How to Find an Expert on PTSD & Trauma for Therapy on The Main Line of Philadelphia

The Main Line of Philadelphia

is a very special place to live.  If you already live here, you know how unique this place is - if you don't live here, you are in for quite a treat.  The suburban area to the west of Philadelphia has been referred to as The Main Line because of the main train line that connects Philadelphia to all the beautiful towns built up along the train tracks: Lower Merion includes Overbrook, Merion, Bala Cynwyd, Wynnewood, Narberth, Ardmore, Bryn Mawr and Rosemont.  Further out we have Radnor, Villanova, Wayne, St. Davids, Berwyn, Paoli, Malvern, Exton and Frazier.  Each town is unique and has it’s own spin on charm.

Finding an expert trauma therapist on the Main Line of Philadelphia

seems harder than it should be.  With Bryn Mawr's Graduate School of Social Work close by, Villanova University, Rosemont College, Saint Joseph's University, Widener, Immaculata, Cabrini, Ursinus and not to mention University of Pennsylvania, Swarthmore and LaSalle, we have so many talented therapists, social workers and counselors.  So, how do you find the therapist who knows just how to help you manage your post-traumatic stress symptoms?  How do you find the counselor you can click with and trust to guide you through an evidence-based method of healing your past traumatic memories?  Choosing a therapist is a very personal decision.  You can have three great therapists, but if you don’t feel safe with them, what’s the point?  If you are looking for a counselor, psychologist, life coach or therapist - I'd like to help you find someone who can help.

Here are some ways to search

Educate Yourself About Methods that Work for PTSD

When you have PTSD, there are only a few ways of treating your symptoms that have been studied and proven to effectively reduce or eliminate symptoms.  Those nightmares you’ve been dealing with, the heightened startle response, hypervigilance, and avoidance of triggering situations – those are the things that get in the way of your life.  These are the issues you’ll want to be sure your therapist knows how to help you manage and heal, not just talk about.  One of the top researched methods for eliminating these symptoms is a method called Eye Movement Desensitization and Reprocessing (EMDR). 

EMDR has been studied and proven as an evidence-based treatment method.  You can learn more about EMDR and how it works here.  Here is a short explanation: when we have traumatic memories, the memories tend to get stuck on one side of the brain and our body tries to heal it by re-playing it over and over, but it stays stuck.  EMDR is a technique that stimulates each side of the body alternately while the patient processes the traumatic material.  This technique helps the brain move the traumatic memory from one side of the body through to be able to process it so it’s not stuck on a loop any longer.  You can find therapists who are trained and certified to utilize EMDR by going on the EMDRIA.org website or asking people who know therapists in the area.  Think about asking friends who have or know therapists, your doctor or someone at your school.  Therapists that come highly recommended and are known to work with PTSD through EMDR methods are a good way to make sure they have a good reputation.  

Google

Type into Google your town and the issue you are looking for help with.  For example, "Bryn Mawr and PTSD" or "Rosemont and Trauma" and see what comes up.  In the top listings that come up in your search, you will hopefully see some links to therapists that specialize in your particular need and are trained in EMDR.    

Psychology Today

What you will most likely see is a result that links to a Psychology Today profile for therapists in your area that have indicated these specialties.  Psychology Today is a great site that is most commonly used for therapists to post their profiles and for clients to find a therapist nearby.  It’s very helpful that you can refine your search by specialty.  The unfortunate thing is that therapists can indicate that we specialize in as many topics as we'd like.  Although a therapist might indicate that they specialize in PTSD, if it's really something we know a lot about, we obtain specialized training in evidence-based methods specifically for PTSD and we will often note areas we are trained in on our websites, so don’t stop with Psychology Today, make sure you read through the clinician’s website as well.

Websites

Check out the websites of potential therapists.  If you are looking for help with flashbacks and the website you are visiting talks a bunch about flashbacks, that's a great sign!  If you are looking for help with a heightened startle response and you're on a website that doesn't mention this symptom, you might want to keep looking.  

Phone consultation

Some therapists offer a free 15-minue phone consultation which is a great service and an excellent opportunity for you to interview your potential trauma therapist.  You are going to be spending a good amount of time and finances on effective therapy, it is very important that you find the right fit for you.

Here are some questions to help you navigate your phone consultation:

1.     What methods do you use to treat PTSD?

2.   How do you help your clients manage overwhelming emotions while they work on traumatic memories?

3.   What do you do to treat the symptoms versus the root of the problem?

4.   How long does it usually take before your clients start to see relief from their symptoms?

5.   How effective are the methods you use?

6.   Given my specific set of symptoms and needs, do you think you can help me and have you helped many others’ with my specific symptoms before?

In an ideal world, you would find a therapist who has special training and expertise in the methods that show the best results and someone who has tons of experience working with eating disorders and trauma.  Unfortunately, this is not an ideal world.  So you'll need to search a bit further.  You'll be searching for someone that you connect with, who you feel comfortable talking to, someone who will be honest with you and you'll know you can be honest with them.  

I hope this helps you in your search for the right therapist on the Main Line of Philadelphia.  If you want some tools to help now, sign up for my newsletter to get some tips and tools for managing PTSD and eating disorders.  If you are still feeling stuck, feel free to call me at 610.314.8402 for a free 15 minute phone consultation.  I am available to listen to what's happening and help direct you to the right person.  If you are looking for help with eating disorders or PTSD, you can read more about how I can help here.

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!

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. 

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:

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.

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

3 Keys to Finally Make Peace With Food by Geneen Roth

Geneen Roth, eating disorder guru, discusses the following topics with Claire Zammit: 

• - How your struggles with food might be impacting other areas of your life such as relationship, finances and career
• - The common misconceptions about the root of weight issues and the truth you must embrace to finally overcome them
• - The practice that instantly changes your relationship with yourself as a foundation for creating a new relationship with food
• - Why uncovering the deeper, positive reason you've been keeping the weight on is a key to releasing it forever
• - What can become possible in your life (and in our world when we do this as women together!) when you make these 3 shifts
• - How you can make 2017 the year you reclaim your power and make peace with food forever

You can hear the 60-minute seminar here: http://bit.ly/2mdrClK

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 !

Guest Writer: My Journey With Bulimia by Melissa King

A brief update from the author:

I wrote the following post just over 6 years ago. I had been fully recovered from bulimic symptoms for about 4 years at the time. It’s now been 10 years of recovery and I still deeply believe in all of the words I speak in this piece. The only thing that’s changed is that I feel even further away from experiencing desires to binge or purge. There was a time when it was hard to imagine feeling completely comfortable around food, easily stopping when full, and not thinking about the ice cream in the freezer constantly. I hope this article helps some of you! Be brave. Recovery is totally possible! - Melissa

My Journey With Bulimia

December 6, 2010

About ten years ago I developed a condition known as bulimia. I never would have guessed that a smart girl like me would struggle with something like that. I knew better. I had learned about eating disorders when I was younger and could never make sense of why someone would force themselves to vomit after eating or avoid eating all together.

I think very differently about eating disorders today. You can be intelligent, self-aware, and informed about eating disorders and still struggle with the “disease.” I remember the first time I displayed signs that I was at risk for developing bulimia. I was reading a book about how bad refined sugar was, and I was doing an excellent job of eliminating it from my diet—that is until I was tempted by a birthday cake brought into work one day. I decided to treat myself to a slice, and as I was finishing it, I felt deeply concerned about how the sugar might be harming my body. I don’t know what made me think of it because I had never chosen to throw up food before (nor did I know of anyone who had), but I quickly went to the bathroom and vomited in a stall.

I felt much better after getting rid of the sugar and didn’t think of it again until a year later. I had begun a big transformation in my life. I was starting to question my faith, my choice of career, the reasons for my failed romantic relationships, etc. I decided to go to counseling, and after a few sessions the counselor asked, “Where is Melissa?” I didn’t understand what she meant, but after some back and forth, she finally explained, “You tell me everything you think you SHOULD do and SHOULD want, but you don’t tell me how YOU feel and what YOU want.”

No one has said anything that has impacted me more deeply than that statement. I realized that I had become so good at assessing what I thought other people wanted that I had become disconnected from my own desires, feelings, and opinions. It’s like they were crowded out by the noise of all the other expectations and demands I thought I had to meet.

After that session, I started concentrating on my inner world and made a lot of effort to to connect more deeply with myself. As part of that exploration, I went back to dance class. Dance was an innate joy for me. It was my childhood passion, something I knew that I didn’t do to please anyone else. I hoped that dance would remind me of what it was like to feel.

And it worked. The feelings that dance inspired in me became recognizable in other areas of my life. In an attempt to follow this, I started spending more time alone so that I could learn to hear my own voice. I stopped going to church so that I could figure out what I really believed about God, without pressure from others. I also got a second job and began saving to spend six months in New York studying dance. New York was a place I had always wanted to live and I wanted to gift myself with the opportunity. And lastly, I decided to finally lose the weight I had gained since high school. For the first time, I was choosing to take my dreams seriously and have confidence in my ability to achieve them.

Several months later the pounds were coming off and I felt amazing. I was losing weight in a healthy way and sticking to a diet plan longer than ever before. I felt like I was discovering my real body: lean, healthy, strong, and energetic. I felt beautiful inside and out.

Somewhere close to my goal weight, I gave in and ate something that I knew was higher than the amount of calories I needed. I became afraid. Seeing myself eat food that was not in my plan made me fear that I was stepping back into old behaviors. In the past, I would stick to a diet for a little while but would always end up giving into temptation, promising myself that I would start again the next day. It was a bad cycle that I didn’t want to continue. Not only that, but I was falling in love with the “new” me, the me that was living from her heart, the me that was committing to her goals, and the me who was coming out of her shell and no longer hiding under extra weight. I felt more confident. I was getting attention from boys, and I was interacting more with people. I didn’t want to lose those things. That’s when I remembered my experience with the sugar elimination diet. I realized that I could just get rid of what I ate in the bathroom and my problem would be solved. So I did.

I never imagined that I would do it again. I thought it was a one-time thing. But it did happen again. Not often, at first. But every time I felt unsure about the calories I had consumed in a meal or I knew that I had too many, I ultimately found myself in the bathroom.

At one point, I became concerned that I might have an eating disorder. I remember going online and looking up the symptoms for bulimia. The criteria noted that an individual must have a certain number of symptoms to be diagnosed. Although I thought I might need help, my symptoms didn’t match enough of the criteria. I wasn’t bingeing at all and I wasn’t vomiting enough over the course of a week. As a result, I worried that I would not be taken seriously, so I was too embarrassed to seek help.

Eventually the symptoms did grow. It became harder to vomit if I didn’t eat enough, so I started to binge. My bulimia began to look very “textbook.”

In May of 2001, I moved to NYC. I accomplished some amazing things and had some wonderful experiences. During that time, I had periods when I went for months without symptoms and others when I vomited every day. I eventually went to counseling again, and during those sessions, my counselor offered me one important insight about bulimia. She simply said, “Maybe you’re not ready to give it up.” For the first time I considered the notion that I could give myself permission to continue. What a scary idea, but she was right to suggest it. 

From the time my symptoms began, I was resistant to them. After every purge, I promised myself it would be the last time. My mind was filled with figuring out ways to keep it from happening again. By accepting bulimia’s place in my life, I was able to learn from it and understand why it was there. Since my mind was free from thoughts of guilt, criticism, and resistance, I had space to feel the emotions that bulimia was trying to bring to the surface. I started recognizing the feelings I felt when I would binge and purge and realized how they were connected to other challenges in my life. When I saw the connections, I could start resolving the problems in other ways.

It took awhile, but I eventually let bulimia go. I would stop for several months, have a bout, then stop for many more months, have another bout, then stop for a longer period of time, etc. It’s been over three years now, maybe almost four, since the last period of symptoms.

I believe my bulimia represented a step toward healing. It often felt that people around me viewed bulimia as a problem, as a step backward, as something I was doing wrong. At first, I joined them in this conclusion. But bulimia came into my life when I was beginning a fight to be true to myself and resist the external pressures around me to please others, to follow another’s lead, to do what other people thought was good rather than what I felt was good. I didn’t know how to say “no.” I didn’t know how to negotiate. For years I had been taking in, absorbing and adjusting to what others wanted so that I could gain their approval and respect, ultimately depending on them for assurance and confidence. Simultaneously, I ate all the time. That’s how I gained weight in the first place. I just consumed. I dealt with my problems by eating. I couldn’t say no to food either. 

I was finally coming to a point in my life where I wanted to trust myself, but I was scared. It was a battle. I was taking food in (symbolically, others’ opinions, desires, and expectations) but realized that I didn’t want it. So I would push it back out. I was starting to say no and bulimia represented a violent fight inside me. 

It’s hard to be yourself in this world. There are a lot of demands, many that are indirect, and it was hard for me to resist the impulse to meet all those demands. Food was my vice, so it makes sense that my relationship with food symbolically paralleled my relationship with myself and with the world.

I think my bulimic episodes ended when I started trusting myself more and worrying less about others’ opinions, worrying less about someone being upset if I told them “no.” I knew that I didn’t want to continue bingeing and purging because the health risks weren’t worth it to me. So, eventually I chose to stop, probably when I had the internal strength to make that choice for myself (rather than just to appease others). Much of it was learning how to have boundaries. Just like I had to learn how to have boundaries with people, I had to learn how to have boundaries with food.

Does this mean that I have perfect boundaries with people now, that I never overeat, that I trust myself completely all the time? No. I still struggle with these things, just like everyone does. But the experiences I had while dealing with bulimia transpired into major changes in my life, changes I certainly benefit from now. My boundaries are much stronger and clearer, and I have more awareness of when I am compromising who I am. In fact, if I ever have the urge overeat or vomit, and I do sometimes, it’s a great clue to me that I’m not dealing with something in my life the way that I need to. I know that now, so I can take a step back, look at the problem, and figure out a more productive solution. It’s funny, because that solution often means asking for help or making myself more vulnerable with someone (letting someone in), or saying what I feel and risking possible rejection - again, all connected to boundaries. 

Bulimia is complicated and very layered. I haven’t addressed all of those layers here. Furthermore, I can only speak from my own experience; I don’t mean to represent others’ experiences. Over time, I’ve learned that people’s stories and the reasons behind their personal challenges are varied and don’t all fit into a neat little defined box. But I do believe that for many people, symptoms of bulimia actually symbolize an attempt toward health, the body reacting in order to make something right. I believe the symptoms are symbolic of the internal fight of an individual trying to find their voice, to find confidence, to look for a way to move out of whatever problem they have been dealing with, a problem that existed before symptoms of bulimia showed up. It’s never just about bulimia, it’s always about something much deeper. I think that many individuals with bulimia are trying to figure out how to finally have boundaries—with themselves and with the world. If they can find support to understand and transition through it, support to trust themselves, then the stage after bulimia can be fuller health, greater self-esteem and confidence, and healthier boundaries.

ABOUT MELISSA

Melissa King, LMHC is now a psychotherapist in New York City who works with women, gay/bi men, and couples in the first 10 years of a relationship. Find out more about Melissa here. https://www.myheartdances.com

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 !

Guest Writer: Because sometimes a group yoga class isn't for everyone… By Jennifer Kreatsoulas, PhD, RYT

 

"Yoga is the journey of the self, through the self, to the self."

-The Bhagavad Gita

A theme that's been coming up in several conversations I've had lately is how intimidating and uncomfortable it can be to step into a group yoga class. If that's the case for you, trust me, you are not alone, and I understand! It can be scary to try something new, especially if you feel self-conscious about your body or uneasy in your skin. And trust me again, I get what that feels like too! For sure.

These chats with others got me thinking about how I can help those who want some yoga in their life get it at home. I also thought about how home yoga practices focused specifically on strengthening body image and supporting eating disorder recovery might be helpful. After all, that's what yoga has done for me and is the focus of my individual and group work, so why not share it with more people?

So, I decided to go for it and created an online video series called Yoga to Strengthen Body Image and Support Eating Disorder Recovery.

I have to admit, creating the video series was quite an experience! As a one-woman-production, I learned way more than I ever thought I would about video, audio, and everything in between. It was both comical and intensely frustrating at times, but in the end, I feel happy and hopeful about how these videos may empower a whole lot of people, and my fingers are crossed that you are one of them.

Each 30-minute video will show you how to build physical strength, calm spinning thoughts, and begin to cultivate compassion and curiosity about your body. I will also teach you practical, hands-on ways yoga can be used to strengthen body image, support eating disorder recovery, and help with disordered eating patterns and thoughts.

I totally get that it can feel scary to be in your body. But I promise I will be there to guide you. One breath, one pose, one video at a time, we will build new empowering habits to support your ongoing relationship with your body and self.

This video series is perfect for you if you are curious about trying yoga, are relatively new to yoga, or prefer a private setting versus a group class. It's also appropriate for experienced practitioners who would like to explore their yoga practice in new and empowering ways.

I invite you to take a quick moment to learn some more about Yoga to Strengthen Body Image and Support Eating Disorder Recovery. I also invite you to email me with any questions or to share your yoga experience; I sincerely enjoy learning about how yoga has been a healing influence in other’s lives, so please share!

Jennifer Kreatsoulas, PhD, RYT, is a yoga teacher and yoga therapist specializing in eating disorders and body image. In recovery herself, Jennifer is extremely passionate about helping others reconnect with their bodies and be empowered in their lives. Jennifer works with clients in person and via Skype. She also teaches yoga at the Monte Nido Eating Disorder Center of Philadelphia and is a partner with the Yoga and Body Image Coalition. She leads trauma-sensitive yoga classes and teaches weekly flow yoga classes. Jennifer contributes regularly to eating disorder and body image blogs and the YogaLiving Magazine. Connect with Jennifer: www.ChimeYogaTherapy.com

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!

For Therapists: On How to Conduct a Therapeutic Challenge Meal

Exposure therapy can be very effective when done in a way that gives a sense of empowerment and helps people defeat their fears.  If you have a client who has avoided eating normal meals or meals out at restaurants, challenge meals can be a great intervention for them. 

Assessment

Challenge meals are something that I usually suggest to a client after we’ve been working together for a while.  We’ve sat in the therapy room a number of times and I’ve built a therapeutic alliance with them.  I assess for their fear foods.  I find out what their “red” foods are – their biggest fear foods, their “yellow” foods are foods that are moderately anxiety provoking and their “green” foods – ones they eat regularly and don’t usually feel guilty about.  They’ve relayed their goals, their history and are comfortable in the room with me.  Once this stage has been set, we begin working towards their goals.  Often times, their goals include a desire to normalize their eating habits or to be able to eat in social situations without sinking into extreme guilt afterward.  When I see that the client is motivated and willing to take some risk in order to accomplish their goals, I present the idea of a challenge meal to them.  I let them know that sometimes I go out to eat with my clients in order to help them find normalcy around food and restaurants.  I ask if this is something they might be interested in trying.  If fear, other types of resistance or hesitancy comes up, we process that.  I may use Motivational Interviewing techniques in order to help them find benefit in pushing themselves towards their goal.

Preparation

Once the client has agreed to a challenge meal, I start with the easiest scenario first.  We start with green level foods and see if we can make a “normal” meal out of them.  So for example, if they’re regularly eating tuna fish, but eat it with vinegar instead of mayonnaise, and with vegetables instead of bread, we see if we can create something a bit more normal and a bit more challenging.  So I might suggest tuna with mayo on bread or if bread is too scary, perhaps we’d start with a cracker or tortilla.  During the preparation phase, I negotiate with the client and their eating disorder on what would be challenging yet doable. 

The goal is for the client to feel successful so that they desire to try again.  It’s like learning to lift weights at the gym, we start with lighter, easier weights until our body gets used to it and builds up to the heftier weights.  The first few challenge meals may be done in the office and the client may bring the food or the therapist may bring the food. 

Restaurants

When the client is ready to eat at a restaurant, we prepare by negotiating where they want to eat.  We also decide what we will say if we bump into anyone we know in order to keep their confidentiality.  Sometimes we agree to say we know each other from school or a friend or sometimes a parent’s friend.  I am very careful to speak quietly and refrain from any intervention when others’ could overhear.  I usually ask them if there’s a restaurant they’ve been wanting to try or if there’s a type of food they’d like to get support around.  Once we pick the restaurant, then we look at the menu.  When eating a challenge meal in a restaurant, depending on that particular client, we may decide what they will be ordering before we go to the restaurant or we might negotiate once we get there.  Depending on what would most ease the clients’ anxiety, we may do this right before going to the restaurant or the week before.  I wouldn’t want them to fret all week about what they’ll be eating, but sometimes it helps ease anxiety to get used to the idea and sit on it for a week.  Timing of this is at your and your clients’ discretion.  

Beginning the meal

If the challenge meal is in the office, begin the meal as soon as possible in order to leave the most time afterward to digest and process and reduce the risk and desire for a purge.  The client can use the bathroom before the meal begins so that they won’t need to use it for at least an hour after the meal. 

Ordering from a menu

If the food needs to be ordered in a restaurant, help the client decide what to order, ask if they’d like an appetizer or a side dish and assure them they will only need to eat an appropriate amount.  So if they get an appetizer and a main course, they might only eat half of each, depending on their satiety cues.  Eating a variety of foods is good practice to combat ED.  If they’re getting overwhelmed by the menu, help them to narrow it down by quietly reminding them of the original goal they had in mind.  For example, “well, when you chose this restaurant, you wanted pizza, so let’s stick with that – and you can get a vegetable to go with it and that will provide all the food groups: starch, fat, protein and veg.  So which type of pizza looks or sounds the most appetizing to you right now?”  This way they still have choice, but the overwhelming choices are paired down for them.  Pay attention to what they’re ordering to make sure it’s an appropriate meal.  If they’re ordering an appetizer only, be sure it includes all the food groups and possibly suggest they order 2 appetizers or have a roll with their appetizer to supplement their meal or they may just need an entre.  Salads are usually not an appropriate challenge meal, but a salad with a challenging appetizer may make sense.  Diet foods are not appropriate for challenge meals, so eliminate any diet drinks or egg whites, protein bars, etc.  Make sure the food YOU order is also not triggering to your client.  They are watching you.  If you order the same meal as them, it may make things easier on them.  When they have progressed further along, this may become part of the challenge – to tolerate your food item while they eat theirs. 

Hunger signals

Set the stage for the meal by activating the body signals that have been shut off for so long.  Ask the client on a scale of 0-10 with 0 being supremely starving and 10 being so stuffed they feel sick and unable to move – the most full they’ve ever felt in their life – what number are they at right now?  You can use a hunger cue card like the one shown here.

Identify their hunger signal and yours and if you’re in a group, have each member identify how hungry they are both emotionally and physically. 

Meal guidelines

The actual process of a challenge meal should not be emotionally heavy or food focused.  Try to steer the conversation away from inspecting or commenting on the food or body or fullness.  Instead, talk about lighter appropriate topics like the weather, the atmosphere in the room, how their day was, sports – a movie or TV show.  In a group, playing a game can be very helpful.  Some favorites are “contact” or thinking up famous peoples’ names in alphabetical order. 

Eating the meal should not take more than 30 minutes.  Sometimes clients will try to cut food into tiny pieces or take very small bites or eat very slowly.  This will require an intervening prompt from you.  Something like “please take normal bites” or “that’s cut small enough, let’s start the meal now” or “we’ve got 15 minutes left, please keep up the pace so we can finish the meal on time” are some prompts you might use.  It is our job to help them contain and combat their ED voice.  We state the prompt clearly, yet quietly so others’ don’t over-hear and we say it neutrally and without judgment.  If they’re still playing with their food and interventions aren’t working, I usually just let it be rather than getting into a struggle with them in public and process what happened later. 

If they’re getting an especially challenging meal and they’re anxious about it, I will suggest they can cut their meal in half and just start with the first half.  After the first half, we can check into hunger cues and see how they are with continuing.  I often tell clients that I believe it is more important that they feel successful in eating a challenge meal, but perhaps less of it, than eating too much and feeling overly full and triggered to purge.  This is true in an outpatient therapy setting.  Residential or partial hospitalization has more containment and ability to monitor clients after the meal, so that’s a different story.  But for my purposes, I don’t believe feeling overly full is in the client’s best interest. 

After the meal

Once the meal is complete, be sure to sit at the table for a while and discourage any bathroom use.  You can ask them how their meal was and how they feel emotionally.  Ask what the experience was like and if they’d get the same meal next time or if there’s something else they might like to try next time.  Focus on their success and offer any authentic praise for challenging themselves and their ED.  If they have some regret or guilt, help give them the words to combat the guilt internally.  Something like: “This is one meal, it was enjoyable and my body knows how to process it.” Or “I’m defeating ED one meal at a time.  I need food to nourish my body.  I am proud of myself for standing up to ED.”  Another favorite “this is what normal looks like.  People go out to eat and enjoy food and they’re okay so I can be okay too.”

The more exposure, the more the client will get used to eating food and eating it in challenging settings.  This helps lay the foundation for less social isolation and more ability to tolerate food and restaurants.  Really and truly, one meal at a time really does make a difference.  Supporting a client through a challenge meal shows them that they are capable and gives them a successful experience to remember when they’re ready to try it on their own. 

What have been your experiences with challenge meals?  Comment below.

If you want to learn more about challenge meals, I’d be happy to help.  Contact me at 610.314.8402 or TiffanySpilove@yahoo.com

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