Body Image & ACT: Q&A with Author and Psychologist Emily Sandoz, PhD


The collective response to negative body image often includes an attempt to convince people to love their bodies, to embrace every imperfection and to do away with all negative thoughts.  These can be difficult, if not impossible, tasks for most people, particularly amidst the backdrop of a culture that encourages body bashing and a very narrow ideal of “beauty”.  For many individuals, negative thoughts about their bodies are so deeply entrenched that it feels too big of a leap to move from hating their bodies to falling madly in love with them. So if you’re not ready to love your body, what’s left to do?  Emily Sandoz, PhD, along with co-author Troy DuFrene, propose a different path in their new book, Living With Your Body & Other Things You Hate: How to Let Go of Your Struggle with Body Image Using Acceptance & Commitment Therapy. 

In anticipation of our upcoming Fall Community Event, we conversed remotely with Dr. Sandoz to find out more about her work with body image, Acceptance & Commitment Therapy (ACT), and of course, the soon-to-be-released book.  Read on to learn more about ACT and don’t forget to RSVP for Dr. Sandoz’s free presentation in Baltimore on November 17th, 2013, or download the event invitation (pdf).

 

Q & A with Emily Sandoz, PhD

Q: What was your  motivation for writing Living With Your Body & Other Things You Hate: How to Let Go of Your Struggle with Body Image Using Acceptance & Commitment Therapy (due out Jan. 2013)?

ES: Well, a couple of things. First, I find myself more and more aware of how body conscious we are.  At a very early age, people begin evaluating themselves in terms of their body’s appearance or functioning. For many, this can become a primary means of self-evaluation, becoming more of a focus than other things that person really values or strives for.  Further, I think the general public receives mixed messages about what they are supposed to do with those evaluations.  Are they wrong evaluations? Should they always evaluate themselves positively, always love the body? Should they change their bodies? Is it our responsibility to look good, to be strong and physically capable?  This book suggests that all that struggle to manage our thoughts and feelings about our bodies, or even manage our bodies themselves, can just lead to more and more struggle. We suggest that healthy body image is about body image flexibility – being able to receive our experiences of our bodies, good and bad, and to relate to ourselves and the world meaningfully, regardless of those body experiences.

Q: Many people engage in deep and serious battles with body image on a daily basis.   What are the possible repercussions of going through life hating your body? 

ES:It stands in the way of other things that are more important. You can’t help being critical of the way your body is.  That’s what minds do – they are critical.  They have to be!  But hating is getting entrenched in those self-criticisms.  Letting them drive your behavior, so you end up living your life more about managing your self-criticisms than about your relationships, or your career, or your spirituality – whatever is most important to you.

Q: What are the main tenets of Acceptance & Commitment Therapy?

ES: ACT (said as the word “act”) is based on the idea that healthy living is characterized by psychological flexibility, or the ability to experience ourselves, others, and the world fully and without defense, while taking action toward the things we care about, even when it is painful or scary. Not having this psychological flexibility is actually a driving factor in creating psychological stress and problems such as depression, anxiety and eating disorders.  It’s not our experiences (our thoughts or feelings) that are problematic, it’s all the things we do to try to get rid of them.  Those things interfere with the life worth living.

[Psychological flexibility spans a wide range of human abilities to: recognize and adapt to various situations; shift mindsets or behavior to preserve personal or social functioning; maintain balance among important life domains; and commit to behaviors that are congruent with our values. source: Kashdan & Rottenberg, 2009]

Q: What does the research say about the effectiveness of ACT for body image and eating disorders?

ES: This is a relatively new area, to be sure, but preliminary data coming from a number of different labs are largely supportive of the application of ACT to body image and eating disorders.  My own work in this area has recently moved to basic research, focusing on the nature of body image inflexibility, how it develops, and how flexibility can be trained. My hope is that this work can complement the treatment research by promoting continued development based on better understandings of body image flexibility and inflexibility.

Q: Many people are familiar with Cognitive Behavior Therapy (CBT) and Dialectic Behavior Therapy (DBT) but may be less knowledgeable about ACT.  What are the main differences between ACT and other evidence-based treatments for eating disorders and body image such as CBT and DBT? 

ES: Well ACT is a cognitive behavior therapy, but it differs from many CBT’s in that it challenges the idea that thinking must change for observable behavior to change.  In this area, ACT posits that healthy body image and eating does not depend on challenging critical thoughts about the body. It depends on learning to engage in meaningful, values-based action regardless of what thoughts are coming up.

Q: “Acceptance” can be a difficult concept for people to really understand and put into practice.  Why is this?  And what’s the most effective way to define or describe acceptance as it relates to body image?

ES: It’s tough because we sometimes think acceptance means liking or tolerating tough experiences.  Applied to body image, acceptance simply means making room for all thoughts and feelings about the body, whether we like them or not.

Q: What are the potential barriers to “letting go” of one’s struggle with body image? To that same point, what are the possible benefits?

ES: We are trained from a very early age that things that hurt are wrong, that we are responsible for managing our feelings.  In the case of body image, we are also taught that managing our bodies is our responsibility.  We are taught that it’s right to struggle, that we should feel good and look good, and we should be willing to struggle to get there. Because of this, considering letting go of that struggle is hard to even imagine. We find ourselves wondering what would happen to our experiences of our bodies if we stopped struggling. Would our bad feelings about the body completely overwhelm us if we weren’t managing them?  And what about our bodies themselves? If we weren’t struggling – Would we suddenly become grotesque? Would our bodies become completely disabled?  Of course, letting go of the struggle does mean that we expose ourselves to all kinds of hurt that we don’t like having.  Only letting go of that struggle frees us up to do other things that are more important – to allocate all those resources to the things we really care about, even when it hurts. And we know it’s going to hurt because we feel most vulnerable when we’re going after the things we want. So in ACT, we practice doing that, in the presence of the worst kinds of body hurt.  It’s not just hurt anymore, though, it’s hurt with a purpose.

Q: You talk in your new book about the idea that acceptance “isn’t something you do once”.  Can you elaborate on that notion?

ES: Well, it’s not like we pass through some portal where suddenly we are all-accepting and the work is done. It takes practice.  We think we’re doing great, then we suddenly notice all these new ways of inflexibility showing up, these new scary or painful thoughts coming up.  It’s just human nature.  Working on body flexibility is a lifetime commitment to making the things that matter to you more important than managing your experience of your body.

Q: Where does the element of “Commitment” come into play when working on body image struggles?

ES: Building a lifelong pattern of flexibility takes commitment. From an ACT perspective, commitment means noticing when we are being inflexible, when we are working to move away from ourselves and our own experiences, and simply turning back.

Q: What are some of the other areas in life in which the principles of ACT might be beneficial?

ES: Any area of life that is, for you, characterized by attempts to manage your experiences instead of managing the meaning in your life is an area of life that might benefit from the ACT principles.  And the ACT community provides a wealth of resources for people looking to do this kind of work. The Association for Contextual Behavioral Science website has a whole section for folks who are looking for support applying these principles in their lives, and New Harbinger publishes a number of self-help books for a range of difficulties people experience.

Q: On November 17, 2013 you will be in Baltimore speaking about How to Let Go of Your Struggle with Body Image.  What do you hope people will take away from this event and who could benefit from attending?

My main hope is that people may leave curious. Curious about how they struggle with their body image and what costs that has in their lives. Curious about how their lives might look different if they let go of the struggle with body image and embraced their experiences of their body, painful or pleasurable.  Curious about how they might use the time and energy if they weren’t spending it on the body image struggle.

 *     *     *

Emily K. Sandoz, PhD, is assistant professor of psychology at University of Louisiana at Lafayette, LA. She is a therapist who specializes in treating clients using acceptance and commitment therapy. Sandoz is coauthor of Acceptance and Commitment Therapy for Eating Disorders and The Mindfulness and Acceptance Workbook for Bulimia. She received her doctorate from the University of Mississippi, and she lives and works in Lafayette, LA.

On November 17th, Dr. Sandoz will be the featured guest speaker at The Center for Eating Disorders at Sheppard Pratt‘s fall event, How to Let Go of Your Struggle with Body Image.  Click on the link to find out more about the FREE event and to reserve your seats.

The Center for Eating Disorders at Sheppard Pratt offers outpatient therapists trained in Acceptance & Commitment Therapy. If you’re interested in this type of therapy and would like to find out more about starting treatment for an eating disorder and/or body image, please call us at (410) 938-5252.

 

Yoga for Body Awareness & Acceptance

Yoga is defined as a “union” or the coming together of our separate aspects – body, mind and spirit – into one harmonious relationship.  It is often described as the experience of finding balance, or existing in the place between doing and being.

Eating Disorders & Yoga

In the midst of an eating disorder this balance, or union, between body and mind is often upset. Individuals with eating disorders often experience negative body image, and typically have significant difficulty embracing or nurturing their bodies in nonjudgmental ways.  Furthermore, the mind is often exhausted with negative thoughts about altering the body.  The mind may also be preoccupied with rigid and relentless food rules or thoughts about acting on symptoms which are harmful to the physical body.  Some might say that eating disorders represent the antithesis of a body-mind union as the two parts are often at war with each other.

Yoga room

CED’s new yoga room

Individuals with anorexia (AN), bulimia (BN), binge eating disorder (BED) and other specified eating disorders commonly suffer from co-occurring anxiety and/or depression.   These illnesses can further complicate one’s ability to practice mindfulness or establish a mind-body union.  Given that body awareness and mindfulness can be such powerful tools in the journey towards eating disorder recovery, individuals may benefit from trying new and enjoyable ways to incorporate them into their lives.  One of these ways is through a practice of yoga.

Yoga as an Adjunct to Evidence-Based Eating Disorder Treatment

The practice of yoga is well-suited to provide a number of specific benefits for individuals with eating disorders because of its gentle use of the body and the incorporation of mindfulness skills.  Other therapies that incorporate a mindfulness component, like DBT, have been shown to be beneficial to eating disorder recovery.

It has long been accepted, and a number of formal studies have shown, that practicing yoga can help reduce stress and anxiety. It can also enhance your mood and overall sense of well-being.  Yoga has been utilized in the treatment of various conditions including chronic pain, depression, and heart disease.  While there is limited research on the specific effects of yoga for individuals with eating disorders, initial findings are promising but more randomized controlled trials are needed. Many of the research studies on yoga for eating disorders thus far have been fairly small.  In general, those small studies seem to support the efficacy of yoga as an adjunct treatment for anorexia, bulimia and binge eating disorder but more research is needed.

Nourishing Body and Mind at The Center for Eating Disorders

At the Center for Eating Disorders patients explore and develop many coping skills through individual therapy, family therapy, group therapy, art therapy, occupational therapy and CED Leafnutritional counseling.  Through the application of evidence-based treatments such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy and Family-Based Treatment, our patients learn to utilize tools like symptom blocking, grounding skills, deep breathing, emotion regulation, relaxation,  goal setting, leisure exploration and communication. Our goal is to teach the individual to nourish and nurture the body, through proper nutrition as well as through holistic care and attention.

In addition to these existing modalities, The Center for Eating Disorders is now offering Yoga for Body Awareness and Acceptance as an additional way for patients to work on healing their bodies and calming their minds.  Within the context of the group setting, our qualified yoga instructor will guide patients through Asana (poses), Meditation, Guided imagery, Pranayama (breath work), and a cultivation of a nonjudgmental attitude towards the physical body.  Through yoga, patients will experience gratitude for a body that is healthy enough to carry them through life.

Yoga for Body Awareness and Acceptance

In this particular yoga practice, patients will utilize asana to bring awareness to the physical body while connecting breath to movement.  The instructor will help individuals utilize meditation to cultivate mindfulness and a compassionate awareness of what is occurring in the present moment in the physical body without judgment of that moment. Standing postures will be used to promote stability, strength, and balance cultivating an outward focus as well as seated postures to promote internal focus, healing and flexibility.  Groups will also include positive affirmations.  Yoga for Body Awareness and Acceptance will encompass elements of both restorative yoga and gentle yoga, each of which are described below:

Restorative Yoga
Brings recuperation to the organs, nervous system and consciousness. Using long holds to soothe the mind and encourages the student to have an inward focus. With more description and commentary accompanying the postures.  The slower pace of practice will awaken and encourage deeper openings in the physical body. This class is appropriate for all levels of practitioners. Typically utilizing props like blankets and blocks. Most if not all poses are seated or reclined poses. Poses are held for 3-4 minutes, while the teacher reads to the student, or plays music.

Gentle Yoga
Focuses on deep relaxation, rejuvenation, and healing. It promotes physical and mental fitness through poses, breathing exercises, readings, guided imagery, relaxation, and meditations. Appropriate for all levels and ages, especially those new to yoga or seeking a soothing practice. Includes standing and seated postures as well as some vinyasa (flow).

It’s important for individuals to know that yoga is not a standalone treatment for eating disorders. Utilizing Yoga as a complementary eating disorder treatment involves specific elements of yoga practice and should be facilitated by a qualified professional who is familiar with the unique mental and physical aspects of eating disorders.  Yoga for body awareness should not incorporate excessive exercise. Rather, the physicality of yoga should be a means through which the therapist or yoga instructor can supervise a patient’s meditation.    Given the potential medical consequences of eating disorders, individuals should never engage in yoga or other forms of physical movement without prior consent from their treatment providers.

Meet CED’s Yoga Instructor

SZ - yoga instructor

Sarah Ziemann  RN, BSN, RYT 500, Certified Yoga Instructor 

Sarah’s love for Yoga began in 2003 when she received the Book “The Heart of Yoga” in which yoga is explored specifically with adapting to the individual at any age, lifestyle and current state of health. Sarah has worked as a Registered Nurse at the Center for Eating Disorders since 2009. She completed her advanced yoga training at Baltimore’s own Charm City Yoga Center, studying under Kim Manfredi Blades. 

New Collaborative Care Programs for parents, caregivers and loved ones

The Center for Eating Disorders at Sheppard Pratt has long urged the participation and inclusion of family members in the treatment process for both adolescent and adult patients with eating disorders.  In addition to all of our family treatment components, parents and family members have been able to access our community support group as well as a weekly family psychoeducation group.  We are excited to announce that, beginning in July 2012, family members and caregivers of our patients will be provided with an additional level of support and engagement in the recovery process.

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.  [UPDATE: As of July 2013, CC Workshops are open to all family members and support people during any stage of a loved one’s treatment and recovery.] 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, 2nd 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.

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.

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.