The need for this book
During the four decades of
my psychotherapy practice,
close to 90 percent of my
patients have struggled with
eating disorders. Most have
arrived in my office as
therapy "veterans" who have
already been around the
treatment block, in some
cases for months or years,
in and out of multiple
treatment milieus and
therapy relationships, where
they have met with partial
or otherwise unsuccessful
outcomes. Time-worn and
weary, they bring a learned
sense of failure,
frustration, and defeat from
their past struggles.
Describing themselves as "a
day late and a dollar
short," they feel hopeless
and fearful about their
capacity for change,
unprepared to tackle the
tasks of ED recovery in the
face of a disorder that
compromises life quality,
internal resources and
emotional development.
Parents of ED patients,
guilt-laden about their own
'failed efforts,' typically
believe that their child's
eating disorder is
incurable, and fear for the
child's very survival. Doing
What Works promises to alter
this picture, to change the
face of ED treatment; in so
doing, it offers hope and
recovery to so many
sufferers.
The practitioner's
dilemma
The field of ED treatment is
still in its adolescence, as
are so many of our patients.
ED treatment techniques
continue to evolve, leaving
practitioners at a loss for
what may be considered "best
practice" principles and how
to apply them. In the face
of the treatment field's
crisis of identity,
clinicians find themselves
very much on their own,
seeking to find their own
way as formal training
mechanisms continue to elude
us. Our work is at once
enriched, and compromised,
by the divergent viewpoints
of clinicians and
researchers and by a sense
of benign chaos that arises
out of an immense yet
diffuse diversity of
approaches, limited
resources, and in some
cases, personal biases and
misunderstanding of ED and
their unique requirements
for treatment.
Is this book for you?
Whether you specialize in ED
treatment, engage with an
occasional ED patient, or
choose not to treat ED at
all, every therapist,
nutritionist, medical
doctor, psychiatrist,
physical trainer and school
counselor should be prepared
to recognize their elusive
signs, address their
urgency, and refer the
patient for care. Highly
lethal disorders leave
little margin for error in
diagnosis and treatment; the
earlier these diseases are
recognized, the better the
prognosis for recovery and
the possibility of
prevention. ED are likely to
exist as undisclosed
co-occurring syndromes
underlying other conditions
for which the patient does
seek care. Patients,
families, friends, but most
of all, practitioners need
to recognize and understand
the risks of allowing ED to
go untreated.
Fixing what is Broken
ED are the most lethal of
all the mental health
disorders, killing from six
to 13 percent of their
victims, 87 percent of whom
are under the age of 20. The
sad irony is that these
diseases all too frequently
go unrecognized by doctors
and therapists. When they
are treated, more often than
not they are treated
ineffectively. When
treatment does not work, the
finger of blame invariably
gets pointed towards the
disease itself through the
misconception that eating
disorders are 'incurable;'
towards an 'impossible to
treat' patient population;
or towards parents of child
patients for having caused
the problem or for not
addressing it sooner. The
reality is that when
treatment outcomes are less
than successful or when they
fail, it is all too
frequently not the patient
or family, but the
well-intentioned (and
otherwise competent) health
professional who drops the
ball through acts of
misunderstanding, commission
or omission. That, of
course, is the best news of
all, being that it is within
our capacity as
professionals and as human
beings to learn and to
change. Though treatment
failure with ED is often the
result of biological,
neurological or
environmental factors that
lie beyond the
practitioner's control, most
treatment tasks lie clearly
within the purview and
capacity of the
psychotherapist, the patient
and the ED treatment team to
solve.
Even when competent in the
general practice of
psychotherapy, most
therapists are untrained and
unprepared to recognize and
face the unique requirements
and challenges that set this
treatment specialty apart.
Unfortunately, there are
precious few places where
clinicians can go to learn
the science of this art.
Current literature in the
field focuses on
evidence-based research,
ignoring the application of
this research to clinical
practice. By failing to
recognize what they do not
know, practitioners
typically resort to
'default' modes of care,
doing what they know best,
which may or may not
effectively apply to the
treatment of ED, the costs
to patients and families are
exorbitant, and
opportunities lost;
tragically, in some cases,
leading to lost lives.
Students and novice ED
practitioners hunger to
learn what to do with these
patients. Trained clinicians
who already bring skills and
mastery to the task seek to
hone their skills and learn
more. By offering a
meaningful and practicable
system of care, this book
douses the fires of
professional fear and
resistance to ED treatment,
inspiring enough interest
and know-how within the
treatment community to fill
the shortages in the
treatment ranks with
competent ED experts. It
also encourages dialogue
between practitioners and
among researchers and
clinicians, facilitating the
collaboration of existing
resources within our
communities.
What this book does
" Doing What Works educates
and empowers clinicians who
have been reluctant to treat
disorders, while offering
affirmation and legitimacy,
alternative treatment
solutions, and a novel
perspective, to highly
experienced and seasoned ED
practitioners.
" It provides a unique
opportunity for the
multi-disciplinary treatment
team to better understand
and facilitate each others
roles, enabling enhanced
collaboration.
" It provides parents a
practicable bird's eye view
and understanding of
treatment dynamics,
preparing them to know what
to expect, (and what to
demand,) in their role as
advocates for their child's
care.
" Doing What Works
integrates what we know, and
establishes what we need to
learn, in finding a better
way to treat ED.
" Highlight the
professional's use of self
and relationship on the
front-lines of care,
harnessing the provider's
internal strengths to evoke
the patient's optimal
potential.
The contents of this book go
beyond knowing to doing;
beyond formulas to
directives for action; and
beyond knowledge to wisdom;
in seeking outcomes. The
book offers professional
readers practical, usable,
behaviorally-based tools
ironically similar in nature
to those that professionals
seek to offer their
recovering patients. Most
significantly, the book
fosters healing connections,
horizontally, between the
recovering patient and the
world around her as she
socially and emotionally
re-unites with loved ones
and reality; and vertically,
by accessing the patient's
connections to the strength
and potential of her own
resourceful self.
As a treatment 'GPS' mapping
out the most accessible and
workable routes, Doing What
Works alerts and prepares
the entire
multi-disciplinary treatment
team, including patients and
parents, to anticipate and
bypass inevitable detours
and pitfalls intrinsic of ED
treatment, securing a smooth
journey through the tough
passages of a complex
recovery. The concepts and
protocols discussed in this
book will not guarantee
unconditional and timely
success in treating ED
patients; such guarantees
are antithetical to healing
ED, and to life itself. The
proposed guidelines are
offered merely as
approximations, as each
treatment situation demands
unique responses to the
unique requirements of
unique internal and external
variables. Once having
created the structure of
care, the therapist is free
to diverge, extrapolate,
augment and accommodate to
meet the unique needs and
requirements of the patient,
therapist, family, recovery,
and dynamic of the
therapeutic moment.
Doing What Works is the
first and only book of its
kind to:
" Offer an integrative
start-to-finish, sequential,
step-by-step system to
approaching and treating the
ED patient and family; it
does so through the singular
voice of a treatment expert
who has facilitated many
hundreds of ED recoveries
throughout the past four
decades.
" Bridge the chasm between
the worlds of science and
practice in the application
of research outcomes to
clinical practice through an
integration of treatment
approaches.
" Offer ED professionals
insights and opportunities
for personal growth as a
prelude to furthering
professional growth.
" Systematically provide
guidelines for
multi-disciplinary
professional team function
through sequential stages of
care.
" Introduce innovative
treatment concepts in ED
care that include the
"science" of human
relationship and the
mind/body connection, as
validated by the newest
discoveries on the frontiers
of research about brain
plasticity.
How to use this book
In the interest of space, I
have limited my discussion
to those aspects of care
that have particular
relevance within the context
of the clinical encounter.
Citations and resources
provide the interested
reader the opportunity and
motivation to pursue their
own continued learning in
greater depth. My focus in
this book is on the work of
the out-patient therapist
functioning as part of a
larger outpatient treatment
team, though the principles
offered will be relevant to
in-patient clinical teams as
well, and to all the
disciplines that are
represented within the team.
Be aware that purely for
purposes of convenience,
throughout this book I refer
to the patient as 'she' and
the practitioner as 'he.'
Please indulge this device,
recognizing that though the
majority of eating disorder
practitioners are female, at
least one in ten eating
disordered patients is male.
The information I present
here pertains to patients of
all ages, to adults as well
as children; because
integrating parents into the
child's treatment and
recovery process is so
critical, the majority of my
references will be to child,
adolescent and young adult
patients. Each chapter is
designed to be read
sequentially, or to stand
entirely on its own. If read
sequentially, the book
follows the order of the
diagnostic, treatment,
recovery, and post-recovery
processes, tracing the
evolution of these disorders
from their inception through
the evolving stages of their
recovery. Throughout every
stage of the process, the
fabric of healing functions
is intrinsically woven
together with a discussion
about the clinician's unique
use of self in evoking and
optimizing them.
An extensive use of case
scenarios illustrates
treatment concepts and
theories, making this book a
source of 'virtual' case
consultation for
professional readers who
will inevitably see
themselves and their
patients in the cases and
personalities presented.
These cases are designed to
stimulate contemplation and
learning in the reader's
inquiring mind. In reading
the case examples, you may
have chosen a different
path. Because there is never
one 'correct' solution to
problems of this complexity,
the standard for measurement
for success will be the
patient's continual movement
forward towards goals that
are clearly intentional,
purposeful, defined,
directed and operational.
As readers become
increasingly adept at
treating these disorders,
they will discover that
"re-reads" will offer an
ever-increasing depth of
knowledge and understanding
as so much of what this book
brings to you is dependent
upon the professional
experiences that you bring
to it. Where examples are
cited from my own clinical
practice, patients'
identities have been
protected and incidents
disguised through the use of
fictitious names and through
changing circumstances.
Doing "what works" is doing
whatever it takes to bring
about healing
This book is a 'must read'
not only for therapists,
nutritionists, and medical
doctors, but also for
patients, parents and
families who need to join
forces with treating
professionals to mentor
their own or their loved
one's recovery. The author's
reassuring voice resonates
with 40 years of specialty
experience and know-how,
providing therapists the
permission, incentive,
vision and confidence they
need to become self-starters
within a demanding treatment
process---and to help their
patients do the same. In the
treatment of eating
disorders, a great deal is
at stake. Clinicians are
capable, and in fact
obligated, to stop at
nothing to achieve their
goals of helping patients
and families to stop at
nothing in achieving theirs.
The bottom line in the
treatment of ED becomes
healing - complete and
sustainable. It is for us to
learn how, when, and in what
manner to put together and
offer the techniques and
skills that we already know;
how to nuance the quality of
our care-giving with mindful
action, and clearly defined
intentionality; and how to
make loving human
connections with our
patients, brain to brain,
soul to soul in connections
that are themselves truly
healing. By impacting the
patient's emotional
development,
problem-solving, quality of
life and physical function,
self-regulation and self
care, the work we do holds
the potential to become
transformational, saving and
restoring lives and life
quality now, and for
generations to come.
