Dialectical Behavior Therapy for Binge Eating and Bulimia by Debra L. Safer, Christy F. Telch, Eunice Y. Chen
Tags: General, Social Science, Medical, Psychology, Psychotherapy, Psychopathology, Psychiatry, Nursing, Eating Disorders, Psychiatric, Social Work
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to explain that all group members share a problem with an eating disorder and use food to cope with upsetting emotions.
Does the Therapist Have an Eating Disorder?
Many therapists working with clients with eating disorders encounter this question. In our experience, no clear guidelines exist as how to best respond or, indeed, whether there is an optimal answer. The therapist might express this situation to the client by saying: “Well, as I see it, there is not a satisfying way to answer your question. Let me show you why. If I tell you that I don’t have an eating disorder, you might worry that I couldn’t possibly understand your diffculties with eating enough to help you and that I would judge you. But if I said that I did have an eating disorder, you might worry that I wouldn’t be able to be of help to you because I had exactly the same problem.”
Or the therapist might respond: “Almost everyone in our culture has used food to cope with emotions—eating when we weren’t physically hungry but felt anxious or bored. I’m hoping my not having an eating disorder won’t interfere with your experience in treatment.”
In a similar vein, if the client appears uncomfortable and comments about the therapist’s weight (e.g., “You’re so thin”), the therapist might observe that the
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DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA client seems to be comparing him-or herself to the therapist and making a judgment that could interfere with the client’s ability to successfully make use of this treatment opportunity. The therapist might add that he or she sincerely hopes the client will give the treatment a try despite experiencing discomfort and that during treatment, he or she will be taught skills to help cope with these types of judgments.
Patient and Therapist Treatment Agreements
The therapist hands the client a copy of the Group Member Treatment Agreements (Appendix 3.3) or Individual Client Treatment Agreements (Appendix 3.4). Each item is discussed to ensure that the client understands its rationale and to allow for questions. These agreements will be reviewed in the introductory sessions, and therefore a formal agreement is not sought during the pretreatment session. Instead, the therapist asks the client to take the form home to read and think over before bringing it back at the frst session.
The therapist discusses the Therapist Treatment Agreements (Appendix 3.5) in a similar manner. These are also reviewed in Session 1.
Ending the Pretreatment Interview
Inquire whether clients have any questions that have not been answered or issues they would like to raise. Then end the interview by expressing enjoyment over having met the client and by communicating enthusiasm for working together begin— ning with the frst session—using the opportunity to remind the client of the spe— cifc date, place, and time.
INTRODUCTORY SESSIONS
This section contains the material presented in the introductory sessions. In our 20-session research trials, this material is covered during Sessions 1 and 2. Depending on the number of sessions available and other potential factors, the therapist might proceed more slowly. Of overriding importance is the use of these introductory sessions—which complete the pretreatment stage of DBT for BED or BN—to establish the foundation for the remainder of treatment.
Sessions are described for therapists leading treatment in a group format unless otherwise noted. These descriptions can be straightforwardly modifed for the therapist conducting treatment with an individual client.
In our groups, each client receives a three-ring notebook or binder. Hole-punched handouts, distributed at each session, are to be stored in this binder, which clients are instructed to bring with them to each session. We recommend that clients keep the binder readily accessible. Not only might the sight of the binder remind clients of their participation and commitment to treatment, but
Does the Therapist Have an Eating Disorder?
Many therapists working with clients with eating disorders encounter this question. In our experience, no clear guidelines exist as how to best respond or, indeed, whether there is an optimal answer. The therapist might express this situation to the client by saying: “Well, as I see it, there is not a satisfying way to answer your question. Let me show you why. If I tell you that I don’t have an eating disorder, you might worry that I couldn’t possibly understand your diffculties with eating enough to help you and that I would judge you. But if I said that I did have an eating disorder, you might worry that I wouldn’t be able to be of help to you because I had exactly the same problem.”
Or the therapist might respond: “Almost everyone in our culture has used food to cope with emotions—eating when we weren’t physically hungry but felt anxious or bored. I’m hoping my not having an eating disorder won’t interfere with your experience in treatment.”
In a similar vein, if the client appears uncomfortable and comments about the therapist’s weight (e.g., “You’re so thin”), the therapist might observe that the
42
DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA client seems to be comparing him-or herself to the therapist and making a judgment that could interfere with the client’s ability to successfully make use of this treatment opportunity. The therapist might add that he or she sincerely hopes the client will give the treatment a try despite experiencing discomfort and that during treatment, he or she will be taught skills to help cope with these types of judgments.
Patient and Therapist Treatment Agreements
The therapist hands the client a copy of the Group Member Treatment Agreements (Appendix 3.3) or Individual Client Treatment Agreements (Appendix 3.4). Each item is discussed to ensure that the client understands its rationale and to allow for questions. These agreements will be reviewed in the introductory sessions, and therefore a formal agreement is not sought during the pretreatment session. Instead, the therapist asks the client to take the form home to read and think over before bringing it back at the frst session.
The therapist discusses the Therapist Treatment Agreements (Appendix 3.5) in a similar manner. These are also reviewed in Session 1.
Ending the Pretreatment Interview
Inquire whether clients have any questions that have not been answered or issues they would like to raise. Then end the interview by expressing enjoyment over having met the client and by communicating enthusiasm for working together begin— ning with the frst session—using the opportunity to remind the client of the spe— cifc date, place, and time.
INTRODUCTORY SESSIONS
This section contains the material presented in the introductory sessions. In our 20-session research trials, this material is covered during Sessions 1 and 2. Depending on the number of sessions available and other potential factors, the therapist might proceed more slowly. Of overriding importance is the use of these introductory sessions—which complete the pretreatment stage of DBT for BED or BN—to establish the foundation for the remainder of treatment.
Sessions are described for therapists leading treatment in a group format unless otherwise noted. These descriptions can be straightforwardly modifed for the therapist conducting treatment with an individual client.
In our groups, each client receives a three-ring notebook or binder. Hole-punched handouts, distributed at each session, are to be stored in this binder, which clients are instructed to bring with them to each session. We recommend that clients keep the binder readily accessible. Not only might the sight of the binder remind clients of their participation and commitment to treatment, but
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