Melrose Heals: A conversation about eating disorders

Episode 22 - Occupational Therapy in Eating Disorder Recovery

Episode Summary

On today’s episode, Dr. Karen Nelson is joined by Kendra Johnson, a registered and licensed occupational therapist at Melrose. They will discuss occupational therapy and how beneficial it can be when working towards recovery from an eating disorder.

Episode Notes

On today’s episode, Dr. Karen Nelson is joined by Kendra Johnson, a registered and licensed occupational therapist at Melrose.  They will discuss occupational therapy and how beneficial it can be when working towards recovery from an eating disorder. 

 

For a transcript of this episode click here. 

Episode Transcription

Dr. Karen Nelson  00:01

Eating Disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that will find the opportunity for healing. Hi there. I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose center, welcoming you to Melrose heals, a conversation about eating disorders, a podcast designed to explore, discuss and understand eating disorders and mental health. On today's episode, I'm joined by Kendra Johnson, Registered and Licensed Occupational Therapist here at Melrose. Kendra and I will discuss the importance of occupational therapy when working towards recovery from an eating disorder. Now, before I begin, I invite you to take a deep breath and join me in this space. Kendra, welcome to the podcast. I'm so excited to have you here with me today.

Kendra Johnson 01:00

Thank you for having me. I'm excited to be here too. 

Dr. Karen Nelson  01:04

Well, before we get started, I would love it if you could introduce yourself and tell us about your role here at Melrose.

Kendra Johnson 01:10

Yeah, so I'm Kendra Johnson, I'm an Occupational Therapist here at Melrose. I've been an OT for four years, but Mel at Melrose, specifically for three years. And typically what my role is here is helping patients really generalize the skills that they learn with their therapists and dietitians into real world applicability.

Dr. Karen Nelson  01:32

You know, as our listeners are hearing this conversation about eating disorders and occupational therapy, I would love it if you could help us know, what is occupational therapy?

Kendra Johnson 01:45

Absolutely. And I knew this is obviously going to be a question. And I think it's, it's the profession itself, the name is very elusive, like there was even this conversation, I think in like the 90s, that they're like, Okay, no one really knows what an occupation it like. Everyone just thinks it's helping someone get a job, right. But the way that we look at occupations and OT is occupations, or anything that you do on a daily basis, so getting dressed as an occupation, making yourself a cup of coffee is an occupation, going to the grocery stores and occupation, going to get a meal with a friend at a restaurant is an occupation. And so what we kind of do in this setting is we look at how an eating disorder a person's eating disorder is kind of seeping its way into their everyday life, how does it impact all of those things? Because we know it does, right? But sometimes, I think in a very general term, we just look at eating disorders as like, oh, we just need to eat right? Like, let's help the meat. But like there's many different scenarios, and many different occupations that help someone get to eat.

Dr. Karen Nelson  02:49

Absolutely. Well, sometimes another way that I might describe it for a client, if I'm recommending, like, Hey, I think it might be helpful, if you go in and start working with the OT is thinking about occupational therapy is helping with just meaningful activities in their life, right? That there's all these activities that we're doing. And the eating disorder can show up in some of those activities. And so getting that support from an OT, feels like it could be just beautifully complimentary to all of the other support that they may be getting from their care team.

Kendra Johnson 03:24

Absolutely. I think we always talk about building a life worth living for our patients to write to help with motivation, because that is one of the one of the sticky points with eating disorder treatment is like helping the patient find the motivation to want to recover and reminding them of like all of these cool things that you get to do with your life, I think can be a really strong push.

Dr. Karen Nelson  03:43

Well, and I love that you're describing just tangibly for our listeners, what that might look like for the collaboration between the OT in the patient, right of saying, Where are some places that the eating disorder may have? Kind of hijacked some of your joy or pleasure, right? And like, going out for dinner can be a really stressful thing or cooking meals at home? It sounds like those types of activities can be very much supported by working with an OT. 

Kendra Johnson 04:16

Yeah, absolutely. And they're things that help promote their recovery, right in the very remedial sense of like eating, but at the same time, we're practicing skills and strategies in real time to be able to experience and participate in those life occupations fully.

Dr. Karen Nelson  04:33

I love that. Well, and I think it's so important. One of the kind of unique offerings that we have here at Melrose is this referral to occupational therapy and integrating occupational therapists in our inpatient residential care also, you're able to work with outpatient clients as well. This unique place of tangible skills is really what I'm hearing you talk about I mean, that's where your work really seems to lie, right? It's not like we're just talking about it, you're giving our patients skill, like, what do I, how do I remain present in the restaurant when the eating disorder screaming at me and a menu is in front of me? Am I getting that? Like, is that what you might be working on?

Kendra Johnson 05:20

Absolutely. And again, it kind of varies. There's a lot of pieces to go into a restaurant, right? It's like making the joint decision with whoever you're going with of where you're going to go without the eating disorder, influencing that choice, sitting down and not letting the menu or nutrition information, influence your choices, being able to engage in that decision, being able to eat your meal to either meet your meal plan, or based on your hunger fullness cues, again, without letting the eating disorder influence how much of it you're eating. And so it seems very simple. But there's a lot of pieces to work on, just for that one activity.

Dr. Karen Nelson  05:54

Absolutely. Well, in how important I mean, what we know is that when we're kind of practicing the skills and interacting with these thoughts and ideas repeatedly, that's where recovery lives, you know, recovery isn't just a one and done, right? It's not like one day, I'm like, oh, you know, thank goodness that eating disorder is over. It's this continual interaction in that recovery space. And so what a what a beautiful collaboration you're giving, to sit there with our clients and explore what that might look like for them. Wow, that's really cool. How does an eating disorder potentially impact a person's meaningful activities?

Kendra Johnson 06:42

Yeah, so I mean, it's different for everyone, obviously. And when we do our evaluations with patients, we do kind of a semi structured interview with them, where we try to hit in the way that I explained it to them, I'm like, I'm going to talk about different areas of your life. And you can tell me as much or as little as you want about how you think the eating disorder is playing a role. And so I can give you a few examples. So like, if I'm going through the evaluation with a patient, and we start talking about school, a lot of areas that I hit, depending on if they're in middle school, or high school, or college is like, do you get a lunch break? If you do, do you use it? If not, what are you doing and trying to kind of figure out okay, are we packing a lunch? Or are we getting the lunch through the line? What are our options there. And so figuring out how they kind of build their recovery into their school life is, I think, a really big important piece to hit on. Same with work. I know a lot of patients that I work with who work in health care, especially in kind of like hospital settings, or if they work in restaurants can be really challenging for those people to get a break at a consistent time. And so a lot of that sometimes looks like advocating for like some accommodations of like, I need to take a lunch break, and I need a snack break at these times. And like we need to figure out how to make that work. I think more often than not, I've had really good successes with patients advocating for that. It's just the fear of being kind of what they perceive as like a burden to their manager or to their co workers. And it's just like, everyone's got to eat a lunch break, like, right, we just need to really figure out that we are we need to make sure that you get one in for sure.

Dr. Karen Nelson  08:18

Well, what I really hear you talking about is being curious with each patient of how might I continue to facilitate change and move towards recovery in all these kinds of other aspects of my life? Because I think sometimes we may minimize the significance of how the eating disorder might show up. What if I'm not deliberate about looking specifically at some of these areas? Right? I mean, if I spend 40 hours a week at work, but I haven't talked about how I get into lunch, that may be become a pretty significant issue. Absolutely. What do you think about what some of the goals might be for someone coming in to occupational therapy, and and, you know, kind of beginning that assessment process with you? What might be kind of some of those general goals that you're working towards?

Kendra Johnson 09:12

Yeah. So I would say for patients in higher level of care, I kind of piggyback off of whatever the treatment team goals are, and targets are for that level of care. And so a lot of times it's supporting weight restoration and meal planning, adherence and transition planning. For my patients that I work with an outpatient I typically do or administer what is called the Canadian occupational performance measure. It's the copm. And it's a really nice way to take subjective experiences and put an objective number to it so we can monitor change because in my opinion, like we really are wanting to make subjective change with the patient's right. Like we want them to feel better about their quality of life and their ability to maintain their recovery and their own, and that's a hard thing to measure. So with the copm, what it has us do is, basically, I can pick the occupations that we want to work on. And I have the patient rate both their performance and their satisfaction with their performance on it on a one to 10 scale. And so sometimes, and I always am very clear about this, I'm like, your satisfaction with your performance does not need to match up with your, with your perceived performance, right. So like, if I asked you to rate your performance and being able to manage your meal plan independently, and you say your performance is at a two, well, eating disorder might feel very satisfied with that, and that might be at a 10. And that's okay, like, I want to know, I want to know, the honest kind of feelings from you that we can kind of make a plan to maybe start with addressing that motivation piece first, versus changing behavior, immediately, using the copm, for me, at least, is a really nice opportunity to figure out how to prioritize the goals that we're working on together and really highlight the ones that the patient feels motivated and ready to address first. So you can work on building some of that rapport and some of that trust, instead of me forcing my ideas and opinions of like, what I think they need to change.

Dr. Karen Nelson  11:13

Well I think we often talk about that, and just kind of recovery in general, is it's really about this kind of collaboration. And we have this multifaceted care team around our patients and and we're really just there to continue to support and encourage and, you know, facilitate recovery. And it can be hard, right? Like, we can name that, right? Like, it's not like Well, all I have to do to figure out how to eat lunch is just go to talk to Kendra, she'll, she'll tell you what to do. Right? Like, it's, it's a process, and we can really name that. Are there potential personality characteristics that you notice, with patients who may be struggling with anorexia, that impacts their meaningful activities, or their occupations?

Kendra Johnson 12:02

I mean, I feel like perfectionism is always on the top of the list, right? Like, typically, people who are Type A get really good at eating disorders, because like, there's rules to follow, and if you follow the rules, and you're really good at it, but that also can come into play, I've seen a lot of patients who just like, stopped doing art, because they can't do it the way that they want to. And so then they just don't do it at all. Or, yeah, it's basically that all or nothing mentality, right? Like, if I can't do it, right, then I'm not going to do it. And they miss out on a key piece of I think their personality and something that could really allow their mental health to shine and really give them diversity in what they do.

Dr. Karen Nelson  12:43

Let's say we do have a patient that comes in, you've been able to identify that perfectionism, you know, is a, you know, this characteristic that is showing up that may be preventing them towards recovery or or just, you know, full engagement in their life, what might that look like, of how you might start to intervene there?

Kendra Johnson 13:04

Oh, man, I think in a variety of different ways, because I mean, you can use the occupation as a means or as an end, right. So maybe that's having them if we're using this example of the patient doing artwork, like having them maybe trial, some artwork that's a little bit more guided. So maybe it's a paint by number, maybe it's a paint along via YouTube. So it's like, there's not as much abstract thinking involved. It's very concrete. So maybe starting there, or we work our way up to that in different aspects of challenging that perfectionism. I think that still can really challenge their perfectionism and support their engagement with all sorts of occupations.

Dr. Karen Nelson  13:43

I love it. Well, one of the things that I talk about most frequently with all of my patients is I say, notice and pay attention. I mean, you know, it, it really becomes a way that we can be curious about, okay, what's happening with this behavior? And then I use the word experiment. Like, let's try it, right, like, let's just see what happens. And just because we do it once, doesn't mean I have to keep doing it this way, or I don't even have to do it again. And I love that that this place of curiosity, Kendra just feels like it's just this natural place that you're, you know, meeting your patients there. And just being curious of how might we make this different? Maybe what might be an interesting thing for us to talk about Kendra is helping us understand how might you define progress for a patient that comes to you and potentially wants to work on some of these meaningful activities? How do we know if we're moving in the right direction or moving to that place of increased recovery? What do you think? 

Kendra Johnson 14:46

Yeah, that's a very interesting question. I mean, because like we were talking about a little bit before, like it is hard to. It is hard to put an objective quantify are under progress for eating disorders, right? Because again, it's very subjective of like how the patient feels. As an OT, I look at what patients are doing. And not only what they're doing, but what kind of their mentality is while they're doing it. So like, yes, a patient might be going out to a restaurant with their significant other. Are they able to do that and engage fully and be present? Or are they in their head the entire time? So like, step one is yes, getting you to the restaurant. Step two is being able to do that and be there and be engaged and participate fully, without being completely distracted by eating disorder, thoughts or urges.

Dr. Karen Nelson  15:42

I love when you kind of share examples of how you might support clients who may come in with different kinds of presenting concerns, help us know, let, let's imagine a client comes to you. And they you identify that this kind of need for control is really highlighted. Help us know, are there particular interventions that you might use? Or what might be some ways you might talk with them about that? 

Kendra Johnson 16:13

For some people, maybe it looks like me picking a recipe that they're going to cook that week. Sometimes it's if it's a patient who is in our residential or inpatient setting, so they're on site with us, maybe I'll do a meal with them. And I will choose one element of their meal for them. Right. And so helping them practice a little bit of that flexibility, I think is really realistic in life, right? And can help them tolerate it a little bit more when they're doing it with someone who knows that they're struggling.

Dr. Karen Nelson  16:45

Absolutely, absolutely. And why might that be important for you to choose the meal with someone who is struggling with an eating disorder help us know about that,

Kendra Johnson 16:56

Um, a few things. I mean, like we were talking about kind of decreasing the control that they feel like they need to have around meals. For other people. I mean, the internet is a really great place for meal inspiration, and, you know, identifying recipes and meal plans for people. And it can be a really toxic place. When all of a sudden the nutrition information pops up at the end of the recipe, and all of a sudden the patient doesn't want to make it any more. 

Dr. Karen Nelson  17:25

Wow. Because that can be so triggering, and the eating disorder may determine. I'm not making that because it it– Oh, I totally get it. Absolutely. If we think about this idea of maybe positive behaviors around food or maybe more enjoyment, is that possible to create or facilitate the increase of enjoyment around food with someone who may be struggling with eating disorder behavior?

Kendra Johnson 17:51

Absolutely, I think so. And one of the ways that I really like to do that is with our cooking groups here, I think cooking can be extremely therapeutic in terms of eating disorder recovery, for a patient to be able to get in the kitchen and just like, handle the ingredients and work with their hands and kind of do the process from start to finish, I think it'd be really nice. And it can be very anxiety producing for them. And so I feel like the sweet spot for some of our patients in residential and our inpatient unit is doing like a cooking group, like at least three times or so, first time, anxiety is high. Second time, I kind of got the rhythm down, I know what to expect. And the third time, it seems like they really have found their footing. So I really love that aspect of Otieno eating disorder recovery, as well as asking patients what foods they liked when they were younger. When we have a journal group that we run on Wednesdays now, where we give the patients five journal prompts, we give them to them one at a time, so they can't rush through them. And really encourage them to think about their responses. But one of the questions on there is to make a list of all the foods you loved when you were younger. And then we kind of have a rebuttal prompt at the end where it's encouraging them to maybe pick one of those foods to reclaim in the next week or so. And so I think really tapping into like, yeah, there was a time before this eating disorder really took over that, like, you didn't enjoy food, right? Like there were parts of it that you liked and foods that you really enjoyed and like, let's try to get some of those back.

Dr. Karen Nelson  19:29

Oh, I love that. What a beautiful description. What we know is that eating disorders often make a lot of rules and they can when I talk about kind of the collateral damage of eating disorder sometimes with my patients and you know some of that enjoyment around food can be really minimized and kind of thinking I love that of like, remembering when we were maybe a kid and you know, hearing the music of the ice cream truck right like I have Little kids and I'm teaching them the joy of them. There's not many ice cream trucks around anymore PS–but!

Kendra Johnson 20:04

We know they're just kind of vans.

Dr. Karen Nelson  20:07

I know. And there's I know there's a lot of things about vans. Right, Kendra? But right like the joy of you know, me being a kid and hearing the, you know Jenga love the ice cream truck. Potentially that may have been something that my eating disorder took from me that it created a rule no, you can't eat ice cream. And so oh my gosh, I love that. Let's transition a little bit Kendra, and let's talk about body image and how that may show up in some of the conversations that you're having with patients. Are there particular difficulties that you've noticed with your patients, as they come in for support around OT, and body image help us know about that? Oh, gosh.

Kendra Johnson 20:57

I feel like the body image piece of recovery is often the last puzzle piece to kind of get laid right? Like we can get our eating on track. And we can be consistent with it. And even like our judgments about food have dissipated. And yet still, there's this nagging feeling to like, need to comment on all the flaws on my body, right. And so some of the behaviors or habits that I really encourage my patients to focus on is like minimizing our attention to those flops, right? I mean, easier said than done. I think I'm gonna botch this. But there was a study done where they took patients with eating disorders and patients without eating disorders. And everyone kind of wore like, a new tank top and shorts to kind of mimic being naked, but also being modest. So they measured patients like anxiety, depression, body image satisfaction, probably a couple of things before and after they looked in the mirror. And they also track their eye gaze while they're looking in the mirror. And so unsurprisingly, what they found afterwards is like, people typically with eating disorders feel worse about themselves after they look in the mirror people without any new sorters. back to baseline, like nothing really changes. What they found, which I think is most interesting is with the eye gaze is that patients or people who don't have eating disorders kind of just do like an up and down scan. But people with eating disorders tend to focus on like two to three areas of the body. That's where their eyes go. And so I like to kind of tell patients about that study, and really encourage them like, we need to start zooming out, right, we need to stop focusing on just those three flaws that we see and really focus on our body as a whole. And so in conjunction with that, I also like to do kind of an automatic thoughts worksheet with them, where they identify the first word or thought that comes to mind when they think of their body parts from their head to their toes. And oftentimes, what I find with that activity is that patients have like, four or five parts of their body that they perceive as flawed, or have judgments about the rest of their body, they're kind of just fine with also encouraging them to reframe those areas of their body that they see as flawed is to either like make them a neutral statement, or to focus on what that part of their body allows them to do in life, I think is really fun.

Dr. Karen Nelson  23:27

I love that one. It just makes sense, right? You know, I, if I'm focusing in on these areas of my body that create a lot of distress or negative thinking, it only makes sense to me that that's going to generate a negative mood. And then when I have a negative mood, it can generate a desire to not have that negative mood, which Hello, eating disorder. I mean, that is where it lives. And so we talk a lot about that, you know, there's this theory, it's one of the theories that we use in eating disorder treatment is cognitive behavioral therapy, which just means our thoughts inform our feelings, which also inform our behavior. And all of those are, you know, impacting each other. And so like you said, if I discover every time I'm looking in the mirror, I'm pointing out my, you know, I hate my feet, and they're so terrible, and they're just the most disgusting. Wow, no, no wonder I feel bad when I look in the mirror, right? And what if I can change that? Like, how powerful is that? It feels so cool.

Kendra Johnson 24:33

Yeah. When I start working with patients on body image, and I mean more, I would say 98% of the time patients are wanting to improve their body image to some degree. Do a very transparent that I'm like, I'm I come from a very body neutrality mode of practice. Like I'm not striving for body positivity with you. I want you to be able to look in the mirror Are and be like, Oh, my butt looks weird today and continue to go eat breakfast anyway. So like, notice that there's things that we don't like, but not go into the planning stages of what I need to do to change it.

Dr. Karen Nelson  25:11

Wow, good point. Absolutely. That because I think sometimes for our patients, actually, I did another podcast on body image and we talked about, you know, if I'm told that I need to move from negativity to positivity about my body that can feel like a really far leap. And especially if I've spent a lot of time disliking my body, it can feel light years away to get to a place of positivity. I love what you're saying about neutrality, right? That I'm just going to, in, potentially, rather than naming parts of my body and associating negative comments with them, what if I could just name them like, you know, there's my thighs today, there's my arms today, rather than inserting this kind of negative commentary, right? Any particular nuances that may show up you know, we've talked a little bit about certain diagnoses. And if there's any maybe kind of nuances or specifics to how you may approach that any specific techniques that you may use for someone who's coming to you presenting with bulimia. So engaging in potentially restriction or binging and then very characteristically purge behavior. So self induced vomiting, anything particular that you may highlight or address there.

Kendra Johnson 26:35

I think one of the things that I really like to start off with is, again, going back to kind of like the grocery shopping routine of things and planning meals, and how we are going to do that without getting or like without triggering kind of like the binge mentality of I need to get everything I need right now or and then I need to eat everything that I have right now. I find a lot of patients are very fearful of even having like just a normal amount of groceries in the house, because they're fearful that they're going to binge on it. And so kind of educating them, I guess, on like, alright, if we're in a steady place with our meal plan, and our bodies can trust, like you've done a really good job of feeding your body regularly, you're probably less likely to have those urges to binge like, let's like you said, let's try it. Like, let's get a couple meals worth of food in the house and see what happens. And, again, having this mentality of like, yeah, I can have it whenever I want it, right? Because we know when we offer ourselves kind of that freedom to eat food, when it sounds good to us, we're much less likely to binge on it than if we tell ourselves 16 times that, like, we can't eat that or that's a bad food, or I shouldn't eat that.

Dr. Karen Nelson  27:52

Absolutely. Absolutely. Are there particular interventions that you may use to help someone distract from an urge to purge or an urge to engage in self induced vomiting?

Kendra Johnson 28:07

Um, I think just reviewing a lot of good DBT skills like the except skills I really like. I think sometimes that skill of distraction, kind of it seems like it gets overused, right, like I like to distract. I use this for distraction. But I love that the except skill really delineates all the different modes of distraction, right, so we've got different activities we can do, we can distract by contributing to something. And I like really digging deeper into those with patients and figuring out what are the concrete examples that you could use for each of these skills that you could potentially utilize to help distract from those urges. I also think setting time limits after meals to kind of urge surf I think can be really helpful for people to have that kind of countdown on

Dr. Karen Nelson  28:58

Absolutely. I love that well in DBT for our listeners. DBT is just a type of therapy, right that we use here at Melrose, the fancy word is called Dialectical Behavioral Therapy. It's big fancy words for quite frankly, applicable skills, like what are applicable skills that I can use to try and avoid or minimize engaging with eating disorder behavior. And so one of those skills distract is basically how do I shift my attention elsewhere? Right? The accept skill is how do I just name I'm having this urge and and like, I'm having this urge and I don't have to engage with it. Or how do I urge surfs? Probably my favorite one, right? Like, how do I acknowledge Yep, I'm having the urge. And I name that and then I literally hang on. I literally wait. It's like I'm surfing a wave. How do I wait because we know over time, the intensity to use that eating disorder behavior will natch really decrease. One of my favorite things. I had a client actually, several years ago, she sent me a picture of a wave in an ocean. And she said, one of the most helpful things you ever taught me, Karen, is that all feelings come in waves. Now granted, they may be like tsunami wave, right? Like, I'm not saying like a low rip away, like you and I both know Kendra, it could be huge, right? And the wave will never stay at the highest peak forever. And always, it will naturally decrease. And so I love that that you kind of plan with your patients of like, how do you ride the wave and not engage? Yeah.

Kendra Johnson 30:42

And I think, again, going back to kind of OT basics, it's like, how do I create a new routine about what do I do after I eat, right? I also like to explain eating disorders to patients is kind of like this purple web over their brain. And so the more that you're doing these eating disorder behaviors, like that purple web gets stronger, but the more you kind of develop these new recovery behaviors, that purple web just gonna get crusty and dies off.

Dr. Karen Nelson  31:06

Amen. Thank God. Right, it can just blow away. Yeah, so we just gotta let it I love it. I love it. Well, and I think it feels hopeful to me, as you describe, working with your patients to say, what are those behaviors that I can engage in? To continue to work towards recovery, right, to be curious and experiment with? How can I tolerate some of this discomfort? But experiment with how can I potentially make it a little bit better or different? Oh, it just feels super hopeful. I love it. Well, Kendra, I would love it. If you could help us know about, are there any particular tools that you may use to kind of facilitate some of that curiosity or support with clients? I guess specifically, I'm wondering about, I mean, as simple as it sounds, can you use like, you know, arts and crafts, or kind of more of this, like creative side to facilitate some of those changes with clients when you think?

Kendra Johnson 32:13

Absolutely, I mean, I feel like making coping cards is always kind of at the top of our list. And I get, I think, making them with like, fun paper and, you know, creative stickers and stuff like that is much more appealing to patients than just like a white piece of printer, paper and a marker.

Dr. Karen Nelson  32:32

Sure, and help us know what is a coping card? Help us know.

Kendra Johnson 32:34

A coping card is a little visual cue that can help patients kind of document all of the skills that they find helpful for certain difficult emotions to get through or challenging situations to get through so that when those situations arise, like we said, anxiety and stress make it a lot harder to kind of like use our frontal lobe, which is where those coping skills sit. So when you have a visual, visual cue, like coping card, it can be more successful, I guess I shouldn't say, yeah.

Dr. Karen Nelson  33:03

So maybe I'll put a scale like, you know, taking some deep breaths or, you know, putting on low shit or asking for help from a support. Love it. Love it. Do you have specific encouragement or advice for parents or friends or family members, supporting someone going through treatment for an eating disorder?

Kendra Johnson 33:25

I guess my biggest piece of advice would be to kind of check yourself a little bit and your your thoughts and ideas about food and body in the way that you express those ideas. And really, try to create a filter around that, right? Because I do think modeling kind of that body neutrality piece and modeling flexibility with food is a really supportive way to help someone.

Dr. Karen Nelson  33:56

I love that. I love that. So, you know, as I say those words to notice and pay attention, you know, those aren't just prompts for our patients. Those are just prompts for all of us, right? The more that I can be aware, the more intentional I can be in how I can be supportive to my loved one. Oh, I love that. What Kendra, I just cannot thank you enough. This has been just such an important conversation. And I just appreciate all that you have shared with us today.

Kendra Johnson 34:25

Thanks so much for having me, Karen. It was awesome to talk with you but occupational therapy and eating disorder recovery.

Dr. Karen Nelson  34:33

That's it for today. Thanks for joining me, we've covered a lot. So I encourage you to let it settle and filter in. And as I tell my patients at the end of every session, take notice. Pay attention, and we'll take it as it comes. I'll talk to you next time. Melrose heals a conversation about eating disorders was made possible by generous donations to the Park Nicollet Foundation.