Written by Clementine adolescent treatment programs Medical Director Dr. Lauren Ozbolt, MD.
Dr. Ozbolt is board certified in adolescent, adult and child psychiatry and oversees the psychiatric care and attending psychiatrists at all Clementine locations. In her writing, Dr. Ozbolt explains her approach when recommending the use of psychopharmacology to her adolescents and their families.
After years of treating patients with eating disorders, I know the word “psychiatric medications” often sends chills down one’s spine. Furthermore, the idea of using psychiatric medications in adolescents is frequently the stuff of parental nightmares. It is true that some adolescents have been scarred by memories of taking psychotropic medications without explanation or have felt “bullied” into taking medications. I find that many teens are terrified of psychotropic medications and have false preconceived notions about how medications work. As one young girl timidly told me, “I will be a zombie.” (Cue Walking Dead episode)
Thus upon meeting a new adolescent at Clementine, I typically don’t introduce the idea of taking psychotropic medications for the first few weeks of treatment (provided they are psychiatrically stable). I find it is much more valuable at this stage of the game to establish rapport. I really want to take the time to get to know the patient, focus on the nutritional aspects of treatment and try to gain a better understanding of the function of the patient’s eating disorder.
After seeing the adolescent daily for several sessions and establishing rapport, I then may make medication suggestions. Psychotropic medications can be very helpful in the treatment of certain eating disorders targeting such symptoms as anxiety, depression, obsessive thoughts and food preoccupations. I spend a great deal of time providing education about the medication, how it works in the body, risks, benefits and side effects. I will often tell the adolescent what they will find if the “google” the medication and why or why not this may apply to them. I never push a medication though, and often suggest that they take a few days to think about the medication and discuss it with their parents. I similarly, give the parents the same extensive psychoeducation and rationale for my recommendation. If the adolescent decides not to take psychiatric medications, again, I never push or try to convince her to take medication. I don’t believe in trying to convince people to take medication they don’t want to take—especially an adolescent who is in the separation-individuation stage of development where opposition is the rule. Instead, I support the adolescent in their decision all the while, leaving the option for medication open. I find this open approach coupled with a relationship that fosters trust and mutual respect sets a firm foundation for change.
To learn more about our newest location, Clementine Briarcliff Manor, please reach out to a Clementine Admissions Specialist at 855.900.2221.
Content originally published here on August 2, 2016: http://clementineprograms.com/2016/08/02/an-open-and-informed-medical-approach/
Written By Shea Rodriguez of New Haven Residential Treatment Center
For many years New Haven has been known as the most clinically sophisticated program in the country. While we still believe this to be true, there have been many programs that in the last few years have not only expanded but improved. From the beginning, we were distinguished as the only ‘girls only’ program, the only one that was family focused, and the only approach that was truly relationship based. Over the years, other programs have learned the lingo that sells, but New Haven has had over 23 years of experience in perfecting just the right approach to help both adolescent girls and their families. Here are a few of the things that continue to distinguish us among other all other programs.
These are just a few of the many reasons New Haven stands out among the country’s leading treatment centers. New Haven is a unique program that has been a leader in long term residential care for more than 20 years!
written by Clementine Miami Pinecrest Clinical Director Bertha Tavarez, PsyD. Bertha discusses treating an adolescent who is resistant to care. She offers some strategies to help strengthen the therapeutic alliance and build the groundwork necessary for full recovery.
“The sun and the wind were having a dispute as to who was more powerful. They saw a man walking along and they had a bet as to which of them would get him to remove his coat. The wind started first and blew up a huge gale, the coat flapped but the man only fastened the buttons and tightened up his belt. The sun tried next and shone brightly making the man sweat. He took off his coat.” – Anonymous
The metaphor of the sun and the wind is an accurate depiction of the challenges that many clinicians face while working with adolescent patients. Although we may have access to the gravity of our patient’s clinical needs, simply communicating our concerns and providing much needed skills can be met with resistance. Our patients remain “locked in” to their emotional experience while simultaneously feeling “locked out” of the insight and motivation needed to increase their receptivity to much needed skills development. The adolescent, preoccupied with exerting and maintaining control and autonomy, may hold tightly to their coat, rendering our intentions to provide care futile.
So how do we, like the sun, create shifts in awareness and influence change?
The power of reflection
It may be tempting to adopt the roll of cheerleader (“You can do this!”) or problem solver (“Why don’t you try this?”). When an adolescent patient presents with resistant talk (“I don’t want to be here”) or talk that inhibits change (“I got straight A’s with ED, what’s the problem?”). Often the simplest and most effective way of building rapport and loosening the grasp of resistance is to simply reflect the patient’s message in your own words. Often, patients are primed for persuasion and direction. Reflection statements can contribute to feelings of validation and interpersonal trust.
Resistance as an interpersonal process / Resistance as developmentally appropriate
It is important to keep in mind that resistance is both developmentally appropriate for adolescent patients and an interpersonal process that occurs within the therapeutic alliance. Although, we may expect a certain degree of resistance on a developmental level, we can provide corrective experiences around resistance that still promote autonomy. A clinician may benefit from awareness about the resistance that is brewing in a session, abstain from engaging in a power struggle, and promote an alliance with the patients’s desire for autonomy.
Highlight intrinsic control
An effective technique that facilitates a shift from resistance talk to change talk is the clinician’s emphasis on the patient’s access to her personal control. A clinician may reflect the pros and cons experienced by the patient:
Patient: “I got straight A’s with ED, what’s the problem? Gosh! That was so hard!”
Therapist: “It sounds like you did well in school this year, but ED made it more difficult.”
A clinician may also reflect a patient’s choice within the constraints of the treatment environment while having the knowledge of the consequences. For example, the patient may be informed of her choice to select what day an exposure is initiated or asked to reflect on her choice to not participate in a group while being aware of consequence of losing a daily privilege as a result.
If resistant talk persists, the clinician can shift the focus to another closely relevant therapeutic topic that may tie into the overall theme beneath the resistance. For example, if the patient states, “I don’t want to take medications and that’s final!” the clinician can say, “Ok, how about you tell me how you’re feeling about your overall health today?”
Working with patients experiencing resistance and treatment ambivalence can be challenging. However, there are great opportunities at this treatment phase that can strengthen the therapeutic alliance and build the groundwork necessary for lasting change. Motivational interviewing and person-centered techniques are an integral component of the clinical work at Clementine adolescent treatment program.
For more information about Clementine adolescent treatment programs, please call 855.900.2221, visit our website, subscribe to our blog, and connect with us on Facebook, Twitter, and Instagram.
Clementine’s newest location, Clementine Briarcliff Manor, will open on April 24th. To visit or tour a Clementine locations with one of our clinical leaders, please reach out to a Clementine Admissions Specialist at 855.900.2221.
Originally published on April 4, 2017 on http://clementineprograms.com/blog/
Written By Shiri Macri, MA, LCMHC, Clinical Director at Green Mountain at Fox Run’s Women’s Center for Binge & Emotional Eating
When treating Binge Eating Disorder, it’s quite common to identify trauma as one of the root causes of emotional overeating and binge eating. Food does more than simply satiate hunger, among those who suffer from binge and emotional eating. Food and eating become:
How Our Brains Respond to Trauma
When people experience traumatic events, the fight-flight-freeze response is activated at such an intense level that our systems become hyper-aroused and hypervigilant in an effort to protect ourselves from future traumas.
That hypervigilance usually gets translated into distorted beliefs about our worlds, again, as a protective measure. Much like a war veteran might have a startle response to a loud sound, so too do those who experience trauma develop distorted beliefs. Beliefs such as “loud sound = enemy fire” (in the case of the war veteran) or “staying home to binge keeps me from having to go out on dates” (in the case of binge eating) can, at times, only be explained by traumatic experiences.
A Perfect Storm
Often eating becomes the way out of such intense fears and belief systems, especially if eating and food have been made an issue in earlier life. Sometimes families put great importance on eating the “right” vs. “wrong” foods or on having the “ideal” body type. When this is the case, there is already stress and importance placed on eating and food.
It’s in these “perfect storm” scenarios that we most often see people turning to food to escape the dissonance created by trauma, among other things. For example, turning to food as a form of self-medicating difficult, trauma-based emotions; or as a protection, perhaps by attempting to add layers to the body to keep from being exposed; or perhaps eating to avoid situations that may trigger the trauma, like socially related situations.
We know this as an ego-dystonic behavior, in which an individual engages in behavior that is incompatible with his / her beliefs. The result of this behavior only feeds the struggle, in that binge eating to cope with trauma leads to increased dissonance, shame and guilt. These further distressing emotions, in turn, lead a person to return to their coping mechanism; in this scenario, it’s another episode of binge eating. The cycle continues.
Mindfulness as a Path Towards True Healing
We see this painful cycle time and again at our Women’s Center for Binge & Emotional Eating. But we also see true healing among our clients, which happens from the inside out.
When body size becomes a target of healing and people turn to dieting, weight loss programs and surgery, only the external concern is addressed…and, incidentally, is rarely successful. Instead, true healing for those who turn to food after trauma means moving towards the body in a different and more tolerable way. It means plunging into mindfulness, and often therapy.
Traumatic stress, especially when coupled with emotional and binge eating behaviors, requires gentle, compassionate support to heal. And we know that the body can very much be an ally in healing the often frozen state people find themselves in with this struggle. By engaging in a mindfulness practice, whether through meditation or mindful movement such as yoga, tai-chi, qi-gong, etc., people can gently and tolerably begin the healing process.
Trauma-Informed Strategies for Focused, Effective Treatment
Most of the women we treat at the Women’s Center for Binge & Emotional Eating have experienced loss or trauma…whether during childhood or simply from living in a plus-sized body in today’s appearance-obsessed culture.
We have learned through neuroscience that empowering our clients to self-regulate their own arousal systems can put them in charge of their physical and emotional states. Rhythmic activities such as dance, tai chi and drumming integrates the senses to help heal the frozen sense of isolation and separation.
Furthermore, physical empowerment is encouraged through movement activities such as kickboxing.
Lastly, mindful meditation is taught and practiced daily.
Safe spaces for client narratives and emotional expression are essential…as is evidence-based therapy AND relationships. Teaching the language of the inner experience while transforming the inner critic into a self-compassionate advocate supports the path to healing.
written by a New Haven Residential Treatment Center Student
I have been at New Haven for over 5 months now. My journey here has taught me so much about myself and my family. A lot of my family’s progress has happened through Experiential Therapy. My family and I began our treatment with challenging family dynamics that were getting in the way of our relationships with each other. A few months ago, we found out that there was an extreme lack of trust in many aspects of our relationships. So, during one of our family weekends, we completed two Experiential Therapy tasks that were based on trust.
The first task we completed was rock climbing together, blindfolded. I climbed first, with my dad belaying me, and my mom directing me on where to go. It tested me to trust that my mom would lead me “safely “to the top and that my dad would catch me if I fell or needed to rest. We successfully completed the task, twice, once more with my mom belaying me and my dad directing me where to go. The hardest part for me was letting go of the wall at the top and having my mom or dad lower me to the ground. I didn’t trust that they were capable of holding me or that they wouldn’t drop me. After we completed the task twice, I felt safer with my parents and confident that they would be there for me. I then belayed both my parents to ensure them that I would always be there to do the same for them.
Our second task was the “Triangle of Trust”. It was on a ropes course, high up off of the ground that required equal energy from both people in order for you to stay suspended in the air. This was even harder for me and my parents because we are all afraid of heights. After practicing first on the ground, my dad and I went up on to the ropes course. I’m not exactly sure how high up we were, but it was high enough to make me grip on to anything I could so hard that my knuckles turned white. My dad followed me up until we were facing each other, on two separate wires. We grabbed each other’s hands, and leaned into each other as we began to walk. We were wobbly and unstable because my dad was putting more into it than I was. We got a little less than half way, when the difference in the effort being put in took effect, and we fell. Once we were lowered to the ground, I got to go back up with my mom. I had the advantage of already doing the task once, but it was my mom’s first time and the height scared her. She kept looking down. When we held our hands above our heads and leaned into each other, I told her to just look at me. We started moving slowly, talking to each other and taking deep breaths. We got about half way until we were so stretched out that we fell. My parents and I processed our experiences after, and learned quite a bit.
I realized that my turn with my dad portrayed our relationship in these past few years perfectly. Dad would always be putting so much into our relationship, while I resented him for the past and neglected our relationship. The “Triangle” shows exactly how a relationship works. For it to thrive, both people must be equally invested and put the same amount of energy into it. However, if one person is putting more into it than the other person, the relationship will “fall”. For my mom and I, it showed us that we support each other well and that we should trust in each other more.
I am so grateful for the Experiential Therapy that we experienced, because I have learned so much. I am excited to have more enlightening experiences in therapy like these tasks.
By, A New Haven Student