12 Clinical Interventions for Eating Disorders

Here are some tips you might find helpful when working with clients with Eating Disorders, or Disordered Eating:

1.  Find a registered dietician who specializes in Eating Disorders.  It is important that your belief systems and theirs align when working together to treat a client.  For example, most people in the eating disorder recovery field believe that there are no "bad" foods and we work with clients to neutralize food.  However, some people believe in "abstinence" from certain foods or food groups.  When I am looking for a dietician, I make sure that they're not of the school of thought to tell my clients to restrict food groups as it would go against the work we are doing clinically.

2.  Buy large desk calendar and different stickers and create a behavior chart for meals and snacks well done according to their meal plan. Celebrate successes elaborately!

Therapy, Eating Disorder, Interventions, Clinical, west chester, philadelphia, main line, rosemont, recovery

3.  If age appropriate, work with parents on making "no Foods bad".  Everyone in the family can join in on recovery by coming together to share with all food groups. 

4.  If age appropriate, look into the Maudsley Method for re-feeding process.

5.  Work with your client to create an art project around beautiful people, models, actresses, friends or family and others in Pinterest or print outs who are not super skinny.  Process what they find beautiful about these people.  Encourage clients to post up these images on their wall so that they get used to seeing ideal beauty images and other than emaciated models.

6.  Make a list of all clients fear foods and safe foods and medium foods and use CBT to debunk myths of fear foods. 

7.  Eat 'normal meals' together in session - especially with fear foods - exposure therapy.

8.  Find studies that show that whatever fear foods are - are not 'bad' i.e. - sugar is not as evil as everyone says. 

9.  Use ego state work to find out which 'parts' in clients psyche are telling them not to eat and have conversations with them using Gestalt Chair Work. 

10.  Use the books Life Without Ed by Jenni Schaefer as a guilde book, everyone involved should read and the book 8 Keys to Recover from an Eating Disorder by Carolyn Costin can be used for treatment and interventions as well.

11.  The therapist can have client draw their body in the size and shape she believes it's in, then have therapist actually trace clients body and process the difference. 

Therapy, Eating Disorder, Interventions, Clinical, west chester, philadelphia, main line, rosemont, recovery

12.  If there's one body part the client is upset about like their waist, have client draw what they believe is their waist size, then use a string to measure (not using numbers) the actual size and trace THAT onto the paper and process the difference. 

Hope this helps!!

What else do you use as interventions for clients?  Please comment below!!  As always, if you have any questions or concerns, please contact me at 610.314.8402 or through www.TiffanySpilove.com

Overcoming ED: A True Eating Disorder Recovery Story

I have a dear friend out in California, her name is Ashly.  We met while we were both working at an eating disorder recovery facility together.  She's beautiful and successful and she'd shared bits and pieces of this story with me when we worked together.  I was always so touched by the raw emotion attached to her story.  I asked her if she'd be willing to write her recovery story for my blog and she so kindly agreed.  I am in awe of the bravery, honesty and eloquence she put into writing this.  Ashly, you truly are a recovery warrior, thank you for allowing me to share your story here:

 

Recovery Warrior, eating disorder, anorexia, philadelphia, main line, west chester, counseling, therapy, recovery story, antidiet

It’s been almost 10 years to the day (March 7th, 2007) when I first sought help for my eating disorder. I had just turned 21. I had always looked forward to my 21st birthday (as most teenagers do), but it wasn’t exactly the greatest birthday ever. My family took me out to a nice Asian restaurant, decorated with orchids, candles and plush, red velvet booths. My dad ordered expensive champagne that I pretended to drink. I spent most of dinner in the bathroom so I wouldn’t have to look at or smell the food. I got dressed up that night for the first time in a while… black satin pants, white tank top, make-up and high heels. I remember looking at myself in the bathroom mirror thinking how ridiculous I looked. What had happened to me? Why couldn’t I just be happy and normal? I went home that night and sobbed into my pillow. I had no friends, no job, no one I would let anywhere near me. I had dumped my boyfriend right before New Year’s, only because he was worried about me and wanted me to seek help. He had even given me a diamond ring months before – which I swiftly pulled off my left hand and flung it at him while he begged me to get better. I remember him telling me that he had no idea what had happened to me – but I was scaring him. I had joined him and his family on a ski trip weeks before, and looking back, I scare myself. I skied as long and hard as I could everyday, not because I loved it, but because I needed to burn the most calories possible. I wouldn’t go near his mom’s homemade cinnamon rolls, eating a diet bar instead. We’d go out to dinner to fabulous restaurants, and I’d always special order the same thing – and eat exactly half. We’d return to the cabin to watch a movie at night, and I’d sneak off to the bedroom where I’d hide in the closet to do as many crunches as I could stand. My boyfriend caught me one night, and the disappointed look on his face made me so angry. When did I turn into this cold, shell of a person? I loved him more than anything – yet he wasn’t enough for me to let go of my eating disorder.

When I think about how much wasted time I spent obsessing over food and weight, it makes me really sad to have lost those years. I’d spend hours (really, hours) in the grocery store studying every food label before a few chosen items made their way into my shopping cart. Everything had to meet a certain criteria: less than a certain number of calories, a certain ratio of fat and carbs, and no sugar. Protein was ok. For items that didn’t have a label, like produce, I’d Google the nutritional content on my phone. One day, I found this package of “seaweed pasta.” Growing up with an Italian mom and grandparents, pasta was a staple in our house – and I missed it terribly. The seaweed pasta had close to no nutritional value, so I gave it a try. I made a huge plate of it that night. It reminded me of something alien. It was slimy, a little crunchy, translucent and sticky. I topped it with this red Asian marinade since regular pasta sauce didn’t meet my standards, and it was the most disgusting thing I’d ever eaten. I was able to have a few bites before the rest of it was flushed down the toilet. I actually felt a huge sense of accomplishment – I made something taste so badly that I couldn’t eat it. Gold star.

March 6th of 2007, I saw my boyfriend again for the first time since we had broken up. We went to a movie, and I couldn’t even tell you which one because I was too busy counting up all my calories for the day, figuring out what I could eat tomorrow, and how many hours of exercise I would need to burn off that handful of popcorn I just ate. After the movie we hugged goodbye, and I remembered how good it felt to be in his arms. I wiggled my way out of them because I wouldn’t allow myself to start crying. Once home, I ran a hot bath trying to get warm. I was constantly freezing. I put on every piece of warm pajama I owned and crawled into bed. My body hurt. My heart raced. My stomach felt like an endless empty pit. I missed my boyfriend. I missed my old life, old friends, old self. Where was this going? Was this my life now? I was just going to live day by day obsessing over calories, exercise and weight? I didn’t want to live that life. I was absolutely exhausted. I prayed to God that I would die in my sleep that night.

I felt something warm on my bare face and neck. I could hear birds singing. I slowly opened my eyes and saw the most beautiful shade of light filling my bedroom. My mind was quiet and it was peaceful as I lie in my soft bed. I sat up, feeling as though I had awoken from some sort of coma. I wasn’t thinking about food, my body, or anything else. I was simply enjoying the gorgeous Spring morning. I turned toward the side of the bed and swung my legs over. There was a mirror above my dresser directly across from me. I looked at myself and realized now is the time – I don’t want anorexia to be the rest of my life.

The following days, months, and years were filled with doctors appointments, therapy appointments, support groups and days when I didn’t believe I’d ever get better.  It was really hard learning how to let go, and even harder actually doing it. Not even a year into my recovery, I met a boy at college and we started dating. He invited me to spend a week with him in Hawaii over the holidays. He was incredibly sweet, handsome, and shy around me. I had never been to Hawaii, and although I was terrified of losing control over my meals and exercise, I said yes anyway. I had only known him a month or so, but I nervously bought a plane ticket to meet him in Maui. He knew nothing about my struggle with ED. I packed all my “safe” food and had it in a bag under my airplane seat. As the plane started to descend, I could see the islands through the clouds and it was the most beautiful thing I’d ever seen. I was in complete awe. I grabbed my suitcase and walked off the plane excited to see my new crush, later realizing I left my bag of food under the seat. The relief I felt in that moment was overwhelming.

We spent the next week exploring Maui: snorkeling, hiking, surfing, swinging from jungle vines and finding hidden waterfalls. We ate fresh sushi, pineapple, bananas, and this incredible chocolate lava cake. Every. Single. Day. I wasn’t worried about my hair looking perfect or making sure my make-up stayed on. We lived that week in our bathing suits and tanned skin and I felt more beautiful than ever. He was sweet to me, and taught me that being your authentic self is the only path to true happiness. I let someone see me for who I really was, and I wasn’t rejected, abandoned or hurt. We shared the same bed the entire trip but always ended the night with just a kiss. I felt safe, protected, valued and respected. When it was time to head home, I had a true moment of sanity: After a week of having the most fun of my life, eating what my body wanted, and letting someone wonderful really see me, I was still O.K. I didn’t die, I wasn’t out of control, and I felt more like myself than I did in years. I truly believe that decision alone – a plane ticket to Maui – saved my life. Recovery was still hard and a process after this experience, but I learned - at my core - that I was worthy. Worthy of living a full life. In every sense of the word.

ED Recovery, recovery warrior, anorexia, eating disorder, therapy, counseling, bryn mawr, pa, philadelphia, west chester, ptsd

As I sit here proof reading this story, I can hear my toddler playing in the next room while my unborn baby moves in my tummy. I never thought I’d be here: a mom and a wife, with a career that I love. I feel incredibly lucky to be living without my eating disorder. Having the right support, sound guidance, and a professional who helped move me through the root causes of my eating disorder are what keeps me in recovery today. “We have the capacity to redraw the lines between our powerlessness and power.  We’re altered by what hurts us, but with love and consciousness, with intention and forgiveness, we can become whole again.” – Cheryl Strayed

Dining Out ... With an Eating Disorder

Happiness is a piece of cake therapy for eating disorders and body positive in West Chester, pa and on The Philadelphia Main Line, Bryn Mawr and Rosemont, PA

I know, I know, it sounds TERRIFYING!  Yes, I'm serious - you will not die from eating food in a restaurant ... I PROMISE!  It might FEEL like you'll die, it might seem like you'll gain a hundred pounds just from eating the food that is cooked for you back in that kitchen you can't see.  

Therapy for restaurants and eating disorders in West Chester, Pa and on The Main Line, Bryn Mawr, Rosemont, Philadelphia  Counseling

As my friend and colleague, Natalie says, "there aren't calorie ninja's back in the kitchen adding calories to your food"!  I understand the fear - I get that allowing somebody else to prepare your food is giving up control in a way that might not feel safe for you just yet.  Here's the rub, though - even though it might be hard to admit, I KNOW you want to be able to participate in experiences that involve food.  You WANT to be social.  You want to hang with your friends while they get frozen yogurt or try the food at the new cafe.  You want to live your life again... it's just that ED forbids it.  Here are some helpful tips for you to get more comfortable with dining out:

Practice

When you find yourself feeling fear about eating in a restaurant, it's sort of like a phobia - a very heightened anxiety around something specific.  The way to deal with and cure this type of phobia is through exposure - WITHOUT - re-traumatizing yourself.  So you don't want to push yourself to take it all on without practicing and getting comfortable with various aspects of it first.  

Use affirmations - they are wonderfully helpful ways to rewire your brain!

You might want to enlist the help of your therapist, friend or family member.  Tell them some food options that you consider safe.  Start small.  

It's better to have success with something less challenging than to get overwhelmed with something scarier.  

Dining out with an eating disorder therapy and counseling in West Chester, pa  on The Main Line, Bryn Mawr, Rosemont, Philadelphia, Pennsylvania for eating disorders

Your support team member could either get you food from a restaurant or give you food that they made without you present.  Or if you need to start even smaller, you could watch them make your meal so you know it's safe.  Eat with them.  Notice your feelings.  Use anxiety reduction and grounding techniques.  Keep breathing and do your best.  Keep practicing this step until your anxiety stays below a 7 on a 0-10 scale with 10 being the worst anxiety you've felt and 0 being no anxiety at all. 

Increase the challenge slowly

Once you get comfortable with eating meals made by others, up the ante.  If you're still not ready for restaurant dining, try getting take-out or try eating foods you didn't see being prepared.  Use an affirmation like "This food is safe and nourishing; I am safe and I can eat this food".  Make sure you start off each experience with some breathing and relaxing techniques so that you don't associate fear with the experience.

Dining Out

If noise bothers you, choose a restaurant that's quieter or a time of day that's less intense like lunch.  See if you can get a table that's against a wall, in a corner or in a quieter area of the restaurant.  This reduces over-stimulation and feelings of vulnerability.  

Have a plan

In earlier recovery, it's helpful to have a plan.  If you know which restaurant you'll be going to, look up their menu online.  Work with your therapist or dietician to determine which menu item you'll be selecting.  Most restaurants have portions that are significantly larger than the exchanges on your meal plan.  If this is the case, you could anticipate eating half the meal.  One tip is to ask for a to-go box at the beginning of the meal so that you can put half away for later and just focus on what's on your plate.  

Therapy eating disorder support in West Chester, pa and on The Main Line, Bryn Mawr, Rosemont, Philadelphia Pennsylvania Counseling

Go with someone supportive

This experience is hard enough, don't add to it by going with someone who doesn't "get it" or tries to sabotage your recovery.  Some therapists or dietitians will conduct sessions at the restaurant with you so that you can talk through it as it's happening.  If that's not an option, or you're ready for the next step, choose a member of your support group who understands your recovery.  Let them know the plan beforehand and maybe come up with a code word in case you need to abandon the mission.

Remember to breathe

Keep taking those deep belly breaths and know that this is just one meal.  One meal won't make you fat.  If you notice yourself starting to get overwhelmed or anxious, just come back to your breath.  While you're eating, try to focus the conversation on something else like the weather, the new movie just out or anything fun.  Take a sip of water, feel your feet.  You got this!!

Do's and Don'ts:

Do:

  • Keep the conversation light
  • Have some topics in mind to talk about while you're eating
  • Get the food down
  • Chew thoroughly
  • Focus on the conversation, the beautiful setting or anything but the food and body
  • Wear comfortable clothes
  • Stay at the table for the entirety of the meal
  • Set your pace to about 30 minutes to complete your meal

Don't:

  • Count the calories
  • Compare your dish to anyone else's
  • Body check while you're at the table
  • Talk about food, weight, exercise or anything triggering while you're at the table

Keep your eye on the prize!

This experience is not just about today or next week.  You are engaging in this exercise so that you can enjoy your life - so that you can HAVE a life!  Spending all your time in isolation, feeling lonely, not participating in social events is no way to live.  Remember that you are doing this so that you can be happy and free of your eating disorder.  

One day at a time therapy for eating disorders in West Chester, pa on The Main Line in Bryn Mawr, Rosemont, Pennsylvania
One day at a time
One meal at a time
One bite at a time

You CAN recover!!  Recovery from an eating disorder is not a linear process.  It goes all over the place, it's messy at times and sometimes you need to take 5 steps backward so that you can get good 2 steps forwards.  Even one success is worth celebrating, so give yourself credit for EVERYTHING you do right.  

If you're still feeling anxious about dining out and you'd like some support, I'd be happy to schedule a time to help you reach your goals.  Contact me now at 610.314.8402 to learn more about how to dine out with an eating disorder.  Please feel free to share this post with anyone who is looking for help with eating and body issues.

Good luck and enjoy!!

If you have any questions or need support, please feel free to call me at 610.314.8402 for a free 15 minute phone consultation.

Please comment below and tell us your story!

Hats off to a Better Christmas: 8 FREE Tips for Eating Disorder Support

Christmas Eating Disorder Support West Chester, Pa Therapy Counseling

Holidays may be happy and exciting for some of us and for some, they are also very stressful.  Food is definitely a big deal during the holiday season for most people.  Gym memberships go up afterward, people are often found dieting or “cheating” on their diets.  Some binge, some restrict, some over-eat and some fall apart.  I’d like to help you find a bit of peace from my corner of the world during this time when Christmas is fast approaching.  If you haven’t already read them, check out some free tips on normal eating, getting grounded, reducing anxiety, navigating the grocery store… They should prove useful for you as well. 

Here are some tips specific to Christmas:

1.     Create an intention for this holiday

Remember that Christmas can be about celebrating spirituality.  It can be about enjoying family or giving.  It can be about service, love, bundling up on a cold day or anything you want it to be! 

What would you LIKE your intention to be for Christmas this year? 

Intention for Mindfulness in Eating Disorders West Chester, PA Counseling Therapy

Find a purpose and go for it.  If your purpose is about service, think about how you’d like to be of service.  It could be as simple as helping to set up or clean up the party.  You could help the less fortunate through a soup kitchen or donating gifts to children who need them.  If you’d like your purpose to be about reading a great book and drinking tea, then go for it!  Any intention you’d like for Christmas is yours to have!

2.    Get Grounded:

BEFORE you leave your house.  Think about what grounds you?  Do something that feels very grounding for you and set an intention to keep checking in with yourself during the day.  One of my favorite ways to get grounded is to ask myself

“Where are your feet?”

– then look down at them; wiggle my toes, feel my feet on the floor or in my shoes.  When I do that, I can rest assured that right here, in this moment, I am safe.  In this moment, where my feet are, I am okay.  Here are some other examples of grounding activities:

Therapy Journaling in West Chester, Pa
  • Prayer and meditation
  • Aromatherapy: earthy smells like cedar, bergamot, and pine can be particularly grounding
  • Yoga
  • Coloring mandala’s or other coloring
  • Going for a walk
  • Make a list: of anxieties, gratitude’s or plans, etc.
  • Have a bit of a plan for the day – perhaps write it down in the morning.
  • Journaling

3.  Create Foods You Love

Try a new recipe you've been thinking about.  Bring safe foods for you to the event you go to so that you have at least one option while you're there.  

4.  Don't Push Yourself

This is not the time for major challenge meals.  While I encourage you to taste some of every food you're interested in, if you know that a certain food will completely set you off, just avoid it for now.  Challenge meals are best done with the support of a therapist or a support community.  You can practice eating challenge meals until they're no longer as challenging.  Once you've accomplished taking the power out of the challenging foods, THEN you can incorporate them into your holiday festivities.  In this instance, it might be better to be safe than sorry - don't push yourself so hard that you find yourself wanting to act out in a binge-purge cycle.  Support yourself in enjoying Christmas as much as possible rather than pushing yourself into discomfort.

5.  Contain the food

Food for Eating Disorder Therapy and Counseling in West Chester, PA

Do your best to eat meals at the normal times you usually eat them.  So instead of skipping breakfast and going to Christmas hungry, eat your normal breakfast. 

When you get to your event, check into your hunger cues.

On a scale of 0-10, with zero being extremely starving, 5 is having a light sense of satisfaction – being neither hungry nor full and ten being the most stuffed you’ve ever experienced.  How hungry are you?  Aim for letting yourself empty out to a 2-3 before eating a meal.  See if you can stop eating at a 5-7. 

Once you are hungry, rather than grazing on all the different foods, make a plate. 

Allow yourself to put at least a little bit of each food you love on the plate or foods you’d like to try. 

Skip the foods that don’t interest you much.  Sit down and really savor the foods you chose.  Check in with your hunger and satiety signals a few times while you eat your plate.  Once you are satisfied, tell yourself that you can have more when you are hungry again and follow through.  Making a practice of using hunger and satiety cues is extremely helpful in finding balance with food.

6.  Keep Your Boundaries

People tend to project their OWN food and body issues onto others’.  So if you notice yourself engaged in a conversation with someone who’s trying to talk you in or out of eating or commenting on your body, take a step back. 

Check in with yourself and see what YOU NEED, rather than what this person is trying to get you to do. 

Saying you need to use the bathroom is always an easy out to give yourself some time and space to check back in with yourself and get grounded.  Take some deep breaths, splash some water on your face and ask yourself what you need in that moment to take care of yourself before you leave the bathroom.  Here are some examples of things you can say to people who are pushing you:

  • “No, thank you”
  • “I’m okay right now”
  • “Yes, I’m going to enjoy this food right now”
  • “I’m not hungry”
  • “I’ll let you know when I’m ready for ...”
  • “I’d rather not discuss my body with you”

Practice saying these boundaries out loud BEFORE the holiday, so that when you’re in the moment, they flow easily and effortlessly.

7.  Ask for Help

Enlist a member of your support group to be ‘Holiday Buddies’ to practice what I call ‘Book Ending’:  Have a few agreed upon times you with check-in with one another throughout the day – perhaps before, during and after.  You could plan to call or text one another to report how things are going.  If you don’t hear from your buddy, shoot them a text to see what’s going on.  In this way, you have another person who has your best interest in mind to be accountable to.  This practice is also helpful in getting your mind off yourself and your own difficulties.

8.  Breathe

Breathe Therapy in West Chester, PA

Remember that Christmas is only one day out of the year.  Breathe into the gifts you receive whether they are material or spiritual, gratitude or emotions - breathe into this experience of life and know that you can get through this.  You don't need to be perfect and neither does your holiday.  When you feel yourself getting overwhelmed, focus on your breath.  Remember you can start your day over at any time.

I hope you've found these Christmas tips helpful.  If you're still feeling overwhelmed, please feel free to give me a call at 610.314.8402 - I'd be happy to help.

Merry Christmas from Tiffany Spilove Psychotherapy in West Chester, Pa!

Spread the LOVE!  Share this article with someone who might need it - let me know your thoughts and other suggestions!