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
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.