Archive for August, 2010

Utilizing Transference & Countertransference to Deepen the Treatment of Eating Disorders, with Kathryn Zerbe, M.D.

Following an incredibly positive response to her April 2009 presentation on integrated treatment for eating disorders, we are thrilled to welcome Kathryn Zerbe, M.D. back to Baltimore for our 2010 annual professional symposium.  Dr. Zerbe will present, along with 5 other distinguished experts, at Eating Disorders: State of the Art Treatment on Saturday September 25th, 2010.  Her much anticipated  presentation will focus on psychodynamic approaches and the use of transference and countertransference to enhance clinical practice in the treatment of individuals with eating disorders.

Kathryn Zerbe, M.D. is a Professor of Psychiatry and Obstetrics & Gynecology at Oregon Health & Science University.  She also serves as the Director of the Oregon Psychoanalytic Institute and has authored over 60 clinical papers and four books including, Integrated Treatment for Eating Disorders: Beyond the Body Betrayed.  Dr. Zerbe is a Distinguished Fellow of the American Psychiatric Association and a Fellow of the Academy of Eating Disorders. She has been repeatedly selected as one of “America’s Top Doctors” and is a highly sought after speaker both in the united states and internationally.

Find out more about Dr. Zerbe’s work and her upcoming presentation in Baltimore by reading her insightful and thought provoking responses to our questions below.  And don’t miss your chance to attend all six expert presentations on September 25th, 2010. (This event has been approved for 7 CME/CEUs). REGISTER soon!  Space is limited. 

Q & A with Kathryn Zerbe, M.D.

The title of your upcoming talk in Baltimore is “Resiliency, Vulnerability and Growth: Utilizing Transference and Countertransference Reactions to deepen the Treatment of Eating Disorders”.  What specific role does vulnerability play in this process?

KZ: Bewilderment, boundaries, and burnout — these are just a few of the concerns that clinicians are liable to struggle with when treating patients with an eating disorder.  Recognizing that in our quest to be helpful to our patients, we also face a potential undertow because the work to preserve life is taxing in the short run and often takes a commitment of time, energy, and sacrifice in the long run.  Clinicians ‘in the trenches’ know these facts, but what do we do to help ourselves to deal with the hurt feelings that arise when tenacious negative transferences arise, or when we are in a seemingly unwinnable battle with 3rd parties, or experience powerlessness when the patient refutes our counsel?  Awareness to these vulnerabilities, and others, are the first line of defense in staying attuned, steadfast, and nimble in robust clinical practice.

What would you say is the biggest barrier clinicians may face in trying to implement improved strategies for utilizing transference and countertransference in the clinical setting?

KZ: “To know thyself’ and “To be true to thyself’ have been laudable goals since the time of Socrates and Shakespeare, respectively, but such ideals are easier to write about in the abstract than to achieve in real time.  With the daily challenge of managing a lively practice and tending to one’s busy personal life, it is easy to put one’s own needs on the back burner.  Taking a small amount of time weekly to think about the impact of clients is enormously helpful.  In this way, one works on the feelings and clinical formulation one has about each specific person in practice but is simultaneously humbled by what each person teaches us by sharing their unique history and viewpoints.

 

What are the potential consequences of ignoring or ineffectively addressing transference and countertransference issues in the therapeutic process?

KZ: Like most clinicians, I feel extraordinarily blessed to be working in this field where one has the opportunity to witness individuals grow and change over time.  However, burnout is a formidable foe to contend with because change is often difficult, slow, and painful for the patient.  Sensitive clinicians pick up on, or in technical parlance, “contain,” these feelings.  To avoid burnout and to keep the work fresh, invigorating, and growth promoting, the therapist  who ‘knows himself or herself’ best is in a better position to assist the patient, and this is a ‘work in progress’  that is never done until one retires from practice altogether.

In your upcoming presentation, you will discuss strategies for managing “cultural countertransference”. Can you briefly define this term in the context of treating individuals with eating disorders?

KZ: Therapists as well as patients are prone to having conscious and unconscious reactions to media stereotypes, idealized body images, and culture norms as a whole.  We clinicians are in a better position to help our patients by becoming more aware of these potential ‘blind spots’ to  the  prevailing cultural  in ourselves and thinking them through.  Recovery can be enhanced by a timely discussion and critique of noxious cultural norms in therapy.  Both patient and clinician can make use of reading, media, movies, self-scrutiny, and ongoing dialogues with peers or consultants to become more cognizant of our largely unconscious idealization and overvaluation of beauty.   However, as Dr. Catherine Steiner Adair of Harvard University pointed out when she defined the term ‘cultural countertransference,’ in the early 1990s, we must also be wary that too much focus on the culture can be a defense to deepening the patient’s treatment.

Overall, what do you hope symposium attendees will take away from your presentation at The Center for Eating Disorders on September 25th?

KZ: If participants emerge from my talk (which will use art history slides to demonstrate concepts and to provide encouragement for each therapist to bring his/her unique creativity and tenacity to the therapy hour) with permission to ‘take care of yourself’ as you take care of the patient, I will be very happy, indeed.  Perhaps there will be an idea or two that will be new to the ear, but more likely the listener will simply take more seriously the need for ‘time outs’ and the pragmatic and psychodynamic reasons that undergird that need and recommendation.  One of my heroines, Eleanor Roosevelt, said “Do something that is scary everyday!”  I keep that saying on my desk as a reminder that our daily work as clinicians presents us with mysteries and a summons for personal growth that we can’t predict when we get to the office in the morning.  The more tools that we have in our therapeutic hip pocket, the better!  So, I’m looking forward to gaining wisdom from the other speakers who come first and hearing the comments and questions from the audience to, very selfishly, enhance my individual practice!

Our enduring thanks to Dr. Zerbe for taking time out of a busy schedule to provide such thorough answers. Be sure to join us on September 25th for what is sure to be an engaging and enlightening presentation.  Download the Eating Disorders: State of the Art Treatment PROGRAM BROCHURE (pdf) for registration details and deadlines.

If you’d like to order or find out more about Dr. Zerbe’s publications, please click on the links below.  These titles will also be available for purchase at the upcoming symposium.

Published by Kate Clemmer
August 20th, 2010 in CED Events, Editor's Picks, Enhancing Clinical Practice, In the News, Professional Education, Q & A, Therapies, Treatment Providers
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Q & A with Harriet Brown: Part III

In exactly one week, Harriet Brown will visit The Center for Eating Disorders at Sheppard Pratt in Baltimore to speak about her new book, Brave Girl Eating: A Family’s Struggle With Anorexia. Below is the third of her 3-part blog series with us, in which Harriet discusses some of the most important things she’s learned as a parent of an adolescent with an eating disorder.  She also extends a hopeful call to all of the individuals, families and professionals who could benefit from reading her book and attending her presentation on August 25th.

After finding out about her family’s introduction to anorexia nervosa in Part I and delving into the labor of her daughter’s struggle and recovery in Part II, we asked Harriet to reflect on the lessons she has learned that would be helpful to share with other parents and families.  Her very honest and informative answers are below.  If you’d like to hear more from Harriet and have a chance to ask her your own questions, please join us on August 25th from 7:00-9:00pm at The Conference Center at Sheppard Pratt.  Visit our Events Page for more details about this free community event and see more about Harriet and her new book on her website, www.harrietbrown.com.


Q & A with Harriet Brown: Part III

What would you tell other parents who are in a similar situation and looking for support and hope?

HB: I’d tell them four things:

• Full recovery is possible. Many professionals will tell you that once you have an eating disorder, you’ll always have it. That it’s like alcoholism, something you can learn to manage, something you’ll “be in recovery from” for the rest of your life. The evidence suggests that especially for adolescents who are sick for less than three years, full recovery is absolutely possible. Don’t settle for anything less.

• You have more power than you realize. I get emails and phone calls from many parents who say that FBT [Family-Based Treatment] would never work for their family because their child is too stubborn, too entrenched, too defiant, too fill-in-the-blank. FBT doesn’t work for every family, it’s true. But the studies done on it so far show that it works in about 90% of families. That’s the vast majority. I think families often count themselves out, in a way; they think they can’t do it, and then they can’t. The most important piece of helping a child recover using FBT is believing that it will work. Because it usually does.

• Faster is better. Studies show that time is of the essence; the less time a child or teen spends being acutely ill, the better her chance for full recovery. There’s absolutely nothing to be gained by waiting and seeing. You’d never hear an oncologist suggest that a Stage 1 tumor be “watched” rather than treated, yet people say that about eating disorders all the time. Once someone has been acutely ill for 5 or 15 years, her chance of full recovery is greatly diminished. At some point people become chronically ill, and no treatments help. It’s crucial to turn the eating disorder around before that happens.

• You don’t have to do this alone. In fact, you shouldn’t—it’s way too hard and stressful. When we went through this, there were very few therapists trained in FBT. There still aren’t enough, but thanks to Drs. Daniel le Grange and James Lock, who started a training institute to certify FBT providers, the numbers are growing. We also relied on the help of friends and neighbors. Many families don’t want to tell anyone what they’re going through; they feel ashamed, responsible, embarrassed. But secrecy and isolation make recovery that much harder. So look for support. Several other moms and I started a website of resources for parents, Maudsley Parents (www.maudsleyparents.org), which offers information on treatment, recipes, stories about how other families have managed, and links to a lot of useful information.

Who could benefit from reading your book, Brave Girl Eating and attending your presentation in Baltimore on August 25th?

HB: First and foremost, families who have a child with an eating disorder. Our story is about anorexia, but FBT has been very successful with bulimia as well. Second, friends and relatives of those families, because if they really understand the nature of the illness and what families have to go through to make it, they will have a better sense of how to support and nurture those families. Third, professionals who diagnose and treat eating disorders—pediatricians, psychologists, psychiatrists, nutritionists, social workers, dietitians. Many of them have still never heard of FBT. I would love for them to become aware of FBT and be able to refer families to it and, maybe, to get trained in doing it themselves. Fourth, sports coaches and dance teachers, especially in the activities where eating disorders abound: ballet, figure skating, gymnastics, track, cross-country, cycling, as well as wrestling and ski jumping. I recently read a tragic story about a 16-year-old track star who died from anorexia while training. Her high school coach was quoted in the article as saying that in his 30 years of coaching he’d never encountered an athlete with anorexia before. I wanted to say, Really? Even those who are perfectly aware of eating disorders don’t know much about them and don’t know how to support and help their athletes.

Finally, I hope the general public will read this book, too. The more people who truly understand the essential nature of eating disorders, the more our dialogue around EDs will evolve. The more awareness, the faster people can get help, and the fewer people who will become chronically ill.

Many thanks to Harriet Brown for answering our questions and providing hope to other families struggling with an eating disorder.  We look forward to her arrival in Baltimore on August 25th and hope to see many of our readers at the event as well!

Join CED on Facebook to receive formal invitations to this and other free community events throughout the year. If you have any questions about our program or general questions about treatment for eating disorders, please call one of our admissions counselors at (410) 938-5252 or email us at EatingDisorderInfo@sheppardpratt.org.


Published by Kate Clemmer
August 18th, 2010 in Celebrity Topical News
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Baby Steps in the Wrong Direction? Increased Anxiety About Weight in the Very Young Child

Have we as a country gone too far in conjuring up a fear of fat?  Most eating disorder specialists and body image advocates would say we hit that milestone long ago – the proof being in our country’s continued and desperate reliance on dieting despite its 95-98% failure rate.  However, recent research seems to suggest a new low – one that we are concerned may spike unnecessary anxiety in new parents and could further distort our country’s relationship with food and eating, beginning with our youngest and most fragile generations.  That being said, we felt it was important to address this topic within our Nurture blog series.

This relatively new research, out of Eastern Virginia Medical School, proposes that a progression toward obesity begins as early as three months old.  Researchers have referred to their findings as a “tipping point”, suggesting we further scrutinize weight during the earliest months of life.  The study’s online abstract states, “that the critical period for preventing childhood obesity in this subset of identified patients is during the first 2 years of life and for many by 3 months of age.”

This raises a lot of serious concerns about how we might be encouraged to interpret these results.  Should worried parents or concerned childcare providers cut down on or restrict breast milk and formula out of fear for an infant’s future weight category?  Will parents of healthy, naturally larger babies be inclined to panic during weigh-ins at the pediatrician’s office or be made to feel they need to enforce low calorie diets to help their baby or toddler lose weight?  Not only do these things not work to prevent children from becoming overweight, they are also incredibly dangerous and can disturb a young body’s natural hunger and fullness cues, setting the groundwork for a harmful relationship with food later in life. The same disruption can happen when infants or children are persuaded to eat when not hungry or made to eat significantly past the point of fullness.  Ellyn Satter, a family therapist, registered dietitian and internationally recognized authority on eating and feeding speaks to this process on her website, stating,

“Children who eat and grow at the extremes make their parents so nervous that they often interfere. It backfires. In our weight-obsessed culture, parents may try to restrict a robust child with a hearty appetite because they assume that enjoying food and eating a lot means she will get fat. It doesn’t, and it doesn’t work. Children who don’t get enough to eat—or fear they won’t—become preoccupied with food and tend to overeat when they get a chance…

…Pressure on children’s eating always backfires. Trying to get a child to eat more than she wants makes her eat less. Trying to get her to eat less than she wants makes her eat more.”

Understanding the paradoxical outcome of restricting early feedings leads us to question the messages sent by this research study as well as those introduced by most childhood obesity prevention campaigns today.  As a country, we should pause and ask ourselves if increasing anxiety about infant and childhood weight might be hurting more than it is helping?  Promoting an even earlier vigilance and stigma around weight and bodies seems only to be muddying the water further, adding to the very “problem” that studies such as this one seem to be trying to address.

Negative messages about food and weight passed from our culture to our infants and children can lead to strained feeding and food relationships, a diet mentality, low self-esteem and negative body image.  All of these things are also risk factors for the development of disordered eating and eating disorders, including anorexia, bulimia and binge eating disorder which is the most prevalent and is often associated with obesity.  For most adults concerned about a child’s weight or well being, the obvious next question would be, “well than what am I supposed to do?”

Consider moving away from a hyper-focus on weight, body type, BMI or any other calculator of weight. Like most efforts involved in parenting, it’s not an easy task to accomplish particularly when it seems like every newspaper article, concerned relative, or public service campaign is telling you to do the opposite.  Do your best to focus instead on your child’s overall health (remembering that weight does not = health).  Honor and accept your child’s natural body size and shape.  Create positive goals around eating that involve paying attention to your baby’s or child’s internal hunger and fullness cues instead of relying on external messages about how much is “too much”.  Positive goals might also include taking steps to decrease the stress related to feeding a family by learning about and adopting Satter’s Division of Responsibility (DOR) in feeding which can be utilized from the earliest stages of infancy throughout adolescence. As  stated on EllynSatter.com, our goals as parents and as a culture with regards to feeding should be to:

“emphasize competency rather than deficiency: providing rather than depriving: and trust rather than control.” *

We would add that providing education rather than stigma; positive goals rather than “tipping points”: and fostering tools rather than anxiety will go a long way in helping to nurture a culture that cares more about health and less about size.

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*Quotes are copyright © 2010 by Ellyn Satter. Published at www.EllynSatter.com. For more about raising children who eat as much as they need and get bodies that are right for them (and for research backing up this advice), see Ellyn Satter’s Your Child’s Weight: Helping Without Harming, Kelcy Press, 2005. Also see www.EllynSatter.com/shopping to purchase books and to review other resources.

photo courtesy of  pediatrics.about.com

Published by Kate Clemmer
August 13th, 2010 in Body Image, Editor's Picks, In the News, Nurture. Blog Series, Nutrition
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Q & A with Harriet Brown: Part II

On Monday we began a 3-part blog series featuring Harriet Brown, author of the upcoming book, Brave Girl Eating: One Family’s Struggle With Anorexia.   If you missed it, you can go back and read Part I in which Harriet shared about her family’s initial discovery of her daughter’s anorexia and where their journey to recovery began. Today in Part II, we resume our conversation with her about that journey to help her daughter recover, how it affected their family, and what she has learned from it.

Harriet Brown will be speaking at a free community event in Towson, MD on August 25, 2010 – click here for details.

Q & A with Harriet Brown: Part II

You describe your daughter’s recovery as a “slow, painful, infinitely courageous climb back up to health and hope.”  Can you share some of the most important steps your family took along this difficult journey?

HB: The most important step in the journey came when we decided to use family-based treatment and, essentially, empowered ourselves to help her recover. Until then we’d been more or less sidelined; we felt helpless and we didn’t know what to do. We wanted the doctors to tell us what to do and how to cure our daughter. It quickly became apparent that they weren’t going to do that, that they didn’t seem to know much more than we did in certain ways.

When we took on the FBT, we took on both the responsibility and the power to intervene. That was a tremendously liberating step. The worst part of my daughter’s illness for me was standing by helplessly, watching her suffer and starve. The notion that my husband and I could help her required a huge mental paradigm shift—but once we made it, we were much more effective.

Externalizing the disease makes it easier to stay calm, not engage with the eating disorder, and not get angry at what often feels like oppositionality. It helps you understand, as a parent, that your child is essentially being held hostage by an illness, not acting out or being stubborn. It’s very, very helpful.

Another important step was learning to externalize the disease. Anorexia is insidious; it speaks with your child’s voice and looks out of her eyes. It’s natural to think that it’s your child refusing to eat, resisting, raging, or whatever the behaviors are. We made a conscious effort to think of the illness as something separate from our daughter, and that let us see the glimpses of the real her under the savage face of the disease. I characterize the disease as the demon in the book—it’s not that I thought she was literally satanically possessed. Rather it was my metaphor for the way the illness took over her thinking and behavior.

As parents, how did you and your husband manage to take care of yourselves and other aspects of the family while putting the necessary time and energy into supporting your daughter’s recovery?

HB: Well, I don’t think we managed this very well! We made our daughter’s recovery our top priority in the family for many many months. We more or less gave up having a social life, because most social events revolve around eating, and it was a long time before we could eat in public comfortably. We cared for our younger daughter, which mostly consisted of getting her out of the house sometimes so she didn’t have to deal with all the chaos and noise and angst. I went to work sometimes and worked at home sometimes, thanks to a very supportive boss; my husband is a freelancer, so he was home a lot. Other than that we did very little that wasn’t related to re-feeding and recovery. We became very single-minded. And honestly, I think that’s what we needed to do. When you’re engaged in such a full-on onslaught, such an encompassing, overwhelming effort, you have to focus on that as much as possible. In fact that’s advice I would offer families: Don’t think you have to keep up a normal social life during this time. Take care of recovery first, and if you want to fit in other things and they nurture you, great. But don’t feel like you have to. Most families find this process pretty absorbing.

What is the most important thing you learned in the process of parenting and caring for someone with an eating disorder?

HB: I learned the power of love. I know that sounds corny, but the truth is that no one loves your child the way you do. And no one, therefore, has the power you do, the utter commitment, the doggedness, the resilience, to see her through the hell of an eating disorder. And you need every ounce of those qualities as a parent, because this is the most grueling experience your family will likely go through.

We would like to express continued thanks to Harriet Brown for taking the time to address these questions and share her insight and experience with our readers.  Be sure to check back for the third and final Q & A post with Harriet next week.

Interested in hearing from Harriet in-person and getting a signed copy of her book? Download the EVENT FLYER for her August 25th presentation at The Center for Eating Disorders at Sheppard Pratt and find driving directions on our Events page.

Published by Kate Clemmer
August 12th, 2010 in CED Events, Celebrity Topical News, In the News, Recovery, Therapies
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“Brave Girl Eating” – Q & A with Harriet Brown, Part I

On August 25th, 2010, The Center for Eating Disorders will welcome Harriet Brown – journalist, professor and parent of a child who almost died from an eating disorder.  Harriet Brown will be traveling to Baltimore to speak about her oldest daughter, Kitty’s difficult struggle with anorexia and  how their family used love, persistence and Family-Based Treatment (FBT) to help her recover.  In anticipation of her presentation and the upcoming release of her new book (left), we asked Harriet to share a little bit about her family’s experience in this three-part blog series. Her strikingly honest and insightful responses are sure to resonate with and empower countless other families who’ve been impacted by an eating disorder.

Harriet Brown’s presentation on Aug. 25th at The Center for Eating Disorders is FREE and open to the public. More information is available on our Events Page.


Q & A with Harriet Brown: Part I

Before your family went through this very personal experience with anorexia nervosa, what knowledge did you have of eating disorders and the treatment process?

HB: Probably about what most people know, which is basically nothing. I bought into all the usual myths: Anorexia affected white girls from rich families. Anorexia was a bid for attention, a way to act out in a dysfunctional family. I had no idea what I thought about treatment—I probably never gave it a thought, honestly.

When and how did you first become aware that your daughter was struggling with an eating disorder?  What were your initial reactions?

HB: We’d been aware of the possibility for a while—Kitty was a gymnast, and she’d always been on the thin side. I’d even asked her pediatrician about six months before she was diagnosed whether Kitty was maybe too thin; she’d grown half an inch and not gained any weight in a year, at age 13. The pediatrician reassured us, which in retrospect was a mistake; all adolescents need to be growing and gaining weight, and failure to gain can be as much a symptom as losing weight.

My husband and I first noticed an uptick in anxiety, but no weight loss. That’s why I was confused—I thought there had to be sudden dramatic weight loss. Kitty developed some obsessive tendencies around food and other areas, and her anxiety bloomed to the point of interfering with daily life. By now my husband and I were very alarmed. Around then Kitty lost a few pounds—4 or 5—and suddenly we put 2 and 2 together and realized we were dealing with anorexia.

Our first reaction was to push her to eat. That’s when we began to understand what we were dealing with. The harder we pushed her to eat, the more she resisted, and that was not like Kitty. By the time she was formally diagnosed, three weeks later, we were in a state of utter shock and panic. That sense of panic persisted for several months as we tried and failed to get her to eat, as her physical condition deteriorated; she landed in the hospital for dehydration and bradycardia at one point. That hospitalization was a turning point for all of us. We’d been trying to get her to eat, and failing; she was insisting she wasn’t hungry, she’d already eaten, her stomach hurt, all the excuses an individual with an eating disorder offers up. And part of us believed her, because we’d always been able to believe her. I think I was in denial. I know I was, actually. There was a moment, in the hospital, when after 4 hours of re-hydration, her heart rate still didn’t come up. The doc transferred her to the peds ICU. I remember distinctly running alongside the bed and arguing with the doctor about why she didn’t need to be in the ICU. I look back on that moment with horror, because it shows how much in denial I was that this was a life-threatening illness. No parent really wants to think that. And in retrospect I think all families pass through a stage of denial like this, and the best thing you can do is hurry them through it so they can get to the hard work of helping their child recover.

We flailed around unsuccessfully from June to August, when we stumbled on the notion of family-based treatment and decided immediately to try it. That’s when we started to make progress.

…to be continued.

Check back to read more of Harriet’s incredibly poignant account of her daughter’s illness and recovery.  In part II, Harriet talks about the most important thing she learned in the process of parenting a child with anorexia and the critical steps her family took along the way.

If you’d like to comment on this blog, or you want to receive updates when Parts II and III of this blog are posted, please join in the discussion and become a fan of CED’s Facebook page.

You can learn more about Harriet Brown and the upcoming release of her book, Brave Girl Eating: A Family’s Struggle With Anorexia, by visiting her website, www.harrietbrown.com.


Published by Kate Clemmer
August 9th, 2010 in CED Events, Celebrity Topical News, Editor's Picks, In the News, Nutrition, Recovery
0 Comments