• Improving Lives Team

Getting to know "Figs"




What is your name and what title do you go by?


My name is Sarah Maria Filgueiras, most people call me Figs like the fruit. My official title is registered mental health counselor intern. I am a year away from being fully licensed as a mental health counselor.

In other words, I am a psychotherapist. In my practice, I use the wellness model of mental health rather than a clinical medical model. Instead of black and white, we understand mental health as spectrum affected by biology, aspects of their environment, family history, what is going on in their present life and that maybe certain things may be a little distressing. The great thing about the spectrum is that I don’t have to give a diagnosis, which take the pathology out of the symptoms we are experiencing. A lot of the things we count as a diagnosis are adaptive. Adaptive is a way your mind protects itself. For example, let’s look into depression, a lot of the thoughts are self-defeating, hyper-critical. We as people over all need to be critical of ourselves to improve, to learn from our mistakes for self-development. When we become overly critical of ourselves our self-esteem suffers and now, we develop low self worth or pessimistic regarding ourselves or our situation which we typically see in major depressive disorder or a depressive episode. Many of us experience depressive episodes in our lifetime but that doesn’t mean we meet the full criteria for a diagnosis.


What is your educational and personal background?


I did my bachelor’s in psychology at Florida International University and minored in photography. I went to the University of Pennsylvania; I have a double master’s in counseling and mental health services and professional counseling.

I was born and raised in Miami. At 12 years old I moved to small town in the south called Valrico, Florida. When I turned 18 I came back to Miami, and I’ve been a little around the northeast during grad school. Then I decided to come back to city I call home and work at Improving Lives.


What license do you currently hold?


The current license I have is register mental health counselor intern. To explain it to people I kind of say it’s like a residency. What is a medical resident? You already have the medical license, you’re capable to treat and diagnose how ever there is that understanding that we need training, and that it shouldn’t be fully independent. Registered Mental Health Counselor Inter means I can treat and diagnose; however, I am under supervision. Everything I do, say and diagnose is under the supervision of Alfredo Hernandez. I discuss my cases with him once a week and its usually disclosed on the first session with my clients, so they know right away that everything in the room is confidential except for Alfredo.


Do you have a specialty you want to talk about?

My specialty found me, I didn’t necessary seek it out. Many of my clients are in the LGBTQ+ community and in addition to that a lot of my clients are developing eating disorders. As I’ve been working with this population, I realized I really enjoy it and want to specialize in it. To put into perspective; an eating disorder is a war between “control,” and “storm,” that presents as fluctuations in body image, weight, and relationships with food.

A lot of people that have eating disorders have a strong need for “control,” for example, many come from strict families, or pressure to be perfect in different aspects of their lives. The need to feel “in control,” creates a “storm,” or neglect in their personal wellness. A population that finds itself at risk of developing eating disorder includes athletes, especially those where control of their body shape may be heavily emphasized such as gymnastic, ballet, wrestling, rowing, and body building. In multiple studies, they found that approximately a quarter of them meet the criteria for disordered eating[FS1] .

I approach eating disorders with the wellness model by addressing the different environmental factors that encourage the disease, the person’s health and culture. We have to understand that this is no “one size fits all,” type of treatment. In practice primarily implement Cognitive Behavioral Therapy (CBT), with the assistance of our team of nutritionist, psychiatrist.


What are the characteristics of the condition?

Be aware of rigidity. This presents as strict adherence to rules of what they should eat, when they should eat, and how much they should eat. Many of us try to have a healthy diet, but it becomes a concern when these rules don’t allow a person to enjoy experiences such as going out to a restaurant, or activities that include food that’s outside of their rules. Some other characteristics include: constantly thinking about food/calories, measuring success of physical activity by the number of calories it burns, and eating beyond being full. Lastly I want to highlight that a person does not have to look a certain way to have an eating disorder.


Because disordered eating is so normalized in our culture, many people live with the illness untreated. For example, how often do you go to a family gathering and they greet you with comments about your shape or eating? Comments like “oh estás gordita” “ganaste peso,” “estás comiendo?” These same messages encourage people weigh their worth based on pounds and kilos. The first step we can take to change the way we communicate and complement one another is to implement the “5 second rule,” If it cannot be fixed within 5 seconds, don’t comment on it.


Any demographic facts about people with this condition?


Most people that’s seek treatment with an eating disorder are teens and young adults. Although women make up most of the population that seeks treatment for eating disorders, it can also happen to men. For example, now we are seeing a growing population of men with body dysmorphia. There is a growing pressure for men to be large and muscular which encourages the use of steroids, working out more than they should with no rest days.

Body dysmorphia is when you hyper fixate on certain body parts, you either see it bigger or smaller than what they are. Trying to obtain a goal and this is tied to a lot of feelings of self-worth or what’s the perfect ideal type. A lot of men have body dysmorphia in the sense they don’t see them selves as muscular as they are, and they tend to work out a lot more intensely. Most people with eating disorder, have body dysmorphia but you can have one or the other mutually exclusive.


Can you share a success story?


I started a short 9 week disordered eating Spanish speaking group which primarily focused on emotional eating. Many of the things we do are counterintuitive, but they serve the purpose of stabilizing and finding joy in moderation. I had a good turn out with one of members who did a lot of late night emotional eating, which resulted in significant weight gain in the past year. After the 9-week group they continued to use what they learned in group and at first experience some weight gain as their body found equilibrium but later they lost all the weight they gained in those months from emotional eating and more. Overall, they were happier and had a healthier lifestyle even though they’re not doing these crazy rules of dieting like they were doing before. The purpose of the group was not to help with losing or gaining weight rather, finding joy in their food and their bodies that was taken away by “control,” and “storm.”



What is your therapy philosophy or guiding principle?


I view myself as the “fellow traveler”. This guiding philosophy by Irvin Yalom humbles me by reminding me that although I’m the “expert,” I will never be an expert on life. The best part of my role is that I continue to learn as I become part of my clients’ journey of self-discovery.


Resources:


https://www.nimh.nih.gov/health/statistics/eating-disorders


https://www.nationaleatingdisorders.org/help-support/contact-helpline


https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders


Psychology Today Eating Disorder/Disordered Eating Quiz:

https://www.psychologytoday.com/us/tests/health/eating-disorders-and-emotional-eating-test


[FS1]Citation: Greenleaf, C., Petrie, T. A., Carter, J., & Reel, J. J. (2009). Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors. Journal of American College Health, 57(5), 489-496. doi:10.3200/jach.57.5.489-496 The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003.


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