Body Respect Q&A with Linda Bacon, Ph.D. ~ Part II

Welcome to Part II of our discussion with internationally acclaimed author and researcher, Linda Bacon, Ph.D.  If you missed Part I, you can find it here

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Q&A with Linda Bacon, Ph.D. ~ Part II

 

Q: What are some of the repercussions of evaluating a person’s health by their weight?

LB: One key repercussion is misdiagnosis. Some thin people get the diseases we blame on weight – and they often don’t get diagnosed until later when they’re more advanced and harder to treat – and many heavier people never get the diseases we blame on weight. And then of course, it introduces the nocebo effect: tell someone they’re going to get sick and they probably will. So it’s just bad medicine. (And expensive! Those excessive costs attributed to “obesity” can be better attributed to weight bias.) Fat or thin, the conflation of weight and health imbues people with a fear of fat and distracts us from what really matters. It brings stigma, a problem of social justice, into health care. It’s both ineffective AND damaging.

 

Q: How could a focus on weight, or on weight loss, get in the way of effective healthcare? Can you give a specific example?

LB: My knee has been bothering me a lot lately, and that provides for an easy example. My father suffered from similar knee problems. However, he was fat (I use that as a descriptive term, stripped of pejorative connotations) and I’m not, resulting in very different treatment from our orthopedists.

My doc told me to first try physical therapy, that stretching and strengthening the muscles around the joint can help. Surgery was also presented as an option.

But what did my father’s doctors recommend? They put him on diets – over and over again. He never developed a regular exercise habit and struggled with weight cycling and disordered eating his whole adult life.

Carrying more weight may have aggravated my dad’s joint problems; no doubt there are ways it’s hard to be in a fatter body. (I should add parenthetically, that there are also ways it confers health advantage, but that’s a much longer blog post.) But trying to lose that weight is no kind of solution. I can assure you, my father – almost all heavier people – they’ve tried already.

My dad went to his death with knee pain. That’s just not effective healthcare. Even if fat is a causative factor and weight loss may be helpful in reducing symptoms, that doesn’t mean that prescribing weight loss is an effective or helpful solution. (Note also that it’s well documented in the literature: prescribing weight loss is more likely to result in health-damaging weight cycling than sustained weight loss.)

My advice in training health care professionals in respectful care with larger people is to start by considering how they would treat someone in a thinner body. Appropriate exercise? Meds? Surgery? Then do what you can to support your patients in implementing your advice and handling the challenges posed by their particular body.

It’s important to remember that good health habits benefit everyone, across the weight spectrum. And that you can’t diagnose someone’s health habits by looking at them. My father – and people of all sizes – could also have benefited from eating disorders screening. Appropriate eating disorders treatment may – or may not – have a side effect of weight change.

 

Q: On November 7 and 8 you will be speaking at two events in Baltimore, one for the community and another specifically for health professionals. What are some of your main goals for each of those talks and who do you think could benefit from attending?

LB: More than anything else, I want to inspire people. For the general community, I want attendees to leave with a sense of hope, that they can lose the guilt and shame and instead take pleasure in eating, that they can look at their bodies kindly. And I want the health care professionals to leave with a greater sense of agency, feeling empowered that they know how to be helpful for people. I want all of us to walk away with a stronger sense of community, feeling that we’re part of a committed group of people helping to make this a more just and compassionate world.

 

Q: Are you hopeful that our medical community, or even our society in general, will be able to make a paradigm shift away from a focus on weight? What helps you stay focused on and inspired by this goal?

LB: I do feel quite hopeful. I’ve watched the transition that’s been happening over the years, how my message resonates with the medical community, once exposed. Most professionals are feeling disillusioned with the old system, and I’m frequently told that coming to hear me talk is a relief. It allows them to take their disquiet seriously and they feel empowered to be presented with solutions that make sense.

But I’m not naïve. As much as I’d like to have faith in the inevitability of justice being done, and the old paradigm being tossed by the wayside, I’m just not confident that’s going to happen large-scale in the mainstream anytime soon. But I find it very liberating to consider that maybe the point isn’t victory, as much as we would like to see that done. Maybe the real issue is that by speaking my truth, I sleep better at night and it gives me hope.

Desmond Tutu offered this advice as rationale for the work of a freedom fighter: You don’t do the things you do because others will necessarily join you in doing them, nor because they will ultimately prove successful. You do the things you do because the things you do are right.

Dr. Linda Bacon

So I try to let go of the preoccupation with outcome, and find fulfillment in my involvement in something worthwhile, and being a part of this greater community. I look forward to being at Sheppard Pratt soon, and connecting with more people committed to a more just and respectful world.

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Many thanks to Dr. Linda Bacon for sharing her time, expertise and compassion with our online communities.  Please join us November 7th in Baltimore when Dr. Bacon will offer an in-depth training for health professionals and then again on November 8th for an inspiring free community event. Find out more and register for both events here.

See Also: BODY RESPECT Q&A with Linda Bacon: Part I

Hope Through Science: CARRIE ARNOLD Talks About Decoding Eating Disorder Recovery

  

On November 4th, 2012 The Center for Eating Disorders at Sheppard Pratt will welcome Carrie Arnold to Baltimore for a special community event entitled, Hope Through Science: Decoding Eating Disorders.  Carrie Arnold is a trained scientist, science writer and also the creator of the popular eating disorder recovery blog, EdBites.  After her own decade-plus long battle with an eating disorder, Carrie recently released a new book designed to share the science of eating disorders in a user-friendly way that not only educates readers but empowers recovery.  In the book,  she discusses how delving into the biology behind anorexia helped her to overcome her own illness. 

In advance of her presentation, we asked Carrie to share a little bit about the new book,  the recovery journey, and why science is for everyone.  Read on to see Carrie’s responses, and don’t forget to click on the image at the bottom of the post for details on how to RSVP for her upcoming presentation. 

Q:  As a scientist, science writer and someone who has dealt with an eating disorder yourself, you have a unique perspective about some of the most critical aspects of the disorders and the science behind them.  What would you say is the one piece of scientific knowledge about eating disorders that everyone should know?

CA: I think the most important thing for someone to know about eating disorder science is that EDs are real, treatable illnesses. They are not choices–sufferers aren’t choosing to starve, binge eat, purge, and over-exercise. Rather, they are symptoms of a potentially deadly illness that requires rapid, intensive, and evidence-based treatment to bring about full recovery.

Q:  Can you list some of the potential benefits to learning about and understanding the biology of eating disorders? 

CA: For me, learning about science was a way to start moving forward rather than continually looking at my past to try and figure out what might have caused my disorder. Insight didn’t bring recovery. Learning my triggers was important, but trying to get to the “root cause” of my eating disorder wasn’t helpful because there really wasn’t a root cause. Rather, it was a perfect storm of events that tripped my predisposition to anorexia. Malnutrition and ED behaviors were perpetuating the disorder, and the first step in recovery was weight and nutritional rehabilitation.

Q:  What role did this knowledge play in your recovery process?

CA: Focusing on nutritional restoration as the first step of recovery was probably the most important. As much as I hated it (and believe me, I hated having to gain weight and stop ED behaviors!), I could think much clearer when I was at a healthy weight for me, and eating regularly. Studies have shown that reaching and maintaining a biologically appropriate weight is one of the best predictors of recovery, and having a treatment team and family that insisted upon this was probably the most important thing in my recovery.

Q:  Your new book focuses primarily on the science of anorexia but research gains have been made for all eating disorders in recent years.  Can individuals with bulimia, binge eating disorder and eating disorder NOS also benefit from uncovering the science behind their eating disorders? 

CA: Absolutely. I primarily discussed anorexia in my book because that was the disorder with which I had the most personal experience, and because the amount of research out there is so massive that I couldn’t tackle everything in just one book. Understanding what eating disorders are and what causes them (often, individuals have a biologically-based predisposition to EDs that are frequently triggered by an energy imbalance in the form of dieting, an attempt to “eat healthy,” growth spurts during puberty, increased training for sport, etc) can free the sufferer from blaming themselves and their families for past events and instead focus on moving forward.

Q:  Will your talk be applicable to individuals struggling with all types of eating disorders or just those with anorexia?

CA: This talk is definitely for people with any type of eating disorder. Even much of what we know about anorexia can be applied to other disorders–the importance of regular eating, addressing co-occurring conditions, understanding triggers, and relapse prevention. These things are universal.

Q:  While the focus of your book is on the biology and genetics of eating disorders, you make it a point to communicate that environment is still important and does influence behavior.  Why is this an critical reminder for readers?

CA: Many people hear the word “biology” or “genetics” and believe that if an eating disorder is related to either of those two things, then recovery is impossible. Their eating disorder was fate and there is nothing they can do. Which is the furthest thing from the truth! We can’t change our genes, but we can change our environment. Genes don’t act in a vacuum; environment is also important. Psychotherapy, for example, can physically change the brain and help you learn better coping strategies. I have to make sure to eat 3 meals and 2-3 snacks each day to maintain my recovery, as well as taking steps to prevent undue stress and sleep deprivation, all of which can trigger ED thoughts.

Q:  It can be helpful for individuals who are struggling with eating disorders to hear from other people in recovery, to know that it is possible, and that it’s worth it to keep moving forward.  What advice would you give to others who may still be struggling or are trying to find the motivation to pursue recovery?

CA: It was really hard for me to believe in recovery after years of illness, ineffective treatment, and failed attempts at recovery. Ultimately, I couldn’t sustain motivation on my own, especially in the face of overwhelming anxiety and depression. I needed other people in my life to believe in my own recovery until I was strong enough and well enough to believe it myself. It’s one of the most ironic features of my recovery- I didn’t have motivation to get better and sustain recovery behaviors until I was well on my way to wellness. It’s why support from friends, family, and treatment providers is so important.

Q:  What would you say has been the most meaningful or most worthwhile part of your own recovery?

CA: Not being so scared of everything. I can relax at times. I can laugh. I can be myself.

Q:  Who could benefit from coming to your talk, “Hope Through Science” in Baltimore on November 4th?  What would you say to people who might initially be turned off or intimidated by the word “science”?

CA: Eating disorders are so misunderstood that I think anyone touched by an eating disorder (sufferers, friends, family, and clinicians) could benefit from learning more about the subject. Our culture likes to portray science as something that’s just for geeks and eggheads. In reality, lots of people are interested in science, even if they don’t always know it. This won’t be like high school science class – I promise!

Q:  As someone who understands the suffering of an eating disorder and the hard work of recovery, what do you hope attendees will take away with them on November 4th after hearing your presentation?

CA: That recovery is hard work, takes a long time, and requires lots of support, but it’s possible with the right treatment.

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Many thanks to Carrie Arnold for taking the time to share her insight and knowledge for this blog.  Click on the image below for details about her upcoming presentation in Baltimore.  The event is FREE to attend but space is limited so be sure to RSVP.  If you have questions, please don’t hesitate to call us at (410) 938-5252.

2010: Looking Back on a Year of Eating Disorder Awareness, Outreach & Education

2010 has been one of the busiest community outreach years to date here at The Center for Eating Disorders.  We are very glad to have welcomed many of you to our events for the first time.  In addition to providing requested trainings and workshops in the community CED also hosted five major community events on the Sheppard Pratt campus.  These are just a few of the many highlights from the past year…

In January of 2010 CED kicked-off the year with a day long conference  entitled, Promoting Self-Esteem & Positive Body Image: A Program for the Jewish Community. Despite a lingering snow storm, over 100 community members attended including parents and adolescents, educators and school staff, medical and mental health providers as well as rabbis and Jewish community leaders from Baltimore and surrounding areas.

One month later we celebrated National Eating Disorder Awareness Week with a keynote presentation by author and parenting expert Rosalind Wiseman.  In her talk,  Positive Parenting for a Healthy Self-Image, she spoke candidly about relating to kids and adolescents in ways that build self-esteem and body confidence.  That same week in February, we honored student artists from across the state of Maryland at the annual “Love Your Tree” poster art exhibit and awards ceremony. Bel Air High School Freshman, Kiley Baker was honored as her original artwork was unveiled as the official 2010 Love Your Tree poster. More than 130 art pieces were on display and over $1,200 in scholarships and prizes were awarded to participating students and teachers. (Don’t forget: the deadline for this year’s LYT Poster campaign is Dec. 17th, 2010!!!)

Before NEDAWeek 2010 ended, CED therapist, Craig Boas, LCSW  facilitated a community workshop called Mindfulness 101: An Experiential Exploration of DBT Practices for Eating Disorder Recovery and Everyday Life. In addition to these local events, we also launched a blog series called Nurture:  A mind and body wellness blog for moms and mothers-to-be. The blog entries helped to provide support around issues of fertility & pregnancy, eating disorders, body image, media and motherhood.  

In August of 2010, we were honored to host a community presentation by author and parent, Harriet Brown the very  day after the release of her book, Brave Girl Eating: A Family’s Struggle With Anorexia. Her talk was inspirational for the many parents and professionals in the audience and stimulated much discussion about Family-Based Treatment (FBT).  The Center for Eating Disorders is one of a small number of sites across the country that has clinicians who are specially trained and certified to provide FBT for eating disorders.

We switched gears in September 2010 for a focus on continuing professional education for providers.  Five eating disorder treatment experts from across the country converged in Baltimore to present at CED’s professional symposium, Eating Disorders: State of the Art Treatment.  Almost 200 physicians, nurses, psychologists, social workers, dietitians and other treating professionals attended the day long conference to learn about topics such as Family-Based Treatment for EDs, Psychopharmacology and Cognitive Remediation Therapy.  Several of our expert presenters provided guest blogs for us in advance of the symposium.  You can read them by clicking on the links below:

Several days after the symposium, CED staff members, including CED Associate Director, Dr. Steven Crawford, teamed up with fellow advocates from across the country on Capitol Hill to take part in a Lobby Day organized by The Eating Disorder Coalition (EDC).  We spent time meeting with Maryland representatives in congress and senate, discussing how important it is for them to sign on in support of the FREED Act.  It was an empowering day and CED is looking forward to being a continuing sponsor of the EDC in the new year.

Most recently we were incredibly excited to host our fall outreach event,  Intuitive Eating: Making Peace With Food,  featuring Evelyn Tribole, MS, RD, a nationally acclaimed nutrition expert and bestselling author.  There was a tremendous response from the community, and over 200 people from across Maryland and surrounding states converged in Towson on November 21st to hear Ms. Tribole’s engaging presentation.  After the talk, many attendees lined up to speak with her personally about their stories of success with Intuitive Eating.  If you missed the presentation, check out the pre-event Q & A with Evelyn Tribole on our blog.

Many thanks to all who have attended and collaborated around these events.  As we move towards 2011 and a new year we maintain a commitment to providing events and outreach opportunities with the following goals:
  • Increase awareness about the growing prevalence of eating disorders and their consequences
  • Provide opportunities to help individuals, families, schools and organizations prevent eating disorders and promote positive body image
  • Encourage early intervention and improve access to care while decreasing stigma associated with seeking help
  • Support individuals and families throughout the recovery process
  • Enhance professional knowledge and competency through continuing education events for medical and mental health providers

Upcoming community outreach events:

www.EatingDisorder.org

CED on Facebook

CED on Twitter (@CEDSheppPratt)

What is INTUITIVE EATING? A Special Pre-Event Q&A with Evelyn Tribole, MS, RD (Part 1 of 2)

On November 21st, The Center for Eating Disorders at Sheppard Pratt will  host registered dietitian and bestselling author, Evelyn Tribole, MS, RD  as the 2010 keynote speaker at our annual Fall Outreach  Event. Tribole will be speaking at the free event where she will be de-bunking diet myths, sharing important nutrition information and discussing practical ways individuals and families can move toward becoming Intuitive Eaters (even as the food-focused  holidays approach).   Over 200 people have already registered to attend next Sunday’s event, and its created a lot of intuitive eating buzz here in Baltimore.  In case you don’t know what all the excitement is about, Evelyn agreed to answer some of our general questions about Intuitive Eating in advance of  her presentation.  Consider this a sneak peak, come back tomorrow for Part II, and then join us for the main event…Intuitive Eating: Making Peace With Food on Nov. 21st.  

Q &A with Evelyn Tribole, MS, RD (Part I)

What is Intuitive Eating, and what are some of the general benefits for individuals?  For families?

Intuitive Eating is an approach that teaches you how to create a healthy relationship with your food, mind, and body–where you ultimately become the expert of your own body.   You learn how to distinguish between physical and emotional feelings, and gain a sense of body wisdom.  It’s a process of making peace with food–so you no longer have constant “food worry” thoughts.  This means that meals are not a moral dilemma resulting in feelings of guilt and shame, but rather a place to practice tuning into one’s inner needs and fulfilling those needs in a healthy, nurturing way. While there are many ways of incorporating the process of Intuitive Eating, there are three core characteristics:

  • Unconditional permission to eat.
  • Reliance on internal hunger and satiety cues.
  • Eating for physical, rather than emotional reasons.

There are many benefits for individuals and families who eat intuitively. Unfortunately, one of the myths or misconceptions about intuitive eating is that it is unhealthy because people often fear that if you allow yourself to eat whatever you want, you’ll just a eat lot of “junk food” and you won’t be able to stop.  The truth is, there are studies that show Intuitive Eaters are actually healthier, both physically and mentally.  Here are two that illustrate these conclusions:

In 2006, Dr. Stephen Hawk, from Brigham Young University evaluated 343 college students and found that Intuitive Eating does not lead to poor nutritional food choices.  To the contrary, he found that Intuitive Eaters consume a greater diversity of foods, take greater pleasure in eating and have healthy body weights.

A larger study on nearly 1300 college women by Tracy Tylka*, from Ohio State University, found that Intuitive Eaters are more optimistic, have better self-esteem, and a lower body mass index (BMI), but without internalizing culture’s unrealistic thin ideal.  (That part is important, because if you desire or value an unrealistically thin body, it increases your risk for eating disorders).

How does Intuitive Eating compare to our current societal norms and cultural messages around food/eating?

The pleasure of eating has become a lost art in the USA. Instead, eating is commonly viewed as something that will kill you, cure you, or make you fat. This is where we can take a lesson in the pleasure principle from France. An international study found that Americans worry the most about their health and enjoy eating the least. In contrast, the French are the most food-pleasure-oriented and least food-health-oriented. [1] Notably, France has nearly half the obesity rate compared to the USA, for both adults and children [2].

When food restrictions are placed on a chronic dieter, or on a person who chronically feels guilty about eating, it increases the “forbidden food” burden. Consequently, rigid food rules interfere with the individual’s ability to “hear” or be attuned to the eating experience of his or her body.

Can you briefly explain the “diet mentality” you refer to in your book?  From a nutrition perspective, how do diets affect weight and health?

Many times, “healthy eating” or “better nutrition” is code for dieting. Consequently, if you focus solely on these factors, without considering your internal body cues or what would best satisfy hunger, you can easily feel deprived. This in turn may increase cravings and thoughts of food, overeating, dieting, and heighten anxiety around snacks and meals.

There are compelling studies, which indicate that dieting actually predicts weight gain (and often binge eating). While most people know that diets don’t work, not many are aware of the weight-gain hazard. For example, a team of UCLA scientists reviewed 31 long term studies on dieting and concluded that [1]:

  • Dieting is a consistent predictor of weight gain.
  • Up to two-thirds of the people regained more weight than they lost.
  • Diets do not lead to sustained weight loss or health benefits for the majority of people.

A prospective study on nearly 17,000 kids ages 9-14 years old, found that dieting predicted binge eating behavior and concluded that, “…in the long term, dieting to control weight is not only ineffective, it may actually promote weight gain” [2]. Recently, a five-year study on teens, found that dieters had twice the risk of becoming overweight, compared to non-dieting teens [3]. (Notably, at baseline, the dieters did not weigh more than their non-dieting peers.)

I consider dieting a form of “nutritional trauma”. It might sound a bit dramatic, but once your body experiences the biological and psychological deprivation from dieting, your body gets smarter. Consequently, it gets harder to stick with each new diet, because your cells know what to do. When dieting, hunger becomes a feared sensation, rather than a natural process that gears up and down, depending on when, and how much you ate. And if you eat just until the hunger goes away, you will likely be hungry sooner, which sets up a cycle of constantly thinking about food and what to eat. This is a big part of the “diet mentality”. Conversely, if you learn to eat intuitively and feed your body on a regular, consistent basis, by honoring your hunger, it will help build “body-trust”.

…part 2 is now available here:  “Body Image, Eating Disorders & Intuitive Eating”…A Special Pre-Event Q&A with Evelyn Tribole, MS, RD

In Part II of this Q & A, Evelyn answers questions about body image and eating disorders as they relate to Intuitive Eating.  Follow CED on Facebook for additional updates about our blog and upcoming events.  You can also visit our Events Page for more details on how to register for the Intuitive Eating event on November 21, 2010.

In addition to co-authoring the groundbreaking bestseller, Intuitive Eating, Evelyn is also an award-winning registered dietitian in private practice in California and a nationally recognized nutrition consultant;  She has appeared on hundreds of interviews, including: CNN, Today Show, MSNBC, Fox News, USA Today and the Wall St. Journal.  For more info about Evelyn Tribole, click on her picture above or visit her website at www.evelyntribole.com.

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.