Dr. Dawn-Elise Snipes PhD, LPC, CRC, NCC Clinical Director, AllCEUs.com Unlimited CEUs for $99 per year.  Copyright AllCEUs
<ul><li>Self-destructive behavior has been increasingly correlated with a history of childhood abuse and neglect  </li></u...
<ul><li>The term victim has been replaced by the term survivor.  </li></ul><ul><li>The positive connotations of survivor v...
<ul><li>Not all incestuous activities are overtly sexual, some are emotionally incestuous  </li></ul><ul><li>Unknowingly, ...
<ul><li>Survivors of many incestuous acts have parents who tacitly permit the abuse or deny its occurrence.  </li></ul><ul...
<ul><li>Children often do not have the capacity to say what they see and feel.  </li></ul><ul><li>Children who are traumat...
<ul><li>Trauma inflicts a very real toll on what Erickson termed basic trust </li></ul><ul><li>Trust can only be reestabli...
<ul><li>Binges are often preceded by a trancelike state or a period of self hypnosis during the binge so the individual ha...
<ul><li>Dissociation is the mind’s attempt to deal with overwhelming stressors </li></ul><ul><li>Secondary problems of PTS...
<ul><li>Defining your needs and achieving goals are defining characteristics of mentally healthy people.  </li></ul><ul><l...
<ul><li>When these expectable parental functions are not forthcoming, what are the consequences?  </li></ul><ul><li>What o...
<ul><li>Some patients will manifest the behavior that conveys a need to protect their parents.  </li></ul><ul><li>They ref...
<ul><li>Treatment for the Eating Disorder begins by  </li></ul><ul><ul><li>Establishing a descriptive diagnosis of the sym...
<ul><li>Treatment must assist the patient in mastering and transforming their inherent distrust in other people. </li></ul...
<ul><li>The patient will have to find solutions to the loss of her childhood. (i.e. recreating, mourning etc…) </li></ul><...
<ul><li>Most helpful is the ambience that permits patients to speak about the childlike yearnings.  </li></ul><ul><ul><li>...
<ul><li>We all carry more power within ourselves to effect change and survived adversity than we give ourselves credit for...
<ul><li>Survivors of sexual abuse may use promiscuity and sexually stylized behavior to get affection and attention. </li>...
<ul><li>The central thesis of this approach rests on the fact that the eating disorder has been a “solution” albeit a dysf...
<ul><li>What is causing the epidemic of obesity in a culture? </li></ul><ul><li>Obesity appears to be strongly influenced ...
<ul><li>23 to 46% of obese individuals who seek treatment for weight loss binge  </li></ul><ul><li>There are both obese an...
<ul><li>Without being aware we control caloric intake and physical activity to maintain constant energy stores based on in...
<ul><li>When by weight rises above 20% of average, mortality increases dramatically.  </li></ul><ul><li>What may be more d...
<ul><li>The societal contempt of obesity causes great  anguish and can lead to social rejection and employment discriminat...
<ul><li>Many obese patients become frustrated and nondirective therapy because they want the therapist to assume responsib...
<ul><li>Obese individuals may be less sensitive to internal cues, unable to identify hunger, promotions, and other bodily ...
<ul><li>Food may serve as a soothing/transitional object like a blanket or small toy that soothes the person when caregive...
<ul><li>Among obese people who binge and who have problems with depression, medication has not been found effective in hel...
<ul><li>People sometimes acknowledge that they pay only lip service to the idea of eating less.  </li></ul><ul><li>Their t...
<ul><li>Nothing is more crucial for individuals than to find a place where they feel valued for themselves as they are reg...
<ul><li>Any person must change because of a  desire  to do so, not in an effort to please the therapist parent spouse or c...
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Eating Disorders Counselor Certificate Training Part 4

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Part of a 12 part series of courses at AllCEUs.com resulting in the receipt of a certificate in eating disorders counseling. Addresses bulimia, binge eating, anorexia, obesity. Uses The Body Betrayed by Zerbe and Brief Therapy with Eating Disorders by McDonald in addition to Dr. Snipes clinical experiences.

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Eating Disorders Counselor Certificate Training Part 4

  1. 1. Dr. Dawn-Elise Snipes PhD, LPC, CRC, NCC Clinical Director, AllCEUs.com Unlimited CEUs for $99 per year. Copyright AllCEUs
  2. 2. <ul><li>Self-destructive behavior has been increasingly correlated with a history of childhood abuse and neglect </li></ul><ul><li>Traumatic events left indelible and distressing memories, memories to which the sufferer was continuing to return. </li></ul><ul><ul><li>How does the ED act as a solution to this? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  3. 3. <ul><li>The term victim has been replaced by the term survivor. </li></ul><ul><li>The positive connotations of survivor versus victim must not whitewash the patient’s subjective experience. </li></ul><ul><li>The data emphasize that sexual abuse has affected as many as ½ of adult women living in the US </li></ul><ul><li>50 to 65% of all eating-disordered patients reported history of physical or sexual assaults. </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  4. 4. <ul><li>Not all incestuous activities are overtly sexual, some are emotionally incestuous </li></ul><ul><li>Unknowingly, parents may make sexual gestures, encourage age inappropriate cuddling or hugging were repeatedly and by the child to share their beds. </li></ul><ul><li>Some parents may also become jealous of relationships their children have with others and go to great lengths to discourage them from developing relationships. </li></ul><ul><ul><li>What is the benefit to the parents of this? What is this behavior a “solution” to? </li></ul></ul><ul><ul><li>What is the detriment to the child of this? </li></ul></ul><ul><ul><li>How do EDs serve as solutions to these problems for the child? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  5. 5. <ul><li>Survivors of many incestuous acts have parents who tacitly permit the abuse or deny its occurrence. </li></ul><ul><li>The prognosis for overcoming sexual trauma is worse for those whose families are unsupportive. </li></ul><ul><li>As many do 80% of those who have been survivors of incest find it difficult to relax and enjoy sexual encounters, they avoid sex or try to master to compulsivity. </li></ul><ul><ul><li>In what way may be eating disorder serve to protect the person's inner child from revictimization? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  6. 6. <ul><li>Children often do not have the capacity to say what they see and feel. </li></ul><ul><li>Children who are traumatized at a young age may only be able to remember the quality of an event rather than its content or details. </li></ul><ul><ul><li>How do ED behaviors act as solutions here? </li></ul></ul><ul><li>Survivors may regress to earlier patterns of behavior including temper tantrums </li></ul><ul><li>The process of working to the effects of sexual abuse in clinical situations often leads to an exacerbation of the eating disorder. </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  7. 7. <ul><li>Trauma inflicts a very real toll on what Erickson termed basic trust </li></ul><ul><li>Trust can only be reestablished over time with the caregiver who respects limits and boundaries. </li></ul><ul><li>If peers or professionals push too quickly for details, a person treatment may begin to feel revictimized. </li></ul><ul><li>Denial, numbing, self hypnosis, and dissociation a classic symptoms of “solutions” to post-traumatic stress syndrome. </li></ul><ul><li>The abused person may fear for her very survival yet often depends on those who hurt her </li></ul><ul><li>This leads her to disavow her anger at all costs. </li></ul><ul><li>Eating disorders may be expressions of these defense mechanisms. </li></ul><ul><ul><li>Patients will describe how calm they feel after an episode as if they are encased in a cocoon. </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  8. 8. <ul><li>Binges are often preceded by a trancelike state or a period of self hypnosis during the binge so the individual has little recollection of the event itself. </li></ul><ul><li>Many patients do not report a history of abuse until well into the classic therapeutic relationship. </li></ul><ul><li>Memories may emerge in the context of a trusting established relationship or once the individual’s psyche is strong enough to handle it </li></ul><ul><ul><li>In what ways can childhood physical abuse, sexual abuse, emotional neglect create an inherent distrust in the basic benevolence and respect for other people? </li></ul></ul><ul><ul><li>If the parents were not the perpetrators, what impact might this victimization have upon the way child views the parents? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  9. 9. <ul><li>Dissociation is the mind’s attempt to deal with overwhelming stressors </li></ul><ul><li>Secondary problems of PTSD include </li></ul><ul><ul><li>chronic depression </li></ul></ul><ul><ul><li>poor self-esteem </li></ul></ul><ul><ul><li>feelings of powerlessness and hopelessness </li></ul></ul><ul><ul><li>the inability to achieve professionally or interpersonally. </li></ul></ul><ul><li>Like dissociation, the symptom is then used as a “solution” for survival and is not easily given up </li></ul><ul><li>The individual must be helped to see how the eating disorder has become a reliable (albeit unhealthy) way to deal with her own overwhelming anxiety and rage. </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  10. 10. <ul><li>Defining your needs and achieving goals are defining characteristics of mentally healthy people. </li></ul><ul><li>Parents provide us with the capacity to organize our thoughts, plan our activities and achieve our personal goals. </li></ul><ul><li>Through it all we internalize </li></ul><ul><ul><li>the process itself </li></ul></ul><ul><ul><li>some of our parents attributes </li></ul></ul><ul><ul><li>Identifications of our own attributes </li></ul></ul><ul><li>Eventually we generate a vital and flexible internal sense of self (introject) </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  11. 11. <ul><li>When these expectable parental functions are not forthcoming, what are the consequences? </li></ul><ul><li>What occurs when the usual intergenerational boundaries within the family breakdown and the child is left to fend for herself emotionally and physically? </li></ul><ul><li>When a parent is impaired or has a deep emotional disturbance, the child may be called on to care for that parent. Who then cares for the child? </li></ul><ul><ul><li>How can ED symptoms act as solutions to these problems or their effects? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  12. 12. <ul><li>Some patients will manifest the behavior that conveys a need to protect their parents. </li></ul><ul><li>They refuse to knowledge any anger towards them or their treaters. </li></ul><ul><li>They believe rage will push others into abandoning them. </li></ul><ul><ul><li>What may have occurred for a child who believes that she needs to protect her parents and that anger towards parents will push them away, overwhelm them, or cause them to abandon the child? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  13. 13. <ul><li>Treatment for the Eating Disorder begins by </li></ul><ul><ul><li>Establishing a descriptive diagnosis of the symptoms/presenting issue </li></ul></ul><ul><ul><li>Identifying times when the presenting issue does not or has not occurred </li></ul></ul><ul><ul><li>Planning to enhance those times </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  14. 14. <ul><li>Treatment must assist the patient in mastering and transforming their inherent distrust in other people. </li></ul><ul><ul><li>What solutions would help with this? </li></ul></ul><ul><li>Therapists need to be less concerned about the actual veracity of the recollections and more concerned about the meaning and feeling with which the patient and gives them. </li></ul><ul><ul><li>What solutions can help the patient effectively deal with this? </li></ul></ul><ul><li>Realizing that individuals will see different meanings in any event, patients must concur that no person knows the absolute truth. </li></ul><ul><li>It is more important to help her understand and cope with the thoughts and feelings that are motivating the perceptions. </li></ul><ul><ul><li>In what ways can the therapist do this? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  15. 15. <ul><li>The patient will have to find solutions to the loss of her childhood. (i.e. recreating, mourning etc…) </li></ul><ul><li>She made tenaciously hold onto the belief that the therapist can magically become the mother or father she never had. </li></ul><ul><li>These patients may make the therapist feel guilty for establishing boundaries. </li></ul><ul><li>The patient must learn to accept in her adult life an innocence she can never reclaim. </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  16. 16. <ul><li>Most helpful is the ambience that permits patients to speak about the childlike yearnings. </li></ul><ul><ul><li>How?/Why? </li></ul></ul><ul><li>Helping the patient's adult self tolerate and care for the demands of the lonely and angry inner child is a pivotal point in the treatment. </li></ul><ul><ul><li>What would this serve as a solution for? </li></ul></ul><ul><li>Changing long-held life scripts can be challenging, and the therapist and patient must approach their work together as an adventure. </li></ul><ul><ul><li>How? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  17. 17. <ul><li>We all carry more power within ourselves to effect change and survived adversity than we give ourselves credit for having </li></ul><ul><li>Eating-disordered patients must learn to accept that: </li></ul><ul><ul><li>mistakes are inevitable </li></ul></ul><ul><ul><li>personal growth benefits greatly from knowledge </li></ul></ul><ul><ul><li>although she will not be able to change her past, with knowledge and acceptance she can influence her present and her future. </li></ul></ul><ul><ul><li>How can you help her use her solutions and successes to learn these things and empower herself. </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  18. 18. <ul><li>Survivors of sexual abuse may use promiscuity and sexually stylized behavior to get affection and attention. </li></ul><ul><li>Periods of celibacy may in fact be necessary so that a woman who's been sexually abused can learn to establish other types of intimate bonds and ways of feeling empowered </li></ul><ul><li>Some of the new antidepressants have been shown to have positive and selective impacts on PTSD </li></ul><ul><li>The medication helps readjust the internal thermostat that enables these patients to experience intrusive thoughts less intensely. </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  19. 19. <ul><li>The central thesis of this approach rests on the fact that the eating disorder has been a “solution” albeit a dysfunctional one. </li></ul><ul><li>The goal of Solution-Focused treatment is to enhance the self affirming activities (Solutions) to enhance the knowledge that safe interpersonal bonds can be formed and maintained. </li></ul><ul><li>Traumatized patients are frequently very difficult to engage in traditional therapy which is related both to fear of attachment, fear of abandonment, and a reluctance to remember the trauma itself. </li></ul><ul><li>Solution focused therapy provides a nonthreatenting alternative to traditional therapy. </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  20. 20. <ul><li>What is causing the epidemic of obesity in a culture? </li></ul><ul><li>Obesity appears to be strongly influenced by genetic factors </li></ul><ul><li>Many obese people believe they have a metabolic imbalance. </li></ul><ul><li>Energy expenditure is more than 26% less in infants who become obese by age 1 </li></ul><ul><li>Half of the infants of obese mothers become obese by age 1, but lean mother seldom produce obese children. </li></ul><ul><ul><li>What biological, environmental factors, social factors, and emotional factors might contribute to this? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  21. 21. <ul><li>23 to 46% of obese individuals who seek treatment for weight loss binge </li></ul><ul><li>There are both obese and normal-weight individuals who have significant problems with eating but do not purge. </li></ul><ul><li>Among obese people who binge eat are symptoms of </li></ul><ul><ul><li>depression </li></ul></ul><ul><ul><li>sexual dysfunction </li></ul></ul><ul><ul><li>family histories of obesity </li></ul></ul><ul><ul><li>frequent the failed attempt to lose weight </li></ul></ul><ul><ul><li>Body image disturbance also tends to be high. </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  22. 22. <ul><li>Without being aware we control caloric intake and physical activity to maintain constant energy stores based on internal body thermostats. </li></ul><ul><ul><li>Humans will naturally maintain their biological weight set point if they eat nutritious foods when they are truly hungry . </li></ul></ul><ul><ul><li>Failure to eat nutritious foods may leave the person with cravings in order to make up for a nutrient deficit despite having already met caloric needs. </li></ul></ul><ul><ul><li>Likewise, eating when one is not hungry will also lead to overconsumption of energy. </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  23. 23. <ul><li>When by weight rises above 20% of average, mortality increases dramatically. </li></ul><ul><li>What may be more dangerous to health is the fluctuation of body weight brought on by repeated dieting. </li></ul><ul><li>Maintaining a little extra weight without repeated fluctuations produces little or no health risk. </li></ul><ul><li>Many types of cancers are associated with diet </li></ul><ul><li>Sex is also affected by weight and body fat distribution. </li></ul><ul><ul><li>Heavier women desire sexual intercourse more often than did their thinner counterparts. </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  24. 24. <ul><li>The societal contempt of obesity causes great anguish and can lead to social rejection and employment discrimination. </li></ul><ul><li>Many obese people face discrimination and prejudice and pay a higher psychological price for their condition. </li></ul><ul><ul><li>They shoulder constant humiliation for their weight </li></ul></ul><ul><ul><li>They have restricted physical mobility </li></ul></ul><ul><ul><li>They may fail repeatedly at dieting. </li></ul></ul><ul><li>Their increased futility and depression leads to a pervasive sense of having failed to fit into a world of smaller people. </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  25. 25. <ul><li>Many obese patients become frustrated and nondirective therapy because they want the therapist to assume responsibility for them and to make decisions for them. </li></ul><ul><ul><li>This is a solution to feeling ineffective at finding their own solutions </li></ul></ul><ul><li>Control of their lives seems to lie outside them, and it is the therapists job to assist them in </li></ul><ul><ul><li>Finding the “exceptions” and “solutions” </li></ul></ul><ul><ul><li>Highlighting that they were there all along </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  26. 26. <ul><li>Obese individuals may be less sensitive to internal cues, unable to identify hunger, promotions, and other bodily states correctly. </li></ul><ul><li>It is suspected that a maternal gap in early learning behaviors needs to be development of a defective sense of effectiveness and an inability to modulate feeling. </li></ul><ul><ul><li>Discuss this </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  27. 27. <ul><li>Food may serve as a soothing/transitional object like a blanket or small toy that soothes the person when caregiver is absent. </li></ul><ul><li>Weight gain may exacerbate feelings of unlovableness and disappointment in themselves and in others. </li></ul><ul><li>Karl Menenger wrote that we unconsciously equate food with love </li></ul><ul><ul><li>eating voraciously can thus be seen as a way that he can or incorporate the love a person wants. </li></ul></ul><ul><ul><li>Overeating can also help keep us at a distance from others. </li></ul></ul><ul><ul><li>Fat serves as a protective function. </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  28. 28. <ul><li>Among obese people who binge and who have problems with depression, medication has not been found effective in helping their moods. </li></ul><ul><li>Medication has been found effective in some cases, at reducing the urge to binge, possibly by reducing free-floating anxiety. </li></ul><ul><li>Binge eating might be thought of as a dissociative disorder </li></ul><ul><li>One common fantasy among obese people is that weight control is possible without limiting caloric intake. </li></ul><ul><ul><li>If this is the answer to the miracle question, how can we make it a reality? </li></ul></ul><ul><ul><li>What are they really asking for? </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  29. 29. <ul><li>People sometimes acknowledge that they pay only lip service to the idea of eating less. </li></ul><ul><li>Their tendency to deny what is actually eaten while searching for easy solutions to the primary problem </li></ul><ul><ul><li>What is the motivation and how can the therapist help the patient move past easy solutions? </li></ul></ul><ul><li>Resistance can be thought of as a result of the failure to identify the correct solution </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  30. 30. <ul><li>Nothing is more crucial for individuals than to find a place where they feel valued for themselves as they are regardless of what they weigh. </li></ul><ul><li>At times the patient may denounce the therapist who takes the neutral stance about weight loss or weight gain. </li></ul><ul><li>This position rests on the understanding that individuals are of value regardless of their appearance. </li></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs
  31. 31. <ul><li>Any person must change because of a desire to do so, not in an effort to please the therapist parent spouse or child. </li></ul><ul><li>Throughout this process of self-examination the emphasis should be on self acceptance as well as on developing a realistic sense of what may be biologically possible. </li></ul><ul><li>Help the patient examine how this image of the ideal figure solved her problems </li></ul><ul><li>To develop a true self, obese people must take into account both their physical and psychological needs and then integrate the two find solutions to previously unidentified problems </li></ul><ul><li>The goal for nutritional counseling is to help individuals increase their: </li></ul><ul><ul><li>awareness of the need to consistently eat healthfully and exercise </li></ul></ul><ul><ul><li>their social supports </li></ul></ul><ul><ul><li>conscious control over their eating </li></ul></ul>Unlimited CEUs for $99 per year. Copyright AllCEUs

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