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Working with Eating Disordered Individuals in the Context of Couples Therapy

Wednesday, March 21, 2012: 9:00 AM-12:00 PM
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Blue Topaz (The Charleston Marriott)
Working with an eating disordered individual in the context of couples therapy involves complex management considerations. Understanding the impact of changing the eating disorder behavior in the marital system impacts both the individual and system levels. This presentation addresses self-regulation, structural/systems approaches in managing the eating disorder and couples dynamics.
Outline:
  1. Overview of the model
    1. Basics generally is SAFETY, SECURITY and PHYSICAL WELL-BEING
    2. In ED-Couples the order is Physical Well-Being, Security then Safety                                            
  2. Defining difference in Addiction vs Compulsive Behaviors
  3. How it shows up in couples
  4. Assessment:  What is the EVOLUTION?
  5. Assessment: Establishing who is the client?
  6. Assessment:  How does the behavior influence the transactions?
    1. Assessment should clarify which pattern of transactions that the ED is anchored into
    2. What is the quality of transactions by either party in the relationship in general
    3. How does the couple communicate, cooperate, collaborate, and connect with one another?  How does ED impact these patterns?
  7. Assessment : other self-destructive behavior
    1. How much of the couples energy is devoted to the ED behavior?                                                         
    2. Sex and intimacy behaviorContinuation of roles from childhood
  8. Danger of therapy – CHANGING HOMEOSTASIS
    1. Disorder serves or comes to serve a regulatory function to the relationship
    2. The focus on mutual accountability or responsibility is absent/lost/never developed
    3. Fair fighting may not work initially
    4. What helps them tolerate self-destructive behaviors in the relationship?
    5. What is the pathology? 
    6. Changing the basis of attraction
    7. How do the individuals define themselves?

     7.  Treatment Considerations: Ethics

 

  1. Treatment Considerations: Couples & ED
    1. Treatment occurs in stages
    2. Pacing of interventions
    3. Pacing of change  
  2. Foundation Skills
    1. What skills are missing, never developed or lost?
    2. How has ED evolved?
    3. Inverse Skills
  3. Therapist Survival: Pebble and the Waves
    1. Can you do this work?  How do you know?
    2. Do you recognize the impact of the ED on the entire system?
    3. How do you enter the system?
    4. How do you engage in the system?
    5. How do you disengage?
    6. How do you manage the unidentified patient in the system?
This presentation will provide an overview of the function and impact of eating disorders on couples and their interactions and identification of the client as they present for treatment.  Understanding how the role of the eating disorder symptomology in couples systems is a critical foundation for developing the approach to intervention and management of the eating disorder and for the dyad involved in treatment.  Understanding the role of the symptom in the relationship as a critical aspect of the relationship and the evolution and the regulatory processes that occur in the system.  In particular, it will examine how eating disorders differentially influence the relationship based on onset- prior to or during the development of the relationship. The self-regulatory model developed by the speaker will be reviewed and ways to integrate it into the treatment arena itself will be discussed.  This workshop will also present a model (Structural Process, Levitt, 2000) as a foundation for working with the system. This involves creating a foundation of regulation at both the individual and couple level in regards to management of physical health, management of self and management of self in the relationship.  Case examples of the dynamics and multisymptomatic problems which commonly occur and strategies for interrupting these patterns is discussed.  Participants will be encouraged to present clinical issues and situation of relevance to them.  Discussion of ethical consideration and therapist survival are also introduced and examined.

 

Primary Presenter:
Kathryn R. Juzwin, PsyD

Dr. Juzwin is the Director of the Self-Injury Recovery Services programs at Alexian Brothers Behavioral Health Hospital in Hoffman Estates. She supervises and is involved in treating cases involving self-injury, trauma and eating disorders. She has two therapy based work book based journals for therapists treating self-injury for individuals and family work which includes education and journaling exercises. She has also presented, written, and published in the area of self-injury and eating disorders. Dr. Juzwin is an Associate Professor at the Illinois School of Profesional Psychology - Argosy University in Schaumburg. She teaches courses in eating disorders, trauma, and self-injury.



Co-presenters:
John L. Levitt, PhD

Dr. Levitt has more than 30 years working with eating disorders, trauma and complex patients. He has been an active participant in the field of treatment of eating disorders for more than 25 years as a clinician, developed and directed programs, supervisor/trainer and presenter. He has worked in private practice, taught, published and presented on the topics of eating disorders, complex symptomology, assessment, and intervention. He has co-edited four books on these topics with Dr. Randy Sansone. Dr. Levitt currently maintains a private practice in the Chicago suburbs specializing in the treatment of eating disorders, trauma, individual, and couples work.



and Annmarie Belmonte, PsyD

Dr. Belmonte is a licensed clinical psychologist specializing in the treatment of eating disordered patients for 10 years and works with complex symptom management, including self-injury and trauma. She treats individuals and families and works with very treatment resistant patients. She is primarily interested in research and developing relapse prevention and maintenance of therapeutic gains for ED patients. She maintains a private practice, supervises, and presents on the topics of eating disorders. Dr. Belmonte is also academically affiliated. She is an instructor at the graduate level and is the Chair of the undergraduate programs at Argosy University, Shaumburg.



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