I recently received the following email,
so poignant in expressing what so many
of us feel.
Dear Abbie,
I have been counseling girls with eating
disorders for about a year, but I feel
extremely inadequate. I tend not to
treat the eating disorder, but rather to
just treat them as teenage girls with
problems. It is such a challenge to get
them to believe they should eat when
everything in them says food is the
enemy. I just want to say to them. "Eat
anyway. You're not thinking straight
right now and you're starving yourself
to death." Eventually, I can usually say
that, but I really need your book.
Thanks for writing it."
-Linda B.
And so it goes. This young woman speaks
for the vast majority of
psychotherapists who struggle with the
very idea of managing these complex and
hard-to-treat problems. Do you find
yourself resisting treating these
disorders? Might you feel fear of their
complexity, of clients' resistance to
healing, of managing power struggles, of
the lethality of these disorders, of
their intractability and of the
inevitably unpredictable course of
recovery, of your own unpreparedness in
your learning or of professional
burn-out? Do you feel compelled to refer
these cases out of your practice?
The information provided on this site,
private and group
consultation for health professionals,
and my recent book, Doing What Works: An
Integrative System for the Treatment of
Eating Disorders from Diagnosis to
Recovery holds the potential to turn
these concerns around for you as you can
begin to count on successful outcomes
for yoru eating disordered patients and
their families.
The practitioner's dilemma
The field of ED treatment is still in
its adolescence, as are so many of our
patients. ED treatment techniques
continue to evolve, leaving
practitioners at a loss for what may be
considered "best practice" principles
and how to apply them. In the face of
the treatment field's crisis of
identity, clinicians find themselves
very much on their own, seeking to find
their own way as formal training
mechanisms continue to elude us. Our
work is at once enriched, and
compromised, by the divergent viewpoints
of clinicians and researchers and by a
sense of benign chaos that arises out of
an immense yet diffuse diversity of
approaches, limited resources, and in
some cases, personal biases and
misunderstanding of ED and their unique
requirements for treatment.
Whether you specialize in ED treatment,
engage with an occasional ED patient, or
choose not to treat eating disorders at
all, every therapist, nutritionist,
medical doctor, psychiatrist, physical
trainer and school counselor should be
prepared to recognize their elusive
signs, address their urgency, and refer
the patient for care. These highly
lethal disorders leave little margin for
error in diagnosis and treatment; the
earlier these diseases are recognized,
the better the prognosis for recovery
and the possibility for prevention.
Patients, families, friends, but most of
all, practitioners need to recognize and
understand the risks of allowing ED to
go untreated, even as
they are likely to exist as undisclosed,
co-occurring syndromes underlying other
conditions for which the patient does
seek care.
When treatment does not work, the finger
of blame invariably gets pointed towards
the disease itself through the
misconception that eating disorders are
'incurable;' towards an 'impossible to
treat' patient population; or towards
parents of child patients for having
caused the problem or for not addressing
it sooner. The reality is that when
treatment outcomes are less than
successful or when they fail, it is all
too frequently not the patient or
family, but the well-intentioned (and
otherwise competent) health professional
who drops the ball through acts of
misunderstanding, commission or
omission. That, of course, is the best
news of all, being that it is within our
capacity as professionals and as human
beings to learn and to change. Though
treatment failure with eating disorders
is often the result of biological,
neurological or environmental factors
that lie beyond the practitioner's
control, most treatment tasks lie
clearly within the purview and capacity
of the psychotherapist, the patient and
the ED treatment team to solve.
Much like the patients they treat, in
navigating the choppy seas of eating
disorder diagnosis, treatment and
recovery, health professionals, like
their patients, must learn to develop a
high level of tolerance for functioning
within a realm of the unknown, of
ambiguity, ephemera and the
unpredictable. By their nature
counterintuitive, these disorders
challenge commonly held belief systems
and turn typical expectations on them
ear. Setting them apart is their level
of lethality, the comprehensive nature
of the personal and interpersonal havoc
they wreak, the variety and relative
health of the personality types that
contract these diseases, as well as in
the variable quality of input from the
patient's familial support system.
Practitioners need to fully comprehend
the nature of these diseases, the depth
and breadth of their implications on all
aspects of the victim's emotional,
social, physical and personality
development and ultimately on quality of
life.
Treatment requires a fully unique and
integrative approach to patients,
problems, and process; as well as a
uniquely versatile style of practice and
use of the practitioner's self within
the context of the therapeutic
relationship along with a specialized
set of treatment protocols and
exquisitely honed techniques and
communication skills. Abraham Maslow's
guide to the hierarchy of human needs
speaks directly to the evaluating
practitioner's requirement to assess and
respond immediately to the needs of
their patients in a sequence designed
first to save lives, second to attend to
life quality. Working with these
diseases typically gives rise to
emotionally charged issues that demand
clear and constant self-monitoring and
awareness of counter-transference
phenomena. The practitioner's own
attitudes, personal biases, and capacity
for self awareness and self-growth all
factor significantly into effective
observation, deduction and response.
It is for us to learn how, when, and in
what manner to put together and offer
the techniques and skills that we
already know; how to nuance the quality
of our care-giving with mindful action,
and clearly defined intentionality; and
how to make loving human connections
with our patients, brain to brain, soul
to soul in connections that are
themselves truly healing. By impacting
the patient's emotional development,
problem-solving, quality of life and
physical function, self-regulation and
self care, the work we do holds the
potential to become transformational,
saving and restoring lives and life
quality now, and for generations to
come.
The book
Abigail provides both on-site and
telephone consultation for treating
professionals. Her book, Doing What
Works: an Integrative System for the
Treatment of Eating Disorders from
Diagnosis to Recovery is also an
invaluable tool for treating
practitioners.
By offering a meaningful and practicable
system of care, this book douses the
fires of professional fear and
resistance to ED treatment, inspiring
enough interest and know-how within the
treatment community to fill the
shortages in the treatment ranks with
competent ED experts. As a treatment
'GPS' mapping out the most accessible
and workable routes, Doing What Works
alerts and prepares the entire
multi-disciplinary treatment team,
including patients and parents, to
anticipate and bypass inevitable detours
and pitfalls intrinsic of ED treatment,
securing a smooth journey through the
tough passages of a complex recovery.
The author's reassuring voice resonates
with 40 years of specialty experience
and know-how, providing therapists the
permission, incentive, vision and
confidence they need to become
self-starters within a demanding
treatment process---and to help their
patients do the same.
Psychotherapist Abigail H. Natenshon has
specialized in the treatment of eating
disorders with individuals, families,
and groups for the past 40 years. She is
the author of When Your Child Has An
Eating Disorder, A Step-by-Step Workbook
For Parents And Other Caregivers,
Doing What Works: An integrative system
for the treatment of eating disorders
from diagnosis to recovery. Based on
hundreds of successful outcomes, this
book shepherds concerned parents
step-by-step through the processes of
eating disorder recognition, confronting
the child, finding the most effective
treatment for patient and family, and
evaluating and insuring a timely
recovery. A guide to eating disorder
prevention, this book is useful to
parents, health professionals and school
personnel alike in countering the
pervasive epidemic of unhealthy eating
and body image concerns, and destructive
media and peer influences. Her work can
be reviewed further at
www.empoweredparents.com and
www.empoweredkidZ.com.
