Background: Therapists are urged to treat eating disorders with evidence-based therapy models. However, research indicates that the therapeutic relationship is as important to treatment outcome as is the specific model employed. This presentation will focus on the out-of-the-box interactions that we already use -but don't talk about- to solidify safety, connection and empathy (hugs, gifts, emails, limit-setting, etc). This workshop includes clinical examples, experiential exercises and group discussion. Participants will leave with an understanding of "out- of- the- box" interactions, an appreciation of how to process these interactions and reduction of therapist’s shame with this work that we already are doing.
Objectives:
1. To learn three studies indicating the importance of the therapeutic relationship in recovery from eating disorders.
2. To learn an approach that guides recognition and repair of therapeutic breakdowns when using evidence-based treatment protocols.
3. To learn how to use both therapist's and patient's experiences to process "out-of-the-box" interactions, allowing for safety and boundaries in the therapeutic relationship.
- We will discuss the importance of action-oriented, “out of the box” behaviors, such as gift-giving, hugs, self-disclosure and limit-setting, into therapeutic work.
- We will discuss what therapeutic breakdown- What does it look like? How do you know if the therapeutic relationship is growing? Why is it important.
- Using the work of D.W. Winnicott, Diana Fosha and Steven Stern as a base, we will present the need for ongoing assessment of the interactions between therapist and patient. We will discuss the need for non-verbal interactions that allow for both empathy and limit setting and help solidify connection. How, when and why are these “out-of-the-box” interactions needed? The importance of discussing what interactions mean to the patient will be emphasized.
- We will discuss current evidence-based treatment models for eating disorders. In particular, FBT and CBT will be considered as examples, exploring the role of the therapeutic relationship in these protocols.
Self- Reflection and Clinical Examples 20 minutes
Each presenter will introduce a clinical example of an “out of the box” interaction with patients. Participants will then be asked to write down 1-3 “out of the box” interactions they have initiated. These examples will be used later in small group discussions.
Experiential 1 hour
Demonstration role plays will engage participants in evaluating
what is-- and what isn’t-- empathic interaction.
Guided imagery exercises will explore examples of the ways in which we have “gone out of the box” to both engage and limit set with patients. Full group participation
Participants will be divided into groups of 4 to 6 people to
discuss issues generated by the imageries and various “out of
the box” examples that are not part of treatment protocols or traditional training.
Summary: 20 minutes
The group as a whole will reconvene to discuss action-oriented behaviors that have gone well-- and ones that haven’t. We will encourage discussion of complications, mistakes and shame that inevitably occur. Participants will leave with specific guidelines about integrating empathic and limit-setting actions into evidence-based protocols.
This workshop hopes to allow an open discussion about what we are really doing to reach and help regulate our patients. What works? What doesn’t? and why?
Using the work of Winnicott, Fosha and S. Stern as a base, we will question how an empathic relationship with our patients can be established and maintained. We will examine the need for being a “good enough” therapist in which both words and action are needed to reach our patients.
This workshop will include guided imagery, role playing and an open discussion of our “out of the box” clinical examples. How is an empathic relationship established and maintained?
Participants will leave with specific guidelines about considering the importance of the therapeutic relationship. This will allow a questioning of what is needed regarding integrating empathic actions into evidence-based protocols.
Dr. Judith Brisman was the Founding Director of the Eating Disorder Resource Center in NYC for over 35 years. She is co-author of Surviving an Eating Disorder: Strategies for Family and Friends, is an associate editor of Contemporary Psychoanalysis and is on the editorial board of the journal Eating Disorders. She is a member of the teaching faculty of the William Alanson White Institute and she maintains a private practice in New York City. Dr. Brisman is known internationally as among the first in her field to develop a treatment program for bulimic patients. She has published and lectured extensively regarding the interpersonal treatment of eating disorders.
