Dr Danielle Crane Ltd Private Therapy

I am excited to announce that, in addition to working part time as a Principal Clinical Psychologist in the NHS, I will now be taking on clients for online therapy as part of my new Private Practice, Dr Danielle Crane Ltd.

For more information about the therapy I offer, you can view my website:

https://drdaniellecrane.wixsite.com/psychology

I have also started sharing videos on social media:

https://www.instagram.com/drdaniellecrane

https://www.youtube.com/@drdaniellecrane

Facebook: Dr Danielle Crane – Clinical Psychologist

And I have created downloadable resources:

https://direct.me/drdaniellecrane

Treatment of Eating Disorders in Young People

I used to work in a CAMHS eating disorder service with a team of nurses and family therapists. I learnt a lot during my time there and I thought I would share some of it with you.

NOTE: This information should not substitute accessing treatment. Each case is unique and requires specialist intervention.

Diagnosis:

Anorexia Nervosa:

1. Persistent restriction of dietary intake leading to significant low weight (in context of what is expected for age, height and gender).
2. Either an intense fear of weight gain/becoming fat or persistent behaviour that interferes with gain.
3. Disturbed experience of weight/shape, undue influence of weight/shape on self-evaluation or lack recognition of the seriousness of their low weight

Complications of AN

Bulimia Nervosa:

1. Recurrent binges: eating an unusually large amount of food in a discrete period of time and a sense of lack of control over eating during the episode.
2. Recurrent inappropriate compensatory behaviour or purging in order to prevent weight gain.
3. Binge/purge both occur on average at least once a week for 3 months.
4. Undue influence of weight/shape on self-evaluation.

Complications of BN

To be diagnosed with an eating disorder the young person needed to have both the cognitive and behavioural elements of the condition and the they would needed to rule out other possible causes, such as autism or anxiety.

Treatment approach:

At the time, we used the New Maudsley Method, which was developed by Janet Treasure. You can find her book (written for parents) here. This approach involved supporting the parents in refeeding their child. Parents were educated about eating disorders (including all the tips and tricks sufferers will resort to), how to put in place boundaries regarding mealtimes and how to address any maintaining factors such as family dynamics. We stressed that the parents were experts on their own families and supported them in finding their own solutions where possible.

This would be done using family therapy sessions, preferably with the whole family attending, and sometimes also parent groups. In family therapy sessions we would sometimes ask them to bring in lunch so that we could observe how they interacted at meal times and give some helpful observations.

Managing meals:

We advised families to eat together at the table. Everyone should have the same meal and the young person should be given an appropriate portion size for their age. Usually parents know how to feed their child, as they have been doing so for many years before the eating disorder, and therefore don’t require input from a dietician.

We occasionally gave them a worksheet to help them plan their meals.

Meal planner

If the young person has been eating less than 500 calories a day for an extended period then they may be at risk of refeeding syndrome, which is a potentially fatal condition. They would therefore need to gradually increase their intake by 200 calories a day.

It should be made clear that the young person is expected to finish everything on their plate and will not be allowed to leave the table until they have done so.

If the young person tries to negotiate then parents should try to avoid being dragged into an argument and instead must continue to state simple encouragements like ‘I understand it is difficult and you need to finish what’s on your plate’. It will often seem monotonous and can take hours but it is really important to stick with it. Parents will need to work together and make sure they are being consistent even when the young person tries to split them.

Supporting a young person to eat when the eating disorder is telling them not to is very stressful and it may feel cruel at times. It is important to remember that you are saving your child’s life and you are fighting against the eating disorder, not them. When they tell you they hate you or lie to you, it’s generally the influence of the eating disorder. They are acting out of sheer desperation.

Parents should take their child to the GP regularly so their physical health can be monitored. They will generally need weekly weigh-ins, blood pressure monitored (sitting and standing) and blood tests.

It’s important to note that BMI is not an accurate measure in under 18 year olds as they are still developing. We therefore used a measure called Weight for Height, which compares the young person’s weight and height against the normal distribution of other young people of the same age and gender.

Risk managment:

We also provided parents with a rough guide for managing risks:

ED Risk Management

Parenting styles:

Janet Treasure identified six of the most common parenting styles (see below). Ideally parents should aim for the St Bernard emotional response and the Dolphin behavioural response, so that they can calmly guide and support their young person.

PARENT CARING STYLES

Individual therapy:

Once the young person had gained enough weight that they were no longer cognitively impaired, we could also offer one-to-one sessions. I would generally start with Motivational Interviewing, to help motivate the young person towards making changes regarding their eating. More details of this method can be found here.

Once the young person is showing signs of being motivated towards change, we can then start doing some sessions of CBT to help them challenge some of the eating disorder thoughts. We would also then start doing behavioural experiments where we test out some of their assumptions. Details of these approaches can be found here.

Grading foods:

We would start to gradually introduce foods that the young person has cut out. This may involve grading the foods:

GRADING FOODS

I often used the tree of life project with young people towards the end of their treatment, to help them develop a sense of identity separate from the eating disorder. Occasionally they were also taught new skills like poi and juggling so that the focus wasn’t entirely on their eating and they could start rebuilding interests and hobbies. A lot of these activities are also great ways of practising mindfulness.

I remember being surprised that the treatment model involved refeeding before individual therapy. It seemed backwards to expect someone to eat before changing their distorted thoughts. It seemed cruel but it was necessary as often people who are very underweight don’t have the cognitive ability to engage in therapy and are at such a dangerous weight that restoration needs to be prioritised. There’s no time for talking therapies if they’re on the verge of being admitted to hospital.

I’ve seen many cases of eating disorders and I know that generally this method is very effective and it has been supported by research. On a few occasions the young person became too unwell and need to either be admitted to an inpatient unit or a day service, where they were supported to eat or provided with group sessions like art therapy, self-esteem work, etc.

Resources:

Books:

Skills-based Learning for Caring for a Loved One with an ED: New Maudsley Method: Janet Treasure, Grainne Smith, Anna Crane

Help your Teenager Beat an Eating Disorder by James Lock and Daniel Le Grange

Anorexia and Bulimia in the Family by Grainne Smith
Anorexia Nervosa: A Survival Guide for Families, Friends and Sufferers by Janet Treasure.

Can I tell you about Eating Disorders: A guide for family, friends and professionals. By Bryan Lask and Lucy Watson

Websites:

www.eas-ed.co.uk
Website run by the parents of some of our recovered patients

http://instagram.com/facerecovery#
Instagram account run by some of our recovered patients

www.maudsleyparents.org

www.b-eat.co.uk

www.feast-ed.org

http://www.eatingdisorderssupport.co.uk/

http://anorexiabulimiacare.org.uk/

http://www.samaritans.org/

http://www.mentalhealth.org.uk/

http://www.sane.org.uk/

http://www.onlywayisupfoundation.com/

Phone numbers:

For people in Essex: Emotional Wellbeing and Mental Health Service (including the Eating Disorder Team): 0300 3001600

Samaritans: 08457 90 90 90

B-EAT Helpline: 0845 634 1414

B-EAT Youthline: 0845 634 7650

Eating Disorders Support Helpline: 01494 793223

Anorexia and Bulimia Care Helpline: 03000 11 12 13

The Only Way is Up Foundation Helpline: 0845 467 2231

Young minds parent helpline: 0808 802 5544

Enrichment List: Small steps to improve your life

This is list of ideas for things you can do to improve your life:

Get organised:

• Make a to do list
• Get a big calendar and write down everything you need to do
• Get a diary to record appointments in
• Scan or file any important documents
• Shred any documents you don’t need
• Register for online documents where possible
• Unsubscribe from any mailing lists you don’t need
• Clear old emails

Make a playlist of songs you love:

Music can have a significant effect on your mood. Try making a playlist that you love or a few different playlists for different situations e.g. running, cooking, driving or when you’re feeling down. You can ask friends for suggestions or look online for similar bands to the ones you already like.

Clean your car:

Make sure your car is safe and ready to use:

• Wash the outside of the car
• Top up the water
• Check the oil
• Clean the inside of the car
• Put an emergency pack in your cubbyhole: toothbrush, underwear, painkillers, mini torch, water bottle, etc.
• If it’s winter, make sure you have deicer, scraper, blanket, gloves, etc.
• Check your insurance, MOT and road tax are up to date
• Check your tyre pressure
• Update your sat nav

Try some new foods:

Having a balanced diet is important, not only for your physical health but also your mental health. Try to increase the variety of the foods you eat by trying a new food each week or learning to cook a new meal. You could even blindfold yourself and let your friends or family give you various foods to try.

Declutter:

Having too many belongings can make your home cluttered and leave you feeling overwhelmed. Try decluttering and just keeping the items you actually use or love to give yourself more space, time and organisation. Each time you consider an item, ask yourself:

• ‘Do I need this?’
• ‘Have I used this in the last 6 months?’
• ‘Do I love this?’
• ‘Does it work/fit?’

If the answer is no to these questions, then consider throwing the item away or donating it to charity.

You can focus on one area at a time or set yourself a goal of removing one item a day. For clothes, you can turn your hanger around each time you wear something so that way you will be able to tell which items haven’t been used at the end of the 6 months.

Practice Random Acts of Kindness:

Do something kind for someone else without expecting anything in return. This could include:

• Giving out blankets to the homeless.
• Sending a pizza to a friend’s house anonymously.
• Leaving inspirational notes in library books.
• Leaving books on the underground for others to read.
• Paying for the next person in line.

Clean your home:

A clean home environment helps to promote positive change. Try focusing on one room or section at a time. This can include wiping down all the surfaces, cleaning out your fridge or putting everything in its rightful place.

Keep a gratitude list:

It’s easy to end up focusing on the negatives, especially if we’re feeling down. Try to set aside a brief moment each day where you name one thing you’re grateful for. Eg you smiled when you saw a robin in the garden, you got to lie in for an extra 10 minutes this morning or your favourite song played on the radio.

Write a Will:

Writing a Will can help ensure that your family are cared for in the event that anything happens to you. You can use an online guide or ask a professional to help you write it. Consider also writing a letter to your family that you can put with your Will.

Learn a new word each day:

Gradually increase your vocabulary by learning a new word each day. You can subscribe to daily emails, use an app that turns this into a game or simply work your way through a dictionary or thesaurus.

Express yourself through art:

Draw, paint or sculpt something to express yourself. It doesn’t need to be perfect. You could consider:

• Creating a self-portrait.
• Creating two drawings to show the version of you that others see, compared to how you see yourself.
• Make a collage of things that inspire you.
• Decorate a shoe box and fill it with things you love.
• Create a postcard-sized piece of art each day and display them all together at the end of the month.
• Pick something that you find hard to draw and practice it.
• Put paint splatters on a page, fold it in half and then open it back up to see the pattern you created.

Fix things around the house:

Set aside some time to address the little jobs around the house that you’ve been overlooking. This could include:

• Replacing broken light bulbs.
• Sewing missing buttons back on to your clothes.
• Checking the batteries in your smoke alarms.
• Installing updates on your laptop.
• Replacing items that can’t be fixed.
• Touching up any old paint.

Make a time capsule:

Find an old biscuit tin or jar and then fill it with photos, letters and mementos. Ideally get your friends or family to join in and then bury it somewhere safe in your garden.

Pamper yourself:

Treat yourself to your own mini spa day:

• Book a haircut, dye your hair or try a new hairstyle.
• Get someone to give you a massage.
• Exfoliate and moisturise.
• Have a hot shower or bath with candles/bubble bath/calming music.
• Pumice your feet, cut your nails or wax your legs.
• Try a face mask or new make-up.

Fix up the garden:

Make an area where you and your family can play, socialise and enjoy nature:

• Rake up the leaves
• Mow the lawn
• Cut back hedges or overgrown plants
• Pull out any weeds
• Plant some flowers
• Paint the shed or fence
• Make a play area for the kids with a water wall, sand pit, swing or slide
• Hang some lights
• Get some nice chairs to sit on or a table
• Get a chimnea or bbq for summer gatherings
• Put out some bird feeders that you can watch through the window

Make your room a relaxing haven:

Create somewhere safe and comforting that you can retreat to. You could consider:

• Cleaning and decluttering.
• Painting one wall your favourite colour.
• Washing your bed linen with some nice smelling fabric softener.
• Adding a few throw cushions.
• Putting out some of your favourite photos.
• Trying some fairy lights or scented candles.
• Gathering some sentimental items together in a memory box.
• Write down good memories or compliments you’ve been given on the inside of your cupboard door.

Make sure you’re drinking enough water:

Keeping hydrated is important for your physical health, mental health and concentration. Try to swap other drinks for water and aim for around 6-8 glasses a day. You could consider getting a water bottle that shows you how much to drink throughout the day.

Update or create a CV:

Ensure that your CV shows all of your strengths, abilities and experience:

• Find online guides if you need help.
• Look up what skills are required in the job person specification and try to include these on your CV.
• Make sure your contact detail are up to date and you have a respectable email address.
• Detail all your previous jobs and what the roles involved.
• Provide two good references (check your referee is happy to do this first).
• Get someone to proof read your CV.
• Write a cover letter if you are applying to a specific job, stating why you want to work there.

Take care of your pets:

Make sure your pets have a good quality of life by:

• Looking up their husbandry to check you are giving them the best food, housing and care.
• Treating them to a new bed or toy.
• Spending some quality time together by playing, cuddling, training or going for a walk.
• Looking up enrichment activities to provide them with mental stimulation.

Exercise every day:

Try to look after your physical and mental health by exercising every day even if it’s just for a quick walk. You could try:

• Gradually increasing your exercise levels by setting small goals each day.
• Swimming, cycling, dancing, sit ups, walking, yoga, pilates, bungee dance, etc.
• Making a commitment to exercise with someone as you are more likely to follow through with this if you are accountable to someone.
• Including your family eg having a 5 minute dance party each morning with your kids.
• Putting a cross on your calendar for every day you exercise and trying not to break the streak.

Learn something new each month:

Constantly develop your knowledge and skills by:

• Picking a topic that interests you or a skill you want to learn e.g. a language, instrument, magic trick or knitting.
• Researching it online.
• Borrowing books from the library.
• Watching documentaries about it.
• Learning about a different part each week e.g. a different period in history.
• Finding someone who knows more about it and learn from them.
• Trying to teach it to someone else.

Make sure you’re getting a balanced diet:

To improve your physical and mental health, try to:

• Make a rough meal plan.
• Stock up on healthier snacks.
• Try reducing sugar, junk food, caffeine or alcohol.
• Start eating together at the table.
• Try batch cooking.
• Start taking multi-vitamins, minerals, oils, prebiotics and probiotics.
• Try eating mindfully by turning off the TV, putting your phone down and focusing on your meal with all of your senses.

Develop a better morning routine:

Think about what would be the perfect start to your day. Consider:

• Getting up earlier
• Listening to music
• Getting your kids to help with chores
• Eating at the table
• Flossing
• Stretching
• Going to bed and get up at the same time each day

Encourage your child’s independence:

If you have young children, help them learn new skills and gain confidence by:

• Creating a reward sticker chart as encouragement
• Giving them some basic tasks so they can help around the house e.g. sweeping
• Giving them enough time to do up their own coat and shoes in the morning

Practice accepting compliments and giving affirmations:

• Get people to write down things they like about you and stick them around your mirror to see everyday
• Try to say affirmations in the mirror every day, even if you’re not ready to accept them yet
• Give notes to friends or family telling them what you like about them
• Make your child a poster of themselves surrounded by good qualities they have

Practice mindfulness:

Mindfulness has been shown to have significant benefits, especially for your mental health. Mindfulness involves focusing on one thing in your present moment, rather than multitasking or thinking about the past or future. You can set an alarm for 5 minutes or however long you want to practice. During that time, focus on one thing e.g. your breathing, one of your senses or an activity. Each time your mind wanders, gently bring your attention back. Try to do this without making judgments about yourself or the activity. It’s normal for your mind to wander; it’s part of being human. Effective mindfulness isn’t about having no thoughts; it’s about noticing when your mind has wondered and bringing your attention back.

Take a break from social media:

Social media can be helpful in some ways but it’s also good to take a break at times. When you feel like you are spending excessive time scrolling on your phone or that you’re comparing yourself to others, try taking a break. It might be for an evening, day or week.

Start preparing for your day the night before:

Make sure you have the best start possible:

• Set aside some time each night to prepare for tomorrow.
• Try to cross off any remaining items off your to do list.
• Work out what the priorities are for tomorrow.
• Clear up.
• Set the table for breakfast.
• Make lunches for tomorrow.
• Check bags are packed.
• Lay out clothes for yourself and your kids.

Set SMART goals and weekly reviews:

Create a step-by-step plan for working towards the things that matter most:

• Think of something you’ve always wanted to do
• Set a goal and make a step-by-step plan
• Is it Specific?
• Is it Measurable?
• Is it Achievable?
• Is it Reasonable?
• Is it Time-limited?
• Review weekly: have you achieved what you wanted? What small changes can you make for next week?

Create a budget:

Make sure you’re using your money wisely:

• Calculate your income, expenses and any profit
• Aim to set aside some money in savings each month
• Are there any things that you can save money on?
• Do you need to find ways to increase your income?

Spend time outside: Get some sunshine and fresh air:

• Aim to spend a few minutes a day outside or take a brief walk
• Go camping
• Have a picnic
• Fly a kite at the park
• Build castles on the beach

Have a date night with your partner:

It’s important to set aside quality time with your partner, as part of maintaining a healthy relationship. This can range from free activities to paid weekends away. You could consider:

• Going out to dinner.
• Watching a film.
• Filling your bedroom with candles.
• Taking them to where you first met.
• Having a picnic.
• Learning to salsa.
• Trying a pottery class.

Find better deals:

To save more money:

• See if you can find cheaper insurance, electricity, etc
• See if you can get a savings account with better interest rates
• See if you have any money you can set aside in a tax-free ISA

Start a blog or vlog:

Share your thoughts:

• Create an account on a website like wordpress or youtube.
• Choose a theme, name, etc for your blog
• Start writing or making videos about whatever interests you
• Try to write or record something every day or week

Scan and backup your laptop:

Make sure your information is stored safely:

• Complete a virus scan.
• Make sure all your files are in the right place and labelled correctly.
• Delete any old files.
• Clear out your recycle bin and temp files.
• Remove any programmes you don’t use.
• Back up to an external hard drive or google drive.

If you have kids, try planning a learning theme for each week:

• Pick some topics eg colours, halloween, hot and cold, jobs, etc.
• Look up ideas on google and pinterest
• Plan activities, food, craft, trips, etc
• Prepare any supplies or print outs the week before
• Teach your kids about the topic and try to make it as fun as possible
• Consider letting your kids pick the topics
• Consider making a planner of topics and repeating them each year

Plot your adventures:

• Get a big world map. Put pins in to show where you’ve been.
• Get some different coloured pins to show where you want to go.
• Pick one and start planning your next adventure.
• Ask other people who’ve been there for recommendations

Set aside time each day to check in with your partner:

• Talk about how your day has been and how you feel about it
• Anything that’s bothered you- talk about the small things before they become big things
• Take time to think about each other’s perspective before replying

Watch some new films:

• Ask your friends for recommendations
• Look up ‘100 films you should watch’ or other lists
• Try to watch 52 films in 52 weeks.

Write a journal, autobiography or mood diary

• Try writing it from different perspectives: e.g. changing yourself as victim to hero
• Try writing to someone you love
• Try rating your mood each day
• Try recording all the positives of your day, or turning negatives around

Do a brain training puzzle each day:

Mental stimulation is an important part of maintaining good memory and concentration. You can try:

• Daily mental challenge apps
• Sudokus
• Crosswords
• Quick mental maths tests

Show your partner you love them:

Little gestures can say a lot. You can try:

• Writing down everything you love about your partner and give it to them.
• Getting them a small gift that will make their life a bit easier eg gloves when it’s cold
• Leaving cute post-it notes around the house for them
• Taking some cute or sexy photos for them. Whatever you’re comfortable with.
• Making them coffee in the morning

Take photos of your family:

• Invite everyone round for a big family photo
• Have some couple photos or pictures with the kids
• Get the pets involved
• Try some silly props like frames, moustaches, etc
• Try different locations like your garden, the woods, a playground, etc

Reconnect with people:

Catch up with friends and family or make some new contacts:

• Call people and organise to meet up.
• Send out emails to long distance friends/family with some recent photos
• Send a text to someone you haven’t spoken to in a while.
• Get up to date on what’s going on in their lives.
• Get to know your neighbours
• Organise some playdates with kids at your child’s nursery or try some local children’s play groups
• Join a social/sports club
• Invite a colleague out for drinks
• Challenge yourself to speak to someone new today
• Write a letter to someone, even if you can’t give it to them
• Each time you meet someone make an effort to learn their name

Try active listening:

See how people react when they actually feel heard:

• Practice giving people your complete attention: turn to face them and put down what you’re doing.
• Think before you respond. Try to see things from their perspective.
• Reflect back what you think they’ve said e.g. you’re frustrated that they didn’t listen to you at work.
• Look up examples of active listening to help you get started.
• See if you notice any differences in the responses you get.

Read your kids bedtime stories:

Take them on adventures and get them interested in books:

• Borrow some new book from your local library
• Let your child pick which one they want at bedtime
• Try different voices for each character
• Use toys, puppets and shadow puppets to help tell the story
• Encourage them to try reading parts

Help a charity:

Raise money or awareness by:

• Joining in a sponsored activity
• Making a donation of money or time
• Asking your local shelter if you can help walk dogs

Learn a dance routine:

• Try a dance class
• Make up the silliest dance you can with your friend
• Dance around the room with your kids and try to copy them
• Try having a 3 minute family dance party every morning
• Watch youtube dance tutorials

Read every day:

• Read journal articles that relate to your job
• Pick a subject you want to become an expert on
• Read book summaries so at least you know the plot of Macbeth, etc
• Aim for 52 books in 52 weeks or a chapter a night
• Get a book of poetry and read one a day
• Read a news article about a topic you know nothing about

Make a bucket list:

• List everywhere you want to go
• List life milestones you want to reach e.g. buy a house
• List personal goals e.g. gain enough confidence to go out without make up
• Pick one item and make a plan of how you’re going to achieve it

Give up a bad habit for 30 days:

• Try to quit smoking or drinking with help from your GP or an NHS service
• Try being completely honest
• Try not buying anything new for a month except basic necessities

Take a photo every day for a year:

Compile them into a video showing the changes:

• Of yourself
• Your baby
• The view from your window
• Something you love

Face a fear:

Push yourself out of your comfort zone:

• Talk to a stranger
• Pick up a spider
• Try skydiving
• Dye your hair a new colour
• Learn a new skill

Ask your parents about their pasts:

• Learn from them and don’t underestimate the value of the lessons they learned.
• Remind yourself that one day you will miss hearing their stories.
• Write down your favourite stories so that they can be passed down generations.

Do something you enjoy every day:

Try to do an activity each day that brings you a sense of enjoyment, achievement or connection. It may be small but these activities will accumulate and help your mood.

You could try writing down activities on slips of paper, folding them and putting them in a jar. Each day you can pick one out of the jar and try to do it. This could include going for a walk, painting your nails or texting a friend.

Get a free bra sizing:

Lots of people are wearing incorrect bra sizes, which can affect their posture or cause them pain. Try getting a free bra sizing appointment to ensure you are wearing the correct size.

Get to know your community or do something culturally enriching:

• Go somewhere you’ve never been before in your area
• Meet your neighbours
• Join a club
• Buy tickets to a concert
• Plan a museum visit with a friend
• Learn about the history of your town
• Go to an art workshop