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Practitioners…. avoid these common pitfalls
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A person does not
have to be thin or starving to be suffering from an eating disorder. In
fact, many of the deaths from these disorders occur in people who are of
normal weight, but whose purging has imbalanced body chemistries and
electrolytes to the point where the functioning of vital organs is
compromised.
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Don’t expect your
client or patient to voluntarily reveal the existence of an eating
disorder. He or she may not recognize the condition as a problem, or may
feel committed to holding it as a closely held secret.
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A malnourished person
cannot benefit from the psychotherapy process
unless and until he or she has been re-fed. First things first. An
evaluation by a medical doctor must be a first priority for any eating
disordered patient who walks in the door.
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It is a mistake to
assume that by simply treating the patient’s “other” (underlying
emotional) issues, the pathological behavioral aspects of the eating
disorder will eventually disappear. Eating disorders cannot
be treated as you might treat other emotional or mental health problems.
The treatment process is many faceted and based on a framework of
combined attention to physiological, emotional, and family spheres
simultaneously.
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If your approach to
practicing psychotherapy has, to date, been purely non-directive, you
need to rethink whether or not you are game to learn this new approach.
The eating disorder therapist needs to use the self with an active,
directive, though fully client-centered and self-determining therapy
approach. The approach is reality-centered, cognitive-behavioral and
psychodynamic, based on the dynamic here-and now process of the therapy
relationship and of the moment. The eating disordered patient needs to
be educated and informed; the eating disorder therapist needs to be the
educator, guiding the patient purposefully and intentionally through the
process of recovery. At the same time, the patient needs to be empowered
to take on these skills that are first borrowed, then learned, as his or
her own. The eating disorder practitioner functions as teacher,
therapist, reality-tester, cheerleader, communication liaison and life
coach.
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Don’t expect that the
child patient who sees you for individual treatment is not a candidate
for family treatment as well. Eating disorders are family diseases.
Research has shown that family treatment for the young child living
under the same roof with parents is the more effective approach than
individual treatment. The psychotherapist’s orientation must be firmly
rooted in family systems theory with a healthy respect for, and
comfortability with, the need to treat the total family.
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The patient/therapist
relationship must enjoy an inviolate sense of privacy, trust and
protection. Maintain strict confidentiality and avoid the pitfall of
privacy or confidentiality breaches by bringing family members together
face to face to communicate first-hand in a family therapy milieu.
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Remember that the
parents of your child or teenage patients are your patients too. Kids
can’t beat this disease without the help of parents. Parents cannot
be prepared to respond adequately to their child, the disease or the
recovery process without the guidance of the child’s health
professional. Professionals need to empower parents to fight for the
child so the child can be free to battle the disease. The health
professional who does not fully comprehend the effects of the family
system on the disorder and the effects of the disorder on the family
system can make matters worse.
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Remember that weight
restoration does not indicate recovery, though it may be a sign that the
process may have begun to take place in some aspects. Don’t fall into
(or be dragged into) weight watching as a benchmark for recovery.
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