Mirasol's Family Program
When there's an eating disorder in the family, it affects everyone in the family, and every member of the family deserves a chance to heal. Mirasol's three-day family program is the heart and soul of its integrative eating disorder recovery program, bringing together children, parents, siblings and significant others in a supportive, judgment-free environment to discover a new family dynamic. This panel discussion begins with a detailed description of the program, and how it creates a space for the entire family to heal wounds that may have roots more than one generation deep.
Diane Ryan, Executive Director
Maeve Shaughnessy, Clinical Director, Adult Program
Ann Twilley, Trauma Therapist
Katie Klein, Clinical Director, Partial Hospitalization Program
Anne Ganje, Dietitian
Jamelynn Evans, Primary Therapist
Audrey Bailey, Aftercare Coordinator
Mayra Villalobos, Neurofeedback Technician
Download Audio: M4A
Katie Klein: "What our family program usually looks like is three days, typically Wednesday to Friday. It's a really intense three days. We always tell families, 'come ready to work, ready to show up' because their loved ones are here doing really hard work. There are definitely times when the families are a bit nervous, and we try to help reassure them that we will be there to support the family members as well as the client."
"On the first day we start in the morning with a big group, usually with all of the clients as well as the clients who are doing family program and their family members, and as many staff members as possible. We start that group with introductions, and at that time we check in, we usually do an icebreaker, to get everyone comfortable and grounded."
"And then we talk about medicators. A lot of the clients are here because of eating disorders and other medicators. We have all the families take part in that. That's a really great opportunity for family members to start to reflect inwards, and to think, 'okay, well what medicators do I use?' You know it's so easy for family members to look at their loved ones and think 'they're the ones with the issue or the addiction or the problem' but when they start to look inside themselves they might realize that 'oh, I might use reading as a medicator, I might use shopping as a medicator.' It's a really important place to start."
"We also set guidelines. So what do the families and the clients need in order for this to be a safe environment? Maybe they need openness, or understanding, or no shouting? So we set different guidelines like that to set the scene for a productive and supportive environment for family program."
"Our clients eat six times a day, and while families are here, we urge them to eat in the same way, so they get to see what snack looks like, with the array of foods that we have. And usually their loved one will show them the proteins, this is the starch, and this is what my meal plan looks like."
"And then we have them do a 'Reflections' workshop, which is a really neat tool that we have here at Mirasol that helps clients and their families be able to pinpoint problematic or worrisome behavior that they see in their loved one and how that affects them."
"In the afternoon sometimes we do psychodrama, other times we may have individual sessions with the dietitian, with the doctor, with the primary therapist."
"Day 2, we usually do the challenge course, which is awesome. It really gives not just the clients, but the families, an opportunity to experience discomfort, and get a sense of 'this is what my daughter, or sister, or girlfriend feels every day, going outside their comfort zone and having to really work through that."
"Day 3 we do 'Reflections' in the morning, and that can be really intense. Sometimes we do more individual sessions. And then at that point we do a closing circle."
Parents particularly, but other family members as well, feel responsible for the client's eating disorder, and we go to great length here to disabuse them of that notion. We do not hold family members responsible for the client's eating disorder. Everybody is responsible for their own journey and their own life and for their recovery from this point on.
Diane Ryan: "Family program is a critical part of what we do here, and it really is a requirement for beginning the next part of your life because in order to move into recovery in the outside world you need to set a platform with your family of origin, because that's the context within which all of this change transpires. If you have gotten some insight into what your eating disorder is about, and what you need to do about it, and how your life needs to go, it's a moment where you can really express that to the people you love. Parents particularly, but other family members as well, feel responsible for the client's eating disorder, and we go to great length here to disabuse them of that notion. We do not hold family members responsible for the client's eating disorder. Everybody is responsible for their own journey and their own life and for their recovery from this point on."
Katie Klein: "A lot of times I'll have a client who says, 'Well nothing's going to change. What's the point? They're not going to hear it' and my usual replay is, 'But you're going to show up for yourself, right? You're going to be using your voice, you're going to be saying the things that you need to say'. Whether or not your family member changes or hears it — that's not the client's responsibility."
It's not about blame, it's about healing those old wounds, and helping the clients understand that they need to come from that place and acknowledge it, because it wasn't validated back then.
Ann Twilley: "Clients will come in and will have these previous conflicts or even current conflicts but they don't want to do the trauma work, because they might say, 'my parents changed, they're in their own recovery, they're so much better now, so much kinder now, but when I was a child, this and this and this happened'. And it's really important to educate them on that, going back to those wounds, not to dredge them up, but to help them heal at that wounded place because they're acting out in ways that are reflections of those old wounds. It's not about blame, it's about healing those old wounds, and helping the clients understand that they need to come from that place and acknowledge it, because it wasn't validated back then."
Moderator: "What do we do to help clients and their families prepare for something as intense as family program?"
Anne Ganje: "I think as staff we create a space that allows families to know that it's not expected that they will understand the language of therapy and treatment, and doing all those things that Katie was talking about at the beginning, setting that foundation, laying that groundwork and just offering that we know it's different, and we're open to have them imperfectly experience this process. And I really think that puts families at ease, because they're open to the fact that this is different, 'I'm not even used to talking about feelings', whereas for our clients, I think the biggest prep work for them is just being in groups, hearing other clients' experience with family."
I think there's a hunger to talk about their experience. Because if you've got a family member with an eating disorder, that's a trauma in and of itself. So there's an innate human need to talk about that, to share your experience.
Diane Ryan: "And that's one of the reasons why we try to have this be a multi-family program, because I think there's a hunger to talk about their experience. Because if you've got a family member with an eating disorder, that's a trauma in and of itself. So there's an innate human need to talk about that, to share your experience."
Katie Klein: "I can't tell you how many times that a family member ends up talking about something they'd never talked about, or kept a secret, or what happened in their childhood. It ends up being a space for families to be able to do their own work and maybe share a history of trauma. It's really amazing that they feel safe enough here to share those things."
Ann Twilley:"A lot of times the adults — sometimes from lack of education — don't understand certain aspects of what could have contributed to the eating disorder. But also if they'd had trauma, it bleeds into the relationship, it bleeds into how they attach with their child."
Moderator: "What kind of results do we typically see? What kind of changes do we see in the client?"
Katie Klein: "I think there's a confidence that the client did this, and that they showed up for themselves and said what they needed to say, and have worked through that. I think the client also has a lot more insight into their family, and into why the family dynamics are the way they are, and what part the client can play in changing that."
Anne Ganje: "After doing groups with the clients and their family members, there's always a sense of relief for the next few sessions. The client always feels that there's a weight that has been lifted from their shoulders, because now some of those simple questions that people have — 'Should I keep this in the house? Should I not keep that in the house? What should mealtime look like?' — some of the basic stuff is answered, and we can talk about it."
Moderator: "So part of the family program is helping to prepare families for what to do and what not to do when the child, or the wife or the sister comes home?"
Anne G: "Yes, and allowing family members to ask some questions they may have been afraid to ask before."
I appreciate that families share the space that's here, they feel that it's special. The families feel the love that's here, and I'm so proud of that. That is what I feel here.
Audrey Bailey: "By the time I meet with the families, they've gone through a couple days of our programming. When I meet with them, I focus on how they can best support the client, but I also focus on the family taking care of themselves. No matter how your son or daughter is doing, it's important for you to take care of yourself. Oftentimes, the tears come, because they've been holding that in, feeling like 'Oh my gosh, I've got to get it together as a parent, I've got to do the right thing, the perfect thing, so that they don't get triggered again.' So I just open up a space to talk about these things, and this is how you can support your son or your daughter, but really take care of yourself, it's important, self-care for everyone. I appreciate that families share the space that's here, they feel that it's special. The families feel the love that's here, and I'm so proud of that. That is what I feel here."