter was suffering from anorexia nervosa.
  2. With specialized care including parental commitment to participating fully, this potentially fatal disease was curable.
  3. That time was of the essence. We needed to do all possible to keep the disease from taking deeper hold in her brain. No more dismissing her withdrawn mood, weird eating habits, and baggy clothes as nothing more than ordinary tween stuff.
  4. That ASAP is the right thought for accepting the diagnosis and getting going on treatment, but not a realistic mindset for time to full recovery. We had a long haul ahead of us and life for our entire family would never be the same.

The sooner we accepted the enormity of this, the better for Rosie. It felt like the nadir of our lives. How could it not? But in retrospect, I see that it was the beginning of our facing the truth and getting Rosie the help she needed for a real chance at a full life.

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.


A Fine Line: The Intersection of Mental Health and Medicine in the Treatment of Eating Disorders

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Joel JahrausLaurenOzboltClementineBlogClementine’s Chief Medical Officer Joel Jahraus, MD, FAED, CEDS and Medical Director Lauren Ozbolt, MD, CEDS oversee the psychiatric care and attending psychiatrists at all Clementine adolescent treatment program locations. In their writing, they share the many challenges with eating disorder treatment and the broader implications for adolescents and young adults. They stress how accurate diagnosis and treatment necessitate the interaction of a multidisciplinary team including mental health, medical and nutrition.  

I have yet to see any problem, however complicated, which, when you looked at it the right way, didn’t become more complicated.” –Paul Anderson

To say eating disorders are multi-faceted illnesses would be a serious understatement, as any professional in the field would tell you. Not only do treatment teams have to find a balance between their different disciplines when addressing complicated medical and psychiatric issues, but they also face the added challenges of working with patients who are often unhappy about being in treatment, tend to have difficulty trusting treatment providers, may feel in denial of their condition or resistant to treatment, and on top of everything else may face legal or financial barriers to seeking proper treatment. All of these obstacles don’t even begin to cover the myriad of psychiatric and medical comorbidities that typically present in a patient with an eating disorder.

When unraveling an eating disorder medically, we are first encountered with the challenge of discerning whether or not symptoms such as dizziness, tremors, and heart palpitations are the result of malnutrition, dehydration, altered metabolism or from psychiatric manifestations such as anxiety.  Additionally, we also come across co-morbid medical conditions such as hypothyroidism, anemia, and atypical chest pain (just to name a few) that can in turn cause psychiatric symptoms. When psychotropic medications are introduced into the equation, it is important for the team to be vigilant as they themselves can have side effects that can manifest as medical or psychiatric complications. This constant presentation of symptoms that compete for both medical and psychiatric care calls for effective and cohesive clinical integration when treating clients with eating disorders. The underlying illness, whether psychiatric or medical may be challenging to diagnose and one should not immediately rule out the other when complications arise. People with mental health issues often get physically ill; they are not mutually exclusive.

It is clear that there are a multitude of considerations to make when first meeting a client and as promised, the problem is only more complicated when we hone in on any one aspect of the illness. When it comes to evaluation and treatment planning, once again, clinical integration is key. There are several general considerations that we recommend taking into account when first meeting a patient:

  1. Be suspicious- patients may make evaluation more difficult, either by being unwilling to give a full history, unable to give an accurate description of symptoms or too frightened to allow a full physical exam.
  2. Remember that patients with mental illness develop medical problems too.
  3. Be alert for presentations, which make medical illness more likely, but don’t stop considering a medical illness just because they don’t initially fit.
  4. Look for symptoms that make medical illness more likely.
  5. Do not assume a certain symptom “must” be of psychological origin.
  6. Be holistic- note the patient’s feelings and functioning within the current context as well as what happened in the past.

Above all, it is important to be aware of the limitations placed on a patient’s capacity for recovery when looking at a complex illness through a narrow lens. It is crucial that clinicians are acutely aware of the urgency of the patient’s needs, whether medical or psychiatric, and appropriately empathize with the individual to reassure them that you understand their concerns. They need to know that you will you will work to help them feel better whatever the cause.  Integration of the various disciplines involved in the care and treatment of eating disorders takes collaboration. With balance, careful consideration of contributing factors and regular communication, eating disorder providers can successfully help treat their patients in a holistic and effective way.

To learn more, join Dr. Jahraus and Dr. Ozbolt in Tarrytown, NY at the Westchester Marriott on September 15th. RSVP to Professional Relations Manager Jennifer Vargas (jennifervargas@montenido.com).

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.


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.