Bridging the research-practice gap in the treatment of eating disorders: Healing a shattered self and a fragmented field

Friday, March 4, 2011: 12:15 PM-2:00 PM
Point Hilton at Squaw Peak
A critical research-practice gap exists in the eating disorder field. Exploring the most current research and clinical trends, this plenary challenges the false dichotomies between research and clinical work, mind and body, and nature and nurture, and engages the audience in healing both our patients and our field.
Outline of Presentation Content:

I. Overview of the research practice gaps--Maine

2006 AHRQ Report (2006):

      Research doesn’t match clinical practice:

EDNOS is the forgotten step-child:

  • EDNOS overlooked in research , but comprise 50-70% of cases of all ED cases

      Biopsychosocial approach: NATURE needs NURTURE:

  • Focus on biogenetics of the past decade has been misleading

Diversity:  Hidden faces:

  • The changing face of ED- now in over 40 countries
  • Overlooked issues include diversity—cultural, ethnic, gender and age

     The Heart of the Matter

  • Our hearts need to be present for effective, life-altering therapy
  • With base of structure, support, well-informed treatment strategies, and heart, our job is then to make people uncomfortable- the only way that change happens

II. Definitions of recovery and of “good” therapy--Hartman McGilley

What is recovery?:

  • Who decides?
  • Qualitative vs. quantitative; physical/psychological vs. holistic definitions
  • Summary of research to date

Importance of the therapeutic relationship:

  • American Psychiatric Association (2006) names the importance of a therapeutic relationship as the first principle in their treatment guidelines. 

III. Neuroscience and Iintegration of body-oriented therapies into a holistic framework--Ressler  

  • Effective therapy needs to access the right brain
  • The language of the right hemisphere is non-verbal communication that literally wires up the child’s early developing right brain

v     The reparative attachment relationship of psychotherapy “re-wires” the brain in a similar way through right-brain modalities

  • When holistic methods are coupled with traditional methods to bring underlying ED issues into conscious awareness, the distorted lens through which the client sees and experiences the world shifts into sharper focus. The integration of these approaches produces a “whole” greater than the sum of its parts and, thus, a more potent and creative treatment process.
  • Clinicians can learn to use these modalities to “marry” the best of both worlds and enhance attunement and attachment.

IV. Bridging the Gaps--Summary and experiential exercise- all 

When it comes to eating disorders (EDs), the biopsychosocial whole is greater than the sum of its parts, and real treatment is much messier than the current research reflects. This plenary elucidates the critical gaps between what ED researchers study and what ED practitioners confront in their treatment settings. For example, while Eating Disorders Not Otherwise Specified (EDNOS) is the most commonly diagnosed ED in clinical settings, ranging from 50 to 70% of all ED cases, research studies rarely include this diagnostic category. As EDs now cut across co-morbidity, age, gender, socioeconomic class, ethnicity, race, and place, treatment must begin to reflect these diverse realities.

The speakers examine these and other gaps with the intent to integrate research and practice so that each informs the other, ending this arbitrary division. Even the basic question of what constitutes recovery reflects the scientist/practitioner gap. Five decades of quantitative outcome research yields extensive data, but fails to adequately define what constitutes recovery from an ED.  The outcome literature will be reviewed with suggestions regarding how to make research better reflect the lived experience of recovery from an ED.

This plenary also explores the most critical ingredients in the therapeutic relationship, and integrates the recent developments in neuroscience which validates many of the “gut” feelings of seasoned clinicians.  The deepest, long lasting changes clinicians can effect in psychotherapy occur in the domain of implicit relational knowledge, located in the right brain. Research must include and evaluate the effectiveness of these methods in treatment, as the interplay of body-oriented, experiential treatments with traditional, multidisciplinary approaches creates a powerful and life-altering potential for change through integration of body and mind.

Finally, this plenary challenges the false dichotomy between research and clinical work. All clinicians are researchers, collecting impressions, grouping together likenesses, differentiating differences, tailoring clinical efforts based on both empirical and experiential evidence to best meet the needs of our patients. Participants will garner a sense of how they can work to bridge the gaps in this fractured field, healing both our patients and ourselves.

Primary Presenter:
Margo Maine, PhD, FAED

An expert in eating disorders for three decades, Dr. Maine is author of : Treatment of Eating Disorders: Bridging the Research- Practice Gap with McGilley & Bunnell; Effective Clinical Practice in the Treatment of Eating Disorders, with Davis and Shure; The Body Myth with Kelly; Father Hunger; and Body Wars. She is: senior editor of Eating Disorders: The Journal of Treatment and Prevention; vice president of the Eating Disorders Coalition for Research, Policy, and Action; Founding Member and Fellow of the Academy for Eating Disorders; and a Founder of the National Eating Disorders Association.

Beth McGilley, Ph.D., FAED

Beth Hartman McGilley, Ph.D., FAED, Associate Professor, University of Kansas School of Medicine--Wichita is a psychologist specializing in the treatment of eating and related disorders, athletes, trauma, and grief. Dr. McGilley has practiced for over 22 years, writing, lecturing, and directing an inpatient eating disorders program. She is currently an editor for Eating Disorders: The Journal of Treatment & Prevention. She is currently working on her first book, Do They Know: Healing Mantras for Girls in Eating Disorder Recovery. For 3 years, Dr. McGilley has been the sports psychology consultant for the Wichita State University Women’s Basketball team.

and Adrienne Ressler, LMSW, CEDS

Adrienne Ressler is an eating disorders and body image specialist. She serves as the National Training Director for The Renfrew Center Foundation and is Board President and Fellow of iaedp. Adrienne received her degrees from the University of Michigan, where she also served on the faculty in the School of Education. She is a Licensed Master’s Social Worker and has extensive training in gestalt therapy, transactional analysis and psychodrama, as well as the body-centered therapies of Bio-energetic Analysis and Alexander Technique. She has been published in The International Journal of Fertility and Women’s Medicine, Social Work Today, and ISPA’s Pulse. She authored the chapter BodyMind Treatment: Connecting to Imprinted Emotions and Experiences in Effective Clinical Practice in the Treatment of Eating Disorders.