SSP helps teen in eating disorder facility overcome fear of food

About the Provider

Name: Wendy Kimelman
Discipline/Credentials: Licensed Mental Health Counselor (LMHC) and Registered Nurse (RN)
Modalities: Safe and Sound Protocol (SSP), Somatic Experiencing®, cognitive behavioral therapy (CBT)

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Client Background

Name: Karen (pseudonym)
Age and Gender: 16-year-old girl
Program Delivered: Safe and Sound Protocol (SSP) (SSP Core, Hours 1 through 5)

Karen, 16, was in residential treatment for the treatment of anorexia nervosa (restricting type). She experienced significant anxiety related to weight gain, food intake, food prep and body image. Internalizing this anxiety and fear of weight gain and consuming food, Karen was shutting down. She would shake, be unable to access her feelings, feel unable to eat food at the table with other clients, and feel worried during the preparation of food that she was going to do it wrong, and did not know what foods or how much was healthy for her body.

Karen was in an eating disorder treatment facility with clients under 18 years old. She participated in individual and group therapy on a daily basis, and had support from caregivers 24 hours a day.

Despite working with her therapist, group work, and creating a social environment designed to support eating at the table with other people, in addition to normalizing the idea that all foods fit in our diet — that there are no bad foods — and eating for energy, Karen was unable to increase her intake without experiencing severe anxiety that resulted in going back to her restrictive eating behaviors.

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Implementation of the SSP

Provider Wendy Kimelman began delivering the SSP with Karen in her office at the facility one to two days per week for 30 to 45 minutes per session. Karen listened aloud with Wendy present each time.

Karen was a talented artist, Wendy notes, and would typically draw or color during the SSP sessions, rarely looking up during listening. Wendy established a “thumbs up, thumbs midline, thumbs down” process for Karen to identify whether she felt any anxiety or distress, and approached her at times with mutual eye contact to make sure she was not powering through the program. After each SSP session, Karen reported that “this is the only time my brain is quiet.”

Response

One significant change the client noticed post-SSP was how she was able to engage in meal preparation. Prior to the SSP, she struggled to prepare her own meals and snacks without feeling significantly flooded and in fear that she would get too many calories.

Her first meal preparation after the SSP, however, sent the floor staff into Wendy’s office asking, “What did you do to that kid?” The staff reported that Karen was able to prepare her meal without any concerns, and that she seemed relaxed and at ease the whole time.

“These types of changes often occur with SSP, but require reflecting with the client on the change they experience,” Wendy said. “Without reflection, the clients often report, ‘Nothing really changed for me.’ ”

Wendy added that clients may not notice that they feel different until hearing it from other staff, which may sound like someone saying, “How was meal prep for you today? You seemed more relaxed and moved through the process without distress or concern that you were doing it wrong.” This simple reflection is often the first time the client notices that they feel different.

“We use the reflection technique often prior to each SSP session,” Wendy said. “Often, I am in the moment with a client, grateful that they get these moments of what they often call a ‘quiet brain,’ but not seeing the bigger picture. It is the other staff in residential treatment and parents in private practice who will often ask, ‘What did you do to them? They act totally different.’ Clients need time to let the felt sense of safety grow in their awareness, but the felt sense in their bodies is usually immediate. For most clients, the work of noticing the signals their body is sending has been abandoned — they are very good at dissociating from body signals. In order for them to realize the full effect of SSP, they have to realize they are feeling more in their body and then notice that they are growing a safe space in their body. This is happening with SSP based on reports from parents, loved ones and partners even before the client realizes the full effect.”

Discussion

Wendy said she resisted using the SSP in the residential setting because of unexpected schedule changes, but learned to appreciate that the SSP can be done in small doses and later titrated once the client is ready for longer listening sessions.

“The evidence of building safety is solidified for them and for me,” Wendy said. “Using the SSP in a setting where therapy is already occurring is a great way to distinguish body-based or somatic therapy from cognitive therapy. So much of what people are taught about therapy reinforces that they have to think it out and work it out in their minds. Kids and adults alike over-intellectualize therapy. The SSP is a lovely invitation into your body.“

Wendy shared that soon after completing five hours of SSP Core, Karen was able to step down to a lower level of care and, to her knowledge, was not re-admitted to the residential space.