Sunday, 6 February 2011
What Do You Want Me To Write About?
Please followers let me know if you would like me to write about something YOU are interested in for a change. You can email me at deanne@ncfed.com
Friday, 4 February 2011
Top Tips for Working with Eating Disorders: Are You A Coach or Therapist?
This point was raised in CBT Today Dec 2010 by Prof Waller. I introduce all my eating disorder trainings by asking this question. Eating disorders are usually treated by people who describe themselves as therapists because, after all, therapy is about healing the sick, or making ill people well. And therapists do therapy, which is what they are trained to do.
I don't like regarding all people with eating disorders as fundamentally sick. Much of their behaviour makes sense. The person with anorexia sees most women trying to lose weight. Fat people get such a bad break in our society that it almost makes sense to purge if you have eaten too much so that you can stay in control of your weight. It is quite normal for a binge eater to have cravings because dietary chaos makes their blood sugar very unstable.
Prof. Waller suggests that we should coach people to be "her (or his) own CBT therapist" so that the client can make good use of the hours they are on their own, over and above the hour or so they have in the room with their counsellor. I agree and yet feel that this means a great deal more than being a coach.
Do we concur with the view that CBT in its many guises is the best we can do so far for working with eating disorders? Yes, since we are working to change behaviour, and to change the eating disorder mindset and the emotions which inform behaviour, whether this refers to starving or binge eating on chocolate.
Changing the eating disorder mindset requires us to be a guide, to help our clients cope with their lifestyle, and a teacher to provide useful information to deal with myths about nutrition and calories.
But information on its own is only useful when a person has the skills to use it appropriately - so we may need to teach some basic skills such as relaxation or problem solving skills and communication skills to help people become more effective and able to use the information which we have given to them.
When we work on the eating disorder mindset, we also confront some important barriers to change such as how much you feel you need to weigh in order to accept yourself. To do this, we have to help a person to know and realise their deeper aspirations in life rather than simply attend to the eating disorder aspirations of being in control of food and weight. This subtle task is more about being a mentor for change by opening out possibilities which were not there before.
So, coach or therapist? Definitely both and more, and even being a bit of a magician wouldnt come amiss, although the evidence base for conjouring is not yet there.
I don't like regarding all people with eating disorders as fundamentally sick. Much of their behaviour makes sense. The person with anorexia sees most women trying to lose weight. Fat people get such a bad break in our society that it almost makes sense to purge if you have eaten too much so that you can stay in control of your weight. It is quite normal for a binge eater to have cravings because dietary chaos makes their blood sugar very unstable.
Prof. Waller suggests that we should coach people to be "her (or his) own CBT therapist" so that the client can make good use of the hours they are on their own, over and above the hour or so they have in the room with their counsellor. I agree and yet feel that this means a great deal more than being a coach.
Do we concur with the view that CBT in its many guises is the best we can do so far for working with eating disorders? Yes, since we are working to change behaviour, and to change the eating disorder mindset and the emotions which inform behaviour, whether this refers to starving or binge eating on chocolate.
Changing the eating disorder mindset requires us to be a guide, to help our clients cope with their lifestyle, and a teacher to provide useful information to deal with myths about nutrition and calories.
But information on its own is only useful when a person has the skills to use it appropriately - so we may need to teach some basic skills such as relaxation or problem solving skills and communication skills to help people become more effective and able to use the information which we have given to them.
When we work on the eating disorder mindset, we also confront some important barriers to change such as how much you feel you need to weigh in order to accept yourself. To do this, we have to help a person to know and realise their deeper aspirations in life rather than simply attend to the eating disorder aspirations of being in control of food and weight. This subtle task is more about being a mentor for change by opening out possibilities which were not there before.
So, coach or therapist? Definitely both and more, and even being a bit of a magician wouldnt come amiss, although the evidence base for conjouring is not yet there.
Monday, 17 January 2011
Remember The Carers (And Try Not To Blame Them)
Carers can be a valuable resource in helping the patient to change. He adds that educating them in the treatment model can help them to assist the patient.There are now a great many books written specifically to help the parent help their loved one to fight the eating problem.
Therapists are taught not to attribute blame to families and to consider them a useful treatment resource. I can still remember, however, when family therapists such as Minuchin and Selvin Palazzoli claimed great success in treating anorexia by targeting unhelpful patterns in family behaviour such as detouring (avoiding issues) enmeshment (not giving the patient "space") and putting a nice face on no matter how you feel.
Families factors are also known to increase the risk of someone getting an eating disorder. There may be weight specific pressures such as mothers who go on diets and who are always groaning about their size, fathers who reward their daughters for losing weight, brothers or sisters who tease each other for being too fat, or even mothers who are overweight and their daughter says to herself "I surely do NOT want to look like you when I grow up!"
And there are pressures associated with eating disorders that come from families, like pressure to succeed, parents who teach their children to behave like adults all the time, and parents who put out messages that it is not acceptable for the child to have any feelings.
Personally, I have read hundreds of life stories from sufferers and from counsellors who want to specialise in treating eating disorders, many of them have had their own experience of anorexia, bulimia or binge eating. Sometimes I say to myself no wonder this person had an eating disorder when I read what has gone on in a family, the lack of caring, the abuse, the cruelty, the awful examples of weight control behaviour that has passed from mother to child.
Then I meet parents who bring their child for help and I ask myself, why is it the father who more often than not brings their daughter, while the mother is "busy" and the mother who usually brings their son because father is "busy" and do these patterns mean anything where the eating problem is concerned?
Many carers call us up at NCFED and beg us to give them some advice about how to help a loved one who is clearly suffering but will not admit to it. We have discovered, by experience, that even the most reluctant sufferer will come to accept some help if the parents come together to get some support for themselves in coping with the eating problem. This will often lead to an extended period of counselling for either the carers or for the sufferer. And how many eating disorder counsellors know what is going to be helpful?
So we rise to meet this need in the following way. We have some information on our website which can be useful for carers. There is a carers page and some information on our information page about how eating disorders are to be treated. http://www.eating-disorders.org.uk/helping_carers.html
We are also offering a 1 day Masterclass in Counselling Carers in April 2011 and hopefully also in 2012. Check out http://www.eating-disorders.org.uk/information.html and please come and join us on what should be a really helpful and inspiring day.
Acknowledgement to Professor Glenn Waller writing in CBT Today December 2010
Therapists are taught not to attribute blame to families and to consider them a useful treatment resource. I can still remember, however, when family therapists such as Minuchin and Selvin Palazzoli claimed great success in treating anorexia by targeting unhelpful patterns in family behaviour such as detouring (avoiding issues) enmeshment (not giving the patient "space") and putting a nice face on no matter how you feel.
Families factors are also known to increase the risk of someone getting an eating disorder. There may be weight specific pressures such as mothers who go on diets and who are always groaning about their size, fathers who reward their daughters for losing weight, brothers or sisters who tease each other for being too fat, or even mothers who are overweight and their daughter says to herself "I surely do NOT want to look like you when I grow up!"
And there are pressures associated with eating disorders that come from families, like pressure to succeed, parents who teach their children to behave like adults all the time, and parents who put out messages that it is not acceptable for the child to have any feelings.
Personally, I have read hundreds of life stories from sufferers and from counsellors who want to specialise in treating eating disorders, many of them have had their own experience of anorexia, bulimia or binge eating. Sometimes I say to myself no wonder this person had an eating disorder when I read what has gone on in a family, the lack of caring, the abuse, the cruelty, the awful examples of weight control behaviour that has passed from mother to child.
Then I meet parents who bring their child for help and I ask myself, why is it the father who more often than not brings their daughter, while the mother is "busy" and the mother who usually brings their son because father is "busy" and do these patterns mean anything where the eating problem is concerned?
Many carers call us up at NCFED and beg us to give them some advice about how to help a loved one who is clearly suffering but will not admit to it. We have discovered, by experience, that even the most reluctant sufferer will come to accept some help if the parents come together to get some support for themselves in coping with the eating problem. This will often lead to an extended period of counselling for either the carers or for the sufferer. And how many eating disorder counsellors know what is going to be helpful?
So we rise to meet this need in the following way. We have some information on our website which can be useful for carers. There is a carers page and some information on our information page about how eating disorders are to be treated. http://www.eating-disorders.org.uk/helping_carers.html
We are also offering a 1 day Masterclass in Counselling Carers in April 2011 and hopefully also in 2012. Check out http://www.eating-disorders.org.uk/information.html and please come and join us on what should be a really helpful and inspiring day.
Acknowledgement to Professor Glenn Waller writing in CBT Today December 2010
Tuesday, 4 January 2011
More Top Tips For Eating Disorders: How Important Is The Working Alliance?
Professor Glenn Waller writing in CBT Today, December 2010 says that a good working alliance is necessary but not sufficient to bring about change in eating disorder symptoms. He says that despite the commonly held belief that this relationship is a key agent of change, the benefit attributed to the working alliance is "relatively small".
I agree. I have met hundreds if not thousands of sufferers who have not recovered despite getting along really well with their therapist. I have met people who are so good at doing therapy that they can deflect the therapist from the real work of change with all kinds of diversion tactics. If we tell a sad enough story we might even find therein reasons why we have an eating disorder but it may not really be the truth.
As a trainer I have suggested that being a good listener while being important, may sometimes deflect from the work that must be done to elicit and change the eating disorder mindset. Everyone needs to tell their story and the story must be heard - but sometimes listening must give way to questioning, guidance and teaching new skills including skills for thinking , or thinking about thinking as well. Some of the techniques of eating disorder treatment are not very person centered at all (though they can be delivered with respect for the person who can "become").
I hope that therapists can suspend the need to be liked by their clients. The eating disorder client knows how to manipulate and sometimes wants to take a diversion from the issues that need to be faced. It is better to know the skills that eating disorders really respond to - so that respect for the therapist's competency can grow into the client's own self respect and self regard.
As Prof Waller says, there is evidence that when clients do change as a result of proper clinical practice the working alliance is enhanced, not the other way round. If you want to be liked, get a puppy. If you want to be trusted, be congruent.. If you want to help people change, know your stuff. Know nutrition, cognitive therapy, emotional resilience training, body image work, lapse prevention, when to stop listening and interrupt.The rest will follow.
I agree. I have met hundreds if not thousands of sufferers who have not recovered despite getting along really well with their therapist. I have met people who are so good at doing therapy that they can deflect the therapist from the real work of change with all kinds of diversion tactics. If we tell a sad enough story we might even find therein reasons why we have an eating disorder but it may not really be the truth.
As a trainer I have suggested that being a good listener while being important, may sometimes deflect from the work that must be done to elicit and change the eating disorder mindset. Everyone needs to tell their story and the story must be heard - but sometimes listening must give way to questioning, guidance and teaching new skills including skills for thinking , or thinking about thinking as well. Some of the techniques of eating disorder treatment are not very person centered at all (though they can be delivered with respect for the person who can "become").
I hope that therapists can suspend the need to be liked by their clients. The eating disorder client knows how to manipulate and sometimes wants to take a diversion from the issues that need to be faced. It is better to know the skills that eating disorders really respond to - so that respect for the therapist's competency can grow into the client's own self respect and self regard.
As Prof Waller says, there is evidence that when clients do change as a result of proper clinical practice the working alliance is enhanced, not the other way round. If you want to be liked, get a puppy. If you want to be trusted, be congruent.. If you want to help people change, know your stuff. Know nutrition, cognitive therapy, emotional resilience training, body image work, lapse prevention, when to stop listening and interrupt.The rest will follow.
Thursday, 30 December 2010
Thursday, 23 December 2010
Motivation Is Not An Infectious State: More Top Treatment Tips
Prof Glenn Waller offering top tips in CBT Today, December 2010 points out that our enthusiasm for the client's recovery will not rub off on the client. He suggests that we should keep focusing on whether change is actually happening rather than expecting it to happen because someone says they are about to change or because we believe they should.
So how will you learn if recovery is actually happening? Perhaps you cannot be sure so you have to suspend your expectations and wait.
I have learned to be patient. When you have a partner, home, lifestyle or eating disorder it is really hard to change. One of my NLP mentors once told me that he takes the following line with addicts - "I insist absolutely that you keep your addiction until it has been replaced by something more useful".
For this reason, I don't reward what people expect me to reward. I don't reward weight loss in people who want to lose weight and I don't reward weight gain in people with anorexia and I don't pat someone on the back when they have had a good eating week. I prefer that people keep doing what they are doing and help them find some helpful options for thinking and doing things differently now and then. People simply cannot recover until they have reclaimed what their eating disorder has stolen from them or when they have build a resource which, by being absent, led them into the eating problem in the first place. This resource might be confidence, compassion, or a feeling of belonging. Whatever.
Recovery from an eating disorder does not happen on the therapist's agenda. It is like a baby learning to walk. You can't force it. When the baby is ready, he or she will just take off. If you try to hurry her, she will fall.
So how will you learn if recovery is actually happening? Perhaps you cannot be sure so you have to suspend your expectations and wait.
I have learned to be patient. When you have a partner, home, lifestyle or eating disorder it is really hard to change. One of my NLP mentors once told me that he takes the following line with addicts - "I insist absolutely that you keep your addiction until it has been replaced by something more useful".
For this reason, I don't reward what people expect me to reward. I don't reward weight loss in people who want to lose weight and I don't reward weight gain in people with anorexia and I don't pat someone on the back when they have had a good eating week. I prefer that people keep doing what they are doing and help them find some helpful options for thinking and doing things differently now and then. People simply cannot recover until they have reclaimed what their eating disorder has stolen from them or when they have build a resource which, by being absent, led them into the eating problem in the first place. This resource might be confidence, compassion, or a feeling of belonging. Whatever.
Recovery from an eating disorder does not happen on the therapist's agenda. It is like a baby learning to walk. You can't force it. When the baby is ready, he or she will just take off. If you try to hurry her, she will fall.
Wednesday, 8 December 2010
Assessing Eating Disorders Properly: A Commentary.
Prof. Glenn Waller, eating disorder expert, has written a bunch of top tips for people working with the eating disorders in the Journal of CBT, December 2010. His first tip is “Monitor and work with physical and psychiatric risk.”
He points out that there is no substitute for a good assessment of such risk. Many psychotherapists don’t do this if they aren’t trained to work properly with these problems. They may say “it’s not about food, it’s about feelings”.
But many people have serious health risks associated with their eating behaviour. Bulimics risk heart and kidney problems. Binge eaters might be suffering from diabetes. Food is chemistry not just calories and ingesting large amounts of sugar puts enormous pressure on the pancreas. Purging leaches potassium from the cells, stopping them from burning energy. Being very thin can cause the inside of your bones to turn to jelly, interrupting the supply of the cells that keep your blood from flowing and your heart from beating properly.
People with anorexia are 57 times more likely to commit suicide than people of any age who do not have the illness. We have to consider them at psychiatric risk. We have to test them for clinically active trauma, for hidden cases of self harm, for depression or for exercise activity that may cause them to collapse.
People do not start developing eating disorders because they are vain or stupid. Losing or controlling weight starts off as a solution for feeling better; and most of us are delighted if we look slim or lose a little weight. But if dieting and weight management goes out of control, the solution becomes the problem that can kill you or ruin your well-being.
Prof Waller recommends you to be a good Assessor. Check out www.iop.kcl.ac.uk/IoP/Departments/PsychMed/EDU/downloads/pdf/RiskAssessment.pdf
But why not come on our specialist training courses. For expert CPD visit http://www.eating-disorders.org.uk/professional-training.html or call us on 0845 838 2040 to discuss your training needs.
He points out that there is no substitute for a good assessment of such risk. Many psychotherapists don’t do this if they aren’t trained to work properly with these problems. They may say “it’s not about food, it’s about feelings”.
But many people have serious health risks associated with their eating behaviour. Bulimics risk heart and kidney problems. Binge eaters might be suffering from diabetes. Food is chemistry not just calories and ingesting large amounts of sugar puts enormous pressure on the pancreas. Purging leaches potassium from the cells, stopping them from burning energy. Being very thin can cause the inside of your bones to turn to jelly, interrupting the supply of the cells that keep your blood from flowing and your heart from beating properly.
People with anorexia are 57 times more likely to commit suicide than people of any age who do not have the illness. We have to consider them at psychiatric risk. We have to test them for clinically active trauma, for hidden cases of self harm, for depression or for exercise activity that may cause them to collapse.
People do not start developing eating disorders because they are vain or stupid. Losing or controlling weight starts off as a solution for feeling better; and most of us are delighted if we look slim or lose a little weight. But if dieting and weight management goes out of control, the solution becomes the problem that can kill you or ruin your well-being.
Prof Waller recommends you to be a good Assessor. Check out www.iop.kcl.ac.uk/IoP/Departments/PsychMed/EDU/downloads/pdf/RiskAssessment.pdf
But why not come on our specialist training courses. For expert CPD visit http://www.eating-disorders.org.uk/professional-training.html or call us on 0845 838 2040 to discuss your training needs.
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