Session: Helping Clients in Outpatient Treatment Move from An Addiction Model to An Integrative Approach to Eating Disorders Treatment and Recovery (2009 Symposium: Reclaiming the Body: Attachment, Somatics, and Image (March 4-8, 2009))

Sunday, March 8, 2009: 11:00 AM-12:30 PM

Barcelona (Westin Long Beach)

Some clients in outpatient psychotherapy for disordered eating are members of 12-Step recovery programs that use the addictions model, based on that of Alcoholics Anonymous, to address eating problems. Many of the tenets of such programs, which work well when applied to alcohol and drug problems, are actually counter-productive for eating disorder sufferers. In this workshop, the presenters will explain ways in which the philosophy of the addictions/abstinence model parallels the schema of eating disorders themselves, and offer clinical interventions for shifting and expanding clients’ perspectives to that of a comprehensive, integrative model of recovery.

I.    Introduction to the addictions model of eating disorders/disordered eating recovery and the various 12-Step programs in which it is commonly used
   A.    Overeaters Anonymous
   B.    HOW
   C.    FA
   D.    FAA
   E.    RFA
II.    Defining recovery: Comparing and contrasting the addictions-model philosophy to that of eating-disordered thinking and to that of on integrative model of recovery
   A.    A feminist viewpoint: concerns involved in applying the 12-Step philosophy to women with disordered eating
   B.    Abstinence and plans of eating: a corollary to sobriety v. developing a natural relationship with food
   C.    Eating disorder symptoms as the voice of split-off aspects of self (i.e., part of a Gestalt) v. eating disorder symptoms as “the disease”
   D.    Ego-syntonic eating disorder symptoms (e.g.,restriction, exercise) and ego-dystonic symptoms (e.g., bingeing, inactivity) as viewed by the addictions/abstinence approach and by an integrative recovery model
III.    Challenges therapists face in treating clients who participate in the programs and adhere to the addictions perspective
   A.    Supporting the development of a client’s inner voice v. attachment to an external regulatory system
   B.    Clients’ resistance to exploring the social/developmental/environmental etiology of eating disorders
   C.    Assisting clients to move beyond an identity of “sick,” and re-integrating themselves into their personal as well as global community.
IV. Blending an integrative model with 12-Step philosophy in clinical treatment
   A.    The role of the body: somatics and body image
   B.    Aspects of 12-Step programs that support healthy recovery
   C.    Appetites, desires, perfectionism and shame
   D.   Therapeutic Modalities: Cognitive-behavioral, interpersonal, psychodynamic, ACT, DBT, body-oriented, feminist and more
   V. Clinical interventions for use with clients: description and experiential exercises
VI. Additional Questions and Answers

The addictions model has been used to salvage the lives of alcoholics since the formation of the 12-Step approach to recovery, Alcoholics Anonymous, in the 1930’s. While these programs offer members an unparalleled access to peer support, a practical spiritual philosophy and a systematic approach to healing at nominal (donation-only) cost, the 12-Step philosophy often doesn’t translate well from its originally intended formula as a treatment of alcoholism to an effective means of treating disordered eating. Some tenets of the addictions model, e.g., that the sufferer has a disease from which she can never be fully recovered, that sufferers cannot trust themselves, and that self-confidence is a liability rather than a strength, are quite resonant with the voice of the eating disorder itself.
Where an integrative model of recovery encourages attention to the body’s wisdom, a reconnection to hunger and satiety signals, and development of self-trust, these programs endorse the belief that the disease has rendered these things untrustable.
The shame that eating disorders sufferers of all stripes, whether overeaters, undereaters, or purgers, feel about their appetites and desires is an essential component that drives the eating disorder and must be addressed in the process of recovery. The addictions model, when misapplied to disordered eating, attributes these appetites and desires to “the disease,” rather than exploring their significance, and does what the eating disorder does: relegates them to split-off parts of self.
In this workshop, the presenters will explain the philosophical perspectives of the addictions model as commonly employed in 12-Step self-help programs, the challenges therapists face with clients who participate in such programs, and clinical interventions for blending the addictions perspective with an integrative model of eating disorders recovery.
We will show how to re-frame the concept of “the disease” to externalize the eating disorder in ways that engender growth and healing, and demonstrate methods for helping clients connect compassionately to banished aspects of self.
We will describe a concept of an integrative model of recovery, in which clients return to a state of balance and self-trust, and develop an intuitive and satisfying relationship with food and with themselves.

Primary Presenter:

Deborah L. Klinger, M.A., LMFT, CEDS

Deborah Klinger, MA, LMFT, CEDS is a psychotherapist in private practice in Chapel Hill, NC. She has worked in the field of eating disorders treatment since 1990. She treats clients across the eating disorders spectrum individually and in groups. She is a clinical member of AAMFT and NCAMFT. An IAEDP Approved Supervisor, she has given numerous presentations on eating disorders, and is published in “Eating Disorders: The Journal of Treatment and Prevention.” She is a yoga instructor,a certified Phoenix Rising Yoga Therapy practitioner, and is pursuing certification as a trauma-sensitive yoga teacher through Bessel van Der Kolk's Trauma Center.

Co-Presenter:

Clare A. Stadlen, LCSW

Clare Stadlen, MSW, LCSW, has over 18 years of professional experience in counseling and psychotherapy. Clare has worked extensively with women, men, adolescent girls, college and grad students, and elders. She gained comprehensive experience in the treatment of trauma and eating disorders while working at the Renfrew Center, a renowned residential treatment center. Subsequently, she helped to create an eating disorder program at a residential trauma center in New Mexico. Clare has lectured to colleges and universities on the subject of body image and eating disorders. She has been in private practice in North Carolina since 2001.

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