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Door-in-the-Face: Engagement Strategies for Engaging Clients in Treatment


Friday, March 24, 2017: 8:30 AM-10:00 AM

Background: It is not uncommon for adults with eating disorders to be ambivalent about treatment. Ambivalence is a good thing! By definition, ambivalence denotes contradictory feelings. Ambivalent patients are curious about engaging in change. Learn techniques from behavioral therapies to capitalize on patient ambivalence and motivate them to engage in treatment.

Objectives: 1.) Assess patient's readiness to commit to treatment 2.) Apply techniques based on levels of motivation to your current patients 3.) Enhance your capacity to engage patients in treatment and work with their ambivalence

  • o A. We will review the literature pertaining to ambivalence and commitment through Behavioral and Social Psychology
    • § Motivational Interviewing to increase patient commitment and how to structure change based conversations
    • § Review DBT Commitment Strategies
    • § Review the Seven Levels of Validation in DBT
    • § Define door-in-the-face philosophy
    • § Integration of DBT and door-in-the-face with adult patients to obtain a commitment for treatment
  • o B. A Clinical Case Presentation highlighting areas to infuse MI techniques as well as DBT Commitment Strategies
    • § Establish the relationship and build a string therapeutic alliance
    • § Decide which door to slam in the face
    • § Responding to patient reactions
    • § Utilizing rewards and consequences throughout the admissions process
  • o Engage the audience in role plays to utilize the therapeutic approaches and practice the attitude behind the therapy
    • § Opportunities to utilize real-life scenarios to practice door-in-the-face and notice the emotions that come up with utilizing this sometimes uncomfortable technique
    • § Working with partners to hone MI skillset when engaging patient in treatment

The literature suggests that while there is a growing list of evidence-based treatments, many clinicians are taking an off-manual, eclectic approach to treatment. A reason frequently given for eschewing the research is that patients are ambivalent and they are not sufficiently motivated to engage in evidence-based treatment. Ambivalence, by its very definition, suggests that clients do have SOME motivation or curiosity about treatment. This presentation wishes to show that instead of ambivalence being a hindrance to starting evidence-based treatment, clinicians can utilize the motivation that is present and capitalize on it by working with the patient to commit to the process, not the outcome.

It is understandable why patients are experiencing ambivalence. Often a patient is utilizing maladaptive behaviors that feel useful and are, to some extent, effective. The thought of relinquishing such behaviors is overwhelming. Working with a patient to engage in treatment is the first step toward recovery and it is not necessary to have the patient bought in to recovery, but to have the patient committed to treatment.

We want to change the way clinicians conceptualize ambivalence to work with patients more effectively throughout the process of engaging in treatment. Working to debunk the common clinical notion that a patient must hit rock bottom or be fully motivated to recover in order to effectively engage. The presentation reviews the literature from Business, Sociology, and Behavior Psychology detailing commitment strategies for initiating behavior change. A clinical case presentation will provide a deeper understanding of the strategies within these therapeutic approaches and further highlight what doors to shut and what doors to open. We will work with the audience to practice techniques to roll with resistance while increasing patient’s commitment. At the onset of treatment it is not necessary to have the patient be in action stage of change, rather it is imperative that we learn to better mobilize a patient regardless of the stage of change he/she may be in.

Primary Presenter:
Karlee McGlone, LMFT

Karlee conducts all admissions assessments to engage patients in treatment. Karlee is passionate about meeting individuals and their families when they are seeking treatment and working with them to get the care they deserve. She provides group, individual and family therapy. Karlee graduated from Point Loma Nazarene University with a B.A. in Psychology and earned her M.A. in Clinical Psychology from Azusa Pacific University. She has clinical experience treating eating disorders in residential, partial hospitalization, intensive outpatient and private practice settings. Karlee is the Membership Chair for the San Diego International Association of Eating Disorder Professionals Board.



Co-Presenter:
Anne Cusack, PsyD

As a graduate from The Chicago School of Professional Psychology, she completed her pre-doctoral internship at Greystone Park Psychiatric Hospital working with various psychiatric populations. Clinically, she has worked as a therapist on a research trial of Dialectical Behavior Therapy for eating disorders at the University of Chicago, as well as provided treatment of eating disorders, mood disorders, substance use disorder, PTSD and personality disorders in inpatient, partial hospitalization, and outpatient settings. She is currently the Academy for Eating Disorders co-chair for the DBT special interest group. Her research interests include treatment development, acceptance, mindfulness, emotion regulation, and self-injurious behaviors.



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