Background: Difficult conversations are a necessary part of treatment. This presentation explores difficult topics that arise in the treatment of eating disorders. Through sharing stories of successes and fumbles experienced by ourselves and our colleagues, we seek to help providers tackle these awkward moments with confidence, humility and therapeutic efficacy.
Slide 1: Introduction
The Fruit Basket Story
Point: Keep perspective as we are facing these difficult and uncomfortable conversations with fear and trepidation that these are poignant moments in peoples lives and it’s an honor to be part of them.
Explore several topics that can be challenging for therapists.
Slide 2: Talk Objectives
Create a dialogue about difficult conversations in therapy. Demystify therapy by talking about the challenges therapists face in approaching certain topics. Often as professionals we don’t talk about these experiences. It can be taboo to admit our discomfort or the desire to avoid a topic.
Provide skills that can aide you in taking on difficult topics with clients
Practice Skills/Exercise
Slide 3: Why are difficult conversations important? How do they further therapy?
Therapists must navigate sensitive topics with skill and intuition, at times tolerating difficult to hear feedback from our clients, while at other times confronting our clients with information that can be hard to say and cause discomfort for both parties.
We teach our clients how to deal with uncomfortable feelings by modeling it for them.
Preventing necessary growth, avoidance gives topics power
We teach clients how to speak truth without judgement by modeling it for them.
Write down a difficult conversation topic on index card and pass in
Slide 4: Topics
Bodies
Therapist sensitivities food, exercise & body
Embodied Therapist
Disclosure
Money
Therapeutic Relationships
Setting Boundaries
Team members/supporters working at cross purposes
Rejection, Inadequacy,Termination
Slide 7: General Principles: Do no harm
Slide 8: General Principles: Facilitate collaborative agreed upon change
Slide 9: General Principles: Be Authentic
Slide 10: Consult- be aware of your own pull toward avoidance
Slide 11: Practice- Imagining Conversations
Slide 12: Stay in the Moment- Deep Breathing, OK, with being uncomfortable
Slide 13: Exercise
Pair up, pass out index cards and practice
Slide 14: Q&A
- Slide 15: References
Presenters will engage attendees in thinking through and guiding difficult conversations with clients and their supporters. Medical dangers associated with eating disorders make knowing how to broach difficult conversations regarding weight, body shape, and eating a necessarily urgent matter. While approaching “deeper” or underlying issues may be more familiar, comfortable, or seemingly relevant to long term recovery, confronting the client’s tangible relationship to food has been shown to be most important in building a strong foundation of recovery (Fairburn, 2008). Modeling experiential acceptance can also be a powerful tool in the therapeutic relationship as experiential and emotional avoidance leads to prolonged symptom use and can be a barrier to wellness (Wildes & Marcus, 2010). Using case presentations, role plays, and group discussion, participants will explore difficult topics that arise in the treatment of eating disorders. Participants will be encouraged to share their experiences involving difficult issues encountered in therapy and discuss provider reactions. Facilitators will offer skills and approaches to addressing topics that prove challenging for providers. Questions to be tackled may include the following:
- Setting realistic expectations for families about early recovery and normalizing the continued use of symptoms
- Navigating problematic outside treatment teams
- Communicating severity of eating disorder to families to facilitate collaboration
- Motivating a client to engage in general self care
- Telling a former restrictor/anorexic that s/he has gained past his or her ideal weight range
- Speaking with a group monopolizer about limiting sharing in group
- Telling a restrictor that his or her meal plan is being increased
- Refusing to treat a client at the current level of care due to ethical limitations
- Limiting a treatment provider’s time or attention when indicated for client’s recovery
Tabitha Limotte, LMFT, is the Assistant Clinical Director at Monte Nido's Eating Disorder Treatment of New York and has worked in the treatment of eating disorders since 2008. Tabitha earned her Master's at Antioch University in California, completed her training at Monte Nido's Partial Hospitalization program in Los Angeles, and received post graduate training at the Center for the Study of Anorexia and Bulimia in NYC.
Dr. Chipps is a graduate of the California School of Professional Psychology and received her post-doctoral training at the University of Nevada, Reno in the treatment of eating disorders. She specializes in the treatment of eating disorders as well as substance abuse. Dr. Chipps is a primary therapist at Monte Nido’s Eating Disorder Treatment of New York and sees clients in her private practice in Manhattan.
