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BETWEEN THE MONKEY AND THE KANGAROO

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Philip Barretta, MA, MFT. 2. ANOREXIA NERVOSA or BULIMIA. Each one is a serious eating disorder. Anorexia and Bulimia - a compounded challenge. 3 ... – PowerPoint PPT presentation

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Title: BETWEEN THE MONKEY AND THE KANGAROO


1
BETWEEN THE MONKEY AND THE KANGAROO
  • WS 27 - 830 -1030 AM
  • Sunday, December 9, 2007
  • Norma Barretta, PhD
  • Philip Barretta, MA, MFT

2
  • ANOREXIA NERVOSA or BULIMIA
  • Each one is a serious eating disorder
  • Anorexia and Bulimia -
  • a compounded challenge

3
  • About 20 to 23 million Americans suffer from
    depression (Gardner 2004)
  • World Health Organization expects an increase in
    these numbers.

4
  • Many reports of increases in the number of cases
    of bulimia between 1988 and 2000 (Hag in
    Psychiatric Times 2005)

5
  • Depression and eating disorders collide(!) in 36
    to 68 of cases (Maser, Weise and Gwertman 1995)
    creating a scenario for SUICIDE. A dilemma for
    us to use hypnosis going against established
    protacols at the time (Kroger - NEVER
    hypnotize a suicidal patient.)

6
  • But.hypnosis is useful for eating disorders
    (Barabasz and Watkins 2005 Lynn, Rhue, Kvaal
    Mare 1993 others).
  • Lots of anecdotes very little controlled
    research hypnosis for depression is bad.
    Recently hypnosis works when carefully applied
    with depressed suicidal patients.

7
  • Yapko (1993)
  • 1. Hypnosis makes active and experiential
    learning possible
  • 2. Hypnosis brings about faster integration of
    germane learning
  • 3. Hypnosis establishes therapeutic
    associations in a more concerted manner.

8
  • 4. Hypnosis disrupts ones habitual experience
    of oneself that augments developing an unstable
    attributional style and,
  • 5. Hypnosis models flexibility by inspiring
    experiences beyond ones usual constraints.

9
  • More energy leads to suicide?
  • Hypnosis does NOT
  • 1. strip away defenses,
  • 2. dissolve ego boundaries or impulse
    control
  • 3. create or amplify hopelessness

10
  • 1907 Pierre Janet used hypnosis with patients
    who were entertaining eating disorders.
  • They ALREADY are in a dissociated state! making
    them relatively easy to hypnotize

11
  • (Pettinati et al, 1985) eating disordered
    patients have a tendency to dissociate when they
    engage in purging behaviors.
  • And because they naturally are more prone to
    dissociate they are more prone to be hypnotized
    because hypnosis necessitates dissociation to a
    certain degree.

12
  • Erickson used indirect suggestion and paradox
    with a 14 year old anorexic girl
  • 1. Distracting frames of reference Lectures
    on oral hygiene and absurdly precise
    instructions for mouth care were presented.

13
  • 2. Depotentiating masochistic defenses The
    patient was instructed to rinse her mouth daily
    with cod liver oil. Punishment for failure was
    eating food. The patient , of course, failed.

14
  • 3. Therapeutic double bind The patient was
    instructed to oversee her parents weight gain.
  • 4. Emotional Catharsis The therapist provoked
    the patient by accusing her of being a liar and
    a coward.

15
  • We use the patients own hypnotic talent and
    reframe the interval perspective.

16
  • Yapko patients often use their hypnotic
    talent to construct the depression
  • 1. Age regression, by primarily focusing on
    past painful events.
  • 2. Age progression, by projecting pain of the
    past as always following them into the future.

17
  • 3. Amnesia, manifested by inability to remember
    positive experiences and achievements.
  • 4. Catalepsy, shown by typical depressed
    behavior of low energy, lack of motivation and
    psychomotor retardation.

18
  • 5. Dissociation, shown by continuous focus on
    negative and angry self- parts.
  • 6. Positive and negative hallucinations, used
    by depressed persons to create and focus on
    perceived hurts and rejections and to ignore
    pleasant, positive events.

19
  • 7. Sensory alteration, shown in depression by
    decreased awareness of pleasurable activities
    and sensations.
  • 8. Time distortion, created when depressed
    individuals mentally extend the periods of past
    pain and project the idea of continuous pain
    and discomfort in the future and minimize the
    possibility of future success.

20
  • And CONTROL!
  • JULIA
  • Bulimic cycle eat and purge up to
  • 24 times each day
  • Anorexic cycle after weight gain starvation
    only water or diluted juice

21
  • Poetry reference to open wounds, death, abuse,
    rape, insanity, betrayal, despair.
  • Gymnastics many awards and medals. (Eating
    disorders are common among elite athletes.)
  • Ive conquered the beam CONTROL

22
  • Enter Milton Erickson
  • Bizarre ideas
  • 1. Contest
  • 2. Focus
  • 3. How rather than the emotional why.
  • 4. Paradox up the ante! (48 times)
  • 5. Divide and Conquer be a fifty
    percenter
  • 50 normal 50 purge

23
  • During anorexic phase
  • I cant swallow a single bite I may never
    be able to swallow again.
  • CAPISTRANO!
  • The fasting stopped.
  • Tracking for differences
  • Self monitoring.
  • Refusal to involve family
  • Inability to stop the eat-purge behavior STUCK

24
THE METAPHOR
  • You remember when you told me how you were able
    to make a transition from holding onto the
    balance beam and then being able to release it
    and you felt like you had wings and you were
    free to move . on the balance beam, of course
    Well, I wish you could have had a chat with a
    polar bear at the Denver
  • Zoo

25
  • Every behavior has a positive intention.
  • Destructive even stupid behavior is a
    misguided but
  • WELL INTENTIONED effort to cope.

26
  • Issues about food represented a survival
    mechanism.
  • Purging kept her alive
  • Fasting gave her control They couldnt
    make me do ANYTHING (nor can I)
  • The Geyser

27
  • What it takes
  • 1. Patience she would NOT be pushed!
  • Trusting our pre-suppositions Though she
    refused to address the abuse by her father (it
    never even entered the discussions), she was
    dealing with it in her own way through poetry.

28
  • Taking extraordinary metaphorical risks The
    geyser story was a mirror image of her situation.
    Had she not been in a state of readiness for it,
    we might have lost rapport.
  • Willingness to forego insight and focus on
    behavioral change she repressed and avoided any
    reference to the early abuse (from 3 ½ to 13).
    It was hidden yet obvious ghost in our sessions.

29
  • The Past to be learned from NOT lived in.
  • Hypnosis is the empowering phenomenon.

30
  • This case is described and discussed in greater
    detail in Hypnosis and Treating Depression
    Applications in Clinical Practice, edited by
    Michael D. Yapko, Routledge Taylor Francis
    Group.
  • ISBN 0-415-95305-7
  • Chapter 8 Using Hypnosis and Metaphor in the
    Treatment of Comorbid Depression and Eating
    Disorders.
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