Eating Disorders Counselor Certificate Training Part 8

Dr. Dawn-Elise Snipes PhD, LPC, LMHC, CRC, NCCClinical Director, AllCEUs.com

Unlimited CEUs $99 per year. Copyright AllCEUs.com

Determines clients ◦ willingness to openly discuss and explore

behavior patterns◦ Willingness to consider altering eating behavior◦ Willingness to disclose accurate information


Power◦ Relinquish role of expert◦ Use client’s verbage

Collaboration◦ As necessary as understanding diagnosis is

getting client buy-in Faith

◦ In the client◦ In the self-regulatory feedback loop


Develop curiosity regarding each client as an individual and her unique reality

Be sensitive to client’s language, idiosyncrasies and personal views of the world and her problems

Sensitive to clients goals without passing judgment


Consumer/Determination◦ Has identified the behaviors as a problem and is

internally motivated

Complainant/Contemplator◦ Ambivalent about change. Still has lots of fear

Visitor/precontemplator◦ Not ready for change, do not identify a problem

The major responsibility for determining the type of relationship rests with the counselor


Solution focused therapy rejects the notions of resistance and inherent readiness for change.

Stages of Readiness are determined by the client’s motivation


The clients sense of safety/alliance with the therapist

Client and therapist have similar goals for treatment

The cost/benefit of the current behaviors◦ Fear of fat vs. desire to be healthy◦ Social pressures vs. desire to change◦ Sense of self-efficacy


Listen and sympathize with frustration and ask what it would take so they would not “have” to continue in counseling

Work with significant others who choose to participate

Reinforces positives and leaves the door open to retun

Provide basic education (increase awareness)

Determine if the “visitor” has another complaint that could be addressed

Support client in her desire to discontinue counseling


Yes…but

Key activities◦ Increasing dissonance (miracle question) and

self-efficacy (Exceptions) to increase motivation and empowerment

◦ Minimize discussion of the problem instead focusing on solutions

◦ Not necessarily a time to assign “doing” tasks, but more reflection and observation


The customer has determined that she has a problem AND is ready to set aside the “yes, buts”

The therapist◦ Agrees with the client’s goal◦ Believes she can assist the client in finding a

solution◦ Uses therapeutic skills to guide client to a

solution


Amplify Reinforce Highlight/Increase positive action behaviors


Counselor must help client understand the difference between cognitive and behavioral relapse and the concept of relapse warning signs

Counselor must normalize potential “slips” and relapses

Counselor works with client to develop a relapse prevention plan


What kind and type of therapy did you have in treating your eating disorder

What parts of your treatment were helpful, if any?

What interventions were helpful and under what circumstances

Do you believe you have any other issues such as depression or anxiety?

What interventions or strategies that were helpful in the past might be helpful now?


Focus on tomorrow, not way in the future. ◦ “If your problem was solved magically

overnight, what would be the first thing you noticed different when you woke up in the morning?” Take me through the rest of your day and describe what else is different.

The response is fleshed out to help the client identify specifically what she wants to be different


When has what worked and why? Under what conditions has each activity

produced an exception and failed to produce an exception◦ Why is it important to understand when activities

fail? Spontaneous Exceptions vs. Deliberate

Exceptions


Use scaling questions to help the client stop viewing things in terms of dichotomies

Have the client rate on a scale of 1-5 (It is helpful to give verbal anchors) and then explain why she chose her number.

Scaling can help therapists highlight ignored exceptions and positives


Highlight positive actions or events

Agreement with and restatement of the client’s goal

Provision of homework assignment and rationale if appropriate


Keep a quarter by your bed. Toss it each morning. ◦ Heads= pretend it is your miracle day. ◦ Tails= Regular Day.

What “resistance” might you anticipate? How can you help the client overcome

this? (Schedule homework assignment) Pay attention to how you feel different and

what others notice as different on your Miracel days


Attend to present and future with little attention paid to the past

Explore a problem free future Enhancing exceptions and previous

solution patterns Provide feedback and therapeutic

compliments Assign homework


Separate the person from the problem

Stay focused on client strengths and resources

Don’t take a position regarding the client’s situation

Constantly check in to see if the client’s specific goals have changed. (i.e. I want to be happy, but have realized that losing weight won’t make me happy it is…)

Continually evaluate the client's stage of change…watch for yes buts which indicate…


Explain the necessity to focus on small goals one at a time

Highlight the necessity of setting realistic goals

The necessity to tolerate behavioral and attitudinal slips or relapses


Must be concrete and practical Must be presented as a way to create an

“exception” related to a client’s identified goal How many calories

◦ What about this compromise rewarded/reinforced the client’s willingness to increase calories?

◦ Calorie Counting---good or bad??? What foods How often: every 3-4 hours The food plan template 50-25-25 ish 1500-

2500cals


Create a table asking…◦ Time◦ What did you eat◦ Were you hungry◦ Were you craving sweet/salty/spicy or a specific food?◦ Did you purge?

If yes, how did you feel afterwards and what could you do differently next time?

If no, how did you feel afterwards and what did you do to prevent the purge?

What information/exceptions can you derive from this type of

table?

How might this table be helpful?


Addressing seemingly unrelated concerns can have a positive (or negative) effect on eating behaviors.

Why?

Part of brief therapy means meeting the client where they are at, and developing mutually agreeable goals.


Conduct a clinical assessment to identify◦ Medical reasons for cravings or mood issues◦ Co-Morbid mood issues◦ Client’s understanding of her eating disorder◦ Client’s readiness for change◦ What has and has not worked for the client

Develop mutually agreeable goals focusing on what the client hopes to achieve


Eating Disorders Counselor Certificate Training Part 8

Health & Medicine

Transcript of Eating Disorders Counselor Certificate Training Part 8