Monte Nido & Affiliates Education Training Manger Jacquie Rangel shares a heartfelt letter to her younger brother in this week’s blog post. Read Jacquie’s moving post about her eating disorder recovery journey and her love and appreciation for her brother.
You are one incredible human. I don’t think you know how lucky it is to have you as a sibling. You’ve been my youngest brother since I was seven-years-old and I find more and more that I have so much to learn from the way you are in the world. Though the lessons you have to offer now lay in other spheres of my life, I will never forget all that you taught me about supporting a person through an eating disorder. Your persistent belief in recovery has helped me heal myself and has served as inspiration as I help others who are committed to healing themselves.
I’ll never forget the winter break I came back from my freshman year – the point I was unable to hide my eating disorder any long. I remember witnessing the blend of excitement and confusion in your eyes. You knew it was me, but not quite the same person you were counting on for stories about University life. I remember flinching when someone at school commented on my weight from afar. You didn’t know what an eating disorder was, but you knew the change in my demeanor and my lack of energy was somehow linked to the change in my body. I remember you bringing me a pair of your pants to try on and standing firm in your insistence when I told you that was a ridiculous idea. I remember the gentle look of compassion you gave me when I realized I was able to slide them on easily- finally seeing myself clearly.
Fast forward to next year when you barreled through the doors of Oliver-Pyatt Centers to spend time with me on YOUR birthday, not even deterred by the fact that you were spending part of the day in a treatment center. I know it hurt you when I snapped because you starting talking about birthday cake, but you kept a smile on your face and the conversation upbeat. That afternoon Mom told me you had been up the night before researching everything you could about eating disorders and what you should and shouldn’t say to a person in the thick of it. At just 12 years old!
Giving it some thought, it isn’t actually surprising that it was a child who was able to get through to the part of me who was ready to fight. While other people in my life were coming at me with data, pleading and frustration you approached me with the age-appropriate curiosity of a child. It’s a tactic we easily forget about as adults because we try to come in with our version of the answer to the “problem”. The issue with this method is that we make assumptions rather than trying to hear a person who ultimately feels very unseen. To this day, whether you’re doing work leading your chapter of Project Heal at American University, advocating with the Eating Disorder Coalition on Capitol Hill or up late discussing your concern for a friend whose eating patterns raise concern, you maintain your unquenchable and open-minded curiosity. You ask questions non-judgmentally, you listen attentively to the response and you adapt your understanding as you learn.
Feli, I can’t thank you enough. You’ve been a beacon of light for me when I was lost and you’ve been here on the other side to appreciate the finer details of life beyond an eating disorder. Stay curious, stay hopeful and keep your heart open, brother.
Please give us a brief description of your background and what guided you towards the treatment of eating disorders.
I was originally drawn to working in this field because of my background in athletics, specifically competitive figure skating, and the devastating impact disordered eating and eating disorders have on professional athletes. My background is in complex trauma and attachment and in that work it’s so common for those suffering to find a sense of safety and comfort in an eating disorder. When I began working at an eating disorder facility many years ago it became a way to meld different aspects of my background that I felt so passionate about, trauma, art therapy and attachment work.
In your own words, please describe the philosophy of Monte Nido.
Monte Nido’s philosophy is what drew me to the West Coast from the Midwest. I feel so energized by the work we do with people and that we believe each person has a healthy voice inside that can help them transform their life. We meet people where they are at, without judgment, and hold hope that they can recovery because we have been through the journey ourselves and try to live it every day. We believe in being “human” and that seeking help is the first step to lead people back to themselves.
What is your favorite thing about Monte Nido & Affiliates?
My favorite thing about Monte Nido is how important it feels to us to live authentically and to mirror that to our clients. I am in awe everyday at the soulful moments we share with each other and I truly believe that we have some of the most talented clinicians you’ll ever meet.
What’s your soulfood?
My soul food has changed over the years but I’d probably choose something that’s been a staple in my family throughout the years. My family is originally from Australia so we live, breathe and die by pavlova. Its a dish that always makes me feel connected to them no matter how far away they may be.
What are three facts about you that people do not know?
Three facts people may not know about me: First is that I was a competitive figure skater for 18 years of my life. Second is that I was a children’s book illustrator before I became a therapist. Because of this art and storytelling are a big part of the work I do with people. Finally, the third is that I spend most of my free time in my garden with my daughter. I have a green thumb that is deeply connected to my soul self.
Kelly Souza, PsyD has been working in the field of mental health for the past 14 years in various settings including residential foster care, a psychiatric hospital, various partial hospitalization and intensive outpatient programs and outpatient therapy centers. Kelly recently moved into her current role as Monte Nido & Affiliates Senior Director of Clinical Programming for California and offers a glimpse into her soul in this week’s blog post…
Please share a brief description of your background and what guided you towards the treatment of eating disorders.
I’ve worked with many different populations including residential foster care ages 5-17, adolescents on probation, psychiatric hospital with severe chronic mental illness, substance abuse at all levels of care, and eating disorders. I’m recovered from an eating disorder and eating disorder treatment has always been the population I’ve been most passionate about not only due to my personal experience, but because when clients choose life and choose recovery, what unfolds is such a beautiful process. I’ve always been a huge fan of Monte Nido, as I believe we provide the very best treatment and the quality of clinical care is unmatched. Being an Orange County native, I never had the opportunity to work for Monte Nido until they came to Orange County. I was thrilled when the decision was made to open a Day Treatment in Newport Beach.
In your own words, please describe the philosophy of Monte Nido.
When I think of Monte Nido’s philosophy, I think of treating clients as a human first, and a client second, which is also how I see myself— a human first and a therapist second. I see us as treating the soul and reconnecting with ourselves in ways that extend beyond the physical body. I see us as focusing on being in relationship with people and passions we have, rather than being in relationship with an eating disorder. I see us as focusing on examining our relationship with food and learning to enjoy foods we’ve never imagined we could and letting go of our rules and disordered ways that has prevented us from living in the moment and according to our healthy voice.
What is your favorite thing about Monte Nido & Affiliates?
My favorite thing about Monte Nido is that when I come to work, it doesn’t feel like coming to work. We’ve created spaces that feel like an extension of my home and my family. I love coming and doing the work we do with clients, holding the space for them to do what they need to do, and having the support of an amazing team behind me- at all levels throughout the company.
What is your soulfood?
My soulfood is probably spaghetti and garlic bread. My mother is 100% Italian and my grandmother use to make the most amazing spaghetti (totally from scratch) for family dinners. It is a very special memory I have from my childhood.
What are three facts about you that people do not know?
I prefer rain over sunshine. I wake up totally elated when I see it’s raining outside
I am a terrible cook… I even manage to botch foolproof crock-pot recipes!
I love bookstores and libraries… I can spend hours in a Barnes & Nobles
Monte Nido RainRock Primary Therapist Carissa Surace, MFT shares some of her work with families in this week’s blog post. Carissa explains how she went through some trial and error to determine the best way to engage with families during their first session together. Read on to see what question Carissa uses to help begin the conversation…
“What’s it like to eat together?”
This is my favorite question to ask when it comes to family work at Monte Nido. It can be difficult to know where to start when a set of parents or a partner come to a session for the first time. Usually by the time the first family session comes up the client has been in program for a few days, and a rapport has already been built. Generally we as the therapist already have a lot of information on family dynamics from referral sources, collaboration with outpatient providers, introductory phone calls or emails with primary supports, family assessments, and of course, initial sessions with clients. With all of this upfront information, while necessary to gather, it’s important to also hold space for that loved one’s unique experience. Having a family member or partner with an eating disorder is scary, and it can be hard to know where to start or what questions to ask.
At the very beginning of my journey as a family therapist I would make the mistake of setting up initial family sessions as an open forum for questions and answers between the family members. For the more treatment savvy families this was okay, but for the less experienced families I quickly realized I was leaving too much space and not providing enough structure for the session. After some trial and error of asking very specific questions in an attempt to get the exact right flow of conversation (I’ve since learned that’s not a real thing) I realized that I could always bring it back to the food.
A common expression that we often tell clients and families is that the work “is about the food, and it isn’t about the food.” Since the food behaviors are usually what families notice and become the most nervous about before their loved ones enter treatment, it makes sense to start sessions there. As therapists, we know that there are many underlying issues when it comes to food behaviors, and that the stress and energy is taken out on the food. But this can be difficult for family members to understand or know what to do with. Oftentimes concern for a loved one will manifest in the statement, “I don’t understand why you can’t just eat” which results in frustration for both the client and her supports. Because the food behaviors are what is most obvious in someone with an eating disorder, I have found that it makes sense to start family sessions with questions about the food.
There are a lot of secrets when it comes to eating disorders, especially for loved ones, but what they do know is that eating with their person is challenging and stressful. Clients usually also know this, and have generally been open to talking about it because discussing the energy around the food feels safer than talking about the thoughts and feelings behind the behaviors. Moreover, it’s not uncommon for clients and families to be hesitant about doing any family work at all. Loved ones might be wanting to keep family secrets in the dark, and clients can often be protective of the family system, or worry that their fragile connections would be destroyed by letting a secret slip in front of a stranger, so talking about the food is a great way into the system to not only build trust, but to get a lot of good information.
I have yet to experience a room full of silence during a family session when I ask what it’s like to eat together. There is really no wrong way to answer, which sets all parties up for success and allows the therapist to pick up on important themes and patterns. For example, if I ask “What is it like to eat together?” the client might say “I get really anxious because I feel like I’m being watched all the time and my parents are policing me.” A parent or partner might respond with “I just want to her eat something and I’m afraid if I leave her alone she won’t eat anything all day.” This is a great way to jumpstart talking about ways in which to give support and go over different levels of responsibility for both the client and her family.
There are many ways to approach family sessions. Of course each family is different and there are an infinite number of ways to approach family issues, but taking it back to the food is a great way to invite everyone to participate while getting valuable information to help structure ongoing family work.
Call to mind the biggest bully from your childhood. Look at their face, hear their words, and feel their overwhelming presence. Now, imagine that instead of being able to escape when the bell rang, you had to take them home. Every action you took and thought you had would be criticized and ridiculed repeatedly.
Maybe this is where our current insecurities and negative self-talk come from. But maybe our biggest bullies weren’t kids from school and have been slowly forming over time from within ourselves. Either way, many of us engage in this bullying on a daily basis and it can become so familiar that we don’t even question its validity.
Often, when I ask my clients for evidence that their negative self-talk is true, they look at me bewildered. This might be the first time that they have questioned these statements. They may be in disbelief that anyone would think anything different about them apart from what they have been repeating for so many years.
I learned pretty quickly that simply telling a client that they are worthy of being loved, both by others and themselves, would be met with a polite smile and an immediate objection. I saw this deficit of self-love and knew the solution but getting clients on board was the challenge. Just like most of what we do at Monte Nido, my job is to help clients realize the usefulness of this concept, rather than prescribing it to them.
Loving oneself is the foundation for our ability to love others. It allows for intimacy, compassion, and forgiveness. When we can see ourselves in our truest form, as our soul selves, we can realize our unbounded capacity to express and receive love with others. But too often we don’t allow space for that self. We instead focus on the regrettable things we have said or done and have gotten into a habit of bullying ourselves into being “better” people. Allowing compassion for ourselves does not give us carte blanche to act in destructive ways but it does give us the opportunity to see where we have strayed from our values and to bring us back in a gentler way.
Loving kindness, or Metta as it’s known in Pali, is the practice of extending kindness to ourselves and others through the use of simple phrases in meditation. There are four classical phrases but I always encourage clients to find statements that feel most authentic to them. The phrases I recommend are:
“May I be happy.”
“May I be healthy.”
“May I be safe.”
“May I live with ease.”
These phrases are repeated, silently, in the mind to allow us the space to connect compassionately to ourselves. There is no expectation, nothing is forced, and the purpose is to simply allow what comes up. While the execution of this practice sounds simple, it is often quite difficult for those recovering from an eating disorder. The instinct may be to reject the part of themself that continues to struggle with urges or behaviors, believing that continued bullying will motivate them to change their actions. But with loving kindness, our clients can connect with their healthy self to offer a gentle reminder of their worthiness to recover.
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On my self acceptance journey, I have learned several things:
1. Acceptance is not the same as enjoying. Acceptance is a bit like gravity. You don’t have to like it, but no amount of wishing to float is going to make floating possible.
2. Acceptance might require a period of grief. If you have been willing your body to be one way for any period of time, transitioning to a new way of thinking about your body might make you sad, might make you angry, and will take time.
3. Acceptance makes life easier. I spent a number of years vigilantly fighting against my body, speaking negatively of it, and putting myself at risk unnecessarily. It is only because I accept my body that I’m able to live with the ease that I do.
4. Acceptance is good for you. In the same way that speaking negatively about yourself makes you feel worse, when you are able to speak about yourself from an accepting place – and that can be neutral – you’re better off. By simply changing the way I spoke about my body, I felt and feel differently in it.
5. Sometimes acceptance means needing help. This was a hard one for me, as I am superbly independent. But I accept that I need help navigating the world as a woman with different ability. I am choosing to ask for help more and more, and find that this process affirms itself. For you, this might look like speaking with your therapist or dietitian about body image. And about the challenges of self-acceptance.
6. Acceptance of what is leaves room for everything else. As I mentioned before, my process of accepting my disability was not always graceful. I fought it with all that I had. And now, I live, breathe, and sleep easier because I’m not fighting against myself.
I wish for you the all benefits that body acceptance has to offer. I wish for you the peace that I have found in accepting my present moment body as it is. I wish for you the ability to give yourself permission to approach body acceptance as a part of a larger body journey.
And whatever is in your collection of “should’s” SHOULD be examined immediately…What is there? Get curious. And let me know!
Although I was diagnosed with MS when I was in high school, I didn’t have any permanent disability until I was in my late 20s. Starting in high school, I loved shoes. High heels specifically. I felt like they made me look older, more sophisticated, and elegant. I acquired and wore lovely high heels through high school, college, and part of graduate school. Near the end of graduate school, I stopped being able to wear high heels if I had to travel a long distance. I would ask my partner to park the car close to wherever we were going. I would wear heels to walk into place where I knew I would sit. I would take off my shoes if I was walking any great distance. As my disease progressed, I wore my high heels in my home only. I would walk in them as though I were practicing to wear them ‘for real,’ but never did.
I completed graduate school in 2009. I stopped being able to wear high heels entirely in 2010. And here is where my declaration of not being crazy should come into question: I didn’t stop buying high heels until the end of 2012. I have strong memories of going into the shoe department, and trying on heels. Of literally trying to make my foot and body coordinate in a way that it could not. Sometimes I stood up in the heels. Sometimes, I tried to walk around. Sometimes I just looked at the shoes on my feet. And then I’d buy them. I would take them home, store them with the rest of my high heels, all the while repeating to myself the message that I “should” be able to wear the shoes. That to be a respected professional, or found desirable, or recognized for my work, high heels were a mandate. WHAT A LOAD OF CRAP.
Even as I was truly unable to comfortably wear these shoes, I was unable to separate my feelings about what it meant to wear high heels from my lived experience. I was living in the “I’ll get back there someday-land,” and not practicing any acceptance of what was. I was stubborn, and insistent that I should be able to wear the shoes.
In this part of my mourning-accepting process, I talked a lot of shit. I made nasty remarks about my body. I made fun of myself in a way that felt protective, but wasn’t. I was so preoccupied by my disability, and my inability to meet my own standards, that I lost more time and energy then I am proud to admit.
And then I was given an enormous gift that in the moment felt awful, but changed the way that I viewed myself. My fear of being seen as that which is other was confirmed, and out of my frustration, I committed to stop fighting against myself.. It took a while, but I did arrive to the space where I eliminated the shoes that didn’t work for me. And I ultimately moved past the space where heels held much energy.
This may seem like a small thing, but it was not at all trivial for me, as it was my first overt expression of acceptance of what is. I am a disabled woman, and I can’t wear high heels. Those are two facts about me that actually say very little about who I am. I imagine that you would find a similar ending if you thought about the parts of yourself that you struggle to accept. Those parts are not all of you, and they’re probably not the most important parts of you, either.
I’d like to start this post by stating that in all the ways that matter, I am a sane person. I’ll circle back to this, but want you to feel comfortable knowing that I am sane. (This will come into question later.)
“But I don’t want to accept this body.”
How many times have you said those words? To yourself? About yourself? How many times have you heard someone else use these words about their body?
When I think about body acceptance, and all that it allows for, I am deeply relieved. And I haven’t always been. As I hear often from my clients, body acceptance gets confused with complacency. It gets confused with liking one’s body. And now, because it is a buzz-worthy expression, it has kind of moved to the cool kids table. If you’re not accepting, you’re not in the club.
When I think about body acceptance, I am thrilled to know that it is possible. I am thrilled because I know that it can happen after years of having complicated, tumultuous relationship with one’s body. I am thrilled to say confidently that body acceptance is one step to healing one of our most important relationships: that with our own bodies. For humans who feel at home in their own bodies, some degree of body acceptance is possible. This is not to suggest that body acceptance is simple, but for most, it is possible.
From this place of acceptance, we can be gentle. We can be kind. And we can be curious.
Over last 10 years, I have treated many hundreds of clients, at all levels of eating disorder care. I have heard my clients talk negatively about their bodies. I have observed how damaging body comparison can be. And I have encouraged my clients to speak kindly of their bodies. ‘Comparison is the Thief of Joy’ is one of my favorite expressions.
In that same time, I have also lived with multiple sclerosis. And over the last five years, I have become a disabled woman. Living the body with changing abilities is rather extraordinary…It’s a little bit like having the rug pulled out from under you when you least expect it. You continue to operate from a place of not expecting the rug to be pulled at all. And you know that it will.
I am not going to make any grand ovations that I have been consistently graceful in the acceptance of my body. That would be a lie. But I have learned a lot about body acceptance, and the good that can come from it.
Monte Nido’s Eating Disorder Center of Philadelphia Primary Therapist Kate Funk shares a special review of the book Dancing with a Demon by Valerie Foster. Read on to see why Kate feels this book is an invaluable resource for families of loved ones struggling with eating disorders.
Monte Nido’s Eating Disorder Center of Philadelphia had the pleasure of welcoming Valerie Foster to our site for an afternoon of casual lunch and story telling. Valerie introduced herself as, “a mother” and later explained how her career as a high school English teacher paved the way for her to become an author. Valerie was inspired by her daughter’s eating disorder recovery to write the book- Dancing with a Demon. The work tells the tale of a young woman who struggles to fully recover while her family feels held hostage by Anorexia Nervosa. Valerie’s warm demeanor and obvious passion for eating disorder advocacy intrigued me, but I knew I had to read the book when she highlighted it’s focus on the effect the eating disorder had on her family.
There are countless books that catalog the descent into Anorexia, but the focus on the family is something that is often missing. I took the copy she left our staff and devoured it in four days. The book encapsulates what so many of the families I work with experience: blame, misunderstanding, excruciating pain, debilitating fear, and feeling completely desperate for their loved one to get well. The author’s candor and courage to tackle such challenging topics make this a fantastic and hopeful read for those supporting someone with an eating disorder.
Valerie explores the frustration and misunderstanding that is associated with having a family member with an eating disorder. As the illness begins she finds herself mystified trying to decode the behaviors she observes. She searches for clues to protect her daughter but slowly realizes she is unable to outsmart the disorder. The author struggles with feeling responsible for the illness but also faces blame brought on by her community of friends and colleagues. She describes feeling like a failure not only due to her daughter’s illness but with her two sons who she admits were lost in the shuffle as her focus was primarily on Jenna’s health. Valerie finds herself completely devastated and isolated in the fight for her daughter’s life until she finds some relief in asking and receiving help, finding solace in prayer, and practicing self- care.
The importance of caregivers caring for themselves is vital and I appreciate the book’s focus on this element. At Monte Nido, we often see family members that are clearly drained. Unfortunately, it is rare for me to meet caregivers who have their own therapist to support them, let alone those who routinely practice self- care. Valerie discusses her struggle reaching out for help, feeling like she must justify a massage or a short weekend getaway all the while feeling completely exhausted and emotionally overburdened. Some of the most valuable insights in the book come from therapy sessions where the author learns to care for herself while also realizing she can’t force her daughter to recover, though she can be there for Jenna, she can’t walk the journey for her.
Dancing with a Demon by Valerie Foster is an excellent book for any parent whose child is facing an eating disorder. That being said, there are a few disclaimers I’d like to make. The family described in this story is incredibly close, which may be a turn off to some who aren’t as tight knit. Despite their clear bond, it is easy to look beyond their relationship and connect to the author’s pain and feel inspired by her harrowing experience. Another detail worth mentioning is the chapter titles. Each chapter’s title corresponds to her daughter’s rapid weight loss. These titles help the reader feel the sense of frantic urgency a parent must feel watching their daughter’s health decline. Due to this aspect, I would not recommend the book for clients who are currently struggling. These numbers may be triggering and validate the all too common feeling of “not being sick enough”. Despite these particular details, parents and families who are supporting a loved one with an eating disorder would find this book invaluable when navigating guilt, shame, and juggling life stressors while still holding hope for their family member’s full recovery and return to wellness.