Medical Evaluation and Structure
Addressing any medical risks and subsequent medical needs with a physician is an essential structure for outpatient therapy for eating disorders. It is important to have a doctors with whom you can have In the medical evaluation, it is important that it is important for the treatment of the same things to the client. to do the following:
- Carefully examine lab work, to identify any potential electrolyte imbalances, including sodium and potassium irregularities, which could cause heart arrhythmia or other organ damage.
- Address gastrointestinal difficulties or irregularities including slowing of gastric emptying, which occurs in many eating disorder clients, as well as extreme patterns of diarrhea, constipation, bloating, and esophageal damage such as dilation or rupture, constant sore throat, or reflux.
EKG or other tests may be warranted. ___ ___ ___ 1 ___ ___ ___ 0
- Discuss amenorrhea or other irregularities in the menstrual cycle and closely examine histories of being underweight for body type or extreme weight loss or changes over time.
- Look for dental and bone problems like osteoporosis, tooth decay, and gum erosion, and question for headaches, fatigue, and abdominal pain.
In the assessment, you or the physician can a referral to a psychiatrist for a complete assessment, or your client & # 39; s selected physician can address and monitor the use of the psychiatric medication.
Dietary Intervention and Structure
It would be treating a client with eating disorder behavior, it is essential to have the proper dietary guidance and consultation in order to help the client successfully address the nutritional aspects of the eating disorder. It would be wise to find a dietitian who has worked with eating disorder clients and has expertise that will sure proper treatment.
Also, clients tend to believe dietitians more than therapists with regard to guidance on normal body weight, diet concerns, and living in a healthy way Utilizing a dietitian also increase the size of the client 's needs.
A dietitian, with the treatment awfully to be able to to provide a structure for eating that will allow you to focus primarily on the emotional and problematic areas of the client & # 39; s life.
When looking for a dietitian to work with outpatient clients who have eating disorders, consider the following:
- Find a dietitian who has had experience working with eating disorder clients and who treats them differently than clients with other dietary issues.
- Look for a dietitian who can provide structure and even simplicity in her approach to eating disorder clients - one who does not focus on dieting, watching fat grams, and counting calories, but who understands the obsessive nature of eating disorders and can providing already structure and guidance without increasing obsessive ruminations.
- Find a dietitian who is familiar with the exchange program, food pyramid, and intuitive eating and can mix and blend These approaches to meet the needs of her eating disorder clients.
A good dietitian is an invaluable asset to a therapist in the treatment of a client with eating disorders.
Emotional Support and Structure
Creating a sense of belonging in a group, offering referrals to other sources, and by just "being there" It is easier to provide emotional support on a regular and consistent basis if is a structure or a model from which to work. It is important to I will create an emotional structure that will allow consistent and regular emotional support. Ideas for Creating Structure for Emotional Support:
- Ask the eating disordered client, family members, or friends for help. Ask them to contribute in maintaining a home and relationship - to take part in tasks in the family system or in the regular activities of friendship. "It is not only" okay "for family members or other loved ones to ask the client to help" something to offer. "" Clients often feel like "" sudden and feel guilty and " It is to sweep the floor, take someone for a ride, or listen to someone else & # 39; s struggles, there is a need for everyone to feel important and to feel that they are not receiving, but are giving to others, and that what they have to offer is of worth.
- It is important that they are emotional condition on a regular basis. It is also important for these discussions for family members and friends to express their feelings to the client, and Bringing structure and regularity to this emotional sharing, such as making a commitment for family, friends, and loved ones to "check in" on a daily basis to see how the client is doing, may help provide some structure with the emotional support.
It will help family members and friends feel less helpful, less resentful, and less panicked if they have have their For example, in a family a younger child may be asked to just ask the eating disorder client to play with them a couple of times a week as a way to include the client in the family.
- clarifying "double messages," confusion, or incongruence; and giving a constant reminder or invitation to talk and give reassurance that family or friends are present and available to the client.
- Asking clients to express emotion on a regular basis. Forms of expression may include writing, letters, journaling, talking on the phone, talking face-to-face, meditating, relaxation, or imagination .
Behavioral Structure
Behavioral assignment within the context of out of society therapy is an important component of structure. Behavioral structure can help a client to begin to feel a sense of control over her disorder and to have hope for the possibilities of getting well.
It is helpful to use concatenation of the behavioral intervention for the specific client, but the key to behavioral structure is the emphasis on commitment, follow-through, They will benefit if they have benefits if they are beneficial if they have benefits if they know that the structure is there to support them and help them in their recovery.
Family Intervention and Structure
Eating disorder clients are part of the family system. Consequently, eating disorder treatment requires a recognition of the role or function of the eating disorder within that family system. Families can become involved in treatment in the following ways:
- They can become educated about eating disorders by reading books and articles.
Support groups can provide support group can provide support group can talk about the stress, emotional damage, and difficulties an eating disorder has caused them. their feelings and deal with their own personal pain without attacking their loved one.
When appropriate, involve the family in therapy to empower them to deal with the eating disorder. Teach them how to support their loved one through recovery, develop correct boundary systems, and look at the inter-generational roles that family have dynamics. Teach them to look at their own personal issues with self-esteem and selfimage, as well as any other issues with body and food, or other family dynamics that can trigger or cause the eating disorder to worsen.
- It is important to address Family rules about food, body image, societal image, and expectations about how one is to live and eat. If problems are found in the family system, it would be advisable to make recommendations for further treatment for family members , whether individually or otherwise, to aid in the family & # 39; s healing.
- If you have several clients who are struggling with eating disorders, it may be helpful to have families come together to learn from each other about eating disorders and their impact on them as families and on the clients. Often, clients learn a great deal from watching other families go through the same dynamics that they are personally going through with their own family.
- Everyone should have a job, no matter how small and insignificant it may seem. Having a job helps family members feel less The job of one small child in helping an eating disorder client may simply be saying "I love you" to the client on a daily basis.
- Family meetings where the client moderates the discussion about jobs, roles, accountability, and making refinements helps the family to feel empowered and helps the client to have self-respect.
- Family council meetings are also important members of decipher and get rid of double messages and confusion, and begin to communicate clearly, directly, and more with each other.
- It is important for them to serve on a daily and regular basis. It is also important for them to eat, but provide structure, security, regularity, expectations, and agreements which will help the client eat .
Mating sure the family is not blamed for the eating disorder. The vast majority of parents of a child The client & # 39; s goal in treatment should be to to emotionally independent while learning to enjoy meaningful connections with family members.
Group Intervention and Structure
There are many types of groups possible including support groups, structured groups, themeoriented groups, and experiential therapy groups. The mainstay In addition, group treatment rounds out a full outpatient treatment program which includes individual therapy group. for group treatment in an outpatient setting. group therapy, family support groups, medical treatment, and dietary counseling. respiratory to homogeneous rather than heterogeneous psychiatric therapy groups. Some of the advantages of group intervention are as follows:
They no longer feel like they are alone in their struggles and conflicts.
- It makes clients to feel connected and gives a sense of belonging, which they often have not felt for a long time.
- It should them to learn things from each other that they can not learn from a therapist or in individual therapy.
- They can see other clients struggling, which can be a constant teacher and reminder of what they do not want, so leading to positive motivation toward recovery
- They have the opportunity to see others & # 39; successes and victories in the recovery process, which increasing levels of hopefulness about the possibility for getting well themselves.
- It 's possible for one more time to support more structure and support, which helps clients maintain their progress between less frequent individual therapy sessions.
- They are the prophetic clich for group therapy with clients who have eating disorders. They are the other people 's patterns, thoughts, and games, they have the opportunity to give more accurate confrontation and help each other to become more honest.
- Clients have opportunity for healing from shame and guilt which surrounds their eating disorder habits, past mistakes, or history of abuse by revealing what is were secrets and feeling love and acceptance persist past difficulties, behaviors, or problems. to feelings of acceptance, comfort, and healing.
As many as 30% of those suffering with eating disorders severe enough to require inpatient treatment have personality disorders. It Some people ready to work hard in therapy may feel energized by those who do not seem able or ready to take advantage of that format. Still, group Due to the concerns and struggles in running an outpatient eating disorder group, the following guidelines and suggestions are given:
- Do screening with participants in group to ensure that they have an adequate level of motivation prior to being allowed in the group.
- Make sure that the clients are involved in regular individual therapy and other modalities of full, comprehensive outpatient treatment before they are allowed to participate in a therapy group.
- While the client is involved in outpatient group therapy, individual therapists and group therapists should collaborate on capitalize on the therapeutic progress in both. Collaboration will allow accelerated progress in treatment.
- Care should be taken not to to "war stories" to be shared in group. New members in a group may tend to use the group format to compare eating disorder behaviors in an inappropriate and unhealthy way.
- A structured group program such as Dialectical Behavioral Therapy created by Marsha Linehan (Understanding Borderline Personality Disorder, The Guilford Press, 1995) may be useful in preventing clients to take responsibility for the work that gets done in group.
- If the group is having difficulty generating work, the therapist should feel free to create structure and generate some energy and work in the group to help clients get through any slow times that occurs.
Issues to Address in Outpatient Therapy
The following issues are important to address in treatment of clients with an eating disorder:
Relationships: Relationship issues and an outpatient therapist to intervene in relationships before the client gets to a place where she is regularly stuck and where family relationships are very seriously damaged. Eating disorder can create such emotion, tension, dishonesty, anger, resentment, hurt, and misunderstanding in relationships that it is important to begin early to involve loved ones of the client so that they can become more supportive, firm, and loving system for It is important to build "this is very important due to the trust difficulties is seen with eating disorder clients. It is important to build a relationship so that the difficult work can be done and you can model healthy dynamics and relationships.
You can teach clients a cognitive behavior approach to understanding the difference between thoughts and feelings thoughts and feel the impact thoughts have on their feelings. You can Help them become aware of the negative mind and the negative self-talk that happens inside, and the damage this self to esteem by fostering self-hatred and negative feelings about themselves. client from her eating disorder and help her learn to fight against the negative mind and the eating disorder instead of fighting against herself.
Spiritual connections: Many clients have spiritual difficulties due to feeling guilty, unworthiness, and the luck of closeness to a Higher Power or anyone else. Due to poor relationships in the past, old pain frequent gets in the way of believe that a I love God who cares about them and their not reject them because of their felt unworthiness. Clients often push people away and withdrawal, not only from their relationships with themselves and others, but also their relationship with "a higher power. "Spiritual connectedness gives the client a sense of purpose and value in them in and out ability to recover and to find purpose and meaning in life.
Perfectionism and personal expectations: Often, persons with eating disorders struggle with eating disorders These needs believe others what expectance of them are. How need to understand how perfectionism interferees with their growth and development. they also need to to see how this contributions. to nobody can be perfect, clients' creative such dissonance and feelings of failure will they to use the eating disorder to That perfectionism is their solution to beliefs that they are "not good enough", addressing these beliefs directly is important.
Adaptive functions of eating disorders have become way to mask them or cope with their pain, their feelings, their stresses, and their fears. Addressing They are trying to avoid avoiding insanding and helping themselves insarding and help increasing their ability to deal with their life in a healthy, functional way. They will begin copying in a healthy way are far more positive and good for them than hiding and running away through their eating disorder and other behaviors.
One way to do the client journal and keep a diary so that they are can feel are. Allowing feelings without self judgment for those thoughts and feelings. This will also provide insight into issues in their lives and their need to restrict, to binge, or purge.
This exercise helps clients is not constituating goes along with other people. This exercise also encourages them to take risks by themselves and encouragements themselves and looking for their goodsings with themselves and encounters themselves comfort zones which helps them to build more confidence. Helping clients find more their dreams and passions can expand their possibilities, excitement for life, and hope for the future.
Identify and attention needs: Often, a woman 's eating disorder is an attempt to develop a sense of identity-a niche for herself where these must be addressed for the client to be able to understand The destructiveness of the eating disorder. They need to be able to address how they need are met through illness and that need can be through through wellness.
"Honesty, integrity, and self respect come out out of efforts to be" Walk the talk: help people develop more congruency in what they say do more congruent behavior that matches "congruent behavior that matches" congruent.
Help them understand what the process of change is and give them a model of what they will go go so so they will not be surprised. Teach them that their recovery difficulties can be predicted, so they will not discouraged or feel guilty about inevitable struggles, mistakes, and bumps in the treatment process.
Family, community, and friends also need to be included in treatment whenever possible. It Teach them how to ask for help for replace the hollow and empty promises of an eating disorder.
Many with eating disorders feel Facing shame: An important issue to address in the context of therapy is a client & # 39; s intense feelings of shame, self-hatred, and self-accused that are often at the very core of the eating disorder. to make that mental process explicit and to have it an angoing therapeutic discussion is important in the therapy of eating disorders.
Comparing and competitiveness: intense tension to compare to compare to other people-especially other eating disorder sufferers. Clients all too often compare themselves with others in hopes to feel good, or as self damaging ways to "they themselves feel bad. Their competitiveness is some of them the same pattern they are to themselves," Somebody has something that I do not have, "and that means they are better at the eating disorder than Help them begin to challenge that negative purpose. I am. "It is important to help them, over the course of time, to address the underlying purpose or function of the comparing and competitive jealousy.
False guilt and boundaries fellow guilt in which they feel bad about themselves and experience intense feelings of guilt over things that do not, in fact, belong to them. They feel guilty over the inability to be perfect , or they feel guilty over their powerlessness to change struggling family members. understanding the difference between the feelings of having done something wrong and the feelings of being powerless to fix, change, or make a situation better. Many It is essential to help them address internal and external boundaries and to address responsibility for their own, internal self, and not the internal selves of other people.
Finding middle ground: Black and white thinking, mind reading, and personalization are common cognitive distortions of eating disorders. I am a strategy that lies "somewhere in the middle" rather than out on the extreme ends of the spectrum of perception, strategy, or emotion is a positive focus in outpatient therapy.
Telling the truth: addressing dishonesty, deception, and confidentiality is a very important therapeutic issue in the treatment of eating disorders is responsible for themselves. It is also in the honest expression of their For many clients feeling and thoughts that hope for recovery going on or what they have really done, with honesty, directness, and clarity rather than keeping it vague, hidden, and secret, is a major change for them. , giving up their confidentiality is the point when things start to improve for them.
Helping them to communicate specific. Helping them to communicate specifically, it is important to understand that many messages are communicated. They are to very themselves, is a very helpful ongoing the interview. Oftentimes they say things that do not mean after they are many people in pleasing other people and there are many dishonest with themselves and others. Honest communication can open the door to change.
I have a child and demonstrating how, as a little girl, she may have interpreted things, made decisions, or arrived at emotional conclusions based on some of those interactions, can be a They need to see see that the eating disorder is very good. an expression of those early emotional and often painful decisions or decisions.
Separations: Addressing the separation between the client can and begin to see the eating disorder as separate from themselves and not as part of their identity, then they can begin to empower It is also important for the risk of losing themselves. It is also important in terms of helping them correct, let go of, or amend the eating disorder consequences that have impacted them and others for many years.
Taking risks: eating disorders are so fear and avoidance based on recovery, to put a great deal of emphasis on risk-taking in which the client faces fears, challenges themselves to do things differently, Having an ongoing emphasis on taking risks and facing fears is very helpful whether they succeed or struggle. Avoidance poor quality low order low emotional, behavioral, communication, or relationship. self esteem and therefore, facing fears is imperative to recovery.
Inpatient Structure
Treating eating disorders in an outpatient setting can yield success, but it is a dedicated, multi-disciplinary approach and may take longer than some may hope for. Severeating disorder illness may need to be treated in a controlled and structured inpatient facility where the rigid cycles of self-hate and self destruction can be supervised and addressed around the clock. Outpatient therapy can then again be used to support and aid the client's ongoing recovery from the eating disorder through aftercare which is so important.
