The Center for Eating Disorders Blog

Seeing From a Different Angle: Improved Outcomes for Individuals with Treatment Resistant Eating Disorders, with Lucy Serpell, PhD, DClinPsy

Now less than two weeks away, CED’s annual symposium is attracting health and mental health professionals from across the country, but it seems no one has further to travel than our opening speaker, Dr. Lucy Serpell who will make the trip to Baltimore from her home base in London. Dr. Serpell will present one of six expert presentations at the September 25th professional education event, Eating Disorders: State of the Art Treatment. Her presentation, entitled “Seeing from a Different Angle: Shifting Clinical Perspectives & Expanding Skill Sets to Improve Outcomes for Individuals with Treatment Resistant Eating Disorders”, will address some of the most notable clinical challenges for those working in the field of eating disorder treatment. Visit our Events Page to register for the symposium, and read on to find out more about Dr. Serpell and her upcoming presentation.

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.

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