Held on the 17th June, 2017 at the Seedfield Development and Training Centre in Bury.
By: Dr Kirsty Sturzaker – Clinical Psychologist, Outpatient Adult Eating Disorder
And: Dr Magdalene Sampson – Clinical Psychologist & Acting Service Manager, Outpatient Adult Eating Disorder Service
The aims of the workshop were:
- To increase knowledge of the main diagnoses of Eating Disorders
- To consider what it might be like to work with people with an Eating Disorder
- Explore stereotypes and stigma
- Provide an overview of the main evidence based model for treating an Eating Disorder
At the start of the day the group explored our own thoughts and feelings towards clients with Eating Disorders. The exercise in itself proved to be quite challenging and responses such as: selfishness, frustration, therapist doing all the work, a sense of being de-skilled and others came out of the discussion.
The facilitators then described, and outlined the prevalence of, the 3 main disorders using the diagnostic criteria (DSM-V), these are Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. Two other criteria were also explained briefly: Other Specified Feeding or Eating Disorder (OSFED) and Unspecified Feeding or Eating Disorder (UFED).
There are a number of reasons why an Eating Disorder develops including socio-cultural, biological, relationship patterns, family and individual factors. We explored these in some detail throughout the day and put together a formulation using a case study to identify if an eating disorder was present by looking at ‘vulnerability factors’, focusing events’ and ‘triggering events.
The physical effects of an Eating Disorder on the individual were many, with heart prob-lems (cardiac arrest) being the most common, and as such the facilitators work with doc-tors so that the whole person can be monitored.
NICE guidelines state that CBT is the approach to be used when working with someone with an Eating Disorder http://www.nice.org.uk/guidance/ng69
This created some discussion in the group as some attendees who were counsellors had found themselves working with people with an Eating Disorder and felt that the work was going very well with their clients making positive changes.
Both Kirsty and Magdalene have also been trained as CAT therapists and although there has not been an RCT to explore the effects on working with an Eating Disorder, they also felt that there would be some impact through this approach. The overall sense was that not one approach suits everyone and the client should have a choice of treatment through the NHS but until research has been undertaken to provide evidence of the effectiveness of other modalities, CBT will continue to be offered.
The practitioner working with a client with an Eating Disorder is open to a number of potential process and therapeutic relationship issues. The main ones identified in the group were; Therapist doing all the work particularly if the client has been ‘sent’ for treatment; Feeling pressured to complete the work in a set number of sessions; Ther-apist being seen as the ‘expert’ by the client and family; Client avoidance – using a lot of time at the start of a session ‘chatting’; Concerns around ‘duty of care’; Managing the balance – autonomy vs responsibility
Finally, we revisited our list of thoughts and feelings that we put together at the start of the day. It was interesting to see that after our discussions and learning around how someone develops an Eating Disorder we were able to dismiss the majority of our assumptions and preconceptions which left us with a good feeling and a sense of not being scared or over-whelmed by such a referral. Also, should we find ourselves with a person who has an Eating Disorder or we are unsure, we now know who we can contact for advice and support as both Kirsty and Magdalene were happy for anyone to email/telephone to discuss an issue.
Overall, the day was very informative and at times challenging. The facilitators used different methods of training from direct information, working on a case study and watching DVDs which all helped to make the day interesting and extremely thought provoking and I urge those who have no knowledge of this area of work to take some time to gain a basic understanding of the issues just in case you find yourself sitting in front of someone who has or might have an Eating Disorder.
B-eat (formerly the Eating Disorder Association) – Tel: 01603 619090
– Email: b-eat.co.uk
Provides book lists, information, details of support groups, professional database of NHS and private services, training events, message boards and publishes the European Eating Disorders Review