Fostering Inclusivity in Eating Disorder Awareness

Did you know that an eating disorder is a physical AND mental illness that affects people of ALL backgrounds? Instead of pigeonholing this condition to one particular category of people, National Eating Disorders Association's Awareness Week (February 25-March 3) is fostering inclusivity this year to show how this disease impacts "individuals at all stages of body acceptance and [to emphasize that all] eating disorders recovery .... stories are valid." This message matches the association's 2019 theme: Come As You Are. To gain more insight on eating disorders for this week of awareness, we reached out to clinical psychologist Laura Cusumano, Psy.D., who specializes in eating disorder treatment. She is also an alumna of Divine Mercy University and currently provides treatment through Potomac Behavioral Solutions in Arlington, VA. Dr. Cusumano has extensive experience working with people suffering from eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID). In her 2017 dissertation for the Psy.D. program, she integrated the virtues of humility and temperance into Radically Open Dialectical Behavior Therapy (RO DBT) to develop a Catholic adaptation of RO DBT for those with anorexia nervosa. "I found the RO DBT material to be well suited for this adaptation," she said "and I would like to expand upon it in the future." In an email response, she shared detailed answers to questions about eating disorders, their causes/effects, stigmas still associated with them and more! Read on to gain a deeper understanding of the disease that's estimated to impact 20 million women and 10 million men in America at some point in their lives. Q - How can someone detect if their friend or loved one has an eating disorder, and how do you safely address it? Dr. Cusumano - There are several subtle signs that may indicate that a person is struggling with an eating disorder. You may notice that your friend or loved one has started to talk about eating "clean" or going on a diet. The person may make negative comments about his or her body, express a desire to lose weight, and/or compare his or her body to other people's bodies. You may observe your friend or loved one making changes to his or her exercise routine, and the person may become anxious or upset if he or she misses a workout. Your friend or loved one may decline invitations to go out to dinner or prepare a separate meal when eating with others. During a meal, your friend or loved one may engage in unusual eating behaviors, such as cutting food into very small pieces. The person may also stop sharing meals with others altogether. You may also notice a change in your friend or loved one's mood and energy level. If you are concerned that your friend or loved one may have an eating disorder, I encourage you to share your concerns privately with that person. Spend some time doing research on eating disorders so that you have information to share. Use "I" statements to express that you feel worried and to share things that you have observed about the person's behavior (e.g., "I'm worried about how frequently you're going to the gym."). Your friend or loved one is more likely to be receptive to what you have to say when you phrase things in this way. Having this discussion may feel awkward and uncomfortable for both of you, and that person may have a negative reaction or deny that something is wrong. Let your friend or loved one know that you are here to talk whenever he or she is ready and offer to provide the person with resources. Encourage your friend or loved one to seek professional help. Q - What are common resources that you are confident in providing to men and women with an eating disorder? Are any resources gender specific? If so, why? Dr. Cusumano - I really like the National Eating Disorder Association's (NEDA) website: www.nationaleatingdisorders.org. It has a wide breadth of information about the spectrum of eating disorders and how they typically manifest. The information on the website ranges from general (e.g., "What are Eating Disorders?") to specific (e.g., the "Identity & Eating Disorders" section). It is important to note that eating disorders can affect people of any race, ethnicity, sexual identity, or gender. There is gender-specific information on the NEDA website. This is because eating disorders manifest differently across different populations. For example, most women with eating disorders desire to have bodies that fit our culture's thin ideal. In contrast, many men with eating disorders have a drive for increased muscularity. Body image distress varies between men and women, and this should be taken into consideration during treatment planning. The Academy of Eating Disorders, a professional association dedicated to eating disorder research, education, treatment, and prevention, also has a variety of useful resources available on its website: www.aedweb.org. Q - How are therapists currently working with physicians to diagnose and prevent eating disorders? Dr. Cusumano - When a patient starts therapy with me, I refer him or her to a dietitian for nutrition counseling and a physician for medical monitoring. Eating disorders can be life-threatening, so it is extremely important for the patient to work with a treatment team. Medical complications can include dizziness, fainting, dental problems, electrolyte imbalances, arrhythmia and other heart problems, muscle weakness, organ failure, and menstrual irregularities in women. It is essential for therapists to consult regularly with physicians about their mutual patients to ensure that patients are being treated at the correct level of care. A patient may underreport symptoms, and if medical stability is not assessed, he or she may not receive the proper intensity of treatment. With regard to prevention, therapists encourage physicians to promote positive body image when talking to their patients and to educate them about nutrition and healthy amounts of physical activity. I have worked with patients who have reported that the only strategy their physicians recommended to address their health problems is to lose weight. Even though physicians may have good intentions when they make this recommendation to patients, the recommendation could backfire and trigger body image distress and an eating disorder in people who are predisposed to develop them. Therapists work to educate the physicians with whom they share patients in order to craft an approach that is both empathetic and direct about the dangers of eating disorders in an effort to prevent them. Q - How can someone with an eating disorder reframe their thinking patterns so they do not consider themselves overweight or undesirable?  Dr. Cusumano - Enhanced cognitive behavioral therapy for eating disorders (CBT-E) is an evidence-based treatment that has demonstrated to be effective in treating a transdiagnostic range of eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder. Treatment consists of helping a patient establish a regular pattern of eating and challenging the factors that maintain the person’s eating disorder, such as dietary restraint and overevaluation of shape and weight (i.e., body image distress). Through the use of cognitive reframing, patients learn how to challenge their unhelpful thinking patterns in an effort to develop a more balanced way of thinking about themselves. The process of challenging one’s cognitive distortions about body image is often difficult, and it can take a while for patients to recognize that their worth is not dependent on their appearance. It is often helpful for patients to participate in group therapy that focuses on body image so that they can support one another through this process. Q - What is a misconception about eating disorders you'd like to be dispelled? Dr. Cusumano - Most of the time, when people think of anorexia nervosa, they imagine that all those who suffer from anorexia are underweight. Anorexia nervosa is diagnosed when a person restricts his or her energy intake to less than what his or her body needs to function (based on factors including age, height, and gender), resulting in low body weight. Anorexia is also characterized by an intense fear of gaining weight or becoming fat, and body image disturbances are also present. Despite the diagnostic criterion regarding low body weight, anorexia can affect people of all shapes and sizes. The intense fear of being fat and body image distress can occur in people who restrict their energy intake and remain in a normal weight range or above average weight range. This is known as atypical anorexia nervosa. Many of my patients who struggle with restriction have a formal diagnosis of atypical anorexia. It is a myth that a person must be underweight to suffer from anorexia. Q - After getting your Psy.D. degree, what other training did you seek to specifically treat clients with eating disorders? Dr. Cusumano - My primary training in treating people with eating disorders actually took place while I was still enrolled in the Psy.D. program in the Institute for the Psychological Sciences at Divine Mercy University. I completed my internship at The Emily Program in Minnesota. The Emily Program is dedicated to providing treatment to those suffering from eating disorders. During my internship, I worked at the outpatient, intensive outpatient, and partial hospitalization levels of care. I had wonderful supervisors who guided me through learning evidence-based methodologies for treating eating disorders. I learned how to support patients during therapeutic meals and to challenge them to use skills effectively so that they could work toward recovery. My time at The Emily Program was extremely valuable to my development as a therapist specializing in the treatment of eating disorders. Currently, I work as a postdoctoral fellow at an outpatient practice that specializes in providing evidence-based treatment of eating disorders. I have gained training in family-based treatment (FBT) for anorexia nervosa, which is the primary evidence-based treatment for adolescents. I hope to continue my training and may pursue certification as an eating disorder specialist later in my career. Q - What advice would you give to parents who think their child or teenager has an eating disorder? Dr. Cusumano - As a parent, recognizing that your child is exhibiting signs and symptoms of an eating disorder can be frightening and leave you feeling helpless. If you suspect that your child has an eating disorder, it is important to discuss your concerns with your child in a compassionate, not critical, manner. Remember, your child is suffering from an illness, and he or she is not completely in control of his or her behaviors. When you talk to your child, focus on the behaviors you have observed, rather than your child’s appearance. Use “I” statements when sharing your concerns. Gather information from resources such as the NEDA and AED websites, and seek professional support. Many parents will find FBT to be the best treatment option for their child. From an FBT perspective, parents are the best equipped at providing the care that their child needs to recover from an eating disorder. An FBT therapist will guide and empower parents to take control back from their child’s eating disorder so that their child can recover. If your child is struggling with an eating disorder, know that recovery is possible! Treatment outcomes are generally positive when eating disorders are detected early. Learn more about the Doctor of Psychology (Psy.D.) in Clinical Psychology program offered at Divine Mercy University to gain skills to treat those who suffer from eating disorders.

Managing Holiday Anxiety

By Jessie Tappel, LCPC, Director of Communications, Divine Mercy University The holidays are an exciting time of good cheer, warm family traditions, and spending time with friends. Or, are they? For many people, the idea of attending large family gatherings, numerous holiday parties, traveling to or from home can produce anxiety and stress. In fact, anxiety and depression are very common during the holiday season. According to the Anxiety and Depression Association of America (ADAA), three out of four people surveyed reported feeling anxious and/or depressed during the holiday season. The American Psychological Association also notes that the added stress of the holidays will increase a women’s reliance on unhealthy behaviors more often than men, placing them more at risk for effects of stress, both physically and mentally. Juggling work and added family responsibilities, such as planning for holiday gatherings, shopping for gifts and cooking, leave most women feeling like they can’t take time to relax during the crunch to get everything done. Where does this pressure come from? We might think of the holidays as a magical time, one of rest and relaxation and filled with joy and gratitude for all that we have. Hollywood paints a picture of what our holidays should look like, and there is undue pressure for our holidays to look like a scene out of a 1950’s sitcom. Is this ever the reality?  Nostalgia returns with every commercial of fireplaces, warm food, snow falling, and opening presents on Christmas morning. We long for the day when we can return to the idyllic picture of no responsibility and the proposed meaning of relaxation. How is it possible to relax and enjoy the holidays when they are the busiest and oftentimes most stressful time of the year? The holidays are a time that uncover memories of the past year or force reflection on the year’s accomplishments and events, either positive or negative. We self-evaluate how we did compared to those around us. Did we reach our goals or fail yet again to complete that pesky New Year’s resolution? The perceived societal pressures that naturally form throughout the holiday season can amplify these memories and expectations for the future. The unrealistic expectations that are placed on oneself can induce a greater anxiety during these times. Comparing your life to those around you can be an additional, unnecessary stressor that leads to unrealistic expectations for you and your family. It is important to remember that everyone faces challenges throughout the holidays, in varying forms, sizes, and intensity. This time of year is not all about carving turkeys, peppermint mochas and spiced candles. It is easy to feel pulled in many directions over the holidays. Trying to set healthy boundaries in order to reduce stress and exhaustion can be difficult. It is important not to be focused on what the holidays are supposed to be like and how you are supposed to feel. What is the true meaning of the holidays? If you are comparing your experience to a greeting card ideal, you will fall short every time. Be realistic about what you can and cannot do. Remembering your limits is important. It is impossible to control everything that will happen these next months. Separating what events are in and out of your control is helpful in reducing anxiety and undue pressure to perform to a self-imposed standard.   Keeping in mind the reason for the holidays will refocus the concern and anxiety that you may feel. “Have no anxiety at all, but in everything, by prayer and petition, with thanksgiving, make your requests known to God” (Philippians 4:6). Anxiety and worry place the focus on the wrong issues and causes us to lose sight of the reason for which the holidays exist. Peace of mind is something that everyone desires. We all want to be able to rest and enjoy life, family, friends, and work and not get caught up in the drama of the season.   Busyness breeds distraction. It is important that we focus on what the meaning of the season is rather than all the details that provoke anxiety. In the Gospel of Luke, the story of Mary and Martha gives an example of overcoming the self-imposed to-do list. Luke tells us that “Martha was distracted by all the preparations that had to be made.” Who was telling her that the preparations had to be done? Jesus calls Martha to come and spend time with him and break away from the obligations she felt she had to do.   During this holiday season spend some time reflecting on what is truly important. Make a plan to overcome the stress and anxiety easily felt throughout these weeks and let us truly contemplate the words of the Gospel “Do not be anxious about your life, what you will eat, nor about your body, what you will put on. For life is more than food, and the body more than clothing.” (Luke 12:22)

Facing the Realities of Mental Illness

“Whoever suffers mental illness always bears God’s image and likeness, and has an inalienable right to be considered a person and treated as such.” - St. John Paul II Mental health is a critical component of wellbeing.  As a society, we don’t have to look far to encounter those who struggle with mental illness. Statistically, 1 out of every 4 people will experience mental illness in their lifetime.   The World Health Organization (WHO) recognizes October 10th as World Mental Health Day. It is an annual event that provides an opportunity “for all stakeholders working on mental health issues to talk about their work and what more needs to be done to make mental health care a reality for people worldwide,” according to the Mental Health Foundation. This year, the theme for World Mental Health Day is focused on young people and mental health in a changing world. Young people are more anxious and depressed than ever.  According to the WHO, half of all diagnosed mental illnesses begin at the age of 14, and many of the illnesses we experience are either left undetected or untreated. In terms of the burden of the disease among adolescents, depression is the third leading cause affecting their health, and suicide is the second leading cause of death among those ages between 15 and 29. As the rates for mental illness increase, we cannot neglect the grave problem that the stigma of mental illness presents, especially for young people.   So how can we even begin to take part in combating the stigma of mental illness?   Pope John Paul II gives us an important insight on how to take care of those suffering in a 2003 address on the theme of “depression”: “The role of those who care for depressed persons and who do not have a specifically therapeutic task consists above all in helping them to rediscover their self-esteem, confidence in their own abilities, interest in the future, the desire to live.  It is therefore important to stretch out a hand to the sick, to make them perceive the tenderness of God, to integrate them into a community of faith and life in which they can feel accepted, understood, supported, respected; in a word, in which they can love and be loved.”   Every human person has a need for family and relationships within society, and for many who struggle with mental illness, isolation and loneliness  are realities in their daily life. We are all asked to contribute our gifts and talents--through our own personal vocations--to reach those who are suffering in the ways which we are able, integrate them into a community and begin to combat the reality of mental illness. Find out how you can help combat mental illness by furthering your education with a master’s or doctoral degree in psychology or counseling. Request program information today!

John Paul II and the Therapeutic Alliance

M.S. in Counseling Student, Vincent T. reflects how his experience in Romania challenged his way of interacting with those around him. In St. John Paul’s writings, themes of personalism and integrity are intimately linked. For instance, Love and Responsibility provides us with a challenging definition of the human person: “the person is a good towards which the only proper and, adequate attitude is love.” If we consider the nature of love as essentially self-gift to our beloved (as the “object” of our love), then his definition provides us a lens by which all our actions may be filtered. When we internalize the notion that every human person, of whatever class or social status (rich/poor, able-bodied/disabled, this or that racial background, etc.) of whatever relationship (family, friend, “mere” acquaintance, business associate, exchanger-of-goods, passer-by, etc.), then we must approach that person with an attitude of love, an attitude of self-gift. In the counseling courses I am taking at Divine Mercy University, they emphasize that one of the most important factors in counseling another human person is, what the literature calls, the “therapeutic alliance.” The relationship between the therapist and client is more important than the techniques used by the therapist or the cognitive framework under which therapy is conducted. While recently in Romania, fellow classmates have articulated this notion of being with the client in this way: “I know that I cannot fix the client.” In the service economy in a world where we are habituated to view others as objects, we tend to see them as either recipients of goods or givers of goods. Entering a therapeutic relationship presents us with a challenge: If I’m not fixing my clients with my expertise, then what am I doing? The idea of the therapeutic relationship calls counselors to be aware of their feelings and thoughts while interacting with the persons who present themselves for therapy. While research literature does not establish the metaphysical causes for the effectiveness of therapeutic alliance, it seems that St. John Paul’s definition of the human person provides insight into why the therapeutic alliance is so essential: Our clients are the sort of thing that our only adequate response to them is love. In loving another, we exchange the most miraculous of goods, the most sublime thing that we have to share, that part of us that can neither be bought nor sold: ourselves. A day this week found two teams in Braca, a remote town in the mountains, where there is a population of male and female adults who have developments of MS that manifest as intellectual and physical disabilities. Born during the days of the infamous Romanian orphanages, these persons were cast away by their families first, then by society next. The location of the facility may be significant, as it is located about an hour away from the city of Oradea where the Smiles Foundation has several places of operation.  While Smiles has no formal relationship with this location, we visited the site to be present to the men and women there who are largely ignored by society and practice the therapeutic art of simply being with the other in a way that is meaningful to them. These human persons who suffer are still human persons, these goods towards which the only appropriate response is love greeted us with absolute joy. Even though they did not know or understand who we were, about 20 of them flocked around our bus with whoops and screams of pure delight. In some way, they knew we were coming to visit them, a rare event. But on the walk from where our bus stopped to the place where we would engage some of them in games and activities, a member of our team saw one of the men with a t-shirt that brought home the strange experience that we objectify even the most sacred of moments. In a country where the bulk of the population does not speak English at a location and  where none of the residents could read, an intellectually challenged human person strolled along with us bearing a t-shirt that read, “In Flames: Used and Abused.” In some ways, the slogan on the shirt was a proclamation much like the archetypal blind seer, Tiresias. The person who donated the shirt to the facility had no idea who would be wearing it at a later date. The child of Our Common Father had no idea what the shirt said, but the shirt spoke truth: From his earliest life in the harsh and abusive environment of being disposed in an orphanage to his removal to a remote part of the countryside, to be the recipient of a disposable t-shirt from a person who had not been used or abused - the witness of this man’s shirt spoke volumes. Rarely are we committed to making each act of ours towards another a true act of love whereby we honor and respect the other. Rarely do we seek encounters in which our actions are wholly ordered to giving of ourselves to recognize the dignity of their personhood and legitimate needs. As a counselor-in-training,  thinking about the dual process of what is happening is a needed skill. Introspectively, some of the questions that arose were: Are we demonstrating conscious love toward the men and women we encountered in Romania? Had we been objectifying anyone during the visits? How could we encounter differently so that the persons whom we met would not be objects upon which we practiced skills, but rather human persons who would be the recipients of self-gift freely given?

An Interview with the Dean: School of Counseling

Dr. Harvey Payne humbly acknowledges the gift of counsel as God’s use of mankind to help other people heal, grow and develop. As Academic Dean for the School of Counseling at Divine Mercy University, he helps position students to become licensed counselors who later provide therapy for people across the world. “My biggest joy as a counselor is having people contact me after 10 or 12 years since I worked with them and them letting me know how they’re doing and how they’ve continued to grow and flourish” said Dr. Payne. He has practiced as a mental health professional for 30 years in the U.S., Kuwait, Saudi Arabia and Kazakhstan. He also has 11 years of academic experience, including years of service as the dean for a college of counseling. In the interview, Dr. Payne detailed his experience in the field and how it molded him into the academic dean for a Catholic-Christian graduate counseling program. Q: How did your experiences as a counselor differ from those as a psychologist? Dr. Payne: The thing that strikes me is how similar the two are. This is because both roles consisted of trying to understand the person that I was sitting with – their views, emotions, thoughts. This would allow me to help them dig deep into the good desires of their heart and figure out how to best flourish in the midst of whatever suffering or difficulty they were experiencing. The big difference for me is that my doctoral degree and training in clinical psychology had a specialization in working with children and adolescents with neurodevelopmental disorders and learning how to assess using psychological tests to better understand them and help parents and the school work with them. In 1984, I graduated with a master’s in counseling – similar to our degree at DMU – that really taught me the primary skills of how to sit with people, develop a working relationship, get a basic understanding of people, and use techniques to work with them. After getting my counseling degree, I developed a community counseling center and supervised other counselors. I then realized that I wanted more in-depth training and that moved me to getting my Psy.D. degree in 1990. I later completed my postdoctoral fellowship at a children’s hospital in 1991. Q: How is the curriculum of the Master of Science in Counseling program at Divine Mercy University tied to the Catholic-Christian faith? Dr. Payne: The way we understand people is from our Catholic-Christian Meta-Model of the person, so that’s the lens that we see everyone, which is foundational to all our courses. We emphasize that people are created for the good and that their desire and movement is towards the good – even with pain and disorder. A key  focus in our Catholic-Christian Meta-Model of the person is the deep need for relationships to grow. So when we look at someone who is struggling we don’t look at them as pathological, we try to look at the relationships that they need to heal and develop. Those aspects are woven through all of our courses. Q: Unlike other Master’s in Counseling programs, the one at Divine Mercy University places an emphasis on moral character and spiritual flourishing, crisis and trauma, a systemic model of the person, and addictions. What influenced you to include these counseling principles and why do you think it’s important for students to have this knowledge? Dr. Payne: There is a distinct reason we included each of these principles in our curriculum. Moral character and spiritual flourishing: We believe who the counselor is and how they relate to others is the most critical variable in helping people. So making sure that your own spiritual and moral life is flourishing is vital to help other people. The saying “Transformed people, transform people” is the way we like to think about this relationship dynamic. We also recognize that people, especially those in America, who are religious and spiritually minded is very high.  Researchers report that 96% of individuals living in the United States believe in God; more than 90% pray; 69% are church members; and 43% have attended church, synagogue, or temple within the past 7 days (Princeton Religion Research Center, 2000). With this knowledge, we are able to understand the perspective of people who seek counsel, effectively develop our program and properly train students. Crisis and trauma: We know that there’s a very high rate of trauma (e.g. sexual, physical abuse, natural disaster, domestic violence, etc.) that people go through on a daily basis. Without an understanding of crisis and trauma we would be missing a big component of understanding people. Systemic model of the person: This model is an understanding of people based on their relationships, such as family and friends, and their attachment to others. As social creatures, it is important to know the history of relationships and how they are attached to understand the behaviors of a person. Addictions: As a Catholic-Christian university, we understand that in our faith people work on developing habits of virtue. However some people adopt habits, or addictions, for coping that end up being more harmful than helpful.  So we work to help them flourish with better ways of resolving of handling their struggles. Q: Aside from academics, which qualities make someone a strong candidate for the M.S. in Counseling program at DMU? Dr. Payne: We’re looking for people who have basic interpersonal skills. Also, people who have a heart and passion for other people and feel comfortable working with them. But if the individual doesn’t come in with those skills it is very difficult to develop them. Another thing we look for is grit: the ability to keep plugging even when the going gets tough. This quality is important because the coursework, training and ongoing work will be challenging. So people need to have a sense of perseverance. We also want them to understand that they’re not out there drowning on their own; we’re in the water with them to guide and support them. We also look at a sense of compassion for people, regardless of their situation or state. We’re really looking for students who want to help a wide variety of people. Q: Any advice you’d give to a newly licensed counselor that you wish you knew when you started? Dr. Payne: I’d tell them that it might feel like you have finally arrived and now you don’t legally need supervision, but my advice would be to find a group of like-minded counselors and mental health professionals for clinical, professional and personal support. Counseling is not something that you want to do on your own – especially when you have a challenging case. There will be times when you need to get information and help from other people. Q: How are students able to gain clinical experience from an online program? In other words, how do the online learning platform and three on-site residencies adequately prepare students to become licensed professionals? Dr. Payne: At Divine Mercy University, we use innovative technology and break students up into a triad (counselor, client and observer) in a virtual classroom. We are able to view and videotape students as they participate in “role plays.” While they’re practicing the skills, their instructor virtually enters into the room to observe, give feedback and even provide additional feedback after watching recordings. We also have three on-site residencies where students come to the campus in person. That’s a time of intense hands-on training and meeting students to see how they’re doing. All students also have a year-long practicum and internship in their local area before they can graduate. Q: Lastly, what has been your most fond experience as a counselor or as the dean for the School of Counseling? Dr. Payne: My most fond experience as dean is watching the profound growth and change of students throughout the program – from interviewing them as applicants, seeing them at the residencies and seeing them flourish in this vocation of counseling. I enjoy following the personal, professional and clinical development of our students. Learn more about the Master of Science in Counseling program at Divine Mercy University.
About DMU
Divine Mercy University (DMU) is a Catholic graduate university of psychology and counseling programs. It was founded in 1999 as the Institute for the Psychological Sciences. The university offers a Master of Science (M.S.) in Psychology, Master of Science (M.S.) in Counseling, Doctor of Psychology (Psy.D.) in Clinical Psychology, and Certificate Programs.