The Collaborative Care Workshops are designed to help provide education and support for the friends and family members who are most central to the patient’s recovery process.

Building from the strengths of the family based model, Janet Treasure and her colleagues have developed a series of workshops for caregivers of loved ones who have been diagnosed with eating disorders as a way of meeting the needs of the carers.  The workshops are designed to educate carers on the key skills that clinicians have in treating eating disorders so that there is more continuity in care between the treatment setting and at home. The workshops are designed to address the most universal needs of the carers: connection with other carers; support; and skills training. Sessions reflect an adult learning modality in which skills are taught and then there is ample time for participants to practice these skills experientially. Key skills taught include motivational interviewing, communication, the trans-theoretical model of change, self-care and behavior analysis. Research suggests that participation in these workshops, leads to benefits for both the carers and the patient. (Treasure, Sepulveda, Whitaker, Todd and Lopez).

 ~ Outpatient Collaborative Care Workshops at CED ~

The 6-week Collaborative Care workshop series will be offered to parents, significant others and primary caregivers of individuals who are stepping down from our higher levels of care (inpatient or partial hospital programs).  Typically, participation in the workshop series will begin the week following a loved one’s discharge from the eating disorder unit.  Participation in the program will provide caregivers with the following resources, skills and opportunities:

1. Provide basic eating disorder education, including current research findings about treatment recommendations, course of illness and treatment, prognosis, and basic understanding of how eating disorders are maintained.
2. Define and recognize symptom substitution behaviors and strategies for managing these should they arise.
3. Analyze carer needs and learning to implement self-care strategies, including mindfulness techniques.
4. Learn effective communication skills to improve communication with their loved one who has an eating disorder.
5. Recognize caregiver styles and learning to maximize strengths while working towards the most effective caregiver style.
6. Define the different stages of change in the trans-theoretical model of change and understand how these stages can impact a loved one’s motivation throughout the treatment process. 
7. Learn how to help increase their loved one’s motivation towards recovery.
8. Improve emotional intelligence by learning basic emotion regulation skills.
9. Learn the basic theoretical model of cognitive behavioral therapy, as well as basic CBT techniques.
10. Learn how to analyze how caregiver behaviors may inadvertently contribute to the maintenance of eating disorder behaviors in the family context.

Additionally, caregivers will learn about the interventions most commonly used by the Center for Eating Disorders.  Providing carers with education on the basic theoretical underpinnings of cognitive behavioral therapy and dialectical behavioral therapy will ensure that carers understand the skills that their loved ones have been taught in treatment. This will allow carers to be more fully able to support their loved one in attempts to challenge and/or block eating disorder cognitions and behaviors when they are at home. For more information about this program please email the Collaborative Care group facilitator, jmoran@sheppardpratt.org.

The Center for Eating Disorders has also added a 4-weekend Collaborative Care workshop series exclusively for family members  of current CED inpatients and partial hospital patients.  Please call us at (410) 938-5252 for more information.

Visit our website: www.eatingdisorder.org

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 References & Additional Resources:

Lock, J; Couturier, J; and Agras, W.S. (2006)Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy. Journal of American Academy of Child and Adolescent Psychiatry, 45(6), 66-72.

Lock, J.; Le Grange, D.; Agras, W.S. and Dare, C. (2001) Treatment Manual for Anorexia Nervosa: A Family Based Approach. New York: Guilford.

Silverman, J. Anorexia Nervosa: Historical Perspective on Treament (1997). In D.M. Garner & P.E. Garfinkel (Eds), Handbook of treatment for eating disorders, 2^nd edition(pp 3-10) New York: Guilford Press.

Treasure, J., Schmidt, U. & Macdonald, P. (Eds). (2010) The Clinician’s Guide to Collaborative Caring in Eating Disorders: The New Maudsley Method. New York: Routledge.

Treasure, J., Sepulveda, A., Whitaker, W., Todd, G. & Lopez, C. (2010) Family and Carer workshops. In Treasure, J., Schmidt, U. & Macdonald, P. (Eds). (2010) The Clinician’s Guide to Collaborative Caring in Eating Disorders: The New Maudsley Method.(pp167-173) New York: Routledge.

Treasure, J.; Smith, G.; and Crane. A. (2007) Skills-based learning for caring for a loved one with an eating disorder: The new Maudsley method. New York: Routledge.

Lucy Serpell, PhD, DClinPsy is a Clinical Psychologist at North East London NHS Foundation Trust and is a Lecturer for University College London. She has over fifteen years of research and clinical experience working with individuals who have eating disorders. Dr. Serpell is particularly knowledgeable about the roles of cognition, motivation and personality as they relate to the perseveration of eating disorders and she is passionate about developing research that contributes to advancements in treatment. She has published and presented her work internationally and is uniquely qualified to speak on the topic of innovative therapies for individuals with complex and treatment resistant eating disorders.

When asked about her upcoming presentation, Dr. Serpell provided some very informative and professionally stimulating responses which we were excited to share here on our blog.

Q & A with Lucy Serpell, PhD, DClinPsy:

When we surveyed a community of eating disorder treatment professionals, the number one most requested area for additional training was the topic of improving strategies and outcomes for individuals with chronic, complex or treatment resistant eating disorders. Can you offer insight into why this topic is in such high demand for clinicians in our field?

LS: Eating disorders differ from many other mental health problems in that people often have a strong attachment to the disorder. This makes it hard for them to accept and benefit from treatment. We know from our research that there are a number of ways in which the eating disorders can be functional for an individual. These may include helping them to manage the chaos of life, helping them deal with difficult emotions or enabling them to avoid difficult situations or demands. Working with our patients to understand how the eating disorder is maintained and why change is so difficult can build engagement and help people inch slowly towards a decision to recover.

How would you characterize treatment resistance as it pertains to eating disorders?

LS: Resistance is often seen as a fixed characteristic residing in the patient. I prefer to characterize resistance as something which ebbs and flows and which is created out of the interaction between clinician and patient. Even the most resistant individual may at times feel differently. It is our job as clinicians to nurture and grow this spark, at the same time as validating how difficult it feels to give up something so highly valued. In addition to the valued nature of the eating disorder, we are discovering more about neuropsychological factors which are likely to contribute towards resistance. Again I’ll talk more about these in my presentation.

What are some common reasons behind treatment resistance in this population? Why is it important to determine what drives the resistance for each individual?

LS: We have developed both qualitative and quantitative methods for exploring the specific pros and cons of the eating disorder for each individual. It is essential that the therapist and patient have a clear idea of these pros and cons so that treatment can be effectively tailored to the individual. For example, if a major advantage of the eating disorder is that it helps someone manage difficult emotions, then alternative strategies for emotion regulation needs to form a central part of therapy.

Part of your presentation will include strategies for adapting standard Cognitive Behavior Therapy (CBT) in treatment for individuals with severe anorexia. What are the main reasons why such adaptation is necessary for this patient population?

LS: I’m a great believer in evidence based strategies. The work of Fairburn and others has shown that there is a role for CBT in the treatment of anorexia nervosa as well as other eating disorders. However, I’m aware that many individuals with AN don’t enter CBT treatment for some of the reasons I’ve described above. Many also baulk at the idea that weight gain is an essential component of therapy. I’m keen to think about ways to adapt CBT in such cases so that more of these very chronic and severe patients can also benefit.

After hearing your presentation on September 25, 2010, what are some general themes that you hope attendees will take with them into their own practice?

LS: Primarily, I hope that they increase their understanding of the complex and multifaceted nature of resistance and develop key skills for working in this area. They will learn that resistance is more than a list of pros and cons and that it may be composed of both ‘illness’ and ‘choice’ components. I hope that this will help attendees to avoid hopelessness, frustration and burnout when working with these challenging patients and that their improved engagement will lead to fewer patients being labeled as ‘hopeless cases’. Many of these individuals can and do recover even after many years of illness.

Many thanks to Dr. Serpell for lending her time and unique clinical expertise to this Q &A discussion. We are very much looking forward to the full presentation on September 25th, 2010. If you would like to attend Eating Disorders: State of the Art Treatment but have not yet registered, please be aware that discounted registration expires on September 17th, 2010! You can download the full Program Brochure (pdf) for event details, and complete your registration online.

You might also be interested in reading these additional Q&A blogs featuring some of our other upcoming symposium speakers…

Updates & Evidence-Based Nutrition Guidelines in the Treatment of Eating Disorders, with Marcia Herrin, EdD, MPH, RD, LD

Cognitive Process and Remediation in Anorexia Nervosa, with James Lock, MD, PhD

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

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 3^rd 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 25^th?

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.

• Integrated Treatment for Eating Disorders: Beyond the Body Betrayed (2008)
• The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment (1993)