tag:blogger.com,1999:blog-1449641905298601952.post3245486482663469947..comments2024-03-04T00:43:25.831-08:00Comments on Drop It and Eat: Drop the Diet, Manage Your Weight: Making Enemies 101: Tips From the BlogosphereHikerRDhttp://www.blogger.com/profile/15170145903147301280noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-1449641905298601952.post-65836154886737149772011-10-21T03:21:15.594-07:002011-10-21T03:21:15.594-07:00As a parent advocate what I would recommend to any...As a parent advocate what I would recommend to any provider treating eating disorder patients is actual training with clinicians who are experienced and have demonstrated skills in FBT/Maudsley. The books are good, but only as intellectual preparation. Without really working it through, talking it out, and watching families from intake to discharge I find that it is hard to completely conceptualize the difference between clinical stances.<br /><br />I've had many clinicians tell me that there were not one but several 'light-bulb moments' that they had to go through to get from where they were to where they ended up. It was challenging, too. But they also say that they really enjoyed their work more - partly because they were more successful, but also because they were less frustrated by the interactions with patients and families.<br /><br />It's possible you'd get the training and not change much in your approach. You may not find it helpful and you may not agree with it even understanding it better. I do think that anyone treating eating disorders should at least explore it - and that families of patients of all ages should at least know about the option and be able to discuss it with people who are skilled and trained in it when choosing who to work with.<br /><br />I really appreciate your willingness to discuss it. Your blog is great.Anonymoushttps://www.blogger.com/profile/17219492984914810944noreply@blogger.comtag:blogger.com,1999:blog-1449641905298601952.post-57479330981517626462011-10-12T19:07:16.633-07:002011-10-12T19:07:16.633-07:00@Laura I would welcome any recommended reading tha...@Laura I would welcome any recommended reading that you believe best addresses the Maudsley approach/FBT protocol.<br /><br />Also please note that when we use the word children, we are describing a large and variable group of individuals--10 year olds and 17 year olds are quite different, and themselves quite variable. But no "child" is put in charge, without regular medical check ins and accountability to a nutritional plan.HikerRDhttps://www.blogger.com/profile/15170145903147301280noreply@blogger.comtag:blogger.com,1999:blog-1449641905298601952.post-64662649297195256292011-10-12T02:55:51.735-07:002011-10-12T02:55:51.735-07:00We have the same goal.
The way you are talking a...We have the same goal. <br /><br />The way you are talking about families above is a stance that could make you not a candidate for offering a family-based approach. But it doesn't mean those families might not be excellent candidates for the approach with a nutritionist who has a different stance and training.<br /><br />All the family situations you describe that are "not ready to step up" are indeed typical. We were one of them. Those are normal families and normal attitudes - because families don't start out knowing what an eating disorder is, what the dangers are, how many wrong ideas they have about weight and nutrition and mental health, or what heroic work they are going to need to do - THAT'S WHERE GOOD CLINICAL CARE COMES IN. Eating disorder professionals' job is to get families from that bewildered, clueless, frightened place to where they need to be. You can't do the job without them. You are not describing dysfunctional toxic people - you are describing EXACTLY the people who need your help, your specialized help, to save their children's life. They are also the same people that, when not actively involved in the team, undermine recovery.<br /><br />THEIR learning curve, and your professional skill at guiding them, is what makes the difference.<br /><br />Children in charge of their own meal planning? Professionals giving children instruction on meal planning? I'm not a fan of that with ANY illness. If the justification for that is that the parents are clueless then you have a FAR greater problem at hand. But a young person with an eating disorder being in charge of their own meal planning and monitoring? They have a mental illness that skews their judgement, makes them incredibly anxious - they are mentally ill and without normalized nutrition will stay that way.<br /><br />Family-Based Maudsley Treatment is only one way to address all of the above - there are others. But FBT - the manualized, trained kind - is all about taking a family in crisis and chaos and lack of understanding and getting them to a place that no clinician can do alone with a patient - and unless the family is so toxic and unwell as to require foster care or legal intervention, clinicians should be working closely with the family no matter what approach or combination of approaches they are using.Anonymoushttps://www.blogger.com/profile/17219492984914810944noreply@blogger.comtag:blogger.com,1999:blog-1449641905298601952.post-67572015637463781262011-10-11T19:09:10.052-07:002011-10-11T19:09:10.052-07:00@ Laura First, thank you for dropping by to respon...@ Laura First, thank you for dropping by to respond!<br />For clarification:<br />-I always start with the belief that there is the potential for change, both for the child and for the family.<br />-parents should never be "cut out of the picture" if they are living in the same home. Nonetheless, just how involved they are and need to be varies with each situation. Most importantly, all parents need to set appropriate limits, have food available, be supportive, and bring their child to the necessary appointments. But they don't all need to play the role of measuring, plating and supervising meals--if the child is successful at doing so, for instance.<br />-so let's take diabetes. A newly diagnosed Type 1 diabetic child is often admitted to the hospital at the onset of their disease for education and management. A CDE and RD as well as MD are often doing the decision making subsequently, as the family adjusts and learns how to manage--how to adjust the insulin, adjust carbohydrate intake for changes in physical activity, etc. And the degree of involvement of the parents varies with the age and competency of the child.Even a pre-adolescent, for instance, is taught to test his own blood sugar, is taught to monitor for symptoms, and educated how to treat a low blood sugar. Yes, parents, too are brought in. Of course. But I don't think this analogy holds.<br /><br />As for how rare it is to find families not ready to step up--it is unfortunate, but true, that it is far from uncommon. Remember that the population you encounter is seeking help, perhaps via the internet or is self motivated to read your book. But patients show up to see providers like me because they have to, because their MD sent, because their child is losing her hair, because others are commenting, etc--not necessarily because they are concerned (of course, some come very concerned, too). Often they are in denial, or believe it will just go away. They believe their child needed to lose a few pounds anyway, perhaps. I could go on. Trust me, this is way too common--it is not rare at all. They complain about their daughter not being able to dance, or missing a soccer game for appointments. They want to spread things out appt-wise, but want us to okay their child playing multiple sports in a season. Really, I could go on.<br /><br />In the ideal world, families would be able to support their child in recovery, help feed them, set appropriate limits on their physical activity and see the progress that prevents secondary effects from anorexia. Wouldn't we al like to see this?<br /><br />Finally, it is unfortunate that you and your family were considered poor caregivers and inappropriately prejudged. The medical community has it's work to so--that is for certain.HikerRDhttps://www.blogger.com/profile/15170145903147301280noreply@blogger.comtag:blogger.com,1999:blog-1449641905298601952.post-38335155574649844802011-10-11T05:18:46.764-07:002011-10-11T05:18:46.764-07:00Let me try an analogy on you? If we were talking a...Let me try an analogy on you? If we were talking about diabetes, for example, would it change your stance? <br /><br />Wouldn't you start with the assumption that patients need, and deserve, parents who will step up, learn what they need, make and keep appointments, take care of shopping and cooking, monitor for symptoms, and create a home environment safe for treatment and maintenance?<br /><br />Would you at an intake appointment believe that the family "might" be able to do what is needed? More to the point, do you think the family senses your skepticism? <br /><br />As a clinician, would you consider cutting the parents out of the picture because of their weaknesses and flaws, or would you start where they are and do everything you can to get them to a better place? Would you be thinking of success stories, or failures?<br /><br />The truth is, patients with eating disorders who don't have parents who are ready to step up are far less likely to recover. Period. They're far less likely to thrive in many ways. They are also quite rare - the exception. A lot depends on the clinical stance. If they have clinical care that doesn't do EVERYTHING possible to get that family in a good place they are also less likely to recover.<br /><br />We don't do less to help families facing cancer, or diabetes, or a car accident because they aren't perfect or even functional - we know that the family has far more influence and agency than anyone else and CAN NOT be marginalized in the process without grave risk to the patient. It just isn't an option.<br /><br />And who decides? A clinician with an hour or two experience with a family in crisis? The parents themselves? Social services?<br /><br />Hiker, clinicians who fail to START with optimism, belief in the family, and the knowledge that without the family the patient is in even worse shape than they might be even in the most dysfunctional environment, great harm can occur. Inadvertent, well-meaning, but genuine harm. That's where the anger comes from.<br /><br />Our family experienced that, and I see countless families go through it as well. When my husband and I were guilty until proved innocent, marginalized, and held at arm's length we WERE poor caregivers. When we were empowered, coached, educated, and believed in we did pretty heroic work as a family. Same family, same illness - very different outcome.<br /><br />Really, there are no "Maudsley-style bloggers." There are just individual people, like me, and each of us are different and none of us agree on everything. I applaud your anger and frustration at me and others - and look forward to your insights along the way. You care and you're engaging. That's the point - for all of us.Anonymoushttps://www.blogger.com/profile/17219492984914810944noreply@blogger.comtag:blogger.com,1999:blog-1449641905298601952.post-70111689014116293452011-10-11T04:17:12.066-07:002011-10-11T04:17:12.066-07:00I think anger can be a great motivator. It reminds...I think anger can be a great motivator. It reminds us of the real danger and real need for immediate action when it comes to eating disorder treatment. But so often in blogging, as in life, this anger can alienate the wrong people; the people who are affected by the anger are more often than not the people who would actually have been the most likely to listen. Those who could do with hearing these messages of anger and frustration are sadly never the ones listening anyway. <br />And I suspect the reason you felt this anger so acutely was the fact that you truly do put your heart and soul into your work - this is so obvious here on your blog.PJhttps://www.blogger.com/profile/14486135269960422312noreply@blogger.com