NPR’s Diane Rehm Show recently featured an interview with Clare and Elena Dunkle, authors of companion memoirs documenting Elena’s struggle with anorexia nervosa. Also appearing on the show was Dr. Angela Guarda, Associate Professor of Psychiatry and Director of the Eating Disorders Program at The Johns Hopkins Hospital.
Dr. Guarda advises families struggling with anorexia to seek out a “good Maudsley trained therapist.” “It’s now pretty well established,” she said, “that that is the technique that works the best for the most patients. It doesn’t always work, but it works in over 70 percent of young patients. “
Also known as “Maudsley Family Therapy”, the Maudsley Approach is a treatment for anorexia developed by Christopher Dare of London’s Maudsley Hospital. Instead of isolating the anorexic in a residential treatment facility — what Maudsley advocates sometimes call a “parentectomy” — the child remains at home and her family assumes full control of her treatment with guidance from a therapeutic team.
Phase one of Maudsley Family Therapy focuses solely on weight restoration. A parent or other family member is present at every meal, enforcing adherence to the meal plan. In phase two, parents gradually pass control of meals to their son or daughter. Only in phase three, when the teen has stopped restricting food, does the emphasis shift to psychological and family factors underlying the illness.
Proponents often cite a 2010 Stanford University/University of Chicago Study as evidence that Maudsley is the most effective treatment for anorexia. According to this study of anorexic patients ages 12 to 18, a year after treatment, 49 percent of those in the Maudsley group were in remission, compared to 23% of those who received individual therapy.
So why doesn’t Mirasol use the Maudsley approach in its teen eating disorder treatment program?
For starters, the study compared the Maudsley method to individual psychotherapy, as if those were the only two treatment options.
Family therapy is an important component of Mirasol’s residential eating disorder treatment program. Family members are active participants in both our teen and adult residential eating disorder treatment programs. All clients participate in regular phone or videoconferencing sessions with family members. During our three-day family camp, family members and friends come to Mirasol to share the experience of intensive residential treatment with their loved ones.
But family therapy is only one piece of the puzzle. Anorexia, bulimia and binge eating can result from a bewildering variety of factors including a genetic predisposition. Teens with eating disorders struggle with feelings of shame, guilt, body dissatisfaction and a lack of control. The eating disorder may become the individual’s attempt to regain control and cope with these intense emotions.
Imposing greater parental control over eating is not the best approach for a child who already feels powerless to take her place at the table. So long as the solution always comes from the outside, the teen cannot find the solution within. At the core of Mirasol’s treatment philosophy is a profound respect for the individual, for the choices we make and for the connections we forge with ourselves and others. Through peer encouragement and cognitive and emotional restructuring, we help our clients learn to self-regulate, manage their emotions and care for themselves.
Our goal is to provide all our clients with the skills and tools they need to live successfully in the world, not just for a few months or years, after treatment, but for the rest of their lives.
Primary trauma therapist Ann Twilley and I spent an enjoyable and informative two days at the 26th Annual International Trauma Conference in Boston.
Organized and keynoted by Bessel van der Kolk, presenters and attendees included many luminaries in the field. Both researchers and practitioners advocated for increased broad–based financial support for research in the treatment of PTSD and attachment disorders with neurological interventions, particularly neurofeedback. I was delighted to have an opportunity to speak with Dr. van der Kolk about Mirasol’s long-standing commitment to the use of qEEG and neurofeedback protocols for all clients.
Among the highlights for me was a presentation by Arietta Slade on the results of her research initiative, “Minding the Baby.” Slade’s program provides two years of support including therapeutic intervention and education for expectant mothers and their babies who are at risk for attachment challenges. Preliminary results indicate that such programs can help break the cycle of attachment disorders that could otherwise produce life-long consequences.
The use of neurofeedback, based on an increasingly sophisticated understanding of the role the nervous system plays in trauma, was woven throughout the conference workshops. Sebern Fisher, PhD, referred to the power of neurofeedback as effectively reconnecting the individual with the “good-enough mother.”
The second day’s workshops included a presentation on the use of energy medicine in the treatment of trauma. This provided an additional complement of tools as we address issues of helplessness and emotional dysregulation and empower our clients to master their neurological responses and therefore their impact on recovery.
All in all, the conference was informative, inspiring and reassuring. As the field expands and integrates neurological research findings into the best practices in the treatment of trauma, Mirasol will continue its commitment to providing a treatment experience that is solidly evidence-based, highly individualized, proven effective and always on the leading edge.
Mirasol Executive Director Diane Ryan was featured in a June 15, 2015, interview with Lon Woodbury of Struggling Teens. In a podcast entitled “Eating Disorders on the Wild Side,” Ryan describes how Mirasol uses wilderness experiences to help teens recover from eating disorders. She explains how the focus on adventure therapy evolved from discontent with teens who had been to other eating disorder treatment facilities where they weren’t allowed to go outside, and how Mirasol evolved a program that combines outdoor activities with the nutritional support — including eating six times a day — required for recovery from an eating disorder.
Woodbury and Ryan concur that eating disorders and related emotional issues often result from a disconnect from the self and others, and that the outdoors can be a powerful intervention for troubled teens by plugging into a natural environment that we are hard-wired to appreciate.
For additional podcasts in this series, visit http://www.strugglingteens.com/artman/publish/interviews.shtml
In this video, a Mirasol graduate describes how art therapy not only enhanced her creativity, but helped her process emotions she could not express in words and, ultimately, work through the issues that lead to her eating disorder.
I came to Mirasol with a background in photography, but a lot of the mediums I’ve worked in here are things I’ve never explored before, so it’s actually been very revealing. There are things coming out of me that I never thought I could do.
A lot has been brought to the surface for me creatively.I feel like for the first 30-some years of my life I never was creative, but it’s always been in there, and I found it here.
There were so many times I had so much emotion coming up in me, and I didn’t have words for it, so doing the art therapy was a way for me to express that emotion in a way that I couldn’t do in any other modality.
The installation that I did was a month-long-process. It started with me going out into the desert, and I saw this chicken wire in a roll, and so I pulled it up out of the ground, and a small tree was stuck to it.
And the second I lifted it out of the ground, I knew exactly what I was making.
There were a lot of components that I felt needed to be inside the wound-up chicken wire, and those had to do with the symptoms of my eating disorder and substance abuse.
I needed things to symbolize each one of those elements. So I again went back out into the desert, looking for things like shards of glass to represent self-harm, an old rusty beer can for my substance abuse, rusted metal for darkness and depression — just all of the things I had done to myself.
When I started creating them and putting words on them and sticking them inside, I recognized that the roots coming down into the tree were me. They were my true, authentic self.
And the tree coming up in the middle was still attached to the wire, but it continued to grow above that. And so, just because all of those things happened to me, it doesn’t mean the tree
was choked off and couldn’t live.
On the top, I cut a lot of cloth ribbon and on each one, I put things like “passion” and “joy” and “hope” and “happiness,” and all of the things that I can have in my life, having worked
through all of those things that have come out because of my eating disorder and substance abuse.
To help ease the transition from residential treatment to life after Mirasol, Mirasol provides dietitian-assisted menu planning and grocery shopping outings, along with weekly cooking classes.
In this video, Mirasol Chef Dee O’Leary provides a hearty helping of practical kitchen skills such as prep work, knife safety and the importance of healthy fats, seasoned with entertaining tips for “getting down with your food”, letting vegetables “party in the pan” and judicious use of “aerial assault”.
Look out Anthony Bourdain, Dee is a rock star! We’re so lucky to have talented chefs like Dee, who delight in sharing their love and knowledge of food preparation with Mirasol clients.
Top 10 Eating Disorder Blogs of 2015
Eating Disorder Hope Award
- Why There’s No Maudsley at Mirasol June 18, 2015
- Trauma Conference was Informative, Inspiring and Reassuring June 16, 2015
- Eating Disorders on the Wild Side June 16, 2015
- The Healing Power of Art Therapy June 8, 2015
- Cooking Class at Mirasol June 7, 2015
- “Horse Sense”: Lessons from Equine Therapy June 2, 2015
- Why Wilderness? May 18, 2015
- First Backpacking Trip with Mirasol Clients May 5, 2015
- Wilderness: A Powerful Intervention in the Treatment of Complex Trauma April 23, 2015
- QEEG Neurofeedback in the Diagnosis and Treatment of PTSD April 22, 2015
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