Crafting My Own Curriculum at Carolina House Eating Disorder and Mental Health Treatment Center - with Mireya de los Reyes

“My name is Mireya. My pronouns are she/her. If you haven’t met me yet, I’m a Clinical Intern here at Carolina House. Right now, I’m feeling _____.”

This is how I introduce myself when we go around the room with a check-in at the start of each therapeutic group at my internship worksite. Carolina House is an eating disorder and mental health treatment center in Durham, NC about a 20 min drive from UNC. They offer individualized residential, partial hospitalization, and intensive outpatient care for adults of all genders.

When I was first given my list of potential intern-worksite pairings, I debated over which site to select for my Gil internship. What I knew was I had a strong interest in clinical psychology – classes like PSYC 242 and 245 at UNC had prepared me with foundational knowledge of evidence-based therapies and the diagnostic presentations of different mental illnesses. What I felt I was missing was first hand experience in a clinical setting, and so I sought a worksite where I could directly interact with clients and gain clinical exposure to a broad population of people with different mental health issues. I read through former intern blogs such as this one searching for such an experience, and after meeting with Emily Dolegowski, our Gil Program Manager, to discuss my potential worksites, I decided that Carolina House was the best fit for me and my goals.

As the first Gil Intern at Carolina House, I have been afforded a great amount of flexibility to craft my own internship experience. I maximize the amount of time I can be there in-person around my class and extracurricular schedule, typically working on-site twice a week for 4-5 hours. I spend my time at Carolina House rotating between the Homestead, where the eating disorder residential program (RTC) is held, the Carriage House, where the eating disorder partial hospitalization (PHP) and intensive outpatient (IOP) programs take place, and the Cottage, the main site of the mental health residential program.

The first few weeks of the semester, I worked through materials that Emily, who in addition to being our program manager works as an intern therapist at Carolina House, graciously put together for me. I watched documentaries on eating disorders and mental health inpatient units, closely reviewed diagnostic criteria in the DSM-5, and studied resources for providers and family members of those with eating disorders. This has been so helpful for my understanding of eating disorders especially. As a research assistant in Dr. Anna Bardone-Cone’s eating disorder and body image lab, I am familiar with some of the literature about eating disorders, but I now have a much better understanding of how they are commonly linked to trauma and often manifest as a way to serve a purpose in someone’s life through control or perfectionism. Through my internship, I have also taken advantage of the webinars and training materials provided through Acadia Healthcare, the umbrella healthcare company under which Carolina House falls. I now possess an entirely deeper understanding of what the residential level of care for mental health disorders looks like and how patients can step up or step down in care.

Every day I’m at my internship brings something new. The facilities at Carolina House are not cold, but instead have a homey environment surrounded by nature. I love working at a smaller treatment center where the clients know me and are usually enthusiastic to see me. In the RTC programs, clients often watch TV in the living room during the breaks in their daily schedule of therapy groups, individual/family sessions, and therapeutic exposures, and they enjoy giving me movie recommendations and trying to convince me to go with them on their weekend outings.

With all of the programs, I shadow groups led by the different therapists at Carolina House. Some of the groups I have shadowed include DBT groups, skills groups, goal-setting groups, and experiential therapy groups like psychodrama. During group, I listen in on the clients’ discussions and participate in the activities alongside them, filling my worksheets with my own thoughts from the exercises. Often, I feel that the clients are better educated on therapeutic techniques and skills than me, and I leave the session with bullet points of acronyms for coping skills or types of treatment to look up later.

At the eating disorder residential house, I provide meal support for the clients during snack times. This involves eating alongside them; engaging them in conversation to draw attention away from disordered thoughts and normalize mealtimes as an enjoyable, social activity; and challenging them to complete their meals (a skill I am still working towards improving). Some days I get to shadow Emily more closely, and I observe how she supportively challenges clients during mealtimes, leads groups, and documents detailed individual and group session notes. I’ve gained insight into how situations are handled as they come up at a treatment center, and it has given me a new appreciation for mental healthcare workers from the therapists whose groups I shadow to the Behavioral Health Associates who are with the clients at all times throughout the day.

I recently had the opportunity to lead my own Joyful Movement group for the ED RTC clients, and I was so happy with how engaged the clients were for our discussion of movement versus exercise and during the storytelling movement activity meant to connect us back to the play aspect of movement. This group I led was a part of my larger project of creating a resource guide for Joyful Movement groups at Carolina House. I am grounding my discussion topics, worksheets, and movement activities in evidence by pulling from eating disorder workbooks and readings, as well as pulling inspiration from my own years of dance experience, courses I have taken, and relevant webinars I attend through UNC and Acadia. Sometimes I work on this curriculum remotely and other times I do this while I am on-site, sitting on the admin building couch while listening to the clinical team go about their work around me.

In the admin building and during treatment team meetings for both the mental health and ED programs that I join virtually, I get to observe how different types of providers work collaboratively to best help each client. I listen as they discuss how a clients’ week is going, recommendations for their medication and/or meals, and plans for their discharge. I never thought I would get this level of exposure to the private sector of mental healthcare in my undergraduate years.

Along with leading more Joyful Movement groups, I still have many things I want to do before the end of the semester such as shadowing intake and individual client sessions, diving deeper into how insurance is handled to best benefit clients, and going on an outing with the residential programs as promised. This internship has been an invaluable experience for me and I am not ready for it to come to an end.

I would like to extend a huge thank you to the entire clinical team at Carolina House including my mentor Mark Kooser, Carolina House’s Clinical Director, for being willing to take on Carolina House’s first undergraduate clinical intern and allowing me the opportunity to engage with all of CH’s programs to the fullest extent, and Emily Dolegowski for structuring this experience for me and graciously allowing me to haunt her office hours with my many questions about her job and my curriculum. And to the clients at Carolina House who teach me just as much as the classroom can, if by any chance you read this: thank you for allowing me to learn alongside you and for letting me be a part of your recovery.