We’re back to introduce you to another clinician on the team! This week – our newest (and only!) psychiatric nurse practitioner, Celeste Kehoe. Celeste is currently seeing clients virtually and will continue to see clients in our office once we return to in-person counseling. We’re excited to have her on our team! Find out a little more about Celeste in this interview and call our office today (910) 790-5000 to schedule your first appointment with her.
Why did you decide to become a nurse practitioner (NP)?
I had worked as a registered nurse for several years prior to returning to graduate school to become a nurse practitioner. While active duty in the US Navy, I had the opportunity to work on an inpatient psychiatric unit and this is where I found my calling to work in psychiatry. I have always enjoyed talking with and listening to clients and the nurse practitioner role afforded me the chance to expand my role as a nurse. As a nurse practitioner, I feel I am still able to provide individualized care and take the time to truly form a therapeutic relationship with my clients.
“I’ve never met with an NP or psychiatric provider. What should I expect during my first appointment with you?”
During our initial appointment, I will collect information regarding your history and symptoms that you are experiencing. After listening to your concerns and answering any questions you may have, I will offer treatment recommendations. We will then collaboratively decide which treatment option, if any, would be best for you. I strongly believe that my clients should have an active role in their treatment. The best approach in most cases is the combination of therapy and medications. My role is to listen to your concerns and symptoms, make treatment recommendations and monitor your response to medications so that you have an optimal outcome.
“I have concerns starting or switching medications. Any insight or advice?”
Starting any medication whether it be for medical or psychiatric reasons can be worrisome. Whether we have decided together to try a new medication for the first time or switch from another, my approach is to go low and slow. This helps to minimize any side effects and allows you to adjust to the medication.
What book are you currently reading or podcast are you currently listening to?
I try to read a new book each month. Currently for pleasure reading I am reading, “Before We Were Yours” by Lisa Wingate. As I feel it is important to continuously keep abreast of new information and continuing education, I am also reading “Eating Disorders – A guide to Medical Care and Complications” by Dr. Philip Mehler and Dr. Arnold Andersen.
One thing you want your clients to know about you?
I have worked in a variety of settings including outpatient clinics, clinical research trials, correctional facilities and on a university campus. All of these experiences have helped me grow as a prescriber and nurse practitioner.
Thank you for your adaptability and patience as we’ve transitioned to telehealth over the past 6 weeks. Although shelter in place will be lifted this Friday, our office will remain closed for in-person visits through the end of May. Insurance companies are still allowing telehealth without restrictions for the remainder of the month; we intend to benefit from their flexibility by continuing to provide therapy via video or phone to ensure everyone’s safety. We hope to protect our clients and staff and do our part to “flatten the curve”. In addition, we do not feel in-person visits while wearing masks is conducive to effective therapy.
Chrysalis is delighted to be offering a 4 week wellness workshop for frontline workers. For county, state, and New Hanover Regional Medical Center employees, this will be FREE with your insurance benefits. We are excited to offer support and care for those most impacted by COVID in their workplace.
Stay safe and be well!
April 4th, 2020
To Our Valued Clients,
We will continue to remain closed for in-person sessions throughout the duration of the shelter in place order. Mental health services are considered essential and we could not agree more! We know these are uncertain and challenging times and urge you to continue to connect with your therapist and/or dietitian for support. Telehealth options include phone or video sessions. We are also offering our outpatient groups via Zoom, in addition to virtual Intensive Outpatient Programming (IOP). We are excited to welcome a new addition to our staff- our psychiatric nurse practitioner, Celeste Shamel. She is now offering telemedicine sessions and accepting new patients. Please stay safe and well and know that we are here to help!
Stay well and be safe!
March 26, 2020
Dear Valued Chrysalis Client,
As many of you know, we have successfully launched telehealth over the past week and a half and are now offering phone or video sessions in addition to virtual groups and virtual IOP. In light of the current circumstances, we are electing to remain closed through April 5th at this time. We will continue monitoring the situation and make decisions on a week by week basis about re-opening the practice to clients for in person sessions. Our number one concern is the safety and well-being of clients and staff and we seek to minimize the impact of COVID on our community by practicing social distancing for the near future. Our admin team is still operating and can assist you in your scheduling needs. Please don’t hesitate to call us at 910-790-9500 or email firstname.lastname@example.org.
March 20, 2020
We are now offering all appointments through online or telephone sessions. This is for all existing clients and new clients. Contact our office at 910-790-9500 or email email@example.com to schedule your appointment.
March 17, 2020
Our leadership team has come to the decision to end in-person office visits effective close of business today, through the end of the month. We want to ensure the well-being of all clients and staff and minimize the impact COVID-19 has on our community. Effective 3/18/20, all individual counseling and nutrition appointments will be offered via telehealth. This is temporarily being allowed by all insurance companies in light of the current situation. We hope to add video conferencing capabilities in the very near future, but due to the unprecedented demands on the servers of the various telehealth platforms, this option is not fully functional at this time and therefore we will be conducting therapy via telephone only to ensure uninterrupted care free from technical glitches. For now, all outpatient groups and IOP services are suspended until our HIPPA compliant virtual platform is more sound. We will inform you as that occurs.
We understand that this is an anxiety provoking time and we are committed to helping you through it. We will periodically add updates to our website and social media and will have administrative staff working remotely to answer your calls and emails.
Our administrative staff will be contacting you to discuss the logistics of this change in delivery of services (i.e. you will be expected to electronically sign a telehealth informed consent) and answer any questions you may have. Your regularly scheduled appointment(s) stand and your clinician will look forward to talking you then.
Thank you for your patience during this ever-evolving situation. We hope you stay well and will look forward to being able to connect again in person.
March 14, 2020
To our Valued Clients:
In light of the recent concerns over COVID-19, we wanted to assure you we are committed to the safety and well-being of all our clients and staff. To that end, we are following CDC recommendations regarding sanitation and taking all precautions necessary. As a Joint Commission accredited facility, we have infection prevention protocols in place and hope to maintain a germ-free environment. Everyone that enters our building is expected to abide by our protocols.
If you or someone you live with is experiencing symptoms, please contact our office to determine if telehealth services are an appropriate option for you. We offer a confidential and HIPAA compliant platform for telehealth should you need to utilize this service.
As of now, we are operating on a normal schedule for all services. We will continue to monitor the situation and abide by all recommendations by the CDC and government officials.
We’re back to introduce you to another clinician on the team! This week – our newest dietitian, Lizzie Briasco. Lizzie will see clients out of our office and facilitate IOP groups and meals. We’re excited to have her on our team. Find out a little more about Lizzie through this interview and call our office today (910) 790-5000 to schedule your first appointment with her.
Why did you decide to become a dietitian?
I wanted to become a dietitian to teach people how to be empowered by food, not scared of it. As a former competitive athlete, I saw first-hand how proper nutrition positively impacts performance – and how easy it could be for food and exercise to become an unhealthy obsession. I want to help people of all backgrounds and activity levels define and then develop healthy and sustainable relationships with food, movement, and their bodies.
I’ve never seen a dietitian before. What should I expect during my appointments with you?
Contrary to popular belief, dietitians are not the food police! I am interested in your eating patterns, how they are currently impacting you and other areas of your life, and potential changes that will help you reach your goals. I’m here to provide nutrition education, tools, and resources, and then we will work together to implement them into a plan that works for you. While I am an expert in nutrition, I am not necessarily an expert of your body or your lived experiences. I can, however, help you develop those skills!
I know how to eat healthy and there is a lot of information to find online. What will be different with seeing a registered dietitian?
There is indeed a lot of information online, but it is not necessarily accurate. Registered dietitians, especially those with additional training and certifications, have the practical experience and research skills required to decipher actual science from “bro science” propagated by the media or your local juice bar guru. We understand the science of nutrition and how to translate it into daily habits. Seeing a dietitian provides a non-judgmental space to ask questions and explore concerns about all things food-related, and we can provide encouragement and accountability that may be lacking elsewhere.
What book are you reading or podcast are you listening to?
Currently, I’m reading “The Adonis Complex” to learn more about body image issues in boys and men (it’s not really talked about but it’s definitely a thing!). I’m not a huge fan of listening to podcasts because it’s hard for me to pay attention when I can’t see who’s talking, but I do like playing the “Food Heaven” or “Food Psych” podcasts when I’m doing things around the house. Learning never stops!
Fun fact about you…
I almost didn’t become a dietitian! After I completed my undergraduate degree in nutrition, I took a non-traditional path and worked in the Northwoods of Minnesota for a year as a server/bartender at a family resort lodge. I didn’t take an internship or clinician-esque job right away because I disagreed with the many weight-centered approaches and weight-stigmatizing attitudes taught in traditional nutrition education…then I found the dietetic internship through the University of Minnesota -The Emily Program, discovered a whole new approach to nutrition that emphasized compassion and mindfulness instead of shame and deprivation, and the rest is history!
This blog is written by Kelly Broadwater, LPA, LPC, CEDS-S, a psychologist and Clemson alumnae…
Dabo Swinney, head coach of the National Champion Clemson Tiger football team may not know it, but he is an expert in Positive Psychology. I would venture to say that his motivational tactics are responsible for much of the success of the Clemson football program, a program that has played for three–and won two– National Championships in the past four years. He is the inspiration behind the team that achieved a perfect 15-0 season last year, culminating in the underrated Tigers (predicted to lose by 6 points) trouncing the Alabama Crimson Tide 44-16 in the title game.
So what exactly is positive psychology? Defined, it is “the scientific study of human flourishing, and an applied approach to optimal functioning. It has also been defined as the study of the strengths and virtues that enable individuals, communities and organizations to thrive”.
The field of positive psychology is founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, and to enhance their experiences of love, work, and play. Sounds exactly like the philosophy that fuels the Tiger football team, who although adored by their fervent fans historically have lacked respect from commentators and the college football community at large. Despite that, thrive they have! Ever the underdogs, they prove time and time again that they have the biggest heart of any team in the nation. After the awe-inspiring win over Alabama for the 2018 National Championship, Coach Swinney had this to say, “When you get a young group of people that believe, are passionate, they love each other, they sacrifice, they’re committed to a single purpose, you better look out. Great things can happen and that’s what you saw tonight.”
Positive psychology researches concepts such as grit and resilience. More and more, researchers are proving that inborn talent doesn’t necessarily determine success. Instead, grit, a relatively new concept in psychology, is becoming the key factor in achievement. Positive psychology defines grit as “passion and perseverance in working toward significant long-term goals”. In 2000, Swinney was let go from his coaching position at Alabama when the entire staff was fired, and briefly went into real estate. He was hired at Clemson the following year and by 2009, was an unlikely choice for the head coach position (he’d never even been a coordinator). Unranked nationally by the end of his second season, Swinney’s Tigers started to climb each year to earn the #2 spot in the country by 2015 and to play for Clemson’s first national championship since 1981 the following year. His long-term goals, established when he took over as coach in ’09, were realized thanks to his passion and perseverance.
What researchers are discovering, and what Dabo Swinney already knew, is that what we accomplish often depends more on our passion, resilience, and commitment to our goals, rather than our innate talents. Take Hunter Renfrow as an example. Once mistaken for a water boy, this 5’10 walk on ended up earning a scholarship and making the heroic last second game winning reception during the 2016 National Championship; he is now an NFL player.
So how does one develop grit even if you’re not a Clemson football player? Positive psychology experts recommend the following:
Develop a passion. A big component of grit is perseverance. Few people are willing to work tirelessly on something in which they’re completely uninterested. Research has shown that people have much greater work satisfaction and job performance when they do
something that fits with their personal interests. However, it’s unlikely that people try something and immediately know that it’s what they want to do for the rest of their life. An Interest has to be developed and deepened before it becomes a passion.
Practice Deliberately. Practice doesn’t always lead to mastery. What is it that sets apart those who achieve extraordinary levels of mastery in their fields? They don’t just practice; they practice deliberately. Here’s how to do it:
Set a stretch goal (a goal that exceeds your current level of skill)
Practice with full concentration and effort
Look for immediate and informative feedback
Repeat with reflection and refinement
Focus on Purpose. At the heart of purpose is the idea that what you do matters, not just to yourself but to others. Purpose has a pro-social focus. In any activity, there are bound to be setbacks and moments of boredom, doubt, anxiety, and disappointment. We’re more likely to push through the hard times if our efforts give us meaning and contribute to something larger than ourselves.
Researchers have found a correlation between grit and purpose. Grittier individuals were more motivated to seek meaning in their lives, and the contribution of their efforts to the lives of others revealed a powerful source of motivation. One way of focusing on your purpose is to seek out the pro-social benefits of whatever it is that you do. Doing so is linked to greater satisfaction at work and in life.
Swinney is known for giving impassioned speeches during post-game interviews, and coming up with catch phrases on the fly that turn into mantras- “Bring your Own Guts” and “All In” being a few that come to mind.
During the 2018 National Championship parade and celebration in Clemson after the Tigers returned home from California, Swinney said the following: “Why not little ole Clemson? Somebody’s going to be 15-0 one days, so why not Clemson?…I challenged these guys with this quote, ‘So what you can vividly imagine and ardently believe and enthusiastically act upon, will inevitably come to be. The 2018 team is the best ever… It’s not that we won- it’s how we won.’”
Challenge yourself to take a page from Swinney’s playbook, focus on what you can “vividly imagine, ardently believe, and enthusiastically act upon”. You may surprise yourself and others, the same way “little ole Clemson” has.
Kelly Broadwater, executive director of Chrysalis, is a second generation Clemson Alumni and die hard Tiger fan. She has been known to use sports analogies in her work with clients and believes Positive Psychology concepts create “wins” in and out of the therapy office.
Today’s blog is written by Lauren Francis, Master’s Level Psychology Intern at Chrysalis Center. Lauren completed her course work for her Master’s Degree at Appalachian State University in April and is fulfilling her field placement requirements at our office as a Recovery Advocate for IOP and as an individual therapist offering pro-bono counseling.
Remember this scene from the movie Mean Girls? So many women can relate to this scene because, unfortunately, it is what many women do. We often put ourselves down for the way our bodies look or the food we eat. It has become such a natural part of conversation that most people don’t even realize they are doing it. I mean, what do we expect? The media tells us we must meet standards that are not achievable and that we should not stop pushing ourselves until we look like the airbrushed, PhotoShopped models in our favorite magazines. But those goals are unrealistic and dangerous. I am here to tell you to remember that no one looks like those pictures in the magazines, not even the models themselves.
It makes sense that women would come up with this sort of defense mechanism to combat the guilt and shame that society says you should feel for not having the “perfect body.” In fact, there is even a name for this phenomenon – fat talk. Mimi Nichter coined the term fat talk (3) and defines it as conversations one has with family or peers involving statements that shame her own body shape or weight. Research shows that fat talk endorses the thin ideal and is a prevalent form of communication within female friend groups (1,2,4,5). Some of the most commonly reported topics involved in fat talk consist of conversations regarding dieting and working out (1). Other common statements that can be considered fat talk are declarations such as “I’m so fat” or “my thighs look huge in these shorts” (3).
Significant positive correlations have found between higher levels of fat talk and disordered eating in friend groups. Additionally, those who reported more exposure to fat talk also reported more participation in fat talk later on (2). This suggests that once individuals are exposed to fat talk, they are more likely to participate in fat talk themselves, and therefore develop a higher risk for engagement in disordered eating behaviors. The occurrence of fat talk — in most forms — seems to promote rumination surrounding negative feelings one may have about his or her body. This ruminative thought process has the potential to turn into co-rumination, or the tendency to extensively discuss problems, concerns, or negative feelings with peers, which has been found to be significantly associated with increases in disordered eating behaviors (5). Conversely, it has been shown that individuals who have diagnosed eating disorders participate in fat talk significantly more frequently than those who are not diagnosed with an eating disorder (4) speaking to the bidirectional nature of this issue.
While research related to fat talk is still in the beginning stages, based on what we know so far, it seems that this seemingly harmless form of communication is much more dangerous than we once thought. So, what can we do to stop it? Well, the first step is being informed. Having a term for what you are hearing and then, understanding its impact, are essential in making a difference. Secondly, try acting as an advocate to end fat talk. When you hear a friend or family member saying negative things about their bodies, have them read this blog or explain what you know about fat talk to them. Finally, send positive messages to those around you. Make statements about peoples’ intelligence or strengths rather than their physical appearance. It is time to start empowering each other to realize that what truly matters is much more than what we see in the mirror.
1)Bardone-Cone, A. M., Balk, M., Lin, S. L., Fitzsimmons-Craft, E. E., & Goodman, E. L. (2016). Female friendships and relations with disordered eating. Journal of Social and Clinical Psychology, 35, 781-805. doi:10.1521/jscp.2016.35.9.781
2)Cruwys, T., Leverington, C. T., & Sheldon, A. M. (2016). An experimental investigation of the consequences and social functions of fat talk in friendship groups. International Journal of Eating Disorders, 49, 84-91. doi:10.1002/eat.22446
3)Nichter, M. (2000). Fat talk: What girls and their parents say about dieting. Cambridge, MA: Harvard University Press.
4)Ousley, L., Cordero, E. D., & White, S. (2008). Fat talk among college students: How undergraduates communicate regarding food and body weight, shape & appearance. Eating Disorders, 16, 73-84. doi:10.1080/10640260701773546
5)Rudiger, J. A. & Winstead, B. A. (2013). Body talk and body-related co-rumination: Associations with body image, eating attitudes, and psychological adjustment. Body Image, 10, 462-471. doi:10.1016/j.bodyim.2013.07.010
Pregnancy can be a lovely and exciting time for many women. It is a momentous, life changing event, where the woman’s body will now become a vessel for another life to grow and flourish. This can feel empowering for many women and they take on the changes necessary for nourishing this new life without much effort or thought. For others, it is not that easy. Pregnancy (and motherhood) require a great deal of strength, both physically as well as psychologically and emotionally, even when moving into this space as an overall healthy woman. What if you are struggling with an eating disorder when you become pregnant? Or are in recovery from an eating disorder when you become pregnant? This is the case for many women- in American and worldwide. Consider the following statistics to better understand why this is an issue that needs to be attended to, rather than ignored.
Eating disorders affect approximately seven million American women each year and tend to peak during childbearing years
Pregnant women with active eating disorders are at a much higher risk for delivering preterm and low birth weight babies
Pregnant women with an active eating disorder appear to be at greater risk for having a Cesarean section and developing postpartum depression
Pregnant women with active eating disorders are at increased risk of hyperemesis, delivering infants with significantly lower birth weights and smaller head circumferences
For many women, a healthy weight gain during pregnancy is approximately 25-35lbs. The necessary gain can be higher for women who have been struggling with an eating disorder, as their pre-pregnancy weight may be dangerously low. This can be extremely triggering for some women, and close supervision and guidance from a trained eating disorder specialist is usually necessary. Other maternal issues that can occur are psychological upset, perinatal depression, anemia, increased risk of hyperemesis gravidarum, and more problems with episiotomy repair. While studies regarding the risk to the baby vary greatly it is possible for women with a history of an eating disorder had a higher rate of miscarriage, small for gestational age babies, low birth weight babies, babies with microcephaly, intrauterine growth restriction, and premature labor (especially if the mother’s body mass index was <20). History of an eating disorder or struggling while in pregnancy with an eating disorder can also adversely affect the breastfeeding relationship between mother and baby.
Women who struggle with an eating disorder previous to or during a pregnancy are at a higher risk for perinatal distress and are more likely to indicate postpartum mood issues, anxiety, panic attacks, self-esteem and body image issues, and other mental health concerns. These issues have negatively affect not only the new mother, but the infant, and the significant other/partner of the woman suffering.
Woman suffering from an eating disorder while pregnant will show many different symptoms and signs that are as varying and different as woman themselves. Some common factors for health care providers and loved ones to be aware of are:
Little to no weight gain throughout pregnancy
Fear of weight gain during pregnancy
Excessive exercise to avoid normal pregnancy weight gain
Induced vomiting (sometimes hidden as morning sickness)
Fainting, dizziness, dehydration, chronic fatigue
Avoiding meal times with others
Increased depression or anxiety symptoms
Effective treatment throughout the pregnancy and postpartum period are important in order to promote a healthy outcome for both mother and baby. There are several supports that should be in place, with the two most important being an OB that is somewhat knowledgeable about eating disorders and an eating disorder specialist for therapy. Meeting with a nutritionist that is trained in treating eating disorders will also be very important for a healthy outcome. Medication may be necessary during pregnancy or in the postpartum period, especially if co-morbid psychological issues are present. Group therapy, support groups and peer and peer support along with birth and parenting classes are also great ways to supplement the support that is necessary during this time.
At the Chrysalis Center, many of these services are offered by trained eating disorder specialists, which can help achieve a healthy pregnancy and postpartum period, both physically and emotionally.
Megan Schlude, MA, LPA facilitates the Motherhood Matters program, which offers specialty services to women in pregnancy and the postpartum period, including women suffering from an eating disorder during the perinatal period.
At Chrysalis, we believe that a supportive, healing environment is essential in order for change and growth to occur. We seek to offer such an environment to clients and help them create that in their lives and relationships. Read More