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Although still a fledging in Australia, this treatment is gaining ground as being a better approach the traditional CBT. My daughter was mostly mindfulness and CBT – neither of which was very successful with her. My son is more DBT but because we are in Australia, we only have limited access to full training (unless you live in bloody Sydney) so our professionals in train parts of DBT. Overseas the DBT treatment is showing excellent results and a highly advised must for eating disorder recovery.

The information below comes from the Behaviour Tech website.

What is DBT?

Overview

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

What are the components of DBT?

In its standard form, there are four components of DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.

  1. DBT skills training group is focused on enhancing clients’ capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. Groups meet on a weekly basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for particular populations and settings.
  2. DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy and runs concurrently with skills groups.
  3. DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
  4. DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work with people who often have severe, complex, difficult-to-treat disorders. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. Teams typically meet weekly and are composed of individual therapists and group leaders who share responsibility for each client’s care.

What skills are taught in DBT?

DBT includes four sets of behavioral skills.

  • Mindfulness: the practice of being fully aware and present in this one moment
  • Distress Tolerance: how to tolerate pain in difficult situations, not change it
  • Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
  • Emotion Regulation: how to change emotions that you want to change

There is increasing evidence that DBT skills training alone is a promising intervention for a wide variety of both clinical and nonclinical populations and across settings.

What does “dialectical” mean?

The term “dialectical” means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For example, DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals. In addition, all of the skills and strategies taught in DBT are balanced in terms of acceptance and change. For example, the four skills modules include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness).

How does DBT prioritize treatment targets?

Clients who receive DBT typically have multiple problems that require treatment. DBT uses a hierarchy of treatment targets to help the therapist determine the order in which problems should be addressed. The treatment targets in order of priority are:

  1. Life-threatening behaviors: First and foremost, behaviors that could lead to the client’s death are targeted, including all forms of suicidal and non-suicidal self-injury, suicidal ideation, suicide communications, and other behaviors engaged in for the purpose of causing bodily harm.
  2. Therapy-interfering behaviors: This includes any behavior that interferes with the client receiving effective treatment. These behaviors can be on the part of the client and/or the therapist, such as coming late to sessions, cancelling appointments, and being non-collaborative in working towards treatment goals.
  3. Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life, such as mental disorders, relationship problems, and financial or housing crises.
  4. Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.

Within a session, presenting problems are addressed in the above order. For example, if the client is expressing a wish to commit suicide and reports recurrent binge eating, the therapist will target the suicidal behaviors first. The underlying assumption is that DBT will be ineffective if the client is dead or refuses to attend treatment sessions.

What are the stages of treatment in DBT?

DBT is divided into four stages of treatment. Stages are defined by the severity of the client’s behaviors, and therapists work with their clients to reach the goals of each stage in their progress toward having a life that they experience as worth living.

  1. In Stage 1, the client is miserable and their behavior is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is for the client to move from being out of control to achieving behavioral control.
  2. In Stage 2, they’re living a life of quiet desperation: their behavior is under control but they continue to suffer, often due to past trauma and invalidation. Their emotional experience is inhibited. The goal of Stage 2 is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated.
  3. In Stage 3, the challenge is to learn to live: to define life goals, build self-respect, and find peace and happiness. The goal is that the client leads a life of ordinary happiness and unhappiness.
  4. For some people, a fourth stage is needed: finding a deeper meaning through a spiritual existence. Linehan has posited a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connectedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.

How effective is DBT?

Research has shown DBT to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning. For a review of the research on DBT, click here. In this video, DBT Developer and Behavioral Tech founder Dr. Marsha Linehan describes the amazing changes she’s seen in people who have received DBT and gotten out of hell.

Dive Deeper

Philosophy and Principles of DBT

DBT is based on three philosophical positions. Behavioral science underpins the DBT bio-social model of the development of BPD, as well as the DBT behavioral change strategies and protocols. Zen and contemplative practices underpin DBT mindfulness skills and acceptance practices for both therapists and clients. DBT was the first psychotherapy to incorporate mindfulness as a core component, and the Mindfulness skills in DBT are a behavioral translation of Zen practice. The dialectical synthesis of a “technology” of acceptance with a “technology” of change was what distinguished DBT from the behavioral interventions of the 1970s and 1980s. Dialectics furthermore keeps the entire treatment focused on a synthesis of opposites, primarily on acceptance and change, but also on the whole as well as the parts, and maintains an emphasis on flexibility, movement, speed, and flow in the treatment.

The Development of DBT

In the late 1970s, Marsha M. Linehan attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, and non-suicidal injury. Trained as a behaviorist, she was interested in treating these and other discrete behaviors. Through consultation with colleagues, however, she concluded that she was treating women who met criteria for Borderline Personality Disorder (BPD). In the late 1970s, CBT had gained prominence as an effective psychotherapy for a range of serious problems. Dr. Linehan was keenly interested in investigating whether or not it would prove helpful for individuals whose suicidality was in response to extremely painful problems. As she and her research team applied standard CBT, they encountered numerous problems with its use. Three were particularly troublesome:

Learn More

Understand the Underpinnings of DBT: Behavior Therapy

It is essential to have a solid applied understanding of the Behavior Therapy paradigm before venturing into the room with a client to do CBT, DBT, or many other evidence-based treatments. Click here to explore video training segments with teaching from Dr. Marsha Linehan about Behavior Therapy.

Learn the Basics of the Treatment Model

Learn about Potential Adaptations of DBT for Your Setting

Further Learning Opportunities

If you are interested in attending a workshop or want to implement the comprehensive DBT model in your practice, visit the BTECH Training Options page to discover what the right next step is for you or Contact Us with your questions.

References

Allmon, D., Armstrong, H. E., Heard, H. L., Linehan, M. M., &.Suarez, A. (1991). Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients. Archives of General Psychiatry, 48, 1060-1064.

Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., Bishop, G. K., Butterfield, M. I., & Bastian, L. A. (2001). Efficacy of Dialectical Behavior Therapy in Women Veterans with Borderline Personality Disorder. Behavior Therapy, 32, 371-390.

Linehan, M. M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.

Linehan, M. M., Schmidt, H., Dimeff, L. A., Kanter, J. W., Craft, J. C., Comtois, K. A., & Recknor, K. L. (1999). Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence. American Journal on Addiction, 8, 279-292.

Verheul, R., Van Den Bosch, L. M. C., Koeter, M. W. J., De Ridder, M. A. J. , Stijnen, T., & Van Den Brink, W. (2003). Dialectical Behaviour Therapy for Women with Borderline Personality Disorder, 12-month, Randomised Clinical Trial in The Netherlands. British Journal of Psychiatry, 182, 135-140.

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feelings and anorexiaThere is a blog doing the rounds at the moment of how it is to feel during an eating disorder, particularly anorexia. It is a haunting read. Many of us, either parents/carers or sufferers relate to every feeling. It highlights where we are or have been. We can shout, YES! we agree with all of that.

But we need to balance out what is the need for validation and the need for truth. Every story about living and surviving, or living and still struggling with an eating disorders needs validation. They are your personal journey, your personal thoughts and feelings. Validation is essential, otherwise it takes away your value as a person. It makes your journey a real one. It also helps those of us who don’t suffer with an ED to understand what is going on in the mind of someone who does. It helps those who suffer to know they are not alone nor in some weird, hateful universe of their own making.

The truth of these feelings though is what is needs to be understood. In the depth of the grip of an eating disorder (particularly anorexia), the mind is totally in the control of the ED. It is manipulated, distorted and controlled. Normal perceptions, thoughts and feelings are not happening. What you think and feel is based solely upon the eating disorder and not based in truth or reality. The ED distorts reality, life, decisions and perceptions so badly that your feelings get mixed into this mess as well. It may seem like truth, that this is all there is and it is real. But once you are on the other side, into recovery or recovered, you can see these feelings were not based on truth. Life is not like that, the people around you are not like that, you are not like that.

All mental health illnesses distort our perceptions and govern our thoughts and feelings. When I am severely depressed I know I think all sorts of weird, paranoid, self-inflicting thoughts. I feel many things but none of them based on the reality around me. It’s when I am back in safer lands that I realise that those feelings were not true nor indicative of what was happening to me or around me. My daughter used to think and feel like this current highlighted blog post, but she will tell you now that she knows those feelings to be just about all false. That it was the anorexia that coloured everything and gave her those dreadful feelings.

A good therapist will hear your feelings and validate them. They will allow you to identify and explore your feelings.

A better therapist will THEN point out the ED behaviour and teach you to separate yourself from the negative and distorted feelings.

Our whole team based their care of my daughter on this. They called each anorexic thought, feelings and behaviour into the open and pointed out how false and wrong they were. Without taking away my daughter’s need to be heard or validated.

She never felt she had to apologise for her feelings or she was wrong for feeling them. She did learn that the anorexia had given her thoughts and feelings that were not true about herself and life around her. She learnt to counter each negative feeling with a positive one.

When writing our stories, we need to be mindful that we show that these feelings are only for here and now in the grip of the illness. We need to put forward what happens after therapy and into recovery, that our feelings change and we see things for more differently as the ED loses it’s grips. We need to ensure that our stories are not ‘blanket’ approaches, one size fits all. Above all we need to share that hope lives and that the negative, destructiveness of an eating disorder does not last.

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Finally, have found the time to write this. This is our experience, I can’t talk for everyone who has asperger’s and an eating disorder (usually anorexia). Asperger’s is a spectrum illness so everyone is unique and on different areas of the spectrum. Anorexia is also unique for each person, particularly in their recovery.

By the time most sufferers of anorexia get to medical help, despite whatever other co-morbid illnesses are present or traumas suffered, the immediate concern and treatment is for the anorexia. Everything else is put aside til stability in health is achieved. It is also difficult to tell exactly what the mix of health issues can be too. The anorexia masks so much because it dominates the body and mind totally, and it also mimics so many other illnesses. It’s further into recovery with stable health and a mind more nourished, to get a better picture of what else is happening.

Will’s asperger’s was diagnosed early on but being high functioning and barely over the diagnosis line, it’s easy to think he is fully able to function like others. Whilst he has anxiety/depression the asperger’s affects his treatment plan.

Sophie’s asperger’s didn’t come to light until during her anorexia recovery. The anorexia highlighted the Asperger traits that she had carefully hidden or compensated for. It’s also the same for her, barely over the diagnosis line, it’s easy to forget the asperger’s traits in her recovery treatment.

Rigidness/black and white
Asperger’s is often about rigidity in thought and behaviour. When they get a thought or behaviour it can become a mantra, so tightly held it is very difficult to teach them how to let go and that it is safe when they do. Part of treatment is learning to be flexible. Teaching them that change is part of life, but also helping them negotiate that in a safe way. Change triggers a lot of emotions and rigid behaviours. They also love order and a set routine and knowing well in advance what might happen so they can plan to cope with that. Anorexia is also black/white, rigid thinking, routine or set patterns of behaviour. The two illnesses feed upon each other, and strengthen the thinking and behaviour. Treating the anorexia becomes a struggle of strengths. Both therapist and sufferer can feel blocked and frustrated that they cannot move into more flexible thinking and behaviour patterns. With Sophie, there is so far she can go before she hits the rigidness of the Asperger’s. Then it becomes very difficult to help her understand what is really going on. She also cannot fully understand why she cannot become more flexible, why others recover without the rigidness. An example would be food rules and fears, letting go of the incredible rigidness and fears she had was more to do with the Asperger’s than the anorexia. But the two illnesses together created a very formidable barrier.

Empathy and connection
Asperger’s is often called the ‘mask’. The face doesn’t show the normal display of emotions, nor is there the ability to connect with others on an emotional level. They get (sometimes) the logistics of it, can see other’s doing it, but cannot make the connection themselves. They cannot understand how it feels or is for another person. Anorexia is about cutting all emotions off, becoming numb, checking out so social interaction and normal emotional responses are damped down or non-existent. It helps the anorexia control the person and allow it to destroy the body and mind. Recovery is learning to feel again, connecting with your own buried emotions and reaching out and connecting to others. This is critical to recovery. Couple this though with someone with Asperger’s and again, they can only get so far in identifying emotions and feeling them, or expressing empathy for others. Sophie half gets empathy, and struggles to socially connect. She doesn’t get how to be a friend and often overwhelms her subjects. Will lacks empathy and struggles to connect emotionally. Both want to have full and normal emotional responses and connection. Both will also struggle to do that. In Will’s case he thinks a ‘pill’ will make him happy and be able to connect and feel for others. However that will never happen because of the Aspergers. Only therapy (that he may or may not be able to understand how to do) will help him to learn his version of empathy and connection.

Friendships and Social Awkwardness
Making and keeping significant friendships is a very difficult thing for someone with Asperger’s to do. They can be inappropriate in their responses, not understand social cues and ‘rules’, are unable to communicate at the deeper level that friendships require. Anorexia tries to isolate and destroy friendships for control. Friends of someone with anorexia also can find it all too hard, and just walk away. The majority of sufferers end up having to remake friendships all over again. Meaning, if you have Asperger’s then how do you make those friends again, how do you learn to social and emotionally connect to make friends when you can’t. Nevermind getting past the rejection phase of losing all your friends whilst being ill with anorexia. Sophie perceives her friendships on a different level to what they are. She can take offence when none is given, is very literal and little sense of humour. All Asperger traits. Making new friends in anorexia recovery is difficult – you feel an outstanding, different, still have food or social issues. Add a layer of Asperger’s to this and new friend making becomes a minefield of stops, starts, failures, and if lucky an occassional win.

 

These are the main ones that can create tension, frustration and a block to recovery. Whilst the other traits of Asperger’s can trip things up (little eye contact, perceptions of other’s talk and actions, being literal) they are more to do with relating to the treatment team. Sufferers can think their team is not believing them, blaming them, or is not making an effort. Instead of sticking to the team and pursuing a relationship, too many leave and start a pattern of changing therapists. This doesn’t aid long term recovery and can be behind many relapses.

The need is for a therapist who understands both conditions to help navigate the trickier parts.

The two illnesses requires more patience and understanding from all  – the sufferer, family and friends – that recovery is going to be on very personal terms.

Denying or not treating the asperger side is also harmful. It leaves the sufferer with no full understanding of why they are like this, or how to change or learn to live with it.

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This post is two excerts from Weightless about the inner voice that is part of a lot of mental health illnesses and how to manage them. Worth reposting for my readers. I really like the bit about saying “Oh I’m hearing the critic now”. Sophie was taught to say “Oh it’s that anorexia voice again, it’ boring”. We learnt that pushing or arguing with the voice just adds more fuel to the fire. Taking away it’s power to hurt you by ignoring or downplaying it can be far more effective.

And yes the asperger post is next.

Distinguishing the Inner Critichttp://blogs.psychcentral.com/weightless/2014/10/how-to-distinguish-your-core-self-from-your-inner-critic/

  • It’s harsh and mean. If you’d never say these things to someone you love, it’s your inner critic.
  • It’s black and white. You are either beautiful or ugly. Your dreams are either possible or impossible.
  • It’s the voice of reason. It mentions things that are supposedly in your best interest, such as “If you go forward with the book, you’ll ruin your reputation. Your work isn’t ready for that level of scrutiny. Better hold off for a while.” I’ve realized that, today, my inner critic is largely made up of this voice. It’s the voice that says, Are you sure you should be the one writing this book? Can’t you think of 50 other writers who should be writing this book instead of you? You’re not very good at public speaking. Let’s never do that, OK?
  • It says, “you aren’t ready yet.” “You need more time to prepare,” or “You need more experience.”
  • It spews self-critical thoughts about aging or your weight, shape or size. It says that you look too big or too old. It says you need to lose weight or shouldn’t be wearing this or that.
  • It rehashes negative core narratives.
  • It attacks you with critical thoughts, and then shames you for having those thoughts.
  • It sounds like your parents, siblings or your boss or anyone else who’s been critical.
  • It sounds like your company or culture.

What to do when the Inner Critic is LOUDhttp://blogs.psychcentral.com/weightless/2014/10/what-to-do-when-your-inner-critic-is-roaring/

  • We never win an argument with our inner critics.
  • Instead, when we hear self-doubt,  name the inner critic: “Oh, I’m hearing the critic now.”
  • Explore the inner critic’s motives. We can ask: “What are you trying to do? What are you trying to prevent or protect me from?”
  • Tell the inner critic in a sincere way: “Thanks, but I’ve got this one covered.”
  • Separate yourself from the inner critic. Instead of saying “I’m having a freak-out right now,” say “My inner critic is having a little freak-out right now.” This helps to train our minds to realize that the inner critic is just one voice within us, and “not the primary one.”
  • Seek out humor. Ask yourself, “What is absurd or funny about what my critic is saying right now?”
  • Pretend that you’re putting all the inner critic’s thoughts away into a cup, box or bowl. Then move it into another room. Get back to whatever you are doing knowing that the inner critic is no longer present.
  • Notice where the inner critic’s voice resides in or around your body. Then picture that voice withdrawing, or moving away from you.
  • Picture a volume dial for the inner critic. Simply turn it down.

One thing she does miss in the ‘what to do’ is using your distractions toolbox. Friends, movie, doing something different or active can be like changing the channel on the TV. Removes you from the place where the inner voice was trying to get attention.

The inner critic

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People tend to think that all is well from their external observation, Sophie is in recovery and life is moving forward rather than backwards. A very easy assumption to make, after all she has been in a good stage of recovery for sometime now, so of course you should have all moved on.

Wrong.Families in mental health recovery

Sophie is still dealing with the legacy of having anorexia. The dreams, sudden fears and panic attacks of slipping backward, the literal distance between her and me and being unable to cope on her own at times. She still doesn’t know how to talk to someone else outside of the family and therapy people about her illness. She fears that knowledge in the hands of others will mark her out as ‘always the anorexic’. She is still finding it overwhelming dealing with feelings and emotions after being numb for so long. It literally floors her until she can find the path through all the emotional forest to the other side.

Her brothers still have questions, and have had their own therapy sessions this year in talking about how ti was for them. Again they don’t want to talk to anyone other than a qualified therapist. It is all too hard, and they find no one else barely understands what it was like for them. As for Will, I cannot even begin to express where he is just now.

As for me, the mum, in all this, I too am on the recovery road still from the anorexia. It sill brings fears when I hear Sophie say certain things or do certain things. Fear that she may be slipping, or her mind is still doing un-conscience ED behaviours. I still find myself feeding her more than she needs. I still remember too closely the feelings, fears and awfulness of that whole time. As much as I am moving away and stepping into a new life, the past is still there. And as any mum/parent is aware, the thought and knowledge that this can all happen again – very easily. I too still use therapy as I reach each next stage of recovery to point to the next stage and steps. This is where my faith steps in and holds me strong. Without God I could not let Sophie go as easily as I have and live her own life in a different city. I trust Him with her safety and her recovery.

It takes a long time to develop an eating disorder, it takes even long to recover. It is never just the suffer who experiences this, but the family, loved ones around them. There is no timeline for ‘being recovered’ for anyone involved. As humans, there is grief, guilt, change, relationships and trauma (all part of the anorexia experience)  that have to be travelled and sorted before we can smile again at the future. Be gentle with us who are in recovery. Don’t expect too much, or expect us to bare our souls to you. It takes time.

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It gets so frustrating when even treatment centres cannot do the ‘right’ thing by eating disorder patients. LOL, really the fact that you managed to get a coveted position in a treatment centre is a major achievement in itself – that means you actually found a doctor who believes you have an eating disorder and got you a referral to the treatment centre.  What do you do when the whole thing turns out to be intensely disappointing. What do you do when you are released, you are no better than when you were admitted.

So up front, I get why treatment centres treat and run the programs they do. They have many different people, all unique and all not going to respond to just one form of treatment. So the treatment centre to run effectively, also has to streamline what they can and can’t deliver. That is reasonable. I also understand that they can’t also perform miracles. Basically the patient has to be willing to comply in the end with eating and wanting to recover.

But …

  1. They promise to not discharged unless fully weight restored – but they do.
  2.  They work on punishment and penalties – but the rest of the eating disorder treatment approaches don’t (and they are the ones with the most successful recovery stats).
  3. Some patients have been back over 3 times (several patients) – doesn’t that send a clear message ‘it’s not working’.
  4. Therapy is with-held unless fully weight restored. (see point 1 for how ludicrous this is).
  5. For critical patients they can quite easily discharge you after a few weeks, barely beginning your recovery program.
  6. They send you to their ‘preferred’ ongoing treatment psychologists, ignoring your home team. This creates ill feeling back at home and also introduces another unknown person into the recovery program.
  7. Critical patients are thrown in with groups of patients on their 3-4th visit who treat the centre as a party atmosphere. They are exposed to new tricks, manipulations, ways of purging etc.
  8. Treatment centres run down previous care and treatment, without knowing facts etc and make you feel you are even trying to care.
  9. I am not talking about adults either, but kids, young teenagers in these treatment centres.

get serious about treating eating disorders

The goal of initial treatment is to fully weight restore. This is supposed to ground rule wherever you are treated. If you don’t get that much at least, then what is the point of the treatment centre or hospital to start with. You might have just as well stayed home and tried to treat yourself. It also builds a mistrust in the treatment centre and their ability to really help you. Treatment centres should be aware after treating so many patients, that patients only eat to get out. So releasing them under goal weight and believing that they will eat at home, is also to the point of ludicrous.

A few weeks in a treatment centre (unless you are incredibly willing to change) is also not enough time. In anorexia cases and severe weight loss, weight simply cannot be restored in that time, nor can health, mind or any psychology work be done to start to change behaviours. Again all this does is, help the anorexia dig in deeper and become more chronic.

And what really, really annoys me, is the treatment centres and professionals who think you CANNOT do psychological treatment when underweight. There is SOOOOO much more to the psychological treatment than just getting cooperation and changing behaviours. If our team had taken that approach, then nothing would have been started til much later. Part of the whole concept of getting Sophie to eat in hospital, was talking about the psychological hold the anorexia had on her. The psychiatrist spent time every week with her, just gently stating the same points and discussing the illness. Whilst Sophie didn’t always respond, the seeds were sown. We could all see that she could begin to glimpse the anorexia as different to her and try to grasp what she needed to do. Of course it was beyond her to try to change behaviour much, but the seeds where there, she had already started on the right track BECAUSE therapy was started at a low weight and in hospital.

The biggest gain, is creating the relationship between sufferer and treatment professional, whether counsellor, psychiatrist or psychologist. Whilst many therapies points and techniques do need a receptive and working mind, the constant therapy appointments at the early stages of weight gain and recovery is gold. When Sophie left hospital the first time, she already had relationship beginning with her team. She learned through constant contact, this team was committed to her. The beginnings of trust were developing. They may not have been able to change her mind yet, but she knew that they were going to stick with her and bring her through. She also had the gentle repetition of the initial psychological separation from the anorexia already happening.

Running down previous treatment therapies, people and hospital treatments is unprofessional and really unhelpful to both sufferer and carer. There is no ‘one’ perfect fix. Why do professional assume their treatment centre offers the best and only way. Who gives them the right to run down others, particulary when they aren’t even delivering the appropriate level of base care. Different techniques work for different people not a one size fits all. You may not agree with another’s treatment ideas, but that is not to say they are wrong, nor that they won’t work.

If a treatment centre cannot even offer the basic, long term care and much needed psychological care, then what hope is there when your loved one comes home still failing, still underweight, still refusing to eat. Where do you go for help then? In rural, regional areas there are no choices available. In small countries, you are lucky to have only one treatment centre – which if that fails in its duty, then what next. We are not providing appropriate care nor offering solutions when we send home our patients still underweight, with little or no therapy and all we do is create distrust in centres and hospitals, distrust of health care professionals and allow the eating disorders to tighten/deepen their hold.

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From Libero Network

This month we are talking about Mental Barriers, which is interesting because in the last few months my life has been defined by mental barriers. More specifically, my life has been defined by one of my largest mental barriers: not being good enough. Or, I suppose I should say thinking I’m not good enough.

When in recovery this was a struggle – what if I’m not strong enough to recovery? I’m not “disciplined” enough… I’m not strong enough… I’m not “special” like the people who recover. All lies.

Now I am through recovery (and thus have proven wrong all of those previous statements) and yet my barrier remains.

Lauren B - we are capableWhether it’s a new job, a request for help, or an amazing opportunity, my first response is no. Not “No I won’t do it” but rather “No I can’t do it”.

And even though I have an army of people around me cheering me on, with complete confidence in me (the same way I have complete confidence in them), I still cling to this single phrase: I’m not good enough.

Truth be told, if I really dissect it (my favourite thing to do!) I think the phrase is more “What if I’m not good enough?”

At its core, I think this barrier is more about fear than anything else. Yes insecurity comes into play, and yes pessimism does, too; but mostly I think it’s about fear. The fear of not being good enough, the fear of letting people down, the fear of not measuring up – of failing.

It’s amazing the power fear will take if you let it – it can completely handicap you and keep you from moving forward, keep you stuck standing in one place while you hesitate to even take one step forward for fear you mess it up.

This is not living. This is not thriving. And this is not justified.

The truth is we are capable of far more than we give ourselves credit for.

And any voice that tells us otherwise (whether it comes from within us, or from the outside) is a lie.

Sure, there are some thing I cannot do – for example, I probably couldn’t become a successful accountant – why? Because I work in words, not numbers, and the thought of money sends me into a panic attack. But here’s the thing: I don’t really want to become a successful accountant. Why? Because I work in words, not numbers, and the thought of money sends me into a panic attack. I hope you are getting my point?

I believe we are all created with passions and desires that relate directly to our abilities. If you are passionate about something and feel the desire to do it, then this means you are also equipped to do it. Sure there may be some training along the way, and a few mistakes and trips (of course!) but you will still be able to do it. You will be capable.

The same can be said for recovery – anyone can recover. There is nothing “special” about those who do it. We are not the “chosen few” – if anything, we are the few who chose it.

When you really want something, and you are driven towards it, and you have your eyes, heart, and mind set on the goal, you will succeed. Maybe “success” won’t look exactly how you thought in the beginning, but you still will succeed.

But calling yourself “not good enough” or assuming failure can be a self-fulfilling prophecy – so don’t let it be. Fear is the enemy of progress; but fear of this type cannot exist unless we bring it into existence.

And so even though I know it’s easier said than done, this month I encourage you to start breaking down your mental barriers – whatever they are – and for those of you who struggle with not being good enough, with self-doubt, with fear, I want you to know you’re not alone. I want you to know I am with you. And, most importantly, I want you to know that like any other mental barrier, it is something within us that can be broken down. It doesn’t have to control you and it certainly doesn’t have to define you.

So that job? That big opportunity? That goal? That thought of entering into recovery? DO IT – because you can, and as soon as you embrace this truth, you will.

Much love,
Lauren Bersaglio

Founder, Editor-in-Chief, Libero Network

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