Ten Years Later: A Clinician’s Reflection

By Sarah Ravin, Ph.D.
Licensed Psychologist
FEAST Advisory Panel

Ten years ago, I wrote my first essay for F.E.A.S.T: A Clinician Faces Old Ideas As She Pursues A New Career At that time, I was a post-doctoral psychology resident looking forward to a career as a psychologist specializing in the treatment of eating disorders.  A year after the publication of that essay, I earned my Florida Psychologist license.  Since then, I’ve played multiple distinct but intersecting roles in the eating disorder world.  By approaching eating disorders through different professional lenses, my knowledge and understanding of these conditions have broadened and deepened, and my commitment to helping those affected by eating disorders has grown ever stronger.

As a practicing clinical psychologist, I’ve had the honor of assessing, treating, and consulting with over 300 individuals and families with eating disorders, anxiety, depression, and related mental health concerns.  As a researcher, I’ve compiled and analyzed treatment outcomes on my patients and published the results on my blog. As a professional advisor for F.E.A.S.T, I’ve written essays, consulted with parents, and spoken at conferences.  As a scholar, I’ve read countless research articles and attended professional conferences to keep abreast of the latest developments in this rapidly changing field.  As a writer, I’ve kept a blog and written articles for online publications on eating disorders and related topics in mental health.  As a speaker, I’ve presented to audiences of eating disorder professionals and young psychologists in training.  Each of these roles has been illuminating, challenging, and fulfilling in its own way.

More transformative than any of these professional roles, however, has been the process of becoming a parent myself.

A decade ago, as a child-free young professional, I believed strongly in the power of parents to guide their children to recovery.  I kept parents fully informed and actively involved in their child’s treatment.  I knew that parental love, investment, and intuition were essential ingredients that only parents could bring to the treatment process.   But back then, these principles and beliefs were somewhat abstract, stemming from my knowledge of the research base and my clinical experience.   Now, as the mother of two small children, I have experienced first-hand the playful joy, the constant stress, the crippling guilt, the unconditional love, the worry, the unshakable bonds, the all-consuming investment, and the enormous responsibility of parenting.  Nothing else quite compares.

Being a mother affords me access to an internal parental compass that I’ve found infinitely useful in my professional work.  I have experienced the heart-gripping worry of parenting a sick child, and I have harnessed my maternal instincts and unwavering love in service of my children’s ultimate well-being.   Now, when I’m faced with a challenging clinical dilemma or approached by a terrified parent desperate for guidance, I can easily imagine my own daughter or son in this situation. When I ask myself, what would I do if this were my child?  The answer often becomes clear. Thankfully, I have not yet encountered a terrifying brain disorder or a life-threatening illness in either of my children.   But if these challenges arise in my family’s future, I can only hope that I can guide my children through them with half the fortitude, grace, commitment, and determination that I witness every day in the parents I counsel.

In my clinical work over the past ten years, I have experienced, time and time again, the incredible power of true collaboration between parents and clinicians to provide a circle of safety around recovering patients.  I have had the honor of meeting desperate, lost, and terrified parents, teaching them skills they never thought they’d need, educating them about the illness their child is facing, instilling hope for full recovery, and empowering them to take charge of guiding their precious child through this daunting process.

I have treated defiant, combative adolescents with anorexia nervosa who hurled obscenities at me for the first few weeks of treatment, then gradually softened and engaged in conversation as their brains were re-nourished, and participated actively and confidently in their recovery towards the end. Here’s a vivid illustration of the passage of time:  the first patient I saw for Family-Based Treatment in private practice was an angry, hostile middle-schooler who fits the description above.   She recovered from anorexia nervosa in less than a year, then returned to me for treatment for depression later in high school.  Since then, she graduated from a prestigious university in another state, got an excellent job, and is now a young professional in her 20’s living and working independently.   She is happy, healthy, socially connected, and living a productive life.  She has been fully recovered from anorexia nervosa for nine years now.  I know all of this because she returns for a session once a year when she is in town visiting her family.   I can’t help but smile when I think of her incredible transformation.

Over the past decade, I have witnessed a number of positive changes in the eating disorder field.  First, the grass-roots movement of parent advocates has grown exponentially in size and strength.  F.E.A.S.T. has a substantial presence at professional conferences.  The voices of parents and other caregivers are increasingly welcomed as integral parts of research, treatment, and advocacy.   Second, the demand for Family-Based Treatment (FBT) is increasing and FBT services are becoming more widely available.  Meanwhile, many more FBT-based trainings and talks are available at professional conferences.   Third, our field has become increasingly aware of the role of weight stigma in delaying access to care and undermining treatment. Many clinicians have adopted a Health at Every Size philosophy, recognizing that restrictive eating disorders occur in people of all shapes and sizes, and that full recovery should not be constrained by what is deemed a societally attractive BMI.  Forth, there is a greater awareness of the vital role of full nutrition in recovery from all types of eating disorders.    Finally, there seems to be a bit more awareness of eating disorders on the part of pediatricians and primary care physicians.  These first responders seem to be quicker to identify the early signs of eating disorders and quicker to refer for treatment, at least in my neck of the woods.

And yet, there is still work to be done.   A few weeks ago, a parent whose son I am treating in FBT attended a local support group for parents of individuals with eating disorders.  The other parents in the group reacted with shock and criticism when this mother described how she plates her teenage son’s food, eats meals with him, and attends weekly family therapy sessions.  “Don’t be the food police,” they advised her.  This mother was equally shocked that the other parents in the room, mothers and fathers of teens and adults who had been ill for a number of years, had never been involved with their child’s eating or therapy sessions, and in fact had been specifically advised by their child’s clinicians to “stay out of it.”  Fortunately, this mother was well-informed enough to understand that she was providing her son with evidence-based treatment which is likely to result in full recovery in a shorter time than the “don’t be the food police” approach.   But still, her confidence was shaken, and she carried around a vague sense of guilt for days afterward.

I envision a future in which all parents are strongly encouraged to participate actively in their child’s treatment, from therapy sessions to doctor’s visits to food preparation and meal support.  I imagine an era – perhaps a decade from now – in which the majority of participants in a community parent support group are magic-plating their children’s food and supporting them through mealtimes, regardless of their age.   And most of all, I hope to help create a future in which parents are viewed as the leaders of their child’s treatment team, in which true collaboration between families and clinicians is universally expected as a standard part of eating disorder care.

Dr. Sarah Ravin received her B.A. in psychology from Smith College and her Ph.D. in clinical psychology from American University.   As a licensed psychologist in private practice near Miami, FL, she provides evidence-based treatments for children, adolescents, and young adults and consultations to parents who are supporting their children’s recovery. She specializes in Maudsley Family-Based Treatment (FBT) and Cognitive-Behavioral Therapy (CBT) for eating disorders, anxiety, depression, and related mental health issues.  Contact Dr. Ravin at info@drsarahravin.com or visit her website at www.drsarahravin.com for more information.