All in the Family......... and elsewhere

I knew I should not have picked up the Wall Street Journal before my walk this morning.  I love this section and usually learn so much in a few short pages.  The temperature's quite cool  today after a terribly hot week last week and I've opened all the doors as well as the one to the screened porch.  Our cat is in heaven and hasn't come back into the house for a couple of hours now.

As usual, the Personal Journal's Health and Wellness section that appears on Tuesdays is crammed with interesting information about Sleeping Types (are you a short sleeper?), other options besides bypass surgery, food addictions (I hope folks pay attention to this study because as I've said previously here, I do think there's a genetic link to all of this), and especially the article titled, "Do You Get an 'A' in Personality?" 

In an earlier post I talked about Family Week at a residential eating disorder facility, communication,  and the value of the exercise that uses Gary Chapman's book, The Five Love Languages.  Along comes an article that delves even deeper into the entire subject of co-existence and family relationships.  

One of the neat things about people is we can be related and yet be so different!  One family member might crave peace and quiet while another just loves to crank up the latest rap recording.  (The solution here might be headphones.)  Another might want everything to be "just so" while a supervisor might find "organized chaos" to be the answer in his/her office.  I'll never forget one summer when, having not too much to do while my three professors were on vacation, I "straightened up" one of their offices, placing books in alphabetical order and so on.  Well, although I did not get fired, I did get a dressing down.  Before I did this, he knew exactly where in each stack or where on the desk or table a specific article or book was related to a paper he was working on.  When I was done, his entire orderly (so to speak) world was upside down.

In this latest article, Elizabeth Bernstein grabbed this reader by noting in the first paragraph, "In the never-ending quest to help people co-exist peacefully with their spouses, children, siblings and in-laws, therapists are turning to tools used to assess the psychological stability of pilots, police officers and nuclear-power plant operators: personality tests."

Bernstein focuses on the family, especially one with a teenage daughter who moved back into the household and who has an entirely different lifestyle from that of her parents, who are goal-oriented - mom's an accounting consultant and dad's an attorney.  Their daughter, Maggie, "....is an introvert, a feeler who craves harmony and needs time and freedom to discover what she wants to do."

Bernstein then notes that mom, after she and her husband and Maggie took the test and heard the results, said, "It helped us see that she is a different person and will have a different path."

Key words.  Important words.  Our children are different people on different paths.   

I think this article is especially important for families whose son or daughter (or both or all) struggle with perfectionism, anxiety, and an eating disorder.  As many specialists will note, particularly those who are up-to-date in the eating disorder field, for progress to be made in a family whose member is struggling with an eating disorder, there needs to be a calm and nourishing (pun intended) environment.  If the family members do not understand each other on a much deeper level, it's more difficult to create that environment.

For years this tool has been used in the workplace.  Perhaps the MBTI could be considered another window into the activities of a family, now that family members are increasingly -- thank goodness -- being accepted as members of the team.

Time for my walk!

Thoughts About the Latest Family Week

Having just returned from another Family Week at a new (in terms of my loved one’s experience) residential eating disorder treatment facility, I’m very tired out and also remain hopeful.  I’ve participated at least four times in these educational/therapeutic sessions and have valued each one in a different way. 

I’ll mention a couple of aspects of what I learned and in addition first say a few words about readiness, a topic that is being lectured on as I write this this morning by Dr. Ovidio Bermudez at a meeting of the local chapter of the IAEDP.  His presentation is looking at “various aspects of readiness for change in the treatment of eating disorders….”  At the conclusion, the details mention that “Participants will:  1) be able to discuss the effects of malnutrition on neurological function as it relates to willingness and ability to change, 2) recognize different aspects of ambivalence as it relates to readiness for change in the treatment of eating disorders, and 3) be exposed to practical tips to be used in the clinical setting as they assess and work with readiness for change in patients with eating disorders.”

I’ve included this information because readiness, I’ve learned, is a huge factor in whether or not a treatment is going to take.   I agree that each time one is admitted and stays in a residential facility or who attends an IOP (intensive outpatient program) or who is participating in therapy will learn tools.  The question is how to nudge a person towards a state of readiness in which she or he makes a commitment to use these tools to develop new behaviors and stick with them.  Readiness is the key, I think.  The expression strike while the iron is hot is relevant.  When your loved one says “I’ve had enough” or something similar, don’t delay.   Dr. Bermudez is discussing this today and I hope he will be invited to speak at future functions to continue to present the latest research on the concept of  readiness.  Sheila M. Reindl in her book Sensing the Self devotes important space to this concept.

Looking at my notes, I’d say that for me the most valuable aspects of this recent Family Week exercise were first the message about the importance of the work of the loved one and the family members/friends that I wrote about in a previous post and second, the focus on discharge planning and getting ready for one’s loved one to come home.  There were several sheets handed out with helpful tips integrated into at least three  Question and Answer sessions with a therapist, the lead nutritionist, and a staff member who have been associated with this facility for several years.  I am hoping that the facility will publish these tips on its website and I’ll come back here and post links if this is being done/has been done.  

Two examples are first, to dispose of (in agreement with your loved one based on what is termed a “clothing contract”) any articles of clothing that are too small (so the person isn’t tempted to lose weight to get back into those clothes) or too large (so the person doesn’t have clothing available to hide in).  As so many of us have learned, our loved one's body image can be so distorted that s/he has no idea of his/her actual size anymore.   Included would be clothing that conveys the message that s/he isn't worth much.  So many are filled with shame and think of themselves as worthless.  Again, it’s important to do this with their permission or approval rather than just toss things that they have specifically chosen and purchased themselves.

This inner voice of shame and worthlessness is an aspect of what is called the negative mind; a concept that is integral to the treatment here and that I have experienced personally and fully agree with the existence of.  Peggy Claude-Pierre writes about this concept in her excellent book, The Secret Language of Eating Disorders (Vintage Books, 1997; available in paperback).

A second tip is to throw out ALL fashion magazines or any magazines that in any way focus on body image/appearance.  We were gifted at this latest facility with an outstanding lecture – truly outstanding – by a woman who has been in recovery for twenty years whose doctoral dissertation and continuing research is focused on body image and how the media manipulates what you see – in magazines, advertisements, and even movies!!!!  Julia Roberts, for example, in the movie Pretty Woman was represented by five different women.  Several industry celebrities often are represented on the covers of magazines by only their face (also brushed) and by the body or body parts of others.  Truly astonishing.  How in the world can anyone expect to have their own body look anything like what’s represented, when what’s represented isn’t real.  I’ve seen bits and pieces (sorry about the pun) about this before but never in a comprehensive statistical presentation illustrated with very familiar names. 

So, bottom line for me this time is that I learned in interaction with my loved one more than I ever have about what’s behind my loved one’s eating disordered behavior.  I saw that the involvement of a truly knowledgeable lead therapist and an outstanding staff have made this a safe place to explore in depth many things. This process takes time.  (Back to my argument that insurance companies need to fund at least ninety days of residential treatment; probably more.)

I continue to believe, as is presented at this place, that eating disorders are coping mechanisms that evolve into terrible addictions/destructive habits.  I believe this particular coping mechanism tendency is present genetically in those who develop eating disorders and this predisposition leads to the disruption of the thought processes of our loved ones when triggered.  The “negative mind” is fed and becomes powerful; the actual or rationale mind of the person is still there but needs the support, encouragement, love and treatment process to re-emerge, develop new behaviors and get on the path to full recovery.

An important closing note for those who believe that one can snap out of it or that like any addiction/habit, one can quit easily, it is very important to remember that one needs to eat to live so dealing with this coping mechanism is a lot more difficult than say stopping smoking.

Reflections on Communication - Family Week

I’ve participated in Family Weeks at several eating disorder residential treatment facilities.  These programs are usually scheduled towards the end of a person’s stay when they are healthier nutritionally (and this is another topic I want to expand on having read Dr. Julie O’Toole’s Give Food a Chance and now am reading Answers to Anorexia by James M. Greenblatt, MD) and have made substantial progress therapeutically.   Sometimes the week is a long weekend; other times it’s a full week.  Sometimes, depending on financial ability, the entire family travels to participate; others, just one person.   It’s hard work, no doubt about it, and I’ve witnessed a lot of progress among family members, myself included.

Family Week also provides up-to-date information about eating disorders.  Sometimes, it's the first time family members have actually had a chance to sit down, discuss, and digest what's going on because life has focused on getting one's loved on into treatment.  I have inevitably found it to be a good experience.

Early on, Family Week left me feeling like I had been beaten up and was to blame for the illness.  I certainly had made decisions that I know added to the anxiety and stress felt/experienced in the family; so had others.  But some families haven’t experienced turmoil and still a family member develops an eating disorder.  What then?  This discussion in response to a post by Judy Scheel, Ph.D., LCSW titled "Linking Early Attachments to Eating Disorders" (11/1/2011) illuminates my and others' discomfort and partially explains why I wrote this post about communication and family week.

Parents can understandably be very reluctant to participate especially, as Dr. Janet Treasure notes in her book Skills-Based Learning for Caring for a Loved One with an Eating Disorder, since these illnesses cause great strife in the family unit and can tear it apart without appropriate support and guidance through family counseling.  Now, though, science and research are catching up.   We know that genetics as well as environment play a large part.  We know that people – whether parents or their children – are different; even identical twins.  So traits become an important factor as is behavior.  Communication – nonverbal as well as verbal – is very important.  Mirroring is a major factor.  We know we can still learn new ways of doing things.

Over the past six years especially the content of Family Week has improved, at least where I’ve gone to participate.  Family members are more likely to be included in the team, recognizing that once the person leaves the facility and especially if s/he is not yet an adult, s/he is going to go back to the home.  So, the question is, how can everyone help make the situation better for the person who is in recovery and who is still pretty raw from a lot of introspection as well as adaptation to new behaviors to replace old, maladaptive ones?

I need to say this another way.  When one becomes accustomed to doing things a certain way, one needs to consciously work on doing things another way.  When a person  has been ill with an eating disorder, they have developed behaviors and thought patterns that need to be changed.  Nutrition alone is not going to change this fact.  Nutrition and then behavior modification is.  That's why, even with the new Maudsley Method, family and individual therapy are very important to help the person in recovery really get into recovery.  Since at least 60 percent of those who develop eating disorders have struggled with anxiety disorders including OCD, these disorders need to be addressed.  Since fifty percent (according to the latest study) of people do not respond to the Maudsley Method (and it will be interesting to pick the results apart to understand why fifty percent do not, assuming that therapy is part of the picture to help people learn new ways of thinking and doing and responding), there still is work to be done.

I’ve already mentioned LEAP, the wonderful communication theory developed by Dr. Xavier Amador and expanded upon in two of his books:  I Am Not Sick, I Don’t Need Help and I’m Right, You’re Wrong, Now What.  Seminars have been held across the United States and there’s a website with more information.  I have found this theory of communication to be very helpful.  The goal is to help your loved one believe not only that you’re listening, but also that you’re understanding.  S/he wants to be heard.  There’s a great on-line primer.  I try to review it often.

Another is to create a safe, loving household where everyone is treated with love, respect and dignity while the parent(s) or partner remain as calm, cool and collected as possible.  In this context, how does one express love?

One of the Family Week exercises I truly found eye-opening and very helpful is based on work by Gary Chapman about what he calls The Five Love Languages.  I happened to see one of his books on display in a local bookstore this past weekend and remembered how this exercise had affected our family.  Basically, because of our own “stew”, each of us has a different “love language” not only in terms of how we hope to have love expressed to us or put in another way how we interpret someone else’s love for us, but also how we express love to others.  Chapman believes that there are five categories of love, which are:   things done for you, physical touch, time spent, talking/conversation, and gifts.

Each family member in our group was asked to independently order, from most important to least important,  these categories not only for themselves, but also what we all believed was the order of importance for other members in our family and then share, while guided by the family therapist.

So, for example, a person may believe that the most important way they can show love for a family member is by providing material things including gifts.  This belief usually means that the person needs to work long hours away from home to earn the money to do this.  On the other hand, the child or the spouse/partner may instead believe that time spent with them or in conversation is much more important. 

If your child came into the world being ultra-sensitive to touch, light and noise, then it would help her/him if the family would go easy with the bear hugs, rowdiness and the tickling.  Changing behavior to recognize this sensitivity can be interpreted as love.  On the other hand, some parents grew up in homes where hugs were few and far between but their child loves and even craves to be touched.  Touching stimulates the release of the hormone oxytocin, about which I’ve posted here earlier.  Maybe touching is one of the keys to recovery. 

 

The bottom line is that if a person isn’t getting what they need, what they believe is love, or s/he is struggling with his/her disruptive feelings and emotions and not getting the right kind of help from their parent(s) or other family members for them, they may feel neglected and unloved.  Notice that I highlighted the words “may” and “feel.”   It's important to reflect on this. 

Where does this fit in?  First, it’s important to recognize that this is not a “blaming” exercise.  Rather, it’s a “getting to know you better” exercise for the entire family.   There are other helpful exercises, as well.  Going back to LEAP, if a person really thinks they are being heard and understood, this belief provides a base for progress.

Unless a home is truly dysfunctional and abusive, most family members really do want to create a loving environment for their children and for each other.    If the family knows that eating disorders, depression and anxiety are prevalent in the family tree or that these or other brain disorders are already appearing, then the family’s goal is to make the home a safe haven for their children where they can learn effective coping mechanisms when confronted with situations that might trigger anxiety, for example.   If anxiety is quieted so that the person does not turn or return to an eating disorder as a coping mechanism but rather to a positive mechanism, then the person is making progress.  Having a safe, loving environment in these situations is very important.  Knowing a person’s love language can be useful on the path to recovery.