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ED ED in Adolescence: What Would Big You Do for Youth You?

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Kintsugi

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I’m rapidly reorganizing my thinking and approaches at my new job working with adolescents with eating disorders in an inpatient/group home setting. It’s been pretty nonstop until today, as the organization is struggling to retain and regroup staff following major structural changes, and I was pretty much fast-tracked between being recommended by a therapist, my very old and close college friend, and being very highly trained thanks to the prestige of my former position with the government.

I remember starting my last job and feeling pretty overwhelmed there, too, so I’m trying not to make any snap decisions about the value of working at this facility. On the one hand, my friend helped me dodge a major bullet working for another institution, which I researched after being cautioned by her and found an outlandish number of lawsuits and former attendees claiming that they were extremely traumatized by the punitive nature of the facility. On the other hand, this facility lacks any consequences at all for its clients, and approaches to managing problematic behavior and guiding clients through the tumult of their disorders outside of their time with clinicians is very DIY because of the lack of structure and training. I’ve had to take it upon myself to set up meetings with various spokes of the medical team wheelhouse in order to garner a modicum of understanding regarding the policies and philosophies guiding the treatment of these teens.

Being thrown into the fray with little notice and less training, especially considering my own history of trauma and ED/chronically disordered eating habits, caused a weird internal backfire where I was positioned to be more reactive than proactive in my approach to managing the needs of the clients. The other staff are themselves completely fragmented in their approaches to this work, offering no stable or singular methodology or even the slightest appearance of consistency, even going so far as being completely oblivious to the main tenants of the treatment paradigm I was able to establish my first week through meetings with clinicians.

In short, it’s very chaotic, and I’m still trying to figure out how to approach these teens in my efforts to assist them. The one constant in my thinking is that I’d like to be the sort of person I needed when I was a traumatized teenager with a rabid case of anorexia.

So what is it you would do or say if you could go back as an adult to your adolescent self, whether you had PTSD, BPD, OCD, an ED, etc. at that juncture of your development?

Something I think is fundamental to my own experience is hearing the message I fought tooth and nail to refute or depose—that I am worthy, and there’s not a damn thing wrong with me.

Another thing I’ve tried to communicate—and I’ve been stared at like I’m speaking gibberish—is that even if it’s total crap that a teenager is the only one in a household doing the hard work, even though the adults should be pulling their own weight of accountability, that hard work will be a gift to your future self that just keeps on giving in adulthood.

Promulgating this messaging often feels like beating my head against a wall (that might actually have a greater tangible effect), but I’m trying nonetheless.

I’d love to hear some ideas from this community, especially those who have struggled with BPD since adolescence (or earlier).
 
I’m rapidly reorganizing my thinking and approaches at my new job working with adolescents with eating disorders in an inpatient/group home setting. It’s been pretty nonstop until today, as the organization is struggling to retain and regroup staff following major structural changes, and I was pretty much fast-tracked between being recommended by a therapist, my very old and close college friend, and being very highly trained thanks to the prestige of my former position with the government.

I remember starting my last job and feeling pretty overwhelmed there, too, so I’m trying not to make any snap decisions about the value of working at this facility. On the one hand, my friend helped me dodge a major bullet working for another institution, which I researched after being cautioned by her and found an outlandish number of lawsuits and former attendees claiming that they were extremely traumatized by the punitive nature of the facility. On the other hand, this facility lacks any consequences at all for its clients, and approaches to managing problematic behavior and guiding clients through the tumult of their disorders outside of their time with clinicians is very DIY because of the lack of structure and training. I’ve had to take it upon myself to set up meetings with various spokes of the medical team wheelhouse in order to garner a modicum of understanding regarding the policies and philosophies guiding the treatment of these teens.

Being thrown into the fray with little notice and less training, especially considering my own history of trauma and ED/chronically disordered eating habits, caused a weird internal backfire where I was positioned to be more reactive than proactive in my approach to managing the needs of the clients. The other staff are themselves completely fragmented in their approaches to this work, offering no stable or singular methodology or even the slightest appearance of consistency, even going so far as being completely oblivious to the main tenants of the treatment paradigm I was able to establish my first week through meetings with clinicians.

In short, it’s very chaotic, and I’m still trying to figure out how to approach these teens in my efforts to assist them. The one constant in my thinking is that I’d like to be the sort of person I needed when I was a traumatized teenager with a rabid case of anorexia.

So what is it you would do or say if you could go back as an adult to your adolescent self, whether you had PTSD, BPD, OCD, an ED, etc. at that juncture of your development?

Something I think is fundamental to my own experience is hearing the message I fought tooth and nail to refute or depose—that I am worthy, and there’s not a damn thing wrong with me.

Another thing I’ve tried to communicate—and I’ve been stared at like I’m speaking gibberish—is that even if it’s total crap that a teenager is the only one in a household doing the hard work, even though the adults should be pulling their own weight of accountability, that hard work will be a gift to your future self that just keeps on giving in adulthood.

Promulgating this messaging often feels like beating my head against a wall (that might actually have a greater tangible effect), but I’m trying nonetheless.

I’d love to hear some ideas from this community, especially those who have struggled with BPD since adolescence (or earlier).

As a teacher, w CPTSD and teen issues, my personal biggest issues were belonging, feeling stupid, and not fitting in. In the special needs class, I taught my kids who were diagnosed with PTSD, DID, those whose parents reported alters, and those who constantly were zoning out....about their "smart part"-everyone has one, some know it, many people don't know it. It was a general concept I taught to the whole class. We then looked at our strengths. It was a door to talking about their "dumb part" or the way they felt stupid or different. I also gave written positive feedback, used the word proud, and said "thank you" for.....sharing, honesty, being brave, taking a risk-whatever was appropriate. Kids don't hear "thank you" enough, and that helps develop trust. When I was a teenager, I got sick, and needed to know people really cared-not just told lip service.
 
Kids don't hear "thank you" enough, and that helps develop trust.
I agree with this, and it’s something that’s been easy to translate from working with developmentally disabled adults, most of whom were nonverbal, who also tend not to hear “thank you” enough. There are three types of praise emphasized in behavior modification training geared towards person-centered work (basically any caretaking position where the person served needs behavioral guidance away from maladaptive behavior/coping strategies), and I try to use all three in an hour every hour, especially when I know the kids hate the rule they’re following, like asking me to flush the toilet (to ensure no one is purging).

Something I’ve asked them to keep me accountable for is not using the phrase “Would you mind” when I am in fact instructing them to do something that isn’t negotiable. It’s definitely had a positive impact on my relationship with them, because we all have a nice laugh about it when they correct me, as I’ve told them that *I* absolutely hated that phrase as a teenager. I think it helps remind them that they’re not the only ones working on themselves, that I was also a teen once, and reminds me of what being a teenager really felt like. I mention this because I think that the lack of gratitude expressed towards teens/kids is tied up in taking for granted just how much adults run their lives and how maddening that can feel as they gain the tools and will to be increasingly independent. If I asked a coworker if they would mind doing something, no would be an optional answer, but when I ask a child, I really mean “You must do,” and framing it otherwise rhetorically is very annoying IME for the recipient of that instruction.

kids who were diagnosed with PTSD, DID, those whose parents reported alters, and those who constantly were zoning out....about their "smart part"-everyone has one, some know it, many people don't know it. It was a general concept I taught to the whole class.

This is interesting. I wonder if most of our clients aren’t familiar with the wise self DBT paradigm. My T also encouraged me not to see my dissociative self, who is so efficient and smart when at the wheel, as pathological and instead asked me to frame this trick of the mind as a valuable skill. I have always had a very strong love/hate relationship with dissociation, because it’s both destructive and useful, and she always took the position that she didn’t want to “take away” my ability to dissociate but simply help me get to a place where I was choosing whether to use it as a skill instead of it happening whenever. That really helped me reframe my goals re: dissociation as well as my relationship with it as a part of me rather than a broken thing I had.

I needed someone to talk about the lesser known/more taboo parts of mental illness and abuse.

That’s very much my goal, and it’s a delicate balance, as I can’t disclose my personal history. I tip my hand in terms of just how much I know about trauma and mental health when I think it will help normalize someone, though, or something they’re struggling with. One client claimed she had MPD, and I said, “Dissociative identity disorder?” Just the way she looked at me and said “yeah” let me know she was both surprised and relieved with my familiarity. It was a very small moment that I believe may be the reason she so readily shares her thoughts with me. I don’t know. It seemed to help open the door.

I would have needed to hear that I was worth fighting for. That I was loved and valued.

This is definitely something I’m working on. Just like me at that age, hearing the above would most definitely cause a volatile reaction, because when they get the slightest compliment, they act as if they’ve been spit on. I know what it’s like to have a head full of voices clamoring to shout down anything positive sent my way. In the plainest language possible, I try to remind them that I don’t need my job for the money (I don’t): I’m only there because I believe in trying to help them save their own lives. They’re uniformly in denial about just how close to their own mortality they are. They’re battling a condition with the highest mortality rate in the DSM, and most of them come straight from emergency treatment at the hospital. I desperately want to communicate—I mean really get it through—to them that I am there because I believe they are worth showing up for and deserve to be treated with care and respect. It’s so hard when that’s the very idea they have eschewed to the point of almost dying from malnutrition.

I needed someone to just listen.

Definitely a lot of that for me. Thank you for underscoring it, though. Sometimes I’m so desperate to counter their core negative beliefs and cognitive distortions that I forget to just sit back and fully absorb as much as possible before they clam up again.

I needed someone to see me. Really, truly see me.

Luckily the clients themselves get this. I am so happy when I watch one approach another who is clearly going through some personal internal hell, and they say, “I see how hard this is for you, and I see how hard you’re trying. You’re doing great.” Those moments make me forget how frustrated I can be with the failing infrastructure of the organization. They’re really special. They’re each incredibly special. Even if I sometimes want to tell them to stop being brats... :bag:
 
I agree with this, and it’s something that’s been easy to translate from working with developmentally disabled adults, most of whom were nonverbal, who also tend not to hear “thank you” enough. There are three types of praise emphasized in behavior modification training geared towards person-centered work (basically any caretaking position where the person served needs behavioral guidance away from maladaptive behavior/coping strategies), and I try to use all three in an hour every hour, especially when I know the kids hate the rule they’re following, like asking me to flush the toilet (to ensure no one is purging).

Something I’ve asked them to keep me accountable for is not using the phrase “Would you mind” when I am in fact instructing them to do something that isn’t negotiable. It’s definitely had a positive impact on my relationship with them, because we all have a nice laugh about it when they correct me, as I’ve told them that *I* absolutely hated that phrase as a teenager. I think it helps remind them that they’re not the only ones working on themselves, that I was also a teen once, and reminds me of what being a teenager really felt like. I mention this because I think that the lack of gratitude expressed towards teens/kids is tied up in taking for granted just how much adults run their lives and how maddening that can feel as they gain the tools and will to be increasingly independent. If I asked a coworker if they would mind doing something, no would be an optional answer, but when I ask a child, I really mean “You must do,” and framing it otherwise rhetorically is very annoying IME for the recipient of that instruction.



This is interesting. I wonder if most of our clients aren’t familiar with the wise self DBT paradigm. My T also encouraged me not to see my dissociative self, who is so efficient and smart when at the wheel, as pathological and instead asked me to frame this trick of the mind as a valuable skill. I have always had a very strong love/hate relationship with dissociation, because it’s both destructive and useful, and she always took the position that she didn’t want to “take away” my ability to dissociate but simply help me get to a place where I was choosing whether to use it as a skill instead of it happening whenever. That really helped me reframe my goals re: dissociation as well as my relationship with it as a part of me rather than a broken thing I had.



That’s very much my goal, and it’s a delicate balance, as I can’t disclose my personal history. I tip my hand in terms of just how much I know about trauma and mental health when I think it will help normalize someone, though, or something they’re struggling with. One client claimed she had MPD, and I said, “Dissociative identity disorder?” Just the way she looked at me and said “yeah” let me know she was both surprised and relieved with my familiarity. It was a very small moment that I believe may be the reason she so readily shares her thoughts with me. I don’t know. It seemed to help open the door.



This is definitely something I’m working on. Just like me at that age, hearing the above would most definitely cause a volatile reaction, because when they get the slightest compliment, they act as if they’ve been spit on. I know what it’s like to have a head full of voices clamoring to shout down anything positive sent my way. In the plainest language possible, I try to remind them that I don’t need my job for the money (I don’t): I’m only there because I believe in trying to help them save their own lives. They’re uniformly in denial about just how close to their own mortality they are. They’re battling a condition with the highest mortality rate in the DSM, and most of them come straight from emergency treatment at the hospital. I desperately want to communicate—I mean really get it through—to them that I am there because I believe they are worth showing up for and deserve to be treated with care and respect. It’s so hard when that’s the very idea they have eschewed to the point of almost dying from malnutrition.



Definitely a lot of that for me. Thank you for underscoring it, though. Sometimes I’m so desperate to counter their core negative beliefs and cognitive distortions that I forget to just sit back and fully absorb as much as possible before they clam up again.



Luckily the clients themselves get this. I am so happy when I watch one approach another who is clearly going through some personal internal hell, and they say, “I see how hard this is for you, and I see how hard you’re trying. You’re doing great.” Those moments make me forget how frustrated I can be with the failing infrastructure of the organization. They’re really special. They’re each incredibly special. Even if I sometimes want to tell them to stop being brats... :bag:

I love everything you wrote here.
 
At 17 I was leaving home. Not really any plan in place other to get my parents and all their “holier than thou” “this is how you should be living” crap off my back. Which is pretty much how I saw it - reasonably or not.

I’d found ways to cope with my shitty life. My parents not approving (vocally) was reason to not listen to them. Because at 17? I had the brain and strong will of a 17 year old.

If I was forced into treatment that I didn’t want, to change my one coping skill for living? I’d need any advice to start with an acknowledgement of that: you don’t want to be here, you’ve found a coping skill that seems to be working well from your perspective, I get it.

That would be essential to me taking on board anything else a treatment person wanted to contribute. If they can’t acknowledge I’m doing my best with what I’ve got and I don’t need anyone else’s approval? Maybe we can work together.

I spent a long long time in that mindset. My preferred coping skill apparently made me “mentally unwell”. The people that got through? Were the ones who were upfront that all they were doing was offering ‘an alternative way to be.’ One that might not include so much internal suffering.

I’d listen to those people. The ones that started with the premise that I was entitled to do things my way, and all they were doing was showing me some alternatives to consider.

And if they could back that up with why their alternative might include less suffering? Then I usually gave their ideas a lot more time than I was prepared to let on.

In an ED setting, that needs to include rock solid, bulletproof info on exactly how good nutrition is going to reduce my internal suffering.

I was the kind of person that I wasn’t going to take your word as gospel. In my day, you needed to be ready with names of books I could read that would substantiate your ideas. These days? That’s probably websites or podcasts.

It sounds like this is the kind of typical ED environment where there’s going to be a strong tribal alliance between the patients which silently undermines the message trying to be taught to them. Know that alliance is there, it’s a very powerful, persuasive force, and it’s legitimate. They really do understand each other, and they have been thrown into the same shitty situation that they don’t really want to participate in. They’re getting advice from each other. IME you don’t fight with that, you just keep offering ‘an alternative’ that you can back up with more than “because I said so”.
 
It sounds like this is the kind of typical ED environment where there’s going to be a strong tribal alliance between the patients which silently undermines the message trying to be taught to them.

Interestingly, I anticipated this, but it’s quite the opposite. Just as my ED-affected self would never encourage my friends/loved ones or pets to restrict food, they do not express to one another in any way other than validating how reasonable/necessary urges to restrict feel that restricting is a good, healthy, or righteous thing. They actually echo the messaging we (the staff and medical team) preach to each other. Much like one who self-harms would not stand by and encourage their friend to carve trenches into their body, these kids are very much in support of their peers’ recovery. It’s their own intrusive negative self talk/ED voices that they struggle with personally. I am not worthy of food, but these people around me are beautiful and worthy. Y’know? And that, at least, is very powerful, even if when the same words come out of my mouth I know it’s not getting through half as clearly.

I also anticipated that they would never guess my own issues, but I know at least a few caught me in my first days engaging in what they call EDBs—eating disorder behaviors. I didn’t know I had them until I learned more about these behaviors in the latter part of my first week. One has tried to bait me by making up a story about someone on the medical team sharing her history with ED and emphasizing repeatedly that they prefer to be treated by people who understand ED personally. I didn’t take the bait, and I confirmed that the story was fabricated, but nevertheless they obviously see something worth baiting, and they have made numerous comments to me on a near-daily basis that I know are designed to make me blurt our something personal. I’m not used to working with clients who are so crafty. It’s really a mind f*ck. And I’m seeing increasingly that it’s imperative I make a plan before mealtimes, because I know it’s not gone unnoticed that I’m always the last person to choose a food and sit down. I have an EBD I WAS aware of, one that sticks out like a sore thumb to everyone who knows me and that I’ve very plainly explained to people is a holdover from my ED: I prepare food and then wait 10 minutes before eating it, no matter how ravenous I am or how long it took me to cook. It used to drive one of my coworkers insane until I told her it was a ritual leftover from anorexia—my last standing exercise in daily self-denial. Obviously I can’t do that at work. I can’t make a plate of food and walk away (I always leave the room for this period). I also can’t take forever to eat (there’s a timer), spin a spoon and lick it instead of scooping food, tear food apart methodically (I did this my very first meal, and I think it was the biggest hint), always choose the smallest available utensils... yeah, basically everything I know as my way of eating is actually textbook EDBs.

Now that it’s been... almost 3 weeks? I’m feeling more ready to deal with my own shit more gracefully. Overhauling all of my usual eating behaviors over night sucked really bad, and it absolutely took energy away from the rest of my actual job. Luckily, I’ve been assured that I’m far from the first person to struggle most with being a good example for normalized eating.

Also luckily, re: your points, @Sideways , we very much aren’t a “because I said so” institution. The kids go through multiple sessions both in groups and individually daily with therapists and dieticians where they are positively loaded with factual information. Sadly, at least a couple of the clients know that they have basically destroyed their bones/organs/teeth/esophaguses etc. Several will probably die if they relapse after this. That’s just what it is. I’m trying to help them focus on the fact that they are so, so close to being adults, and gaining healthy coping skills now will be invaluable in adult life, where they will be able to choose the environment they want to foster and pursue for themselves, but having PTSD and having been in their exact shoes myself, I know how difficult it is to imagine a future, especially a future free from toxic family dynamics.

I also left home when I was 17, although my circumstances were far better. I went to college very, very far away from home, and next month will be my 11 year anniversary of Never Moving Back. I could have never ever conceived of the life I have now, the liberties I have, the happiness I’ve found, the equilibrium I’ve gained. I still have around a half dozen PTSD meltdowns a year, and I still have symptoms I’d rather not, but the majority of my life is ruled by rational thinking and positive relationships.

When I’ve interacted with teens here on the forum, I’ve been able to be very frank about my own experiences and say things without putting on kid gloves. This forum is for peer support 14 years old and up, so even if the member is 14, I’m speaking to them as a peer. I wish I could be half as candid with my clients, but I can’t be. It’s not that I want to give them my personal sob story; I just wish I could be more direct. There are so many incidents of kids crying crocodile tears to parents about made up stories of staff cruelty that everyone seems all too willing to treat them like fragile young children rather than people on the cusp of young adulthood, so anything that could possibly be called harsh (like reminding someone they are going to actually die if they don’t commit to recovery for their own sake) brings on a lot of pearl-clutching. But the staff who do say the hard things also seem to be the most respected. It’s a very blurry line still.
 
I applaud you for even thinking about this. The best you can possibly do is be conscious of DO NO HARM. and that is a tall order to achieve and contain in consciousness.
For me those that truly influencing me in my life did not even know what was happening to me. They were relatives that for some reason or another who truly just looked at me, and responded to me like I was the last person on earth. Where my parents were neglecting, these relatives (few and far in between of both sexes) just listened to me, validated my existence, and generally connect with me like human. What I remembered from my body memories and some I was really young is that they respected my autonomy, boundaries and gave me initiative to be creative and spontaneous...I am using these words because now I know that was the impact. not to mention their appreciation for my humor and humanity. Just be you and be your best around them. I think emulating that is what they need not an input or influence. Remember their individual stories and treat them like an individual rather than one of the kids. I think by thinking about this you are already conscious of that. Kudos. You may change but I feel they may change you even more than you are anticipating. Good luck. Every child needs one good adult in their life. Just one!
 
that everyone seems all too willing to treat them like fragile young children rather than people on the cusp of young adulthood

Right. Fragile dying young children would get the health care necessary to save them in my book, its doing them the courtesy to talk to them *as adults* and letting them decide at this point, because they pretty much botched their life to this point.

So yeah. I get boundaries & consent gets tricky, there.
But goddamn sensitivity aside. They have a life threatening condition.
It IS caring for them to not let them die, and encourage that mindset.
 
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