Comprehensive Treatment of Eating Disorders

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Title: Comprehensive Treatment of Eating Disorders

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At Castlewood we begin with the premise that each person who walks through our doors defies simple categorization. The result is a residential treatment program for eating disorders that allows for the treatment of each individual with an emphasis on compassion, respect and empowerment. – PowerPoint PPT presentation

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Title: Comprehensive Treatment of Eating Disorders

1
Comprehensive Treatment of Eating
DisordersPreferred Provider ConferenceSunday
January 31stTheresa Chesnut LCSWCastlewood
Treatment Center for Eating Disorders800 Holland
Road636-386-6611www.castlewoodtc.comtheresa.che
snut_at_castlewoodtc.com
2

Comprehensive Treatment of Eating Disorders

In less than 2 hours
3

The secret of life that we are all looking for
is just this
To develop through sitting and daily life
practice the power and courage to return to that
which we have spent a lifetime hiding from to
rest in the bodily experience of the present
moment even if it is a feeling of being
humiliated of failing of abandonment of
unfairness.
-Charlotte Joko Beck

Back to Basics

5

6
Compassion

In other traditions demons are expelled
externally. But in my tradition demons are
accepted with compassion.
-Machik Labdron The Places That Scare You

7
Eating Disorder Takes Away

Ability to be human (stay out of your body!)
Voice
Ability to be in your body
Breathe
Pleasure
Joy
Spontaneity
Allowance to have needs wants desires
Passion and vibrancy
Balance
Intimacy with self and others
Resulting in the loss of self
Loss of soul and spirit

8
How is Recovery Measured

Recovery is not just the absence of symptomsit
is the presence of a full life as evidenced by
the ability to be human. A truly recovered life
will reflect spontaneity freedom the ability to
breathe to have wants needs and desires
knowing that the quest for perfection is an
unattainable illusion. Having the ability to
embrace the feminine having close intimate
relationships and it is being aware of the tears
in your eyes (whether out of intense or subtle
sadness or out of joy or from a flicker of
utter gratefulness) and then to allow your tears
to flow freely. It is a life in which decisions
and choices are made more from self and less from
a shame and fear based prison. It is a life
where you fully experience pleasure joy and
passion and believe and know it is good to desire
and enjoy sex

9
vulnerability
eating disorder
vulnerability
recovering
childhood
safety
safety

10
Recovery and Treatment Process

Eventually the eating disorder takes up
residency in the headso work to separate it by
working with cognitive distortions
Offer your client education
Be aware of intense fear and body distortions
All the while taking care of nourishing the body
The goal realigning the head body heart and
soul

The client hired you
to fight their
Eating disorder. To be
warrior for their
recovery

12
In Reference to Eating Disorders

These disorders which are so pervasive in our
current world illustrate that beneath the veneer
of self reliance lies the core of powerlessness
alienation detachment self-hate and shame.
(K.B. Walant 1995)

Each are goodbut not sufficient to treat
eating disorders
Dr. Mark Schwartz

14
Create Safety Then

Get them out of their heads! Working with
cognitive distortions.
Give anticipated guidancethere is no quick fix.
Recovery work has to take place outside of the 50
minute hour.
Realities about the illness relapse and
mortality

Contain Symptoms

Imperative to know and understand the eating
disorder
Inside outside the good the bad the ugly

17
Writing/Journaling

Your worst eating disorder day
Using a journal entry or intense situation
follow the thoughts and map out the feelings and
triggering event

18
Writing Assignments

Dialogue with fat
Have family members write why they believe client
has an eating disorder
Letters to ED to the body from the body
How does the way you relate to food resemble how
you relate to people

Have the eating disorder write and introduce
itself
likes dislikes values fears hopes and goals
What will your life look like in 5 years
What did you learn in your family about food
body size femininity feelings

19
Free Associationalways be listening for
cognitive distortions/errors and be curious

In this body
If I recover
Eating means
Thin normal healthy fateach mean
My eating disorder is active by
Without my eating disorder Im
From ED
I need
I want
I hope

20
Relapse Prevention

21

Faith is taking the first step even when you
dont see the whole staircase
Martin Luther King
Jr.

Are you willing to be
uncomfortable

23
It Is About the Food!

Deconstructing the meaning of food
Write in detail a description of your addictive
behaviors
Have a meal with your client
Explore fears of allowing self to taste enjoy
desire food.

24
Expressive Therapies

25
Interventions

The art as a container allows the person to view
and own the authentic experience thereby
enhancing the observing functions boundaries and
self-esteem.
Art work allows a visual representation of
dichotomous beliefs relationships etc -
thereby allowing the individual to a space to
reconsider and revise what has been.

26
Goals of Expressive Therapies in the Treatment of
Eating Disorders

Embodiment.
Development and enhance affect regulation.
Enhance other self functions such as boundaries
and self esteem.
Re-associate what has been disassociated exiled
parts or ego states.
Access emotion/sensory motor experience
(traumatic/implicit memory).
Dissolve dichotomous boundaries and ways of
perceiving.
Vivify internal resources.

Hilde Bruch (1985) considered anorexia to be
characterized by an underlying disturbance in the
development of self identity and autonomyArt
therapy with the anorexic individual can provide
a means of addressing underlying deficits in the
organization of the self.

The fucking
MUFFIN

Control of Symptom
vs
Recovery

We have to ask our clients to be willing to
stay. You must be willing to stay with your
client.

Relapselapserelapselapse

32
The Balancing Act

33
Restrictive Part

Exercise
Rules yoga pilates work hard push through
it dont listen to your body isolate minimize
deny dont let anyone know lie rigidity feel
the pain feel the burn suck it up be the best
at what your doing be better than everyone else
always compete you dont have a choice (belief)
you have to even if you dont want to you always
have to be in shape control weight weigh
yourself weight training elliptical for 1
hours 2 miles in 12 minutes count calories
burned on machines at gym you must always time
yourself when exercising miss hanging out with
friend or family obligations to exercise 3000
sit-ups and 100 pushups everyday stretching
everyday out of shape Ill be fat Ill gain
weight I have to work harder than everyone else
just to level out theres nothing wrong to
exercise and take care of body if Im going to
be/am a competitive collegiate athlete exercise
will make me happy taking care of your body is
what youve done your whole life you cant stop
now Im slow Im weak Im proud of myself in
showing off my talents to make me feel better
about myself I define (my) self-worth (is only
defined) through my athletic performance and
exercise accomplishments a serious athlete can
never work too hard or too long at their sport
if I dont work hard enough my performance will
suffer even the smallest breaks from training
will cause me to gain weight and be unable to
compete at the same level I have to force myself
to exercise even if I dont feel well Exercising
gives me a sense of power and control over my
life.
Goals start exercising sculpt body lean
muscular fit in shape be a yoga instructor a
personal trainer train to play soccer
competitively again have a regime yoga
retreats live at Kripalu join a gym do yoga
4-5 times a week do sit-ups exercises yoga in
the morning before breakfast.
Eating
Rules pure healthy organic clean perfect
nurturing holistic alternative nothing toxic
nothing processed raw and living simplistic
controlled pretty natural fruits and
vegetables sprouting juicing dehydrating
food no carbohydrates wheat grass highest
nutrient value health food stores Farmers
Markets whole foods Kambucha Yerba Mate no
breakfast a salad for lunch edemame rice
cakes kefir legumes steamed vegetables big
salads veggie juice no soda no coffee lots of
water antioxidants café Gratitude salad bars
raw vegan vegetarian restaurants fasting
cleansing.
Beliefs in control motivated allow self to do
things that critical part would tell you youre
not capable of doing hardworker do whatever you
can to succeed finds misleading happiness
confidence self-assurance determination eating
this way and carrying out this lifestyle will
lead me to connect to types of people that will
lead me to eating healthfully will make me happy
and will bring me joy in life I have to eat this
way and weigh a certain amount in order to stay
motivated determinated worthy confident
capable accepting to be loved and succeed
(make all the things that I envision in my life
to be) as true in my life anything is possible
I can be loved and love myself when I take care
of my body in this way this is the way I grew
up this is how I am the way I view food is
different and I must keep true to myself Im
different I care what I put in my body Im
helping improve mother earths state by eating
this way I contribute to the locals not
corporations it says to eat this way in the
magazines in books etc. to keep healthy
theres nothing wrong with the way I view food
other people dont understand they didnt grow
up in Berkeley CA they didnt grow up learning
about how and why to eat healthfully and
organically is good for our agriculture.

34
Binge Eating Part

Food
Rules dont tell anyone dont let anyone know
be secretive be alone eat past fullness lie
sneak around eat foods that are most enjoyable
to the palate do it again after the pain is
gone if no other alternative use soda or coffee
dont be in touch with hunger and fullness buy
everything from health food stores whole foods
dont purge feel the pain and uncomfort detach
from body keep people away do it alone dont
go out into public afterwards isolate sleep the
whole day dont live life feel hopeless
helpless for oneself gain weight feel like
shit carry out on fantasies with food gorge
with food you like eat when your sad lonely
bored unloved plan the perfect binge
disociate go to the store and buy food so no one
will notice any food gone at the house cheese
with honey almonds/peanut butter/almond butter
cereal with soymilk indian food panninis
carbs organic Amys frozen food
chocolate/yogurt covered anything baked goods
scones muffins breads cookies ice cream
chocolate buy things that are the best quality
when desperate just eat whatever you can find to
fill the void with.
Beliefs it will fill my void I cant cope with
daily stresses and problems in life so I might as
well binge lack of control if I can never stop
eating or control what or how much I eat whats
the point of living Nemesis greatest enemy
greatest fear steals serenity hate yourself it
makes me feel comfortable for the time being
food will love you will lead to obesity will
lead to self-soothing it alleviates loneliness
it comforts me initially its so satisfying
its my only friend a planned binge gets me
something to look forward to in the beginning it
brings happiness and excitement I deserve to
enjoy food and not starve myself doesnt care
this will make me feel better in the moment I
deserve to self-soothe through food nothing else
will make me feel better other than the food Im
craving if I started why stop Why deprive
myself Ive let myself fall a little - might as
well fall the whole way I cant just have 1
cookie I deserve to splurge theres no such
thing of having a normal sized portion of what
Im craving countering urges is impossible if
urges become present theyll never go away until
I act out binge all you want because you know
your not going to live for long bingingdeath.
Feelings anxiety overwhelming distressed
loathing hatred rage depression numbness
suicidality unsatisfied shame guilt no
self-esteem embarrased.

35
Recovery Part

Capable
Creative
Compassionate
Self love!
Connected
Clear
Courage
Curiosity
Tolerant
Acceptance
Strength
Confidence
Trust

36
Critical Part

Comparing myself to unrealistic/impossible
standards.
I criticize for criticizing myself
You cant recover!
Im dead
Failure
Youre worthless
Youll always be rejected
Be thin again
My dreams will never come true
Disgusting
Stupid
No success
Disappointment
Be perfect
Therapy is not working
Youll never be happy
Youre a failure
I hate myself!
Insecure

Errors
Youll never go to college
Why
Too judgmental
Intoxicated
You will never recover!
You should of
Will I
Too hard for you to handle!
Toxic
Im hopeless
Youre not capable
Why did you trust
Youre a piece of shit
Mistakes
Dont let anybody in
Never accept yourself
Be miserable.
INSANE

Uncontrollable
Kill yourself!
Inadequate
Nothings working
End your life
Youre going to become obese
SHAME
Criticism
Dont upset people
Humiliation
Vulnerable
I have no capacity of succeeding in the
future!
I can never change
Pollution!
Too difficult
Fake and unreal
Ostracized
No risks
Poison!

She called upon the different Parts of herself
for Help. If she was going to make it she
needed to Accept them all Unite them all. And
Believe in them all. It was time for a huddle of
tremendous proportions. It was the making of her
Giant.
anonymous

What are you willing to do to recover
Risk not feeling safe
Risk being vulnerable

Still willing
to be uncomfortable

40
Its okay no it is essential to ask for and
allow others to help.
41
How is Recovery Measured

Recovery is not just the absence of symptomsit
is the presence of a full life as evidenced by
the ability to be human. A truly recovered life
will reflect spontaneity freedom the ability to
breathe to have wants needs and desires
knowing that the quest for perfection is an
unattainable illusion. Having the ability to
embrace the feminine having close intimate
relationships and it is being aware of the tears
in your eyes (whether out of intense or subtle
sadness or out of the joy or from a flicker
of utter gratefulness) and then to allow your
tears to flow freely. It is a life in which
decisions and choices are made more from self and
less from a shame and fear based prison. It is a
life where you fully experience pleasure joy and
passion and believe and know it is good to desire
and enjoy sex.