Background: In working with individuals with complex eating disorders who have shown minimal symptom improvement despite significant efforts, it behooves clinicians to re-conceptualize the definition of progress. The presenters offer an alternative definition based on relational and developmental markers. Case examples are discussed and implications of this approach are explored.
I. Progress and Recovery
Working with individuals with eating disorders in intensive outpatient and partial hospitalization settings, we have seen a wide range of severity and chronicity of symptoms among patients. Through this work, we have come to question how well conventional definitions of progress accurately reflect the experience of recovery, particularly among those with more persistent illnesses.
We will address this issue by presenting current definitions of progress in the treatment of eating disorders and considering how these definitions drive our understanding of recovery and subsequent interventions. Views on concepts of "recovered" and "in recovery" will be summarized. We will discuss where the definitions of progress derived and how these definitions reflect the historical and current landscapes in mental health (i.e. insurers, research determining what is "measurable").
II. Where the Definitions Fail
Moving from an understanding of philosophy and definition, we will provide examples of patients for whom these criteria fail to capture true growth and change. Furthermore, we will describe how current definitions can harm patients who may be discharged for failure to make behavioral progress according to existing criteria.
III. Alternative Definitions
We will provide an alternative definition of progress drawing from relational and developmental aspects of treatment. We will support our definition by providing evidence citing relational-developmental work as foundational for attachment and lasting behavioral change. We will review the literature on using less symptom-focused treatment with patients with eating disorders.
IV. Application to Patients
With a working definition of progress identified, we will consider patient characteristics that fit the profile of those who could benefit from an expanded definition. Case examples from presenters' own work will be offered and discussion encouraged.
V. Application to Clinical Work
Finally, we will discuss implications for treatment planning, and explore how approaching treatment with an expanded view of progress requires challenging particular assumptions and managing one's own anxiety as a clinician. An emphasis will be placed on addressing risk and liability issues that clinicians regularly face. The audience will be encouraged to share examples of clients who might best be conceptualized and treated using an alternate definition of progress.
A myriad of factors, including the current healthcare and insurance landscape, an era of evidence-based practice, and changes in training have resulted in a definition of recovery based primarily on symptom-reduction. The aim of this presentation is to assist clinicians in re-conceptualizing the definition of progress in recovery, in particular for individuals with complex eating disorders who have shown minimal improvement despite utilization of multiple modalities and levels of care. The presenters, drawing on contemporary research and clinical experience, assert that a definition of progress that is too rigid fails to account for important relational and developmental aspects of treatment that underlie behavioral change. This presentation will offer for discussion several case examples that highlight with whom and how a symptom-focused approach may fail to adequately address unremitting eating disorders. The presenters will then provide an alternate framework for considering progress in eating disorder treatment, based upon relational and developmental factors. A discussion regarding the type of patient who may be appropriate to be considered within a non-symptom focused framework will be provided. Importantly, attendees will be engaged in a discussion of the implications of symptom vs. non-symptom focused approached for treatment planning, managing anxiety in utilizing a divergent approach, and considering possible implications for risk and liability.
Angela Derrick, Ph.D., is a Co-Chief Clinical Officer at Insight Behavioral Health Centers in Chicago, Illinois, where she is involved in the development and dissemination of clinical programming, services and training. Dr. Derrick has frequently presented both to eating disorder professionals and to the community, and has contributed to publications in the field, most recently to the ANAD Newsletter and the Eating Disorders Review. She is a member of the Academy for Eating Disorders, ANAD and IAEDP. Her clinical interests include the integration of mindfulness-based practices into the treatment of eating disorders.
Ashley Solomon received her doctorate in clinical psychology from Xavier University. She completed her pre-doctoral internship at Friends Hospital in Philadelphia and her post-doctoral training at Insight Psychological Centers in Chicago. She has specialized in the treatment of eating disorders, women’s health, and trauma, and she is currently the Program Director for eating disorder services at Insight. Her research interests are in media literacy and the use of social media in recovery. She is an active member of AED and has published in the International Journal of Eating Disorders and presented at various national conferences.