2 - (OP22) Melting Away Resistance in Treating Eating Disorders

CBT is evidence based and has been shown to be an effective treatment for Eating Disorders. That being said, Resistance is extremely powerful and is one of the reasons clinicians find Eating Disorders so difficult to treat. Unlike other addictions, Food cannot be avoided and in fact, strict adherence to Restricting Food in any ways leads to Binge and Compulsive Eating, only to maintain a cycle of Eating Disorder Behaviors. Patients often begin treatment with a wish to change and a frustration with these behaviors. However, without a careful understanding of their Resistances to change; not as pathology, but rather as vital to their needs and sense of well being, therapy hits a wall, frequently leading to a feeling of ‘push/pull, exactly what is experienced internally for the individual.
We have made strides in the Eating Disorder and CBT world to develop and teach change methods that are successful. There has been a paucity of teaching however on how to work with Resistance; particularly in the field of Eating Disorders. This leads to burnout and feelings of failure both on the part of the patient and clinician. As a clinical and Eating Disorder Teacher and Supervisor, the additional training I got from TEAM CBT’s focus on clarifying the Outcome and Process Resistance with each particular patient early on in the treatment phase, drastically helped me to creatively apply it to working with Eating Disorders and achieve successful outcomes and maintain the therapeutic alliance.
This presentation will outline how to Identify Outcome Resistance. Using What If? and Imagined Exposure Methods, we can help the patient imagine what it would be like to be without their symptoms and behaviors. Not just the good, but also what they will be losing. Then we can clearly examine with them, how these behaviors are used to solve certain problems, or to help them avoid situations; i.e. gives them a reason to avoid a dinner party, or helps to maintain two parents fighting rather than separating. Without looking carefully at the Good Reasons Not to Change, using some paradoxical methods, we’re working blind and our patients themselves don’t understand why they are so ‘stuck’ and feel so out of control with these behaviors. Process resistance as well, will be outlined as we can clearly identify the exposures that they will need to go through, what pain are they willing to face in order to reduce the pain that they are living with. Safety issues and ways use the Gentle Ultimatum to make sure therapists don’t feel pressured by any medical issues will also be touched on in order for the patient to be the one pushing for change while the therapist is not motivated by fear of their patient’s safety. We already have many methods in our toolbox with CBT to offer. Knowing how to work with Resistance arms the clinician with tools to set the agenda collaboratively and builds resilience for the challenges that emerge on the road to recovery from an Eating Disorder.