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 developmental changes that occur in our children during adolescence and the teen years present unique elements to family communication and parenting. As a family therapist, mother, and stepmother, I am drawn to the complexity of this time and how we can be more intentional in our parenting to promote better connection and understanding.

The teen years present an interesting interplay between the need for young people to learn independence and their need to stay safe and connected to family. The question becomes how can we help our teenagers stay in touch with the values and commitments that are important to our families, while allowing them the space to learn responsibility and independence. This is a time for them to gain confidence in making decisions and taking care of their own needs in order to prepare them to manage themselves as young adults in their communities.

Here are a few thoughts on how to keep conversation and connection going during these years:

• Remain curious to your teen’s thoughts, ideas, hopes, and dreams – even if they differ from your own.

• Highlight the positive. Teens often suffer from a sense of low self-esteem and they need to be confirmed in their accomplishments to promote self-worth.

• Be consistent!

• Realize that your teens will make mistakes and grow them into learning opportunities.

• Be intentional in how you are speaking and responding to your teens. Learn what legacies you wish to pass to your children and what legacies you wish to leave behind.

• Let them know they are loved. As much as they may seem to push you away, they still desire connection. Renegotiate the level of closeness and be open to new ways of doing things.

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

Separation and divorce affect children and teens in many different ways, and there are things that you can do as parents to help alleviate some of the difficulty and pain that come with this transition. This is often a very emotional time for the adult partners, and it can be a challenge to fully address the needs and concerns of your children while you are trying to maintain some sense of stability for yourself. As difficult as it may be to put your own emotions aside, how you and your partner handle this transition with your children will have lasting effects on their well-being.

Divorce is a process for a family that continues throughout a lifetime. Divorce often leads to new relationships and extended families, which add to the adjustments for kids and teens. As children age and mature, they discover more questions about the situation, and become more aware of their own feelings. The average adjustment period for an adult to process divorce is 2-3 years, while a child may take 3-5 years. Parents may be ready to move on, while kids may not. Parents are role models in how children learn to be in relationship with each other and process change. Divorce can be an opportunity for you to show your children how to respect others, learn forgiveness, and handle change with as much grace as possible.

Some ways to help your children and teens throughout this transition:

• Seek outside support for yourself and create community through friends, extended family, support groups, legal and financial counseling, therapy, and spiritual activities. Having resources for yourself helps you feel better and be a better parent. This will also help prevent you from leaning on your children in times of distress and/or discussing issues that are not age appropriate for them.

• Remain in continual conversation with your children regarding what is happening. They have many questions that need answers in an age appropriate way. Children get very fearful at this time, and having their questions left unanswered only adds to that fear. Let them know that both parents are there for them and tell them that the divorce is not their fault - over and over again!

• Remain respectful to the other parent. While you may have very strong emotions about your partner at this time, your child has feelings of his or her own. Children and teens have a right to their own feelings about each of their parents, and the right to spend time with both of them. Children identify with both parents, and negative remarks about the other parent can have devastating effects on them. They often take these remarks on themselves and feel as if the parent is talking negatively about them as well.

• Provide outside resources for your kids and teens. It is important for kids to have someone besides their parents to talk with about what is happening. Kids do not want to hurt their parents’ feelings, and will often keep their thoughts and feelings to themselves in order to be “fair” to each parent. Support groups are a wonderful way to create community for them so they do not feel alone. Divorce effects over half of all marriages, yet kids often feel very isolated at this time.

• Co-parent together. While your relationship and/or marriage may be changing, your responsiblities as parents are not. Working together to raise your children is helpful to both them and you. Single parenting is not easy, but it is made easier by helping each other out and remaining open to the other parent’s thoughts and ideas. Try to be flexible with the parenting arrangement when the need arises. Sometimes issues of safety or absence makes this an impossibility, yet it is helpful to keep in mind that children think about and identify with both of their parents even in an absence.

• Create as much consistency and routine as possible for your kids. They are experiencing a huge change in their life that may seem very overwhelming. If possible, try to work slowly through any changes in residence, schools, and activities. This will give them time to adjust and process the loss.

• Create new ways of defining family for you and your kids. What does family mean and how does this look to you? Expand on the ideas of what defines family. While there is loss of the way the family was, there is opportunity to create a new and different sense of how you wish to be as a family now.

• Additional Resources:
  • Divorce Lifeline at 206-694-5757
  • www.divorcenet.com provides legal advice, information on state laws, and help for do-it-yourself divorces.
  • www.fairsharedivorce.com
  • King County Lawyer Referral Service at 206-623-2551
  • Eastside Legal Assistance Program at 425-747-7274 provides a free 30 minute consultation with an attorney.
  • www.careerdiscoveryinc.com
  • www.shaublaw.com

  In my continued learning and curiosity regarding this experience, I invite you to share your ideas and stories on this topic.

In today’s world of computers, cell phones, text messaging, and email, it appears as if communication between people is easy and accessible. While the availability of different modes of communication have made people much more accessible to each other, unfortunately, it has also taken away from actual face to face interactions.

There is something that is much easier about writing down our thoughts in an email and pushing the send key, than there is to voicing them to a friend or partner in their presence. It is often the fear of the other person’s response to what we need to say that often stands in the way of us speaking our thoughts, feelings, and needs to our significant others. Yet, this is exactly what is needed to promote a conversation that will address the issues at hand, and allow the body language to show that will help facilitate the conversation.

Much of communication is not the words that we say, but the way in which we say them. The tone and inflection of voice, the way in which we hold our bodies, and our facial expressions say so much more than the actual words that come out of our mouths. As the saying goes, “actions speak louder than words,” and this includes having a face to face conversation with someone you care about. The next time you are upset, disappointed, frustrated, or feeling misunderstood, try giving yourself and your loved one the biggest gifts of all - your mind, body, and spirit in person!

Helpful ways to get started:

• Realize that your feelings are important, and if shared, will help others learn more about what you need and desire. This promotes growth in the relationship.

• Use “I feel… when you” versus “you always” or “you never” statements to express your thoughts and feelings. This avoids accusatory language and invites openness for discussion.

• We often have defenses up to protect ourselves, so try to express yourself with as much grace and openness as possible. Speak to others as you would like to be spoken to.

• If anger is in the way of effective expression, take some time to breathe, calm down, and think about what it is that you wish to accomplish in the conversation. You can always revisit an issue or conversation later - this is the beauty of being in relationship with others. Now may not be the right time, but later may. Engaging in physical touch with your partner (holding hands, sitting next to each other) while conversing can help to promote closeness and a sense of unity through the discussion.

• Put yourself in the other person’s shoes. Take a few moments to try on the other person’s perspective, even if it is uncomfortable, in order to better understand their needs. While your needs and desires may be different, it is important in relationships to respect the other person’s perspective even if you do not understand it.

• Closeness does not necessarily come from similarities, it comes from acknowledging and learning from each other’s differences. Attempt to learn from each other by being curious to your differences.