F.E.A.S.T's Around The Dinner Table forum

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HateEDwithApassion
Hi,

We have seen the same ED therapist for three years. Nice lady. ED specialist for 25 years. Mainly talk therapy from what I can tell. Don't see any DBT or CBT being used, now that I know what they are. Supportive of us as parents. Never undermined our credibility with her.

However, now that we have experience with DBT skills, I'm beginning to think that my D is just not with the right therapist. She loved her dietician and said she got more out of her time with her than with the T. Hmmm. The T is doing no harm, but also making no progress from what I see. Worse behavior. And now she resists opening up to her at all - doesn't trust her for a variety of reasons. She has asked to switch over the course of the last several years. I resisted. I was afraid to try someone new. She seemed like the expert. 

I'm not afraid anymore. I think my D needs someone who she will connect with. Someone who will challenge her but make her feel that she can do this. So, how did you handle switching to a different therapist. Did you talk to them? Did you do a meeting with your child? Were you totally honest? Did you try to fix the relationship first? Just wondering the best way to handle this - mostly so it doesn't damage my D. Thanks.
19 yo D. AN - since about 15 years old. WR quickly - but the last four years have been tough. Since Sept. 2017, two residential stays, now in IOP, fighting a relapse. ED is hanging on, mental state not great, can't get her to remain at a weight long enough or high enough to see mental healing. She's on a gap year that will likely now turn into two.
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Psycho_Mom
Hi,

It might help you to make a list of what exactly you would like to get out of therapy. You could get input from your d on this. 
It could be something like, 
1. We want help getting d back to behaving in a normal manner. (be specific about what isn't normal)
WE want support for d so that she can do this herself but also want advice on how best to support her (understanding that "support" sometimes means "not letting her do unsafe or stupid stuff.")
2. WE want d to be able to do x and x and y, (handling anxiety in a safe manner is a good one, or noticing her anxiety before it causes problems, or etc whatever.....

Would that help to evaluate a therapist? I definitely think that you should talk first with any new therapist, without d present. Quiz them on their knowledge of ed, ask how they handle this and that situation, find out how much and how you would be included in and/or informed of what's happening. show them your list and ask how they would approach tackling the things on it.

As for letting go of your current therapist. It may feel like a personal relationship, after three years, and it sort of is but it isn't. It's a professional relationship. If her services are no longer what you need, then you let her know that. Any good therapist will not take this personally. Any good therapist wants what's best for her patient. You could tell the current t that you feel d needs x and x and y (again, you could make a list and be specific) and ask if she can provide that, and if not let her know you think it's time for something different. Hopefully this t could stay as a resource for you, one you could see occasionally or ask for advice in future.

We stayed with our t through DBT skills class (it was required by the class, actually) and then for a good while afterwards, gradually phasing out. Now I see her occasionally for advice, and d knows that if she ever needs or wants to, she can go back to see her.

best wishes,
D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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HateEDwithApassion
Thank you both. Making a list of the goals her dad and I would like to see happen is an excellent idea. I am going to do that and share with the new T. 

I meet with the current T tomorrow, without my D. You are both right... I didn't know what I didn't know. I think this relationship has stopped being effective a long time ago. I didn't have anything to compare it to until we started the DBT skills group. Please keep us in our thoughts as we choose a new T. I believe I've found one, and it just so happens that she works closely with the dietician that we already love. Divine intervention - I hope.

I'll report back, but am so grateful for your thoughts and feedback. Wish me luck!
[smile]

19 yo D. AN - since about 15 years old. WR quickly - but the last four years have been tough. Since Sept. 2017, two residential stays, now in IOP, fighting a relapse. ED is hanging on, mental state not great, can't get her to remain at a weight long enough or high enough to see mental healing. She's on a gap year that will likely now turn into two.
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linefine
Hi there,
I've just emailed you.  Not about this subject, but thought I'd give you a heads up in case it goes in your junk folder!
Heather

Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It does not dishonour others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always PROTECTS, always TRUSTS, always HOPES, always PERSEVERES. Love never fails.
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hopefulmama
I am glad this got bumped back up.  I meant to respond when I saw your original post.

We too were in the same situation after my d had been in treatment for about a year.  Looking back I can see that this t was NOT evidence based (although considered a "specialist" in treating EDs.)  

I really like this old blog post from Dr. Sarah Ravin

http://www.blog.drsarahravin.com/psychotherapy/how-to-choose-a-therapist/

Also, I would ask about a treatment plan.  How can you be making progress if you don't have a plan?  When we finally made the switch, our new t developed a treatment plan with goals that would really push my d.  We then evaluated progress towards those goals on a regular basis.

The idea is to get to a place where the therapist isn't needed. I knew we had found the right one when the first thing she told my d was her goal was to not be my d's therapist anymore. It should not be a open ended job.

I am very partial to skills based therapies for ED because most sufferers have pre-existing conditions (depression and anxiety) like my d.  The skills based therapies are needed to change the thought pattern of the brain.  My d is always going to have anxiety.  She was born that way.  It's not good or bad. The key was to teach her to recognize the anxiety and learn new ways to deal it.
Enjoying my 23 year-old daughter's achievement of active recovery that was made possible by the resources and education I found on this forum.

Don't give up hope!
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HateEDwithApassion
linefine wrote:
Hi there,
I've just emailed you.  Not about this subject, but thought I'd give you a heads up in case it goes in your junk folder!


Thank you so much - I wrote back to you, so please watch your in-box. God is good, even when things around us are not!

19 yo D. AN - since about 15 years old. WR quickly - but the last four years have been tough. Since Sept. 2017, two residential stays, now in IOP, fighting a relapse. ED is hanging on, mental state not great, can't get her to remain at a weight long enough or high enough to see mental healing. She's on a gap year that will likely now turn into two.
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HateEDwithApassion
I am glad this got bumped back up.  I meant to respond when I saw your original post.

Thank you so much for your insight. I can't believe how difficult the mental health world is, finding good care for teens. I know in the UK it's even tougher. I so hope we have a story like yours, hopeful! That must have been a relief to see your D click with her therapist and show improvement. I also believe in evidence, behavioral based therapy. She's in DBT skills group and told me tonight she'll be doing it for a little more than a year. I secretly cheered. She likes the group a lot, and while she's not doing any skills that I outwardly see, she's going and taking it seriously. 

Talk went well with current T. She gets it, and will welcome back my D if that's what we ever decide. Doing an intro meeting with a male T next week. My daugher brought him up - we had his name before... DBT specialist, but not ED specialist. Has run adolescent DBT groups, so he'll be strong at reinforcing her group lessons.

As a backup, we will be seeing her ED dietician, who is amazing, at least once a month to monitor weight and behaviors. I have two other ED specialist names ready to go in case we need more support. Yikes - will she ever have time for school? Every provider we find is an hour in one direction or the other. Time consuming.

So, will a total change - type of therapy, gender, etc. be helpful? Who knows. Her dad and I are doing all we can to try and get her the help she says she wants. She's dark again, so sadly, she may have gone off her meds again. Who knows. Exhausting, but at least a new way forward. I'll update next week!


19 yo D. AN - since about 15 years old. WR quickly - but the last four years have been tough. Since Sept. 2017, two residential stays, now in IOP, fighting a relapse. ED is hanging on, mental state not great, can't get her to remain at a weight long enough or high enough to see mental healing. She's on a gap year that will likely now turn into two.
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