Virtual Eating Disorder Care w/ Dr. Wendy Oliver-Pyatt of Within

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Are there dynamics that are worthy of exploration and shifting
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away from This is not about a blame approach. It's
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really empowering. You just skip over that you're actually taking
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away their power. You're disempowering them to have more influence.
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We don't discover and explore these things with neutrality and compassion,
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we really miss something very exciting about helping people heal
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that has much more far reaching effects than just changing
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someone's behavior temporarily.
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You've arrived at the Mental Health Spotlight podcast with therapist
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Caise Andy Oliver Pyatt. Did I get it all correct?
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Yay?
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Well, what's so funny is I was talking we had
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this great Northeast Ohio we need to sort of collaborative
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this past week here Within was here, Kelly, Kelly was here.
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I saw that. I think I saw that.
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I thank you and your organization for being a part
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of it. Oh cool, And she's like, oh, Kaise, I'm
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so excited You're going to meet doctor Wendy. And and
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every time I heard your name, I was like, Yeah,
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that's going to be really fun. And the name was
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making me itch and like what is it with this name?
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And then and then of course it dawned on me
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that you're also the Oliver Piot Center. Yeah, you are
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so many things, Wendy. I'm a little overwhelmed by all
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of your things. I don't even quite know where to start.
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You are now, Wendy, Oh yeah, I.
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Have to refer to you, and I'm like, oh, here
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you are.
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Oh, thank you.
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I would never do your bio justice because there's so
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much on there and I don't know how you'll even
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give us a little snapshot, but tell us a little
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bit about I guess really what started you, your background,
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and then how that has brought you into all of
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these different eating disorder settings.
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Thank you for having me, and like my background, really,
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I'm from a small town in Carson City, Nevada, and
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I was very involved in ballet, so that was a
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big part of my life. And this was back when
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nobody knew anything about the concept of weight stigma, diet culture,
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even eating disorders, and nobody really understood so at that time,
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early in my life, I kind of fell into restrictive
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eating because of being in ballet, and then that led
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to my own struggle and then, thank god, triumph to
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get through to the other side. I was very, very
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fortunate because I was blessed to stumble on the principles
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of mindful eating like very early on. So by the
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grace of goodness, God, whatever, I've found my way into
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the concepts of mindfulness and mindful eating. And that just
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like opened up a whole world to me of not
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just you know, not just a way of like approaching food,
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but really like a way of approaching life that really
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was like very meaningful to me. And in my early twenties,
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during medical school and residency in New York City, I
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sort of became, you know, sort of I evolved. I
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think I was telling you in the pre recording that
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I feel like I grew up in New York and
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I just learned. I just did. I honestly did a
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lot of self help and self exploration. I read M.
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Scott Peck The Road Lest Traveled and things like that
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that go way way back, and read some of the
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books by Jeanine Roth that are sort of the pre
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intuitive eating book. And there was even some writer a
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writer before Jeanine Roth, So all of those people kind
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of influenced me. I fell in love with psychiatry during
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medical school. Accidentally. I was planning to do obigyn my
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whole well, I was planning to be a veterinarian. Then
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I switched to obigyn. But then I did my rotation.
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In my third year of medical school at King's County Hospital,
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encountered my first psychotic patient and just was blown away
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by the watch watching and being a part of somebody
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going from a state of florid ssechosis to the cdity
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and I just fell in love with learning about the mind.
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So I just kind of shift gears and decided I
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really was meant to be a psychiatrist. And that was
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really something that I grappled with because it really was
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also an opportunity to have that shift into the paradigm
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of like what really internally motivates me versus externally motivates me,
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which is a kind of a thing I talk about
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with my patients a lot. And so it was really
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like it was really like, you know, I wanted to
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read the journals that had to do with psychiatry because
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I was genuinely just interested. It wasn't like I should
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read it because I need to know that I'm going
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to be an obg R. And it was like just
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genuinely intuitively was drawn to the mind and the soul
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and healing, and so that led me into psychiatry. Very
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long story, I could go on and on, but I
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went to the State of Nevada. I started, I became
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the State of Nevada Medical Director for Division Mental Health.
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We got funding to do a sort of community treatment
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programs and stumbled into the opportunity to do eating disorder work.
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With one of my co workers, I had written a
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book about eating disorders, and disordered eating.
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Has already written a book by then.
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I wrote a book in two thousand and three. Yeah,
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oh interesting.
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I did not know that.
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That led to some people inquiring, you know, whether or
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not I would want to open a treatment center for
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reading disorders, and I decided, yeah, I think I will
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do that. So it was just kind of a sometimes
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I either think of it as bold or crazy. I
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definitely had imposter syndrome and it was like what am
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I doing? But I had people behind me that believed
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in me. And I opened my first treatment center center
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for open this years in two thousand and three, and
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it just kind of took off from there. We figured
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our own, our own way of treating in disorders based
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on like truly organic process and individualized approaches. So I
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had never been in a treatment center or seen a model.
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It was just this is really based on like the
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human being in front of me. And so my curse
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was that I had no experience developing models, which was
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my blessing. So that's the very long answer, but it
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just took off from there and just never stopped.
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I love that. And it tells us that your original
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background is mindfulness and then medical, and you've made a
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confluence of both of those, is kind of what I'm
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hearing in your your story.
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Yes, I think one of the things I really believe
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in is being true to a bias psychosocial foundation and
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really understanding your patients that informs your treatment, and that
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behavioral approaches need to be really trauma informed, and behavioral
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approaches have to be grounded on like a psychodynamic formulation.
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So I used to always kind of insist that our
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therapist really be able to in a way like once
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you get to know the patient, you should have in
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your mind a framework of like the psychodynamics that are
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driving forward the eating disorder, whether it's temperamental features or
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socio cultural factors, family dynamics or whatever. But to have
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an understanding of like the why, you know, the why
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of the eating disorder, the how of the order, the
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function of the eating disorder, because it's imperative to get
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to the underlying dynamics that are driving the behavior, not
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just only focused on the behavior.
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And did you find at the time that other people
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weren't approaching it with a more looking at a symptom
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approach and just trying to come up with like a
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brief solution base.
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I think that's kind of been one of the problems
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in general with the field. I'm not saying every program
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is like that, but I think that a while. I
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you know, I'm a physician, and obviously the medical aspect
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of your newsorders is like very first and you know,
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right in front of me at all the times. But
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I just think the oversimplification of oh, you just you know,
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you just put weight on somebody and then the brain's
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gonna work great and then they'll be done. I think
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sometimes we want to go that route because we don't
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want to feel like we're blaming people, right, And I
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think there's a way to actually be more authentic and
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more honest with folks. We don't discover and explore these
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things with neutrality and compassion for both the patient and
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the other other parties involved. We really miss something very
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exciting about helping people heal that has much more far
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reaching effects than just changing someone's behavior temporarily.
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Oh, I love that. When I work with young people,
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I say, this could be transformational for your whole life.
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This isn't about whether you had this mule today.
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Yeah. Yeah, And it also can be that one person
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with the eating disorder can the shift in the dynamics.
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If we're exploring it with like compassion and curiosity for
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the whole system, it can actually help the whole system.
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It can help the whole unit or family or group
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function better and be happier, be more peace less. Things
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like hidden from words and language in the relationships, which
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brings more closeness actually.
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And less shame. If we're talking about it for resent,
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it can't hurt us as much.
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Not less shame. I'm glad you mentioned that that's central.
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It's in what you're saying. It's and I know you
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said we don't want to point at people's worlds, but
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our worlds do shape us generally externally, and we have
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to look at those.
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Yeah.
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Absolutely, I think of twelve step. You don't just not drink,
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you have to go through an entire program of personal
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evolution to get better or recivitism is huge.
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Addressing shame is like fundamental to really any kind of
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mental illness, whether it's an eating disorder or substance use
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or something else. But shame is really that one of
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the underlying drivers of people needing to bury their feelings.
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Of course, so I love doing talks on shame. I
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love sharing about shame. I love doing experiential processes with
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clinicians around the around shame. Had some really great experiences
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with that, and that's like superfering and exciting.
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Oh I love that, And we don't talk about it enough.
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It's almost like a friend word that we just need
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to really own even more, and it should be part
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of every recovery. I agree obviously, you you wrote it.
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I'm just talking from what you've already created. I've learned
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what I've learned because you were the pioneer to bring
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this language forward.
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I was stumbling into everything. Hey there's the shame thing.
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Hey wait, stigma.
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I hear that so much with people I interview, and
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I think it's because this is all so new. This
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is still such a new world that we're crafting. And
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again I call you a pioneer because you really are.
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If it wasn't for people like you stumbling and searching,
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we wouldn't have this conversation right now.
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So thank you. That's very very thank you.
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Thank you for doing that. So you came out with
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this with your own version of a model based on
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what you believe so strongly, and then a lot of
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places took this on, Like do all the places you had,
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Clementine Oliver Pyatt that you use this same model at?
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Are they all similar?
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I could say very similar. I mean, my first treatment
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center is in two thousand and three and there's been
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sort of like obviously an ongoing evolution since then, leading
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to Galen Hopen within now. And I tell people, yeah,
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my program maybe five years old, but like it's twenty
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three years in the making, and you know, I would say,
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you know, some of the things that I particularly love
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about it, which I could go on and on about
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things I love about it, in both Galen Home and
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within the way we do food is really really special.
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I think people tend to this sounds a little judge.
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I'm sorry, but I'm opinionated about it. And I think
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when people are thinking about their own healing and like
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what they need to do if they do have to
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go to higher levels of care, really understanding like how
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are they going to do food, what's the approach there
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with food? How do they actually handle food? Because there's
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a wide variation there of how it is handled and
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it has far reaching effects to really give that consideration.
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So I've always been very grounded on helping people shift
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I think, away from what I would call external regulation
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or rule govern needing toward internal regulation, tied in between
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a combination. It becomes sort of a combination of intuitive
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eating and mindful leading, but the early stages of it
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for many patients is really a mechanical eating process because
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you're actually having to do exposure therapy. I'm a really
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big believer in going very slow. I'd much rather approach
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individuals and get exposure to a very broad array of
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non diet foods so that people are able to eat
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the girls cheese, sandwiches and the things that are very
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you know, if you're a college student, I want you
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to be able to eat pizza when you go back
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to college. You know, if your mom or dad, I
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want you a birthday cake. So we have to do
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a lot of exposure therapy. But I really really do
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a belief for both medical and psychological reasons. Going you know,
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starting low, go slow, slower, is sometimes really faster as
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far like long term. So there's some really creative ways
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that we've helped people shift into internal regulation and it
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really is a developmental process as people are healing and
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really helping people take accountability. And I use the concept
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of a monessory concept of like freedom and responsibility, you
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are intertwined, so like as somebody is more responsible to themselves,
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they ought to have more freedom. So using a non punitive,
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developmental natural consequence approach is really a way I think
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that people can heal from the inside out. And so
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some really interesting ways we've evolved in how we do food.
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I think that helped people get out of diet culture mindset,
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and really a big goal of mine is to help
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people become as far as long as they can on
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the continuum towards mindfulness and intuitive eating. And really important
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is to abandon the pursuit of thinness.
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Oh well, you just said two huge things there. You
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ended with abandon the pursuit of thinness. I'm going to
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come back to that. But you mentioned the food, your
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food tenant that you hold, and I want to highlight
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too that now you are currently CEO and overseeing Within
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and Galen Hope. Is that correct both of those?
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Yes?
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Can you tell us a little bit about those? And
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I have to laugh because I found this in my
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I love. I have the socks too, and I wear them.
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I should have my Within coffee mug with me as
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a matter of fact, how terrible of me.
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I got your back, thank you. I don't have Galen Hope.
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I'm to send you a hat from Galen Hope right away.
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Perfect, But tell us a little bit about these two,
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because I believe Galen Hope is in Florida and within
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your virtual setting.
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Yes, yes, yes, so Within is now. I believe in
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about forty tuesdays. I think forty three. I'm not sure.
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I've lost track. We got to get up to fifty.
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But we're coming along. And Galen Hope is in Coral Gables.
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Galen Hope also treats primary mental health. I remember I
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told you that story about my psychotic patient way back when.
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I do love primary mental health, treating OCD, trauma, depression,
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my polar disorder, psychosis. All of that is a true
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passion of mine. So I'm very fortunate at Galen Hope
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I can do both eating disorders and primary mental health,
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which is really really exciting for me. So Galen Hope
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is in person and all levels of care going up
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through residential and within. Is a remote program, and I
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call it remote specifically just so you know, because the
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relationships are not virtual. These are very real relationships that
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our patients are embarking upon. We with them, they with us,
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and amongst them some very deep and meaningful connections, attachments
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and relationships and healing relationships evolve. And I think you know,
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both programs are derivatives of like twenty plus years of work.
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I'm so lucky because when I started both programs there
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was a sort of little mini army of wonderful people
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that had all worked together back at OPC and Clementine,
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And so when I started Galing hopeing with then Health,
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I had such a strong team to help me launch.
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That was why I was able to do it, because
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I didn't have to do so much legwork as the
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team is really I mean, we already had teams that
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were solid and knew how to do the work. So
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that was that was truly exciting for me to see
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that those teams come to fruition again. So within is
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really the embodiment of like twenty plus years of work.
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And I what I did is I pictured walking into
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one of my treatment centers and I said, what is
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you know what's in this door here when you walk in?
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That's like healing for patients. And I mean the truth,
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The truth is like Galeen Hope has the same basically
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the same principles. But I'll just start with within or
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I'll go to the within because people sometimes wonder how
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do you do how do you work with such a
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cute patience in a remote setting? And I wasn't sure
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if we could.
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And this is all new, isn't it, Wendy, Like you
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weren't doing any of this pre COVID. Were we were
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we allowed to do remote back then?
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We were, Yeah, we started this in twenty twenty one.
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I was doing remote care for eating disorders going back
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to like twenty eighteen, twenty nineteen. And that's what got
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me the idea. Even before COVID. I was like, wow,
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like I work with patients that were pretty compromised, Like
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I had people that couldn't go to treatment, like I
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had somebody in a European country. I had somebody who
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was a dolphin trainer as a matter of fact, And
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I was doing high frequency treatment, so I was kind
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of covering psychiatry, nutrition and therapy and family. I was
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just doing a lot of like intensive work, and I
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was going, Wow, this is a person who was purging,
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who was ever exercising, who's restricting, She's getting better and
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I'm not sitting over her. You know, she's not in
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a treatment set. So that got me really excited before
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pandemic even came. But I think, you know, some of
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the things that are really important is you know, among
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among many is high frequency of individual therapy. So I
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really believe that when somebody comes to treatment, you've got
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we're talking about the underlying dynamics, Like you can't get
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to the underlying dynamics. So if you're doing like a
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forty five minute session a week, so you've got to
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invest in the therapy you have. You had that person
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under your umbrella for a very limited period of time,
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Like what are you going to do? Like it's a
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sacred opportunity. By the time somebody has decided to come
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to a higher level of care. They've suffered a lot.
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Even at the IOP level care, they've suffered a lot.
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They're making the decision to come to twelve fifteen hours
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a week of treatment, Like you have to be pretty
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hurting to do what's almost the equivalent of a halftime
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job like com into treatment. So that high frequency of
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therapy is like our investment in the patient and ultimately
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in their healing. And that's something I just don't think
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you can cut corners on having therapists that are really
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curious and compassionate around those underlying dynamics. So it's this
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great journey together.
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Just interrupt you for a second. Sure a lot of
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times what I hear is remiss in other settings is
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they're not getting a lot of individualized care or they're
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not getting a lot of the therapeutic piece that gets
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at the core. So kudos to you for recognizing them.
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Oh think I can't do it any other way. I
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just can't. I just cannot do it any other way.
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I feel like it's punitive if you don't, and it's
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like you're missing out on like the journey with the patient.
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The symptom is the is the opportunity. As I say,
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the symptom is the way into the deeper ourself, So
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we would be really ripping the patient off and ourself off,
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I think, to not go on that journey. So high
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frequency of individual therapy is really important family, family, and community.
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So not just not really just accepting it when the
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patients like, oh I don't want to do family therapy, well,
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guess what we need to involve you. And so we
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have a model both a Galen Hope and Within. It's
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a comprehensive approach where there's not just therapy, but there's
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also coaching and there's also education. I'm actually getting something
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published for Galeen Hope. We call the family Integration model.
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It's very similar to what we do, very similar to
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what we do at Within. We've modified things, of course
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for each organization. But you know, even if the person
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is a really troubled relationship with others in their life,
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or or is really feeling like they are not ready
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to take those steps therapeutic, I mean you still have
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to like dig in and not really accept that, like, hey,
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this person's in these in relationships with these people in
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their life and they've got this really significant illness before us.
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So we can't just like sort of sweep that under
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the rug and pretend like, yeah, we can't we're not
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gonna involve other people. It doesn't mean we always have
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to be therapeutic in the involvement. So it could just
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be that we're doing education with them. It could just
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be that we need to educate people. It could be
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that we have to coach people, like maybe somebody's not
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really the relationship's not going to change a whole lot
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or whatever, but maybe a little coaching would help. And
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then you know, also pivoting and finding the right people
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to have the conversations, like sometimes the coaching is best held,
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you know by maybe an authoritative physician from your team
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needs to talk with like the parents versus the therapist.
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Or sometimes it's the dietitian that needs to talk to
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the mom or about like, yeah, your loved one probably
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ought to not be be doing TRAP right now because
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they have even Rea, you know, so I like really
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mixing and matching who's doing the education and the coaching.
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We have Joe Kelly then and he's always he's done
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a lot of work around like present with him on
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really the circle of care, the circle of moments, so
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it's beyond just the family. And then at Galen Hope, Yeah,
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we've just really established a wonderful model and we do
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a ton of family work and we do like a
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really beautiful family day where the whole family comes in
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once a month and that's really really appreciated by our
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families and we really get to know them.
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So some of the key things are this whole family
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based and the integrative thing you mentioned there's the attention
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to a lot of therapeutic one on one time.
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Yeah, and then you.
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Said your food model. You mentioned that a little bit earlier.
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I want to make sure we come back to that.
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You said you have a very very special way that
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you approach food. Yes, well, can you speak a little
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bit about that.
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Well, some people are pretty surprised when they find out
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that people who are very very compromise with eating disorders
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and I don't use supplements, don't use boost, don't give
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them lunar bars. It's you know, if you're coming to treatment.
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You know, they used to always say like, well, you know,
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the the Oliver Piot Center of the Galen Hope it's
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like it's very a very pretty place, but it's the
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food is hard. You know, we give people some ways,
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you know, to modify what they're get being fed. That's
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based on preferences. Like I always tell people, if I
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had a need disorder and I had to go to
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treatment and they told me I needed avocados, I would
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have a conneption fit. So people do have a way
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to modify their meal plans based on certain particular things
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that are non eating disorder related that we were able
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to determine. And again it's really the principles of exposure
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therapy that we're using. Gradual supported exposure therapy is really
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I think a very important principle, and the shift away
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toward away from extra to internal regulation. And so if
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you will like rewarding the person with more freedom as
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they are moving in the direction of internal regulation and
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finding some interesting ways to positively reinforce the non eating
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sort of behavior, and I think tied in with that.
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And this is something that doesn't get spoken about a lot,
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but when you're creating a treatment mill, you whether it's
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a remote meliu like within or in person like it, whatever,
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I think recognizing you're creating a sort of mini society, right,
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It's like the part the person coming to your treatment
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is making a sacrifice, giving up control, trusting blindly believing
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in you, right, all of these very big steps that
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they're taking. I mean, can you imagine going away to treatment,
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Like you're saying, Okay, you're going to control when I flush,
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go to the bathroom, talking the phone, watch TV, go
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to the store. You know, you're just giving up so
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much autonomy when you and remotely. We have parents that
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can't leave their kids. We have students that if they
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miss X class it's going to be another year until
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they graduate, and people that might lose their health insurance
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if they were to go away for treatment. There's a
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lot of reasons people don't go to treatment that have
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nothing to do with a lack of motivation. There's just
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so many path conserations. We tend to blame the patient.
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I mean just really thinking about what is my social
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environment that I'm in binding these patients to live in.
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So it's really a trick to strike that chord and
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like find a way to create the boundary around the
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disorder behavior and like still be affirming and validating and
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loving and supportive. And so I think that's something that
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we do really really well.
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And you've given that a lot of thought. I really
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appreciate that you mentioned the autonomy, especially with younger persons,
477
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because that's when they're supposed to develop autonomy. And then hey,
478
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by the way, you don't get to choose.
479
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What you do.
480
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One a tough balanced.
481
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It's terribly tough. Yeah it is.
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Yeah, and then being able to, like you said, give
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it back as they're ready to internally motivate and then
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to slowly it's such a treat to hand it back
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00:25:10.880 --> 00:25:11.559
and say, okay, you go.
486
00:25:11.799 --> 00:25:14.359
It really is such a treat. Yeah, it's exciting when
487
00:25:14.400 --> 00:25:17.000
you see that happening. But I mean, you really can
488
00:25:17.039 --> 00:25:20.680
think about the society you're creating and like and amongst
489
00:25:20.799 --> 00:25:24.319
our lovely human patients too, Like, they really are a
490
00:25:24.319 --> 00:25:27.480
big part of the environment that we create, and they
491
00:25:27.559 --> 00:25:30.200
lead one another to healing a lot of time too,
492
00:25:30.480 --> 00:25:33.079
And that's that's the best when you see that happening.
493
00:25:33.119 --> 00:25:35.079
I'm running a group, but I'll just kick back and
494
00:25:35.160 --> 00:25:39.240
let them all talk and be like, yep, you guys
495
00:25:39.279 --> 00:25:39.640
got this.
496
00:25:40.880 --> 00:25:42.920
They typically know more than we do, right, it's just
497
00:25:43.119 --> 00:25:46.079
organizing around it and letting it do that. Now. I know,
498
00:25:46.079 --> 00:25:49.759
if there's nutritionist or dieticians listening dietitians are going, oh wait,
499
00:25:50.119 --> 00:25:53.680
what about this no supplementation, and now you guys can't
500
00:25:53.680 --> 00:25:54.440
believe it? Right?
501
00:25:54.720 --> 00:25:55.880
Yeah?
502
00:25:55.680 --> 00:25:58.680
Yeah, And this kind of maybe blends into another question
503
00:25:58.720 --> 00:26:01.160
I have about for folks looking at the virtual setting too,
504
00:26:01.640 --> 00:26:04.480
how do you manage the medical fragility or the medical
505
00:26:04.480 --> 00:26:07.079
care piece. And then of course for people who aren't
506
00:26:07.079 --> 00:26:08.920
getting nutrition and aren't eating.
507
00:26:08.920 --> 00:26:11.359
A how do you do that? For sure? Yeah, that
508
00:26:11.519 --> 00:26:14.440
was a big big thing for us. How are we
509
00:26:14.480 --> 00:26:15.079
going to manage this?
510
00:26:15.240 --> 00:26:15.279
Like?
511
00:26:15.319 --> 00:26:19.039
Well, first and foremost, we do have very deep medical clearance,
512
00:26:19.119 --> 00:26:22.759
so we know what somebody's coming in. We have incredibly
513
00:26:22.799 --> 00:26:26.880
skilled clinicians that do the medical clearance, review the medical clearances,
514
00:26:27.200 --> 00:26:30.119
so we really know what's happening. We do take patients
515
00:26:30.160 --> 00:26:33.920
out within that, many patients who might otherwise go to residential.
516
00:26:33.960 --> 00:26:36.880
Now that does not mean, just to be clear, I
517
00:26:36.920 --> 00:26:39.839
would never come out and say that we're a substitute
518
00:26:39.839 --> 00:26:42.480
for any level of care, and I know some places
519
00:26:42.480 --> 00:26:44.200
have come out. I would never say that all these
520
00:26:44.279 --> 00:26:48.000
kinds of programs are needed for different scenarios that patients
521
00:26:48.039 --> 00:26:51.400
are in. I will say, though, however, we have successfully
522
00:26:51.440 --> 00:26:54.359
treated many a patient who might otherwise be in a
523
00:26:54.400 --> 00:26:57.680
residential so we can go down to depending on the circumstances,
524
00:26:57.720 --> 00:27:01.920
go down to seventy percent or so of ideal body weight.
525
00:27:02.599 --> 00:27:08.119
And we always really know what we're admitting before we admit.
526
00:27:08.359 --> 00:27:11.680
Make sure you know that we know their vital signs
527
00:27:11.680 --> 00:27:16.720
are heart rate, electrolytes, orthostatic signs, other medical symptoms, other
528
00:27:16.759 --> 00:27:23.279
psychiatric symptoms, suicideality, super excited. I've had the same psychiatrist,
529
00:27:23.759 --> 00:27:28.200
doctor Sam Moss, since inception, and he's just a really humane,
530
00:27:28.359 --> 00:27:31.720
wonderful psychiatrist that's involved in the medical clearances. And Karen
531
00:27:31.720 --> 00:27:34.480
Gudierrez who's a nurse practitioner that's worked with me since
532
00:27:34.480 --> 00:27:36.720
two thousand and eight, and then more recently I have
533
00:27:36.880 --> 00:27:42.440
doctor Dennis Gibson, who is an lovely physician that previously
534
00:27:42.519 --> 00:27:47.160
worked at Acute in Denver, and he oversees the complicated
535
00:27:47.200 --> 00:27:50.599
medical clearances and anything medically that comes up at within.
536
00:27:50.720 --> 00:27:54.359
So we have incredible medical team and then really talented
537
00:27:54.440 --> 00:27:57.880
nursing pool that is very well trained, led by Chrissy Stalker,
538
00:27:58.160 --> 00:28:01.079
who has worked in the field with me since two
539
00:28:01.079 --> 00:28:04.839
thousand and eight. I believe that nurses are really important
540
00:28:04.839 --> 00:28:09.720
for eating disorder treatment. They're trained using biopsychosocial approach kind
541
00:28:09.720 --> 00:28:12.160
of like psychiatry, so they can cover a lot of
542
00:28:12.160 --> 00:28:14.880
bases a lot of times they're doing the education I
543
00:28:14.920 --> 00:28:18.119
was mentioning, they could talk about so many facets of
544
00:28:18.160 --> 00:28:21.079
the illness and recovery. And then we do remote patient
545
00:28:21.160 --> 00:28:26.079
monitoring so we could really closely monitor weight, restoration and
546
00:28:26.200 --> 00:28:29.759
vital signs. Everybody gets devices sent into their home so
547
00:28:29.799 --> 00:28:33.480
that we can do real time remote patient monitoring vital signs, temperature,
548
00:28:33.519 --> 00:28:36.279
blood pressure, all that, so we really know what's going
549
00:28:36.359 --> 00:28:39.720
on with the patients on as frequent at basis as
550
00:28:39.759 --> 00:28:42.599
we need to. And then on the nutritional piece, we
551
00:28:43.119 --> 00:28:46.920
really believe that this is incredibly important. Somebody is sick
552
00:28:47.000 --> 00:28:49.920
enough to need like a PHP level of care. Then
553
00:28:50.240 --> 00:28:52.400
we have to make sure we're doing exposure therapy, so
554
00:28:52.519 --> 00:28:56.240
we do send meals into the home. We've delivered this
555
00:28:56.400 --> 00:28:59.599
was last year we surpassed the fifty thousand marks or
556
00:28:59.599 --> 00:29:01.519
as the me that we've sent into the home. So
557
00:29:01.880 --> 00:29:04.799
because we want them to do exposure therapy will not
558
00:29:05.200 --> 00:29:08.000
cut the corner on that, so they do get meals
559
00:29:08.079 --> 00:29:10.920
sent in and we have a meal support and we
560
00:29:11.039 --> 00:29:14.880
have also a secondary approach for people who are really
561
00:29:14.920 --> 00:29:17.240
struggling that they might even just have one to one
562
00:29:17.319 --> 00:29:21.000
meals or very small groups. Then they can sort of
563
00:29:21.000 --> 00:29:22.680
if they're struggling, they can sort of if you will
564
00:29:22.720 --> 00:29:25.839
graduate to the to the mel you with like where
565
00:29:25.880 --> 00:29:28.200
there's a few more patients and it's sort of just
566
00:29:28.319 --> 00:29:32.119
very structural and very clinical and very like let's get
567
00:29:32.160 --> 00:29:35.839
this food in the mouth. To a more social and
568
00:29:36.079 --> 00:29:38.960
positive reinforcement, we've just had to go very far. We
569
00:29:39.000 --> 00:29:41.440
call it an enhance model. It's really like almost in
570
00:29:41.480 --> 00:29:46.680
some cases, it's almost a substitute for some people for residential. Again, okay,
571
00:29:46.720 --> 00:29:48.759
not to say many people actually have to go to
572
00:29:48.799 --> 00:29:51.759
our brick and mortar residential period or we bring them
573
00:29:51.759 --> 00:29:53.240
in and they don't do well and then like we
574
00:29:53.359 --> 00:29:55.559
have to get them to a you know, that happens.
575
00:29:55.799 --> 00:29:58.200
Sometimes we get people in that refuse to go to
576
00:29:58.240 --> 00:30:00.480
residential and we're like, our jobs going to be to
577
00:30:00.519 --> 00:30:03.279
help them go to a residential probably, And that's okay too.
578
00:30:03.319 --> 00:30:06.480
We're just helping people get well. But the thing that
579
00:30:06.519 --> 00:30:08.759
we've had to do, and when this has been very organic,
580
00:30:08.920 --> 00:30:11.680
is just create a lot of other support so at
581
00:30:11.720 --> 00:30:15.960
within the care is really individualized to their schedule, so
582
00:30:16.200 --> 00:30:19.000
we you could be like, yeah, I have to do
583
00:30:19.079 --> 00:30:23.200
this at ten o'clock on Tuesdays and Thursdays, so okay,
584
00:30:23.240 --> 00:30:25.599
you're gonna do If you're like in PHBO, maybe you'll
585
00:30:25.599 --> 00:30:28.759
do a meal together in an individual session in the morning,
586
00:30:28.839 --> 00:30:32.480
go do your thing from ten to one. Maybe do
587
00:30:32.759 --> 00:30:35.039
you'll do your meal on your loan for lunch, and
588
00:30:35.079 --> 00:30:37.759
then you'll come back for a group and another meal
589
00:30:37.799 --> 00:30:41.200
at dinner. We also have things called the living room,
590
00:30:41.359 --> 00:30:44.200
so if people need that extra meal support, they can
591
00:30:44.240 --> 00:30:46.759
do that, or if they're just having a tough day
592
00:30:46.880 --> 00:30:49.480
or we've you know, got triggered. There's a there's this
593
00:30:49.559 --> 00:30:52.279
living room concept that was taken from you know, when
594
00:30:52.319 --> 00:30:54.799
you have a treatment center, people get well sometimes hanging
595
00:30:54.799 --> 00:30:56.680
out in the living room together, talking with each other.
596
00:30:57.079 --> 00:31:00.400
Have your living room available all day up until ten piano.
597
00:31:00.480 --> 00:31:03.480
Everyone's times that you could just pop in and we
598
00:31:03.559 --> 00:31:06.680
have an app that people can communicate. There's just way
599
00:31:06.759 --> 00:31:11.359
more treatment than a traditional phpying because that's what people need.
600
00:31:11.759 --> 00:31:15.920
Everything we've been creating at within is a derivative, like
601
00:31:16.039 --> 00:31:18.200
of what we've seen that the patients need to hear.
602
00:31:18.720 --> 00:31:20.519
I do feel it evolving because I remember when you
603
00:31:20.519 --> 00:31:23.920
guys were first out and we'd be referring and I've
604
00:31:23.960 --> 00:31:26.640
just watched it's more like you mentioned the enhanced care,
605
00:31:26.720 --> 00:31:29.440
and I mean, I'm asking you some rhetorical questions because
606
00:31:29.480 --> 00:31:32.759
I do know how rigorous your medical oh thing proofle is.
607
00:31:32.920 --> 00:31:34.200
It's I want them in the right place.
608
00:31:34.559 --> 00:31:36.160
Yeah, we're trying to speed it up now that we
609
00:31:36.200 --> 00:31:39.400
have doctor Gibson. That has helped a lot, because when
610
00:31:39.440 --> 00:31:43.160
there's a complicated case, we used to like have certain
611
00:31:43.240 --> 00:31:45.119
number of meetings per week where a few of us
612
00:31:45.119 --> 00:31:48.480
would eyeball the case together because we'd want to have
613
00:31:48.480 --> 00:31:50.960
the clinical and the medical and the dietation. We'd want to,
614
00:31:51.119 --> 00:31:53.240
like because we want to make sure people are not
615
00:31:53.279 --> 00:31:55.720
getting admitted that need you know, that aren't going to
616
00:31:55.759 --> 00:31:58.400
obviously make sure that that they can be safe. But
617
00:31:58.599 --> 00:32:00.799
now we can really, you know, just strike up a
618
00:32:00.839 --> 00:32:04.279
quick conversation between Karen and doctor Gibson or Sam and
619
00:32:04.359 --> 00:32:06.880
doctor Sam Moss and doctor Daniz Gibson, so we could
620
00:32:06.960 --> 00:32:09.799
just do things more, you know more. We've just created
621
00:32:09.839 --> 00:32:13.440
more efficiencies. And you know, having doctor Gibson's been such
622
00:32:13.480 --> 00:32:17.960
a blessing because with doctor Moss and doctor Gibson just
623
00:32:18.000 --> 00:32:21.400
such strong psychiatric and medical care, and then Christy as
624
00:32:21.440 --> 00:32:24.000
a nurse and Karen Good Yeah, Kara is a nurse practitioner.
625
00:32:24.039 --> 00:32:26.720
We just we've just got such strong clinicians that we
626
00:32:26.720 --> 00:32:28.880
can really look at a case and go, can we
627
00:32:28.960 --> 00:32:31.559
bring this on or do we really need to not
628
00:32:31.599 --> 00:32:32.119
bring it up?
629
00:32:32.759 --> 00:32:35.440
And other than medical fragility, are there other things that
630
00:32:35.480 --> 00:32:38.359
a person thinking about, Hey, is a virtual a remote
631
00:32:38.400 --> 00:32:40.680
setting like within for me? Are there other questions they
632
00:32:40.680 --> 00:32:43.480
should ask themselves to know whether or not you know
633
00:32:43.559 --> 00:32:45.279
the right setting or if they need to be like
634
00:32:45.279 --> 00:32:46.440
you said, in a brick and mortar.
635
00:32:46.759 --> 00:32:49.799
Yeah, that's such a good question, I should say. From
636
00:32:49.839 --> 00:32:53.640
the outset, it's in a general way. There's some specific
637
00:32:53.720 --> 00:32:56.559
rule outs for sure, but in a general way, it's
638
00:32:56.640 --> 00:32:59.359
really hard to predict who's going to really respond to
639
00:32:59.359 --> 00:33:03.880
the environment. I think some people who have really got
640
00:33:03.880 --> 00:33:06.559
a tough track record of having a very tough time,
641
00:33:07.160 --> 00:33:10.880
they really respond well. I think not having to give
642
00:33:10.960 --> 00:33:14.960
up so much autonomy and feeling like more grounded. A
643
00:33:15.000 --> 00:33:16.839
lot of times, the battle in your brick and mortar
644
00:33:16.920 --> 00:33:19.440
is the battle about keeping them in treatment. Well, they're
645
00:33:19.440 --> 00:33:21.519
already home, so it's like we're not having to fight
646
00:33:21.599 --> 00:33:24.599
you're with your dog, like you're with your you know,
647
00:33:24.680 --> 00:33:26.839
it's like we don't have to battle that out. And
648
00:33:26.880 --> 00:33:29.160
I think the respect that people feel when they're able
649
00:33:29.160 --> 00:33:31.480
to work in their environment, sometimes that invites like the
650
00:33:31.519 --> 00:33:35.319
healthier self, you know, to the party. So we can't
651
00:33:35.319 --> 00:33:38.359
really say, oh, this one's been so compromised, so therefore
652
00:33:38.440 --> 00:33:40.279
she or he is not going to do well. I
653
00:33:40.279 --> 00:33:44.480
don't think that's the ticket. I think that even just
654
00:33:44.559 --> 00:33:49.440
the smallest amount of willingness to try is a very
655
00:33:49.480 --> 00:33:53.640
good start. The smallest amount of will to try is enough. However,
656
00:33:53.759 --> 00:33:56.839
I will say, you know, if the person's actively psychotic
657
00:33:57.039 --> 00:34:02.160
or actively manning, or really cannot stay safe from a
658
00:34:02.200 --> 00:34:05.160
suicidal point of view, which we have to assess very
659
00:34:05.200 --> 00:34:09.320
seriously in this in this population, from self extreme self
660
00:34:09.320 --> 00:34:13.239
injurious behavior, substance abuse. I always say, with the substance abuse,
661
00:34:13.280 --> 00:34:16.880
if they're kind of at a level where they would
662
00:34:16.880 --> 00:34:20.760
be IOP level or lower level of care with co occurring,
663
00:34:20.880 --> 00:34:23.679
if there's if there's a level of motivation there, and
664
00:34:23.760 --> 00:34:26.400
if there's a level of accountability and support there, we
665
00:34:26.519 --> 00:34:30.960
really can do a very nice job. With substance and morbidity.
666
00:34:31.119 --> 00:34:33.320
There has to be some things we do look for
667
00:34:33.400 --> 00:34:36.559
some things to be in place. We tend to not
668
00:34:36.840 --> 00:34:41.760
admit opiate dependency because of the lethality there. We don't
669
00:34:41.800 --> 00:34:45.079
take patients generally below seventy percent of ideal body. Those
670
00:34:45.079 --> 00:34:47.239
patients generally belong to hospital.
671
00:34:46.760 --> 00:34:48.920
Anyway, that's fair. Yeah, then they need to be in
672
00:34:48.920 --> 00:34:52.400
a more medical setting. Yeah. Something I hear that is
673
00:34:52.480 --> 00:34:55.119
perhaps the complaint clients will say, well, we didn't talk
674
00:34:55.159 --> 00:34:57.840
about that in treatment. That's supposed to be for when we,
675
00:34:58.119 --> 00:35:00.199
you know, were discharged and we're out of treat and
676
00:35:00.320 --> 00:35:03.400
things like you mentioned the pursuit of thinness body experience.
677
00:35:03.880 --> 00:35:05.960
Do you address that in your programming or is that
678
00:35:06.079 --> 00:35:08.760
something that is not set for these places?
679
00:35:08.800 --> 00:35:09.920
Oh? No, we address it.
680
00:35:10.039 --> 00:35:12.920
Yeah, I think, Hey, I figured you did, but I
681
00:35:12.920 --> 00:35:13.440
had to ask.
682
00:35:13.679 --> 00:35:18.599
Yeah, oh, thank you. I mean I think again, biopsychosocial.
683
00:35:18.679 --> 00:35:21.360
I mean, the psychosocial variable is like the impact of
684
00:35:21.400 --> 00:35:23.639
diet culture and weight stigma on our patients is like
685
00:35:23.880 --> 00:35:27.599
profound and you know, every person with an eating disorder
686
00:35:27.760 --> 00:35:31.159
minus maybe our fit, you know, is profoundly affected by
687
00:35:31.159 --> 00:35:35.239
weight stigma. And so I as I've evolved, I've really
688
00:35:35.280 --> 00:35:38.559
come to believe that like fighting weight stigma addressing weight
689
00:35:38.599 --> 00:35:40.679
stigma that should be on your treatment plan, Like, how
690
00:35:40.679 --> 00:35:41.880
are we going to affect how are we going to
691
00:35:41.960 --> 00:35:45.199
help this person combat diet culture even at within, Like
692
00:35:45.360 --> 00:35:47.119
even though they're out in the world, like they have
693
00:35:47.239 --> 00:35:50.480
this bubble of connectivity of the team and the philosophy
694
00:35:50.480 --> 00:35:52.880
and that safety, how are we going to help them
695
00:35:52.960 --> 00:35:56.239
hold on to that those pillers after they beeve. So
696
00:35:56.440 --> 00:36:01.639
I really think addressing that in a very committed way
697
00:36:01.920 --> 00:36:05.000
and with enthusiasm excitement. I have a slide that I
698
00:36:05.760 --> 00:36:10.000
love where it's a lion and I always picture this lion.
699
00:36:10.119 --> 00:36:12.000
I was like, you know, I tell people, especially those
700
00:36:12.039 --> 00:36:15.599
in larger bodies that get especially hammered by weight stigma
701
00:36:15.840 --> 00:36:18.079
and the poison of weight stigma, try to have them
702
00:36:18.159 --> 00:36:21.599
visualizing a lion and like anybody gets in your relationship
703
00:36:21.599 --> 00:36:23.679
with food or your body, like let out a roar,
704
00:36:24.280 --> 00:36:27.159
not allowed, dude, get out of my It could be
705
00:36:27.199 --> 00:36:30.360
the doctor, it could be the family member, the number
706
00:36:30.360 --> 00:36:32.440
one and two perpetrators of weight stama. You got to
707
00:36:32.480 --> 00:36:33.760
help your patients be ready for that.
708
00:36:34.119 --> 00:36:36.760
Oh yeah, we can't create keep that insular world that
709
00:36:36.800 --> 00:36:39.159
we all try to create and expect them not to
710
00:36:39.199 --> 00:36:40.320
be shocked when they walk.
711
00:36:40.199 --> 00:36:41.880
Out the door. It's exactly.
712
00:36:42.199 --> 00:36:44.079
It is a tough world to do this in, isn't it.
713
00:36:44.079 --> 00:36:46.440
It really is. That's what we have the alumni program too.
714
00:36:46.480 --> 00:36:48.840
Out within the free alumni program, we're setting up some
715
00:36:48.920 --> 00:36:52.199
other programming for people post discharge to you, because I think
716
00:36:52.239 --> 00:36:54.840
that's one of the hardest things. Like, that's why it
717
00:36:54.960 --> 00:36:59.719
is so cool. I love, you know, addressing you know,
718
00:36:59.800 --> 00:37:02.079
the cute phase of the illness. But then like the
719
00:37:02.119 --> 00:37:05.039
reintegration piece, which is also a part of what we
720
00:37:05.079 --> 00:37:10.400
do at Galen help the really strong attention to community integration.
721
00:37:10.800 --> 00:37:13.840
Because man, they're going to come out of our care
722
00:37:13.880 --> 00:37:17.440
where we've really really fostered this diet you know, anti
723
00:37:17.480 --> 00:37:21.599
die culture mindset and just be bombarded with dieticulture. You know.
724
00:37:21.800 --> 00:37:24.400
So how do we get them to generalize that? Well,
725
00:37:24.440 --> 00:37:26.280
you got to talk about it and make it it
726
00:37:26.480 --> 00:37:27.840
part of your treamplant, I think.
727
00:37:28.119 --> 00:37:30.239
Yeah, and here from others that are like minded on
728
00:37:30.280 --> 00:37:33.360
a regular basis, like your alumni groups, that this isn't mind.
729
00:37:33.559 --> 00:37:34.719
They don't have to adopt it.
730
00:37:35.079 --> 00:37:38.880
Yeah, it's a therapist to just carry that. Like the therapists.
731
00:37:39.000 --> 00:37:40.679
They may see them once or twice a week, but
732
00:37:40.679 --> 00:37:43.920
they're out there, like you know, bombarded twenty four to seven.
733
00:37:44.079 --> 00:37:46.280
You know, so even.
734
00:37:46.039 --> 00:37:48.159
Dog food now, like I have a puppy and I
735
00:37:48.159 --> 00:37:49.960
was getting them done, and all the dog food has
736
00:37:49.960 --> 00:37:52.400
like calories on it, and the ones like lower calorie
737
00:37:52.440 --> 00:37:55.440
dog food. I'm like, I'm really confused by.
738
00:37:55.360 --> 00:37:57.760
I'm so glad you brought that up. When I saw that,
739
00:37:57.840 --> 00:38:01.320
I was like, okay, you know something said somebody said
740
00:38:01.320 --> 00:38:05.079
that about a cat, you know, an oh cat, And
741
00:38:05.119 --> 00:38:08.000
I'm like, can't we just have like big cats. Can't
742
00:38:08.000 --> 00:38:11.039
we have big people, big cats, big dogs. Like this
743
00:38:11.280 --> 00:38:12.239
diversity is.
744
00:38:12.280 --> 00:38:16.119
Normal, like, so we have to have it. It's a
745
00:38:16.159 --> 00:38:18.519
part of our evolution. Anthropologe your survival.
746
00:38:18.679 --> 00:38:20.599
Yes, so my dog doesn't care.
747
00:38:20.679 --> 00:38:22.000
He has no body image consuner.
748
00:38:22.159 --> 00:38:24.559
That's good. Yeah, your dog is like happy. Just your
749
00:38:24.599 --> 00:38:27.320
dog was like, can have lunch? I wanted to taste
750
00:38:27.360 --> 00:38:28.039
good and.
751
00:38:28.079 --> 00:38:29.519
I want with him to send it to me. I
752
00:38:29.519 --> 00:38:32.960
love that you send meals. Hello, that's great. It takes
753
00:38:33.000 --> 00:38:33.920
a decision out of it.
754
00:38:34.119 --> 00:38:37.199
Yeah, it was really interesting to figure out which meal
755
00:38:37.280 --> 00:38:39.920
company to use. We tried so many different things. But yeah,
756
00:38:39.960 --> 00:38:42.880
it's been quite the journey. I was blown away when
757
00:38:42.920 --> 00:38:45.320
I was like, wow, we've served more than fifty thousand meals.
758
00:38:45.360 --> 00:38:46.880
I don't know we're up to now, were and we
759
00:38:46.880 --> 00:38:49.519
were at fifty thousand last year. That just blew my mind.
760
00:38:49.559 --> 00:38:51.559
I was like, Wow, that's a lot of meals.
761
00:38:52.440 --> 00:38:55.159
And that's another concern for folks and virtuals. They're like, well,
762
00:38:55.239 --> 00:38:57.519
if I'm given too many decisions about food, I'm going
763
00:38:57.599 --> 00:39:00.559
to make the wrong decision or I won't make a choice,
764
00:39:00.559 --> 00:39:01.800
and you're making that easier.
765
00:39:01.920 --> 00:39:04.440
Yeah, that's a part of expecting therapy. It's like if
766
00:39:04.480 --> 00:39:07.320
you're if you're ill enough that you need that level
767
00:39:07.320 --> 00:39:10.159
of care, Like I can't imagine that you're at the
768
00:39:10.199 --> 00:39:14.360
place to like bring you know, exposure oriented recover oriented food,
769
00:39:14.480 --> 00:39:17.519
Like if you could do that, you probably wouldn't need
770
00:39:17.559 --> 00:39:19.599
this level of care. So it's just I think it's
771
00:39:19.639 --> 00:39:23.400
a part of being responsible to the patient's recovery by
772
00:39:23.440 --> 00:39:24.440
making that investment.
773
00:39:24.760 --> 00:39:27.880
Yeah, I agree. Do we have metrics on virtual care?
774
00:39:28.159 --> 00:39:29.840
So I keep calling it virtual? You're gonna help me
775
00:39:30.079 --> 00:39:32.440
save that, Okase? I love remote.
776
00:39:33.079 --> 00:39:38.400
We are very committed to measurement based care. Doctor Shepherd
777
00:39:38.559 --> 00:39:42.320
is our leader with that and since day one, we've
778
00:39:42.480 --> 00:39:45.239
done a measurement based care in a very serious way,
779
00:39:45.239 --> 00:39:48.239
meaning that it's not just doing before and after in
780
00:39:48.239 --> 00:39:51.360
the beginning and end of treatment. We do ongoing measures
781
00:39:51.559 --> 00:39:55.599
and uh, doctor Caitlin Shepherd really taught us really how
782
00:39:55.679 --> 00:39:59.440
to do that well. And we bring the measures into
783
00:39:59.480 --> 00:40:03.199
treatment with the patients, so the patients examine their outcomes
784
00:40:03.480 --> 00:40:07.280
as these measures are done generally on a monthly basis,
785
00:40:07.960 --> 00:40:10.960
and the patients and the therapists and clinical team explores
786
00:40:11.000 --> 00:40:13.920
the measures together and thinks about it together, so it
787
00:40:13.960 --> 00:40:17.000
really becomes it's not just measurement for our purposes, it's
788
00:40:17.079 --> 00:40:20.719
really a therapeutic process. And then you know, beyond that,
789
00:40:20.800 --> 00:40:25.039
of course, holding ourselves accountable to our own outcomes. And
790
00:40:25.079 --> 00:40:29.559
the outcomes that we have seen are on par with
791
00:40:29.679 --> 00:40:32.039
brick and mortar programs and it's you know, depending on
792
00:40:32.079 --> 00:40:35.800
the report, in some cases even improved upon. And we've
793
00:40:35.840 --> 00:40:39.159
also been very committed to doing post discharge measurement based
794
00:40:39.159 --> 00:40:44.239
care and we've gotten relatively speaking, very high response rates
795
00:40:44.400 --> 00:40:47.320
for both discharge treatment, which is very hard to get,
796
00:40:47.360 --> 00:40:50.519
and we've seen that patients go on to continue to
797
00:40:50.719 --> 00:40:54.559
improve post discharge. So I remember when I first heard
798
00:40:54.639 --> 00:40:57.519
the statistic. It's changed a little bit, but I think
799
00:40:57.559 --> 00:41:01.559
the first round I got from doctor Caitlin Sheppard and
800
00:41:01.599 --> 00:41:04.679
she said, yeah, like seventy percent of our patients are
801
00:41:04.880 --> 00:41:07.760
out of the clinical range on the EEDEQ and the
802
00:41:07.760 --> 00:41:10.679
PHQ nine at the time they discharged. It's a little
803
00:41:10.719 --> 00:41:13.639
different than that now, but it's like roughly a seventy percent.
804
00:41:14.119 --> 00:41:16.519
I was really blown away by that. I think it
805
00:41:16.639 --> 00:41:20.360
was really blown away by we've done where we separate
806
00:41:20.360 --> 00:41:24.000
out the patients that have higher symptoms like higher EDEQ scores,
807
00:41:24.079 --> 00:41:27.480
higher PHQ nine scores, and really seeing how those patients
808
00:41:27.519 --> 00:41:31.880
have done really well. Another outcome that I'm really excited
809
00:41:31.880 --> 00:41:34.320
about is the measures around quality of life for some
810
00:41:34.400 --> 00:41:39.039
of our really really more sick complex patients, like really
811
00:41:39.280 --> 00:41:42.960
improve quality of life. So sometimes we haven't seen when
812
00:41:43.000 --> 00:41:45.360
we haven't seen necessarily the outcomes that we want to
813
00:41:45.400 --> 00:41:48.320
see on the EDQ, but we see these quality of
814
00:41:48.360 --> 00:41:51.400
life indices improved, Like that just makes me feel good,
815
00:41:51.440 --> 00:41:54.639
like we're helping people feel better in their life. So
816
00:41:55.000 --> 00:41:58.599
very we're very strict about measurement based care. We have
817
00:41:59.400 --> 00:42:03.000
very high expectations that there isn't a patient that come.
818
00:42:03.159 --> 00:42:06.039
I mean if you're at within your or Galen Hope,
819
00:42:06.039 --> 00:42:08.239
like it's not like we have seventy percent of our
820
00:42:08.280 --> 00:42:10.360
patients are doing it like it's like one hundred percent
821
00:42:10.360 --> 00:42:12.400
of our patients are doing It's we have to see
822
00:42:12.400 --> 00:42:14.760
how we're doing. We have to see how they're doing objectives.
823
00:42:15.039 --> 00:42:17.239
And you need it for to show your own efficacy
824
00:42:17.280 --> 00:42:20.079
and to show that this does work and to keep
825
00:42:20.079 --> 00:42:23.039
building these type of programs. We need these everywhere. I
826
00:42:23.079 --> 00:42:23.920
mean you are everywhere.
827
00:42:23.960 --> 00:42:27.239
But yeah, I was so lucky. Honestly, I have to
828
00:42:27.239 --> 00:42:30.599
shout out doctor Jessica Janey. She's a clinical psychologist that
829
00:42:30.719 --> 00:42:34.599
worked for me at OPC and she helped start within
830
00:42:34.719 --> 00:42:37.960
from ground zero and she didn't really want to have
831
00:42:38.000 --> 00:42:39.920
to handle research, but she had handled it from it
832
00:42:40.000 --> 00:42:42.280
before and like, Jessica, we just have to do it
833
00:42:42.320 --> 00:42:44.400
because we don't know if we can do it, so
834
00:42:44.440 --> 00:42:46.440
we have to do this. And so she set it
835
00:42:46.519 --> 00:42:49.320
up for us. And then Hannah wolf Has also works
836
00:42:49.320 --> 00:42:51.880
with Caitlin Sheppard. They've just taken it from there and
837
00:42:51.960 --> 00:42:54.920
just done a great job with that with that process.
838
00:42:55.079 --> 00:42:57.320
And yeah, and Galen and Hope also as well. We
839
00:42:57.400 --> 00:43:00.840
actually won an award at Galen Hope from greensp for
840
00:43:00.960 --> 00:43:03.800
highest Symptom Improvement about it was like five hundred program.
841
00:43:03.880 --> 00:43:07.519
So we've seen some really great outcomes there. We've seen
842
00:43:07.559 --> 00:43:11.360
some really interesting and outcomes that I think surprise the
843
00:43:11.440 --> 00:43:14.760
field that have to do with engagement and people think, oh,
844
00:43:14.800 --> 00:43:17.280
how are people to engage in like remote care. Well,
845
00:43:17.320 --> 00:43:20.400
we have very very high engagement out within in remote care.
846
00:43:20.480 --> 00:43:22.199
So that's also been really interesting.
847
00:43:22.599 --> 00:43:25.239
You know, we mentioned earlier that COVID allowed at least
848
00:43:25.239 --> 00:43:28.000
for people in my practice to do virtual and it's
849
00:43:28.039 --> 00:43:30.679
amazing how effective it can be. I would not have
850
00:43:30.719 --> 00:43:32.000
guessed it, I know.
851
00:43:32.119 --> 00:43:34.239
So do you do a lot of remote care or
852
00:43:34.400 --> 00:43:35.280
do a little bit.
853
00:43:35.480 --> 00:43:38.800
I do half and half, But my colleagues and our
854
00:43:38.840 --> 00:43:41.119
practice here, I would probably say it's more like sixty
855
00:43:41.199 --> 00:43:44.599
forty maybe seventy thirty. I prefer when I can do
856
00:43:44.599 --> 00:43:47.320
you in person. But there's clients who have recovered, I'm
857
00:43:47.360 --> 00:43:49.519
on their team and I've never met them in person.
858
00:43:49.679 --> 00:43:50.840
That's really interesting.
859
00:43:51.159 --> 00:43:51.679
It works.
860
00:43:52.000 --> 00:43:54.000
It is lovely to see people in person. I have
861
00:43:54.039 --> 00:43:56.719
to say, we always enjoy that. But man, the patients
862
00:43:56.760 --> 00:44:00.679
have some really strong connections. We've had some little reunions
863
00:44:00.719 --> 00:44:03.559
of people at like we've had some patients get together
864
00:44:04.119 --> 00:44:08.199
in different places like alumni after they left treatment and
865
00:44:08.239 --> 00:44:11.079
get together and meet in person. So that's really exciting
866
00:44:11.079 --> 00:44:14.159
when you see the relationships building post treatment.
867
00:44:15.719 --> 00:44:18.280
And our younger populations are so good at this setting.
868
00:44:18.280 --> 00:44:20.760
They're just like I see you, we're buddies. We can
869
00:44:20.800 --> 00:44:23.559
be remote. Speaking of which, what are the ages that
870
00:44:23.639 --> 00:44:27.519
are served in any demographic or ages for both facilities
871
00:44:27.519 --> 00:44:28.920
we're talking out sure.
872
00:44:29.000 --> 00:44:31.639
Yeah, so Within we can go down to age thirteen,
873
00:44:31.800 --> 00:44:36.000
and we've had patients over the age of seventy at Within,
874
00:44:36.239 --> 00:44:40.599
and then at Galeen Hope at our PHP and IOP
875
00:44:40.800 --> 00:44:43.880
level of care, we've gone down to nine or ten.
876
00:44:44.000 --> 00:44:45.920
There's not a rigid cut off there kind of has
877
00:44:45.960 --> 00:44:48.519
to deal with the We do have an adolescent adult program.
878
00:44:48.559 --> 00:44:51.639
Within has an adolest adult and mature adult, and then
879
00:44:52.079 --> 00:44:54.559
Galen Hope has an adolest and adult program, and then
880
00:44:54.599 --> 00:44:58.400
our residential at Galen Hope, the lowest we can take
881
00:44:58.480 --> 00:44:59.840
unfortunately is age thirteen.
882
00:45:00.079 --> 00:45:00.960
He's still pretty young.
883
00:45:01.599 --> 00:45:05.320
Yeah. Yeah, I have this need for residential for the
884
00:45:05.400 --> 00:45:08.719
youngsters and and we try to just involve the family
885
00:45:08.760 --> 00:45:10.400
as much as we can. So it's so it's so
886
00:45:10.679 --> 00:45:12.599
sad when that need comes into play.
887
00:45:12.800 --> 00:45:16.519
Yeah, it's a very unique setting for them. Yeah, ur
888
00:45:16.599 --> 00:45:19.559
Fit do you either, I know within managers Arfa, can
889
00:45:19.559 --> 00:45:21.599
you just talk just real briefly on how urfit is
890
00:45:21.639 --> 00:45:22.840
also addressed.
891
00:45:22.440 --> 00:45:26.039
In these Oh yes, oh my gosh, arfit. I mean
892
00:45:26.480 --> 00:45:31.239
I think addressing it not necessarily of course it's an
893
00:45:31.280 --> 00:45:35.760
eating disorder, but thinking of it as sort of a
894
00:45:35.880 --> 00:45:38.639
you know, depending on the presentation, either a phobia or
895
00:45:38.679 --> 00:45:41.159
thinking along the lines of a trauma and all the
896
00:45:41.199 --> 00:45:44.239
different you know, reasons that somebody the main reasons why
897
00:45:44.239 --> 00:45:46.960
people can develop or fit, and then approaching it as
898
00:45:47.039 --> 00:45:53.280
a very collaborative, exposure based, hierarchical like collaborative decision like
899
00:45:53.360 --> 00:45:57.360
what food if you were able to eat it would
900
00:45:57.400 --> 00:46:00.519
really be meaningful to you, like what would help you
901
00:46:00.760 --> 00:46:05.079
improve your quality of life, and really having conversations collaboratively
902
00:46:05.119 --> 00:46:09.760
with patients. We have our own urfied group and table
903
00:46:10.400 --> 00:46:13.840
at within and at Galen Hope, and many of our
904
00:46:13.880 --> 00:46:16.400
patients at Galen Hope because we have primary mental health,
905
00:46:16.719 --> 00:46:19.760
many of our patients with our food they actually eat.
906
00:46:19.800 --> 00:46:22.840
With our primary mental health patients can do exposure therapy
907
00:46:23.199 --> 00:46:25.679
and just a different approach because there's different things going
908
00:46:25.679 --> 00:46:29.079
on for people. And then we have a very large
909
00:46:29.119 --> 00:46:31.880
coport of our fed patients. We have a lovely arfed
910
00:46:32.039 --> 00:46:35.199
process group at within. I think it might be one
911
00:46:35.239 --> 00:46:38.719
of the larger process groups of any treatment program, and
912
00:46:39.000 --> 00:46:41.719
separate our fred meal support as well. But I would
913
00:46:41.760 --> 00:46:47.559
say overall it's very collaborative, humanistic and exposure therapy based
914
00:46:47.840 --> 00:46:50.280
with a strong buy in from the patient of like
915
00:46:50.360 --> 00:46:53.320
what really matters to you? How can we improve your
916
00:46:53.360 --> 00:46:54.079
quality of life?
917
00:46:54.119 --> 00:46:56.480
Yeah, because you maybe aren't going to get all of it,
918
00:46:56.559 --> 00:46:58.199
but you're going to get just what you said, what's
919
00:46:58.239 --> 00:47:00.000
going to make you live a better life? To eat
920
00:47:00.119 --> 00:47:00.800
everything for that?
921
00:47:01.079 --> 00:47:02.239
Yeah, yeah, I love that.
922
00:47:02.639 --> 00:47:05.599
Now I will put in show notes and everything information
923
00:47:05.719 --> 00:47:08.159
on how to contact. But is the best thing for
924
00:47:08.480 --> 00:47:11.519
folks to start with their outpatient team and then work
925
00:47:11.519 --> 00:47:13.440
on the referral or can they just go directly to
926
00:47:13.519 --> 00:47:14.119
these sites?
927
00:47:14.159 --> 00:47:16.480
And I mean, we love when we have the outpatient
928
00:47:16.519 --> 00:47:19.400
people involved. We think of it as cliche as it sounds,
929
00:47:19.679 --> 00:47:22.639
it really it really does take a village. And I
930
00:47:22.679 --> 00:47:24.840
always tell our outreach team, like, you know, when we're
931
00:47:24.840 --> 00:47:28.000
building these relationships, it's like it really is a community
932
00:47:28.400 --> 00:47:31.480
that surrounds a patient with what I call love and boundaries.
933
00:47:31.480 --> 00:47:35.119
And so when we have that connection with the outpatient team.
934
00:47:35.280 --> 00:47:38.519
It really helps reinforce what we're doing and the patients,
935
00:47:38.679 --> 00:47:41.760
you know, when they're outpatient persons like understands and understands
936
00:47:41.760 --> 00:47:44.239
a program and as everybody's repont into it, you know,
937
00:47:44.360 --> 00:47:48.400
it makes treatment completion happen better, It makes getting into
938
00:47:48.400 --> 00:47:51.599
treatment easier. So we love it. If the person can
939
00:47:51.880 --> 00:47:55.239
you know, have the outpatient person person or persons in
940
00:47:55.280 --> 00:47:57.719
their life be a part of that. I think it
941
00:47:57.880 --> 00:48:01.599
really helps people make the decision to step in and
942
00:48:02.719 --> 00:48:05.719
if and when more like when there's something that comes
943
00:48:05.800 --> 00:48:08.760
up and treatment the person is upset or once we
944
00:48:08.840 --> 00:48:11.960
leave early or doesn't agree with something we're doing or whatever,
945
00:48:12.400 --> 00:48:14.760
that connection with the outpatient provider is very important. So
946
00:48:14.800 --> 00:48:18.679
we send like a data and updates. Some people say ridiculous,
947
00:48:18.880 --> 00:48:21.280
I don't think so, but we send a lot of
948
00:48:21.440 --> 00:48:24.119
data to well, you've had patients maybe aut within, like
949
00:48:24.159 --> 00:48:26.800
we always send updates, so we want to make sure.
950
00:48:27.519 --> 00:48:30.360
The last thing I want is I've heard this story
951
00:48:30.400 --> 00:48:32.280
of like somebody not even knowing what was going on
952
00:48:32.360 --> 00:48:33.960
with their patient treatment. Then all of a sudden they're
953
00:48:33.960 --> 00:48:36.880
on the schedule and they haven't been informed of what's
954
00:48:36.880 --> 00:48:38.320
going on, or they didn't even know they were about
955
00:48:38.360 --> 00:48:40.199
to discharge all of a sudden they're on their schedule.
956
00:48:40.679 --> 00:48:43.199
So we're kind of the opposite of that. We're kind
957
00:48:43.239 --> 00:48:47.280
of annoying, I think, and a little bit intrusive. Maybe
958
00:48:47.880 --> 00:48:51.079
i'd lean that way more than having because the outpatient
959
00:48:51.079 --> 00:48:53.519
person's carrying the person along. We get them for like
960
00:48:53.559 --> 00:48:56.840
maybe ninety days, the outpatient teams like with them for years.
961
00:48:57.199 --> 00:48:59.960
We're just way ahead from ground zero.
962
00:49:00.320 --> 00:49:02.199
So exactly how it should be. And then I know
963
00:49:02.199 --> 00:49:04.199
how to prepare for when my clients are discharging and
964
00:49:04.239 --> 00:49:06.800
get back in. You can talk to your people and
965
00:49:06.840 --> 00:49:08.599
find out what we need, and it's more.
966
00:49:08.519 --> 00:49:10.760
Fun and collaborative and like it's better for the patient
967
00:49:11.000 --> 00:49:11.639
for everybody.
968
00:49:11.800 --> 00:49:15.159
So I know we're getting close on time. But you know,
969
00:49:15.480 --> 00:49:17.599
you've done so much in this community, more than I
970
00:49:17.639 --> 00:49:20.239
could even gather in time with you. But do you
971
00:49:20.239 --> 00:49:23.159
have an aspiration of hope? What's a future thing that
972
00:49:23.199 --> 00:49:26.000
you would love to see in the eating disorder world?
973
00:49:26.079 --> 00:49:27.800
Let's think big for a minute. I guess not that
974
00:49:27.840 --> 00:49:28.599
you already haven't.
975
00:49:28.960 --> 00:49:31.599
Oh you're so so kind. I mean, I'm very excited
976
00:49:31.599 --> 00:49:36.320
about founding co founding with my partner, the Eating disorder
977
00:49:36.760 --> 00:49:39.519
Education Institute because you know, if you look at some
978
00:49:39.519 --> 00:49:41.679
of the research, some of the research says the number
979
00:49:41.719 --> 00:49:45.440
one and two things that impact whether or not somebody
980
00:49:45.480 --> 00:49:48.840
has prolonged duration of untreated illness is, for example, a
981
00:49:48.960 --> 00:49:51.960
lack of a PCP that knows about eating disorders in
982
00:49:52.000 --> 00:49:55.119
their life, or lack of exposure to recovery stores. Those
983
00:49:55.119 --> 00:49:59.000
are some So I think that there's too much of
984
00:49:59.039 --> 00:50:02.679
a limited world of trained folks that actually really know
985
00:50:02.679 --> 00:50:06.199
about eating disorders. So with the Eating Disorder Education Institute,
986
00:50:06.239 --> 00:50:09.760
I'm excited to like really try to expand the world
987
00:50:09.960 --> 00:50:13.760
of folks that really do have very good understanding of
988
00:50:13.840 --> 00:50:16.320
eating disorders. So that's something really exciting. And I'll just
989
00:50:16.760 --> 00:50:19.559
I'll end with this, you know little story. When I
990
00:50:19.599 --> 00:50:23.280
did my residency at NYU, there was no training on
991
00:50:23.360 --> 00:50:25.760
eating disorders. And that was a very long time ago.
992
00:50:25.800 --> 00:50:28.119
And guess what, there still is no training on eating
993
00:50:28.159 --> 00:50:31.000
disorders this many years later. So I said, you know what,
994
00:50:31.440 --> 00:50:33.559
screw it, Like I kept waiting for somebody to do it,
995
00:50:33.599 --> 00:50:36.239
and I'm like, you know what, I'm doing it. I'm
996
00:50:36.280 --> 00:50:39.559
just going to do it. So we've created the Institute
997
00:50:39.639 --> 00:50:43.039
and it's for multidisciplinary training. We have some of the best,
998
00:50:43.280 --> 00:50:47.440
I think, most amazing clinical clinical folks doing the trainings
999
00:50:47.480 --> 00:50:51.199
and the certification and the credentialing. So that'll be starting
1000
00:50:51.239 --> 00:50:53.800
in you know, September. And one of my hopes and
1001
00:50:53.920 --> 00:50:58.000
dreams is that within the field, the field will expand.
1002
00:50:58.000 --> 00:51:01.079
But I really want to see specifically, I want to
1003
00:51:01.119 --> 00:51:06.800
see doctors and psychiatrists have mandatory eating disorder training because
1004
00:51:06.840 --> 00:51:10.920
I think that's where a lot gets missed, like when
1005
00:51:10.920 --> 00:51:13.639
I you know, by the time I'm done in the field,
1006
00:51:13.719 --> 00:51:17.000
I want it to be that, you know, psychiatry residency
1007
00:51:17.039 --> 00:51:20.920
programs require eating disorder treatment. I mean, thirty million people
1008
00:51:20.960 --> 00:51:25.079
have the condition. It's the second highest mortality. Like, how
1009
00:51:25.159 --> 00:51:28.199
the hell did they not have mandatory eating disorder education
1010
00:51:28.239 --> 00:51:31.320
for psychiatrists. So that's I guess that's one of the
1011
00:51:31.360 --> 00:51:32.880
things I'm thinking about right now.
1012
00:51:33.079 --> 00:51:37.480
I love it. We have this mini school education program
1013
00:51:37.480 --> 00:51:39.760
we're working on here, and I know AD does this too,
1014
00:51:39.960 --> 00:51:42.480
where we're trying to train teachers and coaches and how
1015
00:51:42.559 --> 00:51:45.719
that's a teaching Yeah, but it's so hard, right, and
1016
00:51:45.760 --> 00:51:48.679
so you're creating this coalition that it's almost like creating
1017
00:51:48.679 --> 00:51:51.800
a rubric up above that we all need to learn more.
1018
00:51:51.840 --> 00:51:53.920
That's going to help what I'm doing too. But that's
1019
00:51:53.920 --> 00:51:55.719
really going to sign up. How do I sign up?
1020
00:51:55.960 --> 00:51:58.000
Oh? Please do? We would love to have you be
1021
00:51:58.039 --> 00:52:02.719
in our first cohort. We would absolutely that somber right. Yes,
1022
00:52:02.880 --> 00:52:06.199
we're very excited. We have our consolation of about twelve
1023
00:52:06.360 --> 00:52:11.639
different courses, everything from the medical complications Shanga Yani's she.
1024
00:52:11.719 --> 00:52:13.840
Was on here and I just sat there and listened
1025
00:52:13.840 --> 00:52:14.559
her whole time. Was that.
1026
00:52:14.719 --> 00:52:16.559
I know, she's fun to listen to. It's so great,
1027
00:52:16.920 --> 00:52:20.079
But that whole compositive courses and then we're doing a
1028
00:52:20.119 --> 00:52:22.280
practic and we're really excited. It's going to be really
1029
00:52:22.320 --> 00:52:24.760
done at a high level. And we have a Harvard
1030
00:52:24.880 --> 00:52:29.519
educated educator that is helping us design all of our courses.
1031
00:52:29.559 --> 00:52:31.719
So there's a lot of thought that's going into and
1032
00:52:31.760 --> 00:52:35.360
I'm very excited about about introducing that to our field
1033
00:52:35.400 --> 00:52:40.119
and beyond our field so more people can have education anyone.
1034
00:52:40.199 --> 00:52:40.440
Right.
1035
00:52:40.880 --> 00:52:43.480
Yeah, there's going to be a certification for people who
1036
00:52:43.559 --> 00:52:47.239
aren't necessarily wanting to be you know, primary eating disorders,
1037
00:52:47.239 --> 00:52:49.639
but just want to basically, so you know, I envision
1038
00:52:49.719 --> 00:52:51.920
patients that go to like a substance abuse program and
1039
00:52:51.960 --> 00:52:54.559
the clinicians don't know anything about eating source. So just
1040
00:52:54.599 --> 00:52:58.400
expanding the world of individuals multi discpliner that have that
1041
00:52:58.519 --> 00:53:01.400
fund of knowledge that's for this vacation, and then the
1042
00:53:01.440 --> 00:53:04.039
credential will go beyond that and have the pract to
1043
00:53:04.119 --> 00:53:05.039
come as a part of it.
1044
00:53:05.320 --> 00:53:06.800
I think it's it sounds fabulous.
1045
00:53:06.920 --> 00:53:07.320
I love it.
1046
00:53:07.360 --> 00:53:09.519
I'll spread out, We'll spread the word here and our
1047
00:53:09.920 --> 00:53:14.480
practice owner often has fellows here and pediatricians and we
1048
00:53:14.519 --> 00:53:17.159
train them on eating disorders because they don't get any
1049
00:53:17.679 --> 00:53:18.119
they don't.
1050
00:53:18.920 --> 00:53:20.920
That's great. I didn't know you guys had felt. That's
1051
00:53:20.920 --> 00:53:21.639
really cool that.
1052
00:53:21.719 --> 00:53:24.320
Really she does whatever we can do in our little stamp,
1053
00:53:24.360 --> 00:53:26.840
but your stamp is bigger, soona connect her stamp to
1054
00:53:26.880 --> 00:53:28.079
your stamp. Well.
1055
00:53:28.360 --> 00:53:31.199
I appreciate it, I really do. I appreciate everything that
1056
00:53:31.239 --> 00:53:33.559
you guys do. Thank you for allowing me to be
1057
00:53:33.599 --> 00:53:37.199
a part of your wonderful podcast. I really really appreciate it.
1058
00:53:37.280 --> 00:53:39.920
I'm trying to do what you are, get more awareness
1059
00:53:39.920 --> 00:53:42.559
and visibility to eating disorder care and mental health focus.
1060
00:53:42.639 --> 00:53:46.880
So that's amazing. That's great. I mean, these these conversations
1061
00:53:47.119 --> 00:53:51.519
are are really powerful for folks to just understand that
1062
00:53:51.679 --> 00:53:53.559
it's you know, it's as you were saying, it's not
1063
00:53:53.599 --> 00:53:55.880
something to be ashamed of if you're struggling and there's
1064
00:53:55.920 --> 00:53:59.599
like a way through it and there's humane care and
1065
00:53:59.679 --> 00:54:03.639
human people giving that light. You know, you're shedding that
1066
00:54:03.760 --> 00:54:06.239
light on the community at large. My hat is off
1067
00:54:06.239 --> 00:54:06.519
to you.
1068
00:54:07.360 --> 00:54:09.079
Thank you. I'll take it now. I do have one
1069
00:54:09.119 --> 00:54:11.320
more question. It's my favorite. Do you have a word
1070
00:54:11.480 --> 00:54:14.519
to describe this incredible journey you've been on since you
1071
00:54:14.599 --> 00:54:16.360
were at NYU all the way to know?
1072
00:54:16.880 --> 00:54:20.280
I think that I've used the word hope and a
1073
00:54:20.280 --> 00:54:22.559
lot of the things that I've done, I like the
1074
00:54:22.599 --> 00:54:25.559
word hope. And oh this is more than a word, though,
1075
00:54:25.639 --> 00:54:28.519
but hope would be a word that I would say.
1076
00:54:28.639 --> 00:54:32.480
And I combine the combination of like this takes work.
1077
00:54:32.519 --> 00:54:35.719
So the definition of work is dictionary definition is something
1078
00:54:35.760 --> 00:54:38.719
like mental or physical energy directed toward a goal. Right,
1079
00:54:38.800 --> 00:54:42.280
So that's work. And I think if hope is like
1080
00:54:42.400 --> 00:54:44.840
the fuel to help you do the work, right, if
1081
00:54:44.840 --> 00:54:47.039
you don't have the hope, then you don't have where
1082
00:54:47.039 --> 00:54:49.119
are you gonna? You know, you have to do this work.
1083
00:54:49.199 --> 00:54:53.000
Patients that are doing treatment are working, They're doing hard stuff.
1084
00:54:53.000 --> 00:54:55.800
They have tears coming out of their eyes when they're eating,
1085
00:54:55.880 --> 00:54:59.320
you know, the hamburger. So that hope is something that
1086
00:55:00.119 --> 00:55:02.960
we have to hold sometimes for patients and continue to
1087
00:55:02.960 --> 00:55:05.679
have the hope. So I think hope is really important.
1088
00:55:06.079 --> 00:55:09.639
I have a thing about untapped potential. I just when
1089
00:55:09.679 --> 00:55:12.760
I see somebody or I meet somebody or a personal
1090
00:55:12.800 --> 00:55:16.400
life or professional life, I just I get really excited
1091
00:55:16.400 --> 00:55:19.119
about like what's popped, But I feel like it's possible
1092
00:55:19.159 --> 00:55:22.280
for them. So that's something that I think having that hope,
1093
00:55:22.559 --> 00:55:24.719
even if the person's not feeling much of it, Like
1094
00:55:24.760 --> 00:55:26.880
if you're holding that hope or you're seeing that vision
1095
00:55:26.920 --> 00:55:29.519
and then you're in the relationship with the person, they
1096
00:55:29.639 --> 00:55:32.880
feel that and it's so healing. And it's just it's
1097
00:55:32.880 --> 00:55:36.719
such a profound experience to help be a healer in
1098
00:55:36.760 --> 00:55:39.480
somebody's life. I just couldn't trade it for anything. Well,
1099
00:55:39.559 --> 00:55:42.440
it's it's so special the work we do. So and
1100
00:55:42.480 --> 00:55:44.719
I think all the providers, you know, all the providers
1101
00:55:44.719 --> 00:55:47.599
that we get to meet, you know, we're a special bunch.
1102
00:55:47.679 --> 00:55:51.159
You know, we're good. We're good people.
1103
00:55:52.440 --> 00:55:54.719
What we do, what we get paid, we're pretty awesome.
1104
00:55:55.000 --> 00:55:59.480
I know we're a fight, but I appreciate not only
1105
00:55:59.480 --> 00:56:01.280
you coming in and talking about this with me. But
1106
00:56:01.519 --> 00:56:04.719
my intention always set an intention was to listen deeply,
1107
00:56:04.960 --> 00:56:07.559
and I learned much from you today and I'm so appreciate.
1108
00:56:07.880 --> 00:56:10.440
I'm you so generous of you to listen to me
1109
00:56:10.559 --> 00:56:12.239
ramble on and on. Thank you so much.
1110
00:56:12.880 --> 00:56:15.159
I've been enlightened and ignited. I'm gonna go change the
1111
00:56:15.159 --> 00:56:16.639
world when I get off this call. I mean after
1112
00:56:16.679 --> 00:56:18.800
I'm done at work, that is well.
1113
00:56:18.840 --> 00:56:21.039
I hope to meet you in person sometimes speaking of
1114
00:56:21.079 --> 00:56:23.280
in person, and I know you guys just in an event,
1115
00:56:23.320 --> 00:56:25.159
so hopefully I can get up there sometimes. Thank you
1116
00:56:25.239 --> 00:56:26.760
for having me. I appreciate it.
1117
00:56:26.800 --> 00:56:29.280
Thank you, Wendy. Thanks for listening to the Mental Health
1118
00:56:29.280 --> 00:56:32.639
Spotlight podcast helping you hold hope on your recovery path.