Author Archives: Alison Pelz, LD, RD, CDE, LCSW

Must-Ask Questions When Looking For An Eating Disorder Therapist

Must-Ask Questions When Looking For An Eating Disorder Therapist

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Let’s face it, finding the right eating disorder therapist for your eating disorder can be daunting. It can feel downright overwhelming. You may be ambivalent about getting treatment. Maybe you are worried that your eating disorder isn’t “bad enough” to warrant treatment (trust me, it is). Or perhaps you are feeling hopeless about finding another therapist after being treated in the past.

Whether you are an individual with an eating disorder or a loved one of a person with an eating disorder, looking for a qualified therapist can be tough.

This post will give you tips on what to look for in a treatment provider, and questions to ask to help you determine the right eating disorder therapist for you.

Most therapists are willing to talk with you on the phone before you set an initial appointment. They will help assess goodness of fit in regards to scheduling, payment, and issues you may want to address in therapy.

If the therapist doesn’t offer a phone consultation, then these questions can be asked in the initial face-to-face appointment.

You can use the following questions and talking points when interviewing a potential therapist:

How do you help clients with eating disorders?

If a therapist has a lot of experience treating eating disorders, they should have a concise and clear answer. Many well-meaning therapists indicate on their website, referral site, or insurance websites that eating disorders are their specialty, but really don’t have experience treating eating disorders.

Because of the complex nature of eating disorders, try to get a therapist with extensive experience with eating disorders if possible.

Do you have a network of other professionals who have experience treating an eating disorder to whom you can refer me?

The gold standard of care in eating disorder treatment is to have a multidisciplinary team. An eating disorder treatment team usually consists of a therapist, registered dietitian, medical doctor, psychiatrist, family therapist, and possibly other specialists.

If the therapist has experience treating eating disorders, they should have a relationship with other treatment providers in your community. To learn more about eating disorder treatment teams click here.

What hours do you see clients and what are the payment options?

The course of eating disorder treatment can be long. Having a conversation up front with a potential eating disorder therapist about finances and scheduling is important. Be sure that the scheduling and payment options work for you over the longer -term.

Here are a few resources to help you find a qualified eating disorder therapist in your area:

Finding an eating disorder therapist can take time.  Consider breaking down your search into smaller pieces and chip away at it each day.

Additionally, if you feel overwhelmed trying to find an eating disorder therapist, ask a friend or family member to help you in your search.

Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders.

Don’t live in the Austin Area, but want tips about how to improve your relationship with food and your body? Subscribe to my newsletter here.

Must-Ask Questions When Looking For An Eating Disorder Therapist
Must-Ask Questions When Looking For An Eating Disorder Therapist


3 Essential Tips for Moms in Eating Disorder Recovery

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Often, teenage girls are most associated with eating disorders. While it is true that eating disorders often develop in adolescence, they still affect people of all ages. Motherhood, unfortunately, does not immunize us from eating disorders, either.

There are three common circumstances in which adults suffer from eating disorders:

  1. The eating disorder developed in adolescence or in young adulthood and the individual never fully recovered or never received treatment.
  2. The eating disorder developed earlier on in life and it re-occured in midlife.
  3. The initial onset of the eating disorder occurred in adulthood.

In my counseling practice, I exclusively see adults with eating disorders, and many of my clients are also moms.

Motherhood presents a unique set challenge for individuals suffering from an eating disorder. Although, becoming a mother is associated with great excitement, it also comes with some stressors.

New moms are learning how to navigate their new identify while maintaining old identities of partner, friend, employee, etc. Because of this, parents often feel like they are being pulled in a million different directions.

Furthermore, normal changes in the body that are associated with pregnancy and beyond can be particularly stressful for some with an active or history of an eating disorder.

Change is a constant as a parent.  As children grow, their needs change, and so do our roles as parent.  Change along with with other stressors can trigger or exacerbate eating disorder symptoms.

Below there three basic tips to navigating motherhood while in eating disorder recovery.  

1). Make eating disorder treatment a priority.

Moms are often pulled in several different directions, busy taking care of everything and everyone.  Motherhood does not leave much time for self-care let alone recovery.

Making treatment a priority can mean regularly scheduling appointments for yourself with your therapist, dietitian, and other members of your treatment team.    

2).  Let go of perfectionism.

Perfectionist traits are often associated with eating disorders.  Furthermore, motherhood at times can feel like a competitive sport, which can reinforce perfectionism.  

Perfectionism is a never-ending cycle of setting very high and rigid stands in efforts to control and boost self-esteem, and when impossibly high standards aren’t met, feelings of failure set in, and the cycle of perfectionism begins all over again.

Practice doing things “good enough” and focus on making progress. (I am sure you have heard the saying “progress, not perfection”).  For more tips on how to overcome perfectionism, click here.

3).  Get good at saying “no.”

Setting boundaries and limits with your schedule and your children is essential.  There are only so many hours in the day, and you have only so much energy.

It is easy to let your recovery get sidetracked with over scheduling yourself.

One important part of setting boundaries is first assessing what the most important things are to you:  where do you want to spend your energy and time? Second, once your priorities are established, get good at saying no to things that aren’t on your priority list.

So often, there is fear around saying no due to fear of hurting others, appearing selfish, or missing out.  Once you practice saying no, I think you will learn that none of these fears pan out.

Reserving energy and time to focus on your recovery is not selfish.   When you are actively working on your eating disorder recovery and taking care of yourself, you will be more available to be a stronger mother, partner, and friend.

Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders.

Don’t live in the Austin Area, but want tips about how to improve your relationship with food and your body? Subscribe to my newsletter here.



4 tips to cope with weight gain in recovery from anorexia nervosa

4 Tips to Cope with Weight Gain in Recovery from Anorexia Nervosa

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Let’s face it – our society gives us strong messages from social media, print media, our schools, and the health care system that weight gain is bad.   Wherever we turn we are given the message that weight gain is a death sentence. (Which, by the way, is not true! If you want to learn more on this subject I highly recommend reading Health at Every Size).

Folks who are in recovery from an eating disorder have a double whammy to contend with.  One of the key features of anorexia nervosa (or really any eating disorder) is the fear of gaining weight. This fear plus societal pressure to look a certain way can make recovery from an eating disorder feel like an uphill battle.

Therefore, if you are in recovery from an eating disorder, it would make sense that you have an intense fear of gaining weight.  However, weight restoration is a must in recovery in order to maintain your physical and mental health.

Helping clients improve body image while restoring weight, nutrition, and health can be the hardest part of the recovery.  But it is possible with perseverance, patience, and hope.

I have gathered some wisdom from around the web from other treatment professionals and those in recovery to help you along with the process.

1. You are gaining weight that you shouldn’t have lost in the first place.

The weight gained in eating disorder recovery isn’t just regular weight gain–it’s weight restoration. You are healing through the weight gain – giving back what you shouldn’t have taken from your body in the first place.

Weight restoration can be complicated and difficult, and shouldn’t be a journey you embark on alone. To better understand the process, read this article on what weight restoration is, what it’s comprised of, and what you should expect when going through it.  It also includes a discussion of particulars you might not be familiar with, like refeeding syndrome (the complication of increasing food intake too quickly) and hypermetabolism (the increased rate of metabolic activity that often comes along with an eating disorder).

It also covers how difficult the process of weight restoration can be in recovery–and why it is critical to not only have a meal plan for weight restoration but a therapist to help throughout the journey.

Read the whole thing here: Working Through the Weight Restoration Phase of Anorexia Nervosa

2.  Accepting weight gain as part of recovery takes time (and lots of it!).

Accepting your body takes time.  In fact, it can be one of the slowest parts of recovery.  The author of this article provides several useful ways to cope with weight gain, including thanking your body!  It is a must read.

Some of the tips covered are:

  • remembering our bodies changes are never as visible as we fear
  • keeping perspective & remembering that the alternative is worse

Read the whole thing here:

5 Ways To Deal With Weight Gain When You Are In Recovery From An Eating Disorder

3.  Fear of weight gain usually reduces as your eating normalizes.

I have seen this in my clinical practice. As clients start to feel better physically because they are feeding themselves more regularly throughout the day, the fear of weight gain can lessen.

As weight gain also naturally redistributes after the initial gain, the prospect of weight gain becomes less overwhelming. Once your body has come out of life-saving mode, the weight you’ve gained back won’t just sit in one place. It will spread across your body, and will not be nearly as visible as someone in recovery might worry about when starting the process.

“Will I gain weight forever?”: What we know about weight trajectory during recovery from an eating disorder

Yes, Weight Gain Is Hard. Thankfully, We Have 8 Ways to Cope With Weight Gain For You

What this article shows us is that the odds of perpetual weight gain after the initial restoration, are actually pretty low. Your body will adjust back to a stable, healthy weight, and for the most part, stay stabilized.

4.  Weight restoration allows you to enjoy life more fully.

“Going to concerts has always been one of my favorite things to do. The atmosphere, the music — I can go on about it for hours. Ever since my eating disorder came to peak, I’d lost this love.”

Dietary restriction and malnutrition often occur pretty slowly, and sufferers from eating disorders may often not notice that their sense of joy and zest for life is blunted and dulled. Without proper nourishment, your body just isn’t able to sustain you through life as well.

With proper nutrition, you will begin to get feel more like your old self. Your body will have the nourishment it needs to keep healthy, to keep energy sustained, and you will be able to once again be an active participant in your life & hobbies.

How I’m Learning to Love Weight Gain in Eating Disorder Recovery

 

With your renewed energy, your emotions will feel full and vibrant again–allowing you to enjoy life in a way you may have not even realized you were missing out on. With weight gain comes this capacity to feel full and alert and restored.

Accepting weight gain in eating disorder recovery can be a long and difficult journey. It isn’t something that happens overnight. Work and support are necessary components to the journey. Keeping these four key things in mind can help you on your journey to recovery and weight restoration.

Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders.

4 tips to cope with weight gain in recovery from anorexia nervosa
4 tips to cope with weight gain in recovery from anorexia nervosa
5 Signs That It Is Time to Get Treatment for Your Eating Disorder

5 Signs That It Is Time to Get Treatment for Your Eating Disorder

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Anticipating getting treatment for your eating disorder can be daunting for many reasons.

Maybe your friends and family are worried about you and pushing you to get treatment, but you feel like they don’t understand.

Perhaps you have gotten treatment and feel like it hasn’t helped.

Or you may feel like you can beat the eating disorder on your own.

You are not alone.

Most clients I see are often unsure if a) they want to recover, b) they can recover, or c) Their eating disorder is “bad enough” to need treatment.

Furthermore, you may feel ambivalent about getting treatment because your eating disorder may have helped you.  What I mean by this is that your eating disorder may have stuck by your side, given you a sense of control, or provided feelings of safety.  You may even feel like it is who you are.

On the other hand, treatment can offer new ways of coping, improve your self-confidence and self-esteem, and help you achieve goals that you never thought were possible.

Eating disorders don’t go away without professional treatment.

Untreated eating disorders usually get worse and harder to treat as time goes on. They can cause serious medical problems, some of which can result in death.

Here are 5 Signs that it is time to get treatment for your eating disorder:

1.  You think about food a lot. 

If you’re planning out your day around food as soon as your feet hit the ground-what to eat (and what not to eat), when, and how much- you might have an eating disorder.   Thoughts about food take up so much head space and can be exhausting.

For example, you may have thoughts similar to these: “Did I make the right decision about what to eat?”, “She didn’t eat a snack.  Should I be eating a snack?”. Your thoughts about food can be so pervasive at times that they lead to poor concentration, feelings of worry, sadness, and/or guilt.

2. You have problems concentrating on tasks. 

Whether you are at school, work, or at home, it is hard for you to stay focused on the task at hand (or maybe hard for you to even get started).  Your brain needs adequate fuel to function properly, and if you have an eating disorder, chances are you are not properly nourished.  Poor concentration can be the result of inadequate and/or poor quality nutrition and erratic eating.

3. You feel alone.

Eating disorders can be isolating. Eating and food can be a big part of family and social engagements. You may find yourself avoiding social situations because the food associated with these engagements is too anxiety provoking. Or you may attend the social engagement, but feel distracted or not fully present because you feel worried about food or fitting in.

Poor body image may also cause you to avoid social situations.  Feeling worried about how you look and what others are thinking of you may cause you to stay home. Isolation can make the eating disorder worse, increase feelings of depression and anxiety, and erode your self-confidence.

4. You find yourself being dishonest with others. 

Most of us value honesty.  Trustworthy and honest may be words that you use to describe yourself, except when it comes to your eating disorder. Often, eating disorder behaviors such as purging, binge-eating, and restriction are done in secret because you have feelings of guilt and shame around the behaviors.

5. You want to stop your eating disorders behaviors but can’t. 

It is not unusual for people with eating disorders to try to get better on their own.  You may have had success for short periods of time, maybe even months.  But then life happens and the behaviors come back.  Trust me, it is not because of lack of effort, intelligence, or motivation that you can’t stop your eating disorder on your own.  It is the nature of eating disorders.  They are complex, consisting of psychological, biological, and social factors.  Adequate treatment by experienced clinicians is needed to help support you in your recovery.

This is a very short list of signs.  Even if you experience one of them (or none of them but know that you are struggling), please talk to a professional.  I know taking that first step to seek treatment is hard and scary, but if you have any inclination to improve your situation, seek treatment.  The National Eating Disorder Association is a great resource.

Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders.

5 Signs That It Is Time to Get Treatment for Your Eating Disorder
5 Signs That It Is Time to Get Treatment for Your Eating Disorder
3 Important FAQs about Intuitive Eating

3 Important FAQs about Intuitive Eating

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Intuitive eating is a term coined by registered dietitians Evelyn Tribole and Elyse Resch.  Tribole and Resch’s book Intuitive Eating’s purpose is to help chronic dieters and people with food and body image struggles heal their relationship with food.

Unlike diets, intuitive eating sharpens our ability to listen to our bodies and to understand when we are hungry and full, what foods to eat, and when is the best time for our bodies to eat.  This results in a reduction of worry about food and guilt often associated with dieting.

In a nutshell, intuitive eating is learning to tune into your body’s signals in order to feed and nourish yourself instead of a diet or meal plan.

Question:  Is intuitive eating the same as mindful eating?

Answer: Intuitive eating and mindful eating are not synonymous.  However, they do have some overlap.  Think of mindfulness as focusing your attention on one thing.  For example,  you can practice mindfulness when you are petting your dog.  You notice how your dog looks, how it feels to pet your dog, and how your dog responds to your touch.

You can also practice mindfulness while eating.  To do this, you may notice the appearance, temperature, consistency, and smell of what you are eating, free from other distractions.

When I teach clients intuitive eating, I encourage them to practice mindful eating because it helps increase the pleasure of eating and dial into internal signals that your body is giving you in regards to food preferences, and hunger and fullness.

Question:  I want to lose weight. Is intuitive eating going to help me achieve my weight loss goals?

Answer:  No, intuitive eating is not a weight loss program.  It is a way of relating to food.  While diets tell us to look to the diet plan to know how much and what to eat, intuitive eating postulates that we have all of the knowledge within ourselves on how to feed ourselves.  Chronic dieting teaches us to ignore our internal cues.

You may be thinking, “Well, I overeat pretty regularly.  If I start listening to my body and stop overeating, it will lead to weight loss.”  This is not necessarily true because body weight and metabolism are under substantial genetic control.

However, intuitive eating will provide a relief from the vicious diet cycle which will help alleviate the feelings of shame and guilt associated with dieting.

Question:  I think I may have an eating disorder.  Will intuitive eating help me get over my eating disorder?

Answer: I am glad that you have recognized that you may have an eating disorder.  The next step is to get assessed by a treatment professional.

If you do have an eating disorder, getting adequate treatment from professional is a must for recovery.  Unfortunately, eating disorders don’t go away on their own.  Treatment is important to reduce medical risks associated with eating disorders, including death. (Anorexia nervosa has the highest mortality rate of all psychiatric conditions.)

That being said, intuitive eating could be part of your treatment process, in the later stages of treatment.  Together with your treatment team, you will be able to determine if and when intuitive eating is right for you.

Unsure if intuitive eating is right for you?  Call me for a free 15-minute phone consultation.

3 Important FAQs about Intuitive Eating
3 Important FAQs about Intuitive Eating
5 Surprising Ways to Support Your Loved One with an Eating Disorder

5 Surprising Ways to Support Your Loved One with an Eating Disorder

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Knowing what to do to help your loved one with an eating disorder can be confusing, worrisome and at times downright frustrating.  But, you can’t just sit back and watch them suffer because you are concerned about their health and well-being.

You may feel like you don’t know what to say or do for fear of making their disorder worse. Or, you say well-intended words of encouragement only to result in a screaming match.

You are not alone.

You have probably heard the expression “Put on your oxygen mask before assisting others“, right?  This rings true for caring for a loved one with an eating disorder.  I am not suggesting that you don’t get treatment for your loved one with an eating disorder.  But, taking care of yourself is a must.

This post is not going to tell you exactly what to say or do to make the eating disorder magically disappear.  Instead, I’ll go over what you can do for yourself so you can be emotionally & physically available to support your loved one in their recovery.

Tips to support a loved one with their eating disorder:

Learn about eating disorders. 

Oftentimes eating disorders are misunderstood, even by well-respected medical providers.  Although eating disorders appear on the surface to be about food, they really aren’t.  Eating disorders help the suffer manage stress, uncomfortable feelings and give a sense of control.

Learning about the particular type of eating disorder your loved one has, the medical and psychological factors associated with it most likely will leave you feeling less overwhelmed.

The Eating Disorder Sourcebook by Caroline Costin is a great starting point because it gives a comprehensive overview of eating disorders.  Gurze Books is a publisher that exclusively publishes eating disorder books – they have books as well as workbooks.  Lastly, the National Eating Disorder Association has a wealth of information on their website.

Encourage treatment.

Unfortunately, eating disorders don’t go away on there own.   Often suffers initially don’t want to go to treatment because it can feel scary and overwhelming.  Or perhaps they are in denial about having an eating disorder.  Sufferers may try to recover from their eating disorder on their own, but it rarely works.

Adequate treatment is a must for full recovery.  Treatment is important to reduce medical risks associated with eating disorders and even death (Anorexia Nervosa has the highest mortality rate of all psychiatric conditions).

To learn more about what treatment involves read Building a Treatment Team to Help Conquer your Eating Disorder and treatment options.

Practice Good self-care.

Self-care is more than just a mani-pedi or a massage.  While those things may be part of your self-care routine, self-care means deliberate acts that you do to take care of your physical, mental and emotional health.

Examples of self-care could include: getting enough sleep, engaging in hobbies, spending time with friends, taking breaks, and setting limits at work and home.

Good self-care is needed by everyone but is particularly important to prevent burnout from caring for someone with an eating disorder. Furthermore, you are setting a good example by modeling good self-care for your loved one because self-care is a skill that is taught in eating disorder recovery.

Set boundaries. 

In the literal sense of the word, boundary means a dividing line.  Boundaries are often associated with dividing geographical space, for example, the boundary line between two countries.

In the world of psychology, boundaries mean the physical and emotional limits that separate your needs from others.  Boundaries make us feel safe and teaches others how to treat us.   Being honest about how you feel and asking for what you need (and don’t need) are signs of healthy boundaries.  Setting firm boundaries can also help you manages stress, avoid burnout and improve personal relationships.

When someone struggles with setting firm boundaries it can leave the person feeling like a “doormat”, manipulated and used and erodes self-esteem.

I see all too often that caretakers take on too much, or feel they have to help control their loved one’s eating disorder behaviors.  This is a lose-lose.   This can make the caretaker feel exhausted and it doesn’t allow the person with the eating disorder to take full responsibility for their own recovery.

Just as with self-care, learning how to set boundaries is a key component in eating disorder recovery.  So when you model firm boundaries you are helping your loved one!

Find support for yourself.

Having a loved one with an eating disorder can be challenging at times.  Additionally, the course of treatment for an eating disorder can be lengthy.  You probably have heard the phrase,”This is a marathon, not a sprint“. This certainly holds true for eating disorder recovery.  According to the National Eating Disorder Association, recovery can take months and even years.  Although there is no specific timeline for recovery my clinical experience informs that recovery takes at least a few years.

Finding support for yourself can help promote a healthy relationship with your loved one, reduce stress in the household or family and get unstuck from patterns of behavior that may be reinforcing the eating disorder.

Many parents, families, partners or spouses find it helpful to get professional support through support groups, group counseling or individual therapy.

Supporting a loved one with an eating disorder can be challenging, but can yield great rewards in your personal growth as well as your loved one.

I know I didn’t give you a cure-all to help your loved one recovery from their eating disorder.  But, I hope a gave you tools to help manage your stress, worry and make you a more effective support person for your loved one.

Remember: taking care of yourself will help your loved one by leaps and bounds in their recovery!

Are you looking to learn how to better support your loved one with an eating disorder?  Call now for a free 15 minute consultation.

5 Surprising Ways to Support Your Loved One with an Eating Disorder