Body Dysmorphia

Body Dysmorphia is a fancy name for when a person thinks that their body is ugly.

http://en.wikipedia.org/wiki/Body_dysmorphia

As I look back, I look at old pictures of myself where I think I look really great! However, at the time of the photo, I did not believe that I looked good. I'm certain that telling someone when they are in the moment that they look good will not get through. It seems more like the negative comments have more weight than the good. Even those we trust implicitly cannot get the message through that we look good. Why? Because what matters most is what we think about ourselves. It is not about the fact that we look good or not, it is about other things, such as if we feel successful and fulfilled in our lives. This is not a common theme for young people, as they are struggling to become the complex adult they wish to be.

So, how do we get through to these young men and women? Consider Equine Assisted Psychotherapy. Feedback does not come in a judgmental form, heck, it doesn't even come from other people. There are many people across the US and abroad who are using EAP as a method for treating eating disorders and body dysmorphia (for example Selah House and Timberline Knolls).

Some of the symptoms a parent or guardian might see that are a serious cause for concern are:

• cutting on legs and arms
• excessive piercings
• tattooing
• eraser burns on legs and arms
• withdrawn
• binge eating
• no eating
• excessive exercise
• not eating with others
• hoarding food
• not touching food such as not touching food with lips when eating
• obsessive and/or compulsive behaviors around food or exercise

Often, people with these symptoms are difficult to spot, they are not necessarily judgmental of others with weight or other physical problems. They are, however, very judgmental about themselves.

An example of a session could be to observe several different horses with different weights or trouble maintaining or dropping weight. Is the individual's observation of the appropriate weight of the horse accurate? If they see the ribs of the horse, do they believe the horse is too thin? If a horse is obese, do they notice? This activity can be a gauge of what the person observes in the environment, and may be helpful later when it is time to look into the 'mirror'. Which horse do they think represents themselves the most, and what about that horse reminds them of themselves. Are these traits positive or negative?

Try a grooming exercise, and have the client observe all parts of the horse, looking for any differences in the way things look or feel as compared to other parts of the horse. Are the chestnuts observed? Are they viewed as normal, ugly, possible wounds? How connected to the horse can get client become, or are they more withdrawn and find it difficult to physically and/or emotionally connect with the horse. Who in their life to they touch? What is this touch like? What if they touch the horse with different parts of their body, such as, not with their hands, but with their knee, leg, shoulder, head? What is their perception of the horse's response to them? If the horse walks away, comes near, ignores them, picks at the ground for food? What is important is to find out what it means to the person, not what we think it might mean. These tools help us find out where our client is, where they are in their life, what they see, and how they see it. If these perceptions are skewed, better to let them see it on their own, be a guide, don't correct them, or you will only emphasize their belief that others are judging them.

I remember a great demonstration regarding body dysmorphia at the 2011 EAGALA Conference. They called it "The Beauty Pageant". They had a pony and a donkey and several suitcases full of clothing and accessories. Volunteers were asked to spend time with their equid, getting to know them, and then dressing them accordingly. They were then asked to walk their dressed-up equid around for a beauty pageant, and talk about their experiences.

Recently, we purchased some clothing and various articles from Goodwill, and have been using them with families. We are fortunate to have the miniature horses, which makes this much easier!

Recent Events

Mental health is much more complicated than is realized. Particular diagnoses do not necessarily mean that a person is unfit to carry a firearm. There exist laws to prevent purchase of firearms to youth, and therapists are always on the look for suicidal or homicidal ideation, but it is rarely seen. When it is, action is taken... immediately. 

Diagnoses could be considered labels. No one should be stuck with such a label, and no one should be treated differently because of that label. We call that ‘stigma’ and it is something those who work in the mental health community would like to eliminate. NAMI works on this particular issue. 

http://www.namimt.org/

Only a person who has committed a crime is statistically likely to be a repeat offender. We should not assume we know what a person will do based on their health or mental health, because we don't. Psychosis is caused by a variety of factors, and is often treatable, or goes away. Schizophrenia doesn't make a person aggressive toward others or not care about the well-being of others. 

Recently, we have seen two boys with Autism commit horrendous crimes. Youth with Autism are generally not aggressive, unless there is a disruption to their schedule, or if they are having difficulty communicating and become frustrated. What is often seen is an immediate destruction of property, swinging out, and often harming oneself because of anxiety and frustration. It appears to be more often seen in children/youth who are considered non-verbal. Try taping your mouth shut and your fingers together – you would become frustrated within the first day. These children live their lives in this manner. When episodes occur, they do not last long, and are certainly not including time to calculate a crime over days, weeks, or months. This suggests that this type of crime has a strong environmental element, which is the responsibility of the community to change. 

For another opinion on this important issue:

http://host.madison.com/ct/news/opinion/column/dr-kurt-newman-how-to-ensure-children-s-mental-health/article_a64d5a96-512c-11e2-8a67-001a4bcf887a.html

Make a Difference in Someone's Life

Recently, an old friend of the family, who I've known since I was a little girl, committed suicide. He left behind three beautiful girls, and I have been wondering how something like this happens. Overall, I don't know, but in this case, I had some ideas. 

My friend was always very popular, very charismatic, and well-loved. He was very talented, he could sing and play the piano very well, and we all enjoyed his playing and singing when he would share. Despite this, he didn't call anyone and ask for help. He could have called any one of hundred of people, but he didn't. Why not?

Perhaps because he was so popular, that it was difficult for him to sort through what was real and what was not. People who are famous or rich, or in the lime-light for whatever reason, seem like they have perfect lives, but I'm wondering if it's not all that great. 

I have a hard time determining who are the good guys and who is trying to take advantage of me and my family. No matter how old I get, I still get tricked from time to time. However, take the example of the famous person - there are apt to be more bad guys trying to take advantage of them than of me. On top of that, some folks may not mean to hurt another, but just want to ride on the coat-tails of someone who appears to be doing well. 

For someone who is popular or famous and suffers from mental illness, this can be very dangerous. Even with all our faculties we still have a hard time making good judgements and choices. When some of our abilities to interpret data are damaged or not working very well, we end up with the wrong responses in our behavior. This could be as innocent as thinking someone is our friend when they really aren't, or as serious as believing we are a burden to our friends and family. 

When someone pretends to be your friend, you feel pretty icky, but imagine thinking that the people who love you the most would be better off without you around? More than icky. 

If someone you know struggles with the question of whether or not you need them, remind them. If you have an acquaintance that seems different, say something. When you walk down the street, or go in and out of a business, hold the door for someone, smile, make eye contact, be nice. Those kinds of things helps people who feel lonely and depressed to question their decision about the world, and helps them see that there is good out there. You really can make a difference in someone's life. Please try at every chance you get.

EAGALA - The Professionals

EAGALA stands for the Equine Assisted Growth and Learning Association, and their website can be found here:

http://www.eagala.org

Fresh Steps EAP is not only an EAGALA Distinguished Program Member, but has always promoted and adhered to the EAGALA code of ethics. This includes having both a Licensed Mental Health Professional and and Equine Specialist. (See earlier blogs). This isn't about being on a 'high-horse' about what EAP should be, rather, it is about protecting the public. It is common sense that you would go to a specialist in the medical field, and this is no different. You should look for someone who is licensed (or license eligible under the supervision of a licensed professional) any time you need mental health services.

Certainly, only a licensed professional can bill you insurance, but it isn't just about funding. Licensing exists to provide an avenue for lodging complaints if a licensee is not providing ethical care. Without a license, if you are unhappy or worse, hurt in some way, it is just too bad. Sorry, no refunds, no recourse. Just learn to live with it.

Therapist work hard to acquire their licenses, and are very proud to have it. If they decide to move away, their license is often transferable to another state, because the standards are often the same. The same is true for credentialing in such a specialty as Equine Assisted Psychotherapy. When you hire someone to guide you through this amazing process, you want to know that your team is certified and knows what they are doing! An Equine Specialist not only has specialized training with communicating with horses and interpreting behaviors, but also to use this information in mental health.

Both human members of the team invest in themselves to be trained through EAGALA, and maintain continuing education requirements and pay for their membership to the organization. If they do not adhere to the ethics of EAP, a complaint could be lodged against them, and they could not only lose their membership, but also their credential. This is a huge investment in both time and money, and would not be taken lightly! Continuing education is provided by EAGALA who also approves of seminars by members for members. I can't say enough about how important continuing education is. It makes sure that your providers are giving you the best possible care with the most up-to-date treatment methods available. Since EAP is so new, this is even more important.

EAP and Depression

Many people come to Fresh Steps because they are suffering from depression. Depression has symptoms to include feelings of sadness, lack of interest in usual activities, poor appetite or overeating, having no energy or feeling fatigued, inability to sleep or sleeping too much, feeling hopeless, having a hard time concentrating or working, among others. See you therapist and talk about your symptoms to find out if a mood disorder describes your symptoms. You may find that medication paired with therapy helpful.

Using EAP to treat depression has one difficult part - getting to the arena to work. If you are depressed so much that you are unable to get to your appointments, you may need to see a psychiatrist for medical assistance. If you are able to make it to see the horses, talk to your therapist about how you feel, and be sure to give yourself time with your new friend, the horse.

Why the long face? Horse faces are very emotive.

If you are an EAP practitioner, be sure to give your clients time to be with their horse, and talk about how the horse feels about them. How does the horse feel today? Is the horse engaged with your today, or is the horse occupied with looking out the door or sniffing items in the arena. What does that mean about the horse, and about you?

Since self-esteem can be low with depressed mood, many comments may reflect this, such as the horse not liking me, horse is disinterested, etc. Take time to guide clients to change this feeling by noting behaviors of the horse that challenge this negative view. For example, what are some other possible feelings the horse may have? We have 8 dodge balls with opposite feelings words on each. Sometimes it is easy to just start with having an individual or family explore the feelings words and take some time to think about what each one means. It may also be helpful to see if clients notice that the words are opposites (for children). 

Feelings Balls: dodge balls with paint marker words added to each side

Having a vocabulary for the feelings one is having is essential to sharing with others. In EAP, people have the chance to show how they feel, and process feelings without talking about them. However, outside the arena, family members hope for verbal communication that will help them better understand their loved one. It is ultimately the goal to have a person feel better, but natural supports to include friends and family are necessary for prolonged healing and connection.

Activities that are a great start are feeling for breathing, where on the horse's body can you feel breathing? Sometimes we bring out the stethoscope, and allow participants to listen to breathing and heart beats. This activity helps 'center' a person, and keep them in the present moment. Adults tend to daydream about what was, or worry about what will be. Keeping them focused on the here and now with their horse will help refocus unhelpful cognition.

When there is a success, big or small, be sure to celebrate this success. This could be as simple as having a treat for the horse, or spending time in green pasture together. Be creative. This is simple, it is using positive reinforcement for the little things, like even showing up for a session despite feeling fatigued! Remember also to use retreat and approach so that clients can build trust and rapport with your therapeutic team as well as with their horse.

Part 3: Approach vs Retreat

Approach and retreat is a very powerful intervention to develop trust, confidence, and willingness. Horses play this game with each other - I have also observed them playing with new clients. It is simply that a person or horse approaches the other, may or may not make physical contact (for a short moment) and then walk away. This is repeated many times, depending on the individuals and their brief interaction when they are together.

Horses with eyes and ears forward, ok to approach!

When working with horses, the relationship and communication is what becomes important in the long run. As Pat Parelli always says, "Horses don't care how much you know until they know how much you care." 

I think people are much the same. Take whatever angle you are pursuing, and fill in the blanks. When a horse starts to turn their head away, or look away, take a step back, or turn and walk away. The horse's sense of curiosity gets the best of them. Perhaps they are thinking, "Hey, why aren't you just trying to get me?"

When the horse expects the interaction to create pressure, they stay away. Remember, horses move away from pressure, and move into pain. What we would like is to walk out to the paddock and have the horses walk right up to us in a friendly, comfortable way. If we are consistent with them, and retreat when there is too much pressure, the horses will start to feel more confident about the interaction, and they WILL walk right up to us. 

Our outdoor arena is about 80' x 130', and I have often asked those who are new to Parelli to release a horse into this arena with them, and get the horse to come to them. Of course, they don't believe this is possible, but it is! I have them put pressure on the horse's bubble (space) behind the horse, or stare at their tail. Initially, the horse runs around, or runs away. Then, they start to change directions. If they turn towards the person, I have the person take a step back, or turn and walk away from the horse. When the horse starts to run away or stop paying attention to the person, the resume staring at their tail. Believe it or not, I've never seen this NOT work... since that's a lot of negatives, THIS WORKS EVERY TIME. It works so well, that often the horse will start to follow the person, no halters and no lead ropes needed. It is an amazing feeling when the horse follows like this.

Take a moment to put this concept into perspective with others, whether children, spouse, students, clients, or whomever. If the person you wish to engage is feeling pressure from you, release the pressure so the conversation or interaction can happen. Some people will move in despite the pressure, but the relationship will be impaired in the long term. Start to look at your interactions with others and see if you are creating pressure, then approach and retreat until the situation feels more comfortable. Is now the right time to discuss this? Perhaps waiting till the crisis is over, or talking about things before a crisis begins? These are advanced versions of approach and retreat.

Part 2: Ball vs Chair

The Ball versus the chair has been a really great simulation for me, and for both children and adults. It is a great tidbit of information I gleaned from the Parelli Level 2 home study course. The idea is to get the ball and chair to move, without lifting them. The ball seems obvious, right? Push it, and it goes. However, if you push the ball, it can get away easily. Remember your soccer coach? He or she told you about 'ball control' and how important it was. 

You can even try this simulation at home if you have a large activity ball. If you lean forward and use your fingers as you push, you can easily turn and stop the ball if needed, and it doesn't 'escape'. An escape with a real horse means that you have put too much pressure (see Part 1) and the horse moves away too far and/or too quickly. To solve the issue of a horse escaping, we put the smallest amount of pressure, and when we get the smallest response, we stop the pressure and add petting the horse to let them know they did the right thing. The idea is to get the horse as sensitive to human touch as they are to a fly! What would this look like for a person?

The chair is obviously going to respond differently in this activity. In the picture below, the chair has four legs, and is sitting on sand. Try to push the chair from behind, without lifting it. What happens? The back of the chair comes up, and the front legs dig deeper into that sand. What's not moving? The front legs are not moving. How do you get the legs moving while you push the chair? Give a little encouragement to the legs by pushing with your foot, for example. The chair magically slides smoothly through the sand. The idea here is that you must problem solve for something that is not moving - the opposite of the escaping ball. Determine what is not moving, and find a creative way to encourage the non-moving element. What does this look like with a person?

What part is moving more like a ball or a chair?

Take a moment to think about people, and parts of their behavior that are either a ball or a chair. When you ask your boss for a new computer monitor, is their reaction more like a ball or a chair? How about when you ask your husband to go to a movie? Kids to go to the pool? When you can determine what type of movement you are dealing with, and you are asking questions rather than reacting, you keep the ball moving slowly and within your reach, and you don't have to strain your back by lifting the chair!

A more specific example:

You wish to motivate your 18 year old daughter to finish her resume. It is almost the end of the summer, and you are not sure why she has put it off. 

1. Check in with your feelings. Are you angry? Frustrated? Afraid of her reaction to you if you talk about it? What elements are at play for you and your daughter, pressure, or pain?
2. Thank yourself for the input, and put the feelings to one side. Your goal is to motivate, and if your feelings get in the way, this can create too much pressure (escape) or pain (digging in) for your daughter, neither with desirable results.
3. Ask a question. You may need more information to determine what aspects of this issue are more like a ball or a chair for your daughter. Don't use the word, "WHY" - it puts people on the defensive. Who (can she ask for help), what (tools does she need), when (does she have time), where (can she get the information she needs, and how (can you assist), are good words to try.
4. Approach and Retreat. Tune in next week for more about how to use this tool.