Behavioral Change, Interpersonal Understanding
What Happens When is an Advanced Training course in the specialized treatment of eating disorders. Offered as a year-long series of downloadable webinars, unlike any other training of its kind, WHW dives deeply into the intricate, challenging, detailed questions that arise day-to-day when treating patients who are suffering with eating disorders.
What Happens When introduces Dr. Judith Brisman’s therapeutic program, in which behavioral intervention is integrated with Interpersonal psychodynamic thinking. Through the use of clinical presentations, readings and discussion, we question how to effectively integrate psychodynamic thinking with the direct behavioral intervention needed when working with eating disordered patients. What works—and why? Prominent professionals in the field are guest lecturers throughout the course.
We Consider What Happens When…
- You meet the patient for the very first time
- The patient is vomiting every day but says nothing is wrong—except the vomiting
- Your patient wants to lose weight but won’t talk about what she is eating
- The treatment team disagrees as to whether a higher level of care is needed
- Your patient is anxious and scared
- You don’t know what to do
Trimester 1 (6 Hours)
An interpersonal understanding of the patient begins the very first session. What is the patient doing with you as he or she asks for help with disordered eating? Often history and exploration has to be overlooked in an attempt to reach the patient and speak the language of food and weight immediately. How to interweave the urgent voice of the patient with the steadying, exploring and limit setting voice of the therapist is crucial in work with these patients. How to negotiate the needs of two people becomes the work of the very first session.
Discussion of papers by Dr. Brisman (Bulimia in the late adolescent: An analytic perspective to a behavioral problem) and Dr. William Davis (Reflections on boundaries in psychotherapeutic relationship)-- considering boundaries with patients and the interpersonal treatment of the eating disordered patient.
We indeed want to help the patient “make it go away” – while at the same time setting the stage for the exploration of just why the disordered eating has been needed. Treatment involves an ongoing integration of behavioral intervention with Interpersonal psychodynamic treatment. Technical interventions as well as psychodynamic understanding of the patient will continue to be discussed in depth.
Are eating disorders a result of lack capacity to sooth or put words to feelings? Or are they the result of a relational enactments? Papers by Diane Barth (Speaking of Feelings) and Judith Brisman (When actions speak louder than words) will be discussed with an eye towards these questions.
Many of our patients enter treatment with a physician of their own. Sometimes, as is with the case of anorexic patients, it is mandatory that a physician, skilled in the treatment of eating disorders, is a part of the team. Sometimes, as may be the case with body dysmorphia or binge eating, it’s less clear whether a physician’s presence is urgently needed. Regardless, we see trouble that a doctor might miss. How can therapists and physicians better talk to each other. This workshop will discuss when, how and why medical assessment and intervention may be needed-- and what to do when a problem is missed.
A discussion of the medical complications with our patients and the relationship with the physician will continue to be discussed. Dr. Tyson's article , Medical Assessment of Eating Disorders in Treatment of Eating Disorders, will be referred to throughout.
Trimester 2 (6 Hours)
Nutritionists and registered dieticians are often in the difficult role of weighing patients and setting the structure of what is needed for healthy eating. This role easily can be fraught with issues of control for our patients. Many patients think they know more than the nutritionist; many want to leave. Understanding what the relationship with the nutritionist means to the patient is an important part of the treatment and one in which an Interpersonal understanding of the relationship can add significant value.
Continued discussion of the role of the registered dietician in the treatment of the patient. We'll be reading articles by Teixeira, (the Role of Autonomous Motivation in Eating) and Saloff-Coste (Nutrition and Psychotherapy Clarifying Roles).
What can we expect from the treatment of the anorexic patient? How quickly should she gain weight? What happens if weight swings up and down on the scale? How can we know if she is telling the truth about what is being eaten? (After all, we’ve all had patients who binge eat and water overload to make goal weights). Is there a place at all for interpersonal thought during weight restoration? This presentation will explore detailed concerns, interventions and clinical theory regarding treatment of the anorexic patient. How treatment should proceed, literally week to week, will be the focus of this talk.
Treatment of the anorexic patient will continue to be discussed with a case presentation and reference to articles by Dr. Michael Strober, (Managing the Chronic, Treatment Resistant Patient with Anorexia Nervosa) and Janet Treasure (The Toolkit for Carers: The Carer's Role in Eating Disorders).
Involvement of the family is a critical aspect of any treatment. All families need to be worked with closely—the question is how and why. Often parents have knowledge not available to the professional team. What should parents do with this knowledge? Parents SHOULD be calling. How to put those calls to best use is the focus of this presentation.
Continued discussion regarding involvement of parents in treatment. We will be comparing Maudsley Family Based Treatment with other ways of directly involving parents in the care of their child. Articles by Dr. Rabinor,, Dr. Brisman and Dr. Le Grange will be used as a base of discussion.
Trimester 3 (6 Hours)
Case presentation regarding medication and the eating disordered patient. "Medication and bulimia: Binge/purge dynamics and the “helpful” pill" by Drs. Owen Lewis and Judith Brisman will be discussed.
Dr. Bermudez will lead an interesting discussion on how and when to consider a higher level of care for patients. The role of medication, the goals of residential care and the path towards outpatient care will be discussed. AUDIO ONLY.
Dr. Sands will teach us how to work with the dissociated aspects of our patients. Who is the part of the patient who turns to food? How can we reach that part of the patient when there is so much shame and dread involved in knowing who that person is?
Dr. Brisman will lead a continued discussion on reaching the dissociated aspects of the patient. Clinical material will be discussed with a backdrop of papers by Dr. Philip Bromberg and Dr. Brisman.
Dr. Tony Bass will work directly with us to consider how the dissociated aspects of ourselves can—and need to be—integrated in our work. What Happens When… she doesn't mention her weight? Please contact us about this program.
We will be reading a paper by Dr. Bass and continuing to discuss his work in depth with an ongoing focus on case material.
For information about accessing the tapes, please contact Dr. Judith Brisman at email@example.com.