Houston Eating Disorders Specialists

Hello Colleagues,

HEDS turned 4 years old in June! What a perfect time to reflect on our fantastic year full of growth and new experiences.

Our 2012 professional meetings provided a wonderful venue for training while catching up with friends and enjoying delicious food. Thanks to our Vice President, Michelle Crow Fee, for organizing six bi-monthly meetings. One of my favorite meetings featured our very own Melissa Cook, LPC, who presented on Validation, including excerpts from her book The Power of Validation.

With the enormous help of our new Communications Chair, Jill Sechi, the HEDS website was totally revamped and now has capacity for payments, event registration, membership applications and much more. The results are beautiful, professional, and efficient. Check it out if you haven’t already at www.houstoneds.org.

Mara Gittess has continued her tireless work as Advocacy Chair, most recently organizing HEDS’ efforts to lobby for HB3227. Thanks, Mara, for keeping us informed and inspired to advocate for EDs! Ever busy, Mara also developed and produced our first newsletter.

Thanks to the hard work of Michelle Fee, we finally completed the arduous process of becoming a non-profit organization. Isn’t it nice to be tax exempt?

Also thanks to our Secretary, Deb Michel, for keeping us on track by preparing agendas and taking minutes for every meeting. Terry Fassihi did a fantastic job keeping us in the black and current with our bills as our Treasurer.

We kicked off 2013 with our first HEDS Conference: The Journey of Hope. The conference was a huge success with about 100 professionals and 50 community members in attendance. Our excellent speakers were a perfect mix of local and national experts. Thanks to all of you who served on the Conference Committee or volunteered, especially Michelle Crow Fee, Amanda Buller, Linda Chase, Melissa Cook,  Terry Fassihi,  Andrea Gaspard,  Mara Gittess,  Debbie Grammas,  Christina Kontos,  Marcia Laviage,  Deb Michel,  Jill Sechi,  Judi Turner and Nancy Wilson.

In 2013, Amanda Buller  took on the daunting role of Education Committee Chair and began organizing our educational events, and Debbie Grammas  has agreed to pitch in and help her. This is perfect timing for Michelle Fee  who would rather be busy with the arrival of her beautiful first child Doran. Lara Allen  stepped up to help organize and oversee the Membership Committee. Deb Michel  has taken on the challenge of our newsletter.

Introduction of New Leadership

I can honestly say that serving as President of HEDS for the last three years has been one of the most meaningful, growth-producing experiences ever in my professional career. I stand amazed and grateful for the privilege of witnessing our hard work and effort manifest into such a strong, professional group. And now it is time for the changing of the guard. As I step into the role of Past President, I am thrilled to announce Terry Fassihi as the new President of HEDS. Our new Leadership Team includes Michelle Fee as President Elect, Deb Michel as Treasurer and Newsletter Chair, Mara Gittess as Secretary and Advocacy Chair, Lara Allen as Membership Chair, Amanda Buller and Debbie Grammas as Education Co-Chairs, and Jill Sechi as Communications Chair.

Remember, the Leadership Team can use all the help we can get, and besides, we have so much fun! We encourage any of you who would like to join the HEDS Leadership Team to give us a call. I am excited about the future of HEDS as we continue to work together to promote better understanding and treatment of eating disorders in our community. I’ll see you at our next meeting!

Sincerely,

Jana Rosenbaum, Past President, HEDS

By: Theresa Fassihi, Ph.D.
Director, Houston Eating Disorders Center

It is estimated that 10 million Americans suffer from eating disorders, which usually first strike young women between the ages of fourteen and 20.  That means 10 million American families are affected by eating disorders. ¹

So many parents describe the desperation of watching helplessly as their child or adolescent starves herself or himself, or engages in other frightening behaviors such as bingeing and purging, or abuse of laxatives and diuretics, or driven exercise.  When families seek help for their child, they have sometimes been told that “it’s not about food” or that their child must learn to manage their eating on their own and they should not take the role of “food police.”  Sometimes they are told that it will be better to separate the child from the family for recovery to occur.  Essentially, they are being told to get out of the way and let others fix the problem.  Parents report that this makes them feel helpless and blamed.²

This also impacts the results of treatment.  When young people do participate in residential or inpatient treatment, far away from their families, often in other states, they often return home in the stage of early recovery to limited support, and the risk of relapse is high.  Families may have had some involvement in treatment, but may still feel unprepared to support their child’s recovery.

“In-patient programs are not cost-effective and there is no evidence for their long-term efficacy,” James Lock explained (personal communication, March, 2009).  Also, he notes that patients are in an artificial environment when they go away for treatment, so translating what they learned to their own homes remains a challenge.

In many cases, residential or inpatient treatment is necessary, and should not be ruled out as an option. Fortunately, many programs are making more of an effort to include families more in the treatment process.  Research findings strongly support involving families extensively in treatment.

The Academy for Eating Disorders (AED) issued a position paper in 2009 that supports family based treatment:  “The AED stands firmly against any etiologic model of eating disorders in which family influences are seen as the primary cause of anorexia nervosa or bulimia nervosa, and condemns generalizing statements that imply families are to blame for their child’s illness. The AED recommends that families be included in the treatment of younger patients, unless doing so is clearly ill advised on clinical grounds.” ³

It is becoming more common to involve the family closely in the treatment of children and adolescents with eating disorders.  One promising model of treatment is The Maudsley Approach, and a version developed in the U.S. known as Family Based Treatment.  These treatments share the view that  the family is the most powerful resource for a young person’s treatment.  The family plays a crucial part in supporting a patient’s recovery.  Instead of getting out of the way, parents take a more natural role in making sure their children are eating in a nutritionally sound way and not engaging in any other dangerous behaviors.  This treatment model was originally developed in England at The Maudsley Hospital in London in the late 1970s by Christopher Dare and Ivan Eisler.⁴

According to the AED, “a consistent finding in work completed recently is that family involvement appears to be useful in reducing both psychological and medical morbidity, especially for younger patients with a short duration eating disorder, and that this form of treatment is acceptable to parents and patients alike.”

Family Based Treatment (FBT), has been manualized in the U.S. by James Lock and Daniel Le Grange.  Training in the techniques also is offered regularly through their training institute (http://www.train2treat4ed.com).  They have conducted extensive research supporting the efficacy of this treatment. ⁵

Briefly, FBT occurs in three phases.  In Phase I, the parents are in charge of their son/daughter’s weight restoration.  Siblings take a role of supporting their brother or sister, but do not get involved in their eating.  A therapist supports the whole family, serving as consultant rather than “boss” of the process.   The emphasis is on empowering the parents to take care of their child’s health and well-being.  Parents collaborate closely together and identify their shared goals and strategies.  They stay “on the same page.”  Parents learn to understand what is going on in their child’s mind as a result of the eating disorder, the cognitive distortions and the obsessions caused by the illness.  While they learn to be empathic, they also deliver the firm message that they are not going to let their child continue the eating disorder behaviors.  Ongoing medical monitoring ensures that the process is medically safe.^6,7

In Phase II, when the child or adolescent is eating normally and has attained a healthy weight, he or she begins to gradually take back control of his or her eating, perhaps starting with one meal or snack and building up.   Along with this growing independence in meeting nutritional needs, it becomes possible for the individual in recovery to regain more freedom and autonomy in other areas, so that staying well has both intrinsic and extrinsic rewards.  Of course, the eating disorder thoughts will still be present and the child or adolescent will continue to need support to battle the powerful urges that result.   In therapy sessions, the patient is very engaged in describing these challenges and also working to resolve them.  If there are setbacks, more family support of nutrition can be established temporarily as the patient and family develop strategies to move forward again.

In Phase III, the therapy focuses on adolescent developmental issues.  At this point, the adolescent is controlling his or her eating and maintaining a stable weight.  The eating disorder symptoms are no longer the idiom of communication between parents and the child, so discussion of other adolescent issues such as independence, leaving home and sexuality may now be discussed.  As the adolescent is now functioning age appropriately, the parents are more about their own relationship and other interests.  Everyone knows the eating disorder could resurface and need to be addressed again, but there is hope for full recovery.

Of course there is no one-size-fits-all treatment that works for everybody.  There are advantages and disadvantages to Family Based Treatment.  Notable advantages include:

1. Cost effectiveness – Many more people can recover without going into inpatient or residential treatment with strong family support of nutritional rehabilitation.  Or, lengths of stay can be much shorter.  For example, University of California at San Diego has a model of family treatment in which the family and patient are trained in the Maudsley Approach in one week of inpatient care.  Most are then able to complete weight restoration with outpatient support.
2. Reduces risk of relapse – With ongoing family support available, individuals in early recovery who begin to engage in eating disorder behaviors can quickly get back on track by increasing family involvement in supporting healthy nutritional behavior.  The amount of support can be quickly adjusted to meet the individual’s needs.  Research has indicated that relapse rates are much lower for patients treated with Family-based therapy than with individually focused treatments.
3. Healing relationships – Working on recovery together as a family can be an excellent way to strengthen family connections and clarify healthy roles, which may have been disrupted by the eating disorder.

There are certain families that may not find this to be a suitable treatment.  Some factors that could interfere with the effectiveness of this approach include:

1. Practical barriers – it may not be possible for family members to make themselves available to support nutritional rehabilitation on the ongoing basis that is necessary in initial stages of recovery.
2. Lack of clinical support – therapists trained in the Maudsley model of treatment are not available in all cities.  Although the approach has been around for a while, the training has only recently become widely available. Fortunately, it is now possible to participate in intensive training and supervision and become a credentialed FBT therapist.
3. Patient refusal – some adolescents are unwilling to work with their families on nutritional rehabilitation.  Although some resistance is to be expected, if it seems insurmountable, it may be better to look at other options.

Although Maudsley, or Family Based Treatment, may not be right for all families, the model has strengthened awareness in our field of the importance of making families a part of the recovery process to the greatest extent possible.  Given the strong research support for family-based treatment for adolescents with eating disorders, researchers are also looking at ways to include families more closely in adult treatment.  For example, research is being conducted into treatments for eating disorders that involve spouses. 

References

1. Brown, Harriet. Brave girl eating: A Family’s Struggle with Anorexia. New York: Harper Collins, 2010.
2. Lock, James, le Grange, D.  Help Your Teenager Beat an Eating Disorder. New York: Guilford Press, 2005.
3. LeGrange, Daniel,  Lock, J.,  Loeb, K., and  Nicholls, D.  “Academy for Eating Disorders  Position Paper: ” The Role of the Family in Eating Disorders.”  International Journal of Eating Disorders 43 no. 1, (2010): 1-5.
4. Robin, A. L., Siegel, P. T. and  Moye, A. (1995), Family versus individual therapy for anorexia: Impact on family conflict. International Journal of Eating Disorders, 17: 313–322.
5. Lock, James; Le Grange, D;  Agras, WSD; Moye, A; Bryson, S;  Jo, B.  “Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa.”  Archives of General Psychiatry 67 no. 10, (2010).  Downloaded from ww.archgenpsychiatry.com on February 20, 2012.
6. Lock, James, le Grange, D.  Treatment Manual for Anorexia: A Family-Based Approach. New York: Guilford Press, 2001.
7. Lock, James, le Grange, D.  Treating Bulimia in Adolescents: A Family-Based Approach. New York: Guilford Press, 2007.

Helpful Websites:

• http://maudsleyparents.org/
• http://www.feast-ed.org/
• http://www.train2treat4ed.com

Room A – Andrea Gaspard, MEd, LPCI

Meredith Cook, LPC, presented tips for families and friends on how to support their loved one struggling with an eating disorder.

Debbie Grammas, PhD, and Chris Webb, CPRP, MT-BC, provided great information on the role of body image in the development and treatment of eating disorders.  Chris Webb provided a variety of creative ideas to engage clients and make them more aware of how their body image plays a part in treatment.  Audience participation was solicited for a couple of these activities and members of the community volunteered to demonstrate activities, such as the trust walk and musical conversations.

Aaron Fink, MD, provided a wealth of information on the use of psychotropic medications in treatment of eating disorders.  Dr. Fink educated attendees about which medications have been approved for the treatment of anorexia nervosa, bulimia nervosa, and binge eating disorder as well as which medications to avoid and why they can be harmful.

Keesha Broome shared her story of how her father influenced her life.  Fathers Mike Polan and Don Blackwell then shared their stories of navigating their way through their own daughters’ eating disorders treatment.  It was apparent that many fathers in the room viewed this information as extremely helpful and found validation in hearing that they were not alone in their experiences.

Room B – Nancy Wilson, MEd, LPC

Laura Laine, RD, LD, was the first presenter. Laura has worked as a dietitian and spiritual director, and is founder of the Sophia Grace Center for Nutrition, Health & Spirituality. Her presentation was entitled, “Follow the Yellow Brick Road: The Spiritual Path to Hope.”

Ovidio Bermudez, MD, was the second presenter.  Dr. Bermudez is the Medical Director of Adolescent Services and Chief Medical Officer at Eating Recovery Center, as well as a founding member of the Houston Eating Disorders Center and Houston Eating Disorders Specialist. Dr. Bermudez presented on “Updates in the Refeeding Process for Adolescents with Anorexia in the Inpatient Setting.”

Brandi Powell, RD, LD, and Jill Sechi, RD, LD, were co-presenters for the third break-out session. Jill is a dietitian who works in private practice as well as at the Houston Eating Disorders Center. Brandi  and Jill presented on “Supporting Recovery with Nutritional Rehabilitation: Utilizing an Interdisciplinary Approach.”

The final presentation, conducted by Caryn Honig, RD, LD, and Amy Waldner, LCSW, was entitled, “It’s not about food or weight: Combining Traditional/Non-Traditional Approaches for the Treatment of Eating Disorders.” Caryn is a dietitian and owns The Healthy Weigh, a private practice offering nutritional counseling where she counsels patients who struggle with eating disorders.

Room C – Linda Chase, LCSW

Our keynote speaker, Craig Johnson, PhD, FAED, CEDS, a leading mind in the research, development, and implementation of eating disorders treatment, made a comprehensive and informative presentation titled, “New Developments in the Understanding and Treatment of Eating Disorders.”

During lunch, Shern-Min Chow, KHOU 11 News, lead a panel discussion titled, “Stories of Hope.” The panel members, four individuals in various stages of recovery from various types of eating disorders, shared their own powerful and courageous stories of the journey to recovery.

Deborah Michel, PhD, CEDS, and Kathy Veath, RD, LD, BSN, presented on the important topic of “Eating Disorders in the Age of Anti-Aging:  Implications for Treatment and Hope for Recovery in Women Midlife and Beyond.”

What is Mentalizing and Why Eating Disorder Patients Should Do It:  How Mentalizing Based Treatment Can Strengthen Recovery From Eating Disorders,” an interesting and helpful topic, was presented by Theresa Fassihi, PhD, CEDS, and Heather Murphy, LPC-Intern.

Carolyn Costin, MEd, LMFT, CEDS, presented “From Disordered to Recovered: Taking a Client Through the 8 Keys to Recovery,” a very insightful and practical approach to the treatment of eating disorders for clients and/or professionals.

The 2013 HEDS Conference was a huge success. Here are a few snapshots from the event!

Andrea Gaspard, MEd, LPC-Intern

Andrea Gaspard is a licensed professional counselor intern supervised by Rebecca Compton, MEd, LPC, CGP and Deborah M. Michel, PhD, CEDS.  She received her Bachelor of Science degree in Nutritional Sciences from Texas A&M University and completed her Master of Education degree in Counseling at the University of Houston.Andrea’s professional experience includes working with children and adolescents who have been victims of abuse and neglect.  She also has experience working with adults with severe mental illness, anger management problems, substance abuse issues, and those that have been victims of domestic violence.   In addition, Andrea has facilitated grief and bereavement support groups specifically for children as well as for families that have lost a loved one.

Andrea’s interest in eating disorders led her to undergraduate studies in Nutritional Sciences at Texas A&M University.  During her time there, she became interested in the psychological aspects of eating disorders.  Consequently, she chose to pursue her master’s degree in counseling in order to suffering from these illnesses.  Andrea’s desire to utilize her knowledge of both the nutritional and psychological dimensions of eating disorders brought her to The Woodlands Eating Disorders Center so that she could pursue specialization in the area.

Andrea provides individual counseling to children, adolescents, and adults.  She also conducts family and group therapy.  Andrea is a member of the Houston Counseling Association and the Texas Counseling Association as well as HEDS.

Heather Murphy, MA, LPC-Intern

Heather received her Bachelor of Arts in Psychology from the University of St. Thomas in Houston, TX, and a Master of Arts in Clinical Psychology from the University of Houston – Clear Lake.  Heather began treating eating disorders in 2007 while working with The Menninger Clinic’s Eating Disorders program.  She has experience working with eating disorders on an outpatient basis as well.

Heather has extensive experience with group psychotherapy, but also sees individual clients on an outpatient basis. She works with adolescents and adults with many diagnoses, such as anorexia, bulimia, and binge eating, and the illnesses that often co-occur with eating disorders like mood disorders, anxiety and trauma, and personality disorders. In addition to treating eating disorders, Heather sees clients who may be struggling with disordered eating and body image issues, but do not meet the criteria for a diagnosis.

Heather enjoys helping clients find creative ways to express their emotions, employing many art therapy techniques. Her goal in working with clients is to guide them in working towards living their lives according to their values. She uses an eclectic approach to treatment, which is influenced by many types of therapies, such as Acceptance and Commitment Therapy, Dialectical Behavior Therapy, Cognitive Behavioral Therapy and Positive Psychology.

Heather is a member of the Association for Contextual Psychology, Houston Eating Disorders Specialists and the American Counseling Association.

Guy Bender, MS
Elisabeth Crabtree, MSc
Candace Dixon, BS
Jean Dixon, MS, LPC, CGP
Nicole Garber, MD
Elisabeth Garrison
Andrea Gaspard, MS, LPCI
Sindhu Idicula, MD
Nicole Leitner, MA, LPCI
Erika Loehmke, PsyD
Jennifer Nagel, RD, PA-C
Laila Narsi, LCSW
Hannah Szlyk, LMSW
Tessa Pack, RD, LD
Kallan Rotolo, DTR
Mackenzie Spellman, BS
Barbi Topek, LCSW
Stacy Vollands, MS, LCDCI
Walker Wellness Clinic