One More Bite by Joy Jacobs

Mother's Day Wish

2011-05-08T12:16:47-07:00

My day today started in the best way possible, with a note of appreciation and gratitude from one of my “moms” (meaning, the mom of a family I am working with utilizing family-based treatment) thanking me, in essence, for helping to re- empower her as a parent when an eating disorder threatened to rob her child of life. Previous treatment experiences had been disempowering; FBT, in contrast, validates both the rights and responsibilities of parents.

This is one of the most rewarding aspects of family-based treatment, empowering families to restore life to a loved one. It can sometimes be excruciating and thankless, but comes with infinite rewards—the most important of which is life.

My Mother’s Day Wish for all the moms out there is that you find the support and resources that you need to extricate your child from the grips of an eating disorder. You can do it, even when you might think you cannot. We will talk more in future posts about how to solve some of the practical obstacles that present themselves in FBT. Motherhood can sometimes be a thankless endeavor. Today, I give thanks to the amazing moms who have crossed my path. You are an inspiration.

A New Forum for Family-Based Treatment

2011-04-16T14:08:56-07:00

I am very pleased to announce that Psychology Today has offered to provide a forum for family-based treatment and One More Bite, starting with this posting. This blog will now be shared by Eating Disorders Blogs and Psychology Today.

When I started this blog about two and half years ago, it was with the hope that it would provide a much- needed forum for better understanding and utilizing family-based treatment (FBT) for eating disorders (otherwise known as the “Maudsley approach”). At that time, many eating disorder treatment providers had not heard of FBT. Much has happened during that period of time, and thankfully now the word has spread regarding the power of FBT in treating child and adolescent eating disorders (as well as more empirical support for it). Yet, much remains to be accomplished in disseminating this treatment and in having it appropriately applied. It is my hope that this blog will help in that mission.

For those of you who are new to this blog, to follow is a more detailed description of the purpose of this blog, the meaning of its title, and resources for further information on FBT.

I am a clinical psychologist specializing in eating behavior and was lucky enough to be one of the early people who sought out training in family- based treatment. I was drawn to this treatment by its powerful results and by the way it turned traditional notions about the etiology and treatment of eating disorders on its head. Unlike more traditional therapies, which often tended to blame parents and families for eating disorders, FBT envisions parents and families as the best resource in treating eating disorders. It is grueling work for all involved but its effectiveness can be astonishing when witnessed first hand and it continually keeps me coming back for more.

“One more bite” in the language of family- based treatment is the measure of a successful meal. It means that the individual with an eating disorder, with the love and support of family, has accomplished a remarkable achievement—eating just one more bite than the eating disorder would have allowed him or her to eat alone. If you have ever witnessed such an event, and the tears and struggle that come with it, you will see the pain of an eating disorder at its most basic level. You will also see the triumph that comes with wrestling it down and making it go away, hopefully forever.

In addition, this blog is an opportunity for us all to have (metaphorically, that is) "one more bite"--reflecting on what happens in the therapy by allowing us to explore thoughts that evolve and simmer over time. One More Bite is a forum for you—whether you have an eating disorder, have a child, sibling, or other loved who struggles, or are a therapist providing guidance to these heroic individuals and families.

Here we can chronicle the triumphs and disappointments that occur day by day, meal by meal, therapy session by therapy session, in the process of helping a loved one (or oneself) recover from an eating disorder. This blog also explores the very real challenges of weight maintenance and psychological recovery once weight restoration has occurred and the struggles that families, patients, and therapists face in confronting the eating disorder head on.

If you are not familiar with Maudsley therapy, excellent resources and references are available online . I will refer you to them rather than replicate this work.

http://www.feast-ed.org/images/FBT_page_for_FEAST.pdf

http://maudsleyparents.org/whatismaudsley.html

Since this is your forum, I ask you to please email me topics that you would like to see discussed. I encourage everyone--patients, siblings, parents and therapists-- to chime in. Please write to me at: joy@drjoyjacobs.com

Thanks for coming and until later, be well.

People Magazine Looking For Families to Interview

2011-02-10T15:28:59-08:00

Hi all,

I do not typically use this blog to field media queries, but I think this one may be worthwhile. People Magazine is looking to interview families who have utilized the Maudsley approach. People has a very large circulation and sharing your experience could provide an opportunity to help other families, some of whom may be geographically isolated or currently in a form of treatment that is not providing results. If you are interested, please contact Alicia Dennis from People directly at: alicia_dennis@peoplemag.com

Note there is a "_" between the first and last name

Update from the Field

2011-01-28T13:16:55-08:00

Last Friday, I attended an informative and invigorating conference on FBT jointly sponsored by UCSD and Maudsley Parents. The day was chock full of information summarizing the latest FBT research, as well as clinical applications and family stories. Slides from the presentations can be accessed on the Maudsley Parents Website at www. maudsleyparents.org.

Most personally exciting and rewarding for me was having the opportunity to connect, one-on-one, with many families who I have worked with—often by telephone—over the years, as well as watching families coming together to share tips, strategies, war stories, and tales of courage. I think it is fair to say that we finished the day with warmer hearts, sharper minds, and heightened energy for our respective missions.

Thank you to Maudsley Parents and UCSD for providing this experience for all.

Bringing the Sparkle Back

2010-12-23T12:17:13-08:00

My last post reflected on the challenges that face families affected by eating disorders at this time of year.

This post is about hope. It is about the opportunity that you have to restore your child to life.

If your child is currently struggling with an eating disorder, he/she likely looks and acts strikingly different than before ED. If you celebrate Christmas, you may miss the sparkle in your child’s eyes as presents are opened this year—a sparkle that ED seems to have extinguished.

Know that with your support and love, and with full weight restoration, that sparkle can return again. Make it your mission to help rekindle your child’s passion for life. It is possible, one bite at a time.

Season's Meanings

2010-12-09T14:24:55-08:00

For most families, holiday time is jam-packed with gift shopping, decorating, party hopping, cooking and eating galore. When an eating disorder has taken over the house, this season quickly takes on new, more complicated meanings. Celebratory occasions can rapidly turn contentious and good intentions can quickly go awry. If this is the new reality of your household, frustration and sadness can quickly invade.

More than ever, now is the time to take each day as it comes, letting go of expectations for what you think this time of year should be like and instead focusing on acceptance of your current reality (and often this is on the hard work of refeeding). Take time to reflect on your goals for the new year and the steps you need to be taking now to get your family there. Acceptance does not mean you like the current state of affairs but rather that you acknowledge the current state of affairs as it is. This opens the door to necessary action. In essence, this acceptance is a crucial prerequisite to change.

Refeeding and Its Rewards

2010-11-09T10:50:03-08:00

Home-based refeeding is hard work, hands down often the hardest endeavor parents will ever undertake on behalf of their child. I am often on the receiving end of phone calls from parents exploring various treatment options for their ill child. As discussed previously on this blog, the array of treatment options and often conflicting advice from various treatment professionals can be dizzying. When I explain the key concepts of FBT to parents for the first time, especially the central tenet of home-based refeeding, parents are often taken aback. They have seen the beast of anorexia first-hand and fear facing its wrath at the introduction of an adequate meal. My job is to metaphorically take their hand and guide them through the fear, to empower parents to heal their child, and to stare the beast down, once and for all.

The rewards of this are countless. The return of life being primary among them.

The job is not easy but it is essential..it is the path to recovery.

Another Thumbs-Up for Family-Based Treatment

2010-10-04T16:30:21-07:00

The evidence continues to grow...supporting the utilization of FBT for teens with anorexia. See the breaking news at: http://www.eurekalert.org/pub_releases/2010-10/sumc-ftf093010.php

Families can lead to the cure, everyone. Keep your spirits and efforts focused on recovery.

Family Feeding Dynamics Meets FBT

2010-09-15T16:24:54-07:00

I am a huge fan of the work of Ellen Satter. If you are not familiar with her work, she focuses on healthy feeding practices for families. You can learn more about her approach at her website: http://www.ellynsatter.com/. On her homepage Satter says, “My mission is to help children and adults be joyful and competent with eating.”

This is also my mission. It is not easy in the wily world of eating disorders. For families struggling with the unpredictable, scary and often frustrating world of eating disorders, the family feeding experience can often feel anything but joyful. When ED has taken over the table, joy disappears. And parents watching their child whither away before their eyes can often feel anything but competent.

The grace behind the refeeding process is the opportunity to bring a sense of joy and mastery back into your family’s life ...getting there one bite at a time.

Weighing In

2010-08-30T16:42:39-07:00

To say that refeeding is a difficult process for all involved understates the endurance and herculean effort required. It is thus understandable that when a child with anorexia starts to make progress in eating again and restores a bit weight-wise, there is a tendency for the family to think the problem is “over,” declare victory, and attempt to move on. If this is done prematurely, the results can range from disappointing to devastating.

Anorexia is a sneaky illness and can continue to linger in unexpected and unpredictable ways. Celebrate those mealtime victories but remember that long lasting results depend on full weight restoration—meaning, a healthy weight for your child’s body, not what a weight chart indicates in minimally acceptable. This is the essential, foundational element for full recovery.