Eating Disorders Part 3: Brief Interventions

Therapy with Eating Disorders
Dr. Dawn-Elise Snipes PhD, LPC, LMHC
Clinical Director, AllCEUs.com
Unlimited CEUs $99 per year. Copyright AllCEUs.com

Objectives
Based in Part on Brief Therapy with Eating Disorders by
Barbara McFarland, and the Overcoming Disordered Eating
Protocol by the Centre for Clinical Intervention
 Shifting paradigms to one of resourcefulness vs. sickness
 Identifying key interviewing questions to develop a
strengths-based alliance

The Therapeutic Relationship
 Determines clients
 Willingness to openly discuss and explore behavior patterns
 Willingness to consider altering eating behavior
 Willingness to disclose accurate information

Motivation Determinants
The clients sense of safety/alliance with the
therapist
Client and therapist have similar goals for
treatment
The cost/benefit of the current behaviors
Fear of fat vs. desire to be healthy
Social pressures vs. desire to change
Sense of self-efficacy vs. being out of control
What other cost-benefits might they need to consider?

Critical Strengths-Based Interviewing Questions

Treatment History Questions
 What kind and type of therapy did you have in treating
your eating disorder
 What parts of your treatment were helpful, if any?
 What interventions were helpful and under what
circumstances
 Do you believe you have any other issues such as
depression or anxiety?
 What interventions or strategies that were helpful in the
past might be helpful now?

Using the miracle question
Focus on tomorrow, not way in the future.
“If your problem was solved magically overnight, what
would be the first thing you notice is different when you
wake up in the morning?” Take me through the rest of
your day and describe what else is different.
The response is fleshed out to help the client
identify specifically what she wants to be
different

Explore Exceptions
 When has what worked and why?
 Under what conditions has each activity produced an
exception and failed to produce an exception
 Why is it important to understand when activities fail?
 Spontaneous Exceptions vs. Deliberate Exceptions

Scaling Questions
 Use scaling questions to help the client stop viewing things
in terms of dichotomies
 Have the client rate on a scale of 1-5 (It is helpful to give
verbal anchors) and then explain why she chose her
number.
 How anxious does it make you to think about…
 How accepted do you feel by…
 How helpful was therapy/x-intervention in the past?
 How often have you been successful at going a day without
bingeing?
 Scaling can help therapists highlight ignored exceptions
and positives
 What other ways could you use scaling questions?

Feedback Messages/Summary
 Highlight positive actions or events
 Agreement with and restatement of the client’s goal
 Ex. “You want to get control of your eating so you don’t feel you
have to purge to maintain your weight.”
 Provision of homework assignment and rationale if
appropriate

Coin Toss
Keep a quarter by your bed. Toss it each morning.
Heads= Pretend it is your miracle day.
Tails= Regular Day.
What “resistance” might you anticipate?
How can you help the client overcome this?
(Schedule homework assignment)
Pay attention to how you feel different and what
others notice as different on your Miracle days

Goals of the First Session
Attend to present and future with little attention
paid to the past
Explore a problem free future
Enhance exceptions and previous solution patterns
Provide feedback and therapeutic compliments
Assign homework

Second session and beyond
 Separate the person from the problem
 Stay focused on client strengths and resources
 Don’t take a position regarding the client’s situation
 Constantly check in to see if the client’s specific goals
have changed. (i.e. I want to be happy, but have realized
that losing weight won’t make me happy it is…)
 Continually evaluate the client's stage of change…watch
for yes buts which indicate…

Developing a Relapse Prevention Plan
 Identify triggers and interventions
 Identify vulnerabilities and prevention strategies
 Identify effective coping tools for dealing with high risk
situations
 Develop a daily mindfulness protocol
 Other??

More tips
Explain the necessity to focus on small goals one
at a time
Highlight the necessity of setting realistic goals
The necessity to tolerate behavioral and
attitudinal slips or relapses

Food Planning
 Must be concrete and practical
 Must be presented as a way to create an “exception”
related to a client’s identified goal
 How many calories
 What about this compromise rewarded/reinforced the client’s
willingness to increase calories?
 Calorie Counting---good or bad???
 What foods
 How often: every 3-4 hours
 The food plan template 50-25-25 ish 1500-2500cals

Self Monitoring Journal
 Create a table asking…
 Time
 What did you eat?
 How much did you eat?
 Were you hungry? If not, what prompted your eating?
 Were you craving sweet/salty/spicy or a specific food?
 How did you feel after you ate?
 Did you purge?
If yes, how did you feel afterwards and what could you do
differently next time?
If no, how did you feel afterwards and what did you do to
prevent the purge?
 What information/exceptions can you derive from this type of
table?
 How might this table be helpful?

The Ripple Effect
 Addressing seemingly unrelated concerns can have a
positive (or negative) effect on eating behaviors.
 Why?
 Part of brief therapy means meeting the client where they
are at, and developing mutually agreeable goals.
 For a client who does not want to gain weight and is still adamant
about eliminating whole food groups, how can you align goals?
 For a client who is terrified of gaining weight if she stops exercising
and affiliated behaviors, but cannot “moderate” her activity in the
gym?

Overcoming Disordered Eating Treatment Protocol
 What Is An Eating Disorder
 How Ready Am I To Change
 How Eating Disorders Are Maintained
 Self-monitoring
 Regular Eating and Weighing
 Binge, Purge, Driven Exercise
 Moods Disordered Eating
 Dietary Rules
 Progress and Review Barriers

Overcoming Disordered Eating Treatment Protocol
cont…
 Over-evaluation Of Weight and Shape
 Challenging Thoughts
 Challenging Dietary Rules
 Checking, Avoidance and Feeling Fat
 Low Self-esteem
 Improving Low Self-esteem
 What Are Mindsets
 Changing Mindsets
 Relapse Prevention

Summary
 Develop mutually agreeable goals focusing on what the
client hopes to achieve
 Use the miracle question to help clients identify their
goals
 Support the client’s successes and avoid reinforcing
undesired behaviors
 Explore the use of journals and the handouts to help
clients process between sessions
 Develop a relapse prevention plan early in treatment to
help clients address the main presenting symptom.

Eating Disorders Part 3: Brief Interventions

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