Monthly Archives: March 2016

Eating Disorder Recovery

Copy of The Blame Game

Errors of Thinking- #8 Mind Reading

 

Copy of Copy of Copy of Never make an exception of yourself-2

Mind Reading can happen in two forms.  The first form assumes that someone else should know what you are thinking.  This can happen naturally in relationships.  After all, the more time we spend with someone, the more likely we are to know how they feel about something. We are better able to read their non verbal cues and often recognize needs before they are communicated.  But you can run into trouble when you start expecting the person to act or do something without ever communicating that need.

Imagine you are coming home from a really long day.  You still have to cook dinner for everyone, you still have to deal with the dishes and getting everyone to bed. After dinner your partner usually watches the news and then helps the kids with homework. But that night, you also have to work on a project that is due tomorrow. The only way you see that happening is if you hand off the clean up duty to your partner that night.  Okay, all settled, you think to yourself. So you rush in, you tell your partner, I really have to work on a project tonight. He nods his head. So you make dinner, eat dinner, and your spouse disappears to go watch tv as usual after dinner leaving you with dishes. So you storm into the tv room and start a fight about how you have to work on your project and why can’t he just do the dishes! Your spouse says, “I thought you were going to work on it after you put the kids to bed.  I had no idea you wanted me to do the dishes.  All you had to do was ask.”  It’s then that you realize you never actually told him how you wanted his help. You made a plan that involved the two of you but never communicated it.  Sound familiar? That’s one form of mind reading.

The second form of mind reading assumes that you know what another person is thinking. In general, this thought tends to be negative and riddled with anxiety. For example, you raise your hand to answer a question in class, but your answer is wrong. You are embarassed. As you look around the room, you think the guy sitting across from you who is looking at you thinks you are stupid.  Next thing you know, you are so embarrassed, you have resolved to never answer a question in this class again.

You can see how if you are anxious to begin with, this kind of thinking can catch on like wild fire, and before you know it, you are feeling pretty depressed.

Engaging in mind reading, in either form, is a recipe for disaster.

So what can we do about it?

Communicate, communicate, communicate.

In the first example, it’s pretty clear how communication could’ve eliminated an unnecessary argument and saved time.  If you are changing normal routines and responsibilities, it’s always good to check in with the people that are affected so that you aren’t leaving the success of the new routine up to whether or not the person is an excellent mind reader. Chances are, they aren’t.  In the example above, the person communicated the need (working on the project) but not the plan (partner does dishes). No matter how much you are in sync with another person, it never hurts to get verbal confirmation.

In the second example, there are several questions you can ask yourself. First of all, clearly identify what you think the other person is thinking.  “The guy across from me thinks I’m dumb because I answered the question wrong.” Next, write it down. Just seeing it on paper may make you question your assumption.  Next consider the evidence for and against your conclusion. You may only be considering evidence that supports your conclusion and missing the larger picture. And what is the quality of your evidence? If it’s just a look someone gives you, that’s not the same as the person shouting “Duh,” after your professor corrects your answer.  Then ask yourself, if the thought were true, would it mean more about you, or the person? In this example, what does it say about the other person that they would think someone is stupid for answering a question wrong?  Finally, you can always try acting counter to the thought. If the thought makes you want to crawl under your desk, then maybe you should try raising your hand again at the next question.  Or perhaps you would look at the other student and smile.

Like I said before, mind reading can happen naturally. In small doses, it doesn’t cause a problem. But if mind reading is causing you anxiety or leading to miscommunications that are causing arguments, then it’s time to address the common error of thinking.

-Dr. Norton

#GetSunEatCleanBeWell

 

Dr. J. Renae Norton is a clinical psychologist, specializing in the outpatient treatment of eating disorders such as anorexia, bulimia, bulimarexia, and binge eating disorder (BED), as well as obesity. She is also the author of The Sun Plus Diet, due out in summer 2016. 

Let’s Connect!

Like me on Facebook

Twitter @drrenae

Contact Dr Norton by phone 513-205-6543 or by form

Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship. This information is not necessarily the position of Dr. J. Renae Norton or The Norton Center for Eating Disorders and Obesity.

©2016, Dr. J. Renae Norton. This information is intellectual property of Dr. J. Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2016, Dr. J. Renae Norton. http://www.eatingdisorderpro.com/

 

 

Is Residential “Treatment” Really Treatment?

Nothing worth having wasnever achieved without effortI have been saying publicly that residential treatment centers for eating disorders don’t work. Behind the scenes, I have lamented the atrocities my patients have undergone while in residential treatment. Given that this problem has finally been exposed, I would like to share with you some of the experiences my patients have shared with me, as well as my own experience with this exploitive form of “treatment.”

Let’s start with the patient that was effectively incarcerated in a residential treatment center for nearly a year. She entered the center at 90 pounds and eleven months later, and only after a court order, she escaped weighing 180 pounds. She described the state of her body at that point as consisting primarily of “pasty white blubber.”

While she was in “treatment” she was not allowed to communicate with her parents, who were not allowed to communicate with her either. She was forced to eat 4000 to 5000 calories per day in the form of cereal, bagels, candy bars, soft drinks, and highly processed proteins such as hot dogs, hamburgers, chicken fingers etc. If she refused to eat this polluted excuse for real food, she was isolated and tube fed. She was not allowed to do any fitness work, despite being healthy physically. She pleaded, begged and threatened staff, but to no avail until her parents got a court order to have her released.

The trust between psychologist and patient, which is truly the foundation of healing for any patient, but especially for patients with eating disorders, had been so damaged as a result of her experience at this residential treatment center, that she could not bring herself to engage in treatment again. Her trust for practitioners had been damaged beyond repair at that point. (If you’re out there, CJ, and you’re reading this, I pray you found your way back to good health. Sending you positive vibes and good wishes. You can do it.)

This residential treatment center was charging $10,000 a week ($40,000 a month) and the parents were paying about $10,000 of that out-of-pocket per month. In other words, they paid close to a hundred thousand dollars for the so-called treatment that their daughter received. The insurance company paid a tidy sum as well. No wonder the treatment center kept this young woman against her will and against the wishes of her parents! They were making a fortune. One thing is for sure, they were not particularly interested in her well-being. Their motive was clearly profit.

Think that sounds harsh? According to the most recent article in the New York Times, for profit residential eating disorder facilities have grown over the past few years, along with their elaborate marketing efforts and business development plans. Private equity investment companies are responsible for the proliferation of these treatment centers. Why? Because there is money to be made in exploiting a disorder that is not very well understood and becomes increasingly difficult to treat the longer the patient goes untreated. For parents grappling with their worst nightmare, these facilities promote their facilities as being critical to the survival of a loved one. They use scare tactics to coerce parents and significant others into signing their loved ones into treatment. In the case of the patient above they threw away the key.

When scare tactics don’t work, some treatment centers market their businesses, using expensive brochures, as something akin to a luxury spa or a drug and alcohol treatment center for the uber rich. The question is, do these programs actually help? Not according to the research. Their success rates are abysmal, at around 30%. My experience is that they make things worse. The example above may sound extreme, but I could share many more like it.

A question the consumer should be asking is who regulates these places? As far as I can tell, apparently no one regulates them, which sets the stage for people who desperately need good treatment to be exploited. For example, in order to do business they have to have referrals, right? I have seen first hand how this plays out. A therapist, who used residential treatment as a “consequence” for continuing to purge, refers an unwilling teen to a residential treatment center. The parents, who are at their wits end, agree to relinquish the responsibility of trying to save their daughter’s life to the treatment center. The treatment center plays on their fear and insists that this is the only course of action in order to protect their child. So the unwilling child ends up in residential treatment half a continent away.

But, and this is the kicker, the child can only get out of the residential treatment center if she agrees to go back to the referring therapist! Don’t forget, she wasn’t doing well with that therapist. However, since she would do anything to get out, she agrees. The therapist and the treatment center refer back and forth, patting each other’s backs and padding each other’s wallets.

In my humble opinion, this is a conflict of interest that has the potential to be damaging to the client. In this case, the patient went through this scenario 3 times with this therapist and in the end it backfired. The child decided she wanted to stay in the residential treatment instead of living her life. (No homework, no chores, no decisions…..just a lot of TV and the occasional art class and group therapy session.) She had already missed two and a half years of high school and wasn’t used to the demands of going to school. In addition, her friends were no longer her friends. When she came to me and I declined to put her back in a residential program, what do you think she did? Went back to that therapist and ended up back in the residential treatment center, again!

As you might imagine, despite courting me relentlessly to refer to them, I have never received a referral from a residential treatment center looking for after care for their Cincinnati clients. It does not seem to matter that I am qualified or that I can demonstrate excellent outcomes, as soon as they realize I will not be referring to them, they are uninterested in referring their graduates. Huh!

I was recently contacted by an investigative reporter, who is planning to file a class action suit against residential treatment centers in California, where she had been a “victim” of such treatment herself. I hope that she wins or that she is at least able to shine some light on a seemingly unregulated industry.

On a more positive note, relatively speaking, let’s take my patient who is currently in remission after only nine months of treatment here at the Norton Center. She came to me from a residential treatment center where she had been on bed rest for 14 days prior to being released. Why was she on bed rest despite the fact that she was medically stable? Because she was refusing to eat any of the institutional processed and highly polluted foods that she was being offered. The bed rest was a “consequence” for not eating. Another consequence was that the staff were instructed not to speak with her. She was to have (in her words) “no human contact.”

She was also being forced to either drink or be tube fed 6 to 8 Boosts a day. If you read the ingredients of a boost, there is almost no food in it. The first ingredient is water, the next ingredient is a GMO sugar. The third ingredient is high fructose corn syrup, another sugar, only this time a sugar on steroids, which is also genetically engineered. Finally, we get something that resembles a food in protein concentrate. However, because it is from a concentrate, the protein has been denatured, which renders it more dangerous than healthy. Then, we start with all of the hydrogenated processed oils, including vegetable oil, canola oil, high Oleic sunflower oil and corn oil. Hydrogenated oils are dangerous. Awesome! Right?

Try to imagine what this would be like: lying in a small room in your bed, unable to get out of bed except for your supervised bathroom visits, and all you have to look forward to is trying to get down a Boost. And when you can’t, or when you throw up because you are so sick of it, no worries—a tube is inserted into your little body and you are fed the Boost through the tube. Let’s see you throw that up.

The insurance company for this patient was being billed around $1500 a day. The Boosts cost $20.21 per day. What were they charging for? She received therapy from a social worker for a short period sporatically during the week, had art therapy every day and spent “maybe 5 minutes a day” with an M.D.

This patient is currently in complete remission, her weight restored to normal. She is back in school full-time, getting straight A’s, setting her sights on law school, traveling with her orchestra, doing amazing art, and voluntarily eating about 2500 clean calories a day, which is good considering that she is fairly petite.

Why do I bring this client up? I firmly believe that the majority of eating disorder patients belong in outpatient therapy. When a patient is able to still participate in work, school, family life, extracurriculars, and friendships, they are able to stay connected with their real life, with its problems and challenges. Inevitably, those challenges and problems are discussed and dissected during session. Her recovery is tied to the successes she has in coping in a different way with those issues.

Another reason intensive outpatient treatment (IOP) works better is that it allows the family to participate. In the case of this patient, (and most of my patients) I could not have been nearly as successful without the involvement the mom. The research is clear, family treatment is the only form of treatment that has been shown to be effective in treating Anorexia. Most families cannot relocate to be with their child throughout the months that she is in residential treatment, such that she is alone and all too often isolated from her loved ones. In addition, the cost of IOP in my practice is closer to $1500 a week instead of the $1500 a day charged by residential programs.

The main thing though is that recovery doesn’t happen locked in a beautiful tower with spa amenities. It doesn’t happen locked in a small prison like room with supervised bathroom visits. Recovery happens when a patient encounters a difficult moment in her real life, among her family and friends, and makes a choice to consciously try a new behavior, instead of relying on the more comfortable Eating Disorder (ED) behaviors.

My advice for anyone considering treatment would be this: look past all the packaging. Resist the fear and guilt tactics. Ask yourself the following: Do you connect with the therapist? Does your child connect with the therapist? Is there even a therapist? (In most treatment centers, the actual therapist sees your child for an hour a week.) Does the treating practitioner understand the role that polluted food plays in the development and escalation of disordered eating? Or the role that clean food plays in recovery? Will they include the family in treatment? Is treatment individualized or is it a one size fits all approach? Can his/her life continue while getting treatment assuming s/he is medically stable?

Answers to these questions should help you make an informed decision.

-Dr. Norton

#GetSunEatCleanBeWell

Dr. J. Renae Norton is a clinical psychologist, specializing in the outpatient treatment of eating disorders such as anorexia, bulimia, bulimarexia, and binge eating disorder (BED), as well as obesity. She is also the author of The Sun Plus Diet, due out in summer 2016. 
Let’s Connect!

Like me on Facebook
Twitter @drrenae

Contact Dr Norton by phone 513-205-6543 or by form

Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship. This information is not necessarily the position of Dr. J. Renae Norton or The Norton Center for Eating Disorders and Obesity.

©2016, Dr. J. Renae Norton. This information is intellectual property of Dr. J. Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2016, Dr. J. Renae Norton. http://www.eatingdisorderpro.com/

It’s Pi Day (3.14)! Clean Pizza Tutorial!

O N E D R O P

It’s Pi Day (3.14) and right now the internet is blowing up with photos of pies and pie recipes.

Most people who know me, know that I am not a baker. I make pies once a year.  Therefore, I will not be discussing sweet pies today.

However, I am all about discussing PIZZA PIE! (You’re shocked, aren’t you?)

Here’s the question I am asked every week by new patients:

“Dr. Norton, does eating clean mean giving up pizza?”

(Wait for it..)

No! You can still have your pizza!  (We are going to have to modify it slightly, and I promise you it will taste a thousand times better than any pizza you’ve had before!)

One thing that I work really hard to help my clients understand is that eating clean does not mean deprivation. It means finding the highest quality foods and adapting old recipes to work with new ingredients.

Let’s start with the dough. This is really the biggest modification of pizza.  We can go one of two ways. You can use either Einkorn Pizza Dough or Cauliflower Pizza Crust.

Why Einkorn? Einkorn is a very ancient grain (still used in Italy today) that still has much of the original protein and is not nearly as starchy as the hyper hybridized wheat found in the United States.  If you are non celiac gluten sensitive, you might want to try the Einkorn dough.  (I get my einkorn flour at Jovial Foods). You may be pleasantly surprised that it is easier to digest with no tummy trauma.

“But Dr. Norton, I can’t eat wheat.” Then I suggest you try making cauliflower pizza crust. You haven’t heard of this? Here’s the most amazing, easy recipe! This is also a great recipe if you are trying to get more vegetables into your child’s diet.

Then we need some organic tomatoes. I only buy glass jar tomatoes and it is incredibly easy to just use them straight from the jar, or take a moment and make a super quick tomato sauce (basil, garlic, oregano). I top my pizza with raw organic shredded cheese and grass-fed unprocessed pepperoni. And because I love tomatoes so much, I add a little fresh sliced tomato on top as well. You can top yours with whatever organic ingredients you like. Keep your meats grass fed/pastured and your cheese raw and organic. That’s really the key to adapting this for clean eating.

Here’s what my pizza looks like:

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Although it may not look like it, the Einkorn crust was very crispy and the organic ingredients were wonderful together. (Also, I’m drooling looking at this picture while I type. Seriously, this beats any takeout or restaurant pizza any day.)

Consider topping yours with some fresh organic basil after pulling it out of the oven. The aroma of the tomatoes with the fresh basil will send you to pizza heaven.

Happy Pi Day!

-Dr. Norton

#GetSunEatCleanBeWell

 

 

 

 

Errors of Thinking- #7 Uncritical Acceptance of the Critic

 

Copy of Copy of Never make an exception of yourself-5

I’m going to let you in on a little secret, just because someone says you are lazy, doesn’t mean it’s actually true. Even if it’s your mother!

Are you shocked?

I find that many people suffer from this error of thinking and sadly, it’s often those that are closest to us whose criticisms go unquestioned.  Instead we accept it, and repeat it back to ourselves as if it were true. It’s painful when people who are close to us criticize us.

The deeper issue though, is that we define our self worth by what others think of us.  Stop and think about that for a moment. If a person praises us, we think we are worthy. If a person criticizes us, we think we are unworthy. From my vantage we have relinquished the control of our self esteem to an outsider. And that’s never a good thing.

How do we conquer this error of thinking?

Stop and ask yourself:

Is the person criticizing you an authority on the topic? (Usually, they aren’t.)

Does this person have all the information? (Usually they don’t.)

Is this person’s criticism constructive or destructive? (Constructive criticism is often situation specific, and is not a generalized assassination of character.)

Finally:

If you are in the moment and experiencing criticism, and can feel your emotions rising, do not respond immediately. Give yourself permission to think about what the critic is saying when your emotions have cooled off.

Remember, just because someone says something about you, it doesn’t mean it’s true.

-Dr. Norton

#GetSunEatCleanBeWell