Jul 3, 2015
Marion MacDonald

Backpacking with Mirasol Clients

trail-bossThere were those of us — myself included — who doubted it would be possible to incorporate backpacking into a residential eating disorder treatment program. Executive Director Diane Ryan, Admissions Director Carol Magee and I began talking about expanding Mirasol’s adventure therapy program to include backpacking in October, 2014. The challenges seemed overwhelming. First of all, since clients obviously don’t come to treatment outfitted for backpacking, we needed to purchase all the equipment from tents, sleeping bags and sleeping pads to flashlights, hiking poles and utensils. Over the next six months we patrolled eBay and Craigslist for good used equipment, and picked up additional items at sales. Friends got wind of the project and stepped forward with gear to loan or donate.

We took a leap of faith and purchased 10 wilderness permits in January. The timing was tricky, since we needed to make sure that any clients participating in the program were medically and emotionally stable and that they had arrived at a point in their treatment where a wilderness experience such as this could provide a significant boost to their recovery.

Of course the biggest challenge was the food. In retrospect, it’s hardly surprising that food would be an issue for an eating disorder treatment program. But I had not anticipated the difficulty of balancing the need to comply with each client’s carefully tailored meal plan with the need to maintain pack weight and bulk appropriate for a beginning backpacker. Our heartfelt thanks go out to Chef Dee O’Leary, who went way above and beyond the call to prepare hearty, backpack-friendly meals and snacks for our brave beginners!

The day before the hike was pandemonium, while we packed and repacked between checking the weather and trying to figure out how to transport staff and gear from three locations to a single departure point. We were nearly two hours behind schedule when we set out Thursday morning, but it was a gorgeous spring day with temperatures in the mid-70s and a cloudless sky.

Over the next three days, we shared the magic of a sparkling stream that threads its way between walls of red conglomerate and yellow volcanic tuff in the Galiuro Mountains. There’s no real trail, so we wandered back and forth across the stream in the shade of giant Fremont cottonwoods and Arizona sycamores. We made camp on a sandy beach where there was a nice deep pool warm enough for a refreshing dip and with sun-baked rocks where we could stretch out like the many lizards we saw along the trail.

Evenings we shared our experiences from the day and stories of how we all came to be huddled around a crackling campfire deep in a canyon in the heart of southern Arizona.

I cannot say enough good things about the hard work and dedication of Executive Director Diane Ryan, Primary Therapist Katie Klein and Counseling Assistant PeiDong Zhang, who provided loving and tireless support to all the members of our group.

Only time will tell if this daring experiment produces lasting results. But the obvious delight of the clients who participated was an inspiration to us all.

As one of them remarked, “I always wanted to experience an outdoor adventure like this, but I didn’t think I could. Now I have the confidence to continue exploring my own.” May that confidence stay with you and sustain you and you move forward in your recovery!

Thanks for a memorable weekend, and a very big “wu gong*” to all of you!

*”Wu gong” became our favorite all-purpose expletive after PeiDong identified a large scary bug using his digital dictionary. For example, you might exclaim, “wu gong!” if a giant centipede was crawling down your back.

Jun 18, 2015

Why There’s No Maudsley at Mirasol

Maudsley Family TherapyNPR’s Diane Rehm Show recently featured an interview with Clare and Elena Dunkle, authors of companion memoirs documenting Elena’s struggle with anorexia nervosa. Also appearing on the show was Dr. Angela Guarda, Associate Professor of Psychiatry and Director of the Eating Disorders Program at The Johns Hopkins Hospital.

Dr. Guarda advises families struggling with anorexia to seek out a “good Maudsley trained therapist.” “It’s now pretty well established,” she said, “that that is the technique that works the best for the most patients. It doesn’t always work, but it works in over 70 percent of young patients. “

Also known as “Maudsley Family Therapy”, the Maudsley Approach is a treatment for anorexia developed by Christopher Dare of London’s Maudsley Hospital. Instead of isolating the anorexic in a residential treatment facility — what Maudsley advocates sometimes call a “parentectomy” — the child remains at home and her family assumes full control of her treatment with guidance from a therapeutic team.

Phase one of Maudsley Family Therapy focuses solely on weight restoration. A parent or other family member is present at every meal, enforcing adherence to the meal plan. In phase two, parents gradually pass control of meals to their son or daughter. Only in phase three, when the teen has stopped restricting food, does the emphasis shift to psychological and family factors underlying the illness.

Proponents often cite a 2010 Stanford University/University of Chicago Study as evidence that Maudsley is the most effective treatment for anorexia. According to this study of anorexic patients ages 12 to 18, a year after treatment, 49 percent of those in the Maudsley group were in remission, compared to 23% of those who received individual therapy.

So why doesn’t Mirasol use the Maudsley approach in its teen eating disorder treatment program?

For starters, the study compared the Maudsley method to individual psychotherapy, as if those were the only two treatment options.

Family therapy is an important component of Mirasol’s residential eating disorder treatment program. Family members are active participants in both our teen and adult residential eating disorder treatment programs. All clients participate in regular phone or videoconferencing sessions with family members. During our three-day family camp, family members and friends come to Mirasol to share the experience of intensive residential treatment with their loved ones.

But family therapy is only one piece of the puzzle. Anorexia, bulimia and binge eating can result from a bewildering variety of factors including a genetic predisposition. Teens with eating disorders struggle with feelings of shame, guilt, body dissatisfaction and a lack of control. The eating disorder may become the individual’s attempt to regain control and cope with these intense emotions.

Imposing greater parental control over eating is not the best approach for a child who already feels powerless to take her place at the table. So long as the solution always comes from the outside, the teen cannot find the solution within. At the core of Mirasol’s treatment philosophy is a profound respect for the individual, for the choices we make and for the connections we forge with ourselves and others. Through peer encouragement and cognitive and emotional restructuring, we help our clients learn to self-regulate, manage their emotions and care for themselves.

Our goal is to provide all our clients with the skills and tools they need to live successfully in the world, not just for a few months or years, after treatment, but for the rest of their lives.

Jun 16, 2015

Trauma Conference was Informative, Inspiring and Reassuring

Trauma Conference LogoPrimary trauma therapist Ann Twilley and I spent an enjoyable and informative two days at the 26th Annual International Trauma Conference in Boston.

Organized and keynoted by Bessel van der Kolk, presenters and attendees included many luminaries in the field. Both researchers and practitioners advocated for increased broad–based financial support for research in the treatment of PTSD and attachment disorders with neurological interventions, particularly neurofeedback. I was delighted to have an opportunity to speak with Dr. van der Kolk about Mirasol’s long-standing commitment to the use of qEEG and neurofeedback protocols for all clients.

Among the highlights for me was a presentation by Arietta Slade on the results of her research initiative, “Minding the Baby.” Slade’s program provides two years of support including therapeutic intervention and education for expectant mothers and their babies who are at risk for attachment challenges. Preliminary results indicate that such programs can help break the cycle of attachment disorders that could otherwise produce life-long consequences.

The use of neurofeedback, based on an increasingly sophisticated understanding of the role the nervous system plays in trauma, was woven throughout the conference workshops. Sebern Fisher, PhD, referred to the power of neurofeedback as effectively reconnecting the individual with the “good-enough mother.”

The second day’s workshops included a presentation on the use of energy medicine in the treatment of trauma. This provided an additional complement of tools as we address issues of helplessness and emotional dysregulation and empower our clients to master their neurological responses and therefore their impact on recovery.

All in all, the conference was informative, inspiring and reassuring. As the field expands and integrates neurological research findings into the best practices in the treatment of trauma, Mirasol will continue its commitment to providing a treatment experience that is solidly evidence-based, highly individualized, proven effective and always on the leading edge.

Jun 16, 2015
Marion MacDonald

Eating Disorders on the Wild Side

woodburyMirasol Executive Director Diane Ryan was featured in a June 15, 2015, interview with Lon Woodbury of Struggling Teens. In a podcast entitled “Eating Disorders on the Wild Side,” Ryan describes how Mirasol uses wilderness experiences to help teens recover from eating disorders. She explains how the focus on adventure therapy evolved from discontent with teens who had been to other eating disorder treatment facilities where they weren’t allowed to go outside, and how Mirasol evolved a program that combines outdoor activities with the nutritional support — including eating six times a day — required for recovery from an eating disorder.

Woodbury and Ryan concur that eating disorders and related emotional issues often result from a disconnect from the self and others, and that the outdoors can be a powerful intervention for troubled teens by plugging into a natural environment that we are hard-wired to appreciate.

For additional podcasts in this series, visit http://www.strugglingteens.com/artman/publish/interviews.shtml

Jun 8, 2015
Marion MacDonald

The Healing Power of Art Therapy

In this video, a Mirasol graduate describes how art therapy not only enhanced her creativity, but helped her process emotions she could not express in words and, ultimately, work through the issues that lead to her eating disorder.

I came to Mirasol with a background in photography, but a lot of the mediums I’ve worked in here are things I’ve never explored before, so it’s actually been very revealing. There are things coming out of me that I never thought I could do.

A lot has been brought to the surface for me creatively.I feel like for the first 30-some years of my life I never was creative, but it’s always been in there, and I found it here.

There were so many times I had so much emotion coming up in me, and I didn’t have words for it, so doing the art therapy was a way for me to express that emotion in a way that I couldn’t do in any other modality.

The installation that I did was a month-long-process. It started with me going out into the desert, and I saw this chicken wire in a roll, and so I pulled it up out of the ground, and a small tree was stuck to it.

And the second I lifted it out of the ground, I knew exactly what I was making.

There were a lot of components that I felt needed to be inside the wound-up chicken wire, and those had to do with the symptoms of my eating disorder and substance abuse.

I needed things to symbolize each one of those elements. So I again went back out into the desert, looking for things like shards of glass to represent self-harm, an old rusty beer can for my substance abuse, rusted metal for darkness and depression — just all of the things I had done to myself.

When I started creating them and putting words on them and sticking them inside, I recognized that the roots coming down into the tree were me. They were my true, authentic self.

And the tree coming up in the middle was still attached to the wire, but it continued to grow above that. And so, just because all of those things happened to me, it doesn’t mean the tree
was choked off and couldn’t live.

On the top, I cut a lot of cloth ribbon and on each one, I put things like “passion” and “joy” and “hope” and “happiness,” and all of the things that I can have in my life, having worked
through all of those things that have come out because of my eating disorder and substance abuse.