Teen Eating Disorders
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Finding a Therapist


Linda described the first 10 months after by-pass surgery as “heaven.” She felt like a normal eater and did not battle hunger. She went from weighing 409 pounds to 270 pounds, and then she “hit a wall.” Realizing her weight provided emotional protection, she felt vulnerable and uncomfortable with the attention she was getting. She became complacent with her eating habits, and by the time she sought help, she was up to 302 pounds, grazing on candy, ice cream and cookies. She was despondent and felt out of control.

Janet reported a similar story of post-surgery relapse. She lost 100 pounds and went for help after regaining 30. Her relapse reflected low self esteem, a judgmental husband, and a fast-paced lifestyle of frequent restaurant eating and drinking.

Both stories are examples of how the success of the surgery can get reversed. It doesn’t have to be that way, and often, the use of supportive psychotherapy in the post-surgery period can be the best form of relapse prevention. Janet and Linda used therapy to keep their relapses from becoming collapses. But many surgery patients who need help are uncertain how to find the right therapist. Here are some guidelines to help simplify the process.

Credentials

The three most common credentials of practicing therapists are as follows:

M.D. – medical doctors who specialize in psychiatry. Not all psychiatrists engage in “talk therapy.” Psychiatrists have expertise in prescribing medications such as anti-depressants and anti-anxiety agents.

Ph.D. – clinical psychologists. Psychologists’ training includes an emphasis on research, as well as clinical interventions.

M.S.W./ L.C.S.W./ C.C.S.W. – licensed or certified clinical social workers. Their training includes clinical internships and is less research oriented. Look for a therapist who is licensed or certified by your state.

Regardless of the therapist’s credentials, it is important to remember therapy is a collaborative relationship where the forming of a trusting therapeutic alliance is critical. You want to feel safe enough to be yourself. While issues of age, gender, cultural and life experience may effect your sense of having the “right fit,” an empathetic therapist overcomes these gaps by putting themselves in your shoes, understanding your problem even when they have not experienced it themselves.

Specialization

Some therapists may have a special area of clinical interest. A therapist with a background in eating disorders, health psychology, or addictions may be a useful alternative if you are unable to find expertise in weight control, compulsive eating, or obesity. From a broader perspective, Linda and Janet are examples of how overeating is triggered by stress, lifestyle imbalances, and difficulties with emotions and relationships. A therapist who helps you manage any of these areas more effectively may be indirectly helping you manage your food and weight.

Styles

There are many approaches to psychotherapy and no one “right” way exists. The two most prominent forms in practice today are cognitive behavioral and psychodynamic. Evidence supports the benefits of cognitive behavior therapy (CBT) in the treatment of weight and eating problems. This approach views feelings, thoughts and behaviors as inter-related and targets distorted or unproductive beliefs that underlie negative behavior. For example, Linda’s relapse was influenced by thinking in black and white. She overreacted to small lapses in her eating by believing she had blown it. She abandoned her meal plans, leading to daily grazing and the feeling of giving up. She needed to learn to forgive her mistakes and use positive recovery strategies.

Psychodynamic therapy views current functioning as being influenced by past experiences and feelings. This style encourages insights and resolution of inner conflicts in order to enhance personal effectiveness. Janet realized she was repeating old family patterns by reacting to her husband’s criticism indirectly with “I’ll show you” eating. This clarity motivated her to improve her assertiveness skills.

It is not uncommon for these two approaches to be combined, perhaps with other techniques, into a blended style considered “eclectic.”

Shopping

My son needed a therapist and I asked two friends (both of whom are therapists) for their recommendations. When the same name was mentioned by each friend, I thought this is the person my son should try. He did, and was pleased with the choice. Ask someone you know whose opinion you trust – friends, family, a minister, or a doctor. Your surgeon or surgery center may have a recommendation. Some centers have psychology staff available to assist you.

These are some questions you might find helpful in evaluating the appropriateness of a therapist. What are your credentials and educational background? What is your experience with treating obesity, compulsive eating, and with lap band or gastric bypass surgery? What kind of therapy do you practice? What special training or certifications do you have?

Other factors that may influence your choice are insurance considerations, fees, location, and time availability. Some of these questions can be addressed by phone before scheduling the first appointment.

Getting Started

Most therapists understand that initial sessions are mutually evaluative. Try to avoid asking too many questions, since you want the therapy to begin and to know what it is like to work with that therapist. You can evaluate whether to go forward by considering a few questions:

1) Did the therapist seem to understand me and show interest in me?

2) Could I learn to trust this therapist?

3) Did I get adequate feedback?

4) Is the therapist skilled, non- judgmental, sensitive, and respectful of my pace?
5) Can this person help me learn and grow?

If you have reservations, you can schedule an appointment with someone else. You can always go back if you change your mind.

Making a Decision

The eating and weight changes that follow surgery can lead to a variety of reasons for seeking therapy. Linda and Janet wanted to stop their relapses. Other patients use therapy when relationships are destabilized, for trouble adjusting to their new bodies, if they yearn for the old pleasure and escape of eating, or to decide on a new set of life priorities. In addition to assisting in weight maintenance, therapy can nurture desired behaviors, enhance motivation, challenge negative beliefs, clarify goals, and promote self-responsibility. It’s an important choice to make and I encourage you to make it.

Lee Kern, M.S.W., L.C.S.W., is the clinical director for Structure House, a residential weight loss facility in Durham, NC, that offers a unique behavioral approach to weight loss and healthy lifestyle change. Structure House provides a Post-Bariatric Surgery Program, designed to combine specialized classes on nutrition, psychology and exercise to enhance the long-term effectiveness of obesity surgery. This one-of-a-kind program includes treatment options specifically designed for post-surgery patients, such as surgery-focused medical assessments and development of personalized eating and relapse prevention plans. This revolutionary program is anticipated to be the missing link in ensuring lifelong weight control and improved health. For information, visit www.structurehouse.com or call 800-553-0052.