Childhood Eating Disorders Blog

Dear Readers,

It’s been getting a little academic on this blog the past few posts, so we thought we’d lighten it up a bit and talk about a new online eating disorder self-help resource that launched recently. It’s called Iceberg, and you’ll find it online at: www.eatingdisorderselfhelp.com.

The website originates out of the Marino Therapy center in Dublin, Ireland, which means there are a few stylistic differences you’ll have to get used to, such as our common nemesis going by the name “eating distress” instead of “eating disorders.” Everything is more subdued and polite in the United Kingdom, even eating disorders, which we know to in fact be brutal and deadly. In a way, it’s a less harmful name, though because one is not stigmatized as “disordered,” i.e. abnormal, but instead considered to be in a heightened state of discomfort.

Another quirky thing about the site is its beautiful homepage image of a very white iceberg, which looks just like a mound of delicious whipped cream. Could this be designed to subliminally attract the eating-disordered community? It doesn’t matter because the content is solid and helpful. I liked the stories of recovery under “tips and inspiration,” and there is information for teachers, coaches and athletes, family and friends. If you want to hear more voices of others battling eating disorders, the moderated posting system might be to your liking. The iceberg, by the way, is supposed to be a metaphor for the way eating disorder symptoms are just the tip of the iceberg, a telltale sign that there are underlying issues at play.

Marcia calls Iceberg the European version of America’s esteemed something-fishy.org, which always bears mentioning and touting. This site has a very good selection of articles by professionals, if you are looking for trustworthy advice. If you are a doctor, it will make you cringe, but there is an exhaustive list of really stupid things doctors have said to patients, too. If you are a doctor just entering the field, this would be a good page to read to avoid damaging future patients. The page even begins with a disclaimer at the top telling doctors no offense was intended by publishing ignorant comments made by medical professionals. It seems that Americans are just as sensitive and polite as our counterparts across the Atlantic.

Take care,

Nancy and Marcia

Dear Readers,

            In my last post, the first of a two-parter, I outlined a form of meal-support therapy developed at the British Columbia Children’s Hospital by Dr. Pierre Leichner and his colleagues. This continuation of the post details how the team translated their program into a method that parents could use at home.  

            Dr. Leichner and his staff then went back to Intensive Treatment Service patients who had successfully recovered using the meal support program and asked them, “If you had to tell family and friends what was helpful to you and what was not, what would you tell them?” The results of these interviews formed the basis of a BC Children’s Hospital instructional DVD, “Meal Support Therapy for Friends and Family.” Basic ideas such as how to handle family conflict when it erupts at the table, or how parents should and shouldn’t encourage their child to eat are covered in the DVD.

            Before a patient is discharged the ITS program conducts one to four “conjoint meal support” sessions with parents and child. Dr. Leichner admits that some families are too enmeshed to successfully practice meal support at home, but notes that this is only in a minority of cases. Most families are able to continue the positive changes at home. He points out that the more entrenched the disorder, the longer it may take for the family to get on track, a fact which argues for families getting meal support training as early as possible in the child’s recovery process. 

            Although there is some overlap of his meal support program with Family Based Training, Dr. Leichner says, “We don’t use the same language, “parent in charge,” or “the power of language.” It’s not about finding causality. It’s more about helping people with the skills of the family meal. It’s more like rehab, giving people the tools, coaching them without necessarily getting into any kind of causality. We emphasize collaboration.”      

            Just as in the clinic, parents sit down with their child before the meal to anticipate what might happen, possible difficulties and how they might respond to them.  “Each family has to find the bottom line, something below which is not acceptable,” explains Dr. Leichner. Not eating at all, for example would be unacceptable. Other negotiated bottom lines could be the content of the meal or the length of time the child will sit at the table. A dietitian aids the family in setting up a meal plan, and can offer suggestions on food choices.

            The key to family meal support, says Dr. Leichner, is patience. Recovery doesn’t happen overnight, and there will be ups and down, progress and relapses. He urges parents to find their own sources of help from a network of friends, family members and professionals so they do not feel alone in their efforts.

            To order a copy of the BC Children’s Hospital DVD “Meal Support Therapy for Family and Friends,” click here. Dr. Leichner reports that the DVD and manual have been translated into French.

Take care,

Nancy

Dear Readers,

            While researching the article, “Family Based Treatment: New Directions,” which appeared in the Summer 2009 edition of Eating Disorders Recovery Today newsletter, I gathered more good material than I had space for. So I’m devoting some blog posts to interviews that didn’t make it into the article. This one, on Dr. Pierre Leichner’s  work with meal support for kids with eating disorders, will be a two-parter, so stay tuned for the next installment!

            For those of you who are not familiar with Family Based Treatment (FBT), also known as the Maudsley approach, it emerged about twenty years ago from researchers at the Maudsley Hospital in London. A central feature of FBT is that parents, who were once blamed for the child’s disorder, become an integral part of the recovery process through refeeding their child at home. This method, though demanding on the parents, has been shown in studies to be highly effective, and is growing in popularity in the United States.

            My goal in the article was to see how Maudsley is being refined and adapted in the U.S.  I found a number of examples of such innovative work, but I also encountered several practitioners who, completely separately from FBT, developed techniques that emphasize the important role of parental support and help in adolescent recovery from eating disorders.

            One of these experts is Pierre Leichner, M.D., psychiatrist and former psychiatric director of the eating disorders program at the British Columbia Children’s Hospital in Vancouver, who developed a family meal support program.

            Fifteen years ago, Dr. Leichner began to see two trends emerge : an increasing emphasis on client satisfaction and client feedback in clinics, and the realization that friends and family could be important aids in recovery. The old hierarchical model was giving way to a more egalitarian, collaborative approach, whether the treatment was for eating disorders, drug addiction, diabetes or depression.

            In the late ’90s, Dr. Leichner developed, through trial and error, a more collaborative way to coax eating-disordered children and adolescents to eat again. Dr. Leichner calls meal support  therapy–where a group of eating-disordered patients eats meals with the help of a coach–“one of the most underrated and understudied parts of managing people with eating disorders.” If therapists and doctors “can find common ground with the patient” instead of forcing the patient to eat in order to recover, Dr. Leichner discovered, the results could be exceptionally good.

            Dr. Leichner relied on interviews with former patients to help refine his meal support technique. “We peeled away the onion constructed of medical myths: You can’t trust a patient to tell you what works, you can’t trust a patient to do exercise, you can’t trust them to serve themselves meals—those were all myths,” he says.

            At British Columbia Children’s Hospital’s Intensive Treatment Service (ITS), up to 12 inpatients sit down to regular meals with two support staff members. A patient new to the group might have meals served to her or him for the first week or so, but within a month, most are serving themselves. The setting is homey, with metal cutlery and glassware. Food is served family style, in large bowls set out beside the table. Patients serve themselves, and then sit down. All have been coached before by a dietitian on serving sizes and quantities before the meal, so supervision at the meal is minimal.

            “We strive for more and more autonomy, until patients feel comfortable sitting at the table for a full half hour,” says Dr. Leichner.   Soon, patients who were refusing to eat or drink, some of whom were being tube fed when they arrived, are feeding themselves on their own. “It’s difficult to do,” Dr. Leichner says of his method, but the positive environment of the meal setting and the way the staff “rewards recovery” rather than continuation of bad behaviors makes change possible.  

Take care,

Nancy

Coming in the next and last installment of this post: Continuing meal support therapy at home after leaving the hospital.