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.


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.


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.