The Sun and Wind Dispute: Navigating Motivation and Readiness for Change in Adolescents with Eating Disorders

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Clementine Miami Pinecrest Clinical Director Bertha Tavarez, PsyD discusses treating an adolescent who is resistant and treatment ambivalent. Dr. Tavarez offers some strategies to help strengthen the therapeutic alliance and build the groundwork necessary for full recovery. 

“The sun and the wind were having a dispute as to who was more powerful. They saw a man walking along and they had a bet as to which of them would get him to remove his coat. The wind started first and blew up a huge gale, the coat flapped but the man only fastened the buttons and tightened up his belt. The sun tried next and shone brightly making the man sweat. He took off his coat.” – Anonymous

The metaphor of the sun and the wind is an accurate depiction of the challenges that many clinicians face while working with adolescent patients. Although we may have access to the gravity of our patient’s clinical needs, simply communicating our concerns and providing much needed skills can be met with resistance. Our patients remain “locked in” to their emotional experience while simultaneously feeling “locked out” of the insight and motivation needed to increase their receptivity to much needed skills development. The adolescent, preoccupied with exerting and maintaining control and autonomy, may hold tightly to their coat, rendering our intentions to provide care futile.

So how do we, like the sun, create shifts in awareness and influence change?

The power of reflection

It may be tempting to adopt the roll of cheerleader (“You can do this!”) or problem solver (“Why don’t you try this?”). When an adolescent patient presents with resistant talk (“I don’t want to be here”) or talk that inhibits change (“I got straight A’s with ED, what’s the problem?”). Often the simplest and most effective way of building rapport and loosening the grasp of resistance is to simply reflect the patient’s message in your own words. Often, patients are primed for persuasion and direction. Reflection statements can contribute to feelings of validation and interpersonal trust.

Resistance as an interpersonal process / Resistance as developmentally appropriate

It is important to keep in mind that resistance is both developmentally appropriate for adolescent patients and an interpersonal process that occurs within the therapeutic alliance. Although, we may expect a certain degree of resistance on a developmental level, we can provide corrective experiences around resistance that still promote autonomy. A clinician may benefit from awareness about the resistance that is brewing in a session, abstain from engaging in a power struggle, and promote an alliance with the patients’s desire for autonomy.

Highlight intrinsic control

An effective technique that facilitates a shift from resistance talk to change talk is the clinician’s emphasis on the patient’s access to her personal control. A clinician may reflect the pros and cons experienced by the patient:

Patient: “I got straight A’s with ED, what’s the problem? Gosh! That was so hard!”

Therapist: “It sounds like you did well in school this year, but ED made it more difficult.”

A clinician may also reflect a patient’s choice within the constraints of the treatment environment while having the knowledge of the consequences. For example, the patient may be informed of her choice to select what day an exposure is initiated or asked to reflect on her choice to not participate in a group while being aware of consequence of losing a daily privilege as a result.

Shifting focus  

If resistant talk persists, the clinician can shift the focus to another closely relevant therapeutic topic that may tie into the overall theme beneath the resistance. For example, if the patient states, “I don’t want to take medications and that’s final!” the clinician can say, “Ok, how about you tell me how you’re feeling about your overall health today?”

Working with patients experiencing resistance and treatment ambivalence can be challenging. However, there are great opportunities at this treatment phase that can strengthen the therapeutic alliance and build the ground work necessary for lasting change. Motivational interviewing and person-centered techniques are an integral component of the clinical work at Clementine adolescent treatment program.

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.


Back to School

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The start of a school year includes many varied emotions and feelings. Our Clementine adolescent eating disorder treatment program team members have compiled a list of some of their favorite quotes, tips, and advice on maintaining recovery and thriving throughout the school year. We wish all of you returning to school a happy and healthy year!

 

Ten quotes to start the year:

The way we see the problem is the problem.

The main thing is to keep the main thing the main thing.

Live out of your imagination, not your history.

We are not human beings on a spiritual journey. We are spiritual beings on a human journey.

Motivation is a fire from within. If someone else tries to light that fire under you, chances are it will burn very briefly.

Management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall.

Effective leadership is putting first things first. Effective management is discipline, carrying it out.

There are three constants in life… change, choice and principles.

Trust is the glue of life. It is the most essential ingredient in effective communication. It is the foundational principle that holds all relationships.

While we are free to choose our actions, we are not free to choose the consequences of our actions.

Beginnings are scary! Remember that things are only new for a day. Trust yourself and know that you will adjust and find your way through it.” 

– Clinical Director, Clementine Pinecrest Bertha Tavarez, PsyD

Remember it is OK to be you. Those that really care about you will love you for you and accept you for all of your uniqueness.” 

– Primary Therapist Coral Seco, MS, RMHCI

 

Activity:

Make a Bio Poem: Things you want others to know about you

I like it when _______

It upsets me when _________

Anything you want to add that you want others to know about you.

Decorate it to illustrate the true you!

 

Take it one day at a time.” 

– Recovery Coach Manager Rebecca Garcia

It is essential to fuel your brain and body for a new school year! Make sure to wake up with enough time to have breakfast before school. Prepare your lunch the night before. Pack portable snacks to make snack time easier; try trail mix, chocolate covered pretzels, or peanut butter crackers.” 

– Registered Dietitian Alyssa Mitola, MS, RD, LD/N

Advice:

Make long and short term goals.

Use a planner with a schedule and decorate it.

Create a Top 10 list of where to seek and find help when you need it. Have contact information included for easy access.

 

Stay hydrated during the day. Remember to take your vitamins and meds. But, most importantly, listen to your body; when you need to re-fuel, when you need a study break, when you need to close those books and re-charge. Honor your body, as well as your mind. It’s going to be a great school year!” 

– Clementine House Nurse Vanessa Hernandez, BSN, RN

Doing one thing at a time will get everything done.” 

– Primary Therapist Jessica Aron, PsyD 

Advice:

Learning well is always more important than getting A’s.

When frustrated with homework or an assignment, leave it for a while, do something else, then go back to it.

Aim at being your best self and that will suffice. You can never be a better cat than a cat. If you are a butterfly, be the best butterfly you can be.

 

Consider joining a club or getting involved in extracurricular activities. It can be a nice way to spend time connecting with peers, meeting new friends, and getting involved in community service and your school.

– Primary Therapist Jeanette Alonso, MSEd, LMHC

School is important, but not more than your inner peace and fulfillment. Choose a schedule that allows you to create balance.  Just because you are capable of something, does not mean it is in your best interest to do it. Allow your heart to be a part of the process when planning your daily schedule and routine.” 

– Oliver-Pyatt Centers Founder and Executive Director Wendy Oliver-Pyatt, MD, FAED, CED

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.


Maintaining Recovery in College: Part Two

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Senior Director of East Coast Clinical Programming Dr. Melissa Coffin, PhD, CEDS continues our series on tips for women entering or returning to the collegiate environment after treatment. We hope these tips will assist you in navigating this transition and embolden you to truly enjoy your college experience.

Dr. Coffin has been a pivotal member of Monte Nido & Affiliates since 2008 and has extensive experience in the treatment of anorexia nervosa, bulimia nervosa, binge eating disorder and compulsive over-exercise. She has presented nationally on eating disorders, body image, food rules and self-care at conferences by the National Eating Disorder Association, the Binge Eating Disorder Association, and the International Association for Eating Disorder Professionals.

Embrace change. College is an exciting time in life and it is ripe with new opportunities. Be open and flexible to the changes that come with it even if it means trying something that you’ve never done before.
Be mindful. With all of the opportunities in college you have to pick and choose what is most important so you don’t spread yourself too thin. Be conscious around how you spend your time and what you commit to as that will shape your experience.
Engage in self-care. Make sure to schedule time in each day to relax and take care of yourself, even if it’s just for a short time. Having rest, sleep, and time to decompress regularly will help to keep your stress in check.
Stay connected. Not only will you be forming new relationships in school, you still have your family and friends at home. Use your resources to stay connected with old and new.
Ask for help. It’s OK to ask for help from family, friends, and professionals if you need it. There are those on campus that can help you with your mental health, medical health, academics, financial issues, social needs, career planning, et cetera. Reach out and ask for what you need. The counseling or health centers are usually good places to start.

 

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 learn about summer programming at Clementine, please visit our website or reach out to an Admissions Specialist.


Article Spotlight

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

 

A Letter to Parents of Children Heading to College Psychology Today

5 Truths About Eating Disorders the Stereotypes Don’t Show The Mighty

Motivation to Recovery: Adolescent Research on Anorexia Eating Disorder Hope

Why Yoga is an Excellent Practice While in Eating Disorder Recovery, and What Parents Should Know More Love

Who Are You Recovering For? Project Heal

 

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 learn about summer programming at Clementine, please visit our website or reach out to an Admissions Specialist.


Clementine’s Summer Programs

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With the summer in full swing, parents and families may find themselves looking for programs that will help treat and prepare their children before they had back to school in the fall. At Clementine, we offer programs that incorporate highly personalized medical, psychiatric and nutritional care with an extensive academic program in an effort to help them make that transition as comfortable as possible.

Summer programming for adolescents take place at our locations in Briarcliff Manor, NY; South Miami, FL and Portland, OR. At all of these locations, school times are still honored the same as they are during the school year but the times are cut in half and end late August. The culture at these locations still focus on personalized, supportive programming and collaboration between faculty, families and patients. However, during the summer we help to attain a new goal of sustainable, preparedness through an additional education plan.

Teachers lead classrooms Monday through Thursday and on Friday recovery coaches take over. Teachers select various topics on current events to incorporate into programming in an effort to prepare adolescents for their transition back into a typical school atmosphere. Each day is dedicated to a different programming aspect. Tuesdays are dedicated to how to write a college essay, how to create an effective budget, how to write a proper letter and how to apply for a job. Wednesdays incorporate a rotation of Ted-Talks and academic games intended to increase socialization skills and conflict resolution. Thursdays are dedicated to movies and discussion and Fridays are career days where local professionals come in to expose adolescents to the professional opportunities in the real world.

It is essential students maintain a balance between their academics and treatment so we make sure to incorporate a sufficient amount of each in their day. If for some reason a student is falling behind there are ways to accommodate based on their specific needs. If a student has a lot of school work, some of the activities listed above can be suspended for a private tutor to come in.

Our summer program at Clementine offers a specific treatment plan for your child on their path to healing with an additional academic component in our curriculum. It is our hope that through this program your child will leave treatment feeling better than before and with a foundation for their future school year.

 

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 learn more about summer programming at Clementine, please visit our website or reach out to an Admissions Specialist at 855.900.2221.


Our Clementine Family: Nicole Palumbo, MS

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Clementine Briarcliff Manor Math Teacher Nicole Palumbo, MS shares her personal journey to joining the Clementine family in this week’s blog post. Nicole shares her passion for teaching and some of what makes the work being done at Briarcliff Manor so special. Read on to learn more about Nicole and the Clementine Briarcliff Manor team…

 

What is your name and what are your credentials?

My name is Nicole Palumbo. I am a graduate of Buffalo State College (B.S.) and Canisius College (M.S.). In addition to serving as a classroom teacher for many years, I have extensive supervisorial and managerial experience, serving as the Mathematics Department Chair at two prestigious New York City private schools, as well as serving as Board President at a large cooperative in Lower Manhattan.

Please give us a brief description of your background.

Born and raised in Buffalo, New York, I moved to New York City shortly after completing graduate school, ultimately landing in Northern Westchester County, New York. With over 20 years experience in the classroom, my primary focus (by choice!) has been the middle school grades. I absolutely love working with adolescents and feel very lucky to be part of an amazing team of people focused on this age group.

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

A typical day starts as one might expect in any educational setting: arrival, clerical duties, and readying the classroom. Once done, I then move on to one of the less traditional aspects (but truly a highpoint), walking down to the breakfast area to greet my students. Seeing their faces light up is incredibly rewarding, and very powerful. My students are happy to see me, happy to come up to the classroom, and happy to get started on their coursework. What more could a teacher ask for? The classroom is one of many safe places in a typical day for our adolescents, but the classroom offers a bit of a divergence from their typical routine, as a result, they come relaxed, focused, and ready to learn.

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

The philosophy of Clementine is pretty straightforward: The whole is incomplete if the parts are not in working order. Like a chain, we are only as strong as our weakest link. The Clementine program serves as the solder necessary for reinforcing the weak points. By shoring up the weak points, we help to cultivate the skills necessary for pushing back against the pressures that weaken our adolescents over time. The Clementine program provides the tools necessary for helping our clients go the distance.

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

The education team works very closely together. Although each team member’s role differs, and we may not all be in the classroom at the same time on any given day, we are in constant communication. We take a hands-on approach to learning, tailoring instruction to meet the needs of the individual. Our adolescents feel supported, and are at ease while working with us. We offer a safe environment that encourages healthy risk taking. We teach our adolescents that it is okay (and perfectly normal) to experience uncertainty, and that it is through mistake making that some of the most profound learning takes place. We teach our adolescents the skills necessary for success inside the classroom, and offer strategies for applying those skills outside the classroom as well.

What is your favorite thing about Clementine?

My favorite thing about Clementine is the caring staff and our amazing adolescents. My job is more rewarding that I ever thought possible. I truly enjoy coming to work each day.

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

  • I rang the opening bell at the New York Stock Exchange twice!
  • I don’t know my left from right (I have to think about it, it isn’t automatic)
  • I love rollercoasters!

 

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 learn more about our newest location, Clementine Briarcliff Manor, please reach out to a Clementine Admissions Specialist at 855.900.2221.


Summer at Clementine

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Summer provides a finite time frame for treatment. At Clementine, the multidisciplinary team is committed to making the most of each and every day a patient is with us by providing the care and environment necessary for healing and growth.

Our specialized programming integrates highly personalized and sophisticated medical, psychiatric, clinical and nutritional care with comprehensive academic and family support. We place a focus on back-to-school preparedness while delving into the developmental needs of the adolescent girls we treat. We do this through daily supported exposure therapy, the development of life skills, step-down programs and aftercare planning. Aftercare planning begins upon admission and places a strong focus on academic reintegration.

Through progress-indicating benchmarks, Clementine’s level system offers the possibility of measurable change in a defined time frame. It provides time-sensitive opportunities to evaluate readiness for movement; family outing passes; and self-portioning, which allows the adolescent to gradually handle food more independently as she progresses in treatment. We also evaluate readiness for step-down programing and discharge.

Embedded in the Clementine culture is a philosophy of close collaboration – among our team members and with our patients’ outpatient providers. We work together to instill hope and trust, and heal the entire family. We take a holistic approach to get our patients on the path to long-term health and a sustained recovery.

 

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 learn more about our newest location, Clementine Briarcliff Manor, please reach out to a Clementine Admissions Specialist at 855.900.2221.


Education and Adolescent Eating Disorder Treatment

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We know consideration of an adolescent’s educational needs is an important component of treatment. At Clementine, a personalized education plan with a multi-disciplinary approach to learning begins upon admission, and we are committed to integrating where each adolescent is at academically, balancing what is in the best interest of her recovery. We believe an important part of residential treatment is preparing them for the real world outside of residential treatment and the back-to-school readiness component is key.

Our goal is to help teens to restore healthy and normal adolescent development. Healthy development is one of the key factors for solidifying a foundation for full recovery from an ED. Supporting our teens’ intellectual, cognitive and educational development is a key component of that process and we view our educational program as an essential part of our treatment program.

Research has shown that teens with eating disorders are particularly vulnerable to the stresses of developmental and academic transitions. We pay particular attention to helping our teens manage these real life transitions and the demands of their academic careers through the development of self-care and stress management skills. To learn more about the educational program at Clementine, visit here.

 

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 learn more about our newest location, Clementine Briarcliff Manor, opening on April 24th, please reach out to a Clementine Admissions Specialist at 855.900.2221.


Article Spotlight

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

 

Surviving Spring Break while in Recovery Angie Viets 

Movement Therapy the Supports Weight at Every Size Eating Disorder Hope

On the Importance of Community in the Path Toward Self-Acceptance and Recovery NEDA

Signs of Disordered Eating in Children and Teens Project Heal

5 Strategies to Relieve Anxiety Psychology Today

What I Want Parents to Know about Eating Disorders More Love

 

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.

 


Our Clementine Family: Megan Hamann

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megan-hamann-20171Clementine Academic Liaison Megan Hamann has been working in the education field for over ten years. In her role, Megan ensures that the adolescents are able to stay on track with their school work while on their journey to full recovery. Learn more about Megan and her work at Clementine in this week’s “Our Clementine Family”…

What is your name and what are your credentials?

My name is Megan Hamann. I hold a Bachelor’s degree in Early Childhood Education from Asbury University in Wilmore, Kentucky and I also have my Master’s degree in Special Education from Florida Gulf Coast University, in Fort Myers, Florida. I am looking forward to beginning my Specialist degree in Education leadership in the Fall here in Miami.

Please give us a brief description of your background.

Surprisingly, teaching was something I never thought I would do! School definitely was not my favorite thing growing up. However, after a decade of being an educator, I wouldn’t have it any other way! I decided to pursue education, to make it a fun and enjoyable experience for my students.

I have had the privilege to teach in amazing schools, focusing on grades 1st – 6th. I hold certifications in ESOL, Elementary K-6, English 6-12, and Special Education. Having taught in Georgia, Naples, Florida, and Miami, I have had a wide experience in different public school systems, as well as Charter Schools. However, one of the best experiences was teaching at Ada Merritt in Miami – one of the top International Bachelorette schools in the country! I love all the experiences I have had, especially the wonderful students & administrators I have worked with, which has thoroughly helped in the position I hold today!

I began working for Oliver Pyatt Center in 2015 after I was looking to step back from the public school system to spend more time with my children. I started OPC as the English teacher and after a few months of working with the clients, I was asked to fulfill the role as the Educational Liaison. I love to work with the adolescents, parents, school counselors and principals on a daily basis to ensure the adolescents are able to stay on track with their education while they focus on their recovery.

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

Typically, my day begins by checking my email to make sure I can connect the adolescents with the teachers or counselors who have emailed assignments or tasks. On the days I am in the classroom with the adolescents, I check in with them to see how their work load is. We aim to maintain a healthy balance of school work with their treatment. If adolescents are overwhelmed, we cut back, if they can handle more work, we add more. When adolescents first admit, we create a personal plan for each. We look at their work load, course requirement for graduation and the reality of what can be attained during our school hours at Clementine to find the best fit for each adolescent in treatment.

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

Education, as well as recovery, is something that effects the adolescents for the rest of their lives. While their recovery and focus on treatment is the number 1 priority, education is also an important part of their lives as well. Our goal is to maintain the appropriate balance to keep the adolescents on track for graduation, while they focus on recovery. However, this is different for each adolescent that comes in, which is why communication is a key factor in the success.

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

Teamwork is key at Clementine! Education is just a piece of the puzzle that we all bring to the table. Without that piece, there would be a big hole in the picture! As our team brings together information, it is amazing to see how certain parts of the Eating Disorder can affect school, learning capabilities and also social aspects as well. As an educator, I aim to bring my knowledge together with the doctors and therapists to help understand why the school situation is impacting the clients positively or negatively.

What is your favorite thing about Clementine?

My favorite aspect of Clementine has been working with schools and adolescents all over the country! I have learned a lot about the school systems and medical leaves, school & state requirements, and have met so many wonderful people who are also focused on wanting the best for our adolescents. Guidance Counselors and principals play a key role in helping the girls attain success as well, it has been such a joy to work with such caring people!

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

When I was in college, I was a nanny for a family who had four kids under the age of three in SoHo, NYC! That was an experience! I also backpacked Europe after I graduated college with only a couple hundred dollars! My biggest secret is – When I was in college I had a major intestinal surgery that took a year to fully recover from, I know that is odd to share here, but I have seen that it has helped me connect with the girls in a very intimate way. I had to take a semester off my college classes and felt it was the end of the world, however, to get better and recover was actually what I needed. I was able to continue to finish school, I finished just a little later than I first anticipated. However, that ended up being the best thing for me. I love to share this with the clients, so they know I completely understand how hard it is to stop their ‘plan’ for school and focus on the quality & health of their own life. I understand it is hard, but we will work together to get them to a place where they can be successful!

 

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.