Background: Clients with eating disorders are often entrenched in their thought patterns and need a new way of seeing things. Using metaphors helps clients attach to a concept before having to apply it to themselves. In a culture that emphasizes quick fixes, the skill of therapeutic, productive communication deserves more discussion.
I. Introduce ourselves and our practice settings
A. Clinical experience and type of client interaction
B. Personal style and how it has evolved and developed
II. Introduce the concept of metaphor through discussion of the science
A. Ian McGilchrist’s book The Master and His Emissary
B. Works on metaphor by George Lakoff related to how metaphor affects language and the mind
III. Review multiple cases and how metaphor has been essential
A. Unique ones we’ve never seen again
B. More helpfully, issues that come up over and over again where we’ve chosen favorite metaphors to combat the eating disorder entrenchment and find clients suddenly moving forward again
IV. Take questions and cases from the audience
Clients with eating disorders become literal, rigid, and binary in their thinking. The combination of their inherited temperamental traits, their learned goal-directedness, and their malnourished brains cause them to become fixed in thoughts and distortions. The intelligence and articulateness of the clients allows them to use what looks like logic to defy clinicians’ assertions that their mindset, behavior, body shape and size, and goals can (and must) all change. We now live in a medical world that is becoming more and more focused on quick fixes, brief interactions, short lengths of stay; medications more than personal growth, a number on a scale more than a thriving whole person.
At the core of what eating disorder professionals do, though, is defy all these modern medical trends and hold on to the absolute essential piece of what it is to engage someone sick one-on-one…we talk to our clients. We insist upon seeing them as complicated, whole people living in a complicated, but potentially joyful and engaged, world. To do this successfully, whether in a hospital setting with the most medically compromised patients in the country, or in a residential setting, or in the outpatient office, we have to use unusually sophisticated techniques of communication to break through clients’ resistance, mistrust, and egosyntonic relationship with their eating disorder. Carolyn Costin and Jennifer Gaudiani discovered that they both rely heavily on metaphor in their client communication. Both feel strongly that the use of metaphor is an essential tool which is vital to them in working through the very complicated problems an eating disorder brings. They felt that sharing their accrued clinical experience of using metaphor—in two very different clinical settings—would be enlightening and also validating (and useful) for clinicians of all sorts.
Using fascinating scientific developments in the understanding of how metaphor works in the brain as a theoretical underpinning, Carolyn and Jen will develop the thesis of metaphor as a vital tool, discuss multiple cases, and then solicit questions and cases from the audience to help support and develop the communicative skills off all in attendance.
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Carolyn Costin, MA., MEd, MFT, FAED, CEDS, recovered from anorexia in her twenties, became a therapist and saw her first eating disorder client in 1979. Carolyn has become renowned for her clinical acumen, her 4 books, her speaking engagements, and her residential and day treatment programs, Monte Nido & Affiliates, now in California, Oregon, Boston and New York. Carolyn's books, The Eating Disorder Sourcebook, 100 Questions and Answers About Eating Disorders, 8 Keys to Recovery from an Eating Disorder and Your Dieting Daughter, help sufferers, loved ones, professionals, and the public understand, treat, and overcome these confusing and complicated illnesses.
Dr. Jennifer L. Gaudiani, MD, CEDS, is the Medical Director of ACUTE and an Associate Professor of Medicine at the University of Colorado School of Medicine. She oversees the clinical, strategic, and administrative management of ACUTE, attends on the service, and maintains engagement with patients when not attending clinically. Dr. Gaudiani completed her undergraduate work at Harvard College, earned her medical degree from Boston University School of Medicine, and completed her residency and chief residency in Internal Medicine at Yale. Dr. Gaudiani has published extensively medical complications of eating disorders and has lectured nationally and internationally on the topic.
