Podcast Transcript

Episode 61: Getting the Family Involved In Eating Disorder Treatment and Recovery

[Bouncy theme music plays.]

Sam: Hey, I’m Sam.

Ashley: Hi, I’m Ashley, and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome. We would love for you to join us on this journey. Let’s learn together.

Ashley: Today’s episode is all about families and support persons. We will cover topics such as when do families get involved, how can they help, and what do they do with their own fatigue, and so much more, with therapist Jessie Huebner, LMHC, LPC, CEDSC, QS, and CEO founder of Restored Purpose Counseling Services. She’s going to be joining us for our conversation today. Restored Purpose Counseling Services is a group practice that provides nutrition therapy and additional eating disorder services in Florida to all genders of clients ranging from age 12 and up, so incorporating family for them is a must. Whether you are a clinician or a support person, this episode is surely going to be helpful for you.

Jessie received her master’s degree in mental health counseling from Liberty University in Lynchburg, Virginia, and is a licensed mental health counselor in the state of Florida and New Jersey. She is an active member of the International Association for Eating Disorder Professionals and served on the South Florida chapter for over three years. Jessie is the founding president of the Jacksonville IADEP chapter currently. She is a certified eating disorder specialist consultant and is a trained EMDR therapist. She has extensive experience working in all levels of care from residential, PHP, and IOP to outpatient in roles of therapy and clinical director. She also believes in giving back to the community and as such has been a committed member of the National Alliance for Eating Disorders and previously assisted in leading their free community support groups. She also currently serves on the National Board for IAEDP. Jesse is a qualified supervisor in Florida and helps equip the next generation of therapists working towards licensure. Buckle up, y’all. This episode is going to be great. And we are so excited to have Jessie with us today.

Hey everyone, welcome back to another episode of All Bodies, All Foods. A topic of conversation that really never comes to an end is how to involve family in supporting someone experiencing disordered eating and eating disorders, body image concerns, and even recovery efforts. Sam and I have talked about this a lot, but we wanted to bring on an expert and guest today to give us a continued idea of what is necessary in family support, and perhaps, Jess, what you have found to be extremely important in the work that you do with families and support persons. So before we dive into this, you all, I wanted to let you know that we have Jess Huebner joining us today. And Jess, we would love to learn more about you, how you got into the field, what motivated you to become a certified eating disorder specialist, and why you feel family support is so critical in the healing process. So take it away.

Jessie: Absolutely. Thank you so much. It’s a pleasure to be here, and I think with everybody along the journey of getting in the niche of working with eating disorders, somewhere along the lines, there is an impact. So for me, I’m a recovered clinician, and personally, it impacted me and I wanted to give back and do what maybe I didn’t get in my journey, so that’s kind of the spark for working specifically with eating disorders and just wanting to help people feel more confident as a person. So that’s my background, and I knew right away I wanted to work with eating disorders and I just did my own work to make sure I could show up good and then just worked in a different spectrum of care from residential, PHP, IOP, outpatient, and the thing I saw is the importance of having families involved and getting them to buy in. Otherwise it’s like, “here’s my child, can you fix them?” And then they go home to the same environment and nothing changes. So I think that that was always a passion point for me is making sure the parents are equipped to support their kiddos or their loved ones, whichever role it is. And then also just making sure that we’re, together, pivoting and making new patterns because otherwise if we’re repeating the same patterns, things might not change. So that’s kind of what got me excited about that. And then just working in a treatment center where I did family night for many, many years and got to work with a lot of families and see a lot of cool things change in the environments and people heal. So that’s me.

Ashley: Yeah. Jess, did you always know you wanted to be a therapist?

Jessie: I didn’t know if I wanted to be a therapist. I don’t know if anyone ever, as a therapist, thinks this like, “Oh, will I be able to handle hearing other people’s issues and it not impact me.” That was my biggest barrier, honestly, to becoming a therapist. I was like, “what if I take it all home with me?” But thank God with the time and practice and supervision, you learn to set boundaries and to like make that space good, but then you don’t carry it home with you, so I did know I wanted to help people, I just didn’t know what that looked like. And everything I kept like going, you know, to the vision board and read what I wanted to be, kept pointing back to the therapist and helping, and it was always really, really specific to females and identifying individuals as females as my really niche and just all the things that we deal with, and I just wanted to like make a change in our culture and an impact.

Ashley: Yeah, that’s awesome.

Sam: Well, I think you’re doing that, and it really stuck with me when you said that you really wanted to give back what maybe you didn’t get or wish that you had as part of your journey. I always think that makes for such a great clinician, someone who’s actually been through it. We’re talking about family work today and getting the family involved and two things come to mind for me. One is just like you mentioned, sometimes we have families who are like, “okay, here’s my kid, can you make them better, and then just call me and I’ll pick them up when they’re recovered?” And those families need some education that we’re going to ask them to get involved a little more than that. And then also on the other side of it, sometimes have clients who are like, “Jessie, my family is not going to be a part of this. I do not want my mom and dad or whoever in my therapy session at all.” So my question is for you, how do you work with families who are maybe like, “fix my kid” and also the clients who are like, “no thank you, I don’t want any family involved.”

Jessie: That’s a great question because there is definitely those scenarios. So one thing I always encourage is that I think everybody should have their own therapist. So I think you’re dealing like, let’s just say in the situation for working with adolescents, that your child is struggling with something significant. How has that impacted you as the mom or dad? You need to work through your own concerns, because I’m thinking as a mom myself, I would have a lot of things coming up. So I always encourage parents to get their own therapy, the child to get their own therapy and then have an outside person that’s not the individual therapist, not their parents’ therapist, be the middle person to be the family [therapist] and work through the family systems. And I would just encourage the person that’s resistant to it. “Okay, where do you live? You know, like let’s draw, like, do you live at home? Do you depend on your parents? Okay, we really need to involve them in the process because otherwise we’re just going to be doing a piece of the work. We’re not going to be able to fully heal if we don’t involve your parents. And then let’s just try it and see.” And then also encouraging the parents to get their own work so they can work on it. If they don’t do individual therapy, I really encourage parent coaching because that might be a little lighter than psychotherapy, but I think it’s important because the parents also don’t know what they don’t know. There’s not always a manual for “my child is struggling with the eating disorder. Here’s what you do.” I mean, there’s more resources now, but back then.

Sam: Right, yeah, we actually just had someone on the show who created the recovery roadmap for parents and it’s an entire, you know, all these modules you work through. And it’s so cool that there are providers out there who are dedicating their whole careers to educating families, because it’s really important. You know, parents can be such a powerful part of the process. Are there any situations where maybe you don’t involve families and it makes sense maybe just to focus on your work with your client?

Jessie: Absolutely. If there’s a situation where the parent is kind of aggressive or it’s like not a healthy, there’s very huge strong dynamics there that are not healthy and helpful and they’re not willing, the parents are not at a place to hear and heal, then I think that that would be more detrimental. I can definitely think of a situation where I had family sessions and it just was like World War III every session and it was not helpful at all. And if anything, I feel like the client regressed every time, so we kind of did pause and worked more individually on that person. And I feel like better healing did occur. And when she was ready, then we did the family work because there were definitely deeper issues in the family dynamics, and obviously, if there’s any, you know, it’s abusive or it’s just not good. I would strongly just encourage like individual work. And then maybe they have people they identify as their family or their support person that maybe we could help encourage them. Like, “hey, these are my parents, but this is really the people I identify as my support system.” Maybe they come into a session and learn a little bit.

Sam: That’s great. And at Renfrew, we really define family loosely. We call it family therapy, but if you want to bring in your best friend, your roommate, that can be family, too.

Ashley: So I’m curious about bringing in the family. I’m imagining at all the different levels of work that somebody is at, whether they’re new to therapy, whether they’re in recovery or they’re just smack dab in the middle of working on stuff, that bringing in a family member or a support person is like they’re going need to learn different things along the way, so, what do you think would be really important for family, a family member or a support person to know at the very beginning? What would be important for them to know somewhere along the way? And what would be important for them to know as they walk through recovery with their loved one?

Jessie: Sure. I think at the beginning, maybe the expectations of what the recovery process is going to look like usually are not clear. It’s not just a straight line, as we all know, recovery can be very curvy, front, back, sideways, you know, and just being able to paint that just because it takes longer than maybe they expected because I think people think, “okay, I’m going to do residential, I’m going to do PHP, I’m going to do IOP. Okay, I’m done.”

But in reality, sometimes it does take longer, we, you know, individuals might need to repeat a different level of care, so I think that’s always important to point that out. And then I want the parents to know that they have to trust their provider. If you trust us, like let us do what we do and don’t try to undermine what we’re doing, ‘cause I know that can be a barrier sometimes where you’re not in sync and you’re not on the same page, because I like to get them involved where we’re like, “okay, we’re together. We’re fighting to get your eating disorder of your loved ones away. That’s our goal is we’re not going to let any kind of thing come between us where there’s like, you know, splitting or anything like that.”

And then in the middle where we’re maybe getting a little weary and we’ve been doing this, like just the pep of like, “okay, listen, it is a journey and you’re doing a great job and just continue to keep helping do things for yourself. “That whole like analogy of you got to put your own oxygen mask on, otherwise you’re not going to be able to support your loved one. So if that means you’re getting rest, you’re seeing therapy, whatever it is that you’re also knowing that it is, we’re still on the journey. There’s not a timetable of,  “okay, at January 1, I’m going to be here to never need therapy or nutrition or anything again.” And then when we’re farther along and we haven’t, you know, stone lots of symptomology, we’re at a good range, life seems to be popping back into normal, know that there’s still going to be like any type of major life changes, things could pop up, any kind of rocky things. “Hey, we’re still here to support, just know that it’s not a one and done, like never ever going to have an eating disorder thought or, Oh, a slip happened. Like it’s okay. That’s it. I mean, we have to go all the way back to the very beginning. We just might need to, you know, have a little extra support for a few minutes or something.”

Ashley: Yeah. That is really making me think a lot about fatigue. And I know a client likely experiences fatigue, especially if they’re like, again, there’s no time frame to this, right? And it could be longer than we think. And so how do we support family members that are also experiencing that? Just fatigue of this process just keeps going on and on.

Sam: Treatment fatigue.

Jessie: Yes. “Can we just be done with therapy already? We’re done. We’re done.” Yeah, I totally understand that. And that does pop up a lot. And so I try to pull back a little with like, especially let’s say they’re in the lower level of care, they’re just seeing an outpatient provider, one hour, 50 minutes a week, something like that. Let’s look at the big scheme of your full week. I’m asking for one hour of your time. And this is like, if we think about what this one hour can do to help prevent things, to make sure we’re still addressing things and we’re getting to the deeper rooter cause versus “we’re just going stop, behaviors have happened.” I would encourage them to continue doing it. If it’s once a week feels too much and we’re at a really good healthy space, maybe we go to bi-weekly or maybe we even just go to once a month and we kind of take a break and reassess, but don’t just quit altogether. That’s what I would encourage. And then if someone’s feeling really fatigued, “I’m just tired of talking,” if whether it’s the identified client or it’s the family, just encouraging, “what are we doing to take care of ourselves?” Because oftentimes if we’re feeling fatigued, then maybe the fun in life isn’t happening. Maybe we don’t get enough sleep. The things that bring us joy, maybe we’re not doing those. So I would encourage to take an assessment of ourselves to make sure that we’re still showing up for ourselves and enjoying life to the fullest and that we’re not meant to just be in treatment and that’s it. We’re meant to have fun and enjoy life and do hobbies and things like that. And eating disorders are a part of our life when we’re a family that struggles with it, it’s not the thing that defines us. It’s a part, it’s a chapter.

Sam: Yeah. Mm-hmm. I love that idea of shifting the focus. It’s like, how can we bring in some fun? How can we bring in- just making life richer and taking time to take care of yourself? I would love to give family members that might be listening in sort of a peek behind the curtain. And maybe they’re on the fence thinking about trying family therapy. I’m just curious if you have, are there some favorite interventions that you use in session? You know, what can families expect when they go into family therapy? Like what are some things you might try with them to help with communication or to help with problem solving or yeah, just curious about what happens in the room when people are working with you?

Jessie: Yeah, absolutely. I will say I’m definitely one of the therapists that will be very individualized, whatever the client and family needs we’re going to do, and I do try to bring in a bunch of different modalities. I’m not a one-size-fits-all kind of person. So I’ll say for like an example, one of my families that I worked with that was like a mom, dad, twin sister, and the twin sister was one of the twin sisters was the identified client. We worked together and just kind of like talked through things. And one of the things was the identified patient really did art and she was kind of more of a quiet person, so in order for this session to like unfold more, she would bring her project that she worked on and we would discuss it, and so many things would happen just from her being able to explain what she drew or what she created. And that would make so much more connections for the family, and that helped her as somebody that was more quiet and maybe speaking, what she’s feeling wasn’t her strong suit at that moment. That’s one analogy that I know worked really well and a lot of light bulbs came on. Another time I’ve done where we practice different communication skills because oftentimes there’s the disconnect. “You’re not hearing me, you’re not listening to me” and really practicing reflective listening and respect in how we talk to each other and our nonverbals and things like that, because the nonverbals sometimes send us into then we’re just like fighting and the tension is there and we’re not able to have like clear communication. And then assertiveness is another one. Maybe you have the individual come to you and tell you all the times they get triggered, but they’re not able to tell their loved one that “this is impacting me when you say X comments or when you do this, this bothers me.” So being able to use the I-statements is a really big one. I know I’m sure a lot of people know that, but I’ll be surprised how many people actually don’t use I-statements or know what I’m saying when I say use I-statements.

Ashley: I was going to say, Jess, could you give us an example of an I-statement?

Jessie: Yeah, so, “I feel blank when blank happens,” right? Then there’s even another part to it, too, “I feel frustrated when you say this,” but then you can come back. And now that I’ve learned, you know, whatever it was, maybe let’s say mom comes home, she’s frustrated off work. And she just rattles something really inappropriate to her daughter, and now she’s like, “I feel less than when you come home and you yell at me.” But then the daughter learns, “oh, mom had a hard day at work and she didn’t really mean that. And I understand now that you had a bad day at work or something.” And you just kind of get a little bit more insight to what’s happening, but at the same time, you’re not placing the blame, “you made me feel less than,” whereas that often are “you made me feel this way,” and we’re taking ownership to how I feel, we’re identifying it, and then we’re expressing it, and then it can help the other person on the other side realize, “oh, my reactions or frustrations are now starting to impact the people around me. And how can I even work to, maybe when I come home, if I’m frustrated, I’m going to take a deep breath before I walk in the door and leave it at the door kind of thing.” That’s just a very loose example.

Ashley: Yeah. That’s a great example. I feel like our people that we work with, like finding their voice is one of the biggest hurdles that we help them overcome in this process.

Sam: This work is so tricky because I think there are a lot of clients and families who they’ve heard of I-statements and they’re sort of like, “oh yeah, I know how to do that. That’s easy, that makes sense.” And then when you’re in the session, it’s like, “I feel like you’re being mean.” And it’s really helpful to have a therapist there. It’s like, “well, that’s not a feeling. Let’s kind of, you know, go back here. Like, what actually are you feeling? You know, are you feeling sadness? Let’s get the emotion wheel out.” And, you know, this stuff is, it’s a lot trickier when you’re like actually doing it.

Ahley: Yeah.

Sam: And, and to have a therapist there to help guide you is, is just so helpful.

Ashley: I love the emotions whell, Sam. I want people to always print one out and hang it on their refrigerator. I’m like, “please put it in the kitchen, put it where you can see it and identify, point to an emotion.”

Jessie: My favorite one is, “I’m fine.” I’m like,” wait, can you show me where fine is on the emotion wheel? Well, let’s dig a little deeper. What are you feeling?”

Ashley: Okay, so just kind of in conjunction with this, as we were talking about different tools or interventions that you use. In the field, so this might be a more clinically driven question, but in the field, there are, you know, so many theories, I would say, that various clinicians practice from and, and they all have their roots in something, you know, and all kind of focus on, you know, different types of things. And I know that you mentioned you do prescriptive approach, so really what that particular family system needs, but I was curious if there was a particular theory that you gravitated to and like CBT or family based therapy or Sam and I are really, we use the Unified Treatment Model at Renfrew and feel like it, you know, we love that one. So yeah, I was just curious if there was a model that you kind of gravitated towards.

Jessie: Yeah, so I would say I definitely bring in a lot of like DBT, CBT, but I would say when I’m working with families, depending on the age range and what is the presenting concern, I would not, I’m not, disclaimer, I’m not a certified FBT therapist, but I will do like alcohol, like a pseudo FBT approach, where we’re doing a lot of family involvement, but I have to assess that the family has that ability to do it. And in those situations, maybe it’s a client that has a great solid family that’s willing to help with plating food and helping be in that support person and learning about what we’re needing, like the dietitian and the pediatrician, and they’re really involved with what’s happening and they’re learning and they’re able to set those firmer boundaries and no negotiating and stuff like that. That works lovely. And I’ve seen very good success where we do that and they make strides and they don’t actually end up going to higher level care. But then I’ve seen other people where we try it, and unfortunately, they’re just not able. So that’s one of the ones I use a lot with like adolescents, especially if there’s a high resistance to go into higher level of care. “Let’s try this.” And then I’ll outline what it looks like and what’s involved. And, and then the parents might realize, “wow, actually, maybe that’s why there’s treatment centers and it is a little bit easier to have somebody else do some of the harder when they come back, I’ll be able to support them, but I won’t have to do it as intense”. So I would say I use that a lot, especially with individuals struggling that might need to restore some weight or have a lot of symptomologies with their behaviors that need more support. That’s one of the biggest ones. And then just teaching the parents also on like CBT, “how do you reframe even some of the thoughts you’re having and how can you support your daughter or son with some of the things they’re struggling with?” So that one, and then a big, that’s not a necessarily a modality, but psychoeducation on diet culture and how those words and terms and everything just pops up and how that can be, and how we talk about our own bodies. As parents, the way we talk about our body and food and other people’s bodies, it’s going to be picked up by your loved ones. They’re going to understand it’s not OK to be in this size body, or it’s not OK to eat this, or whatever it is that you’re saying, they’ll pick up on it, and so learning and educating on your relationship with food, your relationship with movement, your own biases that you might have about what people look like or shouldn’t look like. So those are some of my main ones that I use.

Ashley: Yeah. That last one, educating on diet culture and just all of this stuff that like, even as I’ve been in the field for a little over 10 years in the eating disorder field specifically, and I’m still learning things about, I would say like fat phobia or weight stigma or diet culture that I didn’t even realize was a thing, you know? That education is just so important, I would say.

Sam: It’s ongoing.

Jessie: Absolutely. Yeah, because then it gets tricky into the “wellness.”

Ashley: Right. It turns into that well, yeah, yeah. Which we’re inundated with that right now at the beginning of the year.

Jessie: Yeah. Exactly.

Sam: It reminds me of Chrissy Harrison’s book, The Wellness Trap, which I probably recommend in every talk I ever do. But man, it’s tricky. It’s just so it’s so tough. The messages that families are getting and, and like you had said earlier, Jessie, you know, getting the family’s trust, and you might be saying things that go against everything they thought was true. You know, trying to help families understand, you know, all, all of the lies and the myths and the misconceptions that are part of diet culture. I mean, there are families that, I mean, and it makes sense, they think a lot of this stuff is healthy that, that they’re hearing, you know, to cut out this or cut out that and that certain food is bad and it’s really tough, I think, to get family’s trust. Do you find that when you’re doing the diet culture education, do you find that it’s tough because it might not be part of the family’s belief system?

Jessie: That you just like, yes, sometimes you feel like you’re talking to deaf ears and not hearing you and nothing you say is really resonating, and they’re like, “no, this is factual. This blank is bad for you. Like, we’re not having this. We will not do this. We’re only going to eat blank and we’re not eating, you know, whatever it is, they’re cutting out and eliminating and just saying that we don’t do that. And we always exercise this much.” And we whatever it is, it’s very entrenched in their belief system, so sometimes having that conversation, it might be you’re treading very lightly at first because you can’t just go into the deep end with people that you can kind of tell. I’ve had conversations with people and you can just kind of tell where they stand with like certain things. And then you tread lightly, you build the trust, just like you’re building rapport with your clients, you have to build rapport with the parents and get them to buy in that you know what you are talking about and that you have their best interests in mind, and that’s the biggest thing. And then having the client also advocate how maybe these things do impact them once they’re able to find their voice again. And it’s, I think that’s when the healing happens. When the parents realize their belief system in blank, whether it’s like some kind of wellness or diet culture trends, has impacted them, and that might be one of the main reasons why they’re really struggling to find healing because of how enriched it is at home.

Sam: Yeah. Exactly. It can just make recovery. I mean, I don’t want to say impossible, but it can make it so hard to recover in a home environment where your whole family is sort of doing things, you know, dieting and doing all kinds of, you know, stuff to try to change the shape and size of their body, and then you have this kid and who’s trying to recover. And it’s just so hard, which brings me to my next question. I was wondering what other kind of hurdles or roadblocks you hit when you’re working with families and might be helpful for folks listening out there. They might say, “hmm, maybe that does sound like me a little bit.” I’m just curious, what do you notice when you’re working with families?

Jessie: I mean, there’s a couple. There’s a lot of different things. I could probably list a ton, but I’ll just try to keep it more into themes. One thing I noticed is the family kind of have this hands off, “you fix my child. We didn’t do anything to cause this or be a part of it. We’ll pick up our kid after our sessions or whatever. And, and then just go on our merry way and we’re not going to change anything.” They have to change. They’re the problem. That one is a really hard one to work with if there’s not a willingness to buy in, to learn, to even like shift the narrative a little bit.

Sam: Yeah.

Jessie: Another one would be, again, the really entrenched in diet culture, maybe the parents are really into like wellness and there’s nothing wrong with enjoying movement and enjoying certain foods. But you kind of know when somebody is in it, because they’re going to talk about it because that’s all they’re thinking about is what they’re not eating or, you know, they’re dieting or whatever. So I think that when the conversations are always happening at the dinner table or at home about what we’re eating, what we’re not eating, that this is bad, all the labeling. I think that often it’s really hard to have parents to undo that and to change the way they function and to buy in that this might have been one of the issues that caused it.

Sam: Or a risk factor at the very least.

Jessie: Yeah, exactly. And I think the other one is just the unwillingness, where there’s just a strained relationship. I think there’s wounds that we have to work through. The eating disorder is just something that popped up, but there’s actually deeper things, whether it’s codependency or just distance in the relationship. And maybe it feels like the parents operate more authoritative, where there’s not that approachability and they need more of that loving, nurturing. Or maybe the parents are just so busy working that they’re never there, and the eating disorder, it kind of like was trying to direct their attention. And for the parents to realize there was a part, maybe they’re not the cause, right? We’re not going to put a place on you did it, that kind of no blaming, but more just like, there is an impact of how things are happening and how “I want to have my parents to be a part of my life. I don’t want to just, you know, they work and we have nice houses, but I don’t actually have a relationship with them.” So I think that sometimes the eating disorder serves a purpose where it might bring the family to have like a whole new dynamics and learn to change things, so those are some of the big themes. I’m sure there’s way more. I’m just thinking, yeah.

Sam: Yeah, these dynamics are hard to tackle in family therapy. And in an attempt to help these kinds of concepts land, we even have sort of like from Janet Treasure, we have the animal models to describe some of these dynamics. You talk about the parent who is sort of like hands off, like “I don’t have anything to do with this. Fix my kid. I’ll pick them up when they’re recovered,” we call them the ostrich parents, you know, because, and we teach parents about this. We’re not calling them ostriches behind their back, but you know, these caregiver models where it’s sort of like, “okay, what animal do you think might be playing out here for you?” And every parent sort of gravitates towards one animal. And, you know, there’s the ostrich who sticks its head in the sand, but then, you know, maybe there’s the kangaroo who puts the kid in their pouch and just is way over protective and worried that this kid is going to feel too many, you know, distressing feelings. And so it can be helpful to sort of have these little cartoon animals and makes it a little easier to talk about.

Ashley: I’m just sitting here thinking of all of the complexity of this. The individual is not only working on themselves, but obviously they’re having to lean into developing maybe a more helpful communication style, even with their family members and labeling what they need, and it’s making me very thankful that there are folks that can do this work. And just like you said, maybe they even have an additional therapist that is just the family unit therapist while they’re going through this whole process. So another question. Can you share some success stories? What do we see when our clients do family therapy? How do they come out on top?

Jessie: Yeah, so I think that some of the big changes and shifts you’ll see is, for me personally, I’ve seen families, like again, the client was talking about at the very beginning, I saw huge shifts and changes and I would see them years later and they’re just like, maybe it was like a National Alliance event or something, they would come up and be like, “we’re doing so good and blah, blah, blah.” And just hearing the changes that they’ve made, the success. So hearing the family is no longer spending so much time talking about food all the time. They’ve learned to adapt maybe an all foods philosophy. Maybe they’ve learned to communicate better and you see the happiness. I mean, you can just tell when families are happy and they want to be around each other and want to be together, and there’s better dynamics. You can just see that. It manifests itself in how they act towards each other and around each other. So hearing people like “we went on a vacation together and there was no meltdowns and we enjoyed different restaurants and we just had so much fun and there wasn’t any like, I didn’t get to do X or I didn’t have this.” And, you know, just being able to show up and enjoy life together as families is a big theme I see in families that heal together, and the closer dynamics that they experienced, because they’ve worked through a lot of the issues that maybe weren’t being talked about.

Ashley: Mm-hmm. Doesn’t that feel like it sounds so lovely to just heal together? I love that. And to be able to just show up authentically as yourself, every member of your family, to just be able to show up. That sounds so great.

Sam: Yeah, and what a pleasant surprise, as a side effect, where the family can actually become closer as a result of eating disorder treatment. And sometimes it’s not something families, you know, thought would happen. It’s unexpected, but it can be a beautiful thing.

Jessie: Exactly.

Ashley: So Jess, I’m curious, is there any piece of psycho-ed that you would want family members to know about off the cuff. I’m thinking, we know that eating disorders don’t travel alone. They might travel with another mental health disorder. We noticed that, or yeah, we know that suicidal ideation might be stronger in somebody that’s experiencing an eating disorder. Is there any sort of that material that you’re like, “you all need to know this, this is very important?”

Sam: Yeah, that’s a great question to wrap up the episode. It’s like, what, what could, should families leave with here? You know, what are some really important things they should know?

Jessie: Well, I definitely think that one is an important one. So we’ll just say that definitely the co-occurring and the things that occur with it, and also another thing I think that I always like to educate on because you come in, let’s say I’m in an outpatient and they come in my doors and they have no idea about higher levels of care. “What does that even mean? What are you meaning about all these other things?” So I like to educate the parents from the get-go on the different levels of care so that if and when we have that conversation, they’re already a little informed on what that looks like. I also like to educate that eating disorders usually work in teams. And the important role of having a dietitian, having your pediatrician, having a psychiatrist if you’re taking medications, that important piece of having the team. It looks different. It’s not just therapy alone or just the dietitian alone, that the collaboration piece is important and having a family support therapist as well. I always like to tell them, “sometimes it might get harder before it gets easier.” So they don’t think like, “okay, I found therapy. Everything’s going to be up, bepeaches and roses from here and everything’s going to be great.” Sometimes it might get a little harder because we’re starting to attack some of the patterns that the eating disorder is no longer getting to get away with. We’re really just setting some boundaries. And now the eating disorder is not liking that. And we might feel like there’s tantrums that happen. Our child might react in a way that we’re like, “this is not characteristic of my child. They don’t usually act this way.” We’re fighting to get that eating disorder out of your child. So those are some of the things I usually share and would provide. And then just the importance of what therapy is and what therapy is not and the importance of what in the context of a therapy session with an adolescent or a young adult, I’m not going to share everything so don’t come calling to me and be like, “hey, tell me everything what’s going on with my child.” We have breaches here. I want to keep it confidential so that your child feels comfortable. But I will encourage family sessions where you guys can talk about things. But I think that’s something I noticed that from parents, like, “can you tell me everything that they’re telling you?”

Ashley: Can I ask a question just to jump in on that real quick? What if a family, what if the child has essentially like two separate families? What if parents are not together? How do you bring in that family dynamic together?

Jessie: I’ve definitely had let’s say divorced parents and they even like maybe split custody where they live. I’ve definitely dealt with that before. So typically I would make sure that we’re involved and then, as far as like art-wise and all that jazz, but also I would really want to make sure that there’s a healthy, like we’re able to be civil if they’re not in a good, you know, like sometimes there’s heated tension between the parents. And I just want to make sure we can agree to be together for your child and set aside any beef we might have with each other during the sessions or during the treatment of your child’s care. So I will have guidelines set with the parents separately and encourage that our focus is your child, not the tension between the two of you. And then really just making sure that maybe we do sessions just with one parent, “okay, when we’re at this person’s house, this is the things I’m struggling with and let’s make sure you’re completely on board” because I have noticed where one parent, the home environment is like, “okay, we’re making these changes, we’re doing this.” And then the other home environment where they’re at 50% of the time, they’re not in sync yet. They’re still doing the same things and not really helping with accountability. “Oh, they didn’t eat this or they didn’t do this or they didn’t want to go to therapy, so we didn’t tell them to go to therapy.” Just having the boundaries set in place and having it congruent at both locations and having the, “we’re going to do this together and we’re going to all make changes together.” Whatever that might look like at each household.

Ashley: Yeah, thank you.

Sam: So helpful. Jessie, thank you so much for being here. We covered a lot of ground, and I really think that if there are any parents out there listening, they really have a good sense of some of the benefits that might come of joining family therapy and participating in their child’s recovery. So thank you for the work you do. Thanks for being here. And thanks to our audience for listening in. We’ll see you next time.

Thank you for listening with us today on All Bodies, All Foods, presented by the Renfrew Center for Eating Disorders. We’re looking forward to you joining us next time as we continue these conversations.

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by the Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

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