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I just can’t help myself! I need to give this to you all again. I’m still blown away myself when I re-read these.

Enthusiastic CARF surveyors said July 23, 2010, “Mirasol is light years ahead of any other program in the country.” Continuing they said, that in all of their years working in the mental health field, they had never seen a program as excellent as what we do at Mirasol.

CARF, a national accrediting agency that examines and awards accreditation to more behavioral health facilities than any other agency, examines Mirasol every three years. A CARF endorsement means that a program’s policies and standards meet the highest possible criteria of excellence. An accreditation by CARF is proof of excellence in all areas of a facility.

Last Thursday and Friday two CARF surveyors arrived. Both of them were long-time inspectors. One member of the team was an RN with 30 years of experience in the mental health arena. The other was a man with behavioral health experience as a social worker but also an experienced surveyor having done surveys for CARF for over 25 years.

When the survey was over, our management team and the surveyors gather round for “the” report. The entire staff had worked for months making sure that we had everything ready. After the CARF people gave their report, I was stunned. I knew that we had an excellent program. I knew we were really good, but I didn’t imagine in my wildest dreams how good we are!

Basing their comments on our outcome data and after viewing our treatment at the units they said our treatment was like magic.

I have never wanted to play the game of outcomes. “Mine is better than yours. “ “No, mine is much better…….. “ Statistics can be manipulated and when I hear someone claiming a success rate of 92% at a year, I know it’s not true.

The CARF team made me promise that I would share some of our numbers with our stakeholders which are all of you!

When someone enters treatment, we do quite a lot of psychological testing. Two of the most important psychological instruments we administer are the Eating Disorder Inventory-III and the Beck Depression Inventory.

I’m going to give you all of this information just as we gave it to the surveyors. It’s rather complicated but you can read the numbers – I’ll help.

The Eating Disorder Inventory 3 (EDI-III) is the third edition of a test that reports in multiple scales. The test consists of 91 questions answered in terms of frequency of behaviors from always to never.

Reports consist of 21 separate scales; three are validity scales, four are eating disorder risk and composite scales, nine are psychological scales, and five are psychological composite scales. Results are presented as percentiles for all, anorexia, bulimia, and EDNOS diagnoses.

For simplicity of reporting percentiles of two risk scales/composite scores are used, each chosen for broad-based relevancy to Mirasol’s program, the Eating Disorder Risk Composite (ERDC) and the Global Psychological Maladjustment Composite (GPMC).

In addition, the 9 psychological scales, including Low Self-Esteem (LSE), Personal Alienation (PA), Interpersonal Insecurity (II), Interpersonal Alienation (IA), Interoceptive Deficits (ID), Emotional Dysregulation (ED), Perfectionism (P), Ascetism (A), and Maturity Fears (MF).

These will all be compared for pre and post scores for the total, anorexic, bulimic, and EDNOS populations.

B Results: The information presented in the following chart is based on residents who completed the program during the years of 2007, 2008, 2009, and through June 2010.
You can readily see the differences between the pre-scores and the post-scores. But look at the post scores for EDRC for 2007, then 2008, 2009, and finally 2010. You’ll see that the scores progressively get lower – meaning that our patients are getting a lot better!
Now do the same for the GPMC.

You can readily see the differences between the pre-scores and the post-scores. But look at the post scores for EDRC for 2007, then 2008, 2009, and finally 2010. You’ll see that the scores progressively get lower – meaning that our treatment is more and more effective and our patients are getting a lot better!
Now do the same for the GPMC.

Risk Scales and Composite Scores

2007 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 22) 53.27 28.00 56.55 31.45
Anorexia (N = 9) 64.89 47.67 63.89 45.78
Bulimia (N = 13) 45.23 14.38 51.46 21.54
2008 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 34) 54.06 21.50 54.44 25.21
Anorexia (N = 11) 62.18 37.18 56.64 28.18
Bulimia (N = 20) 44.70 9.40 50.35 19.85
EDNOS (N = 3) 86.67 44.67 73.67 50.00
2009 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 20) 49.35 13.60 49.35 18.15
Anorexia (N = 3) 61.67 40.67 52.00 36.00
Bulimia (N = 13) 41.85 3.46 52.08 13.54
EDNOS (N = 4) 64.50 26.25 38.50 19.75
2010 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 11) 46.10 11.82 44.00 10.27
Anorexia (N = 6) 42.33 17.5 31.83 14.17
Bulimia (N = 5) 50.60 5.00 58.60 5.60

Here are the results for the individual scales as named above. Take a look at the self-esteem scores – pre and post 2007, 2008, 2009, 2010. The improvement is substantial with lower scores each consecutive year.

Psychological Scale Scores
2007
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N = 22) 56.5 30.6 53.6 31.0 51.2 32.8 62.6 50.5 58.3 29.1 62.8 48.5 57.0 42.3 57.2 39.1 56.0 44.6
Anorexia
(N = 9) 60.7 45.1 59.9 45.6 50.2 38.6 69.9 53.1 59.2 39.8 66.2 58.0 67.7 53.2 63.6 49.6 66.2 56.3
Bulimia
(N = 13) 53.7 20.6 49.2 20.8 51.9 28.8 57.5 48.7 57.6 21.8 60.4 41.8 49.5 34.7 52.8 31.9 49.0 36.5

2008
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N =34) 59.2 26.6 54.7 23.6 54.0 34.4 60.1 43.2 56.3 25.7 51.6 43.4 56.5 45.2 45.8 24.0 55.1 34.2
Anorexia
(N = 11) 68.1 30.8 62.3 26.0 58.9 42.1 59.5 44.5 55.8 26.2 45.3 34.8 59.5 54.3 41.3 21.0 59.5 45.8

Bulimia
(N = 20)
52.2
21.4
47.7
19.5
50.5
26.1
57.8
39.3
54.1
21.0
53.6
44.4
50.7
38.6
45.9
23.5
54.5
27.5
EDNOS
(N = 3) 73.7 46.3 74.0 42.0 59.0 62.0 77.3 64.7 73.3 55.7 61.7 68.3 84.3 56.7 62.3 38.7 43.3 36.0

2009
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N = 20) 47.8 17.7 53.1 18.9 46.5 27.8 53.9 34.7 58.5 22.8 50.9 35.5 52.7 39.0 50.5 18.3 43.9 35.7
Anorexia
(N = 3) 44.0 41.0 52.7 37.7 61.7 62.0 42.7 39.3 81.0 45.0 38.0 41.7 41.3 27.3 51.3 28.0 58.3 67.7
Bulimia
(N = 13) 52.8 13.2 59.0 15.4 46.5 19.9 61.3 38.1 55.5 18.6 54.9 33.2 52.1 35.4 45.6 14.3 46.5 31.5
EDNOS
(N = 4) 34.3 14.5 34.3 16.0 35.0 27.8 38.0 20.0 51.3 19.5 47.5 38.3 63.0 59.5 65.5 24.0 24.3 25.3
2010
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N = 11) 47.4 15.2 47.6 14.4 40.8 14.6 55 24.9 50.6 16.2 47.2 22.8 52.5 31.8 38.8 14.2 45.5 21.3
Anorexia
(N = 6) 32 19 32.7 19.3 34.5 17.3 56.3 34.7 49.3 16.5 38 19.5 43 25.8 30.5 21 37.8 21.5
Bulimia
(N = 5) 65.8 10.6 65.6 8.4 48.4 11.4 53.4 13.2 52.2 15.8 58.2 26.8 63.8 39 48.8 6 54.8 21

Last but certainly not the least is one of my favorite tests, the Beck Depression Test. It’s short, only 21 questions, and highly accurate. The client answers the questions on a scale of 0 to 3, with three indicating the strongest symptoms and the 0 indicating few symptoms. Most of the clients who admit to Mirasol are severely depressed when they come in.

Look at these scores, pre-treatment and post-treatment from 2007, 2008, 2009, 2010. The post treatment scores show that there is very few, if any, depressive symptoms existing. All of the patients have greatly improved feelings of well-being.
2007 Results Pre BDI Post BDI
ALL (N = 23) 34.26 18.13
Anorexia
(N = 9) 41.00 26.33
Bulimia
(N = 14) 29.93 12.86
2008 Results Pre BDI Post BDI
ALL (N = 34) 31.50 13.03
Anorexia
(N = 11) 35.45 16.00
Bulimia
(N = 20) 27.85 10.00
EDNOS
(N = 3) 41.33 22.33
2009 Results Pre BDI Post BDI
ALL (N = 19) 30.42 7.89
Anorexia
(N = 3) 28.67 17.00
Bulimia
(N = 12) 31.42 7.25
EDNOS
(N = 4) 28.75 3.00
2010 Results Pre BDI Post BDI
ALL (N = 12) 29.83 10.5
Anorexia
(N = 6) 25.67 12.17
Bulimia
(N = 6) 34 8.83

I hope to keep reporting outcome information quarterly as well as reporting long-term outcomes. We have found that our treatment results are long lasting – at one year, 70% of our clients are still in recovery. This does not mean that they have not slipped a time or two, but because of our Focused Continuing Care, the slips have been very short lived.

I happened to connect a couple of days ago with Judy Avrin who is the mother of Melissa Avrin. Melissa died from bulimia two years ago at the age of 19. When I read this I felt like I’d been punched!

We’ve all read about anorexics that have died at very low weights. I somehow downplayed the fact that bulimia is a killer as well.

Someday Melissa was founded in 2010 by Judy Avrin following the death of her daughter Melissa to an eating disorder. A 501(c)(3) nonprofit organization, Someday Melissa’s mission is to promote recognition and awareness of eating disorders and the importance of early treatment. Along with Danna Markson, LCSW and director Jeffrey Cobelli, Judy created a documentary, “Someday Melissa, the story of an eating disorder, loss and hope.”

One of the spiritual sites that is part of my daily meditation is one that’s called In the Rooms. They email a lovely reading every day. The reading today is right on track with the idea of each one of us learning to love ourselves as we are.

Mind-Body Connection

My state of mind affects my body. Wherever thought travels, a chemical travels with it. The chemicals in my body are then affected by my thoughts. This means that who I am on the inside affects who I am on the outside. I am not just guessing at this, it is not some New Age notion that neurochemical and physical makeup are interconnected. My state of mind and my level of inner spirit have the power to impact and improve me physically. Today I will affirm within me that I have a beautiful and healthy body and mind. I will thank a Higher Power for giving me a healthy, strong and beautiful body. I will do this as often as I can remember to do it throughout my day.

My body is beautiful, strong and healthy.

The same is true of the face, which is shaped and formed according to the content of the mind and soul, and the same is again true of the proportions of the human body. Thus can this member of astronomy describe each kind of soul. For the sculptor of Nature is so artful that he does not fashion the soul to fit the form, but the form to fit the soul.
Paracelsus, 16th century physician, alchemist

For many of us, perhaps the hardest thing of all is to believe that “I am a good person.” We can climb mountains, work hard, acquire many skills, act ethically – but truly feel that one is good deep down? Nah!

Every once in awhile, I get a marvelous article from my friend, Rick Hansen. Feeling like a really good person is always one of my goals and Rick gives some good thoughts on how to do this!

We end up not feeling like a good person in a number of ways. For example, I once knew a little girl who’d been displaced by her baby brother and fended off and scolded by her mother who was worn down and busy caring for an infant. This girl was angry at her brother and parents, plus lost and disheartened and feeling cast out and unloved. She’d been watching cartoons in which the soldiers of an evil queen attacked innocent villagers, and one day she said sadly, “Mommy, I feel like a bad soldier.”

Later in life – whether in school or adulthood – shamings, moral indictments, religious chastising, and other criticisms come in many shapes and sizes. Feeling morally compromised – the essence of not believing you’re a good person – is fed by related though different experiences of worthlessness, inadequacy, and unlovableness: as my ranch-born father would say, “feeling like you’re the runt of the litter.”

I’ve also known people – including myself – who have done bad things, or said them or thought them. Things like hitting an animal, risking the lives of their children while driving buzzed, being mean to a vulnerable person, stealing from a store, feeling contemptuous, or cheating on a partner. These don’t need to be felony offenses to make one feel guilty or ashamed.

In effect, to simplify, it’s as if the psyche has three parts to it: one part says, “you’re not good”; another part says, “you’re good”; and a third part – the one we identify with – listens. The problem is that the critical, dismissive, shaming voice is usually much louder than the protecting, encouraging, valuing one.

Sure, there is a place for healthy remorse. But shining through our lapses of integrity, no matter how great, is an underlying and pervading goodness. Yes it may be obscured; I am not letting myself or others – from panhandlers to CEOs and Presidents – off the moral hook. But deep down, all intentions are positive, even if they are expressed problematic ways. When we are not disturbed by pain or loss or fear, the human brain defaults to a basic equilibrium of calm, contentment, and caring. And in ways that feel mysterious, even numinous, you can sense profound benevolence at your core.

Really, the truth, the fact, is that you are a good person. (Me, too.)

When you feel deep down like a bad soldier – or simply not like a good person – you’re more likely to act this way, to be casually snippy, self-indulgent, selfish, or hurtful. On the other hand, when you feel your own natural goodness, you are more likely to act in good ways. Knowing your own goodness, you’re more able to recognize it in others. Seeing the good in yourself and others, you’re more likely to do what you can to build the good in the world we share together.

1. Take in the good of feeling cared about – When you have a chance to feel seen, listened to, appreciated, liked, valued, or loved: take a dozen seconds or more to savor this experience, letting it fill your mind and body, sinking into it as it sinks into you.

2. Recognize goodness in your acts of thought word and deed – These include positive intentions, putting the brakes on anger, restraining addictive impulses, extending compassion and helpfulness to others, grit and determination, lovingness, courage, generosity, patience, and a willingness to see and even name the truth whatever it is.

You are recognizing facts; create sanctuary in your mind for this recognition, holding at bay other voices, other forces, that would invade and plunder this sanctuary for their own agenda (such as the internalization of people you’ve known who made themselves feel big by making you feel small).

3. Sense the goodness at the core of your being – This is a fundamental honesty and benevolence. It’s there inside everyone, no matter how obscured. It can feel intimate, impersonal, perhaps sacred. A force, a current, a wellspring in your heart.

4. See the goodness in others – Recognizing their goodness will help you feel your own. Observe everyday small acts of fairness, kindness, and honorable effort in others. Sense the deeper layers behind the eyes, the inner longings to be decent and loving, to contribute, to help rather than harm.

5. Give over to goodness – Increasingly let “the better angels of your nature” be the animating force of your life. In tricky situations or relationships, ask yourself, “Being a good person, what’s appropriate here?” As you act from this goodness, let the knowing that you are a good person sink in ever more deeply.

Enjoy this beautiful goodness, so real and so true.

By the way, I’m a really good person too! — Jeannie