MY APPROACH
I believe that a compassionate approach to the self, experiencing rather than avoiding emotions, being present, directly facing painful and deeply held stories and experiences, and taking action toward what actually matters to you are essential aspects of healing and seeing life clearly. Amid the struggles, tragedies, and difficulties that confront us each individual has the capacity to live a vital and meaningful life deeply connected to others and what matters to you. This doesn’t mean immunity from difficult and painful emotions or experiences, but that you will be able to experience and respond to these events with adaptability, flexibility, and resiliency.
I will work with you to change unhelpful and unworkable habits or behaviors bringing you to therapy, to develop a greater sense of compassion and gentleness toward yourself, and to increase your ability to respond in skillful ways to life’s challenges. For most of us, our reactions and response to our pain lead to suffering. When we mess up, we think “I’m so stupid, how could I have done that, I’m such an idiot?” which leads to shame, a powerful and constricting emotion that usually causes us to hide or lash out. When we feel invalidated or hurt by another, we think “I’m broken” which may lead to isolation or attempts to overcompensate by overworking or perfectionism and never feeling “good enough.” Sometimes when we experience difficulty, we try to numb with any number of behaviors, food, or substances which lead to avoidance. These responses only serve to distance us from our most authentic self and to strengthen the inner critic which too often runs the show.
Only when we learn to acknowledge and make room for our pain, we create space to respond differently in more adaptive ways. We can say “I messed up and that hurts, I really wanted that to go differently. I know was doing the best I could at the time with what I had. This is disappointing, and I’m ok. Next time I’ll try…”
When we feel invalidated we can offer ourselves compassion, “That didn’t feel good to be misunderstood. I know I feel hurt right now, how can I take care of myself?”
When we want to numb or avoid we can ask ourself “What am I avoiding? What feels too big to face right now? How might I face this difficulty with courage and vulnerability? Ugh, I really don’t like this feeling, but I know I can make room for it to get through it.”
Working to understand and change the relationship to yourself and others after years of believing the voice of the inner critic as fact and habitually reacting to pain by avoidance or other unworkable patterns takes immense courage, practice, and patience. It is a privilege for me to be part of your journey.
Because each individual’s history, goals, and context is unique, I use an integrative approach to therapy rooted in mindfulness and connection to yourself and others. My predominant theoretical orientation is Acceptance and Commitment Therapy (ACT), I integrate aspects of Dialectical Behavioral Therapy (DBT), Mindfulness-Based Interventions, Cognitive Behavioral Therapy Enhanced (CBT-E), and Interpersonal Therapy (IPT). For families of adolescents, I also use Family Based Treatment (FBT). My approach to therapy is flexible, responsive, and creative based on what you want to change, explore, and heal. Learn more about Acceptance and Commitment Therapy Here.
Core Values Guiding My Therapy
Resiliency Compassion Hope Action Patience Non-Judgment
Knowledge Learning Integrity Balance Trust Equanimity Wisdom
TREATMENT FOCUS
I specialize in the treatment of eating disorders, disordered eating, body image dissatisfaction/body dysmorphia, and co-occurring anxiety and depression. I work with adolescents (14+) and adults in all stages of recovery, from seeking therapy for the first time to individuals who have participated in multiple treatments. I also work with individuals struggling with compulsive or addictive exercise. Due to the complex medical and psychological nature of eating disorders and related conditions I work closely with other providers such as nutritionists, psychiatrists, and medical doctors to ensure a comprehensive and collaborative treatment approach. If you are not currently working with a nutritionist or medical provider, I will work with you to find a specialist appropriate to your needs. Although I specialize in eating disorder and body image treatment, you don’t have to have an eating disorder to work with me. I also see clients wanting help for anxiety and depression.
- Bulimia Nervosa
- Binge Eating Disorder
- Anorexia Nervosa
- Orthorexia
- Disordered Eating
- Emotional Eating
- Chronic Dieting
- ED + DMT1
- Exercise Addiction
- Body Image Dissatisfaction (either occurring with or without an eating disorder)
- Body Dysmorphic Disorder (BDD)
- Depression
- Anxiety
- Mood disorders
- OCD
- ADHD
- Perfectionism
- Trauma
- Self-injury
- Athletes
- Vegan/Vegetarian
FAMILIES AND OTHER SUPPORTERS
Supporting a loved one who struggles with an eating disorder or related mental health condition described above is difficult, frightening, and challenging. Because families and supporters often become significantly involved in an individual’s struggle with food, weight, shape, and exercise concerns I encourage family and other identified supports to participate in treatment, with the client’s permission and as is clinically appropriate. Families and other supporters can be some of the best advocates and helpers for clients in their journey to recovery, but often need a little help in learning how to best do so, especially when the client is an adolescent.
I work with families and supporters to improve and enhance communication, increase compassion, provide education, navigate limits and boundaries with disordered behaviors, develop an understanding and awareness of “triggers” (why does my loved one make a 180 turn when I say XYZ?), learn how to provide effective support, and enhance personal coping skills.
I also provide support and coaching to supporters who may be experiencing caregiver fatigue, feel stuck, or simply need more support and education about their loved one’s experience.
For families of adolescents I offer a highly focused intervention called Family Based Treatment (FBT), also known as the Maudsley Method. FBT focuses on empowering parents to first re-nourish their child and interrupt eating disordered behaviors, second to allow the adolescent to regain autonomy and independence with food, and lastly to address developmental processes that the eating disorder interrupted. Family Based Treatment requires that each family member attend sessions (including siblings) and that parents or other caregivers are initially actively involved in preparing meals and snacks and supporting their adolescent while eating.
HOW I CAN HELP
Recovery involves a combination of acquiring and practicing new skills, exploring current and past biopsychosocial influences, experiencing emotions, and most importantly rediscovering and accepting yourself.
Below are some of the categories we may address and work through in therapy:
- Increase recovery-oriented actions that decrease or interrupt eating disorder symptoms.
- Establish coping skills to tolerate and experience challenging emotions, urges, or situations.
- Improve relationships and communication.
- Clarify and move toward what is truly important to you.
- Enhance connection to your physical body.
- Explore the impact of life events, relationships, temperament, self-beliefs, and other biopsychosocial factors influencing your struggles.
- Develop a personal mindfulness practice to reduce stress and anxiety and more adaptively respond to life’s challenges, irritations, and disappointments.
- Understand how eating disorder behaviors function for you as well as underlying physiological mechanisms that maintain food-focused thoughts and actions.
- Provide education about eating disorders, anxiety, and depression.
- Connect to other eating disorder specialists for nutritional rehabilitation, medical care, psychiatric management, and adjunct therapies.
- Reduce anxiety and depression.
- Decrease obsessive thinking about food, exercise, and/or your body.
- Offer hope and compassion through a non-judgmental and empowering therapeutic relationship.
- Increase psychological flexibility.
If you are interested in working with me or have questions please email me at alison@alisonraman.com or call 253.691.1281.
WHAT IS FAMILY BASED TREATMENT?
Family Based Treatment is a highly focused, solution oriented intervention designed to help adolescents recover from anorexia or bulimia in the context of their family rather than long-term residential or inpatient treatment.
The treatment is divided into three phases and generally takes 6-12 months of dedicated effort, although shorter or longer time periods may be required. The basis for FBT is to empower parents to help their teen make behavior changes around food, bingeing, purging, exercise, and other behaviors related to the eating disorder.
Parents often blame themselves or wonder if they caused an eating disorder in their child. Early theories about the cause of eating disorders posited that families, particularly rigid and over controlling mothers, caused eating disorders but this view is outdated. Blaming yourself as a parent is disempowering and unhelpful, you need all the confidence you can to challenge the eating disorder with zeal.
And, more importantly, as of yet there is not an identified “cause” of eating disorders, despite what popular media may purport. Ongoing research about physiological mechanisms, socio-cultural influences, trauma, appetite regulation, genetics, and more will hopefully continue to shed light on the reason some individuals develop eating disorders and some don’t.
As such, FBT does not focus on the cause of the eating disorder but rather focuses on re-nourishing your child and modifying the myriad of strange and troublesome behaviors associated with the eating disorder. Initially, FBT is intensely focused on weight restoration (for anorexia) and symptom interruption in bulimia.
Also essential in this initial stage of treatment is a powerful separation, or externalization, of the eating disorder from your adolescent. It may seem as though your child has been taken over by an alien, their personality slowly eroded by the anorexia or bulimia. In this phase of treatment, you will begin to see and understand the anorexia or bulimia as separate from your teen, unraveling the disorder from your child. Although it may seem like your teen and the eating disorder are one in the same, the child you once knew without the disorder is in there! In this sense, when conflict arises in the context of the eating disorder which it undoubtedly does, know that the eating disorder is in control, not your teen. Remember, your teen did not choose to have anorexia or bulimia.
The second phase of treatment begins after your teen demonstrates significant weight restoration and significant symptom reduction, the focus of therapy becomes on slowly handing back control of food and exercise to your teen. Teens with anorexia may have completed weight restoration, but still struggle to manage to feed themselves appropriately without support. In this case phase two may be delayed until food rituals and behaviors decrease markedly. Other aspects of phase two include helping the teen navigate re-engagement in activities and social events while diligently monitoring for relapse and continued improvement.
The final phase of treatment commences after full weight restoration and when symptoms related to the ED have abated. At this point, the family begins to discuss the tasks of adolescent development and address other deferred issues that may have come up but during first phases of treatment.
WHAT IS THE ROLE OF THE THERAPIST?
In FBT, the therapist serves as a consultant and collaborator to help the parents make their own decisions regarding how to help their child eat and make behavior changes toward recovery. The therapist provides information and education about eating disorders and general adolescent development to help the parents find a solution that works within their family system, but does not provide a specific prescription. The role of a therapist is to help the parents identify resources, provide knowledge to make informed choices, and empower them to take action against these dreadful illnesses.
HOW DO I MAKE SURE MY CHILD IS MEDICALLY STABLE?
Adolescents must be medically stable to participate in FBT. The frequency of medical monitoring (labs, weight, EKG, DEXA, etc) will vary by need. The medical providers (MD, ARNP) are an integral part of the team in FBT.
WHAT IS THE ROLE OF A DIETITIAN?
Parental consultation with a Registered Dietician may also be necessary to help parents address nutritional questions, review growth charts, and provide helpful guidance on meals and snacks. In FBT, however, the role of dietitian differs from other approaches where the RD prescribes a meal plan for the client as is typically done in treatment centers and for adults. A dietitian often plays an important role in FBT, but does not prescribe a meal plan directly to the teen.
WHAT IS REQUIRED OF THE PARENTS OR CAREGIVERS?
Starting FBT requires significant time and resources from caregivers, much in the same way families make adjustments to help a child recover from an illness like cancer. Some families may have to enlist the help of close relatives, take time away from work, oeen recover. All family members attend each session. The second session of treatment is a family meal where the therapist observes the family eat and coaches the parents.
Caregivers are initially responsible for providing supervision, support, and structure around every meal. This means preparing meals and snacks, sitting at the table or near your teen while eating, and providing encouragement and support when eating and after completion of the meal. For teens with bulimia, being available for support or distraction after a meal is of particular importance to prevent purging.
During the initial phases, teens may have to be absent from school and other activities to ensure completion of meals and for parents to monitor exercise and purging. As your teen progresses through treatment parental involvement in meals and snacks shifts back to your teen as your teen takes on more autonomy.
WHAT IS THE ROLE OF SIBLINGS?
The primary role of siblings in FBT is to distract and provide support to your child with the eating disorder as is age appropriate. A brother or sister may play games, watch movies, or just be there to provide some laughter or a listening ear. Siblings do not take on a role in helping the child eat other than participating in family meals and snacks, as helping your teen eat is the job of the parents.
HOW DO I KNOW IF FBT IS RIGHT FOR MY FAMILY AND CHILD?
FBT has been shown to be effective for adolescents with a short duration (1-3 years) of AN and ongoing studies show increasing evidence for its usefulness in bulimia. However, some complicating factors described below may hinder the success of this treatment modality. Before deciding FBT is not right for your family, however, please consult with your therapist.
- Families must be willing and available to attend all sessions together. If scheduling does not allow for a parent or sibling to consistently attend sessions, FBT may not be right for you.
- Caregivers must be available at every meal and snack initially to ensure completion of meals and support symptom interruption. If consistent presence at meals and snacks is not possible, even after trying creative solutions, another treatment option may be a good choice.
- Teens with severe OCD may be less responsive to treatment.
- If you as a parent, do not want to do FBT, then you should not be forced to try this method.
- If your child has severe depression, psychosis, or substance abuse. Active suicidal ideation or other severe behaviors like assault or running away should be stabilized prior to commencing treatment.
- If abuse and neglect is present in your family.
- Families in the middle of divorce or separation may not be a good fit depending on the circumstance.
- If a parent has an eating disorder or has a history of an eating disorder, this should be discussed with the therapist to determine how this may affect treatment. Some parents with eating disorders are able to support their child successfully as they “know what it is like” and do not want their child to struggle as they have.
WHAT ARE THE ALTERNATIVES?
There are a variety of other approaches and treatments for eating disorders that may be helpful for your child and family. Numerous intensive facility based treatment centers with dedicated, knowledgeable, and compassionate staff offer the containment, structure, and support your child and family may need to start or maintain the recovery process. Individual providers (dietitians, psychologists, therapist, MD’s) can also form an effective treatment team.
WHERE CAN I FIND MORE INFORMATION?
There are numerous resources for information about FBT as well as communities of parents who have participated or are participating in this method.
Maudsley Parents
http://www.maudsleyparents.org
Families Empowered and Supporting Treatment of Eating Disorders
Books
Help Your Teenager Beat an Eating Disorder by James Lock, MD, PhD and Daniel LeGrange, PhD
Brave Girl Eating: A Families Struggle with Anorexia by Harriet Brown
COLLEGE STUDENTS
Navigating the challenges of education, social life, work responsibilities, physical wellness, and mental health during college and graduate work taxes even the most resilient, intelligent and driven individuals. If you are struggling with an eating disorder, anxiety or depression just getting through each day can be exhausting.
Eating struggles that may have begun in adolescence or childhood, which may or may not have been treated previously, may start to show up again during the transition to college. Added stressors of pursuing a degree, leaving your natural support system, and adapting to a new environment can exacerbate ongoing struggles with restricting, bingeing, purging, or unhealthy exercise. For some individuals, eating disorders develop for the first time in the college or graduate years.
If you, a friend, roommate, teammate, or your son or daughter is struggling with an eating disorder or “subclinical” symptoms, please contact me to see if I might be a good fit for you to help you recover or maintain the progress you’ve already made. I also work with individuals struggling with anxiety and depression.
Email: alison@alisonraman.com or Phone 253.691.1281
FEES
Individual 50-60 minute Therapy Session: $200
Family Coaching or Support Session 55-minutes: $200
Payment is due at time of service. I accept cash, check, or credit card. I will provide you a receipt if you wish to seek reimbursement from your insurance provider. Reimbursement from your insurance company is not guaranteed and determined by your insurance companies medical necessity guidelines.
I am not an in network provider for insurance companies.
GOOD FAITH ESTIMATE STANDARD NOTICE:
“RIGHT TO RECEIVE A GOOD FAITH ESTIMATE OF EXPECTED CHARGES” UNDER THE “NO SURPRISES ACT”
Effective 01/01/2022
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (720) 845-6600.