This article is written in collaboration with Dr. Linda Warren of Bainbridge Pediatrics.

Two years ago, my mentor and colleague, Michelle Naden, invited me to join a team of therapists named Collaborative Family Therapy. It had been a dream of mine to work in a collaborative way with other therapists, health care professionals, and community resources to better serve families, so I felt honored to accept the invitation. Working openly with a team has created layers of meaningful support for me and the people I serve. One of these layers has been Bainbridge Pediatrics, a group of three pediatricians and their support staff. Our teams share the value of seeking and providing a network of resources that can “wrap around” the families that seek our assistance. This is for the purpose of minimizing isolation and maximizing communication between providers and patients, and between providers.

We decided to write a piece on family eating because it is a topic that crops up often in our work. Food can be a tricky issue for many young people and their parents. On the medical side, Michelle Bombardier, SLE, and Catherine Whiting, OT, approached Dr. Linda Warren at Bainbridge Pediatrics to discuss working together to address feeding problems developing in young children and their families on Bainbridge Island. These medical providers were seeing more families struggling with the challenges of feeding their kids, and on the mental health side, we at CFT were seeing more families struggling with eating disorders. Dr. Warren introduced us to several excellent books on the topic. She and her medical colleagues also began a monthly group for “Picky Eaters.” She initiated this piece that focuses on how to create a family environment that promotes healthy eating for all ages. Our teams work to help families decrease stress around eating and to increase communication and connection within the family. Some of the most useful resources that guide us in this area are the books written by Ellyn Satter, a licensed nutritionist and therapist, who has written extensively about children and food.

Satter, licensed nutritionist and therapist, says that it is the parents’ responsibility to provide good nutrition for their children. The what, how, and when to eat can become confusing and overwhelming questions for families. Some of the questions we hear are:  How much responsibility should a parent take when it comes to decisions about eating, and how much should be shared with the children? How does responsibility shift as children grow? Different messages bombard us through the media, and we have become a society that is conflicted about food and body image. Concerns about “healthy” body shape and size, food allergies, and the relationship between food and behavior are just a few of the topics that parents and children raise when they consult us.

We will begin to answer some of these questions with Ellyn Satter’s definition of the “division of responsibility” (1990) between parent and child. She refers to this division in the following way:

1. The parent’s job is to decide what, when and where to provide food, regular snacks, and meals. They are also responsible to offer a variety of foods.

2. The child’s job is to decide whether and how much to eat or not to eat. Control in this area is with the child.

In exploring the first part of the division of parents’ responsibility, Satter provides some helpful things for parents not to do. She says: Don’t become a short order cook, and don’t pressure your kids to eat (1987). This means no bribing, arguing, rewarding with dessert, or tricking kids into eating it.  She coaches parents to offer a child the food, and let them sit and decide if they want to eat. If they don’t eat, Satter says to wait until the next snack or mealtime to offer food, milk, or juice. The goal is to raise a competent and “intuitive eater,” (Tribole & Resch, 2003) one who knows what he or she wants to eat, knows when he or she is full, and who enjoys eating.

The second part of Satter’s division states that how much a child eats is his or her responsibility. Often parents become concerned about their child not eating enough, or too much. It is helpful to develop trust that a child will eat what he or she needs, and to know that this will fluctuate over time. It can be helpful to look at a larger time frame and to focus on what a child eats over the course of a month, rather than a day or week.  Satter (2005) believes that parents need to stay within their division of responsibility, which is to provide the structure and the food choices. When parents gravitate towards the children’s responsibility of how much to eat, a power struggle often ensues. The struggle can be fueled when parents continue to worry over their children’s eating habits. Satter says it is helpful for parents to keep these worries in check so children can learn how much is enough, a skill that is important to develop on the way to becoming “intuitive eaters” (Tribole and Resch, 2003).

The division of responsibility ideally shifts as children grow. For adolescents, autonomy and identity become central themes of their development, and they often become more self-conscious or struggle with self-confidence. With an influx of hormones, their bodies typically grow rapidly and they must adjust to internal and external changes daily. Adolescents need to make more choices for themselves, and parents need to let them explore these choices with food. Parents can still influence their growing children by offering healthy choices in the home and by eating meals together. The goal is for parents to support their children and to trust them to care for themselves. This will develop a healthy balance of responsibility between parents and teens.

Satter (1987) states:

• During the teen years, you continue teach and guide your child, building on the foundation of instruction and interaction that has gone before. The way you treat your child is the most powerful part of the instruction, as it has been at all previous times.  Your attitude of respect and interest and your willingness to play a supportive, rather than a controlling role, will have an enormous impact on the way you and your child feel about each other. (pp. 245-246)

Family meal times provide a great opportunity to create and nurture connections within families. These occasions offer parents the structure within which to live out the division of responsibility described by Satter. In order to provide more detail on the benefits of family meal time, we offer some interesting research findings that highlight some significant benefits of family meals:

A 1999 study from University of Michigan found that meal time at home was the single strongest predictor of better achievement scores and fewer behavioral problems with kids. Meal time proved more powerful than time spent in school, at church activities, studying, or playing sports.

A Harvard study in 2000 showed that eating family dinners together most or all days of the week is associated with eating more healthfully. These families consumed higher amounts of nutrients such as calcium, fiber, iron, B6 and B12, C and E.

A study in 2004 from the University of Minnesota found adolescents who ate with their families did better in school, were less likely to use drugs and alcohol, and were less likely to have low self-esteem and depression.

The information from these studies listed above reinforces the significance of family meal time as a way to help kids make positive choices in their lives. For more information about this topic we suggest the books below. We also invite you to contact us at CFT and Bainbridge Pediatrics to talk about your questions or concerns.

Recommended Reading:

How to Get Your Kid to Eat… But Not too Much, 1990, by Ellyn Satter. Secrets of Feeding a Healthy Family: Orchestrating and Enjoying the Family Meal, 1999, by Ellyn Satter.
Child of Mine: Feeding with Love and Good Sense, 2000, by Ellyn Satter
Intuitive Eating, a Revolutionary Program that Works, 2003, by Evelyn Tribole and Elyse Resch.
Your Child’s Weight: Helping without Harming, 2005, by Ellyn Satter.

The following is a paper written by a fellow colleague, Tony Stanton. He is a psychiatrist who has published extensively in his field, and holds years of experience working with troubled youth. This piece shares a summary of the values that Narrative Therapy embodies, and that we as practitioners working with this perspective commit to uphold in our work with clients and each other.

A Little Working Paper on Values in the Practice of Narrative Therapy

Underlying our mandate to help our clients is an affirmation of their inalienable right to experience safety, respect, and meaning in their lives. To uphold this mandate the following values are put forth as possible useful points of discussion.

1. We ask permission before we offer help and we keep a strict eye on confidentiality. The exception is when we feel that someone is not safe.

2. We value curiosity and inquiry towards all the factors that either impede or promote the heart of creativity in our clients. This means that we value questions more than quick answers and that we help our clients to be explorers in their own lives. It also means that we value descriptions of real life more than diagnostic categories.

3. We help our clients search towards the preferred stories of their lives so that these stories are revealed and honored over any limiting stories that may be restraining their lives in the present. This means that we help our clients become detectives towards their successful experiences and those people from their past who have supported them.

4. We take a stand against those stories that may be dominant in our culture which prevent our clients from knowing themselves and from experiencing themselves as capable of exercising choice towards their preferred values. Such stories may include subjects of race, physical appearance, or limiting ideas of what constitutes being a person.

5. We affirm that our own work will be based on a community of support for each other - and that this support will exemplify the same values that we promote for our clients i.e. respect and support for each other’s creativity. To this end we need to meet with each other regularly as well as make ourselves available to each other on a more casual basis.

6. Whenever it is useful we will help our clients to experience us as a larger community which is committed to the rights stated above. While we are not a 12 step program we should exemplify the same principles of support and sharing that are manifest in such a program. Clients may need to know that we are not isolated individual therapists - that we help each other and that we engage the larger world outside of our own practices.

7. We believe that the body and mind constitute an exquisite instrument for the discrimination of value and that this instrument can make precise decisions through what is known as “common sense” or intuition if we free it from the burden of external restraints. It is part of our job to return this “instrument of the discrimination” back to its proper functioning.

8. We promote the knowledge each of our clients can obtain of those gifts they hold towards their families and the larger community - gifts which ultimately enhance the lives of those they are in contact with. This might be called helping people to know their place in “the larger scheme of things” and experiencing themselves as “having meaning” in the lives of others.

T. Stanton

I invite readers to share a blog by two of my most trusted colleagues, Kurt Johns and Michelle Naden. They are both Licensed Marriage and Family Therapists at Collaborative Family Therapy on Bainbridge Island. You can find their blog at www.practicalnarrativetherapy.com

I would like to invite readers to meet a trusted and knowledgeable colleague, Joseph Shaub.  I am honored to have him share his wisdom and experience with you.  He is a collaborative family lawyer and mediator with offices in Seattle and Bellevue.  He is licensed as both an attorney and marriage and family therapist.  Joe has many more informative and helpful articles on a variety of topics in his website: www.josephshaub.com.  He has offered this informative article on the benefits of the collaborative law process.

CHOOSING COLLABORATIVE LAW

Divorce is such a hard road.  Sadly, lawyers can make that road so much harder.  They’re not bad people - most of them are truly lovely folks if you knew them socially.  However, their role is to protect their client.  “Protect them from what?” you might ask.  Well, protect them from being “ruined,” “screwed,” “wrecked” or “destroyed by their spouse,” if you asked them.  Lawyers, in their role as protectors are also dispensers of paranoia.  It’s part of the training.  It’s like a magical transformation, but rather than turning from an ugly duckling to a swan, or Clark Kent to Superman, the divorcing person enters the lawyers office wanting the “fair” outcome, not wanting to screw their spouse and emerges hyper-vigilant and hyper-protective of their “rights,” having heard for an hour or two what they are “entitled to.”

The good news is that there’s a large and growing group of lawyers in King County who want to help smooth the path of this otherwise rocky life transition.  They are “collaborative lawyers” and its important for anyone commencing this process to know about them.

Collaborative Law started in the early ‘90’s when a Minneapolis lawyer named Stu Webb decided he just wasn’t going to go to court any longer.  He asked all of his colleagues if any of them were willing to agree to forego the soul-rending process of divorce litigation and commit, with their clients, to working out all the details of a legal divorce by negotiated agreement.  He had a handful of takers… and the word got out.  Collaborative Law began to spread throughout the country.  To get an idea of its breadth and scope log onto the website of the International Academy of Collaborative Professionals at www.collaborativepractice.com.

This form of healing, supportive practice - in which lawyers make a paradigm shift from protecting the narrow interests of their clients no matter who else may be hurt in the process (the spouse or their children) to developing a broader view of what a client’s real interests are - is now being practiced by many professionals in Washington.  The lawyers in King County Collaborative Law understand that an adversarial divorce which locks people into years of animosity and children into a life of negotiation between enemy camps simply can’t be in anybody’s interests.

Collaborative Law, as practiced in Washington is a “team approach,” recognizing that there are many elements of a divorce - the legal, the financial, the parental and the emotional.  So, we have collaboratively trained lawyers to support, advise and advocate for their clients; collaboratively trained financial specialists to act as neutrals, assisting the couples in understanding their current and future financial needs - and resources - in a non-adversarial manner; collaboratively trained mental health professionals, who act as divorce coaches, assisting people in managing the most acute emotional reactions that come up during the divorce process and child specialists who support the children through this alien and utterly unwelcome change in their lives.

While the collaborative law team approach is certainly more costly than doing it yourself, or working with a mediator, only, it is no more expensive than a conventional adversarial divorce where lawyers run into court to win temporary orders on behalf of their clients, stressful and incredibly comprehensive information gathering is conducted through a “discovery” process and a costly (both financially and emotionally) settlement conference is conducted where both people are separated with their lawyers and a settlement official shuttles between the two rooms with offers and counter offers in an effort to pound out a settlement in a day.  This process leads to next-morning regret for at least one person as sure as the sun rise in the east.  This doesn’t even include trial, which virtually guarantees destruction of whatever is left of the relationship between two people who shared years of intimacy and often children that they both love.

Collaborative practice can expose people embarking on this awesomely challenging life journey to a group of professionals who are committed to helping both people identify and achieve high-end goals that will serve them for the ensuing days, months and years.  An image evoked by one collaborative professional often is that of the divorced husband and wife sitting side-by-side (with their new partners if that be the case) at their children’s graduations or weddings and experiencing the gratitude of these children in finding a way to end the marriage (if end it must) in a loving, respectful manner, mindful of the integrity of everyone involved.

It’s a challenge, to-be-sure.  Yet a challenge well worth taking.

For more information visit the Collaborative Law page of Joseph Shaub’s website: www.josephshaub.com and the website of King County Collaborative Law, www.kingcountycollab.org.

The month of February brings with it a day designated as Valentine’s Day. This day has become known as the day to celebrate love and connection in our society. With this celebration comes the expectation of “ideal love,” and how to express this. While candy and flowers have come to symbolize this day as a way to honor our loved ones, I invite the question of what does truly honor the process of love and connection with the people we care about.

Valentine’s Day has come to represent romanticism and gift giving, which can be a wonderful and gracious activity. This day has become a way to remember and appreciate the people that have significant roles in our lives, most notably our romantic partners. Yet, for some of us, this day can also invite feelings of not being connected and appreciated – the feeling of being lonely. The expectations of society, as well as the expectations that we place on our selves and our loved ones, can prevent this day from being fully celebrated in the way that we intend it to be.

This process raises the question of why we need a particular day of the calendar year to designate a time to show appreciation to our loved ones. It appears to be a shared human desire to be acknowledged and appreciated by those we are in relationship with. Yet, somehow along the road of our relationship traveling, we sometimes seem to lose connection with what we truly appreciate about our partners, our friends, and our own selves. Somehow we get caught in what we think – and society says - we “should” be achieving in our lives and in our relationships.

By slowing our selves down and connecting with what is truly meaningful in our lives, we can find renewed understanding and appreciation for what is of value to us. By thinking about what is working for us in our relationships and what attracts us to those we care about, we can focus on the positive aspects of relationships. This in turn leads to a continued understanding of what we are committed to in our connections. It is the small things in our interactions with others that often are the most powerful. Remembering to say aloud what we appreciate about our loved ones can have the most profound effects on the quality of our connections. We are creatures of habit - sometimes for the better, and sometimes for the worse. As we get comfortable with our surroundings and relationships, we often get “used to,” and maybe take for granted, what is truly a gift to us. Whether we are in a committed relationship or not, we can all take some moments to honor how we feel love in our lives, and how we share it with others.

One way to do this is to ask our selves some questions. Who are the people we are grateful for in our lives and why? Who in our lives have had significant influence on us, and what was it that attracted us to them? What did we and /or do we continue to contribute to these relationships? If we are single at this moment, what is important to us in a committed relationship at this time in our lives - and what is it we are committed to waiting for? In the spirit of Valentine’s Day, who are the people in our lives that we honor as our loved ones?

I invite everyone to enjoy the celebration of appreciation and love for those who are the most dear to us – on Valentine’s Day and everyday.

I invite your thoughts and ideas on this topic!

Life presents us with many opportunities for experiencing change and transitions. Sometimes it appears that the only constant in life is change. How we approach these transitions and proceed through them can greatly influence the outcomes that we experience. Some areas in our lives that often present us with a need for change are: relationship and family transitions, career choices, living arrangements, and the social/political/economic considerations of our time.

While some changes that we find ourselves working with may be of our own choosing, others often are not. There are times that we may find ourselves experiencing a need or a request for change that we are not ready or prepared to move into. While it may seem during these times that we are not in control of our life circumstances, it is important to remember that while we may not have control over what life presents us, we do have control over something very powerful – our attitude towards these situations. Inviting change in with an attitude of openness and curiosity can increase our opportunities for growth.

In times of change, it is helpful to reflect upon the values, commitments, and hopes that we have for our selves and our families. By staying connected to what is deeply important to us in life, we can gather the strength and courage needed to embrace change. Staying in tune with what we truly value and stand for in life allows us to align our thinking and actions with these values and commitments. There is an anonymous quote that states: There is no growth without change, no change without fear or loss, and no loss without pain. It is often through the hardest and most painful experiences in our lives that we experience the most growth.

Change often presents the unknown, and the unknown often brings with it a sense of fear. It is important in times of change to connect with community and support systems that can help us move wisely during these times. We can reap great benefits and feelings of security by seeking support and guidance from our community resources. By tapping into our community, we can find legal/financial counsel, individual/family therapy, spiritual guidance, and group sharing. We form our identity through our relationships with others, and it is during times of change that we need to stay in relationship with those who are able to understand and support us.

Self-care is another resource for us during times of change. It is important to notice how we are handling the stress and excitement that comes with transitions. By taking care of our physical and emotional health, we are better able to engage the extra energy that moving through change may take. Life changes can bring new awareness and developments in our lives. By keeping an open and positive attitude, noticing what choices we do have in our lives, utilizing our resources, and taking care of our health, we can move forward in the best way.

The New Year often invites a process of reflection into our lives. Upon entering a fresh calendar year, we often take the opportunity to draft intentions and ideas about what areas we might like to create change in - often know as New Year’s Resolutions. For some, this process has become a ritual that is welcomed, assured, and productive. For others, it develops into a process of expectations, anxiety, and possible failures. The initial intention is typically the same for both responses - a call to do something differently.

Looking forward to the future often connects with the experience of looking back towards what once was. Noting what stands out for us from the past is usually a precursor to setting up our hopes and dreams for the future. How we choose to respond to our memories - more specifically the memories that we claim are disappointments or failures - can affect our current state of being. While we usually have as many successes filed away in our personal narratives, these often get passed over during the commitment of “self-improvement.” Self-improvement has the opportunity for some to metamorphosis into self-criticism, which often steals from our memories of accomplishments and appreciation in our lives. In my work with others and in my own personal experiences, I have learned that we often spend more time thinking about what we could have done differently, the big “what if,” rather than sharing appreciation with ourselves for what we feel we have accomplished successfully.

Reflection about our past disappointments tends to result in feelings of guilt and shame, while reflection upon our personal successes typically produces feelings of pride and effectiveness. By honoring where we have been and the learning curve of the trials and tribulations, we are more apt to remember the skills that we used that brought us to a feeling of success, or that enabled us to make it through difficult times. When we remember these skills, they can then be applied, adapted to, and utilized in our current experiences.

When we are witness to our loved ones’ difficulties and struggles, we typically respond with grace, acceptance, and a sharing of the confidence that we have that they will move through these times. It would seem very beneficial to apply this same grace, acceptance, and confidence with our own selves. Often there are many influences in our lives that are participating in the experiences that we are having. Some of these may be in our control, while others may not. It is important to recognize these other factors in the equation of our lives. Some examples of these influences are physical limitations or injuries that come our way, family and social crises, emotional and behavioral health issues, occupational changes, relationship difficulties, and the choices of others. These are all issues that we deal with over the course of time that may impact our ability to manage our choices in certain situations.

Community plays a substantial role in how we perceive ourselves. It is helpful during times of committed change to surround ourselves with a supportive environment. Connecting with others who share similar goals and commitments as we do can create a network of accountability and understanding for all. We help ourselves as well as our community. There is something transforming about hearing others’ shared experiences and narratives – especially when we can relate them to our own. We build our sense of self through relationships – they become a mirror for how we perceive ourselves.

By looking at our so-called “failures” with a lens of compassion, we can ask ourselves what we might have learned through these times and how that has been, and might be, useful going forward. Making goals for ourselves can be a growing and productive enterprise, and bringing our personal knowledges of what we do well in the world can help us in moving towards these goals. Some questions and ideas to ponder while constructing new commitments and goals for the New Year are:

• When reflecting upon past accomplishments and successes in your life, what were some of the things that were doing at the time that contributed to these experiences?
• What were you thinking and feeling?
• Who were you in relationship with?
• What motivated you, and where did you feel energy for working on your hopes and dreams.

• When you think of times that were the most difficult for you, what stands out for you about how you were able to move through these times?
• Were there particular resources – spiritual, social, or community based– that were helpful to you?
• Did you say to yourself you do not know how you may get through these times and then did?
• What guided you to new places, and what new opportunities developed along the way?
• Who did you meet during these times, and do these people still play a role in your life?

I wish you the best in moving forward with your commitments, values, hopes, and dreams for this New Year!

Making the connection about how our mind and body work together is an important part of being healthy. Our mental perspective often affects our physical well-being, and the reverse is true as well. Tuning into what our body is telling us can be helpful for improving our mood and overall outlook on life. We have choices in how we can care for our ourselves. It begins with a simple scan of how you are feeling head to toe, inside and out. Often times our moods and emotions are directly related to how we are caring for ourselves at that time. One example of this is why we feel better after we exercise. Exercise increases blood flow and the natural mood elevating chemicals in our body that help us to feel better. By taking a daily inventory of how we are feeling physically and emotionally, we can start to invite connection between the two.

Below are some helpful ways that you can tune into how your body is speaking and help care for it:

• Be thankful and appreciative of at least one element of your body every day. We often overlook and take for granted what our bodies are doing well. Appreciation is the key to staying positive and continued success in self-care.
• BREATHE! Pay attention to your breathing throughout the day. Taking time to notice and slow down your breathing is one of the best ways to combat stress and fatigue.
• Start your day with a glass of water… 50% to 60% of your body weight is water! One of the main causes of headaches is dehydration.
• Take note of the first nutrition that you give your body in the morning. Think of food as fuel and put the best gas you can into your tank. You will most likely follow this pattern into the rest of the day and evening. People often feel better the days that they are eating well and getting the nutrition that they need. Remember that your brain requires glucose to function properly.
• Ask yourself if you are getting the rest you need to fulfill the demands you are asking of your mind and body. Fatigue can aggravate depression and other psychological and physiological symptoms.
• When was the last time you exercised? Exercise clears the mind as well as the body, and has been proven to decrease symptoms of depression.
• Ask yourself where in your body you feel the emotions you are not expressing. Thoughts and emotions that are not expressed often lead to physical symptoms such as stomachaches, headaches, acid reflux, neck and back pain.
• Seek out quality collaborative health care. Find practitioners who will work together to give you the best care possible, and who are willing to look at multiple approaches to a problem or issue.
• We have one body to take us throughout lives - treat it as you would any cherished relationship. If we neglect our bodies they tell us. What has yours been telling you?

Referral sources that you may find helpful:

• www.bellevuechiropracticassociates.com
• Candace Aasan, LN, NP (425) 576-8017
• Scott Rose, NP (425) 576-8017
• www.chensacupuncture.com
• www.overlakefamilymedicine.com
• www.redmondmassage.com