Eating disorders are complex animals whose treatment requires a variety of approaches. After 20 years in the field, I continue to be amazed by the creativity of health care professionals who work with eating disorders. Last week I had the opportunity to sample some of the wonderful work that’s being done when I traveled to the Chicago area to present a workshop at an eating disorders conference. The conference was titled, “Replenishing Our Toolbox: Innovative Therapies for Eating Disordered Clients,” and was a joint venture of Castlewood (a residential eating disorders treatment center in St. Louis, MO), The Awakening Center (an outpatient eating disorders treatment center in Chicago), and the National Association of Anorexia Nervosa and Associated Disorders (ANAD). At this one-day conference, there were two keynote speakers and 14 one-hour workshops.
Going Beyond Cognitive-Behavioral Therapy
The morning keynote speaker was Mark Schwartz, ScD, clinical director of Castlewood. I’ve heard him speak many times and never tire of his insightful and informative presentations. He focused on an area in which he has great expertise: early childhood attachment. He explained how manipulative misattunement of a parent to a child—when a parent’s treatment of an infant or child is designed to satisfy the parent rather than to meet the needs of the child—can set the stage for an eating disorder to occur. He discussed the limited scope of Cognitive-Behavioral Therapy (CBT) in helping individuals with eating disorders. CBT is a therapy that aims to identify self-defeating or distorted thought patterns and teaches the individual strategies to change their thoughts and behaviors. Schwartz’s speech advocated for a practice that goes beyond the reaches of CBT, toward a more internally-focused therapy that involves working with the parts of the client that are responsible for problematic behaviors (e.g., the part of self that binges or purges). As a mother connects to her children, so must an individual connect to all parts of his or her self in order to heal.
Next, my co-presenter, Clare Stadlen, LCSW, and I gave our workshop, “Helping Clients in Outpatient Therapy Move From a 12-Step/Addictions Based Model to an Integrative Approach to Eating Disorders Treatment and Recovery.” There were four other wonderful workshops going on at the same time, addressing topics such as relapse prevention, support groups, and family-based treatments for adolescents with anorexia nervosa.
Treating Bulimia Nervosa with EMDR
The lunchtime keynote speaker was something completely different. James A. Kowal, PhD, spoke on “The Effectiveness of EMDR in Treating Bulimia Nervosa.” EMDR is Eye Movement Desensitization and Reprocessing. It was created as a treatment for trauma, when psychologist Francine Shapiro, PhD, discovered that moving her eyes rapidly side to side reduced the disturbing effects of memories of painful experiences. She learned that this was because the eye movements were a form of alternating bilateral stimulation, in which stimulus is applied alternately to each side of the body, resulting in connection between the two sides of the brain, supporting the processing of traumatic memories. Kowal has researched the effectiveness of EMDR in the treatment of bulimia, doing MRI’s of a patient whom he worked with throughout the process. He showed slides of the MRIs, and explained the changes in the patient’s brain that were evident as treatment progressed. Fascinating!
Beginning to Discuss Binge Eating Disorder
I hated having to choose two out of the nine afternoon workshops, but I eventually chose to attend, “Not For the Faint of Heart: 6 Essential Risks of Recovery from Binge Eating Disorder,” given by Amy Pershing, LMSW, from the Center for Eating Disorders in Ann Arbor, MI. I was thrilled to see this on the bill, as Binge Eating Disorder (BED) is not yet categorized as a full-fledged diagnosis in the Diagnostic and Statistical Manual (DSM), and the eating disorders field has been slow to recognize it, focusing much of its attention on anorexia and bulimia nervosa. Pershing gave a lively presentation that explained the internal world of the binge eater: the ongoing conflict between the inner Binger and the inner Dieter, and how they enable the inner Critic and inner Rebel to run the show, quieting the voice of the person’s true Self. She stressed the importance of “being a renegade,” that is, refusing to align with culturally-accepted thinking about body size, weight, and shape, in order to recover.
Bodywork and Trauma
My last workshop of the day was “Somatic Releasing Through Experiential Bodywork,” given by Stephen Schaefer, LCSW, and Jennifer Hedgecock, MSW, from Puente de Vida treatment center, a residential center in San Diego, CA. I’m a yoga therapy practitioner and a yoga instructor, and I’ve always been interested in and a proponent of incorporating body-oriented therapies into eating disorders treatment. Schaefer and Hedgecock explained their process of first stopping patients from channeling emotions through eating disordered behaviors, next identifying those emotions and connecting them to an event, trauma, or loss, and then using a unique method of body work to enable the individual to release the emotions from her/his body. They showed a video of this approach used in a group setting at their treatment center. It was extremely powerful and emotionally moving work. Schaefer explained that he and Hedgecock created this modality, and that this conference was the first time they had presented it anywhere. I felt honored and excited to be among the first to learn of yet another amazing means of helping people with eating disorders cope.
At the end of the conference, tired and ready to return home to North Carolina, I felt sated: my mind had dined at a smorgasbord where I’d gotten to taste samples of rich and exotic items, and I was happily filled. I was returning to my private practice renewed and my toolbox replenished.
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