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

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Allyson_1
I'm looking for recommendations for an individual therapist or group therapy for my 15 yo D, diagnosed w/ AN last November. Also diagnosed with anxiety/depression. We've finished FBT & my daughter is "weight restored" according to her FBT therapist, her current individual therapist and her pediatric ED physician, based on her historical growth charts  But her anxiety, over all physical pain (new complaints every day) and frequent isolation has not subsided, even with medication.  I think it is time for a change.  I am looking for a good therapist who does DBT for AN in the Washington, DC area.  Alexandria or Arlington are fine too.  Rockville, MD is too hard to get to during the school year during rush hour.  We really need help here.  My daughter is so frustrated as am I.  Exhausted too.   Thanks.
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tina72
Maybe I get something wrong, but what do you mean you are "finished" with FBT? If your d was diagnosed last November it is very unrealistic that you are finished with all 3 stages of FBT in 6 months or there is something going wrong. Normally stage 1 takes at least 6 months...so maybe your d is not better because you were urged to rush through the stages and gave back control way too early? Just a thought, maybe I got that wrong.
Keep feeding. There is light at the end of the tunnel.
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Allyson_1
Well, we have finished meeting with the therapist that we met with as a family.  We met December through April once a week. Our therapist moved out of the area shortly after my daughter hit the doctor's goal weight and my daughter started phase 2. She had already started individual therapy by that time so she's continued with that but there was no mention from the team of starting with a new FBT therapist for the family.  We haven't given back control.  We are sort of in a stage 2 holding pattern.  I plate all her food & urge snacks.  She has some intuitive eating (getting her own snacks & an occasional plating of dinner (that I add to) but not often or consistently.  My husband works long hours so it is usually just the 2 of eating all of our meals together but that's been the case throughout.
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Ellesmum
I’d be very wary of ‘weight restored’  have a read of the thread below about CAMHs weight recovery calculation, it’s entirely possible that with further gain your daughter will make strides with her mental health. My d also has a lot of physical pain due to calcium deficiency and vitamin d so perhaps supplement that and if possible get a bone scan.  If it’s stomach ache that’s normal and digestion takes a while to get back to normal.  Hopefully someone in your area will be along with a recommendation soon. 
Ellesmum
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scaredmom
I would try to get another team that is well versed in ED to be honest and one that is capable of managing her mental health as a whole.  Usually the teams are not just ED specialists, they also understand other mental health issues in conjunction with ED- that would have been part of their training. That is where we are. D is 2 years in and I still plate meals etc and she does have some choices and is doing well. However, she does have anxiety and we (the FBT social worker and I) are trying different things to help her move through- meds help too. 
I do support you getting specific mental health help for your d as she does seem to somatize her feelings. As long as there is truly no medical issues for sure she will need help with that. 
There are so many options for you/her I would think, CBT, DBT, etc.  Have you looked at the category about Reviews for Treatment providers? there may be something there too. 
I do hope someone from your area, will be here shortly. 
Also there is a lot of traffic on the facebook page for carers where you can ask directly for recommendations in your area and you may be able to connect personally with someone there. 
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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tina72
Allyson_1 wrote:
Our therapist moved out of the area shortly after my daughter hit the doctor's goal weight and my daughter started phase 2. She had already started individual therapy by that time so she's continued with that but there was no mention from the team of starting with a new FBT therapist for the family.  We haven't given back control.


So that is not really clear for me, phase 2 is normally starting to give back control...it is way too early for phase 2 and you will need a new FBT therapist for help with phase 2 and 3. I am also quite concerned wether she is really WR. Many professionals set target weights too low, as mentioned, and a 15 year old is still growing and must develop a female body and is therefor never WR at that age. Is periods back constantly?
What individual therapy is that? If it is CBT it might help with anxiety but you as the family should be envolved and know what they do there....
Keep feeding. There is light at the end of the tunnel.
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Allyson_1
The individual therapist my d is working with is working on DBT.  But, my daughter doesn't seem to be absorbing any coping skills.  The therapist tells me my d says everything is going well when she goes in for session.  I attended one session last Friday and called her out on it saying, to my d's claim that things were good,  "well not really, I found you curled up on the bathroom floor 3X this week and otherwise isolating yourself.  Therapist is suggesting we need family DBT (but it is a required commitment of 6 months).  Since we've been at it with this team for 7 months already, I am hesitant to commit to 6 months.    After the therapist wanted me to attend my daughter's last session (at which my daughter stormed out & I met with the therapist alone), My D says she doesn't want to go back to her again.  She doesn't want the family involved any more.  I realize this is still ED talking & acting strongly but I don't know where  to go from here unless I can find another therapist with ED experience & anxiety/depression experience.
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Ellesmum
I think you do probably need another ED therapist and I'd also up her calories again, it's hard work being 15 and becoming a woman. I'd certainly be trying for a higher weight to see if that helps, too many people get trapped in a body they hate with rampant ED thoughts because they haven't got to their happy weight.  That's not to say she doesn't need therapy and meds but she does need the chance to be fully nutritionally repaired. My d has gained 17kg, been eating probably 9 months but needs more and for a long time yet despite vast improvements. 
Ellesmum
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scaredmom
Just a few thoughts. 
Your d has only been WR for just a few months. It takes a long time for the brain to start to heal. At 6 months post proper WR my d's brain started to improve and then at one year after WR it was that much better. I do feel as I said above to continue with ED specialized care and support as best as you can and have availability.
I think you are very early still. Your d may not be lying when she says she was "good" to the therapist. It may be a function of where her head is at at this time. 
I think more time for brain healing and keeping her weight up,  may be needed at this time while you tackle the anxiety and other issues as best possible. 
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Mamaroo
Hi, the brain takes a very long time to heal. When my d was WR she was mentally in the same bad place as before. We just kept on feeding and at around WR + 6 months my old d started to come back. The brain healing can take anywhere between 6 and 12 months. Our treatment centre didn't offer individual psychological sessions until the 6 months post WR mark, as it would've been a waste of time. She attended about 3 sessions when the psychologist said she could find nothing to sort out.

Try and get her out of the house more often. My d would never go out if left up to her. Tell her you need to go shopping for new coffee tables and just walk around a furniture store. I dragged my d to the park after our medical appointments. Organize for friends to come around and just watch Netflix. They won't do these things on their own.
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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debra18
I think it's summer vacation now in your area. Is your daughter in camp or she is home all day? I found it very important to keep my daughter constantly busy and she learned to use distractions to help with anxiety. She is taking piano lessons now. This week was the week between school and camp. I kept her constantly busy with different activities including Russian lessons I ordered online, puzzles, painting,.etc.  There are many things you can do to help your daughter deal with anxiety. 
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Garden
It sounds like when you say the DC area, you mean actual DC proper? I'm in the burbs of Virginia, and we have found Prosperity Eating Disorders in Herndon to be amazing. They also recommend Spirit Open Equestrian, which does equine (horse) therapy for different needs, including ED.

Check with your daughter's pediatrician to make sure there aren't physical issues. I was told that if you need a DEXA scan to go to Children's National, as they have a machine that is better for kids' bones. I'm not sure it would make a difference at 15, but it was recommended for my 5'3" daughter. I know it's exhausting, but I would be aggressive in seeking help for your daughter. You only have a few years to get this all under control before college/she turns 18 and you don't have medical authority. 

Great question from above, re: is she busy enough over the summer? Could she be a CIT at a day camp or get some service hours somewhere? Summer can be very isolating and unstructured, and can add to depression, I think.

Good luck!
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Allyson_1
Yes,  we can  get to Arlington and Alexandria or downtown DC pretty easily.  I am thinking ahead to the fall. I'd like to find a new therapist/team this summer & I expect we will need to continue therapy once school starts.  My d is in high school in DC and uses the metro so DC & Northern Va are accessible & some parts of Maryland.   I think Herndon could be difficult to get to during the school year as it is 45 minutes from us in non rush hour traffic.   Have you or anyone else had experience with a place called Mind, Body, Health in DC (and Arlington)?  They have a couple of therapists who specialize in EDs & Anxiety. 

Her summer is pretty full with one CIT camp, She's been riding horses for years so is continuing to ride 2X/week & is doing a 5 day teen meditation retreat next week.  A bit of travel with me too. Also getting some executive functioning coaching & working on her 10th grade summer assignments.  So, summer is pretty full but not over booked.

Our ED MD said no need for a DEXA scan She only lost her period once (bc of losing a lot of weight with the flu a few years back) but has been pretty regular since then even with restricting so he doesn't see a need. Dr. says she is orthostatic though so I am upping the calories again.  We have an appointment with a rheaumatologist soon to check out all the constant complains of pain in her joints.    Therapist thinks it is somatization but getting checked for peace of mind.   My D. had arthritic lyme disease 2 years ago affecting he knee joint.  I'm wondering if there is some lingering connection?
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tina72
Allyson_1 wrote:

Our ED MD said no need for a DEXA scan She only lost her period once (bc of losing a lot of weight with the flu a few years back) but has been pretty regular since then even with restricting so he doesn't see a need.


I am no doctor but as far as I know having periods is no sign that you can not have osteoporosis, too. I know a lot of AN patients who never lost their periods but have bad bones. Please check her vitamin D status as well and check if she has grown in the last 2 years. If not or if her vitamin D level is low, I would insist on dexa scan. It is recommended for all AN patients as there is a high risk of osteoporosis later.

Lyme disease: Are you sure that was totally cured? In some cases these bacteria can stay in the body and make problems years later when they are not all killed with antibiotics. Has that been checked?
Keep feeding. There is light at the end of the tunnel.
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Allyson_1
Thanks, will do re the scan. She is taking calcium & D3 daily but a scan is worthwhile.
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scaredmom
Allyson_1,
You sounds so well organized with good medical care and follow up for your d. You really have done a great job with it all. She has a lot of great things to do in the summer! It all sounds lovely. I do hope you get the therapist in your area to help your d.

All the best,
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Hope46
Dr.Sarah Bennet is a clinical psychologist specializing in ED, FBT certified, in NW DC (42d street). http://www.sarahbennettphd.com. She has been excellent with our daughter (atypical AN, diagnosed age 12). 
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Juno
Hi Allyson_1! One thought is to question the idea of individual therapy at all right now. I wasted money and time on this idea when my d was still recovering. There is so much brain healing that needs to take place that it's not always possible for them to access therapy. 

It did really help me to have DBT skills to respond to her distress and the voices of the forum to push us forward and be on guard for back-sliding. Books are great for this--the one I read is called Helping Teens Who Cut--its a good intro to how to handle emotional dysregulation even if you haven't yet seen cutting. A family program could be good too but, if your gut is telling you she's not ready, a book might be a better starting place.

My son went to Potomac Behavioral Solutions for Depression/PTSD/Anxiety and we were really happy with them. They're in Crystal City, also work with eating disorders and are very good at keeping up with current best practices. We worked with Sandra Pinney as a nutritionist--she's great and has an office near Foggy Bottom.

I agree with some of the posts above that you may want to keep pushing the weight up until you see some reprieve. It feels counter-intuitive but my d's body image distress really lessoned when she got to 110%. Her body needed this to grow and fill out and heal.

One more thing--a few local moms are meeting for coffee in DC next week (7/13). If you'd like to join us or be on a local list, send me a note. I'm sure the others will have more ideas!
Mom of a younger outpatient
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Allyson_1
Thank you for you reply. We are using Potomac Behavioral. We did FBT with them for 5 months but then our therapist moved out of state. My daughter was WR by then and just starting phase 2. Potomac didn’t suggest another FBT therapist do it all sort of ended. At that point my d was in one on one therapy with a different therapist at Potomac ( 4 months now) and there doesn’t seem to be much progress. Potomac suggested we go a family DBT therapy but it is a 6 month commitment and something about that rubs me the wrong way. But I may just be tired.

Your idea that one on one therapy may be too soon is an interesting one. I don’t feel my d’s brain is healed yet and her good days seem to be bc of the Prozac not necessarily the healing. Still bad periods of wanting isolation and difficulty interacting with peers.

Unfortunately, I will be out of town on the 13 so can’t meet but would love to be on the list!! Very isolating for me too.
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