Host Dr. Flowers, co-host Robin French, and VIP guest Kristin Agar discuss Kristin’s expertise/practice specialties which include: illness, grief, loss, alcohol, drug, and eating disorders with her offering of individual, group, and family psychotherapy. Kristin discusses how she tailors each of her interventions to the needs of each family. Kristin shares how she is often assisted during interventions and therapy sessions by her buddy and co-therapist, Jet, an English Setter who provides a calm and supportive presence to those with whom she works.
—
Listen to the podcast here
Tailoring Interventions To The Needs Of Each Family With Kristin Agar [Episode 33]
Eating Disorders
Welcome to the show.
Robin, how are you?
I’m great.
Good.
We’re on episode 33. Can you believe it?
I remember episode one.
Do you?
I am so excited to have Kristin Agar with us from Little Rock, Arkansas.
It’s good to be here.
Welcome.
You had the choice to do it over Zoom, and you and I started chatting with Robin, and I said, “What if you flew in to see us?” You and I go way back, we’re good friends and colleagues, and we haven’t seen each other in a year since pre-COVID. I was like, “Come on down. We’re both vaccinated. Robin’s vaccinated.” We’re all past that. Thank you for coming down.
It’s my pleasure. Thank you for having me.
Glad you’re here.
Can I read a little bio on you?
I would love that.
Can I humor you with this? For those who don’t know who you are, which most of our readers will, but for the mothers and fathers out there, I’d love for them to hear this. Kristin Agar is a clinical interventionist, psychotherapist, and consultant from Little Rock, Arkansas. She’s been in private practice since 1992, where she provides intervention services, outpatient treatment, and case consultation locally and nationally.
Intervention services include planning and facilitating interventions, clinic transports, and providing continuing care. Kristin is trained in both invitational and rehearsed models and tailors the intervention to the needs of each family. Rather than focusing solely on the patient, the emphasis is on the healing for all of the family. She’s a certified intervention professional, a certified Love First clinical interventionist, and a certified ARISE interventionist.
Her clinical services include individual group and family therapy specializing in alcohol, drug, and eating disorders, as well as illness, grief, and loss. She’s a member of the Trusted Provider Network, the Network of Independent Interventionists, the International Association of Eating Disorder Professionals, the National Eating Disorder Association, and is a founding board member of the Eating Disorder Coalition of Arkansas, and a member of the FBI Citizens Academy Alumni Association at the Little Rock Field Office, and a dog rescuer.
That’s the most important right there, the dog rescuer. What dogs do you take in or rescue?
I rescue senior dachshunds, weenie dogs.
Very cool.
I currently, though, have a therapy dog, Jet, who comes to work with me and also goes on interventions with me. She’s such a calming presence for people who are anxious and nervous that people come into my office and if they don’t see her there, they turn around and look as if they want to cancel and I say, “Do you want to reschedule when Jet’s back?”
I’m working on Skye, trying to get her trained to become a therapy dog. She’s only eight months old. I’ve already spent a few thousand dollars in training. She’s not quite there yet though, so I may send her home with you to Arkansas.
Running around on the farm of it.
There you go. That would definitely work.
I know. Good for you, and my friend Nancy who as well she rescues dachshunds as well. What is her latest dachshunds?
Boss. Beautiful dog. He was a show dog.
Beautiful long-haired like just all the way down to the floor.
He is the boss. My dog is, he loves him.
My face mask is, trust me, I’m a Dogster and it’s a miniature dog.
I love it. That’s great.
How did you two meet? How do you know each other?
Professionally, we probably met at a conference, we’ve known each other for a long time, and we’re good colleagues, and then we became, I hope, good friends.
Indeed. Yes, we are, and we’ve done some work together, we’ve done some interventions together, consultations, and referrals. We’ve had a long and wonderful relationship, in my opinion, and we’re really good friends.
That’s right. When I have a problem, sometimes I just pick up the phone and call her and say, “What do I do?”
Likewise.
She tells me the truth.
Not what you want to hear.
She doesn’t make it easy. Thank you for doing that. Kristin saved my life and referred me to an amazing trauma therapist, Jill Krush, up in the Boulder, Colorado area. I went up to Jill and did a weekend retreat for trauma therapy. It was an amazing experience. Kristin was good enough to send me up there. Thank you. We get to do things like that for each other.
That’s sweet.
Yeah, absolutely.
Your specialty is eating disorders, correct?
That is true. Yes, I do a lot of different areas of practice, but primarily these days it’s eating disorders, alcohol and drug problems, process addictions, and then still my first love has been oncology from years and years ago when I worked here in Houston at MD Anderson on the Leukemia Service. I’m most well known for the eating disorder intervention work and complex mental health and alcoholism, all together.
Sometimes one and then sometimes all.
I’m just going to ask a simple question. What is an eating disorder? For those reading, what is it?
In a general way, I would say an eating disorder is an abnormal relationship with food.
An eating disorder is an abnormal relationship with food.
I think that’s so true. When you’re when it all rolls down to brass tacks, that’s what it is. Just an abnormal relationship with food.
What triggers it?
It can be anything. Back in the old days, we thought, “It’s the mother’s fault.” Everybody blamed the mother for being a bad mother, which couldn’t have been further from the truth. We attribute eating disorders to lots of factors. Trauma history within the family, house fire, abuse from the culture itself where there is an outrageous desire to be thin to the extent that people are willing to die. Initially, we saw young girls, the profile was of a young girl who makes a four-point and is smart as a whip, is a cheerleader who develops anorexia nervosa.
That has changed. Not that other illnesses related to eating disorders or eating disorder diagnoses were not around, but they certainly weren’t as well known or as prevalent, including bulimia nervosa purging through various methods and ARFID, which is Avoidant and Restrictive Food Intake Disorder. Binge eating disorder is classified now in the DSM-5 as a real diagnosis. Used to have a different name, compulsive overeating. There are other food disorders, but those are the most common ones, as well as orthorexia.
Do you think that Instagram, Facebook, and social media have had a huge influence on the numbers that we’re seeing rise in eating disorders?
I’m glad you brought that up. Yes, because we are seeing people who are presenting themselves as who they really are not on social media, and when you see them in person, and they may be very ill, or they don’t have on makeup, or they’re trying to act like they’re okay. On social media, they are being portrayed as somebody perhaps that they’re really not.
We were seeing all kinds of things that are eating disorder-friendly websites, such as Pro Ana, the Bimbo Game, which is about eating disorders and body image. There’s all kinds of stuff out there. That has a huge impact, not just on young girls now. People who have eating disorders are of all ages, from young to the elderly, all genders, different socioeconomic categories, and there are a lot of different factors. It’s not just this anorexia.
Eating disorders are not just a young girl’s issue. They affect all ages and genders.
It’s little girls and young women.
Skinny and want to stay little like a boy. It’s much more complicated.
We’re seeing it in gay males who want to look beautiful and look handsome, and we’re seeing it in the trans population. We’re seeing it really, as you said, in the older geriatric population. Something you and I talked about earlier was you’re seeing a rise in baby boomers, and the numbers in baby boomers of eating disorders. I wonder why.
It makes me wonder sometimes if an eating disorder was dormant for a while and has resurfaced. A great example regarding that would be what happened during COVID. The inability to cope with the unknown, the fear. We’re seeing a great deal of people with eating disorders now who are middle-aged baby boomers.
Earlier we were talking about nowadays seeing young ladies in all ages trying to be as thin as completely possible and then we were talking about Marilyn Monroe. I had no idea Marilyn Monroe was a size 12 or 14 exactly and Nicole Smith the same thing probably 14, 16 probably.
In that day the beauty was in curvy, voluptuous Miss America right back in the ‘50s. Now what we see is thin, muscular, very fit, not curvy or voluptuous.
Sure. You’re a licensed clinical social worker in a thriving private practice in Little Rock, Arkansas, and what brought you to have a specialty? I know you have many specialties in the addiction field, but what was it about the eating disorder specialty that really drew your attention? Were you seeing a lot in your practice and you wanted to learn more or how did that unfold for you?
It’s been a very interesting journey for me. I do see people with eating disorders in my practice and many people come to me almost at death’s door and well into the disease process. I begin thinking about what can I do to help this population get the medical care they need sooner, rather than at the end of the disease process when they perhaps have developed SEAN, Severe and Enduring Anorexia Nervosa.
That led me to contact a couple of interventionists in the country, Heather Hayes in Atlanta, and Judith Landau in Colorado, and Debra and Jeff Jay in Michigan. I decided I would train if they would let me come into their training on how to do an intervention with people who have eating disorders because it’s complicated. There are a lot of different factors that we don’t think of with alcohol and drug interventions.
Oftentimes it involves getting an air ambulance to transport the person who’s so gravely ill up to say Denver Acute, the only intensive care hospital for eating disorders in the country. I’ve spent a lot of time with educating professionals through lectures around the country about when to refer somebody. If somebody has an eating disorder, they need to be seen by a therapist who is trained and has experience with treating eating disorders.
Early Intervention
Isn’t it amazing how as mental health professionals, we’re trained in graduate school to refer when it’s outside of our box, outside of our specialty, or our training area? I’m certainly not an eating disorder specialist so I would refer out or use one of our providers as that expert. What you were talking about, we were talking about why don’t people refer out. Why do we wait so long? Why do we wait until a 5 foot 1 woman or man for that matter, 5 foot 10 man is 94 pounds or 74 pounds? Talking about the need for early referrals and early intervention in the eating disorder process. Can you talk a little bit about that?
I think a lot of it comes down to denial of the severity in both the person with the eating disorder and their loved ones. “It’s not that bad.” Much like other addictions, “It cannot be that bad.” Denial is very strong. When you’re watching it happen, it can be gradual. For somebody with a binge eating disorder, you don’t notice some of the things that are occurring.
Then you turn around and the person’s got all kinds of medical problems, diabetes, high blood pressure, perhaps. They are being referred for gastric bypass or a gastric sleeve. There are many situations in which people don’t notice, not on purpose, but do not notice or do not put together the complex picture of what’s happening. If I say, “Have you seen any evidence of any bulimia?” It was just purging through vomiting, exercise, diuretics, laxatives.
They’ll say, “We did see a big box of laxatives or we just thought she was getting sick all the time after meals.” We begin to ask and with providers, we’re saying, “Are you trained?” You mentioned the Eating Disorder Coalition of Arkansas, and we want people to be saying, “I treat them if they’ve been properly trained because if you don’t know what you’re doing, you can really mess somebody up.”
It’s just like an addiction as well. Addiction for alcoholism or addiction for drugs. That person sitting in front of you, many times, probably isn’t being fully truthful.
Imagine that.
“No, there’s no problem here. I’m fine. I eat when I want to eat. I’m healthy.” You have to know how to pick up on the nuances.
I do believe that it’s a little odd if someone says they have a normal exercise routine. I run three hours on the treadmill every day. I’m not kidding. It’s really true. It’s grown to that point because it takes more and more as the person gets sicker than sicker. Families get just desperate to help their loved ones. They try and do all kinds of things. My passion really was born of that and watching people be so sick and have options, and opportunities to get people into treatment sooner rather than later.
What I have discovered for myself is that my passion is to do interventions not screaming, hollering, or yelling interventions where you tell somebody everything bad, “We’re getting the car, we’re going to treatment.” Interventions wherein we prepare a family to approach with love, not shame, blame, and guilt. We want to switch that over to compassion, and care and hope to get not just the patient into treatment, but to help the whole family system heal because the entire family system, as with other addictive processes, everybody gets sick with this.
We want the patient to be treated and the family as well. The old days of sending the person off to treatment and when they come back, everything will be just fine. What we also know is that you all know lots and lots of family members who’ve begged somebody to get treatment for a problem and they’re not successful.
Collaboration With The FBI
Cry, holler, everything but what we know is that one-on-one addiction or an eating disorder will win, but together we are stronger. I use Heather Hayes’ analogy about you’ve got a terrorist in your home. Your loved one is the hostage. You’re the one trying to rest your family members back from the terrorists. In some cases when I do an intervention, the terrorist is alcoholism. Sometimes it’s gambling.
Sometimes it’s an eating disorder and you are in the fight for your life. Get that person back. We treat the family as well. They are just as traumatized. Intervention is a way to prepare people for treatment, both for the person of concern and the loved ones, “Here’s what’s going to happen, this is how it goes.” When I work with the family, I have them sign a contract for the work they’re willing to do, including support groups, therapy, and different actions, so that we can bring the family back together and everybody has a good shot at healing. That’s the goal.
Family Dynamics
I’ve seen you do that work, interventions that you have invited me to be a part of. We had a great time but the work that you do preparing and getting the family ready and then sitting there with the family pre-intervention and then working with the family post-intervention is it’s a beautiful unfolding of healing and you’re amazing at what you do. Do you see often that eating disorders run in a family? Like a mother and daughter, father and son, mom and dad both? Do you see that often?
I do that there is a generational trickle-down, if you will, much like other illnesses, breast cancer, and anxiety disorders. Yes, it is generational. Mom or dad or somebody has been on a perpetual diet and kids pick up, “This is what you’re supposed to do.” I end up sometimes treating both generations. Very true.
That’s so interesting.
Do you find also that in some of these instances, though when you have the family has to heal, there are siblings that are overlooked because all the attention is given to the sick member?
You are absolutely right. I know when I worked over here at MD Anderson, all the focus would be on the patient and their siblings would literally be left out because all the attention was focused on the ill child. That’s part of what we noticed. Again, we go back to everybody who needs help. When you’re fighting and dealing with a chronic, potentially life-threatening illness, it affects everybody. That’s why we have support groups for little kids whose moms and dads and siblings may have an addiction or an anxiety disorder, bipolar, or depression. We have to work with everybody to help them heal.
That’s right. Speaking of a terrorist in your home, I know this is different, but you have a special project coming up with the FBI. I would love to hear more about that.
I have worked with the FBI via the Citizens Academy and worked with them to educate high schoolers about drug addiction. There’s a national film that the FBI produced in 2014 called Chasing the Dragon, and it is about 7 or 8 people and their real-life stories of how their drug addiction developed, some recover, some don’t.
The FBI field office in Little Rock, along with state agencies around Little Rock and in other parts of the state have come together to develop Chasing the Dragon documentary Arkansas. We have families who have experienced and recovered, families who’ve lost people, and we feel very passionate about how important it is for us to do that. Certainly, it’ starts at home, I have lost a family member myself to drug addiction. We’re trying to educate and help families and people deal with it. We’re better it’s much better now, but it’s hard to keep up with them.
Sometimes that’s why people like you and I are in this field is I’ve lost two sisters and you’ve lost family members and this gives us also that sense of purpose of giving back in our passion and prevention.
For other people. That’s a huge piece of it.
Signs Of Eating Disorders
What are some other signs that you can let the audience know to pick up on these eating disorders?
People think about, you say eating disorders, the first thought is usually anorexia nervosa, which is a desire to be very thin. People see that and say, “That’s an eating disorder.” Changes in appetite, changes in appearance, intolerance of colds, refusal to participate in meals but loves to fix them. There are all kinds of things that you would see in medical problems, gastro problems, and neurology problems in terms of brain dysfunction when the brain shrinks from the absence of nutrition, and cardiac involvement. People think about Karen Carpenter, the singer who died years ago.
For anorexia, those are some of the symptoms. With bulimia, you might see evidence of purging through vomiting or boxes of laxatives. In binge eating disorder, you might see cartons and excess food trays that are gone without explanation. All of these, as well as the other eating disorders, are a sign of difficulty and suffering. Educating people about there’s nothing funny about it. People do make jokes, but I don’t think that people understand sometimes that they are jokingly offending somebody. We try to educate people and help them to understand.
Eating disorders are a sign of difficulty and suffering.
I’d love to ask you what your clinical opinion of gastric bypass and sleeves are. I have done in my practice over the last 30 years probably thousands, literally, of gastric bypass presurgical evaluations, preparing someone. Really evaluating whether they’re appropriate and can follow physician rules and follow a very strict diet and quite frankly not die. Before a physician approves that or before that physician will perform, they should have a presurgical psychological evaluation to determine appropriateness for that.
You mentioned that’s a good stepping stone to have a colleague who will say, “Yes, this is appropriate. No, this isn’t appropriate.” You took it one step further, and a physician and I’ve never seen this with any gastric bypass specialist that I’ve ever worked with here in Texas. You have a colleague in Little Rock who performs a surgery that will actually put their patients on a restricted calorie diet as small as the diet they’ll be eating after the surgery for a period of time prior to surgery to make sure they can follow that diet.
Exactly. Now that is much more common in bariatric centers around the country that they do an assessment because if you’re going to have that surgery, do you have the support? Do you have what you need to be able to be compliant with what’s necessary for the healing? If the doctor says, “I’m going to put you on this diet, come back in six weeks.”
If they have sometimes gained weight, they’re going to say, “Are you eating less? Are you eating exactly what I tell you?” It’s a way to see if this person is compliant or they’re not. Not everybody’s a good candidate for that. When people have tried everything else though, sometimes that’s the best thing they can do, but you want to make sure it’s somebody who can be able to follow because it’s not an easy thing to do.
It is not easy. I’ve seen some great stories and great outcomes in gastric bypass and sleeves, and I have you and I both have seen some just measurable outcomes in that surgery. I just want to say if you’re considering that surgery, visit with a specialist. Visit with a psychological expert who understands and a nutritionist. Prepare yourself and make sure that that’s appropriate because your life is drastically different when it comes to food and vitamins and you’re not even able to process vitamins any longer. Absorb, that’s the word I was looking for.
How is that going to affect you and your family, your work? It has far-reaching consequences. Also, the body image piece of that. Even though you’ve lost the weight, many people say to me, “I still see myself as very large.” They may not be. In fact, some people have had a problem with anorexia. If you have a team, I’m really big on a team approach when I treat people, even in my private practice. We want a medical doctor or psychiatrist and absolutely have to have a dietician who is, in my opinion, eating disorder trained. It’s a team approach to the person, loved ones, and their whole circle.
They’re men in their world. Let’s say it’s a woman. She loses weight, and she looks great, but what they don’t realize, because I’ve had a few friends go through this, is that men start looking at their wives, and these husbands weren’t accustomed to that.
Do you know the last number I remember, and I’m terrible at statistics, so we’re not going to quote numbers today, but it’s about the divorce rate after gastric bypass after a year is well over 50%. It’s around 60%, 70% of people get divorced after that surgery, which is just wild. I have a question. I go to a fitness center and work out. At the fitness center, I don’t care if I go at 6:00 AM, 6:00 PM, 3:00 on a Saturday afternoon, or 2:00 on a Sunday.
There’s a woman there that is about, if I had to guess, she’s probably, she’s very tall. She’s 5 feet 10, 5 feet 11. She is either on the treadmill or on the elliptical going as fast as she can and her spine from the top, bottom of her neck, all the way down, you can see every single notch. Her shoulder blades and her elbows are huge, her knees pop out, her legs are just thin and her arms are just thin. I get so mad at the fitness facility. I don’t know why I’m mad at the fitness facility, but I get pissed off at the reactor.
Do you know why, because here you’ve got somebody who’s clearly ill and something terrible could happen right in front of you? People have heart attacks, they have all kinds of problems.
I literally watch for her when I’m there because if something happens while I’m there, I want to help her. That’s how bad I think it is and I don’t know what to do. What would you suggest?
I’ll tell you what I did when I witnessed that at the place where I work out. I spoke to the manager and then the owner and said, “You need to look at this. This is not just a liability for your company, which to me is not the most important thing but this person is ill and if you are allowing the person to continue to work out here, it does not take a rocket scientist to see that he is not well.”
Do you think it might be a good idea to say, “We need for you to stop exercising and see a doctor? When we have approval, you can come back.” I have witnessed that and I’ve seen it in some of my patients. I have gotten calls from athletic centers about this and I say, “Here’s what you ought to do to save the person’s life because they are caught in the trap of it.” They cannot stop. Remember, the brain stops functioning when you’re overloading your body or underfeeding you. Either way, it doesn’t function properly.
A person’s brain stops functioning properly when they are overloading or underfeeding.
That’s right, yep. I agree, I’m going to say something to the fitness center, the manager.
You should, you could be saving her life. I was going to ask her, I heard something about this nickname you have, Tink. Do you want to tell us that story?
Yes, I’ll tell the story. Tinkerbell. I’m called the Tinkster. You can thank Heather Hayes for that.
That’s cute.
A number of years ago, several of my colleagues, Heather, and a few other people, we participated in what’s called Shatterproof Challenge. That is an event where people repel down bank buildings to, one, wipe out the stigma of addiction and provide funds to educate children about the dangers of drugs and addiction. We were prepared and had ourselves already and we were going to high-five all the way down this 24-story building. As we got prepared and they put us in the harnesses, every question they asked me I would answer and my voice got higher and higher because I was scared to death.
When they said, “Sit back, I wasn’t going to wait for Heather or anybody else.” She’s over there asking, “Is this thing going to hold me? Are you sure you’ve got this plugged in?” They looked at me and did the thumbs up and I flew down. I didn’t wait for anything. They said, “There she goes, Tinkerbell.” From then on, I’m the Tinkster. I flew down there. I was on floor eleven and Heather hadn’t even taken off yet.
Maybe you missed your calling as a SWAT team or something like that. You could have.
I am interested in it. I am very interested. The only thing I did miss was they were giving instructions that you were supposed to look up and look into the window at the eleventh floor, but they were changing out my harness because they took your picture. I looked like I was texting going down when I was really concentrating on the break. That’s the thinkster, that’s me.
I told you earlier that really what she was doing is in her mind she was pretending she was doing an intervention scaling down a wall and she was going to slide into a window and save someone.
That’s funny.
Advice For Families And Friends
Let’s wrap up on what advice you have for families and friends, loved ones reading to this that think maybe they have a friend or a loved one with an eating disorder.
The first thing I would say is if you see something, say something. There are many organizations, IDEP, NEDA, and the Academy of Eating Disorders that have websites where you can ask questions, learn, take some quizzes, and get educated about how to best approach, and then certainly consult someone who has experience in treating this to see how do we approach our loved one, what can we do. Those of us who do this are, I am always open. People can call me anytime to ask me, “Does this seem like a real eating disorder? What do I need to do?”
Educate yourself. You can do so in a free venue via websites. Learn about it. Get some advice from a professional who knows this, and who can guide you to get in with the medical community, Begin to look at what level of care if you need outpatient counseling all the way up through inpatient and intensive care. There is help out there. When I hear people say, “I guess I’m stuck with this for the rest of my life.” My blood just boils. Yes, are there some people who don’t recover? Yes, but there are many people who do and you would never have known it. Act early, don’t keep the secret. Ask for help. You can call me anytime.
How do people call you?
You call my phone number, which is 501-258-5393. Although I’m sure you cannot tell it by my accent, I am in Arkansas.
She works all over the United States, really internationally, but mostly the United States. Do you have a website?
I do not.
I love it. That’s fantastic.
How about your email? If they want to email you? [email protected].
That’s Agar. I love it that you were here and that you took time out of your busy schedule to come spend time and you came to J. Flowers Health Institute. We got to go to dinner last night and spend some time together. Thank you. I cannot wait to see you for Caitlin’s wedding in Austin.
Three weeks. Thank you so much.
Great to meet you in person finally. Dr. Flowers, if they want to reach you, how do they do that?
Go to our website, JFlowersHealth.com and there’s a Contact Us button right there. Thanks, everybody.
We’ll see you next week. Bye.
